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.

A Swedish Social Experiment Gone Awry?

In the “you’ve got to be kidding” department, one taxpayer-funded preschool in Sweden (“Egalia”) is attempting to oppose gender bias by intentionally avoiding specific personal pronouns such as “he,” “him,” “she” and “her.”  The children are no longer “girls” and “boys” but are referred to as “friends.”  This permits little “Johnny” to grow up in a gender-neutral environment, one that does not encourage “him” (or “it”) to pursue things that otherwise little boys like to do.  Indeed, the school’s administration invented a gender-free term – “hen” – to use when referring to someone.  According to Jenny Soffel of the The Associated Press, “every detail has been carefully planned to make sure the children don’t fall into gender stereotypes.”  As one of Egalia’s teachers observes, “Society expects girls to be girlie, nice and pretty and boys to be manly, rough and outgoing.  Egalia gives them a fantastic opportunity to be whoever they want to be.”

The school’s agenda goes beyond the use of gender-specific pronouns.  The report notes that “boys and girls play together with a toy kitchen, waving plastic utensils and pretending to cook… Lego bricks and other building blocks are intentionally placed next to the kitchen, to make sure the children draw no mental barriers between cooking and construction.”  Furthermore, the children have access to reading material that encourages tolerance of gay, lesbian, bisexual and transgender people.  The library includes “a story about two male giraffes who are sad to be childless — until they come across an abandoned crocodile egg.”  Supposedly the favorable response to the crocodile egg demonstrates the giraffes’ willingness to accept other species.  Of course, the story does not include the likelihood that the crocodile may one day have a hankering for some giraffe stew.  However, there are no books that reinforce common stereotypes such as Snow White and Cinderella.

Then again, there is one activity in Sweden that allows for selection based on gender.  Abortion!  According to The Local (Sweden’s News in English), in 2009 one Swedish woman procured an abortion based on the embryo’s gender (it was a girl and she wanted a boy).  The Local reported that Sweden’s National Board of Health and Welfare ruled on the matter and determined that “it is not possible to deny a woman an abortion up to the 18th week of pregnancy, even if the fetus’s gender is the basis for the request.”  This is in a country where being an unborn child is risky at best.  In 2009, there were 11,935 live births compared to 37,524 reported abortions.

Perhaps being a giraffe in Sweden is less dangerous after all!

 

Swedish Preschool Fights Gender Bias, Drops ‘Him’ and ‘Her’

Read more: http://www.foxnews.com/world/2011/06/27/swedish-preschool-fights-gender-bias-drops-him-and-her/#ixzz1QVQLDb4R

 

“Sweden rules ‘gender-based’ abortion legal,” The Local, http://www.thelocal.se/19392/20090512/

 

“Abortion statistics in Sweden,” http://www.johnstonsarchive.net/policy/abortion/ab-sweden.html

On the Matter of Public-Funding for Abortion

 

This past week, I took the opportunity to respond to an editorial column in a local newspaper. In that column, Julian Sereno complained of efforts of legislators present and past to prevent public monies from subsidizing elective abortion. Sereno’s column may be read in its entirety at the following URL:

http://www.thedurhamnews.com/2011/06/15/207203/abortion-opponents-imposing-their.html

 

For those of you looking to hone your critical thinking skills on the anvil of bioethics, I would encourage you to read Sereno’s column, analyze his arguments, and then formulate a response that adheres to a 250-word maximum limit.  Post your response here for the benefit of others and/or for critical interaction.

Once you have completed that task, if you are begging for more work, feel free to critically review my response, which may be accessed at the following URL:

http://www.thedurhamnews.com/2011/06/22/207338/all-legislation-proceeds-from.html

 

I hope you will take this small exercise as an encouragement to engage others in your community on matters bioethic.

Autonomous Robots Autonomous Children

I read an article recently in IEET, a transhumanist journal, about regulating autonomous robots. The author lays out reasons why it is hypocritical to regulate or prohibit the construction of autonomous robots. His initial premise is that we make children all of the time, and for all intents and purposes they are the same thing as autonomous robots:

My suggestion is this: If creating children is morally unproblematic, then so is creating autonomous robots, unless we can identify morally relevant differences between the two acts. But what exactly is the moral issue with creating robots that is avoided when we create human beings? Or, in other words, when we’re talking about autonomous beings, why is the responsibility of the parent seemingly less than the responsibility of an inventor?

He lays out several of the arguments people typically give for why children are different from robots and then proceeds to refute them. He concludes that “[u]ltimately, it could be that there is a defensible moral difference between creating children and autonomous robots. But it is not obvious what that difference is, despite our taking it for granted.”

Robots don’t mature from infant to adult. They don’t bleed. They don’t reproduce. They don’t suffer. Robots are assembled by people, and the only way they can “do” any of these functions is if they are programmed to mimic human beings. They cannot do these things on their own. Children are assembled by a series of hormonal and biological mechanisms, some of which remain a mystery to us today. Parents merely provide the parts; they don’t program children to bleed or suffer or rebel. And while the author makes a distinction that children born through IVF are constructed just as robots are constructed, I would contend that IVF doctors are putting the parts together, but that the child does not grow in the directional process to adulthood until it is put back in the uteral environment where that same set of signals and biological mechanisms can do its work.

Most importantly, human beings are more than the sum of their parts. They have personalities, creativity, and are capable of things that no mechanical object can be capable of without being programmed to mimic human behavior.  Humans suffer, and they hope. Even robots that solve novel problems are programmed to do so. The information and tools to assess a scenario is front-loaded by the programmer, while humans are capable of true creative innovation. To assume the premise that creating children is not morally different from creating a robot presumes a reductionistic and deterministic view of children that does not match with experience and observation. Robots are programmed by their inventor, but anyone who has children knows that while they may take on certain personality traits of their parents, they are most assuredly not “programmed” by their parents (See your nearest toddler).

Even my husband’s Mac which seems slightly autonomous because everything is automatic and it seems to correct its own problems, is not truly autonomous. The only way a Mac would “attack” a human being is if it is programmed to do so, and in that case it still comes down to the evil that men do to one another, the weapons are just smaller, faster, and more complex.

Breaking News: Insurance Coverage Affects Access to Health Care!!

 

Okay, so maybe it’s not breaking news:  the type of insurance you have may affect whether or not you can get in to see a doctor.  In particular, if you have Medicaid-Chidren’s Health Insurance Program (CHIP) insurance (sometimes called “Public Aid”), you might have trouble finding a doctor who will see you.

In a study published in the June 16th New England Journal of Medicine, women posing as mothers of children with common health conditions called 273 pediatric specialist clinics throughout Cook County, Illinois.  They made two calls, one month apart, to each clinic, trying to get appointments for their purported children.  The calls were identical, except that one time the callers said they had Medicaid-CHIP insurance;  the other time, they said they had Blue Cross Blue Shield, a “good” private insurance.  The results are unsurprising but sobering:  66% of the callers reporting Medicaid-CHIP coverage were denied an appointment, compared with 11% of those reporting private insurance coverage.  For those Medicaid-CHIP patients who did get appointments, the average wait for the appointment was 42 days, compared to 20 days for the privately insured.

On the surface, one might attribute these inequalities to a bunch of bad, greedy doctors.  The reality, however, is more complex.  In Illinois, Medicaid-CHIP pays about 20 cents on the dollar (when it finally gets around to paying, which is sometimes six months after the fact).  Because of this, physicians may actually be spending more money than they take in for each Medicaid patient they see.  One can only  do that for so long and still keep the doors open and the lights on.  No, the inequalities do not merely stem from the behaviors of individual, money-hungry doctors;  the inequalities are built into a disastrously flawed system.

I am looking forward greatly to the upcoming CBHD conference examining the “Scandal” of Christian influence on bioethics.  Christians are perceived as being very concerned about issues like abortion, physician-assisted suicide, and embryonic stem cell research, which threaten human dignity by estimating a person’s worth based on their age, appearance, or utility to society.  But it seems that we are perceived as being less concerned about the structural, systemic factors built into our health care “system” which daily lead to insults to human dignity by estimating a person’s worth based on their pre-existing conditions, income, or occupation (i.e., their ability to get insurance).  I wonder, if we Christians really stood out in society because of our concern for the latter as well as for our concern for the former, whether we might not have a greater hearing and make a greater difference in all areas of bioethics.  (Remember Mother Theresa?)

Hope to see you at the Conference!

What Are Your Thoughts?

Blogging is unique because there is potential for open dialogue between writer and reader. To enjoy this unique quality I have decided to do something different than the norm. I would like to offer you an opportunity to respond to one question.

Feel free to use quotes from favorite authors, old papers (the ones you have buried in some deep corner of your thumbdrive), recent papers, or whatever. Try to keep it under 5 sentences… If you are not a fellow blogger on [email protected] please make note (briefly, I might add) of who you are.

Oh yeah, despite my track record, I intend to reply to all comments (if there are any)…

So, here it is:

In medical ethics, is it ever right to take away someone’s autonomy? Cases? Examples?

Cover-ups

Recently I have been reading the account of David’s life in first and second Samuel. Although he had a close relationship with God, David had his ethical failings. Much of his problems started with his adultery with Bathsheba which he tried to cover up when she became pregnant. His first cover-up attempt failed when he called her husband Uriah back from battle, but he refused to spend the night with his wife while his companions were at war. Next he tried to cover it up by having Uriah killed and taking Bathsheba as his wife. The consequences in David’s life and in his family were devastating.

Cover-ups have been a part of the fallen human response to errors and wrongdoing from the garden of Eden to Watergate.

One of the common ethical issues in medicine is how to deal with medical errors. For most of us our first response is to cover it up. Explaining to a patient that an error was made that has had or could have a bad effect is not an easy thing to do, but reading about David reminds us how bad a cover-up can be.

Should Alzheimer’s Patients Have The Right-To-Die?

Erik Parens and Josephine Johnston, two scholars from The Hastings Center, recently wrote an article titled: “As Tests to Predict Alzheimer’s Emerge, So May Debates Over the Right to Die (http://healthland.time.com/2011/06/08/as-tests-better-predict-alzheimers-patients-may-contemplate-their-right-to-die/#ixzz1Pvs2A0mc, June 8, 2011).” They noted that although the persona of Dr. Kevorkian (a.k.a., “Dr. Death”) was less than appealing, “Yet he forced us to confront questions that, much as we might want to, we cannot ignore.” For example, are some outcomes, such as the fate of Alzheimer’s patients, worse than allowing those patients the option to end their lives? If the answer is “yes,” then it may appear rather cruel to deny an Alzheimer patient the right to die. Consequently, the authors observe that “It is vitally important for us to explore all of the reasons against allowing or assisting Alzheimer’s patients to end their lives. And it is equally important to begin to explore the reasons on the other side.”

Furthermore, emerging procedures now make it possible to predict Alzheimer’s in an individual. This raises the stakes considerably because individuals who are currently in their right mind can state in advance a right-to-die preference rather than suffering from Alzheimer’s in the future. Parens and Johnston believe that, “Fear should not keep us from trying to imagine whether we can honor the truly informed requests of people who believe that the way of dying that fits best with their understanding of a good life, is to leave before Alzheimer’s fully takes hold.” Indeed, “we have an ethical obligation to face these questions, in solidarity with the millions of individuals and families who otherwise will have to face them alone.”

I do not think we need to be afraid to ask questions or seek solutions. However, I see a couple of problems, not only with the so-called right-to-die alternative, but also with making this option available to Alzheimer’s patients:

1) First, while it may be possible to predict Alzheimer’s in a person, it isn’t possible to foresee whether the individual will truly suffer from the disease. Currently I have a relative with Alzheimer’s. While some may feel pity for this individual, it is my observation that she is generally in a very positive, albeit diminished, state of mind. In reality, she seems downright giddy most of the time. But suppose she was diagnosed in advance with Alzheimer’s and requested the right to die before the disease took hold? In her current state, would the right-to-die continue to be her actual preference? Would she be locked into a decision that was made when she was in a coherent state of mind?

2) Secondly, it seems that we are facing the “perfect healthcare storm” with aging baby-boomers, a gloomy economy, concerns about healthcare allocation, and the lack of concrete moral direction in the field of medicine. According to the National Institute on Aging, “as many as 2.4 million to 5.1 million Americans have AD. Unless the disease can be effectively treated or prevented, the number of people with AD will increase significantly if current population trends continue. That’s because the risk of AD increases with age, and the U.S. population is aging. The number of people age 65 and older is expected to grow from 39 million in 2008 to 72 million in 2030, and the number of people with AD doubles for every 5-year interval beyond age 65. In the years to come, AD is expected to pose physical and emotional challenges for more and more families and other caregivers, in addition to those with the disease. The growing number of people with AD and the costs associated with the disease also will put a heavy economic burden on society.” http://www.nia.nih.gov/nia.nih.gov/Templates/ADEARCommon/ADEARCommonPage.aspx?NRMODE=Published&NRNODEGUID={2D13AE9A-D6EF-4546-9F02-66D3B3CC1453}&NRORIGINALURL=%2fAlzheimers%2f AlzheimersInformation%2f

It would be my fear that end-of-life decisions would be made for Alzheimer’s patients if it was deemed to be in their best interest.