Pastoral Concern over so called ' legal' abortions in Namibia

HOW SHOULD WE THINK OF  UNBORN CHILDREN  THAT ARE TERMED  'NON-VIABLE',  AND  FOR WHOM DOCTORS  SUGGEST A  THERAPEUTIC ABORTION'?   
(With particular application  to  Anencephaly  / Holoprosencephaly)

[A talk given to our church on 06/ 08/2008 - by  Pastor  Joachim Rieck] This talk was given  in response  to the distressing news  given to  a  family in our church whose child was  diagnosed in the womb with HPE.  A wide  range of doctors were consulted  in Southern Africa  and their  immediate response was, "abort!"  We  are happy to report that  this family chose to  carry this child to full term, despite this very poor diagnosis. 

Little Rachel  was born on the 30th October 2008.  Against  all human expectations she has done  well, and she has reached all her milestones, and today, almost  a year later  she is on the verge of walking. This is nothing but the hand of God, and a wonderful  answer to the  prayer  of  her parents and the church.This also happened to  remind the medical  fraternity   that they are not God! 

Twice in a relatively short time span, parents associated with our church have  received the devastating news that their unborn child‘s brain development is abnormal.  Apart  from the devastating news  that these  two sets of parents  had both been  subjected to, there comes now the additional  suggestion, “abort this child -  it is not viable”. The  common reasons given  are,    

• “should this child be born  its quality of  life  will be poor“  
• “the medical costs will be very high” 
• “you have to think of yourselves and your quality of life! “  

In both these cases mentioned, the suggestion by medical practitioners has been therapeutic abortion.

It also might be worth while mentioning that the devastation and the shock are not limited to the parents alone. Close family members and friends suffer from similar shock and hurt. In the process the influence of family members may have a strong bearing on whether or not that child will be aborted.

Let me make my own position clear...

I am not a medical practitioner. I am a pastor – a shepherd of souls.  As such I cannot make a medical diagnosis or perform surgery.  I am not trained in this area. Therefore I must respect medical doctors and their expertise.  I must listen to them when they describe the symptoms and when they make a diagnosis (which may not always be right)[1]

So, while  the  medical practitioner  may make an accurate diagnosis,  he or she  does not  always make a good prescription  - particularly in  such cases  where  severe brain disorder  is concerned.

The standard prescription  I am afraid to say in such a case in Namibian medical practice, is abortion.

As a pastor, I am called to deal with life.  I am called to protect life and respect life.  My duty is to instill hope in hopelessness. My motto must be “while there is life, there is hope - who knows what God will or can do? “[2]. And ultimately I    believe that life and death is in God’s hands (Job 1:21). My work is that of a healer and not of a destroyer.  The only destructive work that I must be involved in is the destruction of sin – in whatever form  that may appear. My work is therefore “pro-life“.

In this paper   I  will seek to  help you  to  understand the prognosis  of   children in the womb with  brain disorders, and then come  look at the  theological prescription  to such situations.

Describing  the  2 kinds of brain disorders  which I have had to deal with

a. Anencephaly is a distressing condition of infants whose brains have failed to develop during gestation beyond a very rudimentary stage.

b. Holoprosencephaly [3]  is a birth defect that occurs during the first few after conception. It  is a disorder in which the brain does not grow forward and divide as it is supposed to during early pregnancy.  This brain malformation can range from mild to severe and is classified into four types:

• Alobar (severe)--where the brain is not divided and there are severe abnormalities.
• Semi-Lobar (moderate)--where the brain is partially divided and there are some moderate abnormalities; where there are two hemispheres in the rear but not the front of the brain.
• Lobar (mild)--where the brain is divided and there are some mild abnormalities.
• Middle Interhemispheric Variant (MIHV) -- where the middle of the brain (posterior frontal and parietal lobes) are not well separated. 

Children diagnosed with HPE may have a small head (microcephaly), excessive fluid in the brain (hydrocephalus), variable degrees of mental retardation, epilepsy, endocrine abnormalities, or abnormalities of other organ systems such as cardiac, skeletal, genitor-urinary, and gastro-intestinal. Mildly affected children may exhibit few symptoms and may live a normal life.  Facial deformities are often present in many children diagnosed with HPE. 

How common is this defect?

It is estimated that HPE affects between 1 in 5,000-10,000 live births. Since many pregnancies with a fetus diagnosed with HPE end in miscarriage, the frequency of HPE among all pregnancies may be as high as 1 in 200-250.

Current studies indicate that only 3% of all  such children  with HPE survive to delivery and the vast majority of these infants do not survive past the first six months of life.

A Common Question:  Is  such a child ‘viable’?

The question  which is almost always asked   in such a case is this, “Is it possible that the child with only a rudimentary brain is in fact "brain-dead" and therefore not a person, but a "living corpse" in whom only residual life remains?“

Let me take the worst case  scenario  - anencephaly  -  the condition whereby  the  unborn child only has a brain stem.   Such a child has a very  poor prognosis. These children most often  die in the womb, and if not , then  during  child birth or very soon thereafter. Here’s the point. The child  may have a poor prognosis, and  it will in fact die (as we all must, some time),  but  the greater fact is that  the  infant with anencephaly  exhibits physiological life in the womb! 

The unspoken assumption  by many  is that  life  and viability  only begins  outside of the womb. I  will  challenge that assumption  philosophically, and more importantly theologically.

1. The Philosophical challenge  

What  does  'brain dead'  mean ? [4]

The standard definition of "brain-death", based on our present state of knowledge requires, that to certify human death, we must be certain that the total brain be dead.

Infants with anencephaly, even when they totally lack the cerebral hemispheres, still may have a brainstem or other rudimentary brain tissue, and thus their whole brain is not dead. It is true  that they may be  capable of little more than most elemental and primitive reflexes, and thus from a common perspective  be considered as non-viable. However, the fact that the infant with  such brain disorders faces early death does not prove it  to be   a non-person (or a child without a soul)   any more than if it were an adult dying with severe brain damage.

It is a well known fact that the human body can continue to function physiologically with little actual input from the brain. The unity of a living human organism is not dependent on the action of any primary organ, such as the brain, but on the interaction of other essential parts (e.g. heart , lung , liver , kidneys etc).

It is not at all clear, however, how a system of many organs can regulate itself so as to act in a unified way without some primary organ that is the principal regulator.

The clinical data are much better explained by noting that a complex organism has many levels of organization.

Thus in sleep the brain ceases to play so great a role in regulating physiological function as in the waking state, while the lower levels continue to function in relative independence. What is decisive however is that without the brain, the higher specifically human functions of thought and will and of voluntary bodily actions cannot take place.

Thus total brain-death, with its absolute elimination of even the possibility of specifically human function is the best criterion of human death.

By this criterion the infant with anencephaly is not dead, but is a living person  similar  to a person  in the "persistent vegetative state".  The total brain is not dead  and since the living child with anencephaly cannot be safely judged to have suffered total brain-death, he or she must be treated as a person with the rights proper to such.

 2. The Theological Challenge: 

The Sola Scriptura   principle:  What does God’s Word have to say on the matter?

Is the Bible authoritative and sufficient for counsel in these matters? Historical Christianity says “yes!”. I submit the following theological reflections:

a. All of life is theological.  A key principle in Christian theology is that man and his life are from God (Gen. 1: 26, 27). Man is created by God and must live by the rules of His design. This means that the principle of life belongs to God, and may not be taken by any man. This constitutes the   6^th commandment (Ex. 20:13).  The only exception for a man to be killed at the hands of another human being,  is for murder (capital punishment) [5] .

b. Sickness / death / abnormalities are a result of man’s fall (Gen. 3). 
Such deformities are  a part of being a fallen human being.  Every human being and not just anencephalic babies are subject to this rule.   Think about the even worse fact that through sin we are all deformed in our spiritual relationship to God and in our character! Think about the fact that our bodies will weaken (become abnormal) sometime, and we shall die!

c.  Christ is  the Redeemer from sin   
In this  life  God, through Christ,  redeems  fallen mankind from  the curse of sin. He justifies His people and calls them righteous.However, we continue to live in our fallen bodies until death. How does God help us to live in this body of sin?  Paul answers this question in Romans 7:25,  “Thanks be  to God, through Jesus Christ our Lord!”  

How does Jesus deliver us in the pain of our present fallen-ness? The answer is that He gives us grace in our trials (e.g. Matt. 11:28; 2 Cor.  12 :9). This means  that  He may not deliver  us from  sickness / abnormalities / death,  but  that He delivers us in  these things,  through  death into eternal life, at which time we shall receive our  perfect resurrection bodies[6]. 

Psalm 23 tells us that God walks with His people through the valley of the shadow of death. These are not just sentimental thoughts. They are theological facts and certainties. 

d. Further Theological Reflections:

(i)    Scripture is pro –life.  Life begins at conception. Life and death as being in God’s hands (Job 1:21), not ours. Even physical handicaps  are  from God(Ex. 4:11; Jn.9:1-3)

(ii)  Scripture speaks of unborn children in the same language as those already born. The  child  has a soul  and identity in God’s eyes  ( e.g. Ps.  139) 

(iii) There is a difference between killing (abortion/ euthanasia) and letting die (switching of respirators etc).

(iv) God’s providence tends to bring unusual situations into our lives.  These happen because God may have a greater purpose through our trials   e.g. the sanctification of His people (e.g.  Hebr.  12: 1 - 13). Therefore we must be careful that we do not trespass against / or ignore  God’s providences, which are always directed towards His greater glory and ultimately for our own comfort (Rom 8: 35-39)

FURTHER ISSUES   TO CONSIDER:

1. Medical Issues

• Is the mother’s life presently in danger so that abortion becomes a necessity?  No! In fact, studies indicate that a legal abortion has a higher risk factor than child birth[7].

• Is therapeutic abortion   really therapeutic?  (see emotional/psychological  issues  below ) 

• The tendency of  medical practitioners towards  immediate (short term)  ‘pain relief’, without  adequate  consideration of  the long term effects  spiritual/ emotional factors  is of great concern.
• The blessing and curse of modern medicine: The blessing of being able to intervene; but the curse of knowing ahead of time what the prognosis will be.   If there were no sonar equipment, this would not have been an issue.
•  The child   is not on the same level as a tumor or an appendix that must be removed. In an abortion, what is it that dies? Tissue or Human Life?

2. Emotional/ Psychological Issues

• The mother’s   emotional life if she were to abort needs to be considered.  The history of women that have aborted (even in such desperate cases) is associated with emotional trauma – if not in the short term, then in the long term.  

• Pastorally speaking it is better to carry   the living child to full term, and then deal with death. This promotes a healthy conscience and promotes healthy grieving.

• The question of motives:  Why does one wish to have an abortion?  Is it merely because it is inconvenient? 

3. The support structures for families with severely handicapped children

 

• The role of the church. The Christian church  in history  has been the major agent  of  help  and  compassion  for parents  with severely   handicapped children  (Gal.  6:2). Nothing has changed. The church remains God’s most useful tool for compassion.

• Prayer:  This is not the very least we can do! It is the very first! The church will pray and fast that God’s will be done. We may be sure that whatever comes from our Heavenly Father’s hands will be best for us. In this regard it is not even wrong  to   pray  for healing. In this regard  see  David’s prayer for his  desperately sick child -  2 Sam.  12: 13-23. Hope in God  remains a fundamental pillar of  the Christian life.  The point is that God  remains sovereign, and whatever He gives is good.

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[1] In a new study, researchers at Kennedy Krieger Institute have found that a significant number of children with severe brain disorders are being misdiagnosed, potentially affecting treatment and outcome.  The study, published online in the March 2004  issue of the American Journal of Medical Genetics, looked at 104 children diagnosed with holoprosencephaly, or HPE, a rare condition in which the brain does not grow and divide into hemispheres as it should during the first few weeks of pregnancy. Of 255 children referred to the study with a diagnosis of HPE, upon brain scan review, 19 percent actually had other types of brain disorders, and not HPE.   For further info: webmaster@kennedykrieger.org  

[2] See  2 Samuel  12: 1 -23.  David’s son born to Batsheba   would die  by God’s decree.  Yet against all hope  David hoped  for  his newly born  son’s life. He therefore prayed and fasted  to that end. God  chose to take the child.   The point is that  it is right for a parent to go on praying until God’s will is made certain.

[3] This information is  taken from  the internet: The Carters Center s for  brain research on Holoprosencephaly and related malformations.

[4] Most of this material was gleaned from  an Internet  article  “ Moral Principles Concerning Infants with Anencephaly”   by Fr Benedict Ashley, P.P.---  “BeNotAfraid.net”  

[5] Ex 21:12 ; Lev 24:17 ; Rom 13:4

[6] 1 Cor 15 :42-44

[7]  Quoted from “PhysiciansforLife.org “  an article by  Dr Lance Radbill : “ Abortion is a surgical procedure, and like any surgical procedure, it can have serious risks. A Swedish study indicated that legal abortion is more dangerous than childbirth because the maternal death rate from legal abortions was 39 per 100,000 abortions while the maternal death rate from childbirth was 14 per 100,000 live births.