Confession of a Eugenicist

 

I have a confession to make:  I am a eugenicist.

 

I am a family physician who provides obstetrical care.  I love taking care of moms and babies.

It has insidiously become the Standard of Care to offer to all pregnant women testing that will inform them whether there is an increased risk that their unborn children have certain genetic abnormalities or birth defects.  If I do not offer these tests to all pregnant women, I am considered to have provided substandard care, and the wrath of a society that tolerates Nothing But The Best will descend quickly upon me.  If I do offer these tests, I am practicing “Good Medicine” — and eugenics.

 

How did eugenics become Good Medicine again?

 

I don’t want to practice eugenics.  Yet I am compelled to by the Standard of Care;  and the Standard of Care is shaped by the existence and marketing of these tests.  It’s the old story in our technophilic society:  we are constrained to use a technology merely because the technnology exists.

 

Why were such tests even developed in the first place?  Was it only for diagnostic purposes,  simply to provide information to prospective parents?  Of course not.  Clearly these tests were developed to help guide therapy;  and because the primary “therapeutic” option is induced abortion of fetuses who are not up to snuff, it seems equally clear that eugenic considerations drove their development.  So, the eugenic ideal drives development of eugenic technology, which, marketed and disseminated, drives the Standard of Care, which drives what I do in my office and provides the ammunition for the licensing board — and malpractice lawyers — who are looking over my shoulder.

 

Thus am I an unwilling eugenicist.  Thus am I compelled to do the dirty work for the eugenicists of our society.

(This is not to say that all parents who opt to undergo this testing do so for eugenic purposes.  I realize that some do so solely for diagnosis.  I am writing here about the development and mandatory offering of such tests.)

 

Maybe the time has come for a new  medical association.  Instead of the AMA, perhaps we should inaugurate the HMA:  the Hippocratic Medical Association, the members of which will adhere to a different Standard, who will pledge to uphold the ideals behind the Hippocratic Oath.  The members of this association would return to the ethos of that Oath which, according to anthropologist Margaret Mead,  marked one of the great turning-points in the history of the human race, because, “For the first time in our tradition, there was a complete separation between killing and curing . . . One profession . . were to be dedicated completely to life under all circumstances, regardless of rank, age, or intellect–the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child . . .”

 

The Human Factory

I am sure many of you “foodies” have heard of the less than appetizing ingredient added to the long menu of strange “eats”—human breast milk. For those of you who are less than food savvy: do not fret, the milk you have been buying is likely from a cow (but I would still check the label).

This may seem to be a relatively obscure fact and even completely unrelated to the world of bioethics. However, you may think differently after reading the following article:

http://www.foxnews.com/health/2011/05/02/new-yorkers-sample-cheese-breast-milk/

For those of you who do not have the time or the interest to read this article…

Miriam Simun created a temporary art installation called the Lady Cheese Shop, which produces breast milk cheese, in hopes to make people think about the various ways human bodies are used as factories “producing blood, hair, sperm, eggs and organs that can all be harvested to be used by others.”

Can you think of any reason why human blood transfusions are generally accepted and human breast milk products “raise eyebrows”?

Treatment of HIV-infected Individuals to Prevent Transmission

The interim results of the HPTN 052 study released last week indicate that treating HIV-infected individuals dramatically reduces the likelihood that they will transmit the virus to their sexual partners.  This study of HIV-positive patients whose heterosexual partners were HIV-negative and whose disease was at a stage at which treatment would be considered optional showed a dramatic decrease in transmission to their sexual partners for those treated immediately and was stopped early due to the results.

This study raises some interesting ethical questions.

Are HIV-positive persons who have an unaffected partner now obligated to undergo treatment even if there is not evidence that the benefit of the treatment outweighs the adverse effects for the individual?

If treatment of infected persons is an effective means of preventing the spread of HIV, how aggressive should those responsible for public health be in seeking to identify and treat those with HIV?

What should be done in countries with a high level of HIV that already cannot afford antiretroviral treatment for the more severely affected?  If treatment of all infected people would dramatically reduce the incidence of new cases in those countries where do we get the resources to provide that treatment?

The Imago Dei Has Something to Offer

In their case the god of this world has blinded the minds of the unbelievers, to keep them from seeing the light of the gospel of the glory of Christ, who is the image of God. – 2 Corinthians 4:4

The Rapport sculpture, Reynolds Medical Bldg., TAMHSC

In my two years of involvement in the ethics community at a state medical school, I’ve found that the Christian concept of the imago dei speaks to unaddressed problems in bioethics.  The philosophy of materialism so dominates medical study and practice that descriptions of the individual do not rise much past the biological system that is the body.  Theological and, to a large extent, metaphysical explanations are excluded.  This leaves ideas on ethical behavior merely as encouragement to be nice or to ensure individual choice.

The Bible uses many terms to describe the human being, including nephesh, ruach, lebh, basar, psyche, soma, and sarx.  None of these descriptions falls into a neat, Western, body-soul-spirit framework.  These words instead speak of a richness that extends far beyond any reductionist view of the person.  The doctrine that people are created in the image of God (Gen. 1:27, 9:6) gives us insight into human purpose and ethical behavior toward others.

Last fall, I presented a poster at a symposium and included in it a paragraph on using the imago dei as a basis for a theory of personhood.  A medical researcher nearby left her poster and asked me what data I used to support my conclusions.  I explained that my paper examined the theoretical constructs we use when treating our patients.  It never occurred to her that she had, or might need, a philosophical framework in order to interpret her own data.  Medical practitioners need to recognize the body as one aspect of the whole person formed in a way to reflect God, even to represent Him in the world.  Ultimately, an understanding of our humanity in terms of the imago dei points to the new Adam who in His blameless life was, and is, the image unmarred.

 

On Michael D. West and the Medical Crusade to Defeat Death, Part 2

In last week’s blog, I introduced the topic of Michael D. West’s crusade against human mortality. West’s ardent desire, as he puts it, has long been to  “extract the ‘green essence’ of life, the secret of the immortal renewal of life, to hold it in my hand and to give it to my fellow human being.”

The quest, for West, is, in fact, a matter of moral obligation of such gravity as to trump any concern of “trespassing in a realm in which we humans have no right to go.” Neighbor love, he believes, demands biomedical crusade. As he further states, “Every human being should have not only the right but the passionate duty to reach out with all his or her strength to help others, even if it involves such controversial technology as cloning. If that means playing God, then it is playing God in a good way. I realized that I would do anything to save a human life, short of harming a fellow human.”

 

What key assumptions do you find in West’s defense of the biomedical crusade against death?

What do you think of the criticism that West and others like him are  “playing God” in their pursuit of the “green essence?” Is there a legitimate concern that biomedicine might be encroaching upon divine sovereignty over human life? If so, where is the line to be drawn?

Does the fact that West’s critics generally  value the project of medicine (i.e. human intervention in the course of disease) undermine their use of the “playing God” argument?

 

“Cleaning Up the Population”

 

Recently a disconcerting news event in New Hampshire went relatively unnoticed by the outside world, which–I suppose–is not all that surprising.  A freshman lawmaker, Martin Harty (age 92) resigned his short-lived position as a Representative after forcefully inserting his foot into his mouth.

Harty haphazardly spoke to a constituent, a board member of the Disability Rights Center, espousing the shipment of “defective people to Siberia to freeze.” By “defective people” he meant: “the mentally ill, the retarded, people with physical disabilities and drug addictions.”

Harty said in his own defense, “I was just kidding with her”…

Oops.

The most concerning part about this story was in the fallout. House Speaker William O’Brien nearly dismissed Harty’s comments: “While he has earned the right to say what he thinks, needs to appreciate that, as a representative, he will be held to a higher standard.”

Then, after Harty publicly announced his resignation, O’Brien said: “We both agreed that this is what is best for the House to move forward and focus on critical issues, like balancing our budget without raising taxes and giving voters an opportunity to pass a school funding amendment to ensure local control.”

Don’t get me wrong: We all do dumb things. We all make mistakes.

However, O’Brien made light of a comment that has horrible direct and indirect consequences; consequences that substantiate being considered “critical issues”. His comment cannot be absolved by resignation without being addressed. Discarding any group of people based upon their ability to be a productive part of society is not an idea that should be taken lightly. That mistake has already been made too many times.

For the value of a human life is not derived from the life lived, but instead from the One who has given life.

For the full article on this news topic check out this link.

 

Human Rights and the Significance of Human Dignity

One of the current students in the MA in Bioethics program at Trinity has also been observing in my medical office the past few months.  When there is a lull in the care of patients our conversations often turn to bioethics (while the paperwork on my desk waits a little longer to be attended to).  The other day we were talking about the concept of human dignity and whether it was a morally significant concept.  We agreed that it was and that we need to be clear that it has to do with the intrinsic worth of human beings.  It also needs to be distinguished from the concept of being dignified which is a very different cultural concept with which it is confused.

That discussion made me think about an essay by David Little in the book Prospects for a Common Morality. In his essay Little points to the impact of the rising concept of universal human rights that is changing the face of our global community.  He says that “some advocates and defenders of human rights seem to suggest that there are certain moral beliefs and concomitant claims about the world that are universally true and universally justified.”  This universally justified understanding of human rights is closely related to the idea that human beings have intrinsic moral value or dignity.  The impact this idea is having in global political processes makes it clear how significant this idea really is.

Is it better to be “sorry than safe” or “safe than sorry?”

Yesterday I gave an oral exam to a student (who is bound for medical school) in my bioethics course.  On a list of unpleasant encounters, oral exams probably rank somewhere close to the top next to “giving a class presentation” and “asking a girl out for the first time.”  However, this exam was an enjoyable experience for both of us, I believe.  We engaged in friendly dialog about several bioethical issues, but the focus was on the status of preimplanted embryos.  He admitted early on that he wasn’t convinced that preimplanted embryos are individual persons deserving moral protection.  After all, there is the issue of twinning that may occur during the first 12-14 days (not to mention the amount of fetal loss).  How can it be that the fertilized zygote is an individual human being when it could possibly twin before it implants?

Admittedly, the twinning argument appears forceful.  Many ethicists (including some professing Christians) agree and contend that human embryonic stem cell (hESC) research is not morally wrong because it does not entail the destruction of individual human persons.  Furthermore, it’s better to be “sorry than safe” about the matter i.e., it’s better if we proceed with hESC research and reap the benefits, even if it turns out that we are wrong about the status of early embryos.  On the other hand, if we play it safe and forego hESC research, then we’ll be sorry that we missed out on a technology that may revolutionize human health care.

In my initial response, I noted that twinning is a rare phenomenon that we don’t fully understand.  Of course, this student wasn’t going to fall for the “it’s all a mystery” reply.  But before I tell you how eventually responded, I would like to hear your thoughts.  How would you convince this student that the zygote is an individual human being deserving moral protection?  Or, perhaps you disagree with this point of view.

On Michael D. West and the Medical Crusade to Defeat Death, Part 1

This past week I picked up a copy of The Immortal Cell, written by gerontologist Michael D. West, founder of Geron Corporation and, later, CEO of Advanced Cell Technology (ACT).  Geron and ACT  were quite  significant  in the early development of  human embryonic stem (HES) cell research. In West’s personal account of the history of the field, there is much to grab the reader’s attention, perhaps none more so than the conclusions he reached one afternoon as a young baccalaureate while reflecting upon death. As he recounts (p.30),

“I realized that it was simply not in my nature to accept death or be defeated by it. The call wasn’t even a close one. I could never again resign myself to laying my loved ones down in the grave. It was crystal clear to me what I had to do. I had to defeat death.“

 

Interestingly, West presents this life-changing experience on the back-end of a discussion of how he came to surrender his belief in man as a special creation to an evolutionary account of human origins. This juxtaposition raises some interesting questions:

Can evolutionary theory truly accommodate West’s intense loathing of human suffering and death? On what account can these be viewed in negative terms if they come part and parcel with the evolutionary process?

Does West’s crusade against death entail the notion that human evolution has somehow reached its pinnacle?

If West et al conquer death, how might human evolution proceed? If people are going to live forever and the resources to support them are finite, then it would seem that the instinct for self-preservation would demand a halt to reproduction. Ironically, a core feature of the evolutionary process – reproductive success – will have to be resisted, or so it seems.

Setting aside the consideration of a campaign against death within an evolutionary paradigm, on what points may Christians agree and disagree with West in his view towards death?

The Philanthropic Principle

And he called the twelve together and gave them power and authority over all demons and to cure diseases, and he sent them out to proclaim the kingdom of God and to heal. – Luke 9:1-2

The Methodist Hospital, Houston, Texas

As I sit writing this article on the 21st floor of M.D. Anderson’s Pickens Tower, I survey the names that dot the skyline of the Texas Medical Center: St. Luke’s Episcopal Hospital, the Methodist Hospital, Baylor (Baptist) College of Medicine—all philanthropic ventures founded by Christians.  Today, their respective denominations are only nominally involved, providing some guidance for chaplaincy programs, some of which include Muslim services.  Granted, these medical institutions are now massive, multi-million dollar operations, yet many of their congregations have significant wealth that could be used to provide funding.  Obviously, they are plagued by the theological waywardness of their respective churches, but other more traditional churches lack involvement in health care in a similar fashion.  In speaking with a pastor of a large Baptist megachurch, I learned that they had stopped investigating opportunities to build a charitable medical clinic because of the fear of lawsuits.  Financial and physician resources were at their disposal, but such a ministry was a risk they were not willing to take.

During my year at Trinity in 2008-2009, I made several trips to Lawndale Community Church in downtown Chicago.  As many of you know, Lawndale has built an extensive medical clinic for the people of that neighborhood.  Though drawing its membership from some of the poorest of people, Lawndale has made it a priority to spread the Gospel through practical programs ranging from sponsoring a pizza parlor to providing medical care.  In Christian circles some mention that poorer patients look for opportunities to win cash through lawsuits, but Lawndale views medical outreach as a necessary risk in their pursuit of Christian goals.

 

Baptist Medical Centre, Nalerigu, Ghana

Today, unfortunately, we face the trend of Christian groups pulling out of medical care.  American Christianity now boasts some of the largest churches ever, with extensive programs and services that include multi-site ventures and online attractions.  Few, however, see medical care as a main function of the church.  Take the Baptist Medical Centre (BMC) in northern Ghana, for example.  BMC, like other Christian hospitals founded by Americans in Africa, is facing the withdrawal of American financial support for its mission.  Part of the reasoning behind the separation is to allow Ghanaians to mature in their leadership of such projects.  This is certainly a proper goal.  However, much of the termination in sponsorship is based on the idea that hospitals siphon off funding that could be better used in programs that are specifically evangelistic.  The fact of the matter is that chaplaincies in hospitals provide excellent ways to present the Gospel to people who would avoid any other Christian ministry.  The Muslim population is one of the major groups BMC serves, and these people would never enter a Christian building otherwise.  The fact of the matter is that pastors (not to mention Christian doctors and nurses) stationed at the hospital have a constant opportunity to communicate the hope and healing of Jesus.  No pastor hidden behind church doors here.

Conflict between two philosophies of health care in America has reached a fever pitch.  The medical field is marked by a battle between health care based on government oversight versus medical services maintained by profit found in the marketplace.  I recommend we reconsider medical care based on philanthropy as a third option.  There is great wealth to draw from, and health care is tailor-made to work hand and hand with the Gospel of Jesus.

For more information about Christian philanthropy and medical care, visit these websites:

The Faile Foundation of the Baptist Medical Centre, Nalerigu, Ghana

Lawndale Christian Health Center, Chicago, IL

Baptist Medical Dental Fellowship

Christian Community Health Fellowship