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.

Final Reflections on “The Scandal”

 

This past week, Fox News reported on the circumstance of Yousef Nadarkhani, an Iranian pastor and leader in Iran’s growing evangelical movement whom Iran’s Supreme Court has determined may be executed  if he persists in refusing to renounce his Christian faith.

The news of Nadarkhani’s predicament served as a reminder to this reader of the serious stakes involved in identifying with Jesus Christ. Not all Christians are called to martyrdom – and my prayer is that Yousef would be released without further harm – but we are all called to assume the risk, and this because loyalty to God comes first and that loyalty entails fidelity to the gospel of Jesus Christ, which is  offensive to the unbelieving soul. Even as we endeavor to live our lives in a winsome way (1 Cor 10:32-33) – we ought not be surprised if ridicule, scorn, or even violence come our way as we proclaim the gospel message in both word and deed.

As I continue to reflect upon “The Scandal,” (see prior posts)  I think often about the question of content for a Christian bioethic. Some professing Christians argue largely on pragmatic grounds for the public casting of Christian bioethics in a “publicly accessible” language (i.e. purely philosophical argument). A more robust bioethic – one replete with theological warrant – has its place, the thought goes,  in discussions among those operating within a Christian worldview,  but not in the broader debate where Christians encounter nonbelievers who are skeptical, if not overtly hostile, to the Faith.

So, a number of questions arise: Can we truly be faithful to the Christian mission when confining theological argumentation to intramural bioethical discourse?  Can the “doing” of bioethics be rightly compartmentalized from the task of evangelization or the bearing of prophetic witness in a decadent culture?  Is it truly unethical, as some maintain, for physicians to evangelize their patients?

And finally, as I think about our brother Yousef Nadarkhani, I find myself asking, “What cost am I willing to endure in my identification with Christ in the public square?” Christian martyrdom, or the prospect thereof, forces a confrontation with truth both for the believer and the unbeliever. It demands from all a consideration of ultimate value  – specifically, is Jesus really worth dying for? To think in these terms may help us navigate the question of how best to formulate our “public” bioethics.

Your thoughts?

Fertility and Cancer

Bioethics is about dealing with the difficult topics, so here is one that I find particularly difficult. The more I learn about the infertility industry, the more opposed I am to IVF and many of the variants of in vitro procedures. The United States has very few regulations on this billion dollar industry, and the risks to mother and child seem to be underreported (See the web site for the documentary, Eggsploitation). Furthermore, I am skeptical of companies that make a substantial profit off of something that is so emotionally laden. Oftentimes, these companies are not up-front with the success rates of IVF, so an emotionally distraught couple is willing to pay thousands of a dollars for a procedure that has a success rate of 30-40% . One couple that I talked to told me that there are bioethical decisions at every step of the process and couples walk in ill-prepared to make these decisions. Many couples are so upset that they may not be in a position to think through these decisions. Personally, I am particularly wary of cryogenic freezing of embryos. There are a number of ethical issues related to this one particular procedure, such as what to do with left over embryos, or how does freezing affect the health of the embryos, considering how very delicate they are.

In general, however, I am also against dismissing certain medical procedures just because they may be used for unethical purposes. For example, I cannot categorically dismiss a DNC procedure even though this is used for aborting a pregnancy. DNC is also used when a miscarriage occurs, and in that sense, it is a much more humane procedure for the death of a baby in utero than the alternative. I also cannot categorically dismiss cosmetic procedures even though some people undergo them for trivial purposes because there are many cases where cosmetic procedures have helped restore a patient’s physical features and facial mobility after accidents or burns.

So, when I came across this article from ABC news about a young woman in her twenties who wanted to freeze her eggs (not embryos) because chemotherapy can cause early menopause in women, I am not sure if this situation can be evaluated from the same ethical categories as a typical IVF case. The young woman wanted to preserve her fertility so she had several of her eggs frozen. She had to take drugs that cause hyper-ovulation, a risky procedure in and of itself, and will likely have to conceive through IVF, although there may be other options available, such as inserting the unfertilized egg into her fallopian tubes.

A news story is one thing. About a year ago I had given a talk on faith and science. After the talk, I met a young woman who was in the audience. She had just recently completed chemo therapy for breast cancer, and was finally trying to put her life back together. She was young, probably not yet thirty and her mom was with her. She told me that she and her husband decided to have some embryos frozen until she was cancer free and was ready to have children. They had to quickly make this decision because, in her case, it was likely that the chemo would affect her fertility. To make the already cloudy ethical waters even murkier, she refers to the embryos as her children. They had apparently only fertilized (or only saved, I am not sure) 2 or 3 embryos, as many as she and her husband planned on having. She referred to them has her children and sees them as such; not something to be discarded or stored indefinitely.

Both of these young women give me pause. Ethical problems abound in reproductive technology. But these women, particularly the second girl that I talked to, do not view these children as commodities. And the technology may very well help them to be able to have children even if cancer treatment might take that opportunity away. Usually I hold a firm stance against IVF, but is this a case where reproductive technologies are less morally tenuous?

On a final note, the ABC article mentions an experimental drug called triptorelin that women can take concurrently with chemo that decreases the chances of infertility (or early onset of menopause) in women. Hormonal drugs always come with risks, however this seems like an ethically robust alternative to an in vitro procedure. Furthermore, this drug is cheaper than freezing eggs or embryos, and thus far seems to be safer than the hyper-ovulation drugs. Also, because tripotorelin can be taken during chemo, chemotherapy does not need to be delayed as it would with freezing procedures.

The Tragedy of Bioethics

At last week’s CBHD conference, a few of us were treated to a unique “Drinking-from-a-firehose” experience.  Jerome Wernow gave a talk with the eyesplitting title, “Bioethics:  Facing a Philosophical Theology of Tragedy and Mystery.”  Intrigued at the title in the conference brochure, but having no idea at all what it might refer to, I slid into a seat in the classroom where Dr. Wernow was to speak, prepared to be befuddled.  Instead, in the space of about about twenty minutes, those of us in the room were given an alluring glimpse into a poignantly beautiful picture for doing bioethics that alters what I see when I look at a patient.

I will attempt to present gleanings from the rich feast that was Dr. Wernow’s talk.  The early 20th Century Russian philosopher Nicloas Berdyaev wrote,  “There can be no moral life without freedom in evil, and this renders moral life a tragedy and makes ethics a philosophy of tragedy.”  As anybody who has witnessed the anguish of those who seek an ethics consult can attest, as anybody haunted by the dark questions our modern technology raises would agree, in bioethics all decisions are fraught with tragedy;  ethics consultants are actors in one-act medical dramas that are tragedies.  And tragedy is neither lessened nor assuaged when good and evil alone are used in bioethics’ calculus.  Our knowledge of good and evil is damaged, the product of a lie (“your eyes shall be opened, and ye shall be as gods, knowing good and evil“); it was in the very act of grasping for the tree of that knowledge that we were banished from the tree of life.  When we approach people whose stories have taken a catastrophic turn and we wield only the calculus of good and evil, our bioethics is left lifeless, empty, and tragic.  According to Wernow, to address tragedy we must turn to mystery, to “Mystery-revealed:” Christ, in whom is Life.  The question we ask as Christians doing bioethics is not just, “What is good?” but “How do I bring eternal life into this tragedy?  How do I bring the mystery of Life into the abyss?”

There was an amazed silence in the little classroom when Dr. Wernow finished.  Unfortunately, that is all I can leave the reader with.  I am not even sure that in my pathetic summary I presented Dr. Wernow’s vision remotely accurately;  his ideas poured out quickly and passionately, I could take only skeleton notes, and he has not as yet published an article or book that sets out the implications of the “Philosophical Theology of Tragedy and Mystery.”  But I sure love his vision of bioethics-as-drama instead of as sterile philosophical specimen;  and I can embrace the quest to bring the Mystery of Life into tragedy as a robustly and profoundly Christian way to engage and immerse myself in the tragedies of a fallen world.

 

Faithful presence

The CBHD conference last week was one of the best since I began attending in 2007.  One of the things that has stuck with me and that I am continuing to think about is Dennis Hollinger’s thoughts about living in the world in faithful presence, an idea he attributed to James Davison Hunter and his recent book, To Change the World. Hollinger said that the foundation of Christian bioethics is our Christian worldview which many in our society do not share and will not accept.  When we look at how we can try to translate the bioethical good that we are able to understand from our Christian worldview into a world that does not accept that starting point he suggested living in the world in faithful presence.

He indicated that there would be several characteristics of that approach.  We would focus on honoring God and loving our neighbor.  We would have modest expectations of our impact on our culture consistent with the Biblical metaphors of salt, light and leaven.  We would need to be bilingual, speaking in a thick fuller language to those who will accept God’s truth and a thin less complete language to those who will not.

I have been thinking about what it means to live in faithful presence in relation to bioethics in our society.  For me it includes caring for my patients compassionately and trying to be better at preparing them for the difficult places in life.  It includes helping my online bioethics students understand what a Christian worldview is and how it applies to the issues they will face in life.  It includes helping students on the Taylor campus see how their faith and how they live fit together.

What does it mean for you?