Suicidal “ideation”???

Have you ever seen the word “ideation” except when paired with “suicidal”?  I’m hungry right now–am I experiencing hamburger ideation?  When I want sex am I experiencing erotic ideation?  Nope.  “Suicidal ideation” is a term used by health care professionals to undermine the possibility that rational people can think about committing suicide and that those wishes ought to be respected.  It is condescending and paternalistic.

And note the grammar.  Suicidal ideation is always something that happens to me, never something I actively do.  I can’t say, “I am ideating about suicide;” ideation is always something that I (passively) experience.

Enough. Got to go. I am experiencing coffee ideation.

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Yes, You Were Misinformed

I love Joyce Wadler’s occasional columns for the New York Times. Under the general heading, “I Was Misinformed,” she comments with great wit on the various aspects of growing old.  But this week, she made a basic error that set me thinking.  Upset after visiting her mother, who has dementia, she calls her friend Harry:

“If I’m ever in this situation just get me the pills and book the trip to Oregon,” I tell him. “Don’t let me exist like this.”

“I know,” says Herb, who goes down this road with me once a week. “Oregon or if the weather is nice, Vermont.”

Grounding the banter comparing the advantages of Ben & Jerry’s to a trip out  West, is the assumption that there is some connection between developing dementia and making use of “Death with Dignity” laws in states such as Vermont, Oregon, and California.  I had a discussion a few days ago that highlighted the same misunderstanding.   I was explaining to a fellow attendee at a conference on aging and society, that my presentation would be on preemptive suicide as a strategy for avoiding Alzheimer’s Disease.  “Oh,” he exclaimed, “my state is voting on that next month!”  Nope. Wrong.  Your state (Colorado) is voting on a law very much like the ones passed in other states.  They all require that the person ending her life be competent, and they all require a physician’s determination that death is likely to occur within six months.  In other words, they are completely irrelevant to someone with dementia.  If you have dementia, you’re not competent, and you are not especially likely to die within the next six months.

This is a very common, and very puzzling, error.  Surely someone as sophisticated as Wadler understands the basics of these laws, and yet I run into this misunderstanding all the time.  Is this a form of denial, a refusal to accept that once one starts down the path of dementia, there is no escape?

Book review: “Inside the O’Briens”

Lisa Genova is a novelist I would love to meet. She is a Harvard-trained neuroscientist, but she probably doesn’t spend much time in the lab these days. In   2007 she wrote Still Alice, which became a best seller and, as they say, a major motion picture. Still Alice portrayed a vibrant, brilliant professional woman facing early onset Alzheimer’s. She tries to make the most of the good years still left to her, while planning for her suicide when her dementia overtakes her.

Genova found a terrific niche. Americans are fascinated by the brain, how it works and how things go awry (cf. our current obsessions with Alzheimer’s and autism). Her next book, Left Neglected, depicted another woman, a hard driving executive who survives a car crash with her body and her intellect intact, but unable to connect to anything on the left side of her body. Her left field of vision, hearing, movement, smell, were all gone.   Almost more interesting than the neurological phenomenon is the story of how a woman who is her family’s main breadwinner negotiates her responsibilities in this new world. Love Anthony is the rather too sentimental story of a boy with autism, told variously from the perspective of Anthony and of his mother.

I just read Inside the O’Briens, published last year. I found it the most gripping of Genova’s novels. Joe O’Brien is an Irish cop in South Boston, the kind of guy that you want to describe as “salt of the earth.” He loves his job, his wife Rosie, and his four grown kids. But sometime in Joe’s forties, some odd things begin to happen: weird rages, an inexplicable fall, trouble concentrating.   Eventually Joe and his family are navigating the scary and challenging world of Huntington Disease. HD is a dominant genetic disorder, meaning that if even one parent has the disease, each child has a 50/50 chance of getting it. It is 100% penetrant: if you have the gene, you will certainly get the disease (if you don’t get hit by a truck first). The condition is marked by increasing neurological dysfunction, until you cannot move, eat, or speak, although you remain conscious and aware. Inside the O’Briens is a clever title that signals the double-barreled scope of the novel. On the one hand, the HD gene is “inside” Joe, and potentially inside each of his children, and an unborn grandchild. On the other hand, the story gets “inside” the close-knit family, and depicts how the O’Briens, individually and together, cope with Joe’s condition, with the social and economic implications of his early retirement, and with the real possibility that each of them could have the disease. Each of the kids has to grapple with the question of whether to get tested, and the oldest son and his wife must also decide whether to test their newborn baby.

This is a great beach or airplane book—a compulsive page turner that also leaves you with the feeling that you’ve entered someone else’s world and learned a lot.

Punish women for having abortions?

Donald Trump got into a lot of trouble yesterday for saying that abortions should be illegal and that women (as well as abortion providers) should be punished for having them.  It was a field day for Democrats, of course, but the pro-life forces were equally dismayed, and Republicans hastened to perform damage control, not wanting to be seen as “waging war on women.”

So maybe I’m alone in finding his perspective a little refreshing?  Trump, of course, quickly backtracked to say that women were “victims” of abortion and should not be punished.  March for Life reiterated its position that women often had abortions out of desperation and “deeply regretted” the act later.  Another pro-life group said that women needed to “heal,” not be punished.

By saying that laws should punish women as well as providers, Trump was at least giving women the respect of acknowledging that they were not poor vacillating victims, but responsible deciders who stood by their actions.  The “victimhood” road is a very dangerous path.  This is the road Justice Kennedy took when he frustrated and disappointed prochoice women by upholding a ban on so-called “partial birth abortion,” noting that “it seems unexceptional to conclude some women come to regret their choice to abort the infant life they once created and sustained.”  That kind of patronizing condescension does no good for women’s causes.

Wheaton College

I guess this is the “other stuff,” in Bioethics and Other Stuff.  I am copying below my essay that was published today on the website of the American Academy of Religion, as part of Religious Studies News.

Wheaton College, Larycia Hawkins, and Our Academic Life Together

The case of Larycia Hawkins has brought much gnashing of teeth in many areas of academe. Hawkins, a tenured professor of political science at Wheaton College, a Christian liberal arts college, was placed on administrative leave with a recommendation for the initiation of termination proceedings. On February 9, 2016 Hawkins and Wheaton agreed to part ways, with the settlement terms remaining private. According to the College, Professor Hawkins was in trouble for her public declaration (outside the classroom) that Christians and Muslims worship the same god. Some commentators suspect that Wheaton was using the theological issue as a pretext for firing someone who is female and African-American, on a mostly white campus, or that she was really under attack for her act of wearing the hijab as a statement of solidarity with Muslim women. But I am going to take Wheaton at its word here, the better to explore some of the academic implications.

Wheaton can perhaps be faulted for a lack of clarity in the lines it draws. But in general, Wheaton and similar colleges go out of their way to make clear to students and faculty what the expectations are for belief and behavior, and what the consequences can be for crossing those lines. (It is also possible that Hawkins and Wheaton are engaged in a genuine hermeneutical debate about aspects of evangelical doctrine, a debate in which I am not qualified to engage.)   Although I cannot imagine teaching in such a college or sending a child of mine there, I acknowledge that as long as Wheaton is clear and upfront about its requirements, it has the right to enter into a contractual agreement with faculty in which they give up certain areas of academic freedom as a condition of employment. As Wheaton says on its website, “members of [the] faculty, who have voluntarily signed our Statement of Faith and the Community Covenant, commit to accept and model these foundational documents with integrity, compassion and theological clarity inside and outside of the classroom.” For clarity, I am going to call these institutions “faith-circumscribed.”

Although Hawkins is a political scientist, she works on questions of religion, and while we have never met, I think of her as a colleague. I received my doctorate in religion and currently teach in a religion studies department.   Professor Hawkins’s case rekindles for me a concern I have had since graduate school, a concern for which there is no comfortable forum.

From the time I was a graduate student at the University of Iowa, I have been a member of the American Academy of Religion.   I served for two terms on the Board, and was a co-chair of the Church/State Studies Group. Some scholars participating in AAR and its sister society, the Society for Biblical Literature (SBL), come from colleges such as Wheaton, which have faith-based requirements for hiring and retention. The same is true in other organizations, such as the American Historical Association, the American Society for Church History, the Law and Society Association, and others. Our annual meetings are in many ways the backbone of the disciplines; they are where we try out new ideas, network with other scholars, and build scholarly fellowship with people outside our subdisciplines.

At its conferences, AAR and SBL have panels on every conceivable topic, many of which—gay rights, reproductive ethics, ecumenical relations, the historicity of the Bible, and so on—are guaranteed to run afoul of some institution’s Statement of Faith. My problem is this: when a panel includes scholars from faith-circumscribed institutions, are we all playing by the same academic rules? When I give a paper, I am giving it my best shot at that moment. It may be wrongheaded or just plain stupid, and I may change my mind tomorrow—perhaps in response to a persuasive argument from some other scholar on the panel–but at that moment, it is sincerely my best scholarly understanding of the question.

The same cannot necessarily be said for faculty at faith-circumscribed institutions. My concern is not that the scholar’s faith leads her to certain conclusions; that’s what we want, and that’s true for all of us, religious or secular.   My concern is that the scholar may be led to conclusions that she is not free to voice publicly, for fear of dismissal.   Imagine a panel discussion on, “Do Jews, Christians, and Muslims Worship the Same God?” a timely topic in view of Pope Francis’s recent remarks on the subject.   Someone who teaches at Wheaton, who is driven by her scholarly investigation to decide that the answer is Yes, must either withdraw from the panel or be less than forthright in her presentation.

So if some, but not all, of us are “giving it our best shot,” on panels and journal articles and symposia, what does that say about our academic life together? Are we truly involved in the same enterprise? I don’t see how that can be the case. And if we are not involved in the same enterprise, what consequences follow from that? If I invest time and money to read a scholarly book, should I avoid those written by scholars from faith-circumscribed schools, because I cannot trust the sincerity of their conclusions? If I am putting together a panel, should I invite scholars from faith-circumscribed schools, knowing that they come with one hand tied behind their backs?

To sum up, I have no idea if Hawkins is right, from an evangelical perspective, that Christian and Muslims worship the same god. And I accept that Wheaton was within its rights to fire Hawkins. But, that forces me to the conclusion that Wheaton and similar schools are not engaged in the same academic enterprise as noncircumscribed schools. The AAR’s mission statement includes the following: Within a context of free inquiry and critical examination, the Academy welcomes all disciplined reflection on religion—both from within and outside of communities of belief and practice—and seeks to enhance its broad public understanding. What can it mean for “free inquiry” if some of us are not free to inquire?

I had to laugh…

I had to laugh. A recent article in Annals of Internal Medicine describes an experiment to determine the “safety and behavioral effect” of disclosing to subjects the pleiotropic effect of the APOE genotype. Pleiotropy describes genes that have more than one effect.  In this case, having the APOE4 version of the gene heightens one’s risk of Alzheimer’s Disease, and also of coronary disease. The researchers concluded that participants could, indeed, handle the information that their genotype also conferred an increased risk of cardiac disease.  I was laughing because, not too long ago, the shoe was on the other foot. In the late 1990s, the pleiotropic nature of APOE4 was a favorite dilemma for bioethicists, for the opposite reason. Most people assumed that it was beneficial to tell people of their increased cardiac risk, given available medication and lifestyle changes, but as Robert Wachbroit wrote, it was ‘medically useless and socially harmful’ to reveal an increased risk for AD. It’s interesting that the perception has flipped, given that we still have no effective interventions for Alzheimer’s Disease.