After Dinner Conversation - Bioethics: After Dinner Conversation - Themes, #3

After Dinner Conversation Themes – Bioethics

After Dinner Conversation publishes fictional stories that explore ethical and philosophical questions in an informal manner. The purpose of these stories is to generate thoughtful discussion in an open and easily accessible manner.

Names, characters, businesses, organizations, places, events, and incidents are either the product of the author’s imagination or are used fictitiously. Any resemblance to actual persons, living or dead, events, or locales is entirely coincidental. This book is published in print and electronic format.

All rights reserved. After Dinner Conversation Themes is published by After Dinner Conversation, Inc., a 501(c)(3) nonprofit in the United States of America. No part of this book may be used or reproduced in any manner without written permission from the publisher. Abstracts and brief quotations may be used without permission for citations, critical articles, or reviews. Contact the publisher at [email protected].

ISBN 979-8-2247539-2-5 (ebook)    

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Copyright © 2024 After Dinner Conversation

Editor in Chief: Kolby Granville

Edition Editor: Ben Mulvey

Story Editor: R.K.H. Ndong

Copy Editor: Kate Bocassi

Cover Design: Shawn Winchester

Design, layout, and discussion questions by After Dinner Conversation.

https://www.afterdinnerconversation.com

After Dinner Conversation believes humanity is improved by ethics and morals grounded in philosophical truth and that philosophical truth is discovered through intentional reflection and respectful debate. In order to facilitate that process, we have created a growing series of short stories across genres, a monthly magazine, and two podcasts. These accessible examples of abstract ethical and philosophical ideas are intended to draw out deeper discussions with friends, family, and students.

Table Of Contents

From the Edition Editor

Sacrificing Mercy

The Human Experience

Euthanasia

In Defense of The Harvest

Two-Percenters

The Decay

Visions of Midwives

On Good Authority

Step Back

All Harriet’s Pieces

Author Information

Additional Information

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From the Edition Editor

BEFORE THERE WERE MECHANICAL respirators the question of when to disconnect a patient from such a machine to allow death to come did not arise. Before dialysis machines became publicly available, the question of who will benefit from this technology and who will we allow to die were not asked. Such hard moral questions were often beyond our capacity to imagine. But imagination is the purview of fiction.

As a professor of philosophy, I am familiar with scores of bioethics textbooks designed to introduce college students or medical professionals to the complexities of ethical decision-making in the biomedical realm. But those textbooks, replete with discussions of ethical theories, usually lacked the intimate details of real lives necessary to connect theoretical insights to the nuances of real moral decision-making, the kinds of judgments that real people must make in often tragic circumstances. So, I would often look to fiction for what I needed.

That brought me to the After Dinner Conversation series of stories that directly address ethical issues. The stories gathered together in this volume speak to a broad array of ethical concerns specifically in the biomedical realm. They each represent a cluster of issues and questions that usually appear in bioethics textbooks. But they illustrate real life in ways not found in those textbooks.

All good fiction, all good speculative or science fiction, is interesting if it captures a relatable sense of reality. The stories in this collection can potentially sensitize us to the complexities of the present and reveal images of the about-to-happen, such that we are not completely surprised when it comes time to make the serious moral choices that we inevitably must make.

Ben Mulvey – Editor

Sacrificing Mercy

Henry McFarland

INWARDLY I RAGED AGAINST Jenny’s religion, her God, and yes against her. She had a chance at life, at health. How could she refuse it? Damn the religion that told her to destroy our hope! But showing my rage would make it harder to persuade her. Besides, it was time to help her into bed. The doctor’s visit had exhausted Jenny, and she quickly dropped off to sleep. She looked as peaceful as a saint in a stained-glass window and as fragile.

On a spring day ten years ago, a petite young woman with a pixie haircut pushed a shopping cart piled high with groceries across our college campus. Some cans fell from the top of the pile. I picked them up and offered to help push the cart. Jenny’s bright blue eyes widened in a smile that lit up the world.

Jenny led me to the food pantry at a local church, where an obese woman with a loud cough sat on the stoop and puffed on a cigarette. Jenny sat next to the woman and said in a cheery voice, Good morning Mrs. Simpson, I hope you feel better. Come on inside, we’ve got tomato soup—your favorite.

Mrs. Simpson might have been better off if she used the money she spent on cigarettes to buy her own soup. Still, something in Jenny’s kindness to her touched me. Because of that, and to spend time with Jenny, I began to help in the food pantry—just one day a week. Soon my life revolved around Jenny. We married the week after graduation and settled down for a blissful four years of health.

Then came four years of sickness. Cardiomyopathy attacked her heart and began a deterioration that doctors could slow but never stop. I did what I could for her, including learning how to draw her blood for the tests that never found any hope. Nothing stopped the disease. Every halting step she took, every moan she made, every tear she shed reminded me of how helpless I was.

Only a new heart could save her, but the chance of that was slim. People who needed hearts far outnumbered the donors. The hospital put her on a waiting list, but she’d likely die waiting.

My one source of hope was a daily internet search for information on possible new treatments. Three years ago, there was something promising. I told Jenny about it as I drew her blood. They just started trials on a way to grow a new heart.

So that’s why you looked so intense, like you wanted to jump inside your computer. How could they do that?

With stem cells from embryos that are clones of the patient.

Her eyes narrowed. Cloning’s unnatural.

Nature wasn’t helping us much. It’s a way to get a new heart without waiting for a donor. I swabbed a spot on her arm with alcohol. Her flesh once had a rosy glow—now it was almost blue. You’ll just feel a little pinch now.

You’re always so gentle. Mike, what happens to the baby?

Baby?

Her eyes got narrower, her forehead wrinkled. The embryo, what happens to her?

Don’t know. Maybe they won’t have to use an embryo.

As the disease progressed, Jenny’s life seemed to shrink. One by one she had to give up the activities she loved. Her worst moment was when the doctor said that she could no longer teach. She wept on our way home after that appointment, and her hands clutched the cross she wore around her neck. At home, we embraced on the sofa, and she poured out her sorrow and frustration.

I feel so useless.

Jenny, no, you still mean the world to me.

I can’t work. I can’t help around the house. I can’t even be a wife to you anymore.

I was all too aware of that last loss, but I didn’t want that to show. You’re the woman I love, and don’t you ever forget it. You aren’t useless.

Jenny hugged me tighter. I love you too, Mike. I must have faith. God has a reason for all this.

I didn’t say anything about God’s reasons. Soon after we’d started dating, Jenny gave me her big open smile and asked me to go to church with her that Sunday. At Calvary Evangelical, the congregation gathered in a large undistinguished space with a high ceiling, like the waiting room in a train station but with an altar and pews. Nothing hung on the walls but a large cross. During the service, she stared at the altar with a wide-eyed fascination. I was mildly interested, or maybe less than mildly. Luckily it only took an hour.

As we left, Jenny gave a little laugh. At least you didn’t fall asleep. That’s a start.

Time to be positive. I liked the choir.

She hugged me. You’re a good person, Mike. Keep coming to church. You’ll get it.

I didn’t get it. Jenny wanted me to go to church, so I did, but with no real conviction. For hope I looked to research, not to heaven.

NOW RESEARCH COULD save us. The trials were over, and the method worked. Dozens of patients had gotten newly grown hearts. Jenny had a chance, and I brought her to Dr. Yifang Phang to take that chance.

The doctor explained the procedure. All we need now are some cells from your body—a blood sample will do fine. We can use that to start the cloning.

Jenny’s voice was weak but clear. What happens to the baby?

Dr. Phang took a deep breath. You mean the blastocyst? It would not be viable after the stem cells were extracted.

So you’d kill her.

Dr. Phang sounded as if she were reading a script. Some would feel that way. Others would question whether a blastocyst, that’s what I prefer to call an embryo at such an early stage, would really be a baby.

Jenny leaned forward. Her eyes were fixed on Phang. Whatever you call the embryo, it’s a human life at its earliest stage, when it’s most helpless, most vulnerable.

Not all share your point of view. Also, the process here is not similar to the typical process that results in the birth of a baby. The blastocyst would be formed by somatic nuclear cell transfer, not the union of a sperm and egg.

Jenny paused for a moment. Is there any other way to get the stem cells?

Phang shook her head. Not for this procedure. It requires embryonic stem cells because of their greater pluripotency, their ability to become other types of cells. In a few years, we may be able to use other types of stem cells. But Mrs. Thompson, you don’t have that time. Without a new heart, you won’t live more than a few months.

Jenny sighed. Could we do something else instead?

This new procedure is the only way to get a heart. There’s no real chance of an old-fashioned transplant with a donor heart. Now that we’ve developed this new technology, getting donor organs has gone from hard to almost impossible. No one thinks of donating organs when new organs can be grown instead. Besides insurance wouldn’t cover it.

That surprised me. We hadn’t had an insurance problem before. Why not?

Phang gave me a sympathetic look. Because the heart wouldn’t have the recipient’s own genetic makeup, the patient would need lifetime treatment with anti-rejection drugs. Those drugs are very expensive and often have serious side effects. Because it’s so much more expensive than using an organ cloned from the patient, the insurance companies won’t pay. The cost is well over two million, not including the anti-rejection drugs post-transplant.

That we could never afford.

Doctor, I can’t have this procedure. Jenny sounded so calm.

I reached over and touched her hand. Jenny, this could save you.

She turned to me. I’m sorry, Mike. But this procedure is wrong. I can’t do it. I don’t fear my death.

I feared her death! Without her I’d be alone. I felt nauseous. We’d been on a long journey, and with the destination finally in sight, she refused to move. Phang was the specialist. Couldn’t she say something to change Jenny’s mind?

Phang’s voice showed no emotion. Then all I can do is continue palliative care. You should sign a living will. Also, you’ll need a medical power of attorney. You’re likely to go into a coma before you die, and you should designate someone to make decisions for you during that time. She gave us the paperwork, and Jenny left the office with me trailing behind.

The next night, Jenny, her breathing slow and labored, lay in bed. I sat next to her and took her hands in mine. Please Darling, have the procedure. I need you, to have you near me, to hold you.

Jenny sounded regretful but adamant. Mike, I love you so much. Please try to understand. The procedure goes against my beliefs.

"If you have this procedure, you can have your life back. You can teach again. Once you told me that poor people