Safe Passage

I came across this description of the duties of a physician, from an 1858 lecture to medical students:  diagnosis, treatment, the relief of symptoms, and the provision of safe passage.

The provision of safe passage struck me as a concept we would do well to rehabilitate.  It is an evocative phrase:  protecting and helping someone on a long voyage.  That is generally not how we are taught to think about death in medical school.  Death is failure!  It is a cliff, a precipice to be avoided, rather than a voyage that everyone ultimately has to make.  We have a tendency to approach the precipice in one of three ways:  most often, we try to keep the dying patient from falling over the edge, wrapping them up and pulling them back  from the brink with ventilator hoses and feeding tubes and intravenous drips and every heroically inappropriate medical intervention and test we can conceive of;  or we realize that there’s nothing we can do, so we abandon them;  or, increasingly, in the name of “compassion,” we push them over the edge with physician-assisted suicide.  What a difference it could make if, instead of treating death as a precipice from which we attempt to keep a patient indefinitely, we understood death as a voyage each person will have to make.  What a difference if, instead of being trained to stave off the inevitable at any cost, doctors were trained to recognize — and to help patients recognize — when the voyage is approaching, how to help patients to prepare for it, and how to help them to make it a “safe passage,” a good death for them and their families.

 

Crossing Species Boundaries

Recently I have been reading a book entitled “Genetics: Science, Ethics, and Public Policy,” which offers a survey of various topics/issues in articles written by a broad spectrum of authors. Though the book is a bit dated (new research has been published since 2005) many of the reflections are still poignant.

One particular article has been on my mind as of late: “Crossing Species Boundaries,” written by Jason Scott Robert and Francoise Baylis. What they set out to establish in this piece is not a well-polished perspective on why or why not interspecies hybrids or chimeras from human materials should be made. So don’t get too excited.

However, they do have a number of insights as to the way we think about these things. In so doing, they offer a brief survey of some the current views and issues that arise, which have me thinking that…

I am going to begin a series that will address some of the latest topics, questions and ethical concerns that are associated with this issue–crossing species boundaries. With any luck this will offer more time and space to address the issue thoroughly.

Here are some topics I am thinking about addressing: recent developments/research, human nature, and the human species.

If you have any other ideas surrounding this issue that you think ought to be discussed, feel free to leave a comment.

What’s in a name?

Interacting with students often reminds me of the importance of some very basic things.  Recently I was reminded of the importance of defining the terms we use in bioethics.  In reading reviews of case studies by some of my online students I saw how their unquestioning acceptance of definitions influences how they think.

The terms involved were “abortion” and “passive euthanasia” and the definitions were from a textbook by Lewis Vaughn that we use in the course.  Vaughn’s text, which I reviewed in the summer 2011 edition of Ethics & Medicine, is generally good at representing a wide spectrum of views on current issues in bioethics, but sometimes some less objective things slip in.

Abortion was defined as “the intentional termination of a pregnancy through drugs or surgery”, which sounds pretty straightforward.  From the way a student was using the definition in a case review I realized that the definition would include and equate abortion with such things as the induction of labor for the delivery of a healthy term infant or a C-section to save the life of an infant in distress.  The fact that an abortion is a termination of pregnancy that includes the intentional ending of the life of the fetus was left out.  That part of the definition makes a big difference.

Passive euthanasia was defined as “allowing someone to die by not doing something that would prolong life.”  That is how James Rachels defined passive euthanasia in his classic defense of active euthanasia that was based on there being no moral distinction between active and passive euthanasia.  What that definition leaves out is the idea that any euthanasia involves the intent to end another person’s life.  This definition of passive euthanasia includes all the times we allow a person to die by choosing not to initiate or continue any possible life-prolonging treatment, but there is a significant difference between allowing a person to die of his or her disease when treatment has become more of a burden than a benefit and doing something with the intent of causing the person to die.  Intending another person’s death is the key to what is wrong with euthanasia and leaving that out of the definition makes a big difference.

What’s in a name?  The difference between right and wrong.

Cybrid-gate in the UK

In last week’s blog (July 26), I highlighted an article from Wired magazine (August 2011) titled “Extreme Science”  in which Wired explores seven “shocking experiments” that scientists could learn from if they were willing to set aside their ethical concerns.  One experiment involves cross-breeding humans with chimpanzees in order to better understand human development.

What I find fascinating about all of this is that the Wired article was written as if unethical experiments don’t occur; as if, in reality, scientists are guided by a moral compass.  But are they?  Just 2 days before I wrote my blog, The Daily Mail (a British publication) reported that over a 3-year span scientists “have created more than 150 human-animal hybrid embryos in British laboratories.”  So, what Wired posed as a hypothetical thought experiment was already happening (albeit secretly) in the UK.

According to The Daily Mail, “155 ‘admixed’ embryos, containing both human and animal genetic material, have been created since the introduction of the 2008 Human Fertilization Embryology Act.  This legalized the creation of a variety of hybrids, including an animal egg fertilized by a human sperm; ‘cybrids’, in which a human nucleus is implanted into an animal cell; and ‘chimeras’, in which human cells are mixed with animal embryos.”  http://www.dailymail.co.uk/sciencetech/article-2017818/Embryos-involving-genes-animals-mixed-humans-produced-secretively-past-years.html

The Human Fertilization and Embryology Act of 2008, Section 4A, contains some of the following prohibitions:

“(1) No person shall place in a woman –

(a) a human admixed embryo,

(b) any other embryo that is not a human embryo, or

(c) any gametes other than human gametes.

(2) No person shall –

(a) mix human gametes with animal gametes,

(b) bring about the creation of a human admixed embryo, or

(c) keep or use a human admixed embryo…”

So far, so good.  Or so I thought.  The Act continues:  It is illegal to do #2 above (i.e., mix human gametes) “except in pursuance of a license.

In other words, it is still possible, with government authorization, to mix human gametes with animal gametes to create an admixed embryo.  The only restriction, according to the Act, is that the admixed embryo cannot be kept or used after the first 14 days of its existence.  Indeed, it is also possible, according to the wording of the Act, to create an admixed embryo, store it (i.e., freeze it) over a period of time, and then at some future point do research on it, as long as it is not allowed to live beyond 14 days.

(To view The Human Fertilization and Embryology Act of 2008, go to:  http://www.legislation.gov.uk/ukpga/2008/22/contents)

But the story’s intrigue deepens.  The creation of the cybrids” in the UK was apparently done in secret.  As noted in a recent Christian Medical Fellowship blog (July 26): “there seems to be a murky mix of confusion and secrecy from which the true facts and figures are difficult to extract.”  But why the secrecy if research was being done within the guidelines of The Human Fertilization and Embryology Act?

Furthermore, the research was not carefully documented.  It is less than clear the exact numbers of cybrids that were created.  The Christian Medical Fellowship reports that, “According to The Independent “many more cybrid embryos were created – 278.  That large number is naturally of concern, but also of concern is that the numbers don’t match the figure of 155 released last week.  The Government has avoided answering that question.  Moreover, if all funding (apparently) stopped in 2010 and the licence was revoked from the only researcher, when were these 155 (or 278) embryos created?  Were they all created before 2010?  Or are they still being created?  If so, by whom?” http://www.cmfblog.org.uk/2011/07/26/155-animal-human-embryos-created-in-the-uk-%E2%80%93-we-think/?doing_wp_cron

In other words, in spite of government oversight, an assortment of so-called “ethical guidelines,” and the best intentions of scientists, it’s less than obvious that research is done within any firm restrictions.  The CMF concludes that “the glaring discrepancies in the figures issued by The Human Fertilization and Embryology Authority shows it is not fit for purpose when it comes to regulating the scientists.  It is incapable of keeping accurate records and is unable to keep on top of what is going on in research, either with embryos or eggs.”

I ended last week’s blog with the following observation:  “Humans have also demonstrated a natural tendency to push the moral envelope, to give priority to what can be done over what should be done.  Time will tell whether experiments that are now considered unethical will one day be the norm.”  Apparently we no longer need to wait for “time” to make this announcement.

Readings on Perspectives on Animals

I find that often my readings will reinforce each other in remarkable ways. Sometimes a book that I read just recently will inform the book that I am currently reading, allowing me to see the arguments from a different perspective.

I am currently reading through A Rat Is a Pig Is a Dog Is a Boy by Wesley J. Smith. I’ve read Smith’s Culture of Death, and will occasionally read his blog, Second Hand Smoke. Smith is well-known for his work against assisted suicide and euthanasia. However, in reporting on current events, Smith covers everything from stem cells to euthanasia to organ donation to healthcare. In his latest book his addresses the animal rights movement. The underlying theme in is work is the idea of human exceptionalism, or to put it another way, he addresses the cultural trend towards various forms of de-humanization. Smith has done much of his work in the public square engaging in politics, forums, and the media. His writing is meant to be provocative, and can at times put off the academic who is used to reading more tempered (sometimes tempered to a fault) materials. However, I can respect the reason why he writes the way he does, because, in reality, some things should shock us that just don’t anymore.

The byline to A Rat Is a Pig Is a Dog Is a Boy is “the Human Cost of the Animal Rights Movement.” And, indeed, there is a cost to putting animals’ rights on par with humans’ rights. Contrary what most people believe, this doesn’t elevate animals to a higher moral status as much as it de-elevates humans to a lower moral status. Thus far Smith has made a very clear distinction between animal welfare which is something we should be concerned about, and animal rights, which he contends is a slippery slope towards de-humanization.  Using Biblical language, this is the difference between being stewards over God’s creation and caring for what he has placed under our authority, and denying the image of God in man (and possibly idolizing the created thing rather than the creator).

Interestingly, I had recently read through God in the Dock, a collection of essays by C.S. Lewis on theology and ethics. The book is edited by Walter Hooper who discusses in his preface his diligent efforts of recovering the essays from magazines and publications. Many of these essays were in what Hooper calls “ephemeral publications,” so often the topics are addressing a particular issue of the day. However, I found that these essays provide a wealth of wisdom on topics that are surprisingly relevant to us today in 2010. This is most likely because Lewis was addressing timely issues with timeless truths.

There were several essays that cover topics important to bioethics questions. If you have not had a chance to read them, you can find some of Lewis’ essays here. Two essays that were particularly helpful regarding the moral status of animals and our obligations to them are “The Pains of Animals” and “Vivisection.”

“The Pains of Animals” is an interaction between C.E.M Joad, head of the department of Philosophy at the University of London, and Lewis over his chapter in The Problem of Pain on animal pain.  Joad is trying to reconcile the issue of animal pain before the Fall. He takes issue with Lewis’ explanation that animals have sentience but not consciousness because it does not follow, to Joad, that an all-good God would allow “creatures who are not morally sinful” to experience pain. He also takes issue with the idea that animals do not have a conscience because they seem to have memory. The rest of his essay wrestles with the implications of animals having a soul.

Lewis’ patient response is helpful for framing a Biblical view of the moral worth of animals. His first comment is that if God is good, “then the appearance of divine cruelty in the animal world must be a false appearance.”  He makes no claim to know the reality behind the false appearance.

Lewis then proceeds to patiently and clearly address Joad’s specific issues which I think are helpful in articulating concerns with animal pain, but does not leave it there. He also addresses how we feel when we see animals in pain. He deals with pity for the poor animal and what we do with those feelings of pity.

Lewis’ other essay, “Vivisection” addresses a debate on whether it is appropriate to experiment on live animals, including surgical experimentation. He begins by addressing the rhetoric of pity on both sides of the debate – the poor animal, or relieving human suffering. He criticizes this rhetoric for not really addressing whether the issue is right or wrong as much as competing to see which one is emotionally weightier. Today we see this rhetorical approach used in many areas of bioethics, such as the embryonic stem cell debate and in the current animal rights movements. By identifying this tactic, he is able to move beyond this and approach the topic at hand, is vivisection morally wrong?

For the rest of the essay, Lewis addresses the hinge of the issue: “Now vivisection can only be defended by showing it to be right that one species should suffer in order that another species should be happier.” Lewis essentially addresses the issue from the perspective of virtue ethics.  He comes down hard on the typical vivisectionist because cruelty without pity is morally base, but is careful to outline the Christian perspective that animals are not morally equivalent to man, and refers to the use of animals in sacrifice. He draws a careful balance here that I think is very helpful to think through.

Overall, this book and these essays provide an interesting perspective on animals and our moral responsibility to them. I have not finished A Rat Is a Pig Is a Dog Is a Boy, so I may have to post a review once I am done or make an addendum to my statements here, but thus far, I have benefited from reading about the issue from two different authors, with two different tones, from two different backgrounds, writing on current events in two different time periods.

Talking about Human/Animal Hybrids

For three years a laboratory in the U.K. has been secretly producing human/animal embryos, and has apparently made about 150 embryos. A search for “U.K. human animal hybrids” will turn up several articles reporting on this. See here for one of several articles on this. Technically, the creation of human/animal hybrids is legal under the 2008 Human Fertilisation Embryology Act However, there are regulations in place, including the destruction of these embryos at 14 days.

 

The reasons given for rejecting this research include that it is “dabbling in the grotesque.” The difficulty with this argument is it is based on a personal revulsion which I believe is valid, but is a difficult position in the public square. Without an appeal to something more than a personal revulsion, those that are not repulsed at the thought of human/animal hybrids would see themselves as having an equally valid position. Appealing to our natural inclinations is important, and should not be discouraged. Leon Kass’ appeal to the ‘yuck’ factor in human cloning  (Kass, Leon R. Life, Liberty, and the Pursuit of Dignity, 2002) is a valid argument and a strong framework for appealing to what could also be called a moral law. But these arguments are also important reminders of how what was once disgusting becomes unsettling. What was once unsettling becomes mildly palatable.  And finally, what was once mildly palatable becomes acceptable. The initial inclinations are all but forgotten. To take this a step further, those in favor of this work consider it a “moral imperative” to pursue this research because they believe it can save lives, cure diseases, and help scientists understand human development.

 

The “dabbling in the grotesque” argument is not robust enough for the public square. Yet, this is often the argument against such new technology, an appeal to revulsion, and the fear of a “Planet of the Apes” (or worst case) type scenario. While helpful, I think Lord Alton’s approach calls out the underlying problem. From the article:

 

Last night he said: ‘I argued in Parliament against the creation of human- animal hybrids as a matter of principle. None of the scientists who appeared before us could give us any justification in terms of treatment.

‘Ethically it can never be justifiable – it discredits us as a country. It is dabbling in the grotesque.

‘At every stage the justification from scientists has been: if only you allow us to do this, we will find cures for every illness known to mankind. This is emotional blackmail.

‘Of the 80 treatments and cures which have come about from stem cells, all have come from adult stem cells – not embryonic ones.

‘On moral and ethical grounds this fails; and on scientific and medical ones too.’

 

Lord Alton does appeal to the “yuck” factor by saying that it is dabbling in the grotesque, but he also appeals to the failed science, which is likely why this project has lost funding, to the U.K.’s global image, and to the scientists use of manipulative tactics.  He appeals to pragmatism (and money), politics, and character as well as the personal revulsion. I believe these arguments carry weight in a secular public square. Hopefully, these types of arguments allow for a common language for addressing issues and regulations regarding questionable research.

 

As a final note: In framing the issue of constructing human/animal hybrids, it is important to clarify the different ways that human and animal genetic material can be combined. The possibilities are hybrids, cybrids, chimeras, and transgenic (or xenotransplantation). Hybrids are the gametes from two different species. Cybrids are animal cells with human nucleus, which contains human DNA. Chimeras are organisms that are either human with animal parts or animals with human parts (or animal embryos with human cells). Transgenic embryos are usually an animal that has been implanted with specific human DNA so that it will develop an organ or material that is compatible with humans. This technique is often used with pigs to cause them to produce human insulin. See my article here for a more extensive discussion on these terms. The important point to note is that not all human/animal combinations are morally equivalent.

Stop those prying doctors!

 

Florida residents have their saviors in the Florida legislature to thank for shielding them from the insidious “prying into personal lives” that doctors have shamelessly been inflicting upon patients.

Apparently, doctors have been asking their patients questions about whether they own guns, and – prepare yourself for a shock – if the patient answers in the affirmative, some doctors have actually been counseling patients on how to store the guns safely and protect any other people in the home, particularly children, from accidental harm.

Fortunately, some attentive citizens were alerted to this disgusting practice and enlisted the NRA in helping them to get the Florida legislature to pass, and the Florida governor to sign on June 2nd, HB 155, which prohibits physicians from making written or oral inquiries regarding firearms ownership or recording such information in a patient’s chart (unless the doc believes “that this information is relevant to the patient’s medical care or safety, or the safety of others”).

It is a great relief to see that the physician-patient relationship — too long the purview of a suspiciously-dressed clique of highly-trained, dedicated professionals and their trusting patients, too long full of “prying into personal lives” as exemplified by questions like, “How do you feel?” “Does that hurt?”  “What do you use for contraception?” and “Did anybody in your family ever have cancer?” — is at last being exposed and regulated by those people we all trust way more than we do our doctors, the elected representatives in our legislatures.  My only regret is that some of the original provisions of the bill, such as the stipulation that a violation would amount to a third-degree felony punishable by up to five years in prison and a fine as high as $5 million, did not make it into the final legislation.

Encouraged by the NRA’s success, other bodies are stepping up to protect the unsuspecting public from some of the horrifying practices that routinely take place behind the closed doors of the consulting room.  The Tobacco Growers Coalition is promoting legislation to ban doctors from making inquiries about smoking, the GFFFA (Greasy Fried Fast Food Alliance) is working to make it illegal for doctors to counsel their patients about healthy diets, the NARL is drafting laws to ensure that doctors don’t counsel pregnant patients against abortion, and the Colombian drug cartels are looking for ways to prevent doctors from advising patients against using their special brand of products.

Sound too ridiculous to be true?  OK, I made that last paragraph up.  But read this.

Lest anyone misunderstand, this post is not about gun ownership, nor do I have anything against the NRA.  This post is about unwarranted encroachment upon the sanctity of the central economy of the medical profession, the physician-patient relationship;  and about what sort of Rubicon has been crossed when the paranoid intrusion and constraint represented by this bill is placed upon the good will and judgment of a doctor — and enshrined in the law of the land.

The Elusive Higgs Boson

Ahh, the infamous “God Particle.” Come on think about it for a second; you remember your physics teacher saying something about it between naps…

Just in case you forgot and this brief non-physicist explanation is not enough, Click Here.

The “God Particle” is an unproven hypothesis (until now maybe), which physicists hope will elucidate why certain particles have mass and even less weighty questions like: how did we come to be?

Researchers of Geneva (and Illinois)  have been diligently working with the Big Bang Machine, the multi-billion dollar 17 mile long Large Hadron Collider, that excellerates protons to nearly the speed of light in order to smash them together to reveal exotic particles. Their work has recently brought a glimpse of what may be the “God Particle,” evidence of such is still pending.

If this last remaining particle predicted by the standard model of physics is “proven,” some believe it may reveal something about “how God thought about putting the universe together.”

As exciting as the possibility of this new discovery may be to some, I think we would be remiss not to take  a moment to reflect upon the discoveries of the 20th century. After all, we know and have seen that every new technology, discovery, or scientific advancement comes with its own bundle of ethical problems. This can be seen in IVF just as clearly as the unveiling of subatomic particles.

So, what are some ethical concerns this new discovery could bring?

What great hope could it promise for our future? or, What great sorrow could it bring us?

 

Don’t get me wrong; I am not cynical about science, medicine, or technology. I, not unlike you, am just aware of the apparent problems that these discoveries or inventions bring.

You might be thinking: so what would you have then, luddite, no scientific improvement?

Probably not.

But, would I suggest that we consider each step a little more cautiously?

Absolutely! Every discovery has consequences: good and bad.

 

Thin language and the Scandal of Bioethics

As I continue to reflect on the recent CBHD conference one of the things that strikes me is the tension that was going on regarding the use of what Dennis Hollinger called thick and thin language in the communication of ethics by Christians.  As Christians we have a rich store of moral values that God has revealed to us in scripture and in the person of Jesus Christ.  We have access to that moral truth through the Holy Spirit who enables fallen but redeemed people to begin to comprehend these things from the mind of God.  Those who are not in Christ cannot begin to understand this foundation of our ethics.

That leaves us with a dilemma.  What should we do when we seek to communicate with those who do not have access to God’s resources?

We could strive to always communicate using the fullness of the scriptural and theological language that makes Christian ethics a rich source of moral truth.  That is faithful to what we believe and could be a witness of a different way in our largely secular world.  It would also be likely not to be understood by those outside of Christ and rejected without an attempt to comprehend it by many whose worldview has no place for the supernatural.

We could use the thin language of philosophical ethics and common morality to try to communicate what we believe about the moral issues of contemporary bioethics.  That would stand a chance of being understood by those with a different worldview and could have an impact on issues that we care about.  It can also be seen as an abandonment of the fullness of what we believe and have the potential of causing us to lose what is distinctive about Christian ethics in an attempt to be accepted at the table.

I would suggest that we could also use the thin language of common morality to try to bring those who do not accept Christ closer to him while we engage in the public dialog on bioethics.  When we enter the public discourse on bioethics all the participants are acknowledging that they consider moral values to be important.  They open themselves to the existence of those moral values that God has written on their hearts.  If we can help them see the existence of those moral values that have been intuitively understood across cultures and across time, they may then be able to make the step to understanding that we all fall short of those standards and are accountable to the one who made them.  That sets up the problem we all have that Jesus came to solve and the gospel can begin to make sense.  That was the process used by C. S. Lewis in explaining Christianity in Mere Christianity. I think we can use it today.

Going where no man should go

In a recent article titled “Extreme Science” (August, 2011), Wired magazine broaches a topic that few mainstream publications would be willing to touch.  What could be accomplished if scientists were prepared to set aside the “moral compass” that guides them (assuming there is one)?  Imagine the advances waiting to be made.  As Wired observes, in the real world (as opposed to the sci-fi world), “Most scientists will assure you that ethical rules never hinder good research – that there’s always a virtuous path to testing any important hypothesis.  But ask them in private… and they’ll confess that the dark side does have its appeal.”  http://www.wired.com/magazine/2011/07/ff_swr/

For example, scientists could separate sets of twins at birth in order to control and monitor their individual environments right from the start.  The gain from such an experiment is a possible solution to the nature vs. nurture dilemma.  Think about a twin study in which both individuals are eventually identified as gay, regardless of their distinct upbringing.  This could offer proof that homosexuality is all nature and not nurture.  In another example, Wired considers the possibility of “womb swapping,” i.e., switching “the embryos of obese women with those of thin women.”  Again, the experiment would determine whether environment or genetic factors determine an individual’s weight.  Then there is an experiment right out of a science fiction movie, one that cross-breeds a human with a chimpanzee.  Wired reports that the technique would be “frighteningly easy” and it would teach us much about human development.

But what actually prevents unethical research from happening?  It could be argued that these experiments are blatant violations of individual autonomy.  But the fact of the matter is that human autonomy is already disregarded with other procedures (e.g., human embryonic stem cell research, abortion, etc.).  In other words, what is the essential moral difference between destroying an early embryo in lieu of subjecting it to controlled research?  One may even maintain that the twins, separated at birth, are at least alive as opposed to embryos that are destroyed.

Then again, one could argue that the main difference is that twins will eventually come to understand their situation and realize that their autonomy has been violated.  On the other hand, destroyed embryos will never know their fate.  Fair enough.  But if morality is governed by utilitarian concerns, as it already is, it would seem that the value gained by subjecting embryos to questionable research outweighs their future concern for autonomy.  And if “awareness of one’s autonomy” is the key moral criterion, then research could be extended to any human lacking awareness (e.g., newborns, coma patients, etc.).

In short, humans have the rational capacity to consider all options to achieve an objective.  Humans have also demonstrated a natural tendency to push the moral envelope, to give priority to what can be done over what should be done.  Time will tell whether experiments which are now considered unethical will one day be the norm.