Selling Kidneys: Part III - Autonomy

Before exploring the ethical issues of autonomy bout up in selling kidneys it should be reminded that:
Part 1 argued that though alternative procurement methods are available all are insufficient in fulfilling the current lack of kidneys, and
Part 2 living, laparoscopic nephrectomies are adequately safe procedures.

The most common concern for vendor procurement models surrounds the obvious fact that most kidney vendors would be poor. Two concerns come to the fore: 1) vendors will not appreciate or understand the health risks associated with the procedure or 2) that payment will “economically coerce” the poor into the surgery out of necessity.

The first concern should be secondary if we assume that any vendor system would necessarily demand lifelong and comprehensive healthcare for vendors, as well, the practice of full disclosure of medical risks for those who agree to be living donors.

Thus the second fear should be centrally considered. It is perhaps the roadblock for the legal consent for the construction of a regulated kidney market. The concern rests in the understanding of autonomy. I submit three reasons for why autonomy is actually upheld, rather than undermined, when vendoring is permitted.

1) Coercion can only be properly rendered as external and intentional.
2) Laws prohibiting the sale of kidneys are paternalistic and inconsistent toward the poor.
3) The dangers associated with kidney transplantations are comparable to other acceptable occupations.

First, autonomy is defined by the absence of coercion. So to ensure that autonomy is upheld it must be shown that a kidney market will not coerce the poor into selling their kidneys. Coercion can be understood in many ways that are intricately catalogued by James Stacey Taylor in his book, Stakes and Kidneys. It should suffice here that coercion must be both external to the individual and intentional. One cannot coercive oneself, thus coercion is, ipso facto, always an external force. Moreover, the agent of coercion must have an intentionality in the action of coercion. Here the situation of poverty is both rested in the individuality of a person’s situation and has not intentional in colluding for control, thus autonomy cannot be limited by one’s economic situation. As Taylor states, “Given that the impoverished person would thus retain full control over their action even as they (desperately) sell a kidney there is nothing in their economic situation that bars them from being fully autonomous with respect to this sale” (53-59).

Also, if autonomy is understood as the ability to choose compared to coercion as the limit of choice then restricting kidney markets actually offer more autonomy because markets offers more choice.

Second, laws that prohibit the sale of kidneys are both paternalistic and inconsistent toward the poor. The issues concerning the poor as the primary population of vendors for market models need not be the case. Requirements for vending could easily stipulate a certain level of personal, yearly income or some similar financial qualification. However, this would lead to blatant paternalism of the poor. Peter Hoyer states, “A paternalistic attitude to [vendors] implied that they are poor, ignorant and endangering their health.” The issue becomes inconsistent when the same federal system that bars kidney sales out of concern for the poor that may be exploited by the medical community also do not offer sufficient options or programs to the poor to increase their standard of living so that they do not, out of desperation, desire to sell a kidney. Robert Vetch makes this point succinctly: markets are only permissible if one, the society has the economic ability to provide the basic necessities for all their citizens and two, if such a country does not ensure such a minimum standard of living. As he states, “If we are a society that deliberately and systematically turns its back on the poor, we must confess our indifference to the poor and life the prohibition on the one means they have to address their problems [lack of financial security] themselves.”

Third, there are comparative dangers found in completely acceptable occupations, which under the same principles should ethically justify kidney markets. Even the highest mortality rate for nephrectomies (.06%) is lower than for other generally accepted occupations, such as commercial fisherman, merchant seaman, tax drivers, construction workers, and those in armed forces. Thus the same principles that allow for the poor to enroll in the armed forces – a statistically dangerous occupation – would also imply consent to a regulated kidney markets, especially considering the fact that the advent of laparoscopic nephrectomies will further lower mortality rates.

Hopefully this post helped to illustrate why autonomy of even poor vendors would not be undermined by regulated kidney markets. However, the ethical issues surrounding beneficence, non-maleficence and equity must still be considered in later posts.

Random Questions of Heaven and Love

A dear college friend recently posed two questions to me:
1) I want to know what you think heaven is?
2) How can you love God or others if you don't know that you are loved by God and others?

In answering the questions for my friend, I thought I would post the answers for anyone who reads this blog (which my advisors assures me is only myself) (Which would consequently make this a self-acknowledged schizophrenic sentence)).

I think the best way to answer these questions is anecdotally. I want to walk around their meaning so as to circumscribe an answer, but not actually articulate one.

1) I want to know what you think heaven is?
First, to ask what heaven is opens the metaphysical door to endless discourse. Could it be that heaven can be understood by its proximity to God – we can know of God, but we cannot comprehend God.

More concretely I would have to think that heaven has some type of materialism – or (paradoxically) at least a spiritual materialism. Augustine states, “When the body is made incorruptible, all the members and inwards parts which we now see assigned to their various necessary offices will join together in praising God; for there will then be no necessity, but only full, certain, secure and everlasting felicity” (CoG 22.30.1178). It seems such place for our bodily and communal worship would be heaven – a place too of physicality (Though I may have to reflect on this).

Another way I think about heaven is in purposely not thinking about. A good friend said to me once, “Jason, at some point theology becomes more important than just who gets into heaven and who goes to hell.” Christian teleology should be directed toward being nearer to God, and hoping for salvation in heaven only insofar as it allows one may nearer to God.

Also, the lines of ‘Amazing Grace’ have always been helpful in conceptualizing heaven: “When we've been there ten thousand years / bright shining as the sun / We've no less days to sing God's praise / then when we've first begun.” The boredom that can so quickly overcome us now will have no place in our insistent and eternal worship of the Triune God who’s pure Love and Goodness will forever enrapture our attention.

Dante’s Paradiso tried describe the divine scene in heaven and only found that words were inadequate for descriptions and ended with, “My will and my desire were turned by love / The love that moves the sun and the other stars.” This seems a fitting way to end my answer to what I think heaven is.

2) How can you love God or others if you don't know that you are loved by God and others?
This is unfortunate to say, and may sadden me to share it so explicitly, but this is the truth: I cannot love God or others, until I know and accept that God loves me. In Matthew 22:34-40 Jesus answers that the greatest command is to love God and neighbor. The second derives from the faith in the first. To not know God would be to exonerate the second imperative. To love is first to acknowledge that God loves. If one does not know God then one cannot, properly speaking, love.

Of course, I may be intimate with a lover, friends or family members – and even on occasion show deep compassion for a stranger. Yet, all this is not love.

Consider my grandmother. I ‘love’ her more than anyone else I have ever known. She is growing older and weaker each day. The way I ‘love’ her though is too direct, too intimate. There is no space for God. A Christian who loves through God’s love – a mediated love – concomitantly creates distance and irreducible collapses the difference between the loved and beloved. I cannot properly and absolutely love my grandmother because I am both not close enough and too close to my grandmother. This may seem impossible, but let me explain.

First, I am too close to my grandmother to love her. This is because I cannot see that my grandmother and I are not limited to the temporal life we share together. If one does not know God loves them then they cannot understand how to love one in a way that anticipates immortality. So I cannot love my grandmother because I am too close to her.

Second, I am not close enough to my grandmother to love her. This is because if I do not know God loves me I will only see my grandmother as simply my grandmother, and never my sister in Christ. Only by accepting such a radical siblinghood can I ever truly love my grandmother. Thus, I do not love my grandmother because I am not close enough to her.

So though it is sad, one cannot love until they know God loves them, and if they love God they must love their neighbor.

Thanks for the questions.

Oh the [In]humanity: A Theological Apology for Zombie Films

Zombie movies often have a heavy veneer of superficiality. The Resident Evil movies, Grindhouse and Doom all make this point nicely. On the other hand, more 'refined' zombie flicks have given way to social commentary: Romero's Dawn of the Dead and 28 Days Later both fall into this category. These movies have often been used to question and critique 'mindless' consumerism, the breakdown of the family, and the ascension of the individual over society, among other issues.

Yet, theological reflection seems scant. I would submit that zombie movies in particular can be used as vehicles for theological reflection.

All of this came about when my beloved friend had an evening free from his wife to see the new Resident Evil 3: Extinction with me. As we are both theology students are discussion always are reduced to questions of God. Yet, my beloved friend and I seemed unable to respond to the movie theologically. So with some good ol' Samuel Well's "theological imagination" I came up with some ways Christians can begin to redeem the damned:

1) Immortality through worldly means is distortive and vain:
Through the consequence of sin we all must suffer death. As death looms over us with inevitability we seek immortality through worldly ends instead of Godly ones. Paul shares, "To those who by persistence in doing good seek glory, honor and immortality, he will give eternal life" (Romans 2:7). The virus that causes the zombie outbreak in the Resident Evil trilogy was created to essentially create worldly immortality. However, it only leaves to a mere immortality, but not sanctification; a deformation, but not transformation. More than just medical means to extend the length of life there are a myriad of ways we try to vainly grasp immortality. Through fame, career, status we all seek out a means to an end that if extended to such a point or brought to their logically outcomes all still lead to death. Christianity does not deny the reality of death, but reassures us that Christ conquered death for all.

2) The consciousness of humanity permits the knowledge of Good and God:
Most horror movies and almost all zombie movies convey to the audience the intrinsic value of civility and humanity. The grotesque zombie places into relief the virtue of man. Even as humanity is still marred by sin, grace is given by God so that man may still know the Good. Zombies, I would argue, cannot know the Good, as they are soulless and consequently spiritless, unable to self-transcend, ergo unable to know the Goodness of God. This assumption that Zombie's do not have souls leads into the final point – and was also discussed in another blog.

3) Christian resurrection will not be zombie-like re-animation:
If zombie movies promise anything it is an illustration of what is to be rejected when a Christian considers the doctrine of bodily resurrection. Paul said, "But someone will ask, 'How are the dead raised? With what kind of body do they come? Listen, I will tell you a mystery! We will not all die, but we will all be changed, in a moment, in the twinkling of an eye, at the last trumpet. For the trumpet will sounds, and the dead will be raised imperishable, and we will be changed. For this perishable body must put on imperishability and this mortal body must put on immortality." (I Corinthians, 15:35-38). The resurrection of the dead will not be grounded in a crass physicalsim, and cannot be separated from the mind. Zombie movies are a via negative for understanding the resurrection of the body.

The professed creed ends, "We look for the resurrection of the dead,
and the life of the world to come. Amen." Thus the resurrection of body cannot be denied, but in what fashion it is raised makes all the difference. In Luke two disciples are walking on the road to Emmaus, and are joined by the risen Christ. Though they do not recognize Jesus until supper they do not confuse him for some walking dead. The zombie is relegated merely to this image of illustrative death. Thus, it entails all the horror of the anthropomorphized understanding of death – literally, death incarnate. Such a future bears little good news for the faithful, and thus zombie movies are properly in the genre of horror.

I would like to thank both my beloved friend and Coptic Christian for their insights into this issue, and without whom this post would have been impossible, or at least far far less insightful.

Does God Suffer? No!

Today Fr. Thomas Weinandy lectured at Garrett-Evangelical Theological Seminary. He was the culminating speaker for the Forum for Evangelical Theology’s series on the question of God’s Sovereignty.

During last year’s presentations God’s sovereignty was critiqued through the lens of a number of traditions: Patristic, Calvinist, Moltmannian, Open Theist, Process, and Thomist.

Fr. Weinandy’s lecture was not especially surprising, but was “illustrating” – as he seems to hold a penchant for drawing diagrams of the divine. Nevertheless, God’s impassability was defended, evil was stopped before it could become ontologized, and the distinction between Creator and creation was upheld.

It would be unduly discursive if I were to simply describe the lecture in total, so I will simply touch on two – while scourging the theological and rhetorical power of three – issues in his lecture: 1) God’s immanent workings pointed to God’s wholly Otherness, and 2) God’s love is in absolute action, constantly.

First, God's transcendence can be found in how God immanently related to the world. As Weinandy stated, "Thus, while he is intimately present o and dynamically active within the created historical order, God has revealed, through his very presence and activity, that he exists in a manner that differs in kind and not merely in degree to that of everything else within the created historical order." The biblical theophanies and the sanctification of God's peoples are examples of such immanent workings of God that distinguish God the creator form creation.

Second, God's immutability supports God's ability to be love. Usually the contrary is argued that only a suffering God can love. However, Weinandy noted, "God is immutable or unchangeable in his love and goodness not because his love and goodness are static or inert. That would be a contradiction of terms. Love and goodness are, by their very nature, dynamic and active. To say that God's love is immutable is to say that God's love and goodness are eternally perfectly in act and no further act of love could make his love and goodness more perfectly in act.... the divine attribute of impassibility specifies that God's love and compassion are so ardent that no change could enhance the ardor of his love or compassion." He unfortunately went on to use the metaphor of God as the eternally perfect kisser who is always ready to lay a wet one on you; as I said unfortunate.

During the question and answer session Dr. Vaux asked if this wasn't 'whole-sale Greek metaphysics.' The Fr. responded, "This is whole-sale revelation! If I thought I started out with Greek philosophy and just added revelation, I would give up."

A good friend of mine noted that he loved how the whole lecture seemed to be a doxology, not an opportunity for the Fr. to show his knowledge per se, but a time to preach the truth of God: that God is all loving, all knowing, eternal and unchanging. And appropriately the lecture ended with, AMEN.

Pagan Gnosticism and Christian Revelation

Augustine in his early and wayward years was a Gnostic. He allied to the common dualism between the enslaved material corpus and the liberated spirit. Later he would rightly turn to a God who made the heavens and the earth and saw both as good and a God who would make Himself truly man, scourging the docetic Christology of others, like Marcionites.

However, more than the penchant anti-materialism that defined the early Gnostics, there name sake also helped to define them: they believed themselves the bearer of gnosis – the bearers of secret knowledge.

And who doesn’t enjoy being the keeper of a secret?

However, this gnosis is what separates Christians from pagans. The knowledge Christians hold – that Christ is Lord – was never meant to be a secret. While paganism is gnostic, Christianity is revelational. The Great Commission is essentially to continue the revelation: preach, baptize and teach to the nations (Mt. 28.19-20).

There are then two sides to this Christian currency. On one hand being Christian is to share the gospel (to be revelatory), and on the other hand being Christian is to know that Christ revealed all (to reject gnosis).

Though Christianity is to be revelational it does not always succeed: sometimes not being honest about the knowledge it has and sometimes coveting the knowledge.

In a secularized society it is often not fashionable to share the knowledge of Christianity. Instead the knowledge is unduly (and heretically) bifurcated. Often Christians talk of ‘Jesus’ as a wise and worldly teacher in public, but stop at proclaiming his radical and salvific message. Personally, I muse at the number of times I have shared that I am an atheist to a Christian and their response is something resembling affirmation. To be Christian is to witness, not in partial, but in total.

Other times Christians seem to covet their knowledge, seeing the gospel more as secret than as revelation. My beloved friend wrote a sermon recently that feared as much: “I love the parable of the prodigal son, but it also scares me. It troubles me because it ends with the older son outside the party, refusing to come in. Sometimes I worry the church is like the older son, wanting to keep God all to themselves, wishing that God would not be so forgiving to those who don’t deserve it, questioning whether they really want to follow a God who throws such outrageous parties.” Perhaps the message is just too radical; we can’t fathom such audacious mercy. So, instead we covet the Father, believing the younger son gone for good.

However, it is not enough to simply share the revelational message – it is to rebuke those other teaching that believe in a secret knowledge that extends outside of the Word.

Paganism ultimately tries to give meaning to history – in a word, Astrology. Slavoj Zizek rejects this cosmic – if not still somewhat inscrutable – ordering. Thus, part of his resonance with Christianity is that both reject the secret ordering of the world that can only be gleamed (or, if you prefer decoded) by understandings of planetary alignments and seasonal happenings. Christians thus are called to render history intelligible as if a Janus Bifrons (note the irony of using pagan Gods as an example): always looking back to the incarnation as the beginning of history, but also looking toward the future and the promised Parousia, which will mark the end of history. Reinhold Niebuhr also makes this distinction warning that Christianity (and humanity at large) often tries to rationalize history as some slow march to a culmination that humanity itself wills. For the secular world this is embodied in the belief in technological progressivism, and for Christianity (as Niebuhr saw it) the Social gospel’s post-millennialism. Of course, both are to be rejected. As Mark reads, “But about the day or hour no one knows, neither the angels in heaven, nor the Son, but only the Father. Beware, keep alert; for you do no know when the time will come” (Mark 13.32-33).

Moreover, there is a current trend in popular fiction that emulates Gnosticism, and which should be repudiated. Three books that exemplify this are: Dan Brown’s The Da Vinci Code, Rhonda Byrne’s The Secret and Paulo Coelho’s The Alchemist. Even the titles of these books suggest a gnosis, and promise that the secret can unlock some fulfillment that can come from outside the Church. The Secret and The Alchemist both uphold a dualism between the mind and body, as if purposing a peculiar anthropological ‘big-headed’ Apollinarianism – in that the body becomes only some vessel for the Mind, which need only take cue from the fanciful flight of Peter Pan and, “Think happy thoughts.” Yet this is at the same time to reject the materialism of the world in-and-of-itself while also rejecting the limits of materialism. Certainly, this is not a Christian message.

The Da Vinci Code can be differentiated. The other two books offer a gnosis extra ecclesiam Brown offers a gnosis intra ecclesiam. Thus nominal Christians don’t really have the knowledge of Christ and God, but rather a politically and patriarchal version. Only a few carefully selected persons – most who aren’t particularly religious – become the bearers of the secret. In the end however, Brown’s Christianity falls into worshipping the symbols and signs themselves, rather than Christianity that use the symbols and signs only as mediation that points to God. And most importantly the meaning of these symbols – such as the cross – is not masked to hide the importance behind it, but prominently displayed and proclaimed to all, so that all might know the knowledge.

Christian revelation that comes from Christ and continued by the Holy Spirit is not to be coveted, but to be shared. That Christ is Lord was never meant to be a secret. The implication of that gospel is that there is no other secrets to be found out. We are all equally welcome to know the good news and share it with others.

Jesus is Not 'Real'

While driving on Interstate 70 outside of Columbus, Ohio I saw a number of Christian billboards lining the highway. One read, “Consider where you want to spend eternity! Repent!” Another read, “Avoid hell, repent. Jesus saves!” Wile I admonish both of these signs for using Christianity as an eternal hedge-bet (read Paschal) they did not disturb me as much as one black and white sign that said simply, “Jesus is Real.”

However, Jesus is not ‘real’.

Do not misunderstand me; this is not a sophomoric attack at the historical foundations of Christianity. Nor is it a rejection of the incarnational presence of Christ.

No, what makes the sloganized and simplified claim of ‘Jesus is Real’ so insipid is that it perpetuates the Enlightenment project that demands Cartesian certainty that begins with doubt and moves to belief only through reason. This leaves a Church that is merely empirical rather than confessional. Here, faith and reason are not only rent from one another but made antipodean – each placed against the other.

The God who gave his name as ‘I AM WHO I AM’ is not adequately – nor could be – properly understood by pure rationalism. All of this is part of the tired trek to fit God into an ontological equation. However, such rationalistic algebra will always fall short, unless we turn to the phrase from Ecclesiastes that states, “Only God is God.”

There is desire to make Jesus a magnificent historical quest, and at times there is a place for that. Certainly the particular and historical nature of the incarnation is a testament to the worldliness of the Christian message. However, the historical quest should also be held in tension with the spiritual quest. This quest shares the road with reason alongside faith.

Instead of the sign reading, ‘Jesus is Real’ it ought to read, “Christ is Lord.”

Why Not Catholic?

I take the Creed seriously, or as seriously as an atheist can take such a thing. So, when it states, “I believe in one holy catholic and apostolic Church” I take that just as serious as the line “We believe in one God.”

So why aren’t creedal-confessing Christians Catholic?

An Episcopalian some what heatedly told a class of mine that he was in fact catholic, just not Roman Catholic. However, this ‘catholicity’ he affirmed is non-substantive. A ‘Catholic’ Church that is also apostolic must be one that is substantive and particular and rooted in a historical construction.

I met with Dr. Stephen Long during my first visit to Garrett-Evangelical. I had recently finished his book The Goodness of God. While reading it I was struck at how centrally and reverently he discussed the sacraments. While we talked in his office, I asked him, “Dr. Long why aren’t you a Catholic?” He saw three problems with being Catholic: the celibacy of the priesthood, the ordination of only men, and the fact that he was already an ordained minister of the United Methodist Church.

Of course, Dr. Long might be harboring a few other theological qualms with the Catholic Church, but probably not too many. I’ve heard him support the Catholic dogma of the Immaculate Conception and he has published a paper on the need for the Papacy.

Dr. Long has also been critical of the Protestant church being defined by protest. He (and I) agrees that the joint declaration has answered most of the questions that originally created a schism within the Church. The Methodist Church in a resolution last year also agreed with the joint decalration. So, do most Protestant stay so for only three reasons: they want priests to marry, women to be ordained and because they happen to already be Protestant?

Besides the second issue, the other two do not hold theological purchase; and I would hesitantly suggest that even second need not justify a schism in the Church (while I would also suggest that the addition of the ‘filioque’ to Creed didn’t either).

Recently an editorial articlein the Christian Century made the point that the Pope’s declaration that Protestant churches are not, “churches in the proper sense” should not alarm Protestants. The editor went on to say that the Pope’s message was a technical statement not necessarily a moral one; rather, Rome simply meant that some Protestants don’t hold the presence of Christ in the Eucharist, fewer uphold bishop delineated apostolic succession and none recognize Papal authority.

The author then went on to write, “At the same time, most Protestants would affirm, with Augustine (and against the Donatists), that the church exists by God's grace, sometimes in spite of human efforts.” Of course, the invisible Church should be affirmed, but the author takes such a doctrine to its relativist-slipper-slope conclusion, “Ironically, in this sense [that they can witness to the pluriformity of the Spirit’s work in the world] Protestants can be more "catholic" than Catholics.” Yet isn’t this ecclesial carte-blanche exactly what has lead to the current state of undue liberalism?

A good friend of mine and Ph.D. candidate has remarked of this same problem with the word, ‘liberal evangelical.’ He criticizes that it often means those who want to claim the name evangelical, but while at the same time relegating its denotation so anyone can claim it. Similar, the author misses the point about what it means to be ‘catholic.’ It may be a nice or amusing sentiment to call Protestants ironically catholic, but in that very moment the term is robbed of any significance it began with. The Church must draw lines in the sands for the doctrine of extra ecclesiam nulla salus to be meaningful. If not, then all are anonymous Christians and humanity is to be silently conscripted into the ranks and rolls of the ‘catholic’ Church without exceptions – the final step of the Church become nothing more than a secularized humanism.

Brent Waters recently mused in a class lecture, “If you are going to be a heretic pick a good heresy... however, I wonder if a Protestant could even be a heretic these days.”

One things for sure, there’s not much stopping them from being Catholic.