The Imago Dei Has Something to Offer

In their case the god of this world has blinded the minds of the unbelievers, to keep them from seeing the light of the gospel of the glory of Christ, who is the image of God. – 2 Corinthians 4:4

The Rapport sculpture, Reynolds Medical Bldg., TAMHSC

In my two years of involvement in the ethics community at a state medical school, I’ve found that the Christian concept of the imago dei speaks to unaddressed problems in bioethics.  The philosophy of materialism so dominates medical study and practice that descriptions of the individual do not rise much past the biological system that is the body.  Theological and, to a large extent, metaphysical explanations are excluded.  This leaves ideas on ethical behavior merely as encouragement to be nice or to ensure individual choice.

The Bible uses many terms to describe the human being, including nephesh, ruach, lebh, basar, psyche, soma, and sarx.  None of these descriptions falls into a neat, Western, body-soul-spirit framework.  These words instead speak of a richness that extends far beyond any reductionist view of the person.  The doctrine that people are created in the image of God (Gen. 1:27, 9:6) gives us insight into human purpose and ethical behavior toward others.

Last fall, I presented a poster at a symposium and included in it a paragraph on using the imago dei as a basis for a theory of personhood.  A medical researcher nearby left her poster and asked me what data I used to support my conclusions.  I explained that my paper examined the theoretical constructs we use when treating our patients.  It never occurred to her that she had, or might need, a philosophical framework in order to interpret her own data.  Medical practitioners need to recognize the body as one aspect of the whole person formed in a way to reflect God, even to represent Him in the world.  Ultimately, an understanding of our humanity in terms of the imago dei points to the new Adam who in His blameless life was, and is, the image unmarred.

 

On Michael D. West and the Medical Crusade to Defeat Death, Part 2

In last week’s blog, I introduced the topic of Michael D. West’s crusade against human mortality. West’s ardent desire, as he puts it, has long been to  “extract the ‘green essence’ of life, the secret of the immortal renewal of life, to hold it in my hand and to give it to my fellow human being.”

The quest, for West, is, in fact, a matter of moral obligation of such gravity as to trump any concern of “trespassing in a realm in which we humans have no right to go.” Neighbor love, he believes, demands biomedical crusade. As he further states, “Every human being should have not only the right but the passionate duty to reach out with all his or her strength to help others, even if it involves such controversial technology as cloning. If that means playing God, then it is playing God in a good way. I realized that I would do anything to save a human life, short of harming a fellow human.”

 

What key assumptions do you find in West’s defense of the biomedical crusade against death?

What do you think of the criticism that West and others like him are  “playing God” in their pursuit of the “green essence?” Is there a legitimate concern that biomedicine might be encroaching upon divine sovereignty over human life? If so, where is the line to be drawn?

Does the fact that West’s critics generally  value the project of medicine (i.e. human intervention in the course of disease) undermine their use of the “playing God” argument?

 

“Cleaning Up the Population”

 

Recently a disconcerting news event in New Hampshire went relatively unnoticed by the outside world, which–I suppose–is not all that surprising.  A freshman lawmaker, Martin Harty (age 92) resigned his short-lived position as a Representative after forcefully inserting his foot into his mouth.

Harty haphazardly spoke to a constituent, a board member of the Disability Rights Center, espousing the shipment of “defective people to Siberia to freeze.” By “defective people” he meant: “the mentally ill, the retarded, people with physical disabilities and drug addictions.”

Harty said in his own defense, “I was just kidding with her”…

Oops.

The most concerning part about this story was in the fallout. House Speaker William O’Brien nearly dismissed Harty’s comments: “While he has earned the right to say what he thinks, needs to appreciate that, as a representative, he will be held to a higher standard.”

Then, after Harty publicly announced his resignation, O’Brien said: “We both agreed that this is what is best for the House to move forward and focus on critical issues, like balancing our budget without raising taxes and giving voters an opportunity to pass a school funding amendment to ensure local control.”

Don’t get me wrong: We all do dumb things. We all make mistakes.

However, O’Brien made light of a comment that has horrible direct and indirect consequences; consequences that substantiate being considered “critical issues”. His comment cannot be absolved by resignation without being addressed. Discarding any group of people based upon their ability to be a productive part of society is not an idea that should be taken lightly. That mistake has already been made too many times.

For the value of a human life is not derived from the life lived, but instead from the One who has given life.

For the full article on this news topic check out this link.

 

Human Rights and the Significance of Human Dignity

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.

Is it better to be “sorry than safe” or “safe than sorry?”

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.

On Michael D. West and the Medical Crusade to Defeat Death, Part 1

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?

The Philanthropic Principle

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

The Methodist Hospital, Houston, Texas

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.

 

Baptist Medical Centre, Nalerigu, Ghana

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:

The Faile Foundation of the Baptist Medical Centre, Nalerigu, Ghana

Lawndale Christian Health Center, Chicago, IL

Baptist Medical Dental Fellowship

Christian Community Health Fellowship

 

Parental Guidance Before and After Birth

 

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…

 

Although this is not yet in our grasp, Gender selection and disease screening are already a possibility. What if more options become available?

 

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.

 

What do you think?

 

Lessons from the life of Joseph Maraachli

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.

What is it?

In a recent class, I presented the following images to my students:

Baby
Cute Puppy

I then asked the question, “In a fire, whom would you save first, and whom would you save second?”  Of course, the clever response is, “Tell the young woman to grab the baby and the embryo, and take the puppy by the leash while you’re at it.”  But suppose there really was a fire?  And suppose there was an actual “pecking order” where difficult choices had to be made?

Most of the students chose the baby, then the woman, then the embryo, then the puppy.  I agreed with the students to take the baby first although it becomes more complicated if it was someone else’s baby and the young woman was your wife.  But there was surprise when I said I would choose the puppy first before the woman!  Very quickly I added that the “woman” was not a real human, but an android that appeared to be a human.

If the “whom-to-save” decision is based on appearances alone, then perhaps a different pecking order would emerge.  After all, the embryo doesn’t look very significant.  Indeed, it’s difficult to determine that it’s a human.  On the contrary, the human embryo and the baby are both human beings, something even Peter Singer would acknowledge.  So it seems that appearance alone cannot be the deciding factor when making difficult ethical decisions?

My next question was, “What did you base the ‘whom-to-save’ decision on?”  This is where ethical considerations come into play.  Ethical decisions are made every day established on assumptions about the status of early embryos.  It is assumed by many scientists and practitioners in the medical community that the early embryo is not a person and, therefore, it can be destroyed for the purposes of embryonic stem cell research.

So I raise the question, “What is the early embryo?”  And bear in mind, the debate is not about whether it is a human being.