Yet much as we yearn for civil discourse, we need to recognize that this strain of vitriol is, and has been, very much part of the American scene. Commentator Bill Moyers recently observed: "I would say it's more deranged than delirious, and definitely not un-American. Those crackpots on the right praying for Obama to die and be sent to hell -- they're the warp and woof of home-grown nuttiness. So is the creature from the Second Amendment who showed up at the President's rally armed to the teeth. He's certainly one of us. Red, white, and blue kooks are as American as apple pie and conspiracy theories."
A kind of road rage seems to have taken over. Anyone with a differing opinion is demonized. But is there another way? Surely a more civil discourse and reasoned ethics is as deeply part of the American tradition.
I had the good fortune this week to be a fly on the wall at a phenomenon that tackles tough issues of ethical principles and choices in a different way. Sitting in on a weekly "Ethics Consult" at the Chicago Medical School, I witnessed a passionate and reasoned effort to deal with situations that present ethical choices. Every week, one or more physicians present a case that they see as having difficult ethical elements.
I was a privileged observer, invited because I had lectured earlier in the day, at the invitation of Dr. Mark Siegler, a renowned medical ethics scholar. Mark established the consult and moderates it. The details are confidential but I have his agreement that I can share my impressions. The day I participated, the issues turned around organ transplant choices, care of a very sick infant, and treatment of a difficult and homeless patient.
The scene: a room with about 50 people, most in white coats. Constant eruption of buzzing demands from pagers as doctors responded to urgent calls (they left the room and quickly returned). The consult started with someone reading a short presentation of the situation, followed by an intense, engaged, and caring discussion of the issues and choices. Technical, medical exchanges were very much at the fore. The issues were real and immediate; decisions were in the offing.
What struck me most forcibly was that this discourse was serious, engaged and respectful. People listened to each other. They were asking for help and listening to a wide range of suggestions, not shyly or cagily advanced, but put forth in clear and opinionated terms. People asked questions to understand the cases better. These were tough issues that can be seen in different ways, but these doctors had to make a choice. They had no way to duck the matter; the responsibility lay on their shoulders. They listened to others' advice but made their decisions alone after they left the room.
Everyone learns from the process. And at the end of the two-hour meeting, the papers outlining the cases are collected (so nothing leaks) and everyone leaves, rushing to their next obligation.
I came away with two thoughts.
The first is that the ethics consult formula could and should have much wider application. I can readily imagine it at the World Bank or the United Nations Security Council or Judge Goldstone's commission on Gaza. People who are grappling with complex ethical choices need a safe, demanding, and respectful space to thrash out the issues and options.
And second, the kind of discourse I was privileged to witness among deeply engaged and committed doctors is what we need in the public policy sphere. It's about facts first, about curiosity and a readiness to listen. It's about hearing different views. It's about a willingness to change opinion and then take responsibility. It's an idealistic pragmatism that is surely as much part of the American tradition as mud-slinging invective.
And it's about realizing that ethics, whether inspired by the theological principles of love, or by a physician's determination to help people, is about real choices nuanced by daily realities, more than absolutes and unbending principles.
