Tuesday, December 31, 2013

Sometimes We Just Mean Different Things [Jay Watts]

One of my favorite conversations in the Roald Dahl book Charlie and the Chocolate Factory didn't make it into either movie. Willy Wonka brings his guests to a room with what he describes as square candies that look round. All of his guests correct him that the candies are actually square candies that look perfectly square from their perspective, but Wonka continues to insist they look round. Finally, determined to prove his point, he opens the door to the room and, as he does so, all the square candies on the table look round to see what is happening. They are square candies that look round.

I love that scene, and it highlights a problem that often arises in important conversations, especially centering on issues in which we invest ourselves emotionally. We mean different things when saying the same words. These definition problems corrupt conversations to such an extent that the only way to move forward is to back up and clear up the confusion.

In the last two years I know of at least three different pro-choice advocates in high profile exchanges that claimed that it is common knowledge that life doesn't begin at fertilization. All people educated in biology, so they say, understand that life is a continuum and there is no point at which we can definitively say “life began there.” The parents were alive, the gametes were alive, the zygote is alive, the embryo is alive, and on and on. How can pro-life advocates claim life began at fertilization when that event is surrounded by life?

Others routinely object to the claim that life begins at fertilization because it is silly to attribute to a single celled organism or undifferentiated cellular mass the same status as a reasoning, feeling human being. Human life can't begin at fertilization unless you think that zygotes and embryos are like you and me.

If all the parties involved are arguing in an honest spirit, which does happen, then we are very much like Willy Wonka and his guests arguing about the square candies that look round. What do we mean by looks round? What do we mean when we say life begins? We need to both ASK clarifying questions and OFFER clear definitions. Instead, we often plow ahead getting more and more frustrated that otherwise reasonable and moral people seem to be so blind to the strength of our positions.

The claim that life begins at fertilization is a scientific claim supported by embryology. It isn't wrong to say that life is a continuum from a macro perspective, but that fact doesn't mean we can't recognize individual organisms. Our claim is that the life of an individual human organism begins at fertilization, and this is nearly universally acknowledged. Dr. Ronan O' Rahilly and Dr. Fabiola Muller address this in Human Embryology and Teratology, 3rd ed.(2001):
      Although life is a continuous process, fertilization is a critical landmark because, under ordinary circumstances, a new genetically distinct human organism is formed when the chromosomes of the male and female pronuclei blend in the oocyte”

So we can concede that life begets life begets life without getting so confused that we can no longer see individuals. After all, Ryan Gosling and I are both living human beings that are products of life within a continuum of life, but few people would have trouble distinguishing us as individuals. In the same way, doctors like Malcolm Potts may argue that life exists in a continuum with no clear beginning, but he apparently had little trouble differentiating the mother from her unborn child when performing abortions or when affirming the autonomy rights of the former over the right to life of the latter.

The people arguing that life can't begin at fertilization because we can't equate zygotes and adults are making a different kind of error. It is a simple category mistake. That human life exists and begins at fertilization is a matter of scientific observation. Anyone with a passing knowledge of genetics can affirm that adult Jay actually has quite a lot in common with zygote Jay. The organism that I am now began at that moment. The DNA that determined so much about the adult that I am was in place from the beginning and central to the self-coordinated development that moved me through all the subsequent stages of growth. Who I am today is a product of who I was then and the sum total of environmental influences I have encountered.

But that isn't what they usually mean. They are claiming that embryonic life lacks some deeper meaning or value. Since it is obvious to everyone, so they say, that all the aspects that make life valuable are absent in nascent human life then it is clear that valuable human life can't begin at fertilization.

This is a philosophical claim. Our claim is an appeal to science. We need to be equipped to help them see the difference. When the life of an individual human organism begins is a question of science. If they wish to claim that morally meaningful human life is differentiated from biological human life then they need to be prepared to offer philosophical arguments to that point. We also bear the responsibility of defending our philosophical position that human life has value by virtue of what it is, not what it can do or offer society. All of these arguments are philosophical and are of a different category than the question of when life begins.

Sometimes we just mean different things when saying that same thing. It is our job to clear these points up with clear definitions and not be swept up by our passions into an argument corrupted from the outset by misunderstanding. That way, we are not like Willy Wonka trying to convince a group of people that candies that clearly look like squares look round. 

Monday, December 30, 2013

A summary of Kaczor on ectopic pregnancy [Megan]

In his article "The Ethics of Ectopic Pregnancy:  A Critical Reconsideration of Salpingostomy and Methotrexate," Christopher Kaczor speaks to the debate on the moral permissibility of treatments for tubal pregnancies.

Don't stop reading just because of the medical jargon — Kaczor's arguments are easy to follow and critical to the current conversation. The following is a summary.

An ectopic pregnancy is one in which the embryo implants somewhere other than the uterus, usually in the mother's Fallopian tube. Because of space limitation, the embryo will not fully develop inside the tube and, if the pregnancy continues untreated, will cause the tube to burst. This leads to internal bleeding that could, without immediate medical treatment, kill the mother. The dilemma we face is a situation in which two lives are threatened. Since we don't have a medically consistent way (yet!) to transplant to embryo to the uterus where it can safely develop, the embryo's future is bleak. It cannot develop fully where it is. The greater moral good in this situation is to save one human life — the mother's — rather than lose two.

Traditionally, the conservative view on morally permissible options for treatment of ectopic pregnancy have been:

1) Expectant management, or allowing the pregnancy to spontaneously end naturally, which happens around half the time; and
2) Salpingectomy, or the removal of the entire Fallopian tube with the embryo inside, which foreseeably but unintentionally causes the death of the embryo. The words "foreseeably" and "unintentionally" are key to the conversation (the principle of double-effect).

Either treatment is considered morally permissible — and in many Catholic circles, may be considered the only options — but Kaczor offers valuable insight on a third and (possibly) a fourth option.

Salpingostomy is a procedure that involves the removal of the embryo alone from the Fallopian tube. Objections to this procedure include the certain fatality of the embryo, as well as the idea that "simply removing" the embryo is the same as "simply killing" someone by beheading. Also, many object on grounds that Salpingostomy violates Directives 36 and 45 of the Ethical and Religious Directives for Catholic Health Care Services (see below).

As for the certain fatality of the embryo, the removal of the entire tube fares no better. Speaking like a true ethicist, Kaczor makes the case that the certainty of an effect doesn't necessarily mean that the effect was intended.

Besides, Kaczor writes, there are documented cases (albeit few) such as L. Shuttles in the American Journal of Obstetricians and Gynecology in which an embryo has been successfully transplanted in the uterus. Thus, we see that though no standard procedure has been developed to date, it is possible. It could be argued that removal of the embryo from a location where it will certainly die (in the tube, where it cannot develop fully) to a location where it is at least possible for it to be transplanted is prima facie better for the embryo.

Similarly, acting upon the embryo directly (rather than removing its environment) doesn't necessarily mean that all effects of doing so are intended. Kaczor cites Thomas Aquinas' thoughts on the moral permissibility of acting in self-defense as grounds for showing that it is possible to act on the body of another (even damaging that body) without intending the results.

Lastly, the wording of Directives 36 and 45, if interpreted literally, not only forbid a treatment like Salpingostomy — they also forbid transplantation of the embryo to a safe location — if and when it becomes possible — which would result in the safety and survival of both the embryo and the mother! The directives are better understood as applicable to uterine pregnancies, not tubal pregnancies, Kaczor concludes.

Kaczor also addresses treatment by use of Methotrexate (MXT), a drug that inhibits cellular reproduction in fast-growing tissue. MXT is used to treat certain kinds of cancers and, in the case of ectopic pregnancy, is believed to be effective in halting the growth of the trophoblast (which can continue even after the embryo spontaneously dies) into the wall of the Fallopian tube. If no fetal heartbeat is detected, its use is not problematic and results in less intrusion and shorter recovery time for the mother.

While Kaczor stands his ground by reminding readers "Neither the certainty of the effect nor the acting upon the body of another entails that a lethal effect which follows from the action must be intended," he does note that there are unknowns when it comes to MXT, such as whether or not MXT quickens the embryo's death. Given the lack of information about the way the drug works, he leaves the conversation on MXT open and urges that it remain so until more information is available.

My thoughts are as follows:

Cases involving ectopic pregnancy call for a different kind of conversation than cases of elective abortion. And while all conversations involving human life should be handled carefully and compassionately, it is especially true for these.

Women who are given this diagnosis often face a tremendous emotional trial as well as doubting questions on whether treatment is morally okay. Any treatment (save the extreme rarity of successful transplantation) or lack thereof will involve the death of a human being. We who communicate about these things mustn't forget that.

When individuals ask about cases in which the mother's life is at risk like ectopic pregnancy, I bring up the analogy of a medic on a battlefield with two gravely wounded soldiers before him. He can choose to do nothing and lose two lives, or he can choose to save one. The medic's choice, like the doctor's procedure, does not undermine the humanity and value of the life lost. It is tragic, and the result of living in a broken world.

I think that when treatment is necessary in cases of ectopic pregnancy, Salpingostomy, or removal of the embryo alone, is the better option. It — unlike Salpingectomy, which holds the same outcome for the embryo — preserves the mother's Fallopian tube and fertility. Kaczor's reasoning is sound.

Note:  The following are excerpts referred to by Kaczor.

Directive 45:  "...every procedure whose sole immediate effect is termination of pregnancy before viability is an abortion."

Directive 36:  "It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum."

Tuesday, December 24, 2013

Silent Night, Holy Night, Messy Night [Jay Watts]

A pastor and his family in a small village in the mountains of Java opened his home to our mission team. Bule, white people, rarely visited this town; in fact, we were told only one other team of bule missionaries, from Germany, had ever spent time in this village at all. The families lived in modest homes with little inside, but they did own cattle among other things that they kept in stables connected to their houses. In most cases, the stables were simply a room like all others. As we sat at the table about to share in the bountiful meal they proudly set before us, the cows provided the background music with a continuous song of lowing. I would soon speak at a gospel rally to hundreds of people from villages throughout the area. At that moment, we feasted in a humble home with cows and livestock in the next room.

As a Christian, I believe that the God of the universe, the creator and sustainer of all, entered the world as a baby through a young virgin girl named Mary. It is a remarkable story and as a former atheist I understand how utterly unbelievable the story sounds to ears not accustomed to hearing it. That said, this post is not to defend the belief. It is actually to marvel at that first night.

Those men I sat with woke up early in the morning to lead their livestock to a grassy area to graze. I realized that God chose as the witnesses and heralds of his great coming into this world men such as these: not kings or rulers, but odd humble people that know the love of God, their families, and their community. It was not a palace or castle, but a stable like theirs with animals and certainly all the odors that accompanied that place.

Where I live, the world Jesus was born into is as foreign as this Indonesian village was to me. As I reflected on the short time I spent in that village, I was grateful to God that he allowed me to work in ministry with men and women who helped me see the world differently. A truly silent night with none of our modern distractions. It was through that kind of culture that God came into the world. A young simple woman betrothed to a carpenter from the line of David gave birth. Angels announced the event to shepherds who were keeping their sheep at night. As Luke 2:16 - 20 says:

They hurried off and found both Mary and Joseph, and the baby who was lying in the feeding trough. After seeing them, they reported the message they were told about this child, and all who heard it were amazed at what the shepherds said to them. But Mary was treasuring up all these things in her heart and meditating on them.

If you have ever had the privilege of spending time with people like these, then you know how cool it is that God chose this way. This is the way. Jesus's way. He comes to the humble, the meek, and the least of these and elevates them through love and grace. “He humbled himself by becoming obedient to point of death - even to death on a cross.” Philippians 2:8

As a result, we can come to him with all of our mess, all of our weirdness, all of our sin. He met us where we live on a silent night and made a way.

Merry Christmas, everyone.

Wednesday, December 18, 2013

I Offended You? So What? [Jay Watts]

A young woman sat with her arms crossed and lips pursed while shooting me a look that must have been intended to vaporize me on the spot. I was talking to her and some of her fellow students about abortion and the pro-life position, and it clearly made her unhappy. She finally raised her hand and the whole room seemed to gird their loins for what was about to come. I asked her, “Did you have a question or comment?”

She rather forcefully said, “I am offended that you would come here and say these things.”

My response was as follows:

Ok, let's talk about that for minute. I have presented an argument in support of the position that abortion is objectively wrong because it unjustly takes the life of an innocent human being. The lines of evidences that I appealed to were scientific (the identity of the unborn as a human life from fertilization) and philosophical (human beings have value by virtue of what they are not what they can do or how I feel about them).

I also understand that hearing people argue for views you disagree with can be unpleasant. It bothers you to hear someone say you are wrong, just like it bothers anyone including me. I can get really irritated over people disagreeing with me about trivial things. It is natural to have emotional responses to discussions about all sorts of things, but especially about something as objectively important as abortion.

Anytime someone disagrees with us and offers arguments for their position there are only a few options open to us in response. (1) We can quietly listen, consider their views, weigh the counter arguments, and decide they were wrong. (2) We can listen, consider, weigh, then decide we are wrong and adjust our beliefs appropriately. (3) We can listen, consider, weigh, and then decide that we simply lack sufficient information to come down on one side or the other. (4) We can offer counter arguments on the spot addressing the specific lines of evidence offered.

All of those are perfectly appropriate. There are certainly counter arguments to everything that I have said today offered by genuinely brilliant people at an academic and sophisticated level. I've read them and learned from them, though I obviously found them less than persuasive in the end. I encourage you to find and read them and would be happy to point you in the right direction.

But when you say that you are offended, all that you are doing is telling us how you are emotionally responding to what I am saying. I already conceded that we all struggle with our emotions in this kind of conversation, both in my original talk and just a moment ago, so you aren't adding anything to the discussion that addresses the substance of what was argued.

Finally, and I'm not saying you are doing this, but when some people say they are offended what they are really saying is that I'm upsetting them so I ought to stop talking about abortion. I reject that all together. No one has a right not to be offended. Sometimes there are questions of such importance that we are compelled to engage in public discussion knowing that it will be upsetting to do so. Imagine how you would feel if someone suggested that you shouldn't be allowed to argue for positions with which they disagree simply because they are incapable of controlling their emotions. 

Tuesday, December 17, 2013

The Argument from Overpopulation - Blog Q&A [Daniel]

This is the first of a regular feature on the LTI blog where we will  respond to questions asked on our LTI Facebook page. If you have a question you would like to ask please leave a comment in the thread there and we will pick one regularly to respond to on here. This week’s question was about overpopulation as a justification for abortion.

The Argument from Overpopulation

  In the western world it's especially common to hear that the overpopulation of the world provides justification for abortion. After-all if we can’t adequately live in the world as it is right now why should we burden the world with even more human beings?

 Before I explore this argument in any depth it’s important to address the assumption that the world is in fact overpopulated. For a further exploration into the claim that the world is already vastly overpopulated Danny Dorling’s book Population 10 Billion is worth investing in to deal with a number of misunderstandings and falsehoods in this area. It's not at all clear that the world is in fact overpopulated and there remains debate amongst the scientific community to when or if this will happen. However, what is clear is that the failure of countries and individuals to take responsibility for how they live and how they use the world’s resources of which they are meant to be stewards of will continue to take its toll. Christians must take responsibility for how they live as good stewards and acknowledge that how they choose to live can and does affect other people. The world’s population will continue to increase but is abortion a morally permissible way of solving it?

  I think it would be fair to describe this argument as eugenic; it’s the idea that certain people within our society should be encouraged to limit how many children they should have (or whether they should have any children at all). Abortion therefore functions as a means of population control. This argument is primarily directed at those in poverty it essentially encourages the poor to procure abortions so that what space is left can be used by those with more desirable traits, and who aren’t poor. So rather than responding to the factors that lead to poverty or investment in the better use of our resources it is argued that abortion should be encouraged to help the rest of us. It should be pointed out however that if this is ‘solving’ the problem of overpopulation then it is only a euphemism for eliminating those who are seen as the problem. This approach is the moral equivalent of throwing a grenade at a mouse.

  The argument leaves us with what really appears to be a false dilemma; either abortion or overpopulation that results in global poverty. It may be true that many people’s preferred standard of living could be affected by an increasing population but selfish motives for a particular standard of living alone do not justify abortion. Life is far more than the sum of how many nice cars one has or how many nice restaurants one can frequent. To put one's pleasure above human life is morally impermissible. However, this is the one consistency with all arguments for abortion; they are always for the benefit of someone other than the preborn.

  This false dilemma also leads to a number of other morally problematic conclusions. For instance if an infant, disabled, irreversibly sick, or elderly human being is a burden in an already allegedly overpopulated world shouldn’t killing them also be justified? From a consequentialist view they cannot yet or never will contribute to society in any materially meaningful way which means they are currently burdens taking rather than giving. From this perspective if the world were in fact overpopulated their killing should also be justified on the basis of its better consequences for those who can contribute. It could be argued that the infant will one day contribute in a material sense but the same argument would work for the preborn so the advocate of an already overpopulated world cannot accept this. This leaves the advocate of the argument from overpopulation in a moral quandary, because most of those who advocate this argument rightly don’t support the killing of infants, disabled, irreversibly sick or elderly human beings. Yet their view supports the logic in for it; unless, that is, they are assuming something about preborn human beings. This exposes the question begging nature of the whole argument, there is a hidden assumption that there is something about preborn human beings that provides moral justification for their killing.

  Like all arguments in support of abortion the argument hinges on the moral status of the preborn. If the preborn aren’t fully human and the subject of personal rights, especially the right not to be intentionally killed for the benefit of another, killing them should be permissible if the preborn are not of sufficient moral value. In this instance the argument must be supported by a defence of the assumption that there is a morally relevant difference between preborn human beings and those that have been born before it can be accepted.

  If the person who uses this argument cannot do so then they must explain why the argument from overpopulation does not also equally support the killing of infants, disabled, irreversibly sick or the elderly if resources are so scant in this overpopulated world. As Francis Beckwith has said ‘if the unborn are fully human, then this is also a good argument for infanticide and the killing of all humans we find to be financially burdensome or emotionally taxing.’.

In summary the problems with the argument for abortion from overpopulation are;

1. Current assumptions on overpopulation are unfounded or unproven.
2. It promotes a eugenic view of human life.
3. It singles out families in poverty.
4. It equates ‘solving’ the problem of overpopulation with eliminating the most vulnerable human beings in our society.
5. It promotes a false dilemma by suggesting that we must choose between overpopulation and abortion.
6. It promotes a standard of living above human life.
7. It suggests that the poor must make space for the rich.
8. If followed to its logical conclusions it suggests that the killing of infants, disabled, irreversibly sick and the elderly can be justified.
9. Killing those who cannot or won’t contribute to an overpopulated society could be morally permissible.
10. The argument is guilty of begging the question by making an assumption about preborn human beings that makes killing them morally permissible.
11. The whole argument hinges on whether the preborn are fully human beings and a subject of rights, it assumes not without any justification.
12. The questioner must explain why their argument does not equally apply to infants, disabled, irreversibly sick and the elderly.
13. It leads to absurd moral conclusions.
14. Even if true it does not support the pro-choice conclusion that abortion is a fundamental right that can be exercised for any reason throughout pregnancy.


Monday, December 9, 2013

Blogging Dellapenna Pt 2: Midwives and A Few Good Men [Jay Watts

Chapter 1 of Joseph Dellapenna's Dispelling the Myths of Abortion History entitled “Only Women Bleed” has several sections and for the purposes of eating this elephant in manageable bites (a metaphor I have always found a bit unsettling as an elephant lover) we will focus only on the first point. A broad discussion of the new orthodoxy of the history of abortion. There are two key points to this new orthodoxy:

1) Abortion has always existed in societies and has been an accepted practice with little to no social condemnation. (This argues that the unborn have never been understood as persons within society.)

2) Abortion laws in the United States were established to protect the women often injured and sometimes dying from unsafe abortions. (This argues two things: Now that abortion is safe for women restrictive laws are no longer necessary, and the unborn have never been understood as persons under the law.)

As I am writing this, a character on an episode of the old sitcom Bewitched is claiming that women in the pioneer days gave birth during lunch and were back at work in the fields by late afternoon. Modern women are simply making something complicated that is naturally easy. I know this is shocking to suggest, but it may be that childbirth is not so naturally easy as a character on an old sitcom would have you believe.

Dellapenna begins with an interesting introduction on the odd nature of human childbirth in comparison with other animals. He notes several differentiating factors including our large brains combined with a narrow pelvis designed for walking upright, the inability of women to bend enough during childbirth to remove the baby alone, and the inability to do certain tasks alone like unwind the umbilical chord if needed or clear mucus out of the baby's mouth. These all require the human birth process to be assisted. Other mammals can give birth in seclusion, but when humans do so, Dellapenna argues, we probably face the highest incidences of fetal and maternal death of any mammal.

As a result, assisted delivery has been a part of the human birthing experience for as far back as we have records. Why does this matter to the history of abortion? Because midwives and what passes for doctors throughout history (I will give ample reasons in the next few posts for my mocking what people used to call doctors) have been intimately involved in child birth in a way that other members of the community have not been.

Dellapenna acknowledges that it can be taken as axiomatic that as long as women have been getting pregnant there have been women so desperate to avoid having a child that they would risk just about anything to end the pregnancy. And who would these desperate women go to for help? Those people most identified with pregnancy; midwives.

Part of the new orthodoxy is to assure us that abortion has not been the social and moral taboo that people like me try describe it as today. Dellapenna points out two curiosities in regards to our historical records concerning midwifery that seem to raise questions about that claim from the outset. The two are so intermingled that it does no real good to enumerate them separately.

Midwives practiced medicine in a time when medical knowledge was deficient at best. They experimented with herbs, oils, and other techniques to assist in labor and pain management. Given their total lack of knowledge of microorganisms, the importance of sanitary conditions, and the impact of numerous environmental and physical factors on the efficacy of any solution it is understandable why people would have limited basic expectation from their midwives. Dellapenna quotes historian David Hunt as saying, “[i]t was hoped that she [the midwife] would cut her nails, wash, and remove the rings from her hands before beginning.” Even though there seems to be evidence that midwives were safer than doctors, it is not surprising to learn that women and children did die during lboth pregnancy and labor under the care of midwives, and, as there is little so dear to most properly functioning emotional beings as family, it is understandable why midwives developed an unsavory reputation.

As a response to this reputation Dellapenna says, “It is no wonder then that even the earliest regulations enacted for midwives included requirements that midwives demonstrate themselves to be 'of good character' and prohibited them from certifying the cause of death of someone under their care (mother or child). Ecclesiastical regulations requiring midwives to have licenses from the church expressly forbade abortion and infanticide”.

So what? Remember the scene in A Few Good Men (spoiler alert) with Colonel Jessup (Jack Nicholson) on the stand. He claimed the he ordered all of the marines not to “Code Red” Santiago (the victim) and ordered Santiago to be immediately transferred from the base the very next morning to protect him. At the same time, he claims that his orders are always followed. Lt. Kaffee (Tom Cruise) sees some inconsistencies in this story. If Santiago was to be transferred why didn't he pack or call anyone to give them the good news? If Col. Jessup's orders are always followed, why was it necessary to transfer Santiago to protect him? Kaffee asks, “Why the two orders?” The events are much more consistent with Jessup being the bad guy who is lying to cover up the truth of what happened.

In our best Kaffee attitude let's ask some questions. If abortion held no stigma and enjoyed widespread approval, why did the midwives have a bad reputation? Why did being of good character require an oath not to participate in abortions? Quoting Dellapenna, “By the nineteenth century, the moral reputation of midwives had become so suspect that they were often characterized by novelists as 'drunken incompetent slattern[s].' That such an unsavory reputation arose in large measure from the association with abortion and infanticide belies the claim of abortion rights activists that abortion was socially accepted until the late nineteenth century.”

One could get the impression that a certain point in the new orthodoxy has been conceded in all of this discussion. Abortion, whether it was accepted or despised, has been common and was a normal activity for midwives. That point will get more attention in the future but we can address it now with one final lawyerly moment from Dellapenna as we close out this post and move on to the next section.

“In the remarkably detailed diary of midwife Matha Ballard for the period of 1785 to 1812, when many historians now insist that midwives were commonly performing abortions, there is no mention of even a single abortion. We cannot assume that Ballard simply did not report such activities; her diary includes accounts of incest, illegitimacy, child abuse, and other unsavory activities. If Ballard did abortions so routinely that they did not strike her as significant, it would still be extraordinary that, in such a detailed record of the events of her life, she would not mention it even once. Either Ballard, considered abortions even viler than the activities she recorded or she neither did nor knew of any.”

Either way, they fit in the new orthodoxy about as well as Jessup's two orders in his explanation of the events in A Few Good Men.

Wednesday, December 4, 2013

Restrictions on Surgery Effecting the Health of Teens in Michigan!! [Serge]

I hope you can forgive the double exclamation points in the title, but I have learned of a tragic circumstance that effects each and every adolescent person in Michigan seeking medical care!  Such restrictions of medical care have the potential of delaying surgery that is best performed early on and have the potential of harming not only women, but adolescents of both sexes!! (Sorry, but I thought it needed another double)!!

Let me lay out the problem.  There is a certain procedure that is routinely performed on adolescents in this state, but legal and professional restrictions have made it darn near impossible to such a procedure done at all!  Since it is done on so many of our young persons, it would stand to reason that we would eliminate all barriers to this important medical procedure, but it turns out that under the guise of "safety" and "informed consent", the restrictions are outrageous!

First, every specialist who performs this procedure in Mid-Michigan has admitting privileges at local hospitals.  The medical board that covers these so-called "professionals" actually insist on this, under the reasoning that doctors should be able to handle emergency problems from their surgery patients themselves! This is clearly ridiculous!  Also, offices in which this procedure are routinely performed are expected to adhere to standards similar to outpatient surgery centers, and are accredited every 5 years.  The fact that these procedures cannot be done anywhere by anyone greatly restricts access to medical care for this safe surgery!

Second, adolescents under 18 are required by law to have their parent's consent before they have this procedure done.  Can you believe that!  Requiring a child to actually have their parent present is an insult to the privacy and decision making process of 14 year olds everywhere!  Why can't we simply trust children to make their own decisions?

Third, for those adolescents who can actually get their parents to consent to the examination, let me describe the Draconian consultation!  First, an imaging study is taken, and the poor child and parent are forced to see the result of the film and actually listen to the possible complications of the surgery!  Then the "doctor" performs a physical exam and answers any question they have.  What a waste of time and a barrier to care!  Then there is an actual waiting period of at least 24 hours before the procedure is done!!

Lastly, for every patient who is somehow successful in weaving their way around the litany of regulations and barriers, the "doctor" actually charges a fee to this procedure done.  I'm not kidding!  Real money!  This may be the worst restriction possible!

If you haven't figured it out, I'm not talking about abortion access.  I'm talking about access to routine third molar surgery.  These "restrictions" that I mention are dealt with every single day by my own patients, in the office where I practice.  Yet the same type of standards, when applied to those adolescents seeking abortion care, are seen as some horrific barrier to care.  The recent ruling about the restrictions in Texas makes this point.

The question is this: what is a more impactful event in the life of an adolescent, third molar removal or a surgical abortion?  If we have standards and regulations for patient safety for those seeking wisdom teeth removal, why do we remove them for teens seeking abortion?

Monday, December 2, 2013

Evidence that the Emergency Contraceptive Ella May Cause Abortions [Serge]

I had a great time speaking with Josh Brahm on Life Report last week on the subject of contraception.  I have constantly maintained that the available evidence reveals that Plan B doesn't work after fertilization because, well, Plan B really doesn't work.  I have also claimed that there is evidence that Ella has a post fertilization effect, and in fact may cause abortions when ovulation is not stopped.  A recent tweet by Jessica Valenti suggests that this idea that certain EC's may cause abortions received the typical treatment - a change of subject and an insult.  Ramesh Ponnuru makes the same claim as I.

Well I've taken a few science classes in my day, but that doesn't make me right.  It would be nice if we had some study that investigated whether or not there was an effect on the endometrium if a woman took a single dose of Ella after ovulation.  Well, in fact, there is...

I have the full text, and what is reveals is pretty clear.  The investigators gave women a single dose of ulipristal (labelled cdb-2914 in the study) after they had ovulated.  They then measured the effect of the medication on the endometrial lining, both histologically and with ultrasound.  They measured 3 doses, 10mg, 50mg, and 100mg (the dose of Ella is 30mg).  Did these doses have any effect on an embryo's ability to implant?  Clearly, the answer is yes:

CDB-2914 also was associated with decreased expression of peripheral node addressins (PNAds), which are important L-selectin ligands found on the surface of endothelial cells. Recent studies have shown that L-selectin ligands are up-regulated during the implantation window, making the uterus more receptive to the trophoblast (17,18).
In other words, there is direct evidence that Ella decreased the action of endometrial cells that are known to be important for implantation.

 Although a thicker endometrium might be expected in those with continued endometrial proliferation after an antiprogestin, in this study, women with proliferative endometrium on mid-luteal biopsy did not have a thicker endometrium. Either effect of CDB-2914, endometrial atrophy or continued proliferation,however, may hamper implantation.
 Here the authors acknowledge directly that Ella may hamper iplantation if taken after ovulation has occurred.  Its hard to get any clearer.  Even the summary acknowledges this:

In summary, decreased endometrial thickness and decreased L-selectin ligands expression may be the earliest features of the antiprogestational effect of CDB-2914 in the luteal phase, heralding other endometrial changes. In our studies, endometrial maturation appeared to be more vulnerable to a small, single dose given in the follicular phase than with a single dose given either in early or mid-luteal phase. Whether this is a direct endometrial effect or secondary to an ovarian effect is not known. Taken together, these endometrial effects in the absence of ovarian and menstrual cycle effects suggest mechanisms by which CDB-2914 might be effective as an emergency contraceptive (28).
Science is a stubborn thing.  We now have experimental evidence that Ella has an effect on the endometrium that can act to prevent an embryo from implanting.  The burden of proof is now on the other side to give evidence that this is wrong - which almost certainly they will not do.  Its far easier to insult us.

This is especially important considering the latest news about Plan B.  Because of its ineffectiveness, more and more women will be encouraged to take Ella (especially since cost is no longer an issue).

Friday, November 29, 2013

Blogging Dellapenna in December [Jay Watts]

Throughout December and early January I will be rereading a few books. One of them will be the massive Dispelling the Myths of Abortion History by Joseph Dellapenna of Villanova University School of Law. I am preparing a talk for the 2014 SALT Conference in Montgomery, Alabama that will include some elements addressing our need to know the history of abortion in the United States in order to counter the largely fabricated narrative often offered to defend current abortion laws.

The central issue is always what are the unborn and what are our obligations (if any) to them. So any appeal that centers on arguing that people in the past didn't believe the unborn were fully human and that abortion has always been common fails to address the central issue. It is no more decisive than arguing that prior to the 18th century slavery was widely embraced and had been historically accepted so the African slaves must be a class of human life we are allowed to enslave.

That said, there is wisdom in understanding the world we live in within the context of the events of the past that brought us to this moment. Ecclesiastes 1:9 says: “That which has been is that which will be, And that which has been done is that which will be done. So there is nothing new under the sun.” We wrestle with moral issues that are rooted in ancient questions but feel altogether new because the medical science and technologies that raise the questions are novel.

Also, the hole in our knowledge begs to be filled. As a result, myths framed as history can thrive in the absence of a substantial response. As Hadley Arkes says in Natural Rights and the Right to Choose, we end up absorbing the premises of the other side. He shares a story about Lincoln's aggravation with General Meade celebrating driving the Confederate invaders “from our soil.” Lincoln was said to have responded, “Will our generals never get that idea out of their heads? The whole country is our soil.” Dellapenna points out in Chapter 1 that “even strongly anti-abortion authors like George Will have reiterated the new orthodoxy, presumably because this spurious history has become so thoroughly embedded in the popular culture that it has taken on the aura of unquestionable truth.”

Considering the emphasis Blackmun placed on the historical argument justifying the majority decision in Roe v. Wade, it is important to examine what Dellapenna calls the new orthodoxy and see if the history of abortion framed by men like Cyril Means and James Mohr corresponds to the best evidence that we have available. Admittedly, this will not answer the question of whether or not abortion is wrong, but it may help us to understand where we find ourselves and how we got here. If we discover that our past is a bit more brutal than we hoped, it certainly would not be the first time that this was true. And as Christopher Kaczor points out in The Ethics of Abortion, if we are justified in treating another class of human beings in this manner, in defining them as something less than us, then it will be the first time in history that we were right.

As I reread Dispelling the Myths of Abortion History, I'll simultaneously revisit Marvin Olasky's Abortion Rites and Arkes' Natural Rights and the Right to Choose. The blogging will follow Myths, but I'll frequently reference the others as well. I hope that this will serve to expose some fantastic work that others have done to correct the new orthodoxy while introducing many of you to books that have enriched my understanding of this issue.

Tuesday, November 26, 2013

Plan B Not Effective for Majority of Women [Serge]

I have been making the claim for many years that the evidence is clear that Plan B emergency contraception is less effective than frequently advertised.  When first made available, the manufacturer claimed that Plan B EC was about 90% effective in reducing unwanted pregnancy when taken after unprotected sex.  Later on, and very quietly, researchers admitted that the effectiveness is not even close to 90%.  In fact, here is the quote from researcher and senior fellow of the Guttmacher Institute James Trussell:

The risk of pregnancy for women requesting ECPs appears to be lower than assumed in the
estimates  of  ECP  efficacy,  which  are  consequently  likely to  be  overestimates.  Yet,  precise estimates of efficacy may not be highly relevant to many women who have had unprotected intercourse, since ECPs are often the only available treatment. A more important consideration for most ECP clients may be the fact that data from both clinical trials and mechanism of action studies clearly show that at least the levonorgestrel regimen of ECPs is more effective than nothing.
It turns out that Dr. Trussell was far too optimistic even in this assessment.  Now, it turns out that for many women, Plan B EC is not actually better than nothing

The European manufacturer of an emergency contraceptive pill identical to Plan B, also known as the morning-after pill, will warn women that the drug is completely ineffective for women who weigh more than 176 pounds and begins to lose effectiveness in women who weigh more than 165 pounds... 
 These pills, which use a compound called levonorgestrel to prevent pregnancies, are the most effective morning-after pills available without a prescription. Other pills sold in the United States require a prescription, are less effective at preventing pregnancy, or cause side effects such as nausea or vomiting. Plan B One-Step, which retails for $50, is the only emergency contraceptive drug in the United States available to women of all ages without a prescription.
Emergency contraception advocates reacted to the news about Norlevo with dismay. "There's a whole swath of American women for whom [these pills] are not effective," says James Trussell, a professor of public affairs at Princeton and a senior fellow with the Guttmacher Institute, a think tank for reproductive health issues. 

Data for the years 2007 to 2010 show the average weight of American women 20 years and older is 166.2 pounds—greater than the weight at which emergency contraceptive pills that use levonorgestrel begin to lose their effectiveness. The average weight of non-Hispanic black women aged 20 to 39 is 186 pounds, well above the weight at which these pills are completely ineffective. A CDC survey published in February found that 5.8 million American women used emergency contraceptive pills from 2006 to 2010.
The advocates of Emergency Contraception have been pushing this medication women of all ages without prescription despite the fact that the evidence has been available for quite a while that it was not effective.  This is shameful.

Wednesday, November 20, 2013

Wise Choices for Young Pro-Lifers [SK]

Per a request, a few thoughts on how young, highly motivated pro-lifers can lay a solid foundation for a lifetime impact...

1) Read more books and fewer blogs—At least twice a year, scale back social media and hit the books. To get the big picture and avoid some costly youthful errors, pick up Hugh Hewitt’s “In but Not of: A Guide to Christian Ambition to Influence the World.” Next, tackle J.P. Moreland’s “Love Your God with All Your Mind.” Then, move toward mastering the moral logic of the pro-life view. Begin with Kreeft’s “Unaborted Socrates,” Beckwith & Koukl’s “Relativism,” and my “The Case for Life.” Master those three titles. That is, read them many times over and mark them up so thoroughly they are almost unreadable. All pro-life Christians should master those titles. If you are thinking of pro-life apologetics as a vocation, devour Beckwith’s “Defending Life,” Kaczor’s “The Ethics of Abortion,” Lee’s “Abortion and Unborn Human Life,” and Arke’s “Natural Rights and the Right to Choose.” Again, re-read these gems until you master them. Then, re-read them again every year.

2) Take more speech classes—Mastering the pro-life position will make you smart. Public speaking will make you useful. Here’s the bottom line: Good speakers are not born. They are organized. They march into a speaking event knowing exactly what they will say, how they will say it, and why it matters to their audience. With a little sweat, you can be that organized. You don’t have to be cool or clever. But you do need training. Get it now, while you are young. My friend Marc Newman—a speech and debate professor—is a good place to start. Watch for his speaker's training seminar and be willing to travel to get there.

3) Consider grad school—Not because you need it to master the pro-life view (tackling a good reading list will do that), but so you can get past the gatekeepers who control access to the audiences we most need to reach. Now, you can certainly start speaking prior to finishing grad school—indeed, I know some excellent pro-life speakers who have no college degrees—but if you want to reach the widest audience possible, credentials help. While no Christian university that I’m aware of offers an applied bioethics degree aimed at equipping pro-life apologists for effective service (sad), that shouldn’t deter you from enrolling. Biola University and Houston Baptist University both offer excellent M.A. programs in Christian apologetics, with classes covering many of the worldview topics that surround the abortion controversy.

4) Aim to be a change agent not a celebrity—Mastering the pro-life position—both intellectually and rhetorically—will not land you a keynote address at the Southern Baptist Convention or World Youth Day, at least right away. But it may put you in front of the very audiences most at risk for abortion. Let’s be honest: Most people attending adult Christian conferences aren’t contemplating killing their unborn offspring. But three blocks over is a Catholic high school with 400 students, half of them secular. Two blocks beyond is an evangelical one filled with kids who struggle articulating a biblical worldview on a host of topics, including abortion. And in between are 20 church youth groups, almost none of which have ever featured a pro-life presentation. The keynote speaker at the Christian conference won’t be reaching those kids. But you might. There’s no better place to sharpen your speaking skills then a high school classroom. Get to know the teachers. While an all-school assembly may be out of reach, many teachers will let you speak to their classes if you present a good outline and demonstrate you can graciously handle questions. Later, you’ll get the assembly.

5) Deepen your intellectual skills outside of school—Consider attending Summit Oxford Study Center, run by my friend Kevin James Bywater. If you can’t attend Summit Oxford, spend two weeks at Summit’s student conferences in Colorado or Tennessee. You might also join us for the Clarkson Academy in London. In short, do something that broadens your horizons and ruins you for a normal life.

6) Find a good horse to ride—That is, pick a good mentor to help get you into the game, preferably a gracious but demanding pro-life leader who will make you read tons of stuff and force you to take reasonable risks. Forget all this silly talk about being a self-authentic individual. In your 20s and 30s, what you really need is someone to copy. You will never find your own voice until you master someone else’s. Once you find a mentor, copy his or her speeches, writing style, platform manners, etc. Indeed, you might get lucky and have a few mentors before you launch. Take them one at a time, though. I started with Gregg Cunningham, then Greg Koukl. I spent six years with the first and seven with the second. Both men were invaluable to me. Later you can become your own man/woman.

7) Get over your fear of support raising—I’ll put this bluntly. Pro-life groups are broke, nearly all of them. Most have little money to pay you. So what? Why should that stop you for getting paid to work full-time saving children? Learn to raise your own financial support like missionaries do. Yes, it’s scary. But ask yourself this question, courtesy of Gregg Cunningham: “Are any of the fears you have about support raising worth the price of human lives that could have been saved if you were fully funded?” Here at LTI, we’re offering support raising training in June at the annual Friends for Life Camp. Stay tuned for details.

8) Ask the right questions—and ask them often!

Wrong question: What can I do to be a pro-life rock star right now? 
Right question: What can I do now, in my youth, to lay a foundation for making a maximum impact after age 40 when my intellectual and speaking skills will be honed to a razor sharp focus and, through age and maturity, I’ve earned the right to be heard on a national level?

Wrong question: Will my generation of pro-life advocates end abortion?
Right question: Will my generation of pro-life advocates work harder and smarter than ones before and what can I do to make that happen?

Wrong question: How do I know if God has specifically called me to pro-life work?
Right question: Why do I need private revelation from God when I already have the clear command of Scripture to rescue those being led away to death?

[Edited to add #8]

Saturday, November 9, 2013

Advice to New Pro-Life Speaker [SK]

Short version of my advice:

First, grab the attention of your audience with a compelling introduction. Second, announce the topic of your talk. Third, tell your listeners why your topic matters. Fourth, announce your thesis and mention the main points you will cover supporting it. Move through these initial steps quickly to keep listeners riveted to the content. 

Longer version (edited letter--name changed):

Hi Bill,

Lots to like here. Your passion for the pro-life issue is incredible and comes through well on the recording. After listening to so many dull speakers, you are a breath of fresh air. Thank you for taking your subject seriously. Both in your speaking and writing, you convey a mastery of the issue from an intellectual standpoint, and this is sorely lacking in most presentations on abortion. Nice job!

My suggestions for improvement are limited to two main points that you'll have no trouble implementing:

Point #1—Talk less about yourself and more about why what you have to say matters to them (the listeners), especially early in the presentation

It's okay to grab their attention with an opening story (I do that), but make that story relate to them as quickly as possible. For example, listeners don't care about what you like and don't like, only why your remarks have significance for them. Right out of the gate, they must understand that what you are about to say is crucial and if they fail to listen, a price will be paid that will impact them personally. 

Back in 1996, Marc Newman gave me some advice on structuring my opening remarks that I follow religiously. First, I grab the attention of my audience with a compelling introduction. Second, I announce the topic of my talk. Third, I tell my listeners why my topic matters to them. Fourth, I announce my thesis and mention the main points I will cover supporting it. I move through these initial steps quickly to keep listeners riveted to the content. 

Let’s unpack those steps with more detail:

1. The introduction—March right in the front door of your talk with a short story or illustration that immediately draws listeners in. Put simply, you have about 90 seconds to convince the audience you are worth listening to, so make it count. Your story or illustration must relate to the content you’ll present and fit nicely with your thesis. It should also be simple. For example, you’ve heard me use an illustration from Omaha Beach—where on June 6, 1944, the first wave of Army rangers sustained horrific casualties because they dropped into deep tidewater and had few weapons with which to engage. My hunch is that you'll choose a different illustration next week, but remember this: If you think the audience won’t immediately grasp its significance, toss it for something else that is easily understood and relates better to your thesis for the night. Get after it!

2. Topic Statement—Tell listeners your theme for the evening. Make it clear and to the point: “My topic tonight is, “Equipped to Engage: Making a Case for Life on Hostile Turf.” Or, you might pose your topic as a question: “Tonight I want to ask a very specific question: How can you make a case for life when you’re under fire?” 

Note: If you are talking to a hostile or mixed audience, include a brief statement of goodwill after announcing your topic. Your combined topic and goodwill statement—aimed at setting a gracious tone for the evening—might look like this: “Tonight I’m going to address the topic, ‘The Case for Life.’ I realize abortion is a contentious issue that impacts some people personally. Rest assured, my purpose tonight is not to provoke controversy for controversy’s sake. Nor do I wish to condemn anyone. Rather, I’m just trying to get at the truth the best way I know how. So here’s what I propose. For the next 35 minutes, I’ll layout my reasons for thinking the pro-life view is persuasive. After that, I’ll open the floor for your questions and hear what you have to say. Fair enough?” That’s all there is to it. If you get too wordy here, you’ll sound apologetic or insincere, so keep your goodwill statement brief. 

3. Significance Statement—Immediately after announcing your topic, tell your listeners why it matters to them. Don’t skip this step! Envision taking your audience by the lapels and saying, “Listen to me! You must get what I’m about to tell you because if you don’t, this, this, and this will happen to you. But you can turn the tables and win if you listen up!” Following up on the example of Omaha Beach, I might say, “This topic of equipping yourself to engage on hostile turf is crucial to every Christian high school student listening to me right now. And here’s why: Seniors, in a few short months—and the rest of you, in a few short years—you will leave the safety of this Christian school and land on that beach known as the university campus. The minute that landing craft gate opens, you will find yourself confronted with ideas that run counter to everything you’ve heard about abortion. If you are not prepared, you’ll be outgunned and in way over your heads before you’ve memorized your class list.”

4. Thesis statement and rationale—Now you are ready to tell them how to engage. State in clear terms what you are going to argue: “Pro-life students can equip themselves to engage on hostile turf if they do four things: clarify the nature of moral reasoning, focus on the one question that really matters, make a persuasive case for life, and answer common objections.” 

Of course, you will want to plug in your own examples and thesis, but I think you can see how even with that minimal skeleton outline, I already have a workable structure for my talk, one that my listeners can quickly grasp. And by communicating up front what I'm going to say and why it matters to them, I draw them in. Although your talk had good ideas scattered throughout, I did not discern a visible structure on which you hung your material and made it relate to the overall thesis you were arguing. True, roughly six minutes into it, you did say that we must do something on the issue (a point you reiterated around the 15 minute mark), but then you went back to talking about yourself. A better plan is to announce your thesis early—“Anyone who believes in the humanity of the unborn and the inhumanity of abortion needs to do something”—and then immediately preview the main points you will drive home to make that case. 

In short, once you draw them in with a good intro, tell them why what you are going to say matters. Next, clearly articulate a thesis—something you will argue—then use personal stories to illustrate that thesis within the overall structure of the talk. Almost always, you should talk less about you and more about why your subject matters to them. March right in the front door and get to your point—quickly!

Point #2—and this relates to my first point—rethink using testimonies.

Truth is, I’m not a big fan of testimonies unless they are very short (3 minutes or less) and relate to the overall structure of the talk. In general, the pro-life movement spends way too much time on personal stories and not enough equipping people to argue our case. Stories appeal to some listeners, but when the evening is over, now what? How are those attending able to translate what they heard to those who don't agree with us? Answer: they're not! Rather than use a lengthy story about your personal journey to illustrate your pro-life work, let your training content and your delivery illustrate your mission/passion. Of course, you could still communicate a short personal example about your journey, but do it to help illustrate one of your main points, then move on. Short personal anecdotes work. Long testimonies are fraught with pitfalls and have limited training value.

Also, when you discuss graphic visuals, your tone should be personal, pastoral, and comforting—especially to those wounded by abortion. Speak directly to them, not about them. Give them the gospel as the antidote to post-abortion guilt. If you are showing abortion pictures (and you should), there is no need to describe the actual abortion procedures. As Gregg Cunningham points out, when you show pictures of abortion, abortion protests itself. Let the short 55-second clip do the heavy lifting for you.

Finally, if you are using your talk to invite donors to support your local pregnancy centers, you’ll want to relate your remarks to their work in a more compelling way. For example, if your topic is "Abortion and Moral Reasoning," use your significance statement to say something like this: “Some of you may think that Sharon and her staff are just about giving away baby clothes to young mothers. If you think that, you are mistaken. The stakes are way, way higher. Put simply, day in and day out, Sharon and her staff are engaged in an idea war for the hearts and minds of clients. In short, if that abortion-minded client believes that moral truth is a mere preference like choosing chocolate over vanilla, her child is in grave danger. And if she thinks that her child has no value unless she arbitrarily assigns it value, her child remains at risk. Make no mistake: These two questions—the question of truth and the question of human value—are in play in every counseling situation Sharon and her staff encounter.” Then, at the end of your talk, use the "Schindler’s List" example to encourage people to give like Oscar Schindler did. I remind them that Sharon, like Schindler, is giving her all to save lives. I end with this question: Are we taking our holocaust as seriously as Oscar Schindler took his? If so, we need to act like it and support the local pro-life pregnancy center.

All in all, this was a great start for you and lots better than my first talks. Unlike most speakers, you have all the natural gifts. Your passion is infectious. Your knowledge is stellar. The organizational and structural parts will come easy for you. Let me know if I can clarify anything further.

Glad to have you on board,

Note: updated for spelling and quote links.