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The Androgynous-Minded Ethicist

What did the left-brain hemisphere say to the right-brain hemisphere when they couldn’t agree on anything? "Let’s split!” OK, I’ll admit it’s a bad joke. The point I’m trying to make is that a wide division has been created between left-brain and right-brain thinkers, and, for the subject of health care ethics, this is no laughing gray matter.

Our brains are separated into two cerebral hemispheres: left and right. Although both sides appear the same, their functions differ. The left hemisphere controls sequential functions (reading, writing, talking), whereas the right side interprets things simultaneously (shapes, forms, faces). As Daniel Pink describes in his book A Whole New Mind, "The right hemisphere is the picture; the left hemisphere is the thousand words,” and each of us has learned to rely on the dominance of one side over the other to make sense of the world.1

Don’t know which side is your dominant hemisphere? Take the right-brain/left-brain quiz at http://www.web-us.com/BRAIN/braindominance.htm

In view of the fact that studies indicate women are predominantly right-brain thinkers and men are predominantly left-brain thinkers, the quiz suggests I have an androgynous mind. Rather than shun this revelation, perhaps I should dust off my David Bowie record albums and embrace the ability to toggle between left-brain, rule-based detachment and right-brain, emotion-based empathy.

This makes perfect sense to someone like me who teaches an affective subject like ethics in the automated, computer-based world of online education. Medical ethics is a meaning-making endeavor in which a scientific, detached approach alone cannot help patients make meaning of their illness or suffering.2 Ethical decision-making requires left-brain thinking as well as right-brain thinking in order to perceive relevant contextual features. Consider how empty ethical values such as empathy and social justice become when defined out of context. The left-brain thinker is likely to lose all sense of empathy for a noncompliant patient, for instance, if he focuses solely on what the patient says, and ignores how it’s said. Likewise, the right-brain thinker may be see that the patient is fearful or upset, yet have no idea what was said. Enter, the androgynous mind.

What is required for ethical discourse is a little bit of androgynous thinking. Take the current debate over health reform. Politics aside, most Americans agree that we need to fix the health care system; however, the emphasis in town hall meetings across the country has been solely on politics and economics. Whereas the left-brain thinkers among us might take a literal approach to words such as "universal access,” and obsess on the logistics of providing care to aliens throughout the solar system; right-brain thinkers wax poetically about human rights and the see the word "universal” as a metaphor. However, when someone suggests "universal access” to the androgynous mind, literal and contextual meanings are interpreted synchronously as the obligation to insure that no American is denied needed health care. The "S-word,” socialized medicine, has been used by those who fear a new plan will raise taxes and ration care in order to pay for increased benefits. To the left-brained ethicist, any national approach to health care reform must first lay down the rules to decide who gets access to scarce resources and who does not (e.g., a nine-volume, 64,000 page manifesto that takes a dozen lawyers to decipher). The right-brained ethicist will remain ignorant of rules and focused on the weepy and sometimes hysterical needs and desires of each and every patient (i.e., the kind of doctors that Hollywood celebrities like Michael Jackson seek out). Undoubtedly, you can see that each perspective by itself is half-witted. Good, you are beginning to join the ranks of the androgynous-minded. The androgynous-minded ethicist recognizes that left- and right-hemispheres are as inseparable as yin and yang: both perspectives are necessary in order to provide effective health care. Whether you support President Obama’s health reform package or not it is important to address the health care problem in America with an androgynous mind in order to determine what is truly fair and ethical for all Americans.

Only after a holistic review of ethical values, can we really begin to compare counterproposals and schemes. Which plan really fulfills the ethical values we cherish most? In this way we can rise above the political shouting matches of special interest groups to a meaningful debate. As health providers and students of allied health and nursing, we can help our patients and communities articulate their priorities and values, not merely in terms of the "bottom line,” but in terms of a moral vision of accessible, affordable, and high quality medical care.

To prevent any assertions that the real purpose of this month’s commentary was really an excuse to discuss the need for health reform, let me conclude as I started, with a brain joke. Did you hear about the online instructor who went to the doctor because he was having headaches trying to arrive at an ethical solution to the class’ debate on health care reform? An MRI was performed and the results clearly showed that in the left-hemisphere there was nothing right, and in the right-hemisphere there was nothing left.

References

  1. Pink, D. (2006). A whole new mind. NY: Riverhead Books Charon, R. (2001).
  2. Narrative medicine: A model for empathy, reflection, profession, and trust. Journal of the American Medical Association, 286(15), 1897-1902.

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