Abortion, at any time, for any reason?

By Mark McQuain

Last week, Virginia delegate Kathy Tran introduced a bill to eliminate some current restrictions on late term abortions in the Commonwealth. During the committee hearing on the bill, she answered a question by one of the other committee members to the effect that her bill would permit a third trimester abortion up to and including the point of birth. That exchange may be heard here. She later “walked back” that particular comment as outlined here. Virginia Governor Ralph Northam, who is a pediatric neurologist by training, added his comments to the discussion on a call-in WTOP radio show, where he implied that the bill would additionally permit parent(s) and physician(s) to terminate the life of a “severely deformed”, “non-viable” infant after the birth of the infant, which may be heard here (the entire 50+ minute WTPO interview may be heard here). That particular bill is currently tabled (the actual bill may be read here).

These events deserve far more reflection and discussion than can be afforded in the small space of this blog. I want to discuss two comments by Governor Northam and then comment on expanding abortion to include the extreme limit of birth.

First, during his radio interview, the Governor added qualifiers to the status of the infant that are not only not in the bill submitted by Delegate Tran, they are specifically contrary to it. Section 18.2-74(c) of the Code of Virginia is amended by Tran’s House Bill No. 2491 to read ([w]hen abortion or termination of pregnancy lawful after second trimester of pregnancy):

“Measures for life support for the product of such abortion or miscarriage must shall be available and utilized if there is any clearly visible evidence of viability. “(markup/emphasis in the bill)

To be generous to the Governor, it is unclear why he qualified his comments the way he did, given that the bill is explicitly discussing a potentially viable infant. Options include that the Governor was simply ignorant of the specifics of Tran’s Bill (possibly), was actually purposefully advocating for infanticide (unlikely), or wanted to defend the loosening of restrictions on very late term abortions, clearly intended by her bill, by introducing at least one conditional situation that a number of people might initially consider reasonable (most likely). The firestorm caused by his so-called “post-birth-abortion” comment completely obscured any attention to the equally tragic portion of Tran’s Bill that eliminates a huge portion of the Code of Virginia section 18.2-76, which currently requires a much more specific informed consent process, inclusive of a pre-abortion fetal ultrasound to attempt to educate the woman on the nature of the human being she is desiring to abort.

The second comment by Governor Northam was made parenthetically while expressing his opinion that the abortion decision should be kept between a physician and the pregnant woman, and out of the hands of the legislature, “who are mostly men”. Does this imply all men be excluded from the abortion discussion or just male legislators? Should male obstetricians likewise be excluded from this discussion? Following the Governor’s comment to its logical conclusion, shouldn’t he refrain from similar comments/opinions regarding abortion since he is also a man? This is absurd. Representative government specifically, and civil discourse more generally, is not possible if ideas cannot be debated unless the particular people involved in the debate are all the same sex, same race, same ethnicity, same height, same weight, same age, etc…

Aborting a healthy, viable baby just prior to, or, at the very moment of, birth seems to me to be the least likely example of the type of abortion that anyone on the pro-choice side of the abortion debate would use to make the case that abortion is a good and necessary right. Presently, immediately after birth, the baby (finally) has the protection as a person under the Fourteenth Amendment. Eerily, as I have shared in this blog before, almost identical concepts were discussed during the 1972 oral arguments of Roe v. Wade, such as the following exchange between Justice Potter Stewart and attorney Sarah Weddington, who represented Roe. (see LINK for transcript or audio of the second reargument Oct 11, 1972, approximately one-third of the way through):

Potter Stewart: Well, if it were established that an unborn fetus is a person within the protection of the Fourteenth Amendment, you would have almost an impossible case here, would you not?

Sarah R. Weddington: I would have a very difficult case. [Laughter]

Potter Stewart: You certainly would because you’d have the same kind of thing you’d have to say that this would be the equivalent to after the child was born.

Sarah R. Weddington That’s right.

Potter Stewart: If the mother thought that it bothered her health having the child around, she could have it killed. Isn’t that correct?

Sarah R. Weddington: That’s correct.

I am one blogger who is praying that Governor Northam’s “post-birth-abortion” misunderstanding of Delegate Kathy Tran’s Bill liberalizing abortions through the end of the third trimester never causes Justice Potter’s 1972 infanticide equivalent to become a reality.

Gender & Pain

By Neil Skjoldal

Last week, The Washington Post  published a summary of a recent article in the Journal of Pediatric Psychology entitled “Gender Bias in Pediatric Pain Assessment.”

The participants of the study were shown a video with a child described as a girl or boy enduring pain.  The authors  “then asked adults to rate how much pain the child experienced and displayed, how typical the child was in these respects, and how much they agreed with explicit gender stereotypes concerning pain response in boys versus girls.”  The study found that “the ‘boy’ was rated as experiencing more pain than the ‘girl’ despite identical clinical circumstances and identical pain behavior across conditions.”

Isaac Stanley-Becker, the author of The Post’s article, noted that the authors of this study were surprised that “the downgrading of female pain was driven by female participants, who were more likely than men to say that the pain of the subject was less severe when told she was a girl.”  Stanley-Becker further notes that these results are similar to an earlier study with female nursing and psychology students as participants, suggesting that there is “crossover to the health-care profession.”

It might be difficult for some to imagine anyone purposefully reacting to children’s pain in this way. However, in treating patients in a manner which honors their dignity as humans, it is good to be aware of any possible biases that may exist.  It appears that future research will continue to examine these matters.

Gene-editing public discussions: looking ahead

By Jon Holmlund

Passing along word that the National Academies of Medicine and Science are planning an international commission on human gene editing, the editorial board of the New York Times has issued a welcome call to make the public discussion of the issues as broad as possible.  Read the whole thing, but this key graph is particularly important (emphases mine):

“As gene-editing technology advances toward the clinic, scientists will need to do more than listen to the concerns of bioethicists, legal scholars and social scientists. They will have to let these other voices help set priorities — decide what questions and issues need to be resolved — before theory becomes practice. That may mean allowing questions over societal risks and benefits to trump ones about scientific feasibility.”

See the 29 March 2018 post on this blog regarding two calls—the Times linked to one, and quoted from the author of the other—for broader discourse.  This discourse is urgently needed, but must go beyond risk-benefit discussions to the broader meaning of, and issues raised by, heritable human gene editing in particular.  (Somatic human gene editing, to treat a known disease in an existing individual in a way that cannot be passed on to the next generation, is less troublesome ethically, except insofar as it enables the heritable version of gene editing.)

The challenges to effective public deliberation of heritable human gene editing are formidable: getting truly wide participation; getting the scientists to inform and educate non-scientists without trying to lead them to a set of preferred conclusions; engaging the developing, as well as the developed, world; obtaining “religious input” that is more than token; and sustaining the conversation as long as necessary to hold attention in our short-attention world.

It seems that to execute on that will take a pretty large group of dedicated people engaged in a focused, full-time effort to make it happen.  Existing science and ethics groups, like the National Academies, may be the default nominees, but it also seems like a broader group of facilitating entities is needed.  The “global observatory” mentioned by the Times editorial would, as proposed, be established by an “international network of scholars and organizations…dedicated to gathering information from dispersed sources, bringing to the fore perspectives that are often overlooked, and promoting exchange across disciplinary and cultural divides.”

Hear, hear.  One hopes that this happens—and that individuals can find a way to help make it happen.  Spread the word—people should be encouraged to set aside time, energy, and mental space to consider this revolution for the human race.

Revisiting the definition of death

By Jon Holmlund

The Hastings Center shows Christmas Day 2018 as the date of publication of its report, “Defining Death: Organ Transplantation and the Fifty-Year Legacy of the Harvard Report on Brain Death,” arising from a 2018 conference of the same title at Harvard Medical School.  The full contents are freely available at the link above.  The occasion for the conference was the 50th anniversary of the 1968 report that defined brain death as one way to determine, alongside the more traditional use of cessation of the heartbeat and breathing, whether a person had died.  Report contributor Robert Truog puts it this way: brain death can be thought of as “permanent apneic [absence of breathing] unconsciousness.”

Subsequent to the 1968 report, the Uniform Determination of Death Act, formulated in 1981, stated that a human has died if there is either irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem.

Initially, according to one retrospective, the 1968 report was motivated mostly by a desire to determine when intensive medical care of a comatose person could be stopped and still be consistent with the aims of medicine, and, indeed, avoid a murder charge.  Nowadays, we often associate the use of the brain death criteria with the decision to harvest the decedent’s organs for transplantation, but that is said to have been a secondary concern in 1968, probably reflecting the state of organ transplantation at the time, as opposed to after the ensuing 50 years of development.

One reviewer in the report worries that concern about the use of brain death criteria has become “too philosophical,” as it were; the 1968 conferees were not trying to define death analytically, but prudentially, to guide the practice of medicine.  So contemporary critics shouldn’t be too harsh in their hindsight.  However, Robert Veatch counters that to ask whether the brain has irreversibly stopped functioning is not the same as to ask whether we should treat individuals with dead brains and beating hearts as dead humans.  He further comments that, since the brain also acts in some sense as a gland, secreting hormones, the current ways of determining brain death may not take that into account.  He identifies three broad approaches to defining death:  circulatory/somatic, whole-brain, and higher brain.  He lists at least six current significant disputes about brain death: whether patients and families should have the right to refuse treatment; which criteria to use to determine brain death; whether those criteria actually assess all the functions of the brain; whether doctors apply the criteria accurately and consistently, without excessive error; whether brain death as currently determined is truly irreversible; and whether whole-brain criteria should be favored over criteria around blood circulation or criteria that focus, more narrowly than whole-brain death, on higher-brain functions including loss of consciousness and associated loss of integrated function of body and mind.

Sections of the new report include essays reviewing and offering a contemporary critique of the concept of brain death, a discussion of whether “donation after [brief] circulatory determination of death” (DCDD) is an acceptable approach to obtaining vital organs for transplantation, whether the “dead donor rule”—briefly, the idea that one’s organs should not be removed from one’s body for transplantation into another person until that one (the proposed donor) has died—should be followed, using brain death to inform law and public policy, the future of xenotransplantation (specifically, transplanting animal organs into humans, known as xenotransplantation), and reflections on the case of Jahi McMath, the girl who was declared brain dead in 2013 after complications of a tonsillectomy, but whose body was subsequently kept alive at her parent’s behest until bodily functions finally failed to the point where she was declared dead to the agreement of all concerned in mid-2018.

There is much to consider here—particularly alongside the 2008 report, “Controversies in the Determination of Death” by the then-President’s Council on Bioethics.  Candor requires that your correspondent has in the past argued on this blog for the dead donor rule and has expressed concern about potential overzealous use of the “DCDD” approach by transplant surgeons in a hurry to procure organs for transplant to a needy, waiting recipient.  But a revisiting of the matter is in order, and a matter for future posts.  In the meantime, the cited reports are readily available on the internet for review by all interested parties.

Self-Awareness, Personhood and Death

By Mark McQuain

Many philosophers argue that attaining the threshold of self-awareness is more valuable in determining a human’s right-to-life than simply being a living member of the human race. They require a human being attain self-awareness (reaching so-called full “personhood”) before granting unrestricted right-to-life for that particular human being. Lacking observable self-awareness relegates one to non-personhood status, and, though fully human, potentially restricted right-to-life status. The philosophic argument seems to be that only self-aware things suffer harm, or at least, do so to a more meaningfully significant degree than non-self-aware things.

Consider the following thought experiment. I finally designed a computer with sufficient complexity, memory, external sensors and computational power (or whatever) that, at some point subsequent to turning the power on, it becomes self-aware. The memory is volatile, meaning that the memory cannot hold its contents without power. The self-awareness, and any memory of that self-awareness, exists only so long as the power remains on. If subsequently powered off and then powered on again, the computer has no prior memory of being self-aware (because the memory is volatile and is completely erased and unrecoverable with loss of power) so becomes newly self-aware, with new external sensory input and new memory history. The longer the power remains on during any such power cycle, the more memory or history of its current self-awareness the computer accumulates. The computer’s hardware is bulletproof and is essentially unaffected by applying or disconnecting the power.

In this thought experiment, do the acts of turning the computer’s power on, allowing the computer to become self-aware, and then turning the power off harm anything?

By stipulation of the thought experiment, the computer’s hardware is unaffected by these events so no harm has occurred to the physical computer. Also, by stipulation, subsequently turning the computer’s power on again results in the computer becoming newly self-aware, with absolutely no memory of its previous period of self-awareness. The prior self-awareness is neither presently aware nor even in existence – it existed only during the prior power cycle. Perhaps as the designer, I may be harmed if I miss interacting with the computer as it was during its first self-awareness. The same perhaps goes for any other similar self-aware computer that had constant power during the experiment and witnessed the power cycling of the first computer.

But, what about the first computer? Was that computer harmed when I turned the power off? If so, what, exactly, was harmed? Following power-off, the computer has no self-awareness to be self-aware of any harm. The self-awareness no longer exists and that same self-awareness cannot exist in the future. Non-existent things cannot be harmed. Looking for some measure of group harm by assessing any harm experienced by other self-aware computers witnessing the event appears to be a problem of infinite regress (“It’s turtles all the way down”), as their self-awareness of the first computer’s self-awareness is also transient and becomes instantly non-existent when they power off. We will ignore the designer for the purpose of this experiment.

Assume now that the initial computer is a human brain. Some consider the physical brain a single-power-cycle, self-aware computer. For most humans, at some point after conception, we become self-aware, though philosophers disagree and cannot define the exact threshold for self-awareness. We can lose that self-awareness to physical brain injury or disease. Most believe the self-awareness certainly ceases with physical death, that is, it is volatile like the self-aware computer in my thought experiment, since, after death, there is no longer a functioning physical brain to sustain that self-awareness.

But if the thought experiment holds, requiring human beings the threshold of self-awareness before granting so-called personhood privileges such as unrestricted right-to-life is a meaningless threshold with regard to harm if that self-awareness is volatile and therefore not sustained in some manner after death. For self-awareness to be the determinant of harm in a living being, it must be non-volitile, meaning it sustains beyond death. However, if the self-awareness is sustained after death, then it is sustained in a non-physical manner (since the physical brain is obviously dead by definition of death). If self-awareness exists non-physically, might it also exist more fully than we can appreciate in a premature, a diseased, or an injured human brain prior to death?

Facebook & Ethics

Most of us probably know that Facebook keeps track of its users.  Its programmers have created algorithms that can guess our preferences in all sorts of areas, even in politics.  Most of us probably also know that Facebook has come under scrutiny for its actions (or non-actions) during the previous election cycle. Its founder, Mark Zuckerberg, has made appearances before Congress in order to try to explain his company’s behavior.  At first he denied there was any problem, and then as evidence mounted, he began to acknowledge that Facebook should have done better in exercising oversight.

Recently, both The New York Times and The Washington Post have reported on Facebook’s approach to mental health, specifically as it relates to its users’ potential risk of committing suicide.  Facebook programmers have created algorithms that have been used to monitor its users for potential suicide risks.  In some situations, they have called authorities in order to address users whose online postings made them seem like they were in immediate danger.

Understandably, Facebook has resisted regulation.  With a motto like “Move fast and break things,” it is easy to comprehend why it would not want any regulatory activity at all.  However, mental health is a serious matter and the suicide rate in the United States is alarmingly high.  This seems to be qualitatively different than Facebook knowing what kind of vacations I prefer or what kind of automobile I drive.

In his Washington Post op-ed, attorney Mason Marks writes:” Facebook is losing the trust of consumers and governments around the world, and if it mismanages suicide predictions, that trend could spiral out of control. Perhaps its predictions are accurate and effective. In that case, it has no reason to hide the algorithms from the medical community, which is also working hard to accurately predict suicide. Yes, the companies have a financial interest in protecting their intellectual property. But in a case as sensitive as suicide prediction, protecting your IP should not outweigh the public good that could be gained through transparency.”

There are several ethical issues at play here.  Do Facebook users have any idea of what the company is doing with their information?  Can a non-medical company be involved in the “practice of medicine” (Marks’ term) without any meaningful regulation?  What should Facebook be allowed to do with the very personal mental health information that it gathers from its users?

Every generation wrestles with doing ethics in light of rapidly developing technology. In 2019 that conversation continues at even a quicker speed.

Cyborg Society

By Mark McQuain

A cybernetic organism, or cyborg, is an organism that is part human and part machine. My favorite TV show in the mid 1970’s was “Six Million Dollar Man”, the story of an injured test pilot who lost both of his legs, his right arm and his left eye. His doctors made him “better than he was” by replacing his injured limbs and eye with artificial parts that actually enhanced his functional ability. Technology in the 1970’s was completely inadequate to accomplish those tasks and even now still lags far behind that TV show.

Perhaps the closest that any single person has come to becoming a cyborg is Steven Mann, an electrical engineering professor at the University of Toronto who, beginning in the 1980’s, literally began attaching various computers and cameras to his body and wearing them regularly to the point where, he argued, the equipment became part of him and he felt somewhat “unplugged” if he wasn’t wearing his equipment. The early equipment was so bulky, that in retrospect, he looked frankly ridiculous. As computers advanced, it became more difficult to recognize the equipment. The following photo shows that progression.

Steven Mann

Now most of the rest of us do not imagine that we are anything like Professor Mann. But I think we are more like him than we realize. Consider this – how many of you have a sense of disconnected-ness if you can’t find your smartphone? I would argue that most of us feel “unplugged” when we are without our phones. That certainly seems to be the case with anyone younger than 30. Your calendar, to-do lists, contact information, credit cards, airline or movie tickets are all stored on your phone. In that sense, part of your identity is in your phone. My wife and I joke that our children would not regularly communicate with us absent the ability to text.

Issues of faulty child-rearing aside, my point is not just our dependence on technology, and not just the nearness and intimacy of that technology. We have become dependent upon other artificial tools and parts such as walkers, hearing aides, prosthetics, pacemakers and insulin pumps, which are not just intimate but, in some cases, actually vital. But none of those machines affects our thinking or changes how we interact with one another.

Consider two new exercise systems popular this Christmas – Peloton and the Mirror (Disclaimer – I am not encouraging another Christmas gift). Both use smartphone technology to augment the exercise experience, allowing an individual to access what appears to be unlimited options in coaches, resources and locations. Notice the ads. They seem to elegantly emphasize both virtual community and individual physical isolation. And, while this technology is not cybernetically attached to us (yet), it, like the smartphone technology upon which it is based, appears to be detaching us from one another.

From a bioethics standpoint, I wonder whether, in augmenting our reality via our cyborg progression, we aren’t also becoming isolated from that reality as we become more dependent on the very technology we use to connect with one another.

Will a cyborg society make us more or less connected within that society?

#HappyNewYear

Gene-Edited Animals as Trailblazers

By Jon Holmlund

 

The Chinese researcher who says he edited the genes of two recently-born twin girls is named He.  He’s not a deity, that’s just his name.  (I don’t think it’s pronounced with a long “e,” by the way.)  His motivation appears to have been to be the first, to show that He could really do it. 

While scorn is mostly being heaped on He, this work has been going on in livestock for a long time, in attempts to make animals with leaner meat, or more meat, or ones that are disease-resistant, or more tolerant to hot or cold weather, or ones that have softer or more durable fur for shearing and making into cloth.  Or, cattle could be altered so they don’t have horns, and don’t have to be dehorned after birth.

Proponents consider this work to be just like crossbreeding, only a lot faster.  That’s an oversimplification, of course, since cross-breeding follows naturally occurring processes of genetic modification, not the synthetic editing of specific genes, but for the moment that’s beside the point.  The agriculture industry is keenly interested in it—the potential could be large.  Some governments want to push it.  Which ones?  You guessed it—China—but also the US, as part of the current administration’s efforts to reduce regulation and foster innovation.

Reportedly, some of these animals’ meat has been tested, and found safe.  (No claim, yet, that it’s delicious.)  But nothing commercial, at least not yet in the U.S.

One problem, though:  the animals have unpredicted other abnormalities.  Some pigs edited to be meatier also had an extra vertebra in their spines.  Some rabbits similarly edited had unusually large tongues.  And the edited animals often don’t make it to live birth, or even implant into adult females to cause pregnancy.  The process sometimes uses cloning to create the animal embryos in the first place, and it’s speculated that the cloning process, not the specific gene editing, is causing the problems with pregnancy.  But that’s not for certain.

In recent decades there has been a hue and cry over the safety of genetically modified plant foods, but they appear to be safe for human consumption, and they don’t fundamentally alter the biosphere.  The meat or milk or fur of genetically engineered animals would seem likely to be safe for human use, also, and if the animals really are created just for human use, some bizarre deformities may not be so objectionable.

Of course, that prompts questions of animal use and welfare that require more than a short blog post.  But in the case of humans, we would anticipate living with and caring for gene-edited offspring.  We would not be producing them solely for use or consumption.  Or would we—for example, for organs to transplant?  Probably not.

Proponents of limiting the use of artificial human reproductive techniques sometimes argue that it is good for children to be received as gifts, and that, rather than being “ordered to specification,” their specific characteristics be welcomed as something of a surprise.  I suppose that off-target effects of heritable human gene editing could prove to be surprises, indeed.

One scientist quoted in the general press says that, regarding editing animals, ‘if we don’t try, we will never learn.” Another, an animal advocate, says, again about the animal work, “I think it would be an understatement to say we should be more cautious…I think we’ve already gone over the line with animals, and now humans.”

For sure, and now, with humans, a major question will be, how will we regard and handle the mistakes?

The hope of Christmas

By Steve Phillips

Every year at this time I try to spend some time reflecting on the meaning of Christmas and for this blog I try to reflect on how the meaning of Christmas interacts with bioethics. This year the Christmas musical program presented by the choir that I sing in at our church was focused on the themes of hope, love, joy, and peace represented by the outer candles of the Advent wreath that we light each of the four Sundays of Advent. As I have been thinking about the meaning of Christmas I have been focusing on the hope of Christmas.

One of the reasons that I have been thinking about hope is that I see so much hopelessness in the small rural community where I live and practice. Many of the patients that I care for feel hopeless. It can be seen in how the community is impacted by substance abuse and suicide as I wrote about last year. Many would relate the hopelessness to the poor economic climate of the community, and that does have a significant impact on people’s lives. But being poor does not necessarily entail hopelessness. There are many examples of those who are economically poor but rich in hope and joy. Hopelessness comes from a poverty of the soul that is more than just economic. It comes from a lack of positive relationships and positive social interaction. It comes from a lack of anyone or anything in which people can put their trust. Hopelessness comes from seeing that this world is far from what it ought to be and having no reason to think that will ever change.

The message of Christmas is that, even though we live in a broken world that is not what it ought to be, there is a remedy for the brokenness of this world. The way by which our brokenness can be healed came to earth as a baby born in Bethlehem. Jesus became one of us to be God’s clearest revelation of himself to us. His death provided the answer to our brokenness. His resurrection provided assurance of the hope that we can have in him. That is the hope of Christmas. Jesus is the answer to our own hopelessness, the hopelessness of those in our communities, and the hopelessness of the world.

After God

By Mark McQuain

In the December issue of The Journal of Medicine and Philosophy, editor Dr. Mark Cherry invited reviews of the late Professor H. Tristram Engelhardt, Jr.’s book After God: Morality & Bioethics in a Secular Age. Dr. Engelhardt passed away this past summer and was the co-founding editor of the Journal. The emphasis of this recent edition was to review the themes of After God and offer emphasis as well as counter arguments to these themes. The above link offers some free access to several articles though most require subscription or individual purchase.

I became familiar with Dr. Engelhardt’s theses on the weaknesses and limitations of secular bioethics during my coursework at Trinity by reading his book “Foundations of Bioethics” and hearing one of his guest lectures. One argument against a transcendental basis for morality or bioethics was that not everyone acknowledged a particular transcendental source. Wouldn’t pure logic and rational argument be a better method for grounding our bioethics? Couldn’t we simply develop a universal secular bioethics that everyone would rationally agree with? Engelhardt’s answer was simply – No. In Foundations of Bioethics he said: “The more a moral vision, moral understanding, thin theory of the good, account of right conduct, etc., has content, the more it presupposes particular moral premises, rules of evidence, rules of inference, etc. The more it gains content, the more it will appear parochial and partisan to one among numerous particular moral understandings. Universality is purchased at the price of content. Content is purchased at the price of universality.(p 67)” In other words, “to resolve moral controversies by sound rational argument, one must [already] share fundamental moral premises, rules of moral evidence, and rules of moral inference and/or of who is in moral authority to resolve moral controversies.(p 40)”

In After God, Dr. Cherry argues that Dr. Engelhardt carries his previous theses to their logical conclusions within our present culture “which shuns any transcendent point of orientation, such as an appeal to God or to a God’s eye perspective on reality.” Per Cherry:

“Without reference to God to guarantee that the virtuous are rewarded and the vicious suffer, there is no reason to believe that rationality requires one to be moral, much less why it would be prudent to act in accordance with morality. We are confronted with foundational concerns regarding sexuality, reproduction, suffering, and death, but without any particular guidance regarding how properly to engage and confront such challenges. Instead of content-full moral answers to guide bioethics and healthcare policy, we are left with a diverse set of lifestyles and death-styles among which to choose with no definitive reasons for preferring any particular choice of one over another. If the universe originated out of nothing, and is going nowhere, for no particular reason, then everything is ultimately absurd. Such, Engelhardt argues, are the epistemic and moral implications of a culture that seeks to be fully after God.”

It strikes me as somewhat ironic that this issue of the Journal comes out during the advent season, a time when Christians celebrate the incarnation of God on earth, necessarily asking us to consider how our present culture views its secular bioethics “after the death of God”.