I think Joe hit the nail on the head. One of the reasons I’ve focused on personhood during my short bioethics career is that American physicians are increasingly unable to distinguish between the human being and the biological system. Some deny altogether the existence of anything beyond the physical body, but others only consider the spirit or the soul to be some sort of esoteric thing about which one might philosophize. As a result most physicians believe that if they know the medical information, perform the procedure correctly, and achieve a good outcome then they have practiced good medicine. Tips they can gain from Abraham Verghese about interacting with the patient are icing on the cake. An inspirational insight from Atul Gawande allows them to be reflective in their spare time. But really, those kinds of things are for humanities professors or hospital social workers. In the medical curriculum, we see this value system in ethics teaching that amounts to not much more than instruction on managing emotional responses. “Use this phrase when talking to a patient about cancer so they will feel this way.” “When you enter the exam room, perceive the patient’s disposition by examining facial cues and posture.” If the physician uses a stimulus-response framework for patient interaction, then he has fallen back into the same problem all over again. That’s why mentorship is so important in medicine: a student “lives life” with the attending physician so as to acquire his way of looking at the world, not just his skills. That’s why the oaths—Hippocrates, Maimonides, or others—are so important: they emphasize that medicine is a covenant between two people before it’s anything else. And, most notably, that’s why a medical practice most consistent with Jesus’s healing ministry is one which would still have something to offer if the machine and the lab report were not even there.
This past week, Fox News reported on the circumstance of Yousef Nadarkhani, an Iranian pastor and leader in Iran’s growing evangelical movement whom Iran’s Supreme Court has determined may be executed if he persists in refusing to renounce his Christian faith.
The news of Nadarkhani’s predicament served as a reminder to this reader of the serious stakes involved in identifying with Jesus Christ. Not all Christians are called to martyrdom – and my prayer is that Yousef would be released without further harm – but we are all called to assume the risk, and this because loyalty to God comes first and that loyalty entails fidelity to the gospel of Jesus Christ, which is offensive to the unbelieving soul. Even as we endeavor to live our lives in a winsome way (1 Cor 10:32-33) – we ought not be surprised if ridicule, scorn, or even violence come our way as we proclaim the gospel message in both word and deed.
As I continue to reflect upon “The Scandal,” (see prior posts) I think often about the question of content for a Christian bioethic. Some professing Christians argue largely on pragmatic grounds for the public casting of Christian bioethics in a “publicly accessible” language (i.e. purely philosophical argument). A more robust bioethic – one replete with theological warrant – has its place, the thought goes, in discussions among those operating within a Christian worldview, but not in the broader debate where Christians encounter nonbelievers who are skeptical, if not overtly hostile, to the Faith.
So, a number of questions arise: Can we truly be faithful to the Christian mission when confining theological argumentation to intramural bioethical discourse? Can the “doing” of bioethics be rightly compartmentalized from the task of evangelization or the bearing of prophetic witness in a decadent culture? Is it truly unethical, as some maintain, for physicians to evangelize their patients?
And finally, as I think about our brother Yousef Nadarkhani, I find myself asking, “What cost am I willing to endure in my identification with Christ in the public square?” Christian martyrdom, or the prospect thereof, forces a confrontation with truth both for the believer and the unbeliever. It demands from all a consideration of ultimate value – specifically, is Jesus really worth dying for? To think in these terms may help us navigate the question of how best to formulate our “public” bioethics.
The USA Today recently reported on the difficulties faced by African-Americans seeking healthcare in Alabama. Death rates are higher for most categories of illness in black communities. Oftentimes, physicians are unfamiliar with the obstacles encountered by residents in a particular neighborhood, such as the lack of fresh, healthy food in the grocery stores. USA Today touts a new federal Health and Human Services program as a first step in identifying health disparities. Churches provide support groups that assist in educating people about their health. However, there is little time or money being spent by the Christian community to build clinics in communities such as this one in Alabama. An overall infrastructure for providing charitable ministries is missing.
In Texas, it is common for people to say that if a person wants to have good healthcare they need to pull themselves up by their bootstraps. An African-American friend of mine at Trinity once told me in response, “The problem is, some people don’t have any straps.”
This past fall, I had the privilege of attending the Houston Symphony’s production of
Kaddish. The Kaddish Project seeks to commemorate the noble struggle of individual Holocaust survivors, including four who have made their homes in Houston. Much of my research at Trinity focused on the concept of personhood, that we are more than just biological systems but instead are “someones,” persons. I couldn’t help but think of this as I heard the chorus sing the song of the persecuted Jews: I am someone and “I am here.” Though mocked and beaten in the streets even in the days before World War II, the Jewish people of Europe taught their children that they were of value even though others thought otherwise. The soloists and chorus related the story of one survivor’s recollection of a concentration camp. When the prisoners arrived, those under 14 years of age and over 65 were separated to the left and killed. They were less than optimal for the German labor camp, so they were eliminated. Kaddish led me to reflect on how physicians were a significant part of the German “Final Solution.” They were the ones who deemed the crippled and deformed, the mentally deranged and deficient economic burdens. That’s why I think that as we look for disease and perform technical procedures, it’s important for us to remember that our patients are someones who we must relate to and care for.
In a recent British court case the mother of a 21-year-old woman who was pregnant with her second child asked that doctors perform a sterilization procedure at the time of her planned C-section. The woman has a mental disability and the court is being asked to determine if she is capable of making her own decision regarding sterilization. If it is determined that she is not, her mother is asking for permission for her doctors to sterilize her. The mother says that this would be in her daughter’s best interest due to her inability to care for further children and the likelihood that she would be separated from those children.
This request raises the concern that sterilization of those who had a mental disability was what the eugenics movement of the early 20th century proposed. That attempt to rid society of those who were not desired by preventing their birth showed disrespect for the intrinsic human worth of those with a disability. However, there is a big difference between sterilizing someone in order to decrease the burden on society and doing so because it is in the best interest of the person with the disability. The mother says she desires her daughter to be sterilized for the daughter’s benefit.
The moral difference between the eugenics movement and this mother’s request is one of intent. To sterilize a person who lacks capability to make her own decisions with the sole intent of limiting the number of potentially mentally disabled offspring in society is wrong. To sterilize a person who lacks capability to make her own decisions with the intent of doing what is in her best interest may be right thing to do. If the mother’s intent is not actually her daughter’s best interest, but her own, then it may not be right.
Even though the acts may be the same and the consequences may be the same, intent is the deciding factor in this moral decision.