Love and Respect

A fellow family physician who cares for people at a clinic in Central America wrote about the death of one of her long-time patients in an e-mail last week.  The woman came to the clinic barely able to breathe and with her heart failing.  As they tried to stabilize her to take her to a hospital for further care, she knew that she was dying and requested not to be taken there.  She said “I want to die here, with the people who loved and respected me, my clinic.”

She expressed the understanding that there are some things that are more important than having the ability to treat diseases effectively and extend people’s lives.  We should strive to provide high quality, effective medical treatment, but caring for people is more than that.  It includes loving them and showing them respect as sisters and brothers in the human family.

All of our patients eventually die.  When they do will they know that they were loved and respected by us as we cared for them?

Liberal Politics and the Failure of “Neutrality”

In America, liberal political philosophy has been the dominant political influence in almost every arena of public life including bioethics.  Liberal politics promotes the principle of “neutrality,” the notion that, in pluralistic societies (i.e., societies where there is widespread and deep disagreement about basic questions of morality), laws and policies should not support any particular vision of what is good.  This minimalist view of morality limits or dismisses any appeal to specific religions justification when making bioethical decisions.  Consequently, the suggestion of grounding ethical reflection on a particular belief system is deemed a bad idea because it favors one particular moral perspective over other perspectives.  The main concern of politically liberal society is to ensure social cooperation between diverse members of a society.

This creates an inevitable demarcation between public policies and private convictions.  Thus, anyone with religious convictions must maintain those principles in his or her own private sphere; public expressions of private beliefs are not welcome in the liberal society.  Unfortunately, liberal political philosophy’s principle of neutrality does not provide a way to settle ethical questions.  On the one hand, there is a crying need for moral direction; on the other hand, moral guidance from a religious perspective isn’t welcome.  Accordingly, we have medical questions that require resolution but, by reason of political liberalism’s support of neutrality, there is no particular point of view that can become the standard in bioethical matters.  The negative consequence of neutrality is an inevitable deadlock; medical ethical decisions have to be made but our laws and policies lack any defining understanding of what is good.  Yet in order for a society to function, it must devise some means to achieve a common ground.  It is thus a question as to how a pluralistic and polarized society should proceed in the absence of a moral consensus.

I honestly see no workable solutions to this predicament.  How do you think things will unfold in the coming years?

Confession of a Eugenicist


I have a confession to make:  I am a eugenicist.


I am a family physician who provides obstetrical care.  I love taking care of moms and babies.

It has insidiously become the Standard of Care to offer to all pregnant women testing that will inform them whether there is an increased risk that their unborn children have certain genetic abnormalities or birth defects.  If I do not offer these tests to all pregnant women, I am considered to have provided substandard care, and the wrath of a society that tolerates Nothing But The Best will descend quickly upon me.  If I do offer these tests, I am practicing “Good Medicine” — and eugenics.


How did eugenics become Good Medicine again?


I don’t want to practice eugenics.  Yet I am compelled to by the Standard of Care;  and the Standard of Care is shaped by the existence and marketing of these tests.  It’s the old story in our technophilic society:  we are constrained to use a technology merely because the technnology exists.


Why were such tests even developed in the first place?  Was it only for diagnostic purposes,  simply to provide information to prospective parents?  Of course not.  Clearly these tests were developed to help guide therapy;  and because the primary “therapeutic” option is induced abortion of fetuses who are not up to snuff, it seems equally clear that eugenic considerations drove their development.  So, the eugenic ideal drives development of eugenic technology, which, marketed and disseminated, drives the Standard of Care, which drives what I do in my office and provides the ammunition for the licensing board — and malpractice lawyers — who are looking over my shoulder.


Thus am I an unwilling eugenicist.  Thus am I compelled to do the dirty work for the eugenicists of our society.

(This is not to say that all parents who opt to undergo this testing do so for eugenic purposes.  I realize that some do so solely for diagnosis.  I am writing here about the development and mandatory offering of such tests.)


Maybe the time has come for a new  medical association.  Instead of the AMA, perhaps we should inaugurate the HMA:  the Hippocratic Medical Association, the members of which will adhere to a different Standard, who will pledge to uphold the ideals behind the Hippocratic Oath.  The members of this association would return to the ethos of that Oath which, according to anthropologist Margaret Mead,  marked one of the great turning-points in the history of the human race, because, “For the first time in our tradition, there was a complete separation between killing and curing . . . One profession . . were to be dedicated completely to life under all circumstances, regardless of rank, age, or intellect–the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child . . .”


The Human Factory

I am sure many of you “foodies” have heard of the less than appetizing ingredient added to the long menu of strange “eats”—human breast milk. For those of you who are less than food savvy: do not fret, the milk you have been buying is likely from a cow (but I would still check the label).

This may seem to be a relatively obscure fact and even completely unrelated to the world of bioethics. However, you may think differently after reading the following article:

For those of you who do not have the time or the interest to read this article…

Miriam Simun created a temporary art installation called the Lady Cheese Shop, which produces breast milk cheese, in hopes to make people think about the various ways human bodies are used as factories “producing blood, hair, sperm, eggs and organs that can all be harvested to be used by others.”

Can you think of any reason why human blood transfusions are generally accepted and human breast milk products “raise eyebrows”?

Treatment of HIV-infected Individuals to Prevent Transmission

The interim results of the HPTN 052 study released last week indicate that treating HIV-infected individuals dramatically reduces the likelihood that they will transmit the virus to their sexual partners.  This study of HIV-positive patients whose heterosexual partners were HIV-negative and whose disease was at a stage at which treatment would be considered optional showed a dramatic decrease in transmission to their sexual partners for those treated immediately and was stopped early due to the results.

This study raises some interesting ethical questions.

Are HIV-positive persons who have an unaffected partner now obligated to undergo treatment even if there is not evidence that the benefit of the treatment outweighs the adverse effects for the individual?

If treatment of infected persons is an effective means of preventing the spread of HIV, how aggressive should those responsible for public health be in seeking to identify and treat those with HIV?

What should be done in countries with a high level of HIV that already cannot afford antiretroviral treatment for the more severely affected?  If treatment of all infected people would dramatically reduce the incidence of new cases in those countries where do we get the resources to provide that treatment?

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”…


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.