April 29, 2016
Earlier this week, Mark McQuain posted a nice summary of the recently-published work by J. Craig Venter’s group to identify a “minimal genome” for a type of bacterium, the mycoplasmas, which are, as the group points out, “the simplest cells capable of autonomous growth.” Mark wondered aloud what the implications would be for our understanding of what it is to be human—how many genes do... // Read More »
April 28, 2016
Much of American history can be described as the struggle to
expand the moral community in which an increasing number of human beings are
seen as having basic rights under the constitution. We forget sometimes that
though the inclusion of all people was perhaps implied in our early documents,
as in “We hold these truths to be self-evident, that all men are created
equal…” from the Declaration of Independence, it has taken historical time and
struggle to come closer to realizing that ideal. This struggle has been the
quest for recognition of more and more individuals not assumed initially to have
the right to vote and exercise control over their lives, which included African
Americans, women, minorities, and more recently the LGBT community. The growing
recognition of more and more individuals as being full fledged citizens has
been a slow, often painful, birthing process of freedom, in the sense of
unleashing human potential and possibilities, within the democratic process.
The recent uproar over the
Anti-LGBT law passed in North Carolina is a reminder of how difficult it is
for many states and communities to accept and accommodate historically
marginalized people into the mainstream of society. This law was a quick
reaction by the right wing North Carolina legislature and governor to an
ordinance passed in Charlotte, similar to what other cities around the country
are doing, allowing transgender people to use restrooms according to their
gender identity. Perhaps this law also should be seen as a reaction to the
Supreme Court ruling in 2015 legalizing same-sex marriage, which has been
propelling society toward greater openness and acceptance of LGBT life styles,
integrating them into the mainstream. Many who favor the Anti-LGBT law claim
that individuals born as male, but are now identifying as female, could pose a
risk to women and girls in public bathrooms, though there seems to be no
substantial evidence whatsoever of such a risk. My sense is that the
individuals who support this law in fact are using risk as a smokescreen in attempting
to preserve what they perceive as waning values and norms in society: In the
name of conservatism they hang on to an exclusionary vision of society that no
longer fits the conditions of expanding freedom and opportunity.
So what some see as waning values and norms, others see as
moral progress toward more robust democratic ideals and values. This inherent,
historical struggle of opposing social and political forces has resulted with
unexpected rapidity in the social and legal acceptance of gays and lesbians in
the past 20 years in the United States. Most young people today especially
those living in metropolitan areas, like Charlotte, where cultural diversity is
a daily reality, readily accept that people naturally have different sexual
orientations and gender identities, which people should be free to express in
their lives. This liberal openness to diversity likely stems from the fact that
they live in the midst of, and have normal interactions and friendships with,
people of diverse sexual orientations and gender identities, which prompts them
to look upon them as neighbors and as normal people. On the other hand, my guess
is that many of the advocates of the Anti-LGBT Bill in North Carolina have
little or no contact (of which they are aware) and no or limited relationships
with LGBT individuals. Also, part of the resistance to greater inclusion of the
LGBT community could be stem from the anxiety
of having to recognize one’s own uncomfortable feelings and inclinations about
sexuality and gender.
An additional factor to explain the reluctance of many
self-identified conservatives to accept alternative sexual and gender
orientations may be related to religion. Particularly, in the “bible belt”
regions, regardless of whether or not they are followed by church leaders and
members, clear notions of basic moral norms of right and wrong are assumed.
Sadly, religious morality has been historically integrated with and used to
justify a range of regional cultural values and norms—even heinous ones such as
the use of Christianity to justify the institution of slavery. But in fairness
even many Christians outside the bible belt follow Catholic natural law theory based
on certain features about human nature from which basic norms are predicated
about what is “normal” as well as “right” and “wrong” in a content rich,
objective sense. In short, the point is if one believes that members of the
LGBT community are engaging in a personal life style that is assumed to be
inherently immoral, a barrier to inclusion is created.
So we in America today are in the midst of a culture war between
conservative communities in rural and smaller towns on the one side espousing religious
assumptions about human nature (which affects how they perceive risks) and liberals
celebrated diversity in more progressive, metropolitan areas on the other. Advocates
on either side of this divide bring to bear ideas and theories in an effort to
convince others of their position. However, my sense is that articulating
arguments to defend the root moral assumptions of either side is unlikely to
change the minds of individuals on the other side. The result seems to be
communities of individuals living in parallel universes with alternate moral
vocabularies who “talk at” each other. Though I am for a liberal, moral
vocabulary to account for moral progress within the democratic process, the
real change that many of us liberals seek really is at the emotional, and even
spiritual, level relating to how human beings are able to show empathy and
respect for their fellow human beings in their communities.
We know human identity is based largely on social
identity within a particular group or groups related to broad social categories
such as religion, race, ethnicity, social class, etc. and to more specific ones
such as professions, sports teams, political parties, etc. One of the inherent
features of social identity is that individuals have a sense of self-identity by
virtue of their group affiliations, which is also defined in terms of groups
with which they are not affiliated and to which they stand in opposition. When
group identities become rigid, to the point of engendering animus toward other
groups, barriers are created which can marginalize the rights of individuals in
those groups. But through exposure to, and openness to personal relationships
with, individuals outside one’s own group, group identity becomes more flexible
and open to change—this is an inner change of heart and disposition toward
Perhaps many of those who self-identify as conservatives in
North Carolina who favor the Anti-LGBT law, and who also are predominantly
Christian, should remember the ministry of the central character of their faith
tradition. The thrust of Jesus’ ministry as defined by scholars like John Dominic Crossan is one of
radical inclusion and hospitality. Jesus spent his time interacting with,
eating with, and drinking wine with those on the margins of society who were
outcasts and viewed as unclean and dangerous according the prevailing hygiene
laws. His message to these people was that they too can be included in the
moral community and be loved like all others. This is a robust message of
compassion and love.
Ultimately, struggle for expanding inclusion can only
succeed when opponents of bills like the Anti-LGBT Bill are able to show
members of the LGBT community the kind of compassion and love Jesus showed to
those on the margins of society in his day. The struggle of inclusion really is
the struggle to expand what one thinks of as the moral community, or more
simply, the neighborhood.
The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.
April 28, 2016
INTRODUCTORY NOTE FROM MYRA CHRISTOPHER
Lynn Webster, author of the blog below, is a member of Pain Action Alliance to Implement a National Strategy (PAINS) Steering Committee. He is also one of the most authoritative and committed experts in the United States working on both pain and addition. PAINS has been benefitted tremendously from his involvement in our efforts to “transform the way pain is perceived, judged and treated.”
Over the last couple of years, PAINS has come to understand the importance of embracing the need for dramatic change in the way two diseases – chronic pain and substance abuse disorders, especially opioid addiction -- are addressed, and that by advocates focused on both working together, we are far more likely to improve the health and well-being of all Americans.
Although relationship the between these two public issues is not yet clearly understood, there is without question a correlation between the two. Unfortunately, these two patient populations have often been pitted against one another by the media and fear-mongers for personal or political advantage. PAINS has attempted to reach out to those focused on opioid addiction and to neutralize some of the ill-will between those focused on pain and those focused on addiction.
These efforts are gaining some traction with people of goodwill – no matter their primary locus of concern; PAINS is committed to this work because we are confident that there are shared values and common ground upon which we can collaborate.
We are grateful to Dr. Webster for allowing us to post a blog he wrote shortly after the sudden death of one of America’s great artists, Prince. We believe it makes a compelling case for what PAINS is trying to do.
The Conversation Is About Compassion and Addiction
|Lynn Webster, MD|
I still don’t have all the facts about the circumstances surrounding Prince’s death. I wasn’t Prince’s physician during his lifetime, and I had no opportunity to look at his medical records either before, or after, his death.
All I know about Prince’s death is what you know. Some entertainment media outlets (TMZ, Variety, and more) initially reported that Prince was treated with naloxone, which is the antidote for opioids including heroin, in the days before his death. An autopsy (in which I had no participation) was conducted on Prince’s remains, and according to CNN, it could be weeks before we know why the beloved musical icon is no longer with us.
Several of my colleagues and friends posted a link to my blog on their social networks, and they told me they were surprised to see that some of their supporters had reacted swiftly and furiously. For example, Jan Favero Chambers, President/Founder of the National Fibromyalgia & Chronic Pain Association, was gracious enough to post a link to my blog on her Facebook page.
Among the negative comments she shared with me was this one:
“Jumping the gun a bit. We don’t know the cause of death. Respect his memory, by not posting this.”
If you look at the comments below my original blog, you’ll find someone raised an objection there, too:
“Why are you using Prince to draw people into this article? Do you know his medical history? Have the autopsy results come back? Please school me on your knowledge,” reads the comment.
Empathize, Don’t Blame, People in Pain or With Addiction
As I said in my response to that comment, part of my life’s work is to teach people to empathize with, and not blame, people in pain or with addiction. The untimely death of a beloved musical icon provides an opportunity to test our ability to demonstrate compassion. That is why I blogged about it.
I blogged about the death of Prince not because I jumped to conclusions about how he died. As I wrote then, I didn’t know any more about the cause, or causes, of his death than anyone else who hadn’t treated him or viewed his medical records.
But what I did know is that we, as members of society, had experienced a communal loss. While that’s tragic and sad, it provides us with one benefit: an opportunity to compassionately discuss the difficult topic of addiction and related issues.
Since TMZ, Variety, and other entertainment media had linked Prince’s death with naloxone, which is the antidote for opioids including heroin, I believed (and I still believe) that it was a good time to discuss addiction.
Addiction Is a Disease, Not a Character Flaw
Addiction is a disease, and yet it frequently elicits anger and judgment rather sympathy and support. This is true for everyone, famous or not, with addiction.
I don’t know whether Prince was one of the people with addiction. But what I do know is that, as an addiction specialist, I treated thousands of people with addiction over the years. My professional background qualifies me to make the observation that it’s wrong to deny compassion to the people in various stages of the disease of addiction.
When we blame people with addictions for the choices that led to their addictions, we overlook the fact that addiction is a complex problem. Because there are so many factors involved in addiction, it’s inaccurate and unfair to point a finger at an individual and say, “This disease is your fault.”
It is true that we all own some agency for our decisions, but once the disease of addiction is firmly rooted, the power to choose is stolen by the brain.
My concern was that, if the medical evidence supported the conclusion that Prince died of addiction, the outpouring of devotion that his memory had inspired would turn to rage against him. That, in my opinion, would be a shame, because the people we care about — whether they are family members, friends, colleagues, or celebrities whom we’re unlikely to meet in person — are as worthy of our love in their sickness as they are when they enjoy their full health.
To me, the death of Prince represents an opportunity to begin a discussion about why we negatively judge anyone who is sick. It provides us all with an opportunity to open up our hearts and listen to people in pain and with addiction.
And, most of all, it gives us a chance to feel compassion toward all people, sick or healthy, famous or anonymous, rich or destitute, gifted performer or shy wallflower, and friend or stranger. We’re all members of the same tribe, the human race, and we’re all entitled to love and understanding during every stage of our lives — whether we make good choices or bad choices, and whether we enjoy the happiness of success and health or the difficulties of sickness and even death.