I’m honored that Mr. Teigen, who blogs at Lutheran Colportage (a colporteur is someone who sells Bibles or devotional literature), would care to engage with my most recent paper on the image of God and PVS. Here is Mr. Teigen:
On Reading Pastor Baker’s Paper
Pastor Baker is dealing with an entirely new subject for me. Pastor Baker has identified himself in his blog as a Missouri Synod Lutheran who is concerned with ‘life’ issues. I have admitted to him that I shudder when I read what Lutherans have written on that subject. I wanted to study Pastor Baker’s paper with the idea that I would learn something from him. He seems like an earnest kind of guy who wouldn’t try to overwhelm the reader with the sincerity of his emotions but would rather use the power of honest persuasion.
I don’t know anything about the idea of the ‘Image of God.’ I am not very well versed on Catholic philosophy and that is where the Imago Dei concept comes from. I look to my Cross and Livingstone, The Oxford Dictionary of the Christian Church, for some background.
The concept actually comes from Genesis 1:26 where the Bible states that man was created in the image of God. The dictionary explanation presents some theological terminology in Greek and Hebrew which I do not read.
The entry continues with the observation that there have been many theories on how to explain the idea. ”most located it in human free will, but others found it in man’s superiority to creation, or in a quality of his soul, such as simplicity or immortality, or in his reason. With St. Augustine there was a new influential development in the doctrine of the image: the notion of the Son as the Image was dismissed as subordinationist and man’s soul came to be regarded as a direct image of the Holy Trinity, manifesting a threefold structure in memory, understanding, and will (memoria, intelligentia, voluntas).
“In the 16th cent. the Reformers expressed their doctrine of man’s total depravity by asserting that the image was utterly lost as a result of the Fall. For those who opposed this view (not just RCs, but others such as the Cambridge Platonists, and more recently some liberal Protestant theologians) the doctrine of the abiding image of God in man provided a convenient expression for their belief.” [F.L. Cross and E.A. Livingstone, eds, The Oxford Dictionary of the Christian Church, Oxford University Press, 3rd ed., 1997, p. 820].
Pastor Baker approaches his subject from a Lutheran perspective. He states that there is no precise definition of the term in both in the classical and contemporary periods of Lutheranism. Nonetheless the author believes that the term is useful in considering the core issue of PVS (persistent vegetative state). The Lutheran idea is that when Adam and Eve sinned they “lost” the image of God but that did not mean that they stopped being human. Neither was there an essential change to human nature after the Fall.
The central Lutheran idea is that the idea of imago Dei deals with two things: 1) the image of righteousness and holiness that Adam and Eve possessed prior to the fall into sin, and, 2) the perfection of all bodily faculties in concert with such righteousness and holiness.
Pastor Baker maintains that the imago Dei consists of integrity of both body and soul. After the fall humans remained human, both body and soul, although corrupted. Some vestiges of the image of God remain and humans are still different from animals.
The focus of Pastor Baker’s paper is the relationship between the image of God and medical condition of the persistent vegetative state (PVS). I recognize the term PVS but I am not familiar with its meaning. I recall that there was some considerable public furor about a series of celebrated cases within the past ten or twenty years. At the time of the Schiavo case I took some detailed notes but I am not willing to take the time to re-review these issues. My recollection is that the issue ultimately came down to whether the law of the land should prevail or whether a higher law should prevail. My own opinion is that the law of the land (positive law) takes precedence.
But, Pastor Baker’s paper is not about civil law and medical practice. His study is of the relationship between the imago Dei and PVS.
I consulted the Merck online manual for a consideration of the condition of PVS. The manual states that “a vegetative state is absence of responsiveness and awareness due to overwhelming dysfunction of the cerebral hemispheres, with sufficient sparing of the diencephalon and brain stem to preserve autonomic and motor reflexes and sleep-wake cycles.”
“The most common causes are traumatic brain injury and diffuse cerebral hypoxia.”
“Prognosis varies somewhat by cause and duration of the vegetative state.”
“Most patients in a persistent vegetative state die within 6 mo of the original brain damage. The cause is usually pulmonary infection, UTI, or multiple organ failure, or death may be sudden and of unknown cause. For most of the rest, life expectancy is about 2 to 5 yr; a few patients live for decades.”
“There is no specific treatment, but supportive care should include the following: providing good nutrition; preventing pressure ulcers, providing physical therapy to prevent limb contractures.”
The Merck Manual addresses the question of life-sustaining care. ”Decisions about life-sustaining care should involve social services, the hospital ethics committee, and family members. Maintaining patients, especially those without advanced directives to guide decisions about terminating treatment (see Medicolegal Issues: Advanced Directives), in a prolonged vegetative state raises ethical and other (e.g. resource utilization) questions.”
I cannot stop here. I know that Pastor Baker is a pro-life Lutheran so to prepare myself for what might be one of his arguments, I go further in the Merck Manual to a chapter titled “Consent and Surrogate Decision Making.”
The manual states that “When immediate decisions are medically required, the doctrine of presumed consent applies. In other circumstances, consent must be obtained.” This is pretty clear and reasonable, I think.
The idea is that “when adult patients lack capacity to consent or to refuse medical treatment, health care practitioners must rely on an authorized surrogate for consent and decision making. All surrogates . . . have an obligation to follow the expressed wishes of the patient and to act in the patient’s best interests, taking into account the patient’s personal values to the extent known.”
Of course, “if the decision of an authorized agent or proxy seems to conflict directly with instructions in a living will, the outcome depends on the scope of discretion given to the agent or proxy. Normally, the durable power of attorney for health care confers broad decision-making discretion on the agent. Nevertheless, the health care practitioner should determine whether the document gives the agent broad discretion beyond the written instructions or limits the agent to the written instructions. Legal advice may be needed.”
The Manual reasonably concludes that “Patient choice is not limitless. For example, health care practitioners are not required to provide treatments that are medically inappropriate, such as those that are against generally accepted health care stands. However, sometimes there are legitimate differences of opinion regarding what is inappropriate. Labeling a treatment as ‘futile’ does not generally hep if said treatment may outcomes other than mortality or morbidity that are important to the patient. Physicians do not have to act against their conscience, but if they cannot comply with a requested course of action, they may have a responsibility to try to transfer a patient to another physician or institution of the patient’s choice.”
Well, so much for the Merck Manual on PVS. What’s on Pastor Baker’s mind? What does he have to say about PVS, a medical condition, and the imago Dei, a theological concept?
Baker’s definition of PVS seems consistent with the Merck Manual and so I will not pursue his definition. I am interested in what Baker says about the connection between the medical and the theological.
Baker asks the question: ”Do PVS patients possess the image of God?” Lutherans, Baker says, would answer in the affirmative. Then Baker asks if such patients “should be accorded respect” and I think that the answer for both a Lutheran and a secularist would again be in the affirmative.
Pastor Baker’s thesis is that “the particular nuances of the imago Dei in the orthodox Lutheran tradition do not readily lend themselves to an abstract biblical and theological concept to concrete cases concerning human care.”
Pastor Baker has written a challenging paper. It is a part of his course work at Creighton University. I would think that the prof would give him a good grade. I am awarding him an ‘A’ for his work.
