One of the current students in the MA in Bioethics program at Trinity has also been observing in my medical office the past few months. When there is a lull in the care of patients our conversations often turn to bioethics (while the paperwork on my desk waits a little longer to be attended to). The other day we were talking about the concept of human dignity and whether it was a morally significant concept. We agreed that it was and that we need to be clear that it has to do with the intrinsic worth of human beings. It also needs to be distinguished from the concept of being dignified which is a very different cultural concept with which it is confused.
That discussion made me think about an essay by David Little in the book Prospects for a Common Morality. In his essay Little points to the impact of the rising concept of universal human rights that is changing the face of our global community. He says that “some advocates and defenders of human rights seem to suggest that there are certain moral beliefs and concomitant claims about the world that are universally true and universally justified.” This universally justified understanding of human rights is closely related to the idea that human beings have intrinsic moral value or dignity. The impact this idea is having in global political processes makes it clear how significant this idea really is.
Yesterday I gave an oral exam to a student (who is bound for medical school) in my bioethics course. On a list of unpleasant encounters, oral exams probably rank somewhere close to the top next to “giving a class presentation” and “asking a girl out for the first time.” However, this exam was an enjoyable experience for both of us, I believe. We engaged in friendly dialog about several bioethical issues, but the focus was on the status of preimplanted embryos. He admitted early on that he wasn’t convinced that preimplanted embryos are individual persons deserving moral protection. After all, there is the issue of twinning that may occur during the first 12-14 days (not to mention the amount of fetal loss). How can it be that the fertilized zygote is an individual human being when it could possibly twin before it implants?
Admittedly, the twinning argument appears forceful. Many ethicists (including some professing Christians) agree and contend that human embryonic stem cell (hESC) research is not morally wrong because it does not entail the destruction of individual human persons. Furthermore, it’s better to be “sorry than safe” about the matter i.e., it’s better if we proceed with hESC research and reap the benefits, even if it turns out that we are wrong about the status of early embryos. On the other hand, if we play it safe and forego hESC research, then we’ll be sorry that we missed out on a technology that may revolutionize human health care.
In my initial response, I noted that twinning is a rare phenomenon that we don’t fully understand. Of course, this student wasn’t going to fall for the “it’s all a mystery” reply. But before I tell you how eventually responded, I would like to hear your thoughts. How would you convince this student that the zygote is an individual human being deserving moral protection? Or, perhaps you disagree with this point of view.
This past week I picked up a copy of The Immortal Cell, written by gerontologist Michael D. West, founder of Geron Corporation and, later, CEO of Advanced Cell Technology (ACT). Geron and ACT were quite significant in the early development of human embryonic stem (HES) cell research. In West’s personal account of the history of the field, there is much to grab the reader’s attention, perhaps none more so than the conclusions he reached one afternoon as a young baccalaureate while reflecting upon death. As he recounts (p.30),
“I realized that it was simply not in my nature to accept death or be defeated by it. The call wasn’t even a close one. I could never again resign myself to laying my loved ones down in the grave. It was crystal clear to me what I had to do. I had to defeat death.“
Interestingly, West presents this life-changing experience on the back-end of a discussion of how he came to surrender his belief in man as a special creation to an evolutionary account of human origins. This juxtaposition raises some interesting questions:
Can evolutionary theory truly accommodate West’s intense loathing of human suffering and death? On what account can these be viewed in negative terms if they come part and parcel with the evolutionary process?
Does West’s crusade against death entail the notion that human evolution has somehow reached its pinnacle?
If West et al conquer death, how might human evolution proceed? If people are going to live forever and the resources to support them are finite, then it would seem that the instinct for self-preservation would demand a halt to reproduction. Ironically, a core feature of the evolutionary process – reproductive success – will have to be resisted, or so it seems.
Setting aside the consideration of a campaign against death within an evolutionary paradigm, on what points may Christians agree and disagree with West in his view towards death?
And he called the twelve together and gave them power and authority over all demons and to cure diseases, and he sent them out to proclaim the kingdom of God and to heal. – Luke 9:1-2
As I sit writing this article on the 21st floor of M.D. Anderson’s Pickens Tower, I survey the names that dot the skyline of the Texas Medical Center: St. Luke’s Episcopal Hospital, the Methodist Hospital, Baylor (Baptist) College of Medicine—all philanthropic ventures founded by Christians. Today, their respective denominations are only nominally involved, providing some guidance for chaplaincy programs, some of which include Muslim services. Granted, these medical institutions are now massive, multi-million dollar operations, yet many of their congregations have significant wealth that could be used to provide funding. Obviously, they are plagued by the theological waywardness of their respective churches, but other more traditional churches lack involvement in health care in a similar fashion. In speaking with a pastor of a large Baptist megachurch, I learned that they had stopped investigating opportunities to build a charitable medical clinic because of the fear of lawsuits. Financial and physician resources were at their disposal, but such a ministry was a risk they were not willing to take.
During my year at Trinity in 2008-2009, I made several trips to Lawndale Community Church in downtown Chicago. As many of you know, Lawndale has built an extensive medical clinic for the people of that neighborhood. Though drawing its membership from some of the poorest of people, Lawndale has made it a priority to spread the Gospel through practical programs ranging from sponsoring a pizza parlor to providing medical care. In Christian circles some mention that poorer patients look for opportunities to win cash through lawsuits, but Lawndale views medical outreach as a necessary risk in their pursuit of Christian goals.
Today, unfortunately, we face the trend of Christian groups pulling out of medical care. American Christianity now boasts some of the largest churches ever, with extensive programs and services that include multi-site ventures and online attractions. Few, however, see medical care as a main function of the church. Take the Baptist Medical Centre (BMC) in northern Ghana, for example. BMC, like other Christian hospitals founded by Americans in Africa, is facing the withdrawal of American financial support for its mission. Part of the reasoning behind the separation is to allow Ghanaians to mature in their leadership of such projects. This is certainly a proper goal. However, much of the termination in sponsorship is based on the idea that hospitals siphon off funding that could be better used in programs that are specifically evangelistic. The fact of the matter is that chaplaincies in hospitals provide excellent ways to present the Gospel to people who would avoid any other Christian ministry. The Muslim population is one of the major groups BMC serves, and these people would never enter a Christian building otherwise. The fact of the matter is that pastors (not to mention Christian doctors and nurses) stationed at the hospital have a constant opportunity to communicate the hope and healing of Jesus. No pastor hidden behind church doors here.
Conflict between two philosophies of health care in America has reached a fever pitch. The medical field is marked by a battle between health care based on government oversight versus medical services maintained by profit found in the marketplace. I recommend we reconsider medical care based on philanthropy as a third option. There is great wealth to draw from, and health care is tailor-made to work hand and hand with the Gospel of Jesus.
For more information about Christian philanthropy and medical care, visit these websites:
As I sat sipping coffee and reading articles on the moral implications of genetic interventions in the germ-line (don’t yawn), a perfect picture was painted at the table across from me. A young and boisterous child spoke of his aspirations for the future, vehemently proclaiming to a doubting adult audience, “I want to be a teacher, a singer, a dancer, a hospital man, I want to be everything.”
His ambitions were a bit outlandish.
His father, or who I believed to be his father, responded: “Do you know how you can be all of those things? You can be an actor. This way you can be a teacher one day, and a singer another, and…”
“No, I want to be them all!”– Clearly the aspirations of the father were distinct from that of the son.
Imagine, if you will, that your direct (active) influence on your child could begin before conception. What if you could unify your aspirations before birth? No longer would you have to squelch his dreams as he bellows across Starbucks…
John Harris, recognizing this future possibility in his book Enhancing Evolution, avows an ethical parity in genetic interventions before conception and parental influences after birth. Could this be true? Are encouraging your child to play an instrument and (in some future world) fashioning an embryo to be a world-class musician morally equivalent?
I would say there is a distinct difference between choosing for our children potential traits in embryo and guiding our children along in life. No doubt both influences are according to parental values. However, by choosing traits we are no longer discussing influence in terms of persuasion and direction, we are discussing a new kind of coercion.
If you haven’t read the news reports, Joseph Maraachli is a little boy with Leigh syndrome. The degenerative neurologic disorder left him on a ventilator in a hospital in Ontario. His parents requested that he have a tracheotomy to allow him to be cared for at home like his older sister who had died of the same disorder several years before. Joseph’s physicians and the hospital where he was in Canada did not think the tracheotomy was in his best interest and obtained a court order to remove him from the ventilator to allow him to die. In March he was transferred to a hospital in St. Louis against the wishes of those treating him and on March 21 he had the tracheotomy, described by his physician in St. Louis as a common palliative procedure. Within three weeks he was able to be weaned off the ventilator and was able to return home with his parents on April 21. His life expectancy at that point was about 4 to 6 months.
What can we learn from Joseph’s experience?
It seems that those of us who are physicians sometimes feel that our training and experience allow us to know better than others what is best for our patients. We need to remember to listen to those who know our patients best. Sometimes parents really do know what is best for their child.
It also seems that when people disagree on what is best it is better to err on the side of life.
Recently, the Chicago Tribune reported the C-section delivery of Finnean Lee Connell on February 11, 2011 to 61-year-old Kristine Casey. Not only is Ms. Casey the oldest women on record in Illinois to bear a child, she also appears to be the state’s first parturient “grandmother.” Through the wonders of assisted reproductive technology, Ms. Casey’s uterus was recalled from post-menopausal retirement to incubate the child that her daughter, Sara Connell, and husband Bill had conceived via in vitro fertilization.
Commenting on the birth, Casey’s obstetrician, Dr. Susan Gerber, stated “the surgery itself was uncomplicated, and the emotional context of this delivery was so profound.” Indeed, it was for Ms. Casey, the fulfillment of a “deeper calling” that emerged as she contemplated her post-retirement years and her daughter’s protracted struggle to bear children. Of the whole experience, her daughter remarked, “It grew beyond the two of us having a child,. . . It was about the closeness with my mother, and our family having this experience that was unique and special.”
Also contained in the Tribune report was the analysis of Josephine Johnston, a research scholar at the Hastings Center, who reportedly “had no ethical objections to the idea of a 61-year-old having a baby, as long as she had undergone a thorough medical and psychological evaluation.” For Johnston, Ms. Casey’s surrogacy “seem[ed] like an unquestionably loving and generous thing for a family member to do . . . It’s a great story to tell the child . . . It’s one of those situations where outsiders might wonder if it’s OK or healthy. But the experience of that child and his family will be that it’s good. … If they treat it as good, it will be experienced that way.”
Your comments? Do you think Johnston has it right? Will this be “a great story” for Finnean and his family? Why might others “wonder if it’s OK or healthy?” Has Johnson passed over some important ethical concerns?
This past fall, I had the privilege of attending the Houston Symphony’s production of
Kaddish. The Kaddish Project seeks to commemorate the noble struggle of individual Holocaust survivors, including four who have made their homes in Houston. Much of my research at Trinity focused on the concept of personhood, that we are more than just biological systems but instead are “someones,” persons. I couldn’t help but think of this as I heard the chorus sing the song of the persecuted Jews: I am someone and “I am here.” Though mocked and beaten in the streets even in the days before World War II, the Jewish people of Europe taught their children that they were of value even though others thought otherwise. The soloists and chorus related the story of one survivor’s recollection of a concentration camp. When the prisoners arrived, those under 14 years of age and over 65 were separated to the left and killed. They were less than optimal for the German labor camp, so they were eliminated. Kaddish led me to reflect on how physicians were a significant part of the German “Final Solution.” They were the ones who deemed the crippled and deformed, the mentally deranged and deficient economic burdens. That’s why I think that as we look for disease and perform technical procedures, it’s important for us to remember that our patients are someones who we must relate to and care for.
In a recent British court case the mother of a 21-year-old woman who was pregnant with her second child asked that doctors perform a sterilization procedure at the time of her planned C-section. The woman has a mental disability and the court is being asked to determine if she is capable of making her own decision regarding sterilization. If it is determined that she is not, her mother is asking for permission for her doctors to sterilize her. The mother says that this would be in her daughter’s best interest due to her inability to care for further children and the likelihood that she would be separated from those children.
This request raises the concern that sterilization of those who had a mental disability was what the eugenics movement of the early 20th century proposed. That attempt to rid society of those who were not desired by preventing their birth showed disrespect for the intrinsic human worth of those with a disability. However, there is a big difference between sterilizing someone in order to decrease the burden on society and doing so because it is in the best interest of the person with the disability. The mother says she desires her daughter to be sterilized for the daughter’s benefit.
The moral difference between the eugenics movement and this mother’s request is one of intent. To sterilize a person who lacks capability to make her own decisions with the sole intent of limiting the number of potentially mentally disabled offspring in society is wrong. To sterilize a person who lacks capability to make her own decisions with the intent of doing what is in her best interest may be right thing to do. If the mother’s intent is not actually her daughter’s best interest, but her own, then it may not be right.
Even though the acts may be the same and the consequences may be the same, intent is the deciding factor in this moral decision.