The limits of medicine and technology

 

In Too Much to Know, author Ann Blair notes that in our culture, which virtually deifies technology, we believe that we can find technological solutions to all problems, even those that are actually addressable only by attending to ourselves.*

Perhaps this confusion about the proper solution to a problem is part of the crisis in medicine and bioethics. The knee-jerk expectation of the public and the medical enterprise alike is that for every problem people bring before a doctor there can be found a solution, and that a technical solution will be the best. But what if that assumption is incorrect?

What if there are some patients for whom a technical solution is the worse option? Maybe there are some depressed patients for whom the best solution to their problem is not another pill, but the balm of human compassion and the encouragement to use the resources they have at hand to find comfort. Maybe there are some people with terminal diseases for whom the best solution is not every last possible intervention trying to sustain bodily function indefinitely, but rather help in strengthening faith and preparing for death.

Maybe instead of attempting to eliminate disabilities by trying to detect and eliminate fetuses that have them, we should be striving to be a people who can love and cherish those among us with worse disabilities than our own. Maybe instead of seeking absolute certainty (an illusion at best) by demanding that every technological test and scan be made available, we should be learning to live in the freedom of the inevitable uncertainty that comes with life on this planet.

Maybe there are types of human suffering that medicine was never meant to address. Maybe there are problems that we can only address by fixing not the problem, but our selves. And maybe part of the task of bioethics should be seeking the wisdom to discern between the two.

 

*This summary of Blair’s thought is from Alan Jacobs’s review in the May/June 2011 Books & Culture.

The Promise of Crossing Species Boundaries

 

Last week I discussed the Myth of Crossing Species Boundaries, which reflected on the fictional works of yesterday and today. So, as I promised, I wish to address now “the context that made these fictional fears, so real.”

Indeed, we are and have been capable of amazing scientific feats (well not me). Among many other skills, we are able to mess with tiny parts, and manipulate them to be and do things outside their normal function…

We are able to grow human parts in/on an animal, fuse human cells with animal eggs, create animals to have human blood running through their veins, attempt human organ growth in animals, implant a mostly human organ into an animal, and even transplant human-brain stem cells into an animal brain.

However, as Paige Cunningham wrote in a recent article: “When the great naturalist Joseph Kolreuter [pioneer in study of plant hybrids] painstakingly and methodically cross-pollinated hundreds of plants in the 18th century, he could not have foreseen the 21st century version of hybrids: human-animal (HA) hybrids.”

In its natural form (or traditional understanding), ‘hybriding’ takes place during mating or crossing, as in the case of a plant’s cross-pollination or a horse and a donkey being the last two animals on an island… The new understanding, armed with the unraveling of DNA and new reproductive technologies, involved a Doctor (Mad Scientist) wearing a lab coat in a clean room.

These new processes enabled a new world of possibility. A new world of promise. Promise of potential cures. Promise of a new life. Promise of replaceable parts. Promise of a better future. This is why we so quickly breeze past the concerns of science fiction and the warnings uttered by the skeptical.

But promise, in any form, is rarely without its ethical and theological concerns. As we are well on our way into HA hybrid research we would do well to reflect upon these critical questions:

 

Is there a qualitative difference between being human and being an animal?

Are there no boundaries to our research on animals?

Do any boundaries even exist? Boundaries between species, boundaries we ought not cross…

What of human dignity?

 

 

 

 

 

House calls and Hippocrates

Last week I was in the “piney woods” of northern Louisiana.  I had thought I would write a blog entry from there, but time and internet access were scarce, so I’m doing it this week. My wife and I were visiting her parents, Aaron and Betty.  I have always enjoyed being with them and this trip was no exception.  It was also a time to check on how they were doing.  They are both in their 80s and have some significant health problems.

On Tuesday Betty’s visiting nurse came to see her, and it made me think of the part of the Hippocratic Oath that says “Into whatever houses I enter, I will go into them for the benefit of the sick.”  Physicians don’t take care of their patients in their homes very much any more.  There are good reasons why things have changed, but there are things that have been lost.

The nurse who comes out to see Betty is becoming part of the family.  They offer her tea and cake and Aaron teases her like he does his daughter.

In the sterile environment of the hospital or office a patient can become a diabetic or an arthritic or a stroke victim.  In her home she is the person she really is and it is harder to miss that.  Those of us who care for the sick need to remember that what we are doing should be for the benefit of those we care for.  Those who receive our care are real people with homes and families who are welcoming the physicians and nurses and others who care for them into their lives just like they would welcome us into their homes.

We need to enter into their lives as respectfully as we would enter their homes and realize we are being accepted as a part of their family.

Rise of the Planet of the Transhumans

Futurist Ray Kurzweil predicts a future in which “the very nature of what it means to be human will be both enriched and challenged as our species breaks the shackles of its genetic legacy…” (from The Singularity is Near website).  Why would humans plot such a scheme?  They do it because transhumanists see the human body, in its current form, as limited and defective.  In his book From Human to Posthuman, Brent Waters observes that what unites the proponents of transhumanism is an “unwavering belief that the current state of the human condition is deplorable, and the only effective way to remedy this plight is for humans to use various technologies to radically enhance and transcend their innate and latent capabilities.”  Science journalist Brian Alexander concurs, “Transhumans regard our bodies as sadly inadequate… which restricts our brain power, our strength and, worst of all, our life span.”  Kurzweil believes that to accomplish the goals of transhumanism and overcome our imperfections, humans need to become “less biological” and more technologically enhanced, more “God-like.”  The emergence of transhumans is referred to as a ‘technological singularity,” a time when humans achieve “inconceivable heights of intelligence, material progress, and longevity.”  Indeed, in the mind of many futurists, this can be accomplished sooner than we think, perhaps as soon as 2030.

One basic presupposition of transhumanism is the view that human nature is not fixed but is malleable.  Waters observes that for transhumanists, “There are no given features, such as finitude and mortality, which define the quality and character of human life and lives.  Personal, social and political identities are subjected to continuous deconstruction and reconstruction.  In this respect, medicine (and I would add ‘technology’) can be used to deconstruct and reconstruct human bodies.”  Transhumanists think that the true essence of human nature is information, information that be downloaded onto something more durable such as a computer or a robot.  Theoretically the information could be backed up indefinitely resulting in a type of virtual immortality.  In the end, as described by Joel Garreau in Radical Evolution, we may have a world where there is a distinction between the “Naturals” and the “Enhanced.”  In this world, “Naturals,” i.e., those who have not received genetic enhancements, may be viewed as if they disabled because they simply cannot keep up with those who are genetically superior.  Others describe the next possible step – the Singularity – when machines begin to outperform the intelligence of humans to such an extent that they become “ultra-intelligent” and begin to replicate themselves.

Christians agree that the human body is defective and limited.  The doctrine of depravity, which includes the effects of sin on the human body, is one of the core doctrines of the Christian faith.  And in response to the question of whether human nature is fixed or malleable, one possible rejoinder is both.  In other words, could it be that some psychological and experiential features of human nature are subject to change while personal identity is kept intact?  Ted Peters writes, “…changes in the body, even if resulting in changes in the mind, do not risk a loss of identity.  Beyond the therapy and even beyond the enhancement, our transformed self will still be our self.”  The common sense understanding of human identity, the view that best fits human experience and Scripture, is one that posits the continuity of an individual’s identity i.e., an individual remains the same individual throughout his or her existence.  This continuity cannot be explained by simply reducing human nature to mere information.  In addition, a strong case could be made that the continuity of identity can only be explained by putting forward a robust description of human nature, one that accounts for the common experiences of self-awareness, memory, the ability to identify people, places, etc. and the capacity to engage in self-reflection.  Moreover, the psychological powers to think, be aware of, choose, reflect, experience (pleasure and pain, emotions), and the like, are consistent with the view that a personal agent, and not simply information, is involved.   If human nature consists merely of information, then how are we to account for these common experiences?  Actually, it is more natural and intuitive to make reference to “you” acting in such and such a way, rather than to suggest that information is responsible for your actions.  In sum, the view that human nature is merely information leaves too many phenomena unexplained

Then there is the matter of consciousness.  John Searle (Professor of philosophy at the University of California, Berkeley) is noted for having a deep appreciation for the complexities of consciousness.  He questions how “consciousness can be reduced to zeroes and ones, that there is not some deep mystery behind it.”  Indeed, human consciousness itself is difficult to explain if humans are reduced to transferable data.

For Christians, the human is more than a list of psychological functions.  J.P. Moreland reminds us that Scripture consistently presents humans as individuals who are the same and remain the same throughout their existence.  For example, in Psalm 139, David assumes the continuity of his identity when he reflects on God’s hand on his existence before his birth.  The reason that David could write about his early existence was because he was the same person before birth and in his present state of existence.

Concerning the question of whether humans are mere information and whether there is a distinction between humans and machines, the Christian response is rooted in the doctrine of the imago Dei, and, in my opinion, the notion of substance dualism.  Genesis 1:27 teaches that “God created man in his own image, in the image of God he created him; male and female he created them (NIV).”  Humans are not mere products of evolution that can be reduced to information.  On the contrary, humans are persons created by God in his image.

History Books and Modern Language

Current events sometimes collide with academic reading. I’m reading a book on the history of eugenics in Germany and how many eugenicists, as well as and Nietszchean philosophers and later the Nazi supporters used some of the language and ideas from Darwinism to promote a “science-based” ethic. I had just finished the chapters on the rise of moral relativism and ethics based on scientific language from Darwinian theory, when I turned to some current events in the bioethics world (For two good resources on current events in bioethics go to www.bioethics.com or Bioedge ). Two stories at the top of the list were on sex-selection. One was one multiple birth reduction. While the articles deal with very difficult topics, if you step back and read the articles, particularly the justifications given by the parents, the language is coated with medical and scientific justifications along with the notions of the healthiest or most fit or the ones that are more valued by societal norms as being worthy of survival.

 

The book I was reading is From Darwin to Hitler by Richard Weikart. Weikart is a historian and does not make the argument that Darwinism necessarily results in the atrocities of World War II. Rather, Weikart traces through the history of ideas in the German (and European) culture that lead up to the rise of Hitler. He does however note how many of the early eugenicists and the Nazis used Darwinian language of natural selection and survival of the fittest to justify deeming some members of society weaker and less valuable than others. I think one of the important take away points to this is how Darwinism as laid out in On the Origin of Species and in Descent of Man does not have the moral capacity to deem these actions wrong, or even deem them a mis-application of Darwinism, even though Darwin himself is reputed as being a gentle naturalist.

 

The problem is ethics drawn from Darwinism undercuts itself creating a morally devoid ethic of survival of the fittest and propagation of the species. In one sense this type of naturalistic ethic is relativistic because instincts are natural and therefore not morally wrong. This allows anything to be justifiable as long as it is instinctive. Darwin showed this in Descent of Man by looking at the animal kingdom and comparing animal instincts to human actions. In another sense, Darwinism removed the individual from a place of importance and elevated society or the good of the whole above the individual. In this second sense, death was deemed justifiable in instances where it would benefit society by weeding out the weaker. This was justified by using the language of natural selection and survival of the fittest.

 

So turning to the new technologies available in knowing the sex of your child early in pregnancy and technologies, such as those used by Microsort that allows a couple to select the sex of their child, the justification for this is either prevention of sex-linked disease or “family balancing.” Another article on sex selection was about China and how it was dealing with the inevitable ramifications of their population control policies (see here and here. Population control was one of justifications used by eugenicists in the late nineteenth and early twentieth century. The last article I read (in an oddly similar vein) was about multiple birth reduction.

 

I think in future blog posts it might be interesting to trace through some of language used to justify controlling reproduction. There are some differences. The eugenics movement both in the U.S. and in Germany involved some people taking control of others reproduction by deeming some not worthy to reproduce. Today, it is seen more subtly in the form of parents wanting a certain type of child or a certain sex or a certain number, all of which are dictated by what society values. In the case of the United States, we value having many choices and personal autonomy. It is less subtle in China and India where many people value boys over girls. One of the doctors mentioned in the article who was at one time against reducing twins and has since changed his position, is quoted as saying that “[h]e became convinced that everyone carrying twins, through reproductive technology or not, should at least know that reduction was an option. ‘Ethics,’ he said, ‘evolve with technology.’ It seems that the ethic has not changed as much as one would think; it is the means to carry out that ethic that evolve with technology.

The End of Morality

Part 2 of 2

In the grandiosely titled article “The End of Morality,” published in the July/August Discover, Kristin Ohlson writes of brain experiments not unlike those I wrote about yesterday in “Toward a Brain-Based Theory of Beauty.” Researchers placed subjects in functional MRI scanners, gave them moral dilemmas to think about, and mapped the areas of the brain that lit up during the experiment.

The similarities between the two articles end there. Where the studiers of beauty went no further than asserting what could rightfully be asserted, that there was a correlation between perceptions of beauty and certain areas of brain activity, the studiers of morality marched right past correlation into causation:  “You have these gut reactions and they feel authoritative, like the voice of God or your conscience.  But these instincts are not commands from a higher power.  They are just emotions hardwired into the brain as we evolved.”  Where the beauty study interacted with centuries of thinkers and thoughts about beauty, the studiers of morality are ready to discredit “that inner voice we’ve listened to for tens of thousands of years.”

Ohlson and the researchers she quotes seem to fall into the reductionism of believing that the brain is “all there is,” that there is nothing above or behind what happens in the brain that causes it to behave as it does. She writes of “morality . . . as a neurological phenomenon,” of the “underlying biology” and the “biological roots of moral choice,” failing to see that there may be something underlying the underlying biology, something that can’t be measured in a scanner. Joshua Greene, one of the morality researchers, asserts that “There is no single moral faculty; there’s just a dynamic interplay between top-down control processes and automatic emotional control in the brain.”

The hubris is almost breathtaking:  the article’s headline reads, “Neuroscience offers new ways to approach such moral questions, allowing logic to triumph over deep-rooted instinct.”

This type of reductionistic, naturalistic, materialistic, mechanistic thinking, with its implied determinism, conveys a stunted view of humanity that will diminish our perception of human dignity if we allow it. As Christians — indeed, as humans — we must resist falling prey to this sort of selective memory which remembers that we are dust, but forgets that we received life from the breath of God.

 

(Postscript:  In all fairness, the two articles that I described were quite different.  The first was a formal scientific study in a scholarly journal, the second an article written by a freelance writer for a popular magazine that has to sell copy to survive.  This fact does not affect my central point, however, which is that the reductionism embodied in the second article — and in so much of the literature surrounding particular fields of research — is false, prevalent, and will diminish our understanding of human dignity if we follow it.)

Beauty and the Brain

 

Part 1 of 2

A close family member of mine is in a rehab hospital, struggling to overcome a brain injury.  This has naturally led me to reflect again on the nature of our brains, the ineffable complexity of this organ that has the consistency of grape jelly, how our brains are related to who we are as humans, what makes a person a person, free will, and the efforts various scientists, philosophers, and ethicists have made to arrive at a conclusion to these questions.  There is a fascinating body of research related to brain function, some of it disquieting (just as it is disquieting to look into our own souls, it can be so to look into our own brains), much of it disappointingly reductionistic.  Too much of the literature surrounding the research draws unwarranted conclusions from the results of experiments, proclaiming triumphantly that “this shows that what we thought were complex and uniquely human functions really turn out to be just the result of these neurons firing in response to those hormones which evolved in response to such-and-such showing that there’s nothing really special about us after all and that free will is an illusion . . .”  Religious devotion, marital fidelity, sexual preferences, altruism — all of these and more have been explained away by unjustifiably materialistic, reductionistic, and usually evolutionary conclusions drawn from observations of brain function.  In the process, human freedom and dignity are maligned.

When I saw this article entitled “Toward a Brain-Based Theory of Beauty,” I thought for sure that I was in store for more of the same triumphant debunking of something — the ability to appreciate beauty — that is unique to humans.  I was pleasantly surprised to find otherwise.  In the study, participants looked at paintings or listened to musical excerpts while lying in a functional MRI scanner.  They were asked to judge each one as “beautiful,” “indifferent,” or “ugly,” and the parts of their brains that lit up with each response were mapped out.  The researchers found that the same part of the cerebral cortex was activated by the perception of both visual and auditory beauty.  In their discussion, the researchers then actually interacted with some philosophical thought on the subject of beauty, before arriving at the conclusion that “Beauty is, for the greater part, some quality in bodies that correlates with activity in the mOFC [a certain part of the brain] by the intervention of the senses.”

Here, it seems to me, is brain research done aright, brain research which respects human dignity.  There are no wild speculations, no debunking, no assumption that “what we’ve observed is the whole story.”  Instead there is humility (“We emphasize that our theory is tentative”), respect for historical human experience and thought outside of science, and the acknowledgement that there is more to beauty than what can be seen with a functional MRI scanner.  This stands in stark contrast to a recent article from Discover magazine with the grandiose title “The End of Morality,” which we will take a look at tomorrow.

The Myth of Crossing Species Boundaries

 

Before beginning this series on Crossing Species Boundaries, I would like to mention my serendipitous oversight in last week’s blog. Due to the hubbub of everyday life, and unlike most weeks, I did not have a chance to read all of my fellow bloggers blogs…

Gary Elkins discussed “Cybrid-gate in the UK,” where he more than adequately articulated the current policies concerning human-animal hybrid research.

Gary’s presentation offers a good look into how some scientists continue doing this research under the radar, while recognizing that researchers can create human-animal hybrids in full accord with the stipulations set forth. I commend this to you for a view of current policy on this issue.

Now for some introductory thoughts:

Throughout history and cultures there has been a strange fascination with this idea of human-animal hybrids. Many of the great ancient writers and poets spoke of such mythical creatures: the Menotaur, Medusa, The Sirens, et al.

In more recent fiction (last 100 years or so) we see the same: The Fly, The Island of Dr. Moreau, and, a more recent film, Splice (I didn’t see it either). These are—of course—just a handful of the myriad examples.

These are depicted as having some kind of command over the rest of mankind.

In the days of old they were god-men—powerful aberrations that incite fear in those who see them. The Sirens, at the sound of their voices, rendered man mad. Medusa’s victims, at her mere sight, would turn to stone.

The Fly evokes a more animal sentiment; the insect, with which the mad scientist crossed, begins to gradually diminish his humanity, much like a metamorphosis. Such is the case with Dr. Moreau’s Beast-folk after his death; they forget his laws and fall prey to their own instincts.

While the ancient mythological writings reflected their religion (or vice versa), it is also important to remember that the pieces of recent fiction were written in a historical-cultural context that reverberated the fears caused by the scientific-medical possibilities at hand.

 

Next week, we will discuss the context that made these fictional fears, so real.

 

 

 

Two Cheers for Transhumanism?

In response to last week’s blog, someone asked about my view of transhumanism and how it relates to Genesis 6: 1-4, the mysterious passage about the ‘sons of God’ and the ‘Nephilim.’  While I claim no expertise in Old Testament interpretation, I am aware that there are several explanations of this passage.  As indicated by one source, the ‘sons of God’ could be angels, or royalty, or simply a reference to pious men (see The Expositor’s Bible Commentary).

Regardless of the identity of the sons of God or the Nephilim, perhaps the key verse to consider is Genesis 6:3, where the Lord declares, “My Spirit will not contend with man forever, for he is mortal…” (Apparently, as a general rule of thumb, the average lifespan will be “a hundred and twenty years”).  In contrast to Scripture, a key tenet of transhumanism is the belief that human mortality may be optional and the only obstacle to immortality is inadequate technology.

As described by Celia DeaneDrummond and Peter Manley Scott in Future Perfect,

“The goal of transhumanism is to download the contents of human consciousness onto a vast computer network and… achieve a kind of disembodied yet intelligent immortality… This will constitute an evolutionary advance… that could lead to immortality – that is, immortal intelligent life in a machine that gets constant back-ups.”

Much could be said about transhumanism’s view of human nature and the advances in technology that give rise to utopian notions of humanity’s future.  But I find it worthy to note that transhumanists share an interest in a theme that is also central to the Christian faith – that our hope is in God’s gift of immortality through Jesus Christ!  As Paul writes, “To those who by persistence in doing good seek glory, honor and immortality, he will give eternal life (Romans 2:7, NIV).”  And again, “For the perishable must clothe itself with the imperishable, and the mortal with immortality.  When the perishable has been clothed with the imperishable, and the mortal with immortality, then the saying that is written will come true: ‘Death has been swallowed up in victory’ (1 Corinthians 15:53).”

Two cheers for transhumanism?  Well, I think transhumanism is correct in observing that our bodies are defective and that immortality would be a good thing to achieve.  However, given that transhumanism’s presuppositions are not in line with Scripture (e.g., their view of human nature, the causes of human imperfection, and the nature of what happens at death), I view the movement as flawed.

*In next week’s blog, I will continue to examine some of the tenets of transhumanism.

Safe Passage

I came across this description of the duties of a physician, from an 1858 lecture to medical students:  diagnosis, treatment, the relief of symptoms, and the provision of safe passage.

The provision of safe passage struck me as a concept we would do well to rehabilitate.  It is an evocative phrase:  protecting and helping someone on a long voyage.  That is generally not how we are taught to think about death in medical school.  Death is failure!  It is a cliff, a precipice to be avoided, rather than a voyage that everyone ultimately has to make.  We have a tendency to approach the precipice in one of three ways:  most often, we try to keep the dying patient from falling over the edge, wrapping them up and pulling them back  from the brink with ventilator hoses and feeding tubes and intravenous drips and every heroically inappropriate medical intervention and test we can conceive of;  or we realize that there’s nothing we can do, so we abandon them;  or, increasingly, in the name of “compassion,” we push them over the edge with physician-assisted suicide.  What a difference it could make if, instead of treating death as a precipice from which we attempt to keep a patient indefinitely, we understood death as a voyage each person will have to make.  What a difference if, instead of being trained to stave off the inevitable at any cost, doctors were trained to recognize — and to help patients recognize — when the voyage is approaching, how to help patients to prepare for it, and how to help them to make it a “safe passage,” a good death for them and their families.