All We Need is (Unconditional) Love

On March 24, 2017, Joe Gibes posted an entry on this blog, entitled “A ‘disabled’ person speaks out against a particular form of discrimination.”[1] That post featured links to several stories about Kathleen Humberstone, a young woman with Down Syndrome who spoke at a recent UN event commemorating World Down Syndrome Day, which was observed on March 21.

After reading through Joe’s post and the stories to which his post links, I’d like to add the following two very basic observations (which I will only state here – further elaboration shall have to await another time):

  • OBSERVATION #1: Thankfulness and disability are entirely compatible – indeed, one can be genuinely thankful for one’s disability. “Thank you Down’s syndrome!” Kathleen says enthusiastically, in her prepared remarks for the UN event.[2] It’s hard to imagine she doesn’t mean this sincerely.
  • OBSERVATION #2: As Hans S. Reinders has said repeatedly,[3] often the thing that people with profound intellectual disabilities need most is simply to be chosen as friends. This point is easily generalizable to persons with any kind of disability—very often, what we “need” most is simply friendship, not “healing” or “relief” or “freedom” from the (supposed) “burden” of disability itself.

With continued developments in prenatal genetic testing techniques, including the relatively recent advent of non-invasive prenatal testing (NIPT), it has become even easier to detect, at earlier and earlier points in pregnancy, the presence of disabilities such as Down syndrome. And this, of course, opens the door to so-called “selective termination” of unborn children who test “positive” for such conditions.

For Denise Humberstone, Kathleen’s mom, this makes no sense whatsoever. Why shouldn’t we accept all persons, Denise wonders, including those with Down syndrome and other disabling conditions, with the same kind of unconditional love that we would offer to any other, nondisabled person?

“Whatever happened to unconditional love?” she asks. “When did society decide we should want and love a child only if it is as perfect as medical research allows?”

In a Facebook post[4] written just prior to Kathleen’s speech at the UN event, Denise addresses the “unrealistic demands for perfection” that appear to drive so many of these decisions to abort unborn children diagnosed with Down syndrome and other disabilities:

I’m also wondering if in parallel to scientific research, these unrealistic demands for perfection stem from the fact that we are also now living in a world where we can not only get anything we want off the internet but that item always comes with a return form should it not be up to your expectations. Not perfect? Bam! Return it, free-post, no questions asked, item will be replaced in no time….

What are we teaching our children? People are worthy of life and love only if they are perfect? We can’t cope with children unless they’re perfect? Your marriage/partnership won’t last unless your children are perfect? Siblings will be ok as long as they are all perfect? I can assure you that my friends are not happier because they don’t have a child with special needs…. There is always something to be unhappy about, it’s human nature.

So why can’t we just go back to the basics and try and love unconditionally? Why can’t we just deal with the hand we’ve been dealt… and rise up to the challenges that life throws at us?

Around the same time as Joe posted his blog entry about Kathleen Humberstone, quadriplegic and disability advocate Joni Eareckson Tada posted a blog entry[5] about World Down Syndrome Day. Here’s what she wrote:

I love smiling children… the image imparts such hope and joy, reminding us we are all made in the image of God. I especially delight in the smile of a child with Down syndrome. Anyone who has rubbed shoulders with someone who has Down syndrome will rave about the love, openness, and zest for life they bring to every family. Their laughter and joy is infectious. Today, as we celebrate World Down Syndrome Day, I’m reminded of a touching video I saw two years ago – titled “Dear Future Mom,” it shows children and teens with Down syndrome. Each has something brief and sweet to say about their disability. Then, they look into the camera and address the worries of any pregnant woman who is fearful about carrying a child with Down syndrome.

This video blessed me so much, I just had to share it with you. Perhaps you know of an expectant mother who has learned her baby has a genetic disorder. Please share this with her – the smiles on the faces of these young people will ease fears and give hope, helping her welcome her precious baby into the world.[6]

In the end, Kathleen Humberstone and the children and teens featured in “Dear Future Mom” remind us of what we all need the most: unconditional love.

 

[1] See http://blogs.tiu.edu/bioethics/2017/03/24/a-disabled-person-speaks-out-against-a-particular-form-of-discrimination/.

[2] http://www.bbc.co.uk/newsbeat/article/39339338/downs-syndrome-teenager-addresses-the-un-in-geneva

[3] See, for example, his Receiving the Gift of Friendship: Profound Disability, Theological Anthropology, and Ethics (Grand Rapids, MI: Eerdmans, 2008).

[4] https://www.facebook.com/denise.humberstone/posts/10155948159319126?comment_id=10155950465429126&reply_comment_id=10155950568324126&notif_t=feed_comment_reply&notif_id=1488705525554890

[5] http://www.joniandfriends.org/blog/world-down-syndrome-day-2017/

[6] “Dear Future Mom” can be viewed here: https://youtu.be/Ju-q4OnBtNU.

Fairness in our moral critiques

Recently a friend sent me a statement by a group of Christians in higher education which took a stand against prejudice and mistreatment toward women, racial minorities, and immigrants. I felt there was an implied request for me to endorse this statement. The statement grounded the concerns of this group on the understanding that all human beings are created in the image of God. I agree wholeheartedly that the concept of the imago Dei is an essential foundation of Christian ethics, and it is clearly wrong for any group including women, racial minorities, and immigrants to be mistreated and not given the respect due to anyone who is made in the image of God. However, I was concerned that this statement about the ills of American society was silent about other ways in which groups of human beings made in the image of God are mistreated. They made no mention of the millions of unborn fetuses who have been killed by abortion. They made no mention of the millions of children who are disadvantaged by being raised without the benefit of having to parents because of the irresponsible sexual behavior of their parents.

The concept that every human being has dignity because each person has been created in the image of God needs to impact everything that we do. Unfortunately those on one end of our politically polarized society find it easy to ignore the dignity of women, racial minorities, and immigrants. We do need to speak out against that. However, those on the other end of that spectrum commonly fail to respect the human dignity of unborn fetuses in their emphasis on personal liberty related to abortion. They also fail to respect the human dignity of children who are the victims of the sexual revolution and the breakdown of marriage and family that it has encouraged.

We need to be careful that we are not blind to our own prejudices and need to stand up for human dignity based on all of us being made in the image of God no matter who in the political spectrum is made uncomfortable by the stand that we take.

A “disabled” person speaks out against a particular form of discrimination

Amidst lots of dark and tragic stories, a bright ray on the BBC website this week: Kathleen Humberstone, a 17 year-old English girl with Down syndrome, addressed the UN in Geneva to mark World Down Syndrome Day.

Rather than reading anything I have to say, a far better use of your time would be to read what Ms. Humberstone said. You can find the full text here; if you scroll down you can listen to her speech and an eloquent talk her mother gave afterwards.

The speech is only 3 minutes 42 seconds, and the mother’s talk 5 minutes 48 seconds. It is well worth every second of your time to listen to these women. However, for those of you who don’t have the time or place to listen, I will give a few highlights here.

From Kathleen’s talk (when she refers to “testing,” she’s talking about prenatal genetic testing to detect and abort fetuses suspected to have Down syndrome):

Bonjour, Hello! I can’t believe I’m here! I’m at the UN, in Geneva! Do you know why? Because I have 47 chromosomes. That’s just crazy!! Thank you Down syndrome! I’m here to talk to you about my life and why it is worth living . . . I love everybody. I can’t help it! I hope everybody loves me. I have Down syndrome. Yes. Is that so wrong? So, why all this testing? Why? My name is Kathleen Humberstone and I love my life!!

From Kathleen’s mother’s talk:

You know that trisomy 21 happens to be one of the easiest disabilities to identify at the moment in utero. More will follow. And eventually all disabilities will be identifiable in utero. So, parents of future generations will have quite a few choices to make. Now sadly, the real downfall of people with disabilities is that we parents still have not found this unit of measurement which would enable us to quantify all they bring to society. But how on earth do you quantify something so strong, so beautiful, and yet so invisible, so intangible, and therefore so worthless, so meaningless, and so easily dismissible to most people who can’t experience it? And how can you blame them? I long for the day when we can quantify this most powerful and almost magical je ne sais quoi, because you would finally understand that our children are not a burden; disabilities are not a burden; they are everything but. I’ll tell you what the burden is. It’s a growing lack of empathy and a thick-lined cloak of altruism: “We don’t want them to suffer.” But it’s not just a burden; it’s also a threat to people like my daughter. It’s time beings-in-the-making stop being discarded solely on the ground of their predicted disabilities. Because we are also doing away with a mountain of hidden abilities. . . you know what else is so sad? A society without disabilities, without diversity, without differences, will not be any happier than the one we’ve got now. It’s an illusion.

Also see here.

The Gift of Finitude

I’ve been thinking a lot lately about finitude. About limits. Incompleteness. Even failure.

Like the friend of a friend who is dying and has just been admitted to hospice, whose young teenaged daughter is facing the prospect of a life without her mother.

Like the colleague who is grieving the loss of both a spouse and a parent within a month of each other.

Like my power wheelchair that keeps breaking down, making everyday activities significantly more challenging.

Like the never-ending “to-do” list that seems to be anything but finite, and never quite seems to get any shorter.

Life is, in a word, full of limits. Boundaries. Unavoidable stopping points.

Or is it?

What if we could transcend our limits, as recent developments in genetic and related technologies (e.g., CRISPR) seem to promise? What if, through genetic manipulations of various sorts, we could significantly reduce our limitations—eliminate specific diseases and disabling conditions, improve cognitive function, “select” for desired physical traits, and so on?

If we could do these things, should we do them?

Of course, as anyone who has followed the field of bioethics for even a short period of time knows, these questions are neither new nor hypothetical. In many ways, the “future” is already here: we “enhance” ourselves, “transcend” limits and boundaries, and otherwise seek to “overcome” finitude in a myriad number of ways, on a daily basis. And much of this is salutary.

Still, it’s always worth pausing to consider: supposing finitude could be eliminated entirely from our lives (which seems extraordinarily doubtful), is it the sort of thing we ought to try to eliminate? Put differently: is there anything good about finitude, such that we ought to embrace it (even if in a qualified way)?

Gilbert Meilaender, a bioethicist and Distinguished Fellow of The Center for Bioethics and Human Dignity, suggests that there is something good about finitude. In a reflection on the “created duality” of our human nature—we are simultaneously both “free” and “finite”—Meilaender observes that this “two-sidedness” to our nature both opens up possibilities and imposes certain limits upon us. We are, he observes,

created from dust of the ground—finite beings who are limited by biological necessities and historical location. We are also free spirits, moved by the life-giving Spirit of God, created ultimately for communion with God—and therefore soaring beyond any limited understanding of our person in terms of presently “given” conditions of life…. Made for communion with God, we transcend nature and history—not in order that we may become self-creators, but in order that, acknowledging our Creator, we may recognize the true limit to human freedom. Understanding our nature in this way, we learn something about how we should evaluate medical “progress.” It cannot be acceptable simply to oppose the forward thrust of scientific medicine. That zealous desire to know, to probe the secrets of nature, to combat disease—all that is an expression of our created freedom from the limits of the “given,” the freedom by which we step forth as God’s representatives in the world. But a moral vision shaped by this Christian understanding of the person will also be prepared to say no to some exercises of human freedom. The never-ending project of human self-creation runs up against the limit that is God. It will always be hard to state in advance the precise boundaries that ought to limit our freedom, but we must be prepared to look for them.[1]

I am inclined to agree with Meilaender. Moreover, as I have shared in an autobiographical essay published recently,[2] my own experiences as a person with a physical disability have taught me valuable life lessons that, arguably, might not have been learned otherwise—lessons such as the value of patience and endurance, accepting my limits (an ongoing struggle, I must admit!), and even the importance of having a sense of humor at the (sometimes ridiculous) circumstances in which one finds oneself. Our limits shape our character, our career, and our life choices as much as do our “freedoms”—often in surprising and unexpected ways, and frequently for the better.

None of these reflections, of course, even begin to scratch the surface of the “what?”, “where?”, “when?”, “how?”, or “why?” questions related to the ethical permissibility (or lack thereof) of pursuing various genetic, reproductive, or other technologies. Nor do they, by themselves, tell us whether (and when) we ought or ought not to avail ourselves of abortion, physician-assisted suicide, euthanasia and the like.

They do, however, remind us of one very simple, yet all-too-often overlooked fact: finitude is, in many ways, a gift. Let us not neglect it.

 

[1] Gilbert Meilander, Bioethics: A Primer for Christians, 3rd ed. (Grand Rapids, MI: Eerdmans, 2013), 3-5.

[2] See “Why am I Disabled? Reflections on Life’s Questions and God’s Answers,” in the Beyond Suffering Bible (Tyndale, 2016), available at beyondsufferingbible.com and http://www.joniandfriends.org/bible/.

Caring and risk

One of the basic realities of the medical profession is that caring for the sick may at times involve risk to physicians and others who are providing that care. Sometimes the risk is relatively minor such as when we care for those with minor respiratory infections and may become ill ourselves. That seemed to happen to me every time I was on a pediatrics rotation during my residency. Sometimes the risk is much higher such as when Dr. Kent Brantly and others at the missionary hospital where he worked in Liberia chose to care for people who were dying from the Ebola virus. Dr. Brantly became infected with the Ebola virus in spite of all the precautions that were taken and was fortunate to survive. While we understand that there are some risks that it may not be reasonable to take, and it is appropriate to take all available precautions to minimize risk, there is an understanding within the medical profession that taking a certain amount of risk is part of doing what is best for the patients that we serve.

However, this understanding that it may be necessary to take on what is at times a significant risk in order to care for those who are in need is not limited to physicians and those in other related medical professions. This is a characteristic of the church as well. John Donne expressed this not just in his poetry, but in his life when, as a parish priest in London during the plague, he chose to stay and care for the dying when almost everyone else who had means to do so was fleeing the city.

Currently as a nation we are dealing with a situation in which caring for those in need involves a certain amount of risk. Refugees fleeing from the violence in the Middle East are in need of our care, but caring for them involves a risk of exposing ourselves to the terrorists who are causing the violence that they are fleeing from. It is appropriate to take reasonable precautions just like we take precautions to avoid the spread of infectious disease, but our fear of risk should not keep us from caring for those who are in need. This is a time when the church needs to stand up and say we are willing to take some risk to care for those who need our help, and show our nation that we should care for those in need even when it means some risk to ourselves.

Christian ethics and the powerless

The recent political campaign and election week have had many of us thinking about politics and government. For those of us who look at bioethics from a biblical perspective we have had to think about how our perspective on moral issues affects public policy and how we as a people govern ourselves. What do we do when no one seems to support a public policy platform that includes both care for the poor and care for refugees that we see in God’s message to Israel through the prophets and respect for the value of every human life including those who are unborn, terminally ill, or disabled who have been made in the image of God?

One thing to remember is that our ethical beliefs are first about how we ourselves should live. For Christians that means being willing to submit to God’s moral truth and live our lives in a way that reflects his goodness and love. Our next obligation is to do what we can to protect those who are the most helpless and on the fringes of society, including influencing public policy to help accomplish that end. That is the focus of much of what the prophets told Israel and what Jesus demonstrated in how he cared for those around him. We need to stand for what is right in every situation, but focus on public policy that protects those who are weak. That can include preventing the unborn from being killed, protecting the old, infirm, and disabled from being euthanized, and providing care, including adequate health care, to the poor, the immigrant, and the refugee.

We should not be surprised that biblical values do not line up fully with any of the major political groups in our very divided and very secular society. We live in a fallen world. The political process recognizes that people are basically self-centered and appeals to that selfishness to get elected whether that involves an appeal to protect the voter’s economic well-being at the expense of others or an appeal to satisfying the voter’s desires without moral limitations. The Bible tells those of us who follow Jesus that our focus should not be on ourselves, but on others, particularly those who cannot stand up for themselves. In a fallen world that perspective is not likely to win elections, but we still need to appeal to the sense of what is right that people have written on their hearts to move government toward protecting and caring for those who are powerless.

Race & Physician Assisted Suicide

Is physician-assisted suicide only for white people? That is a question that came to mind when reading a recent Washington Post article by Fenit Nirappil that reports on the proposed “Right to Die” law in Washington, D.C.  The law is drawing opposition from members of the African American community.

The Post article quotes a Georgetown Law School professor, Patricia King, who states, “Historically, African Americans have not had a lot of control over their bodies, and I don’t think offering them assisted suicide is going to make them feel more autonomous.” In other words, the law would have no benefit for those who already feel a high level of skepticism about the current medical system. Interestingly, the article also reports that only “one African American has chosen to exercise the provisions of the law in Oregon, which became the first state in the country with such a law in 1997.”

The concerns reported in the article are worth consideration. For some members of the African American community, the law brings back painful reminders of the Tuskegee experiments. For others, it is a reminder that many in their community lack resources to receive the best treatment available. A recent article in the Daily Caller  quotes D.C. Council member Brianne Nadeau: “Those with least access to quality health care are most likely to get a late-stage terminal diagnosis . . . They’re least likely to have coverage for expensive interventions. I believe they’ll also be most likely to consider this option as their best option, even if it’s not.”

It’s not clear whether or not the issue will become law in D.C. However, it is wise for the council members to listen to the concerns of their community.

The cost-effectiveness of prenatal screening for Down syndrome

Because the British National Health Service is a governmental single-payer system decisions about what is covered in that system involve public discussion. That leads to public discussion of ethical issues that frequently manage to avoid the public eye in the US. A recent article in the Daily Mail talks about an issue that is being debated by the British NHS. They are currently deciding whether noninvasive prenatal testing, also known as prenatal cell-free DNA screening should be covered by their health system and whether it should be covered only for those at high risk for chromosomal abnormalities or as a general screening test. This test identifies chromosomal abnormalities in a fetus more accurately than previously available screening tests, but is more expensive. The most common abnormality identified by this test is Down syndrome.

Some of those involved in this discussion have suggested, according to the Daily Mail article, that an analysis of the lifetime costs of caring for children with Down syndrome should be included in a cost-effectiveness analysis of whether this test should be provided for general screening. That suggestion has raised significant concern among parents who have children with Down syndrome. Their concern is based on a significant ethical issue. For the cost of caring for children with Down syndrome to be considered as a part of the cost-effectiveness of this screening test one would need to be balancing the cost of using this screening test for general screening against the costs of care that would be saved by the system not having to pay for the care of those fetuses with Down syndrome who were aborted. That means that a child with Down syndrome who is allowed to live is being seen as a financial liability to the system and that the cost of medical care for that child is being used to justify the cost of screening. What would be left out of such a cost effectiveness analysis would be the value of the lives of those children with Down syndrome. That is why the parents of children with Down syndrome are justifiably upset.

Cost-effectiveness analysis can be appropriate when we are comparing alternate ways to treat a disease or save a person’s life, but we need to be careful that what we are analyzing is the comparative costs of treatments that provide benefit to the person being treated. We should not do a cost-effectiveness analysis based on saving costs by ending the lives of those for whom we should be caring. This applies whether those lives are lost by abortion or by euthanasia.

Gender Indiscrimination

Steve Phillips has recently written in this blog about gender dysphoria and our culture’s struggle to respond consistently to it. Please see here for that discussion. North Carolina recently passed a law requiring individuals to use the bathroom of their biologic sex rather than their self-identified gender. This has resulted in claims of gender discrimination and gender phobia against those who do not wish to be in the same shower or bathroom with someone of the opposite biological sex, regardless of how that someone chooses to self-identify his or her gender.

In early June, a young high school student in Alaska, whose biological sex is male but who identifies as a female, recently placed 5th and 3rd place in the girls 100 meter and 200 meter state high school track meet. Interestingly, the cries of discrimination focused almost exclusively on the claim that this was unfair to the other women running in the same race. Said differently, there have been extremely few claims of gender discrimination or gender phobia against those who do not want to be in the same sporting event with someone of the opposite sex, regardless of how that someone chooses to self-identify his sex.

Why is there a difference?

Notice that in both cases, opposing sides agree that males and females are different, deserving different bathrooms and different sporting competitions, the latter a successful result of Title IX federal regulations beginning in the 1970’s. Both sides seem to agree that the issue is how to discriminate who belongs in which group. In both examples, one side argues that subjective self-identification is a sufficient claim to gender group membership while the other side demands objective biological criteria. So who is right?

And why is the girl who finished 6th in the 100 meter Alaska High School Track meet less likely to be called bigoted if she complains about having to race against the boy who identifies as a girl as when she complains about having to share the shower with him after the race? If the difference is one of fairness/justice in public sports competition, it is unclear why we should elevate public sports competition above private social interpersonal contact in terms of our bigotry tolerance.

But let’s say we do. Both the IOC and the Women’s Sports Foundation have position statements that effectively argue that the issue comes down to objective biological criteria, namely testosterone levels. At least in competitive sports, subjective self-indentification is not a sufficient claim to gender group membership.

But what about public bathrooms? Curiously, the Justice Department is using Title IX, that landmark federal regulation banning sex discrimination by schools that receive federal funds, to effectively require schools to be rather gender indiscriminate. Effectively, they are requiring schools to allow students to use sex-segregated bathrooms based on their self-identified gender or move away from sex segregated bathrooms altogether. As Jeannie Suk recently stated in The New Yorker: “The discomfort that some people, some sexual-assault survivors, in particular, feel at the idea of being in rest rooms with people with male sex organs, whatever their gender, is not easy to brush aside as bigotry. But having, in the past several years, directed the public toward heightened anxiety about campus sexual assault, the federal government now says that to carry that discomfort into bathrooms is illegitimate because it is discrimination. [emphasis mine]”

It seems that our culture’s response to this issue remains incoherent.

Body Integrity: Choice vs Design?

In my search for new topics I ran across the obscure “Body Integrity Identity Disorder,” or BIID.  This is described as a condition—if, indeed, it is a legitimate diagnosis—in which a person is troubled by the presence of a perfectly healthy body part, nominally a limb, and wants it amputated to restore a sense of personal wholeness.  One 2009 review argues that this is a rare but definable illness in which the sufferer makes a reasonable request for “treatment” that ought to be not only taken seriously, but honored, in select cases.

Briefly, the author of the paper in question, one Christopher Ryan, argues that a person with BIID is not necessarily psychotic (BIID is proposed as a diagnosis of exclusion, after the clinician has considered psychosis and other psychiatric conditions), and appears to be normal but has “clinically significant” impairment in personal functioning.  Central to the argument is the assertion that the person with putative BIID is not delusional.  Delusions rarely arise in otherwise normal people.  They are demonstrably false (e.g., “my relatives have been replaced by impostors”) while the BIID claim is inward and subjective (“my personal sense of integrity is violated”), and as such, is unassailable.  People with BIID keep it a secret, while delusional people never let you hear the end of it.  (Did I mention Area 51?)   In short, people with BIID are not crazy, and should not be so labeled.

BIID is not exactly presented as a major public health problem.  In his paper, Ryan refers to five reported or known cases.  Five.  I must say, with so few cases, I wonder whether they might not be 5 cases of mis-diagnosis rather than the emergence of a new disease that had not yet been formally recognized.  At the time of Ryan’s paper, no specific associated brain injury had been reported.  (I confess I have not attempted a search of the more recent literature.  This is a blog post, not a review article.)

Healthy limb amputation, Ryan argued, is not only ethically permissible but required in select cases on grounds of autonomy and net benefit to the patient.  Do you object?  On what grounds?  “Do no harm” begs the question—a risk-benefit assessment is required.  “It’s illegal?”  Shouldn’t be.  “We don’t know enough about it?”  We should collect the data; in fact, BIID should be a formally reportable condition with a data registry.  (Can we get that for abortion and oocyte donation, BTW?  Oh, forgive me [slapping my own wrist].)  “We should err on the side of caution?”  But nothing else works—notably not cognitive therapy.  (In my world, however, we don’t give up on an experimental drug if it fails the first 5 times it’s tried—we get more data before abandoning it.)  “There will be flood of requests for amputation?”  Hardly likely—if anything, a trickle, provided the diagnosis is applied with cautious medical judgment (emphasis mine), and the cost to society of making people disabled will be small if healthy limb amputation is limited to people with “genuine” (Ryan’s word, not mine) BIID.

Objecting clinicians have an obligation to refer, Ryan argues.  And the possibility of future replacement with an artificial limb is an opportunity for medical device development and treatment.

This is a serious topic and argument, but I must be candid—I have a hard time writing this post with a straight face.  A doctor has a better chance of seeing Sasquatch, and a much better chance of winning the lottery, than ever seeing a case of BIID.  And so most of us probably have the reaction I had, and ethicists like Arthur Caplan and my man Wesley Smith had (and that Ryan condemns):  a desire for healthy limb amputation is “crazy.”

But of course, in our autonomy-driven world, it’s anything but.  And it’s potentially the tip of an iceberg that includes, as Smith has revisited several times, not only cutting of healthy limbs but also cutting the spinal cord, making a seeing person blind, and, of course, the trendy case, transgenderism.  The logic underlying these cases is similar if not identical.

Individual autonomy must have its limits, if society is to establish and defend a point at which human life must be defended.  One argument is here (HT to Paige Cunningham for the link).  As that writer states, the rule of law requires “some concept of the objective value of human life” that is independent of individual autonomy.  It’s a point worth mulling over in the current context.  Ryan excludes from the diagnosis of BIID cases in which the person seeks amputation as a means of sexual gratification.  But how can he get away with that?  Why wouldn’t autonomy permit, in select cases, a sadomasochistic pact for mutilation or even murder?

Please forgive the indelicacy.  I will end with this:  the notion of BIID speaks directly to the nature of the human soul.  For if the soul is a real, metaphysical entity that encompasses all ultimate human capacities and directs the physical development of the individual (as I hold, in agreement with J.P. Moreland, as I understand him), then BIID reflects a sickness of the soul that needs healing.  But that requires God and His purpose.  But to say that each individual has sovereignty over his or her own physical identity the neo-Gnostic position that Robert George decried at last summer’s CBHD conference (available for purchase here):  the mind is all that matters.