A Breath of (needed) Fresh Air

After months of being wary of the air that I breathe, I inhaled a breath of fresh air yesterday.  The rejuvenating experience came in the form of Speaking Peace & Seeking Reconciliation in a Fractured Culture, an online conversation with David Bailey and Marilyn McEntyre, sponsored by The Trinity Forum and Coracle.  David Bailey (12:00 ff) quoted an African proverb that gives a needed perspective in these unsettled and unsettling times:

 When I saw them far away, I thought they were demons

When they got closer, I thought they were animals

When they got close, I saw they were human

When they got face-to-face, I realized they are my brother and sister

That proverb reminded me of something I had read in Roger Scruton’s On Human Nature. There, he wrote of “the kind to which we belong”:    

We are the kind of thing that relates to members of its kind through

interpersonal attitudes and through the self-predication of its own mental

states. . . . To understand your emotions I must understand how you

conceptualize the world.  I cannot simply describe your behavior as though it

were a response to the-world-as-science-would-describe-it.[1]

Scruton pointed out that Milton used Genesis to create an allegory that was not only “a portrait of our kind,” but also “an invitation to kindness.”  That portrait, said Scruton, shows us as humans what we are and what we must aspire to be.  When people are deprived of religion, philosophy, and the “higher aims of art,” however, Scruton saw dire consequences:

Human nature, once something to live up to, becomes something to live down to instead.  Biological reductionism nurtures this “living down,” which is why people so readily fall for it.  It makes cynicism respectable and degeneracy chic.  It abolishes our kind—and with it our kindness.[2]

Amidst the divisions evident in our culture in recent days, it seems timely to take the advice offered in yesterday’s online conversation by Marilyn McEntyre.  She talked about how poetry introduces truth in subversive and surprising ways; it plows up the ground or soil of our language.  She recommended that we spend time listening to others, and “call each other’s attention to the very words we are using.”  (14:54 ff)

This is advice worth heeding, and now is not too early to begin.

[1] Roger Scruton, “Human Kind,” in On Human Nature (Princeton, NJ: Princeton University Press, 2017), p. 45.

[2] Scruton, pp. 48-49.

“Belly of the Beast”

For those who are aware of the dreadful 1927 Supreme Court decision Buck v Bell, the subject of the forced sterilizations of ‘undesirable’ people is not new. In a blog written over three years ago after the publication of Adam Cohen’s book Imbeciles, I stated, “If we devalue a person simply because they do not meet our standard of what a person should be, we are all devalued.   The story of Carrie Buck needs to be told and retold, and I am grateful to Cohen for retelling it.” But 1927 was a long time ago. Surely our society has moved past the awful eugenics program that devastated the lives of so many and is no longer capable of such barbaric actions.

Not so fast.

Thanks to her new documentary, “Belly of the Beast”,  director Erika Cohn and her team take on the subject of forced sterilizations of women in the California state prison system.  It has already been shown in virtual cinemas, but will be broadcast on PBS on November 23. The trailer can be seen here and a very interesting interview with the director, producer Angela Tucker, and subjects Cynthia Chandler and Kelli Dillon is available here.  

This is story needs to be told because it confronts something that many have long suspected: America’s infatuation with eugenics did not end with the defeat of the Nazis in World War II.  It continues to the present day, with the majority of society looking away from such horrific examples, at least in part because the victims are women of color.  The New York Times review of “Belly of the Beast” puts it this way: “Those on the frontline are not only fighting bad actors who abuse their power, they are also battling a public that at best does not care and at worst condones it.”  

If we seriously wish to honor the principle of justice in bioethics, we must address this issue head-on.  Like so many honest treatments of injustice, “Belly of the Beast” will not be easy to watch, but we must learn its lessons well if we are truly to confront this evil. It is long past time to send Buck v Bell and everything done in its wake to the ash heap of history. Looking away is no longer an option.

When the President has COVID-19

This fateful year took another sad and surprising turn last week with the announcement that both President Donald Trump and his wife Melania tested positive for COVID-19.   The story became even more serious as we saw him being flown to Walter Reed Medical Center for treatment.  We wish President Trump and the First Lady a speedy and full recovery.

The media, of course, has raised important questions such as “When was he diagnosed?” and “Did he attend a political fundraiser while he was positive?”  Of more immediate interest at the moment is, “How is he doing?”  The president’s personal physician, Dr. Sean Conley, has addressed the media at least twice over the weekend, giving updates that have left many questions remain.

The ethical treatment of any patient includes the patient’s right to have his or her personal health information kept private.  Health care systems do not look kindly upon employees who reveal patient’s personal information to the press.  HIPAA laws are designed to ensure this protection.  The CDC website states it clearly:  “The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge” 

When your patient is the president of the United States, the rules seem to be different.  For example, over the weekend the Washington Post ran an article on the health of President Franklin Roosevelt as he was seeking his unprecedented fourth term in office.   The Post quotes Jay Winik’s book, 1944:  FDR and the year that changed history, and FDR’s visit with Dr Bruenn at the hospital that would become known as Walter Reed Medical Center:  

“Listening to Roosevelt’s heart and lungs with a stethoscope increased [Dr.] Bruenn’s sense of alarm: as Roosevelt inhaled and exhaled, Bruenn heard rales, telltale rattling or bubbling sounds indicating that fluid was building up inside the president’s lungs . . . Roosevelt was literally starting the slow process of drowning from within.”

What would the public have done if they had known — vote for Republican nominee Governor Tom Dewey?  It is difficult to imagine, but one never knows.  There are other examples from history of the public not knowing the medical condition of the president.  Ethically speaking, what does the public have the right to know, especially in an election year?

Back to the present.  On Saturday, October 3, Dr Conley gave a press conference updating President Trump’s health.  Not much long after, the press received quite a different (and more negative) message, apparently from White House Chief of Staff Mark Meadows.  On Sunday, Dr Conley addressed the discrepancy: “. . .I didn’t want to give any information that would steer the course of the illness in another direction. . .”  It raises the question of how information given at a press conference could possibly steer the course of the illness.  If he meant ‘steer our understanding of the course of the illness,’ he should have worded it that way.  I do not envy Dr Conley’s role.  At some level he is both the president’s physician and the president’s spokesman, with a very powerful audience of one.

Any president’s health will always be a bit of a mystery to the public and I believe that, in principle, the president deserves privacy.  My preference would be that his spokespeople state the facts in the most straightforward way possible.  If that isn’t possible, then perhaps wait until it is.

International Commission on HHGE Channels Warnock Committee

In various ways, the International Commission on Heritable Human Genome Editing (HHGE) is built on the same grounds as the former Committee of Inquiry into Human Fertilisation and Embryology (Great Britain).  That committee was charged to “consider recent and potential developments in medicine and science related to human fertilisation and embryology; to consider what policies and safeguards should be applied, including consideration of the social, ethical and legal implications of these developments; and to make recommendations.”[1] 

The Committee of Inquiry into Human Fertilisation and Embryology became known as the Warnock Committee, named for its chair, philosopher (later, Baroness) Mary Warnock.  The  “recent” development of concern was a reference to the birth of Louise Joy Brown on July 25, 1978:  the world’s first baby born through in vitro fertilization (IVF).  “Potential” developments the committee addressed during their two-year stint included the use of human embryos in drug testing; nucleus substitution (cloning) to provide replacement organs; and the insertion of “replacement gene(s)” for genetic defects.[2]  These all have in common the use of embryos for research.  The majority of the Warnock Committee argued that if the embryo could not feel pain, and “there were no absolute outrage of general moral sentiment,” then “the embryo might be used for research”[3] In her memoir, Warnock wrote that, in the Warnock Committee deliberations, the “disputes were on the whole civilized:  we did not have any rampaging pro-lifers on the committee . . .”[4]

The recommendations made by the Warnock Committee became Britain’s Human Fertilisation and Embryology Act of 1990 (HFE Act) and gave rise to the regulatory agency, the Human Fertilisation and Embryology Authority (HFEA), established 1991.  The latter is the body responsible for the licensing and inspection of all labs in the U.K. that deal with IVF, donor insemination, and human embryo research, as well as the storage of sperm or eggs.  The HFEA also regulates and oversees the use of mitochondrial replacement techniques (MRT) in the United Kingdom.  The International Commission on Heritable Human Genome Editing (HHGE) used the MRT example to design it own “translational pathway”:

By a “translational pathway’ for HHGE, the Commission means the steps that would be needed to enable a proposed clinical use to proceed from preclinical research to application in humans. Elements that formed the pathway leading to clinical use of mitochondrial replacement techniques in the U.K. have informed the Commission’s development of a clinical pathway toward HHGE, presented in this report. (p 39/225)

The HHGE has, as a portion of its task,

a need for a framework to inform the development of a potential pathway from research to clinical use, recognizing that components of this framework may need to be periodically revised in response to our rapidly evolving knowledge. In addition, other important discussions are ongoing internationally about the implications for society of human germline genome editing and include issues such as access, equity, and consistency with religious views. (p 44/225)

Here’s hoping the HHGE will do a better job of listening than the Warnock Committee did.  Natasha Hammond-Browning, evaluating the Warnock Committee’s handling of the pieces of evidence submitted to it, concluded this:

. . . the Warnock Committee adopted a utilitarian approach in drawing up its recommendations, and it could be assumed that any evidence that adopted this approach would have been favoured over other bright line viewpoints; for example, the view that the embryo must be protected from conception, or the view that the embryo/foetus should not be protected at any stage of development.[5]

[1] Mary Warnock, A Question of Life:  The Warnock Report on Human Fertilisation & Embryology, (Oxford, UK: Basil Blackwell, 1985), 4.

[2] Ibid., 71-4.

[3] Ibid., xv.

[4] Mary Warnock, A Memoir – People & Places (London: Duckbacks, 2002), 33.

[5] Natasha Hammond-Browning, “Ethics, Embryos, and Evidence:  A Look Back at Warnock,” Medical Law Review 23(4): 588-619; doi: 10.1093/medlaw/fwv028.

International commission: go slow with heritable human genome editing

The international commission on heritable human genome editing (HHGE), formed by the US National Academies of Medicine and Science and the Royal Society of Great Britain, has issued it report.  The 224-page report is freely available for reading here, and a summary news report can be accessed here.

The upshot:  not too fast.  The commission’s 11 major recommendations, briefly reworded and rearranged in order, are:

  • Before attempting any pregnancy with a gene-edited human embryo, “a significant cohort” of edited human embryos should be studied in the laboratory to ensure that the desired gene edit(s) “can be performed with sufficiently high efficiency and precision to be clinically useful.”  (No attempt would be made to bring these embryos to birth, and they would exist solely for research purposes, after which they would be destroyed.)
  • This efficiency and precision have not been demonstrated yet, and “no attempt to establish a pregnancy” with an edited human embryo should be made until they have.
  • Even then, the attempt should come only after “extensive societal dialogue” within any country whose leaders are considering endorsing the attempt.  This dialogue would include medical and scientific concerns, which the report addresses, and also “societal and ethical issues that were beyond the Commission’s charge.”  (Your correspondent has just begun reading the report, so cannot say yet whether the Commission considered how to proceed if one country green-lights edited human pregnancies while others do not.)
  • The only conditions that should be considered for editing are those of a serious disease caused by a single gene abnormality, for which the prospective parents have a less than 25% chance of having an unaffected child using current preimplantation genetic diagnosis (PGD).  Further, the resulting edited gene would be common and non-disease causing in the general population, and no embryos without the diseased gene would be edited. (This would seriously limit the use of HHGE—not permitting it for genes that increase the risk of cancer, for example—but, like the first point, would also raise concerns for conservative ethicists who consider all human embryos, from conception, to be human beings with the right to life.  If you’re troubled by PGD in general, this recommendation won’t satisfy you.)
  • The above would need to be followed for every proposed “treatment” of genetic disease—there is no “one-size-fits-all” approach to setting up a regime for heritable gene editing in general.  (This would have the effect of limiting the “industrialization” of HHGE, it appears.)
  • The actual transfer of an edited embryo to a woman’s uterus should be subject to (future) “rigorous” regulatory review and approval—that is, the edited embryo would be checked, in the laboratory, before transfer, to be sure that the edit had succeeded.   After transfer and through pregnancy, birth, and the life of the individual, close medical monitoring would be mandatory to learn what medical problems may have arisen.
  • A potential work-around should be studied in the laboratory: making human eggs and sperm from stem cells, with the intent of being able to use them for in vitro fertilization to give rise to an embryo without the abnormal gene.  However, the Commission recognizes that there are other canned worms, so to speak, to be dealt with here—such as whether this approach to begetting children is ethical at all, apart from any use of gene editing.
  • Any country embarking on HHGE in actual pregnancies should first put in place “mechanisms and competent regulatory bodies” to oversee standards and adherence to them, publication of results, and oversight in general.
  • An International Scientific Advisory Panel should be established in advance to oversee the progress of the science overall, before pregnancies are attempted—essentially, a single point of review to prevent intrepid scientists from “going rogue,” as it were.
  • An international body (presumably a different one from the above) with appropriate expertise should review every new proposed medical application of HHGE before pregnancies with the relevantly-edited embryos are established.  So, presumably, attempts to edit the gene for Huntington’s disease would be assessed separately from attempts to edit the gene for sickle cell anemia, for example.
  • An international mechanism should be established to adjudicate cases of alleged deviation from received guidelines or standards, and its’ results should be transmitted to individual governments and publicly released.

It looks like a careful report, welcome in its caution, although, as noted, those who hold that human life begins at conception will still likely object to the endorsement to continue with laboratory-based research.  “Just say no” to the prospect of HHGE—a position your current correspondent has consistently advocated on this topic—does not appear to be in view.  One might also be forgiven for skepticism over the effectiveness of any international body, given the controversies that arise from our existing international bodies for medicine and health, not to mention other endeavors.  Some such efforts, such as the regulatory harmonization of human clinical trials and drug development that governs the US, the EU, and Japan, work pretty well, but arguably are limited.

It is also worth mention that the California Institute of Regenerative Medicine (CIRM), established with Proposition 71 in 2004, ostensibly to translate embryonic stem cell research into cures (with creation and destruction of human embryos for the purpose), is proposed for renewed public funding in California with Proposition 14 in this November’s election.  Nothing approaching a cure was achieved under the CIRM, and even proponents of human embryonic stem cell research argue a renewal is unnecessary, because there is plenty of private money supporting related work already.  Further, the CIRM came under charges of insider dealing, because it needed to draw its leaders from the small pool of experts who tended to have career or monetary interests in the field to begin with, raising repeated concerns about a conflict of interest.  Would such potential conflicts plague the national and international bodies proposed by the HHGE Commission?  (Full disclosure: your correspondent will eagerly vote “no on 14” on his mail-in ballot this fall.)

Finally, so-called “somatic” gene editing—a fundamentally ethical undertaking by which a person’s cells may be altered to make them into a treatment for disease—is here to stay, as are certain forms of gene therapy that don’t involve heritable changes.  Expect to hear about those more in the future; they are subject to standard human subject research concerns, and to justice concerns like the eventual costs of the treatment.  Those topics for another day.

The NFL is back!

As we observe another Labor Day, our annual transition from the heat of summer to the cool breezes of autumn, it is refreshing to know that the National Football League is planning to start its 2020 season in just a few days.  As you are probably aware, team officials throughout the league have factored COVID-19 into their planning this year and have made adjustments accordingly.  For example, my hometown team, the Miami Dolphins, will be limiting their home attendance to just 13,000 fans per game (which is 20% capacity of their home field, Hard Rock Stadium).  

What caught my interest in the run-up to the new football season was a recent article in The Washington Post describing a former player’s concern about chronic traumatic encephalopathy (CTE), the concussion-related disease that has profoundly affected many players.   

In the past few years, the NFL has acknowledged the negative impact of traumatic head injury associated with football-related concussions and reached a financial settlement with players.  This settlement, according to the Post, “already has awarded nearly $790 million to retirees with cognitive impairment or conditions such as Parkinson’s or Alzheimer’s.”  

The Post reported last week that neurologists are working on experimental scans that would identify the presence of CTE while players are still alive.  It tells the story of Sean Morey who was Pro Bowl player for the Arizona Cardinals: “Morey estimates that he suffered more than 20 concussions over his career, most of them undiagnosed, and countless other blows to the head.  Following the 2009 season, he began having blind spots in his vision and excruciating headaches that would leave him immobilized for hours at a time.”

The tests are still in development and more work must be done, but the goal is a worthy one.  The ability to have a diagnostic test that would clearly show whether or not a player has CTE (or the extent to which they have it) would be a major step forward for the many who wonder if their current mental impairment is a result of their playing days.  Eventually, it could lead to the development of a treatment that could help affected players live happily past their playing days.

Not that long ago, the NFL was in denial about these issues (hence the book, League of Denial by Mark Fainaru-Wada and Steve Fainaru), creating a major ethical (and legal) problem.  I hope as research continues that the league will continue to help those who have helped make football so successful.

A Tale of Two Elders

Concern for elderly relatives and friends has been heightened during the coronavirus pandemic.   In the last month, I have visited two nonagenarians:  one was in the assisted living portion of a large multi-level care facility; the other, in her own home.  In both, frequent hand washing or sanitizing by visitors was done.  The assisted living facility visit required a mask and at least six feet of distance between us at all times.  The second nonagenarian refused to wear a mask, and we ate several meals together, maintaining some interpersonal distance.  Both visits were incredibly special, and I am grateful that we all continue to be well.

Thanks to Andrew Cockburn’s “Elder Abuse” article in Harper’s Magazine, I have formulated some important questions to ask about the care facilities for elderly that abound in our nation.  These should be helpful for relatives and friends who are either in long-term care facilities, or contemplating moving into one:

  1. Are you/will you be close to concerned relatives or friends, or far from any potential visitors?
  2. How often are visitors allowed?  What are the rules, including during a pandemic?
  3. Who owns the facility?  Have there been any fines levied for substandard care/other problems?
  4. Is the facility in a state that has legislation holding harmless the facility during this pandemic?
  5. Does the state where the facility is located have an ombudsman for senior care?  Is that office functioning now?
  6. Is there a local newspaper/reporter who publishes on senior issues?  Read their articles, and consider sending an email to interact with the writer of any article on elder concerns.  Building bridges in the community is important.
  7. Not to put too fine a point on it, but who will be paying for the care?  The “Elder Abuse” article points out that nursing homes strive to obtain the “right mix” of Medicaid and Medicare patients.  A COVID-19 diagnosis can benefit facilities monetarily; but then, so can discharging Medicaid patients in an effort to open beds for patients with higher-paying Medicare benefits.

Using data from the World Health Organization, Cockburn reports the differences between, inter alia, the United States and Greece, in terms of elderly casualties from COVID-19.   The United States has 515 nursing home beds per 100,000 population; Greece, 15.  The United States has 39 COVID-19 deaths per 100,000; Greece, with the “largest proportion of elderly people in Europe,” has two deaths per 100,000.  The author suggests, “One might almost conclude that the death toll that has so traumatized and destabilized much of Western society in 2020 was not wrought principally by the coronavirus, but by nursing homes.”

The nonagenarians I recently visited are both Americans.  The masked 93-year-old in an assisted care facility has been restricted from speaking with other residents he meets in the hallway or when he walks outside on the well-manicured grounds.  He has spent months having meals delivered to his room where he eats alone.  He spends thousands of his retirement dollars per month, but cannot be said to be happy with his purchase.  The other nonagenarian I visited lives alone.  She has not seen the inside of a store since March, because other people shop for her, using lists she has provided.  Her budget is significantly smaller than her counterpart described above, but she is rich in relationships.  For her birthday this summer, she received 123 cards. 

The Greek model of elder care seems clearly a better choice. Americans could do this — without importation tariffs.

Pediatric Fertility Preservation for Hormone Suppression in Transgender Youth

Last week, I received an e-mail update on current research and treatment being performed at the institution where I did my residency training. One of the interesting research areas was in the discipline of pediatric fertility preservation. Pediatric patients who undergo cancer treatments often take medications which cause destruction of their testicles or ovaries, not uncommonly resulting in infertility problems when the patient reaches adulthood. Advances in cryopreservation techniques of reproductive tissues are offered as a solution to preserving one’s fertility after pediatric cancer treatment.

The cryopreservation technique in the pediatric population is not limited to cancer treatment. There have been advances in providing fertility to non-cancer medical conditions that previously caused infertility. Two such conditions are Klinefelter syndrome and Turner syndrome which affects sex chromosome anomalies male and female patients, frequently resulting in infertility problems in those patients. By cryopreserving these patient’s testicular or ovarian tissue when they are children, when the number of the reproductive cells are in larger number and/or have the best potential for future reproductive function, in vitro fertilization techniques using these preserved cells when these patients reach adulthood can improve fertility.

The same pediatric fertility preservation treatment is now being offered prior to the hormone medication used to assist pediatric transgender youth transition from their birth sex to the opposite gender. Hormone treatments are used to intentionally suppress the transitioning person’s natural sex hormone production. This causes body habitus transformation to the desired gender. Continuous hormone suppression severely reduces (and can eliminate) baseline anatomic testicular or ovarian function causing permanent infertility in the transitioning patient. There is additional concern that the infertility persists even if that hormone treatment is later discontinued. Limited data exists to make conclusive statements on this subject as studies on long-term physiologic effects of hormone treatment used to transition pediatric patients are lacking; this is true even in the adult population where the number of patients who have transitioned is much larger.

Bioethically, we have moved beyond the question of whether we should be doing hormone suppression to assist in gender transitioning in the pediatric population and begun to discuss whether that child’s fertility ought to be preserved following such hormone administration. A simple Google search for non-hormone treatment of gender dysphoria in the pediatric population shows mostly hormone-based treatments for the first pages of results. With more effort, non-hormone options can be found.

The Mayo Clinic update that I received describes the transgender fertility preservation treatment along with a constellation of other pediatric medical conditions whose treatments potentially cause infertility (i.e. the cancer chemotherapy treatment causing infertility described earlier) as if all of these programs should be considered medically (and ethically) equivalent.

Are they?

If they are not, shouldn’t we be debating the medical and ethical pros and cons of pediatric transgender hormone administration more thoroughly before we consider how (and why) to preserve the very fertility of the pediatric patients we are altering by intentional hormone suppression?

A contemporary reprise of theories of justice

This blog’s being sponsored by an evangelical Christian university means, among other things, that at least some contributors, notably the current writer, tend to adopt a set of basic Christian assumptions (monotheism, tenets of historic Christianity, biblicism) in approaching matters of bioethics, including justice.  In that light, a recent summary of a Christian framework for justice, by the Presbyterian pastor Timothy Keller, is worth a careful read.  It is a concise and erudite summary of the different secular approaches to justice in pluralistic American society, contrasting them with a Christian approach.  (It does not attempt to address frameworks specifically grounded in other religious traditions.)

Drawing on the teachings of the Bible, especially the example of Old Testament Israel as embodying universal, enduring principles of justice intended by God, Keller characterizes biblical justice as encompassing concern for community that entails a moral imperative to generosity; equity in treatment of all human beings; corporate responsibility, meaning that sometimes, people bear responsibility for sins of others; but also individual responsibility, meaning “I am finally responsible for my sins, but not all my outcomes”; and an imperative to advocate for poor and marginalized people.  Of these, the contours of corporate vs individual responsibility will certainly spark debate among Christians, but living out these principals is, Keller argues, the responsibility of the Church in a secular world.

The big contrast is with atheistic, secular approaches to justice, which must and do fail because they neglect, avoid, or despise appreciation for human teleology—what are people for, what is their purpose?  Keller invokes Alastair MacIntyre’s Whose Justice?  Which Rationality? and, with MacIntyre, takes the position that “behind every understanding of justice is a set of philosophical beliefs about (a) human nature and purpose (b) morality, and (c) practical rationality—how we know things and justify true beliefs.”  Disagreement about these, particularly about human nature and purpose, leaves the prospect for secular agreement about justice well-nigh hopeless.  The rationality of the Enlightenment failed in this regard, and the popular current secular default that morality springs from common sense begs the question, assuming a common moral intuition that need not and does not pertain.

The current American secular landscape is dominated by four theories, which lie, progressively, on a spectrum of sorts, from individualist to collectivist, in order:

  • libertarianism, the position that justice is the maximization of individual freedom, which fails to appreciate the importance of community and the depths to which sin distorts human affairs, and which is too grounded in individual self-interest;
  • modern liberalism, which focuses on fairness, most recently following John Rawls’s A Theory of Justice, and emphasizes rights or entitlements, often to be guaranteed by the state.  It fails for reasons that have been well-rehearsed many times elsewhere: an enthronement of individual autonomy, a lack of a standard for adjudicating conflicting rights-claims, and an unwarranted faith in reason (notably in cost-benefit analyses), attempting to exclude religious values, but, in America at least, assuming Judaeo-Christian principals and values to support fairness judgments;
  • utilitarianism—justice is what produces the greatest good for the greatest number—which, for all its usefulness in individual judgments, fails as an overarching approach for many well-known reasons, including incommensurability of goods, potential to embrace mistreatment of minorities, insufficient criteria for what is “good” in the first place, and over-reliance on the language of “harm” to ground judgments;
  • postmodernism, the notion that “a just society subverts the power of dominant groups in favor of the oppressed.”  This may be the loudest current voice, and it draws the lion’s share of Keller’s attention.  This approach, Marxist in its foundations, starts from the presupposition that human affairs are the product of impersonal social or historical forces—the old “scientific theory of history.”  Keller provides an excellent, quick digest and explanation of what the current radicals, articulating Critical Theory (or Critical Race Theory when applied to racial relations), are talking about when they invoke “dominant discourses,” “intersectionality,” and “checking one’s privilege.”

Let us be clear—Critical Theory is rubbish, and Keller hits it hard.  Among its defects: deep incoherence—if everyone is blinded by their circumstances, so are the Critical Theorists; it reduces humans to automatons and fails to account for universal sin, moral agency, and the union of soul and body (I suppose if you deny that people have souls, and think they are just bodies, you just might be a  Marxist materialist); it denies human sinfulness and common humanity and makes forgiveness and reconciliation impossible; it invites extreme self-righteousness on the part of its adherents; and it sets the stage for oppression under the disguise of opposing oppression.  (Memo to the young: we just spent a century battling the various demons of totalitarianism, and you get to decide what you think of the second coming of Mao.  Study well.  Read attentively.  Choose carefully.)

Read the whole thing.

The Old Guard

In an effort to disconnect from the craziness of life, I recently watched “The Old Guard,” a popular 2020 Netflix movie.  [Note:  spoiler alerts ahead.]  It tells the story of four “immortals,” led by Andromache of Scythia (also known as “Andy,” portrayed by Charlize Theron), and the ups and downs of their existence.  

As we are introduced to each of the immortals, we find that they were born in different centuries and have been alive for a very long time.  The bulk of their time seems to be participating in battles that have taken place throughout history  (e.g., The Crusades, the Napoleonic era, etc.).  It’s not clear from the movie that they were always immortal, but each one finds out quickly after sustaining a deadly wound and suddenly come back to life.  A fifth immortal, Marine officer Nile Freeman (portrayed by KiKi Layne) is introduced in a graphic scene where her neck is violently slashed and she is basically dead, but remarkably, she heals without explanation and without scars.  Within a few scenes, Andy takes Nile taken from her military camp and has introduced her to the team of immortals.

Obviously, there are some big questions here that we hear the immortals ask throughout the movie:  “Why me, why am I immortal and others are not?”  Or, “What are we supposed to be doing with this ‘immortality’?”   “Are we making any difference in a world that seems like it is getting worse instead of better?”  By the end of the story, the viewer gets an idea about the difference that the immortals have made throughout the years, but the “why” question remains unanswered.  Andy is a confirmed atheist and views Nile’s faith in God as illogical.  

More ethical issues arise when Big Pharma gets involved.   The villain of the movie, Steven Merrick (portrayed by Harry Melling) is the young Zuckerberg-esque head of his own pharmaceutical company.  He enlists help from a former CIA agent, James Copley (portrayed by Chiwetel Ejiofor) to capture the immortals and to run a series of endless tests on them.  As you might expect, the immortals are eventually captured and meet Merrick face to face.  He informs them that it is their duty to submit to his torturous experimentation because in the long run, they will help humanity.  He goes so far as to tell the heroes that it is ethical duty to do this because they could help so many people.

Copley’s ruthlessness clearly tells the viewer that his ethics are problematic.  He is not simply an altruistic scientist, he is an entrepreneur who wants to ensure that the immortals do not fall into the hands of his Big Pharma competitors.  His words about helping humanity ring hollow because of his overall devotion to the bottom line.  Or as he was told at the end of the movie, “It was not your choice to make.”

“The Old Guard” is a cautionary tale cloaked in the garb of a twenty-first century Netflix feature with all the special effects one might hope for.  Humanity never seems to learn their lesson; technology always seems to have a leg up on ethics.  In our fast-paced world, a cautionary tale may be just the thing we need.