Journeys of Transformation

In my last post, “A Preview of Coming Attractions” (02-11-13), I signaled the start of a multi-part series of review essays covering three recently published books addressing ethical issues surrounding enhancement technologies and practices. I had intended to launch that series with today’s post. Before starting that series, however, I want to go on a brief discursus, one that will, I believe, turn out to be relevant to the themes to be touched on in the forthcoming series.

Last week, I attended the annual “Christ and Culture” lecture at California Baptist University in Riverside, California. This year’s speaker was Ralph Winter, producer of the first three X-Men films and numerous other successful film projects. Using such recent films as Les Miserables, Toy Story, Avatar, and others as illustrative examples, Winter set out, in the broadest sense, to show “how the gospel is often displayed in… contemporary film.” The unifying theme in all these stories is what Winter referred to as a “journey of transformation.” In each of these stories, the main character/hero grows through experiencing some form of adversity, learns something important about him or herself, and is transformed positively in some way.

One of Winter’s central concerns in his lecture was to explore the general question of how Christians engage with the broader culture, and particularly with how they communicate their messages to that culture. Here, Winter contends that “Christian stories often fail because we’re afraid of the journey,” by which he means that “our stories often hide from pain”—they avoid addressing the painful, the difficult, the ugly, the uncomfortable aspects of life—and place an emphasis on propositional assent over against an embrace of the “transformational journey” that is the life of faith. That is to say, there is a tendency to focus on the destination (heaven) to the exclusion of the journey that we take along the way.

What does all of this have to do with bioethics? There are at least two central lessons to be learned here.

First, in the context of genetic enhancement technologies and practices, it is worth asking the question: to what extent is the “enhancement enterprise” (broadly speaking, the attempt to “improve” human capacities by way of genetic or other interventions and/or technologies, as well as the cultural push toward embracing that agenda) in fact driven by a deep-seated, underlying “fear of the journey”—that is, a fear of those aspects of the aging process that are ugly, uncomfortable, painful, and so forth? Put more simply, to what extent is the drive toward “enhancement” really a flight from the inevitable realities of our lives as embodied creatures? (I do not propose to answer this question here; I pose it, however, as an important background issue to be kept in mind when considering specific arguments regarding the enhancement enterprise.)

Second, and more generally, our bioethical reflections—whether on beginning of life issues, end of life issues, or whatever—must always be attentive to the lived reality of embodied human existence. In particular, we must be willing to face the sometimes harsh realities of pain, suffering, indignity, and so forth, that can accompany the experience of various medical and other conditions. This is especially pertinent at the end of life, where the dying process can (but does not necessarily) involve significant levels of pain, discomfort, and distress. In a word, our bioethical reflections must tell “stories” that are true to the lived realities of human existence. If we are not willing to face these sometimes difficult realities, our pronouncements on bioethical issues are likely to seem shallow, insensitive, or even irrelevant.

This is not to say, of course, that our arguments and other reflections on bioethical issues should be overly-negative or fatalistic. Indeed, a focus on truth mandates that we tell “the truth, the whole truth, and nothing but.” This means being attentive to the fact (for example) that while the aging and dying processes can be characterized by pain, discomfort, and suffering, they are not always so characterized (indeed, with the skillful use of pain management techniques, they rarely need to be—but that is a different post altogether). The aging and dying processes can also be characterized by peace, joy, personal growth and development, and a sense of fulfillment. In a phrase: these processes can themselves be “journeys of transformation.” From the perspective of Christian theology, of course, the entire human lifespan can be understood in this way as well. The key point for present purposes is simply this: our bioethical reflections and arguments must attend to the potentially transformational aspects of the experience of pain, suffering, and the like, in addition to other considerations having to do with rights, obligations, principles, and so on.

Human life, in other words, is as much about the journey as it is about the destination. And that fact can make all the difference when it comes to bioethics.

Medicine Men of the Mind

This past week I made my yearly journey from Wisconsin to Arizona by automobile with my dog to visit my husband who winThis past week I made my yearly journey from Wisconsin to Arizona by automobile with my dog to visit my husband who winters there. In this yearly process, I have discovered the delight of audiobooks. This year, I explored the holdings of our local library in rural Wisconsin, but the only audiobook of substance that they had (the only non-Evanovich) was Ayn Rand’s Atlas Shrugged, an author of whom I had heard, but with whom I was not acquainted. It has been fearfully intriguing to ponder the ways in which her philosophical ideas have crept (or been smuggled) into our culture—not wholesale, but part and parcel.

While her political ideas are not too dissimilar from anti-socialist emails that are making the rounds these days (or so I’ve heard—emails about professors applying socialist paradigms to grades and failing the whole class because those students with ambition and ability ultimately refused to carry the weight of the non-ambitious in the class—“Atlas shrugging”), it is her ethical ideologies that are most disturbing. For Rand, the moral measure of man is his hedonistic happiness. Correspondingly, she also rejects any doctrine of altruism. Her ideal is a society ruled by Men of the Mind, where selfishness, or rational self-interest, is the primary virtue. Ironically, Rand’s appeal is to the ideal of rationalism and not the reality of fallen rationality in a fallen world. While Rand objects to hedonism, in reality she makes no distinction between rational and irrational happiness, and therefore hedonism is a reality in a society of fallen persons of differing rational capabilities.

Men of the Mind are persons who choose to think, and such thinking requires a state of fully focused awareness achieved by the volitional act of focusing one’s consciousness. One can choose to focus their mind to a fully active, purposefully directed awareness of reality—or one can become unfocussed and let oneself drift in a semiconscious daze, merely reacting to any chance stimulus of the immediate moment, and making random, irrational associations. Such an unfocused semi-conscious drift as Rand describes is alarmingly true of our culture today, as we have become fractionated and distracted by the barrage of stimulants that confront our senses, and, as a result, are losing our ability to “perceive.” There is no time for, or importance given to, the use of the mind for thoughtful reflection–just mindless reacting to external stimuli which we require to ever greater degrees.

In Atlas Shrugged Rand vividly depicts the “end” of a society ruled by the “Mystics” (persons who rule society on the basis of faith, altruism, or other non-rational ideologies which find their source and goal in God or society) as one ensconced in violence which is the means to the promotion of their ways. Yet she, fatefully does not portray what a society ruled by Men of the Mind would look like. She claims that objectivism and capitalism are the systems most beneficial to the poor but she does not portray what would happen to those who are unproductive or somehow rationally challenged in a society where there is no altruism. Does she not believe that they would then turn to violence to support themselves, taking from those who have what they need for their lives and happiness by force and justifying such actions as their only means of procuring their own survival and happiness? Would not the end be the same but with a different ruling class?

It seems that her rational perception has been blinded to the reality of evil inherent in mankind. And that blindness is easily coupled with her attitude toward the fact of original sin. Rand refers to the concept of “original sin” as an evil and a monstrous absurdity which she claims makes a mockery of nature, justice, reason, and morality.

Her perceiving is also blinded by failing to perceive the reality of our human interdependence as objectively evidenced in that fact of our birth and growth. In Atlas Shrugged there are no families, no marriages, no children. One can easily surmise the reason: marriages, families, and children require self-sacrifice, a cardinal vice in Rand’s philosophical world. Even romantic love is a matter of rational self-interest; hence, there is no room for agape love. But with no marriages and families, the society she envisions is an unstable collection of hedonistic individuals, subject to disintegration. And with no children that society has no future, unless, of course, they can continue to cull members from the wider world.

Medicine, too, has fallen prey to her ideologies, where Men of the Mind have taken over from Men of Compassion; where the data of our senses is replaced by data from machines; where there is no room for altruism; where personally defined “happiness” and self-fulfillment have become the goals and ends of “medical care”; where technology and innovation serve the desires of the wealthy, but not the basic needs of the poor; where Money, Productivity, and Efficiency have come to be the image and symbol of success—the gods of a profession that was. Medicine is no longer about caring, because caring belongs to subjectivity, and is unproductive and inefficient, to the Mystics of the Spirit or of Society (which Rand lumps together in one malevolent category). Such a system no longer serves the needs of the vulnerable and needy for whom it was intended. Is this indeed where we are headed?

After the Super Bowl: Reflections on “Perfection” and Enhancement

By the time you are reading this, many of us—myself included—are (or soon will be) in full “withdrawal” mode from the “high” of yesterday’s Super Bowl. We were amazed by the awesome displays of athletic prowess on the field and caught up in the drama of watching this year’s AFC and NFC champions battle it out to the very end for the right to be called “Super Bowl champions”—the very best in the game of football, at least for a short while. Who could not have been impressed by the on-field exploits of Joe Flacco, Ray Rice, Jacoby Jones, and Colin Kaepernick? Who could not have been touched by the soaring notes of Jennifer Hudson singing “God Bess America,” or the soulful tones of Alicia Keyes singing the national anthem?

In similar fashion, we find ourselves fascinated by the accomplishment of Olympic athletes, musicians, artists, intellectuals, and others at the “top of their game,” or their art, or their craft.

Truly, these are specimens of excellence—indeed, one might say, of a certain kind of “perfection.”

Or are they?

Perhaps these NFL players, “great” as they already are, could in fact be more than what they are now—faster, stronger, more agile, more powerful. Wouldn’t that be good for the game? Wouldn’t that make the game even more exciting, more engaging, more thrilling?

Suppose, by way of a taking a pill or getting an injection—Human Growth Hormone (HGH), for example—football players could develop stronger muscles and greater physical stamina.  Would we want them to do so? Would we consider their resulting on-field performances as genuine reflections of their actual athletic abilities, or more akin to “cheating the system”?[1]

Suppose, more generally, that we “mere mortals”—those of us who are not Super Bowl champions, famous musicians, acclaimed scholars, or Nobel prize-winning scientists—could take a pill that would improve our memory, make us more intelligent, or help us feel more confident? Would this be a good thing?

And, finally, suppose we could alter the human genetic code permanently, through genetic engineering, either to eliminate unwanted conditions (diseases, genetic disorders, and so forth) or to enhance certain desired, genetically-linked traits (intelligence or sociability, for example). Should we avail ourselves of such opportunities?

In the wake of the Human Genome Project and other scientific breakthroughs, each of these scenarios is increasingly moving from the realm of “science fiction” to “reality,” a fact that should prompt us to ask—and reflect upon—a number of important philosophical and theological questions, among them the following:

  • What does it mean to be an “excellent” specimen of something (a book, a table, a human being)?
  • What does it mean to “flourish” as a human being?
  • Should we seek to “enhance” ourselves? If so, are there limits to how far we should go in pursuing enhancement?
  • What, if anything, is the value in human limitation? Are there limits that we should never seek to surpass?

In subsequent posts, we will explore some of the issues surrounding enhancement (genetic and otherwise). For the moment, as we bask in the afterglow of this year’s Super Bowl, it is worth taking a few moments to reflect on just what it is about “great” athletic, musical, intellectual and other human achievements that we find so appealing, and whether “enhancement” would render those accomplishments more or less so.


[1] The NFL is reportedly looking seriously at introducing HGH testing prior to the start of the 2013 season. See http://www.nfl.com/news/story/0ap1000000133761/article/goodell-confident-hgh-testing-in-place-by-next-season

The Whitewashed Tombs of the Right

“Woe to you, scribes and Pharisees, hypocrites! For you are like whitewashed tombs, which outwardly appear beautiful, but within are full of dead people’s bones and all uncleanness.”– Matthew 23:27

I received several comments on last week’s post about Hubertus Strughold, so I thought I’d follow up with another post.  The fact that Strughold has been well-respected in American medical circles despite his leadership in medical experimentation in Nazi Germany may shed light on deep-seated philosophical problems that undergird America’s healthcare crisis.  It is no secret that the Allies marveled at the technological and scientific capabilities of the Germans as they marched through that country in the final days of World War II.  Though it used the scientists of the Third Reich to the ultimate success of putting a man on the moon, American medicine may also have adopted harmful philosophical ideas that cripple U.S. medicine to this day.  The technological and scientific accomplishments of American medicine may be the whitewash that hides the philosophical problems that are the dead people’s bones that affect patient care and make us incapable of solving systemic healthcare problems.

Dachau, notorious for its human experimentation

Several writers on this blog have commented on the failures of the “business model” of medicine.  Joe Gibes has written several posts on the subject (see his “Black Friday” post), and Steve Phillips has recently mentioned the “manufacturing efficiency” that has been brought to human reproduction.  It is well-known that many Americans sided with the National Socialists in Germany in the 1920s and 30s because they saw them as a bulwark against the tide of communism that seemed to be sweeping over Europe (Russia fell to the Communists in 1917).  In the culture wars in America the last two decades, it appears the right-wing has propelled the “business model” of medicine to the fore as a bulwark against the Left’s move to bring government-run healthcare to America.  It is a classic case of the end justifies the means.  Why Christians allied themselves with the right-wing to form the “Religious Right” in the 1980s I’ll never know.  But it looks like a deal with the Devil.

The New Sabbath: The Preaching of the Word and the Healing of the Sick

Citing our rat-race lifestyle and dependence on technological gadgets, many Christian commentators have written about our need for a Sabbath.  Many talk of a “Sabbath” as abstinence from anything for any period time while others consider the need to take a day off, though it might not be Sunday.  I think there are a number of reasons to make the first day of the week, when we commemorate the Resurrection, a time of not only worship and rest but also fellowship with those who are sick.

Luke chapter 9, for instance, shows how Jesus’s ministry coupled preaching with healing.  It is fitting that as we set aside the Lord’s Day to hear the preaching of the Word, alongside the other aspects of worship such as the celebration of the sacraments, we should dedicate the rest of the day to fellowship with others, particular those who are in need.  A good friend of mine related the story of how his friend’s church had a list of people to bring food ready within a day when she had cancer.  Too often we think of “home visits” and hospital visitation as the job of professional clergy.  However, using the Sabbath to extend the body of Christ into the homes and rooms of those who are ill is the role of every Christian.  I’m sure none of the pastors of our churches would mind if we asked for the names of those in the hospital.  Some churches print such information in the weekly bulletin.

Yes, Sunday afternoons are a good time for a nap, but I think our Lord’s Day could be richer if we spent time in fellowship with others, especially those who are ill.  As Thanksgiving approaches, I remember fondly my front-yard football games with my cousins at my grandparents’ house after a turkey meal.  That’s the spirit of the Sabbath: a time of rejuvenation for not only the mind and body but also the soul.  I also think those who are sick and injured are happy to have someone take them outside, too, even it’s not to throw around the pigskin.  I’m always disappointed when hospitals do not take the opportunity to provide at least an outdoor courtyard for patients to sit with their friends and family.  For instance, I visited a hospital that was just a quarter mile down the street from a nice, municipal park several miles in length (and an adjacent lot available no less).  When it’s a hot summer day in Texas, it’s too far to walk with someone who is ill.  Just a little more thoughtfulness and a little better planning and the hospital really could have put something nice together for its patients.

Now if you’ll excuse me … I have two loved ones to see in the hospital.

 

A Theology of Technology

with Chris Ralston, PhD

In our last post we noted that Baylor’s Technology and Human Flourishing conference underscored the need for, as we put it, a “robust theology of technology.” We thought we’d follow up with some reflections on what such a theology might look like.

In chapter three of their book entitled Bioethics: A Christian Approach in a Pluralistic Age,[1]Scott B. Rae and Paul M. Cox develop a helpful framework for thinking about “Medical Technology in Theological Perspective.” The following is a very brief synopsis of their discussion.

The golden leaves of the pecan in autumn in central Texas.

The starting point for thinking about medical technology in theological perspective is the creation narrative as recorded in Genesis 1 and 2—specifically, with what has been termed the “dominion mandate” and with the doctrines of general revelation and common grace. At the creation humankind was charged with a mandate to “subdue the earth and be its master” (p. 94). The fulfillment of this task was, however, complicated by the entrance of sin into the world. Consequently, the post-Fall mandate includes “working toward improving the creation, or reversing the effects of the entrance of sin” into the created order, a significant aspect of which is dealing with death and disease (p. 95). Importantly, the dominion mandate is constrained by our role as stewards of rather than masters over creation: “At creation, human beings were charged with both dominion and stewardship. Creation was theirs to use for their benefit, but it ultimately belonged to God and they were responsible to him for its proper care” (p. 95).

According to the doctrine of general revelation, God provides both the “natural resources” and the “human ingenuity and wisdom” requisite for human beings to fulfill the dominion mandate (pp. 95-96). The doctrine of common grace affirms the notion that “God’s grace… is bestowed commonly, or on all humankind, irrespective of one’s membership in the community of God’s people” (p. 97). (Consider, for example, the rain that God sends, which falls on the “just” and the “unjust” alike; cf. Acts 14:17.)

Taken together, God’s general revelation and common grace provide human beings with “the knowledge and skill that are necessary to develop the kinds of technologies that enable humankind to subdue the creation” (p. 97). This is no less true of medical technology than of other forms of technology.

Crucially, however, medical technology can achieve only a “partial and temporary” victory over death and disease—it can never conquer them entirely. Moreover, given the sinful nature of humanity, technology can be put both to good and evil uses, in service of both virtuous and vicious ends (pp. 98-99). Consequently, “[w]e must distinguish between the use of any particular medical technology per se and its intended or actual use in practice. That is, it is possible to see virtually any medical technology as a part of God’s common grace to humankind. But that does not exempt it from moral assessment of its uses” (p. 99).

Engaging in such “moral assessment” of technology—whether medical technology specifically or other forms of technology more generally—was one of the key tasks to which Baylor’s IFL conference was devoted.

In this vein, I (Cody) sensed that most of the attendees were wrestling honestly with how to use technology wisely and still be authentic in their Christian faith.  On several occasions people mentioned the desire to avoid a “Luddite” dismissal of technology altogether, as if separating from electronic gadgets offered a particular kind of spiritual purity.  Most understood that spiritual health is essentially a matter of the heart, and the external aspect of using technology may or may not indicate the status of the soul.  Instead, many Christians opt for a view of technology that stresses the fact that we use technology and technology should not “use” us.  When technology is no longer useful or, even worse, when it begins to sets us back or harm us as Christian people, we lay it aside.  Or as the Reformers might have put it, “Let us do all Soli Deo Gloria, For the Glory of God Alone.”

We’d like to close with a brief note about the notion of “virtual” technology.  A number of the speakers at the IFL conference dealt with this issue, from discussions of how a child’s involvement with outdoors activities or handicrafts can improve ADHD symptoms to the importance of the local gathering of believers as the body of Christ in church worship.  These ideas emphasize the importance of place, “being there” if you will.  As Kay Toombs mentioned in her talk, we can relay information about a spouse’s illness to many people via a Facebook status update, but this is very different from sharing this information in the presence of someone who can hold our hand.  And this is very directly related to our being ensouled beings, not just cerebral beings that communicate data but spiritual people who are there, in a particular place.  It’s nice that we are able to share with you some of this information over the Internet, but it might be even better if you can now go and discuss some of these heart-felt issues with a friend over a cup of coffee.

We invite further reflection on these topics from our readers.

 

 

 


[1] Eerdmans, 1999, pp. 91-127.

Technology and Human Flourishing, Baylor University

with Chris Ralston, PhD

I was honored to have Trinity colleague Chris Ralston come to Texas and join me for Technology and Human Flourishing, a conference of the Institute for Faith and Learning at my alma mater, Baylor University. We thought we’d give a quick run-down of some of the ideas presented.

On October 25-27, 2012, scholars, undergraduate and graduate students, faculty, and other interested individuals from across the globe gathered at Baylor University in Waco, Texas to discuss issues surrounding the relationship between technology and human flourishing. The conference featured a variety of individual paper presentations and plenary speakers, ranging across a broad spectrum of topics, from “Building Emotions into Machines” to “Interstellar Exploration and Human Flourishing.”

Many of the presentations engaged with a number of common themes, including the relationship between science and faith; epistemological questions about the sources of knowledge, in particular the question of whether or not science exhausts the domain of “knowledge”; and questions about the impact, for better or for worse, of technology on human dignity and flourishing. Some of the specific questions raised include the following: How does technology encourage us to think about ourselves? About human nature? As our capacities to manipulate the physical “stuff” of our bodily existence (DNA, genes, etc.) expand, will this encourage us increasingly to think of ourselves strictly in physicalist terms? Should we think of ourselves in such terms? And what would be the implications or consequences of so thinking about ourselves?

In addressing these and other related questions, one recurrent thought that emerged is the notion that technology should be assessed not only in terms of what it can do (what can be done with it), but also in terms of how it affects us as human beings, both individually and collectively. That is, how does technology and its various applications shape us, whether as individuals or as society? In this regard, the conference highlighted the need for a deep, robust theology of technology—one that avoids the twin dangers of Luddite rejection of technology on the one hand, and a naïve acceptance of “all things new” on the other. The challenge is to remain open to the potential blessings of technological development, while at the same time resisting what has been termed the “technological imperative”: the assumption that if it can be done, it should be done.

Ian Hutchison, a nuclear engineer at MIT, provided some excellent comments on scientism, much of it coming from his new book Monopolizing Knowledge. Hutchinson is an ardent proponent of the natural sciences, for they have been quite literally his “bread and butter” for many years. However, he made the argument that we are greatly mistaken if we think that scientific tools give us all there is to know about the universe.

At dinner, we had the honor of sitting at the same table with Dr. Hutchinson and one of my former philosophy professors, Dr. Kay Toombs, whose research and commentary on the experience of illness over the years I highly recommend. Dr. Hutchinson had concluded his lecture with a word about the counter-cultural nature of being a Christian and how simply re-discovering virtues about the wrongness of covetousness would be of great help. I made the comment over our salads that is seems strange that speaking against covetousness is thought of as a new idea, for in fact it used to a part of Preaching 101. He agreed that his ideas weren’t all that revolutionary but that we need to have the faithfulness to pursue them even in the face of opposition.

It seems fitting to have more than one MIT professor at a technology conference, and Rosalind Picard of the MIT Media Lab followed well in the footsteps of Dr. Hutchison. In the first place, her research bringing affective (emotional) components to computing and robotics is just plain fascinating, but its application to helping autistic adolescents is heart-warming as well. One could sense from her talk that she is a kind, Christian woman and that she brings a warmth and a Christian ethic to a field that is oftentimes cold circuitry.

For all you Kierkegaard fans out there, the IFL while be recognizing the bicentennial of his birth next year with a conference that includes Richard Bauckham in the line-up, and the 2014 conference on faith and film also promises to be worth the trip as well.

 

Eugenics and the genetic testing of embryos and fetuses

In a recent article in the Australian media Julian Savulescu, a noted Oxford ethicist who is a visiting professor at Monash University in Melbourne, makes the contention that selecting which babies are born by doing genetic testing on embryos or fetuses and only allowing those that are desired to live to birth in the way that it is allowed in Australia shares the moral problems of past eugenics programs that we have rejected. His point is that the current practice in Australia allows selection of embryos by preimplantation genetic diagnosis and fetal testing with selective abortion only for diseases and not for sex selection or other non-disease characteristics. By allowing selection based only on diseases the society is saying that “lives with disability are less deserving of respect, or have lower moral status.” That is why we rejected the eugenics programs of the past.

Savulescu points out that “If either the embryo or the fetus has a moral status – then it would be wrong to kill either, whether or not a disability is present. If the embryo or fetus does not have a moral status, it should be permissible to destroy an embryo or abort a fetus for any reason. In this way, paradoxically, allowing testing for diseases, but not for other genes, is eugenic in objectionable ways.”

It would be easy to go from there to saying that genetic testing of embryos and fetuses for the purpose of selecting who will be allowed to be born should not be done based on the principle of the value of all human lives underlies our rejection of eugenics, but he does not go that direction. Instead he moves toward the permissibility of all embryonic and fetal testing by saying that lifting the restrictions on personal liberty imposed by limiting genetic testing of embryos and fetuses to testing for disease would resolve the moral objection that the current policy involves morally impermissible eugenics. He gets there by saying that since most people already accept the testing of embryos and fetuses for diseases, we should not say that all such selective testing is wrong based on the moral status of embryos and fetuses and the way to validate people’s acceptance of testing for diseases is to allow testing for non-disease characteristics.

Savulescu’s means of getting to his conclusion is an interesting and commonly used one to justify things that have previously been understood to be wrong. Rather than giving arguments for why we should believe that a human embryo or fetus does or does not have full moral status, he says we have already accepted a limited practice that would otherwise have been considered immoral, so we should accept a broader version of the same sort of practice. This is the process by which immoral behavior takes over a society, and also the process by which an individual falls into immorality. First justify a very limited violation of morality, and then once that is accepted use that to justify further immorality.
That is why we need to stand firm on basic moral values such as the dignity and value of every human life. Defending the moral status of the weakest and most defenseless human beings is essential to avoid the acceptance of things like aborting fetuses because they are female that currently seem obviously wrong, but may become accepted by a gradual breakdown of moral values.

Eugenics in Our Day

Researchers have now developed a technique for doing genetic testing of a fetus by using cells circulating in maternal blood, avoiding the more invasive and dangerous technique of amniocentesis.   These new technical capabilities hail the dawn of a new age of eugenics, or the pursuit of “good (eu) genes.”  With these new technical achievements, physicians can gain knowledge of the child’s genetic makeup as early as 7 weeks after conception.  This can mean a new opportunity for interventions earlier in the pregnancy for the sake of the health of the child or it may provide doctors with more information to inform a decision to abort the child.

Arthur Caplan helped develop guidelines for organ transplants in the 1980s and has for some time pressed for similar oversight of the “wild west” of reproductive medicine, largely because of its eugenics implications.  He is very aware that genetic testing could be used for selecting athletic ability, eye color, or gender.  Sex selection using abortion is already something practiced in countries like India and China, and genetic testing using maternal blood would only make it easier.  However, Caplan is firmly pro-choice, saying that there are good and bad reasons for an abortion.  As Caplan puts it,“Sexism is not a good reason for ending a pregnancy.”

What is missing in this discussion is our response to those with diseases and abnormalities.  To many, a chromosomal defect like Down Syndrome or a physical abnormality like malformed limbs is a good reason for ending a pregnancy.   Too often our attitude to those with abnormalities and diseases is to consider them as unfortunate mistakes rather than opportunities to live in fellowship with another human being.  We think getting rid of the mistake solves the problem, especially when it involves fetal tissue out of our line of sight.  If our drive for perfection bumps into human autonomy, we back off.  If it does not, we proceed in getting rid of the patient if we can’t get rid of the disease.  This is a serious misunderstanding of the ethos of medicine.  An improvement in our ethical strategies will not come from a new set of protocols to use in the clinic.  It will only come about if physicians adopt a new value system concerning the purpose of medicine and develop their character accordingly.

Henri Nouwen, well-known for living in the L’Arche community for adults with disabilities, articulated  a vision of such an ethic when he said, “When we honestly ask ourselves which person in our lives means the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand.”

Click here for a video of Art Caplan discussing gender selection.

The Physician and Chaplain Are Kin

One of our good family friends has been in the hospital the last several weeks, and I’ve gotten to spend a lot of time with her. She is in her eighties and regards me as her “grandson by choice,” and I remember fondly visiting my grandparents in my high school years and listening to her vivid stories and witty humor. She has a firecracker personality and that shines through even though she has a number of medical problems.

One day this week, I went to see her at breakfast-time, and I offered to continue to help feed her eggs and coffee. She declined, saying that she was sleepy. I knew the food would be good for her but felt at that instance I should put down the plate and just sit quietly with her as she drifted off to sleep. The conditioned impulse in me wanted me to jump and run off to “get some work done.” But I knew that what I was doing was a key part of the healing process, an important part of medicine. My presence in the room had an impact on her allowing her to sleep peacefully. And her presence with me allowed me to reflect on things that I’m often too busy to think about it.

Unfortunately, physicians often neglect these very human interactions in their rush to analyze the latest data and strategize about the next procedure. But as leaders of the health care team, I believe it is required for them to be aware of the spiritual health of their patients. Over the course of the morning a half dozen nurses, occupational therapists, and respiratory therapists scurried in and out of the room. All of them were polite and technically adept, but none of them really understood the real situation of an elderly woman over 30 miles away from her home sick in the hospital. Of course, it is the physician who sets the tone for awareness of the patient’s human situation. I was beginning to think that the best thing for this sweet lady was for her to return to the smaller, rural hospital for the sake of her spirit.

Many people write with regret on how the medical profession has become a technical endeavor almost void of spiritual insight. The colleagues of Hippocrates didn’t just draw up some guidelines for medical practice but instead swore an oath before the gods because they knew the gravity of their profession. Likewise, the Christian disposition of medicine in America has historically coupled church charity and chaplaincy with medicine because it takes into account the spiritual well-being of the sick and the injured. I pray the physician and chaplain shake hands and once again embark on this healing endeavor together.

Addendum: Today, I asked for a Gideon Bible to read to my friend. There wasn’t a Bible to be found on the entire floor, even at the other nurse’s station. The nurse said, “This isn’t a hotel.” I replied, “I think you need it more here than at a hotel.” To her credit, she agreed.