This post was written by Mark Hansard on October 15, 2008
In “Down on the Transplantations,” Anita Kuhn, an editor for Touchstone Magazine, reviews a recent article from the New England Journal of Medicine about the definition of patient death and when it is ethical to remove a patient’s organs for transplant. According to Kuhn, the NEJM authors admit that the definition of patient death has been changed to allow more favorable conditions for organ transplants. The old dead donor rule (”cold, blue and stiff”) is no longer in use because in the 1960’s it was changed to “devastating neurologic injury.” This definition, commonly referred to as “brain death,” allowed the organs to be removed from a body when they were still in use. Often, organs die when the patient dies, and so are not useful for transplant. But brain-dead patients still have functioning organs, and their bodies appear alive–they metabolize, excrete waste, and even mature sexually. This, of course, has raised ethical questions in the minds of some ethicists and medical practitioners about removing the organs from such a patient.
Therefore, some experts have proposed a definition of “cardiac death,” in which the patient’s heart is not operative for three to five minutes. But this also has ethical difficulties, as it is possible to revive a patient’s heart even after five minutes of ceased activity. Kuhn writes that this often leads to an ethically inconsistent position in which “irreversible cessation of cardiac function,” comes to mean “we won’t try to resuscitate.”
Interestingly, Kuhn goes on to note that the NEJM authors, instead of retreating to the old dead donor rule because of ethical problems with the new rules, instead say that the problem has been the dead donor rule itself. What is needed, they say, is informed consent ahead of time, either from the patient or the patient’s family, that the organs can be removed even from “irreversible neurologic injuries that do not meet the technical requirements of brain death.” Kuhn gives an interesting analysis and critique of this view, which definitely worth reading here.
This post was written by Mark Hansard on April 2, 2007
This year marks the 75th Anniversary of Aldous Huxley’s Brave New World, and for many reasons, Huxley’s Orwellian story remains as relevant today as it did when he wrote it.
In fact, in two important areas, Huxley’s novel is remarkably prophetic. The opening scenes in which we are introduced to a genetic engineering factory, observing as new embryos are created, assembly-line style, with certain genetic proclivities to fit within their needed castes, are chilling. After embryos are created, named, and “bottled,” for example, they make their way on the conveyer belt to the “social predestination room,” in which they are genetically examined, chosen for their future caste according to the needs of the society, and carefully environmentally engineered.
While we are a long way from social and genetic engineering on this scale, we are taking our first steps toward such engineering through market forces already at work. Recently ABC News ran a profile of a woman in Texas who runs an embryo bank out of her home, in which she includes “Ph.D. sperm,” and eggs donated from “attractive” females with at least a college education. You can read about it here. There is certainly enough market interest to make such “designer babies” ubiquitous. I would be grieved (although not surprised) if eventually we saw the government design “aggressive” babies for use in the military. Huxley reminds us that such abuses are a realistic possibility.
Another thought provoking facet of Huxley’s story is the use of soma, a drug that the government uses to keep people blissfully ignorant and peaceful, “happy” at all costs. As one character admonishes a distraught friend, “What you need is a gramme of soma…One cubic centimeter cures ten gloomy sentiments.” Here he is repeating a mantra with which he was blissfully brainwashed as an unsuspecting embryo on a conveyor belt.
It seems to me these scenes are remarkably prophetic in that in contemporary American culture we see a confluence of unbridled hedonism and increasing government parentalism. These days it’s not just that every individual has a right to pursue happiness, it seems that the government is increasingly seen as the institution that must provide such happiness for the individual (e.g. making trans-fats illegal in New York restaurants—do we not have the ability to make these decisions on our own?). The use of soma in the novel allows the government not only to control the population, but to keep them happy and to protect them from themselves. Are we headed toward our own drug-controlled, parental society? Only time will tell.
One thing’s for sure. Every once in awhile, we all need a good dose of Brave New World.
Part 2 Part 3
This post was written by Mark Hansard on January 31, 2007
Britain’s Royal College of Obstetricians and Gynaecology has recently joined a growing number of ethicists willing to seriously debate the merits of infanticide under certain conditions. According to an article in The Times, a British newspaper, the Royal College has succeeded in getting infanticide on the docket of an ethics panel, which would debate if infants ought to be allowed to die or be “actively euthanized” if they are severely handicapped or in severe pain. The ethicists are hoping to raise the issue for public debate in Britain.
Peter Singer, a philosopher and ethicist at Princeton, has argued along similar lines for years. And The Times notes that it is already legal in the Netherlands to euthanize babies who have severe diseases or deformities.
Of course, the logic of decisions by courts in the West has led to this situation. The Times quotes John Harris, a bioethicist at the University of Manchester, who said, “We can terminate for serious fetal abnormality up to term but cannot kill a newborn. What do people think has happened in the passage down the birth canal to make it okay to kill the fetus at one end of the birth canal but not at the other?” Good point. It certainly makes no reasonable sense to make it legal to kill a fetus before it comes down the birth canal, but not kill it after. The only thing that has changed for the fetus is location.
There are several issues worth pondering here.
First, while early on, Christian ethicists were charged with the “slippery slope” fallacy for warning such things would take place if abortion were legalized, it appears they were right all along. The logic of the abortion arguments seems to lead to such considerations as infanticide and the euthanization of the elderly.
Second, it seems, for Christian ethicists, there is more than one issue here. Of course, there is the old issue of personhood: exactly what is a person, and is there a biological way to measure personhood? (I’m skeptical there is such a way. How many cells does a person have to have in order to be a person? What about the fact that, at several points in our lifetime, all of our cells have died and been replaced with new cells? Does that make me a different person?).
But another quite important issue is a thoughtful theology of suffering. Arguments that would make euthanasia legal (for the young or old) seem to assume that pain is the greatest evil and ought to be avoided at all costs. But Christian theology seems to say that pain, even horrendous pain, can be used of God to accomplish good ends. The symbolism of the cross, for example, points us to Jesus’ excruciating death that bought our redemption. Paul’s thorn was used of God to keep him humble (2 Cor. 12:7 ff, setting aside for the moment the debate about what exactly the thorn was). Who are we to judge that a person who is in serious pain has a life not worth living?
Third, infanticide raises the specter of eugenics, which in some (admittedly small) scholarly circles is mounting a resurgence (e.g., Richard Lynn’s Eugenics: A Reassessment). The Times quotes Simone Aspis, a member of the British Council of Disabled People, who said: “If we introduced euthanasia for certain conditions it would tell adults with those conditions that they were worth less than other members of society.” Exactly.
This post was written by Mark Hansard on September 6, 2006
Advances in fields like biotech and nanotechnology accumulate at such a rapid pace, it is difficult for thoughtful reflection and ethical considerations to keep up. In a startling interview in the latest edition of Mars Hill Audio, bioethicist Nigel Cameron explores the future of nanotechnology and other tech advances, and what they will mean for medicine and bioethics in the near future.
Nanotechnology refers to computer chips and other tech devices that are produced on a “nano scale,” roughly 100,000 times thinner than a human hair. According to Cameron, people in the nanotech field believe that, in the near future, we will be able to manipulate matter in ways never dreamed of before. For example, the National Cancer Institute is predicting that by the year 2015, cancer will be a livable or completely curable disease. Nano-chips, because they are so tiny, will be able to precisely target cancer cells and destroy them, presumably without destroying healthy cells.
But this also raises other possibilities for nanotechnology, such as human enhancement. For example, “transhumanists” want to be able to transform the human body into the next evolutionary step: human beings that are part computer. Computer chips could be implanted in the brain, so that memory could be enhanced, email could be checked, or a movie watched without using a computer screen. According to Cameron, serious scientists are discussing these possibilities, not just science fiction writers. In addition, he says, “The biotech industry wants to be able to patent embryos so that there would be royalties on every baby born.”
Should biotech companies be able to patent genes? Should we use computer technology to enhance the human brain? These are questions that, according to Cameron, very few Christians are thinking about in this country. In fact, he says that while there is a long tradition of contemplating the “meaning of technology” in Europe, there is almost no thought given to this subject in the United States. Philosophy of technology would explore such topics as how technology ought to be harnessed or implemented in the future, what its purposes and limits ought to be, and how tech advances in nanomedicine, for example, would change our understanding of what a human being is.
It seems that as Christian intellectuals we ought to be engaging the questions that are now being asked in our society: “How much of the human body could be enhanced by machines? How much of the body should be replaced by machines?” And “How much of the human body ought to be patented?”
But at a deeper level, perhaps we ought to contemplate the concept of “giveness” as it relates to our humanity. That is, from where do we derive a right to alter ourselves? And is there any limit? Such deeper questions would touch not only on biotechnology, but on the field of cosmetic surgery as well. Another important question: what are the implications of using mechanical or technological metaphors to discuss human beings?
Cameron’s latest book on this topic is How to be a Christian in a Brave New World, co-written with Joni Eareckson Tada. Another excellent resource to keep up with biotech advances and ethical questions is the email newsletter from the Humanitas Project, called Living in the Biotech Century. You can sign up for this twice monthly service at www.humanitas.org.
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