Book Review – The Value of Human Life

There are many topics which tend to remain in the world of the elite or the learned.  One of these is Jewish Medical Ethics.  A recent book came out which I believe will allow those not as versed in the subject to get a good sense of how halacha confronts modern medicine.  Feldheim published The Value of Human Life, which contains articles from a Jewish medical ethics conference held in Italy in 2008.  All the usual suspects are represented, such R. JD Bleich and Professor Avraham Steinberg.  The essays cover topics regarding infertility, organ donation, end-of-life care and also two essays on general issues of taking care of oneself during life.  The book is sparsely footnoted, which makes it easily readable (for those who want more in depth discussion, this book is not the primary source).  One of the more fascinating stylistic points of the book is that they kept the essays in a similar format to the actual presentations, including stories, references to other talks, etc.  I would recommend people read this book to get a feel of the questions that would need to be asked and investigated if, G-d forbid, people should confront the harshness of life.  While I don’t agree with all the opinions presented, it is important to know debate exists, and the authors tend not to give definitive answers so much as the questions needed to be investigated. 

As a healthcare chaplain, one of the more neglected elements is that families don’t know how to be advocates for themselves, speaking up when something doesn’t seem appropriate or right.  Some of this is due to lack of informedness.  If I don’t know, I can’t know what questions to ask.  I always find myself in the role of patient advocate, teaching patients and families that they have options and choices they can request from the healthcare provider.  Obviously, there is a limit, but the limit is not as narrow as sometimes presented.

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The challenges of living and dying

In the latest New Yorker, a Dr. wrote an article called Letting Go: What should medicine do when it can’t save your life.  In this piece, the Dr. chronicles the terminal illness and death of a young woman from cancer, intermingling other stories of the terminally ill as well as anecdotes about modern medicine, hospice, and medicare.  The basic premise was that when it comes to death and dying, people tend to try to do everything possible, regardless of whether the experimental treatment will be beneficial, instead of being presented options and making choices that sometimes mean stopping curative treatment for palliative treatment/hospice.  The Dr. bemoans the fact that most doctors do not spend the time discussing with families the options about treatment with an eye toward what the patient and family really want.  Instead, doctors talk about treatment options and often avoid discussing the high likelihood that the treatment will be a failure and potentially just be harmful.  The message from the article is to know that everyone has the option of saying, ‘enough is enough,’ and opting for comfort instead of cure. 

I take issue with a few points in this article.  First, as often is the case with medically related articles, there was a lack of discussion regarding the role of psycho-social and spiritual support in talking with families.  Granted that most people would want to hear from the doctor, because doctors still have an air of authority around them.  Nevertheless, many of the challenges confronting people when they face life and death would well be served with people who would provide an ear to listen to the struggles, etc. 

Second, as a chaplain in healthcare, I hear many common refrains, which the article defends, such as; ‘I wouldn’t want to live like that, on tubes and things.  I don’t want to be a burden on others.’  I have often thought about end of life decision making on a personal scale.  While as I am healthy I can say I don’t want X,Y and Z, in considering what I would want if I were sick, I am not so sure I wouldn’t want life sustaining measures, even if the amount of time was negligible.  I believe that when we are faced with death at our doorsteps, many of us would sing a different tune.  I could be wrong, but often I wonder if our judgments about what is quality of life is skewed because of health.  This is also why many were claiming the new healtch care bill contained death panels.  The fear of end of life discussion making was that someone else, the government, would be dictating to me, the citizen, when I should die.  Now, the reality is that the conversation is important to have, and have and have and have.  People should occassionally rethink their advanced directives and living wills for perhaps the choices change as the circumstances change. 

I think articles like the one in the New Yorker are valuable.  Awareness of options is important.  Yet, I caution readers to consider what they would if in the same shoes as the article’s protagonist.  I think more would have opted for the course she took than would have said: ‘fine, I give up.  All I want is to be kept comfortable.’  This is especially the case when “young.”

When we don’t know what to choose

The NY Times magazine had an interesting and heartwrenching piece in this past weekend’s magazine.  In “What Broke my Father’s Heart, ” Judith Butler describes the deaths of her two parents and the challenges the family faced while her father was declining in his health.  In this piece, she describes the choices her mother made which prolonged her father’s life to a point of complete mental deterioration instead of allowing nature to take its course.  Her mother decided to have a pacemaker placed in her husband to prolong his life.  She then immediately felt regret and spent the next few years wishing she could turn it off.

The piece describes the family’s struggles with the current medical establishment regarding the lack of discussion of advanced planning as well as what they perceived to be unnecessary medical procedures.  The story concludes with the author’s mother deciding against anything aggressive that might incapacitate, thus allowing her to die on her own time in complete control. 

I will leave aside the clear political leanings of the article.  In terms of the human element, I always find that either people are ill-informed and don’t know what to ask or that people are too timid to ask questions.  At the same time, there are drs. who sometimes forget that healing isn’t always about making physically better.  Drs also run into problems when it comes to advising because there is a fine line between allowing for patient autonomy and also providing them with legitimate, expert advice. 

Read the piece and consider the challenges of dealing with our elderly.  This goes back to the piece I discussed a few weeks ago about the dual thinking about death and dying.

Responsiblity above all else

Without placing blame on any particular party in the Gulf oil spill, R. Shmuly Yanklowitz discusses the issue of collective responsibility from a Jewish perspective.  It is refreshing to get a perspective on a major current event without having to resort to finger pointing.  The finger pointing is potentially important from other perspectives, but when it comes to lessons learned, perhaps better we observe what else we can garner from a tragic situation. 

In this piece he discusses human fallacy, arguing from the Shulchan Aruch that while error is natural for human beings, blaming something on an accident doesn’t always remove personal responsibility.  We should learn from the oil spill that we need to be more wary of what we do in our lives and minimize potential damage and accident.  Our goal in life is to both do good and avoid harm.

Heart of Darkness (?)

Chief Rabbi Lord Jonathan Sacks addresses a fundamental principle of humanity in the following thought of the day. 

We must never forget the danger that lies beneath the surface of the human heart
Thought for the Day – BBC Radio 4 – June 2010
 
Our thoughts continue to be with the families of the victims of the shootings in Cumbria that left 12 dead, 25 injured, and families and communities torn apart. And in the aftermath people have been asking, how could it have happened?
 
The killer, Derrick Bird, was described by those who knew him as quiet, unassuming and friendly. He had just become a grandfather. He looked after his elderly mother, enjoyed his hobbies and had just come back from a holiday. A close friend said: “He was a really nice guy. Something must have clicked in his head. He must have just snapped.”
 

People do just snap, and there have been other similar tragedies in recent times, in Dunblane in Scotland, and in America in Columbine and Virginia Tech. Usually the killers are younger but it can happen in the most unpredictable way, leaving behind a trail of grief and bewilderment.
 

One of the great errors of modern thought was to believe that we are rational creatures who make decisions on the basis of deliberation and calculation. Reason, said the heroes of the enlightenment, can cure of us the passions and prejudices of the past. We now know that the human mind doesn’t work that way.
Neuroscientists have shown how decision making is inseparable from emotion. There are two systems at work in the human brain: the amygdala which generates highly charged emotional reactions, and the prefrontal cortex, more rational and deliberative, capable of thinking beyond the immediacy of the situation. The second system is significantly slower, so it’s always at risk of being overridden under stress or fear or anger. That’s how we often act irrationally and how, in extreme cases, ordinary people can commit terrible crimes.
 

Christianity called this original sin. Jews called it the evil inclination. “The heart,” said Jeremiah, “is deceitful above all things, and beyond cure. Who can understand it?” The Bible traces this back to the first two human children, when Cain in a fit of anger killed his brother Abel — then said, in sudden realisation of his guilt, “My sin is more than I can bear.” That’s why perpetrators of violence like Derrick Bird often end by turning it against themselves.
 
So for all our everyday calm, we must never forget the danger that lies, like an unexploded mine, just beneath the surface of the human heart. Meanwhile to the injured and the bereaved, we send our shared grief and our prayers.
 

We human beings constantly struggle with the duality of being animatistic and cognitive beings with souls.  As such, we must continuously work towards overcoming the animal, base nature in order to better serve the world around us.  We must put our divine side forward, acting with justice and in accord with our fullest emotional, spiritual and intellectual potential.

Islamic law and modernity

I saw the following report posted at Elder of Ziyyon.  In it, we find Islamic law trying to find a leniency for people who are breaking the law.  I guess this is a way to confront modern culture.  Whatever, it is, I think I will let the piece do the rest of the talking. 

Women in Saudi Arabia should give their breast milk to male colleagues and acquaintances in order to avoid breaking strict Islamic law forbidding mixing between the sexes, two powerful Saudi clerics have said. They are at odds, however, over precisely how the milk should be conveyed.

A fatwa issued recently about adult breast-feeding to establish “maternal relations” and preclude the possibility of sexual contact has resulted in a week’s worth of newspaper headlines in Saudi Arabia. Some have found the debate so bizarre that they’re calling for stricter regulations about how and when fatwas should be issued.

Sheikh Al Obeikan, an adviser to the royal court and consultant to the Ministry of Justice, set off a firestorm of controversy recently when he said on TV that women who come into regular contact with men who aren’t related to them ought to give them their breast milk so they will be considered relatives.

“The man should take the milk, but not directly from the breast of the woman,” Al Obeikan said, according to Gulf News. “He should drink it and then becomes a relative of the family, a fact that allows him to come in contact with the women without breaking Islam’s rules about mixing.”

Obeikan said the fatwa applied to men who live in the same house or come into contact with women on a regular basis, except for drivers.

 Al Obeikan, who made the statement after being asked on TV about a 2007 fatwa issued by an Egyptian scholar about adult breast-feeding, said that the breast milk ought to be pumped out and given to men in a glass. 

But his remarks were followed by an announcement by another high-profile sheik, Abi Ishaq Al Huwaini, who said that men should suckle the breast milk directly from a woman’s breast.

Shortly after the two sheiks weighed in on the matter, a bus driver in the country’s Eastern Region reportedly told one of the female teachers whom he drives regularly that he wanted to suckle milk from her breast. The teacher has threaten to file a lawsuit against him.

Under Islamic law, women are encouraged to breast-feed their children until the age of 2. It is not uncommon for sisters, for example, to breast-feed their nephews so they and their daughters will not have to cover their faces in front of them later in life. The custom is called being a “breast milk sibling.”

But under Islamic law, breast milk siblings have to be breastfed before the age of 2 in five “fulfilling” sessions. Islam prohibits sexual relations between a man and any woman who breastfed him in infancy. They are then allowed to be alone together when the man is an adult because he is not considered a potential mate.

“The whole issue just shows how clueless men are,” blogger Eman Al Nafjan wrote on her website. “All this back and forth between sheiks and not one bothers to ask a woman if it’s logical, let alone possible to breastfeed a grown man five fulfilling breast milk meals.

“Moreover, the thought of a huge hairy face at a woman’s breast does not evoke motherly or even brotherly feelings. It could go from the grotesque to the erotic but definitely not maternal.”

Al Nafjan said many in the country were appalled by the fatwa.

“We have many important issues that need discussing,” Al Nafjan told AOL News Friday. “It’s ridiculous to spend time talking about adult breast-feeding.”

The original adult breast-feeding fatwa was issued three years ago by an Egyptian scholar at Egypt’s al-Azhar University, considered Sunni Islam’s top university. Ezzat Attiya was expelled from the university after advocating breast-feeding of men as a way to circumnavigate segregation of the sexes in Egypt.

A year ago, Attiya was reinstated to his post.

Should this be the last generation?

Peter Singer, the often controversial philosopher, is at it again. In a post online, entitled Should This Be the Last Generation, he posits a seemingly timeless philosophical question; should we continue to populate the planet and why? 

His arguments are based on the following assumptions (which seem to be premises for many of his other notions):
1. Most of life is about suffering and chasing after illusionary satisfaction.
2. Human beings have no intrinsic value (Singer is also a proponent of euthanising those who are physically and mentally challenged).
3. Bringing unborn into the world is a form of cruelty because we are bringing people into a world to suffer.

While he presents an argument that seems in favor of this crazy scheme, Singer comes to the conclusion that life is worth living for most, so therefore, ending human life is not worth it.   After presenting his argument, he poses the following questions:

1.  If a child is likely to have a life full of pain and suffering is that a reason against bringing the child into existence?

2.  If a child is likely to have a happy, healthy life, is that a reason for bringing the child into existence?

3.  Is life worth living, for most people in developed nations today?

4.  Is a world with people in it better than a world with no sentient beings at all?

5.  Would it be wrong for us all to agree not to have children, so that we would be the last generation on Earth?

To answer his questions in one shot, I would argue that of course life is worth living.  To even begin questioning whether the world would be better without us is coming from a place of arrogance.  How would we even know or how would a comparison be possible as no sentient beings would be able to judge a world without humans. 

For those of us who believe a higher power, regardless of title, many of his questions can be answered as follows:  Life has an intrinsic value for each and every one of us.  Most of us never fully grasp what that value and purpose is, yet we recognize a certain quality of being special.  I would assume that this thinking is somewhat across the board, even in third world countries (maybe especially so, as reproduction continues to remain higher).  Yes, life is depressing at times, a theme we find as far back as the book of Ecclesiastes (Qohelet) and other works of that genre, but, as to quote a commentor on the piece by Singer, better to have lived and loved and lost than never to have lived at all.  Bringing a child into the world is a joyous occassion with hopes and dreams.  Very often those dreams get shattered, but it does not mean a mistake was made, or that the parent should then be considered harmful as they brought the unborn into the world to suffer.  Rather, it means life is never what we plan it to be, which for some can be quite sad, while for others brings about greater, more lasting joys.

Update Jun 17, 2010:  Peter Singer responds the critiques of his piece in the following post.