Tuesday, January 11, 2022

Part I

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In a Man’s Chest Beats a Pig’s Heart? Medical Science Moves Ahead — a Look at the Issues and Implications

Well, you know the basics of how biology works. Human beings have human hearts, pigs have pig hearts, but as of last Friday, there’s a human being whose actual life is being sustained by a pig heart that has been transplanted into his chest.

The operation took place last Friday, and it’s being billed as a major medical development. It took place at the medical center at the University of Maryland. The patient who received the pig heart was David Bennett Sr. As of yesterday, it was reported that he was doing well. Mr. Bennett knew that this was a very first in terms of modern medicine. He knew that when it comes to any kind of innovation like this, the survival rate is not high. He knew that the surgery had never been done before, but as he said, “It was either die or do this transplant.” He said, “I want to live. I know it’s a shot in the dark, but it’s my last choice.”

It’s a very interesting development and one that from the Christian worldview, presents a number of huge issues. But even as you just look in the field of medicine, even in the secular environment of modern medicine, there are many questions that arise from this, and they’re being acknowledged even as the press is breaking the story just yesterday of how the transplant has taken place. For one thing, it is extremely interesting to note that transplantation is just a very, very recent medical development. We’re talking about just the last half century in terms of any meaningful sense in which the transplantation of human organs and tissues can be described as anything like normal medicine. But just in purely secular terms, that’s how so much of medical progress moves forward.

Something is considered unthinkable, then it becomes imaginable, then it becomes experimental, and if effective over time, it becomes largely routine, but routine in this sense has to be a special category. In the entire nation last year, there were about 3,817 Americans who received donor hearts. Every single one of those, donor human hearts. But as you’re looking at that number 3,817, it would’ve appeared so massive as to be beyond the imagination of the original heart transplant surgeons. But at the same time, it pales over against the need for effective human transplants and for healthy organs to be transplanted into persons who have severe heart disease. But you’re looking here at a 57-year-old man. His heart condition was not only life threatening, he had been told that he faced imminent death. He was offered the opportunity to be the very first human being to receive a genetically altered pig heart.

He received that heart, as I said, on Friday. Immediately as the heart was put into his body, taken out of the pig, put into the human chest, as soon as the transplant surgeons had successfully connected the pig heart, it began to beat. That’s a simply amazing thing just to think about it. It’s amazing when it comes to a transplant human to human, but in this case, we’re talking a transplant pig to human. But then we also have to say from a secular perspective, what are the concerns here? Well, interestingly, there are several very important issues of medical ethics that even the secular world acknowledges. You can look at these from two different perspectives, from the human side and from the animal side. We’re talking about xenotransplantation. That’s a word that begins with an X and it means the transplantation from one species to another. Just even to say it, even to articulate the word invokes the fact that we’re talking about something that is truly ominous even if truly promising.

The ominous part comes from the fact that when you’re talking about different species, you are talking about different genomes, different genetic structures. You’re also talking about different viruses. One of the issues is whether or not porcine, that is to say pig viruses, might follow the transplantation of pig organs. But on the other hand, just from a secular perspective, there has already been proved a great deal of effectiveness in using pig heart valves in human beings. There are literally thousands of Americans walking around with functioning heart valves that came from pigs. By the way, why pigs? Two reasons. First of all, pigs, don’t take this the wrong way human beings, but pigs are physiologically more analogous to human beings than other animals and at least in one dimension, that comes down to size. The size of a pig’s heart is at least roughly analogous to the size of a human heart. There’s something else here and that is the fact that even as in any transplantation, there is the risk of the rejection of the tissue or the organ.

When it comes to pigs, there has been less rejection than from other species. Then there’s something else. This particular heart that was implanted in this human chest cavity was genetically altered. There have been six very important changes to the genetic structure of the pig and thus of the pig’s heart. One of the intentional genetic changes was to turn down the rejection element that is built into the genome structure, which is to say, one of the things that was done here was a genetic manipulation to make the pig organ more acceptable to the human body, to turn down the human body’s defense system in recognizing the pig heart as something that was not right. One other big issue that even the secular world recognizes is the danger of passing on genetically-altered traits. This has a great deal to do with the danger of altering the human genome, but there remain questions about what would happen over time in successive generations because there is no simple one way transfer of this kind of genetic information.

If you’re talking about transplantation, by definition, you’re talking about a two-way street. But nonetheless, medical ethicists and federal authorities had, at the last minute, come to the consensus that this experimental surgery could go forward, and it did on Friday. As of yesterday, Mr. David Bennett, with a pig’s heart pulsating in his chest and pumping his blood, had reached the first milestone. He survived the surgery. Now there’s another ethical dimension that is even recognized, perhaps even in an exaggerated sense by the secular worldview and that is the question as to whether or not it is right to treat animals as merely instruments and instrumental understanding of animals, because just think about it. The existence of this pig was forfeited in order that its genetically-altered heart could be taken out of the pig, the pig thus died, and put into a human being. Clearly, you can’t do that in human to human transplants.

Furthermore, and this gets to one of the very interesting issues we discuss regularly on the briefing, the modern world nearly idolizes the idea of individual consent. Now we as Christians understand that is an important issue. We should be able to consent or to deny consent to medical treatment when it comes to our own bodies or as parents for their own children when it comes to normal medical decisions. But when it comes to a pig, the pig can’t grant consent. Now, as I said, this is even coming from a secular worldview. It was very interesting that I was able to find an academic article that had been published at the National Institutes of Health. That article was actually published in a journal, which has the memorable title, Animals. The author of the article was Bernard E. Rollin. In his argument about ethical and societal issues occasioned by xenotransplantation, he focused in on what was then… He wrote this article back in 2020, just barely two years ago.

He wrote then about the fact that these issues were going to be confronted likely in the event of a transfer of a donor heart from a pig to a human being. He writes this, “A major issue emerges from animals being kept under conditions that failed to meet the need dictated by the animal’s biological and psychological natures. Xenotransplantation,” wrote Dr. Rollin, “those animals will be kept under deprived laboratory conditions that similarly failed to meet the animal’s natures.” Very interesting secular argument. The pig has a nature. The human being has a nature. The pig’s nature is going to be compromised for the human being. But it’s also very interesting to note that Dr. Rollin understands where this is going, and this is what we might call the technological imperative. If something like this offers goods for human beings, human beings will find a way to justify them.

As Dr. Rollin writes, “The effective genetic engineering on the welfare of animals engineered was a truly ethical issue as it almost invariably pitted the well-being of the animals against human well-being.” He concludes, “As we know from the rise of industrial agriculture and the history of animal research, human benefit usually wins.” That is to say that even as you will have the animal rights community complain about this, the reality is that the overwhelming need of human beings for transplanted organs such as heart will overcome any denial or any opposition from the animal rights movement. But at this point, our responsibility was to consider what the secular worldview was thinking about this, what people thinking from a secular perspective understand about this. But now let’s think as Christians, and let’s understand that we have issues that are brought to the fore that simply don’t exist in the secular worldview.

For one thing, we know that there is a categorical distinction, not just a species differentiation. There’s a categorical ontological distinction between the human being and the pig. The human being is not only a more developed mammal than is the pig, the human being is made in God’s image. Thus, when you think about what some people will criticize as an instrumental view of animals, the Bible actually sanctions that instrumental view. Now it doesn’t do so in terms that deride or depreciate the animal. It does so in a way that demonstrates the specialness of what it means to be human. Now, just think about the Old Testament. Just think about the animals that in Genesis nine are given to human beings for food. Just think about what comes even earlier in Genesis 1, with human beings given the assignment of dominion over all the things that creep, that crawl, that swim, that fly.

Then consider also that very early in the Old Testament comes the sacrificial system. There again, you see the distinction between the animals that are sacrificed and the human beings made in God’s image. We respect the animals because they display the glory of God, but we also understand that the glory of God is maximally displayed in the right use of all the goods that God has given us in creation. The right use, in this case, could well extend to the use of animal organs, tissues, and other entities when it comes to transplant surgery. Now the need is just overwhelming. The need for transplanted organs in this country amounts to tens and tens of thousands of organs that are needed. There is simply no way that there will be an adequate supply of donor organs coming from human beings. So if indeed ethical difficulties and difficulties in medical treatment are overcome so that you could have donor organs from pigs, that would be a true game changer.

Dr. Muhammad Mohiuddin, scientific director of the University of Maryland’s animal to human transplant program says, “If this works, there will be an endless supply of these organs for patients who are suffering.” Again, an endless supply is here promised. As we conclude this, we need to recognize that there is no clear biblical prohibition against the idea of using animal tissues and beyond that, animal organs, but we also understand that the biblical understanding, the biblical doctrine of humanity would warn us against doing anything that would endanger the human genome or that would endanger future generations by some kind of transfer of genetic or viral material.

So those questions are going to have to be answered. In the meantime, this is a major medical story. It’s a legitimate headline and it is also just a fascinating issue that arrives like so many of the biggest issues of our day, in this case, virtually out of the blue. The surgery took place last Friday. Yesterday, the major media broke the story that it had happened.

We pray that Mr. Bennett will be well, but we also pray that our society will think very, very clearly about what is at stake, both positively and by consideration, negatively as you think about any major medical development. What we can’t do is simply fall prey to the technological imperative that if it can be done, it should be done. Those are two very different questions.

Part II

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The Achievement and Limitations of Human Justice — Three Life Sentences for Killing Ahmaud Arbery

But now we shift to a question of justice. As so often the case, the question of justice comes down to whether or not the punishment fits the crime. This was certainly raised in the sentencing phase of the trial of three men who had killed Ahmaud Arbery in Brunswick, Georgia.

You’ll recall that back in November, on November the 24th, the three men were convicted of multiple counts of felonies, including felony murder. You’ll also recall that the sentencing phase was extended into this year, into 2022. It took place just last week when all three men were given, in one way or another, life sentences. Two of them were given life sentences without the chance of parole. The third man also convicted of multiple counts of felony murder was given a life sentence, but with a 30-year minimum upon which he can apply for parole. The point is that the youngest of them was given life without the opportunity of parole, the two older were given two different sentences, one with the opportunity of parole, the other without. By the way, the opportunity to apply for parole does not mean being granted parole. In any event, it’s going to be 30 years into the future. You’re also looking at the fact that all three of these now convicted criminals, indeed, you would say convicted murderers, are facing federal charges with a federal trial that may begin in just a matter of a few weeks.

You’ll recall that Ahmaud Arbery was running through a largely white neighborhood in Brunswick, Georgia when he was stopped by the three men, basically chased down in their vehicle. Then in an altercation that he had been trying to flee, he was shot to death. You’ll also recall that the trial was itself quite a headline event. The convictions came in the context of so much racial tension and so many questions about justice in the United States. But one of the things we need to note is that across the country, there was a near consensus in the fact that this jury had done its job, that the prosecutors and the jury had indeed pressed forward to justice. There was a sense across the country of satisfaction that justice had been done, but that could only be completed if the sentencing was consistent with the convictions that were handed down last November.

When you look at the actual convictions, multiple felonies, indeed multiple counts of felony murder, and in the case of at least two, counts of malice murder, life in prison without the chance for parole was the maximum sentence, and two of the three were granted that maximum sentence. The next most maximum sentence in this case would be life in prison with the opportunity of parole that was given to the third of the individuals, but the point is, this is exactly how the American justice system is to work. We need to note that this system of justice is indeed not only the rule of law, it is a very significant human achievement.

To put together a system of justice in which a jury of citizen peers judges the relative guilt or lack of guilt of an individual credibly charged with a crime, especially the most serious cases dealing with the most serious crimes, just think about the achievement of what it takes for such a justice system to be in place, a justice system with the checks and balances, a justice system with protections for the accused, a justice system with the presumption of innocence the state, the government has the responsibility of proving guilt. In this case, the three men were guilty and the state was able to prove their guilt. A jury of their peers convicted them and now, a duly authorized judge has handed down these very significant sentences.

But even as we here recognize the achievement of the rule of law, we just had to come back to something that Christians have to think about in every single case like this. The limitations of human justice are also made clear here. This prosecutor, this jury, this judge could not give Ahmaud Arbery back his life. The legal system could not give the son back to his mother and his father. The reality is that both the achievement and the limitations of human justice were on display here.

But in a fallen world, to be able to see the achievement of the rule of law is a very significant thing. It is God’s gift to us. It is based upon the inheritance of Christian principles and Christian civilization, and for that reason, it is to be honored.

Part III

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Is School for the Students or for the Teachers Union? Look to Chicago for the Wrong Answer

But next, we shift to the city of Chicago where the big story is what is not happening, and what’s not happening there is school and the public schools of the Chicago public school system, which is the nation’s third largest public school system.

The Wall Street Journal gets it exactly right in an editorial entitled, “The Scandal of Chicago’s Teachers.” What you’re looking at in Chicago is a teacher’s union that has more malignants and more power than just about any other union you can imagine in this nation. The union of Chicago public school teachers is so powerful that even the very democratic, very liberal current mayor of Chicago, Lori Lightfoot, has come to understand that the Chicago Teachers Union is the enemy of the good for children and is the enemy of the mayor, in this case. Mayor Lightfoot has made some amazingly candid statements critical of the union and of its leadership.

Now we want to be careful here. We’re not generalizing the behavior of Chicago’s teachers union to all public school teachers and administrators across the country. We are pointing in particular to the danger of a labor union that clearly serves its own members rather than the children in the school district that are supposed to be the central priority. We know a great deal in the aftermath of the original months of COVID-19 and the shutdown of so much of society, including the public schools. We know how devastating that experience was for children. Devastating in educational terms, yes, but also devastating in social and even psychological terms. You also have the recognition that even liberal public health activists had come to the conclusion that it is safer for children to be in the schools rather than out of the schools. It is now known that in the main, the COVID-19 virus is not particularly threatening to young children and teenagers, many of them, by the way, can now be vaccinated. The reality is that the Chicago Teachers Union stands out precisely because it is an exception to the general rule.

Now, the Omicron variant coming on has given the Chicago Teachers Union the opportunity to shut down the schools once again and to go to remote learning. This has led to an absolute confrontation with Chicago’s mayor and it is led to consternation for Chicago’s public school parents. The editors of The Wall Street Journal described the situation with the Chicago Teachers Union as, “The political scandal of the year so far.” As the editors pointed out, it is unfolding in plain sight in Chicago. This is going to be a real political challenge, not only for Mayor Lightfoot there in Chicago, but all also for President Joe Biden, who ran seeking and receiving the avid support of the public school teacher unions, which have outsized and extremely liberal, even radical understandings and policy positions. It’s going to be very interesting to see if the president of the United States has the courage to speak directly to the misbehavior the public school union there in Chicago.

But from a Christian worldview perspective, the biggest issue here is the fact that the COVID-19 pandemic and so much bad behavior and bad policy during this pandemic has led many parents, Christian parents, but also non-Christian parents to reconsider what had been a fundamental assumption, which is that the public schools were friendly. Now, there is the understanding. Of course Christians have concerns far beyond COVID-19, but now you have the understanding on the part of many parents that those who are actually teaching and running in many public school systems, again, not all but many such as in Chicago, do not really have the best interests of their children at heart. It’s also very interesting to hear the leaders of the Chicago Teachers Union assure Chicago’s parents over and over again that they want to be back in the classroom with children, but only, they say, if the experience can be made safe. That sounds like a pretty good argument until you begin to ask the question, what in the world is meant by safe?

There are huge worldview issues that are involved in defining the word safe. In the context of COVID-19, we have really seen how that word can become a very clear dividing line, not just between the safe and the unsafe, but between the sane and the insane, the honest and the dishonest. It’s going to be very interesting in days and months ahead to reconsider what it means when we say, “We want to be safe. We want our schools to be safe. We want our children to be safe.”

Christians understand that in invoking the word safe, we mean both more and less than the secular worldview can understand. We’ll be thinking about that together in days and weeks to come.