DEATH AND THE LAW — The Tragedy of the Pregnant Dead Woman

No one said the field of bioethics was an easy one.  About to begin semester II of my course conducted at Cardozo Law School in NYC it is powerfully apparent that the issues under discussion are everpresent, highly emotional, charged with fundamental concepets of law, ethics, morality, religion  that are deeply felt and hotly contested. 

 In this case  Marlise Munoz, the mother,  is brain dead.  Her family, her functional health care proxies have decided that she would not have wanted to be maintained on futile life support.  The Texas hospital fought the families decision to terminate life support because she is pregnant and Texas law mandates that life support not be discontinued under such circumstances. In this particular case the fetus has been determined to be grossly abnormal and not viable.  But the world of legal bioethics holds firmly to the notion individual automony.  The recognition of the individual’s right to make their own medical decisions (or their proxy’s when they are incapable) is fundamental. The husband is such an individual.  His decision in his wife’s behalf is to discontinue life support.

 The Texas penal code has determined that and unborn child was “alive at every stage of gestation, from fertilization until birth.”  Of course the argument against this position is simply this– a fetus  requires a living mother to allow it to develop into a viable human being.

 Obviously their are strong emotional and deeply felt issues here.  I will never convince someone who believes aborion is murder to change their position.   Ideology should never be an excuse for not evaluating particular situations. If I have learned anything from my exposure to the field of bioethics it is exacty that.  The law and its ethical ramifications need to be applied to particular cases.  And real world situations are rarely black and white.

 It is reasonable to argue that termination of a viable fetus is murder.  It is equally reasonable to recognize that living tissue does not mean a living being.  A fetus may be “alive” from conception.  A sperm and an egg are “alive” as well.  Every cell of may body is “alive” as I type write now.  But is each cell a living being? And is everyone of my cells entiled to equal protection under the law?

Does a woman’s body commit murder every month when an unfertilized but living egg is ejected from her body?  And what about the millions of living sperm spilled without leading to conception?  Is this murder as well?  

And now to examine this particular case.  It is clear that her loved one’s have suffered enough.  Their decision to terminate life support would have been hers had she been capable of  making such a decision.  That is ultimately the criteria that the courts and bioethics supports.  

RISKS OF MEDITATION ? Interesting Perspective

I must confess.  I am one of those wannabe meditators.  I know I should.  I understand the physical, psychological, spiritual benefits it can provide.  I will return to it.  But wait.  Is there a downside to meditation?

 In his NYTimes magazine piece of 1/14/14 Dan Hurley discusses the risks and benefits of focussed mental attention (meditation) versus the usual mindless daydreaming that seems all to natural to us.  He offers clear examples of the benefits of meditation.  Even the military has exploited its benefits for achieving concentration and resilience during war.  He refers to Jon Kabat-Zinn’s pioneering work in the West on stress reduction and physical healing from mindfulness meditation. Even improved test-taking can seemingly benefit from it. So where’s the problem?  Ah, it seems as if the flip side of concentrated mindfulness, “spacing out” is actually good for the creative process.  Also, something call “implicit” learning seems to be impaired by meditation. It is the type of activity that becomes routine and habitual, below our consciousn awareness.  So what is the answer to life’s challenge to meditate or not?  Ah, once again it seem as if the middle way, a balance between periods of meditation and times to let the mind roam free is the answer.  But it is clearly the meditation part of the equation which needs our mindful attention, being mindless comes naturally to us all.

WHAT IS YOUR NET WORTH? — Is This About Money?

I have written about the concept of “net worth” before. Why do we assume that it refers to money and material possessions?

 The NYTimes article by Paul Sullivan (1/17/14) refers to the concept as “having enough, but hungry for more”.  It refers to the issues of cheating to obtain higher grades, of insider trading and fraudulent business practices, of competing against others in a society in which desires override need.  

When is enough, enough?  Do we know individuals who dreamed of having a million dollars in assets only to find themselves striving for 5 or 10?   And when is a billion dollars not enough– when someone has 2 or 3 or 50– isn’t that obvious?

The lesson of King Midas has never been learned.  Human nature is the powerful determinant of human behavior.   Psychologists who study happiness refer to this as the “hedonic treadmill”.  Acquisitions bring temporary satisfaction, but like any addiction, it is short-lived.  The rush of dopamine that drives this activity must be re-supplied.  As the mania continues there is no time for anything else. Ever try to stop eating potato chips or pistachios?  I find myself seeking the next one before finishing the last.  

Net worth cannot possibly be about anything else.   It is competition among inherently competitive individuals. How will any of us view our own net worth? Could it be something quite simple and ultimately more satisfying?  How did we treat other human beings?  How did we treat the planet? How did we treat ourselves?   As long as society promotes the acquisition of material goods, the accumulation of financial assets as equating to “net worth” we may find ourselves on that same treadmill.  Change requires stepping out of the stream that carries us along.

Private time, family time, time to pursue personal development, relaxation, acquiring knowledge for its own sake.  Pausing to enjoy the fruits of their labors, nurturing and cherishing personal relations—none of that occurs.  The Wolf of Wall Street roars its self-absorbed, abusive and karmically poisonous yelp.  The Book of Ecclesiastes spoke of the Bonfire of the Vanities. And at the end of the day, the end of all our days, there is no joy.  

WHAT IS ANTI-JUDAISM? Does it Matter?

Would I be at all interested in the history and horrors of anti-Semitism if I were not a Jew?  Hard to say.  But I would like to think so.  It is a powerful, terrifying but fascinating force in world history for at least the past 2000 years.  And continues to be so.

 Just visit the issue of the “quenelle” salute or the boycott of Israel or the powerful emotions the topic still engenders as evidence.  David Nirenberg in this book “Anti-Judaism: The Western Tradition” explores this deep and disturbing concept.

 It is actually not identical to anti-Semitism because he demonstrates that anti-Judaism functions as an explanation for life’s problems, tragedies and disappointments.  Although he does not rely on the term “scapegoat” itself—it surely is that.  He describes overhearing a conversation after 9/11 between a construction worker and his friend.  When discussing what happened they both agreed–it was the Jewish influence on making New York City the center of greedly capitalism…..and besides, the Jews killed Christ.  He was amazed by the quick conclusions that had been made.  He noted that a similar conversation could have taken place in the 13th century.  

It has occurred in societies and cultures in which there were few if any Jews at all.  Shakespeares Merchant of Venice played to an audience in which no Jews would have been present.  They had been expelled during the Crusades and allowed back in by Cromwell.  It didn’t matter.

To Nirenberg, anti-Judaism is a system of thought.  It is a way to make sense of the world, a world in which chaos and suffering abound.  It is an easy fix for whatever ails an individual or a community or a nation.  It has universal appeal because it seems to explain all failures and frustrations.  It is dangerous because we have seen the consequences of its beliefs.

THE CASE FOR OPTIMISM — Really

Its ironic.

 Just before I began this blog I was pondering something personal and rather annoying.  Last evening I had been sharing some of my frustrations with a fellow physician over the changes in our profession and as I sat before this blank page it came to me.  Be optimistic.  Out of the blue, without warning or even reason, it came.

I think it was because I also suddenly realized how fortunate most of us are to be living in this time and in this country.  For thousands of years our ancestors suffered, really suffered on a daily basis.  Early hominids likely scavenged for food, fought off powerful predators, feared horrific attacks by rival tribes, watched their children die early and frequently, saw their wives die in childbirth, suffer from infections, bad teeth, blindness in ways that are easily treatable today.

No one had to worry about end of life care.  Death came unexpectedly and swiftly for most.  Children often died in the process of being born or shortly afterwards. Fear was truly the default emotion for mankind.  Anthropologists and paleontologists have confirmed these findings when unearthing the remains of early man.  Traumatic injuries, evidence of broken bones, wounds inflicted by weapons were a common cause of death for all ages and sexes.

America is not a perfect utopia.  But it is a pretty amazing place to live.  No one forces anyone to come, or to stay.  This country was founded on optimism.  Everyone’s ancestors came here with the hope that their lives would be better…..and especially the lives of their children and grandchildren.  They had no guarantees.

 Today we complain about taxes, the mess of Obamacare, the frustration with our political leaders, our lack of good jobs etc. etc.  Yet if we stop to consider what our ancestors had to endure we might just be silent, and grateful.  

And, yes, even optimistic.