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.”


“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?


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:



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:



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.