The ID Report

Ideas have consequences. That was the title of Richard Weaver's 1948 book which opened with this observation: “Every man participating in a culture has three levels of conscious reflection: his specific ideas about things, his general beliefs or convictions, and his metaphysical dream of the world.” The primary focus at ARN is on the Darwin vs. Design debate, but the reason we think it is such an important debate is because these are powerful ideas that have consequences in many other areas of life. Bioethics is one such area we would like to focus on in this month’s newsletter. What is the underlying ‘metaphysical dream of the world’ that was driving the decisions of those involved in the Terri Schiavo case? For the most part they remain unstated, but like a CSI forensic scientist we can piece together the clues with the help of our featured authors Jim Reitman and Wesley Smith to get a pretty good picture.

Perhaps more painful than any other object lesson to emerge out of the life and death of Terri Schiavo is this recurring realization: Once end of life controversies are relegated to the courts, all the colorful subtleties that comprise meaningful life making it worth pursuing, are bleached white by the caustic chlorine of the ethic of radical individualism, and its derivative Contractual Model of decisionmaking upon which both the courts, and increasingly the medical profession, lean all too heavily. It has become obvious over the last 40 years in a succession of legal controversies over the so-called “end of life” issues that the god of personal autonomy has now bullied its way into medicine and has all but totally extinguished the ethics of care.

Our featured author, Jim Reitman, has tackled three such “end of life” dilemmas in a series of articles promoting a rational alternative to the Contractual Model of decisionmaking, a Wisdom Model based on precepts found in Old Testament wisdom literature. Drawn from the books of Job and Ecclesiastes, the Wisdom Model reveals that ambiguity is the rule rather than the exception in “end of life” decisionmaking, and the added pain and disillusionment of suffering while life remains, typically makes a travesty of ethical individualism and the Contractual Model of decisionmaking: Personal preferences expressed in the face of uncertainty are “held hostage” by the pain of suffering and the contagion of despair. Such preferences are thus bedeviled by ambivalence and jeopardize true community and care. The Wisdom model looks suffering and ambiguity squarely in the face to reveal how these counterparts of suffering induce our profound disillusionment with self-sufficiency and draw our attention away from our own demands and toward a larger design for our lives. Such Wisdom cannot help but restore true community and care to end of life decisionmaking.

The first article deals with the issue of Physician Assisted Suicide and exposes how the radical individualism underlying recent legal precedence in end of life cases has insidiously emasculated the medical profession by ignoring moral deliberation, and eliminating the prerogative of true care and advocacy in end of life scenarios that come to the courts’ attention. The article makes it clear why the next step to Court Assisted Suicide in the Schiavo case was such a short step, revealing how both due process and equal protection for the medically disabled were trampled by the radical individualism that has imbued the “death with dignity” movement with such power that determines the outcome in such cases.

The second article tackles the dilemma of Medical Futility and exposes how the premise that advance directives can truly preserve autonomous choice has really become the “emperor with no clothes.” Even conservative theists have been hoodwinked into believing that Advance Directives, including the Durable Power of Attorney for Healthcare, can really protect the wisdom of community and care against the incursions of legally sanctioned radical autonomy. The Wisdom model illuminates why neither Schiavo’s parents, nor the governor of Florida, nor the medical profession (in their futile attempt to physiologically define the limits of meaningful life), nor the President, nor the Congress of the United States could withstand even the most tenuous and ambiguous of presumptive “previously expressed preferences.” The article also reveals why the very notion of expressed preferences is itself fatally flawed by the ambiguity and uncertainty that typically characterizes end of life decisions.

The third article exposes the deceptive and deadly philosophical underpinnings of the rationale for Partial Birth Abortion as a legitimate solution to the agonizing anguish of Fatal Congenital Anomalies discovered in utero by genetic testing. By revealing how the rationale itself is fatally flawed even in this seemingly logical and acceptable way to mitigate the suffering of bearing a doomed pregnancy to term, the article uses the Wisdom Model to subvert the rationale for abortion in any case, possibly excepting clear and present danger to the life of the mother (as in ectopic pregnancy).

Together, these three articles provide a sound rationale to question radical autonomy as ever constituting an adequate or legitimate basis for finding lasting meaning in so-called “end of life” dilemmas. The Wisdom Model provides a rational template to surface the issues that truly contribute to lasting meaning, and to develop the circle of community that helps discover that meaning over time, as disillusionment and the pain of suffering give way to redemptive purposes in that suffering.