A Not-So-Open Discussion

Courtney Thiele posted on March 3oth about an article in the Washington Post describing “a new push to de-stigmatize the nation’s most controversial medical procedure by talking about it openly and unapologetically.” A clinic in Maryland called “Carafem” dispenses abortion pills, and “promises a ‘spa-like’ experience for women with an open and unabashed approach to pregnancy termination.” (quotations from the Washington Post’s article)

This clinic is no doubt trying to move the experience of abortion as far away from Gosnellian horrors as possible. But despite the claims of the owners (and the Washington Post), their own terms reveal that it is not openness they seek, but a façade to hide the truth.

Whenever we hear the term “stigma,” we know that we’re getting lectured about judgmental people who are imposing their bad thoughts, and seeking to infringe upon someone’s freedom. The term in medical use describes a “mark” due to some condition, and therefore a natural consequence and characteristic identifier. In non-medical parlance, it has come to represent an externally imposed non-physical mark, unfairly applied.

For those wishing to deflect criticism, this is a useful word. It serves to convey the impression that if we feel anything negative about an entity or act, it is the fault of external forces, usually having malevolent intent. “Stigma” becomes a surrogate—a strawman—for “guilt” and “shame.” The founders of this clinic, of course, are trying to sell abortion, and trying to blame the guilt that participants may feel on judgmental others.

Most revealing is the clinic staff’s use of a term describing the abortion itself. They dodge the truth when they state how the abortion pill will “pass the pregnancy.” Pregnancy, as we know, is a state of being, not something to pass out of one’s body. It occurs because something is in the body, namely an embryo or fetus. By misusing the term, the clinic staff belies their understanding that the issue is about the human being of the embryo. But, if they acknowledge its being then moral questions must arise, and their goal of casual and stress-free abortion fails. Better to not acknowledge it. Simply talk around it, by substituting a misleading term, and we can pretend there isn’t really a person there.

I’ve seen enough about the coarsening of our culture to have a general sense of pessimism about the ability for many to see through this verbal obfuscation. Still, the sense that a pregnancy is a human is not going to go away, and unlikely to be something the modern public is oblivious to, especially with technological advances in ultrasonography. I doubt that there will be a time when those who take part in abortion are completely free from the burden of guilt, knowing that what they have passed was not simply their condition, but someone on our common path toward birth.

The Power of a Commercial

I don’t know about all of you, but one of my primary reasons for watching the Super Bowl each year is for the commercials. They often are silly and extravagant, but also can be creative, entertaining, and even impactful. This week I was extremely encouraged to hear of a positive impact that a super bowl commercial made a few years back. Five years ago Focus on the Family aired a commercial featuring Pam Tebow, Tim Tebow’s mother (the 2007 Heisman winning quarterback) sharing the life affirming story of her “miracle baby,” Tim. Watching the commercial was Susan, a young woman who had just found out she was pregnant and was planning on having an abortion. The commercial impacted Susan so profoundly that after watching it and contemplating it afterwards, she decided to continue the pregnancy and keep her daughter. Now her daughter is four years old and one of the greatest sources of joy in her mother’s life. This little girl was given a chance at life that began with a Super Bowl commercial. How incredible and beautiful is this example of the impact something as small as a commercial can have?!

This year many of the commercials had a heavy tone, but powerful messages were shared, as well. For example, the Proctor and Gamble commercial calling for the reclaiming of the phrase “like a girl” sends the message that being a girl or woman is something powerful and good. This commercial demonstrated “like a girl” should not be used as an insult, but should mean giving it your all, recognizing the inherent value of girls and women that should not be forgotten. Dove also put out a commercial emphasizing how important it is for fathers to be in their kids’ lives. This demonstrated the importance of fatherhood and how being there for your children matters. I hope that, like the commercial featuring Pam Tebow, these commercials inspire positive changes, and even lead to future decisions that have a powerful bioethical impact.
For more on Susan’s story check out this link

Bioethics Exam

In keeping with the evaluation-obsessed spirit of the time, here is a little bioethics test. No multiple-choice fill-in-the-bubbles here, no simple true/false; but bioethics usually isn’t so simple, is it? So it’s OK if you don’t have a No. 2 pencil, you can still take today’s exam!

_______________________

1. The patient-physician relationship depends on trust, and close observation, and appreciating subtleties, and giving one’s full attention to another person. So, who thought that making the doctor spend the office visit typing into a computer was actually a good idea???

2. Why does the NRA know better than physicians in Florida what they should be saying to their patients in the exam room?

3. What is just and right about a medical insurance system in which people have to stay in jobs they hate because of the fear of getting sick, and which bankrupts many people who get a serious illness? Give examples to support your answer.

4. If doctors have huge malpractice premiums, which they pay for by charging patients more for medical care, then essentially patients are paying doctors so the doctors can protect themselves from patients. Does this make sense? Explain.

5. Compare and contrast: Why should taking one’s own life be considered a more dignified death than any other? Is there really any dignity in death itself, or is it in the way that we face it?

6. Why should doctors be trusted more than anybody else with the right to kill someone?

7. If all of these prenatal genetic tests weren’t developed and marketed for specifically eugenic purposes, then just what were they developed and marketed for?

8. Is there any evidence that “evidence-based medicine” (aka statistic-based medicine) is better than whatever we did before?

9. Is abortion the problem, or is it the symptom of a lot of other problems?

10. In the DSM-V (the latest version of the official guidebook to diagnosing psychiatric illness), grief over the death of a loved one that lasts longer than two weeks can now be considered a disease and treated with medications. What will be the next normal human experience to be turned into a disease?

EXTRA CREDIT:

11. What does it mean to be human? Who gets to decide?

*  *  *

Since this is an ethics blog, you’re on your honor to score yourself fairly. Good providence!

Abortion and the personhood of the fetus

In my post last week I addressed the idea that uncertainty about the personhood of a human embryo or fetus should lead us to think that we should refrain from causing harm to any entity that might be a person. Therefore, if we are uncertain about whether a human embryo or fetus is a person we should protect that embryo or fetus in case it is a person.

One of my students, Mark Taylor, wrote a paper this spring in the Medical Ethics class I teach that took a different approach to the disagreement in our society about the personhood of the human fetus in relation to the issue of abortion. In contrast to Judith Jarvis Thomson who took the position that abortion should be permissible even if the fetus is a person, he suggested that there are reasons to consider abortion impermissible even if the fetus is not a person.

His arguments are based on the idea that the impermissibility of an action is based more on the moral obligations of the person performing the action than on the rights of the object being acted upon. He presented an argument from aesthetics and virtue and an argument from justice that supported the position that abortion is impermissible even if the fetus is not a person. The first argument says that a fetus is a complex human organism which is a thing of beauty which has been created in most cases by an action chosen by the mother which was known to lead to the creation of such a beautiful being. To choose an abortion would be an irrational act that would be wrong in the same way that it would be wrong to create a great work of art only to destroy it. It would also violate the virtue of responsibility by engaging in an action know to add beauty to the world only to destroy that which is beautiful rather that caring for it. This argument only applies to the abortion of pregnancies that result from consensual sex, but those make up the vast majority of abortions. He argues that failure of contraception does not negate this argument since it is know that contraception is not foolproof.

The argument from justice is based on Rawls’ concept of justice as fairness and the use of the veil of ignorance. Central to Rawls’ system is the idea that a just society is one in which a person who does not know what role he or she will play in that society would judge the society to be fair. Taylor argues that one of those roles that the one judging the fairness of the society might assume behind the veil is the role of the fetus. Even if the fetus is not a person, we all go through the stage of being a fetus so just as the person behind the veil might take on the role of a child the role of the fetus should also be considered in whether the society is just. If the role of fetus is one that the one judging the fairness of the society may assume then it would not be concluded that if would be just to allow a fetus to be aborted.

These arguments suggest the possibility of being able to argue for the impermissibility of abortion no matter what position is taken on the personhood of the fetus. If the fetus is a person then the traditional arguments against of killing an innocent person apply. If we do not know whether a fetus is a person then we should refrain from killing an entity that could be a person. If the fetus is not a person there are still reasons why a person would have a duty not to destroy the fetus based on obligations of virtue and justice that are not dependent on fetal rights or personhood.

The implications of uncertainty about personhood

Many times the different parts of my life conflict with each other, but sometimes they come together in interesting ways. Susan Haack’s recent post on the article “The Fetus, the “Potential Child,” and the Ethical Obligations of Obstetricians” from the journal Obstetrics and Gynecology contained a quote that connected with a reference to an article by Christopher Tollefson by one of my students in a recent paper. The authors of the Obstetrics and Gynecology article stated that the issue of whether a fetus has full moral status is “irresolvably disputable” and from that drew the conclusion that the fetus has no independent moral status and subsequently reached the conclusion that abortion is permissible. Tollefson, however, has argued that an inability to decide whether a human being at a certain point in development has full moral status should actually lead to the opposite conclusion.

In his article “Embryos, Individuals, and Persons: An Argument Against Embryo Creation and Research” in the Journal of Applied Philosophy in 2001, Tollefson argued that in order to conclude that destructive research on human embryos is permissible it would be necessary to establish conclusively that the human embryo is not a person. His argument is that if it is uncertain whether an entity is a person or not it would be wrong to intentionally kill it. Therefore, it is wrong to conclude that it is permissible to do destructive research on early human embryos because we don’t know or can’t know whether those embryos have full moral status. The uncertainty about their moral status means that we should avoid the possibility of killing a person if those embryos would happen to be persons. That same idea can be applied to the “irresolvably disputable” issue of whether a fetus has full moral status. If the issue is unresolved then there exists the possibility that a fetus is a person with full moral status and we should not kill a fetus if that possibility exists.

An example that would be readily understandable to many of my rural Midwestern patients and neighbors can illustrate this point. Assume you are a deer hunter in the woods of rural Indiana and you see something move in the underbrush. You are not sure whether it is a person or a deer. It would be morally wrong to shoot at whatever was moving without determining with certainty that it was not a person. In the same way doing embryo destructive research or an abortion is wrong unless you are able to determine with certainty that what is being killed is not a person. Uncertainty about the personhood of the embryo or fetus means that it would be morally irresponsible to kill it.

It would be sad to think that the typical deer hunter has more moral responsibility than a medical researcher or physician.

Euthanasia, pediatric and adult, and the underlying concept of a life not worth living

Jon Holmlund’s recent post about pediatric euthanasia in Belgium made me think about what I had posted a couple of weeks ago about PGD and lives not worth living. There is a way in which the concept of a life not worth living underlies a whole spectrum of ethical issues from PGD and selective abortion to pediatric and adult euthanasia. There is a basic conflict between those who take different ethical positions on these issues over whether there are certain quality of life issues that can allow one person to decide that another person’s life not worth living.

For those who take the position that it is permissible for couples who are at risk to have a child with a serious genetic disorder to use PGD or prenatal diagnosis with selective abortion to try to insure that any child that is born is free from the genetic disorder, a part of the argument for their position is that it is permissible to discard the embryos found to have the disorder or abort the fetuses found to have the disorder due to the poor quality of life that would be experienced by those children if they were born. That is saying that the lives of those children would not be worth living. That decision is being made by the parents for their children and being confirmed by the physicians and others who participate in the process.

Those who support the permissibility of active infant euthanasia as practiced in the Netherlands under the Groningen protocol are also saying that the infants whose lives are being ended have lives that are not worth living. Again this decision is being made by the parents and confirmed by the physicians involved that the infant’s life is not worth living.

The situation with voluntary euthanasia of children as it has recently been allowed in Belgium is more complex. If the child does not actually have full decision making capacity or is being overtly or covertly coerced, it is again someone other than the child who is making the decision that the child’s life is not worth living and the situation is similar to infant euthanasia. If the child has full decision making capacity then it could be reasonable to consider the situation to be the same as adult voluntary euthanasia.

With adult voluntary euthanasia some would argue that the concern about one person deciding that another person’s life is not worth living is not an issue because it is the one whose life is being ended who is making that decision. However, whether what is being done is voluntary active euthanasia in which a physician is administering a lethal drug or physician assisted suicide in which the physician prescribes the drug with the intent that the patient will self-administer it, the physician who is involved must make the decision that the act of ending that patient’s life is warranted. Few would be willing to take respect for autonomy so far as to say that anyone who requested assistance to end his or her life should be provided the means to do so without a judgment by the physician that the decision to do so was an appropriate one. Assisting someone to commit suicide who is despondent over a break-up of a relationship is irresponsible. Thus physician participation in voluntary active euthanasia or assisted suicide requires an independent decision by the physician that the decision to request assistance in ending life is reasonable. The only way a physician can make the decision to participate is to decide independently that the patient’s life is not worth living.

The only situation in which ending a life to avoid a poor quality of life could be done without one person deciding that another person’s life is not worth living would be unassisted suicide. There are Christian and Kantian arguments for why that is not morally permissible, but that lies outside the realm of these thoughts.

Since all of these actions, from PGD to adult voluntary assisted suicide involve one person making a decision that another person’s life is not worth living, a crucial issue is whether it is morally permissible for us to make such a decision about another person’s life. For those of us who have an understanding that every human life has value simply because of being human, we must answer that it is not permissible to make that decision. We understand that no matter how difficult a life may be that person still has value and our response to those whose quality of life is poor and who are having to endure more suffering than it would seem that they ought to is to affirm the value of that person’s life by caring for the person’s needs. We cannot say that another’s life is not worth living.

Life, death, technology, and really hard questions

A tragedy is unfolding in Texas, unfortunately in the public eye, of a 33-year old woman who suffered a severe injury to her brain on November 26th, when she was 14 weeks pregnant. Her brain, we are told, has stopped functioning; her other bodily functions are being maintained artificially. Her now 20-week old fetus is still alive. Her family has asked the hospital that, in accordance with the woman’s previously expressed wishes, her bodily functions no longer be maintained mechanically. The hospital has refused, citing a Texas law that prohibits the removal of life-support for a pregnant woman; the husband has sued the hospital to have the life-support removed.

Here is a tragedy in which all choices are fraught with deep sorrow, and in which difficult questions are legion; if we think we have answered one, seven more spring up to take its place. Before I discuss them any further, let me lay my cards on table: First, I am pro-life. This implies far more than that I am simply against abortion! But I do believe that in most situations, abortion is not the right or best option. Among other reasons, I believe this because I am a physician still enamored of the Hippocratic tradition, and because I am a Christian — that is, I believe Christ’s claims that he is divine, and that therefore his statements such as “Do unto others as you would be done by,” and “Whatever you do to the least of these you do to me,” are more than just suggestions, and apply to how I treat all people, whether in utero or ex utero. However, there are rare instances in which abortion is the “least bad” alternative, such as when continuing a pregnancy places the mother at risk of serious harm or even death (and while this is indeed rare, I have known patients for whom this was judged to be true).

Second, I have some pretty strong beliefs about technology, which readers of this blog may have divined. I do not believe in the technological imperative which states that “Because we can do such-and-such, we are obligated to do it.” I strongly hold that people should be free to choose not to have technological interventions performed upon themselves. Related to this, I believe “Technology creep” is a rampant problem in medicine: techniques designed for one application are indiscriminately generalized and applied everywhere they can be applied, just because they can be, just because they are technology, and because we assume that technology always makes things better — when often all it does is dehumanize the situation.

That said — of all the questions this tragedy raises, the two questions I pose today are, Is stopping life support for the mother equivalent to abortion? And a related question, Does the pro-life position necessitate holding that this woman should be kept on life support for the sake of her unborn baby? The reasons to answer Yes are compelling. There are two people on life support: one who will almost certainly never get off of it alive, and another who has the potential to get off of it alive if the other stays on a little while longer. If the machines are disconnected, two people will die. As far as we can tell, the machines are not a burden to the mother (if she is indeed “brain-dead,” then by definition she isn’t suffering). When she said that she would never want to be maintained on machines, she probably wasn’t considering being pregnant and on machines, and who knows what she would have wanted in that case? It seems it would be better to err on the side of temporarily maintaining her bodily functions for the sake of her unborn child.

And yet there are enough caveats here to make me wonder. Is stopping the life support in this situation tantamount to abortion? I am not sure that it is. By withdrawing the life support, we withdraw a technique and allow the natural course of events to take place; the intention is not to kill the fetus (although that is what surely will happen as a result).  By induced abortion, we introduce a technique to change the natural course of events, with the intention to kill a human being. It seems to me that there is enough of a difference between the two that we should not conflate them. Again – it is well-accepted that there is no ethical difference between withholding treatment and withdrawing treatment. If we are to say that withdrawing the treatment in this case is abortion, does that not imply that withholding (not starting) the treatment in the first place would also be abortion? That smacks of a tyrannical technological imperative, a place I don’t think we want to go. Again –  The second formulation of Kant’s categorical imperative runs something like, “We should never use someone only as a means to someone else’s ends.” I am no philosophy major, but it sure feels like keeping this woman on life support against her express wishes is making her a means without considering her as an end.

If one were to abstract this situation from its context, consider it as a theoretical problem, the “least bad” outcome would be for the woman to be supported until her baby is born. But this is not an abstract, theoretical problem. I have sat at the bedsides of many, many patients who have been trapped in webs woven by dubious uses of technology. I have seen many, many people enduring the “living hell” that this woman’s husband has described experiencing over the last few months. Granted, these experiences of mine don’t carry the weight of rational arguments; but they remind me that these decisions are not carried out in the academic ether. I do not believe that withdrawing the life support for this woman is equivalent to abortion; and, related to that, I don’t believe the pro-life position necessitates holding that keeping this woman’s body functioning in order to allow her baby to reach viability, against the express wishes of her and her family, is the only ethical solution. There are those who will disagree with me, some vehemently; I understand their positions and respect them. (I am not speaking for Trinity International University, so don’t get mad at them!)

I don’t have space to go into all of the other issues this situation raises (one of them being the definition of “brain death” — see here for a thoughtful reflection on the matter). But one more issue I will address: There are a lot of people who have written and said uncharitable and judgmental things about this woman’s husband and family. While I am uncertain about what is the right thing to do in this situation, I’m quite certain that passing judgment on the family is wrong.

Pro-Life Equals Pro-Animal

There is some buzz being generated within the political and religious blogosphere these days about animal welfare issues, and it is standing out because of its appeal to an unusual audience of perceived kindred spirits. It makes the argument that “pro-lifers” are the intellectual and spiritual brethren of “pro-animal” advocates. To some this would seem an interesting, if somewhat opaque, syllogism, perhaps akin to Knights of Columbus who are also Master Gardeners.

But it has some intellectually-serious proponents. I must admit to being a fan of one of them, Matthew Scully, a former political speechwriter for figures including George W. Bush and Sarah Palin, in large measure because his writing is eloquent and compelling. I’m a sucker for both, and I freely confess that I would be a model of Stockholm syndrome for anyone making an argument in such a way as Mr. Scully typically does. I have to tread cautiously when I read people whom I like stylistically so as not to be easily persuaded by their prose alone.

So Mr. Scully has posted an intellectually rigorous and rather long post in the National Review Online entitled “Pro-life, Pro-Animal,” which links the issues of respect for human life and the welfare of animals. He starts off well-enough, with an argument that I can support in the context acquitting responsible animal stewardship as a hazard to the notion of human dignity:

“Far from presenting any threat to human dignity, animals and their moral claims upon us — the basic obligation never to be cruel, not just the option to be kind when it suits our purposes — are a constant hindrance to human presumption. What is the mark of that special status of ours, anyway, if not precisely the ability to be just instead of merely dominant, to be the creature of conscience and bring mercy into the world? A loving concern for humanity that stops there, instead of spreading outward in a sense of fellowship and active respect toward ‘our companions in creation,’ to borrow a lovely phrase from Pope Benedict, is too close to self-worship, and bad things come of it.”

I agree with this; human dignity is affirmed, not threatened, when we reflect the compassionate God in whose image we are made. The animals over which we have been granted dominion, in the Judeo-Christian conception at least, offer abundant opportunites to display the full measure of our humanity as stewards of God’s creation.

Where I part company with my erudite friend begins when he starts to wander into the weeds of anti-scientism. I am insulated in small animal practice, a practice filled with animals that are pets and where I am able to totally ignore the fact that the meat my patients and I eat is not harvested from “steak trees” but involves the death of animals to get it. Understood. But I have also spent time on the “kill floor” of a slaughterhouse, and I have colleagues who are intellectually-serious and ethically-motivated as they fulfill their oaths in family farms and within large commercial operations alike. They use moral reasoning as they care for their porcine and bovine patients. Veterinarians are grudging philosophers, generally a sort with a practical bent and a love for scientific proofs. But we are often moral idealists, ones that use the science of animal behavior and physiology to undergird our practice. It is science that recognizes that most livestock don’t lead a charmed life in most environments, that there are dangers in seemingly-idyllic settings, and that safety is an appropriate motivator for their appropriate care. This is why a statement like this from Scully is so difficult to take:

“No matter what new perversion of animal husbandry the industry might devise, it can always count on the sign-off of friendly veterinarians, as true to their oath (“to promote animal health and welfare, to relieve animal suffering”) as Dr. Gosnell was to the Hippocratic oath.”

This is an ad hominem attack and, sadly, reveals a growing divergence between livestock veterinarians and groups like the Humane Society for The United States, formerly natural allies. There are bad characters in the food animal industry, without a doubt. Scully paints a picture in his piece of some of the bad ones, and reminds us of the worst practices in some of the large-scale food operations. Yet the idea that all veterinarians involved in this industry (for Scully doesn’t narrow down his condemnation) are morally-equivalent to the reprehensible abortionist Kermit Gosnell loses me rhetorically from then on. No thinking anti-abortion advocate considers all those who perform abortions to be the equivalent of a Gosnell, despite a profound dislike of their work. To paint livestock veterinarians with the same brush as a convicted murderer is offensive, and careless in its symbolism.

He notes, as he references other authors that are making the case for moral equivalency between the pro-life cause and vegetarianism (or, less dramatically, the pro-animal cause), that “author Mary Eberstadt writes that factory farming and similar abuses of the animal world are ‘simultaneously morally urgent and widely ignored by many people, including and inexplicably by many well-meaning but hitherto under-informed Christians.’” On this I suspect he is mostly right (as, then, is she) and Christians need to better engage the issue before a watching world. I am hopeful that we can be in agreement where they have good points and criticize them when their arguments seem to fall short. There is much to be mined in both areas.

Ukrainian Bioethics

I returned from Kyiv, Ukraine, last week as part of a team that is working to strengthen a partnership with a Christian seminary there. As we met with various program heads within the school, I asked a few questions about how ethics are taught, and what bioethical issues the Ukrainian people face. Some of the answers were surprising.

Ukraine, of course, is the long-suffering nation to the west of Russia, most often remembered as the breadbasket of the former Soviet Union, as the nation where millions starved to death in Stalin’s effort to break the farmers that resisted collectivization, as a nation where much of the fighting—and death—from World War II occurred, and as the location of the horrific Chernobyl nuclear disaster of 1986, some seventy miles north of Kyiv. Ukrainians know what it means to endure; their national anthem is “Ukraine Is Not Yet Dead.” Ukraine’s history has witnessed many affronts to human dignity, perhaps one most chillingly on display at the “Museum of the Great Patriotic War” (a.k.a., World War II) where gloves made of human skin and a bar of soap made from human fat show just what human beings are capable of doing to each other. The Ukrainian people were saved from the atrocities of the Nazis to be dominated by the Soviets, exchanging one form of tyranny for another.

Years of communist rule still leave their mark on Ukraine. Something especially notable when out and about in Kyiv is the utter absence of physically-challenged people, the handicapped, on the city’s streets. It isn’t that they don’t exist. But communism in the Soviet Union served to create an “ideal society,” free of suffering and disability, filled with “perfect” people. In reality, this meant warehousing the mentally and physically-handicapped—and orphans—into hidden-away institutions. This mindset has been slow to change. Handicapped access is limited, to be charitable, and it is hard to imagine that a shopping trip would be anything but excruciating for anyone in a wheelchair. As much as I groan at some of the excesses, as I perceive them, in our “Americans with Disabilities” Act, I’ll probably now more gladly accept its quirks and demands as a way of affirming the dignity of those who suffer challenges I have yet to face in my own life.

It is easy to criticize the post-Soviet outlook, this vestigial communist view of human beings, as an American. But how much do we sanitize the pursuit of perfection here? What are enhancement technologies but a reflection that we have a need to be free of problems, to be our “best selves?” We tuck away our dying elders in nursing homes so that the inevitability of decline and death don’t confront our pursuit of happiness.

A member of our team wryly reflected that, in Ukraine, their faces are from the West but their minds are from the East. As I mentally checked off the list of bioethical issues we face in the West—challenges with assisted reproductive technologies and pre-implantation genetic testing, with use of technologies for human enhancement, and with limitation of burdensome treatment at the end of life—it became clear in discussing bioethics with the seminary faculty in Kyiv that most of these issues are completely off the radar of the vast majority of Ukrainians. Abortion is still hideously common as a method of birth control in Ukraine, as it is in Russia and elsewhere in the former Soviet Union. But the idea that we would use medicine to end life with physician-assisted suicide or euthanasia, or spend scandalous amounts of financial treasure on cheating the aging and dying process, seem arcane in Ukraine. One director even noted that the people of his country don’t have time to be depressed (even as they have faced generations of addictions) because they are too busy just surviving. A study in contrasts, this nation, where children are forgotten in orphanages and old women, the babushkas, may beg for money to supplement their meager pensions, but where children are bundled for warmth with the smallest hint of chilly air and people give up their seats on crowded buses for the elderly and for women with small children. These are a people acquainted with suffering and sorrow, and they have a certain respect for those who have suffered for more years than most (the elderly) and for those who hold the eternal promise of a better future (the children). A rather elegant ethic there: respect and promise.

Wiser minds than mine have delved into the mystery that, within the crucible of suffering, we may be best equipped to find evidence of grace in daily life. It was a visit to a church in Kyiv that I could best see this illustrated. There is, in Ukraine, a national church that had been suppressed, harassed, and persecuted at every turn, one that has survived communism and the economic anarchy that followed, and today sends workers into other former Soviet republics. It is, in fact, a joyful and beautiful place. It is a church that is ministering to orphans and the mentally and physically handicapped, bringing them out of the shadows to which communism relegated them. Ukrainian bioethics is more, forgive the awful word here, “primitive” in a sense, because the technologies that are such qualified blessings in the West have yet to meet this part of the world. But it is the church that is leading the way toward negotiating the ethical issues in a society in transition and embracing the notion of human dignity, a church that just may impact the course of a nation that is, indeed, not yet dead.

 

An Update on the Bei Bei Shuai Case

A few months ago I mentioned a trial that was set to begin here in my hometown of Indianapolis this September. It involved Bei Bei Shuai, a Chinese immigrant facing charges of murder and feticide whose story I recounted, with a few observations about its potential significance.

Recently the case was settled out of court, with a plea deal that gave her a much lesser charge of “criminal recklessness” instead of murder and feticide. By pleading guilty to this misdemeanor, the year-plus in which she had already served in prison before bonding out was applied to the sentence she was given, and Bei Bei Shuai is now a free woman. She and her attorney had rejected a plea deal a year ago that would have had her plead guilty to feticide, but not murder, charges, punishable by up to 65 years in prison. The choice appears to have been a wise one for her.

I have read the scuttlebutt from this outcome throughout the world (a side note: the British take a far more intense interest in the goings-on in America than their former colonists do in those of the United Kingdom; could anyone tell me the last time among the American media we read of an intriguing case in, say, the Yorkshire Dales?). The general consensus was palpable relief among those in the abortion rights camp (also found under such nomenclature as “reproductive rights proponents” and “champions of women’s health”). The winner for most unctuous of these was on the “RH Reality Check” site, dedicated to “Reproductive and Sexual Health and Justice.” Here the Indiana case was depicted as the latest among the efforts of “anti-abortion activists toward criminalizing pregnancy to both attack reproductive rights and punish pregnant women for failed pregnancies.” It is curious that it omits the fact that ingestion of rat poison by Miss Shuai in her eighth month of pregnancy led to this pregnancy “failure.”

A conviction would have potentially devastating consequences for them, and they knew it. Indiana is a socially-conservative bastion among the Great Lakes states, and is not the state in which they wanted this case tried. That said, an acquittal on all charges would have been a blow to the prosecution, though likely not all that crushing to the overall movement toward protection of the unborn. There are some glimmers of encouragement for those who grieve abortion, about which others have spoken, and there is a faint sense that the tide may be turning. The Bei Bei Shuai case was a tragedy for all involved, and speaks more to the damage that the Fall has inflicted on humanity than to wider legal precedents. I have a sense that Bei Bei’s friends and supporters may have a bit less need for her now, and I have a hopeful (if perhaps Pollyannaish) image of the Body of Christ reaching out to Bei Bei Shuai, at once the criminal and the victim, with the love of God that transcends an agenda.