Religious Liberty and Human Dignity

A December 30th AP article relates the results of a poll that asked respondents about their views of religious liberty. The lead paragraph reads, “Americans place a higher priority on preserving the religious freedom of Christians than for other faith groups, ranking Muslims as the least deserving of the protections, according to a new survey.” The article goes on to detail the percentages of people who thought it was important to protect Christians’ religious liberty vs. the percentages who thought it important to protect Muslims’ religious liberty, etc.

Of course, the results of all such surveys are suspect, because the way the questions are worded determines the outcomes. Given that caveat, the questions this survey asks are fundamentally self-contradictory. To speak of religious liberty for one religion but not another is an absurdity. If “religious liberty” does not apply to all religions, then it is not religious liberty, but religious hegemony. On this understanding “Religious liberty” is a Hobson’s choice: “You have the liberty to practice your religion, as long as it is the one I approve.”

Christians should be particularly keen on this issue, for at least three reasons. First, since we desire the freedom to practice our faith according to our consciences, to disallow the same freedom to those of other faiths is flagrantly hypocritical (and whom did Jesus castigate more harshly than the hypocrites?). Second, Christians have often been (and still are in many parts of the world) subject to religious persecution; if we do not defend the religious liberty rights of others, we have no reason to expect our religious liberties to be defended when someone decides it is the practitioners of our faith who should be persecuted. Finally, religious liberty is closely intertwined with human dignity; denying religious liberty to a certain group entails the denial of their human dignity, and as Nigel Cameron once said, “Human dignity is indivisible; any assault on anyone’s dignity around the world is an assault upon mine.”

 

(Also see Steve Phillips’ post from December 9th.)

(Incidentally, the Cameron quote is from a Frontline interview from about sixteen years ago on assisted reproduction; the whole interview makes fascinating reading, considering all that has transpired since then.)

 

(I could not find the actual questions asked in the survey; this post is based on the reporting of the survey results.)

Refusing to Acknowledge the Human Dignity of Refugees

One useful method to try to deny the fact that someone possesses basic human dignity is to cultivate an “us vs. them” mindset. To do this we must ignore the individual in front of us and instead see only the class of people they represent to us. This helps us to forget that the other person possesses the same human dignity that we have, and allows us to place the other person in a category of “bad people” who are inferior to and opposed to us “good people.”

I made a friend several years back, a Syrian man who was in the States for some higher education. He used to tell me over lunch about the glories of Damascus, and he looked forward to going back there. After he finished his education he did return to Damascus, where he set up his own business. We maintained a regular e-mail correspondence.

Then the Syrian civil war broke out. I became worried for my friend and expressed as much to him, but he reassured me that he wasn’t in much danger. He was apolitical and kept a low profile. But one day he stopped answering my e-mails. I wrote several times with no response. I assumed the worst.

However, about a year and a half later, I heard from him again. He had been arrested for doing business with “the wrong kind of people,” and thrown into a jail. There he had been tortured, seen people killed in front of him, and experienced horrors that he refused to write to me about. Somehow he had gotten out, and he is now establishing a new life in Europe, learning a new language and finding new work.

My friend is a refugee, fleeing monstrous evil. There are some politicians and government leaders, even in this country, who would lump my friend in with his persecutors, placing him in the category of “doesn’t deserve our help.” In so doing they would categorically deny the human dignity that he inherently possesses. They would do this by relegating my friend and all other Syrian refugees to the “them bad guys” category — those people, who are fundamentally different from and pose a danger to “us.” Unlike someone with full human dignity status, they are not worthy of our help.

I don’t know much about public policy. There may be perfectly sound reasons to keep out Syrian refugees which don’t involve the outright denial of their full human dignity. If so, I haven’t heard any yet. And to practice this blatant denial of an individual’s human dignity harms not only those whom we would keep out; even more, it damages the character and soul of the people who practice it.

Dignity and Destiny: Humanity in the Image of God

The idea that human beings are made in the image of God is foundational for all of Christian bioethics. Sometimes such a foundational idea becomes so much a part of how we think that it is easy to forget that it could be misunderstood in ways that are quite harmful. In his book, Dignity and Destiny: Humanity in the Image of God, John Kilner has taken a very careful and detailed look at what the scripture says about this vital concept which has indeed been misunderstood in harmful ways at times.

Three ideas stood out to me as I read:
1. Jesus is the perfect image of God.
2. Being made in (or according to) the image of God means that human beings have a special connection to God which confers dignity on every human being.
3. We have been created with an intent that we will be a reflection of God’s glory as our ultimate destiny.

In Jesus we see what being the image of God really means. Being like Jesus is what we aspire to as we are transformed by God into what he desires for us to be.

In being made in the image of God we have a connection to God that is not lessened by the Fall. Even though we are sinful and fall far short of actually reflecting the glory of God as we are now, being an image of God is what we were made to be and that is something that gives worth to every human being no matter how much we now fall short of what were intended to be.

Human beings do have some attributes that we can manifest to a greater or lesser extent that are similar to and currently weak reflections of the attributes of God. However, those attributes have been twisted by sin and we do not reflect God very well. This does not mean that the image of God has been damaged. Jesus is that image and he reflects God perfectly in human form. It just means that our actual reflection of God’s glory awaits our final deliverance from sin and restoration to what God intended us to be.

Understanding these things about our being made in the image of God helps us to avoid misunderstandings that have been destructive at times in the past. Some have looked at how sin has made us so much less that we were intended to be and have thought that meant that the image of God in us had been lost or damaged. If that is true then being made in the image of God loses its ability to teach us that every human being has been given a dignity that should lead us to respect the value of every human being. When we see that the image of God has not been harmed by sin and it is still what God desires each of us to be and has provided the way for us to be through Jesus, then being made in the image of God retains its power to be the foundation of Christian bioethics.

The Lost Narrative

In their article “Autonomy vs. Selflessness at the End of Life” published in the Summer 2015 edition of Ethics & Medicine, Hannah Martin and Daryl Sas provide a useful foray into the battle over the meaning of human dignity.

The authors describe an alternative to the “flat” version of human dignity espoused by proponents of physician-assisted suicide (PAS)—a version based solely on self-determination. In other words, a human dignity reliant only on autonomy (or, control) in decision-making lacks the depth and breadth inherent in the actual human experience. Our own individual creation ought to be sufficient to convince anyone of our lack of control over the nature of life, and brief reflection on the sheer improbability that there is any life at all should be enough to cause one to ask if there is some other force behind it.

I would add that the concept is not just flat but paper-thin, and bases its appeal on what could be called “the lost narrative.” Martin and Sas refer to the “poignant narratives of dying” that drive state laws legalizing physician-assisted suicide. These narratives succeed when we fail to articulate an alternate, and in fact, accurate view of the human experience of dying.

The authors help greatly to provide the alternative, a view in which dignity is based on virtues such as love (and its selflessness), courage, humility, and blessings such as God’s grace. Without these, autonomy will push us towards the extremes of “absolutizing life’s sanctity by claiming autonomy in life and…absolutizing life’s dignity by grasping at autonomy in death.” In fact, without God, mankind could never find balance, but instead be driven (as we seem to be) toward the extremes.

And without proper balance, where would someone establish the threshold of sufficient suffering to warrant early death? And if selflessness is removed as motive, what horrors might the medical profession produce? The “suffering” of family members and medical staff would enter into the equation (unchecked by selfless love) and push the patient toward an earlier and earlier death.

For the proponents of PAS, suffering is only bad. Human dignity becomes simply avoidance of what we can’t control. Such a view robs mankind of any hope that anyone can be anything more than the person who flips his own switch. But for those of us who have been in the presence of dying, we have had the opportunity to see for ourselves what is and is not dignified. We see it in the selfless love of caregivers, of family, and of the dying, all cherishing those final moments, wishing there were more to spend together, and never ready to end it all too soon.

Seeing the Horror

A video released by The Center for Medical Progress (CMP)  about Planned Parenthood included these words: “Some viewers may find this content disturbing.” It was to warn the viewer about the images of piled fetal body parts dumped from a bag by an abortion clinic worker.

What might be most disturbing…and chilling…is not the body parts, but the casual and glib attitudes of the Planned Parenthood staff toward them.

A subsequent post  in the Bioethics Forum of The Hastings Center attempted to explain away this indifference:

…most of us also don’t want to see graphic photos of any other type of surgery either. But our desire to look away isn’t inconsistent with thankfulness for the life-saving and health-preserving results of any type of medical procedure. It just means we don’t want to watch their gory accomplishment. But physicians don’t have the privilege we have of enjoying medical results without seeing the unpleasant in-between.

I suspect that the author hasn’t watched all the videos. And I’m not sure what purpose bioethics institutes will serve for our society if they harbor notions that fetal vivisection is comparable to “enjoyable” medical results that are “life-saving and health preserving.”

Yes, as a physician, I can see body parts…and worse…without passing out. But every physician must recognize the moral significance of the connection to the human, or else the profession of medicine is not a moral endeavor. In contrast to attitudes of the abortion clinic workers, in the CMP’s videos, the former StemExpress employee Holly O’Donnell expresses a depth of moral insight to recognize that each of these aborted fetuses was more than just a “tissue opportunity.”

It had a face…I remember picking him up…he was big…I remember holding that fetus in my hands when everyone else was busy…It’s really hard knowing that you’re the only person who is ever going to hold that baby…I would think about things like that…I wonder at age 3 if she would like a color…or I wonder what it would look like, her mom or her dad…

Planned Parenthood’s brutality is the logical consequence of Dr. Alan Guttmacher’s (former president of Planned Parenthood) belief, subsequently effectively written into law by the Supreme Court, that “…no baby receives its full birthright unless it is born gleefully wanted by its parents.” Yes, Planned Parenthood and its supporters are being purely logical. But pure rationality in the face of human dismemberment is no virtue. Watching Planned Parenthood staff speak of selling fetal body parts, I am reminded of G. K. Chesterton’s words in Orthodoxy: “The madman is not the man who has lost his reason. The madman is the man who has lost everything except his reason.

A biblical view of animals

Sarah Sawicki ended her post on 8/1/15 with the questions “How can I address injustices toward animals without promoting logic that excludes some people from personhood? Is it possible to balance these two causes, or must one fall in favor of the other?” I think she is correct in her concern about the use of a capacity definition of personhood to establish the personhood of chimpanzees in order to protect them from what is seen to be abuse. I think that a biblical view of animals gives us a foundation for protecting animals while still maintaining a distinction between human beings who have personhood and animals that are not persons, but still have value and who we should care for responsibly.

Biblical Christianity has a long history of supporting the responsible care and treatment of animals while still maintaining the distinction between human beings and animals. One of the things that William Wilberforce and his friends fought for in England in addition to the end of the slave trade was an end to the cruel treatment of animals.

The Bible clearly states that animals are a part of what was good about creation. They are distinct from human beings who have been created in the image of God, but they are still a valuable part of creation. There is a difference between the value of human life and the value of animal life, but both have value. Human beings were created to have a role of being stewards of God’s creation which includes responsible care of animals. Due to our fallen sinful nature we have not done that very well and animals have suffered from the result of our sin. That is something that Christians need to address.

The Humane Society of the US has been working with some evangelical Christian leaders to produce an Evangelical Statement on Responsible Care for Animals which is scheduled to be released in late September. The statement will address in more detail the biblical foundation for how we should view animal life and care for animals responsibly. The Center for Ethics at Taylor University will be hosting a discussion of that statement on October 6 to talk about the responsibility that Christians have to care for animals.

In Memoriam

Memorial Day serves as a holiday so that, we might hope, we pause to remember those who gave the ultimate sacrifice for our freedom. We might take a holiday from thinking about things bioethical as well. But could this day hold a lesson for the field of bioethics?

To set aside a day to remember those who died in defense of freedom is not simply to make some gesture for the fallen; what we do today is of course meaningless to them. To think upon those who have passed away, especially those who died for our freedom, is to set aside time to wonder what that means for how we should live. There is no better incentive for a man to ponder what he ought to do with his life then to be reminded how easily it is lost. And if someone dies for us, then we must ask—was it worth it? What features of character and conduct must we have to merit such a sacrifice?

Perhaps the best-known modern portrayal of this idea is in the movie, “Saving Private Ryan.” As he lay dying, Tom Hanks’ character utters the words to Matt Damon’s character, Private Ryan: “Earn it.” The movie then shows the older version of Private Ryan in sorrowful remembrance, asking if he had in fact done so.

If we think about various issues in the field of bioethics, we can recognize that there are those who have made the ultimate sacrifice as well. We could consider victims of medical experimentation, perhaps. We might also consider the nearly invisible—the human embryos also sacrificed for experimentation or convenience. But there is one group whose ultimate sacrifice comes foremost to mind this Memorial Day—the aborted. These millions are far more numerous than any other group of Americans that has lost their lives for our freedom.  Of course, we could argue whether this is truly “freedom” that abortion has provided, but that is how it is justified to us.

So what features of character and conduct would render us worthy of that which has been sacrificed? It is impossible to come up with any that are consistent with nature of the act of abortion itself. For to be a people of such character to have earned the “freedom” that the aborted have given us would be to be a people who would not do the procedure at all.

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.

Speaking about dignity

Several years ago, while on the verge of delivering the baby of a seventeen year old, I was taken aback by the number of friends that she had asked to accompany her at the event…an event formerly considered far more private than one in which fifteen or so friends might attend (it was a large delivery room). And speaking of private, the wording and location of her tattoo demonstrated further that private areas had lost their former distinction.

The only practical option at that time was to ignore the crowd and attend to the imminent delivery, and ensure the newborn’s and mother’s safety. I could only hope that everyone had the sense to stay out of the way if an emergency arose. There was no time for instructions, explanations, or crowd control.

All turned out well. The teenager delivered a healthy baby, and I stayed on duty on labor and delivery. Our paths never crossed again, but I have thought of that brief encounter many times over the ensuing years.

When I think of the struggle to protect human dignity from innumerable external onslaughts, I think of battles such as those over public policy, technology, and cultural trends. But what I have not seen well is how the struggle extends to the hospital bedside, when the most pressing threat is from the patient herself. How much ought we, as physicians, while comforting and testing and treating and advising, take a firm stand and square off with patients, to explain why they themselves are the biggest threat to their own dignity?

Such a stance doesn’t reconcile easily with the current notions of patient autonomy. A sense of patriarchy within the medical profession comes rushing back, and it would be foolish to claim that patriarchy was always done well.

I am hard pressed to think of examples of seeing a physician address such concerns, unless couched in biomedical terms. It is difficult to know which of the numerous behaviors a patient exhibits falls, ethically and practically, within the realm of the practice of medicine. What I can say, with the advantage of some years, is that with the transformation of medicine to an autonomy-centered realm, we have lost sight of the most important defender of each person’s human dignity: the person herself. If we are to claim our dedication to a patient’s dignity, then should we not be more willing to speak the truth about it—even if it shines a light on an area the patient would rather not be seen?

Thank you for treating me like a person

I went down with the resident to the emergency department to hear the patient’s story (aka “Take a history”) and perform a physical exam as part of the patient’s admission to the hospital. As we were getting ready to leave, the patient said, “Thank you for treating me like a person.”

What does it say about our medical system when “treating someone like a person” is considered an object of special gratitude, peculiar enough to be singled out and mentioned?