Reflections From the Front: Tough Discussions

Lessons from the Front: Tough Discussions

I heard a fascinating talk today from John Hill, MD, a Carle Foundation Hospital critical care physician who discussed end of life issues with patients and families in the ICU. At times, he reminded us, we need to reframe the families’ questions. It isn’t “Doing everything” or “Not doing anything”, but arriving at realistic goals shared by the patient or their surrogates and the treating team.  Graciously navigating the recurrent renegotiation of goals based on the daily changes in the physical status of the patient is the next, and often more complex part of the process.

Advance Directives have some limited benefits in regard to outlining specific courses of action, but their most valuable role is in establishing who the appropriate proxy is for discussions if the patient is unable to speak for him or herself. Many, unfortunately, stop short at naming a proxy but do not have the necessary discussions with their surrogates about what their true wishes for end of life care are.

Prognostication is always difficult, particularly when “it is about the future”, per Niels Bohr. (I had always thought Yogi Berra said that.) This is one thing that makes these discussions so uncertain. As a physician or nurse at the bedside, nothing beats daily communications with the family to establish rapport and trust to facilitate conversations. The natural inclination for some of us, however, particularly when we are not accomplishing the hoped-for turnaround in clinical status, is to withdraw from daily ongoing family discussions. When a physician withdraws, the family gets its information from multiple, often discordant sources, worsening communication.

Withdrawing from family interactions is often a natural tendency, particularly if we aren’t helping the patient to improve. A few years ago, I was, despite my best efforts, slow in establishing a correct diagnosis in a patient with Amyotrophic Lateral Sclerosis.  My delay in diagnosis made no difference in long-term outcome, but severely impaired the husband’s confidence in my care. As this sweet lady lay dying in the hospital from a complication of her ALS, I had to daily screw up my courage, and whisper a quick prayer for wisdom before venturing back in to see her and her family.  I could have signed off the case, leaving further care to the primary care team, since I had no medical intervention to offer, but my conscience wouldn’t let me. [I didn’t bill for my last few weeks of visits with the patient.] I will never forget some of the more subtle presentations of this rather common disease, nor will I forget the way God answered my prayers for courage and wisdom in meeting the family daily.

Dr. Hill’s take home lessons?

1)      Tough conversations regarding prognosis and patient wishes are easy to avoid, but we shouldn’t give in to this temptation.

2)      The quality of the relationship and discussion with the proxy has a profound impact on the ability of the surrogate to assist the medical team in decision making.

3)      Withdrawing from a patient and family due to our own feelings of inadequacy is not only bad medicine, it is cowardly and unethical.

TIUEthicsBlog2012Number1

Q&A: On the Observance of Sanctity of Human Life Sunday

 

 1) What do we mean by the phrase “Sanctity of Human Life?”

Specifically, we mean to communicate the biblical truth that each and every human life, being made in the very image of God, is a special object of God’s love and concern (Gen 1:26-27; 9:6; James 3:9).

God is no respecter of persons, and so we ought not to be either. Every human life, no matter how young or old, no matter how functional or dysfunctional, is truly worthy of our love and deepest respect. While human life is not to be worshipped, it is to be valued greatly and protected.

 

2) What is the origin of the practice of observing a “Sanctity of Human Life” day each year?

President Ronald Reagan began the annual tradition. By his proclamation, January 22, 1984, the 11th anniversary of the Roe v Wade decision, marked the first national observance of the Sanctity of Human Life. That tradition has been continued by some, but not all, presidents since Reagan.

Political observances aside, Christians across the denominational spectrum have annually been calling attention to the tragedy of abortion on demand ever since the Roe v Wade decision (Jan 22, 1973).

Roe v Wade was a wake up call. Specifically, it awakened evangelical Christians in America to the responsibility of being salt and light (Matt 5:13—16) in a culture that was growing increasing callous towards human life.

 

3) What does it mean to be “salt and light?”

Being salt and light entails bringing the gospel of Jesus Christ to bear on a lost and dying world. Preaching and personal evangelism are of paramount importance to the task, but they are incomplete and often rendered ineffective if our words are not matched by lives radically altered by the Gospel.

A life radically altered by the Gospel is one that is no longer controlled by fleshly desires and worldly thinking, but rather, it is in tune with God. It values what God values, and it finds deep and abiding joy in obeying His commands.

What is it, then, that God commands of His people?  Here is the answer He gave through the prophet Micah:

He has told you, O man, what is good;
And what does the LORD require of you
But to do justice, to love kindness,
And to walk humbly with your God?   (Micah 6:8, NASB)

 “Doing Justice” – that is what Sanctity of Human Life Sunday is about.

Among other things, “doing justice” demands that we advocate for those who cannot advocate for themselves, that we uphold the interests of the weak over and against the schemes of those who would oppress them.

Human Life is under attack, and doing justice demands that Christians concern themselves with the problem and minister accordingly.

 

4) In what ways is human life under attack today?

Human life is under attack across its entire spectrum. On the back end, it is threatened by the evil of euthanasia. The notion that killing can be a genuinely compassionate ministry to the aged, disabled, and/or infirm is a lie borne straight from the pit of Hell.

Even towards the healthy, we see in our culture a blatant disregard for the value of human life. Murder and violent crime are the obvious signs, but no less concerning is the disregard for human life that permeates much of what passes these days for entertainment.

For the Romans, the sinful appetite for violence was satiated at the Coliseum; for Americans, the appetite is no less strong though the venue for its satisfaction may be different. Yes we have our sports arenas for modern-day gladiatorial contests that feature all the violence without, it is hoped, the killing (e.g., UFC);  but we also have our television viewing rooms, our video game stations, and comfortable cinemas where, for our viewing pleasure, human bodies are violated, desecrated, and discarded like rubbish.

Now, what generally gets the most attention at Sanctity of Human Life observances is the assault on human life on the front end, and elective abortion in particular, which has claimed over 50 million lives in the US since Roe v Wade.

Many, frankly, have grown tired of the public controversy over abortion and just wish it would go away. But, absent a mass awakening in our country to the Gospel of Jesus Christ, the killing will continue. As the Christian’s charge to protect the innocent and vulnerable is neither optional nor in harmony with the worldly ethos of our day, we may expect that the controversy will continue.

We can take heart, however, in the fact that we stand in good company for Christians have been battling the evil of infanticide from the Church’s earliest beginnings. In Roman culture, it was socially acceptable for fathers to abandon unwanted babies on the doorstep of the family home – death by exposure largely served the same purpose that abortion does today. Convinced, however, that all human life is a gift of the Creator God and thus to be valued and protected, early Christians not only refused to participate in the horrific practice, but even more, they rescued many an abandoned child.  As they did so, they provided a powerful witness to the love of God and his gracious salvation extended to helpless sinners.

Human life on the front end is also threatened in our day by the effort to control reproductive outcomes and, in particular, the attributes of our progeny. Whereas the Romans had to wait and see what “nature” delivered, nowadays we have the increasing capacity  to determine what first goes into the womb.

Implicit to the drive to select children of a specific type or kind is the judgment that some children are not worth having.

In China, that judgment has manifested in a higher abortion rate for female offspring that has left the population with an enormous gender imbalance. That imbalance poses for China serious threats to peace and order – both internally, and with its neighbors.

Here in the U.S., gender selection is occurring, though not on the same scale as in China. Its not that we are any more humane, however, its just that our focus has been more on the elimination of babies perceived as defective.

And so, for example, those among us who lived in the days prior to pre-natal testing recognize that we have in our midst fewer children with Down’s Syndrome. Current estimates are that somewhere close to 90% of children identified through pre-natal tests as having Down’s Syndrome are now aborted.

 

Reproductive medicine has not only yielded an increasing capacity to control the makeup of our children, it has also created a huge “surplus” of human embryos. Most of these embryos have been consigned to the freezer. Few will ever come to occupy a womb, but instead, most will either expire on the freezer shelf or be dissected and destroyed in a medical laboratory.

To assuage the conscience uneasy about embryonic experimentation, researchers and their supporters tell us that these embryos are not really human beings or “persons,” but we know better. We were all embryos at some point, just as we were infants, and then toddlers, and then children, and so on.

From conception onward, we are who we are: individual persons known and loved by God and, thus, to be loved according to His command: as neighbor. Neighbor love is sacrificial, but note, it sacrifices not the interests of the one being loved, but rather, those of the one who loves. Killing an innocent neighbor can never be a genuinely loving thing to do.

 

 5) So, what is the Christian to do?

First, we must recognize the assault against human life for what it is. Most fundamentally, it is spiritual warfare. We face an enemy, Satan, whom the Scripture describes as a “murderer” (John 8:44) who “prowls around like a roaring lion looking for someone to devour (1 Pet 5:8).

Second, we must then utilize spiritual weapons.

1)    The Gospel Truth

The Gospel of Jesus Christ calls sin for what it is, but doesn’t leave the matter there;

It also proclaims in Christ Jesus redemption and forgiveness to all who would repent and place their faith in Christ Jesus;

It is lived out through daily ministry to neighbor – word and deed must be in sync.

2)    Prayer

Much prayer is required. We are up against a mighty foe, and so, we must call upon the Most High God

3)    Guarding our hearts and minds

We must take care to not let that which is unwholesome and impure to capture our hearts or minds;

This is not a call to disengage from culture, but rather, a reminder of the need to filter it and deny it a controlling influence.

 Third,  we get involved  i.e., we seek to be salt and light.

1)    Through personal evangelism

Hearts and minds must be transformed by the Gospel. Yet, as the Apostle Paul in his letter to the Romans declared, “how can they believe in the one of whom they have not heard?”

2)    A personal, social ministry – several avenues exist

Making other people’s problems our own; sharing burdens

Working with agencies whose aim it is to uphold the value of human life

Advocacy in the Public Square: telling the truth in love, pointing our culture to God’s vision of the good life

Science, politics, ethics, and emergency contraception

Last December 7th, Health and Human Services Secretary Kathleen Sebelius instructed the FDA not to give over-the-counter (OTC) status to the emergency contraceptive drug Plan B One-Step for girls under age 17 (It is currently OTC for all women 17 years of age and older). Sebelius gave as her reason her “conclusion that the data … are not sufficient to support making Plan B One-Step available to all girls 16 and younger, without talking to a health care professional.”

Commentators immediately went ballistic, bemoaning the “fact” that the science shows that this product should be approved OTC for all ages, but that politics overruled the science. Last week a Perspective piece in the New England Journal of Medicine (NEJM) made the same assertion, as did an earlier Viewpoint in JAMA.

However, there is more to these claims of scientific-objectivity-being-overruled-by-politics than meets the eye. Science can only tell us what is or what can be, never what should be. You cannot from the premise, “We can do such-and-such,” derive the conclusion, “Therefore, we should do such-and-such,” without the intervening value statement that “Such-and-such is good, or desirable, or right.”

In his inaugural address, President Obama promised to “restore science to its rightful place” in government, to “base our public policies on the soundest science.” But public policy decisions are inevitably decisions about what should be done; every regulation in the law is an acknowledgement that those governing believe that one particular way of doing or taxing or regulating something is better than the alternatives. In other words, every policy decision is based in some part on ethics and morals — things which objective science cannot reveal to us. To “restore science to its rightful place” means “let’s get our facts straight.” This is important: good ethics (and good policy) must start with good facts. But science’s rightful place is not, and cannot be, to make the ethical decision for us.

Science can tell us the chances of Plan B One-Step preventing pregnancy after unprotected intercourse. It can give us statistics about how women use it and what the potential side effects are. It can not tell us whether or not it is a good thing that a 12-year-old who just had unprotected intercourse should be able to get the medicine without talking to an adult such as a medical provider.

Sebelius appealed to a lack of scientific data in making her decision; I do not know if she also had an unspoken political agenda. It seems at least mildly improbable that someone so staunchly pro-choice, who is part of the administration of a President and a political party that do not oppose Plan B on political or ideological grounds, would herself do so to gain political points or power. But I do know that, contrary to all the pundits, this decision, like all policy decisions, cannot be made by empirical science alone. The accusation of “Politics trumps science” is just a front for those whose own politics, morals, and ethics lead them to a different conclusion.

Part II: Helping Those in Need

While I promised to address the problems of Medicare/Medicaid in NH a couple weeks ago, I am going to forego that to discuss a matter that is a necessary detour in this journey: How do we appropriately help “other” people? We all know that we should, but how?

“It is the church’s responsibility to tend to the poor, sick and needy.” “No, it is the government’s responsibility.” “I’m not going to give him money he will just buy a bottle of booze with it…”

It is my brazen contention that your answer to this question will make ripples in history.

This question is more prominent, I think, for those of us who are Christians. After all we have biblical mandates that encourage us to lend a helping hand to those in need. Nonetheless, the conundrum is universal. We all feel the urge to help “others” who are “underprivileged” or “disadvantaged” or “without”.

I believe we can glean some insights from this unfortunate experience in my own life. If nothing else, I think you will come to realize that there are right ways and wrong ways to help those in need.

 

An Anecdote (this is a true story with fake names to protect their naivete)

Many years ago my kind-hearted college roommate, Scott, brought a guest home from downtown Raleigh. This guest was a homeless man and crack addict who had been living on the streets for the better part of his life. Upon entering our small apartment Scott announced to me and my other roommate, Jim: “I am going to give him [as if he were not standing right there] a warm meal and a bed to sleep on for the night, and then drop him back off downtown tomorrow.”

 

A kind gesture, right?

 

I pulled Scott aside out of earshot and said, “I strongly encourage you to keep a close eye on him while he is here.” (I hope you sense the foreshadowing.)

 

The next morning I awoke early and departed for a long day of work and school.

 

When I came home that evening, my laptop had mysteriously disappeared from my desk… Of course, I did not want to jump to any conclusions, so I went to Jim to ask if he knew where my laptop was and if he had seen our guest leave. To that he replied: “No… and yeah, he came in here and asked for a book bag. So I gave him my ol’ one that was in my closet.”

 

To which I replied: “So, let me get this straight, you gave a homeless man, who came into our home with nothing, a bag…” At this point the picture was starting to come together for Jim.

 

It turned out that our guest, whom Scott was trying to help, decided to take some things with him before he left. Jim gave him a new bag (to store his hot laptop) and Scott gave him a ride back downtown—how nice?! My roommates were literally accomplices in a crime!

 

The Moral(s) of the Story

1.)  Just because you think what you are doing is helping somebody, does not mean it is… Our guest most likely sold the laptop and bought drugs (he told us he was a crack addict).  If this is true, neither Scott nor Jim did him any service.

2.)  Helping people requires an effort on both parts. It is rarely as easy as it seems. While giving a warm bed and a warm meal or a dollar in a can may be easy (and perhaps a good that God graciously blesses you for because He alone knows your heart) these gifts may not be beneficial to the person in need.

3.)  Very often, people you help will take more than you give them or they will not stop taking. You give an inch, they take a mile…

4.)  Temporary solutions may offer no long-term resolve!

 

Final Thoughts

Our intentions do not produce results, our actions do. The means by which we help people has greater consequence(s) than our good “hearts”. Therefore, we should be careful how we choose to assist those in need. I believe that this principle has broader applications than in our daily lives. It’s application extends beyond the individual into the community and into our society.

 

Later, we will assess how our society has chosen to “help” those in need.

 

 

 

Costly grace and bioethics

I am currently reading Dietrich Bonhoeffer’s book, Discipleship, and thinking about how what he said relates to bioethics. One of the significant concepts in this book is the idea of costly grace. Bonhoeffer wrote “It is costly, because it calls to discipleship; it is grace because it calls us to follow Jesus Christ. It is costly, because it costs people their lives; it is grace, because it thereby makes them live. It is costly, because it condemns sin; it is grace, because it justifies the sinner. Above all, grace is costly, because it was costly to God, because it costs God the life of God’s Son – “you were bought with a price” – and because nothing can be cheap to us which is costly to God. Above all, it is grace because the life of God’s Son was not too costly for God to give in order to make us live.” (45)

One of the difficulties of Christian ethics (including Christian bioethics) is that when we focus on doing what is right it can seem like we are saying that doing what is right is necessary to gain God’s favor and that we are negating the foundational Christian doctrine of salvation by grace. That was a significant issue in Bonhoeffer’s Germany. The established church had taken a position which Bonhoeffer called cheap grace. They were saying that since God’s grace is freely given and we can do nothing to earn it, we should not try to do what is right, but should conform to the standards of society to show that our salvation is entirely free and not related to any effort of our own. That led them to conform to the Nazi regime’s practices that were engulfing their country and not to oppose them.

Bonhoeffer helps us to see that Jesus has paid the price for our salvation and that we can do nothing to earn it, but that God’s grace calls us to be disciples of Jesus. As we seek to follow him by the power of his Spirit and his transforming grace, we will seek to live by his standards. The moral reflection of Christian bioethics helps us to understand how God would have us live in response to his grace in our increasingly complex world.

Bonhoeffer, Dietrich. Discipleship. Minneapolis: Fortress Press, 2003.

Top Biothethics Story of 2011?

What do you think was the most significant bioethics-related event of 2011?  I would have to say, in my opinion, that it was the November 17 announcement by Geron that it would no longer pursue research on human embryonic stem cells for the treatment of spinal cord injury.

You may remember that it was less than 3 years ago when President Obama lifted the ban on funding of human embryonic stem cell research. Geron was the first company to benefit from this decision and it promptly received FDA approval for its research.

From a pro-life perspective, Geron’s decision to stop its research is good news, not because a promising treatment has been scuttled, but because it signals a lack of confidence in an unethical procedure (it destroys human embryos, after all).

Why would a company that was fueled by all the hype about stem cells make this decision?  Geron stated that the decision was a cost vs. benefit decision. In other words, the research was very expensive, but the promise of therapy was too far off into the future to justify its continuation.

Will Geron’s decision mark the end of human embryonic stem cell research? I suppose it depends on who you ask. Many researchers acknowledge that we are not even close to successful therapeutic applications of stem cells. According to Dr. Bryon Peterson (professor, Institute for Regenerative Medicine, Wake Forest Baptist Medical Center), embryonic stem cells “are not ready for ‘prime-time’” and “There are too many variables about these cells that we just don’t know about.”[1]  ABC News reported, “many experts say the announcement signals a symbolic end to the era of embryonic stem cell research that many researchers worked so hard to launch.” Others are not willing to admit defeat, citing the strong public and political support of stem cell research. Dr.  Daniel Salomon, a professor of experimental medicine at the Scripps Research Institute in San Diego, maintains that the work should be continued.

Ultimately, time will tell who is right about the matter. But expensive hype can survive only so long without tangible results.


[1] http://abcnews.go.com/Health/Wellness/scientists-rethink-embryonic-stem-cell-research-geron-announcement/story?id=14966735#.TxYahIE8CSp

Cloned Pets

TLC aired a special called “I Cloned My Pet” that traces the journey of three former pet owners through the process of cloning their beloved pet who had died (see here and here). Watching the interviews with the pet owners, particularly Danielle, the owners sought cloning in order to bring their beloved pets back rather than deal with closure and the loss of their pet. However, my interest is less in the psychological factors and more in the technology and appropriate use of technology. I understand that there is a psychological factor here, but I think it is important to look at how technology is being used and if it is ethical.

 

Our society finds solace, comfort, and sometimes salvation in technological progress. It is the cultural air that we breathe. When having to deal with some of the most devastating things in life, we turn to technology to help us: reconstructive surgery after a severe accident, IVF for infertility, cosmetic surgery for the effects of old age, arthroscopic surgery for joints, and a myriad of other technologies that are used every day in hospitals. Thankfully, we live in a world where many of these technologies are available, and people who have had to deal with trauma or sickness can benefit from them. However, our technological capabilities also raise questions, such as distinguishing the difference between therapeutic and enhancement technologies. Now let us add that technology can help a former pet owner deal with the loss of a beloved pet by cloning.

 

Distinguishing between therapeutic and enhancement technologies is an area that many bioethicists are working on. There is most certainly a gray area here; not all of the above technologies are strictly therapeutic, however some may argue that they have psychologically therapeutic effects. However, there are similarities between certain technologies listed above. IVF and cosmetic surgery seem to be marketed differently than the other technologies. Infertility and the effects of old age are very emotional topics, and it seems that the reproductive industry and the cosmetic industry banks off of people’s fragile emotional state. That is where I see a similarity between those industries and cloning a pet. I believe all three of these industries sell happiness (or solace or security) to people.

 

The way the former pet owners talked in their interviews, it is as if they believed cloning would bring their pet back to them. And they evidently believe this strongly enough that they are willing to pay $100,000 price tag for it ($50,000 for the people on TLC per an agreement with the South Korean cloning company). Let’s examine the technology:

 

  1. Cloning is a very inefficient process, so much so that Ian Wilmut, the scientist whose team cloned Dolly the sheep, has abandoned the notion of human cloning (he moved on to ESC research). For every one successful clone, there were hundreds of botched clones. Many were botched at the embryonic or gestational stage. Some had severe abnormalities at birth. Less than 1% of clones are successful (this is a very generous estimate), so for everyone 1 successful clone 99 (or more) had to die.
  2. Cloning does not make a copy of the original. One of the pet owners was hoping that his cloned dog would recognize him. This is not possible. A clone is analogous to an identical twin that is displaced in time.* Anyone who knows identical twins knows that you end up with two completely different individuals. It is unclear to me if the cloning company is up-front about this, or if it allows people to believe whatever they want to believe, including the idea that the clone has some of the memories of the original. This is visually seen when we look at other cloned animals. The coat color does not always match the original animal because environmental factors play a role.
  3. Dolly the sheep, famous for being not only the first cloned mammal, but also the first healthy cloned mammal that could reproduce, died an early death from age-related issues. Dolly started developing problems with arthritis and other age-related issues when she was only six years old (normal life span is about eleven years old). Very little has been reported on the longevity of a cloned mammals, but the idea is that cells have a shelf life. They cannot go on replicating indefinitely. Again, it is unclear to me whether the South Korean cloning company has been able to fix this “little” problem of old DNA and shorten life-spans or not. The former pet owners were obviously very upset over the loss of their pet the first time, and rather than move on, they have opted to clone their pet. If the clone’s lifespan is expected to be much shorter than normal, comparable mammals, this sets them up for further disappointment, let alone reliving the loss of their pet. Cynically, this does set the cloning company up for repeat business

*Technically, once the DNA starts replicating, identical twins do not have identical genomes.

Finally, aside from assessing the technology, there is a stewardship issue here. I have always had pets. Growing up we had a variety of cats, dogs, birds, hamsters, lizards, and even a chinchilla. I loved all of our pets, and each one seemed to have its own little personality. I currently have an incredibly sweet cat and a rather clumsy aquatic turtle. I had adopted my current cat when she was about a year old from an animal shelter, and she truly has been one of the friendliest, most docile cats I’ve ever had.  For people that have a soft spot for caring for domesticated animals, there are a lot of animals that need homes. Here in Texas, we receive quite a few displaced animals from natural disasters. Given the inefficient and expensive cloning procedures, it seems that the best way to care for animals is not to clone them, but rather to consider caring for another animal. Animals are not people, and while I would not necessarily be so bold as to recommend adopting a child because that is a big decision for a couple to make, animals are always adopted. So, if these owners would like to have a pet, why not adopt one of the thousands of animals that are too domesticated to survive in the wild? The answer is likely that these pet owners want their old pet back. Unfortunately, no matter what the cloning company promises them, they are still adopting a completely different pet than their original.

On the dignity of being a burden

My candidate for one of the most unhelpful (although well-meant) comments patients make in the discussion of end-of-life and other care issues:

“I don’t want to be a burden on anybody.”

Why unhelpful? Because we can have very little control over whether we will become a burden. A burst aneurysm, a car accident, or some other unforeseen event, and wham! we’re a “burden,” dependent upon others, through no fault or planning of our own. And people somehow have got the idea that being dependent on somebody else diminishes their dignity.

But not only is this not a Christian idea, it is an anti-Christian idea. Maybe so many Christians cling to it because we were raised on the pious-sounding but non-Bilblical nostrum that “God helps those who help themselves.” Or maybe it’s because we have appropriated the assumptions of our independent, individualistic culture. Whatever the reason, John Stott provides a powerful corrective in the final book he wrote before his death, The Radical Disciple (IVP Books, 2010). In the chapter on “Dependence” he points out that we all come into the world, and most of us leave it, dependent on the love and care of others (pages 110-111). “And this is not an evil, destructive reality. It is part of the design, part of the physical nature that God has given us.”

He continues, “I sometimes hear old people, including Christian people who should know better, say, ‘I don’t want to be a burden to anyone else. I’m happy to carry on living so long as I can look after myself, but as soon as I become a burden I would rather die.’ But this is wrong … the life of the family, including the life of the local church family, should be one of ‘mutual burdensomeness.’ ‘Carry each other’s burdens, and in this way you will fulfill the law of Christ’ (Galatians 6:2)

“Christ himself takes on the dignity of dependence. He is born a baby, totally dependent on the care of his mother. He needs to be fed, he needs his bottom to be wiped, he needs to be propped up when he rolls over. And yet he never loses his divine dignity. And at the end, on the cross, he again becomes totally dependent, limbs pierced and stretched, unable to move. So in the person of Christ we learn that dependence does not, cannot, deprive a person of their dignity, of their supreme worth. And if dependence was appropriate for the God of the universe, it is certainly appropriate for us.”

Getting our priorities right

Sunday I had a decision to make. It was one of those small decisions that reflect our underlying priorities. Just as it was time to get up to get ready for church I received a call that a patient was being admitted to our local hospital under my care. She was stable and the ER doctor had written her admitting orders, but I did not know her and needed to see her to be sure her planned care was appropriate. I had several options. (1) I could go to see her before church and miss singing with the choir. (2) I could go to church and sing with the choir, but leave before Sunday School to see my new patient so I could be home in time to see the IU basketball game at noon. (You have to know how much I care about IU basketball to understand why this was a real consideration.) (3) I could go to church and Sunday School (which I knew was going to be a time of sharing concerns and praying for each other) and then go to the hospital and likely miss watching at least some of the game live. (4) I could wait until after the game and go to the hospital later in the afternoon.

At this point some may be wondering what this has to do with bioethics. There are no life and death choices here. There are no principles at stake that will change the course of our culture. But ethics is largely about the little decisions we make every day. It is about deciding which of the good things we do have the highest priority.

So what was I to do? I decided that for that morning my first priority should be worship and prayer. There are times that the care of a patient needs to come first, but in this case the patient was stable and her immediate needs had been taken care of, so she could wait until after the opportunity for corporate worship and prayer. My own entertainment could wait, so I set the DVR to record the game to watch later and went to see my patient as soon as we had finished our time of prayer.