Tag: medicine

Christians and the biopolitical

Matthew Loftus:

Christians must develop and encourage practices of suffering that accompany those in pain, like Simon of Cyrene carrying the cross during Christ’s passion. The ethical imperatives of the Church are only intelligible to a watching world to the degree that Christians are willing to walk alongside those who suffer and bear their pain with them. Without these practices of accompaniment, Christian moral teaching about issues like abortion or assisted reproductive technology is a cold set of rules enforced by people who have the privilege of not having to bear their cost. It is through these experiences — and not just experiences with those who forsake an accessible but immoral technological intervention, but also accompaniment with the poor, the imprisoned, and those whose suffering cannot be relieved by any human means — that Christians are able to experience growth through suffering and acquire the perspective from below that shapes their advocacy for those who need the work-towards-shalom the most. 

A powerful essay. 

The themes of that essay do not immediately seem directly related to the themes of this interview with Loftus, but I think they are. Responding to claims by some doctors that we should ration Covid care to favor the vaccinated and disfavor the unvaccinated, Loftus, himself a physician, says, 

I think it is a matter of justice not to ration care away from the unvaccinated, because to do so, I think, is to pass a judgment on someone’s other personal health decisions that we would never apply in any other case. All health care is a mixture of trying to provide justice while also being merciful to others. It’s impossible to be a good health-care worker and not be willing to be merciful with people who, quite frankly, got themselves into the trouble that they’re in and had many opportunities not to do so. But it’s also a matter of justice in giving that person what they need to survive or, if not to survive, to die in a way that honors the person they are. 

Loftus is pointing here to a version of what Scott Alexander, in one of the more useful ethical essays I have read in the past decade, calls “isolated demands for rigor.” When doctors treat people for health problems that arise from obesity, they don’t withhold care until they learn whether those people have some kind of genetic predisposition to obesity or are fat because they eat at McDonald’s every day — they just treat the patients. Oncologists don’t give better treatment to lung cancer patients who smoke less or don’t smoke at all. We only think to subject the unvaccinated-against-Covid to that kind of strict scrutiny because the discourse around Covid has become so pathologically tribalized and moralized. 

But Christians in particular have a very strong reason not to employ such strict scrutiny: We believe in a God who sought out and saved “people who, quite frankly, got themselves into the trouble that they’re in.” In an earlier reflection on this general subject, I mentioned Eve Tushnet’s wise comment that “mercy to the guilty is the only kind of mercy there is.” The rationing of medical care away from the unvaccinated is structural mercilessness. It is anti-shalom

medicine as religion

Giorgio Agamben:

It has been evident for quite a while that science has become our time’s religion, the thing which people believe that they believe in. Three systems of beliefs have co-existed, and in some ways still co-exist today, in the modern West: Christianity, capitalism, and science. In the history of modernity these three “religions” often and unavoidably intersected, each time clashing with one another and then reconciling until they gradually reached a sort of peaceful, articulated cohabitation (if not a true collaboration, in the name of a common interest). What is new is that, without us noticing, a subterranean and implacable conflict between science and the other two religions has ignited. Science’s triumphs appear today before our very eyes, and they determine in an unprecedented way every aspect of our existence. This conflict does not pertain, as it did in the past, to general theories and principles but, so to speak, to cultic praxis. No less than any other religion, science organizes and arranges its own structure through different forms and ranks. To its elaboration of a subtle and rigorous dogmatics corresponds, in praxis, a vast and intricate cultic sphere that coincides with what we call “technology.” It is not surprising that the protagonist of this new religious war is the very branch of science whose dogmatics is less rigorous and whose pragmatic aspect is stronger: that is, medicine, whose object is the living human body.

The Deep Places

I’ve just read Ross Douthat’s forthcoming memoir The Deep Places and it is truly exceptional: a vividly narrated account of his disorienting spiral into chronic illness, and of his eventual recovery. (Not quite a complete recovery, I take it, but nearly so.) Ross manages a really remarkable thing here: to weave together his story of a body’s pain, a mind’s vacillations, and a spirit’s struggles with an account of how the medical establishment deals with, or simply refuses to deal with, conditions it does not understand — and, as if all that isn’t enough, an account of how, in response to the establishment’s failures, sufferers form communities that sometimes carry them to healing and at other times take them down long paths of confusion and illusion. That Ross can weave all this into a unity and even make the book a kind of page-turner — that’s something special.

Let me close by pointing out one more layer of meaning: Ross’s illness happened to him in an era of self-presentation through social media — an almost universal phenomenon, yes, but one that’s intensified for public figures like Ross. I’ll end with this passage from the book, in which Ross discusses meeting, during his various professional travels, a kind of hidden nation of sufferers, most of whom were rather older than him: 

There was comfort there, of a sort: I was just living under a storm front that had rolled in a little early. But there was also a feeling of betrayal, because so little in my education had prepared me for this part of life — the part that was just endurance, just suffering, with all the normal compensations of embodiment withdrawn, a heavy ashfall blanketing the experience of food and drink and natural beauty. And precious little in the world where I still spent much of my increasingly strange life, the conjoined world of journalism and social media, seemed to offer any acknowledgment that life was actually like this for lots of people — meaning not just for the extraordinarily unlucky, the snakebit and lightning-struck, but all the people whose online and social selves were just performances, masks over some secret pain.

Lordi

As a follow-up to my recent posts on vaccination — one and two — I just want to say that it’s especially nice to see people in high-risk groups getting vaccinated.

open letter from a distinguished surgeon

Doctors call 768

I confess to experiencing not merely disquiet but also exhaustion, in the face of endless demands that I, a trained and experienced surgeon, wash my hands before operating on patients. The chief impetus for these demands seems to arise from one Miss Nightingale, an admirable woman no doubt but one trained neither as a surgeon nor as a physician. Nothing in my extensive experience — as, may I repeat, a highly trained surgeon — indicates the need for such a practice. It is true of course that not all of my patients have survived the operating theatre, but no surgeon has ever had a perfect record of success, and I have good reason to believe that Miss Nightingale in the Crimea manifested no spectacular powers of healing.

Moreover, we do not fully understand the chemical properties of soap; it may well be — indeed I suspect that this is the case — that the introduction of soap-suds, or even hands that have recently been in contact with soap-suds, to the human form will induce more symptoms in an infected or otherwise diseased part of the body than it could possibly ameliorate. In these cases the natural condition of the surgeon’s hands is surely safer than the introduction of a substance as thoroughly unnatural as soap. Indeed, two distant relations of mine have recently written to inform me that they have with their own eyes seen human skin terribly burned, and organs of the human body discolored and withered, in response to contact with soap. Testimony so compelling cannot possibly be dismissed.

I am further concerned by the prolonged and highly agitated statements from her Majesty’s Government on this subject. However well-meaning these public servants may be, their record of — let me speak frankly — incompetence in other matters disinclines me to heed their pleas in this case. Indeed it seems likely that their entire campaign on behalf of hand-washing is prompted by a desire to create a political triumph over the Loyal Opposition, who until recently blessed us all with their wise governance.

In conclusion, and in brief, let me simply say to Miss Nightingale and others who agitate so shrilly on behalf of the strange practice of hand-washing: These are my hands, and whether to wash them or no is my choice. 

Your ob’t servant, &c. &c. 

the wait

This piece by Don McNeil (which in a sane world would have appeared in the New York Times, but that’s another story) is a sobering reflection on just how chaotically incompetent the vaccine roll-out is here in America. People are getting vaccinated, to be sure — my wife being one of them, thanks be to God, because she has a medical condition that would make contracting covid-19 very dangerous indeed to her. But it’s happening in a way that seems almost random. As McNeil points out, being a frat boy appears to be a qualification for getting vaccinated; but I, teacher of frat boys, don’t have a snowball’s chance in a Texas summer of getting the jab. I’ve been teaching students in person for almost an entire academic year, and that doesn’t factor into anyone’s calculations. I fully expect to be the last person in America to be vaccinated against covid-19 — I mean, assuming that I don’t get the disease itself. 

UPDATE:

My friends at The New Atlantis have posted an informative and slightly worrying Q&A about the new covid strain. A necessary read, even if we in America also have other things to worry about.

If you do not subscribe to The New Atlantis you really should. They are doing vital work, which they describe here.

genetic synecdoche

Together with philosopher David Wasserman, Asch wrote in 2005 that using genetic tests to screen out a fetus with a known disability is evidence of pernicious “synecdoche.” Ordinarily, synecdoche is a value-neutral figure of speech, in which some single part stands for the whole—as in the common use of “White House” to stand for the executive branch of government. But Asch and Wasserman’s meaning was more loaded: prenatal genetic tests, they argued, too often let a single trait become the sole characteristic of a fetus, allowing it to “obscure or efface the whole.” In other words, genetic data, once known, generally become the only data in the room. Taking a “synecdochal approach” to prenatal testing, Asch and Wasserman warned—in the era just prior to consumer genetic sequencing—allows one fact about a potential child to “overwhelm and negate all other hoped-for attributes.”

We won’t know what Asch would have made of 23andMe, designer babies, or broader claims for personal genomics. But her intellectual legacy only grows more relevant in the era of ever-cheaper, personalized genetic data. Asch understood that there are plenty of things technologies like prenatal genetic testing can tell us. But the choices and challenges in defining a life worth living, and living well—it may be that these aren’t technological problems at all.

Not everyone agreed that gout was a malady, or a bad thing. Some saw it as Nature’s warning, or as a deliverance from worse afflictions (it was better than haemorrhoids, for instance), and had no desire to be cured of it. As this book says, it was often regarded as a life assurance, not a death sentence. Gilbert Sheldon, Archbishop of Canterbury under Charles II, ‘supposedly offered £1000 to any person who would “help him to the gout”, looking upon it as the only remedy for the distemper in his head, which he feared might in time prove an apoplexy; as in fine it did and killed him’. William Cowper congratulated a friend on contracting the disorder, ‘because it seems to promise us that we shall keep you long’. Hester Piozzi’s husband grew worried and alarmed if his gout did not return regularly.

Besides, gout was very much a mark of status. Lord Chesterfield said it was ‘the distemper of a gentleman, whereas the rheumatism is the distemper of a hackney coachman’. It attacked not only the wealthy but the creative, which meant that no man of letters could afford to be without it. Some thought it was the hallmark of genius, a view obstinately perpetuated by Havelock Ellis. In short, it was an honour to have gout and the phrase ‘the honour of the gout’ was in free use. The authors quote Earl Nugent’s apology to the Duke of Newcastle for failing to wait on him: ‘He received the Honor of His Grace’s card here, where he has been detained by the Honor of the Gout.’ For a person of the lower orders to aspire to the honour of the gout was unthinkable. Artisans and crofters did not know their luck; hard work every day kept uric acid at bay. ‘Live upon sixpence a day – and earn it’ was the cure for gout advocated by the surgeon John Abernethy.