Sleepless in Afghanistan

In the June 22/29 JAMA, Dr. Joshua Alley, a surgeon with the 452nd Combat Support Hospital in Khost, Afghanistan, writes eloquently in an essay entitled “Sleepless” of staying up all night treating an enemy combatant severely wounded in a firefight with US troops.  Despite the fact that this patient “wouldn’t hesitate to slit my throat if he could,” the team of doctors works heroically to save his life.  Dr. Alley asks, “Why do we go to such trouble to treat our enemies?  Automatic action?  a trained response?  fear of bad publicity, echoing Abu Ghraib?  the Geneva Conventions looming over our heads?  some Pollyanna notion that when we nurse him back to health, he’ll fall down sobbing and ask for forgiveness for his actions?  a desire for “actionable intelligence” that he might give our interrogators once he’s off the ventilator and talking?

 

“Maybe some of these thoughts enter my mind, but the reason I went nearly sleepless that night is so that I can sleep all the other nights . . .”

 

He goes on to write, “One mark of a civilized people is our response to wounded enemies.  Cultural refinements like art, music, architecture, and technology don’t make us civilized.  Some of the most barbaric monsters in human history have been avid subscribers of such refinements.  How we relate to our wounded enemies, though, is our moment of truth. . . ‘Do good to those who hate you,’ we read in Matthew’s gospel.  And tonight, I can sleep, because last night I didn’t.”

 

It seems that underlying Dr. Alley’s treatment of this bloodthirsty enemy is a recognition that (even if he doesn’t put it in these words) this person, like all others, is a human being, with the dignity that all human beings — even our enemies — possess, the dignity that merits the best treatment he knows how to offer.

 

I encourage you to read the essay in full, if you can get your hands on a copy of the journal or your institution has online access.  There is powerful truth in what Dr. Alley writes.  Our actions in situations like the one he details do demonstrate what sort of civilization we have, what sort of people we are, what sort of bioethics we espouse, whether we really believe in human dignity, whether we take Jesus’ words seriously.  There are other situations as well that reveal those qualities in us:  for instance, how we treat the poor among us, how we treat the alien, the widow, the defenseless and vulnerable.  As a society, we may do well measured by how we treat our wounded enemies.  But what about the undocumented foreigner who needs basic health care?  Or who is more defenseless and vulnerable than a “disabled” child developing in a womb — or worse, in a Petri dish?  Measured by how we relate to these, we live in the Darkest of Dark Ages, employing a thin veneer of cultural refinements to convince ourselves we are a civilized society.  What an opportunity to be salt and light!  What an opportunity for Christians to make a difference!  (And coincidentally, next week’s CBHD conference will explore the Christian influence in bioethics!  I hope to see you there.)

Politics For the Greatest Good

In yesterday’s post entitled “Ethics and Government–Solomon’s Request,” (if you haven’t read it you should right now) Steve offers a poignant reminder: Being able to discern what is right from what is wrong and implementing those decisions are at the heart of the political life. Ideally, each decision made in the daily grind must be led by wisdom for the whole cause.

I am reminded of Clark Forsythe’s Politics for the Greatest Good: A Case For Prudence in the Public Square. In it he presents a view that moves beyond typical incrementalism and instead promotes prudentialism (a new word–accept it)—making good decisions and implementing them effectively.

He especially directs attention at those who are both religiously driven and politically interested, Forsythe warns, “One of the main temptations of religiously minded, politically involved citizens is letting their zeal race ahead of realism, obstacles, available resources and other constraints.”  After all, “Prudence requires an accurate view of reality and of human nature, both its potential and limits.”

Forsythe calls upon some poignant historical examples of prudential activists—the American founders, Wilberforce, and Lincoln.  He then offers some critical reflection upon Colin Harte’s position in Changing Unjust Laws Justly, which gives him opportunity to further distinguish between compromise and prudence, as well as to further clarify the difference between incrementalism and prudence.  Forsythe’s final section offers practical applications of his view to abortion and other critical issues in biotechnology.

While I would contend that a great deal of his piece boils down to common sense political and public relations, Forsythe’s effort to revive prudence is crucial in the daily grind of political decision-making.

 

Ethics and government – Solomon’s request

Sometimes today ethics is seen as a very personal thing. Autonomy is emphasized and morality is about a person making the best decision for his or her circumstances.  Solomon’s request when God told him to ask for whatever he wanted reminds us that ethics undergirds the ability to govern well.  Solomon’s response to God in 1 Kings 3:9 was “give your servant a discerning heart to govern your people and to distinguish between right and wrong. For who is able to govern this great people of yours?”  He reminds us that governing well is based on being able to discern what is right and wrong (ethics).  If those who govern choose to believe that there are no objective values and that everyone must do as they see best then it will be difficult to govern well.

May God help those who govern to remember that governing well is based on ethics and being able to discern what is right and wrong.

What Can We Do About Death?

The above title introduces a Hastings Center article about the future of healthcare in America.  It raises the question of what can be done in response to disease, aging and death.  Needless to say, our options are limited.  We can endeavor to stay healthy and extend life, we can take risks and face a premature death, we can be victimized by disease, crime or natural disasters, and we can even choose to die.  But disease and death are inevitable.  The question is, what can a society do when its citizens have unrealistic healthcare expectations that simply cannot be met in our current system?  Daniel Callahan (co-founder of The Hastings Center) and Sherwin Nuland (retired clinical Professor of Surgery at the Yale School of Medicine) suggest that it’s time for America to reinvent the healthcare wheel.  That is, it’s time to reconsider how we view life, aging, and death.  In their view, humane healthcare means a greater emphasis on “public health and prevention for the young, and care not cure for the elderly.”  They even suggest the “cut off” age of 80.  Consequently, individuals under 80 should receive greater healthcare priority over individuals 80 and above.

Callahan and Nuland write:

“The real problem is that we have medicine excessively driven by progress, which aims to rid us of death and disease and treats them as the targets of unlimited medical warfare… That warfare, however, has come to look like the trench warfare of WWI: great human and economic cost for little progress. Neither infectious disease nor the chronic diseases of an aging society will soon be cured. Cancer heart disease, stroke and Alzheimer’s disease are our fate for the foreseeable future. Medicine and the public most adapt itself to that reality, one that has mainly brought us lives that end poorly and expensively in old age.”

And:

“We need to change our priorities for the elderly. Death is not the only bad thing that can happen to an elderly person.  An old age marked by disability, economic insecurity, and social isolation are also great evils.” (http://www.thehastingscenter.org/News/Detail.aspx?id=5393)

Their bottom line is to focus more on care for the aged rather than costly state-of-the-art curative care.

I tend to agree with Callahan and Nuland.  There are practical matters (e.g., the costs) that must be taken into consideration as well as quality of life concerns.  The thing that troubles me is to establish a specific cut-off age for prioritizing healthcare allocation.  I know individuals in their 80s who are not aging well, but others in their 80s and 90s who are aging very well.  I don’t know what the final answer is to this dilemma, but I think that healthcare allocation has to be based on a case-by-case basis rather than a specific age.  It’s  more complicated to do it on an individual basis, but an age-specific criterion does not take into account individuals who can experience strong quality of life into their 80s and beyond.

Neuroethics in the Courtroom

Neuroscientist David Eagleman of Baylor College of Medicine has proposed new ways of applying our knowledge of the brain to the judicial system.  He correctly acknowledges that our legal system is based on assumptions of a person’s free will but proposes a new way forward based on the idea that free will is essentially non-existent.  He cites a number of cases that suggest that information regarding a person’s neural circuitry can predict future behavior and indicate what treatment (instead of punishment) if a crime is committed.  Eagleman’s ideas bring up a number of questions:

  • Is there any evidence for “free will” (agency might be a better term) running on top of the circuitry of the brain?
  • If a medical test indicates the likelihood of a person committing a crime, is this grounds for taking legal action?
  • Might one consider the mind to be the interface between the body (brain) and the spirit?
  • We often speak of a person’s “presence” (in a room, on stage, etc.).  Can this be explained by biological processes or does it indicate the existence of something non-material?

 

A Testimony of Grace and the Plasticity of the Brain

I wanted to share an article from Touchstone magazine by Denyse O’Leary, a Toronto-based journalist and author whose writing and perspective I greatly respect.

The link to the article is here:

“There Is a Country for Old Men” by Denyse O’Leary

 

To offer a little context:

During my days of writing and reading radio programs, I wrote a program on a book O’Leary co-authored called The Spiritual Brain.  Christian bioethicists would appreciate the book’s approach. The pervading worldview in neuroscience is materialism. Materialism says that whatever we perceive to be our personality, a spiritual experience, conviction, love, or any type of immaterial sense is just the result of neurons firing in the brain. O’Leary’s book looks at examples from neuroscience that cannot be explained from a materialist perspective, but can be explained if one assumes that people are both material and immaterial (i.e. body and soul; physical and spiritual).

The Spiritual Brain is the type of writing that I am used to reading from O’Leary. She tends to cover hot-button science and culture issues. She will often write about the implications of materialism or Darwinism. Her Touchstone article, “There Is a Country for Old Men,” provides a glimpse of what it means to live those views out. This article is about a ninety-year-old man’s journey back to God after trying to rebuild his brain after a stroke, staving off Alzheimer’s for as long as possible, and facing some long-held guilt from his World War II days.

We never know how God is working in someone’s life, even as they are in the twilight of their lives or in a coma or navigating through the fog of Alzheimer’s. We know so little about how the brain actually works, and to say that someone is as good as dead when he or she is in advanced stages of Alzheimer’s or in a coma is short-sighted. There are still many mysteries about the mind/brain connection and just how plastic the brain is. Mr. O’Leary’s testimony reminds us that no matter what our culture may say about someone’s “usefulness,” or “quality of life” God sees people differently. Neither Mr. O’Leary’s brain nor his spiritual state was nearly as “set” as some may think.

Abortion Prevention

Nigel Cameron wrote that it is important to see elective abortion as a symptom, not the disease.  Because this is true, if Roe v. Wade were overturned tomorrow, and some states started to outlaw abortion, the abortion problem would not end;  because even if Roe v. Wade goes away, all of the reasons that women have abortions will still exist.  What will those of us who call ourselves Pro-Life do to address some of those underlying causes?  What are we doing to address those underlying causes?  (Do we even think about what the underlying causes are?)  What are we doing to promote a social and cultural environment that is less inimical to the raising of and providing for children?  What are we doing to help those who do choose to carry their babies to term, particularly among the poor in whom abortion is so prevalent?  What are we doing to support them in feeding and housing and providing a safe environment and medical care to their children?  (Why are Pro-Lifers so heavily represented among those who are most vocally opposed to health care reform and gun control?)

 

I hope and pray that some day Roe v. Wade is overturned.  But I believe that we as a Christian community must work more energetically to show that being Pro-Life means more than picketing and praying.  At the very least, it means making sacrifices to help women and families with children.  It means getting more involved in the messy lives of those around us.  If we can address some of the reasons so many women feel that abortion is their best or only option, maybe we can go a long way towards accomplishing what we can never accomplish merely by overturning a Supreme Court decision.

 

A Father’s Right?

In American culture it has become a tendency among our citizenry to declare rights into societal recognition. We vehemently proclaim: “I have a right to… [insert important issue here]”! It seems that we have been endowed with this innate presumption that we can declare powers and liberties over things.

These presumed or declared rights, whether rightly founded or not, typically metastasize into something grotesque and mutinous. Growing and growing until they are completely unrecognizable from their origin, which usually has a vague link to one of the “inalienables.”

However, there arises a rare occasion when a citizen chooses to test the boundaries of our acknowledged inalienable rights. This citizen usually becomes the cause, sacrificing life and limb for its noble ends.

Recently such a case came to my attention—well, maybe. A young man, Greg Fultz, thought it to be an exercise of his right to free speech to purchase a billboard ad of himself holding a silhouette of a baby. The baby was his, or would have been anyway:

So, I am left to wonder:

Is Fultz “exercising” his right to free speech?

Or

Is Fultz’s exercise of free speech, concerning the death of his child, harassment and a violation of the privacy of the mother?

And finally, is there any hope for the Father’s Rights argument in a case like this?

 

Bioethics Alumni Update

Ever wonder what alumni from the Trinity bioethics degree program do after Trinity?  Alumni are active in engaging bioethical issues in many different professional fields and in various contexts. Periodically, the Bioethics blog features updates about bioethics alumni and how they are applying their training.

Today’s featured alumni:

Radovan Jakovljevic (MA ’10) serves as parish priest in the Serbian Orthodox Church in Chicago. He is currently working on establishing a bioethics curriculum for his parish to be used as a teaching tool to spread awareness about the important ethical issues in medicine and health care.

Christian Vercler (MA ’07) is currently the chief resident in plastic surgery in the Harvard Plastic Surgery program. He served on hospital ethics committees from 2003 – 2009, and presently mentors several Harvard medical students. He is also active in writing articles for ethics publications. His more recent publications include:

Vercler C., “Neuroethics: mind over matter?” Emory Ethics News and Views. Vol.15, no. 2, Spring  2007.

Vercler C., “Pregnant with thyrotoxicosis—ethical options.”  Today’s Christian Doctor. Vol.39, no. 2, Summer 2008.

Vercler C. “Communicating Errors” in Angelos, Peter (ed.) Ethical Issues in Cancer Patient Care, 2nd ed. Springer Verlag: New York, 2008.

Tapper E, Vercler C, Cruze D, Sexson W. “Ethics consultation at a large urban public teaching hospital.”  Mayo Clinical Proceedings. May 2010; 85(5): 433-8.

Vercler CJ., “Review of Jones JW, McCullough LB, Richman BW. The ethics of surgical practice: cases, dilemmas, and resolutions.”  New York: Oxford University Press, 2008. Ethics & Medicine. 26: 2. 2010.

Vercler CJ. Journal Discusison. “Ethical Issues in Face Transplantation.”  Virtual Mentor: American Medical Association Journal of Ethics. 2010; 12(5):378-382. http://virtualmentor.ama-assn.org/2010/05/jdsc1-1005.html.

Ball CG, Navsaria P, Kirkpatrick AW, Vercler C, et al. “The impact of country and culture on end-of-life care for injured patients: results from an international survey.” Journal of Trauma, 2010; 69(6): 1323-1334.

Are you a Trinity bioethics alumni? Let us know how you are using your bioethics degree by emailing the Alumni Office at [email protected].

 

Why the Church Needs Bioethics

One of the reasons that I became involved in bioethics and pursued the Masters in Bioethics at Trinity was my concern that many people in the church did not seem to understand the moral issues that they faced when dealing with their own medical issues and those of their family.  Abortion was seen as a significant moral issue, but many other important issues were ignored by the church.  My approach to making an impact in the church has been to help students at a Christian university understand bioethics so that they can impact the churches that they will be leading in the future.  John Kilner has added another way of impacting the church by editing the recently published book, Why the Church Needs Bioethics: A Guide to Wise Engagement with Life’s Challenges.

Attached is a flyer describing the new book. 1 Intro Flier

I want to express my thanks to John and all the others involved for providing this resource to help draw the church’s attention to the ethical issues we all face.