Wrongful birth, the next expression of a life unworthy of living

Last week I wrote about how the idea that we can judge that there are some lives that are unworthy of living underlies the practice of aborting fetuses who have major abnormalities. I suggested that we need to remember the serious consequences that followed the acceptance of the idea the there are lives unworthy of living in Germany in the first half of the twentieth century.

This week the news reminds us that once an ethical barrier is broken we human beings tend to pursue the breach as far as we can. Aborting a fetus with some type of disability violates the basic moral principle that all human lives have great value. The violation of that principle is justified by saying that some disorders can make a person’s life not worth living. That is claimed to make the abortion permissible. But what if the abortion is not done because the parents don’t know that the child has the abnormality until after the baby is born? Some are taking the next step to say that it is not only permissible to do an abortion when a fetus is known to have an abnormality but that parents have a right to know about any and all abnormalities of their unborn children so that they can abort them. Violation of that assumed right has resulted in physicians being sued for the harm of allowing a wrongful life. It is in the news because several states, including Kansas and New Jersey, have proposed laws to ban such lawsuits.

Those who support the laws banning wrongful life suits go back to the moral principle that every human life has value even if the person has significant disability. They say no suit should be based on saying that a child’s life is not worth living. They may understand that doing so puts us back in the moral climate of pre-Hitler Germany.

Life unworthy of living

Sometimes we need to remember the past. Of course that is what historians try to teach us. The recent translation into Italian of the 1920 German book Allowing the Destruction of Life Unworthy of Living by Karl Binding and Alfred Hoche prompted a reminder by Italian historian Lucetta Scaraffia about how the central idea of the book played out over the next few decades in Germany (see Washington Post article).

She suggests that the history of that idea is relevant to current bioethical issues. Some of those have been discussed recently on this blog. A few days ago Joe Gibes wrote about decisions to abort fetuses found to have major abnormalities such as Down syndrome. Back in December Jon Holmlund wrote about the use of PGD to diagnose embryos with major genetic disorders so that parents at risk for having a child with such a disorder could choose to give birth to a child without the disorder and not bring embryos with the disorder to birth.

Both the practice of aborting fetuses with a major disorder and doing PGD to choose which embryos should be brought to birth to avoid giving birth to a child with a genetic disorder involve the concept of a life unworthy of living that Binding and Hoche wrote about. If we make a decision to abort a fetus with Down syndrome or even one with a more serious disorder we are making a decision that the life of the person who that fetus will be is not worth living. If we choose to create multiple embryos and choose to implant those who do not have a serious genetic disorder so that they can live, but choose not to implant those who have the disorder so that they will not live we are saying that the lives that would be lived by those embryos who are discarded are not worth living. Whether one believes that and embryo or a fetus has full moral status or not they are unique individuals who have live that they would live if they are allowed to. Not allowing them to live those lives due to the presence of a disorder is saying that those lives are not worth living.

Remembering what happened in Germany helps us remember what a serious thing it is to say that a person’s life is not worth living. The idea that Binding and Hoche wrote about began as a philosophical concept, but it was embraced by the German government under Hitler as a reason for German physicians to put to death mentally deficient children whose lives were thought to be not worth living. Later that was expanded to large numbers of Jews and others whose lives were not thought to be worth living. The experience in Germany helps us to see that the idea that there are people whose lives are not worth living depends on a negation of the fundamental idea that every human life has inherent value. As Christians we understand that this value is due to our being created in the image of God. Even for those who do not have that understanding the inherent value of every human being underlies the concept of universal human rights that has become the foundation for global justice.

The German experience reminds us that there are some lines that we must not cross. One of those is saying that another human being has a life that is not worth living and using that as the justification for ending the life of an embryo or fetus.

The myth of non-directive genetic counseling

An article and its accompanying editorial in this month’s American Journal of Obstetrics & Gynecology report on a study comparing the practices and attitudes of two types of specialists regarding prenatally diagnosed fetal abnormalities: maternal-fetal medicine (MFM) specialists, who are obstetricians; and fetal care pediatric (FCP) specialists, who are (as the name suggests) pediatricians. The article is titled, “Prenatally diagnosed fetal conditions in the age of fetal care: does who counsels matter?”

The answer to the question posed in the title is decidedly yes. For instance, compared to the pediatricians, the MFM obstetricians reported  more than twice the pregnancy termination rate among patients carrying a fetus with Downs Syndrome. They were more likely than the pediatricians to “somewhat or strongly support” a decision to abort a fetus with Downs Syndrome. The discussion section of the article notes that pediatric and obstetrician specialists may “hold contrasting perceptions of life with disabilities . . . We cannot explain why, after multivariate analysis, our reported termination rates differed between specialties for Downs Syndrome.”

Two observations: First, those who deny that prenatal genetic testing is eugenic claim that the counseling given around such testing is non-directive, that is, that it does not influence a woman whose fetus tests positive for some condition to have an abortion. They say that the counseling gives just the facts: “Your fetus has Downs Syndrome,” not,”You should abort this fetus because it has Downs Syndrome.” If the results of this study are true, it exposes that claim for the wishful thinking — or insidious deception —  that it is. As the study authors write, ” …our study supports concerns that prenatal decisions and outcomes may sometimes reflect provider attitudes.”

Second, isn’t it interesting that between obstetricians (who typically do not care for Downs Syndrome patients) and pediatricians, it is the specialists who actually care for patients who have Downs Syndrome, who actually know something about how the syndrome affects people and families, and who are far more familiar with the details of living with the syndrome, who are the ones less likely to recommend that a woman abort a fetus who is suspected of having it?

Being pro-life: abortion prevention revisited

 

I have missed my usual Friday posting to this blog twice in the last month. We have had as a guest at our home since January a little 18-month-old girl, and while she is a wonderful delight, caring for her has consumed much of the time and energy that I normally spend  preparing for and writing this blog.

We are caring for this girl as a part of a volunteer network called Safe Families, which provides temporary homes for children of families that find themselves in a variety of difficult circumstances, whether it be temporary homelessness, a stint in the hospital or drug rehab, or time in prison. It is a good alternative to DCFS and other dangerously overloaded components of the social safety net.

I see working with Safe Families as part of being a pro-life physician. In particular, I see it as a part of trying to address abortion by providing support to those women and families who do choose to carry their babies to term rather than abort them. I am not holding myself up as a paradigm in this area; there is much more I could and should be doing. But anyone who identifies as pro-life must ask oneself, “What am I doing to be part of the solution to this problem of which abortion is a symptom?” Too often we look to the government to take care of the problem of abortion. We think our part in the solution is simply voting for the right candidate or sending money to the right lobbying group. Now those are not bad things; but if that is all we do — if we are looking solely to the government to fix the problem — we are abdicating our responsibility and opportunity to make a difference in the lives around us with the love of Christ.

It’s far more trouble to reach into the troubled lives around us with Christ’s love than it is to vote for a particular candidate. For our family it has meant disrupted schedules, re-ordered priorities, deferred schooling, missed blog entries. But it has also meant the joy of seeing a little girl flourish, of serving Christ, and of making a little difference in a little corner of the world where someone could very easily say, “In my situation, I can’t have this baby, I don’t have the support I need, and abortion is my best option.” Reaching out to those around us will of course look different for different people in different circumstances; by no means do I think that everyone can or should take children into their homes! But just think what a difference it would make in turning a culture of death into a culture of life if it became known that this people, the followers of Christ, were radically committed to helping and promoting the life and welfare of the mothers and children among whom we live.

Abortion, breast cancer, and truth

 

Eric Zorn wrote a provocative column for the Chicago Tribune last week maligning the various bills in various state legislatures that require a woman to be notified, before undergoing an abortion, that there may be a risk of breast cancer associated with abortion. In the column, Zorn argues that there is unequivocally no such risk, pointing to authorities such as the American Congress of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO) that have come out with statements denying a connection between abortion and breast cancer.

Intrigued, I searched the web and came up with differing opinions on the topic. Unsurprisingly, pro-life websites tended to assert a connection between abortion and breast cancer, while pro-choice websites tended to deny that there was any association between the two.

Still intrigued but unsatisfied, I did my own search of the primary scientific literature. Using a medical journal database called Ovid to which I have access through my hospital, I found over 2000 articles in medical journals. I did not read through every one, but after several pages of abstracts and articles I found multiple studies that showed a correlation, and multiple studies that showed none. I could not of course check for ideological bias in each study, but certainly some of the articles did not reach an ideologically pre-determined conclusion; for instance, one would expect that in China, the bias would be towards showing the safety of abortion, but a recent study from that country showed a correlation between abortion and breast cancer.

I think that we in the pro-life camp must be very careful about how we approach this topic. We must not, by ignoring or dismissing the studies that do not reflect our views, pretend that there is a consensus in the scientific literature where in fact none exists; ACOG, WHO, and Eric Zorn may use such subterfuge, but we should not resort to those tactics. We must be careful how we interpret even the studies that do show a correlation, remembering that they demonstrate only a correlation between abortion and breast cancer; and we know that correlation does not imply causation. If we are to be completely truthful, we must not pretend that the studies say what they in fact cannot say.

And finally, I don’t think we should spend too much energy on what is ultimately a side issue. I understand that one of the ways to show that abortion is wrong is to bring to light the ways that it hurts women; however, we should not put more weight on the connection with breast cancer than it can scientifically bear, else we run the risk of having our position undermined by something that is incidental to our main argument. Abortion would be wrong even if it lowered the risk of breast cancer, and we had best not rest our arguments against abortion on shaky science that very well might be disproved some day.

Q&A: On the Observance of Sanctity of Human Life Sunday

 

 1) What do we mean by the phrase “Sanctity of Human Life?”

Specifically, we mean to communicate the biblical truth that each and every human life, being made in the very image of God, is a special object of God’s love and concern (Gen 1:26-27; 9:6; James 3:9).

God is no respecter of persons, and so we ought not to be either. Every human life, no matter how young or old, no matter how functional or dysfunctional, is truly worthy of our love and deepest respect. While human life is not to be worshipped, it is to be valued greatly and protected.

 

2) What is the origin of the practice of observing a “Sanctity of Human Life” day each year?

President Ronald Reagan began the annual tradition. By his proclamation, January 22, 1984, the 11th anniversary of the Roe v Wade decision, marked the first national observance of the Sanctity of Human Life. That tradition has been continued by some, but not all, presidents since Reagan.

Political observances aside, Christians across the denominational spectrum have annually been calling attention to the tragedy of abortion on demand ever since the Roe v Wade decision (Jan 22, 1973).

Roe v Wade was a wake up call. Specifically, it awakened evangelical Christians in America to the responsibility of being salt and light (Matt 5:13—16) in a culture that was growing increasing callous towards human life.

 

3) What does it mean to be “salt and light?”

Being salt and light entails bringing the gospel of Jesus Christ to bear on a lost and dying world. Preaching and personal evangelism are of paramount importance to the task, but they are incomplete and often rendered ineffective if our words are not matched by lives radically altered by the Gospel.

A life radically altered by the Gospel is one that is no longer controlled by fleshly desires and worldly thinking, but rather, it is in tune with God. It values what God values, and it finds deep and abiding joy in obeying His commands.

What is it, then, that God commands of His people?  Here is the answer He gave through the prophet Micah:

He has told you, O man, what is good;
And what does the LORD require of you
But to do justice, to love kindness,
And to walk humbly with your God?   (Micah 6:8, NASB)

 “Doing Justice” – that is what Sanctity of Human Life Sunday is about.

Among other things, “doing justice” demands that we advocate for those who cannot advocate for themselves, that we uphold the interests of the weak over and against the schemes of those who would oppress them.

Human Life is under attack, and doing justice demands that Christians concern themselves with the problem and minister accordingly.

 

4) In what ways is human life under attack today?

Human life is under attack across its entire spectrum. On the back end, it is threatened by the evil of euthanasia. The notion that killing can be a genuinely compassionate ministry to the aged, disabled, and/or infirm is a lie borne straight from the pit of Hell.

Even towards the healthy, we see in our culture a blatant disregard for the value of human life. Murder and violent crime are the obvious signs, but no less concerning is the disregard for human life that permeates much of what passes these days for entertainment.

For the Romans, the sinful appetite for violence was satiated at the Coliseum; for Americans, the appetite is no less strong though the venue for its satisfaction may be different. Yes we have our sports arenas for modern-day gladiatorial contests that feature all the violence without, it is hoped, the killing (e.g., UFC);  but we also have our television viewing rooms, our video game stations, and comfortable cinemas where, for our viewing pleasure, human bodies are violated, desecrated, and discarded like rubbish.

Now, what generally gets the most attention at Sanctity of Human Life observances is the assault on human life on the front end, and elective abortion in particular, which has claimed over 50 million lives in the US since Roe v Wade.

Many, frankly, have grown tired of the public controversy over abortion and just wish it would go away. But, absent a mass awakening in our country to the Gospel of Jesus Christ, the killing will continue. As the Christian’s charge to protect the innocent and vulnerable is neither optional nor in harmony with the worldly ethos of our day, we may expect that the controversy will continue.

We can take heart, however, in the fact that we stand in good company for Christians have been battling the evil of infanticide from the Church’s earliest beginnings. In Roman culture, it was socially acceptable for fathers to abandon unwanted babies on the doorstep of the family home – death by exposure largely served the same purpose that abortion does today. Convinced, however, that all human life is a gift of the Creator God and thus to be valued and protected, early Christians not only refused to participate in the horrific practice, but even more, they rescued many an abandoned child.  As they did so, they provided a powerful witness to the love of God and his gracious salvation extended to helpless sinners.

Human life on the front end is also threatened in our day by the effort to control reproductive outcomes and, in particular, the attributes of our progeny. Whereas the Romans had to wait and see what “nature” delivered, nowadays we have the increasing capacity  to determine what first goes into the womb.

Implicit to the drive to select children of a specific type or kind is the judgment that some children are not worth having.

In China, that judgment has manifested in a higher abortion rate for female offspring that has left the population with an enormous gender imbalance. That imbalance poses for China serious threats to peace and order – both internally, and with its neighbors.

Here in the U.S., gender selection is occurring, though not on the same scale as in China. Its not that we are any more humane, however, its just that our focus has been more on the elimination of babies perceived as defective.

And so, for example, those among us who lived in the days prior to pre-natal testing recognize that we have in our midst fewer children with Down’s Syndrome. Current estimates are that somewhere close to 90% of children identified through pre-natal tests as having Down’s Syndrome are now aborted.

 

Reproductive medicine has not only yielded an increasing capacity to control the makeup of our children, it has also created a huge “surplus” of human embryos. Most of these embryos have been consigned to the freezer. Few will ever come to occupy a womb, but instead, most will either expire on the freezer shelf or be dissected and destroyed in a medical laboratory.

To assuage the conscience uneasy about embryonic experimentation, researchers and their supporters tell us that these embryos are not really human beings or “persons,” but we know better. We were all embryos at some point, just as we were infants, and then toddlers, and then children, and so on.

From conception onward, we are who we are: individual persons known and loved by God and, thus, to be loved according to His command: as neighbor. Neighbor love is sacrificial, but note, it sacrifices not the interests of the one being loved, but rather, those of the one who loves. Killing an innocent neighbor can never be a genuinely loving thing to do.

 

 5) So, what is the Christian to do?

First, we must recognize the assault against human life for what it is. Most fundamentally, it is spiritual warfare. We face an enemy, Satan, whom the Scripture describes as a “murderer” (John 8:44) who “prowls around like a roaring lion looking for someone to devour (1 Pet 5:8).

Second, we must then utilize spiritual weapons.

1)    The Gospel Truth

The Gospel of Jesus Christ calls sin for what it is, but doesn’t leave the matter there;

It also proclaims in Christ Jesus redemption and forgiveness to all who would repent and place their faith in Christ Jesus;

It is lived out through daily ministry to neighbor – word and deed must be in sync.

2)    Prayer

Much prayer is required. We are up against a mighty foe, and so, we must call upon the Most High God

3)    Guarding our hearts and minds

We must take care to not let that which is unwholesome and impure to capture our hearts or minds;

This is not a call to disengage from culture, but rather, a reminder of the need to filter it and deny it a controlling influence.

 Third,  we get involved  i.e., we seek to be salt and light.

1)    Through personal evangelism

Hearts and minds must be transformed by the Gospel. Yet, as the Apostle Paul in his letter to the Romans declared, “how can they believe in the one of whom they have not heard?”

2)    A personal, social ministry – several avenues exist

Making other people’s problems our own; sharing burdens

Working with agencies whose aim it is to uphold the value of human life

Advocacy in the Public Square: telling the truth in love, pointing our culture to God’s vision of the good life

Losing control at Christmas

 

Throughout most of history, having children was not a matter of exerting control, but of accepting uncertainty. Whether and how the act of making love resulted in children was a mystery. In the pages of Scripture, having children — especially when one had been considered barren — was most often seen as a sign of God’s blessing: think of Eve, Sarah, Rachel and Leah, Hannah, Elizabeth …

Somewhere in the modern epoch the mindset changed. Children are still a blessing, but now they are also a liability, and we calculate how many hundreds of thousands of dollars it costs to raise a child. In the modern purview, since childbirth brings liability, it must be brought under control. The most portentous embodiment of this mindset change is the development of contraception. We now speak of “planned” and “unplanned” pregnancies — another way of saying “controlled” vs. “uncontrolled.”

But this is not enough control for moderns, for all contraception, other than abstinence, is imperfect. So when contraception fails, when we lose control, we establish the option of abortion, by which we re-assert control, by which we affirm the supreme modern value of control over life.

But even this degree of control is not enough. Why should we stop at merely preventing children, when we can control their conception? Thus we pursue reproductive technologies, by which the woman barren, like Rachel, or too-old-to-have-children, like Elizabeth, can produce a child. Yet this is still not enough; there is still too great an element of uncertainty, so we assert an ever-greater control over the process of conception by testing these children of reproductive technology before they are born or even en-wombed, in order to control who will live and who will not. Again, the mindset changes: children now are not only a blessing and a liability, but a product, manufactured to certain specifications and precise tolerances.

“Control” is not a bad thing. There are many in this world who would be much better off if they had a greater degree of control over their lives. But since we are a fallen race, the more we seize control of something, the more we ruin it in the process. We see this in our physical environment as we have increasingly asserted control over it; we will see it in our humanity if we continue in the path of controlling ourselves through enhancement and controlling our offspring through genetic manipulation.  One of the most vexing questions bioethics must answer is, How much control is right? And when have we gone too far?

Contrast the modern techno-birth with the most important birth in all of history, which was not a matter of control, but of surrender, surrendering control over birth. In the process, the “perfect” contraception — abstinence — fails! Yet from this act of surrendering comes the greatest gift the world has ever received. Is there a lesson here? Does our greatest good always lie not in grasping for greater and greater control, but in knowing when to relinquish control and surrender?

 

Abortion: Unbridled Democracy in Action

 

When reading a piece by Joseph Ellis on the founding of the US, American Creation, I came upon an insightful saying. I am not sure if this is a common saying and/or if I have heard it before and it just didn’t click. Whatever the case may be, it caught my attention.

The context in which Ellis wrote the phrase, “Unbridled democracy in action,” was concerning the gradual removal of Native American tribes by the expanding United States. However, is it not the case that we see unbridled democracy in action, perhaps even more than ever, in America today?

Here I am not necessarily referring to the destruction of a people as an exercise of liberty, although addressing that may be apropos. I am talking about the extension of liberty at the expense of morality and justice. While we all stand firmly on the preservation of liberty, is this not the very principle people use to justify all kinds of deeds?

 

One such deed is abortion under the guise of “procreative liberty”. This is portrayed best, perhaps, in the mistaken ruling of Roe vs. Wade delivered by Mr. Justice Blackmun:

 

“The principle thrust of appellant’s attack on the Texas statutes is that they improperly invade a right, said to be possessed by the pregnant woman [Doe], to choose to terminate her pregnancy. Appellant would discover this right in the concept of personal “liberty” embodied in the Fourteenth Amendment’s Due Process Clause; or in personal, marital, familial, and sexual privacy said to be protected by the Bill of Rights…” (Section V)

 

The ruling did two dangerous things: 1.) Extended the rights of woman based upon an abstraction of the language of liberty in the constitution (I understand Blackmun cited case precedence also), and 2.) Usurped state’s rights.

The first is true because of a soft/fluid interpretation of the constitution. And despite the claims of Mr. Justice later in his delivery of the opinion of the court,  the second is true because the ruling made abortion legal nationally, which demolished standing state legislation across our nation without legislative due process.

Not to mention that this ruling negated the foundational facet of a three-faceted ideal: the right to life, the right to liberty and the right to the pursuit of happiness. What about life?

Down Syndrome and Thanksgiving

 

Despite today being the retail abomination known as “Black Friday,” I will continue in the vein of Thanksgiving and write about a person I am thankful for.

My nephew’s name is Jacob, and he has Down Syndrome. He just turned 18. He is one of the most loyal and loving people I have the privilege of knowing. He gives incredible, bone-crushing hugs. His cell phone voice mail message ends with, “Love you.” His aunt, my sister, lies in a nursing home, barely able to interact since a brain injury in June; but Jacob doesn’t care about her medical conditions, he just loves to be there with her, because he loves his aunt. I am thankful for Jacob’s example of unconditional love.

When we take Jacob out to eat, he orders french fries. And when he eats french fries, he eats them a certain way, one at a time, dipped just so in his favorite condiment: steak sauce. Lunch takes at least an hour. I am thankful that Jacob makes us slow down. 

Jacob loves music. He owns several guitars, and received a bass guitar for his last birthday. He especially loves worship music. He can strum his guitars, although a guitarist probably wouldn’t call it “playing” guitar. His singing isn’t exactly on key. Yet most Sundays he is in front of his church leading worship with the worship team. His microphone may not be turned up terribly high, but his love for Christ is at full volume. I am thankful for Jacob’s example of unselfconscious worship.

Jacob sometimes requires extra patience. His parents have made extra sacrifices. There are things he does that will drive you crazy if you let them (Is there anybody for whom that is not true?). He will never live independently, and will always require a level of extra care. But the extra care and patience are richly rewarded. And while we think we are making extra sacrifices for Jacob, I sometimes think that God sees it differently: that He is giving us an extra measure of blessing by allowing us to be with Jacob. Yet it seems that too many, when they think of “Down Syndrome,” think only of the extra work and sacrifice and limitations. Either that, or they think of a life that is not worth living. Whatever the thinking, it is both sad and frightening that in this country, about 92% of the unborn babies suspected (on the basis of prenatal testing) of having Down Syndrome are aborted: sad, because of the loss of human life through abortion as well as the loss of the privilege of being with these unique people; and frightening, because of what it says about us as a society. I am thankful that Jacob was not one of the 92%.

Voting on personhood

The issue of how we define personhood or how we define who has full moral status is one of the most fundamental issues in bioethics. It determines who is included in our considerations of ethical issues. The worldview of Christians who understand the Bible to be the foundation of our understanding of God’s moral truth and who hold to the traditional creeds of the church points to a biological definition of personhood. This biological definition would include every living human being from the time he or she became a separate biologic entity as a zygote following fertilization or its equivalent. This is in contrast to those who would define personhood functionally by the presence of what are considered human attributes.
Next week the people of Louisiana will vote on an amendment to the state constitution that would add the following statement, “Person defined. As used in this Article III of the state constitution, “The term ‘person’ or ‘persons’ shall include every human being from the moment of fertilization, cloning or the functional equivalent thereof.”
For those of us with a Christian worldview the proposed amendment raises two questions. 1) Is this definition correct? We would answer that with an unequivocal yes. 2) Is it prudent to add this definition to a state constitution? The answer to that is less clear. If by adding this definition the lives of defenseless unborn human beings are spared then it is clearly a good thing. If this amendment leads to a reaction at a national level which more deeply establishes personal autonomy as the legal priority over the value of the lives of those who are unable to speak for themselves then more unborn lives may be lost than if it were not passed.
We must always be clear in expressing what we understand to be God’s moral truth. When we venture into public policy we need to understand that we are working in a fallen world where that truth may not be understood and a focus on the self may distort it. We need wisdom to decide how to proceed because what is most prudent may not be clear.