The Engine of Shame – Pt I

Steam locomotiveA wise friend–a man who helped me emerge from a period of considerable difficulty in my life–once taught me a simple lesson. In less than a minute, he handed me a gift which I have spent years only beginning to understand, integrating it into my life with agonizing slowness. It is a lesson which intellect cannot grasp or resolve, which faith only begins to illuminate–a simple principle which I believe lies close to the root of the human condition.

My friend taught me a simple distinction: the difference between guilt and shame.

While you no doubt think I am devolving into the linguistic morass of terminal psychobabble, I ask you to stick with me for a few moments. What you may discover is a key to understanding religion, terrorism, social ills such as crime and violence–and why the jerk in the next cubicle pushes your buttons so often. On the other hand, if you’re among those who believe guilt and shame are simply the tools of religion and society to restrict your freedom–that as a perfectly liberated postmodern person you are beyond all that–well, you are probably wasting your time reading this. But most of us recognize the influence of guilt and shame in our lives–even while trying not to focus on them, as they are uncomfortable emotional topics, best avoided if possible.

There is a tendency to conflate guilt and shame, merging them into a single human response to bad behavior or personal shortcomings. Yet they are quite different. Guilt is about behavior, shame about being. Allow me to expand on this a bit.

Guilt is an emotional–or some would say spiritual– human response to behavior or actions which violate a respected set of rules. The rules violated may be internal or external, and may be based either in reality and truth or distortion and error. The rules which may engender guilt must be respected: that is, they must originate from a valid source of authority–parents, elders, religion, law–or have been internalized into one’s personal mores or conscience from one or more such sources. Rules which are not respected pose no difficulty: I feel no guilt at not becoming a suicide martyr for Allah, since I do not respect (i.e. recognize as valid) the rules which promote such behavior. The response to violating respected rules is at its heart based on fear: fear of punishment by God or man, fear of rejection, or fear of ostracization from friends, family, or society.

Since guilt is an uncomfortable emotional state, we generally make efforts to avoid or mitigate it if possible. There are a number of means by which this can be accomplished, with greater or lesser efficacy. We may of course, practice avoidance of the behavior which induces the guilt. If the rules are legitimate and based on worthwhile principles, this is obviously a beneficial approach: if you don’t steal things, you won’t go to jail for burglary. But avoidance may prove destructive if the rules are based on error. For example, if your parents or religion have taught you that all sexual activity is wrong or evil, this can prove a huge impediment to physical intimacy and relationships in marriage.

Guilt may also be mitigated–especially when it is chronic and recurring–by changing the rules. You may leave a religion which is highly legalistic for another less so–or for none at all; you may change your situation or environment to one where the rules can be ignored and not enforced; you may seek counseling to correct perceptions about sexuality or other destructive interpersonal biases or beliefs. Or you may simple practice denial–justifying your behavior through the creation of new internal or social rules, while avoiding or rationalizing the inevitable consequences of your still-errant behavior.

So guilt may be addressed by modifying behavior or changing belief systems, through choice or denial. What then about shame?

Shame–the very word makes us uneasy, striking deeply into the core of our being. For shame is not about what we do, but about who we are. It speaks to a deep sense of unworthiness, rejection, inadequacy, and isolation. It says we are not OK, that what we truly are must be hidden. And this we do with all the energy at our disposal, throwing up an impenetrable wall to keep others out at all costs. For the essence of shame is relational–it says that if you really knew what I was like, you would be repulsed and thus reject me. The resulting isolation–real or perceived–is a devastating threat, engendering a pain so profound it approaches unbearable.

The origins of shame are varied, and not fully understood. We seem to be programmed to interpret certain words and behavior by others–especially parents and siblings in childhood–as not simply critical of our behavior, but a statement of our worth. This is an especially powerful force coming from parents, under whose authority and supervision we are molded into social beings. While this may be especially pronounced in dysfunctional or abusive homes–alcoholism, sexual abuse, and mental illness come to mind–it occurs even in well-functioning family units, and with speech and actions which are not intended as critical or demeaning, but which are interpreted as such. The soil of the soul seems fertile ground to bring forth a tainted crop of shame, even from the seemingly benign bruises of normal human interactions and relationships.

From the Judeo-Christian perspective, this propensity toward shame is understood as rooted in the spiritually-inherited rupture of our relationship with God, manifesting itself in an extreme self-centeredness and self-focus, which acts as a toxic filter letting in the destructive while keeping out the good. Having been born into a state of remoteness from God–perceived at a spiritual level as rejection by Him, though in fact just the opposite–we are acutely sensitized to rejection by others: it fits the mold perfectly. Thus every real or perceived hurt, criticism, or rejection simply confirms that we are rejected, worthless, and of no value. Our self-centered mindset insures that even events not focused on our self-value are interpreted in ways that affirm our sense of shame–hence the child that blames herself for her father’s drinking and abusiveness.

While shame lives deep below the surface–a monstrous child kept hidden from public view–its manifestations are legion, and its ability to percolate to the surface and alter our lives and behavior is formidable. The pain of shame requires response, no less than a hand on a hot stove, and it may be triggered by many means: by concerns about physical size, strength, skill, or ability; by issues of dependency or independence; by competition with others; by worries about personal attractiveness and sexuality; or when dealing with matters of personal closeness and intimacy. Thus triggered, an outward manifestation is inevitable, and will generally fall into one of four general responses:

  • Withdrawal — perhaps the most natural response to pain, we retreat from its source to avoid the risk of exposing our vulnerability. Hence we steer clear of people or circumstances which may trigger shame, withdrawing into a nominally safer–but profoundly lonely–world. This response may range in manifestation from shyness up to deep, pathologic depression or psychosis.
  • Attack Self — The loneliness of withdrawal and isolation is itself a deeply uncomfortable state, and often raises the profound terror of abandonment. To avoid such painful estrangement, many will resort to demeaning and depreciating themselves, thereby becoming subservient to others more powerful, resulting in a condition of dependency. While this may lessen the pain of isolation and abandonment, it further exacerbates the underlying shame by reinforcing one’s worthlessness and inferiority. The relationships so formed are not those of equals, and therefore satisfy the need for true intimacy poorly. Such responses range from obsequiousness and self-demeaning deference to others, to depression, and all the way to masochism, self-mutilation, and suicide.
  • Avoidance — If the shame cannot be eliminated, the feelings most surely can: shame is soluble in alcohol, can be freebased, and its pain assuaged as well by a host of other self-destructive behaviors. One’s choice of drug–chemical or behavioral–is influenced by genetics, neurochemistry, and environment, but all have the common goal of emotional oblivion. Eating disorders, obsessive-compulsive behavior, behavioral addictions to work, computers, gambling, or sex can divert the mind and stimulate sufficient endorphins to make the pain go away–at least for the moment. But the drugs and behaviors only worsen the underlying sense of failure and inadequacy, and lead to fractured and destroyed relationships, loneliness, and sometimes physical illness and death.
  • Attack Others — Rage and anger are common responses to shame, as we seek to defend our threatened worth by destroying the antagonist–or at least diminishing their worth, through sarcasm, criticism, gossip, physical, verbal or sexual abuse, or violence. But as with other coping mechanisms for shame, the outcome is invariably destroyed relationships, and adverse consequences, both legal and personal.

Thus the engine of shame drives a host of behaviors which are both personally destructive and socially disruptive. If you scratch the surface of nearly any dysfunctional personal or social problem–alcoholism and drug abuse, obesity, school violence, inner city crime and teen pregnancy–even international terrorism–you will find at its dark heart the issue of shame. It is, at the very least, a common thread among such societal and personal liabilities, if not a central driving force.

So it behooves us to get a handle on this matter of shame, uncomfortable though it may be. Our responses to its provocations are major causes of personal agony and social crisis. But like a schoolyard bully, once confronted face-to-face, the tyranny of shame can be broken through courage and openness, and the strength of numbers. On these thoughts I will be reflecting in a subsequent essay.

Euthanasia in New Orleans?

skullMy last post, riffing off a report that physicians may have euthanized some patients in a New Orleans hospital during Katrina caught a fair amount of heat for promoting a news story which was, in the eyes of some, an urban legend. One of my more–umm, hyperbolic admirers– has some choice words about my decision to lend credence to this obviously fraudulent story, drawing the conclusion that I am a moron seriously in need of growing a brain, and a threat to my patients’ health and well-being. Well, you can’t please all the people all the time–and no suggestions on just how to grow a brain were proffered, so I guess I am on my own there. But criticism–never pleasant–can be both cathartic and corrective, as indeed it was in this case. And so I thought a few words of reflection on that post might be in order.

First, when I first ran across this report in The Mail, a British tabloid, I was alarmed that it might have occurred, and frankly found the story at first generally plausible (perhaps a bias on my part to believe it existed), but nevertheless found it suspect in some regards. British tabloids are not known for accuracy in their sensationalism–lagging behind even the NY Times in this regard. It appeared to be single-sourced, and only one named witness was given. The witness was separately mentioned in another, unrelated story quoted on the BBC, as a British citizen living in a town near New Orleans, and plausibly involved in relief efforts there, lending some credence to the story. Other aspects of the story seemed very odd–the pharmacy lockdown, the use of high-dose morphine to kill (potassium chloride or barbituates are much more efficient), and the oddness of having a non-medical emergency worker notify the families. Based on these reservations and the single source, I twice expressed some reservations about the story’s veracity. This was clearly not enough skepticism for some, but I trust my readers’s intellects and instincts, and doubt any would be misled to believe the story was absolutely verified. For those who may have come to this conclusion, let’s be clear:

I do not know if this story is true–in fact, there is substantial reason to doubt that it is, and that doubt is growing.

Over the past day or so I have been following the story on the web. It has been repeated almost verbatum in several British, Australian and Canadian papers–often without attributing The Mail as its source. But nothing in the States, nothing from the affected families or local population. To date, Snopes has nothing, pro or con, on the topic. Orac–whose skeptical birddogging of alternative medicine and thoroughness in debunking all things mythical, has an excellent summary of the information to date, and comes down (not surprisingly) on the side of urban legend. Even the crowd over at Democratic Underground are bouncing this one around with some skepticism (odd for this conspiracy-loving crowd–although if it did happen, it was Bush’s fault), which is summarized here.

So why run an iffy story like this as a basis for a commentary on physician-assisted suicide? Well, several reasons: I was at first, less skeptical about the story than I am now–and probably less skeptical than I should have been. Secondly, it was an easy framework in which to comment and discuss many of the issues surrounding euthanasia. How could an urban legend be the legitimate basis for such discussion? The answer, I believe, is simple–and is the reason this story has sustained a life of its own on the web, even if legend: quirks and odd details notwithstanding, the scenario is entirely plausible.

First of all, voluntary and involuntary physician-assisted suicide is already a reality in this country–although it is rare, and much of it is underground. An anonymous survey of over 3100 physicians published in 1998 in the New England Journal of Medicine cited the surprisingly high incidence of physicians who had considered–or performed–assisted suicide: 11% said they would be willing to administer a lethal medication to a patient who asked, even if illegal; 7% would be willing to administer a lethal injection themselves; and nearly 5% stated they had already administered such a lethal injection. Significantly higher percentages said they would consider such a recourse if it were legal. It should be noted that this was not a cross-section of all physicians, but the survey was directed at those involved in terminal care. A smaller survey in JAMA, also in 1998, revealed that nearly 16% of oncologists had participated in active euthanasia–and over 15% of these cases were involuntary (i.e., without patient request). Oregon’s Death with Dignity Act was passed in 1994, and as of 2004, 208 patients have died from a prescription for a lethal dose of barbituates given them legally by their physicians (Oregon physicians are not allowed to directly administer lethal oral or injectable medications). The incidence of unreported physician-assisted suicide (PAS) is impossible to gauge–in part because of the grayness of deaths due to high-dose opiates in terminal cancer pain, which may be either incidental or intentional. But there is fairly widespread support among physicians for some sort of PAS–with as many as a third supporting the idea, at least at the theoretical level.

Furthermore, anyone who has any experience discussing euthanasia with proponents or listening to such debates will have heard every single argument put forth by the anonymous physician in the New Orleans story. We hear about “death with dignity”, “compassion” “they are going to die any, so why not be merciful?” And who would doubt, should such a scenario occur, that the media would be apologists, to prevent exposure if possible to those who committed such acts lest they be “scapegoats”? This story–true or fabrication–embodied the bulk of the rationalizations and arguments of those who support assisted suicide or active euthanasia, and therefore served–even if fictitious (and I surely hope it is)–as a hypothetical framework for addressing these points.

I will in the future be more cautious about such stories–even when they prove a teachable moment, and I apologize if any of my readers were led to place more credence in this story than it appears to merit at this time.

And one more comment–about comments: I continue to marvel at how absolutely clueless and disrespectful some commenters can be. Believe it or not, it is possible to disagree–even passionately–with another individual with insulting them personally or questioning their integrity. The anonymity of the web allows–even encourages–such abrasive discourse, seemingly without consequence. And I generally try to tolerate such excesses in comments, up to a point. But though you are anonymous, your character shines through when you resort to personal attacks and character assassination. The chances that your point or position–whatever it may be–will be heard and considered, by either me or a reader, drop like a rock. And a life lived stewing in a cesspool of anger and hatred–popping your head up only long enough to throw an anonymous turd at someone you do not know, but detest anyway–will be its own reward. I may listen, I will pray for you–but have little interest in giving you a soapbox for your arrogance and condescension. Folks like you have nothing positive to add to life–and the rest of us tune you out immediately. So keep it civil, folks–the Delete Comment button is just too easy to hit.

A Dark Mercy

There have been growing numbers of stories about the heroism of rescuers and medical personnel, such as this one, who risked their lives and personal safety and comfort to rescue, comfort and evacuate often critically-ill patients in New Orleans. But not all the medical care was directed at saving and healing the sick, as this troubling report indicates (HT: Orbusmax):

Doctors working in hurricane-ravaged New Orleans killed critically ill patients rather than leaving them to die in agony as they evacuated hospitals…

With gangs of rapists and looters rampaging through wards in the flooded city, senior doctors took the harrowing decision to give massive overdoses of morphine to those they believed could not make it out alive.

In an extraordinary interview with The Mail on Sunday, one New Orleans doctor told how she ‘prayed for God to have mercy on her soul’ after she ignored every tenet of medical ethics and ended the lives of patients she had earlier fought to save.

Her heart-rending account has been corroborated by a hospital orderly and by local government officials. One emergency official, William ‘Forest’ McQueen, said: “Those who had no chance of making it were given a lot of morphine and lain down in a dark place to die.”

Euthanasia is illegal in Louisiana, and The Mail on Sunday is protecting the identities of the medical staff concerned to prevent them being made scapegoats for the events of last week.

Their families believe their confessions are an indictment of the appalling failure of American authorities to help those in desperate need after Hurricane Katrina flooded the city, claiming thousands of lives and making 500,000 homeless.

‘These people were going to die anyway’

The doctor said: “I didn’t know if I was doing the right thing. But I did not have time. I had to make snap decisions, under the most appalling circumstances, and I did what I thought was right.

“I injected morphine into those patients who were dying and in agony. If the first dose was not enough, I gave a double dose. And at night I prayed to God to have mercy on my soul.”

The doctor, who finally fled her hospital late last week in fear of being murdered by the armed looters, said: “This was not murder, this was compassion. They would have been dead within hours, if not days. We did not put people down. What we did was give comfort to the end.

“I had cancer patients who were in agony. In some cases the drugs may have speeded up the death process.

“We divided patients into three categories: those who were traumatised but medically fit enough to survive, those who needed urgent care, and the dying.

“People would find it impossible to understand the situation. I had to make life-or-death decisions in a split second.

“It came down to giving people the basic human right to die with dignity.

“There were patients with Do Not Resuscitate signs. Under normal circumstances, some could have lasted several days. But when the power went out, we had nothing.

“Some of the very sick became distressed. We tried to make them as comfortable as possible.

“The pharmacy was under lockdown because gangs of armed looters were roaming around looking for their fix. You have to understand these people were going to die anyway.”

Mr McQueen, a utility manager for the town of Abita Springs, half an hour north of New Orleans, told relatives that patients had been ‘put down’, saying: “They injected them, but nurses stayed with them until they died.”

I find this story deeply troubling at any number of levels. I have written before on my concerns about the practice of active euthanasia (here and here), which arise not merely because of my Christian convictions about its morality, but perhaps equally so because of the great potential danger I see in breeching the moral and social levies which protect us from hubris and the creeping progressive tolerance of evil inherent when crossing them. The weariness of great tragedy saps the spirit, making it all to easy to rationalize the repulsive, to move on to the next horrid scene without reflecting on the last. But sometimes we must stop and focus amid the deadening blur of death and suffering. This story demands such a pause.

I am assuming, first of all, that this story is true–although I have seen no independent confirmation elsewhere. The name of the hospital where this occurred is not given, but it makes one wonder if it is the same facility where 45 dead patients were found abandoned. If it proves true, one must wonder whether there will be less outrage over patients euthanized than abandoned to die–somehow I suspect there might be. After all, they were terminated mercifully, rather than just abandoned–which would be oh, so terribly, terribly heartless.

But of course, if they were euthanized they were abandoned–abandoned by their providers and sworn protectors, those whom they trusted to comfort, heal, and protect them. Granted, the circumstances were horrendous: deprived of power, light, medications, and security, threatened by a mob of barbarians bent on drugs, theft, and destruction–one can hardly begin to imagine the terror, the helplessness, the frustration shared by doctors, patients, and nurses alike. It is easy to judge those who were there, sitting as I am dry, safe and secure, far from this hell on earth. It would be foolish to say that–were I there–my behavior would have been different, more noble, more self-sacrificing, more righteous. I would hope so–but I have been known to underestimate my frailties and potential for moral lapses far too often to be smug or self-righteous: I simply do not know how I would have handled this situation, were I there.

But still I must ask: you killed them? Actively, deliberately, methodically? What has occurred here, it seems, steps over a line clearly blurred by the panic, fear, and hopelessness of a terrible storm and its even more horrible aftermath–the opportunism of human evil in the face of Nature’s wrath–into the realm of a darkness far deeper than wind and water and chaos could wreak. Have you not countered evil with evil? “And if Satan cast out Satan, he is divided against himself; how shall then his kingdom stand?”

Could not the morphine you used to end their lives be instead used to ease their pain, their fear, as you stood by their bedside doing what little you could to comfort them? It takes far more morphine to kill than to comfort. Could you not stand and defend them against the looters, the rapists, the thugs–though ill-equipped you might well lose your safety, your well-being, even your life. There is a word for those who act thusly, defending the weak against the strong at the cost of their lives: heroes. Did you not, by actively terminating their lives, avoid the shameful option of abandoning suffering and dying patients to save yourselves? They were condemned to die by their disease, by the untimely fate of a hospital in harm’s way, by social chaos and raging mobs. You are alive today because you expedited their inevitable death. But your life, so secured, is not enobled by this act: you may indeed find forgiveness, but the act remains: a dark mercy, an act of weakness, heinous forever.

The interview in The Mail is redolent with the special pleading and specious arguments so common among those who have compromised principles for expediency, and by those who justify any and all such moral relativism. The paper protects the anonymity of those who so acted “to prevent them being made scapegoats for the events of last week.” Scapegoats? Whose sins are you carrying into the desert, if not your own? What was the proximate cause of their death, if not your syringe?

The doctor informs us: “This was not murder, this was compassion. They would have been dead within hours, if not days. We did not put people down. What we did was give comfort to the end.” Aahh, compassion–I’ll have a double dose, please. Com-passion: “to suffer with”–this is its root, its meaning. To suffer with a patient, to experience their pain while strengthening their spirit–that is compassion. To stand in the breach, between the looter and the lost, to suffer that they may be spared–that is compassion. To stay with a dying patient, when the lights are out and you have no treatment to offer–that is compassion. To stop their breathing with an overdose so that you can escape without abandoning them to die alone may be rational, understandable, defensible, even arguably reasonable–but it is not compassion. Words have meanings: I know what murder means, what compassion involves, what comfort entails–and they are not the same.

The doctor informs us: “It came down to giving people the basic human right to die with dignity.” Death with dignity–is that indeed our right? Who ordains such a right? Who enforces it? What about the bloated bodies floating face down in sewage-laced water, drifting down streets in the company of dead rats and fire ants–is that dignity? Who stole their right to die with dignity? Would you have injected them also to save such an indignity? And how is it we now define “dignity” as the right to die when and where we want–or when our doctor thinks it’s best? Is not dignity instead dying with inner grace, strengthened by those around you, comfortable that your life has been lived with meaning and purpose–though your body be racked by pain–in the presence of others who care? Many died just this way in Katrina–under circumstances just as horrid and terrifying and degrading as the good doctor experienced. They died with dignity–brutally, but with nobility, grace, and courage, saving and protecting family members, pets, friends, strangers.

The doctor informs us: “You have to understand these people were going to die anyway.” Yes, I do understand–and that is true of every living breathing human on this planet. But your patients died early–in your time, not theirs, under your hand, not that of a looter, nor the ravage of a disease, nor the savagery of storm. Your hand, doctor. Who granted you this right, this power?

But someone in this story sees through the hollow rhetoric, the noble talk, the faux compassion: “Mr McQueen … told relatives that patients had been ‘put down’, saying: ‘They injected them, but nurses stayed with them until they died.'” America, meet your new compassion, your new dignity: the nurse will stay by your side after your doctor puts you down.

Now, perhaps this story is a tabloid fabrication. Perhaps–so often the case–the truth of the situation was mangled beyond recognition by truncated quotes, Dowdian ellipses, or the pure fabrication that passes for journalism in our oh-so-enlightened 21st century. And I was not there–would my behavior have been that much different? I don’t know. Tragedy rips the scab–covered by layers of makeup and cheap jewelry–from the deep wounds of the humans spirit. It may reveal bleeding, and pain, and health, and healing–or the putrid aroma of rotting flesh and festering maggots. A white coat does not bestow deity, but bespeaks instead service and sacrifice–and the dark horrors of a dying hospital do not change this simple truth.

Thoughts on End of Life

I have been avoiding any comment on the Terry Schiavo case for a host of reasons: first and foremost, I simply do not have enough information to make a reasoned judgment (nor, as far as I can tell, are the best majority of people opining on her case). There is a huge amount of heat, and very little light, surrounding this case, and countless emotional, impassioned, and often irrational arguments have been made in the media and on the blogs. I despair of adding anything meaningful to this noisy melange, and frankly, the media frenzy, and excesses of both the pro-life and pro-death sides has become offensive and ghoulish.

Yesterday, however, Jerri at the always-thoughful Sue Bob’s Diary, e-mailed me with the following comment and question:

I notice that you have stayed out of the Terri Schiavo issue. I figure that you have a good reason for that. But, I was wondering if you’d answer a question.

… I have a real problem with the idea of removing someone’s feeding tube unless their systems are shutting down and they can no longer absorb nutrients … I just heard a Medical Director of a nursing home on the radio talking about Alzheimer’s patients losing their appetite and having feeding tubes inserted. The MD thinks removing the tube in such circumstances is justified. Perhaps it is if their systems are shutting down and they no longer want to eat…

I saw your post about extraordinary measures and agreed with it. But, as a Christian doctor, do you see acceptable parameters in all this?

Jerri has a habit of prodding me to write about things which I would prefer not to tackle. But not infrequently, her encouragement and the discipline of writing proves helpful in clarifying my own muddled thoughts about a difficult subject. So I’ll give it my best shot.

My comments about Terri Schiavo herself will be very limited, based on what limited knowledge I have. As best I can ascertain, she appears to be in a persistent vegetative state, and it seems likely that her chances for any sort of cognitive recovery are virtually nil. On matters regarding her husband’s and family’s decisions, the courts, governor and congress, I won’t comment for lack of sufficient information. Nevertheless, the issue of end-of-life decisions is far broader, and in my mind far more complex, then the current firestorm could ever resolve. My ambivalence on how best to handle such a situation is my strongest reason for refraining from posting on her case so far.

The challenge of end-of-life decisions is a byproduct of our successes and breakthroughs in preserving and sustaining life. They are the unintended consequence of technological advancement. 50 years ago, it is likely that a young woman with cardiac arrest would have died before she received emergency care, or if not, would likely have passed away shortly thereafter from complications, such as sepsis, embolus, or pneumonia. The advancements in acute emergency medical care and resuscitation have saved many lives, but some of these lives end up so severely impaired that the success proves a pyrrhic victory.

The moral and ethical dilemmas which have arisen from our dramatic improvements in emergency care go straight to the heart of what it means to be human, to be alive, to have meaning and quality in life. If one must use a pigeonhole, I would certainly be classified as a pro-life proponent. Life is perhaps the most precious gift given by our Creator, and cannot simply be measured by a superficial standard such as health, mobility, or even lucid mentation. Yet life is a gift, and not a god. As I have written in Dancing with Death, dying itself is also an integral part of life, and irrational and misguided attempts to prolong it can be very destructive, demeaning, and degrading to its dignity.

It seems to me that there is considerable confusion in our contemporary discussion of end-of-life decisions, engendered by such unfortunate and inexact terms as “pulling the plug.” And each situation must be judged by its own merits, taking into account the overall prognosis for life, patient and family wishes, and the potential for the patient to return to some measure of meaningful relationship with family and others. Here are the core principles I fall back on when considering these difficult decisions. They are by nature generalizations, and exceptions will arise (especially in the very elderly), but they are useful guideposts nevertheless:

  Life is more than any of its components.

We are more than our health, more than our bodies or mind. We are a composite of these things, and more: comprised of soul and spirit, defined as much by our relationships as by our physical or mental capabilities. Our lives do not become meaningless because of physical illness or disability, nor because of mental incapacitation — hereditary or acquired. Our relationships with other humans and with God define us — and not only our ability to relate to others (lost in persistent vegetative state and severe retardation or dementia), but also the relationship of others to us. This why, even though severely mentally impaired and unable to relate to others, an individual still has great value: they are of great value to God, and to others who love and care for them. When we narrow the meaning of life down to physical health or mental capacity, and deem it unworthy based on such factors alone, we are destroying that which is precious to others.

  When the individual’s outlook from a life-threatening acute or chronic illness is optimistic, or uncertain, we should choose to preserve life.

Consider two scenarios: a previously healthy man arrives at the emergency department with cardiac arrest of undetermined length. He is resuscitated, requiring placement on a ventilator. His cerebral function is impaired, perhaps comatose, but it is early in the illness, and his expectancy of return to a normal life is potentially optimistic. Ventilatory or other artificial life support in this situation, where the prognosis of the underlying condition and the chances for optimistic recovery are good, or uncertain, should be aggressively pursued.

This is an entirely different situation from stopping ventilatory support for patient who requires it to live, and for whom clinical evidence, such as length of time in a coma, or absence of brain activity on EEG, indicate little or no chance for functional recovery. In the first case, the cessation of life support will terminate the patient who may well have a very good outcome and lead a normal or nearly normal life; in the second, the patient’s chances of recovering spontaneous breathing and cerebral function are nil, and therefore cessation of ventilatory support allows the underlying disease process to take its natural course. A similar scenario might be found in the patient who is dying of cancer and requiring ventilatory support, where the life support has no hope of changing the outcome — death — but only of changing its timing and prolonging its suffering. The outlook spoken of here involves both mental, relational, and physical, although mental and relation have a much higher priority. Few would argue that Christopher Reeves should have had his life support terminated, despite the fact that he required a ventilator to live, as his mental facilities and ability to have relationships was intact.

  Those incapable of functioning mental, social, and relational abilities, but whose underlying condition is not a threat to life (e.g., persistent vegetative state), should be sustained with basic care and life support.

The persistent vegetative state is very different from that in which the underlying disease is terminal or life-threatening, and poses a very difficult situation. The patient is physiologically alive, requiring no assisted ventilation or cardiac or vascular support to continue living — in other words, their underlying disease will not kill them. In the early days and weeks of such as state, it is often very difficult to determine what the long-term recovery capability of the brain and nervous system may be. Healing of central and peripheral nervous system damage is often agonizingly slow, and may take a year or more to determine their final steady state. When it becomes clear that brain or central nervous system function has reached its maximum recovery, and it is at that time evident that no function associated with higher cortical function — such as speech, comprehension, purposeful movement, or understanding of communication — is possible, then, although the individual is technically alive, they no longer possess the capabilities of a normal functioning human being in society and relationships.

It is at this point that wisdom faces its greatest challenge. The question of whether to cease the most fundamental of life support measures — food and water — is a question which I myself am not completely resolved, although I lean strongly toward basic life support — food, water, basic care.

The problem I have with stopping food and water is the great risk of crossing a very dangerous boundary. If we define life only by our mental state, rather than as a union of mental, physical, and the relationships of ourselves to other and of others to us, it seems dangerously easy to move this boundary based on a subjective judgment about which specific mental capabilities constitute a meaningful life. An otherwise healthy patient with severe Alzheimer’s disease most certainly has very little mental capabilities from a social interaction standpoint. Shall we deprive food and water from such patients? How about the severely mentally impaired who are younger, or unable to speak or hear? Certainly, none of us would choose a life with such severe quality constraints, given the choice. But forcing death when the underlying condition is not fatal, based on a subjective assessment of mental quality, strikes me as a very dangerous boundary to cross.

However, in a case where severe mental impairment or functional brain death is obvious, I would have no moral or ethical quandary with allowing another disease process which might prove fatal to run its natural course. An example would be a severe pneumonia or a septic condition. My own inclination would be toward a very non-aggressive approach in treating such a condition in a patient who clearly had no potential for recovery of higher mental or social function.

This may seem like splitting hairs, but it is not: in one case it is man who initiates death — actively or passively; in the other death is determined by the natural course of a disease. I do not trust man to terminate life based on his own perception of quality of life, cost, burden, or ill-informed self-projection about what the patient might want. The power to initiate death (outside of the safeguards of a judicial context, when society deems a crime warrants it) will invariably lead to an ever-broadening array of “quality of life” issues for which death is “merciful.”

This is, I understand, something of a compromise, and may be viewed by some as inconsistent with a pro-life position, or perhaps the opposite, of playing God. So be it. I believe the danger of actively terminating life, based on purely on an assessment of one’s mental state or quality of life outweighs the obvious burden on society and individuals of preserving life at its most basic function, without functioning mental capacity. Nevertheless, when higher mental function is severely impaired, and the underlying disease process is invariably fatal, or potentially so, allowing that disease process to run its course without aggressive intervention seems to me both ethical and moral. Disease holds the power of death, rather than man.

  Patient and family input on end of life decisions is vital, but not absolute.

Because the heart of human nature is relational, decisions about end of life must involve those in close relationship with the individual as well as the individual’s own preferences. But these wishes are not an absolute. Our individual decisions are not autonomous, but affect others: we do not exist in a vacuum. This is why suicide is both morally wrong and illegal: suicide transfers the emotional pain and personal responsibilities from its victims to their families, and to society. A family’s decision to keep a terminal patient alive on artificial support when hope is gone damages the dying person’s dignity in death, and places the financial burden on society. Such issues are often very difficult to address, since there are many gray areas in predicting timing of death and recovery prognosis.

You see, it’s not just about us, about our vaunted “quality of life.” Jay Nordlinger, in his NRO Online column Impromptus, quotes a reader as follows:

I’ve come to understand that “the point” has little or nothing to do with what the Terri Schiavos, Aunt Winnies, and Aunt Maceys of the world have to offer, or even with their so-called quality of life. Rather, in expecting us to care for and continue to love those who no longer have the capacity to give anything in return, God invites us to pick up the cross. It’s not really about them anymore, it’s about us and what we are willing to give of ourselves in response to the challenge. I have watched hours of coverage regarding the Schiavo controversy; not once has anyone suggested that Terri’s suffering presents an opportunity for her family to give of itself purely…

In far more words, I could not — and have not — stated it as eloquently as this.

Dancing With Death

Boat at sunsetThe war rages on. It is a battle with ancient roots, deeply embedded in religion, culture, and the tensions between rich and poor. It is a war of contrasts: high technology and primitive cultural weapons; knowledge versus ignorance; speed and urgency against the methodical slowness of an enemy who knows time is on his side.

It is a war in which enormous strides have been made, with countless victories large and small.

The enemy is death. The avenger is medicine. And the war is going very poorly indeed.

In many ways, the gains of modern medicine against death and disease are truly impressive: longer life expectancies; progress and cures against heart disease, cancer, and diabetes; surgical and procedural marvels hard to imagine even 15 or 20 years ago. Yet, it is these very advances which seem to lie at the heart of a growing problem. We are so engaged in the battle, so empowered by our growing capabilities, that we have lost sight of the bigger picture. While pushing back the adversary of death, we are ever so steadily being destroyed by the very battle itself.

Several recent experiences have driven this dichotomy home for me. Last week, I was asked to evaluate a man who had been hospitalized for a over a week. A nursing home resident in his late 80’s, his overall health was fair to poor at best, and he suffered from severe dementia. He was unable to communicate in any way, and could recognize no one — not even his wife of many years, who remained in possession of her full facilities. He was admitted to the hospital with a severe urinary tract infection with a highly resistant bacteria, and septic shock. When he arrived at the ER, the full extent of his dementia was not apparent to the physicians there, and his wife insisted that all measures be engaged to save him. Aggressive medical care was therefore initiated — intensive care unit, one-on-one nursing care, hemodynamic monitoring, drugs to support blood pressure, intravenous nutrition, and costly antibiotics. After nearly two weeks of such intensive therapy, the patient largely recovered from his life-threatening infection — returning to his baseline of profound dementia. Yet the underlying risk factors which led to it — his age, a chronic bladder catheter and bacteria-harboring stones, diabetes, — remained in place, lying in wait for another, inevitable opportunity, in a matter of weeks or months. The cost of his hospitalization was easily in 6 figures.

In another situation, an elderly women presented to the hospital with signs of a serious, life-threatening infection in her abdomen. A healthy widower, she lived independently with her sister prior to her illness. Emergency surgery was performed, and an abscessed kidney removed. Her medical condition deteriorated after surgery, with coma due to stroke and failure of her remaining kidney brought on by the infection.

The patient’s sister and living companion communicated the clear final wishes of the widower: a women of strong faith, she wished no extraordinary measures, such as ventilators or dialysis, to extend her life needlessly. She was comfortable with death, and not afraid. The staff prepared to allow her to die gracefully, comfortably, and in peace.

But such was not to be. There was no living will, and the sister did not have legal authority to make such decisions. But the widower’s daughter, a nurse living out-of-state with little recent contact with her mother, arrived in town demanding that aggressive measures be taken to save her. A nephrologist (kidney specialist) was called in. A superb physician, compassionate and dedicated, he had been successfully sued in a similar case after recommending that dialysis be withheld in a patient with a grim prognosis. This was a mistake he would not make twice: the widower was transferred to another hospital, placed on dialysis, and died 3 weeks — and a quarter of a million dollars — later, in an ICU. She never woke up.

The issues which these two cases bring up are numerous, complex, and defy easy answers. They touch upon the subjective measure of quality-of-life and what it is worth; the finite limit of economic health care resources; the relative responsibilities of physicians, patients, and their families in end-of-life decisions; the pressures placed on the health care system and its practitioners by after-the-fact second-guessing in an aggressive tort environment; and a host of others greater or lesser in weight and substance, up to and including the meaning of life itself.

All the players bear responsibility in this passion play. Physicians excel at grasping what they can accomplish, but are woefully inadequate for the task of deciding whether such things should be done. In the urgency of acute care, delay to consider the ramifications of a decision to treat may cost an opportunity to save a patient for whom such treatment is desirable; better always to err on the side of salvage. Pressured by family, potential litigation, or instinct, the path of least resistance is to follow your training and use your skills. And physicians themselves are uncomfortable with death, though inundated in its ubiquity.

Family members naturally resist the agonal separation of their loved ones, often harboring unrealistic hopes and expectations of recovery in the face of inevitable death. A curious dance of denial often ensues between physician and family, as each, unwilling to face the unpleasantness of the inevitable, avoids the topic at all costs. The physician hides behind intellect, speaking of blood counts, medications, and ventilators, or at best tiptoeing around the core issue with sterile terms like “prognosis.” Family members hesitate to ask questions whose answers they already know. Too rarely are the physician and family willing to place the subject squarely on the table, in all its ugliness and fearfulness. Decisions which need to be made are put off, unspoken and deferred. The clock ticks on, the meter is running, and only the outcome is not in doubt.

The tort system provides a ready outlet for the anguish and anger of death of a loved one. In such a period of intense emotional turmoil, the real or perceived indifference of physicians (often a mechanism of detachment by which doctors deal with the horrors of death and illness); the parade of unfamiliar medical faces as no-name consultants come and go during the final days; the compounding burden of crushing financial load from the extraordinary costs of intensive terminal medicine; the Monday-morning quarterbacking by the tort system of complex, often agonizingly difficult medical decisions in critically-ill patients: all present a toxic and intoxicating brew which impels the health care system forward to leave no avenue untravelled, no dollar unspent in prolonging life beyond its proper and respectful end.

This march of madness is not without resistors. Seizing on the high costs, the futility, and especially the lack of personal control fostered by impersonal, highly technical terminal care, the euthanasia movement is maneuvering into the gap. Cloaked in slogans of personal autonomy and “Death with Dignity”, active euthanasia proponents seek to replace the sterile prolongation of a now-meaningless life with the warm embrace of Death herself. Terrified by an out-of-control dying process, an end of a life which embodies all meaning, they seek to control death as their final act of significance. But Death will not be controlled, and those who dance with Death are seduced by her siren. Euthanasia starts with compassionate intent, but ends with termination of the useless. Man does not have the wisdom to control death; The Ringbearer is corrupted by its power.

Our discomfort with death is our confusion about life. Man is the only species cognizant of his coming demise — who then, in the ultimate paradox, lives his entire life pretending it will not happen. Our Western culture, enriched with a wealth of distractions, allows us to pass our living years without preparing for the inevitable. When the time arrives, we use all the weapons at our disposal — wealth, technology, information, law — to resist the dragon. We drive it back for a time — at enormous cost, personal, financial, physical and emotional. Death always wins — always.

I am not of course yearning for a return to the past, a passive resignation to the inevitable anabasis of disease and death. The benefits of medicine and the forestalling of death are precious and powerful gifts, which have greatly benefited many. But like all such great powers, they are useful for good or ill. When the defeat of death becomes an end in itself, detached from the meaningfulness of life lived, it has great destructive energy.

We must learn how to die. And to learn how to die, we must learn how to live — how to seek the transcendent, the power of love, and sacrifice, and giving which makes life rich and enduring. The selfish, the superficial, the transient all gratify for a time, but when this is all we possess, we grasp desperately to their threadbare fabric when beauty and health give way to weakness, fear and death. All great religions understand this: the meaning of life transcends life. In the Judeo-Christian view, life is an opportunity to draw ourselves and others closer to the light and goodness of God, with the promise of an even greater life and deeper relationship after death. Yet even for the agnostic or secular among us, service to others — personal and social — has the potential to endure long after us. None of us will be remembered for our desperate clinging to life in its waning days, but rather for the lives we touched, the world we made better when we lived.

The Children Whom Reason Scorns

You Also Bear the BurdenIn the years following the Great War, a sense of doom and panic settled over Germany. Long concerned about a declining birth rate, the country faced the loss of 2 million of its fine young men in the war, the crushing burden of an economy devastated by war and the Great Depression, further compounded by the economic body blow of reparations and the loss of the German colonies imposed by the Treaty of Versailles. Many worried that the Nordic race itself was threatened with extinction.

The burgeoning new sciences of psychology, genetics, and medicine provided a glimmer of hope in this darkness. An intense fascination developed with strengthening and improving the nation through Volksgesundheit–public health. Many physicians and scientists promoted “racial hygiene” – better known today as eugenics. The Germans were hardly alone in this interest – 26 states in the U.S. had forced sterilization laws for criminals and the mentally ill during this period; Ohio debated legalized euthanasia in the 20’s; and even Oliver Wendall Holmes, in Buck v. Bell, famously upheld forced sterilization with the quote: “Three generations of imbeciles are enough!” But Germany’s dire circumstances and its robust scientific and university resources proved a most fertile ground for this philosophy.

These novel ideas percolated rapidly through the social and educational systems steeped in Hegelian deterministic philosophy and social Darwinism. Long lines formed to view exhibits on heredity and genetics, and scientific research, conferences, and publication on topics of race and eugenics were legion. The emphasis was often on the great burden which the chronically ill and mentally and physically deformed placed on a struggling society striving to achieve its historical destiny. In a high school biology textbook – pictured above – a muscular German youth bears two such societal misfits on a barbell, with the exhortation, “You Are Sharing the Load!–a hereditarily-ill person costs 50,000 Reichsmarks by the time they reach 60.” Math textbooks tested students on how many new housing units could be built with the money saved by elimination of long-term care needs. Parents often chose euthanasia for their disabled offspring, rather than face the societal scorn and ostracization of raising a mentally or physically impaired child. This widespread public endorsement and pseudo-scientific support for eugenics set the stage for its wholesale adoption — with horrific consequences — when the Nazi party took power.
Continue reading “The Children Whom Reason Scorns”

Cult of Death or Heart of Man?

Calico cat & figureDavid Brooks, in his NY Times Op-Ed piece, Cult of Death, says the following about the Muslim terrorists and the Beslan school massacre:

We should be used to this pathological mass movement by now. We should be able to talk about such things. Yet when you look at the Western reaction to the Beslan massacres, you see people quick to divert their attention away from the core horror of this act, as if to say: We don’t want to stare into this abyss. We don’t want to acknowledge those parts of human nature that were on display in Beslan. Something here, if thought about too deeply, undermines the categories we use to live our lives, undermines our faith in the essential goodness of human beings.

It should come as no surprise to me – yet it still does – that people have any confidence remaining in idea of the “essential goodness of human beings.” Yet this is perhaps one of the most durable myths of our modern secular age. It underlies both public policy and private perception, and forms the basis of many failed government and social programs. If you have the stomach for it and the honesty to look objectively, even a brief glance at human history both ancient and modern reveals vastly more evidence of the depravity of man than his essential goodness. Consider briefly the following examples: the Inquisition, slavery, Ghengis Kahn, the Holocaust, the Bataan Death March, the Cambodian killing fields, Rwanda, Idi Amin, Columbine, Saddam’s rape rooms and shredders, suicide bombers on school buses and in pizza parlors, the rape of Nanking, the gulags, and Wounded Knee. And these are only the large historical events, easy to bring to mind. Left unmentioned but vastly outnumbering these are the countless murders, rapes, child molesters, serial killings, drug dealing, and any number of other smaller – but still profoundly evil – events which now barely if ever make the news.

I am not a misanthrope, and am fully aware of the potential for man to achieve great goodness and nobility. From the selfless volunteer at an inner city school to Mother Theresa, countless examples of such goodness and nobility exist, often hidden and far less noticed than deeds of evil. The issue is about the natural inclination, the deep inner nature of man – is it toward good, or rather toward evil? Your answer to this question profoundly affects your worldview.

By taking the position that man is essentially good, you are left with the problem of understanding inexplicable evil, such as torturing school children and shooting them in the back as they flee, as occurred at Beslan. In evil of lesser scope, psychology and social theory are often recruited for this task: the child molester or rapist was abused as a child; inner city crime is a result of racism; the root of terrorism is poverty, injustice, and the oppression of the Palestinians by the Jews. Even there the answers fall short. But could any such combination of social liabilities give rise to such extreme evil, as seen at Beslan or Auschwitz – particularly in beings whose natural bent is toward goodness?

The Judeo-Christian viewpoint on man’s essential nature is that man is fallen: created by a good God to be by nature good, but given free will either to submit to the good or to choose evil. Having rejected the good for personal autonomy independent of God, the natural gravity of the soul is away from God, not toward Him. In God is an unspeakable and unimaginable goodness; in His rejection is the potential for equally unimaginable evil. The Judeo-Christian solution is redemption, not psychology; inner transformation, not social programs.

To resist evil, you must know the face of evil, and recognize the face of good. The secularist denies the existence of God (or counts Him or it irrelevant), and therefore all goodness must have its source within man. The religious liberal believes God is good, but impotent, and therefore man is responsible to do the heavy lifting of all good works. The traditional Christian or Jew understands that man, created by God with enormous potential for good, but corrupted by failure to submit to God and therefore by nature far more prone to evil than good.

Religious affiliation is an unreliable indicator of good or evil behavior. The combination of evil motives with the compulsion of legalistic religion is a potent and dangerous mix, where men pursue their evil goals under the lash of and laboring for an angry god of their own making.

Man’s tendency to evil can be restrained, either by force of law, by force of arms, or ideally by inner transformation, repentence and submission to the power of humility and service. Wishful thinking and false assumptions about the goodness of man will prove woefully inadequate for the encroaching and fearsome evil of our current century.

Intellectual Giants, Moral Midgets

(Note: This post has been edited from the original to include citations from the original article, which is no longer available free of charge).

Amy Richard’s article on her selective fetal reduction in the NY Times Magazine (registration required) has recently been discussed on National Review Online (see also here) and elsewhere. It should be read by everyone with an interest in the abortion debate, or the general state of the culture wars in 21st century America.

Richards begins her story:

I’m 34. My boyfriend, Peter, and I have been together three years. I’m old enough to presume that I wasn’t going to have an easy time becoming pregnant. I was tired of being on the pill, because it made me moody. Before I went off it, Peter and I talked about what would happen if I became pregnant, and we both agreed that we would have the child.

I found out I was having triplets when I went to my obstetrician. The doctor had just finished telling me I was going to have a low-risk pregnancy. She turned on the sonogram machine. There was a long pause, then she said, ”Are you sure you didn’t take fertility drugs?” I said, ‘I’m positive.’ Peter and I were very shocked when she said there were three. ‘You know, this changes everything,’ she said. ‘You’ll have to see a specialist.’

My immediate response was, I cannot have triplets. I was not married; I lived in a five-story walk-up in the East Village; I worked freelance; and I would have to go on bed rest in March. I lecture at colleges, and my biggest months are March and April. I would have to give up my main income for the rest of the year. There was a part of me that was sure I could work around that. But it was a matter of, Do I want to?

I looked at Peter and asked the doctor: ‘Is it possible to get rid of one of them? Or two of them?’ The obstetrician wasn’t an expert in selective reduction, but she knew that with a shot of potassium chloride you could eliminate one or more.

Having felt physically fine up to this point, I got on the subway afterward, and all of a sudden, I felt ill. I didn’t want to eat anything. What I was going through seemed like a very unnatural experience. On the subway, Peter asked, ‘Shouldn’t we consider having triplets?’ And I had this adverse reaction: ‘This is why they say it’s the woman’s choice, because you think I could just carry triplets. That’s easy for you to say, but I’d have to give up my life.’ Not only would I have to be on bed rest at 20 weeks, I wouldn’t be able to fly after 15. I was already at eight weeks. When I found out about the triplets, I felt like: It’s not the back of a pickup at 16, but now I’m going to have to move to Staten Island. I’ll never leave my house because I’ll have to care for these children. I’ll have to start shopping only at Costco and buying big jars of mayonnaise. Even in my moments of thinking about having three, I don’t think that deep down I was ever considering it.

At every level, Ms. Richard’s story displays the moral vacuousness of the contemporary secular mindset. First, there is the impermanence of the relationships which will bear and raise children. She never indicates any consideration of marriage to her boyfriend, either while anticipating a pregnancy or after her child is born. Then there is the casual nature of the decision to have a child. She stops the pill because of hormone-driven moodiness, nobly deciding to keep the inevitable trophy child rather than suffer the agonies of monthly menstrual misery. She never once considers the implications for her child, or the society he will inhabit, inherent in her decision to raise him in an intrinsically unstable and uncommitted parental relationship. Finally there is the stunning reflex decision to terminate one or more of her unborn children when the serpent jaws of a self-gratifying lifestyle arise. No thought of a moral or ethical dilemna ever crosses her mind as she clutches for the salvation of a potassium chloride syringe.

Ms. Richards sees her specialist, and relates the experience of her selective reduction:

The specialist called me back at 10 p.m. I had just finished watching a Boston Pops concert at Symphony Hall. As everybody burst into applause, I watched my cellphone vibrating, grabbed it and ran into the lobby. He told me that he does a detailed sonogram before doing a selective reduction to see if one fetus appears to be struggling. The procedure involves a shot of potassium chloride to the heart of the fetus. There are a lot more complications when a woman carries multiples. And so, from the doctor’s perspective, it’s a matter of trying to save the woman this trauma. After I talked to the specialist, I told Peter, ‘That’s what I’m going to do.’ He replied, ‘What we’re going to do.’ He respected what I was going through, but at a certain point, he felt that this was a decision we were making. I agreed.

When we saw the specialist, we found out that I was carrying identical twins and a stand alone. My doctors thought the stand alone was three days older. There was something psychologically comforting about that, since I wanted to have just one. Before the procedure, I was focused on relaxing. But Peter was staring at the sonogram screen thinking: Oh, my gosh, there are three heartbeats. I can’t believe we’re about to make two disappear. The doctor came in, and then Peter was asked to leave. I said, ‘Can Peter stay?’ The doctor said no. I know Peter was offended by that.

Let us not forget about the professional, clinically detached physician who delivers the death syringe to carefully selected unborns. The lifesaving miracle of high resolution ultrasound and fetal intervention selecting those twins whose crime was being several days too young.

Despite the high-minded rhetoric about “choice” in the abortion debate, at its heart abortion is about unfettered sex, or in the larger moral context, the pursuit of self-gratifying behavior while refusing to accept its inevitable consequences. Spiritual principles, much like the laws of physics, cannot be violated without consequences. No matter how fervently I believe I can fly, flapping my arms while jumping off tall buildings will always make me an undesirable client for my life insurance company. Violating spiritual laws results in even more pervasive effects, since the spiritual tsunamis roll not merely through our own lives, but those of everyone we touch, both near and far. Unlike the violation of physical laws, however, the consequences are far more easily denied, rationalized, and minimized when they are in the realm of the spirit.

In the secular mindset, sexual “freedom” trumps all; the death of the unborn fruits of this behavior is not considered too high a price to pay. Any moral qualms about the ghastly consequences to the child can be mitigated by redefining language – an unborn child becomes a “fetus”, a “product of conception” – to move us a few steps farther away from the uncomfortable and convicting truth. Then we change the subject to a more defensible arena: abortion is about “freedom”, and “choice”, and “women’s health”, and “rights” – all straw-man targets far harder to attack than the crumbling and indefensible edifice at the core of the issue: snuffing out a unique, defenseless human being to promote and enable a self-centered, self-gratifying way of life. Amy Richards has given us a rare, inadvertently honest look into the dark soul of secularism. We should look long and hard, and never forget, what the inevitable outcome of contemporary secularism will produce: shallow, empty humanity, exterminating our young to preserve our shopping preferences.

Our culture is advanced beyond the wildest imaginations of those even a century ago. We clone sheep; take stunning pictures of Saturn from its rings; perform surgery robotically; retrieve information in seconds with web browsers that formerly took years to acquire, if ever. We as a society are intellectual giants in history. Yet as our knowledge increases exponentially, our wisdom withers: we are just as truly moral midgets.