Monday, 25 March 2013

Liverpool Care Pathway - A Personal View

Biological machine, person or persona, psyche or soul, whatever is your standpoint, it is all belief. Science is belief. In my lifetime alone, I have seen the scientific goalposts moved so many times.

Whatever is your belief, it is true to say that how you view the person affects how you treat the person, more especially persons some ethicists might classify as non-persons.

By redefining infanticide as after-birth abortion and the moral status of the individual as a person, murder becomes permissible.

Journal of Medical Ethics -

After-birth abortion: why should the baby live?


Abortion is largely accepted even for reasons that do not have anything to do with the fetus' health. By showing that (1) both fetuses and newborns do not have the same moral status as actual persons, (2) the fact that both are potential persons is morally irrelevant and (3) adoption is not always in the best interest of actual people, the authors argue that what we call ‘after-birth abortion’ (killing a newborn) should be permissible in all the cases where abortion is, including cases where the newborn is not disabled.

A personable person and very human human being, this is Professor Patrick Pullicino giving a personal view in the Catholic Herald -

Dr Patrick Pullicino: ‘It is important to declare yourself’

The doctor who raised the alarm about the Liverpool Care Pathway says science and religion are closely linkedBy Jessica Abrahams on Friday, 22 March 2013
Patrick Pullicino: ‘The spiritual world is so close that it’s just a question of opening people’s minds to it and seeing that science is nothing more than a measurement tool’
Patrick Pullicino: ‘The spiritual world is so close that it’s just a 
question of opening people’s minds to it and seeing that science
is nothing more than a measurement tool’
“Humans are totally spiritual creatures,” says Dr Patrick Pullicino, a professor of clinical neuroscience at the University of Kent. When we look at the human body, “everything we see, to my mind, is basically spiritual; the physical is just a coating”. For Dr Pullicino – a Catholic, NHS consultant doctor and scientist – the scientific and spiritual worlds are very close. “When you start to understand atomic function, science meets the spiritual,” he says.

This view has become uncommon, however, as the two world views are consistently portrayed as being in conflict with one another. The theory that science and religion are opposed can be traced back to the second half of the 19th century, according to the Catholic historian of science Maurice Crosland in his new book Science Under Suspicion. More than a century later it is still widely accepted and has become more prominent in recent years, popularised by vocal scientists like Richard Dawkins.

“The prevalent view among scientists – doctors included – is that science can explain everything and that if something can’t be explained by science it either doesn’t exist or it will be explained in the future when we understand it better,” says Dr Pullicino, whose family is from the mainly Catholic island of Malta. “That, to me, is a very narrow world view. Science only seeks to explore the world by measurement and that can be very helpful in explaining day-to-day processes but it is just a measurement tool.”

It is important to recognise that there is much that science cannot explain, he says. Nobody has ever been able to pinpoint the seat of consciousness within the brain, for example. For Dr Pullicino, this is evidence that consciousness belongs to the soul. Some neuroscientists do argue that the physiology of the brain can explain consciousness.

A controversial theory posited by Stuart Hameroff at the University of Arizona suggests that microtubules – strands of protein found within nerve cells – work as a quantum computer, giving rise to consciousness. “But there’s no evidence for that,” contends Dr Pullicino.

“You might say there’s no evidence for having a soul or a spirit but a lot of scientists just don’t open their minds up to the possibility.” Instead of assuming that the explanation of consciousness, when found, will be scientific, we should be open to the possibility that there might be an alternative explanation, he says.

But can we really reconcile the idea of a soul with modern neuroscience and the knowledge that our thoughts, will, moral behaviour – even, perhaps, our religious beliefs – are tied to the brain and can be manipulated by drugs and altered by illness?

“The soul is the individual, when we say ‘I’ we mean the soul, and the soul goes on; it doesn’t die,” he says. “The soul wills you towards the good and that is always having an effect on the body. Now, whether the body accepts it or not is another thing, and will be influenced by circumstances,” like whether you’re on a particular drug and whether you already have certain predispositions.

In his view, experiments showing that our desires and moral behaviour –things that constitute what we might refer to as the “self” – can be affected by drugs do not necessarily contradict religious beliefs about the soul, though many scientists are ready to assume that they do; the two can work together. “Of course there is body-soul interaction,” he says. Indeed, debate surrounding the body-soul interaction existed long before neuroscience, dating back to the Classical philosophers and, later, St Thomas Aquinas.

The same goes for studies which claim to be able to prompt spiritual sensations by stimulating certain parts of the brain, or which show that spiritual experiences are associated with increased activity in those regions. Certain neurological disorders such as epilepsy are also associated with heightened religious experience because of their effect on the brain. The suggestion sometimes drawn from this is that religious belief is part of normal brain function, but Dr Pullicino disagrees.

“It’s been well known that certain diseases give you hyper-religiosity, epilepsy in particular,” he says. “I had a patient who became very religious and kept running out into the street and proclaiming God. When his epilepsy was treated that behaviour subsided. But to try to explain the whole of religion on the basis that some brain processes seem to have a very sharp effect on belief doesn’t make sense.

“When we come to faith it’s a long process, it’s not just that you light up a centre and you become religious. It doesn’t surprise me that there are centres of religious belief in the brain, but it doesn’t explain faith.”

Nonetheless, modern neuroscience can teach us about how we work and our concept of the soul can be updated accordingly. “Aquinas was writing about the soul in an age when they knew hardly anything about the brain and he ascribed all the functions that we now ascribe to the brain to the soul. He achieved this through reasoning, and his brilliant intellect, but I’m sure if he was alive today there are things he might want to update to take into account neurophysiology.”

On the basis of this, Dr Pullicino says he is “convinced that there are two spirits in the body: the bodily spirit and the soul, the divine spirit”.

Although not orthodox, the idea that man has a spirit distinct from the soul is found throughout the history of Christian thought and is known as the “doctrine of trichotomy”. It is rooted in Pauline writings and the Letter to the Hebrews, which appear to distinguish between the “spirit” and the “soul”. Dr Pullicino also links it to the Jewish philosopher Moshe Chaim Luzzatto, an 18th-century Italian rabbi who identified five parts to the soul which exist in a hierarchy, some more bodily and some more divine. From Dr Pullicino’s point of view, a two-spirit concept provides a model for how consciousness might be spiritual rather than bodily; the interface between the soul and body’s spirit. Since elements of the conscious mind can be altered by age, illness and drugs, we can assign these to the “bodily spirit”, while the soul can be only morally altered.

“Even if this isn’t true, I think it helps to make sense of some of our experiences,” he says. “We know very little about body-soul interaction. Recent developments in neuroscience, for example, seem to suggest that the will isn’t free because it can be manipulated by drugs. The challenge, however, is to re-think body-soul interactions like will on the basis of modern neurophysiology and to incorporate this into Aquinas’s view of the soul. Neuroscience can help us to understand the body-soul interaction.”

Yet he rejects the idea that science can explain everything. “That is a very limited view, especially in medicine, when one should be most open to God and a lot of the decisions have to come from the heart as well as from the mind,” he says. “Today there are challenges all around [for doctors] because people are re-defining what is an acceptable quality of life.”

A particular challenge in neurology is the question of consciousness and patients with “unresponsive wakefulness syndrome” – previously described as being in a “persistent vegetative state”. In the past, many of these people simply wouldn’t have survived, but now that they do there is uncertainty over how they should be treated.

“People say these patients don’t actually have consciousness. The law even suggests they’re not really persons,” says Dr Pullicino. “Modern magnetic resonance scanning shows that some of these patients do have thought patterns. But what do you do as a physician if you have a patient like this and perhaps their family says they want them to be switched off, but you don’t think that’s right?… I think it’s really important as a physician to have your own yardstick and say: ‘That’s as far as I’m willing to go.’ There are always these ethical challenges.”

Dr Pullicino believes these problems have arisen because medicine has become purely scientific and has lost its spiritual aspect. “But medicine is an art as much as a science,” he says.

It is symptomatic of the ever-widening gulf between religion and science – but the two are compatible. “The spiritual world is so close that it’s just a question of opening people’s minds to it and seeing that science is nothing more than a measurement tool.”

Dr Pullicino believes it is possible to bring the two worlds back together. “It’s a question of showing people and opening their minds to it. A couple of years ago I started wearing a little crucifix on my lapel, not when I see patients, but just around the hospital. If you do believe in the spiritual, I think it is important to declare yourself. That way, perhaps, people will start to notice the spiritual world that underlies everything we see.”

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