Healing: The Technical Thesis**
Ken Badley
In recent decades, people both inside and outside the scientific and medical communities have developed a strong fascination with and confidence in a very scientific, technical form of medical practice.
To illustrate that fascination, altering genes may serve as a way to eliminate susceptibility to certain diseases. In principle, the prospect of eliminating diseases is a good thing. It reduces suffering. Eliminating disease would be consistent with what Jesus did. But something is more fascinating about eliminating a disease through genetic manipulation than eliminating it by ensuring that whole nations have clean drinking water. I think this glamour is part of what attracts us.
Glamour aside, we are fascinated for what appear to be good reasons. As US News and World Reporti noted in late 1985, a medical textbook published in 1980 would have missed the following: the first heart-lung transplant, the first use of mono-clonal antibodies to treat cancer, the first implant of a permanent artificial heart (with a model number yet!), the first successful transplant of an animal heart into a person, the discovery of the genetic markers for both cystic fibrosis and Huntington’s disease. I might add that a USNWR article published in late 1985 appears dated in the summer of 1987, for much more has been done in the intervening eighteen months.
Some months ago, The National Geographic mailed me an advertisement for a book that “celebrates the wondrous nature of the human body.” As a Christian, I have no question that the human body is wondrous; David called it that (Psalm 139:14) long before the National Geographic launched their book. The title they chose, however, caught my eye: The Incredible Machine. An incidental reference to “spare-parts medicine” in USNWR1 leaves me with the same impression. That impression is deepened when I walk on almost any large university campus and see a “Health Sciences Center.” When, as a boy, I went to my family doctor, his office was in “The Medical Arts Building.” Such language reveals a shift in thinking that has taken place, perhaps in just the last three decades.
Why have we changed the way we think about medicine? For one thing, medicine and science have explained many things that we previously did not understand. They have removed much of the mystery that previously surrounded the human body and its functioning. This is especially so regarding our understanding of people’s predispositions to certain diseases, and regarding healing. As never before, there now seems to be hope that some of our most dreaded disorders can be treated, and even eliminated.
But many who have tried to think Christianly about these new prospects in the medical world have encountered a tangled hedge of questions. How important (or realistic) is the idea that all persons should be healed of all that ails them? Is it the case that whatever we are able to do, we ought to do? How justly is medical care distributed when expensive, experimental procedures tie up hospital facilities and personnel for months at a time? What risks–both biological and theological–do we take when we tinker with our very genetic make-up? To accomplish healing, are we willing to violate arrangements God Himself may have put in place? What becomes of the person or our conception of the person when people are treated like machines, whose parts can always be repaired or replaced? Christians are not alone when they ask these questions. But many who ought to be asking them are ignoring them.
I suggest that answering such questions is made more complicated by a number of factors. First, most of us are struck by a sense of wonder when we hear what is being accomplished in bio-medical research. Such fascinating developments (and the sheer number of developments) do not invite easy ethical analysis. Second, at first blush, the prospect of longer life, or of a qualitatively better life for people does not invite critical analysis. Such analysis might appear callous as regards life itself, so we are tempted to keep our misgivings to ourselves. Third, we are facing a question of desirable ends and questionable means. “Questionable” is important here; I believe that most of us are not sure the means are wrong. Furthermore, for many people, the attraction of the ends is sufficient reason to conclude that the moral status of the means cannot be allowed to bear on the argument at all. How do we approach the means-ends question then, especially when no one has gone before us, when we have no traditions to stand on in this area?
In what follows, I survey some of the new technologies available in the world of health-care and then outline some principles by which we might approach the dilemmas presented to us by these new technologies. In three areas especially a technical approach to medicine seems to hold the most promise; the elimination of genetically-transmitted vulnerabilities through altering chromosomes; bypassing dysfunctional reproductive organs so that many of those who previously could not have children can have children; and replacing vital organs with transplanted or artificial organs.
Genetic Manipulation
Perhaps the most fascinating dimension of modern medicine is the potential to eliminate genetically the predisposition toward certain diseases. At least 3,000 diseases are related to single genes. Most disorders are related to more than one gene. Through painstaking microscopic comparisons between healthy and unhealthy DNA cells in chromosomes, researchers are able to identify which gene serves as the “marker” for various diseases.
Doctors in the Harvard Medical School recently identified the gene connected to one form of muscular dystrophy. In February, 1987, the marker for cystic fibrosis was identified by researchers at Sick Children’s hospital in Toronto. In the same month, researchers first reported that the marker linked to Alzheimer’s disease had been identified. Diagnosis is now available for 200 of the 3,000 single-gene defects (including hemophilia, muscular dystrophy, and sickle-cell anemia). Clearly, the USNWR article I mentioned above is already out of date.
Once a genetic marker has been identified, medical scientists can attempt to alter the protein in question in the hope of eliminating the disorder connected to the particular gene. Success stories do not abound as yet. But individual cases of healings have been reported where defective cells were replaced in massive numbers. Ultimately, we may enjoy a world where some diseases are eliminated altogether.
Such a prospect should not be pondered, however, without mentioning the darker side of genetic tinkering. Besides any ethical or legal issues that should be brought to bear on our discussion of genetic manipulation, one must not forget that eugenics has been used for evil as well as good. In the post-World War II era, we have learned that Nazi Germany carried out eugenic experiments on its own citizens for at least five years prior to the start of war itself. Part of the plan to develop the master race was the examination of the notion and components of race itself. This side of eugenics did not die with Hitler and his diabolical vision.
Second, we ought to fear any abstraction of “the race” above the person, or the “gene pool” above the dignity of people. Edward O. Wilson does this in his studies of “socio-biology”; he sees the person as simply a link in the development of more DNA. The race will continue and evolve; individual persons do not, and are therefore of little importance in the longer picture. In contrast to Wilson’s view, Pope John Paul II has written that therapy for particular individuals–that is, healing–must always be the goal of any genetic interference. We will return to some of these questions after exploring two further frontiers of modern medicine.
Reproductive Technologies
For reasons no one knows, sterility has doubled in North America in the past thirty years. Fully 20 percent of North American couples are now unable to have children by ordinary means. For them, new medical techniques offer the fulfillment of lifelong dreams: having children. The two best-known methods for bypassing reproductive disorders are Artificial Insemination (AI) and In Vitro Fertilization (IVF, literally “in glass”). A more recent development is embryo transfer, a technique that opens the door wide to surrogate motherhood.
Because the technique of AI is accepted almost universally as a means of breeding better cattle, it was really just a matter of time until it was attempted with people. To accomplish AI, doctors impregnate a woman with sperm from her husband (AIH), or from a donor (AID) if the husband is infertile. If the wife is infertile, the donor-father’s sperm is used to impregnate a surrogate mother.
IVF is slightly different. Doctors surgically remove the egg (actually they take a number of eggs) from the mother and, after it is fertilized in a dish, implant it in her womb. Louise Brown, whose mother’s fallopian tubes were blocked, was much in the news when she was born in July 1978–the first “test-tube” baby. Over 1,000 babies have been conceived this way since 150 of them at one hospital in Norfolk, Virginia (Eastern Virginia Medical School). Ten clinics operate in Canada, all of them offering hope but none of them achieving more than 30-50 percent success (there is no agreement here).
That less-than-perfect success rate implies at least two things worth noting immediately, one ethical implication and one counselling implication. Embryonic “wastage”–that is, very early abortion–is implicitly part of the IVF procedure and will remain so for some time. As techniques improve and wastage is diminished a new prospect will come. People will likely be able to choose the gender of their children simply by not implanting any embryo of the undesired sex. Such choice is already part of the procedure in principle (the numbers are very small as yet) regarding babies showing a proclivity toward certain defects.
The second implication regards women’s mental health. Women whose hopes are raised by the possibility of finally becoming pregnant and who seek IVF as a last resort may suffer greater disappointment if they “fail” in this way too. Already vulnerable, and perhaps (after years of seeing different doctors) by now feeling like the medical system runs their lives, they become the victim one more time. Certainly anyone counselling a woman considering such measures ought to be aware of what the fallout might be if such a procedure should fail.
Embryo transfer, a more recent variation of IVF, has been developed for those women who can carry a fetus but cannot produce an egg. Early in the pregnancy the embryo is flushed out of the donor mother and implanted in the woman wanting the child. (A variation might see the busy mother hiring someone simply to carry her own baby to term). The first embryo transfer was done at UCLA medical school in April, 1983. Like AI, embryo transfer makes way for surrogate motherhood and all its attendant legal and ethical problems. As most of my readers are aware, Mary Beth Whitehead’s original intentions, and her contract with the Sterns were considered secondary to the question of who could provide better care to Sara/Melissa/Baby M. In other words, Judge Harvey Sorkow approached the battle over Baby M as a strict custody battle between a father and mother (which, genetically, it was), rather than deciding the legal status of surrogacy. In doing so, the judge has aligned himself with the Vatican’s condemnation of surrogate motherhood because it undermines the dignity of the child.
Freezing embryos, while not a widespread practice, has been carried out successfully as well. In March, 1981, Zoe Leyland was born in Melbourne, Australia, the first baby to result from a frozen embryo. Once again, however, a new technology with its attendant promise, brings with it legal and ethical questions no one in the scientific or medical communities has adequately answered. What happens if the parents die after an embryo is frozen? This is not a hypothetical question: A Chilean couple died in a plane crash in 1981 leaving two “children” frozen in liquid nitrogen (-321 F). Whose children are they now? A second, more-sinister scenario has a couple wanting to “time” their children’s arrival so that they can accomplish their career goals first. They would freeze for later use the embryos they produce while they are young. To make the picture more sinister, it would be possible to pick out the “best” children at the same time by such criteria as hair and eye colour or stand against such a redefinition of procreation and childhood as that implied by such possibilities.
Replacing Organs
As was the case with the two areas already reviewed, this area of medicine excites people because it also holds a promise of extended life for many. The spectacular element in transplant/implant medicine appeals to us all. Names like Barney Clark, who lived 112 days after the first artificial heart implant, and William Schroeder, who received the second artificial heart, are commonly heard in the news. It is difficult not to hear about such developments.
We also recognize “Baby Fae,” who suffered from hypoplastic heart syndrome, a disorder which usually kills the newborn within a few days because the heart is unable to pump blood. In late 1984, she was given a baboon’s heart in the California hospital where she was born. Because the baboon could not consent to the donation, animal rights questions dominated the debate for some time. But for Christians, another question ought to come to mind: what were God’s intentions when He created different species and ordained the human race as the crown of His creation? Do we go against the divine will when we make such cross-species changes? In the abortion debate, Christians have often argued for the “sanctity of life” over against the “quality of life.” Surely the sanctity argument has some bearing on a discussion of the potential for cross-species transplants to extend life. Baby Fae died. But the questions her short life raised are not settled yet.
The argument I want to pursue here does not demand that I distinguish transplants form artificial organs, or animal donors from human donors. Rather I want to address the larger question of how all such hi-tech procedures affect our understanding of ourselves and of the nature of healing. In doing so, I will refer to all three of the medical frontiers I have explored herein.
Thinking Christianly About Hi-Tech Medicine
How do we think Christianly about such advances as those I have discussed here, especially vis-a-vis the C&MA’s traditional interest in divine healing? Some of what follows applies specifically to hi-tech medicine and our stance toward it. Some other comments apply to the relationship between healing and medical practice generally.
Regarding the technical forms of medical treatment I have explored here, we must confront the fact, first of all, that we have a very limited number of responses available to us. As Thomas Elkins puts it so well, we can be so limited that we hide from what is taking place and deny that it touches us and people around us. Or we can be so accepting that we take what comes without thought or comment. Or we can learn to bring Christian values into what is already here now.ii I assume that anyone who has read this far is interested in the third course of action Elkins mentions. I also assume that my readers know how complex this option will be to follow.
The first question I wish to confront regarding hi-tech medicine is that of motive: are humanitarian ends always in view when new procedures are developed? Traditionally, we have respected the medical community to such a great extent that we have perhaps come to believe that doctors never act from less-than-admirable motives. Two new elements figure in the equation in 1987 that were not present, say, fifty years ago. First, much medical research takes place in university hospitals. Even outside the university hospital, the academic mentality has a strong influence in medicine. One consequence of this environmental factor is that doctors are lured by the prospect of the prestige which accrues to any pioneer or discoverer. Confronted by a patient who might benefit from some extraordinary or experimental procedure, the practitioner cannot help but reflect on what personal benefits would likely follow successful treatment. Thus, the patient may become the secondary consideration. I certainly do not think all, or even most, doctors would allow this to happen, but I will argue that, if only in some pre-articulate way, the prospect of prestige must lodge itself in the consciousness of at least some medical personnel. With some others, the prospect is obviously in the foreground.
A second motive that runs contrary to medical tradition warrants mention here as well: financial profit from bio-medical discoveries. To illustrate, we are presently seeing expanding commercialization in IVF research. John Buster, who pioneered embryo transfers with humans at UCLA, sought investors and formed a company, Fertility and Genetics Research (FGR), to match those wanting children with mothers who could supply the needed eggs. FGR is but one of many such companies. The more successful agencies and clinics increase their market share as their reputation spreads. Those who hold the patents on the instruments used in IVF profit as well. In another field, “bio-tech” companies rush to patent new discoveries. Stock in those companies is bought and sold like that of any other. In the face of this new aspect of medical practice, we must ask whether the healing of persons has not been set aside in favour of more monetary or egoistic goals. Clearly, in some cases it has been set aside.
Also related to the question of motive is the issue of what some of the new procedures are being used for, and what some potential abuses might be. It is already quite clear that (besides any arguably justifiable cases) reproductive technologies are being used to cater to the whims of people who wish simply to make child-bearing more convenient, in some cases people whose homosexual lifestyles are condemned by Scripture. Even in those cases which I suggested might be justifiable–where we would at least be empathetic with people’s reasons for wanting a child, for example–there is good reason for us to pause. Dr. Patrick Steptoe, for one (who delivered Louise Brown in 1978), believes that compassion demands that we continue work on reproductive technology, but he is now concerned about the rising use of surrogate mothers.iii Such people as Jeremy Rifkin and the geneticist David Suzuki regularly call for the banning of all genetic experimentation on humans. Both fear the potential abuses; Rifkin believes genetics is already out of hand. As Christians, we ought to speak out when childbearing is reduced to a set of procedures implemented when convenient to result in perfect children.
We need to address, as well, questions of justice and the poor. Someone has to pay for the medical personnel, the machines, and the days in hospital. In some cases, the costs for a single procedure range over $200,000, enough money to provide a lower level of medical care to a much greater number of people. The question is, when the media report the latest discoveries week by week, and people everywhere have their own expectations for medical treatment raised, are there enough resources to go around? The resource question will perhaps push us to think more clearly about the theological question on suffering as it relates to God’s purpose.
As Harmon Smith, a theology professor at Duke University observes, there is something inconsistent about people’s fascination with “absurd, bizarre experiments” when babies are born daily “who are brain damaged because of malnutrition.”iv A wider, “Christian” view of healing ought to include a response to the inconsistency he has identified.
The last kind of question I want to raise about hi-tech medicine relates to the meaning of being human. Over the long term, I think this question may outweigh all others in importance. What does it mean to be a person, a spouse, a father or mother? The advances in medicine I have discussed above have raised these questions, as well as questions about sexual relations, procreation, death (and when it occurs), and the importance of physical well being.
Mary Beth Whitehead was a married mother of two children when she signed the surrogacy contract that eventuated in Baby M. At that time she wanted to help a childless couple. She did not anticipate what would occur in her thinking the day she gave birth to her daughter. What did occur has caused us to examine very carefully our concepts of procreation and motherhood. We have been forced to ask, for example, if parenthood is just one more thing that our generation will demand to have on its own terms. In this decade, the disorder of infertility is a bit like having a bad heart, which is being viewed more and more like a minor infection: just one of the many things that can be fixed.
We are beginning to see ourselves not as persons, or even organisms which sometimes suffer and are sometimes healed, but as machines which sometimes break down but can always be repaired. “Science” or “medicine” will find new ways to repair us; they will open new doors. I fear that each time we walk through another of those open doors, we dehumanize ourselves further. This is not to say that individuals are not helped with their individual disorders; they obviously are helped. It is to say that the way we view, or value our own uniqueness as God’s special, albeit fallen, creatures is diminished.
As we view ourselves as, and thus become, increasingly just another part of the creation–as opposed to the crown of creation–any idea of divine healing is correspondingly weakened at the root. Although he praised science for its work in eliminating disease, Pope John Paul II asked in 1984 how genetic manipulation could “be reconciled with a concept that credits man with an innate dignity and an untouchable autonomy?”v We must ask that same question, perhaps widening it to include the three areas we have examined here. What will become of our dignity if we change–even if we are simply able to change the very code that has distinguished us from other created kinds, if we learn how to reproduce without families, love, or sex, if we master the science of replacing all our vital organs?
Conclusion
We see then the hi-tech medical procedures have a dehumanizing side to them. Full of bright promise, and the power to reduce or eliminate certain kinds of suffering, the new “fixes” come accompanied by a kind of fanfare that may well seduce us. But such new forms of treatment also bring with them ethical, theological and anthropological questions that we must answer if we are to avoid being seduced by the glamour inherent in these discoveries. May God illuminate us by His Spirit so that we may see the path through these new frontiers.
** His Dominion, 13(4): 19-26 (1987).
i. U.S. News and World Report (1985.11.11:54).
ii. Thomas Elkins, Christianity Today (1985.a.18: 23).
iv. Times Magazine (1984.12.10:57).
v. The Pope Speaks (29,1 [1984]: 17-22).
Source of Information: Ken Badley, Healing: The Technical Thesis