Apparently, these sentiments are more common than I thought. A recent study in the Journal of Palliative Medicine confirms that many members of the public have negative views of hospice and palliative care. Consider the following commentary from an American Medical Association website:

Three decades after hospice emerged as the standard of care for terminally ill patients, the end-of-life treatments that palliative medicine physicians provide are frequently referred to as murder, euthanasia and killing.

More than half of hospice and palliative medicine physicians say patients, family members and even other health professionals have used those terms to describe care they recommended or implemented within the last five years, according to a nationwide survey of 663 palliative care doctors in the March Journal of Palliative Medicine.

In fact, however, the hospice movement is one of the best things to happen in the modern world of medicine. As medical care has become more technological and sophisticated, it is possible to prolong the quantity of life at greater and greater cost to its quality. Rather than allow patients to pass away peacefully, the technological imperative seems to demand that they die in an impersonal ICU bed surrounded by machines, and with a tube in every bodily orifice. But compassionate medical care does not require that we prolong the dying process of the terminally ill.

Back when I was a resident in general surgery, it was not uncommon for me to observe my medical professors simply ignore the terminally ill on their rounds. Sometimes, I was the only physician to actually visit a dying patient during my work day, when I would draw a blood sample or perform a minor procedure. Today, the good news is that hospice and palliative (non-curative) care are recognized as medical specialties in their own right. No longer do physicians ignore the dying; the goal of hospice is to control pain and suffering at the end of life, to give dying patients and their families the help they need in these trying circumstances.

One of my former mentors once once told me: “At the end of life, patients need two things: comfort and company.” Dying patients need relief of symptoms and our presence. It seems to me that this is a wonderful way to honor our Heavenly Father, Who is the Author of life. Hospice care and palliative medicine are loving, compassionate, and effective means to encourage patients as they prepare to come face to face with the Eternal.

Full Online Commentary in American Medical News

Alive Inside investigates … the power music has to awaken deeply locked memories. The film follows Dan Cohen, a social worker, who decides on a whim to bring iPods to a nursing home.  To his and the staff’s surprise, many residents suffering from memory loss seem to “awaken” when they are able to listen to music from their past.  With great excitement, Dan turns to renowned neurologist Dr. Oliver Sacks, and we follow them both as we investigate the mysterious way music functions inside our brains and our lives.

“Alive Inside” focuses on one man’s journey, but it raises many deep questions about what it means to still be Alive Inside. It questions when we stop being human, and what it takes to re-start a life that has faded away. It asks questions about how we see our elderly, and how we are going to treat an epidemic of these degenerative diseases.

In the movie, Dr. Oliver Sacks is heard talking about Henry, a patient who suffers from dementia:

We first see Henry, inert, maybe depressed, unresponsive, and almost un-alive.  Then he is given an iPod containing his favorite music…Immediately he lights up.  His face assumes expression. His eyes open wide.  He starts to sing and to rock, and to move his arms. He is animated by the music.

Later Dr. Sacks continues:

With this beautiful new technology you can have all the music which is significant for you in something as big as a matchbox…I think this may be very, very important in helping to animate, organize and bring a sense of identity to those who are out of it otherwise.  Music will bring them back into…their own personhood, their own memories, their own autobiographies.

You can watch a clip from “Alive Inside” here:

Music may be a tool in helping us treat our elderly with dignity and compassion.

(contributed by Dr. Sharon Christman, Department of Nursing)

Abortion is largely accepted even for reasons that do not have anything to do with the fetus’ health. By showing that (1) both fetuses and newborns do not have the same moral status as actual persons, (2) the fact that both are potential persons is morally irrelevant and (3) adoption is not always in the best interest of actual people, the authors argue that what we call ‘after-birth abortion’ (killing a newborn) should be permissible in all the cases where abortion is, including cases where the newborn is not disabled.

As unsettling (OK, horrifying) as their idea is, there is nothing new here. Utilitarian philosopher Peter Singer and his colleague Helga Kuhse proposed the infanticide of handicapped infants back in 1985, in their well-known book, Should the Baby Live? However, there are two significant differences in this latest proposal: 1) The authors extend the moral permission of killing newborns to all babies, not just the disabled; and 2) They propose the euphemistic phrase “after-birth abortion” to make the act seem a bit more acceptable.

The idea behind all this is a curious inversion of a life-affirming ethic. Francis Schaeffer, in Whatever Happened to the Human Race? once wrote of the moral equivalence of a valued newborn and its status just “10 minutes” earlier, i.e., in the womb. Clearly, he wrote, no one could claim that the moral worth of a baby changes just because of its location (e.g., in the womb as opposed to out of it). That millions of Americans intuitively understand this logic is clear: the overwhelming majority opposed partial-birth abortion before it was made illegal.

The inversion is this: Singer and his philosophical progeny agree with Schaeffer that there is no essential moral difference between the unborn and the newborn. But then they claim that, since abortion (on their view) is morally licit, infanticide must be as well. Then they sanitize it by naming it “after-birth abortion.”

Another victory for utilitarianism. Heaven help us.

Full-text of article in the Journal of Medical Ethics (February, 2012)

Most people think of cell biologists as bench scientists who grow things in little dishes. As a university professor training future cell biologists, I wondered about my students’ perceptions of the need for an ethical framework. I asked my advanced students for their feedback on the pressing ethical issues in our field. Here are some of their ideas:

1. The origin of the cells we work on matters.  We would find it morally problematic to help destroy embryos for stem cell research. Similarly, we would be opposed to using tissue obtained from induced abortions for research.
2. The stewardship of creation matters.  Genetic modification of crops, as well as genetic therapies for disease, may have unintended consequences. While all of us see the potential good in producing more food or curing disease, our knowledge of outcomes is limited. We must be careful stewards of these techniques.
3. Living creatures matter. Therefore, we should be wise in our use of resources. How drugs are tested impacts human beings as well as animals, and our use of  medications may impact the environment. We should develop research strategies that protect the environment and our fellow living creatures.
4. The gift of human procreation matters. Not all birth control methods protect the unborn. We wish to use, study, and develop family planning technologies consistent with a high view of human persons. Genetic screening and other forms of testing may allow for informed decision making. However, we regret that some persons may use test results as a basis for abortion

Ethical standards mentioned by my students include defending human life in its earliest forms, stewardship of the world around us, valuing all of God’s creation, and thinking deeply about how we procreate. Apparently, ethics does apply in a Petri dish after all.  Aren’t you relieved?

For more information: Global Health Outreach

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1) Tia Zirkle’s piece, “The Tao and the Art of Feminine Beauty,” is a thoughtful reflection on Elizabeth Elliot, C.S. Lewis, natural law, and femininity.

2) Christina Kinch, in her essay, “Let Them be Heroes,” gives a theologically provocative defense of the use of frozen embryos for research. Now let’s make one thing clear: neither Christina nor her professor (me) agree with the conclusions of her inventive article, but she helps give a sympathetic face to “the other side” in these debates.

These articles, as well as earlier ones, can be found at: CedarEthics Online.

A recent update reminds us that applications of adult stem cells to treat human diseases continue to progress. Cellerix is a biotechnology company that has adult stem cells in various stages of human testing. This means we may see new therapies on the market within a few years. Some of these treatments may help patients with Crohn’s disease, osteoarthritis, rheumatoid arthritis, and other inflammatory and autoimmune diseases. The cells come from adipose tissue-derived mesenchymal stem cells, are found in the adipose (fat) tissue of adults.

This news comes on the heels of a development just last month, where scientists announced they had successfully isolated colon stem cells from biopsy samples. The inability to culture certain human stem cell types from adult cell lines is one of the main arguments for using embryonic stem cells (which requires the destruction of frozen embryos). These new  developments weaken the argument that embryonic stem cell research is essential to cure certain diseases that plague humanity.

The clinical trials cited above are by no means rare.  A Google search of adult stem cell therapy brings up many therapies already in clinical use. Search [adult stem cell clinical trial] and you will find even more therapies in various stages in development. Some of sources of adult stem cells in these therapies include cells derived from bone marrow, central nervous system, and fatty tissue of adults, as well as cells derived from umbilical cord blood or cells of placental origin, obtained after birth.

For those of us who morally object to embryonic stem cell research, the fact that new and successful clinical treatments use alternative sources of stem cells is a great encouragement. As more biotech companies develop such  treatments, there will be less pressure to terminate the lives of human embryos for the sake of scientific progress.

References:

1. Cellerix Secures 4.95M for Phase III Study of Allogeneic Adult Stem Cell Therapy: http://www.genengnews.com/gen-news-highlights/cellerix-secures-4-95m-for-phase-iii-study-of-allogeneic-adult-stem-cell-therapy/81245764/?kwrd=Adult Stem Cells
2. Researchers Isolate and Expand Elusive Human Colon Stem Cells from Biopsy Samples: http://www.genengnews.com/gen-news-highlights/researchers-isolate-and-expand-elusive-human-colon-stem-cells-from-biopsy-samples/81245626/?kwrd=Adult Stem Cells
3. Is the Progression of Adult Stem Cell Therapies into the Clinic a Good Sign for Technology? http://www.genengnews.com/analysis-and-insight/is-the-progression-of-adult-stem-cell-therapies-into-the-clinic-a-good-sign-for-technology/77899325/?kwrd=Adult Stem Cells

That is a terribly hard thing. I hate Alzheimer’s . . . That person is gone. They’re gone. They are gone.  What he says basically is correct. I know it sounds cruel, but if he is going to do something, he should divorce her and start all over again.

Predictably, the interviewer responded with a question about marriage vows. The Reverend Robertson replied:

If you respect that vow, ‘until death do us part,’ this is a kind of death . . . I can’t fault him for wanting to have some kind of companionship. If he says, in a sense she’s gone, he’s right. It’s like a walking death. But get some ethicist besides me to give you the answer because I recognize the dilemma . . .

To his credit, the televangelist is not guilty of complete abandonment, since he did remark that the husband should take care to provide proper custodial care. But otherwise his comments have drawn almost universal criticism from religious and secular commentators alike. Here are three reasons why Pat Robertson is just plain wrong:

• The traditional marriage vow “until death do us part” is not directly from Scripture, but it is consistent with the Bible’s covenant view of marriage. The “one flesh” of Genesis 2:24 connotes a deep, long-lasting bond. The Lord Jesus, in referring to this text in Matthew 19:4, said, “So they are no longer two, but one flesh. Therefore what God has joined together, let no one separate” (NIV).
• Marriage is about more than two people sharing their lives together; it is a testimony to the relationship of Christ to His church. Ephesians 5: 23 says: “For the husband is the head of the wife as Christ is the head of the church, his body, of which he is the Savior.” Verse 25 goes on: “Husbands, love your wives, just as Christ loved the church and gave himself up for her.” Faithfulness within marriage is therefore a representation of Christ’s faithfulness to His church. And if we would stretch the metaphor, we His church were certainly dead in sin, yet He did not abandon us.
• Speaking of death, the wife is not dead yet! Of course such sloppy thinking is very much in line with the functional view of human personhood, where those who cannot think rationally or make decisions for themselves have less value than the rest of us. So we continue to marginalize the poor, the infirm, the elderly, and the voiceless in our midst, rather than seeing each human being as a valuable person, uniquely created in God’s image.

At the heart of all this is a soft-hearted but poorly thought out concept of compassion. Such “compassion” is a poor substitute for Christian justice, and for a true understanding of the poor in spirit, merciful, and pure in heart of Matthew 5:1-11. Real mercy, love, and biblical compassion begin with a genuine understanding of biblical truth. Unfortunately, this was sadly lacking in Reverend Pat Robertson’s remarks.

The newest papers cover a broad spectrum of topics, and are listed below:

The Nazi Research Data: Should We Use It? – Sarah Wilson

Safeguarding Genetic Privacy – Anna-Marie Struble, Emily Valji, and Jennifer Lilly

Altered Nuclear Transfer Violates Natural Law Ethics – Thomas Bertagnoli

Of Violinists and Fetuses – Dylan Black

Virtue Ethics for Christians – Benjamin R. Kilian

Third-Party Gametes and the Christian – Emily Valji

A man from the Columbus area recently pled guilty to attempted murder. His crime? He tried to force his girlfriend at gunpoint to have an abortion against her will. When they arrived at the abortion facility, she passed a note to the clinic personnel. They called the police, and the man was arrested. So according to Ohio law, if a woman wants to have an abortion, it’s a legal procedure; if she is forced to have the abortion, that makes it murder. The legal status of the unborn child completely depends on the attitude of the mother.

Now it turns out that the woman was never at risk to have an abortion, since clinic personnel would not perform the procedure without her consent. Her baby has been born, and is in good hands. Yet her boyfriend could spend up to 20 years in prison for wanting the baby dead.

This is another strange example of our schizophrenic legal system that fails to afford all unborn children equal protection under the law, as specified in the 14th Amendment to the U.S. Constitution.

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1) The obligation to perform the procedure “in case of emergency”
2) A prohibition for persons participating “indirectly” in the procedure to exercise their right of conscience
3) The establishment of an official list of conscientious objectors

Hmm, this means that pro-life doctors might be mandated to perform abortions in some circumstances, in spite of their moral scruples. Furthermore, nurses and allied health professionals will be obligated to assist in all such procedures — no right of conscience for them. And finally, there will be a list — a “black list” if you will, of “objectors,” exposing such individuals to discrimination and recrimination. If this doesn’t bother you, just think of the McCarthy era in America in the 1950′s to better picture how this might work.

Pay attention as this issue plays out, for as the Council of Europe goes, so will the United States go in the near future.

I have added my name to a petition to appose these draconian measures, that violate the Hippocratic tradition of medicine that has held sway for 2400 years (see petition link below). Please also consider signing, and join me in prayer.

Petition (in French, but click on the British flag to review in English)

Judge Lamberth’s decision should not be surprising, for it is based on clear and unambiguous law. The Dicky-Wicker Amendment, passed in 1996 as part of a federal appropriations bill, has been passed again every year since. This amendment specifically prohibits the use of federal funds for:

(1) the creation of a human embryo or embryos for research purposes; or (2) research in which a human
embryo or embryos are destroyed, discarded, or knowingly subjected to risk of injury or death . . .

In March of last year, President Obama attempted to reverse long-standing policy from the Bush administration banning federal funding for embryo-destructive research through the National Institutes of Health.  That decision has paved the way for billions of dollars in proposed embryonic stem cell projects, in spite of the Dicky-Wicker Amendment cited above.

Two researchers, in collaboration with pro-life groups, brought suit in federal district court. Their research on so-called adult stem cells is promising and not ethically controversial. They fear that the Obama guidelines may de-fund their work. In his ruling Judge Lamberth acknowledged that the researchers had standing to bring their suit forward, and granted the injunction.

The Obama administration is appealing the ruling. Stay tuned.

New York Times Article

Obama Executive Order of 2009

Special Announcement: Health Care Ethics Conference, “Protecting the Vulnerable in the 21st Century,” Sept. 15-17, 2010 (Conference Details)

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Now you may recall that a drug called “Plan B” (levonorgestrel) is already on the market, and is in fact available without a prescription. Many in the pro-life community have expressed concerns that it may interfere with implantation, making it an abortion-causing agent (an abortifacient). This claim is controversial, and not proven either way scientifically.

Here’s the problem: the new drug, ella,  is not related to Plan B at all. It is actually chemically related to the abortion drug RU-486 (mifepristone), so it has a high likelihood of being an abortifacient itself. The FDA is likely to approve the drug for the U.S. market, despite an absence of studies on its possible abortifacient effect.

The Center for Bioethics, along with 19 other American organizations, has signed a letter to the FDA, opposing approval of ella. We have joined such groups as Concerned Women for America, the Family Research Council, the National Right to Life Committee, Americans United for Life, and Life Issues Institute. You can read the letter here.

Achilles tending the wounds of Patroclus in the Trojan War

Followers of the Center for Bioethics and this blog know that I have endorsed and signed the Manhattan Declaration, a Christian statement of solidarity in defense of the sanctity of life, traditional marriage, and religious liberty. In previous posts (1/10/2010 and 7/06/2010),  I have pointed out that speaking out for life, families, and conscience may come at a price, as these principles are under assault in our contemporary society. It appears that these religiously-informed ideas, foundational as they are, are becoming a minority viewpoint, certainly in the United States. And, increasingly, we are a persecuted minority.

So what does this mean for those of us who believe in and teach these foundational benchmarks? We must surely continue our advocacy, but what if we are not successful? At what point is it incumbent upon us to practice civil disobedience, as the apostles did (Acts 5:27-41)? For an insightful discussion of this idea, listen to Dr. Timothy George, one of the originators of the Manhattan Declaration, at this link.

This last idea has been under increasing attack in our public discourse. Last December, Secretary of State Hilary Clinton gave a speech at Georgetown University. In a subtle phrase that Chuck Colson refers to as an example of  Orwellian “newspeak,”she repeatedly referred to “freedom of worship” as a key democratic principle. But the Bill of Rights guarantees our “freedom of religion,” not the more narrowly defined right Mrs. Clinton spoke of. If we accept her terminology, we will lose the ability to define who may work in Christian organizations and churches. This would be an erosion of religious liberty similar to what is happening in Canada, with devastating results for faith-based organizations and charities.

To better understand this, check out Chuck Colson’s recent commentary (below, or go to his website):

Sources:

Robert Kane: A Contemporary Introduction to Free Will (2005, Oxford University Press)
Derk Pereboom: Living Without Free Will (2001, Cambridge University Press)

Free Will Debate (Video)

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