‘Down with the patriarchy!’ he says…

Okay, so the title is pungently truthful, but it must be so. As strong of a statement as this is, I hesitate to call myself a feminist, only because I feel that I haven’t done enough research nor in-depth thinking to truly reach the moral standing of ‘feminist’. Moreover, I would probably refer to myself as a ‘feminist in training’. Perhaps this post can show you why.

Following is a picture of me at a global health conference earlier this year, taken in stealth by a woman who as a part of the (stellar, as I came to find out) organisation, Women in Global Health.

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As a disclaimer, I’m trying to be really careful with the language I use (as always, I guess) in this post, but I guarantee you that, as a privileged, white male, I will undoubtedly make some sort of mistake in language or concepts — please comment to correct me if I err.

This specific panel was an all-women panel, occupied by leaders in their respective fields within global health, who also happened to be women. As someone who wants to end up in the field of global health, I thought this panel would be really useful in order to understand (or at least be introduced to) women’s role in global health now, and what is needed for women to excel unhindered by the patriarchy (by which many fields are unjustly ruled, not excluding global health). The amount of men in the room was astounding, mainly because I could probably count them on both hands without running out of fingers. (Here’s where a moral dilemma comes into play – as of now, I’m just trying to set the scene.) As this was a panel discussion, they gave space for questions to be asked — those who had questions merely had to queue up behind a microphone and wait their turn. I had a question, so I got up in the queue, and happened to be the first male to ask a question. One of the panelists noted, “Ah, you’re the first male to ask a question!” And the audience applauded. My question was, basically, “What is my role as a young male in the field of global health?”

The moral dilemma comes as such. Being honest, I loved getting this recognition as the ‘first male to ask a question’, the applause that came with it, and a twitter post from a women’s NGO in global health. One can see this situation as me being a champion for women’s rights, but I feel like the recognition that I received at this conference might have been a little ironic. In short, women do not need the approval of men to do well in global health.

This reminds me of a conversation I had with a friend (hey there, Saffy!) about Malcom X and what he wrote about the day Dr. Martin Luther King, Jr. gave his speech on Capitol Hill. The U.S. administration was terrified for that day, because the streets were going to be filled with ‘negroes’ and they had no way of sufficiently controlling this crowd of people throughout the march and the speech. However, it turned out that a fair amount of white people were in support of Dr. King, and were planning to come out to the march as well. This then calmed down the administration, which led to them coming around to accepting the speech and congregation of Dr. King’s listeners and advocates. Malcom X argues that this sort of assembly was only okay to the current administration because it had de facto ‘white’ approval. Had numerous white supporters not come out that day to listen to Dr. King, the assembly would not have seemed as okay to the administration. Malcom X tells us that this is a dire problem of (at least the U.S.) society.

I can’t help but draw a parallel to what I experienced this past spring at the global health conference. Yes, one could say that I’m doing my best as a white male to be a champion for women’s rights, and that may be required for all men in this day and age, but I might also add that it’s incredibly important to be keenly aware of what kind of moral consequences one’s actions may hold. One must also be aware of the history to which their actions and beliefs are tied. I, as a white male, must be aware that we (meaning, generally, white males throughout history), have taken control of women, their bodies, and their lives. Following this idea, I would think that ‘being a champion’ for women follows exactly that same mould of the control of women by being the voice that gives approval to women’s rights in society.

So going forward from here — what is my role as a white male in society (not just in global health)? I, too, wish to succeed in global health, but I don’t want to unfairly take opportunities of women in this endeavour. One solution that comes to mind is to be aware of the societal privilege that I am (unjustly) awarded as a white male, and to not ever think of utilising that privilege for a work opportunity or a forward move in my career.

Without trying to offer more solutions, the simple answer is that I will never fully know what is required for women to succeed in global health because, quite simply, I identify as a man, which equally means that I am not a woman. I do not know what a woman needs because I am not a woman. Hence, solutions and answers should not be coming from white men, but from women. Embedded in the preceding sentence is an equal moral imperative to listen to all women’s input, not just the white, middle-class, feminist woman from your local university (which is still an important view, but not the only important view).

I think the duty that I have as a male in society is a negative moral duty, which is to make sure that I am not hindering the autonomy or ability of any woman in my life to make her own decisions and lead the life she wants to live. Outside of this, I will do my best to train to be feminist, to be an advocate of women’s rights, to create a more equal world for all — but the knowledge I gain to back up these actions best not come from men, but women — as they, of course, know what the best is for themselves, and they do not need a man to explain that for them.

 

 

In writing this post, I’ve left out a lot of ideas and topics, not limited to race, heteronormativity, gender, and class. Granted, these topics are incredibly important, but you would most likely be reading a text the length of a chapter, or even a book, if I was left to leave all of my (perhaps too many) thoughts on the matter here.

My request for those reading this post is to do some research about one influential woman in their own society or another, and perhaps comment below to share the (undoubtedly amazing) stories of certain women with your fellow readers.

Españia

After such success at combining Notre Dame’s medical ethics conference with a little adventuring of Rome, I decided to use the same logic when booking my flight to Madrid for the Bare Life & Moral Life Symposium hosted by Saint Louis University, University of Notre Dame, and Trinity University.

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Since I’ve been splitting time between my dissertation and medical school applications in recent weeks, my trip to Spain was admittedly less planned than it was for Italy.  Based on my very quick intro to these cities, I have to say my favor lies with Rome. Perhaps that just means I need to make return visits to collect more data though. 😉

The symposium in Madrid was different from the rest that I’ve been to because it was heavy on (theoretical) philosophy and lighter on bioethical cases. For all of my non-philosopher readers out there, the title comes from Italian philosopher Agamben and his work Homo Sacer: Sovereign Power and Bare Life.  From the Encyclopedia of Philosophy:

Agamben develops [“bare life”] from the Ancient Greek distinction between natural life—zoe—and a particular form of life—bios…Neither bios nor zoe, bare life… can be defined as “life exposed to death”…. (For more, see: http://www.iep.utm.edu/agamben/)

To say I was out of my league is to put it kindly. There were scholars of all types: not just proper philosophers, but also physicians, ethicists, and theologians with specialties in Judaism, Catholicism, and multiple Christian denominations. As such, I spent most of my time silently soaking in the presentation and Q&A session and saving my comments for the more informal but still very robust conversations (mostly related to care at the end of life) over coffee, lunch, and tapas.

Perhaps my background in engineering has made me very comfortable working in teams, but in comparison, the life of the academic can seem quite… lonely.   To my refreshing surprise, however, the symposium attendees in Madrid were about the most charitable, most welcoming academics I have ever met.  They were not only eager to explain some philosophical building blocks to which I hadn’t previously been exposed, but they were also interested in learning about my perspectives as a biomedical engineer / bioethicist / medical school applicant.

On the subject of Spain-adventuring, I must say that my short day trip to Toledo stole the show. Though this may surprise some of my readers, I must admit that I am not too fond of touring churches. I quite enjoy encountering different houses of worship, using them for what they were intended and not really just treating them as a tourist spectacle equivalent to the London Eye or Big Ben.  Nevertheless, since I was only in Toledo for a few hours and it didn’t coincide with the mass schedule, I paid my admission fee and accepted the audio guide that was included with the ticket. In short: SO worth it.

A segment of the ceiling
A segment of the ceiling

Beyond the cathedral, Toledo was just a beautiful city to wander—what you’d imagine if you thought of an old Spanish city: dusty cobbled stone paths, a fortress on the river, and intense summer heat. Here are a few pictures that might convey this better than words.

 

Adiós,

Andrea

Featured Image: taken within the Toledo Cathedral

Irish Solstices

It seems crazy to think that it has been more than 6 months since I was last in Ireland. Since I never actually got my December post up, I figured this was a good opportunity to add some bits from those 5 days in Dublin with the fantastic hostess, Katie!

Strong first impressions remain:

  • Ireland in December is cold. Really cold. Although Dublin and London are fairly close, Dublin is MUCH more damp. Add a bit of winter wind and wowza. Come June, the frigid air was gone, but I was quite comfortable in jeans and a fleece. I survived December with a fleece and my dress jacket (which was more than enough in London), but I could have benefited from a wool sweater or two. The tool of survival: hot water bottles. (As they say in Ireland, ‘Tanks a million,’ Katie!!)
Freezing on the pier at Dun Laoghaire
Freezing on the pier at Dun Laoghaire
  • Since Ireland uses the euro, I thought things would be a smidge less expensive than London. When it comes to food, this is certainly NOT the case.  I don’t profess to have a great understanding of economics, but presumably this is because of importing costs. Porridge was a staple for breakfast (and lunch a few times, too) which made it possible to indulge in a full Irish breakfast.
  • Confession: I remember when I first moved here I kept getting geographically related politics (ie: Great Britain, United Kingdom, England, Ireland / Northern Ireland, Scottish Independence) very mixed up. Traveling and speaking with locals definitely provides new perspective. If you ever have a chance to travel to Dublin, I highly recommend making the Kilmainham Gaol one of your first stops in the city.
  • Biking (or “cycling” as they say) is very common in Dublin. The CocaCola Dublinbikes rental share works quite nice—5 euro for 3 days. The complication in the story, however, comes when you remember Irish Winter Solstice sunlight hours: fluorescent safety gear is near mandatory if you care to ride for more than your lunch hours. During rush hour, this form of transit is elevated to the “extreme” level during rush hour when you start weaving between moving vehicles. (Deep breaths, everyone, deep breaths!) When the traffic is slower, however, it makes for quick transit and a great way to see the lil city.
  • The coast is where it’s at. In December, this meant taking a short train from Dublin to Dun Laoghaire, and in June we visited the west coast. (Keep reading!)
  • Dublin is home to both Jameson & Guinness which seems fitting considering the active pub culture in Ireland. Having toured both the distillery (December) and the brewery factory (June), I can recommend both. Flying Ryanair limits one’s ability of bringing many souvenirs back, but my brother Franz received a teeny bottle of Writer’s Tears, an Irish Whiskey that I first spotted on Katie’s shelf.

For the June visit, I was joined by my friend Zoe, and together we stretched our wings a bit further. We took pit stops in Enis & Gallway…

…But the highlight of our three day jaunt across the island was our coastal walk from the Cliffs of Moher up to Doolin.

From what we could tell, most tourists just make it to the visitor’s center, marvel at the cliffs, and call it a day. On an overcast day, as are a number of days in Ireland, I can understand the desire to make this a short visit. We, however, scored a gloriously clear day and feasted our eyes not only on the “main attraction” (the Cliffs) but also the Aran Islands which are just off the coast. As I expressed previously and will continue to re-state, there is something very awe-inspiring about experiencing natural wonders.

Here’s to a summer of making even more of these memories!

Andrea

Featured Image: 4pm December sunset at Dun Laoghaire

Three cheers for Spring!

If I was paid a nickel for every blog post that I intend to make, well… I would have a lot of nickels by now. But alas, life catches up, and I seem to have far more words floating in my head than I can manage to fit on paper in 24 hours each day. Here’s a tribute to the highlights of Spring 2015!

 

Stonehenge on the Equinox

Cici and Andrea Stonehenge

 

In case you missed that post, check it out here.

Isle of Man

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See Ben’s post here for more pictures & the rest of the story.

 

Lake District

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And see his post here about the “walking” (British word for hiking) in Lake District.

 

Adventures in Scotland

from Glasgow to Edinburgh with Gretchen & Joan

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Theatre bingeing

My love of theatre and the performing arts was treated quite well when I lived in A2, and it has only grown since moving to London. I was probably averaging about 1 show every 6 weeks… until I introduced Gretch & Joan to the West End. After a thrilling night with front row seats to Memphis, we decided that the 2nd of their two day visit to London should be spent going to a matinee (Billy Elliot) and an evening performance (Agatha Christie’s Mousetrap).  Gotta make the most of those London minutes!!

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As a student, I have the pleasure of tapping into the crazy-cheap student tickets with my last my last 6 shows ranging from £0 to£5 each. Just as golfing in Jackson, MI can be cheaper than going to the movie theater, scoring student tickets for the West End can be less expensive than meeting up at the pub. The more that I indulge however, the less I am able to shut my mind off and enjoy the show.   (Well… let’s be real. I don’t think I was ever the type to just shut my mind off.) I described part of this when I spoke of Matilda.  And I think it has become even more noticeable as I indulge. Consider, for example, the Curious Incident of the Dog in the Night. (The Spark Notes summary is here if you haven’t seen the show or read the book.) While the 12 year old girls sitting next to me were trying to solve the mystery during intermission and gushing over how “Christopher is so good at Maths*!!” after the final curtain call, my mind had drifted down some other paths.

 

  • How do we as a society treat people who fall outside of “normal”? From an early age, we learn to be tolerant of people that are different from us. This earns us the badge of being civil. What is the difference between being tolerant and being kind?
  • What responsibilities do parents have to their children? Do these responsibilities depend on the child’s individual needs and talents? I was particularly interested in the contrast between Christopher’s mother and father. The father stayed with him the whole time, but there were some obvious parent / child clashes made more frustrating by misunderstanding Christopher’s autism. The mother—overwhelmed by having an autistic child—copes by having an affair and moving away with the new man, but continues to express her never-ending love for Christopher through letters.

[*Brits say Maths instead of Math. This still hasn’t stopped bringing a smile to my face. 🙂 ]

If I ever become bored, I think I shall develop a lecture series about Social Science, Health, and Medicine in the West End.

 

…And reliving the excitement of seeing London for the first time through the eyes of visitors

Featured Image: from the Columbia Road Flower Market

Catholic Approaches to Bioethics – Discussion on June 22 at 3:30PM

A taste on what I am up to when I’m not working on my dissertation or off adventuring… 🙂

Department of Global Health & Social Medicine at King's College, London

The “Religion & Bioethics” reading group is reconvening to discuss ‘Catholic Approaches to Bioethics’ on Monday June 22nd 330 pm – 5 pm (PLEASE NOTE UNUSUAL TIME), in room 3.1.1 East Wing, King’s Building, Strand Campus.

 Andrea Berkemeier (Bioethics & Society MA student) has kindly volunteered to share with us her knowledge of Catholic approaches toBioethics and will open the discussion. Take a look at Andrea’s blog here.

You can access the reading list here.

Hope to see many of you there! For inquiries, silvia.1.camporesi@kcl.ac.uk

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Afternoon Tea (and then some)

My cousin Cecilia (Cici) and I were born just 4 days apart, and since 1992 we’ve managed to have a number of good adventures together. The last adventure included one of her college roommates, Hailey, as they took on London like champs. I mentioned that Matilda, Westminster Cathedral, and Cadogan Hall in my previous post; here are a few more of the highlights from their visit.

Afternoon tea the Vauxhall Tea House Theatre:

Definitely gave me memories of living in Martha Cook, the University of Michigan residence hall that enjoys Wednesday sit down dinners, Friday afternoon teas, and a number of other lovely traditions. 🙂  This tea, a pretty good representation of traditional British tea, featured black (vanilla) tea with brown sugar cubes and full cream with a 3 tiered cake stand:

– Bottom = finger sandwiches (tuna and coronation chicken)

– Middle = scones + on-site made  strawberry preserves + clotted cream (almost butter, but by calling it ‘cream’ you put on 25x more than would be acceptable for butter)

– Top = dessert. Sometimes little cakes, but this time we feasted on vanilla bean ice-cream and brownies that I’d gamble to say were even better than Zingerman’s.

We enjoyed this so much that Cecilia and I recreated the experience back at my flat on her last full day here. That version even featured a meat pie from Borough market. 🙂

 

Stonehenge / Old Sarum / Salisbury Cathedral

Since Cecilia was able to visit for a full week, we were able to explore London together and take a side trip. So many options to choose from! We settled on Stonehenge with our decision influenced by the fact that this was the Equinox. I had read about some pagan rituals that were supposed to occur at sunrise, but the logistics became exponentially more complicated and expensive when planning outside of regular public transportation hours. Instead, we enjoyed a morning train ride to Salisbury, and then caught the bus to arrive at Stonehenge just before noon.

This worked out quite well because we not only enjoyed the beautiful spring sunshine but also a dance performance (?) by a group of people in costumes. I agree with Cici’s guess: perhaps these were the pagans that overslept.

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After Stonehenge, we enjoyed walking around Old Sarum and then picnicing in the city of Salisbury before heading to Evensong at the Salisbury Cathedral.

Family

I also had the delightful surprise of receiving a message from one of our Polish cousins– he (L) and his girlfriend (M) were in London for the weekend! L had previously lived in London for a few weeks while taking English classes, but insisted that I should be the tour guide. No pressure haha.  This provided an excellent opportunity to try out some of ‘London’s best’ restaurants that I had been reading about, AND take a ride in a black cab. Another tick on the London bucketlist. 🙂

Our first choice was a tapas bar, but it didn’t take reservations and when we arrived (as to be expected on a Saturday night in London) it was literally overflowing with people. But sticking with good SWE event planning stragies, I had made a reservation (the last reservation at that time!) for a table at a well-reviewed restaurant called Antico down the street. Wowza was the food delicious! I feasted on a octopus / shallots / rocket greens (arugala) salad for my primo, a halibut steak (massive!) for my secundo, and a torte for dessert. The only downside was that (being a Saturday) they booked two rounds of guests, so as soon as our desserts were served the waitress began encouraging us to leave. Fine. Time for a walk across Tower Bridge, particularly beautiful at night. 🙂  My cousin is an architect, which made it even more interesting admiring London’s nighttime cityscape.

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These moments go so quickly! Seems like yesterday that I was moving in, but alas final exam papers are soon approaching. The more adventures that I take, the more and more convinced I become that life is better when shared. Thanks so much for indulging me with a visit, Cecilia!

Major photo credits to Cici. 🙂  I snapped a few of these, but again– twice as nice when shared! xx

Dearest Darlingest Momsie and Popsicle

Although there hasn’t been any confusion over rooming at Shiz, and I haven’t yet seen Wicked in London[1], this week did bring a lot of excitement with thoughts of Momsie, Popsicle, and other family things. 

Last Sunday (March 15) was Mothers’ Day in the UK. After I finished my slight panic that I had somehow missed the whole month of April I learned that, although marketed quite similarly, this “Mothering Sunday” [2] is not associated with the US version of the holiday.  The priest at St Etheldreda’s Parish cleared this up during his homily and also connected this to the 21st C rendition of giving special thanks to our earthly mums as well as Mary, Mother of Jesus.

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St Etheldreda’s Parish, the oldest Roman Catholic church in London. Read more about it at: http://www.stetheldreda.com

We happened upon the Latin mass (far more common here in London than it is back home in the US) complete with choir and string quartet. Music included Eberlin’s Missa brevis in a, Palestrina’s Laudate Dominum, and (holiday appropriate) Johann Michael Haydn’s Ave Maria. As my mom likes to say, this is what I imagine heaven will sound like. 🙂

On Wednesday evening, after heading to Westminster Cathedral for daily mass, my cousin and I realized we were again celebrating a special feast– St Joseph’s Day.  Although this might make us sound like rather clueless Catholics, this was actually a vigil feast for St Joseph whose feast day is celebrated on March 19. We were again accompanied by beautiful music (this time organ + all male choir) and this time reflected on the gift of dads.

Westminster Cathedral
Westminster Cathedral

Although the mass ran longer than anticipated, we still had enough time to make the English Chamber Orchestra concert at Cadogen Hall (where I attended Joshua Bell’s performance this fall). This opened with Beethoven’s Leonora, featured an Italian soloist (Gloria Campaner) on Schumann’s piano concerto, and closed with Mendelssohn’s Scottish symphony. I don’t know that I’ve ever had such an excellent view of the stage– I could trace the musician’s eye contact and even follow the music on the last stand of cellists. Such a treat!

Following along with the last stand of cellists :)
Following along with the last stand of cellists 🙂

I also had a few good reminders of the significance of grandparents in recent weeks:

(a) Pope Francis’ address when I was in Rome: “We continue our reflection on grandparents, considering the value and importance of their role in the family. I do so by placing myself in their shoes, because I too belong to this age group. When I was in the Philippines, the Filipino people greeted me saying “Lolo Kiko” — meaning Grandpa Francis — “Lolo Kiko”, they said! The first important thing to stress: it is true that society tends to discard us, but the Lord definitely does not!… (Continue reading at the Vatican website.)

(b) The recent Social Science, Health, and Medicine seminar lecture on “Grandparenting in Europe and the Health Impacts of Caring for Grandchildren” presented by KCL’s Professor Karen Glaser (who coincidentally has ties to University of Michigan!)  There were a number of really interesting (and quite nuanced) findings discussed. ie: Caring for grandchildren on a ‘part-time’ basis (~15 hr / wk) has positive effects for grandparents’ health and well-being. The research has the potential to shape policy for work /retirement / compensation plans for the ever-growing older population. Since I’m looking at this with younger eyes, I’m curious to see if this could impact decisions around maternity / paternity leave as well as suggested work hours for working mums and dads. (Read more on the Grandparents Plus website.)

(c) Letter writing with my own grandparents. 🙂

The Valentine letter I received. Included an interesting WSJ article about med schools. :)
The Valentine letter I received. Included an interesting WSJ article about med schools. 🙂

Sometimes I’m pretty dense, so with just these occurrences this post may not have developed like this. But alas, I also saw Matilda, a special West End treat that I’ve been saving for viewing with my cousin Cecilia and her housemate Hailey.  (So glad the rush tickets worked out– we were the last few in queue to receive the special £5 student rate!!)

Cici & Hailey
Cici & Hailey

I hadn’t refreshed myself on Matilda’s plot since I watched the movie and read the book in grade school, but even if I would have, the theatre version deviates a bit from this. For example opening number “Miracle” features the soloists in the children’s Chorus each singing how “my mummy says I’m a miracle / my daddy says I’m a special little guy” regardless of whether they are acting sweet as angels or throwing tantrums at the moment.  This is juxtaposed with Matilda’s mother, shown at the hospital inquiring why she has become 9 months “fat” and whether or not it can be fixed before her dancing competition that evening. The doctor has the ‘joy’ (responsibility) of informing her of the situation:

DOCTOR
You’re nine months pregnant!

MRS WORMWOOD
Antibiotics, or . . . Oh, my good Lord! What about the Bi-Annual International Amateur Salsa and Ballroom Dancing Championships?

DOCTOR
A baby, Mrs Wormwood. A child. The most precious gift the natural world can bestow upon us has been handed to you. A brand new human being! A life. A person. A wonderful new person is about to come into your life to bring love, and magic, and happiness, and wonder!

MRS WORMWOOD
Oh, bloody hell!

DOCTOR
Every life I bring into this world
Restores my faith in human kind.

Each newborn life a canvas yet unpainted,
This still, unbroken skin,
This uncorrupted mind.

Ev-er-y life is unbelievably unlikely.
The chances of existence almost infinitely small.

The most common thing in life is life . . .

And yet every single life,
Every new life
Is a miracle!
Miracle!

MRS WORMWOOD
This is the worst day of my life! [3]

The audience watched with wide-eyed silence. No nervous or obligatory laughter. In fact, the applause at the end of the scene (where Matilda first enters to sing that her parents say she is “a lousy little worm”, “a bore”, “a good case for population control”…) was even a little hesitant as if the mums & dads were questioning whether or not it was a good idea to bring their little tykes to the theatre.

One might argue that this is theatre at it’s best! Inviting the audience into the world on stage!

Perhaps. But it would also make an good topic for a Bioethics lecture or dissertation: how are topics relevant in bioethics (ie: reproduction, pregnancy, child-birth) represented in popular culture or fictional literature? How do these representations impact our understanding of bioethics in ‘real life’? Some suggest that the provide us with warnings (ie: when I mentioned the Island when thinking about Maternal Spindle Transfer.) But we also hear suggestions that we are rather un-impacted by these sources: ‘those are clearly science fiction’ or ‘creating a Gattaca-esque world is not on our radar’, etc.  I already have my final papers in motion for the rest of the year, but this might fuel some free-time reading.

ASB

PS: In Christian traditions, today is Palm Sunday– the beginning of Holy Week, the holiest time in the Church calendar. It’s admittedly an odd thought that I’ll be apart from my family during this time, but celebrating in London presents a unique opportunity beginning with sung mass this evening at St Mary’s in Chelsea. Furthermore, I feel incredibly blessed to be welcoming my boyfriend Ben Brelje to London on Maundy Thursday and then greeting my sister Gretchen and dear friend Joan Campau right after the Octave of Easter is finished.  Very much looking forward to playing hostess, but this also means that I’ll be taking a break from writing for a bit. To keep the blog going in the mean time, I’ll try to prep some exclusively picture posts from earlier adventures that I haven’t been able to publish yet.  So as Grandma Berkemeier taught us, to be continued… xx

Footnotes:

[1] One of my favorite musicals!  But since I’ve seen it before in the States, it isn’t as high on my list as other performances.

[2] If you’re unfamiliar with this 4th Sunday of Lent holiday like I was, you can read a quick history on Wikipedia.

[3] I removed some parts of the script for reading purposes. Feel free to check out the whole thing HERE.

Featured Image: Stumbled upon Geraldine Street on a chilly walk back from Vauxhall. This is a toast to the lovely Geraldines in my life: Grandma (Geri) Gaydos as well as the coolest kid sister (Gigi) anyone could ask for. 🙂 Love you both!

Roma, Italia

Last week I had the incredible opportunity to participate in a medical ethics conference hosted by University of Notre Dame Center for Ethics and Culture at their Rome campus. As you may recall, this is the second year that I have been able to attend this medical ethics conference.  I had a bit of deja vu returning to the conference that helped fuel my desire to study bioethics, and more broadly, healthcare from the perspective of the humanities. To be fair though, this had a much different feel since we were just a block away from the Colosseum. 😉

I was impressed with how far I have progressed in my understanding of medical ethics in a year’s time.  Don’t misunderstand this as me thinking I’ve got it all figured out. Far from it! But I much better understood the language of this field and have become a bit more comfortable making bioethical arguments.  I guess my studying is paying off. 😉

I could write a book about what I have taken away from the conference discussions and then fill a few other volumes about tasting delicious Italian food… (click for enlargements + captions)

 

 

…strolling through beautiful museums, piazzas, and villas…

 

…standing in awe as a pilgrim in Rome (and Vatican City)…

 

…but I might have to drop out of my master’s program in order to make time for that. Instead, I present to you a snapshot at the intersection: is spirituality relevant to healthcare, medicine, and the understanding of bioethics?

This sends me back a few weeks ago when I was invited to speak to KCL’s Life Society about palliative care. From their website:

“We exist because universities are important spaces for the exploration of ideas and opinions, and it is important that the Pro-Life voice is heard on campus. Our message is a positive one, it is not about shaming or blaming, it is about discovering the beauty of human life, and protecting it.”

To be honest with you, I was pretty freaked out: why are you asking me?  How am I qualified to speak? To which the student in Life Society replied rather straightfowardly: You study bioethics right?  And you’re going into medicine? Seems like you would have a better idea about the topic than any of us!

It is amazing how much you can learn when you have to ‘teach’. I didn’t just want to speak on my own authority since, despite her encouragement, I honestly didn’t think I had much authority at all. In search of good reference material, I consulted a voice for whom I have profound respect, Ed Pellegrino, whose name I was introduced to little better than a year ago and whose literature continues to be a source of guidance in my study of bioethics.

Though I wouldn’t do justice to ‘summing up’ Pellegrino’s philosophy in a blog post, a central aspect is that:

Cure may be futile, but care is never futile.

The optimal end of healing is the good of the whole person– physical, emotional, and spiritual. The physician, manifestly, is no expert in every dimension. He or she, however, should be alert to the patient’s needs in each sphere, do what is within his or her capabilities and work with others in the health care team to come as close as clinical reality permits to meeting the several levels contained in the idea of the good of the patient. [1]

Considering the fact that a patient’s physical condition often provides the trigger to visit a doctor, it follows naturally that doctors have a reputation of focusing on the physical aspects health. Sometimes they are so focused though, that the patients’ emotional and spiritual needs are forsaken.  Although this applies to all aspects of medicine, I think it is particularly relevant to healthcare at the end-of-life which provided a good framework for my talk with the Life Society. It was also helpful for the conference last week where the keynote lecture was about international perspectives on the euthanasia debate… AND this week’s topic in my Case Studies module: “Ethics at the end of life– the biopolitics of dying.”

This post would get out of control if I tried to summarize all of the points relevant to this topic, so instead I’ll leave you with some important questions that I’ve been mulling over:

  • Does care change when cure is futile? Should it change? How so?
  • Aquinas’ Doctrine of Double Effect is often cited as a reason to prohibit euthanasia. Is there really a difference between [a] giving medication to a person that is intended to give them comfort but has a foreseeable outcome of shortening his life and [b] giving medication that has the intended effect of shortening his life? If there is a difference, how should this inform our ethics and legality of end of life care?
  • Conversations about emotional components of health (and even more frequently, spiritual components of health) are often omitted from clinical encounters. How does this effect patients’ care?  Should physicians be responsible for providing this care? If yes, in what capacity? If no, who (which member of the health care team) would better be able to provide this care?

Until next time,

A

[1] If you have access to a university library or other collection of journal articles, I highly recommend reading this full article! –> Pellegrino, E. (2001). The Internal Morality of Clinical Medicine: A Paradigm for the Ethics of the Helping and Healing Professions. The Journal of Medicine and Philosophy, 26(6), pp.559-579.

Featured image: St Peter’s by night

Pre-Vote News: “Mitochondrial Donation: Is it safe? Is it ethical?”

Last night I had the amazing privilege to attend a debate in the Houses of Parliament regarding today’s vote about whether or not to amend their 2008 Human Fertilisation and Embryology Act (HFEA). The debate was hosted by the Progress Educational Trust (PET), an independent organization that “urge(s) you to vote in favour of the Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015.”

I’m rushing this post to press, so please forgive the lack-luster writing quality– I thought you might enjoy an update while the news is fresh. My understanding of biology is helpful, but please understand that I am no expert on this.  All information provided is correct to the best of my knowledge– but if you see some errors, please let me know!

What is mitochondrial disease?

Most info in this section can be double checked on Wikipedia.

  • A set of diseases caused by faulty mitochondria, the “powerhouse” organelle in the body responsible cellular metabolism– converting the food we eat into energy that is usable by our body (ATP — adenosine triphosphate)
  • Symptoms: mostly effects organs that need a lot of energy such as brain (seizures, demintia); heart (cardiomyopathy “heart muscle disease”); muscles (weakness, cramping); ears / eyes / nerves (deafness, blindness, neuropathic pain)
  • Although in 5th grade we learned that all our DNA is stored in chromosomes in the nucleus of our cells that we received from our parents — half from Mom (egg), half from Dad (sperm)– this is only mostly true. It’s more like 49% from Dad (stored in the sperm’s chromosomes) and 51% from Mom (49% stored in the egg’s chromosomes, 2% stored in the egg’s mitochondria). This 2% is exclusively passed through the maternal line. (eg: George’s mitochondrial DNA came from his mom, which came from her mom, which came from her mom… George’s wife will pass on mitochondrial DNA to their children.)
  • While 85% of these mitochondrial diseases are caused by genetic mutations in chromosomal DNA, ~15% of mitochondrial diseases are caused by mutations in the mitochondrial DNA. This subset of mitochondrial diseases is where we focus our attention.

What is mitochondrial donation?

“A type of in vitro fertilization (IVF) that involves conceiving a child using biological material from three people — the child’s parents, plus a mitochondrial donor” (PET briefing).

You may have heard about this in the media as a “3 parent” embryo.  a somewhat misleading description since parents are not just defined by genetic relations. (Think about parents of adopted children.)  Even if emphasize the importance of genetic lineage, the embryo would only receive ~2% of its DNA from the “3rd parent” (the woman who donates mitochondrial DNA). Remember: 98% of the DNA is from the chromosomes of the egg & sperm.

The HFEA is proposing two specific techniques:

1. maternal spindle transfer (MST)

Mitochondria from a donor egg is transferred to the Mom’s egg. The Mom’s egg (now containing healthy mitochondrial DNA from the donor) is then fertilized with Dad’s sperm using IVF techniques.

2. pronuclear transfer (PNT)

Mom’s egg is fertilized with Dad’s sperm using IVF. A donor embryo is formed using donor egg and potentially (though not necessarily) donor sperm. The healthy mitochondrial DNA from the donor embryo is transferred to the embryo formed from the Mom’s egg and the Dad’s sperm. This technique results in the death of the donor embryo, the ethics of which are briefly outlined below.

See the HFEA’s website for more info on these two techniques.

What are the main ethical considerations?

Lots of things to consider! But for time sake (I have to run to class!) I’ll talk about two:

1. Is mitochondrial transfer safe?

Again, this is contested. Based on the debate yesterday, my understanding is that these techniques have been researched for 30+ years. The majority of this time has been spent with animal research, but the last 5 years have used human embryos. The results are promising, but we wouldn’t understand the effects until it is tested in humans.

This technique is unique in the fact that it changes the germ line. It is very difficult to predict the social and biological harms / benefits of this type of alteration. There have been a few experiments in humans that use similar techniques, (US — late 1990s, China — 2003) but the results have either been unsuccessful or indeterminate.

Note: In the US, the FDA has NOT yet approved mitochondrial donation for clinical trials. This takes for-eh-ver, so even if / when this advances to the stage of clinical trials, it will be a long time before it is available to the general public.

2. What is the moral status of an embryo?

A highly contested question. According to UK parliament (2002) the embryo has some non-negligible moral value that is less than the moral value of person after birth. This matches their policy that permits the use of IVF to select against severe genetic disease and states that embryos may be used for research purposes only when they are ≤ 14 days (“early embryos”).

One of the strongest voices on the other side of the fence is the Catholic Church, which states that “human life must be respected and protected absolutely from the moment of conception” (2270). Contrary to popular belief, the Catholic Church does encourage “research aimed at reducing human sterility” (2375). However, it opposes “techniques involving only the married couple… that dissociate the sexual act from the procreative act” (2377 — eg: artificial insemination / fertilization) and strongly opposes “techniques that entail the dissociation of husband and wife, by the intrusion of a person other than the couple” (2376).  This understanding matches the Catholic teaching that sympathizes with infertile couples but maintains that a child is gift– there is no “right to a child” (2379).  As such, the Catholic Church does not support the proposed changes– especially PNT which creates and destroys the donor embryo, a means to the end of creating a healthy embryo.

The vote will take place this afternoon (London time) so stay tuned to the news!  Based on the views exchanged at the debate yesterday and the fact that IVF is permitted in the UK with costs covered under the National Health Service, I’m betting that this proposal will pass at least in part– definitely for MST, but perhaps not for PNT because of the ethical reasons explained above.

And if you made it through that whole post, here are some photos for your enjoyment.

Sounds of Silence

I’m happy to report that this week was filled with interesting lectures* and other events…. and an extra few hours on the dance floor. 🙂 Though my skills don’t come close to those of the dance.addict@mail.com (no joke) who signed in before me, I am quite enjoying the (non-competitive) classes with the KCL Dance Society.  My hamstrings can attest to the fact that I haven’t done so many kicks since I was a majorette (twirled baton in marching band) in high school.

Dancing, running, or even just walking around town– it is rather simple to take the ability to participate in such activities for granted. I know I’ve mentioned this before with respect to navigating numerous flights of stairs at tube stations without lifts or escalators, but I think it is worth revisiting. This week’s reminder came to me on Guy’s Campus, the science / medical campus.   Since I don’t have classes on Guy’s Campus, I don’t frequent it as much, and thus my decision to find a bathroom quickly became an adventure in the basement of the Hodgkin Building: a maze of sloped corridors presumably designed to accommodate gurneys.  Despite KCL’s good intention of hanging signs (TOILETS —> ) I still couldn’t manage to find the regular facilities.  Having spotted a empty handicapped-accessible room with 1 toilet, I decided I didn’t need to pick a fight about about the poor signage (which didn’t actually direct people to this singular toilet).

Now, I’m sure most of you have entered a handicapped-accessible stall someplace: it’s most notable feature is its large size that can accommodate a wheelchair or other similar medical device.  Hospital bathrooms usually add in a few bars that the patient and / or medical assistant can use for support. This bathroom not only had those features, but also (most memorable for someone who is 5’10”) had the sink and hand dryer at levels that would be easily usable by someone who is sitting.  The engineer in me was taking stock of these details: “Nice! Someone was really thinking when they designed this!” But I couldn’t help but think of the countless other public bathrooms that I had visited where the design seemed to forget that people who are confined to wheelchairs probably have the same desire to wash and dry their hands as people that are able to stand.  I’ve never had to navigate a public restroom whilst in a wheelchair, though I think that if I ever had to design one, that is definitely a test I would want to apply.

In Engineering design courses, we are constantly reminded to envision our product from the user’s lens. For example, my senior design team was tasked with building a hearing screening device for newborns in South Africa. Our motivation was rooted in the understanding that most cases of hearing loss could be ‘corrected’ if deaf children who were diagnosed and given treatment (eg: hearing aids, extra language development instruction, etc) before critical language development years; children who were diagnosed after this period of critical language development (typically identified by unresponsiveness to loud noises or delayed ability to speak) would never attain the speaking proficiency of their normal-hearing peers.   Though I dare say my team did a pretty good job of accounting for many of these nuanced factors that can make or break the successful implementation of a medical device into a community, I don’t think we ever considered whether the parents would actually prefer to have a deaf child.

I mentioned this topic in a post at the beginning of last term, and after months of sitting with this idea, it still doesn’t sit well with me.  But a marked sign of development is the fact that I better understanding the arguments surrounding the case and can articulate some of my own perspectives that amount to more than ‘an odd feeling’.

Another marked sign of progress is my improved reading speed.**  In between my assigned readings for my classes, I’ve managed to read some more about this case of choosing deafness in the book that our program director (Dr Silvia Camporesi) recently published–  From Bench to Bedside, to Track & Field: The Context of Enhancement and its Ethical Relevance.  Despite the fact that my teammates and I didn’t consider the possibility that some people would prefer to have a deaf child, Silvia notes that:

“Empirical research suggests that deaf people often have a degree of preference for a deaf child, and a rather smaller number would consider acting on their preference with the use of selective techniques. [***See references below.] It turns out that such parents do not view certain genetic conditions as diabilities but as a passport to enter into a rich, shared culture” (p 54).

THAT is certainly some food for thought for engineers trying to implement hearing screening devices.

Last week we were invited to attend Silvia’s book launch. This was pretty exciting since the last book release that I can remember attending was for Harry Potter 7, and no, J K Rowling did not make a guest appearance at Meijer. This intimate event was shared with a good showing from our Social Science, Health, and Medicine department as well as Silvia’s husband & parents who made the trip in from Italy!

At the book launch with some of my classmates. Photo courtesy of Silvias mom. :)
At the book launch with some of my classmates. Photo courtesy of Silvia’s mom. 🙂

Considering the theme of my musings, I was excited to learn about and attend a Deaf Arts Festival hosted in London this past weekend. (Photos courtesy of Silvia.)

I managed to catch the last part of the student theatre production. Although they provided some super-titles on the background screen, the main method of communication was British Sign Language and a bit of loud, low frequency sounds that you could feel.  Perhaps my favorite part was the silent round of applause at the end of the show– something that looks quite similar to jazz hands or spirit fingers at a basketball game.  I can’t say I understood everything (I think they were performing a modern interpretation of Hamlet?) but it certainly provided some good think time.

And now I’ll leave you here to give you some think-time of your own.

Cheers,

Andrea

*I’ve saved my notes from one of my favorite lectures this week which gave a philosophical response to “What does it mean to love a person?”  If I can time this well, I might be able to release this mid-February… 😉  Stay tuned!

**I suppose that comes with practice, and goodness knows that those skills had become quite rusty during my years at UM.  Reading a biotransport textbook (30% text, 70% equations) is vastly different than reading a paper about withholding blood transfusions from Jehovah’s Wittness children.

*** References:

Middleton, A, J Hewison, and R F Mueller. 1998.  “Attitudes of Deaf Adults Toward Genetic Testing for Hereditary Deafness.” American Journal of Human Genetics 63 (4): 1175-1180. doi:10.1086/302060

Stern, S J, KS Arnos, L Murrelle, K Oelrich Welch, W E Nance, and A Pandya. 2002.  “Attitudes of Deaf and Hard of Hearing Subjects Towards Genetic Testing and Prenatal Diagnosis of Hearing Loss.” Journal of Medical Genetics 39 (6) (June): 449-453.

Featured image: also from the Deaf Arts Festival. Photo courtesy of Silvia.