cellio | consistency?

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consistency?

For the last few days there has been a story in the news about a baby that was born with two heads (twins gone wrong). Or, more precisely, about the surgery that was being done to remove one of them. Some of the reported facts got me to wondering about something.

The second head had brain activity. (I understood it to be activity independent of the other brain.) The additional head had eyes, a mouth, and other features that moved and apparently reacted to environment. If the head remained it was certainly going to become a serious hardship for the child, both physically and mentally. It was not clear to me that its presence was directly life-threatening.

So, the doctors removed an entity that was developed enough to have a working brain and body parts, which was infringing on a host entity through no fault of its own, to preserve the health but not necessarily the life of said host.

Now, I have absolutely no problem with that decision. But I wonder how those who are anti-abortion see it. I did not hear of any protests outside the hospital, and I would be somewhat surprised if a significant number of anti-abortion folks actually objected to this surgery. You'd have to be pretty hard-hearted to object to this, I think.

But I wonder about the reasoning. What are the salient differences between this case and abortion that make the former acceptable and the latter not? Is it just that a suffering child tugs on the heart-strings more than a suffering adult? Or is there a real difference? The analogous abortion case would seem to be an unintended, risky pregnancy resulting in a fetus with a serious not-immediately-fatal defect, like Down's. While many anti-abortion people make exceptions for cases like that, many others do not. They're the ones I'm curious about.

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Interesting question - certainly the second head was as much of a lifeform as a fetus.... unless your definition of "living" is having a set of breathing lungs - in which case the objections to early-term abortion wouldn't make sense, since I don't think fetuses (feti?) develop lungs right away. Having a functioning heart, maybe? Still, I think the same argument re: early-term fetuses would apply. Really, an early fetus is nothing more than a blob of cells, much LESS, if anything, than the second head. The only other thing I could think of, is that the head's "life" was sacrificed to possibly save the whole baby. But even THAT doesn't make sense, as some anti-abortion activists don't think it's right even to spare a life of the mother or siblings (in the case of multiple births). It's an interesting question, indeed.

My own opinion: I am pro-choice about abortion, though I can't honestly see myself ever having one. I believe that women should have that right, and I believe that children have the right to NOT be born to crack-heads, hookers, poverty, or unloving parents. However, if -G-d forbid - because I can't tell you how much the thought horrifies me - I ever had a baby like that, I would never consider NOT having the operation.

Exactly. If it is ok to remove something that has developed to the point of having independent brain activity, then surely it is permitted to remove something that has not even progressed that far -- except that for some people that isn't acceptable. So there must be some other differentiating factor, else the positions are inconsistent.

I'm not entirely sure the condition wasn't fatal. I'm pretty sure I read somewhere that the second head was growing at a more rapid rate than the first.

ah, here we go: http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2004/02/08/whedz08.xml&sSheet=/news/2004/02/08/ixworld.html

Before the operation, doctors had said that it was risky but necessary. "The head on top is growing faster than the lower one," said Dr Jorge Lazareff, the head of paediatric neurosurgery at the University of California's Mattel Children's Hospital, who led the team. "If we don't operate, the child would barely be able to lift her head at three months old."

...

Parasitic heads draw away vital nutrients and can become so heavy that the victims are unable to move.

...

Dr Alan Cameron, a consultant obstetrician and a specialist in foetal development at the Queen Mother's Hospital in Glasgow, said that it was wrong to consider the parasitic head as another living person.

"There would have been absolutely no chance whatsoever of the second head having consciousness in any way because the brain would not have been developed enough," he said.

The eyes and mouth of the second head were poorly formed and non-functioning and it would have relied on the fully formed baby for all of its oxygen and nutrients.

Now, I'm all for a woman's choice, just so you know.

I *think* the idea with anti-abortion people is that the potential of a fetus growing into a fully formed human being should not be interrupted by unnatural causes. Like removing the fetus surgically.

In the case of the second head... it wasn't going to grow into a human. It would always be a partially formed second head. Without the fully formed first head, the second would cease to function as it was very underdeveloped.

Thanks for the additional details. The articles I had seen said that the head would interfere with the child's ability to move its head -- but not everyone considers, say, non-functioning limbs to be justification for abortion either. Not being able to move one's head is certainly a severe handicap -- on par with, say, quadrapalegia.

The eyes and mouth of the second head were poorly formed and non-functioning and it would have relied on the fully formed baby for all of its oxygen and nutrients.

Interesting. Some unnamed-while-I-was-listening doctor on a radio broadcast said that the mouth and eyes were functioning, though certainly not well. I came in part-way through, though, so I didn't get the whole story there.

I *think* the idea with anti-abortion people is that the potential of a fetus growing into a fully formed human being should not be interrupted by unnatural causes. Like removing the fetus surgically.

I think some of them object even in the cases where the fetus has major problems that prevent it from living independently, but this is of course a very small subset of all fetuses.

In the case of the second head... it wasn't going to grow into a human.

Ok, that makes sense. Even the most malformed of fetuses will at least graduate to being malformed humans disconnected from their mothers, after all. So the resulting baby might never get off a respirator or survive the first few weeks, for example, but at least there's a time limit for the host.

For some more perspective from a Catholic who weighs in rather strongly on the 'pro-life' end of things (while understanding that this is a very painful issue for anyone faced with these choices).

The Catholic church strongly opposes euthenasia but does not oppose letting someone go when it is felt by the patient's caregivers that the person will never wake up and only 'heroic measures' are keeping that patient's heart beating, lungs pumping and brain.... firing.

There is the sense that there is a difference between artificial measures used as a crutch while a body heals and those same measures used for a body that will never get any better.

If a womb is temporary assistance to a fetus then one day there will be a human, if not... then one day there will be a miscarriage.

The Catholic church also does not oppose the removal of an ectopic fetus (provided that the portion of the fallopian tube the fetus is attached to is removed rather than that the fetus is detached from the tube).

This would seem to indicate that in a situation where it is utterly impossible for one being to survive and without action another will die that it is morally acceptable to take pre-emptive action. It is defining 'impossible' that is controversial.

The concept of considering despair a sin is tied to the idea of someone having inappropriately defined the 'impossible'.

Was it moral for these parents to try and save one child accepting that there was no chance for either twin to survive otherwise? Would it have been more moral to make this girl and her possible twin as comfortable as possible for whatever lifetime God granted her/them? I don't really know. I pray that I will never be called upon to make such a decision. I also feel for this family, the ordeal they have endured and the loss that they have suffered.

Thank you for this response.

The Catholic church also does not oppose the removal of an ectopic fetus (provided that the portion of the fallopian tube the fetus is attached to is removed rather than that the fetus is detached from the tube).

That's interesting. I hadn't heard this before.

An ectopic fetus, by definition, cannot mature and be born alive, right? Doesn't removing part of the fallopian tube render it inoperable, reducing the woman's chances of having another baby by 50% (or to 0 if this has happened before)? If so, I'm surprised that the church would opt for the path that reduces fertility, given that the outcome for the fetus is the same either way.

This would seem to indicate that in a situation where it is utterly impossible for one being to survive and without action another will die that it is morally acceptable to take pre-emptive action.

That does seem to imply that, yes. So the church supports abortion to save the life of the mother? Or is it still an open issue?

I also feel for this family, the ordeal they have endured and the loss that they have suffered.

So do I. That's an awful situation to find yourself in. I believe I would have made the same decision they did -- there is no point IMO in just making them comfortable while they die if there's a chance of saving one of them (which would then have a fairly normal life). I'm still glad that I have the luxury of a theoretical decision, though!

An ectopic pregnancy is one where the fetus attaches itself to the fallopian tube instead of the uterus. In the process of growing it will burst the tube and kill the mother long before it could ever become a viable being outside of a womb. (I believe the bit about the 'you have to take the tube and not detach the fetus' has something to do with not wanting to interfere with .... a fetus being attached where it... attached itself to. I admit I might have to doublecheck to be absolutely sure how much of this particular part was Fr Lee and how much was official or semi-official teaching)

And... it's not so much that the church is opposed to the idea of .... fertility being hampered. The church also opposes people doing things like in vitro fertilization. It has to do with an idea of 'God is the creator of human life, humans shouldn't muck about with that'. Any fertility treatments that involve conception outside of the mother's body are... not approved of by the Catholic Church.

Fr Lee (who was the one involved in the conversation where this came up) seemed to feel that an ectopic pregnancy was the only situation he'd ever heard of where it was impossible for the child to survive _and_ the mother's life was at risk. (He felt that, say, in coma situations the danger to the mother was being highly overrated)

The impression I have gotten from that and other teachings is that.... if two persons each had a chance to survive a situation, it would be morally wrong to kill one to better the chance for the other. Only when it is _certain_ that there is _no_ _way_ that being A would survive would it be morally acceptable to kill that being pre-emptively in order to increase the chance for being B's survival. (And since it's so hard to be _certain_ about such things, one would be treading on morally murky ground.)

Thanks for the explanation. It's interesting to hear how different faiths look at things like this.

I believe the bit about the 'you have to take the tube and not detach the fetus' has something to do with not wanting to interfere with .... a fetus being attached where it... attached itself to.

I find this interesting because we have a case of an abnormal situation that cannot possibly lead to either party surviving, and even then the church is concerned about not interfering in the events that set that in motion. This is clearly something about fetii in particular, as the church doesn't object to, say, removing cancerous tumors that are equally "natural". And it's not about preserving the life of the fetus, because (1) it's going to die and (2) it would have died anyway. Removing it from the tube, rather than the entire tube from the mother, doesn't strike me as interfering in God's creation of life in that case. Obviously others see it differently. :-)

Any fertility treatments that involve conception outside of the mother's body are... not approved of by the Catholic Church.

I didn't know that. Thanks.

My comment about reducing the mother's fertility is more about interfering with the plumbing that God put there so that people could go forth and multiply. My impression is that the Catholic church takes that obligation pretty seriously, so it struck me as odd that they would opt for interfering in that when doing so doesn't help the fetus. I guess it ties into the same question as above -- there must be some "benefit" to the fetus to doing it this way that I'm just not seeing.

The impression I have gotten from that and other teachings is that.... if two persons each had a chance to survive a situation, it would be morally wrong to kill one to better the chance for the other.

That matches my impression of Catholic (and maybe Christian in general) teachings. And the church defines a fetus as a person, hence the objection to abortion.

Interfaith anthropology ahead:

In Judaism, the fetus is not a person. (You probably figured that out. :-) ) It does not have rights that supersede those of the mother, and if I understand correctly, in a case where a pregnancy threatens the life of the mother abortion is halachically required, because we do not stand idly by the blood of our neighbor. In fact, it would be required in that case even if the fetus were a person, because it would in that case be viewed as a rodef (pursuer). The more general principle is that if someone is about to kill soemone else, you not only can but must interfere, even if that means killing him. Intent of the parties doesn't affect that, so the fact that the fetus doesn't mean to kill the mother is irrelevant. (Aside: the commandment is not "thou shalt not kill", else war and capital punishment would never be permitted either. "Tirtzach" is more like "murder".)

My comment about reducing the mother's fertility is more about interfering with the plumbing that God put there so that people could go forth and multiply. My impression is that the Catholic church takes that obligation pretty seriously, so it struck me as odd that they would opt for interfering in that when doing so doesn't help the fetus. I guess it ties into the same question as above -- there must be some "benefit" to the fetus to doing it this way that I'm just not seeing.

Contrary to how some may interpret certain.... suggestions.... decisions.... preferences..... the church does not currently _actually_ promote an _obligation_ to 'go forth and multiply'.

It just has to do with that idea that.... sex is for family building in the emotional side and for the creating of people in the biological side (and that the two have to go together). Many people seem pretty attached to the idea of frequent (or at least, not infrequent) sex.

So... the obligation is not so much to.... have babies.... as.... not have sex that can't lead to having babies. (ok, as a clarifying modifier there's the whole Natural Family Planning thing that I _could_ go into... but I will not here unless requested.... the previous covers in general most of the relevant territory) Kind of a fine line there for many people.

So... the obligation is not so much to.... have babies.... as.... not have sex that can't lead to having babies.

Good point.

I assume the ban is on active barriers to fertilization (e.g. most birth control), and not that people who are incapable of having kids are forbidden to have sex anyway. There is life after menopause, after all. :-)

More interfaith anthropology: In Catholicism, birth control is forbidden but choosing to have sex during times of the month when the woman is not fertile is permitted. In Judaism, birth control is permitted (sex for pleasure is fine -- commanded, even) but sex during the infertile part of the month is forbidden. The origins of the practices are probably completely unrelated, but the juxtaposition struck me as interesting.

I assume the ban is on active barriers to fertilization (e.g. most birth control), and not that people who are incapable of having kids are forbidden to have sex anyway. There is life after menopause, after all. :-)

Exactly :)

In Judaism, birth control is permitted (sex for pleasure is fine -- commanded, even)

I hadn't known that..

Is there a particular time period when that teaching first recognizably developed?

It's recorded in the talmud, so it's at least that old. (I mean the part about sex for pleasure. I don't know when discussions of birth control first appeared.)

Ok.... since I'm realizing I may have some incorrect assumptions here....

What's the relationship between the Talmud and what Christians call the 'Old Testament'?

What Christians call the "old testament" (approximately) we call the "tanach", or "bible" -- Torah (5 books), prophets, and writings (the other books -- things like Psalms, the histories, etc) (list). I said "approximately" because there are a couple books that the Christians include that we don't and maybe vice-versa. Anyway, all of that is scripture, and the Torah within that is the written law.

The talmud compiles the "oral law" (yes, it eventually got written down -- fear of loss during Roman persecutions and the like). The traditional view is that the oral law was given at Sinai along with the written law, and passed unfailingly in a direct line until it was written down. (Some of us quibble with that. :-) )

The talmud consists of two major parts. The mishna was the original attempt to write down the oral law; it was written down sometime around 200 CE by Rabbi Yehuda ha-Nasi. The gemara came later (completed around 500 CE, I think), and further expands on the points in the mishna, sometimes bringing in other oral teachings not included in the mishna. Almost every statement in the mishna and gemara is of the form "Rabbi So-and-So taught...", where Rabbi So-and-So is an ancient sage.

The talmud has been further augmented through the centuries by later scholars, so you can't just look something up in the talmud to get the current law. (And anyway, there's no index. This is an area where computers really help...) It's the foundation, though, and at about 5000 pages of dense Hebrew (and Aramaic), there's a lot there.

Ahhhhh.....

Catholicism has stuff like that.... (Something that many Christian denominations take issue with)

I think the current average feeling in the Catholic church is that "knowing that stuff is really nice if someone wants to go to the effort but otherwise just listen to your priest who's supposed to know that stuff and he'll steer you the right way"

But writings of the Church Fathers, Encyclicals... those are all that same sort of idea...

Btw, while looking at information on other topics I found an article that was giving a summary sort of of a document called "Human Sexuality" put out by the US bishops in 1990

http://www.americancatholic.org/Newsletters/CU/ac0892.asp

the relevant part of the article

Regarding other birth control methods, the Catholic Church teaches that "a couple may never, by direct means (i.e., contraceptives), suppress the procreative possibility of sexual intercourse" (Human Sexuality, 47). It follows that direct sterilization surgeries are also prohibited, except in those instances when one is directly removing a diseased or cancerous reproductive organ, with the resultant sterilization being indirect and unintentional.

I can tell that this is somehow related to what Fr Lee expressed although I wouldn't be able to say exactly what else might have got him from there to what he said.

The concept of considering despair a sin is tied to the idea of someone having inappropriately defined the 'impossible'.

I didn't know that despair was a sin. Is this tied to the idea that despair is really lack of faith and lack of faith is a sin, or is something else going on?

Is all despair sinful, or only willful despair? That is, if someone has a diagnoed mental affliction that produces despair, is he sinning? Or only if he doesn't seek treatment?

Well.... this is why even though technically despair is considered a sin no one in the church would actually tell the family of a suicide victim that that person had committed despair.

Despair is having decided there will never ever be any hope. That's... a big thing. Yes, a loss of faith. Someone saying "Hey, God... I don't care how ompnipitent you are... I _know_ this will all never get better. Ever."

But 'decided'. Can someone decide something if their own neurochemicals are completely screwed up?

Ok, here might be a good time to quote something from a book I mentioned in my lj "New Question Box: Catholic Life for the Nineties" (again, just as perspective on the Catholic church's view of 'mortal sin')

Q: Is it a mortal sin to use God's name in vain in a fit of anger?

A: The traditional three requirements for a mortal sin are still good ones:

1. Serious matter - that is, the action must be one which is compleely incompatible with a respect and love for God.

2. Sufficient reflection. One must realize when he is doing the action (or refuses to do it in a sin of omission) that if he does hat he is contemplating, he is deliberately rejecting God's love and friendship. In other words he must be fully aware that he is contemplating is a mortal sin.

3. Full consent of the will. Realizing all this he still deliberately wants to go ahead and do it anyway. Considering these requirements, it is difficult to see how the action as you describe it, could ever be a mortal sin.

Thanks!

I suppose there is a danger (theologically speaking) that one could interpret this to mean that no mortal sin is ever fully willful, because if the person really understood he would not proceed. I wonder how they get around that while still recognizing that someone with a chemical imbalance isn't completely in control of himself (a case they presumably want to interpret leniently).

Congratulations, Cellio, welcome to the ranks of Catholic theologians! ;)

Well, yes.... that concept of how far to shade that number 3 in general situations can be.... a source of controversy. (Up there with 'well, are you sure we couldn't select a Sovereign through a fencing tourney? ;)

However, in this day and age it would take someone quite lacking in both knowledge and empathy to hold that a person who is suffering an illness is willfully deciding to experience the symptoms.

It was not clear to me that its presence was directly life-threatening.

The second head would have prevented the complete baby's brain from growing. That sounds life-threatening to me. The extra load on the heart also would have probably been a problem.

Have you read the complete text of the court decision in the Mary/Jodie case? The judge explored a lot of moral issues in surprising depth, while making it clear that his actual decision was rooted as strongly as possible in the law.

BTW, people who work in the education of those with Down's Syndrome are almost uniformly appalled that Down's fetuses are routinely aborted.

Jessie Helms, for all his faults, had the treatment of those with Down's Syndrome as one of his pet causes, and personally adopted several such kids (I believe 6) who had been abandoned by their mothers at birth.

The second head would have prevented the complete baby's brain from growing. That sounds life-threatening to me.

Well, except that the baby was alive and functioning, and brains don't recede on their own. I don't get the impression that the growth of the second brain would have taken away, say, the first brain's ability to regulate breathing or heartbeat. Of course, the child would almost certainly be severely mentally handicapped, but that is not universally accepted as a reason for abortion of a fetus, so that can't be it.

Have you read the complete text of the court decision in the Mary/Jodie case?

No. Where is it available?

BTW, people who work in the education of those with Down's Syndrome are almost uniformly appalled that Down's fetuses are routinely aborted.

I have known exactly one person with Down's Syndrome, so I'm no expert. That said, it seems an awfully big burden to impose on the parents in exchange for a very poor prognosis. The best-case scenario seems to be lifetime, full-time personal care. Given a choice between aborting that one early and trying again for a healthy child or giving up your future to raise a forever-dependent child, I can see why people opt for abortion. And if abortion were to be outlawed, there would have to be a legal way for the parents to abandon the children legally, because otherwise they will do it illegally and that will be much worse for the children. Not everyone is emotionally and financially able to raise such a child, and no good can come of forcing people to try. I'm glad there are people willing to take these kids in when the parents can't do it, but I'm not prepared to say that the parents should be compelled to bring them to term in the first place.

>The second head would have prevented the complete baby's brain from
>growing. That sounds life-threatening to me.

Well, except that the baby was alive and functioning, and brains don't recede on their own. I don't get the impression that the growth of the second brain would have taken away, say, the first brain's ability to regulate breathing or heartbeat.

I don't think it was a question of receding, as much as actual physical growth of the first brain; in which the second head appeared to be a danger. I'm not a medical expert, (and I don't play one on TV) but this sounds bad. Babies' brains do get bigger as they grow, and from what I read, there would have been serious/fatal problems without the surgery.

Ah. That makes sense. Thanks.

Well, we shouldn't draw the line at merely ways to help people by a slightly better version of taking a 'burden' off their hands. We also need to continue to build networks of support to decrease the instances of someone deciding a child, a person is simply too 'resource-intensive'.

Of course we as a society need to make sure that children -- and other dependent people! -- have suitable care. Support networks are important in that goal. But some people are just not suitable to raise a highly-dependent child, and I think in those cases it's better to take the "burden" off their hands, for the sake of the child. Better to find adoptive parents who are up to the challenge than to have the kid end up neglected or abused, or the family in chaos (divorced, jobless, other kids neglected to care for this one, etc). I think if parents self-identify as unsuitable we should take their word for it. No one willingly has a child without at least some desire to make things work; if the parents have gone through all that and concluded that the answer is "no", I think it's wrong for outsiders, who aren't in the hot seat, to pressure them.

Err, I didn't mean to imply that you were doing such pressuring yourself.

I would agree with that. (That if someone really can't care for a child we need options. I would not want someone.... legally penalized.... but I could see asking people who have financial resources if not the emotional ones to help contribute financially to the system that is taking care of the child they could not. 'child support')

I guess I was worrying about the people who might have.... some of the emotional resources if they didn't have to be all alone.... or the emotional resources but not the financial ones... stuff like that.

Everything to do with promoting better human life are complex matters :)

I guess I was worrying about the people who might have.... some of the emotional resources if they didn't have to be all alone.... or the emotional resources but not the financial ones... stuff like that.

Ah. Yes, volunteer support networks that can help people who want to raise a child but need some help to do so are good things.

I would personally see "child support" payments as appropriate if and only if the parents chose to bring the fetus to term knowing that it was going to need extraordinary care. I would be bothered by the double-whammy of "not only do we require that you complete this pregnancy, but you will also give over a portion of your earnings for the rest of your life to support the result". If you choose to bring a severely-disabled fetus to term, you should share in the support. If you choose not to and someone (e.g. the state) compels you to do so anyway, then I think the result becomes the problem of the entity that compelled you. But I suppose that's my wacky libertarian bent showing. :-)

Well.... can I agree with you in the 'if they chose to..... create the child and then it turned out to have these issues' and feel as squickish about the deliberately-ending-the-pregnancy idea as I would about any human being being killed and we'll say to that extent I have resonance? :)

Oh sure. If you and I agreed on everything, one of us would be redundant. :-)

LOL!!!

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