Cerebral Palsy

I spent the day on the pediatric ward (on call) today. It wasn't a very busy day, thankfully, and I was able to spend some time with a little three-year-old (I'll call him John) with cerebral palsy (CP). This little fellow was in hospital for treatment of his rather severe constipation, a relatively benign complication of his complicated medical situation.

John was a cute little boy with bright brown eyes which smiled by themselves. His arms and legs wouldn't quite do what he wanted them to, always overshooting his carefully calculated attempts to grasp things, but they were his own. His perfect little ears fit nicely on each side of his head, nicely suited to frame his small face, even though he is deaf.

He was born at 25 weeks gestation, 15 weeks (almost 4 months) premature. His neonatal pediatricians had predicted he would never make it home alive. His developmental pediatrician, when he did go home, had said he would never walk, talk, think or laugh. His mother, 19 years old, had never laid eyes on him since her C-section. For months he languished, all alone, in a hospital crib in a standard North American tertiary care center. Such things were only supposed to happen in Russia or Romania... When the Children's Services finally took notice, he had been neglected for seven months. Sure, John got his feeds, he had good nursing care from both good nurses and bad, and he was resucitated when he stopped breathing, so he couldn't complain... except he was a little infant, growing up all alone in a hospital bed, in a body that couldn't do what he told it to.

This retrospective scenario becomes more striking when you find out that, at three years of age, little John knows over 200 signs. His new parents, who've had him for more than two years, are delighted to tell everyone about his subtle mood changes, his love for iceskating and how he pulled down the Christmas tree last year. It's quite a sight to see him snuggle close to his mom and eat his pureed diet, and how carefully he tries to touch his little light-up toys.

His adoptive mother's only regret is that she missed being with him for the first seven months of his life. "There's so much time that we can never get back," she says. "He could have had so much more..."

She wouldn't give him up "for all the tea in China."

I guess the moral of little John's story is that every outcome prediction isn't right, that we have every right to hope, and that every drop of love counts.

Prenatal Diagnosis: some details

Just briefly, here are some of the details about prenatal screening and diagnosis...

Maternal Serum Screen

Also known as the Triple Screen, this 2nd Trimester maternal blood test looks at levels of alpha-fetoprotein (AFP), betaHCG, and unconjugated estriol (uE3) in maternal serum. Some centers also look at inhibin level and pregnancy associated plasma protein A (PAPP-A). (They can also check some of these levels in the first trimester, and integrate the results with the Triple Screen.) The first important point is that these tests are not diagnostic tests. They simply try to quantify the statistical likelihood or risk that the baby has one of three disorders: Down Syndrome (Trisomy 21), Edward's Syndrome (Trisomy 18) and open neural tube defects like spina bifida.

It is important to realize that this test, while posing no physical risk to the mother, does not get her any closer to knowing whether or not her baby has one of those three disorders. In fact, using the 2nd Trimester maternal serum screen by itself for Down Syndrome, the false positive rate is about 7%. If you screened 1000 women, 70 will have a "positive test" and only one baby will have Down Syndrome. (There are also, of course, false negatives.) The very real risk, here, is that 69 women will have tremendous psychological stress and worry for no reason. Many of them will move on to have amniocentesis for no reason. Amniocentesis carries a 1 in 200 risk of miscarriage, among other less common risks.

Other tests in what's called the IPS of integrated prenatal screen include 1st trimester serum levels (mentioned above) and a Nuchal Translucency (NT) ultrasound. The NT is done in week 11, 12 or 13, and measures the thickness of the fold at the back of the developing baby's neck, which is correlated with an increased risk of Down Syndrome. This is not a diagnostic test either. In combination with the serum tests it can help lower the overall false positive rate.

Amniocentesis and chorionic villus sampling (CVS) are actual diagnostic tests. A long needle is placed through the abdomen to sample the amniotic fluid or the chorion. Cells from the fluid can be analyzed to determine the baby's sex and presence of all sorts of genetic abnormalities. (The price goes up for each abnormality tested for). After one of these tests one can have a fair degree of certainty as to the presence or absence of a genetic or chromosomal disorder. Amnio has a 1/200, and CVS a 1/100 risk of miscarraige.

On the other hand, a routine ultrasound to check baby's anatomy at around 18 weeks can pick up an open neural tube defect in most cases.

Can you do anything about these disorders? Certainly not Down's or Edward's - no cure for these. For isolated menigomyelocele, a type of open NTD, there is promising research underway showing that intrauterine surgery, between weeks 24 and 30, can be of some benefit when compared to postnatal surgery. However, there are a lot of risks attached to surgery in utero (death being one of them), so that this surgery is not offered routinely.

The conclusion is that a routine 18 week ultrasound for anatomy will pick up many abnormalities in a baby (open NTDs, polycystic kidney disease, gastroscicis, etc.). Surgery, in the future, may be a routine option for some of these, but not really at the moment. As far as I can see, there is no reason to increase stress and worry with a Maternal Serum Screen if you are not going to abort the baby or risk miscarraige from amniocentesis or CVS.

Ultrasound
As far as the safety of ultrasound goes, I know of two large, randomized controlled trials, that demonstrate the safety of ultrasound in pregnancy. Keiler et al, in BJOG, 1997, looked at 4637 randomized pregnancies and found no reduced hearing, no reduced vision, and no difference in height/weight at ages 1, 4 and 7. Ultrasounds have been around for almost two generations, and there has yet to be a study showing detrimental effect. On the other hand, as Leivo et al. showed in a study of 9310 women, perinatal deaths were reduced in the ultrasound group (deaths around the time of delivery). It is a safe and cost-effective means to be reassured about the health of the baby instead of rushing of to a C-Section. It's also been shown to significantly increase parental bonding, as well as objectively reducing pregnancy-related anxiety levels.

Prenatal Screening

I'm now working in Obstetrics and Gynecology, and I'm finding that many profound moral dilemmas (for the rest of the world) are quite mundane and trivial everyday activities. One such issue is prenatal screening.

The rest of the world is quite divided on the issue of screening pregnant women for "defective" babies. Polls show roughly fifty-fifty, I'm told. But routinely, and in Canada, by law, women must be offered access to state-of-the-art tools that will detect the presence of "defects" such as Down Syndrome in the preborn baby. While there is some rhetoric about simply "presenting women with information and leaving them with the choice" the reality in 80% of the cases is that the babies who are discovered to have defects are "terminated".

It is interesting to hear the experts themselves in this area. Their surveys find that 80% of physicians also say that they would terminate if faced with the same defects in their own pregnancy. Yet they do not connect this with why 80% of patients do the same. They only comment that "the issue makes for a good coffee table discussion" but when it becomes a personal reality, we are all under the same pressures to make the choice to abort.

It's quite a perplexing situation, but still quite a black and white issue: the majority of physicians recommend prenatal screening as a tool to eliminate disease and cut health care costs, etc. The rest of us are quite uncomfortable with (at least strongly divided on) the idea of prenatal screening as a society. Women are benignly being offered "information" that pressures them into aborting because, among many reasons, there is little in the way of support for parents of disabled children. Abortion seems a quick and painless fix. After all, you can just try again...

Infectious Rhetoric

In a medical ethics class on assisted suicide and euthanasia, I kept pushing our professor to acknowledge the dysfunctional logic in assuming that a person in a coma or vegetative state was a non-person. She continued to maintain that they weren’t thinking, and therefore weren’t persons. But we think we are persons not because we think, but because we are the kind of thing that can think. That’s why uncle John in a coma is still a person, and when he wakes up, he’s the same person. That’s why aunt Mary is a person even though she’s asleep on the couch in front of the TV. That’s why my two-year-old is a person even though he can’t yet count, read or reason… Not only does this kind of faulty reasoning justify infanticide and other unthinkable atrocities, it also leads to many contradictions of common sense.

As the discussion progressed, we came to the issue of the physician’s responsibility, especially in regard to referring. I was very surprised to hear even some of the more respectable students arguing that by becoming physicians we “abdicate our role as moral agents.” It just seems so silly, that in order to further a patient's right to do whatever they want, I have to be willing to break with any value, tradition, culture, etc. that I have ever held dear. And that’s one of the most tragic realities: that even good people are so confused about life, the truth, and who we are.

By the end of this class, the discussion became a little uglier, with a bit of shouting about how “we have no right to make decisions for other people” and how not referring (i.e. for abortion) was impeding others’ basic human rights. The usual rhetoric. I was pleased that the rest of the class could witness that unusual vigor and thinly disguised anger that this debate immediately generated in a few of our classmates. Although I was thankful for the preparation I had done, which helped me remain calm and collected, the whole thing left me feeling kind of depressed and lonely. And I need a whole lot more grace and wisdom in order to help change even one heart on this issue.

Like a Rolling Stone

I experienced Another Bizzare Moment in medicine the other day.

Here I was, holding a retractor, peering into a deep whole in a man's side, looking at his kidney which the surgeon was (rather vigorously) trying to free from the surrounding fatty tissue. The patient was a 50-something year old gentlemen who recently found out that he had disseminated renal cell carcinoma. His prognosis was poor. All this had come upon him rather suddenly. And now he was asleep on the operating room table.

It was a pretty quiet operation, as things go. The surgeon grunted and puffed away, muttering obscenities under his breath. The kidney, apparently, was being stubborn. The tumor was bigger than originally thought. My mind wandered, which happens often to whomever is holding the retractor. Then the incessant buzz of the background music stopped and over the radio waves, clear as could be, I heard:

Once upon a time you dressed so fine

You threw the bums a dime in your prime, didn't you?

People'd call, say, "Beware doll, you're bound to fall"

You thought they were all kiddin' you

You used to laugh about

Everybody that was hangin' out

Now you don't talk so loud

Now you don't seem so proud...

It's hard to describe how fitting that song was, in that moment, amid the sterile steel and bright lights. One of those ironies of life, I guess.

Paradoxes of the 21st Century

Here are four almost Chestertonian paradoxes we encounter daily:

1. "Reproductive rights" means to not reproduce.
2. Conferences on "population growth" really mean "demographic control."
3. Feminist policy implementation means savage violence to women's bodies.
4. Equality for women in the workplace means "men need not apply."

The Celestial Fire called Conscience

I thought I was getting used to the bioethics mantra. But this article, dripping with sarcasm and published in the most reknowned medical journal, infuriated me.

It begins: "Apparently heeding George Washington's call to 'labor to keep alive in your breast that little spark of celestial fire called conscience,' physicians, nurses, and pharmacists are increasingly claiming a right to the autonomy not only to refuse to provide services they find objectionable, but even to refuse to refer patients to another provider and, more recently, to inform them of the existence of legal options for care."

Here is the rest of this bioethical song and dance in the New England Journal of Medicine, perhaps the most prestigious of medical journals, on the subject of conscience and professionalism. What is nice about this article is that it sums the debate up rather nicely, and reveals the disdain of the bioethics movement for all things moral.

Open hearts

I saw my first open-heart surgery the other day.

A congenial old man, on the rotund side, was in for a "triple bypass." Well aquainted with the medical system, he appeared quite relaxed. We talked about the usual pre-operative subjects. I listened carefully to his heart, and as usual, heard only the soothing "lub-dub, lub-dub."

Minutes later, I put him to asleep. Then there was some cutting, and then a quick zip with a modified jigsaw. Et viola! The surgeon was holding this man's beating heart in his hands.

I don't know which was more mind-blowing: that a live man's beating heart was in the surgeon's hands, or that, at that moment, the surgeon was conversing with the nurse about sushi...

Early delivery of "non-viable" babies

The Story...
As part of my anesthesia rotation I have been learning to do epidural and spinal blocks for women in labor. My first case yesterday morning was a C-section for a woman in her early forties, only 19 weeks pregnant.

The average Joe knows that 19-week-old babies can't survive outside of mom. Nonetheless, I was informed that this baby had a "lethal fetal anomoly." So the baby would likely die before delivery, during, or soon after. The reasoning behind "delivering early," as far as I can guess, is to relieve the mother of the last few harder months of pregnancy - because the baby will die anyway.

The Questions
Now what is the point of continuing a pregnancy once you know your baby cannot live outside the womb? If baby will die on the day of delivery, why not deliver sooner and get the whole tragic ordeal overwith and get on with life? Is there really a difference between letting the pregnancy go to term, and inducing early, when the end result is the same?

The Answers
There's a big difference - morally, psychologically, emotionally and even physically. The moral issue is huge: when the direct effect and intent of inducing labor early is to bring about the death of the infant, the act is immoral (it is murder, abortion, etc.). However, the intent and direct effect of delivering the baby at the end of pregnancy -induced or not- is that the baby moves from the now inappropriate location of the womb to the appropriate location outside. (After nine months, a baby's appropriate environment is outside the womb. Those that don't get out, don't make it.) So when a mother delivers her terminally ill baby at term, and it dies in her arms, this death is unintended and only an indirect effect of the delivery.

Psychologically, when an anomalous baby is "terminated" early, the parents remain very fragile and forever scarred. There is enormous guilt because there was immoral intent. The parents did not want their baby to die, of course, but what they did caused its death. If they wait till the baby comes by itself, they suffer to watch their baby die, but they had no hand in its death. On the contrary, they were able to participate fully in its short but beautiful little life.

Emotionally there is a lot of stress - not to mention bitterness and resentment. This one is hard on marriages, especially if one spouse pushed for it (often the father) and one would rather have waited. I think the majority of pressure for early delivery is from the doctors - they don't offer much support if you want to keep your baby to the end of pregnancy.

Physically, there is a lot of benefit to continuing a pregnancy. When a pregnancy is artificially interrupted, there are many hormonal effects - most of which we don't understand well at all. Post-abortion research is beginning to bear this out (e.g. breast cancer, fertility, etc.). Even so, the whole argument is that a woman will be much better of physically if she avoids the last few months of pregnancy. That may be true.

The Rest of the Story...
So I showed up a little late to the operating room, and didn't have to participate. I just observed from the head of the bed where Dad was sitting next to Mom's head. Before I knew it there was this tiny little bluish squirmy thing on the warming table. She had cute little fingers and toes. She even had her fingers in her mouth. Everything about her was right, just small. She would have fit perfectly in my hand. She was soft and warm to touch and I could feel her little heart beating fast. She was perfect.

They wrapped her in a little knitted blanket and gave her to her Dad to hold. He broke down sobbing. Mom couldn't really move on the OR table, but just stared kind of glassy-eyed at this little creature. I put my arms around Dad's shaking shoulders, and did my best to console them. And then the pager went off and I went off to another job. Another encounter with medicine. It's hard to see the positive side to this one. But out of all this evil good will come.

Child Psychiatry: raising some questions

I don't think this culture's problems can be more apparent than in the field of child and adolescent psychiatry and psychology. At every turn there is a contradiction and denial of the obvious. Here are some recent statistics (from a lecture I had) that are hard to digest:

Conduct disorders: 24.8% of boys (lifetime prevalence)
ADHD: 26.3% of boys (lifetime prev.)
Emotional disorders: 36.2% of girls (lifetime prev.)
Sexual abuse of kids: 1 in 4 girls, 1 in 8 boys
Self-abuse (cutting and burning): 20% of general kid population, 40% residential kids
Fetal alcohol syndrome: 3 per 1000 babies born

Not to mention drug abuse, drug induced psychosis, schizophrenia, eating disorders, suicides, etc...

If these numbers are true, and I suspect they are not far from the truth, what is wrong with us? Do more than half of North American children have a serious psychological disorder?

Perhaps a better way to explain these astounding statistics is this: we'll admit that they describe real behaviors (e.g. real depression and cutting and suicide attempts in 14 year olds who break up with first sexual partner, or real law-breaking behavior in adolescent boys). And that's pretty bad. Then we'll ask why they are now, apparently, so prevalent.

I would suggest it's because we would rather say that the problem is with the kids than with the parents, teachers, and society that raises them. For instance, it's much easier for the tired, overworked teacher to have her problem kids labeled "ADHD" so that the blame for their poor grades doesn't rest on her. And what can a teacher do anyway, if the parents don't back her up? So it's easier for the parents too to have this diagnosis. (This is not to say that real ADHD may exist, just much much rarer than it is diagnosed today).

Here's another example: the 14 year old girl who breaks up with first sexual partner is counseled in exactly this way "Don't worry, that relationship is just the first rung on a long ladder of life's relationships." Going by current numbers, this may be because the majority of counselors are on a long ladder of sexual relationships. But no wonder the girl is depressed! She has formed a deep (although apparently casual) psychological, emotional and physical bond with her partner, which can only properly exist in the context of a lifelong commitment. So of course the girl will may become suicidal or turn to self-injurious behavior to cope. She doesn't get the treatment she needs, and more importantly, no one was there to help her avoid the problem in the first place.

The list can go on and on. The point in common seems to be that adults are excusing their own actions and kids are being increasingly harmed by it...

Stem Cells and the Psychology of Sin

Man’s advancement in the sciences over the last several decades has revolutionized health care and dramatically changed the culture in which we live. An important new advancement in the biomedical sciences is the discovery of stem cells and the means to manipulate them. The ethical implications of this discovery for science and for our culture have generated intense political and theological debate, about which much has been written already. In this article I will review the current science of stem cells, discuss the ethical concerns, and finally consider the question of why so much interest in embryonic stem cell research.

What are stem cells?

“Stem cells” refer to cells which have the potential to develop into more than one kind of cell type. Once they are isolated and grown in a lab, they can technically be reproduced indefinitely. Current literature distinguishes between two kinds of stem cells: embryonic and adult stem cells. Embryonic stem cells are part of the developing baby in its first few weeks of life. The fertilized egg, in a sense, is the ultimate stem cell – by dividing it can generate all the different cell types of the mature adult organism. The single fertilized egg, called a “zygote,” grows by dividing again and again, becoming a multicellular organism, i.e. made up of many cells. During the initial three to five days, any of these cells may separate from the embryo and become a new embryo, called an identical twin. At a certain point, however, these cells cease to be totipotent but are still able to differentiate into every kind of tissue needed for growth and development of the embryo into a mature adult. As the baby develops and becomes bigger, these cells become more and more specialized and lose the ability to become other kinds of cells, so that, in the end, a heart muscle cell cannot become a skin cell, although they both may have come from the same stem cell a few weeks or years before. In the laboratory, scientists are learning how to coax stem cells to develop into whatever kind of tissue they please.

The other kind of stem cells are adult stem cells, found in various body tissues (e.g. brain, muscle, bone marrow), as well as umbilical cord and placental blood. We now know that they are much more common than was previously thought. Scientists had postulated that it would be harder to manipulate adult stem cells to change into different kinds of cells. However, the opposite appears to be true: while embryonic stems cells are proving extremely difficult to control (they often turn into tumours in patients who are treated with them), coaxing adult stem cells to change into the desired tissue and remain stable is a simpler process. The “plasticity” of adult stem cells is now well established. For instance, researchers in Italy have been able to take stem cells from an adult brain and turn them into skeletal muscle.[1] In fact, success stories about adult stem cell treatments are coming in so fast, that LifeSiteNews.com, a news agency that is closely following the issue, reports that they are having difficulty keeping up. As recently as January of this year, a young woman paralyzed in a car accident three years ago from her biceps down, is now walking with leg braces on a treadmill, after stem cells taken from her nose were implanted in her spinal cord.[2]

It is important to note that, to date, all the successful stories have come only from the use of adult stem cells, while most disease research organizations, such as the Juvenile Diabetes, Multiple Sclerosis and Canadian Cancer Societies, most governments, and most researchers continue to support the use of embryonic stem cells.

Is anything wrong with using stem cells?

There is nothing intrinsically wrong with the use of stem cells for research and therapy. However, in order to obtain embryonic stem cells, the newly formed, few day old baby has to die. Extraction of these cells from the embryo results in the death of the embryo, necessarily. On the other hand, obtaining adult stem cells is often as uncomplicated and morally neutral as a simple blood test.

It should seem evident that if the human embryo, a small living human being, is killed to obtain stem cells, then this use of stem cells represents a grave moral evil. However, there are many who disagree that the embryo is human, or that it is a person. But especially repugnant are the views of those today who hold that in spite of the fact that embryos are tiny, living, human beings, the value of their cells to the common good of society outweighs their right to live and grow and be born.

A second moral issue arising from the use of embryonic stem cells is issue of obtaining the incredible number of human ova (unfertilized eggs) necessary for research and development of such “products.” Developing nations especially are expressing serious concerns that their women in particular will be at risk of exploitation by private pharmaceutical and research companies to obtain the necessary human eggs.

Why so much interest in stem cells?

An interest, and indeed, an excitement about the potentials of stem cell research for treating diseases is understandable and should be encouraged. Drug therapy dominates the medicine of today. With the ability to manipulate stem cells to become any kind of tissue we want, the medicine of the future will be dominated by restorative therapies. For instance, instead of using drugs to treat heart failure following a heart attack, stem cells could be injected into the heart which could be influenced to grow into new heart muscle in the damaged heart. This kind of “therapeutic potential,” formerly science fiction, now appears to be right around the corner.

The real question, then, is why the grossly inflated interest in embryonic stem cells, which, besides being obtained from tiny human persons grown and killed for that purpose, have proven to be uncontrollable and ineffective? The answer is not simple, for many forces are at work.

First, with the successes, both real and imagined, of stem cell research, comes a renewed devotion to the cult of health, which already pervades the thinking of modern culture. Phrases such as “As long as you have your health!” and “If you have your health, you have it all!” illustrate the common principle that health is equivalent to happiness. The worship of health by the strong of our society, in pursuit of health and fleeing all suffering, leads to the oppression of the weak and defenseless.

Second, with such incredible “therapeutic potential” comes the possibility of incredible financial gain. A healthcare market dependent on stem cells will generate a multi-billion dollar industry for the companies and researchers who develop the technology and supply the cells. Government healthcare programs and giant insurance agencies stand to save billions in pharmaceutical products and time spent in hospital.

Ultimately, however, the question remains: why, in the face of the immense success of adult stem cells, are embryonic stem cells still disproportionately championed by a conspiracy of governments, the media, and the vast majority of researchers? For it almost seems as if there is an attraction to the sinful, the morally evil, and to all things previously considered taboo. The beginnings of an answer to this question emerge by considering that the use of embryonic stem cells is simply another face of the culture of death, whose other faces include abortion, infanticide and euthanasia. In his letter to the Romans Paul describes the culture of death, at work in every age, “who by their wickedness suppress the truth... they became futile in their thinking and their senseless minds were darkened” for they “exchanged the truth about God for a lie and worshiped and served the creature rather than the Creator” (Rom 1:18ff). He points to the fact that the consequences of living out the culture of death are intellectual darkness, impurity, and ultimately death itself, precisely what is being experienced by our culture today.

Our response to embryonic stem cell research should not be discouragement or dismay – we are confident in the power of the Gospel and the unshakeable foundations of the Kingdom of God. We are encouraged by the words of Pope John Paul II in his encyclical letter, The Gospel of Life:

“I repeat what I said to those families who carry out their challenging mission amid so many difficulties: a great prayer for life is urgently needed, a prayer which will rise up throughout the world… Let us therefore discover anew the humility and the courage to pray and fast so that the power from on high will break down the walls of lies and deceit; the walls which conceal from the sight of so many of our brothers and sisters the evil of practices and laws which are hostile to life.

“In this great endeavour to create a new culture of life we are inspired and sustained by the confidence that comes from knowing that the Gospel of life, like the Kingdom of God itself, is growing and producing abundant fruit (cf. Mk 4:26-29).”[3]

---

[1] Szabo, Paul. The Ethics and Science of Stem Cells. January 2002, p. 23. See www.paulszabo.com

[2] Taken from www.lifesite.net/ldn/2005/jan/05012007.html, referenced 2/27/05.

[3] Pope John Paul II, Evangelium Vitae, section 100.

Infanticide: the sky is the limit

The killing of newborns has, to the best of historical knowledge, been an integral part of every pagan culture. It should come as no surprise that, as our own culture becomes increasingly detached from its Christian heritage, the practice of infanticide should reappear as a socially acceptable and ethically defensible custom. After all, abortion has already won overwhelming approval, and the only difference between abortion and infanticide is the location of the child, i.e. inside or outside the womb.

Modern historians point out that infanticide flourished in areas where food was scarce (e.g. China and Inuit communities), that traditional patriarchal societies practiced female infanticide, and that disabled or deformed infants were routinely killed in almost every culture that has been studied. Some societies have even legislated infanticide, as is the case with the famous Patria Potestas law of ancient Rome. In Rome a father had absolute authority over the life and death of his children, and it was customary for a basin full of water to be present in the birthing room to drown the newborn child if the father so decided. In Sparta, the decision to keep a newborn child was left to a public magistrate. A notable exception were the Jews; Tacitus comments in his Histories that, interestingly, the Jews tended to raise all their young.

The unavoidable clash between Christian morals and pagan culture led finally to a complete ban on infanticide by emperor Valentinian in 374 AD. This triumph came not without a struggle. In fact, as Fr. Hardon noted in a lecture on contraception, the persecution of early Christians was generally not because they refused to offer incense to the emperor, as is often assumed, but because they refused to contracept, abort, or expose their infants. Thus it was then, as it is now, a struggle between the culture of life and the culture of death.

Today, as in ancient times, the Church of Christ fulfills her mandate to proclaim the Gospel of Life to the ends of the earth. Infanticide continues to be practiced with impunity in regions of Asia, especially in China and India. In these two countries “son preference” has decimated the female population, resulting in the “missing women” crisis of the early nineties. The gender ratio, usually 994 women for every 1000 men, reaches lows of 800 women to 1000 men in some Indian states, where sex-selective abortions and female infanticide are commonplace. Government censuses have revealed that over 60 million women are missing in Asia. It is estimated that by the year 2050 there will be a surplus of 90 million men in China alone. (Many have already written on the troubles to be expected from this exceptionally large population of young hedonist bachelors.)

While “son preference” is absent from North American culture, where sons and daughters are aborted at equal rates, the infanticidal mentality is not. Infanticide, where practiced, is rare or at least discreet. Remnants of western Judeo-Christian ethics, and the widespread and universal availability of abortion and contraception have rendered infanticide repulsive and unnecessary. However, the idea of infanticide is gaining favor, especially in academic circles.

The reconsideration of infanticide by western post-modern culture can be attributed to at least two causes. First, prominent bioethicists and physicians are beginning to promote it with unabashed and menacing urgency. And second, widespread abortion, especially partial birth abortion, encourages an infanticidal mentality. The gruesome and impious practice of infanticide is subtly but rapidly becoming the next battlefront in the war between the culture of life and the culture of death in North America.

A brief consideration of the philosophy of these bioethicists reveals fundamental confusion and a surprising shallowness. In the minds of these so-called experts, personhood is independent of human nature, and utilitarian ethics should prevail. For well-known Princeton ethicist Peter Singer, an adult cat has more of a right to life than a newborn human infant. For Singer, simply being human does not imply a right to life. What gives rise to fundamental rights, like right to life, is not being but having certain attributes like self-awareness or a desire to survive. Logically, then, higher animals like cats and primates enjoy the same rights as adult humans, while the rights of infants to live depend on extrinsic circumstances, such as whether they are wanted by their parents or can be afforded by society. Singer rightly points out that no metaphysical change in being occurs to the infant as it passes through the birth canal. Granting that abortion is ethically permissible, as he does, it is eminently logical to extend the abortive vulnerability to infants who have already been born.

Partial birth abortion laws encourage the acceptance of infanticide. This is one of the reasons given by the American Center for Law and Justice (ACLJ) for outlawing the practice in the United States. In a brief filed in the U.S. federal courts, the ACLJ contends that the government has a “vital and compelling interest” in preventing the spread of the practice of abortion into infanticide. “Partial-birth procedures represent the beachhead of abortion's assault on postnatal life, the bridge between abortion and infanticide,” the brief states. “Absent strong legal barriers and vigorous societal condemnation, partial-birth procedures open the way to legal infanticide.”

If Canadians already hear very little about abortion from the media, they hear nothing at all about infanticide. Yet there is well-documented evidence to prove that infanticide is practiced in some Canadian hospitals and many abortion clinics. Nurses and technicians from abortion clinics have reported that failed abortions, where the baby survives, are routinely followed by abandoning, drowning or otherwise killing the newborn. Infanticide is no longer merely a dream of pro-abortion academia, it is instead a quickly spreading reality, a nightmare already coming true.

In addition to infanticide, the insatiable appetite of the biotech industry has given rise to both cloning for experimentation and organ “harvesting”, as well as the horrific but undeniable market for fetal body parts that drives the partial birth abortion industry.

The culture of death wears many masks. Infanticide is just a new mask on the same selfish “non serviam” of Satan. It is another reason to worry for our country, for, as Donum Vitae makes clear, “When the state does not place its power at the service of the rights of each citizen, and in particular of the more vulnerable, the very foundations of a state based on law are undermined.” (Congregation of the Doctrine of the Faith, Donum vitae III) In these times, however, we remember the voice of Christ and find hope in His words, “Be not afraid!” And with prayerful confidence, we beg for the courage and wisdom to continue the fight that has already been won.

Life Support Not Obligatory

For someone who objected that the author of the last article should "lighten up a little" with regard to life support, i.e. not be so down on it:

I see your perspective on the whole subject now a little better - but I think you're getting the wrong message (for a good reason). In fact, you're catching this debate in the middle.

Here's what's been happening - in the Netherlands, Sweden, the UK, and now quite strongly in North America, the "Right to Die" movement has been promoting euthanasia and assisted suicide as a "basic human right." That means that we should all have the right to determine how we end our own life and be able to enlist physicians' help to end it. When someone is not "capable," physicians, hospital ethics boards, and "substitute decision makers" should be able to decide when the plug should be pulled. This was the case with Terri Schiavo, where her husband and judges and doctors decided she shouldn't live anymore. This movement is now gaining a lot of steam, since the principle guiding most people's thought on the matter is that the extrinsic "quality of life" (QOL in the medical literature) determines the intrinsic dignity or worth of a life.

Christianity (and natural law) recognizes the intrinsic dignity of man, who is made in the image and likeness of God. It understands that God, the author and beginning of life, has also the authority over the end of life. Now, a recognition of this authority of God over our life and death has to coexist with an understanding of our duty of stewardship over our bodies. Hence, given different circumstances, we seek more, or less, avidly to preserve our life in the face of illness and human frailty.

(For instance, a 35 year-old father of four might pursue aggressive cancer treatment or choose to be maintained on life support while trying "last resort" medical treatments for a disease that an 85 year old widower might not choose to pursue.)

Hence, also, we recognize that we cannot kill someone, by starvation or otherwise, to end what we determine to be a "life not worth living anymore." Instead, for dying patients or incurable suffering ones, we try our best to alleviate suffering, comfort, and help them see their dignity and understand God's plan for them.

However, the media and the majority of our culture today interpret this Christian understanding as inherently restrictive. "Are you saying we can't choose how and when to die? Do you mean we have to be hooked up to feeding tubes and respirators and IVs until we are absolutely dead?"

We reply that, no, human dignity does not necessarily that we seek always and agressively to prolong and preserve human life, which, after all, is only a brief prelude to eternal life. We just emphasize that no one has the right to end their own or another's life intentionally.

At this point, you walk into the debate, hearing us replying to the culture: "You don't HAVE to be hooked up to life support!" But recognize the objection it is meant to answer. We are emphasizing that no one is morally bound to choose to go on life support to prolong their life, which is what we're being charged with. We certainly don't say that life support isn't great and wonderful and necessary in many cases and good in many cases etc.

What is really at stake is the opposite: people want the right to end their own lives, to have doctors help them do it, and help them end the lives of their "loved ones" when they think it's time for them to go. With Christ and His Church, we affirm throughout the ages, life is good, life is dignified, life is a gift of God, life is not our own.

Excellent Article on "Care" vs Heroic Measures

The lessons of Terri Schiavo

The difference between taking care and heroic measures

Father Raymond J. de Souza

National Post (Canada)

April 1, 2005

Theresa Marie Schiavo has died. Despite her suffering, the human response is sadness at the loss of life because life is always, in even a weak or disabled state, a great good. We pray now that she might enjoy eternal life in the company of the saints in heaven, which is an even greater good.

And therein lies the delicate balance for the Christian believer, as Mrs. Schiavo was. For life is always good -- it is never "unworthy of life"; a human being never becomes a vegetable; life is never without inherent dignity. It is always wrong to destroy innocent human life, even -- or especially – life that is weak.

At the same time, life in this world is not the ultimate good. There are many goods greater even than earthly life -- the truth, faith, honour, loyalty, love. That's why a father does not hesitate in risking his life to protect his family; it is why the church honours the witness of the martyrs. Life in this world -- even for those with longevity -- is only a short prelude to eternity. That's why eternal life is the greater good.

So it is not necessary to prolong life in this world in the face of imminent death, or ravaging disease, or the demands that one's faith be betrayed.

But one cannot deliberately act to directly kill innocent life, whether one's own or another's.

The Schiavo case has given rise to much confusion. The fact that Pope John Paul II had a nasal feeding tube inserted on the day she died caused greater confusion still.

Classic moral thinking about such matters insists that, while there is an obligation to take care of one's own life and health, there is no need to undergo treatment that is disproportionate to the foreseen benefits. That's why many elderly people refuse the radiation or chemotherapy younger people would routinely take.

The key question relates to what constitutes medical treatment and what is just ordinary care. It is generally considered that ordinary care -- which does not constitute treatment -- includes warmth, hygiene, nutrition, hydration and pain control. Ordinary care is not "life support"; it is possible to die from infected bedsores, but preventing bedsores in a comatose patient is not "life support."

In case of imminent death, even ordinary care can be forgone. There is no need to use an IV for fluids if the patient will die tomorrow. But it would be wrong to withhold or refuse ordinary care, especially if it was intended to hasten death.

A good rule of thumb is to ask: What will cause the patient's death?

If it will be dehydration or starvation, then ordinary care, including food and water, should be provided. Otherwise, death is not the result of disease or trauma, but from lack of ordinary care. That's the moral difference between allowing someone to die, and actively causing death. Mrs. Schiavo was not dying; her death was the result of her food supply being cut off.

There are thousands of cases every day in which further medical treatment is refused on the grounds that it would be too burdensome. There are many cases in which even ordinary care is withdrawn because death is imminent, a matter of hours or a few days. No one need die hooked up to a vast array of machines. But it is a different matter to die for lack of food and water.

Yesterday's news also indicated that Pope John Paul II was not getting enough food after his tracheotomy, and so he has had a nasal feeding tube inserted to enhance his nutrition. He is obviously not on "life support" -- the feeding tube is the provision of ordinary care.

Some commentators speculated that the news was evidence that, if it came to that, John Paul would want to be on "life support" as long as possible. There is no evidence for that. The acceptance of ordinary care -- tube feeding -- does not imply anything about other treatment. Given his age and deteriorating medical condition, it would be perfectly understandable -- and morally permissible -- if John Paul indicated that he wished no more aggressive medical treatments.

About five years ago, John Paul himself wrote: "Despite the limitations brought on by age, I continue to enjoy life. At the same time, I find great peace in thinking of the time when the Lord will call me: from life to life!"

That is the balance -- to treasure life in this world and to look forward to life in the next. Death is part of life, killing is not. The lines can become blurred and the situations complex, but the principle remains: Life is always good, but not the greatest good.

© National Post 2005

The Tear of JL

JL is a man, and that is the point of this story.

Because JL is, at the moment, taking his last desparate breaths before going to the next life. As I work through this palliative care rotation, I've seen many responses from those at death's door: happiness, hope, elation, peace, sadness, despair, and ignorance. JL is not responding. He's been denied food and water for almost two weeks now, and defying death, and especially, denying the Culture of Death, he continues to live. His heart beats on and on, quicker every day as his body's supply of fluid runs dry.

JL is not responding, according to his daughter who made the decision to "forego" the "treatment" of food and water. He looks around when spoken to, but who knows what he sees or hears. Poor old man.

I found him alone yesterday (his family absent from their usual cold, bitter vigil). I spoke softly to him about dying. He did not drift back to sleep. I spoke to him about sin and forgiveness - he tried to voice a thought, but his dry hoarse throat just whined. I spoke to him about Christ and His love, His mercy, His hope, His call to repentence. A tear formed in the corner of the eye of this "comatose" man, and he looked at me intently. We prayed together. Now I knew it was WE who prayed together. And he drifted back to sleep.

Today he will die, I do not doubt, a victim of the Culture of Death, who has judged his quality of life too low to be worth living. But I believe he has felt his own dignity, if but for a moment, in the midst of starvation.

Resolutions at a Blank Slate

Perhaps the hardest thing for an artist, author, sculptor, or poet is the first step. The first line of a poem, the first tap with the chisel, the first line on a blank blog window...

Here is the forum for the exchange of ideas and the exercise in articulation. Like working out or jogging regularly, it demands motivation from within and time. If I truly believe this endeavor, this grand endeavor, is worthwhile, I will blog, and blog well.