What Does the Church Teaches about Death and Dying?

Lent is a period for meditation on dying and death. The focus is on Good Friday and Easter Sunday. However after the recent passing onto glory of two ladies in my church due to cancer, I cannot help but meditate on our own mortality. As a Christian I find there is hardly any teaching in our churches about death and dying. The emphasis is on living a victorious Christian life and in receiving all the grace and gifts (health, wealth, prosperity) that God has promised us. I find that churches teaches us how to live well but not how to die well. I wonder why this is so when the symbol of our faith is a man dying on the cross!

Does our attitude towards death affects our pastoral care? Do we Christians learn how to die well? An interesting research paper Religious Coping and Use of Intensive Life-Prolonging Care Near death in Patients with Advanced Cancer (The Journal of the American Medical Association - JAMA.vol.301, No.11, March 18, 2009) shows that people with terminal cancer who have a high level of positive religious coping (belief in God, be at peace with God) are more likely to receive intensive life-prolonging medical care near death. Of the people with positive religious coping in the study; 60% are Christian (Catholic, Protestant, Baptist), 10% others and 10% atheists. This is curious as I will expect that high positive religious copers will be more at peace and ready to leave this life than to hang on by accepting intensive life-prolonging medical care near death.

Michael Balboni, M.Div.Th.M., a researcher at the Dana Farber Cancer Institute when interviewed by Rob Moll on Christianity Today March (web) 2010 in The Medical Hazards of Spiritual Care speculates as to the reason why,

Do you know what pastors and spiritual caregivers are telling their congregants who are sick with cancer?

We really don't know what's going on with clergy. But the kind of support they're offering is probably leading patients to choose more aggressive care. We can only hypothesize why. I'm guessing it has to do with some misunderstandings about the ability of medicine. Fighting cancer is not necessarily the best thing to do spiritually. When people have metastatic cancer, it would appear that they are not being accompanied in quite the right way regarding their medical decisions.

Balboni published a research paper Provision of Spiritual Care to Patients with Advanced Cancer: Associations with Medical Care and Quality of Life Near Death (Journal of Clinical Oncology Dec 14, 2009) in which his team finds that patients with high positive religious coping that are treated by medical professionals who are religious tends to end up with hospice care rather than intensive life-prolonging medical care near death. Is there a difference between spiritual care provided by the clergy and the medical professionals who have religious affiliations? Balboni speculates,

On the other hand, there are certain doctors and nurses who simultaneously understand and/or share beliefs and practices with the patient, and they understand the complexities of the disease and the disease process. Having an understanding in both areas, they seem to be able to offer spiritual advice when engaging medical decisions.

I believe medical professionals have a better view of the disease processes and healing. See my thoughts on healing here. Some clergy and Christians has a different expectation of 'supernatural healing' from God. Even in very terminal cancer patients they are expecting God to work his miracles. The problem with this approach is that while waiting for a miracle, the patient is not preparing for his/her death. Thus when death approaches, everyone is in a panic and the patient ends up with intensive life-prolonging medical care near death (which actually causes more suffering). A better approach will be to accept that one has terminal cancer and prepare for death while waiting for the Lord's deliverance-one way or another.

what do you think?

.

Book Review Roland Chia Biomedical Ethics

Roland Chia is Chew Hock Hin Professor of Christian Doctrine and Dean of the School of Postgraduate Studies at Trinity Theological College (TTC) in Singapore. In this 2010 book which was jointly published by Genesis Books (imprint of Armour Publishing) and the National Council of Churches of Singapore, Chia develops his theological antropological approach to biomedical ethics. Chia has been instrumental in the writing of many of the National Council of Churches of Singapore's positional papers on biomedical ethics including organ trading and euthanasia. It is good that he now consolidate his thinking together in one book on biomedical ethics for the church.

This book is divided into three parts which is helpful in the way he develops his theological anthropology. The first parts deals with the theological foundations which he then applies in some current issues in bioethics in the second part. The third part is his suggestions for the role of the church in dealing with this complex problems.

This is a well written book and I am able to follow his theological discussion and appreciate his approach to these complex issues as a theologian. He notes,

The theological anthropology that we have been developing in these pages seeks to articulate a understanding of determinism and freedom proper to human beings who are self-transcending yet embodied creatures (p.51)

While it is understandable that this thin volume is an introduction to a complex number of issues, I have hoped that he has given more attention to the each individual issues rather than giving a general overall impression. For example, Artificial Reproductive Technology (ART) was reckoned to be bad because of "medicalisation of procreation", "commodification", and "commercialisation of human beings". This is oversimplifying a complex series of procedures. ART includes In Vitro Fertilisation (IVF). We have to examine IVF in light of his theological anthropology and to take into consideration the stigma of infertility in the Asian culture and whether IVF with the sperms from the husband, eggs from the wife and the fertilised ovum implanted in the wife's womb to be necessarily bad. The only shortcoming is that sexual intercourse is not involved. Yes, we do have to pay the doctors, embryologists and hospitals for the IVF services but could that be counted as commercialisation and commodification? (p.87-88).

In the section on abortion, Chia brings out the issue of whether abortion should be allowed in rape victims. While he makes a strong case that rape rarely result in pregnancy (which is not true), he however does not give the answer to this issue (p.99-100). I have hoped that he will.

The section on chimera research is well written and raises many questions. It is an area where more theological thinking must take place. Chimera research involves combining human and animal genetic material.

It is in the final section of the book that Chia gives us our money's worth. It is his call to the church to act, in being missional, teaching, counselling and being involved in public theology.

Public theology is based on the assumption that the creedal symbols and statements of Christianity have public meaning. Public theology therefore have to do with how the faith that Christian profess is linked with how they live and conduct themselves in society (p.200-204)

Chia argues that the church has a role in public policy. This is especially interesting to me as I have just read Tan Seow Hon's chapter on "Religion and Abortion in Singapore" from Issues of Law and Justice in Singapore: Some Christian Reflections (2009) which is published by Chia's seminary under their CSCA Christianity in South East Asia Series.

While the footnotes are helpful, it will be better if there is a bibliography and index to the book.

This is a significant book as this is the first book on the introduction to almost the whole field of biomedical ethics by an influential theologian in a respected seminary in Singapore. I strongly recommend this book to anyone who needs to understand biomedical issues (that means everyone especially pastors and church leaders). I will include this on the reading list when I teach my module on "Biomedical Ethics Facing the Contemporary Church" in June 2010 at East Asia School of Theology (EAST) in Singapore.

.

Virtual Mentor February 2010

Some goodies from this issue. What is informed consent for experimental procedures? Do patients really understand the risk? How will surgical procedures progress if there are no patients? What about the harm during the learning curve?

(For best results, view as HTML or request text version from virtualmentor@ama-assn.org)

Virtual Mentor. February 2010, Volume 12, Number 2: 67-142. Full Issue PDF

February 2010 Contents

Ethics and Innovation in Surgery

From the Editor

Responsible Progress in Surgical Innovation: A Balancing Act
Catherine Frenkel
Full Text | PDF
Virtual Mentor. 2010; 12:69-72.

Educating for Professionalism

Clinical Cases

New Devices and Truly Informed Consent
Commentary by Charles Rosen
Full Text | PDF
Virtual Mentor. 2010; 12:73-76.

Prophylactic Bariatric Surgery
Commentary by Robert E. Brolin, Bruce Schirmer, and Angelique M. Reitsma
Full Text | PDF
Virtual Mentor. 2010; 12:77-86.

Technical Skill and Informed Consent
Commentary by Robert M. Sade
Full Text | PDF
Virtual Mentor. 2010; 12:87-90.

Extraordinary Measures - the Movie

From Summer Johnson on blog.bioethics.net, a review on the movie.

"Extraordinary Messiness"

Hollywood has taken up orphan diseases before--remember "Lorenzo's Oil"? And bioethics movies generally have been increasingly common, even just in the last year. Think "My Sister's Keeper". So why all the fuss about "Extraordinary Measures"?

But maybe its the star power, maybe it's actually that it's a decent movie (although very few have said so except New York Magazine), but Extraordinary Measures is getting a great deal of attention as the father-turned-biotech startup investor-turned underdog against the pharmaceutical industry story has hit the big screen.

read more

Stem Cells to Treat Heart Attacks

I am glad to learn that there are some Phase 2 studies being done for stem cell therapies. After the great hype by stem cell research, it is time we see some useful applications. And this is from adult stem cells which makes most of the controversies about embryonic stem cells moot.

Stem cell therapies for hearts inching closer to wide use

By Elizabeth Landau, CNN

December 18, 2009 9:34 a.m. EST

Dr. Joshua Hare at the University of Miami works on stem cell therapies for heart attack patients.

(CNN) -- If you've just had your first heart attack, doctors may one day be able to reverse the damage done with stem cell therapy.

An intravenous method of injecting stem cells into patients who had experienced heart attacks within the previous 10 days suggested that this method works to repair -- not just manage -- heart damage, a recent study found.

read more

Top Five Books on Life Ethics

My Top 5 Books on Life Ethics

Paige C. Cunningham, executive director, the Center for Bioethics and Human Dignity | posted 11/12/2009 09:11AM

How to Be a Christian in a Brave New World By Joni Eareckson Tada and Nigel M. De S. Cameron

Two pioneers in defending the dignity of human life challenge the church to understand and care about efforts to remake humanity using robotics, embryo harvesting, and genetic engineering. Who better than Eareckson Tada to talk about the use of exotic technologies to heal human bodies?

* * *

Human Dignity in the Biotech Century: A Christian Vision for Public Policy By Joni Eareckson Tada and Nigel M. de S. Cameron

This volume comprises essays from top thinkers and activists in the field on topics like learning from past mistakes, new technology, genetics, and transhumanism. Get ready for the science fiction realities of the 21st century, and get involved.

* * *

Does God Need Our Help?: Cloning, Assisted Suicide, and Other Challenges in Bioethics By John F. Kilner and C. Ben Mitchell

Designed like a field guide, this accessible book covers all the bases. Kilner and Mitchell present the major secular ethical frameworks and contrast them with biblical perspectives. They also sort out promising developments from morally dubious ones

* * *

Bioethics: A Primer for Christians By Gilbert Meilaender

For the reader wanting to dig deeper, Meilaender—a former member of the President's Council on Bioethics—lays out the theological framework. From prenatal screening to organ donation, this volume elucidates and elaborates. A must-read for pastors, teachers,lay leaders, and thoughtful Christians.

* * *

Embryo: A Defense of Human Life By Robert P. George and Christopher Tollefsen

If you have ever wanted to defend the moral value of an embryo without using the Bible, this is the book for you. Simplifying a complex issue, the authors offer a compelling case for the embryo from the perspective of systematic biology and ethical reasoning.

Copyright © 2009 Christianity Today


Shucks, he did not include any of my books *smile*

Here are some of my recommendations.

.

Humanizing Physician Learning

The November issue of Virtual Mentor from the American Medical Association Journal of Ethics is on Humanizing Physician Learning

Educating for Professionalism

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated that residents could work no more than 24 consecutive hours and limited resident hours to an average of 80 per week over the course of 1 month. The creation of this policy was prompted by the 1984 death of Libby Zion, an 18-year-old who was admitted to New York Hospital for a high fever and died while under the care of overworked and fatigued interns. The incident led to a critical reevaluation of resident work hours. The possible harm patients could experience under the traditional training system was serious enough to provide the impetus for a large-scale reform of residency education.

Clinical Cases

The Ethical Dilemma of Duty-Hour Reporting
Commentary by Mary E. Klingensmith and Katrina S. Firlik
Full Text | PDF
Virtual Mentor. 2009; 11:835-841.

Can a Pass/Fail Grading System Adequately Reflect Student Progress?
Commentary by Bonnie M. Miller, Adina Kalet, Ryan C. VanWoerkom, Nicholas Zorko, and Julia Halsey
Full Text | PDF
Virtual Mentor. 2009; 11:842-851.

Should Applicants’ Ethnicity Be Considered in Medical School Admissions?
Commentary by Will Ross
Full Text | PDF
Virtual Mentor. 2009; 11:852-858.

Medical Education

The Winnowing Fork of Premedical Education: Are We Really Separating the Wheat from the Chaff?
Raymond G. De Vries and Jeffrey Gross
Full Text | PDF
Virtual Mentor. 2009; 11:859-863.

The Longitudinal Integrated Clerkship
Ann N. Poncelet, Karen E. Hauer, and Bridget O’Brien
Full Text | PDF
Virtual Mentor. 2009; 11:864-869.

Helping Those Who Need It Most: Medical Education Focused on Poor and Disenfranchised Communities
Charles Vega
Full Text | PDF
Virtual Mentor. 2009; 11:870-873.

Virtual Mentor. November 2009, Volume 11, Number 11: 829-926. Full Issue PDF

Who is a Bioethicist?

This post from blog.bioethics.net contains an interesting argument between two famous bioethicists, Arthur Caplan and Zeke Emanuel on who may be claim to be a bioethicist.

Facts alone won't suffice for the field of bioethics
by Arthur Caplan

When you get old enough as a practitioner in any field young people seek your advice about what they should do if they want to do what you do. Given that my age seems to be increasing exponentially this has been happening to me with increasing frequency. Undergraduates, high school students, medical students, those pursuing degrees in law and nursing and even those interested in a mid-career change have been asking me what they need to do if they want to pursue a career in bioethics.

read more

The Lab Rat of the 21st Century

Christianity today.com (online edition), July 2009

The new executive director at the Center for Bioethics and Human Dignity discusses recent bioethical debates.

Interview by Alicia Cohn | posted 7/23/2009 09:28AM

Organ transplantation on the black market and interspecies animal-human embryos might sound like science fiction, but Paige Cunningham says they are the emerging bioethical challenges.

Closer to home, topics such as abortion and stem cell research regularly fill news headlines. Christianity Today spoke with the new executive director at the Center for Bioethics and Human Dignity about the overlap between science and ethics.

What new bioethical challenges are you considering?

We've been talking with people from India and Africa about issues like the black market in organ transplantation. Crossing animals and humans has been approved in the U.K. There is a shortage of human eggs, so they want to use animal eggs. The reality is that these bioethical issues are not just an American or a Western concern; they are significant frontline issues around the world.

read more

Palliative Care Option and Trends

University of California Davis Professor Ben Rich examines emerging trends in palliative care. As an authority in the medical ethics of this area, Dr. Rich looks at how current laws, such as the Oregon Death With Dignity Act, affect the implementation of palliative options as patients near the end of their lives.





Series: UC Grand Rounds [7/2009] [Health and Medicine] [Professional Medical Education] [Show ID: 16778]

Prenatal Screening and Abortion

More from the August 2009 issue of The American Journal of Bioethics. This asks an important question: Is it ethical to provide pre-natal diagnosis of congenital abnormalities when abortion is not an option?

Prenatal Diagnosis and Abortion for Congenital Abnormalities: Is It Ethical to Provide One Without the Other?
by Angela Ballantyne, Richard Ashcroft, Florencia Luna, Ainsley J. Newson
AJOB 2009; 9(8):48
ABSTRACT |FULL TEXT

Open Peer Commentary

A Closer Look at the Abortion Debate in Iran
by Kiarash Aramesh
AJOB 2009; 9(8):57
FULL TEXT

Prenatal Diagnosis and Abortion are Not in Conflict in Israel
by Ari Z. Zivotofsky, Alan B. Jotkowitz
AJOB 2009; 9(8):58
FULL TEXT

From Iran to Latin America: Must Prenatal Diagnosis Necessarily Be Provided With Abortion for Congenital Abnormalities?
by Daniel Sperling
AJOB 2009; 9(8):61
FULL TEXT

An Unjustified Exception to an Unjust Law?
by David Wasserman, Adrienne Asch
AJOB 2009; 9(8):63
FULL TEXT

Does Prenatal Diagnosis Morally Require Provision of Selective Abortion?
by Diana Buccafurni, Pepe Lee Chang
AJOB 2009; 9(8):65
FULL TEXT

Can, Should, Ought, Must
by Howard Trachtman
AJOB 2009; 9(8):67
FULL TEXT

Prenatal Testing Can Be Advantageous Even When Abortion is Not an Option
by Alexander A. Kon
AJOB 2009; 9(8):69
FULL TEXT

Abortion: Prohibitions and Exceptions
by Sheelagh McGuinness
AJOB 2009; 9(8):70
FULL TEXT

More Discussion On Organ Donation

From the August 2009 issue of The American Journal of Bioethics

Why Consent May Not Be Needed For Organ Procurement
by James Delaney, David B. Hershenov
AJOB 2009; 9(8):3
ABSTRACT |FULL TEXT

Open Peer Commentary

Pardon My Asking: What's New?
by D. Micah Hester, Toby Schonfeld
AJOB 2009; 9(8):11
FULL TEXT

The Organ Conscription Trolley Problem
by Adam Kolber
AJOB 2009; 9(8):13
FULL TEXT

Hypotheticals, Analogies, Death's Harms, and Organ Procurement
by James L. Nelson
AJOB 2009; 9(8):14
FULL TEXT

Survivors' Interest in Human Remains
by Norman L. Cantor
AJOB 2009; 9(8):16
FULL TEXT

Why Intuitions and Metaphysics Are the Wrong Approach for Health Law: A Commentary on Delaney and Hershenov
by Christopher Robertson
AJOB 2009; 9(8):18
FULL TEXT

.

Experience with Pneumococcal Vaccine

I have been unhappy with the pneumococcal vaccine since the company launched it a few years ago. At the start, let me say I have no problem with the vaccine. It is a seven-valent pneumococcal conjugate vaccine (PCV7). It is a good and effective vaccine.

I do have problem with the way the company started marketing the vaccine. Instead of going through the doctors as was the case in most other vaccines, the company decided to go directly to consumers with a media blitz. It took up full pages of advertisement introducing the pneumococcal vaccine and showing a child with brain damage due to meningitis and a guilt stricken mother. This is education by terror and guilt. The advertisement serves to scare people to vaccinate their children. Yes, pneumococcus is a bacteria that can cause meningitis (which is treatable by antibiotics), ear infection, lung infection and throat infection. But by highlighting just the worst case scenarios, the company hopes to panic parents into vaccinating their children.

Doctors should be gatekeepers for medical information because by the nature of their training they know more then the lay-public and are able to offer better advice. That is why all new vaccines and pharmaceutical products are launched through the doctors. There is a lot of medical information on the Internet but how will a lay-person decide which information is dependable or not?

It also does not help that somehow they managed to get the Malaysian Paediatric Association logo into their advertisement. I have written a complaint to the then President of the Association here. Furthermore at that time of the vaccine launch, we have no data about the disease incidence in Malaysia. That means we have no idea how common it is in Malaysia.

The company also recommends a regime of 3+1 which means three injections of one monthly interval during infancy and one booster at 15 months. At a cost of about RM 250-300 a dose, anyone can see what a cash cow this will be to the company. Also this has obviously put this so very important vaccine out of the reach of the poor.

What I have discovered from my reading and what the company did not highlight to the doctors in Malaysia is that the Scandinavian countries and the United Kingdom is giving a 2 +1 regime. This are not poor countries that cannot afford to buy vaccines for their people and are skimping on one dose per child. These are rich countries. When I confronted some senior managers of the company, they reluctantly admitted that some countries are using a 2+1 regime. Why was it kept a secret?
It is not as if the 2+1 regime do not work. Here is a paper describing the experience in Norway

Seven-valent pneumococcal conjugate vaccine (PCV7) was introduced into the Norwegian childhood vaccination program in July 2006 in a 2+1 dose (three-dose) schedule. Vaccine coverage quickly reached high levels and the incidence rate of invasive pneumococcal disease in children under 2 years of age declined rapidly. The vaccine program's effectiveness was estimated to be 74%. Read more

Reading the literature I have decided to adopt the 2+1 dose schedule for my patients. This vaccine is not given free in government clinics but is only available in private medical practice in Malaysia. The reason is to help my patent's parents save at least RM 250-330 per child. Some other pediatricians decided to follow my example. It is interesting that when the company heard about this, I was approached by two of the sales representatives last December, who offered to give me a free vaccine dose for every child I started on the vaccination schedule as long as I keep to the 3+1 schedule.

What do you think I should do?

Experience with Pneumococcal Vaccine

I have been unhappy with the pneumococcal vaccine since the company launched it a few years ago. At the start, let me say I have no problem with the vaccine. It is a seven-valent pneumococcal conjugate vaccine (PCV7). It is a good and effective vaccine.

I do have problem with the way the company started marketing the vaccine. Instead of going through the doctors as was the case in most other vaccines, the company decided to go directly to consumers with a media blitz. It took up full pages of advertisement introducing the pneumococcal vaccine and showing a child with brain damage due to meningitis and a guilt stricken mother. This is education by terror and guilt. The advertisement serves to scare people to vaccinate their children. Yes, pneumococcus is a bacteria that can cause meningitis (which is treatable by antibiotics), ear infection, lung infection and throat infection. But by highlighting just the worst case scenarios, the company hopes to panic parents into vaccinating their children.

Doctors should be gatekeepers for medical information because by the nature of their training they know more then the lay-public and are able to offer better advice. That is why all new vaccines and pharmaceutical products are launched through the doctors. There is a lot of medical information on the Internet but how will a lay-person decide which information is dependable or not?

It also does not help that somehow they managed to get the Malaysian Paediatric Association logo into their advertisement. I have written a complaint to the then President of the Association here. Furthermore at that time of the vaccine launch, we have no data about the disease incidence in Malaysia. That means we have no idea how common it is in Malaysia.

The company also recommends a regime of 3+1 which means three injections of one monthly interval during infancy and one booster at 15 months. At a cost of about RM 250-300 a dose, anyone can see what a cash cow this will be to the company. Also this has obviously put this so very important vaccine out of the reach of the poor.

What I have discovered from my reading and what the company did not highlight to the doctors in Malaysia is that the Scandinavian countries and the United Kingdom is giving a 2 +1 regime. This are not poor countries that cannot afford to buy vaccines for their people and are skimping on one dose per child. These are rich countries. When I confronted some senior managers of the company, they reluctantly admitted that some countries are using a 2+1 regime. Why was it kept a secret?
It is not as if the 2+1 regime do not work. Here is a paper describing the experience in Norway

Seven-valent pneumococcal conjugate vaccine (PCV7) was introduced into the Norwegian childhood vaccination program in July 2006 in a 2+1 dose (three-dose) schedule. Vaccine coverage quickly reached high levels and the incidence rate of invasive pneumococcal disease in children under 2 years of age declined rapidly. The vaccine program's effectiveness was estimated to be 74%. Read more

Reading the literature I have decided to adopt the 2+1 dose schedule for my patients. This vaccine is not given free in government clinics but is only available in private medical practice in Malaysia. The reason is to help my patent's parents save at least RM 250-330 per child. Some other pediatricians decided to follow my example. It is interesting that when the company heard about this, I was approached by two of the sales representatives last December, who offered to give me a free vaccine dose for every child I started on the vaccination schedule as long as I keep to the 3+1 schedule.

What do you think I should do?

Cicely Saunders and Hospice Movement

Living Fully Until We Die
Dame Cicely Saunders' Christian faith and love for terminally ill patients led her to found the modern hospice movement.
Sarah E. Johnson

Today, hospice is an accepted part of American medicine. One out of three terminally ill Americans uses hospice care. People increasingly assume that hospice is part of the dying process. They also assume a key hospice principle: that people should be cared for in such a way that they can live fully until they die. Few realize that the modern hospice movement is young and that Christian faith motivated its founder.

Finish this article from ChristianHistory.net.

Cicely Saunders and Hospice Movement

Living Fully Until We Die
Dame Cicely Saunders' Christian faith and love for terminally ill patients led her to found the modern hospice movement.
Sarah E. Johnson

Today, hospice is an accepted part of American medicine. One out of three terminally ill Americans uses hospice care. People increasingly assume that hospice is part of the dying process. They also assume a key hospice principle: that people should be cared for in such a way that they can live fully until they die. Few realize that the modern hospice movement is young and that Christian faith motivated its founder.

Finish this article from ChristianHistory.net.

Unconventional Wisdom of Peter Singer

UNCONVENTIONAL WISDOM Staring into the Abyss Why Peter Singer makes the New Atheists nervous. By Dinesh D'Souza

Unconventional Wisdom of Peter Singer

UNCONVENTIONAL WISDOM Staring into the Abyss Why Peter Singer makes the New Atheists nervous. By Dinesh D'Souza

Bioethical Issues for the Church (1)

Bioethical Issues for the Church (1)