3-20-2016 Bioethics Part 49

The speaker begins by giving a prayer and reflecting on the previous week's discussion on organ donation. They mention arguments against organ donation, such as the belief that the body is sacred and should not be used for others, and the moral qualms and discomfort some people may have with the practice. They also mention the idea that organ donation can help people avoid facing their own mortality. The speaker states that organ donation is not an obligation for Christians and that individuals should not be judged for their decision to donate or not donate. The speaker then shifts to discussing attempts at reform in the organ donation realm and emphasizes the importance of understanding the ethical and policy issues surrounding organ transplantation. They mention that the debate centers on the nature of death, the ethical obligations of doctors, the moral difference between altruism and commerce, the relationship between individuals and the state, and the meaning of justice and love i Well, let's get started, it's good to see all of you here this morning. Thank you. I appreciate that. Let's pray. Dear God, thank you for this morning, for these people, for this time to spend thinking. And we pray that as we do something a little out of the ordinary this morning that you would give us a real understanding of the difficulties of the world that we live in and appreciation for those who work hard in things that we maybe have never even thought of. We pray these things in Jesus' name, amen. Last week, we saw the landscape of organ donation as it is today. What did we learn about the state of things today? Anything stand out to you just in particular that was like, yeah, that was something I either hadn't thought about or was particularly important or relevant? Yeah, all right, so because you're creating the image of God and that does seem to be born holistically or not just some kind of thing in your brain, then at least there's a question mark there was sharing part of yourself with somebody else. Okay. Anything else? Yeah, I can recap it. So we did start just kind of raising a bunch of questions and then kind of, I gave an argument against organ donation to begin our time. I'm going to give an argument for organ donation next week. The arguments against it are this idea that we bear the image of God holistically, that even in death, my body is mine. Corpses are named. All right, so even when we saw like when Joseph of Arimathea came to claim the body of the guy who had died on the tree, it was the body of Jesus, that's right, corpses are named. Also in organ donation, the body can tend to be treated like a totaled car that is salvageable for the parts that are contained within it for the good of somebody else. The idea is your body parts are only useful insofar as they serve to benefit human life. Therefore, if they're not of any use to you, we should take them from you and give them to somebody else. The question of how far we go with that is something that's going to come up this morning. There's another reason against organ donation, it's just there's just too many questions. There's too many kind of moral qualms that some individual might have with the practice. There's an idea of ignorance, like I just don't want to know, that's probably not very good, but if I do know, if there's what we call informed consent, if I know what I'm getting myself into and I'm like, yeah, I don't really know if I want to do that, that's a legitimate position to hold of just being uncomfortable, it's a very serious thing. And lastly, that organ donation does tend to, at least conceptually, help people avoid the task of facing their own demise, because it's just like, well, we'll just continue to help you. That's not maybe true in every case, but particularly when it comes to maybe just the general sense of things, that people don't want to die in general, nobody wants to die, but we're trying to avoid it at all costs, and so people don't want to feed into that system. These are some of the reasons why we should maybe avoid organ donation. We haven't answered the question of whether it's permissible or not, but we have answered, we answered last week, this question, is organ donation an obligation for Christians, yes or no? No, it is not. If you decide to donate your organs, kudos, I'm going to give reasons for why you should do that next week, but if you decide not to, that is not something you ought to be judged for by other people, ever, for any reason. So, this week, I want to get to talking about some of the real attempts at reform that are going on in the organ donation realm. This isn't in order to make, like, really direct public policy statements, that would have no benefit to us, really, whatsoever, also, I'm not somebody who works in this field, nor is it to get into the details of everything, but rather, my goal this morning, with organ donation in particular, is to help us feel the weight of human technological possibility. To feel the weight of human technological possibility is both blessing and curse, in a very real sense. Hopefully, by the time we're done here, we will have a better idea of what doctors face, when they're trying to, and medical ethicists are facing, when they deal with this kind of stuff. It's very easy, I think, sometimes, I don't think, I know, it's very easy to criticize people who work in a field that you don't work in, can you give me a really good example of that? Yeah, I wasn't particularly thinking of myself, right, that's not, I have a hard time judging other people, I'm not saying people judge me, although they do, if you ever think that preaching a sermon is easy, I invite you to write something, that's true, right, anything else? Cops? That's right, it's a big one, you know, it's so easy, no it's not, talk to a cop for three seconds, politicians, it's really easy to sit there and judge the snot out of them, you run for president and see what happens, right, I would love to see that, it's easy to judge those people, because we've never been in their shoes and from where we're sitting in the peanut gallery, it seems rather easy what they're trying to determine. Some of the things when it comes to organ donation also seem rather easy, but hopefully, as we'll see this morning, they are not. We could do what I'm doing this morning for pretty much any area in bioethics that we've looked at up until this point, but organ donation is kind of the ideal point at which to just kind of stop and take a week and think about broad public policy issues, because there are so many of them. I've been helped tremendously by the President's Council on Bioethics, which is a continuing council that presidents have had through time, in particular a paper called Organ Transplantation, Defining the Ethical and Policy Issues by Eric Cohen, he kind of summarizes what we're going to talk about this morning with this short paragraph. This debate centers on the nature of death, the ethical obligations of doctors, the moral difference between altruism and commerce, the relationship between individuals and the state, and the meaning of justice and love in the provision of organs. The most intense participants in this debate are those calling for dramatic changes in our policy. Not only on practical grounds, the current system isn't working, but also on ethical grounds the current system is morally misguided. The people who are calling for the strictest changes to the system as we know it, which we touched on a little bit last week, are those who are opposed to it for either practical reasons or ethical reasons. So there's a number of things that come into play when it comes to defining how organ donation ought to be done. We're going to start with what might seem like the easiest one. Here's the question. What does it mean to be dead? A few years ago, we went through an extended Sunday school looking at what does it mean to be the church. In the very first week, I said, okay, here's the question that I would like you to define. What is the church? Everybody kind of gave the same exact look. It's a totally understandable look. It's like the look of bewilderment at realizing that you know what the thing is, but how do you actually put the thing into words? Like, it's just, you know, it's the church. So the big question is, what does it mean to be dead? Seemingly equally an easy question to answer. Dead seems to be dead, but what's the first thing that comes into your mind when you think, what does it mean to be dead? The separation between body and spirit, or there's a theological answer. Right, it means what I mean by dead, right? Okay, so no pulse. Ah, for an extended period of time. How long, exactly? Indeed, a pulse, a lack of, we better hope to God that a lack of pulse doesn't mean that somebody's dead. Now, that would be as necessary, maybe, in our definition, it might be necessary but not sufficient, right? So it would have to include that, but that wouldn't be all that mattered. Necessary but not sufficient. Maybe. I'm going to give four of the kind of general, broad consensus as to what it means to be dead. There's four different opinions today about what it means to be dead. This seems absurd, I understand that, however, just bear with me for a second. Number one, and these are not in any particular list, nor am I going to necessarily explain which one I stand with. Number one, whole brain death or death by neurological criteria. Okay, whole brain death or death by neurological or brain science criteria. This is somebody who has usually experienced some kind of traumatic injury or traumatic disease at which point all or part of their brain is dead and or dying. This person can be kept alive through artificial means in order for the family to say goodbye, but this person is not coming back. Their brain is not injured, their brain is dead. Now here's the weird part about people who are brain dead. Now if you hear about this, if you see somebody who's brain dead, what do you think a person who's brain dead would be like? In a coma? Unresponsive. Yes. So I agree with both of those and that would seem to be the way they are, but they're actually not unresponsive. Somebody who can even be completely brain dead can still have, for example, reflexes. Weirdest thing ever, because the nervous system is still in somewhat, some kind of state. When you're looking at the monitor, their heart is still beating. They might even have, if it's only partial brain death, some kind of brain or neurological activity. But the person is brain dead. There's no kind of brain transplant, you're not coming back from it, the brain isn't going to heal itself. They are, in a very real sense, dead. The problem is, is that they are not in what we might totally consider all the way dead and because of technology, now if you take the technology away, they're dead. The reason they are sustained alive is because they're having help breathing and because they're breathing and their heart is beating, though everything up here ain't working. It's one of the weirder things about the human experience. It's only possible because of technology. This allows for organs to be kept in a rather good condition. The major question in this sense though, and by the way, we're defining death because at the point that somebody's dead, what can we do to that person? That too. What else can we do to that person before we bury them? We can take their organs. So the question is, one of the main questions when it comes to brain death is, how much of your brain has to be dead before you're really dead? 100%? 90%? Has there ever been people who were in that state and stopped being that brain dead? Uh-uh. There are people who had like part of their brains die and they can survive that, but there comes a point where you're no longer able to function without the use of machines. And all you're doing is sustaining, essentially, biological activity. You're not, you ain't coming back. We're going to talk about what to do in a situation like that in the future, but the body in this case is not lifeless enough for a burial because their heart's filled. You couldn't just like take everything out and put them in the ground. You'd have to take everything out, wait for them to die, and then place them in the ground. But, one criteria for death is, these people in this condition are dead, and therefore, there's a terrible term, but there's not really a word, harvestable, it's probably not a real word, but it should be. In this case, these people aren't coming back, so at least it's a hypothetical possibility. Okay? That's one, that's brain death. Number two, controlled death by cardiac criteria involving circumstances where life support is deliberately turned off. This is where we get to Brian's thing of, doesn't have a pulse. This is essentially what happens after you pull the plug, okay? So we've now, imagine the first case, we go, no, brain death should not be the criteria, it should be this controlled cardiac ceasing of activity criteria, so we're going to pull the plug, as some of you might not know, when you pull the plug, you don't die. It takes some time. It can take days. A real important consideration when you're like, yeah, hook me up to life support regardless. If only for the sake of your family. When that plug is pulled though, and you are closely monitored, and everybody is waiting for you to die, caring for you in the best way possible, making it as painless as humanly possible for you to expire, when this heart stops beating, it's time to go in. Now we heard about this last week, why is there such a, why would there be such a careful consideration of what's going on, and desire to be quick? Okay, but I'm talking like minutes. Why would they be so like, once it stops, they want to get in there. There you go. Yeah, the organs deteriorate at an extremely fast rate if blood ain't flowing to them, and oxygen is not flowing to them, and all that kind of stuff. So the question is, Brian and Nicole brought this up, how long does your heart have to not be beating in order to go in? Some people say two minutes, some people say 30 seconds, get in there. Some people say 10 minutes, you've got to wait. Every minute is crucial though, and so there's a real debate about even how long one must wait in this case. So controlled death by cardiac criteria. And the third option is uncontrolled death by cardiac criteria. This is when the heart stops unexpectedly. This is when you have, you know, you're just eating your bowl of Wheaties, trying to be a responsible human being, take care of your colon, right, 55-year-old human being, and you drop dead as it were, right, that's at least the way we speak of it. Your heart just stops, and you're just done. These people, as you might imagine, and let's say that, you know, you're not actually able to, it's a full cardiac arrest, you are not coming back from this. These people are not usually used in organ donation situations. Can you think why? There you go, that's right, it's all a time consideration. You die at your house, you call the ambulance, the ambulance comes quickly, it still ain't going to be there for five or six minutes, then once they get there, you're dead, right, so then they're going to have to take you to the hospital, by the time you get there, pronounce you dead by a doctor, you're looking at 20 minutes, and you're essentially useless as far as organ donation goes. Also, one of the burgeoning fields of research and desire is to get some form of transportable functioning life support inside things like ambulances, in order to keep people alive who have heart attacks, to essentially restart their heart just long enough, or keep the blood flowing, in order to then take them to the hospital so that their organs would be viable and able to be utilized exactly. Yes? That's only for people who have like, signed back their license or something? Yeah, yeah, yeah, so we'll get to that in a minute, yeah, we're talking just now about people who have already signed back their license, but there are a good number of people who have signed donor cards who aren't able to be donors, either their organs don't work, their organs are not functioning, if you think about somebody who gets in a massive car wreck whose heart is still beating, if, for example, they had massive trauma done to the center of their being, and they are alive but crushed, you can't use those organs. Now it might be that you've like, damaged your kidney, your left kidney, and your liver, you punctured that, that's gone, but then you've still got like this right kidney thing and your heart's beating, it could be possible that they're like, you're not going to survive, they've signed a donor card, you expire, boom, they can go in and get your kidney, and that's functioning, because it's not a whole package deal, you don't always give up everything, although they do try to make the best use of donors, which is a good thing, at least I'll look into that next week. But in this case of just dropping dead, they're trying to figure out a way to how to keep those people alive, or biologically viable in order to get their organs, because that would open up a large field of organs to be at least potentially harvested, as we saw last week, there is a critical shortage that's only continuing to grow of organs, so any way to get more is desirable. Here's the fourth, this is by far the most troubling, those who have lost quote-unquote higher brain function, this is defined as those who have lost consciousness or self-awareness. At that point, some in the ethical community have said that otherwise functioning humans are really akin to nothing more than the walking dead, they're not actually human. So we should, as a society, take their organs. Oh, it opens up all kinds of doors, you better believe it. It's highly problematic at almost every single level. For one, this redefines the role of doctors, from treating patients to being essentially triage experts, they get to pick who is savable, which sounds good, right? Of course, you're savable, you don't seem savable, piece of cake. The problem is, you go, you're not savable, therefore you are harvestable, because we have all these people who are savable, and you're essentially a vehicle, you're an organ vehicle, and we can take those organs and give them to people who would better benefit from them than you. Now, if that happens to people who have loss of higher brain function, can you think of maybe a possible sector of our community that might also very quickly be rationalized into taking their organs? Totally handicapped, exactly. They are, think about the way we already speak about them, they're obviously suffering, right? Which is not true, you're suffering by dealing with them. They are obviously, they would obviously be better off dead. The very way we speak about that sector of humanity is, let's just call it what it is, completely despicable, and also allows for humans to act in insane ways towards them. Just by saying, they must be living a terrible life, you know what, we should just, you know, get rid of them. Now look at this, it's like two birds with one stone, we remove their suffering and we allow other people to live, let's go. Same thing happens with people who have severe and advanced amnesia or dementia, let's just quote-unquote take them out of their misery. That sounds like a positive or an encouraging, you know, it's for their good, but really it's just a selfish, we need organs, here's some possible donors, let's go get them. All these definitions of death are new possible realities that have come solely based on the fact that we have the ability to keep people alive. Question, are those technologies inherently evil? No, give me a circumstance in which the ability to keep somebody alive is a positive thing. Okay, well in this case, yeah, we're talking about somebody who's died and we can get their kidney, okay, and that's good that somebody else gets a kidney, but just this ability to keep people alive who are near death, why would that maybe at least hypothetically be a positive thing? Yep, there you go, so preemie babies, all those babies, the vast majority of them used to just die, ain't no babies born at 28 weeks, 100 years ago, that was just, that was going to be a dead baby and probably a dead mom. Or you get in a massive motorcycle accident, Ryan Adams, and as a result of that you are, let's say that in that motorcycle accident you go into some massive trauma, or your body is so injured that the doctors put you in a medically induced coma, the only reason they can do that, the only reason they can sustain your life is because the same technologies allows us to have to determine whether somebody is brain dead enough to go in and harvest their organs while they're quote-unquote still biologically alive. Same technology allows for two very, one very difficult situation and one very positive and I think we would all go, yeah, that's a great thing. And somebody, here's the thing, this is why we're talking about this, you don't have to make this decision, you're going to go to work tomorrow and you're going to do whatever it is that you've been called to do in the world, somebody's going to go to work tomorrow and have to wrestle with this every single minute as people just keep dying depending on what you define death as. If this does not drive you to pray for the medical community, I don't know what does, because they don't only have to make these decisions, they have to live with them. So, that's the first question, what does it mean to be dead? I've got like seven years worth of material here. Number two, how do we distribute organs? There's a list, yeah, we talked about this list last week, this list is more or less blind as far as there is not, it's hard to discriminate currently. The idea is how, by talking about utility, we're talking about another form of justice, utility isn't unjust, at least necessarily, but people are going, what should the system be like? Some people claim that it should be completely black and white, the only thing you should know about somebody is essentially their blood type and the need of the organ they have and that's kind of it. You shouldn't take anything else into consideration because that is the most just and fair, blind justice. Then there's, and none of you, by the way, are over there, almost everybody is somewhere between there and absolutely over on this side. Over on this side, on the absolute utility side, is something like this. Should organs go to people who are old or young? In other words, next to your blood type, should we also put how old you are and then at least take into consideration the fact that if you're 85 and you have the exact blood type and you match and you live close enough to the donor and there's somebody who is 25, who should we give the organ to? That's the right answer, who knows, right? But at least some people are like, we should give it to the younger person because they at least have a statistically larger chance of living longer. It's more useful to give it to the younger person. Or how about this? Should we give an organ to somebody who has lived an unhealthy life? Give me an example of somebody who might need an organ as a result of an unhealthy lifestyle. Lung because of a smoker, good? Liver and alcohol, those are the two big ones, right? Or Hepatitis C in a liver, and let's say Hepatitis C was contracted by some kind of like, you know, deviant sexual behavior. Should you take that into consideration when making the call? And here's the hard part, what if I find out tomorrow that I've been a heavy smoker my whole life and I find out that tomorrow I need a new lung? You go, well, I mean, you are a smoker, you shouldn't live that way, therefore we're not going to give you a lung. And you go, yeah, that sounds fair and just. How about this? I wake up tomorrow and I've been a heavy smoker my whole life and I find out that my right kidney is failed and my left one is failing. Do I get on the list? Is my being a smoker going to impart any kind of determination to that or do we not count it? Do we only count it for things like lungs? Because that's what is possibly most directly related. And then what about the fact that I smoke and I also like cheeseburgers a lot? Or what if I smoke and I'm a vegan? Then how does the complex matrix of decision making come out? It seems like it's so black and white, but it gets complicated very quickly. Or how about this? We have one organ, it's a heart, big organ, major organ, and we have two people. One of these people is a recently released prisoner and the other one is a Nobel laureate in economics who gets the heart. Shouldn't we as a society keep those people alive who are most beneficial to the society that we live in? As you can see, if we start adding these things, these things that seem to make some kind of sense, then essentially everybody needs a resume including everything they've ever done and every way they've ever lived. And then remember, somebody always has to make the decision. It's fine if you're the one making the decision, right? But who is going to make this determination and on what basis? And how do you work out the complex math of all this? It's really insane. But here's what's absolutely true. It doesn't matter really if you have somebody who believes in kind of justice or is more way over on the utility side. People are still having to make determinations all the time, all the time. And it's not you who has to make this determination, it's not me, but somebody is saying, a large number of people have to say yes all in a row for somebody to get an organ. So again, we ought to pray for these people because making these kinds of determinations is very, very difficult. Any questions on that one? Opt in or opt out? This gets to something Tim was just talking about. We currently live in an opt in system. In the state of Tennessee, the way it works for us is on the back of your driver's license, you can mark, you have to mark, yes, you can have my organs and you have to sign it. If you do not do that, then you have not given your consent to give your organs. I'm not sure if in the state of Tennessee they can ask your family members, depending on the state, if you get in a big car accident or something and you're rushed to the hospital. In some states, the doctors can come to you and say, do we have your consent? Would he want his organs to be donated? Yes or no? It's essentially implied consent on the basis of family members. In some states as well, family members can say, though he signed the card, we don't want you to take his organs. Families have a large amount of sway, depending on where you live. So we have a shortage. We have a currently opt in, you have to opt in. There's been a large number of people who've said, let's have an opt out system, because you human beings are incredibly lazy, right? You gotta flip over that card, you gotta think about it for like 10 seconds, then you gotta sign it. Instead, what we should have is the same thing, on the back of your license there should be a anti-donor statement. I do not want my organs, and if you don't sign that, we're gonna take your organs. Now what would be some possible problems with that? Well, first let's talk about the benefits, what's the benefit? Tons more organs. It opens up floodgates to a crazy amount of organs. What's the downside? Yeah, we talked about that last week, that is pretty much like an urban legend, which I grew up with as well, they told us at our high school all the time, don't sign the donor card because they're just gonna go in and kill you. That's maybe a hypothetical probability, but let's say that it is like a well regulated system and everything like that, they're going to only take organs from people that fit the criteria we already have, so they can't just go in and be like, well he's got some nice organs, let's go get him. If they just said, look, same kind of criteria apply to who's dead and who's all this, but we're just going to take the organs, if the person expires, we're going to notify the family, we're going to say, we're going to take these organs, we're just going to shift the mindset of the population, to help them understand what we're doing, this is kind of the current idea, we're going to help everybody understand that we need organs and everybody can give organs, and this is going to be a good way to get more organs, and maybe you'll need an organ one day. Okay, right, what if you can't write or speak, good, what if you change your mind, yeah, that's still the case with the opt-in system, in the current system if you have to opt-in, what do you have to do? Make a decision, now in an opt-out system you have to make a decision to get out, but if it's just opting, if it's opting, if it is an opt-out system and you're having to get out of the system and you're just inherently in the system, then what have we lost in the idea of organ donation? Independence, yes, seeing it as a gift, it is no longer a donation, it's just what we do to dead people, and you have to actually work against that. Paul Ramsey, one of the great Christian medical ethicists who died about a generation ago, says this, A society will be a better human community in which giving and receiving is the rule, not taking for the sake of the good to come. The civilizing task of mankind is the fostering, the achievement, or shoring up of consensual community in general, and not only in regard to the advancement of medical science and the availability of cadaver organs in efforts to save the lives of others. The positive consent called for by gift acts, that's what he's arguing for, answering the need for gifts by encouraging real givers, meets the measure of authentic community among men. The routine taking of organs would deprive individuals of the exercise of the virtue of generosity. I'll read that sentence again. The routine taking of organs would deprive individuals of exercising the virtue of generosity. If, as is said, the young rarely think about their own deaths or about giving their organs upon death, then they should be constrained and enabled to do so by the instructions and practices and laws we enact. To become partners in improved therapies or joint adventures in improving therapies could be among the most civilized and civilizing things young people can do. The moral sequence that might flow from education and action in line with the proposed gift act may be far more important than prolonging lives routinely. The moral history of mankind is of more importance than its medical advancement, unless the latter can be joined with the former in a community of affirmative assent or opt-in-ness. We lose the ability to create or promote the virtue of generosity if we just take them from you. All we really work on in that case is the vice of fear. I don't want anybody to take my organs, I'm scared they're just going to take them if I get, you know, if I just go into the doctor's office and they're like, well, how can we figure out how to define this person as dead so we can take their organs? So I'm going to sign that anti-card out of fear. There's never any courage in signing that card of opting out of the system. Going into the system does take courage. It's like, okay, I'm going to be available for the world in death. Here we go. But if you don't have to do that, first of all, you don't even get the benefit of thinking about being generous and you get the downside of essentially just going like, well, I mean, shoot, I guess I'm going to get out of this because I'm scared. There's no ability to promote the goodness of giving of oneself for somebody else. Exactly. Yeah. Right. Yeah, so it implies that you're essentially a jerk because you're not giving something that in some cases isn't even rightfully yours because you're dead, it's not yours, it's the rest of ours. So you're opting out of the system, it's like you're a terrible American or you're a terrible citizen of whatever place you happen to be in the world because you're not going to give us your organs. It's not the kind of society that we would like to promote. Now if you'll notice, I'm going to close with this this morning, I have not read a single Bible verse and I have not argued from an inherently Christian position at all. That's on purpose. We're talking about public policy stuff. This is real world practical wisdom kinds of things. Things that we as Christians are informed by, by the faith that we believe in, but does not stem from, well in Matthew it says, or Exodus such and such tells us this. Do you ever want to know like what's the practical benefit of being a Christian? It doesn't just give you proof text in order to make decisions in the world. It would be really nice if there was some appendix at the end of the Bible that was like listen, here's what death is you bunch of jokers, this is only what death is, don't even think about it. That'd be, I mean in one sense that would seem kind of beneficial, but in another sense it would not force us to really think hard about what it means to be alive, what it means to die, what it means to no longer be living. We wouldn't have to think about, well should we, what kind of society do we want to live in? It's just, okay, we'll just follow God's rules about everything. Now there are a good number of God's rules and we do pay attention to those and pay attention to them closely, because if God speaks we listen, however, when it comes to something like these things, we do have to kind of back up for a minute and say, wait a second, what is the broader picture of what God is doing in the world, how am I called, how are we called as humans to live? And then pursuing life in that direction. It's not easy, but it is incredibly beneficial, not only for ourselves, but for those around us. Let's pray. God, we thank you for this time and we thank you for the mental capacity to think about these things and talk about these things and interact and try to come up with solutions to problems. Now we live in a very complicated world, a world that is getting more complicated all the time. We pray that as we think about these things, this wouldn't just be an academic exercise, but this would be, for ourselves, feeling the weight of technological possibility, of both embracing and enjoying the good gifts that we have and at the same time seeing that those good gifts lead to unique challenges that we've never had before, that we would have humility when it comes to those who work in the medical profession and also a high esteem for them and that we would pray for them in order that they would do good work, that they would pursue just means, that they would work for the right reasons, that they would be as concerned as we are, not only about the advancement of medical procedures, but the very virtuous fiber of human beings that they deal with on a daily basis. I pray these things in Jesus' name. Amen.