Comments: church response to Nuffield report

This is such a hard area to comment. In some ways modern medicine has become a curse. It has become possible to keep a body alive long after it would have died without external support.

A very close friend of mine died of cancer a few years ago. Like Pope John Paul who followed him, he surprised the hospital and elected not to go into intensive care for his final days. Death had become inevitable and he chose to die with dignity and choice. His moment of passing over was timed to show his brothers that he was making a conscious choice and to minimise distress for his wife and eldest daughter. They had to fight the hospital system who advocated for life at any cost.

My previous husband lost a premature girl and had to make the heartbreaking decision to turn off life support when she was less than a day old. Her brain had bled and death was also inevitable. He never forgave his wife of the time for refusing to look upon their little girl. He still cries to this day that he was the only one who had held her hand in love while she lived her short life.

In both cases people had to advocate for the dignity of the soul beyond the body that medicine could keep pumping. They also had to advocate with the religious counsellors at the time.

Conversely there is the morality of it being possible to keep people alive and living with dignity; but with holding the means to do so for reasons of power or economics. This does not just apply to the very young, it is also an issue for the poor and the marginalised.

Posted by Cheryl Clough at Wednesday, 15 November 2006 at 1:54pm GMT

As one who teaches at the college level on the west side of the Atlantic, I can attest to the difficulty students have in understanding that "can" doesn't mean "should." When the ability to do is interpretreted as an imperative to do, any technology becomes the curse Cheryl alludes to above.

George Wald, the Harvard Nobel latureate biologist of many years ago, visted my undergraduate campus while I was a student. During his conversation, he commented that if someone discovered how to generate life he hoped it would be a scientist rather than an engineer. (I'm certain he was drawing a distinction between people who sought only understanding and those who are most interested in solving tangible problems; I don't want to tarnish my engineering friends' reputations!) Here are in fact the central issue of the Schiavo case, the issues surrounding therapeutic cloning (I've wondered what Wald would have to say about that), and ohter breakthroughs.

The writers of the Nuffield document should be applauded for their willingness to say that "can" does not automatically lead to "should."

Posted by David Bieler at Wednesday, 15 November 2006 at 6:38pm GMT

Well said David.

The ethics of understanding that because one can do something does not mean one should do something goes beyond this arena.

It also applies to the use of power. For example, is it possible as a church community to shun and shame people in their sphere of influence? Yes. Can this lead to people committing suicide, taking drugs for sedation, breaking up families? Yes.

Then the question becomes, if we have this much power, should we be using it?

It is again like driving a car. Just because a car is capable of driving at 140 kms an hour, does not mean it should be driven at that speed. Similarly, it might be safe to drive at high speeds on designated roads designed for such traffic. But it is irresponsible to bring that into the suburbs where young children are likely to be on the streets.

Then there is a difference between the technology, those that design the particular model, what it is capable of doing, and how it is operated. The car can be both useful (it gets us to a destination), a burden (greenhouse gases, land fill, consumerism), safe (an ambulance getting you to hospital on time, well designed, driven responsibly), dangerous (driven by an irresponsible driver who causes an accident, breakdowns, design faults). Medicine - drugs and technology has the same parallels. So do social institutions such as churches and states.

There is again the teasing out of where are the design faults in the system: Who is responsible for them? Does anyone take responsbility for them? How do you bring ethics and responsibility into the system in such a way as to ensure dignity and justice for all affected parties?

Posted by Cheryl Clough at Wednesday, 15 November 2006 at 7:07pm GMT

"The writers of the Nuffield document should be applauded for their willingness to say that "can" does not automatically lead to "should.""

Anyone who has spent time in the intensive care units of major hospitals - like UVA, where I did CPE, or has visited the highest care nursing units of a retirement community can attest to that. At both beginning and end of life, there are many difficult areas of decision between 'can' and 'should.'

I sometimes think we are more merciful to our aged and suffering pets than to people.


Posted by Cynthia at Wednesday, 15 November 2006 at 8:30pm GMT

I cannot believe the tenor of these comments.

What is keeping you from employing available technology to save preemies where there is a chance so far as we can tell? Is it merely a cost/benefit analysis? Ought we even make such decisions from within a consequentialist or utilitarian framework?

Posted by The Anglican Scotist at Thursday, 16 November 2006 at 7:40am GMT

My previous husband's other son was the youngest premature baby to survive in Australia at the time. He survived despite having nearly every single complication a premature baby can have. Whole text books were written about him.

That is why the loss of his second child, his little girl hurt so much.

That is why I find people who throw the guilt of "you should have tried" without checking the facts cruel and heartless.

And where is the outrage at children dying of starvation, of preventable illnesses, or being permanently handicapped, for the sake of a few dollars per day or lack of cheap clean water? Or living a day to day existence in fear for their life or being violated?

There are those who are quick to accuse whilst being concurrently complacent to billions of living deaths.

Posted by Cheryl Clough at Thursday, 16 November 2006 at 9:31am GMT

The bishops seem to conflate witholding treatment when it would be "futile" (the baby will die soon anyway) and when it would be "unduly burdensome" (the baby might not die if treatment is administered). Surely there is a significant difference. Burdensome for whom? And what and whose measure of burdensomeness is being used? Can any system of mensuration really tell us the tipping point at which life ceases to be worth living, if life is a gift not a possession?

Posted by Sean Doherty at Thursday, 16 November 2006 at 11:22am GMT

Yes a very good point!! by Sean Doherty

Posted by DaveW at Thursday, 16 November 2006 at 1:29pm GMT

Life is a gift and not a possession. Life should be treated with reverence. Who are we to judge when a life is worth living and acknowledging and when it should be shunted to one side?

A noble sentiment.

Let's start applying it to the afflicted and eunuchs, including GLBTs. Their life is a gift from God. Who are we to deny spiritual resusitation and technology? Or to judge who will live or die in God at the end of their journey?

Posted by Cheryl Clough at Thursday, 16 November 2006 at 4:14pm GMT

Dear Cheryl

I am not sure that life being a creaturely gift translates to "total autonomy to do what I want". Quite the opposite in fact. I am very happy to discuss gender dysphoria and same-sex attraction although this is probably not the place for it as it would be somewhat off-topic!

S

Posted by Sean Doherty at Friday, 17 November 2006 at 9:32am GMT

There's a danger of confusing life with lifestyle. Life is a gift; lifestyle is a choice: not all choices are eqully beneficial; smoe may be positively beneficial, others positively harmful.

For example, in the abortion 'debate' one person's entire life is weighed against another person's transient lifestyle. It is obvious which is the weightier of the two - except to those who have the power to apply the law to their own advantage and the advantage of their like.

Posted by Christopher Shell at Friday, 17 November 2006 at 12:20pm GMT

'Can any system of mensuration really tell us the tipping point at which life ceases to be worth living, if life is a gift not a possession?'

Yes, I doubt there is such a sytem. So decision-making is hard, and needs to be personal, sensitive,& collaborative,as well as professional, clinical, technical. I believe this means letting these tough situations and decisions be influenced, by 'soul'. Not soulless. Soul to me, means listening at the centre & to the centre;& from the centre. Even trying to be open to the infant (infans), being with her or him, seeking to intuit their energy (if not clear desire), trying to go with the grain, the trend, the yes, perhaps desire, of that new, brief life. (there are no machines to monitor this. It seems to call for our openness, to the infant, to true wordless communication of the heart, of soul... Risky for all concerned).

I think pain is not considered enough in may of these discussions. I would urge everyone to bear in mind, the physical pain & trauma suffered by newborns & infants; and the emotional suffering they undergo. This is totally unmitigated for them, by any kind of reflexive process. Raw, un- mediated,unmitigated pain, which is endless for them, as they have no concept of 'time', of beginning or ending --indeed not concepts at all to aaid them (unlike adults--and how terrified WE are of hospital --or even 'just' the dentist).

The other important point is pertinence. Some commentators are literally 'impertinent' as their comments / interventions are intrusive in the lives, suffering & meaning-making of (the)others. Imagine concentric circles radiating out from around the crib. At the centre the 'infant' ('unspeaking one' -- & yet not impassive as we sometimes seem to assume) & the holy family. They are at the centre of it all. They are hurting. They need consideration and appropriate, non-invasive support.

Nursing and other medical staff 'in' the next circle -and perhaps overlapping at point s with the inner one.

And so on, ... out & out &.............

These boundaries need to be observed.

Theoretical considerations are just that. Hardening of the oughteries can often be treated -- if caught in time !

We have to trust people to make their own decisions & respect them and their decisions. If we listen to their feelings and monitor our own it will help greatly, I sense......

Meanwhile, as others have asked --"What of the children and others needlessly suffering around the world, the tragic, avertable deaths of unique beings ?"


Posted by laurence roberts at Friday, 17 November 2006 at 1:20pm GMT

'...in the abortion 'debate' one person's entire life is weighed against another person's transient lifestyle. It is obvious which is the weightier of the two - except to those who have the power to apply the law to their own advantage and the advantage of their like.'

This (kind of) comment is what I would ask you to consider, is literally 'impertinent'(see my lst post above). It would seem to hail from one of the outer circles. Generalisation are all very well, but they have the value, but also the weakness of being general-ised. Ultimately, we find ourselves entering the circle of the particular, the circle of tension, suffering & feeling 'torn this way & that'.

What is the situation of this or that woman who happens to be pregnant ? And is it pertinent or intrusive of me to ask it, in this time and place ? Who am I ? Who do I think I am ?

For many women averting a pregnancy is to them, a matter of life & death. A soul matter.....

************************************************

Also there are those whose fate & / or words testify that they would rather not have come to birth in the first place.....

We may not want to face this. They must.

But I find it hard that there is more concern for a theoretical infant, than for the well-being of that self-same infant when 'it' becomes a social reality, in need of support, education and great emotional & financial investment by us....

Posted by laurence roberts at Friday, 17 November 2006 at 2:34pm GMT

There's no need to decide whether to support or care for babies OR to support or care for parents. Obviously we are called to do both. Anything else is a false dichotomy and a non-choice. Christ calls us to care for those who are needy and powerless and in some cases the needy and powerless are BOTH parent AND child.

So let's not play off concern for 'theoretical' infants (I struggle to know in what sense they could possibly be only theoretical!) with concern for their parents. But neither let us suppose that concern for adults somehow renders mandatory the ending of the life of another. That would also be a false dichotomy.

Posted by Sean Doherty at Friday, 17 November 2006 at 3:27pm GMT

Both could be tackled but are not. People advocate stridently for theoretical infants, because they make and keep the infants theoretical.

You have to enter the delivery room, the ward and join with real infants, real families -- not theorise from a safe distance.

Why do 'pro-life' organisations loose interest in life after its been safely delivered ? This is surely just when help may be needed. Why are so many children born into poverty and poor health ? What has the Bush administaration done for them ? Or adults in poverty and without health care (they were born you know!), and what about elders ?

What has Bush and the republicans done to be pro-life around the world ? They have taken war and increased the conditions that greed terror, as we see so clearly now.

There need be no dichotomy but by Christ there is. And when the PB speaks of taking steps to address it, some afluent American voices cry out --"This isn't gospel!". They want fine religious words-preferablly old lifeless ones, taht can't challenge or change a bean.

Posted by laurence roberts at Friday, 17 November 2006 at 9:23pm GMT

Laurence

Your posting was beautiful. And yes, the pain of the infant is often overlooked. My previous husband's first son has an incredibly high pain threshold from all the needles and other things whilst he spent months in a humicrib. One of the battles that I had to take on when I took this family under my wing is that he had not learn the normal "aversion" responses to things that cause pain or displeasure. He found the idea of respecting boundaries extremely hard to understand.

In fact, when I first came into his life he had been shunted into a school and written off as autistic and incapable of even learning to read or write. Within six months of entering his life, this little boy had been upgraded into a better school and was learning to read and write. I was not able to fix all his major problems because his mother and I did not agree on core strategies, and I chose to defer to her as she was his birth mother and it was her right to choose. It was better for him to be with her than with his father and I, her love was more unconditional. He had enough handicaps in life, and needed an unconditional refuge, and she was the only soul capable of giving him that. (He was expelled from a boarding school within six months because he was too violent).

Posted by Cheryl Clough at Friday, 17 November 2006 at 9:32pm GMT

CS

Your comment about pregnancy being a transitary lifestyle is shocking.

No decent woman ever forgets any child she ever conceives, she counts even her miscarried children for the rest of her life.

It does not take into account how conception occurs. Was the woman raped? How old is she? What is her capacity to care for the child?

It does not take into account the physical intrusion that a pregnancy has on a woman. The hormonal swings, the changes in your body's metabolism, the physical size and then movements of the baby.

There is an unbelievable emotional difference between carrying a child conceived with love and choice (of both parents) and a child conceived by force, duress and hatred. A man might take one minute to rape a woman (don't flatter yourselves, guys), but that then gives him the right to "rape" for continuously for 40 weeks? Plus the emotional baggage that continues, irregardless of whether she keeps the child or hands it over for adoption.

Every decent woman will tell you that one of her worst nightmares is to conceive a child through rape.

Your blase comments about transitory lifestyle reflect indifference to women and their emotional makeup. That is not love.

Posted by Cheryl Clough at Friday, 17 November 2006 at 9:44pm GMT

Sean

I do not see that the two are unrelated.

In both cases there are souls where choices are being made on whether or not to service their needs.

A robust model applies and demonstrates universal principles.

A flawed model is often best highlighted by demonstrating the inconsistency in application.

Posted by Cheryl Clough at Friday, 17 November 2006 at 9:46pm GMT

Laurence

I can't pretend to understand all that you wrote. I'm not sure telepathy is going to help us much in ethics though. I think your idea of impertinence is helpful as it makes the point that it's not necessarily up to the person making a particular comment. There is a difference for example between the way I think aloud about these matters and the way I would care for a woman who has been raped and found out she is pregnant (for example).

However, I think the thinking aloud is important, for three reasons. First, because I am someone who as a friend, pastor, husband, brother etc etc etc will be caring for people in this and other situations. I think I need to think these kinds of things through carefully before I get there! Not in order to impose my view on others - but so that I'm able to offer them more than hopeless abstraction.

Second, because one never knows when one will face these issues oneself. My wife is pregnant. Thankfully everything seems to be going ok so far but who knows what decisions we may have to make together at some point? Again, better to think in advance - although this is not to say that I will necessarily think the same things in medias res.

Third, because noone is an island. Especially if you're a Christian, we're all in this together. The privatisation of certain spheres of life is probably the most damaging development in modern society since it isolates one from mutual support, care and accountability where one needs it most. Because I believe in the body of Christ, I know that when one part suffers, I suffer with it. I am part of the same body as the Christian nurse or the Christian parent. Does impertinence need revision in the light of this?

Cheryl (& Laurence)

Please don't make assumptions about your interlocutors' concern or lack of it for other situations of suffering around the world! I find that quite a bit personally insulting (although I apologise if you didn't mean it personally) as if my concern for the unborn and neonates precludes a wider concern for human life. Hardly. A false dichotomy again?

Posted by Sean Doherty at Saturday, 18 November 2006 at 10:52am GMT

Sean

There are theological circles that obsess about concerns for the unborn whilst at the same time actively sabotaging activities to provide help for others.

If you are not of that camp, fantastic.

For the people who are of that camp, hypocrites.

Posted by Cheryl Clough at Saturday, 18 November 2006 at 3:24pm GMT

Thanks so much Cheryl. Thanks for sharing this with me. I think that probably the adult world finds the pain of the unborn and of infatns unbearable.

Posted by laurence at Monday, 20 November 2006 at 7:13pm GMT

No, no Sean --of course it can't be you personally -- we don't know each other well enough for starters. VERY best wishes for the pregnancy to you both. WoW ! what an amazing moment in life to reach. Just take care of her and the pregnancy--and yer slen !
Yes, abstraction is as you say limited.
Pax amoque

LAURENCE X

Posted by laurence at Monday, 20 November 2006 at 7:18pm GMT

Thank you both.

Laurence, I do find the comment about finding pain unbearable a bit confusing (probably I have misunderstood you). As I understand the arguments in favour of euthanasia for some fetuses and neonates, the issue is precisely the unbearableness of such pain which leads many to feel that death is preferable to life for them (e.g. the quality of life argument and the intrusive treatment argument).

The pastoral and spiritual traditions of Christianity yield profound help here - and a profound challenge to such arguments. They seem to suggest that the role for Christians (following the pattern of the incarnation) in such situations is to be a supportive and caring presence even in the very teeth of incredible pain - rather than assuming one can know which lives are 'worth living' and which are not. This requires the very costly discipline of feeling out of control and willing to cope with a lot of pain and mess, instead of trying to sort it all out and make things safe and comfortable - sanitised, even.

NB I am NOT saying that this is what you are deliberately advocating - but I do wonder how (if at all) you can avoid it as a consequence.

Posted by Sean Doherty at Tuesday, 21 November 2006 at 3:11pm GMT
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