Vaccinations and neighborliness

At the risk of being one of those that rush in where angels fear to tread, I am writing about parents refusing vaccinations for their children. This topic was brought (again) to the forefront by the story (see here) of a measles outbreak linked to a church in Texas. A church visitor contracted measles overseas, and subsequently there have been 21 cases at the church, mostly in unvaccinated people.

Ethically there are many dimensions to the story. First of all is the dictum that “Good ethics begin with good facts.” The pastor of the church in question is reported as having “reservations” about vaccinations, “primarily with very young children who have family history of autism. . .” This is an example of decision-making based on bad facts. The results of the one study that purported to establish a link between the MMR vaccine and autism (funded by lawyers looking for evidence to use against vaccine manufacturers) not only have never been replicated, but have subsequently shown to be so flawed that the medical journal that published them retracted the original article. However, the legend continues to propagate (fueled by the internet) that there is scientific evidence of a link between MMR and autism, and it is unfortunate that a Christian leader has influenced healthcare decisions based on fraudulent data. This is not to say that vaccinations do not carry risk, only that autism is not one of them. (Since the measles outbreak the pastor, to her credit, has strongly encouraged vaccination, and the church has held free immunization clinics.)

Then there is the issue of parental rights vs. the public health interests of society. While I tend to lean towards the side of parental rights, I do not think that trying to balance the rights and interests of one party vs another is the most helpful way to frame this debate. I believe a more helpful approach is found in the story of the Good Samaritan, found in the Bible in Luke chapter 10. When Jesus affirms that the law is summed up by, “Love God with everything, and love your neighbor as yourself,” the question the lawyer asks Jesus is, “Who is my neighbor?” Jesus responds with the story of the Good Samaritan and turns the question on its head, saying, in essence, “You are the one who should be the neighbor — even if it means inconvenience or risk to yourself.” When it comes to vaccinations, who knows how many people who cross our paths are immunocompromised in one way or another? If it means being a good neighbor to those who are vulnerable around us, then vaccination may be one way of “Loving our neighbors as ourselves.” (Plus, when that visitor brings a vaccine-preventable disease into our midst, it won’t be bad for us either.)

Undocumented immigrants and health care

 

In a Perspective piece in last week’s New England Journal of Medicine, Dr. James Breen writes of a segment of the population invisible to health care system reform: undocumented immigrants. Breen asks, If the currently proposed incarnation of health care delivery reform becomes reality, tens of millions of Americans suddenly have insurance, and charity medical care is drastically reduced as the need for it dries up, what will happen to those undocumented immigrants who currently receive that charity care but neither have insurance nor would be eligible to receive it under the Affordable Care Act?

This is a real concern in the current political and social climate. Just as in the past it was considered legitimate to treat certain groups of people as less worthy of respect than others — in our country, most notably African-Americans — so today it seems to be accepted, even respectable, to consider undocumented immigrants as something a little above vermin. This lower-class status is assumed in public discourse, is a plank in political party platforms, and is even becoming enshrined in the law of the land.

Whatever one thinks of how we should ultimately deal with the issue of undocumented immigrants, the fact is, they are here. Roughly 11 million of them. They are endowed with the same human dignity as anyone else. And they will need health care.

In the parable of The Good Samaritan (Luke 10:25-37), Jesus contrasted an expert in the law with a traveling Samaritan. The lawyer asked, “Who is my neighbor?” — that is, “Who is deserving of my care?” The Samaritan didn’t ask who was his neighbor; he was the neighbor, to a foreigner. And in Leviticus 19 we read, “When a foreigner resides among you in your land, do not mistreat them. The foreigner residing among you must be treated as your native-born. Love them as yourself, for you were foreigners in Egypt. I am the Lord your God.” (NIV) God does not make a distinction between “legal” and “illegal” foreigners.  If our health care system does, then here is another place for the Church to step in and demonstrate God’s heart for “the foreigner among you.” By our advocacy for caring for these fellow humans, as well our actual provision of that care where possible, we can embody the love of God in a way that will contrast starkly with the increasingly strident voices around us.

 

Can the Church have a distinctive take on health care insurance reform?

The Supreme Court has finished hearing the case for and against various provisions of the Obama health care plan. All that remains now is to wait for the decision, which will be handed down sometime in June.

There is much to be opposed to in any scheme of health care insurance reform. If we are waiting for a perfect plan before we will declare our support, then we will never support any reform plan. However, I believe the problem of how to justly provide health care to all is an opportunity for the Church to counter the perception of alignment with partisan political agendas and show instead its alignment with an agenda that transcends political or personal preferences.

The doctrine of God’s love, of the self-giving agape which God demonstrates toward us and enables us to show to others, should surely influence our attitude towards health care reform. One expression in Scripture of what our attitude should be is found in Philippians, where Paul writes, “Each of you should look not only to your own interests, but also to the interests of others. Your attitude should be the same as that of Christ Jesus . . .” (Philippians 2:4-5) Much of our resistance to reform comes from considering only our own interests, to the neglect of the interests of others: placing our own desire for limitless choice over the interests of those who have virtually no choices; putting our desire to keep more of our income out of the hands of the tax collector over the interests of those with much more meager incomes who would benefit from the care increased taxes might provide; placing our general principled distrust of government higher in importance than the real good limited government intervention might be able to accomplish in this particular situation. As Christians, we can be concerned not first of all with our own rights and interests, but with those of others, and can willingly insist not on a right to maximum health care but only to a level that is socially equitable and affordable.

As Christians, we have a unique opportunity at this time in history to be a singular witness to Christ by approaching health care and its reform from a theological standpoint rather than the standpoint of a political party agenda or our own rights and interests. By overcoming the tendencies that naturally make us resistant to health care reform, we will show that we are conformed to something other than our culture or our own private interests. By making clear that the followers of Christ are advocates for those unable to afford care, even when it may be disadvantageous to ourselves, we will take our place among the ranks of our Christian forebears who, as they started the first hospitals and hospices in Europe, were at the forefront of health care reform in their day.

The real reason the Patient Protection and Affordable Care Act should be repealed (and it’s not the one the politicians give)

 

First, the bad news: Between 1980 and 2009, annual real per capita health expenditures grew by 4.1%. In the same period, per capita GDP (adjusted for inflation) grew by 1.8%.  In other words, health care costs grew faster than the money to pay for them. The inevitable endpoint, if such trends continue, is eloquently demonstrated in the graph from this 2005 study from the Robert Graham Center (a center for the study of health care policy), which projected that an annual US family health insurance premium would equal the average family’s annual income by the year 2025.

Now, the good news: A study in this week’s Annals of Family Medicine updated the projection, taking into account the passage of the Patient Protection and Affordable Care Act (PPACA) and the recent slowing of health insurance and wage increases. The new calculations push the date when the family’s premium will equal the family paycheck all the way back to 2033!

The PPACA got a lot of people hopping mad, and in an election year, it has become a huge political hot potato. Many feel it went too far, and therefore should be repealed. However, if the studies mentioned above are even close to accurate, the thing should be repealed, not because it went too far, but because it didn’t go far enough. It provided cosmetic surgery when what the patient needed was a heart transplant.

Many Christian voices have joined the chorus attempting to shout down the PPACA. However, this seems to me to be fiddling while Rome burns, because with or without the PPACA, our health care system is becoming unsustainable, and people — real people, like you and me, and disproportionately the poorer among us — are suffering physically, financially, emotionally, and yes, spiritually, because of the ruin they face from health care costs. And without radical change, more and more will join their ranks.

A large portion of Jesus’ recorded ministry involved healing the sick. The main difference between the sheep and the goats in the Matthew 25 parable is how each treated “the least of these.” It is those “least” that will suffer the most as health care costs become increasingly untenable. Therefore, as Christians, we should be at the forefront of efforts to ethically control healthcare costs and provide some level of basic, dignified healthcare to all. These efforts may or may not entail greater government involvement in health care. The recent controversies over contraceptive coverage show what can happen when the responsibility for health care reform is left solely to the government. But either way, it would reflect well on Jesus Christ if his followers took the lead in ensuring that compassionate health care is within the reach of all people. This will require radical change, as well as self-sacrifice; but who is in a better position to lead the way than the followers of the One who changes lives radically because of his self-sacrifice? The PPACA cannot deliver this; if the PPACA is repealed, it should not because it went too far, but because it didn’t go far enough.

Down Syndrome and Thanksgiving

 

Despite today being the retail abomination known as “Black Friday,” I will continue in the vein of Thanksgiving and write about a person I am thankful for.

My nephew’s name is Jacob, and he has Down Syndrome. He just turned 18. He is one of the most loyal and loving people I have the privilege of knowing. He gives incredible, bone-crushing hugs. His cell phone voice mail message ends with, “Love you.” His aunt, my sister, lies in a nursing home, barely able to interact since a brain injury in June; but Jacob doesn’t care about her medical conditions, he just loves to be there with her, because he loves his aunt. I am thankful for Jacob’s example of unconditional love.

When we take Jacob out to eat, he orders french fries. And when he eats french fries, he eats them a certain way, one at a time, dipped just so in his favorite condiment: steak sauce. Lunch takes at least an hour. I am thankful that Jacob makes us slow down. 

Jacob loves music. He owns several guitars, and received a bass guitar for his last birthday. He especially loves worship music. He can strum his guitars, although a guitarist probably wouldn’t call it “playing” guitar. His singing isn’t exactly on key. Yet most Sundays he is in front of his church leading worship with the worship team. His microphone may not be turned up terribly high, but his love for Christ is at full volume. I am thankful for Jacob’s example of unselfconscious worship.

Jacob sometimes requires extra patience. His parents have made extra sacrifices. There are things he does that will drive you crazy if you let them (Is there anybody for whom that is not true?). He will never live independently, and will always require a level of extra care. But the extra care and patience are richly rewarded. And while we think we are making extra sacrifices for Jacob, I sometimes think that God sees it differently: that He is giving us an extra measure of blessing by allowing us to be with Jacob. Yet it seems that too many, when they think of “Down Syndrome,” think only of the extra work and sacrifice and limitations. Either that, or they think of a life that is not worth living. Whatever the thinking, it is both sad and frightening that in this country, about 92% of the unborn babies suspected (on the basis of prenatal testing) of having Down Syndrome are aborted: sad, because of the loss of human life through abortion as well as the loss of the privilege of being with these unique people; and frightening, because of what it says about us as a society. I am thankful that Jacob was not one of the 92%.

Musings from a nursing home

 

It has been five months today since my sister had the first of many brain surgeries for a burst aneurysm. I was visiting her yesterday, and the visit prompted the following random bioethical thoughts.

Health-care payment reform – My sister is in a nursing home, and until recently had been receiving various therapies. Earlier this month her insurance ran out, and suddenly — without notice — now she receives none.

This situation is not surprising, given the claptrap patchwork of healthcare payment that passes for a system in our country. The health-care payment reform debate has been so politicized — that is, it has become a tool of political power that each party wields as a weapon against its opponent — that rational, ethical discourse on the subject seems to have been left in the dust. There is a more ethical way to deliver health care; however, as long as we leave it up to lobbyists, interest groups, and two political parties that seem more intent on power than government, we will see increasing numbers of people left in the medical and political dust.

Human dignity – By some standards, my sister might be thought of as having lost her human dignity. Before June 11th she was an energetic, triathlon-running, blog-posting woman; now we are excited if she can manage a hand-squeeze or a groan. By some estimations, she might be said to have a “life not worth living.” According to some bioethicists, she doesn’t have what it takes to be treated with the respect due to human persons. I’m sure glad they haven’t been taking care of her these last five months.

The search for a cure – Putting aside for the purpose of argument all of the insurmountable hurdles that have to be overcome, imagine for a moment that the fondest dreams of certain researchers reach fruition, and that embryonic stem-cell therapy for brain trauma becomes a reality. Imagine (you have to imagine, because it is all imaginary at this time, never mind the rhetoric to the contrary): What if my sister could walk and talk and laugh again, if only we were willing to sacrifice an embryo, “a glob of cells smaller than the period at the end of a sentence,” maybe an embryo leftover from IVF in fertility-clinic-freezer limbo somewhere?

Much of the Church has taken a stand against embryonic stem-cell research, as is right. But it’s easy to oppose something that has no forseeable hope of becoming reality. What would happen if the unthinkable became possible? Would the Church still stand against it? If cures for your daughter’s diabetes, your son’s leukemia, your wife’s brain tumor, your mother’s Alzheimer’s, were an embryo away? Would we be like the liberal bioethicists and find justifications for what we now rightly oppose? Or would we continue to respect all humans, no matter what size or developmental stage, even to our own hurt?

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.