Posts Tagged Medical Ethics

Sunday, July 9th

FIFTH SUNDAY AFTER PENTECOST

Zechariah 9:9–12
Psalm 145:8–14
Romans 7:15–25a
Matthew 11:16–19, 25–30

PRAYER OF THE DAY: You are great, O God, and greatly to be praised. You have made us for yourself, and our hearts are restless until they rest in you. Grant that we may believe in you, call upon you, know you, and serve you, through your Son, Jesus Christ, our Savior and Lord.

“Return to your stronghold, O prisoners of hope.” Zechariah 9:12

Hope is powerful. It can inspire selfless acts of heroism. It can empower an oppressed people to endure centuries of persecution. Hope can sustain resistance to tyranny and ignite revolutionary change. Often the most slender and fragile hope for a better tomorrow is enough to see us through the darkest of days. It does seem to me that we are held prisoner by hope. Hope appears to be an indispensible element of human existence. It’s what keeps us going. It is as difficult to lose all hope as it is to will oneself to stop breathing. Even those who take their own lives are driven by the desperate hope of finally escaping an existence too painful to endure. And that, of course, brings us to the dark side of hope. Hope can be tragically misplaced.

In last week’s lesson from Jeremiah, the people of Judah were led by the false prophet Hananiah to place their hope in his prediction of Babylon’s imminent collapse. So, too, it seems was the king and his counselors who shaped their foreign policy on the basis of this lie and engineered a revolt against Babylonian domination. Jeremiah’s largely ignored warning that such folly would lead to catastrophic destruction for Judah came true with a vengeance. Babylon crushed the revolt. Judah lost her land, her temple and the royal line of David. Such are the consequences of misplaced hope.

One needs look no further than the field of medicine to find examples of misplaced hope. Of course, I am no enemy of medicine or medical progress. Some members of my family and many of my friends would likely have died in childhood if they had lived just a century ago. Thanks to modern medical advances, they are living full and active lives today. I am glad that medical science is pushing against the frontiers of human knowledge to find cures for various diseases, particularly those that strike during childhood. But medicine has limits that hope sometimes refuses to acknowledge. It is easy to forget that medicine is as much art as science, and that the human body is enormously complex. In spite of its impressive advances, medicine does not have close to all the answers for what ails us. When I was practicing law, a significant portion of my practice involved defending doctors, nurses and hospitals against malpractice claims. While medical malpractice does in fact occur with disturbing frequency, I can say that many such claims arise from unrealistic expectations of modern medicine and the caregivers who practice it. At the end of the day, doctors are only human. Medical knowledge is incomplete. Sometimes people are beyond medical help and cannot be “fixed.” Human beings are mortal-and that is perhaps the greatest sticking point of all. Medicine can’t save us from death; but obvious as this raw fact surely is, that doesn’t make it any easier to accept.

In a recent article of the Daily Express, Jon Austin reports on the work of Dr. Aubrey de Grey, a physician who has dedicated his work to the quest for eternal life. Dr. De Grey believes people who have already been born could live for ten centuries as beneficiaries of ongoing research into “repairing the effects of ageing.” He hopes ultimately to create preventative treatments enabling humans to re-repair themselves on a regular basis and so live as long as 1,000 years or possibly even forever. I hasten to add that Mr. Austin has made a name for himself covering all manner of conspiracy theories and alleged government cover-ups of UFO landings and sightings. So I am inclined to take this article with a very large grain of salt. Nonetheless, that it finds its way into public media at all suggests to me that it speaks to a longing we find hard to suppress. The notion that medical science might possibly lead us to that illusive fountain of youth makes us absolutely giddy.

Can genetic engineering extend our lives indefinitely? I rather doubt it. But not being a scientist myself, I can’t speak authoritatively on that question. What I can say with certainty is that the desire to extend one’s life indefinitely is a selfish, narcissistic, egotistical quest. It reflects a stubborn refusal to accept with gratitude the time one has been given on this planet and to graciously step aside and make room for the next generation. The utter selfishness of pursuing human immortality becomes clear when one considers that it would be entirely unsustainable unless we all decided to stop reproducing or restricted life extending treatments to an elite few. This  perverse preoccupation also goes a long way toward explaining why our country’s health care system is grotesquely skewed toward providing life extending care for us oldsters while neglecting large sections of our population consisting of children and young families. The drive for immortality represents an arrogant promethean effort to put the brakes on history/evolution and elevate the status quo to a level of eternal significance. It is a refusal to let the universe progress beyond the eternal “me.”

The promise that “you shall not die, but become as God, knowing good and evil” is as old as human existence. We should not forget where it came from. Whether attainable or not, extending human life indefinitely is a false hope. Immortality can offer us only selfish misery and loneliness if it is an end in itself. St. Paul understood that well. That is why he insists that, in order to share in Christ’s eternal life, we must of necessity die. That is why Jesus tells us that only by losing our lives can we hope to gain them. Repentance is a kind of death that requires us to let go daily of past sins and false hopes. We are to practice repentance with such regularity that, when the day of death actually comes, it will be “just another day.”  Rather than clinging tenaciously and futilely to life at all costs, we are invited to let our lives fall back into the hands of the One who gave them to us in the first place and who has the power to give them back to us once again, made new and reconciled.

Zechariah encourages Israel to “return to your stronghold.” That stronghold is the Lord, Israel’s covenant partner. God is where all genuine hope is finally anchored. It is within the covenant of baptism, within the community of saints under construction and within the disciplines of discipleship that we are formed through daily repentance and faith into genuinely human creatures capable of living joyfully, thankfully and obediently within the limits of our creaturely existence. Here’s a poem by Marge Piercy that speaks of a transformative life of repentance grounded in sober hope.

Ne’ilah[1]

The hinge of the year
the great gates opening
and then slowly slowly
closing on us.

I always imagine those gates
hanging over the ocean
fiery over the stone grey
waters of evening.

We cast what we must
change about ourselves
onto the waters flowing
to the sea. The sins,

errors, bad habits, whatever
you call them, dissolve.
When I was little I cried
out I! I! I! I want, I want.

Older, I feel less important,
a worker bee in the hive
of history, miles of hard
labor to make my sweetness.

The gates are closing
The light is failing
I kneel before what I love
imploring that it may live.

So much breaks, wears
down, fails in us. We must
forgive our broken promises—
their sharp shards in our hands.

[1] Ne’ilah is a special Jewish prayer service that is held on Yom Kippur. It is the time when final prayers of repentance are recited at the closing of this most solemn of Jewish observances.

Source: The Crooked Inheritance, (c. 2006 by Marge Piercy, pub. by Knopf Doubleday Publishing Group). Marge Piercy was born in 1936 in Detroit, Michigan. She attended the University of Michigan and received her MA from Northwestern University. During the 1960s, Piercy was an organizer in Students for a Democratic Society (SDS). She was also heavily involved in opposition to the war in Vietnam. Piercy is a prolific writer having published seventeen books of poetry and several novels. You can learn more about Marge Piercy and sample more of her poetry at the Poetry Foundation website.

Zechariah 9:9–12

Zechariah is identified in the opening lines of the book bearing his name as son of Berechiah son of Iddo. Zechariah 1:1. His name means “The Lord is renowned.” He is identified, along with Haggai, as one of the prophets prophesying encouragement to the Jews newly returned from the Babylonian Exile. Ezra 5:1Ezra 6:14. Such encouragement was sorely needed. Having left Babylon in high hopes of witnessing a miraculous recovery for their homeland, the people arrived to find only a ruined city and rubble where the temple of Solomon once stood. Conditions were daunting and soon the little settlement was reduced to subsistence living and concerned only with survival. This was hardly an ideal time to begin a stewardship campaign for a new sanctuary! Yet through his repeated proclamation of visions and oracles, Zechariah was able to assure Zerubbabel, the governor of Judah, and Joshua, the high priest, that together they could complete reconstruction of the temple in Jerusalem. Zechariah’s preaching must have been persuasive, for the temple was indeed rebuilt and dedicated around 516 B.C.E.

Sunday’s reading is familiar to us. All four gospels cite or allude to verse 9 in connection with Jesus’ triumphal procession into Jerusalem riding on the back of a donkey. Matthew 21:5Mark 11:1-10Luke 19:28-38; and John 12:14-15. Note the contrast: Zion’s king, though triumphant and victorious, comes riding upon a donkey; but the “war horse,” “chariot” and “battle bow” are destined to be cut off. Vss. 9-10. This king will command “peace” to the nations. Vs. 10. His weapon, his “bow,” “arrow” and “sword” is the people of Israel. Zechariah 9:13 (omitted in the lectionary reading). Through the faithful witness of the covenant people, the king prevails over his foes. This is another of many instances in the Hebrew Scriptures where Israel’s God forsakes war as the means for saving and liberating his people. So, too, Jesus will forsake violence repeatedly in the gospels as the means for bringing about God’s reign.

“Blood of my covenant” is a conventional way of referring to the covenant relationship between Israel and her God. Vs. 11. That it was sealed with blood emphasizes the irrevocable nature of that relationship. “Prisoners of hope” is a difficult phrase and resort to the original Hebrew does not give us much further insight into its meaning. Vs. 12. Yet one might well describe both Israel and the church as “prisoners of hope.” Both communities were created by covenants established in the past, yet which also look to the future for their fulfilment. Hope is not a vague optimism that everything will finally work out in the end. It is shaped by promises of a new age, a new heaven and a new earth, resurrection and a new creation. It is fed by sacred narratives of God’s past acts of salvation and God’s steadfast faithfulness to us throughout history. We are in bondage to this hope that will not let us go.

Psalm 145:8–14

This psalm is a hymn in acrostic form. Every verse begins with a successive letter of the Hebrew alphabet. Acrostic poems usually do not develop ideas but consist rather of loosely connected statements. The technique aids in memorization, but also conveys the message that the whole of the topic is being addressed “from A-Z.” Other psalms in the acrostic family are Psalm 119Psalm 9Psalm 10Psalm 25Psalm 34Psalm 37Psalm 111; and Psalm 112.

As always, I encourage you to read Psalm 145 in its entirety. The verses making up our reading contain a refrain found throughout the Hebrew Scriptures: “The Lord is gracious and merciful; slow to anger and abounding in steadfast love.” Vs. 8. See, e.g, Exodus 34:6Numbers 14:18Nehemiah 9:17Jonah 4:2; and Psalm 103:8. This core confession belies the all too common belief on the part of ill-informed Christians that the God of the Hebrew Scriptures is a “God of wrath,” whereas the New Testament God is a kindly, old, overindulgent grandfather. God does not need Jesus to be gracious or the cross in order to forgive. It is rather because God is gracious that his Word became flesh and because God is infinitely forgiving that God’s Incarnate Word embraces with love those who would nail him to the cross.

All creation testifies to God’s grace and mercy through praise. This “all” includes God’s faithful people Israel as well as the natural world and its non-human creatures. Vss. 10-12. The term “kingdom” might better be translated “reign.” The psalmist is not speaking of something in the distant future and certainly does not refer to a place located “beyond the blue.” God reigns now, whether that reign is recognized and acknowledged or not. In talking about the nature of God’s reign, it might be helpful to reflect back on the reading from Zechariah and the humble king riding not a war horse, but a donkey. God does not rule the world in the way of all the tribes, kingdoms and empires that have drenched the earth in blood to establish their respective reigns.

Romans 7:15–25a

Standing on its own, this little snippet from Romans is a bit confusing. So let’s give it some context. Paul has been discussing the role of the law and its relationship to sin. Law is binding only upon the living. For example, a person is bound to another in marriage for “as long as they both shall live.” But if one spouse dies, there is no longer any marriage and thus no legal obligation of faithfulness for the surviving spouse. So also a person baptized into Christ’s death is liberated from the law which attaches only to the living. The new person raised in Christ’s resurrection is, as we have said, a servant of God over whom sin has no power and the law no jurisdiction. Romans 7:1-6.  The gospel is not about reforming sinners. It is not about teaching an old dog new tricks. The old dog must be taken out back and shot. What is raised up constitutes an entirely new creature.

Law, as we have said before, is given to defend us from ourselves. It serves as a protective hedge around covenant life, ensuring the proper worship of Israel’s God and the essential elements of human life, i.e., marriage, livelihood and sustenance. The law, however, must not be confused with the covenant itself. When the law is understood as a means of drawing near to God rather than as a gift designed to protect and nurture that nearness, it becomes just another occasion for sin. Using the law as a means for achieving right relationship with God is rather like trying to drive your car along a winding mountain road by keeping your eye fixed on the guard rail. In addition to losing sight of your destination, you practically ensure that you will eventually go off the road.

The law functions, then, to bring into focus the nature and depth of sin. On the one hand, the law paints a portrait of life as it ought to be in covenant with God. Yet it is precisely this portrait that illuminates my own life and the extent to which it fails to work itself out peaceably within that covenant relationship. To the extent that I see reflected in the law my own brokenness and despise it, I affirm the law’s judgment. So far, so good. The law works well as a diagnostic instrument, but it is not a cure for what ails me. When I try to use it as a cure, it only becomes increasingly clear that I am hopelessly in bondage to sin. Instead of a protective hedge, the law now becomes a ruthless master whose demands I can never satisfy. So too, my understanding of the God who gives the law becomes distorted.

“So I find it to be a law that when I want to do right, evil lies close at hand.” Vs. 21. Paul speaks from experience here. It was, after all, his zeal for the law that led Paul to persecute the early church and so the messiah he now serves. Similarly, it was the religious leaders of Israel who were seeking to uphold the law and put an end to blasphemy that brought Jesus before Pontius Pilate seeking the death sentence. For his part, Pilate was simply doing his job and trying to keep the peace when he had Jesus crucified. Jesus was not killed by notorious sinners, but by decent, law abiding citizens who were only trying to do the right thing. Sin twists the law as it does everything else to serve its own destructive ends. That is why the folks who never tire of warning us that unless we enshrine “Christian values” in the laws of our land, society will disintegrate. Society might well disintegrate, but anyone who thinks that laws, however “Christian” they might be, can prevent such catastrophe has never listened to Saint Paul.

“Wretched man that I am! Who will deliver me from this body of death?” Vs. 24. That is finally the proper question. It is not a matter of what one believes or what one does. It is a matter of who one trusts. “Thanks be to God through Jesus Christ our Lord!” Vs. 25. When one trusts Jesus enough to share his death through baptism, one shares also in Jesus’ resurrection. Care must be taken to avoid the misunderstanding of “trusting Jesus” as simply another work of the law. Such trust or faith is not a precondition for salvation from sin’s bondage. Rather, the proclamation that Jesus is trustworthy works the miracle of trust in our hearts. Because sin is an absence of trust, its power is broken when the heart begins to trust God once again. When the power of sin is broken, law is superfluous.

Matthew 11:16–19, 25–30

In its usual paternalistic concern for the simple and unlearned, the lectionary has excised Jesus’ culturally offensive and intolerant language from our readings. Specifically, we have been spared Jesus’ harsh pronouncement of judgment upon the cities of Chorazin, Bethsaida and Capernaum where he had performed miracles and works of power. Jesus even suggests that, had his works been performed in the proverbially wicked city of Sodom, that city would have repented and been spared. Matthew 11:20-24. As Professor Stanley Hauerwas points out, “Jesus’ pronouncement of judgment on the cities in which he performed deeds of power makes us, contemporary Christians, profoundly uncomfortable. We want a gospel of love that insures when everything is said and done that everyone and everything is going to be okay. But we are not okay. Like the cities of Israel, we have turned our existence as Christians into a status meant to protect us from recognizing the prophets who would point us to Jesus. Of course we do not like Jesus to pronounce judgment on the cities in which he performed deeds of power, because we do not want to recognize that we too are judged. But the gospel is judgment because otherwise it would not be good news. Only through judgment are we forced to discover forms of life that can free us from our enchantment with sin and death.” Hauerwas, Stanley, Matthew, Brozos Theological Commentary on the Bible (c. 2006 by Stanley Hauerwas, pub. by Brazos Press) p. 116.

The text begins with Jesus citing a child’s proverb: “We played the flute for you, and you did not dance; we wailed, and you did not mourn.” Vs. 17. Like spoiled children who cannot be induced to play at any game, the people of the three towns in which Jesus ministered remain unresponsive to God’s reign. First, they reject the ministry of John the Baptist. That is not surprising. John is an unsettling character. He lives off the bounty of the wilderness and so is impervious to the ups and downs of the economy. He has no stake in the social order and whatever entitlements it may provide. John’s very existence is a challenge to the status quo. His mere presence literally shouts that things need not be as they are. God has no need for children of Abraham, the line of David or the temple in Jerusalem. Fruits, not roots, are what God treasures. Small wonder the public at large dismisses John as a madman.

If John was unsettling, Jesus is downright threatening. Consider the “mighty works” Jesus has already done. He begins his healing ministry by touching a leper. Matthew 8:1-4. Note well that this touch was given before the leper had been healed. That should have rendered Jesus ritually unclean, but instead it cleanses the leper. Next, Jesus heals the servant of a centurion, a hated representative of the Roman Empire. To add insult to injury, Jesus remarks that the centurion’s faith outshines that of all Israel! Matthew 8:5-13. Jesus has the audacity to declare forgiveness to a man stricken with paralysis-presumably by God as punishment for his sins. Matthew 9:1-8. Then, to top it off, Jesus is found eating in the company of notorious sinners. Matthew 9:10-13. It might have been acceptable for Jesus to feed sinners at a shelter of some kind. Nobody would have objected to Jesus preaching to sinners. But to sit down and share meals with sinners who have not repented and have shown no inclination to clean up their acts-that is a bridge too far. Jesus seems to think there is no difference between sinners and the righteous, the clean and the unclean, the legal and the illegal. All those fine social distinctions that define us, tell us who we are and where we stand come apart in his presence. No wonder the good people of Chorazin, Bethsaida and Capernaum dismiss Jesus as dunk bohemian.

Both Jesus and John are written off with cheap ad hominem attacks. The critics cannot argue with the witness of John or the works of Jesus. So they resort to attacks on their characters. John is crazy. Jesus is a drunk. Their followers have been brainwashed by the media. The lectionary is likewise uncomfortable with Jesus. Rather than openly discrediting him, however, it simply edits the offensiveness out of him. But as Hauerwas observes, the good news is not good news until we are made to recognize that the status quo to which we so desperately cling is bad news.

Jesus concludes with a prayer thanking his heavenly Father for concealing the reality of God’s reign from the “wise and understanding” and for revealing it “to babes.” Vs. 25. This is not an attack on wisdom or understanding as such. Rather, it is an assault upon the intellectual energy we expend resisting the kingdom. We all know from our own experience what so often happens when you promote change, however modest, to a group of people set in their ways. Usually, you get all the reasons for why it cannot be done except the true reason, namely, that they don’t want it done. Adults will tell you that poverty, starvation and war are inevitable and give you an endless supply of well thought out reasons for why trying to change any of that is futile. A child will simply ask why we don’t stop fighting and start taking care of one another. It is not that the child is smarter than the adult. Clearly, s/he is not as well educated or knowledgeable. Yet precisely because the child lacks the conceptual tools of adulthood that enable us so effectively to lie to ourselves and rationalize our sin, the child manages to arrive at the truth from which we flee. The child knows what we steadfastly deny. Things don’t have to be the way they are.

Children are too young and inexperienced to understand that the status quo ensures them and their parents a comfortable lifestyle and security that few in the rest of the world can dream about. Children have not yet come to understand that the world is a shrinking pie and we all need to protect our slice. Children have not yet learned the importance of being white or straight or wealthy or physically attractive. A child must be educated to appreciate these distinctions and learn the importance of ensuring that they remain in place. In short, the child must be taught the fine art of self-deception. S/he must learn that the way things are is the way they must be if we are to maintain our way of life. It is not helpful for people like John and Jesus to confuse these little ones by declaring that things do not have to be as they are.

Clearly, the good news of Jesus Christ is not about tweaking the status quo to make it more humane. The good news is the reign of God that makes all things new (and of necessity breaks apart the old.) It introduces a new reality that lies at the core of both the Hebrew and New Testament scriptures. As observed by Walter Brueggemann, “At the root of reality is a limitless generosity that intends an extravagant abundance. This claim is exposited in Israel’s creation texts, sapiential traditions, and hymnic exuberances. This insistence files in the face of the theory of scarcity on which the modern world is built. An ideology of scarcity produces competitiveness that issues in brutality, justifies policies of wars and aggression, authorizes an acute individualism, and provides endless anxiety about money, sexuality, physical fitness, beauty, work achievements, and finally mortality. It seems clear to me that, in the end, all of these anxieties are rooted in an ideology that resists the notion of limitless generosity and extravagant abundance.” Brueggemann, Walter, An Unsettling God, (c. 2009 Fortress Press) p. 171. I would add that the same limitless generosity and extravagant abundance lies at the heart of Jesus’ proclamation of God’s reign. God would give us the kingdom, but God must first pry the status quo away from us so that our hands will be free to receive it.

, , , , , , , , , , , , , , , , , , , , , , , ,

2 Comments