Friday, Oct 19, 2018

Part I

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The culture of death extends its grip in Canada: Toronto doctors lay out procedures for euthanasia for children, without parental consent

We have seen the culture of death extend its grip issue after issue, nation after nation, court decision after court decision, medical policy after policy. But now we are looking at the face of the culture of death staring at us with a radical intensity right across the nation’s northern border. Because the dateline of this story is not the Netherlands, it’s not even Switzerland, it’s not Belgium, it’s rather Toronto in Canada.

In an article published in Crux just a few days ago we read, “In a prestigious medical journal, doctors from Toronto’s Hospital for Sick Children have laid out policies and procedures for administering medically-assisted death to children, including scenarios where the parents would not be informed until after the child dies.”

Now, there is almost an intuition that comes to us in seeing an article like this that it can’t be true. It can’t be true that this kind of policy is being considered at a children’s hospital in Toronto, Canada. It can’t be true, our intuition tells us, that the proposed policy in anticipation of a formal review coming later this year would actually allow minors, that is those under age 18, to demand medically-assisted suicide and to receive it, even without informing the parents of the child. But that intuition would turn out to be wrong, that argument is exactly what is being made by three authorities who propose this new policy, which they want to be ready to be put in place once the Canadian government allows a review of the question of children and teenagers in assisted suicide by the end of this calendar year.

The title of the article published at the Journal of Medical Ethics is this: Medical Assistance in Dying at a Pediatric Hospital. Now, as we have seen, the culture of death moves forward by saying, “We’re demanding this, we certainly are demanding that.” No thinking moral person would ever that. But what’s demanded now turns into the demand for what there was the denial of the demand when you had the first move towards euthanasia or assisted suicide.

There’s the distinction between voluntary and involuntary euthanasia, we have seen that line blurred, we have seen that boundary crossed. There is the distinction between active and passive euthanasia. We have seen that boundary crossed.

And then of course we have talked on the briefing about the fact that in the Netherlands, and proposed in other European nations as well, there is not only the legalization of assisted suicide and forms of euthanasia, but the age of those who might demand either euthanasia or physician-assisted suicide has been pressed lower and lower, such that there is now virtually no minimum age in at least the Netherlands and potentially some other countries as well.

And yet, we have held to the fact that certainly there must be some moral sanity on this continent. We saw nevertheless Canada’s highest court rule that what is defined as medical assistance in dying must be legalized within that nation. We saw Canada parliament and the government of Prime Minister Justin Trudeau respond with legislation and with policies in line with Canada’s high court decision. But we also saw that there were ambiguities, to no moral surprise, in Canada’s response.

For instance, it turns out, as this article in the Journal of Medical Ethics points out, that the Canadian government said that the right to demand medical assistance in dying was limited to adults. But in Canadian law adult is not legally-defined. As it turns out, putting the word adult in that policy could turn out to be virtually meaningless. And that is because this shift to absolute personal autonomy has now reached the point that in the sphere of Canadian medical ethics, a child is assumed to be competent as an autonomous individual unless there can be supplied some argument for why the children, adolescent, or teenager, is not competent.

Furthermore, in existing Canadian medical ethics, a children or a teenager is presumed to have a right of privacy, extending to medical treatments and even to issue of life and death that can allow the child or teenager to exclude family, including parents, even from informed knowledge of what is going on in medical treatment.

The authors of this article, Medical Assistance in Dying at a Pediatric Hospital, go on to say, “This article is intended as a roadmap through the still-emerging legal and ethical landscape of pediatric MAID, that’s Medical Assistance in Dying.” It’s really interesting how quickly they get to what it means to be a minor or an adult in Canada, where I read, “the term adult was not defined in the ruling, that is a ruling that said that medical assistance in dying should be extended by the Canada understanding of human rights to those identified as capable adults.” But the word adult wasn’t defined. And thus, “A vigorous debate quickly emerged regarding whether the term should be interpreted in a way that would allow capable young people to access medical assistance in dying.”

Nevertheless, even though the ambiguity is present in the current Canadian law and policy, at this point, it is assumed that medical assistance in dying is restricted exclusively to patients who are 18 years or older. And yet, as this articles makes very clear, the policy proposed in this document is intended as a roadmap to take medical assistance in dying, that is physician-assisted suicide, all the way down the chronological spectrum, from those who are 18 to those who are younger teenagers, to older children. But you’ll notice there’s no lower limit. That would extend to children at any age unless there is some good argument whereby that child should be assumed not to be an autonomous individual capable of making those decisions on the child’s own, and even possessing a right to privacy so that family members and particularly, specifically parents, can’t even be informed if the child does not want the parents informed.

This academic article is breath-taking and horrifying in its candor. For instance, there are two different positions, two radically different moral positions that are articulated about the larger issue of medical assistance in dying. This comes from a Canadian perspective, but this logic by no means restricted to Canada.

Position A, they say, means that physician-assisted suicide is, “Practically and ethically distinct from other medical procedures that result in the end of life. The position B would be the opposite. That would be that medical assistance in dying is, quote, practically and ethically equivalent to other medical procedures that result in the end of life.”

Now it becomes very clear is that this entire policy is predicated on that second argument. You say that’s abstract, what difference does it make? Well, what we see here is a very significant boundary crossed. Because if you look at position A, that is the position that physician-assisted suicide is practically and ethically distinct from other medical procedures that result in the end of life, what you are underscoring is that physician-assisted suicide is different than merely declining medical care. That’s what’s urgent here.

What is proposed in this policy is consistent with what’s identified as position B. What does that mean? It means that physician-assisted suicide or medical assistance in dying, would be classified as just another medical treatment without any major moral distinction between merely declining care.

Let’s put that in concrete terms. There are those who reach a point where they have every right to decline further care. This is true not only in some cases of advanced cancer, but many other diseases as well. And the Christian worldview says that there is no obligation for Christians to either propose that others undergo, or undergo ourselves every possible medical treatment beyond what would be rightly defined as futility. The Christian worldview says that we should avail ourselves of every appropriate medical option. But that does not mean denying the reality of death and understanding that at some point, medical futility might have been reached. But that is a passive act. That’s an act declining further medical treatment. What’s being proposed here is to make no distinction between that moral act and calling upon an artificial intervention. Indeed, calling for chemically-assisted physician-supervised death.

This article doesn’t take up all that many pages in this prestigious medical journal. But nonetheless, it is dense with horrifying arguments. In one interesting twist, the authors suggest that Canadian medical ethics professionals, the Canadian medical community, should rethink the fact that raising the issue of medically-assisted aid in dying should come from the patient rather than from medical professionals. They argue that in most medical situations, it would be doctors and other medical care providers who would raise options for treatment. Now they’re suggesting that perhaps physicians and others ought to be able to raise with patients the possibility of medical assistance in dying.

Now, let’s just think about what that means. That means a very subtle shift. Now, you might say, “Well, still, the patient would be the decider, the patient would be the autonomous individual making the decision.” But understand what’s going on here. The shift from so-called voluntary to involuntary euthanasia often comes without any declaration that that is what is happening. The shift from voluntary to involuntary is a shift in argumentation, and note how this happens, from the patient raising the issue to the physician raising the issue. And that means that then, there comes the question, what ought I to do? The subtle shift is this, it’s subtle but deadly, it is a shift from you ought to take medical treatment A, to you ought to end your life as a duty to save your family, your loved ones, and the entire society from the burden of caring for you.

The authors write, “Scholarly and applied literatures are united in their presumption that conversations about medically-assisted aid in dying will begin with a patient request.” But then they continue, here’s this shift: “This is diametrically opposed to the way virtually all other medical communication is structured, in which the onus is on healthcare providers to inform patients of the full range of medical options that are available to treat a particular condition.”

They continue, “The positive ethical and legal obligation for clinicians to inform patients is important, because it is a foundational building block.” Listen to these words carefully, “Of informed consent and autonomous decision-making. In order for patients to make autonomous choices about their medical care, they must know the full-range of options that are available to them. Healthcare providers are expected to be the medical experts not the patients.”

That is a horrifying argument. We need to hear it in all of its horror. Here it has suggested that medical professionals should assist autonomous individuals in making autonomous choices by being very clear that they are the experts, that is the medical practitioners and they are going to be informing the patient, not only what the patient might do, but you know how this works. The patient then asks what should I do? Who might they ask but the medical professionals who declare themselves to be the experts.

Speaking of the age of consent, or the age at which persons are declared to be sufficiently autonomous and capable of demanding medical assistance in dying, the articles says, “Young people can be and are found capable of making their own medical decisions, even when those decisions may result in their death. The question facing our working group,” they wrote, “was should the same procedures and protections that govern capacity assessment for other medical practices that result in the end of life also apply to medical assistance in dying.”

Skip several paragraphs and you reach the scary conclusion, and I quote, “usually the family is intimately involved in this decision-making process. If however a capable patient explicitly indicates that they do not want their family members involved in their decision-making, although healthcare providers may encourage the patients to reconsider and involve their family, ultimately the wishes of capable patients with respect to confidentiality must be respected. If we regard medical assistance in dying as practically and ethically equivalent to other medical decisions that result in the end of life, then confidentiality regarding medical assistance in dying should be managed in the same way.”

Yes, you heard that right. They’re saying that children and young people should be increasingly recognized as autonomous individuals, competent and capable of making decisions about ending their own lives. They’re saying that medical experts should be able to take the initiative, even in presenting assisted suicide as an option, and they are saying that increasingly, these children and young people should be seen as being sufficiently autonomous, capable and competent that they can do so in privacy, even excluding their own parents.

By the time they reach the end of their article, the authors are suggesting that the article itself and their general approach means that they want to discuss these issues in public before the Canadian people, because they want the conversation to begin, and thus to advance to be ready for the government’s review of this question, that at least begins formally by the end of this calendar year.

This is where Christians have to understand that it’s not just the sanctity of human life that’s at stake here, of course that’s the most fundamental issue. But behind the sanctity of human life are all these shifts are taking place in the worldview in our secular age. The redefinition of what it means to be human in terms of an absolute personal autonomy, able to define for ourselves even when we will live and when we will die. And then extending that idea of personal autonomy, first of all to those who are 18 and older, but then to those who are under 18, eventually to younger teenagers, eventually even to children.

And then extending beyond that the idea that these autonomous capable competent individuals, regardless of age, can have all these decisions made, and even the consultations conducted without reference to parents. That’s the total package here, and we’re staring reality in the face, we’re not looking even across the Atlantic at Europe, or looking across America’s northern border at Toronto.

And remember that the name of this historic hospital in Toronto is the Hospital for Sick Children, but you’ll notice how all that would be redefined by this proposed policy if indeed it takes this shape.

All this tells us of major shifts that take place in a society that begins intentionally to distance itself, to unmoor itself form its historic biblical worldview that made that very same civilization possible. We see a society that increasingly wants to redefine what it means to be human in solely, exclusively humanistic terms, and anthropological terms, self-defining terms, and secular terms.

But as we have to warn ourselves over and over again, life is not only threatened at the beginning with abortion and at the end now with euthanasia and assisted suicide, it’s threatened at every point along the continuum by a worldview that denies the reality that every single human being at every point along that continuum has a life that is sacred and valuable because of the creator who made us in his image. When you shift to a secular worldview, then you have already began the inevitable process of negotiating when human life matters and when it doesn’t, when human dignity exists and when it doesn’t. To what degree it exists, and then it doesn’t?

The policy proposed in this journal article is exactly the kind of policy that those who originally demanded physician-assisted suicide said, “Would be morally unthinkable.” It didn’t stay morally unthinkable for long.

Remember that the next time you’re told that the step is morally unthinkable, because it too in this age, rebelling against all reason, it won’t stay unthinkable for long.

Part II

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As #MeToo movement celebrates its anniversary, the situation turns out to be more complicated than a secular society can unravel

But next, we shift back to the United States and another major moral shift. This one, what we consider because of the one-year anniversary of the MeToo Movement. It began roughly a year ago, and the days when the initial charges came against Hollywood mogul Harvey Weinstein. The MeToo Movement with its hashtag and with a larger moral messaging in the society began to gain momentum within just a matter of weeks and then months, many prominent and powerful men had been toppled from very significant position because in general terms of charges of repeated sexual harassment, mistreatment, and abuse, and even rape, made by women.

The MeToo Movement was energized as a political movement because of the charge that a basic patriarchy in the society had led to a power imbalance whereby women had been silent for far too long, and not believed for far too long when they accused powerful men of abusing them, and specifically abusing them sexually.

Now, Christians, thinking about this just in general terms from the onset, need to understand that there is validity to that charge. We understand that in a sinful world, sinful men will take advantage when they have opportunity.

Furthermore, we understand the reality of pattern. Sinners tend to follow a pattern of sin. If they get away with sin, they tend to do it again. The victim first is followed buy the second victim, the third victim, and the fourth victim. We do understand that reality. But over the course of the last year, we have come to understand that this situation, and here’s where Christians are not surprised. This situations turns out to be more vexing, more complicated, and more difficult to understand that our society has been able to undertake just in the last year.

For example, USA Today in a front page article makes clear that the United States Congress, which is all up in arms in the aftermath of the MeToo Movement in the last year, hasn’t even been able to make progress towards creating new rules for itself in light of the MeToo moral imperatives.

Cara Kelly and Aaron Hegarty write, “Congress has passed no laws relating to sexual harassment in the workplace since Me Too, not even regarding its own handling of harassment and discrimination claims against Senators and Representatives. This lags, they say, the standard set by the Equal Employment Opportunity Commission for private companies across the country.”

Now, there is something telling, isn’t there? Just forget the issue here for a moment and understand that Congress has thus far been unable, unwilling, or lacking in competence to come up with rules for itself even as congress authorizes the Federal Agency to demand that private companies have such policies. So Congress here is involved in a massive act of hypocrisy. Of course it is, that’s not the first time. But we also note that congress in this case seems to be admitting by inaction that they’re not actually certain what kind of rules to put in place.

But it was another article on the front page this time of the money section of USA Today that points to some issues that should concern us as we’re trying to analyze by biblical worldview. Jorge L. Ortiz is the author of this article, the headline, “Me Too Movement May Have Unintended Consequences.” The subhead in the article, “Workplace Etiquette Could Become Less Clear.”

And this article makes very clear the workplace etiquette has become exceedingly unclear. We talked about this in the immediate aftermath of the original Me Too Movement, when it originated. You had people saying, “Look, here are men who have opportunity to take advantage of women, they ought not to do that, clearly, they ought not to do that.”

But then you had the argument coming, then we need to remove the opportunity. But some prominent feminists came along, women’s employment activists and said, “Well, if you remove the opportunity, then you are removing the opportunity also for women to advance, because you’re taking them out of a context.” Specifically, in the immediate aftermath of the MeToo Movement coming along, you had men saying, “Well, maybe we ought not to meet in private with women to whom we’re not married. Maybe we ought to have at least a glassed wall, or at least to do so in public, in open.” Maybe a married man ought not to put himself in an opportunity where he’s with a woman not his wife, especially in a situation of travel, or intimacy, or privacy, or power imbalance.

But then the feminists came back and said, “No, no, no, we can’t remove the opportunity because after all, that would be discriminatory against women.” And so you see hypocrisy in Congress, but you also see an absolute conflict of priorities amongst those who have even originated the MeToo movement.

So one of the issues we indicated months ago is that there has been a sustained feminist attack on what was originally known as the Billy Graham rule, more recently as the Mike Pence rule. Billy Graham, the prominent American Evangelist and Mike Pence the vice president of the United States indicated that they would not be alone with a woman not their wife. And thus they were castigated. More recently, Mike Pence of course than Billy Graham who dies earlier in 2018, but nonetheless the point was made.

Feminists are saying, “We do not want to remove the opportunity for this kind of misbehavior, we only want to change the rules whereby such encounters are conducted.”

Ortiz writes, “Human resources professionals say, ‘MeToo has increased awareness of harassment, made it easier for victims, male or female, to report offensive behavior and prompted enhanced employee training, especially among larger corporations.’” But he continues, “They also point there’s some negative effects such as confusion about workplace etiquette, and paradoxically the possibility of fewer opportunities for women as male executives struggle to adjust to the new rules of engagement.”

That paragraph is written in a fascinating way. Here we are told of women who are concerned about a decrease in opportunities even as male executives “struggle to adjust to the new rules of engagement.”

But by the time you get to the end of the article, you come to understand there is no agreed upon set of those rules whatsoever. As a matter of fact, this very same article then goes on to say in the very next paragraph, “The confusing stems from cultural differences in a country as vast and diverse as the United States. The next sentence, what may be regarded as an inoffensive hug or compliment in one setting could be interpreted as a come on in another.”

My main point in worldview analysis here is to point to the confusion of a secular culture that is genuinely morally outraged about the abuse of women, but doesn’t have any sane way of responding to that moral crisis with any kind of reasonable set of rules. There is a basic double-mindedness that is so now intractable in our society that you see it reflected in the front page article and the money section of USA Today, in which the writer of the article says, “Hey, this is where it stands in 2018, one year after Me Too.” Even major executives, both male and female don’t really have a clue what the rules should be. And further more in a country as vast and diverse as the United States, what can be a compliment in one place, can be a statement of sexual harassment in another. Yes, that’s the age in which we live.

Part III

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What does the word ‘sin’ mean to a secular society?

But before leaving this issue, I want to turn to yet another piece in USA Today. USA Today in this sense deserves the award for the one-year report of the MeToo Movement. And in this particular case, it’s not a news report, it’s not on the financial page, it’s not on the front page, it’s in editorial, it’s entitled, “Our View, Despite Senate Vote, MeToo Movement Will Endure.” The Senate vote goes back to the confirmation of Justice Kavanaugh, but that’s not even why I find it interesting. I find it interesting because of one tiny little one sentence paragraph that includes one tiny three-letter word that isn’t common in an editorial in any major American newspaper, but the editors of USA Today evidently could not talk about this issue without using that word.

The preceding paragraph describes the MeToo Movement and says, “It holds out the promise of stripping away a lingering abuse, the silent existence and acceptance of sexual mistreatment and assault, particularly of women by men in a position of power, in tandem with, say the editors of USA Today, in tandem with that are the core values of due process and of weighing evidence fairly to avoid inflicting punishment on the innocent.”

Let me just take that that paragraph indicates the double mindedness. Yes, we believe that we must take these charges seriously, but still follow due process, we’re not sure how to do that. That’s a very interesting assessment of that paragraph. But that’s not the key issue. The key issue is the next sentence, “Americans in their DNA know sin when they see it.” So where did that come from? How did we get to sin?

The editors of USA Today don’t just talk about mistreatment or even illegality, they don’t just talk about assault or harassment, they say that Americans in their DNA know sin when they see it. Sin, that short three-letter word, where does it come from? Well, it comes from the Bible, it’s so central to the Christian worldview. We can’t describe what it means to be human without sin. We can’t talk about the human predicament, the most basic human problem without getting very quickly to that short three-letter word. The Bible gets us there so quickly, it shows up in Genesis chapter 3.

The editors of USA Today got to the word sin oddly, ironically enough, in the fifth paragraph of their editorial. But by the time you read the editorial, it is clear that they are not clear on what sin actually means even as they want to make the argument that Americans in their DNA know sin when they see it.

But as we bring everything to a conclusion, just think about this: there is no coherent meaning to sin in a secular worldview, in a secular age, in a secular mind. What exactly would sin mean in a secular definition? And how exactly would Americans in our DNA know sin when we see it, if we have no category of sin by which to understand it.

But it is extremely revealing that the editors of USA Today can’t talk about this issue without using the word sin. But for Christians it’s not enough to use it, we have to understand it. And when we use it and understand it, we have to mean it.