Eight is Enough

 

In response to a family’s having eight babies by IVF and gestational surrogacy:

“In this society, if you have money, you can have miracles!”

“Having children is now a luxurious game for the rich!”

“This completely topples the traditional meaning of parents.”

“From the sound of it, they just tried to have some kind of baby machine.”

“Gestational surrogacy is the business of renting out organs.”

“Why did they have to hire so many people to have babies for them? Did they think they had the right to bear children just because they were rich? Secondly, what respect to life did they show? Multiple pregnancies are super risky.”

These are reactions from the public, press, and government officials to a wealthy couple having two sets of triplets and one set of twins via IVF and two surrogates in China, where there has been an official one-child-per-family policy since 1978. Last month a southern Chinese newspaper broke the story of this family, and you can sense the angry reaction of their society in the quotes above.

(There is apparently a large surrogacy industry in China, despite a 2001 ban on Chinese hospitals doing the procedures. The manager of one surrogacy agency reports being overwhelmed with applications from aspiring surrogate mothers, most of whom are having emergencies and “need a large sum of money.”)

In the uproar, we can see erupting some of the tensions surrounding these technologies that are still somewhat under the surface in our own society: What about the divide between those who can and can’t afford reproductive technology? What does it mean to be a parent, especially where surrogacy is involved? Is surrogacy the commodification of women, the reduction of woman to womb?

There is a lot of worrying that China will catch up and surpass western economy and culture. It seems that in some areas they have already caught up with us: pushing the envelope of societal norms with the use of reproductive technologies, and the commodification of women in the process. In another area they are still far behind us: they have not yet lost the ability to be uncomfortable, shocked, even a little disgusted at the ethical implications of these technologies for families and society.

 

(Sources: Here and Here)

Part 3: Caution, Compassion and Wisdom in Policy

“We should measure welfare’s success by how many people leave welfare, not by how many are added. The so-called war is not over and welfare programs are just not working.”

Last week I made the claim that we should be careful how we choose to assist those in need. This was based on four “principles” that I derived from an anecdote from my life:  Just because you think what you are doing is helping somebody, does not mean it is; Helping people requires an effort on both parts; People you help will take more than you give them and they may not stop taking; and, Temporary solutions may offer no long-term resolve.

The purpose of this week’s blog is that you do not think of me as a heartless beast. I recognize that people have needs they cannot meet. I also realize that not everyone has been given the opportunities I have. However, supporting the needs of the needy must be done with caution, compassion and wisdom. As I stated last week, our good intentions are not good enough for the societal implications.

There are now at least 77 federally funded programs for poor and low-income Americans, and their need has not gone away. These programs range from giving food aid to those in need to giving medical care to children–all of which are ‘goods’ in and of themselves. LBJ’s declaration of war on poverty produced these programs (partnered with FDR’s programs in the 30’s), which offered some temporary resolve for the basic needs of the “others” of American society.  (I think that counts as a declared war that will see no end…) But just as in all ethical deliberation, we must look at the consequences of the action, and then assess the value of the act.

While the mid-90s reform of Welfare has offered some progress and growth, the reality is partakers are not being weaned off the system. It is a benevolent service that creates a co-dependecy and not necessarily to the fault of the recipients. For a quick look into what Welfare offers those who partake, go here. Additionally, “Researchers at the Dartmouth Atlas Project and elsewhere estimate that about 30 percent of Medicare spending does nothing to make patients healthier or happier… and Medicare grew at an average annual rate of 9.3 percent over the past decade!”

Above Welfare and Medicare, Medicaid costs have grown substantially. “Spending jumped from $118 billion in 2000 to $275 billion by 2010. And even before the 2010 Health Act was passed, spending on the program was expected to double in cost to $487 billion by 2020.The 2010 law will boost Medicaid’s cost by about $100 billion a year by 2020.”

The heart of my concern is that there is a frightful similarity in the way my college roommates chose to help a homeless man and the way our society is helping those in need, without cautious consideration for the consequences on the individuals who are receiving these so-called benefits and, ultimately, on the society in which we live.

 

 

Exaggerated response to a limited clinical study

A preliminary report was published online on 1/23/12 in Lancet about the first two patients in safety studies of injecting retinal pigment epithelium cells derived from human embryonic stem cells into the eyes of patients with different kinds of retinal blindness. What can be concluded from the studies is that no tumor formation or rejection was noted in these two patients four months after the injections. That is not enough information to make any conclusions about the safety of this treatment and safety is the only thing these studies are designed to assess. There are some who have questioned why such limited data would even be published, but the headlines in the press were amazing. They ranged from “Early Success in a Human Embryonic Stem Cell Trial to Treat Blindness” (Time) and “Blindness eased by historic stem cell treatment” (New Scientist) to “Embryonic stem cells: can we make the blind see?” (Forbes).

Why would very limited initial results from preliminary safety studies have such an exaggerated response? Part of it undoubtedly has to do with our culture’s desire to find miraculous cures in science. In fact the Forbes article says “Restoring sight to the blind is, literally, a miracle…when the cells inside the eye are damaged, there is nothing we can do. Until now.” Another part may be due to economics. These studies are being funded by a private company, Advanced Cell Technologies, which stands to benefit from any positive publicity. The company’s Chief Scientific Officer, Robert Lanza, was quoted in the New Scientist article emphasizing the improvement in the vision of one of the patients. The studies are not designed to assess the effectiveness of the treatments to improve vision and vision was only measured to look for deterioration as a possible side effect. One of the other researchers involved noted that the other patient was found to have some slight improvement in vision in both of her eyes, even though only one was treated, suggesting any improvement was due to the immunosuppressant drugs used or a placebo effect.

Scientific discoveries can at times be very beneficial, but we need to take very preliminary studies such as this one as what it is – preliminary. We should not induce false hopes in people with retinal blindness that they are going to be cured. We should not forget that there may be some studies and treatments that should not be done, such as those which require the destruction of human embryos when other methods for deriving retinal pigment epithelial cells could have been used.

Getting the Doctors to be the Doctors

Physician readers of this blog probably saw the two-page “viewpoint” piece by Dr. Ezekiel Emanuel in the January 4, 2012 edition of JAMA, under the title, “Where Are the Health Care Cost Savings?” The upshot: “First, physicians must be the leaders and must stop looking to drug companies, insurers, or someone else to initiate and achieve cost savings.” (When I read “someone else,” I think, “government.”) I think there is a lot to this—it’s not just an example of asking physicians to answer to society rather than care for patients, a charge with which Dr. Emanuel is undoubtedly familiar. Consider his reasoning:
• Slowing the growth of health costs means “going where the money is” by identifying approaches that can cut costs by at least $26 billion a year, or 1% of current expenditures.
• That implies improving care of people with chronic conditions like coronary artery disease, diabetes, congestive heart failure, and others. About 10% of the population currently requires about 64% of the costs, and most of the 10% are people with a few chronic conditions like coronary artery disease, diabetes, and the like. These patients would be better served, at lower cost, by concerted efforts to reduce avoidable complications, improve patient monitoring, increase medication compliance, use specialists more efficiently (read: selectively), and use technology and currently-less-reimbursed activities (home visits, lifestyle and transportation services) to achieve these.
• Many popular suggestions for reducing cost would have a low “bang for the buck:”
o Malpractice reform might save $11 billion, or 0.5%, per year;
o Reducing insurance company profits means cutting into an amount that, in 2010, totaled $11.7 billion for the 5 largest insurers;
o Drug reimportation might save $2.6 billion;
o Replacing all brand name drugs with generics would save Medicare Part D less than $1 billion;
o Rationing end-of-life care is similarly misguided—in 2010, only 255 patients nationwide had care costing over $1 million each, and while those with bills over $250,000 add up to 6.5% of health costs, they cannot be identified in advance, so planning good but cheaper care for them prospectively is impossible. Besides that, people would “raise the charge of ‘death panels’”—something else he’s heard before. (Insert the emoticon of your choice here.)
Physician leadership principally means, for Dr. Emanuel, that they must work together to redesign care delivery for chronic illness—a challenge, but “only effective physician leadership can ensure successful redesign.” It also means, however, that physicians should not just accept that they will have to be paid differently (bundled payments rather than fee-for-service), they should take the lead in proposing how that deal would look.
I know, I know—Dr. Emanuel is famously a proponent of the “IPAB,” and the notion that doctors will magically see their way to enlightened new ways to pay them is pretty facile. But I cite this piece to suggest that the core point—the doctors have to be the doctors—is the critical one. It is for the doctors to tell the rest of us—not for us to tell them—how they can best care for us, collectively as well as individually, and to identify and implement best practices for that. It seems to me that, whether the challenge is avoiding unnecessary complications or critically asking whether that expensive, marginally effective new cancer drug is really good for a patient, that we should encourage the medical profession to be out in front here. The challenges are immense, and not new, but can’t strong societal leadership by doctors, in the name of caring for their patients better, be part of a vigorous revived Hippocratism?

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