Lesson 1) How to Save a Life (Administration Ethics)

A fancy contraption can be seen atop Professor von Graft’s desk as you enter for start of term. The tiny copper moose sniffs it curiously until a small beeping sound sends it scurrying away to the other end of the desk. The professor places one of her rather large coffee mugs underneath it and a brown liquid began trickling from it. The smell of brewing coffee fills the dungeons as the students anxiously await their Potions class. Professor von Graft bends down and picks up a rather large and fluffy brown and white drooling puppy from the floor as she makes her start of term introduction.

Welcome to Potions Year Two! For those who joined me for Year One, I hope that you enjoyed your rest between years. If you are new to the dungeons this year, I am Professor Alexa von Graft. Before I found myself teaching at this exceptional school, I studied Biology and Chemistry at Minnesota State University in the United States.I have spent my summer vacation at conferences; I was fortunate enough to travel to the International Potions Symposium, which was hosted in Barcelona, Spain. The new discoveries are ever growing in the beautifully complicated world of potions. I also spent some time traveling back to the northern part of my home, which would include Duluth, MN. I was able to observe the wonderful beauty that lies in the Great Lakes and forests of my homeland, as well as the colossal ships that travel on the waters there. It truly is amazing to see what the Muggles have been able to accomplish without magic. I also picked up a new and very fluffy companion. He is a St. Bernard puppy, who I have taken to calling Preston. You might be seeing him around the classroom from time to time. Feel free to go ahead and give him a scratch. His demeanor, though he is still just a puppy, should assist in calming the nerves I see a lot in my students who spend their time in my Potions class.

This brings me to my new lovely contraption adorning my desk this morning. Professor Soleil, your Muggle Studies professor, has kindly gifted me a Koo-rig Muggle coffee maker, which has greatly reduced my coffee time for my morning routine. As you know, coffee is my favorite potion and I have been lucky enough to successfully brew my first cup this morning in only half the time it would normally take with my regular coffee pot. The Muggles are making great strides in technology that affect even us witches and wizards, from the big to the small.

Moving right into Year Two, the first half of this year we will be discussing magical laws and ethics around various aspects of potions, namely administration, ingredients, and research. Even if you do not plan on a career in potions administration or research, whenever you administer any substance or complete any procedure that affects another living creature’s system, it is crucial to understand the ethical implications as well as the legal stipulations as set by national and international wizarding law.

Today we will be discussing the laws and ethics around administration of potions. This is an important consideration both for those who wish to directly practice the healing arts as well as those who plan to take a more research-oriented approach. If you read the oath that healers take upon certification, it refers to practicing the profession with “accountability and integrity.” This is a rather vague promise that ultimately amounts to healers acting with their best judgment and taking responsibility for their decisions. This pronouncement is intentionally kept with rather open interpretation, however, owing to the variety of circumstances and situations healers witness throughout their careers. In some cases, the best response to a malady may be a rigorous and invasive treatment, while in others it may be an unfortunate necessity to allow the patient to endure without remedy if the treatment would cause more harm than benefit. The most important consideration most healers and researchers face when deciding whether and how to treat a patient is the question of informed consent.

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photo courtesy from here

Some of you will already be familiar with the concept of informed consent. For those of you who are hearing this term for the first time, informed consent refers to the patient or research subject undergoing treatment with full, accurate understanding of the possible benefits and harm that could come from undergoing treatment. This is not just a question of ethics: under the Patient and Subject Comprehension and Consent Law of 1849, the Ministry of Magic requires that all those undergoing treatment from a licensed healer or taking part in a clinical trial sign a consent form. Simply informing the patient about the outcome of treatment is not sufficient evidence that the consent was “informed,” however. One must also take other variables into consideration in order to accurately comply with this law as stated by the Ministry. This will usually involve a patient signing an official document that states they are aware of the risks and benefits of said treatment and are giving their consent to continue.

Firstly, is the patient in a position to give informed consent? In many serious cases, the recipient of treatment will be in a coma or otherwise altered state that makes them incapable of making decisions as to which treatments will be in his or her best interest. Minors are also, under law, incapable of making any decisions of informed consent when being treated. In both of these cases, the Ministry requires the next eligible relation to make this distinction. In the case of minors, it requires a legal parent or guardian to sign the consent form, often allowing the minor to cosign as proof that they have been informed of the process as well. In the case of a patient who is in a coma or otherwise incapable of giving consent, it falls on the closest living relative to give consent unless otherwise stated.  In certain large families, it often becomes something of a nightmare to determine care, as different siblings or children all have differing conceptions of what would be “best” for an ailing relative.

That said, once you are of legal age, it is always a good idea to go to the Ministry and sign what is called a living will. This is essentially just a statement in which you express your desires in regards to treatment in the event that you are no longer capable of making the decision yourself. You can either explicitly dictate how you would like your treatment handled, or you can designate a specific trusted family member as the primary decision-maker. Healers are by law obligated to respect these individual patient desires, even if their personal philosophy regarding treatment differs.

If the individual is cognizant enough to give informed consent, another question is whether he or she is capable of fully understanding the possible effects of treatment? This is particularly important in the case of experimental procedures and clinical trials when it is crucial that the patient acknowledge that they understand that there is not yet total understanding of possible side effects or negative long-term consequences of a particular new potion. Typically in these studies, a patient’s situation is so unpleasant or dire that almost any outcome is preferable to his or her current malady or injury. Others that undergo experimental treatments do so with the true conviction that it is their responsibility to assist in any way possible so that future generations may be saved their own discomfort.

There is another dimension of informed consent that only comes into effect during experimental trials: the concept of the control group. This is something we will discuss in detail in the third lesson when discussing the ethics and legal obligations of those working with patients as researchers. For now, I will simply emphasize that when providing treatment for a patient, even in a research-based setting rather than a clinical one, it is crucial for every participant in the experiment to understand the full scope of the trial, including that for the sake of research, they may not even receive a true “cure” for their affliction, but may be presented with a placebo, or harmless substance typically composed of simple mundane ingredients that emulate the taste and consistency of the true potion.

Regarding understanding and consent, one particular dilemma that healers face that is rather unique to magical practitioners is the concept of consent and understanding when treating non-human magical beings or creatures. It can sometimes be difficult to confirm that consent was appropriately given or that these beings fully understand the implications of treatment and its effects. Also, the effects of a particular spell on a witch or wizard may have drastically different impacts on magical beings, including werewolves. It is the ethical responsibility of the healer to consult with the appropriate magizoologist and refer their patients as appropriate, as well as accurately ascertain the differences in treatment options.

So what is a healer to do when it is impossible to gain consent, either from the patient, his or her family, or any other immediate resource? Say, for example, an unidentified being without any connections is lying in a catatonic state in a bed in a clinic. The clinic has tried unsuccessfully to reach out to authorities to determine who this being is or what brought them to this state. Well, in that maximum of maximums, then the burden falls on the healer to determine the best possible means of treating this being. They must look within themselves to determine what is in their patient’s well-being. This can also include circumstances that require quick action where there simply isn’t time to reach out to family and the patient is unable to provide consent.

However, even within bioethics, the field concerned with philosophy and ethics of biological and medical treatment, there exists a difference of opinion between even the most highly moral and ethical of healers as to what constitutes life. To emphasize, they are not considering one life more important than the other, but they differentiate between what kind of quality of life is worth maintaining, and when a patient should be considered beyond help. Some hold a very life-centered approach: that is, that all life is sacred and should be maintained no matter the personal and economic cost. This would include keeping a patient in a coma on life support and maintaining their most basic bodily functions as well as possible until the body could no longer sustain it, and the patient passed on their own.

Other healers hold a much more brain and consciousness­-centered approach. This philosophy holds that once a being is brain-dead and can no longer maintain their own life functions nor have any quality of life, they should be considered deceased, and resources should no longer be expended trying to prolong a life in a way they see as unnatural. Of course, there exists a wide range in between these two opposing viewpoints, and most healers will fall somewhere on the spectrum. Neither opinion should necessarily be considered “incorrect,” even if there’s disagreement, but rather a show of philosophical discrepancy as to what defines life. Should there be absolutely no means of acquiring informed consent from a patient or contacting any relatives or friends, this definition of life is the difficult decision every healer must make. It is a vital part of their oath that they hold to their own philosophy as to what is best for their patient, and not for their own economic resources.

On that cheery note about living wills and bioethical definitions of life, I will let you go for the day. You are welcome to stay after class and try out my new Koo-rig and discuss potion ethics while joining me for a cup of coffee. Also, feel free to give Preston a cuddle.  Don’t forget, there will be a quiz to be completed that will cover some information from Year One. I am confident all of you will be able to complete it with no issues at all. For the essay, you will be writing at least 300 words about your course of action if you were a healer at St. Mungo’s whose brand new patient were in a comatose state. I look forward to reading your essay submissions!

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In Year Two, Potions students will delve more deeply into potioneering, theory, and will explore in greater detail how certain potions can impact a witch or wizard's biological processes. Enroll