It was nice to read an article from the British Journal for the Philosophy of Science yesterday about one of my journalistic raisons d'�tre: the definition of "health" and how it is ontologically distinguished from disease. Although it is convenient to avoid dealing with this lofty issue, it is becoming increasingly important to understand as we continue to stack gargantuan policies on top of the house of cards that is our philosophical understanding of disease.

I applaud the Bush administration for at least one brilliant tactic: appoint an 18-member bioethics council to ponder over many of the great questions that face philosophers of science. During its tenure, the President's Council on Bioethics held discussions about everything from medical futility to Nathaniel Hawthorne. Brilliant tactic, because everyone knows that philosophers will never agree on anything, and the discussion of such lofty issues would surly stagnate any real progress in science.

Not anymore, boasts President Obama, as he has decided to disband the Council in exchange for a new bioethics commission that offers "practical policy options."

I agree that the public demands "real answers" to questions. However, I'm not confident that Obama's bioethicists will be able to provide better insight into how policies should be decided. Within the field of medical ethics, there is not a clear preference for the baseline rational approach for solving problems. Until we develop a solid framework for what we expect out of the healthcare system, there will always be controversy surrounding any policy decision that involves any degree of rationing (yes, I know you think that's a dirty word) of medical resources.

There is a certain balance between adopting a system that allows decisions to be made simply by majority rule, and creating a system in which minorities are protected from a misguided majority. To teeter to the edge of pure democracy is certainly simpler, but there are enough examples (the Civil Rights bill, women's suffrage, the overturning of Prop 8) where, on hindsight, we have valued the philosophical ensemble over the democratic overture. In the case of bioethics, I fear that the rational basis for adopting or rejecting a policy is not considered nearly enough by those who have the power to affect policy decisions.

The bioethics discussion, lofty as it may be, is an important contribution to the amalgam of opinions that will ultimately affect policy. Some members of the discussion are louder than others, so I'm an advocate for those who can make levelheaded arguments from evidence to learn how to use an amplifier.

If there is one thing to be learned from history, it is that rationality can prevail, when it has supporters who know how to market themselves. Rationalists have it hard: we refuse to allow ourselves to irrationally fight against forces that are, by nature, irrational. I hope Obama can lead by example as an ally for the values that have defined our country and allowed him to become president, instead of placating the ignorance that is now threatening our infrastructure. To say that American's will not accept "philosophical" premises or will kick certain conclusions to the ground (remember "death panels"?) is to throw in the ideological towel. We cannot afford to continue leveraging our medical policy on irrational fears. No one wants to die, but we do not operate our government in terms of telling people that they never will because it is a lie. Yet the fallacious reification we are perpetuating about medical "rights" is equally dangerous when we are leveraging real policies on concepts that are not real.

We need to stop placating our electorate with the sweet nothing that our elected officials love to tell. At least people like the Governator are confident enough to tell the public that we need to face realities we don't want to hear.

Published on June 17, 2009 in Medicine