Book Review: "Life, Liberty, and the Defense of Dignity" by Leon R. Kass, MD

This was a heavy and rich work. I found Dr. Kass to have a profoundly well-thought out explanation of his philosophical perspectives in many areas of bioethics. One complaint I had overall, however, was the tedious nature of his writing, and sometimes I wished he had more specific examples or practical applications for the points he was making. Granted, I agree with him that the defense of dignity is a hard thing, seeing as it is a value he describes as a “soft”, even “symbolic” (p15).

One strength of his writing for the Christian bioethicist is that the defense that he makes for human dignity is frequently made through moral reasoning rather than from Biblical sources, which makes for usefulness in conversation with those who have no belief in divine inspiration of Scripture. Also I appreciated the challenge he makes to Christian bioethicists who becomes “just like everybody else” in their discussion of the issues. (p61)

From his discussion in “The Meaning of Life-in the Laboratory,” I appreciated his pointing out the new beginning that occurs in fertilization, which is entirely different from the separate sperm and egg, that there is a new individual after fertilization is complete. I found his comparison of the in vitro blastocyst with the aborted fetuses (p89), to be painfully obvious—of course a live blastocyst is more viable than a dead fetus! Also I would have liked more elaboration on his mention that the thin-edge-of-the-wedge argument as being faulty or weak (p104). I also liked his approach in regard to legislation, that “not every folly can or should be legislated against.” It seems like there are areas of biotechnology that shouldn’t be funded by taxpayers but also can’t be legislated against (for instance because some would be impossible to regulate), though certainly experimentation on human embryos and human cloning are not among those areas. He provided very clear reasons to object to federal funding of embryonic stem cell research, in response to each of the major arguments in favor of it. He made the excellent point that funding should first go to preventing the causes of infertility (i.e. blocked oviducts from STDs) rather than to expensive high-tech/low-yeild treatments (IVF) (pg 111). Also I believe this is the only place I’ve read that stated that actual cost of funding all these IVF treatments if the government were to pick up the tab, and it is sobering. He ends this chapter with a candid summary of how difficult this discussion has been to him, and I appreciated and felt his honesty.

In his section on genetic technology, he discussed the concerns of having too much knowledge of our own genome and genetic disposition, and it’s dangers. I hadn’t considered this aspect of the matter, but rather had thought only of privacy issues. But the idea of people living life with the knowledge of their genetic future (dementia, etc.) is concerning.

While reading the chapter on cloning, it struck me several times how much has developed even in the seven years since Kass wrote this volume. This was in my opinion one of his best chapters, and the basis of his arguments against cloning was strong. Toward the end of the chapter he pointed out that scientists whose names we don’t know and in places we don’t know are currently working behind closed doors and in secrecy to clone humans. This is a chilling but certainly valid concern. Equally chilling was the discussion on the next chapter on maintain perfusion and respiration mechanically in the newly dead in order to maintain an organ supply.

One of the strengths of Kass’ writing is the candid way in which he admits his personal difficulty with some of the arguments he makes, yet his honestly only serves to strengthen his perspective. For instance, on page 210, he points out his “weakening on the subject of euthanasia is precisely this: I would confess a strong temptation to remove myself from life to spare my children the anguish of years of attending my demented self and the horrible likelihood that they will come, hatefully to themselves, to resent my continued existence.” He notes these reasons might lead him to think he might have a duty to die, but argues against this thought in that “What principle of family life am I enacting and endorsing with my ‘altruistic suicide’?” and also points to another article for further discussion of this concern (210). Later he has a very balanced view as he states he “defends the practice of allowing to die while opposing the practice of deliberately killing.” (p227)

One argument that did appear weak which he used in regard to several issues was that deep within us we find the idea of certain things (i.e. cloning) repugnant, and that this feeling should be taken into consideration and even have possible moral value. This seems a stretch; since there are a lot of things which we may find repugnant but certainly have no moral opposition to.

Overall this is a book I will frequently refer to as I work through these issues, and the insight and candor with which Dr. Kass examined the issues is a rich resource to any who would read it.

On the fear of death and the failure of technology

From Life, Liberty and the Defense of Dignity, by Leon Kass, MD:

The greater our medical successes, the more unacceptable is failure and the more intolerable and fightening is death. True, many causes of death have been vanquished, but the fear of death has not abated, and may, indeed, have gotten worse. Nor as we have saved ourselves from the rapidly fatal illnesses, we now die slowly, painfully and in degradation--with cancer, AIDS or Alzheimer's disease. In our effort to control and rationalize death and dying, we have medicalized and institutionalized so much of the end of life as to produce what amounts to living death for thousands of people. Moreover, for these reasons we now face growing pressures for the legalization of euthanasia, which will complete the irony by casting the doctor, preserver of life, into the role of dispenser of death. We seem to be in the biomedical equivalent of a spiraling arms race with ourselves, creating technologies that heal only to cripple or crush, requiring us to respond either by seeking more technologies that heal or by electing a technological escape from life altogether.

Book Review: "The Contraception Guidebook: Options, Risks, and Answers for Christian Couples"

By William R. Cutrer, MD and Sandra L Glahn, Th.D.

This book was primarily written to discuss the specific ethical concerns Christians might have as they consider different birth control methods, written by an OB-Gyn/Theologian and a patient/theologian.

From the beginning of this book to its end, I was impressed with the humble attitude with which the authors approached these sensitive and controversial issues. Time and time again they acknowledged different perspectives in the Christian community with grace.

The chapter on “The Why of Sex” did a great job at succinctly summing up the viewpoints from two primary schools of thought that exist within the Christian community. The possibility that marriage’s (and thus intimacy’s) primary purpose being procreation is an idea commonly surfacing among Christians. Concerns I have heard from Christians are appropriately out of a humble desire to obey God fully, and the out of fear that treating intimacy in marriage as something that can be separated (by any method of birth control) from the possibility of procreation that would be in rebellion to His plan. I felt that this chapter made several good and helpful points concerning this matter, including the following:

-There are entire seasons in married life (after menopause, during pregnancy, etc) where married people are intimate despite the absence of potential for procreation

-The entire book of Song of Solomon is about the marriage relationship yet does not mention children.

-The very design of the human body also points toward purposes beyond procreation, and specific examples are given

In the beginning of part two, the authors detail methods of more “natural” birth control. I was impressed with his mention of newer and more sophisticated methods used by couples in tracking ovulation, specifically the use of urinary hormone monitoring at home. After recently hearing questions from several people about these methods, I did an extensive search of the medical literature regarding this practice in particular. Specifically it seemed that the ability to predict ovulation by hormonal changes several days prior would make it much more reliable than simple calendar-based plans. I found very little research had been done using home urinary hormone monitoring other than at Marquette University, and was impressed that he was aware of their technique (using the Clearblue fertility monitor) , though I would have liked to see a website for it listed in the back for readers to learn more, given the reliability of the method.

Another strength in this book is the straightforward and clear way in which he describes the female hormonal loops and their feedback. I wish I had read this back in medical school before getting into the more complicated texts. This is a useful section for laypeople, and necessary before they enter the section on specific types of hormonal contraception.

The chapter “Do Birth Control Pills Cause Abortion” was perhaps one of the most helpful parts of the book. I have talked to many women who have concerns about this issue, and rightly so. The authors again wisely handles this section with the grace to allow readers to make their own informed decision regarding it, yet without compromising concerning the sanctity of the life of an embryo. He described all angles of the issue in an easy to understand way, which I believe laypeople would be able to follow easily. The section of the chapter called “Is Any Risk Acceptable” did a good job of putting the concerns in perspective. That we do not routinely sequester pregnant woman from the risks of being out in public where they would possibly contract an illness which would cause fetal death, for example, is a good example of a risk routinely taken in pregnancy, as small as it is. That the best pro-life scientists differ in their views on how to use the information since we don’t exactly know the risk helps me personally dispense grace to Christians who evaluate the information and come to different conclusions.

He also discussed balancing intent with the weight of knowledge. Using the example of a person backing their car up without looking yet not intending to kill a neighbor was poignant. I think of previous generations that didn’t have the same kind of access we have now to information. With the internet and thus latest research being so readily available, we have an obligation as Christians to keep up to date with the latest findings in this area, and I appreciated him reminding his readers to keep up as new info comes out. I truly hope that more research is done in the near future that can provide us with the needed clarity to make better decisions about it.

He continues in his book to cover the other hormonal methods of birth control helpfully and then to discuss the surgical options for more permanent sterilization. From my knowledge of these techniques and procedures, he summed up the information and concerns for each technique quite well.

I found the chapter “The Future of Contraception” to be quite interesting. I had no idea some of these ideas were in the pipeline.

Part Three covered the biblical view of family and its purposes. He again addressed these issues with grace and biblical insight. The idea of having a huge family being something of an idol in some Christian circles was an interesting point. I have occasionally noted the unsaid implication that somehow the large family is more obedient. He discussed this in the context of Gen 1:28. I do wish, however, he’d spoken into the concept of evangelism as a way to obey God in this.

All in all, this was an incredibly well written guide for the Christian family, which I would recommend to friends, family, and patients.