Human Organ Donation: Gift or Graft?

Published in the Opinion page of the Chicago Tribune, May 12, 2000; of The Saint Louis Post-Dispatch, July 18, 2000; and of The Baltimore Sun July 27, 2000. It was also reprinted in a textbook by Lee Odell and Susan M. Katz entitled Writing in a Visual Age, Bedford/Saint Martin's, 2006.

A few days ago, while making rounds at a local hospital, I chanced upon the pictures of two children tacked to a bulletin board in the ICU. One photo showed a despondent, jaundiced infant with a huge, fluid-filled belly and limp, unsettled limbs stretched out in every direction. The other showed a pink, healthy baby beaming as he grasped his foot with his right hand and a toy with his left, as if trying to decide which to chew on first. Only after reading the note next to the photos did I realize that both were images of the same child. His mother sent the pictures with a moving letter thanking the hospital staff for their role in obtaining a suitable donor liver for her son, born with a fatal deformity of the bile ducts. “Thank you for giving our son back to us”, she wrote. A liver transplant was their only hope, and in this case, the benefit was nothing short of spectacular, clearly a gift of life.

Tissue obtained from humans – both living and dead – has proved to be life-saving and life-enhancing for persons with a broad range of medical problems. Despite campaigns to improve public and professional awareness of the benefits of donation, the sharp upswing in demand for human organs for transplantation has not been accompanied by a corresponding increase in supply. While solutions – of both the carrot and the stick variety – have been offered to reverse the donor dearth, none has proven particularly successful, and the unmet demand for organs has fostered commercialization and, occasionally, exploitation of donors and their families. Pennsylvania, for example, recently became the first state to offer relatives of deceased, prospective donors financial incentives to give up the bodies of their loved ones. Documentation of paid or coerced donations from the poor of developing countries and citizens of totalitarian regimes is on the rise. Sordid reports abound of abortion clinics feeding a lucrative black market in fetal tissue.

In the affluent west, “market-based” organ procurement ranks among the more creative approaches that have been proposed, but is little more than a euphemism for buying and selling of body parts. Prospective “organ vendors” could “opt-in” to an organ or tissue “futures market”. After their deaths, their estates would share in the substantial financial benefits currently enjoyed by a few for-profit tissue brokers. The concept of "rewarded gifting" -- an oblique, contradictory term concocted to blunt the funny aftertaste that comes from knowing you’ve just put your innards up for sale – is unlikely to gain wide acceptance.

Before organ transplantation was possible, laws regarding disposition of a dead person’s body made it clear that executors of an estate could not make it an item of commerce. The reason? The body was not considered “property” in the legal sense, and therefore not a part of the person’s estate. As transplantation developed into a therapeutic medical procedure, living organs from dead donors acquired value, and laws were adapted to fit the new reality. Under the Uniform Anatomical Gift Act, which regulates procurement and distribution of human organs for medical purposes, it is still illegal to sell the dead body or its parts, but not to give them away. So some non-profit procurement groups pitch donation to surviving family members, appealing to their altruism, then charge hefty processing fees to for-profit distributors. At times, the same people run both operations. The problem is that these organizations deliberately blur the distinction between giving and selling.

In his insightful book, “The Gift: Imagination and the Erotic Life of Property”, Lewis Hyde points to the existence of two “economies” operating in human relations. One is the “market economy”, where commodities are valued, bought and sold in a calculated exchange. The other is the “gift economy” where goods are given freely without calculation. Gifts can not be purchased or traded, only bestowed on one person by another. Gifts are not capital. Rather than foster competitive self-interest and social fragmentation, they create and strengthen bonds between individuals. We all like to give and receive gifts because they express values that money can’t buy: the esteem of one person or group for another; the desire that others may experience good fortune and happiness, and share in the prosperity of the giver. Gifts are a material expression of good will, of love. They unite rather than divide. In a sense, the practice of organ transplantation today occupies the intersection of these two economies: one man’s gift becomes another man’s capital.

On the one hand, the costs incurred by harvesting, processing and transporting organs should in justice be covered, and some would argue that a reasonable profit may legitimately be made in the process. On the other hand, the organ itself, the generosity of the donor’s family and the life that is prolonged are values that resist an economic paradigm. According to Hyde, “Transactions that involve life itself seem to constitute the primary case in which we feel called upon to distinguish the right of bestowal from the right of sale”. The mother of the child in the photos came to understand that life is the ultimate gift. It is bestowed, not taken, made or earned, and it is a gift of incalculable value.

The industrial age we are quickly leaving behind was characterized by the conflict of capital and labor. As the new era of biotechnology begins, the new dialectic may well be defined by the dichotomy of commodity and gift. Advances in biotechnology that allow us to manipulate human life force us to continue to put a price tags on the priceless, to confuse gift and commodity, persons and property. The tension created by these contrasting values – already evident in the debates on the patenting of human genes, the use of human stem cells and fetal tissue for the treatment of disease – may introduce original and unexpected notions of value and wealth. In time, we may well discover that we have much to gain by giving away what never really belonged to us.

Life after death in our brave new world

Published in the Opinion Page of the Chicago Tribune on May 1, 1999

It was bound to happen sooner or later. Doctors have been squirreling away sperm from dead men for some time, but no surviving relatives had ever been interested in putting these frozen cells to use. At least not until July of last year when the young, childless widow of a thirty-something California man changed that. With the aid of a sophisticated in vitro fertilization technique, she conceived and -- just last month -- delivered a healthy, fatherless infant girl she named Brandalyn. Her husband, Brandalyn’s father, had died suddenly 15 months before conception, and his sperm was retrieved about 30 hours after his death, in a hospital morgue.

Now, another woman in London is waiting her turn to conceive a child from her deceased spouse, after waging a highly publicized court battle to allow doctors to harvest her husband’s sperm cells while he was on life support, comatose and dying. The ensuing hullabaloo among doctors on both sides of the Atlantic has focused on whether a woman’s “right to reproductive freedom” outweighs a man’s right to consent to or decline sperm donation; whether the man’s consent could be implied or should be explicit; whether a child should be “made” without a father in her future. While these issues are passionately debated, they miss the point. There’s more at stake here than legalistic arguments about who’s got a right to what. The real issue is deeper, broader and much more important.

A cynic, it is said, knows the price of everything and the value of nothing. We live in a cynical age, where human sexuality is perceived as “breeding” and, to some in the medical field, nothing more than animal husbandry. Ad campaigns, offering big bucks for the sperm and eggs of bright, good-looking men and women, have hit major college campuses across the country. A supply of “buff” gametes bought and sold to gratify someone’s desire for “superior” children, or worse still, some scientists demand for research material.

But that’s not all. Because the techniques for storage of sperm and eggs have, until recently, been unreliable for preserving the viability of these cells, in vitro fertilization is usually performed first. Then hardier embryos, rather than separate sex cells, are packaged and dipped in liquid nitrogen. By conservative estimates, there are now over 100,000 embryos stowed away in cold storage across the country, waiting for someone to decide what to do with them. They are the silent prisoners of an aging, de-humanized “high technology” bent on methodically undermining the value of human life.

Human beings are not called to breed, but to parent: to give life through love. By “love” we should understand neither mushy sentimentalism nor physical gratification, but the selfless gift of one person to another. Love has many forms: it is the sacrifice of parents on behalf of their children; the dedication of a good professional to his or her work as a service to others; the devotion of friends. In each case, one person makes a free and responsible effort to serve another, often at the expense of personal comfort or pleasure. The most sublime form of human love is the love between a husband and wife.

In marriage, a man and woman promise to give all of themselves to one another -- their bodies, hearts, talents, material possessions and personal ambitions -- as a mutual gift. Sex means giving physical expression to the complete, mutual gift of two persons in a stable, life-long relationship. And it is no coincidence that the physical actions which serve to forge the deepest possible bond between two persons are the same actions by which new human life is generated. This dual meaning of human sexuality – sex for bonding and for babies – reflects the physical and spiritual dimensions of the human person. The generation of new human life is the spiritual translation of the physical action, the deepest fulfillment of the sexual union. It makes perfect sense that a human being should begin life bound together by the love of a man and woman, not thawed out by the dull proficiency of a lab technician.

Human sexuality is about babies and about bonding. They are like two sides of the same coin. Each and every sexual act must respect these two inseparable aspects if sex is to retain its true meaning, and lead to the health and happiness of the persons involved. To separate these two meanings of the sexual act is to adulterate, to cheapen human sexuality. Techniques of assisted reproduction introduce a “third party” into the most sublime, intimate events of human existence. They violently separate babies and bonding, and in the process sever the deep, natural link that needs to exist between love-making and life-giving.

Developed countries, with the US in the vanguard, have rushed to embrace sperm and egg donation -- from the living, the dying or the dead --, embryo cold-storage, and a host of other in vitro reproductive technologies as an acceptable, if not entirely palatable, part of mainstream medical care. Why should we be surprised if the cells which serve as the biological substrate of human life are handled as a commodity to be bought and sold to the highest bidder? Sex is for sale, and a test tube has now become the cold, hard cradle we offer to welcome new human life into our brave new world.

A short history of voluntary death

By following this link, you can read a published version of the paper below. A Portuguese translation of the article may be found here. A version in Italian may be found here.

Differences over embryonic stem cells are part of broader debate

This article appeared in the opinion pages of the Detroit Free Press on July 27, 2001. The subtitle of the piece was "Get rid of mind-body dualism and recognize embryos as human beings". It was reprinted on a multiple sclerosis website together with other articles on this topic.

The debate raging over the use of human embryos and their stem cells is important for many reasons. Perhaps the least important of these relates to the physical ailments that might, in the future, be cured using these techniques. The debate is more important because it is part of a broader conflict whose origins can be traced back for centuries: a clash determined by vastly different ways of understanding what it means to be human.

About 400 years ago, a genius named Rene Descartes -- a man who contributed important and durable insights to science -- goofed when he dabbled in philosophy. He succeeded in driving a deep wedge between the once well-integrated spiritual and physical dimensions of the human person. Over time and almost imperceptibly, the "split" that Descartes imagined between the mind and the body took root, first among intellectuals. Today, it is flourishing in attitudes and behavior at all levels of society.

Thanks to Descartes, Deepak Chopra can claim, "Your body is just the place your memories call home," and people will buy his books. There are many other examples in popular culture that express the theoretical mind-body split in practical ways. But perhaps none is as disturbing as the prevailing attitude of science and society toward human embryos.

Scientists have become exceptionally skilled at growing them up in a petri dish. They can tell us what they might look like if they are allowed to develop and how they might suffer and die from diseases inscribed in their genes. They tell us the great good that someday may come from using parts of them to treat the diseases of other people. They may feel quite satisfied when they discard some embryos in favor of others. They are simply selecting those less likely to burden society and more likely produce. They are strengthening the gene pool and giving another human the best chance for a "good life." But they refuse to grant the human embryos they use the most vital gift of all: respect.

And the reason scientists are incapable of respecting the humanity of their embryos is because "your body is just the place your memories call home." They view the particular human body they are working on as a shell, a car in need of a driver. It can be produced, discarded or recalled for factory defect. It has no memory, no past and, if they decide so, no future.

It's clear that Descartes had no idea what he was getting into when he split himself and us in two. But ideas do have consequences, and unfortunately, bad ideas may have very bad consequences. After four centuries of mind-body dualism, it is time to put things back in their proper place. Honest science must accept nature on its own terms. Bias defeats its purpose, and it is the voice of antihuman bias in science today that claims that an organism shown to be genetically human, biologically human and anatomically human is just a body and not a human.

To be human is to be both body and spirit. Each completes the other, and together both confer wholeness and integrity to each and every human person.

To arbitrarily deny the full humanity of a human embryo is symptomatic of the disintegration that some human beings have forced on others. Today, the weak, the dying, the disabled and those who are unable to speak for themselves, can easily be defined, either in theory or in practice, as less than human. They become living, breathing shells devoid of spirit, of value and therefore of humanity.

Some today might ask, not without an edge of cynicism, "So when exactly does the embryo become a human being?" This critical question is one that science is now fully equipped to answer unambiguously: "It has always been a human being." Where there is a physically distinct human organism, alive and growing, there is a complete human organism. From the moment of conception, there exists an autonomous human life. All that he or she needs to develop is proper nourishment. Nothing else needs to be added to them.

The ethical dilemmas posed by stem cell research, pre-implantation genetic testing and other assisted reproductive technologies are caused by the dualist view of the human person that has dominated scientific theory and practice for four centuries. This view turns the embryonic human body into the disposable part of a potential person, rather than an integral part of a whole person. We should recognize that treating the human body in this way has implications far beyond science and academia.

Could it be that the many real and imagined conflicts that polarize families and society today are an expression of the same split that inclines us to deny scientific reality and imagine the human embryo to be anything other than human?

"Therapeutic" cloning: A human misconception

The term "human cloning" refers to the creation of a genetically identical copy of an existing -- or previously existing -- human being, or to the production of genetically identical tissue from that individual. In 2001, scientists at Advanced Cell Technology in Worcester, Massachussetts announced that they had successfully cloned a human embryo. It was the first time human cells had been grown through "somatic cell nuclear transfer", the same technique used to clone Dolly the sheep about 5 years before. The egg used to coax the human DNA to divide was taken from a paid human donor, and the embryo survived for only a few cell divisions. This artice comments on that event. It was published in the Philadelphia Inquirer on December 13, 2001.

The human cloning effort took its first baby-steps recently when Dr. Michael West and colleagues at Advanced Cell Technology announced the successful regeneration of human embryonic cells from a sample of adult DNA. After removing the normal female half-dose of DNA from an egg given up by a paid volunteer donor, they inserted a full dose of adult DNA into it. Then, using subtle electrical and chemical prodding, the newly formed entity was induced to divide.

And divide it did, for two or three generations, before succumbing to the inhospitable climate of the petri dish. The well-orchestrated media blitz that followed was remarkable for its hubris. ACT investigators had barely summoned up six primitive cells from the human clone they manufactured yet references to the therapeutic benefits of the work figured prominently in their publicity campaign. In an allusion lost to no one, they identified the donor of the cloned DNA as a paraplegic Texas physician and father of two.

Tugging at our heartstrings to gain sympathy for an experiment fraught with ethical and scientific problems hardly seems appropriate, in particular when the weight of current scientific data overwhelmingly favors the therapeutic potential of adult stem cells over those derived from embryos or from cloning. Moreover, a careful look at cloning suggests that a certain “deception” of nature is inherent to this process.

A normal egg will divide only if fertilized. In cloning, the egg is fooled into thinking that conception has occurred. Exposure to the unique natural environment found in the egg and the artificial environment contrived in the test tube causes partially dormant adult DNA to revert back to an activated, embryonic state. DNA normally exists in a fully activated state only once: when the DNA of sperm and egg come together at the moment of conception. So human cloning is simply human misconception.

And misconceptions abound in the understanding that the ACT group seems to have of their own labors. Ron Green, Dartmouth religion professor and ACT’s chief bioethicist, justified the experiments claiming that the clone was not a human embryo, but rather “an activated egg”, “a new type of biological entity never before seen in nature”. Yet the scientific paper and their article in Scientific American referred to a “human cloned embryo” as the result of their experiment. Semantics aside, the ACT group overlooks a simple fact: each and every human life is a new and unrepeatable force of nature. Like any work of art, each human person draws value from singularity. Breaking the mold, ensuring that there can be no two alike, affirms and enhances the value of the original. Cloning humans serves only to promote high-tech narcissism.

Scientists know next to nothing about what happens to human DNA when subjected to the unnatural prodding required for cloning. There is no doubt that the changes to the cloned genome are explosive, as complex as they are subtle. If observations in cloned animals are any indication, DNA cloning frequently causes grave and unpredictable adverse effects to the resulting organism. This simple observation makes blind faith in the therapeutic potential of human cloning difficult to understand.

The technique used by ACT has already resulted in the generation of fully developed animals of a variety of species. Dolly the sheep is the prototype. If this technique is perfected for human DNA and the resulting cells are allowed to develop, the manufacture of a fully developed human organism would be the foreseeable outcome. West and his colleagues at ACT have assured us that their intent is purely “therapeutic” and never “reproductive”. They desire only the parts and not the whole, and since West affirms that he works “to rid mankind of suffering and death”, we might conclude that somatic immortality is his ultimate goal.

Cooking up “new types of biological entities” is hardly a task fit for science. The push to clone advocated by ACT and others is rooted in and will inevitably foster deep misconceptions about what it means to be human, and worse abuses are sure to follow. Remember that, to justify his own utopian agenda, Josef Stalin boasted, “You’ve got to break a few eggs to make an omelet”. By failing to recognize that human life is untouchable, as sacred as it is frail, ACT risks an unsavory association with the totalitarians of the last century. And we know that is a recipe for disaster.

Surgeon General's report on sexual health: The public effects of private behavior

On June 28, 2001, then Surgeon General David Satcher issued a report entitled "A Call to Action to Promote Sexual Health and Responsible Sexual Behavior". An editor at the Philadelphia Inquirer editorial page asked for my impressions, and they appeared in their opinion page on July 8, 2001 next to those of Susan Wilson, a sex educator at Rutgers University. Soon after, it also appeared alongside "counterpoint" articles by Bill O'Reilly of Fox News in the Miami Herald (July 11, 2001) and by Pastor Madison Shockley of the Religious Coalition for Reproductive Choice in the Houston Chronicle (July 16, 2001). The Sacramento Bee (July 13, 2001) and the News-Gazette of Champaign, Illinois (July 15, 2001) and the Holland (Michigan) Sentinel (July 12, 2001) ran the piece as well. The terms "self-possession" and "self-donation" do not appear in Satcher's report. They are my way of classifying categories of social pathology that Satcher describes. The references to freedom of indifference and freedom for excellence are taken from the thought of Servais Pinckaers as published in his book, The Sources of Christian Ethics. A helpful review of this approach to understanding human freedom was published by George Weigel in a paper entitled "A better concept of freedom" in March, 2002.

The “Call to Action”, recently issued by Surgeon General David Satcher, is an effort to identify sound strategies for promoting responsible sexual behavior in the United States. Meant to serve as a starting point for a national dialogue on this important issue, the document offers in broad brush strokes a clear portrait of sexual health -– or perhaps more accurately, sexual pathology -- in America today. At first blush, one might be tempted to ask why is more discussion about sex necessary? We already talk about it quite a bit. Ours is a culture saturated with sexual information and imagery. If Dr. Satcher feels even more dialogue is needed, perhaps it is because the conversation thus far has been neither helpful nor healthful.

Three broad themes run through this document. The first points to what may be called a “crisis of self-possession”. The epidemic of sexually transmitted diseases, including AIDS, and teen pregnancy lamented in the report are often the result of sexual promiscuity. If some persons choose to be promiscuous -- and by Satcher’s account, many do -- it is usually not because they always enjoy what they are doing, but because they want to be truly loved by another person, and believe that sex is a way to achieve this. They seek to placate their loneliness by giving themselves away, but more often than not are sorely disappointed, frequently infected and inevitably embittered by their experiences. Promiscuity occurs because, all too often, persons have not been helped to discern their authentic dignity and the true value of their sexuality. They choose intimacy with anyone and end up trusting no one.

A second trend within the document suggests a “crisis of self-donation”. Satcher suggests that abortion and unwanted pregnancies are bad for society, and their incidence should be reduced. But fixing the numbers will never fix the cause of these tragedies. When a man and woman conclude that their pregnancy is unwanted, they are saying that the life they have helped to bring about is not worthy of being. It’s too much trouble. They fail to understand that the demands that children impose upon parents are actually a great blessing. Nothing can shake us out of our complacency and selfishness faster than the arrival of a child. They offer us countless opportunities to forget about ourselves. Rising to the occasion, rather than shrugging it off can be among the most salutary experiences known.

The third theme implicit in “A Call to Action” is simply this: private behavior has public consequences. For years now, a new right to privacy -- conceived in the so-called “penumbra” of the U.S. Constitution by Roe v. Wade -- has served to protect the personal reproductive choices of Americans from external interference. Yet the unrelenting emphasis on “privacy” and “freedom of choice” advocated for three decades by many of our fellow citizens has not led to demonstrable improvements in sexual health. Why not? Perhaps it is because the brand of freedom they advocate leads only to indifference: it’s OK to abort and it’s OK to keep your baby; it’s OK to have sex before marriage and it’s OK to wait; it’s OK to be promiscuous and OK to be monogamous, and for that matter it’s OK to not play the game at all. So what’s the difference? Who cares! The only thing that matters is the “freedom to choose”. And we all watch dumbfounded as America’s families – husbands, wives and children -- despair of trusting one another, victims of the apathetic chill brought on by freedom misused.

Dr. Satcher would like his “Call to Action” to serve as a point of departure, “common ground upon which the nation could work to promote sexual health and responsible sexual behavior”. This might be a good thing, but only if we acknowledge that true freedom has limits. Those limits are defined not by arbitrary rules and individual choices, but by a law inscribed in human nature. This law binds all of us equally, and guides the behavior that leads to health and happiness. Freedom may then be understood as the struggle for excellence, the effort to achieve a desirable ideal despite obstacles and adversity. With this view of freedom, surrender to indifference is failure. What is needed to restore health to American family life is not more sex education, but education in the proper use of personal freedom.

The use of freedom leads to personal fulfillment only if we give ourselves to others in ways that are appropriate to our nature: self-possession for self-donation. Normally, we enjoy the company of colleagues and neighbors. We relish the companionship of friends and family. We desire intimacy with those closest to us, our spouse and our children. Each relationship fulfills in its own way a basic human need for others. When freedom is used to justify the gratification of our personal whims, we end up avoiding our spouse and children, caring little about family and friends and having sex with our colleagues and neighbors: self surrender for self-indulgence. Which life would you choose for yourself?

Insurance coverage for contraceptives?

This article appeared May 1, 2002 in the opinion page of the Philadelphia Inquirer. Leslie Anastasio, the executive director of the Pennsylvania chapter of the National Abortion Rights Action League, responded a few days later. In most states, the American Civil Liberties Union is leading the legal offensive to force Catholic institutions to pay for the contraceptives of their employees. This campaign is an important part of their Reproductive Freedom Project. See the ACLU's report entitled "Religious refusals and reproductive rights", which outlines their position on the subject. They later issued another document specifically addressing the issue of pharmacists refusal to dispense contraceptives.

Legislation has been introduced in a number of State Houses across America to force insurers to pay for the contraceptives of their workers. Politicians argue that failure to cover these services constitutes a needless burden on women. But don’t be fooled. Concern about providing more comprehensive health insurance is hardly the issue. The disturbing thread running through these bills is the intent to purge from existing law any possible recourse to conscientious objection in matters of human reproduction. And since today the Catholic Church stands alone in her opposition to contraception, one could argue that Catholic health care professionals and Catholic institutions are being singled out for harassment.

The primacy of individual conscience over the authority of the state is a foundational principle of Western culture. In the United States, this principle was challenged by the legalization of abortion in 1973. Within months of the Roe v. Wade decision, the late Senator Frank Church of Idaho passed an amendment to Federal health care legislation recognizing the right of doctors and hospitals to refrain from doing procedures felt to be morally reprehensible. The so-called “Church amendment” served as a template for state “conscience” laws that were subsequently enacted, and that currently stand in most States. These laws were hardly a legal novelty. They simply made explicit an uncontested principle implicit in legal practice for centuries.

Restriction of existing “conscience clause” laws has been attempted with varying success in the District of Columbia, California, New York, Louisiana, Illinois, Massachusetts, Maryland, Texas and other states. They are simply attempts to chip away at the integrity of individual conscience as a legal principle. Under a new, highly restrictive California law for example, the only entities allowed to object in conscience to contraceptive coverage are organizations of explicitly religious character that hire only persons of the same faith, and that devote themselves only to religious training or indoctrination. This law effectively forces Catholic hospitals, educational and charitable institutions to provide contraception to their employees, and would force them to violate state and federal anti-discrimination laws in order to qualify for an exemption. A bill with similar restrictions may soon pass in New York.

The ACLU has been a leading force in the push to restrict conscience laws around the country. Their views are clearly expressed in the document “Religious Refusals and Reproductive Rights” published this past January as part of their ongoing “Reproductive Freedom Project”. They ask, not without a stiff dose of hubris, whether or not an individual or an institution “should be allowed to refuse to provide or cover a health service based on a religious objection,” and argue that to do so in many cases can pose a health risk to the population. What they fail to recognize is that trampling on conscience is itself a cause of serious pathology. It causes schizophrenia: the split personality that results from severing the natural connection that should always exist between moral character and professional competence.

By forcing someone to perform actions that are morally repugnant to them, an unnatural split is introduced between “competence” – the technical ability to perform actions well – and “character” – the moral disposition of the person performing the action. If the legal recognition of conscientious objection is abolished, then the disintegration of the human person is the inevitable result, because conscience is the glue that holds moral character and professional competence together. To respect personal conscience is the only way to promote personal integrity. Only if a government fosters this unity of life can its citizens prosper.

The ACLU also argues that the “right to refuse” prescription of contraceptives –- or for that matter, to refuse sterilizations or abortions -- implies a pre-existing duty to provide these interventions. So according to the ACLU, “conscientious objection” is merely the benevolent state granting some religiously-minded citizens permission to be negligent. To them, “morality” is an arbitrary and malleable legal construct determined by the ruling majority, and a minority opinion may be tolerated as long as it does not inconvenience others.

While the Catholic Church is bearing the brunt of these not-so-subtle assaults on conscience, we need to recognize that this is not “just a religious issue”. It is a universal, human issue with broad implications for all of us. The state does not confer on its citizens the “right” to follow the dictates of conscience. To follow one’s conscience is a duty founded on the inherent moral nature of the human person. When our conscience makes a judgment regarding the morality of an action, we are bound by the verdict. In allowing for conscientious objection, the state merely acknowledges that the moral duty imposed on us by our conscience cannot be violated. It’s not that private conscience is infallible. It is not. Conscience must always refer to an objective truth that transcends the individual, applies to all, and points the way to personal fulfillment. The well-formed conscience, not “majority rules”, is the best moral guide we have. Respect for conscientious objection is simply the acknowledgement of the inalienable right of citizens to be free from external constraint by political authority in religious matters. Safeguarding conscientious objection, especially in matters of faith and morals, is never an obstacle to civil liberty.

The breast cancer debate

This article was published in a "point-counterpoint" format on the opinion page of the Philadelphia Inquirer on October 6, 2002. The contrary view was offered by Polly Newcomb, a research scientist with joint appointments at the Fred Hutchinson Cancer Center in Seattle and at the University of Wisconsin Comprehensive Cancer Center.

Breast cancer is epidemic in developed countries, yet in developing countries it remains an uncommon illness. Scientists seeking to unravel the mystery now have a much clearer picture of why this is happening. As Eugenia Calle, the director of analytic epidemiology for the American Cancer Society in Atlanta put it last week: "The dramatic changes that have occurred in childbearing over the past 50 to 75 years really can explain a fairly large amount of breast cancer incidence in developed countries"(1).

Two critical changes in childbearing have occurred in the west this century: millions of women have chosen to delay childbearing until later in life, and millions have chosen to interrupt childbearing through abortion. Some have applauded these trends as beneficial to personal health and social prosperity. Yet two recent scientific developments, examining the effects of breastfeeding and the effects of abortion on the subsequent development of breast cancer, underscore the negative impact of these dramatic social changes on the health of American women.

The breastfeeding study (BFBC), published this month in The Lancet, was a statistical analysis of data from 47 studies worldwide dating back to 1970, the year when the protective effect of breastfeeding on breast cancer was first proposed (2). The abortion and breast cancer study (ABC) published in 1996 was a statistical analysis of data from all 23 studies available throughout the world dating back to 1957, when a connection between induced abortion and breast cancer was first observed (3).

The BFBC analysis showed that breastfeeding for 6 months or more after delivery effectively reduces the risk of breast cancer, and that “the major reasons for the high incidence rates of breast cancer are the small family size and short duration of breastfeeding that were characteristic of women in (developed) countries” (2). Health organizations are now reviewing existing guidelines on breastfeeding to modify them in light of this new data.

The ABC study showed that abortion was a risk factor for breast cancer, and that the detrimental effect was related directly to the interruption of pregnancy. Predictably, this report generated controversy beyond scientific circles, but the quality of the analysis is undisputed (and was endorsed by the Royal College of Obstetrics and Gynecology in Britain). Today, 37 studies offer data on a possible link between abortion and breast cancer. Of these, 28 show a positive association (4,5).

The strength of this evidence should be enough to convince an objective observer that abortion can lead to breast cancer. Yet abortion providers such as Planned Parenthood have refused to inform women considering abortion of the link. Until last month, even a National Cancer Institute “fact sheet” claimed no likely association between abortion and breast cancer. On June 19, NCI director Andrew Von Eschenbach pulled the “fact sheet” and ordered several NCI divisions to review the issue, a tacit acknowledgment that the epidemiologic data linking breast cancer and induced abortion fits in well with accepted notions of breast biology from a range of scientific perspectives.

Simply stated, the primary function of the breast is to make milk, and until milk is actually produced for the first time the breast is never fully developed. Completion of breast development through lactation seems to be critically important to prevent breast cancer. That’s why having children early in life exerts a profoundly protective effect against breast cancer later in life, and why women who have no children have higher rates of breast cancer than those who have one or more.

The first pregnancy is, for many reasons, a momentous biological event for a woman. Estrogen hormones, which during pregnancy are produced by the developing fetus, reach the highest levels ever, about 20-fold higher than any other time in a woman’s life. These hormones normally accelerate the growth of breast cells, and prepare them for milk production. Milk is not made until after delivery, and if lactation never occurs, full development -– technically termed “terminal differentiation” of breast glands -- never occurs. Most scientists believe that terminal differentiation of breast cells is requisite for protection against cancer. Breastfeeding simply allows breast cells to do what they were made to do. Termination of a pregnancy stops production of fetal estrogen. It is the physiologic equivalent of slamming the brakes on breast development, and opening the door to a host of molecular derangements that can end in cancer.

The prevailing ideology of developed countries pressures women and men to delay childbearing in favor of careers, consumption and affluence, and leads some in the medical professions to ignore abundant scientific data indicating that choosing to avoid breastfeeding or to interrupt a pregnancy are not healthful practices. We should be careful to allow science rather than ideology to guide our work. If ideology prevails over objectivity, the patients we should serve will become the victims of our bias rather than the beneficiaries of our hard-earned knowledge.

Inmate's heart underscores the value of every life

This article appeared on the Opinion Page of USA Today on February 12, 2002. Learn more about Mike Miraglia, the patient mentioned in this article, by following the link. He eventually recieved a heart transplant, and is apparently doing well. He runs a well known catering business in the San Francisco area.

On January 3 of this year, a 31 year-old California man received a heart transplant at Stanford Medical Center. He recovered quickly and was discharged home after an uneventful hospital stay. Cost: about $200,000. Just another medical success story? It might have been, except that "home" in this case was the Vacaville Correctional Center near San Francisco. As it turns out, the protagonist of this story was diagnosed with severe heart failure while serving the fifth of a fourteen-year sentence for robbery. And because his arrest occurred while on parole for an earlier burglary conviction, he will not be up for parole again until 2008. By then, taxpayers will have picked up a medical tab estimated at $1 million.

Criticism of the decision to transplant a two-time felon was surprisingly strong. Los Angeles Times columnist Steve Lopez wrote, "You have to wonder if a law-abiding, tax-paying citizen drew one last breath while Jailhouse Joe was getting a second wind." As it turns out, the convict had indeed cut in line, delaying Mike Miraglia's transplant by a week or so. But the "law-abiding, tax-paying citizen" most affected by the inmate's transplant could be counted among the few who did not seem to mind too much. Through his family Miraglia affirmed "the fact that a heart went to a prisoner was never an issue". It was a medical decision.

Unfortunately, some in California have chosen to make it an issue, despite the fact that when all is said and done every man, woman and child there will have to chip in a grand total of 3 cents to pay for the convict's medical care over the next six years. At first blush, it might seem unfair to make society pay for the extraordinary medical care of someone who has repeatedly shown disregard for the social order. But perhaps we should focus more on the great deal we stand to gain by providing health care to convicted criminals, rather than the little we stand to lose.

The U.S. Constitution guarantees persons convicted of crimes access to the same health care as everyone else. When these statutes have been challenged, the courts have consistently ruled in favor of the inmate, compelling the penal bureaucracy to live up to a high ethical standard. And in matters of human rights, it is much better to aim high than to settle for a minimum. To provide necessary medical care to criminals is to aim high. Neglecting their care is the moral equivalent of "tit-for-tat". Imprisonment becomes retaliation rather than rehabilitation, and society loses when a subtle vindictiveness becomes the motivation for negligence.

If the prisoner from Vacaville had been convicted in some other country, he might well have become an organ donor rather than the recipient of our reluctant largesse. There is little doubt, for example, that Chinese death row prisoners are used involuntarily as organ donors, and that executions -- often for offenses such as robbery -- occur on schedules coordinated with transplant surgery. So compelling is the evidence for this that Congress is currently preparing legislation to prohibit U.S. medical centers from training visiting Chinese physicians as transplant surgeons.

Clearly, the networks of people engaged in the harvesting of human organs are enticed by the impressive profits of a sellers market. And this is a market driven not just by the Third World's wealthy sick. Three years ago, the FBI indicted two Chinese nationals in New York for attempting to sell human organs there. The United Network for Organ Sharing estimates that 200 to 300 Americans each year are buying organs from sources that either pay or coerce donors or their survivors. The actual figure may be much higher.

We should not assume that our own medical establishment is immune from the same economic forces driving organ harvesting. The American Medical Association has recently proposed paying organ donors or their families for their donation. Without a doubt, the AMA is moved by a desire to meet the needs of the sick in a professional and ethical manner. But offering financial rewards as incentive for organ donation may only serve to confuse families, who might read less than noble motives into the solicitations. Perhaps solutions may be found elsewhere. Transplant centers in Philadelphia, Milwaukee and Los Angeles consistently report donation rates of 80% or better, suggesting that physicians, too rushed to carefully explain organ donation to grieving families, bear considerable responsibility for the donor dearth. Perfecting the pitch rather than offering payment may be the most respectful approach.

For the same reason that the cost of medical care for criminals should be borne by the society they offended, organ transplantation should remain a gift from the donor to the sick. They are occasions we have to express solidarity with the weak and the sick, with those who have little to offer in return. If we have difficulty recognizing the value of these gestures, it is because we have not grasped the unique worth of every human life and the importance of promoting this view in our conflicted times.

An assisted suicide kills more than one victim

Causing the death of an individual with an incurable illness remains a crime in Britain. Laws prosecuting those assisting in the suicide of another person were challenged by Diane Pretty, a British woman with advanced amyotrophic lateral sclerosis (Lou Gehrig's disease). She wanted to end her life with assistance from her husband. Her lawsuit sought to guarantee that her husband would not be prosecuted for helping her to die. After losing her case in England, she appealed to the European Court of Human Rights and soon became the focus of a debate about assisted dying in Europe. This appeal failed as well and Mrs. Pretty died without assistance on May 11, 2002. This article was published in the Opinion Page of USA Today on June 4, 2002. It has also been translated into Spanish and Afrikaans.

Diane Pretty, an ordinary British wife and mother of two ended her life in an ordinary way last month. According to her doctor, Ryszard Bietzk, her death was "perfectly normal, natural and peaceful". It might have been different had her request for assistance in dying been granted 13 days earlier by the European Court of Human Rights. Near the end of her difficult three-year illness, Pretty campaigned for a right to die, and lost. Reading her obituary, which was widely publicized in Europe, I could not help recall my own first encounter with assisted suicide, the issue that refuses to die.

Soon after I completed my clinical training as a cancer specialist, a colleague asked me to see a young, HIV-infected man in consultation. For a New York City hospital in 1990, the case was straightforward. He looked fit, without the marked physical wasting that can affect persons with advanced AIDS. He had developed a few thick, dime-sized purple splotches on his back and left arm, the typical skin lesions of Kaposi's sarcoma. I took his history and completed a physical examination, then began to discuss his illness. Before long, he interrupted my spiel. "Look," he said, "all I want to do is die. Can you help me?"

What? Jack Kevorkian and his "suicide machine" were in the headlines, thrusting into our collective imagination a notion that I for one had never entertained. Perhaps those stories, which I had read with detached antipathy, had induced my patient to think about ending his life. More than a decade since my first encounter with the issue of assisted suicide, it still confuses and seduces the sick and their doctors.

To the insensitive eye, my patient looked healthy, not particularly distressed or anxious. He had no pain or difficulty breathing. He was recovering and could expect to return to work. Yet he found his life unbearable, and wanted to be done with it. Perhaps others might have felt compelled, even obligated, to help him end his life. When suffering, moral or physical, is relentless and overwhelming, ending it all might seem like the merciful thing to do. But I can't help feeling that mercy of this sort is misguided.

To advocate physician-assisted suicide is to deny that human suffering has value, and to affirm that the absence of things unpleasant is a necessary condition for a life worth living. Sooner or later, each of us will experience suffering. To shrug it off or run away is to retreat into an imaginary utopia. We need to face it courageously, and try to glean its purpose. Like dark brushstrokes on life's canvas, suffering adds beauty and richness to a portrait.

Until the Renaissance, paintings had a flat, two-dimensional quality. Then, using the technique of "chiaroscuro," artists began representing their subjects' brightness and darkness in powerful new ways. Their works gained an unexpected perspective and depth that more accurately reflected reality. Suffering is to life what chiaroscuro is to painting. Both help us appreciate subtle yet important realities: truths that are easily overlooked yet provide a more accurate and realistic picture of our world.

The shadows and light of suffering offer us a chance to see ourselves as we truly are - frail, needy, too often consumed with things we own or do.Suffering may reveal life's most profound meaning. A common motive for requesting assisted suicide - and arguably, the cause of the greatest possible suffering - is loneliness: the indifference of others, the sense of not being valued or wanted, of being neither loved nor lovable. From such suffering, we learn that human beings discover their identity and dignity by loving unconditionally and experiencing unconditional love in return.

The sick and frail, the elderly and vulnerable, the disabled and terminally ill, can unleash that powerful force of unconditional love. We can give our time and energies to others for no reason other than because they are worth the trouble. The word "compassion" comes from the Latin root meaning "to suffer with." Assisted suicide kills a human being, but there is another victim. Our humanity - the capacity to suffer with the most vulnerable members of our society - dies as well.

To Clone or not to Clone? An Answer from our Genome

This article was published April 19, 2001 in the online edition of the San Jose Mercury News, a newspaper in Silicon Valley.

Earlier this year, the physicians Panos Zavos and Severino Antinori announced their intention to clone human beings. These medical entrepreneurs, unlike others who before them have held human cloning in their cross hairs, are trained in the techniques of laboratory reproduction of humans and animals. So when they spoke, people listened, although for the most part with dismay rather than admiration.

Mainstream scientists were quick to criticize the two fertility specialists. This week for example, Ian Wilmut, the Scottish researcher who cloned Dolly, and his MIT colleague Rudolf Jaenisch, wrote a blistering critique in the prestigious journal, Science. They pointed out that animals from all five mammalian species cloned to date are almost always born with a variety of developmental abnormalities because the techniques used in cloning directly cause subtle, yet serious genetic flaws. To apply these techniques to humans, they reasoned, would be “dangerous and irresponsible”, because the risk of making a human life burdened by severe disability would be unacceptably high.

The appeal for restraint issued to Zavos and Antinori by their professional peers is based on careful consideration of the basic principles of good medicine: above all, do no harm. For that reason alone, it is a call worthy not only of the consideration, but also the acquiescence of the two would-be cloners. Yet scientific arguments alone seem to fall short of providing a definitive, indeed an authoritative NO to human cloning. What Zavos and Antinori’s many critics seem to be saying is NOT YET. Let’s get the kinks out of cloning using animal systems first, before we try it on humans. Science seems unable, or perhaps unwilling, to offer truly convincing arguments against human cloning.

On the memorable date of June 26, 2000, Drs. Francis Collins and Craig Venter announced that the human genome had been sequenced. The book of life was opened and we were all invited to read and learn its doctrine. The first lessons were clear and compelling. We learned that the astounding range of human individuality -- the traits that distinguish one person from another -- can be explained by tiny variations of tiny fractions of the genetic sequence, yet no specific genetic differences could be identified to distinguish members of one race from those of another. "We are all 99.9 percent the same at the DNA level," said Collins.

We also learned that we all harbor at least 50 measurable genetic abnormalities that can lead to serious illness and death, implying that there are no perfect human genetic specimens. These data force us to acknowledge the common origin of the human family as well as the inherent frailty of the human condition. But perhaps the most important lesson, and the one with most relevance to human cloning, could be gleaned by reading “between the lines” of our genetic code.

In his comments to the media, Venter seemed to grudgingly acknowledge a real mystery clouding his experiences as a man of science. On the one hand, he confronted the plain fact of how very little it takes to make our bodies -- just a few molecules, almost identical in structure and a fraction more numerous than those of worms, fruit flies and mice -- and how frail, vulnerable from within we are to disease and death. He recalled hard experiences as a military medic in Vietnam, and how witnessing the heroism and suffering of men and women his own age made him recognize another, higher dimension to human existence. In the end, he could only surrender to what seemed an intuition: “I realized”, he said, “that the human spirit was at least as important as our physiology. We are clearly much much more than the sum totals of our genes”.

And so, when celebrating one of the greatest human achievements of the 20th century, the spokesmen of modern science invite us to contemplate transcendent, spiritual values which so radically distinguish us from our animal kin. They do so because, as good scientists, they can learn only the lessons offered by their data. When wrestling with the issue of human cloning, we cannot ignore these findings that so brightly color our understanding of what and who we are. We can know that man is more than molecules, and on the plane of the spirit, much, much more than our close kin the animals.

"Today, we celebrate the revelation of the first draft of the human book of life”, said Collins. “We have caught the first glimpse of our own instruction book, previously known only to God". Data from human genome compels us to recognize and to reverence the transcendence of human life, and to reject cloning as an ugly violation of that transcendence. At times, in this cynical age in which we live, some intelligent but jaded individuals can seek to justify the self-serving manipulation of other members of the human family. In doing so, they choose to ignore the painfully obvious traits of a higher, spiritual order that grace our animal existence with an extraordinary character. To say NO to human cloning, and other attempts to turn human persons into products for manufacture, is to affirm the there is much, much more to man than genes.

Surrendering to euthanasia

alongside a piece by National Pubic Radio commentator Marion Winik. Both appeared in a "point-counterpoint" format on the opinion page of the Philadelphia Inquirer in the April 17, 2001 issue. She had published a book entitled "First comes love" that served as a basis for her comments.
This article was published

The Dutch parliament’s decision to legalize euthanasia reverses a universal attitude of respect for the process of death and dying, traditional in western societies for centuries. We should not underestimate the importance of this event: for the first time in modern history, a country has decided to sanction in law, as a reasonable act, the deliberate taking of a human life. These events serve to expose a deep fault line in our society defined by divergent notions of the human person and the value of human suffering.

Advocates of euthanasia argue that there can come a time when life becomes too difficult, suffering too burdensome, and when death - on my terms, when I want -- is the only reasonable option. In those extreme circumstances, and always taking proper safeguards, to relieve suffering by putting the person out of his or her misery may even be the most compassionate response. Why should we allow another human being to suffer grievously when, within a few hours or days, they will die anyway? When they do not recognize in what remains of their life any remnant of joy or value? What possible harm can be done by taking the life of a fellow human being in these circumstances?

Confronted by these tough questions, we might feel compelled to relent, to admit that, yes, a life like that should be erased. As a medical oncologist, I have struggled with the “hard cases” from time to time, yet I can only conclude that to deliberately take the life of a dying patient, even in trying circumstances, is a deeply pessimistic and ultimately harmful attitude for patients, doctors and society at large. Let me explain.

Until the Renaissance, even the finest paintings had a two-dimensional, linear quality to them. Then, developing a technique they called “chiaroscuro”, artists learned to represent the light and the shadows, the brightness and darkness of their subjects in a new and powerful way. Their works acquired an unexpected perspective and depth that reflected reality much more accurately. Suffering is to life what chiaroscuro is to painting. It captures the depth and breadth of our existence, and helps us appreciate important realities that perhaps we had previously overlooked. By learning the lessons of suffering, individuals and society stand to benefit, yes benefit, from the experience.

Suffering is always an intensely personal experience. We can never presume to fully understand what motivates a person seek euthanasia, but we can know that persons who suffer deeply are extraordinarily susceptible to external influences. They may be depressed. They may simply be lonely. In a culture that values youthful vitality, witty one-upsmanship and chummy smiles as the paradigm of human virtue, the sick, persons with physical or intellectual disabilities, the elderly and weak will be "in the way", not part of the way. We need to acknowledge that persons who suffer have their own unique, and vitally important contribution to make to society. They issue an invitation that can help us learn to be human: to think of the weak first, to be generous with our time and talents, to never be indifferent to the needs and frailties of others. In this way, with their infirmity, the sick and suffering can help civilize a society that each day seems less and less human.

Doctors and nurses are privileged witnesses of those raw human experiences that so often bring out the best and the worst in us and our patients. Suffering may elicit contradictory responses of courage or fear, anger or serenity, hope or despair, selfishness or magnanimity. There is probably no better window into the human heart than suffering. To witness the affliction of others is always an invitation to exercise true compassion, not the misguided mercy of advocates of euthanasia. Compassion is simply the sincere effort to meet the many and varied needs of the sick until the moment of natural death. To do this is to assert, in a tangible and effective way, the dignity of the human person.

To refuse and surrender to euthanasia is to deny that human suffering has value, and to affirm that pleasure (or at least the absence of things unpleasant) is the only value worth living for. This attitude condemns us to live an unreal life, a two-dimensional existence where suffering is seen as something to be feared and eliminated. The experience of physical pain, the limitations imposed by a disability or an incurable illness, the very personal world of moral anguish are all invitations to seek a good that may be found only over and above our self.

The word “compassion” comes from the Latin root meaning “to suffering with”. Assisted suicide kills a human being, but there is another victim. Our humanity, the capacity to suffer with the most vulnerable members of our society, dies as well.

The Pill at 40: Time to take stock

This article was published in the spring of 2000 in several newspapers, including the Philadelphia Inquirer, the Detroit Free Press, the Toledo Blade and the Louisville Courier-Journal. It elicited strong reactions both in favor and against, and led to invitations for radio interviews. I recall a memorable interview on Philadephia's NPR station during which I discussed contraception with Judy Norsigian, the nationally known feminist and women's health activist.

This week, the Alan Guttmacher Institute devotes the spring issue of Family Planning Perspectives to celebrate the 40th anniversary of the oral contraceptive pill. The world today is very different from the one we knew four decades ago. According to Princeton University historian Lawrence Stone, “the scale of marital breakdown in the West since 1960 has no historical precedent that I know of and seems unique. There has been nothing like it in the past 2000 years, and probably longer”. To what extent can these changes be attributed to the pill?

In 1960, oral contraceptives were first marketed to American women. For the first time ever, women were handed a biological “on-off switch” to control their fertility. Hailed by some as the last, long-awaited step on the inexorable march toward full possession of women’s reproductive rights, the prospect of asserting near complete control over baby-making came as a shock to most at the time. Social engineers pushing the pill understood that they would need to push slowly, to chip away at moral sensibilities, before the practice of contraception could take root and flourish. They first approached married women, offering them a private, reliable way to space their babies. Back then, to prescribe the pill to unmarried women would be nothing short of an invitation to “immoral behavior”. It didn’t take long for traditional sensibilities to dull. By the end of 1970’s oral contraception passed from being an intensely personal, at times distasteful practice, to a popular, liberating expression of new-found freedoms, and in some circles nothing less than a civic duty.

At last, men and women could mate without the looming risk of unwanted children. In 1960, for the first time ever, sex and its perks were effectively disengaged from procreation. Like pressing the clutch on a car, the pistons were firing, but the car was going nowhere. What we sadly overlooked was the damaging logic inherent to contraceptive practice, the “mentality” that acceptance of contraception gradually imposed on our society: if sex without babies is now possible and even preferable, why not sex without marriage? Why not babies without sex for that matter? Thanks to the pill, sex could be promoted as pure recreation, so why not try any and all varieties? After 40 years, it’s time to take stock of the effects of the pill on our society.

Contraception corrupts authentic human sexuality, damaging family life at its root. Sex is meant to be an intimate dialogue; a full, uncompromising, uninhibited exchange between a man and woman. A tie that truly binds. With their dialogue, the couple help to create a new “word”, a new “idea” never before expressed: a new human life. Contraception makes sex a monologue. The only word uttered is a monotone, a resounding “me”. Contraceptive sex is monotonous because nothing truly new and exciting emerges from it. When new life is squeezed out of sex, the source of its vitality and meaning withers and dies. Sex becomes mechanical, and quickly ages.

By accepting the practice of contraceptive sex as a legitimate expression of our humanity, the language of contraception gradually seeps into and undermines every aspect of family life. The spouses gradually begin to view themselves as accomplices trying to balance competing interests, rather than equal partners bound together by love for life. Almost imperceptibly, their relationship becomes an affirmation of the “me” not of the “us”, and the arrival of new human life ends up subordinated to convenience. A child is no longer seen as a gift valued for his or her own sake, but as a “thing”, a product retained or discarded on a whim. The contraceptive mindset inclines us to view children like any other commodity: “I’ll get one when I can afford it”.

Most of us might find it difficult to recognize this attitude explicitly in our own lives, yet who could deny that it has become the predominant attitude in our society? Overwhelming statistical data point to a devaluation of family life on every front. The United States leads the world in rates of divorce and abortion, in teenage pregnancy and unwed motherhood, fatherless families and adolescent suicide. Just last week, the National Center for Health Statistics reported that births to single mothers accounted for one third of the 3.9 million births of 1998. It would seem that the only persons “liberated” by the pill were men, freed from the responsibility of children and fatherhood. Their partners learned the hard way that sex without babies means sex without commitment, and sex without commitment is no fun. American families should open their eyes and recognize that the promise of contraception has not been fulfilled. After 40 years it is clear that enduring family values have very little to do with family planning.

Responses to "The Pill at 40" - Philadelphia Inquirer May 9, 2000

Letters to the Editor

I find ironic the examples that Dr. Jose A. Bufill uses to support his condemnation of the Pill: abortion, teenage pregnancy, unwed mothers, fatherless families (Commentary, May 2). All situations that could have been avoided by use of the pill.

There is no denying divorce rates and the deterioration of the family, but there are so many other causes to point to: greed, materialism, lack of proper preparation and education, poverty, the impossibility of providing for a family without two full-time wage earners, and so many other evils and problems of modern society.

Yes, the pill allows the possibility of less responsible sexual behavior but, more important, it allows the possibility of more responsible sexual behavior. As with most advances in knowledge and technology, the doors are open to both good and bad choices. The answer is not to rid ourselves of these advances, but to assure a moral formation that empowers people to make responsible choices.

David Westerfer

Philadelphia

westerfer@aol.com

Thank you for Dr. Jose A. Bufill's excellent discussion of the social effects of contraception (Commentary, May 2). In a society that for decades has taken it for granted that contraception is a very good thing, it is refreshing to see a clear, intelligent discussion of contraception's destructive power.

More than 30 years ago, Pope Paul VI predicted several disastrous results of the widespread use and acceptance of contraception. He was widely ridiculed at the time. The intervening years have proved him right in every particular. Yet many voices still promote contraception as a solution to the problems it helped cause.

There are very few people today who have the courage and clear thinking to stand against severing the link between sex and procreation. Thank you for letting us hear from one of them.

Patricia Dixon

Moorestown

pcdixon@juno.com

I was astounded to read in Dr. Jose A. Bufill's commentary (Inquirer, May2) that contraception, particularly oral contraception, "corrupts authentic human sexuality, damaging family life at its root," and that sex without the possibility of conception "becomes mechanical and quickly ages." Personally, I find myself much more able to bond with my husband when we can appreciate intimate moments for their own sake, and not have to worry about unwanted outcomes.

The doctor has obviously never had to live with the fear of yet another unwanted pregnancy that his family could not afford; never had to live with the consequences of the damage that a string of pregnancies can do to a woman's body. For many families of modest or poor means, contraception allows the parents the luxury and joy of welcoming their children instead of agonizing over how to feed another mouth and clothe another growing body. Those kinds of fears and worries do nothing to improve the quality of a couple's intimate life.

The Pill has saved the lives and health of countless women, and allowed many more to appreciate loving their mates instead of viewing "their wifely duty" with anxiety and fear. How is this a bad thing?

Vicki Hain Poorman

Roslyn

vhpoorman@compuserve.com

Thank you for running the commentary about the pill by Jose A. Bufill (Inquirer, May 2). Thank you, Dr. Bufill, for addressing that topic so perceptively. May I add that pills are no longer only taking on the role of contraceptives, but are now more and more able to halt life after conception has taken place. Surely you will hear many negative responses to this commentary from people whose highest values are love of money, self-indulgence, and easier and easier abortions.

Tom Leszczynski

West Chester

If there is love between the married couple, taking the pill does not damage this tie (Commentary, May 2). Having babies does not keep a marriage together unless the love is there. Doing away with the pill will not put love back into a relationship. Giving people freedom to plan their own lives does not corrupt. Dictating ideologies to people against their wills is corrupting.

Mary Carroll

Cape May

Kudos to The Inquirer for the commentary by Dr. Jose A. Bufill. I think he is right on about that little pill that has changed the course of history for many women and marriage in general. Bravo to you for the courage to include this article.

Mary E. Daly

Family Life Educational Foundation

Lower Gwynedd

The world is overpopulated; people in Africa are starving because there is no family planning. India and China have penalties for families with more than two children. Far better to use the oral contraceptive than to beget unwanted children (Commentary, May 2). Family and social values can be instilled in our children despite the existence of the pill or any other technique to prevent conception. Parents who limit the number of children they have love them with the same zeal as the parents who do not practice birth control. Family values and family planning are not mutually exclusive!

David Biser

What do we do with the old folks?

This piece was published on June 8, 1999 in the Chicago Tribune and in a small local paper, the Elkhart Truth. Later that year the National Examiner (yes, the tabloid) referred to it under the inch-and-a-half headline: "Gray Rage!" in their September 19, 2000 issue. Their title was taken from the phrase that appears below. The News-Herald, a paper based in Cleveland, Ohio also drew from this piece in a more serious treatment of the issue on the front page of their November 26, 2000 Sunday edition. But, like the Enquirer, they couldn't resist using the same bullet in their headline, also in huge, bold font...

Georgette Smith died last week. She was paralyzed from the neck down, unable to breath without mechanical assistance, to move, feed or care for herself in any way. Completely dependent, but alert and competent, she decided to stop the medical support that was keeping her alive, and died less than one hour after her breathing machine was disconnected. One can’t help but note the sad irony in the circumstances surrounding Georgette’s disability. Last March, she was shot in the neck by her mother, Shirley, who was nearly-blind, chronically ill and irate over the prospect of being sent off to a nursing home by her family. With little hesitation, Georgette decided against the dependent, institutionalized life she had wanted for her mother. And in her ardent desire to avoid the restrictions of life in a nursing home, the mother is now facing jail time, confinement of a far different sort.

Shirley could be the poster child for almost 3 million people in the US today: the disabled elderly, dependent on a range of social services, confined to long-term care facilities, and often lacking the companionship and affection of their families. Don’t get me wrong. Sweeping generalizations in these matters are always inappropriate, and there can be objective circumstances that compel the most conscientious son or daughter to choose extended care for their parent. Nursing home placement is almost always a wrenching decision for all involved, and it’s not difficult to acknowledge the gray rage experienced by some institutionalized elderly over their lost independence.

The fact is however, that some old folks can be a handful: forgetful, wheezy, distracted, stiff, slow, cranky. Not very attractive traits in a culture that values youthful vitality, witty one-upsmanship and chummy smiles as the paradigm of human virtue. At times, our culture seems to lack sympathy for those who suffer. They are "in the way", not part of the way. We need to recognize that people like Shirley have their own unique contribution to make to family life, not just by transmitting traditions and life experiences to our children, but by helping them become more sensitive to the needs of the weak and those who suffer. This "role", if you will, of the elderly and disabled in the family is valuable because it effectively teaches children how to be human, to be generous with their time and talents, to never be indifferent to the needs and frailties of others. So it is that, with their quirkiness and infirmity, warts and all, Shirley and those like her can help civilize a society that each day seems less and less human.

What about Georgette? Could anyone find fault with her decision to let go? Advocates for the disabled, quadriplegics among them, on hearing that she was appealing to the courts for termination of life support encouraged her to go slow, to wait before making an irrevocable decision. They chose life -- clearly a most challenging, difficult life -- and invited Georgette to do the same. They cited a large body of scientific literature -- and undoubtedly a lot of hard personal experience -- showing that, while many patients with spinal cord injury initially feel overwhelmed by their abrupt, severe, usually permanent limitations, the majority recover their sense of purpose and go on to live a full life accompanied by family, friends and all manner of sophisticated gadgetry designed for their independence and productivity. They encouraged her to hope, to see that every problem has a solution, not the other way around. A courageous attitude to say the least, and one that does not escape the criticism of some in our society who can’t understand that happiness is elusive without sacrifice.In time, doctors and scientists, working with the disabled and elderly, may solve many of the difficult problems they and their families face.

For now, the Shirleys and Georgettes of this world should know that their presence in our society is valuable and esteemed. And since this family calamity is now a part of the public forum, like dirty laundry hung out to dry, we should in justice recognize that some good has come of it all. Shirley expressed her deep remorse for her actions, and Georgette publicly forgave her mother before she died. In this they can both find some consolation.