surgery to save or end a life

Anyone who knows me knows I’m aware of the sensitivities associated with abortion.  Although in one sense (something like the sense reflected in the post title) I think it can fairly be seen as a simple issue, I also affirm that it has complexities.

Ben Witherington III posted this story with this photo (warning – surgical photo – thoughI think it’s a very ‘un-offensive’ one!).  Here’s the story behind the photo.

The baby was diagnosed with spina bifida and would not survive if removed from his mother’s womb. Little Samuel’s mother, Julie Armas, is an obstetrics nurse in Atlanta . She knew of Dr. Bruner’s remarkable surgical procedure. Practicing at Vanderbilt University Medical Center in Nashville , he performs these special operations while the baby is still in the womb.

During the procedure, the doctor removes the uterus via C-section and makes a small incision to operate on the baby. As Dr.Bruner completed the surgery on Samuel, the little guy reached his tiny, but fully developed hand through the incision and firmly grasped the surgeon’s finger. DrBruner was reported as saying that when his finger was grasped, it was the most emotional moment of his life, and that for an instant during the procedure he was just frozen, totally immobile.

The photograph captures this amazing event with perfect clarity. The editors titled the picture, ‘Hand of Hope.’ The text explaining the picture begins, ‘The tiny hand of 21-week- old fetus Samuel Alexander Armas emerges from the mother’s uterus to grasp the finger of Dr. Joseph Bruner as if thanking the doctor for the gift of life.’

Little Samuel’s mother said they ‘wept for days’ when they saw the picture. She said, ‘The photo reminds us pregnancy isn’t about disability or an illness, it’s about a little person.’Samuel was born in perfect health, the operation 100 percent successful.

For me, there is an utterly stark difference between the surgical procedure described above, and the various surgical procedures involved with the so-called ‘termination’ of a ‘foetus’ (not to mention the social life conditions, and big and tiny decisions leading up to both!!!).  The starkness is all the more striking between this one, where the surgeon does restorative surgery on a foetus still in the womb, and one particular procedure that I know of, where the surgeon ‘dismembers’ the foetus while (obviously) still inside the womb.  And of course, there are nice, sanitised terms for this procedure, so that would-be mothers do not have to be told that the foetus (or developing baby) inside them is going to be ‘dismembered’ (and please note that descriptions, such as ‘butchered’ or ‘chopped up’ are not ones I’d ever use as they are utterly inflammatory – even though they are perhaps more honest terms than vauge/misleading [even dishonest!?] jargon such as ‘dilation and evacuation‘, which says absolutely nothing about cutting the foetus into pieces before the ‘evacuation’).

Among many other reflections this brings to mind, one is the inability of scientific knowledge  (in general; of which ‘foetal developmental knowledge’ or ‘surgical knowledge’ are specific examples) to guide or direct us in any direct way whatsoever as to (shall we say) which way the knife should be wielded.

14 thoughts on “surgery to save or end a life”

  1. Quite a photo Dale.
    But you speak of dishonesty and I have to add that it is dishonest to suggest the foetus is capable of the level of consciousness/development to be ‘reaching out to thank the doctor’.
    And ‘dilation and evacuation’ doesnt mention dismembering as the vast majority of the time such terminations involve a small group of microscopic cells or an embryo that has no limbs. Abortion at the age of the foetus in this article is much rarer but a foetus this age is so often used in the advertising material of pro life groups. The dishonesty stops me even listening further.
    And what of the ethics of risking of baby’s life to perfect it while in utero? What if the outcome hadn’t been successful? In Ben’s post he refers to Psalm 139 describing how wonderfully made we are and implies God is part of that- and thats easy to take if you look at a cute perfect little hand but the usual reality of a child with spina bifida is a different story. And many birth defects are terminal. If God’s right there why doesnt He use a bit of power to stop devastating abnormalities, you cant get more innocent than a baby?

  2. Thanks for the honest/direct comment, Jack,
    In what follows, I’m trying to treat the issue with due sensitivity AND urgency – a tough ask. Please humour me :)
    To be fair the ‘reaching out to thank the doctor’ comment is preceded immediately by ‘as if’, meaning it is intended in a metaphorical sense, making it not ‘dishonest’ at all, in my view, but rather quite simple and poetic (and quite touching, naturally).
    And I maintain that ‘dilation and evacuation’ is (at one level) dishonest, not because I ever said that every case includes dismembering (which I didn’t ever say), but because it is vague and doesn’t reflect the violence that must necessarily be done to the foetus (in each and every case). Dilation refers to the mothers body, and ‘evacuation’ refers to the change in location of the foetus. Something is not reflected there.
    Having said that, I recognise some dishonesty in much of the pro-life activity, i.e. choosing the worst scenarios, etc. I hope I’ve not done that here.
    As for God’s ‘hand’ in these scenarios, this is a quite specific (and heart-wrenching!) example of a far wider and more general question of God’s ‘hand’ in any scenario/phenomena. The short answer (I have no ‘perfect’ answer) is that I can’t imagine the universe working any other way than it does. And within the only framework that we know of (i.e. the reality we all share) for living and loving, we must do the best we can to make things better, which should include (among many other things) the sharing of life-saving practises and resources with the millions who still don’t have them. Life is fragile and precious (a non-empirically derived statement, but a true one!). Death is real and tragic (also non-empirically derived, but also true). For me, this underlines the need for us to defend life (both quality AND quantity) as best we can (whether in issues of war, death penalty, abortion, euthanasia, etc.). And again, the two ‘procedures’ contrasted above seem to represent different value-systems.

  3. Approximately 50%, I believe, of pregnancies end natural abortion – usually near the beginning. A good many of those foetuses are unviable, which is why they self-terminate. What of those lives that were never viable? They were a life too. With increasing medical know-how, is it not forseeable that in the future we might have the ability to keep alive foetuses which would naturally not survive? What do we do then? The more I think about this topic the less clearcut I realise it is.

  4. Hi Simon, thanks for the comment!
    You rightly recognise some realities there are to this topic. For me, it’s really about value(s). Valuing both the quantity and quality of life (and not only of a foetus or a ‘vegetable’ or an near-deceased elderly person, etc., but of all people). I do think arriving at fixed points of action, ‘this far and no further’ or ‘this but not that’ are important, but the values and thinking behind these points are vastly more important, I think.

    The point (yet again) was that because (or if??) we value life as fragile and precious, we not only can, but should do all we can to protect, preserve and save it. More specifically, we should use our technology (i.e. scans and/or scalpels) to this end (protecting, preserving, and saving life). The contrast my post focussed on was (as the title reflects) between using surgery to save or end a life.

    And again (as my post begins), I fully recognise the complexity AND the simplicity here. It’s both a sensitive and urgent issue, and I certainly hope my post and subsequent comments have appropriately reflected this.

  5. Yes, I agree that the issue seems simple from many perspectives. But of course it is not. I remember reading the book Freakonomics. It turns out that (in the US at least) the large crime drop in the 90’s was largely due to the introduction of abortion a few decades prior. Unwanted children of ill-equipped, young -even teenaged- mothers were….well, absent; they were aborted. And this has a whole lot of ramifications on society via the mother too, not just the child.

    In this way we can end up in the scenario where if we do in fact want to preserve quality of life, we can advocate abortion. Heck it is even conceivable that the use of life-destroying procedures (abortion) might ‘save’ society and ultimately destroy fewer lives. I don’t like this, but it is a valid argument.

    If it should turn out that we could keep unviable foetuses alive, and they would become (naturally) unviable people, would you then advocate setting down the technology?

  6. Thanks again, Simon,
    You’ve once again noted some very real complexities in the scenario. ((apparently the opening paragraph of my post was too brief/vague? because I am aware of these kinds of complexities…))

    I’ve often said that, at bottom, abortion is an issue about human sexuality. Those “ill-equipped, young -even teenaged- mothers” (not to mention irresponsible and selfish would-be fathers!) you refer to play a huge part in all of this. (please see my earlier article about this issue, in which I argue that what is needed most in this issue is respect and self-government (‘self-control’)…)

    As for advocating abortion to preserve the quality of life, I think that’s perhaps the opposite penduluum swing across from the ‘make it all illegal’ approach – both a bit simplistic.

    The values I’m advocating don’t just need to be held by isolated individuals, but by families (honestly, family health/strength/stability affects SOOOO much), communities, cities and nations, etc.

  7. Simon,
    Oh, yeah. If we could only just abort all babies at the first sight of difficulty – that’ll fix things…

  8. Anonymous,
    That’s not at all what Simon is saying. I also disagree with him for similar reasons, but straw-man jabs aren’t appreciated here, because they don’t contribute to a contstructive ethos for conversation.
    Engage patiently and respectfully (that leaves much room for both strong expressions of opinion and a bit of obvious gesting) or not at all…

  9. My point is, anonymous, that at some point we will all agree to ‘murder’ – or at least not act to save a life (heck doctors do it every day). No exceptions. The technology we play with is fire; moral fire. Life is not priceless. If it were, we’d stop driving tomorrow. I certainly come down on the pro-life side of the matter – I could never imagine aborting a life. But I can appreciate that some people have different opinions, and I can appreciate that they might even be correct.

    Dale, re the families, communities, cities, nations thing. Ultimately I think I would argue that if you think through the ramifications of (or perhaps necessary precursors to) an ‘ideal’ world where families and nations have the kind of values [I assume you] to be referring to, that it will inevitably be one in which freedoms are supressed, people are oppressed. Unfortunately, as the Enlightenment has shown us, these things are pivotal to technological advance.
    I have long believed that the happiest people on earth are the likes of the Amish people. Surely they epitomise what you have in mind. And yet how much oppression, death & disease would they have if they don’t exploit modern society’s technology? It is no mere fluke that these people have given up advancement in exchange for values. It is a necessity.

    I put it to you, then, that a society entirely made up of familes of ‘good’ moral fibre will be a society going nowhere, where life-saving procedures do not exist. Anyway, these are my musings, which I’m sure you’ll have major qualms about. But I just keep wondering: if other values are so superior, why do they not present themselves as a supremely successful unit (a family, a nation) which is at the forefront of such morally superior, life-saving procedures? The answer, I think, is that it has.

  10. Interesting, Simon. How do doctors act to not save a life every day?

    As for the rest of your comment, you seem to imagine that there is some kind of direct, total and immediate relationship between live-saving values and freedom/innovation. However, I don’t see that. I think hospitals/doctors are a good example (which is why I’m interested to see what you mean when you say ‘doctors do it every day’). Surely the basic (and overwhelmingly the majority) function of doctors/hospitals is to preserve, protect and save life (quantity and quality), is it not?

  11. Doctors in neonatal units do it all the time. We do it with sick people. We do it with old people. We do not dispose of the motor-car despite the advance knowledge that people will die because of them.

    But the bulk of my point is that I’m suggesting that doctors and nurses (technology) would not exist at all if the kind of values which lead to ‘moral decay’ were suppressed, because it is probably not possible to suppress the freedoms which lead to ‘moral decay’ and still facilitate insentives to technological advancement. But my claim is anythin BUT direct, total, and immediate! Lol :)

    I think we see this with the drug companies today. There is no incentive for them to produce newer and better drugs(technology) unless there is a financial carrot. (But we are all like that ultimately; just look at communism!) I think the problem is deeper than merely having moral families and societies: our entire economy would have to be built differently. Every individual would have to be perfect and selfless. Sure it would be nice if that were the case, but we’re dreaming. (interestingly I think a large reason why we are not more selfless in modern society is that there are just too damn many people! We weren’t designed to be in such large groups where we know almost no one. But again, large melting-pot cities are what allows commercial and technological advancement)

  12. Just checking what you’re actually meaning to say:
    You were talking about doctors who “…agree to ‘murder’ – or at least not act to save a life…”. Now you claim that neonatal units do it all the time; a sentiment which I’m fairly sure would offend (if not enrage?) the excellent and caring staff at the North Shore S.C.B.U. (Special Care Baby Unit) that looked after our son Thomas who was 7-weeks premature. And you claim the same with sick/old people. You can maybe stretch the quite controversial (and therefore not well-used as an example of what’s ‘normal’) example of euthanasia, which is (broadly – and again, controversially – speaking) to ‘not act to save a life’, but I know of no (non-controversial – or jailable!) procedure that is common in hospitals that can even remotely be called ‘murder’.

    ((A key distinction here is between removing ‘life support’ [keeping someone alive who would otherwise die ‘naturally’], and taking an action (scalpel, injection, etc.) to hasten the ending of the life…))

    And as for your other point, I apologise that I don’t see it very clearly just yet. I still don’t see how striving for life-saving values in any way restricts technological innovation.

  13. I went and looked it up. It was in a documentary on Peter Singer and this is what a practicing neonatal doctor said (a doctor in opposition to Peter Singer’s ideas). But it amounts to the same thing as withdrawing care from an elderly/sick person:

    “Sometimes we have a baby who’s so sick, the chance that he would be able to fulfill any kind of neurological development is so remote…they may be blind, they may be deaf, they won’t be able to recognize their parents, they won’t walk, be able to roll over, or feed themselves. And in a situation like that we ask the family what to do….and we can withdraw care.”

    I use the word ‘murder’ because I am trying to point out that there is no real demarcation here: If you were to run with your comments in the above post, you would end up having to admit that society deciding that diabetics don’t have a right to medical intervention would be okay as it is merely removing life support. These kinds of absurdities result exactly because there IS no clear line between murder and removal-of-life-support! I thought you were aware of these matters!?

    My other point/claim: No, no, it’s not life-saving values vs technological innovation. It’s more morality vs. technological innovaton. Essentially I’m saying that if in, say, the year 1500 you got to set up your ideal values for society/families/people, you would find that, sure, people would be much more community-based, much less selfish, much more concerned for each other (including more responsible about sexuality). But you would find that innovation would suffer because innovation is driven by the selfish desire to succeed; make wealth/money. You need competition to drive innovation (no economist would disagree with this). As a result of the lack of innovation, the life-saving technology like the surgery discussed in this article would not exist.
    I can imagine that it is tempting to appeal to the idea that people might want to innovate/achieve for the good of society as a whole rather than selfish personal gain but, as I have said, this has been tried before a-la communism. Great on paper but it just doesn’t happen: remove the reward for personal gain and you remove innovation/technology (and much more)
    Human selfishness is a double-edged sword. In many ways it is bad but it is also good; it is self-gain, ultimately, that drives us to create life-saving technology.

  14. Thanks Simon,
    The whole point of a blog (at least many of them?) is to put ideas/thoughts/reflections out there and get feedback, etc. To engage, etc. You fleshing out your thoughts is helpful to that end – it will help us understand each other (even if we don’t agree totally).

    Firstly, by making a distinction between ‘removal of life support’ (which is passive) and ‘taking action to end life’ (which is active), I certainly did not intend to imply that one was always ethical/moral and the other unethical/immoral. Making this distinction alone between active and passive forms in no way implies when or how each should (or shouldn’t) be used, so it is a non sequitur to suggest that it would force me to deny a diabetic medical intervention. I see no ‘absurdities’ here – and the distinction remains clear to me.

    Secondly, let me clarify (at least) one thing that I did not mean to imply when I talked about the need for families, communities, nations, etc. to have live-saving values… What I did not mean to imply was that these families, communities, and nations become moralistic, so as to make ‘being moral’ such a focus as to distract from any other goal/values – namely creative and technological innovation.

    Which leads me to this: You say “innovation is driven by the selfish desire to succeed; make wealth/money.” This might be the case sometimes, but I contend that ‘selfish desire to succeed’, etc. is most certainly not the only thing that drives innovation. Two words come to mind: creativity and ability (and correct me if I’m wrong, but creativity and ability are not at odds whatsoever with life-saving values).

    But one other clarification is in order. Just so you know, life-saving values aren’t the only values that I think families, communities and nations should have. Another value relevant to this conversation comes to mind: valuing human creativity (which, really, is an out-working of valuing life). I don’t want to live in a family, community or nation where art and technology are demonised or undervalued. Now, (as a clarifier) the complete opposite is also true: I don’t want to live in a family, community or nation where art and technology are worshipped or overvalued. Art and technology should be things that make human life (not to mention plant and animal life!) better, not worse. So by all means, innovation and freedom are essential in my view – and (to bring it back home) a family, community or nation that suppresses these ceases to be moral!

    So, valuing life is no small thing – it is quite relevant to pretty much all areas of human living (medicine, communications technology, city/town-planning, transportation technology/infrastructure, farming, ecology, education, government, entertainment, arts, etc., etc.). Issues to do with abortion are important, but one of many issues which valuing life could make a huge difference.

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