Lenn E. Goodman

The Overselling of Genetic Anxiety

B rochures warning American Jews against genetic diseases are printed in blue on white, the colors of the Jewish prayer shawl and of the flag of Israel. One logo shows the profile of a childs face inset into a Star of David from which falls a single tear. The design symbolizes in particular the tragedy of Tay-Sachs disease (TSD) (See box on p. 21). Normal in appearance at birth, Tay-Sachs children begin to regress and lose contact with their families and environment within the first year of life, declining inexorably toward a totally vegetative state. Death is inevitable, but the child may survive helplessly for as long as two to three years, or even to age four. Frustrated by the lack of any known cure, physicians, geneticists, families, and charitable groups have focused their efforts on preventive measures to combat TSD. Since the early 1970s the effort has largely been concentrated on mass screening among the Jewish population to detect carriers of the disease and to offer them genetic counseling. Unlike the mass screening for sickle cell trait, initiated in the same period, which was severely criticized and eventually stopped on the grounds that it stigmatized the black population and offered no therapeutic benefits to carriers, Tay-Sachs screening has generally been considered a model of community-professional cooperation. Yet we believe that this mass screening effort also involves serious ethical problems-in the style and content of its educational program, in its use of community resources and leadership, and

Prevention--how misuse of a concept undercuts its worth.

Some health leaders and researchers have launched mass prevention programs without sound biomedical groundwork. They have oversold the benefits of prevention and underestimated the secondary effects. Some have forced nonmedical concerns into the medical model. Others have blurred the distinctions between prevention and other measures such as screening or therapy. Some have transferred responsibility for disease to the victim. A few have imputed magical powers to certain symbols of prevention, in order to create an illusion of control.

Medicalization and its discontents

This paper raises the question of the ethically proper balance in health care policy between the medical-clinical-high technology model of health service and the grass-roots, community based or traditional models of care. Paradoxical imbalances between the two approaches are traced to political, economic or prestige factors. Case studies examined include the hospitalization of non-contagious leprosy patients while protecting the anonymity of AIDS-infected prostitutes, medical resistance to the adoption of a clinical role by Community Cancer Centers, and the continued preference in some quarters for elaborate (and often delayed) hospital treatment for such problems as infant diarrhea, despite the availability of much simpler solutions, as in the case of the widely successful oral rehydration therapy. A balanced approach to world health problems, we argue, rests not on inflationary lowering of health care standards to achieve nominal victories, nor on stainless steel high technology panaceas but on mobilizing resources around human needs.

Gh azâlî's Argument from Creation (II)

One achievement of the philosophy represented by Ghazâli is disentangling the creation argument for the existence of God from rival forms of design argument which allow or assume the eternity of the world. From its earliest expressions as an isolated insight which might easily be explained away as myth, the notion that the universe had been brought to be out of what is not was gradually tranformed under pressure of severe Aristottelian criticism into a precise concept, and the argument implicit in such a notion metamorphosed into an elegant and sophisticated demonstration. Backed up by the closely reasoned philosophy of being into which it was now integrated, the argument from creation might confidently hope to be proof against attack.

A Call to Higher Things

Abstract Seeking a responsible middle ground between complaisance and the “religious totalitarianism” of Sayyid Qutb, Miroslav Volf proposes a proper role for religion as a faithful advisor in the public square and an inspired one in the corridors of conscience. But he seems to lose patience with that theme without addressing John Rawls’ case for silencing religious counsels—or engaging the strident atheism of Dennett, Dawkins, Hitchens, or Grayling, and he takes Qutb more as a foil than an adversary to be grappled with directly. Turning away from debates over religion’s proper public role he catalogues the “malfunctions” of faith, sidestepping many of today’s more burning issues in favor of a generic call to “lives of integrity”—while acknowledging that we mortals are “powerless against the lure of evil,” too often seconded by “the power of the systems that surround us.” Prayer, Volf argues, finds its best use when we ask to be made “willing, capable, and effective instruments in God’s hand.” One only wishes he had been more explicit and more ready for down and dirty argument with those who reject the very idea of prayer and with those who imagine they become God’s best instrument when holding an incendiary device.

Coming to mind : the soul and its body

How should we speak of bodies and souls? In Coming to Mind, Lenn E. Goodman and D. Gregory Caramenico pick their way through the minefields of materialist reductionism to present the soul not as the brains rival but as its partner. What acts, they argue, is what is real. The soul is not an ethereal wisp but a lively subject, emergent from the body but inadequately described in its terms. Rooted in some of the richest philosophical and intellectual traditions of Western and Eastern philosophy, psychology, literature, and the arts as well as the latest findings of cognitive psychology and brain science - Coming to Mind is a subtle manifesto of a new humanism and an outstanding contribution to our understanding of the human person. Drawing on new and classical understandings of perception, consciousness, memory, agency, and creativity, Goodman and Caramenico frame a convincing argument for a dynamic and integrated self capable of language, thought, discovery, caring, and love.