Reflections on Euthanasia in Canada

A couple of recent pieces from First Things and Public Discourse reflect on Canada’s dismal situation regarding euthanasia.

After recounting the story of a Canadian man from whom basic treatment was nonvoluntarily withheld, George Weigel maintains in First Things that the church has a duty to “to warm chilled souls and rebuild a civil society committed to human dignity.”  He reminds readers that this dignity is foundational to Western democracy, and that to “reduce a human being to an object whose value is measured by ‘utility’ is to destroy one of the building blocks of the democratic order.”

Arthur Goldberg and Shimon Cowen comment on the Canadian situation from a Jewish perspective in their Public Discourse essay titled “The Contagion of Euthanasia and the Corruption of Compassion.”  Regarding euthanasia they write, “A strong element in contemporary secularism sees human life as the personal property of its person. When suffering renders life burdensome to self or others, it can and may be disposed of; this is, for such secularists, the ‘compassionate’ thing to do. But—as Canadians and others have by now found, again and again—the contagion of assisted suicide, once the command ‘Thou shalt not kill’ is set aside, quickly spreads elsewhere.”  From there, they examine the directions in which the disregard for human life – “the ‘contagion’ of killing” – spreads out from the embracing of euthanasia.

The situation in Canada should be a warning for those of us in the United States who care about human dignity and societal flourishing. The above reflections are indicative of the important role the Judeo-Christian tradition has in defending against a culture of death.

Sherif Girgis Exhorts Pro-Lifers to Eschew Straw-Men

Sherif Girgis has written a thorough response in Public Discourse to the viral “Philosophy Time” video in which James Franco and Elizabeth Harman discus the ethics of early abortion.  In the piece, “In Defense of Elizabeth Harman: Taking Pro-Choice Philosophers Seriously,” Girgis argues that rather than ridiculing Harman’s argument, pro-lifers should seek to thoroughly understand her position and its shortcomings.

Girgis writes:

Though ad hominem argument tempts us all, some strands of progressivism have made a habit of denouncing opponents as fools, bigots, or both—in debates over abortion, religious liberty, the nature of marriage, gender dysphoria, healthcare policy, the appropriate response to climate change, and much more. As an advocate of the conjugal view of marriage, I know firsthand the value of intellectual diversity, having seen the anti-intellectual effects of name-calling and reflexive charges of stupidity and degeneracy. I know how debilitating they are to healthy academic inquiry, and how corrosive they are to our political debates. Pro-lifers should take pains to avoid complicity in this ugly dismantling of the foundations of intellectual exchange and coexistence.

In this case, doing so is also illuminating. Though Harman’s view has struck many casual observers on the Left and Right as impossible to believe, its most basic mistake is one common to all views that would depersonalize the unborn. By giving her view the strongest presentation and defense, I can show its link to more popular theories on which unborn lives don’t matter—and show why they fail.

Throughout the rest of the piece, Girgis explains Harman’s position and concludes by making a case for why her argument is incorrect.  While the essay is a worthwhile read in itself, it is also an illustration of thoughtful and charitable debate.

People who engage with others on such difficult issues should find encouragement in Girgis’s essay to uphold commitments to charity and honesty.  We should also be reminded that a thorough and fair understanding of contrary arguments, even those that seem self-evidently wrong, is crucial to advancing the truth in a winsome way.

Charlottesville and Imago Dei

In light of the events in Charlottesville this past weekend, it is as important as ever for believers in America to understand and be able to communicate what it means that all human beings are made in the image of God.

I have included a couple of excerpts from Dr. John F. Kilner’s Dignity and Destiny: Humanity in the Image of God below, and recommend the book to anyone wanting to better understand the meaning and implications of this theological truth.

“Being created in God’s image…means that all people have a sacredness to them independent of any actual attributes.  A person cannot be demeaned even in another person’s thoughts without that constituting an unholy affront to God.”[1]

“Just as humanity is not merely a collection of separate people but is also an interrelated whole, so humanity’s status as created in God’s image has implications for the whole together. God has a connection with humanity as a whole; and God intends divine attributes to be reflected in humanity corporately, not just in particular people.  God intends justice to be a hallmark of human society, as it is of God’s own character.  Just treatment of all requires taking account of personal and societal relationships in which people live, rather than merely viewing people as individuals.  Where there is injustice, liberation from that oppression is what humanity’s status in God’s image mandates.”[2]

The flags flown by the white supremacists in Charlottesville belong to regimes that were guilty of vile offense against the image of God.  Not surprisingly, the men aligning themselves under those flags hold similar evil beliefs.  In response to such displays, it is vital that believers hold fast to the foundational doctrine of the Imago Dei and live out all that it implies.  While it is obviously right to condemn white supremacy and terrorism, it is important that in doing so, we are able to explain with clarity and conviction why such ideologies are anathema to the people of God.

[1] John Kilner, Dignity and Destiny: Humanity in the Image of God (Grand Rapids: Eerdmans, 2015), 315.

[2] Ibid., 320.

Eugenics in Tennessee

A recent news story from my home state of Tennessee brings up questions of informed consent, reproductive ethics, eugenics, opioid abuse, and other bioethical issues.  In May, White County judge Sam Benningfield issued an order that allows inmates to have their sentences reduced by thirty days if they consent to sterilization procedures: vasectomies for men and (reversible) Nexplanon implants for women.  Benningfield’s order is his response to the repeat drug offenders he sees in the courtroom.  He describes the sterilizations as a means to “encourage personal responsibility,” and also states that, “…if you reach two or three people, maybe that’s two or three kids not being born under the influence of drugs. I see it as a win, win.”

This order is less surprising, perhaps, when considered in light of the United States’ very recent history of eugenics and forced sterilizations. As Kyle Sammin writes at The Federalist,

“[Benningfield’s] idea of ‘trying to break a vicious cycle of repeat offenders’ is, nearly word-for-word, an echo of the Supreme Court’s reasoning in Buck v. Bell, the 1927 case that upheld Virginia’s policy of sterilizing state asylum inmates without their consent. The decision by Justice Oliver Wendell Holmes laid out a similar desire to break a cycle of reproduction by people the judge viewed as unworthy of life: ‘It is better…if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind….Three generations of imbeciles are enough.’”

Benningfield’s order deems inmates’ potential future children as unworthy of life because of their parents’ situations. It treats inmates not as human beings with dignity and agency in one of the most personal and significant areas of life, but as a senseless population to control.

Why People Matter

This time last year, I had the opportunity to index the new book Why People Matter: A Christian Engagement with Rival Views of Human Significance, edited by John F. Kilner. Released in January 2017, Why People Matter explores how five competing philosophical perspectives explain human significance.  Almost everyone understands that people are important, and this book delves into different ways that people outside the faith have defended what they intuitively know to be true about human dignity.  The authors point out the weaknesses inherent in each outlook and defend the superiority of the Christian view of human dignity.

Seven Christian ethicists contribute to the work.   First, Gilbert C. Meilaender provides a critical discussion of a utilitarian understanding of human significance. Next, Amy Laura Hall gives an account of the collectivist outlook.  Russell DiSilvestro tackles individualism, Scott B. Rae covers naturalism, and Patrick T. Smith discusses transhumanism.  Following the exploration of these five perspectives, Kilner and David P. Gushee explain and defend the theological and biblical foundations of the Christian understanding of human significance.

Why People Matter is a helpful volume that winsomely and convincingly defends the Christian perspective that human dignity is grounded in God, rather than in ourselves.  Notably, one of Kilner’s chapters, “Special Connection and Intended Reflection” is an accessible distillation of his recent book Dignity and Destiny: Humanity in the Image of God, which won the Christianity Today Book Award for Theology/Ethics in 2016.  This chapter should prove useful for busy Christians who desire to articulate what it means to be made in the image of God, and why it matters. Overall, this book has the potential to help Christians better understand and appreciate why a Christian anthropology truly is the best defense of human significance.

Samaritan Ministries and Ectopic Pregnancies, Addendum

A couple of weeks ago, I posted this piece commenting on Samaritan Ministries’ policy regarding ectopic pregnancies.  A few days later, my husband was contacted by Samaritan representatives, who requested that he and I meet with them while they were on Trinity’s campus for the CBHD conference. We met Friday afternoon, and they took time to explain their position on treatment for ectopic pregnancy as well as share some details of the policy that are not outlined in the guidelines.

After this conversation, I want to follow up my original post with some additional information about Samaritan’s policy on publishing expenses related to tubal ectopic pregnancies.  First, Samaritan does publish expenses surrounding the procedure, such as hospital stays, even if the procedure itself is not publishable.  Second, as described in the guidelines, they do publish treatment expenses if the baby is known to already be dead, or if the tube has already ruptured and the baby is thus presumed to be dead.  Expenses that are not shared, such as the removal of the fallopian tube when the baby has not died, are also able to be submitted as “Special Prayer Needs,”[1] which other members can choose to give towards (in addition to their regular monthly fee).

Although we still disagree concerning the ethical question itself and the existence of a Christian consensus, I am happy to have a better understanding of Samaritan’s policies after our discussion.  I also realized after our conversation that I had missed a couple of mistakes in my original post that caused confusion.  First, I wrote that “…the condition is highly dangerous to the mother, who is at risk…”  I have subsequently edited the sentence to more accurately say, “…the condition can be highly dangerous…,” since between 40-64% of tubal pregnancies result in miscarriage without rupture.[2]  This fact is relevant to Samaritan’s policy, as they encourage “watchful waiting” and believe that many doctors use scare tactics to pressure women to treat ectopic pregnancies (in whatever way) before determining if the situation will resolve on its own. Also, in my concluding sentence, I accidentally typed “treatments” instead of “treatment,” implying that I was speaking of more than one widely-accepted treatment.  However, in the post I only referred to the removal of the fallopian tube (salpingectomy).

With these clarifications in mind, I believe that the positions of both myself and Samaritan are accurately represented. For anyone who is interested in further discussion of Christian perspectives on various methods of treating ectopic pregnancies, I have listed some resources below:

Kaczor, C. (2001). Moral Absolutism and Ectopic Pregnancy. Journal Of Medicine And Philosophy, 26(1), 61-74.

Kaczor, C.  (2009). The Ethics of Ectopic Pregnancy: A Critical Reconsideration of Salpingostomy and Methotrexate. The Linacre Quarterly, 76(3), 265-282.

Hager, S. E. (2016). Against Salpingostomy as a Treatment for Ectopic Pregnancy. The National Catholic Bioethics Quarterly, 16(1), 39-48.

[1] https://samaritanministries.org/help/guidelines

[2] http://www.tandfonline.com/doi/pdf/10.1179/002436309803889106

Samaritan Ministries and Ectopic Pregnancies

As I was reading Laura Turner’s Buzzfeed essay about Christian health sharing ministries this past week, I was startled to discover that Samaritan Ministries, the insurance alternative my husband uses, does not cover expenses related to ectopic pregnancies.

In Section VIII of the Samaritan Ministries Guidelines, “Needs Shared by Members,” Ectopic Pregnancies is listed as the ninth item under “Miscellaneous Items Not Shared.” The guidelines state:

“Expenses related to the termination of the life of an unborn child are not publishable. The removal of a living unborn child from the mother which results in the death of the child is a ‘termination of the life of the child’ unless the removal was one for the primary purpose of saving the life of the child, or improving the health of the child. This means that the removal from the mother of an unborn child due to an ectopic pregnancy (outside the normal location in the uterus) is not publishable unless the member states they believed the child was not alive before the procedure. Considerations of the health or life of the mother does not change that the removal of a living unborn child from the mother may be a termination of life.”[1]

Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in one of the fallopian tubes.[2]  The condition can be highly dangerous to the mother, who is at risk of internal rupturing and blood loss.[3]  While there are different classifications of ectopic pregnancies and a few different methods of treatment, Turner approximates the cost of surgery to save the life of the mother to be around $15,000.[4]

The cost of such a surgery would not be covered by Samaritan because the treatment would be “related to the termination of the life of an unborn child.” However, the consensus of Christian bioethics is that, at the very least, treatment of ectopic pregnancy by the removal of the fallopian tube is a permissible application of the doctrine of double effect. The surgeon would remove the affected fallopian tube with the intent to save the life of the mother, and foresee but not intend the death of the child.[5]

Or, as Catholic bioethicist Fr. Tadeusz Pacholczyk explains,

When an ectopic pregnancy does not resolve by itself, a morally acceptable approach would involve removal of the whole section of the tube on the side of the woman’s body where the unborn child is lodged. Although this results in reduced fertility for the woman, the section of tube around the growing child has clearly become pathological, and constitutes a mounting threat with time. This threat is addressed by removal of the tube, with the secondary, and unintended, effect that the child within will then die.

In this situation, the intention of the surgeon is directed towards the good effect (removing the damaged tissue to save the mother’s life) while only tolerating the bad effect (death of the ectopic child). Importantly, the surgeon is choosing to act on the tube (a part of the mother’s body) rather than directly on the child. Additionally, the child’s death is not the means via which the cure occurs. If a large tumor, instead of a baby, were present in the tube, the same curative procedure would be employed. It is tubal removal, not the subsequent death of the baby, that is curative for the mother’s condition.[6]

Samaritan’s stated reasoning behind its policy on ectopic pregnancies falls outside of the general consensus of Christian bioethics on this topic.  While there are treatment options for ectopic pregnancies that many Christians would consider unethical, the policy would benefit from added specificity that allowed for at least the most widely accepted treatment to be publishable.

[1] https://samaritanministries.org/help/guidelines?q=ectopic

[2] http://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/basics/definition/con-20024262

[3] http://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/basics/complications/con-20024262

[4] https://www.buzzfeed.com/lauraturner/christian-health-care?utm_term=.kq0Vwv76PL#.kxe4E8e37P

[5] https://plato.stanford.edu/entries/double-effect/

[6] http://www.catholiceducation.org/en/science/ethical-issues/when-pregnancy-goes-awry-ectopic-pregnancies.html

Christian Schools and Pregnancy

The New York Times published an article over the weekend titled “Pregnant at 18. Hailed by Abortion Foes. Punished by Christian School.” The author of the piece tells the story of Maddi Runkles, an 18-year-old high school senior who was banned from participating in her school’s graduation ceremony and removed from the student council after becoming pregnant earlier this year.  The article juxtaposes the professed pro-life beliefs of evangelicals with the way that Christian schools often respond to student pregnancy.  At the end of the article there is a quote from Maddi, who says, “Honestly, that makes me feel like maybe the abortion would have been better. Then they would have just forgiven me, rather than deal with this visible consequence.”

While many pro-choice activists accuse pro-life Christians of caring about babies only while they are in the womb, the myriad of Christian crisis pregnancy centers, relief organizations, and other faith-based charities give the lie to this caricature. However, Christian schools face the hard task of fairly upholding the standards of behavior that they expect from their students, while also displaying a consistently pro-life ethic and supporting students who choose life for their babies.

Maddi’s situation demonstrates the importance of Christian schools having well-designed and consistently-applied policies regarding out-of-wedlock pregnancies. Dr. Kimberly Thornbury was part of developing such a policy while she was Dean of Students at Union University, a Christian university in Tennessee.  Union’s campus newspaper reports on what such a policy looks like here.   In contrast, policies that appear arbitrary or vindictive are antithetical to a pro-life witness.

The Dangerous Message of Physician Assisted Suicide

Zachary Schmoll’s essay today in Public Discourse provides a look at physician-assisted suicide from the perspective of a person living with a disability.  In the essay, Schmoll emphasizes the role that legislation plays in influencing public opinion. Regarding the legalization of PAS he writes:

“Such laws communicate the idea that suicide can be a reasonable, moral, and socially acceptable choice, because some lives are no longer valuable. Suicide is prohibited in all other circumstances, sending the message that most lives have value that ought to be protected by law, even when the person in question does not see that value. In certain circumstances, however—specifically, when an individual is losing his or her own independence—such protections need not apply. Society is affirming, by legalizing physician-assisted suicide, that it is better to be dead than disabled. It is better to be in the grave than to live with reduced independence. This message is sent both to people with disabilities like me and everyone else who interacts with us.”

Schmoll’s piece is an important reminder of the persuasive power of legislation as well as the danger of measuring the value of life in terms of independence.

 

Surrogacy Now Legal in DC

As of April 7th, surrogacy is now legal in the District of Columbia.  B21-0016, the Collaborative Reproduction Amendment Act of 2015, allows surrogacy agreements to be made and enforced.  Previously, surrogacy contracts of any kind (commercial or not) were illegal, and contracting parties could be imprisoned and fined.[1]  The new law permits both gestational and traditional surrogacy.[2]

DC joins 46 states in permitting surrogacy contracts.  Only Michigan, New Jersey, New York, and Washington prohibit surrogacy arrangements.[3]  Although surrogacy is legal to varying degrees across the country, it is a harmful and exploitative method of assisted reproduction.[4]  Perhaps most often overlooked is the fact that surrogacy arrangements violate the human rights of the child.  As George Annas argues, “Surrogacy [arrangements] never [consider] the child’s welfare, only the welfare of the contracting parents.”[5]

[1] http://www.nbc-2.com/story/35095100/legislation-ends-decades-old-ban-on-surrogacy-contracts-in-dc

[2] http://www.creativefamilyconnections.com/us-surrogacy-law-map/dc

[3] http://www.thepublicdiscourse.com/2017/04/19109/ e

[4] http://www.cbc-network.org/pdfs/What-is-Wrong-with-Surrogacy-Center-for-Bioethics-and-Culture.pdf

[5] George J. Annas, “Fairy Tales Surrogate Mothers Tell” in Surrogate Motherhood: Politics and Privacy, ed. Larry Gostin (Bloomington and Indianapolis: Indiana University, 1990), 52.