PHI-413V-RS-T2 Case Study Fetal Abnormality
Case Study: Fetal Abnormality
Jessica is a 30-year-old immigrant from Mexico City. She and her husband Marco have been in the United States for the last three years and have finally earned enough money to move out of their Aunt Maria’s home and into an apartment of their own. They are both hard workers. Jessica works 50 hours a week at a local restaurant and Marco has been contracting side jobs in construction. Six months before their move to an apartment, Jessica finds out she is pregnant.
Four months later, Jessica and Marco arrive at the county hospital, a large, public, nonteaching hospital. A preliminary ultrasound indicates a possible abnormality with the fetus. Further scans are conducted, and it is determined that the fetus has a rare condition in which it has not developed any arms and will not likely develop them. There is also a 25% chance that the fetus may have Down syndrome.
Dr. Wilson, the primary attending physician, is seeing Jessica for the first time, since she and Marco did not receive earlier prenatal care over concerns about finances. Marco insists that Dr. Wilson refrain from telling Jessica the scan results, assuring him that he will tell his wife himself when she is emotionally ready for the news. While Marco and Dr. Wilson are talking in another room, Aunt Maria walks into the room with a distressed look on her face. She can tell that something is wrong and inquires of Dr. Wilson. After hearing of the diagnosis, she walks out of the room wailing loudly and praying aloud.
Marco and Dr. Wilson continue their discussion, and Dr. Wilson insists that he has an obligation to Jessica as his patient and that she has a right to know the diagnosis of the fetus. He furthermore is intent on discussing all relevant factors and options regarding the next step, including abortion. Marco insists on taking some time to think of how to break the news to Jessica, but Dr. Wilson, frustrated with the direction of the conversation, informs the husband that such a choice is not his to make. Dr. Wilson proceeds back across the hall, where he walks in on Aunt Maria awkwardly praying with Jessica and phoning the priest. At that point, Dr. Wilson gently but briefly informs Jessica of the diagnosis and lays out the option for abortion as a responsible medical alternative, given the quality of life such a child would have. Jessica looks at him and struggles to hold back her tears.
Jessica is torn between her hopes of a better socioeconomic position and increased independence, along with her conviction that all life is sacred. Marco will support Jessica in whatever decision she makes but is finding it difficult not to view the pregnancy and the prospects of a disabled child as a burden and a barrier to their economic security and plans. Dr. Wilson lays out all of the options but clearly makes his view known that abortion is “scientifically” and medically a wise choice in this situation. Aunt Maria pleads with Jessica to follow through with the pregnancy and allow what “God intends” to take place and urges Jessica to think of her responsibility as a mother.
PHI-413V Topic 2 Overview
God, Humanity, and Human Dignity
Introduction
Although there has recently been an explosion of scientific knowledge regarding Homo sapiens (i.e., human beings) such as the Human Genome Project (National Human Genome Research Institute, 2015) there is much more to what it means to be human than what science alone can tell us. The question about what it means to be a human person is fundamentally a philosophical and theological question that has been a topic of debate for millennia ("Personal Identity," 2014). We will focus on two aspects of this question: (1) what kind of a thing is a human person? and (2) what (if anything) makes human beings valuable and worthy of dignity and respect? The Christian worldview claims that human beings are the kind of creature that is created by God and that is both a physical and spiritual being capable of relationship with God. In this view, human beings are intrinsically valuable and worthy of dignity and respect because they are created in the "image of God." This discussion will address different views of what a human person is and focus on the distinctives of the Christian view regarding the value of persons.
Moral Status
A term commonly used by ethicists in medical field to talk about a human person's worth or value is moral status (see Beauchamp & Childress, 2013, pp. 62-94). Moral status explains which sorts of beings or entities are valuable and have rights to be treated in certain ways. You might begin by asking, "Why is it that my neighbor has a certain kind of value and a rock does not?" Any answer one gives will describe certain characteristics or capacities that differentiate the neighbor from a rock. These characteristics or capacities explain why the entity has the value it does. For example, we might say that my neighbor has moral status (i.e., value or worth) because he or she is a rational being, or because he or she has the capacity to feel pain and pleasure, etc. Thus, to talk about a being's moral status is to talk about a being's value, as well as why it has that value. The focus here is the moral status of human persons. Does moral status differ among persons? It will be clear below that according to the Christian worldview, moral status does not differ from person to person.
It is nevertheless common for people (including health care professionals) to think and act in ways that assign higher or lower moral status to human persons based on certain characteristics and capacities. The following five theories of moral status are different views regarding what makes human persons valuable. Each of these theories will pick a certain set of characteristics or capacities and claim that a human person is valuable (i.e., has moral status) only if he or she possesses the relevant characteristic or capacity. Consider carefully each of the following theories: (1) a theory based on human properties, (2) a theory based on cognitive properties, (3) a theory based on moral agency, (4) a theory based on sentience, and (5) a theory based on relationships.
1. The theory based on human properties holds that it is only and distinctively human properties that confer moral status upon a human being. It follows that all and only human beings, or Homo sapiens, have full moral status. Some of the characteristics that would endow a human being with moral status would include being conceived from human parents, or having a human genetic code. In this view, one only needs to be a human being to count as having full moral status.
2. The theory based on cognitive properties holds that it is not any sort of biological criteria or species membership (such as the theory based on human properties) that endows a human being with moral status. Rather, it is cognitive properties that confer moral status upon a human being. In this context "cognition refers to processes or awareness such as perception, memory, understanding, and thinking...[and] does not assume that only humans have such properties, although the starting model for these properties is again the competent human adult" (Beauchamp & Childress, 2013, p. 69). Notice carefully this is claiming that if a human being does not have these properties, it follows that such a human being does not have moral status or value.
3. The theory based on moral agency holds that "moral status derives from the capacity to act as a moral agent"; in this view a human being is considered a moral agent if they "are capable of making judgments about the rightness or wrongness of actions and has motives that can be judged morally" (Beauchamp & Childress, 2013, p. 72).
4. The theory based on sentience holds that having sentience confers moral status on a being. Sentience in this context is "consciousness in the form of feeling, especially the capacity to feel pain and pleasure, as distinguished from consciousness as perception or thought." (Beauchamp & Childress, 2013, p. 73). According to this theory the capacity of sentience is sufficient for moral status (i.e., the ability to feel pain and pleasure confer moral status to a human being).
5. The theory based on relationships holds that relationships between human beings account for a human being's moral status. In other words, a human being has moral status only if he or she has a relationship with others who value him or her. Usually these are relationships that establish roles and obligations such as a patient-physician relationship or a parent-child relationship. Of course, there are many types of relationships (family, genetic, legal, work, etc.), even ones in which one party in the relationship does not desire or value the other party. In such a case, a person who holds this theory may be forced to concede that a being's moral status may change, depending on the other party.
Each of the theories above has the following logical structure:
"Human being X has full moral status if and only if it exhibits property Y"
X− the human being in question (i.e., embryo, fetus, 12-month baby)
Y− The property that confers moral status upon that entity (i.e., human properties, cognitive properties, moral agency, sentience, or a relationship in which someone else values X).
Notice carefully that different worldviews would apply these theories differently depending on how they would think about the nature of human persons. It may be that thinking about the value of human beings according to such theories is not compatible with a particular worldview. In fact, the only theory above that is compatible with the Christian worldview is the first theory based on human properties. According to the Christian worldview all a human being needs to have full moral status or value is to be human. However, there is much more to the Christian position as will be seen below.
The Nature of Humanity: Divine Image Bearers
One of the most powerful concepts of the Christian worldview is the truth revealed in Genesis 1:26-27 that humanity was created in the image of God (or imago Dei in Latin)–spirit beings like him. But you were created with both a spirit and a body, indicating that this is your natural state. This becomes even clearer as you learn in the New Testament that one day you will be resurrected to new glorified bodies (1 Cor. 15:42-53).
There is some diversity of opinion among Christians about what the Bible means by the "image of God," but fundamentally it is what sets human beings apart from all other creatures and what endows human beings with intrinsic value and dignity. To have intrinsic value and dignity means that one's value and dignity do not come from anything external or extrinsic. For example, money has value that is purely external or extrinsic because we value it, not for its own sake, but for the things it can get us. Furthermore, there is not something intrinsically valuable to green paper (in the United States) that gives it worth. By contrast, a human being's value and dignity is inherent such that it is something everyone possesses by the very nature of what it means to be human. Human beings have intrinsic value and dignity because they are the only creatures that are created in the image of God.
The image of God is equally present in all human beings regardless of one's worldview or religion or whether or not one believes in God. Millard Erickson notes
there is no indication that the image is present in one person to a greater degree than in another. Superior natural endowments, such as high intelligence, are not evidence of the presence or degree of the image. [Furthermore], the image is not correlated with any variable...[but is] something in the very nature of humans, in the way in which they were made. It refers to something a human being is rather than something a human being has or does. (Erickson, 1998, pp. 557-558)
It follows then that any theory of moral status which equates a human being's value with certain external characteristics, or any function a human being must do, is not compatible with a Christian view of human persons. In addition, the image of God provides a foundation for the genuine equality of all human beings regardless of race, color, creed, gender, etc. It should be noted that the well-known bioethical principle of "respect for persons" (National Commission, 1979) is well supported by the Christian worldview.
While the image of God is equally present in all, its full expression may be hampered by disease, disability, or even sin. The image of God also indicates that you also have remnants of God's character within you, and when fully expressed may include the capability to love (even those who seem unlovable), the capability to create for purpose or simply for beauty, the ability to reason on a very high level, the ability to explore the universe, the capability to communicate with our Creator and to consciously worship him, the ability to sacrifice for others, the ability to be fair (a sense of justice), and an innate ability to sense right and wrong (a sense morality).
But Christians have been called to an even higher purpose–to be conformed to the image of Christ (Rom. 8:29)–that is, restored to the perfect image of God; a lifelong process sometimes called sanctification. The body of a Christian is referred to in 1 Corinthians 6:19-20 as the temple of the Holy Spirit, and as such, Christians are to purify themselves, being transformed by the renewing of their mind (Rom. 12:2).
Humanity was created to love as God loves, to worship and commune with him as he does with us, and to work as he works. Adam and Eve were commanded to be fruitful and multiply, and they were given dominion over all the earth (Gen. 1:28), which is a high order. They were placed in a beautiful garden to care for it and "work and keep it" (Gen. 2:15 NIV). Adam was even given the task of naming all the animals, thus becoming the first biologist, doing a work that continues to this day as new species are still being discovered. Thus, humanity from the beginning was engaged in good work and given responsibility and authority over other creatures, to care for them, and to expand God's kingdom under his sovereign rule. Unfortunately, as will be seen in the next discussion, human beings are fallen image bearers.
Conclusion
While most people in our culture happen to believe that human beings are valuable and worthy of dignity and respect, it is important to stop and actually think about what this means. The question is whether or not one's worldview provides an adequate explanation for these beliefs. Notice carefully how the Christian worldview addresses human dignity and value, and begin to ask yourself how your worldview would explain the value and worth of human beings.
References
Beauchamp, T. L., & Childress, J. (2013). Principles of biomedical ethics (7th ed.). New York, NY: Oxford University Press.
Erickson, M. J. (1998). Christian theology (2nd Ed.). Grand Rapids, MI: Baker Academic.
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. Retrieved from http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.html
National Human Genome Research Institute. (2015). All about the human genome project. Retrieved from http://www.genome.gov/10001772/
Personal identity. (2014). In Stanford encyclopedia of philosophy. Retrieved from http://plato.stanford.edu/entries/identity-personal/
Case Study Fetal Abnormality Example
Case Study Reflection: Fetal Abnormality
Name
Institutional Affiliation
Case Study Reflection: Fetal Abnormality
Introduction
For the first time in 2003, scientists sequenced the human genome in a highly funded Human Genome Project that determined the total number of genes making up a human being (Chial, 2008). This discovery opened an era of rapid medical advances than ever imagined. One controversial medical practice advanced by the outcomes of this project is genetic testing that determines an individual’s probability of developing a certain genetic disorder. Combined with amniocentesis, parents can know whether their unborn babies are likely to develop certain hereditary conditions and if they should consider an abortion (Meilaender, 2013). From a pro-life perspective, children are a gift from God with or without fetal abnormalities and each child is precious and perfect regardless if they have a physical deformity or any condition that might affect the quality of life as they develop.
The Christian view of the nature of human persons is that every individual is created in the image of God as revealed in Genesis 1:26-27. Like God, human persons are spirit beings but with a body that remains on Earth when one dies. In 1 Cor. 15:42-53, the dead will be resurrected to new glorified bodies. While there are varying opinions among different Christians regarding the biblical meaning of the “image of God”, this fundamental attribute is what differentiates human beings from other creatures and endows them with the intrinsic value and dignity. Although the image of God is present in all human beings, illnesses, disability, and sin may hamper its full expression. Different worldviews apply a range of moral theories based on their thoughts about the nature of human persons. The only moral theory that is compatible with the Christian worldview is based on human properties. Christians believe that what a human being needs to have full moral value or status is to be human. The moral theory of human properties is related to the intrinsic human value and dignity. It is only being human that one can have moral status or values, and that other creatures have no full moral status.
In the case “Fetal Abnormality” Jessica, Marco, Maria, and Dr. Wilson use different moral theories to determine the moral status of the fetus diagnosed with a rare condition in which it may fail to develop any arms and a 25% chance of Down syndrome. After Dr. Wilson informs Jessica that abortion is scientifically and medically safe alternative, she is torn between proceeding with an abortion and her strong conviction that all life is sacred. She uses the human-ness theory that the fetus she is carrying is of a human race and therefore has a moral status. In this regard, the fetus is fully human and therefore, it should be given the rights to survive since it possesses a genetic code. While her view on this has significant implications on medical advances of prolonging life and abortion, the Christian view supports that abortion is ending the life of a fully human being.
On the other hand, Dr. Wilson is of the idea that abortion is the rightful decision to take so that the born baby will not suffer congenital problems while developing. He applies the theory of rationality or cognition and sentience theory to make his decision. The fetus has no means to reason or express free will and thus has no moral status. According to Dr. Wilson, fetuses, embryos, and unconscious people do not feel pain and therefore have no moral status. However, Dr. Wilson leaves the decision to Jessica after advising her on the safety of abortion based on scientific and medical records. Marco on his part is free to support the theories of rationality and human-ness to support whichever decision Jessica takes. Maria strongly applies the theory of human-ness and life force theory that supports the survival of fetuses since they have full moral status. She tells Jessica that all should be left to God and that she should take heart and proceed with carrying the pregnancy. In the case, Jessica, Marco, Maria, and Dr. Wilson tend to apply a common theory of human-ness in determining the fate of the fetus.
Each of the theories determine or influence each of the participants’ recommendations for action, but the theory of human-ness features in all the participants’ decisions in the case. This theory influences each of their recommendations about the survival of the fetus. Jessica, a strong believer that life is sacred is informed that the theory of human-ness defines that all humans, regardless of their disabilities have full moral rights. She therefore thinks otherwise, but the suffering future of her born baby puts her in confusion. Dr. Wilson also considers the human-ness theory, but as a professional doctor, he has to leave the decision for Jessica to choose what is right for her. Marco, the husband understands the divinity of life and he is ready to support the wife in whichever direction she intends to take. The theory of human-ness determine her decision to let the fetus survive regardless of the suffering and directs that God knows how the baby will survive in the future.
I agree with the theory of human-ness or species theory. This theory protects the lives of vulnerable individuals who do not have the power to protect themselves from harm. Fetuses, embryos, and individuals with cognitive anomalies or damaged brains are defenseless about what other people decide about what should happen in their lives. This theory perfectly fits the Christian worldview, although scientists have blamed the same model for derailing scientific progress especially studies that use stem cells and unused embryos derived from in-vitro fertilization. I agree that medical science has advanced our ways of understanding complex diseases such as hydrocephaly, anacephalia, and Down syndrome, but going against the will of God is not an option. All human persons have moral values and status and this includes the unborn babies and embryos that are used in scientific experiments.
Conclusion
The debate on abortion has been raging with different views from pro-life activists condemning the practice while proponents citing reasons ranging from women rights and saving lives. While many people believe that all humans are valuable, and should be treated with dignity and respect, countless abortions are conducted in many clinics around the world without the full understanding on the Christian worldview. The Christian worldview maintains that all human persons have moral values and dignity, but the question that often emerges is whether such a worldview offers adequate explanation to Christian beliefs. In this paper, the Christian worldview on human dignity and value has been addressed using the case of fetal abnormality. Jessica who is carrying a fetus diagnosed with Down syndrome and unknown disorder where the baby will not develop limbs is faced with a dilemma. Since the baby to be born is in the image of God, it should be allowed to live than terminating the pregnancy.
References
Chial, H. (2008). DNA sequencing technologies key to the Human Genome Project. Nature Education, 1(1):219
Meilaender, G. (2013). Bioethics: a primer for Christians (3rd Ed). Grand Rapids, Michigan: William B. Eerdmans Publishing Company.
