Friday, March 27, 2015

A00429 - John Arras, Medical Care Philosopher


John D. Arras's research interests included physician-assisted suicide, rationing of medical care and social disparities in health conditions and care.

John D. Arras, a plain-spoken philosopher who preached that doctors should consider fairness and morality, as well as medical issues, in making life-or-death decisions about patient care, died on Monday in Galveston, Tex. He was 69.
He died after having a stroke while vacationing with his family, his wife, Liz Emrey, said.
Professor Arras, who lived in Charlottesville, Va., where he taught biomedical ethics, philosophy and public health sciences at the University of Virginia, served on the Presidential Commission for the Study of Bioethical Issues and was a founding member of the ethics advisory board of the Centers for Disease Control and Prevention.
He conducted research into physician-assisted suicide, rationing of medical care and social disparities in health conditions and care.
In 1981, while on leave as chairman of the philosophy department at the University of Redlands in California, he was appointed to the clinical staff of Montefiore Medical Center in the North Bronx to work as a philosopher.
“We do not tell doctors what to do,” he said at the time. Rather, he said, his job was to help them grapple with complex and often conflicting moral, ethical and legal questions that used to be ignored or taken for granted.
John Dyer Arras was born on Aug. 25, 1945, in San Mateo, Calif. His father, Ernest Arras Sr., owned an engineering company. His mother, the former Margaret Dyer, was a homemaker. He graduated from the University of San Francisco, where he majored in philosophy and French, and earned his doctorate in philosophy at Northwestern University.
He married Ms. Emrey, with whom he served as a Peace Corps volunteer in Sierra Leone, in 1967. In addition to her, he is survived by two daughters, Marina Wright and Melissa Emrey-Arras; a brother, Ernest; a sister, Barbara Scruggs; and five grandchildren.
Before moving to the University of Virginia in 1995, where he directed the undergraduate bioethics program, he was an associate professor of bioethics at the Albert Einstein College of Medicine-Montefiore Medical Center and an adjunct associate professor of philosophy at Barnard College.
Professor Arras was not afraid to address the most difficult philosophical questions.
If flu vaccines were in short supply, should infants or the elderly be given priority? Should undertakers receive precedence in being immunized over some other professions?
“This country doesn’t like to talk about rationing at all,” he said in 2004 when the C.D.C. recruited him and other experts to explore potential ethical issues raised by epidemics.
He returned to the topic last year, in “The Routledge Companion to Bioethics,” writing: “Some people apparently believe that if there is a right to health care, then any explicit rationing of health care must be morally impermissible. Nothing could be further from the truth. If we define ‘rationing’ as the denial of potentially beneficial care on grounds other than the welfare of the patient — i.e., on the grounds of cost, opportunity costs, fairness to others, etc. — then health care rationing is both inevitable and morally justified.”
Discussing doctor-assisted suicide, he argued that an enlightened debate should not be a stark choice between legalization and letting patients suffer. Rather, he said, both sides needed to listen to patients’ wishes regarding the forgoing of life-sustaining treatment, to deliver palliative care, to deal with clinical depression, to understand the ethics and legalities of pain relief, to sensitize insurance companies to issues of the quality of dying, and to amend laws that limit access to ameliorative medication.
When he was at Montefiore, he told a group of doctors that the staff’s heroic efforts to save a 75-year-old diabetic who had been admitted through the emergency room had been wrong, because she had already advised her physician that she did not want dialysis or medication.
“It was a case that foundered on prudence,” Professor Arras said. When death is inevitable and the patient wants it to occur naturally, he added, “the goal of the hospital is not to prevent death.”
He acknowledged that some oppose that view on religious grounds, but he questioned the basis of their thinking. “I don’t know why believers can’t have the view of God as a compassionate innkeeper,” he said, “who gives his residents the right to check out whenever they want to.”

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