Everybody’s Talking About Bioethics Now #COVID19

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Since this pandemic got rolling, it seems everyone wants to talk about bioethics “trolley problem” quandaries like how to decide which of three dying patients gets the one ventilator on hand or whether it is okay to lock up healthy people to prevent the spread of a deadly virus. All the boring stuff suddenly got real and real fast, but maybe it’s not that interesting.

You should give the ventilators to the people with the best chance of surviving, right? I think that is how triage works. And, oh, was it all right to tell people to turn off their lights when bombers were flying overhead in the middle of the night? Sometimes even the rugged individualists have to work as a group. The problem is that some of our rugged individualists have never really been put in a position to make tough decisions, so they aren’t prepared.

And that gets us to the real ethical issues here. It is really unethical to be unprepared for emergencies. Experts in many fields have been warning of coming pandemics for at least 15 years. Even George. W. Bush, bless his tiny heart, knew he had to prepare for pandemics, and he at least took at stab at it. And the ever financially minded Barack Obama prepared for pandemics and even dealt with one on his watch. His didn’t get quite so out of hand, of course, and no one should have to tell you why.

So, the important ethical decisions were made years ago, and many of them had to do with the most attention-starved principle of bioethics, justice. The failure to prepare for a public health emergency affects everyone, as we now see, but too many people have always seen efforts to protect public health as efforts to protect “people not like me.” This isn’t always a sign of racism; sometimes it is just pure classism. Some people just don’t hate based on skin color, religion, sexuality, or any of that stuff. They hate poor people of all types.

This is also not a matter of choosing between the “economy” and the needs of working people. Preparing for a pandemic would have meant having mechanisms in place for extensive testing, tracing, and isolation that would have prevented the need to shut down almost all business activities. With proper preparation, the world would have suffered but could continue functioning.

And I guess a lot of Americans really were satisfied with their employer-provided health insurance that they are now losing, because it turns out their employers really never valued them as much as they assumed. It would seem that intelligent and hard working people should always be able to get healthcare, and that’s what we’ve been trying to tell you. You can be hardworking and intelligent and also poor, and maybe it is good that more people are learning this rather difficult lesson right now. Maybe it will help in the future.

But public health isn’t all about health insurance, though turning infected people away from a hospital because they can’t pay is certainly not a good way to protect the public from a pandemic. No, protecting the public health, which is really protecting national security (and global security) is about being able to deal with emergencies, which would require not selling off all the equipment you might need. Most homeowners have never used a fire extinguisher, but the ones who used them successfully were pretty happy they had invested in buying one and taken the time to learn how to use it.

So, yes, more than a decade ago, epidemiologists, virologists, climate scientists, public health experts, public health ethicists, and environmentalists were warning that the world was becoming much more hostile. How do we prepare to ensure our own long-term survival isn’t really as much fun as debating who gets the last ventilator, maybe, but it can save many more lives.

And maybe you’re saying there’s no point in going on about this now as it’s too late. What’s done is done, you’re saying, but this ain’t over, folks. One way or the other, COVID19 will be resolved, but other pandemics will follow along with drought, flooding, mass migrations, and a host of other public health crises that aren’t that hard to imagine if you only try. You may think I’m crazy, but I’m not the only one. Plenty of experts in relevant fields are already imagining the worst and best case scenarios. Maybe it’s time to listen to them.

Pandemics, Climate Change and the Threat of Innumeracy

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Among other things, this pandemic has shown the danger of innumeracy. Over the past few weeks, many have tried to minimise the effects of the pandemic by posting blogs and memes listing absolutely accurate statistics that are also terrifying to the specialists tracking the number of infections. Just for example, many people said a fatality rate of 2.0 (or even 1.0) was about the same as that for influenza. Of course, a fatality rate of 2.0, would be 20 times as bad as the seasonal flu, and even 1.0 would be tens times as bad.

Among those posting information to minimise the effect of the pandemic were healthcare providers, including doctors who work with infectious diseases. Doctors trained in medicine and not risk assessment are not better at assessing risk and probabilities than the general population. The 1982 book, Judgment Under Uncertainty: Heuristics and Biases, edited by Daniel Kahneman, Amos Tversky, and Paul Slovic, examined the ability of people, with several chapters devoted to medical professionals including doctors, to assess risk based on probabilities. People in general, including doctors, just aren’t that good at it.

Subsequent research in medicine has shown similar results. Without specific training in assessing risk based on statistics and probabilities, doctors are no better than the general public at making decisions. We all need a more robust understanding of statistics, probabilities, and risk assessment.

It would help us better understand the risk of pandemics, and it may help us better understand the risk posed by climate change. Many people still think it isn’t a big deal to have the average global temperature increase by 1 degree.

Pandemic, Panic, and Complacency

Crudely, generally, and absolutely not universally, deadlier viruses are easier to contain geographically than milder viruses. Ebola, MERS, and SARS all have much higher mortality rates than Covid-19 and were limited to smaller regions. The obvious reason for this is that sicker people are too sick to spread a virus to the community and the world at large. Covid-19 spreads easily because it appears to be spread in the absence of symptoms and for an extended period of time. People who are infected travel, go to work, go shopping, visit hospitals, and so on.

Quite a few people point out that the mortality rate for Covid-19 may be overstated because an unknown number of people probably contract the virus without ever showing symptoms, so these survivors are not a part of official counts. That’s true, but it is also true that people who have died of pneumonia and other infections may also have had undiagnosed Covid-19. No one knows which group of people is larger, so estimating the mortality rate is still just a guess.

Given that the mortality rate is only a guess, experts have made their best guesses at somewhere between 1.0 and 2.7 percent. The mortality rate for seasonal flu is 0.1 percent. Based on this, Covid-19 will cause from 10 to 27 times more deaths than the flu. 646,000 people die from influenza annually. If Covid-19 reaches a similar saturation, that will mean deaths from 6.5 million to 17.5 million people.

Each year, hospitals and surgeries strain under the burden of treating complications related to seasonal flu. Add a few million cases of pneumonia to the mix, and you have the potential for a fairly daunting problem. Panic doesn’t help anyone, but this is a serious global health event.

On an Emergent Awareness of Impending Death (#fiction #prose #essay)


Sometimes life just smacks you in the face. You’re just minding your own business and out of nowhere comes a big punch to the gut, or, yeah, a slap to the face or whatever. This mostly happens when you’re young. By the time you reach a certain age, if you are so lucky to live that long, you’ll be punch drunk enough, trust me.

Anyway, that’s why she couldn’t believe her rabbit was dying. No, she wasn’t pregnant or anything—her pet rabbit was riddled with tumors and needed to be put down. She’d never lost anyone that close before, and the tears came in waves. She was inconsolable, as you are when you lose something precious.

So she called her mother for comfort, which is a pretty reasonable thing to do, even for someone who is technically grown up and fully adult. Relying on mothers for comfort is a habit many of us never break until fate forces our hand on the matter. She called her mother and told her the devastating news, but her mother wasn’t really as sympathetic as she had expected, so she was a little crestfallen for a minute.

Her mother listened for a minute or two to the tears and lamentations before saying, “You go on like this for your rabbit when you know I have cancer, too?”

It was true that her mother had cancer and she definitely knew about it, but she was still naïve enough to believe doctors could save lives. She had heard of people surviving cancer, so she assumed her mother would be one of those, not one of the unlucky people you hear about in other families. We’re always pretty sure the worst things won’t happen to us, aren’t we?

She would be sadder and wiser soon enough, and maybe the rabbit served as a kind of omen or preparation for what was to come. Maybe it would help her get through the days, months, and years ahead. When you look back on things, it’s hard to say what helped or didn’t as you can’t imagine how bad things might have been otherwise. Trauma and grief can be pretty all consuming, you know, and your imagination for other possible worlds disappears.

You’re just sort of stuck, boxed in, and frozen.

Anyway, that’s how it all started. Tests, promising results, surgeries, promising outcomes, more tests, different doctors, different hospitals, different promises, and different prognoses were all to follow. Sure, the best of us indulge in magical thinking or just wishful thinking, anything to not indulge in despair, even when despair is rationally the correct choice. You pretend that rabbit cancer is categorically different from human cancer. You pretend doctors are magicians. You just get on with it.

Or sometimes you don’t. You decompensate. You look for comfort in anonymous sex, “mood altering” substances, or purely defiant denial. And you’re done for. Death keeps coming, and you find out you’re strong enough to face it down. I know, some people aren’t strong enough to face it down, but anyone reading this has been strong enough so far, so you’ve been strong for a long time.

Keep it up.

Quaker Eugenics: Antinomies and Paradoxes

Some of history’s most famous and infamous hereditarians were Quakers: Samuel Morton, Francis Galton, Karl Pearson, Daniel Garrison Brinton, and Henry Herbert Goddard. In varying degrees, they exhibited a passion for knowledge and scientific research, concern for the improvement of society, and social action. How their association with the Religious Society of Friends (Quakers) influenced their scientific and social undertakings is a matter of some speculation, but an examination of Quaker values and historical trends may shed some light on their endeavours.

The history of the Quaker religions is relatively short, only appearing in England in the 1650s and in America shortly after that. Early Quakers in England, most notably George Fox, opposed the authority of the Church of England and embraced the idea of personal religious authority. In fact, the early Quakers challenged all authority, refusing to doff their hats for anyone and insisting on using the informal pronouns ‘thee’ and ‘thou’. Quakers asserted that God is within every person and that honesty and simplicity were required of a religious life. Quakers were seekers of knowledge and truth and were suspicious of wisdom received by others.

Whilst their views may not seem surprisingly radical in the twenty-first century, it caused a multitude of problems in the seventeenth century. Quakers frequently encountered conflict with authorities and endured lengthy confinement in prison and even executions. Partly as a result of this history, it would seem, Quakers often took up the cause of prison reform and were (and are) adamantly opposed to the death penalty. They opposed violent conflict of any kind. Their belief that God is within every person led them to accept women as spiritual and political leaders. For the same reason, Quakers opposed slavery early in their history. It is surprising, then, that so many famous hereditarians and even outright eugenicists were Quakers. A brief overview of some prominent individuals and institutions in Quaker history may help unravel the paradoxes of Quaker history.

One of the earliest Quakers, Mary Dyer, was herself accused of producing undesirable offspring. First an Antinomian and later a Quaker, she first appears in the public record in 1637 after becoming the mother to a ‘monstrous birth’. Antinomians preceded Quakers slightly in history, arising in the early seventeenth century. Antinomians were also slightly more radical, rejecting all authority to the point that by today’s standards they might be considered anarchists. Massachusetts Governor John Winthrop wrote tracts connecting Antinomian women and monstrous births, especially Mary Dyer and Anne Hutchinson. After attention came to the birth, the baby was exhumed and Anne Hutchinson was identified as one of the midwives. Winthrop wrote, ‘Then [Hutchinson] confessed all, yet for further assurance, the childe was taken up, and though it was much corrupted, yet the horns, and claws, and holes in the back, and some scales, &c. were found and seen of above a hundred persons’.[i] For Winthrop and others, ‘monstrous’ births were evidence of God’s intent to expose Antinomian heresy. Giving birth to a monster was equated with actually being a monster. Dyer would not become a Quaker until the 1650s, and the idea that sins are passed from parent to child is as old as Christian theology, of course, but Dyer’s experiences set an interesting precedent for the future of Quakers and inherited defects.

Dyer became a Quaker whilst in England. She had gone to England with her husband, who was on an embassy to Parliament. Quaker men and women often took a missionary role and endured long prison sentences as a result. Dyer returned to America in 1657 only to be arrested with two other Quaker missionaries, William Robinson and Marmaduke Stephenson. She was released briefly to Rhode Island but was again arrested when she returned to visit Robinson and Stephenson. They were banished but chose to challenge the law and were eventually sentenced to death. Dyer was forced to witness the hanging of her friends and prepared for execution, but she was given a reprieve at the last moment. She refused to step down from the scaffold and was forcibly removed and banished once again. After being again sentenced to death, she wrote to the Massachusetts General Court, ‘In Love and Spirit of Meekness I again beseech you, for I have no Enmity to the Persons of any; but you shall know, That God shall not be mocked’.[ii] On June 1, 1660, Mary Dyer became the only woman ever executed as a Quaker.[iii] Mary Dyer is now being recognised in the history of feminism. Anne G. Myles says, ‘Mary Dyer and other early Quaker women are at once the great inheritors and progenitors of women’s resistance—resistance to unjust laws and the manifest institutions of power, to that power as it is mediated through the policing of gender norms, and to both of these factors’ capacity to silence women who step out of bounds’.[iv]

In England, both Quakers and Puritans opposed the authority of the Church of England, but in America they opposed each other. The Quaker belief that God was in everyone combined with extreme pacifism and righteous indignation with those who disagreed caused them many problems. Early Quakers opposed war and defended the rights of slaves, women, and the mentally ill. Partly as a consequence of their own oppression and imprisonment, Quakers resisted harsh, dehumanizing, and demeaning punishments.

The Religious Society of Friends arose in the years of 1652–1656 in England, but Quakers began meeting in America at about the same time. These new Friends would sometimes tremble with fervor and became known as Quakers. In early Quaker gatherings, men and women would sit in silence to wait upon the Lord for spiritual guidance and revelation from the light within. The light is sometimes referred to as the Light of Christ or the Light of God. Quakers rejected the idea that a religious authority was necessary to interpret the Bible or spiritual leadings of God. At these meetings, George Fox emerged as a leader of the Quaker movement. Becoming a Quaker required at first to become ‘convinced’ of the truth of Quaker beliefs followed by a slower conversion to a life of inward discipline. Quaker values included pacifism, simplicity, and integrity.[v]

Given the quality of the Quaker values, it is not surprising that the first opposition to slavery in America came from Quakers. In 1688, Quakers in Germantown, Pennsylvania spoke out against the evils of slavery.[vi] David Lovejoy notes that Quaker opposition to slavery increased during the eighteenth century based on Quaker values of equality. He says, ‘For each and every man, regardless of race, was capable of receiving the light if he would but give himself over to it. Religiously, then, Quakers had an inbred sense of equality which, by the middle of the eighteenth century, they brought to bear upon several social problems about them’.[vii] Given the egalitarian nature of Quaker values, the strong opposition to slavery seems unavoidable. The surprise is that later Quakers would become known as the first ‘racial’ scientists.

Among the most influential Quakers in America was William Penn, who had friendships with both George Fox and John Locke. Penn attempted a bold experiment and set out to create a society that embodied the Quaker values and followed the blueprint of a Lockean democracy. When Penn encountered Native Americans in Pennsylvania, he wrote, ‘The worst is that they are the worse for the Christians, who have propagated their vices and yielded them tradition for ill and not for good things’.[viii] Describing Penn’s field report on Native Americans, Frederick Tolles and Gordon Alderfer write:

What is impressive about Penn’s field report on American Indians is the same thing that was exceptional about his practical relations with them—his freedom from the prejudice against ‘savagism’ that colored most 17th century accounts of Native Americans. Because he took them for what they were—no less human, no less endowed with Inward Light than white men—he was able to appreciate and understand their culture in something of the spirit of the modern anthropologist.[ix]

Penn was aware of the negative effects Christian settlers had on natives of America. He attempted to establish a social system that would ameliorate these effects and establish an order of respect for the worth and necessary freedom of all. His Quaker ideals may not have been fully realised, and we will see that Quaker efforts often have unintended consequences and apparent contradictions.

John Howard, for example, was a Quaker prison reformer in England who died in 1790. He testified before the House of Commons in 1774, and many of his recommended reforms had been instituted in England’s jails. Howard was a supporter of providing separate cells for prisoners and providing them with ‘silence, solitude, and meditation’. In other words, he brought solitary confinement to England’s prisons.[x] On his use of solitary confinement, Janet Whitney says,

He practiced them with disastrous effects on his only son. He left them as a terrible legacy to the boys of Christ’s Hospital whose solitary punishment dungeons, instigated by him, were responsible for more than one case of hysteria and insanity. And we see Howard’s system of solitary confinement as one of the most dreaded and dehumanizing agencies in the run of British prisons today.[xi]

That Howard practiced such confinement on his only son indicates that it was not a lack of compassion that guided him, but a lack of foresight of the consequences of his theory. This phenomenon is not unique to Quakers, of course, but the history of Quakers and the treatment of prisoners and the mentally ill shows many well intentioned errors of judgment.

In 1796, English Quakers began a more successful experiment in the treatment of mental illness that continues today. After visiting a Friend who was in the York Asylum, concerned Friends enlisted the help of William Tuke, a Quaker tea merchant, to raise funds for an alternative asylum. The result was The Retreat, a mental hospital that emphasised humane treatment of patients, providing useful occupation, resocialization, and a harmonious environment. The hospital remains a Quaker ministry and now has 160 beds.[xii]

In 1813, Quakers in the United States followed the lead of their English counterparts and opened the Friends Asylum for the Relief of Persons Deprived of the Use of Their Reason. Before Friends Hospital, as it is now called, opened, Philadelphians could pay a shilling to see men and women chained in the dank basement of Pennsylvania Hospital. The Quakers were outraged and wanted to provide ‘moral treatment’ for the mentally ill. The Quakers insisted that patients be given private rooms with windows, compassion, conversation, and the opportunity to walk about the grounds. The Quaker model was adopted by the State Lunatic Asylum at Harrisburg when it opened in 1851. The Friends hospital itself was based on The Retreat in England after Thomas Scattergood, a Philadelphia tanner, visited the hospital at York. The Friends hospital still operates on the model of ‘moral treatment’. Dr. James M. Delaplane, director of the hospital, said, ‘The Quakers did not believe that you should hurt people to make them behave in certain ways and neither do we today’.[xiii]

Although Quaker Elizabeth Fry does not appear to have known John Howard, she was his immediate successor in prison reform in England, though with less disastrous effects. One major difference between Fry and her predecessor is that she was concerned only with female prisoners. She felt female prisoners needed a separate prison staffed by female wards. She managed to gain approval for an experimental prison at Newgate. Of her success, she said:

Our rules have certainly been broken, but very seldom. . . . I think I may say we have full power amongst them [the women] for one of the said it was more terrible to be brought up before me than before the judge, though we use nothing but kindness. I have never punished a woman during the whole time, or even proposed a punishment to them; and yet I think it is impossible, in a well-regulated house, to have rules more strictly attended to.[xiv]

Fry’s success at Newgate expanded her views on the role of women both as prison reformers and as social activists. She encouraged better treatment in prisons, hospitals, lunatic asylums, and workhouses. She encouraged women to move beyond the domestic sphere to help bring about much needed reform. She also exhorted women to visit women incarcerated in all the above institutions, saying, ‘Were ladies to make a practice of regularly visiting them, a most important check would be obtained on a variety of abuses’.[xv] Elizabeth Fry is remembered for her strong advocacy for women and Quaker values. Concern for prisoners and the mentally ill is consistent in Quaker history, sometimes bringing improved conditions and sometimes having less desirable effects.

Abby Hopper Gibbons was an American prison reformer and social activist in the late nineteenth century. She worked with Josephine Shaw Lowell to improve condition of inmates at asylums and prison with particular attention to the women. One of Gibbons’ goals was to have women supervise female inmates.[xvi] In a letter to New York Governor Samuel Tildon in 1882, she appealed to her experience as a Quaker in confronting social problems, saying:

A Friend by birth and education, my path in life has been of a character so practical as to leave no doubt as to the feasibility of selecting women of known capacity and sound common sense. In the sect or out of it we claim no superiority on any ground nor do we confine our experience to a limited class. Largely associated with both men and women in charitable work, I have seen the advantage of cooperation and have noted progress in the internal management of the affairs and institutions. This is conceded by our best men who are glad to have women share the responsibilities and active service for which they are especially fitted. And after all, why should it be more difficult to find women than men?[xvii]

In addition to her work in the prisons and mental institutions, she was also concerned with other women’s issues, including prostitution. She was appalled by the moral double standard imposed on women when it came to vice. As a leader of the moral purity movement, she opposed legislation intended to regulate prostitution and reduce disease. Abby Gibbons argued forcefully for the protection of prostitutes, but her solution may have been to provide more harsh punishment than what already existed. She advocated reformatories to help educate prostitutes in better means of employment (better as defined by the moral purity movement leaders). Margaret Hope Bacon makes this comment on Gibbons’ plan:

These reformatories had been advances over the jails of the period, but the staff treated the inmates as tractable children to be trained and urged indefinite sentences in which this training could take place. Thus, prostitutes arrested and sent to reformatories would actually be deprived of their liberty more harshly than men picked up on any comparable charge.[xviii]

Once again, the effort to care for others and give solutions to their problems can easily become an effort to control others. The liberator sometimes becomes an oppressor. The belief that God is in every woman might mean that every woman’s life must be respected, but Quakers often believe the light of God must be nurtured even when such nurturance takes some amount of involuntary loss of liberty.

Josephine Shaw Lowell worked with many Quakers and was a philanthropist and reformer as well. According to Nicole Hahn Rafter, Lowell is not referred to as a eugenicist in most biographies. Rafter suggests this may be because Lowell died in 1905 before the term ‘eugenics’ became popular. Nonetheless, Rafter credits Lowell and her collaborators with starting eugenic criminology at the Newark Custodial Asylum for Feeble-minded Women. Lowell wanted both to improve conditions for those in asylums and to prevent the need for asylums in the future. She advocated a strong program of eugenics to prevent degeneracy.[xix]

Samuel Morton spent a good deal of time in the nineteenth century measuring skulls for cranial capacity. He believed that brain size was a good predictor of intelligence. He did not appear, however, to have an active political agenda. As a Quaker, he was opposed to slavery, but he did not believe all humans to be of equal intelligence. Despite his apolitical approach, his contemporaries used his research to political ends. One such contemporary was the openly racist phrenologist Charles Cauldwell, and another was Morton’s colleague Josiah Nott, a physician in the state of Alabama.[xx]

Francis Galton is often considered to be the father of British eugenics. Galton was born in a Quaker family, though this fact is often obscured in descriptions of his life. One might think his Quaker heritage was not important to either Galton or his collaborators, but Karl Pearson, another British hereditarian following in Galton’s footsteps, placed much importance on Galton’s heritage. Pearson, also a Quaker, credited Galton’s Quaker heritage for his brilliance. He said, ‘Not only did the Society of Friends unite men religiously but it produced special temperaments genetically . . . Almost a biological type’.[xxi] One must wonder whether Pearson was being intentionally ironic by labelling members of a particular religion as a biological type. Although Galton is considered the father of eugenics and given some measure of blame for the eventual racist and fascist aims of many eugenicists by many, Daniel Kevles claims that Galton was no more racist than most Victorians in England. Kevles claims that British eugenics had more to do with class than race.[xxii]

Galton sought to regulate marriage according to the quality of potential parents. Galton, like Morton, felt that intelligence could be measured by measuring the size of one’s head. He also felt that other traits, such as a strong work ethic, were heritable. When his cousin, Charles Darwin, told him that he had previously thought that men were roughly equal in intellect but differed only in ‘zeal and hard work,’ Galton replied that ‘character, including the aptitude for hard work, is heritable like every other faculty’.[xxiii]       One might think that Galton’s work has now been relegated to the historical record, but he is still seen as a creditable scientist by many, just as he was in his own time. The August/September 2008 issue of Scientific American Minds says of Galton,

In 1883 English anthropologist and polymath Sir Francis Galton dubbed intelligence an inherited feature of an efficiently functioning central nervous system. Since then, neuroscientists have garnered support for this hypothesis using modern neuroimaging techniques.[xxiv]

It is hard to see how neuroimaging could verify the results Galton discovered by measuring the circumference of skulls, but this passage serves to highlight the place of distinction Galton held and still holds. Galton’s advocacy for restricting marriage and family size again seems to be counter to his Quaker heritage. Contrary to Pearson’s comments on Galton’s Quaker heritage, it does not appear that his theories or the practices he advocated were based on Quaker teachings. Pearson’s comments seem to claim that Quaker families are ‘good’ in the sense of being respectable rather than of being moral. By the nineteenth century Quakers had gone from being outsiders always in conflict with the law to being respectable and affluent members of society. It was Galton’s affluence that enabled him to pursue his research, after all, more than his dedication.[xxv]

Galton’s immediate successor was Karl Pearson, a British socialist and Quaker. Pearson, though, had doubts whilst still at King’s College and later whilst studying in Germany. By the time he returned to England, he had become more of an agnostic and an adherent of Spinoza’s philosophy, which proved the existence of God but equated God more with the universe than the spiritual power most Christians worship. Whilst in Germany, Pearson was contemptuous of students studying Darwin’s evolution looking for solutions to social ills. He was instead attracted to German idealism and historicism. Following the ideas of Hegel and Fichte, he believed that moral and social progress was best expressed through the state. In the late 1880s, Pearson changed his mind on Darwin when he came in to contact with social Darwinism that replaced competition among individuals with competition among groups.[xxvi] Pearson did not advocate radical direct action to bring about a socialist state. Rather, he felt a socialist state should emerge slowly following the work of intellectuals. He felt it was up to the ‘power intellectual’ to guide society.[xxvii]

Pearson headed the Galton Eugenics Laboratory in Britain, but he ‘refused to join the Eugenics Education Society, to participate in political activity, or to make available his institutional resources and expertise for the support of legislative measures’.[xxviii] Pearson was intent on establishing eugenics as an academic discipline, and he felt that the social activists associated with the eugenics movement were doing it harm in that area. Pearson did not like to be involved in political activity and preferred to promulgate his research through academic journals and learned talks and activities. He was a racist who disparaged both Jews and Blacks, but he took pleasure in shocking a Newcastle cleric by saying that Adam, the source of all humans, must certainly have been ‘Negroid’.[xxix] It is tempting to say that Pearson’s temperament may have resulted from his Quaker upbringing, which was stern, especially from his father, but that his theories had little to do with Quakerism. His comments on Galton’s Quakerism show that he admired Quakers generally, though, so he was not completely divorced from its ideas. Many Quakers of his time had moved toward socialism of varying sorts. Nonetheless, Pearson did not seem to be following Quaker faith. Instead, he appeared to be following intellectual trends of his time rather than the much older teachings of his religion.

Born of Quaker descent, Daniel Garrison Brinton was a leading American ethnologist who produced prolific publications on race and, more specifically, race inferiority. He divided races into categories ranging from savage to half-cultured to enlightened. He argued that Africans, Native Americans, and Chinese had failed to produce ‘empires’ for want of developed minds. Brinton was adamant that there must be no mixing of the Caucasian race with other races. He said that miscegenation would bring ‘indelible degradation’ to the descendents of the white partner. He put the burden of keeping society stable on the shoulders of white women. He said that only the woman could preserve the ‘purity of the type’. His pronouncement simultaneously established the superiority of the white man whilst relieving him of any responsibility for preserving social order.[xxx] The original tenets of the Quaker heritage appear to have been lost in the mind of Brinton. Lee Baker says of him:

Although his Quaker background and these obituaries raise some intriguing questions, they demonstrate how deeply ingrained notions of white supremacy were even among putative radical scholars and activists, how accepted notions of racial evolutionism were among the intelligentsia regardless of political orientation, and how integral notions of racial hierarchies were to anarchist ideology during the last decade of the nineteenth century.[xxxi]

In short, views on racial inferiority seemed to override egalitarian concerns that are a part of Quaker faith.

Henry Herbert Goddard was reared as a Quaker, and he never abandoned his faith, even if he seemed to have gone far afield of the idea of equal human worth. He was taught Darwinian evolution in school at Providence as a matter of fact. A classmate of Goddard’s said that the instruction enabled Quakers to follow scientific debate without any ‘wreckage of faith’.[xxxii] Though they seem contradictory, Goddard never lost his faith as Pearson had done. Indeed, Goddard seemed to feel his efforts in eugenics would help society by creating more individuals of moral worth such as Quakers. In his study of the ‘Kallikak’ family, he overtly equates ‘Quaker family’ with ‘good family’. Goddard’s steadfast faith, indeed, may have helped him be less steadfast with his intellectual theories.

Goddard conducted a study of the ‘Kallikak’ family in a classic study of hereditary feeble-mindedness. In his study, he asserted that Martin Sr. had two lines of descendents, one beginning with a feeble-minded woman named Deborah and another with a good Quaker woman. He describes the two lines of descent from Martin as follows:

The Kallikak family presents a natural experiment in heredity. A young man of good [Quaker] family becomes through two different women the ancestor of two lines of descendents: the one characterised by thoroughly good, respectable, normal citizenship, with almost no exceptions; the other being equally characterised by mental defect in every generation.[xxxiii]

To solve the problem of inherited degeneracy, Goddard proposes a system of segregation and colonization for the feeble-minded. He sees this as the best way to improve conditions for society. His plan of action is bold, direct, and full of latent prejudice. Goddard’s conclusions would seem to go against the belief that all have God within them, but Goddard’s continued faith in Quakerism, at least nominally, is reflected in how he describes Martin’s courtship of his wife. He says:

During the summer of enforced idleness he wooed and won the heart of a young woman of good Quaker family. Her shrewd old father, however, refused to give his consent. To his objections, based on the ground that Martin did not own enough of the world’s goods, the young man is recorded as saying, “Never mind, I will own more land than ever thou did, before I die,” which promise he made true.[xxxiv]

Goddard seems to view Quakerism as a sign of moral goodness, but he does not, at this time of his life, seem to equate Quakerism with any particular social obligation. He was perhaps too caught up with his research or too impressed by the exciting developments in science to recognise his own prejudice and the negative consequences of prevailing attitudes and practices.

In later life, Henry Herbert Goddard, who had advocated strict eugenic laws, always felt obligated to social commitment. He attempted to follow Quaker values throughout his life, but his later life seems to have had greater humility and sincere devotion. Of his later life, Leila Zenderland says, ‘He committed himself to various causes, sending not only money but also letters containing advice or expressing ‘a concern’ – as we Quakers say’.[xxxv] He supported Einstein’s Emergency Committee of Atomic Scientists, which opposed the use of nuclear weapons. He would not support the Committee on United Europe because it took a hard line with Stalin, and he said, ‘A soft answer turneth away wrath’.[xxxvi] In these later years, Goddard championed gentle parenting and a peaceful demeanor. On intelligence, he decided that there was not enough information about genes to say that intelligence was inherited. He said only that ‘we know enough to safely conclude that the possibilities of variation are great’.[xxxvii] When he was nearly eighty, he sent a Christmas letter, and Deborah Kallikak was among the recipients. Helen Reeves, one of Deborah’s teachers, said that Deborah’s reaction was to say, ‘The nicest thing about it . . . is that he thought I had the brains to understand it which of course I do’.[xxxviii]

Another prominent Quaker of the twentieth century, Jean Toomer, stands in contrast to judgmental theorist such as Goddard. Toomer was a prominent author during the Harlem Renaissance. He was born in 1894 and did not become a Quaker until 1940 after attending meetings for about five years. During his years as a Quaker, he became a sought after speaker and leader with special interest in teaching young people. Rather than social activism, he advocated inward change. He wrote, ‘If we are to consider politics, then surely it should be our aim to come nearer to the Politics of Eternity rather than express views about the politics of our time’.[xxxix] But in 1947 he expressed himself a little differently on the need for inward development and social change: ‘The truth is that both approaches are needed. I have stressed the necessity of inward change because it is relatively neglected in our day’.[xl] Toomer judged himself to be somewhere between one-eighth and one-sixteenth black. He lived among Blacks, whites, and Jews. Perhaps as a result of his own mixed heritage, he opposed attempts at racial categorization. He saw racial purity as a myth and felt that rejection of the idea of race could help to unite individuals as part of the human race.[xli] He said, ‘Human blood is human blood. Human beings are human beings. . . . No racial or social factors can adequately account for the uniqueness of each—or for the individual differences which people display concurrently with basic commonality’.[xlii] Toomer returned to the original Quaker ideal that God is within each person.

Lancelot Hogben lived from 1895–1975 and was a biologist who held, among other positions, a chair in social biology at the London School of Economics. He was a humanist and social radical. He sought the development of a rationally ordered society but opposed the efforts of eugenicists. Although he later described himself as an atheist, he practiced Quaker ethics for his entire life.[xliii] This is not inconsistent with Quaker practice. Many Quakers, especially liberal Quakers of the twentieth century and later, define God in abstract terms, even embracing atheism and defining God as the universe. But even in 1648, Quaker Gerrard Winstanley declared that Christ ‘is not a single man at a distance from you but the indwelling power of reason’.[xliv] This may help to reconcile Hogben’s Quakerism with his exclamation, quoted by Daniel Kevles, ‘I’m an atheist, thank God’.[xlv] Kevles also credits Hogben with convincing Julian Huxley that his views on the unemployed would only help foster Nazism.[xlvi] Hobgen rejected eugenics and favored instead humanistic socialism, hoping always to help bring about an ordered world free from war and poverty.

Whilst Quaker history is filled with people in all periods who resolutely defended the worth of each individual with an egalitarian zeal, a number of changes took place in the nineteenth century. Between 1860 and 1880, the Society of Friends in the United States experienced a revival. After a decline in the numbers of Quakers in the United States in the early part of the nineteenth century, large tent meetings spread to both coasts in the latter part.[xlvii] This is somewhat misleading, however, as it obscures the growing schisms within the Quaker community, which was no longer a single community. Indeed, Quakers in the later nineteenth century divided into factions so different that an outsider would probably not recognise that they were of the same faith tradition. Quaker historian Howard Brinton says,

There were then in the second half of the nineteenth century in America three kinds of Quakers designated by the names of three persons. The Hicksites represented the more mystical, liberal, noncreedal branch; the Gurneyites, the more evangelical, authoritarian and theologically conservative branch; and the Wilburites, a branch whose position was between the other two.[xlviii]

The Hicksites were the most liberal of the three groups both socially and politically. The Hicksites would continue to fight racism, oppose war, and insist on each individuals right and responsibility to seek meaning and follow his or her conscience. The other branches were more conservative socially and maintained the severity of their Quaker forbears, continuing to stress a devotion to religious life and Christ. The conservative branches also established creeds, whilst the liberal branch remained without creed or doctrine. The creeds stressed justification and sanctification and resembled mainline protestant religions more than early Quaker religions. Both Herbert Hoover and Richard Nixon were Quakers, and it seems impossible they could be of the same faith as Jean Toomer and Lancelot Hogben, but the branches are so different that it is consistent with modern Quakerism to produce such diverse individuals.

The apparent paradoxes in the actions of Quakers stemmed partly from changes in the religion, partly in changes in society, and, occasionally, simply from changes in individuals. The early Quaker religion was a religion of radical outsiders who were treated as an underclass both in England and America. These radicals had to fight for the right to even exist, and they were forced at every turn to demand humane treatment. For these Quakers, it was impossible to imagine a loving God that would tolerate inhumane treatment of anyone. They recognised God in every individual and felt that the abuse of anyone was an abuse of God. For this reason, they opposed harsh treatment of criminals, especially the death penalty, and fiercely resisted war in all its forms. These Quakers recognised the equality of races and the rights of women and children. It is no surprise, then, that early Quakers would oppose slavery and the harsh treatment of the mentally ill and prisoners.

By the later nineteenth century, though, Quakers had become more established. Many were now affluent, and Quakers such as William Tuke and Johns Hopkins could afford to donate large sums of moneys to fund institutions. Other Quakers, such as Francis Galton and Karl Pearson could afford to travel the world and attend the best schools. Rather than being outsiders, Quakers could now affect social policy and legislation. Of course, some Quakers would want to enforce their religious severity on others. For many, what might now be called ‘clean living’ was an obvious solution to social problems. Abby Hopper Gibbons would support the moral purity movements. Quakers of this period were likely to believe they had achieved their status in society through purity and religious rigor. The compassion that drove early Quakers to seek freedom for slaves and prisoners now translated into a desire to care for others by exerting some control over their choices.

The nineteenth century also showed shifts in scientific thinking, especially after Darwin’s work became widely known. As mentioned above, many Quakers of this period could afford to attend leading universities in the United States and Europe. The basic tenets of genetic determinism and social Darwinism were presented to many students as facts just as they are today. Quakers concerned with improving society would of course turn to the latest theories from leading scientist of the time. Indeed, it is not surprising that Quakers joined progressive movements and sometimes embraced socialism of varying sorts. The later nineteenth century was a turning point for Quakers as it was for society writ large. Quakers divided into many factions depending on which Quaker values seemed of greatest importance to them. In the ensuing decades, the liberal branch of Quakerism is the only one to remain without a creed in the United States. Hicksites are now members of the Friends General Conference (FGC), which still opposes discrimination, harsh punishments, and war. The modern FGC is also tolerant of universalism (the belief in universal salvation or universal worth) and even atheism or agnosticism. The past involvement of Quakers in eugenics and racial purity movements should serve as a reminder to contemporary Quakers that moral hazards are always present.


            [i] Anne G. Myles. ‘From Monster to Martyr: Re-Presenting Mary Dyer’. Early American Literature. 36:1, 2001, 3.

            [ii] Myles, 3-7.

            [iii] Myles, 3-7.

            [iv] Myles, 18.

            [v] Brinton, 1-15.

            [vi] David S. Lovejoy, ‘Samuel Hopkins: Religion Slavery, and the Revolution,’ The New England Quarterly, 40:2, 1967, 228.

            [vii] Lovejoy, 229.

            [viii] Frederick B. Tolles and E. Gordon Alderfer, The Witness of William Penn (New York: Octagon Books, 1980), 125.

            [ix] Tolles and Alderfer, 124.

            [x] Janet Whitney, Elizabeth Fry: Quaker Heroine (Boston, Little Brown, 1940), 227-228.

            [xi] Whitney, 228.

            [xii] Quaker Tour of England, The Retreat Mental Hospital. www.quakerinfo.com/qt_retr.shtml, accessed July 31, 2008.

            [xiii] Debbie M. Price, ‘For 175 Years: Treating Mentally Ill With Dignity,’ The New York Times. April 7, 1988.

            [xiv] Price, 229.

            [xv] Price, 255.

            [xvi] Margaret Hope Bacon, Abby Hopper Gibbons: Prison Reformer and Social Activist (New York: State University of New York Press, 2000), 145 – 160.

            [xvii] Bacon, 156.

            [xviii] Bacon, 155.

            [xix] Nicole Hahn Rafter, Creating Born Criminals, (Chicago: University of Illinois Press, 1997), 35-50.

            [xx] Milford Wolpoff and Rachel Caspari, Race and Human Evolution (New York: Simon and Schuster, 1997), 89.

            [xxi] Gerald Sweeny, ‘Fighting for the Good Cause: Reflections on Francis Galton’s Legacy to American Heriditarian Psychology,’ Transactions of the American Philosophical Society, 91:2, 2001, 29.

            [xxii] Kevles, 76.

            [xxiii] Stephen J. Gould, Mismeasure of Man, (New York: W. Norton & Co., 1996), 108-109.

            [xxiv] Christian Hoppe and Jelena Stojanovic, ‘High-Aptitude Minds,’ Scientific American Minds, August/September 2008, 61.

            [xxv] Gould, 107.

            [xxvi] Kevles, 23.

            [xxvii] Kevles, 24.

            [xxviii] Kevles, 104.

            [xxix] Kevles, 76.

            [xxx] John S. Haller, ‘Race and the Concept of Progress in Nineteenth Century American Ethnology,’ American Anthropolgist, New Series, 73:3, 719 – 721.

            [xxxi] Lee D. Baker, ‘Daniel G. Brinton’s Success on the Road to Obscurity, 1890 – 99,’ Cultural Anthropology, 15:3, 412.

            [xxxii] Zenderland, 31.

            [xxxiii] Henry Herbert Goddard, The Kallikak Family (New York: Arno Press, 1973), 116.

            [xxxiv] Goddard, 99-100.

            [xxxv] Zenderland, 337.

            [xxxvi] Zenderland, 337-338.

            [xxxvii] Zenderland, 338.

            [xxxviii] Zenderland, 338-339.

            [xxxix] Kerman and Eldridge, 267.

            [xl] Kerman and Eldridge, 267.

            [xli] Kerman and Eldridge, 341-342.

            [xlii] Kerman and Eldridge, 342.

            [xliii] Max Perutz, ‘Friendly Way to Science,’ Times Higher Education. www.timeshighereducation.co.uk, accessed August 4, 2008.

            [xliv] Godless for God’s Sake: Nontheism in Contemporary Quakerism, ed. David Boulton (Dent, Cumbria: Dales Historical Monographs, n.d.), 88.

            [xlv] Daniel J. Kevles, In the Name of Eugenics: Genetics and the Uses of Human Heredity, (Berkeley: University of California Press, 1985), 124.

            [xlvi] Kevles, 127.

            [xlvii] Zenderland, 18.

            [xlviii] Brinton, 234.

When the hospital refuses to provide treatment

Few things are as horrifying as the idea that a hospital might refuse to treat you or a loved one at a time of crisis. This is so frightening, that many used the specter of “death panels” to terrify Americans from supporting the Affordable Care Act, which had no provision for such panels. All the same, we don’t get to go into hospitals demanding whatever treatments we think are appropriate. Doctors, other medical caregivers, and insurance companies all have a say over what treatments are acceptable for various conditions.

One of the most common issues before Hospital Ethics Committees is futility. In all the cases I experienced personally, a family member demanded treatment for loved ones that threedoctorsdoctors deemed inappropriate as they felt it offered no benefit to the patient. In most of these cases, the patient was either dying or already pronounced brain dead when the conflict arose, but other types of conflict over futility arise from time to time.

For a less grave example, consider people who get a cold or cough and go into the doctor demanding antibiotics to treat what is generally a viral infection. Some doctors might prescribe antibiotics just to appease their patients, but others will refuse on the grounds that the treatment offers no benefit to the patient while carrying both costs and some risks. (If you prefer an even more absurd example just to illustrate the point, imagine someone demanding cholesterol medicine to treat a broken arm.) This type treatment is futile because it will have no effect on the condition being treated.

Another kind of futility is both more common and more serious in its consequences. These cases often, though not always, involve infants on ventilators or elderly patients receiving artificial nutrition (feeding tubes) and hydration. In these cases, doctors and the family or other surrogates agree that the feeding tubes or ventilators are keeping the patient alive, but disagree on the value of doing so. In some cases, the patient may be suffering and medical providers feel the patient’s suffering makes it unconscionable to continue treatment. In other cases, the patient may be in a permanent state of unconsciousness or even be brain dead, and the healthcare providers feel the patient no longer exists as a person in any real sense. All the qualities associated with life (consciousness, will, pleasure) are already gone, so treatment has no use.

Few forces in the world are as powerful as the duty we feel to protect our children or to care for our parents or other loved ones. The one comfort we take in the face of such a devastating loss is that we “did everything we could.” When doctors tell us that doing “everything” is costly, painful, and of no value, it can be more than painful to accept. Complicating matters is that most of us have heard of miracle cases where people recovered despite dire prognoses. When told that no more than one in a million patients survive such a condition, family members often only hear that there is some chance of survival. It is a point of honor that they will “never give up” on their child or parent.

I’ve seen doctors handle futility with great skill and also with awkwardness. In one case, a man was convinced the hospital was abandoning his wife at the time she most needed care. The man felt the doctor was expressing the needs of the hospital rather than the needs of his wife. Once he was reassured that she would be cared for even in the absence of treatment, he felt much better about discontinuing treatment. In another case, the doctor made every effort to assure the parents of an infant that she and the entire staff would stay with them throughout the ordeal and do everything possible to reduce both the suffering of the child and the pain of the parents.

It is impossible, of course, to eliminate all disagreements and conflict, but I think doctors who are able to effectively communicate empathy and concern for the patient and the people who love the patient have greater success at avoiding battles with patients. We all want to know our experiences are recognized and validated. We all want to be heard. We also want the dignity of our loved ones to be promoted and protected, especially as they face death, which strips them of autonomy and self-respect. We want healthcare providers to recognize that we hold our dying loved ones in the highest regard even if they can no longer speak for themselves and show why they are worthy of such respect. When we fight for their lives, I think we are really fighting for their dignity and worth as a person. Doctors will do well to keep that in mind.

The Proper Way to Grieve for a Child: Cicero’s Example

Epictetus stated he would embrace death before...
Epictetus stated he would embrace death before shaving. (Photo credit: Wikipedia)

In advising us on how to respond when we encounter someone who has lost a child or suffered an equally calamitous loss, the stoic philosopher, Epictetus said, “Don’t reduce yourself to his level, and certainly do not moan with him. Do not moan inwardly either.”  These negative emotions are dangerous to us and to others, so we must be sure to keep them in check.

This sounds harsh, but Epictetus also advises us not to beat ourselves up when we do give over to grief. He says, “Some who is perfectly instructed will place blame neither on others nor on himself.” Epictetus assures us that death is not to be feared, and our terror of it comes from within, but blaming ourselves for our feelings is also pointless.

Scottish philosopher David Hume, reflecting on the nature of tragedy in art, makes a comment about the best way to comfort a parent who has lost a child. Hume says, “Who could ever think of it as a good expedient for comforting an afflicted parent, to exaggerate, with all the force of elocution, the irreparable loss which was met with by the death of a favorite child?” I’m sure Hume is right that we shouldn’t exaggerate the loss, but I would also advise against minimizing the loss in any way, which is what Cicero’s friend, Servius Sulpicius Rufus,  did after the death of Cicero’s daughter, Tullia.

David Hume
David Hume (Photo credit: Wikipedia)

Sulpicius said, “If you have become the poorer by the frail spirit of one poor girl, are you agitated thus violently? If she had not died now, she would yet have had to die a few years hence, for she was mortal born.” Sulpicius sounds harsh in this instance, but this is actually offered only after he introduced the topic, saying, “If I had been at home, I should not have failed to be at your side, and should have made my sorrow plain to you face to face. That kind of consolation involves much distress and pain, because the relations and friends, whose part it is to offer it, are themselves overcome by an equal sorrow.” If he had been available, he would have comforted Cicero and perhaps avoided the need for such harsh and critical words later, apparently.

Cicero, Kopiezeichnung einer Büste aus London ...
Cicero, Kopiezeichnung einer Büste aus London (Herzog Wellington) (Photo credit: Wikipedia)

Cicero expressed his gratitude for the comforting words laced with recrimination, but also acknowledged their ineffectiveness, saying, “For I think it a disgrace that I should not bear my loss as you – a man of such wisdom – think it should be borne. But at times I am taken by surprise and scarcely offer any resistance to my grief, because those consolations fail me.”

Cicero had also been writing consolations for himself, and he felt himself the inventor of this type of self-help. He said, “Why, I have done what no one has done before, tried to console myself by writing a book.” (This is quoted by Han Baltussen in the Nov. 2009 issue of Mortality in an essay titled, “A grief observed: Cicero on remembering Tullia.”) Unfortunately, Cicero’s Consolations have not survived the passage of time, so we can only infer what they may have said. In a letter to Titus Pomponius Atticus, Cicero remarked that he wrote in order to heal, but his writing also kept him out of public view, preserving the privacy of his grief and avoiding a vulgar display of emotion.

Cicero also took his turn in consoling others, Baltussen notes, “In the examples where Cicero aims at consoling others, we find a subtle approach, developing, as it were, a ‘philosophy of empathy,’ in which he consciously or unconsciously takes personal and political aspects into account. He shows great sensibility in narrowing or widening the emotional gap between him and the consolee.” Cicero noted that one task as consoler was to establish that he needed consolation himself, as he was grieving for his friend’s loss. I think this goes a little beyond mere empathy. Cicero actually feels his own sorrow upon hearing of the sorrow of a dear friend. He understands the friend’s pain because it is a magnified form of his own pain.

I personally feel that Cicero’s struggle with his grief highlights a social failure to deal with grief constructively. Can we not manage to express and process grief openly without fear of censure from friends and counselors? Since the time of Cicero, we have developed grief therapy, expressions of support for the bereaved, and paid lip service to the process of healing. Yet, we still criticize those who can’t “get it together” within a short time. Sadness is seen as weakness, especially for men, and we do not tolerate prolonged grieving. Cicero was lucky to have friends and the ability to spend time grieving and writing his consolations. Men with less power would have had no option but to keep working without respite.

Grief (Photo credit: tombellart)

As for me, I don’t know the best way to console others, but I’ve thought a little about what kinds of consolations have helped me in the past, and these are the things that I appreciate. First, recognize that my pain is of such a magnitude that it obscures the horizon, and I can’t see beyond it. Second, do acknowledge the enormous value of the life I have lost. Third, do remind me that the person I lost had life filled with wonder, love, accomplishments, and happiness. Fourth, remind me also that this person is in a state of peace with no more struggle, pain, or discontentment. Finally, and perhaps most importantly, assure me that I am not alone in the world, my grief is justified, and that a future is possible.

The proper way to grieve for a child

I hate Galveston.

When I look out over the seawall, I find no peace in the sounds of wind and wave or comfort in the roiling swirls of water gently crashing into the jetties. I see only the bodies of children being dragged and slammed with senseless violence against the sand just beneath the waves. As I look out over the Gulf of Mexico, I see only a sadistic child-eating monster mocking the hole in my chest.

And May is the cruelest month, because it was Mother’s Day in 1992 that I lost my niece and nephew to the powerful spring rip tides along the coast of Galveston. My niece, Cindy, who was seven, was pronounced dead on the beach, but my nine-year-old nephew, Doug, was flown to John Sealy hospital and placed on life support. Although the doctors offered us no hope of his recovery, he was kept on life support for 72 hours to monitor his brain activity.

The only photo I have of Doug and Cindy, from 1990.

During that agonizing 72 hours, we did what most families do. We held his hands, stroked his hair, talked to him, read to him, took him his favorite stuffed bear, massaged his legs, and loved him with every ounce of strength we had. At the moment they stopped life support, the Galveston radio station played his favorite song, “Born in the USA.” Yes, we were on the radio. We were on the news. Our family’s grief was broadcast on the nightly news. I avoided the cameras, but the children’s father was there, tears cascading down his face, explaining how he felt about the death of his children. Who needed this explanation?

Perhaps it is surprising, and perhaps it is not, that I decided to enter the medical humanities program at the University of Texas Medical Branch in Galveston. I spent years driving to Galveston and going into the hospital where my nephew died. Sometimes I avoided the building, but other times I went there and sat in the garden specifically to think of what had happened before. When I completed my required ethics practicum, I went on rounds with the doctors in the pediatric ICU—of all places.

As part of this experience, I was able to witness conversations with doctors and the parents of children who would never recover. The doctors were kind, caring, and professional, and every word destroyed me a little. I imagined the conversations the doctors and nurses must have had regarding my family in 1992. I imagined how they debated the proper course to take: how long to keep him on life support, how to break bad news to the family, and how to prepare for the death of a nine year old. I had thought this experience might help me come to grips with my past trauma, but I honestly cannot say it did.

As medical humanists, we study the ways people make meaning of suffering, but I want to tell you with great heartfelt certainty—there is no meaning in the death of a child. And when you try to make meaning of it, you rob me of my grief. I am entitled to my grief. My pain is my own. When you tell me the children were on loan from God, and he has called them home, I am only amazed that you worship a monster and call it God. When you tell me they are in a better place, I want you to know that the world they left behind is immeasurably worse for their absence. When you tell me anything, you amplify my pain and submerge me in the depths of despair with no comfort and no meaning.

What does someone grieving the death of a child need? Solitude. And comfort. Silence. And conversation. A distraction. A project. Time to do nothing. Time to think. Time to cry. Time to scream. Time to fall apart. Time to get it together. There is nothing you can do. But, really, you should try. And you should know when to back off.

I can remember talking to priests, ministers, social workers, counselors, and well-meaning friends. No one can really offer any comfort, but a few people managed to refrain from intensifying the pain. In particular, Robert Schaibly, who was the minister at First Unitarian Universalist Church in Houston at the time, offered sincere condolences with no advice, no explanation, and no demands. He was empathetic and shared my pain without taking it as his pain. No other clerical person I met was able to achieve something that seems so simple. Perhaps the simplest acts require the greatest art.