[Begin full fiction mode. This was based on nothing but my imagination. To pretend to be not totally arrogant, I’m going to put my arguments in the mouth of the character Paul. But even that’s pretty presumptuous. I suppose that’s an inherent problem with dialogue. It’s like playing chess with yourself. Of course you’re going to win. So watch as one figment of my imagination totally works another. So here goes another attempt at this medium:]
I was walking with my good friend Paul (he’s from a place called Tarsus, right off I-5, if you know where that is). We were enjoying the crisp January air when we saw our mutual friend, Job.
“Good day, Job!” said I.
“What is good about it?” he asked.
“Light and life and breath, to begin with,” said Paul. “We live in a wonderfully ordered world under an astonishing heaven ruled by a Good God.”
“Good God?” asked Job sarcastically. “How can you dare to say that? And to me, of all people? Don’t you know that He killed my ten children? Don’t you know that this has been my daily torture for these long years?”
“Dear Job,” said Paul, “I have wept with you about your children. And I have walked with you through those valleys. But this attitude is unbecoming. What alchemy has transmuted your sadness into anger? What has made the pure cold gold of mourning into the boiling lead of rage?”
“It is only rational,” Job retorted. “Rage is the only proper response to so blatant an offense. What have I done to deserve this? What possible good is it accomplishing? And even if there is some good, could it not be accomplished with less suffering?”
“These are all excellent questions,” said Paul. “To answer them, I will need to tell a story and you will need to do a bit of imagining. Would you like me to answer your questions?”
“Though I know it is a dangerous thing to do with you, I will play your game.”
“Wonderful!” exclaimed Paul. “Imagine a woman is pregnant. The pregnancy is complicated and the woman dies in childbirth. The woman’s husband and now father of the child names him Jamal. Jamal’s doctors notice that he looks blue. He is worked up and diagnosed with Tetralogy of Fallot, a birth defect of the heart. Untreated, Jamal has slightly better than even odds that he’ll make it to his fourth birthday and almost no chance of seeing adulthood. The doctors tell Jamal’s father that there is a cure, but it will require multiple, painful heart surgeries. What should Jamal’s father do?”
“He should get the surgeries.”
“But wait,” said Paul. “He is causing terrible pain to his own son. He’ll have to spend countless days in a nightmarish hospital, away from the sounds and sights and smells of home. It will involve a hundred needle sticks that Jamal will not understand, tape and tubes, beeping and buzzing. For his first few years of life, Jamal will several times be thrown into a whirlpool of confusion and pain.”
“Yes. But it will be for his own good. Several short years of pain will lead to a tenfold longer life.”
“Alright. But shouldn’t we get the consent of someone before performing a procedure on them?” asked Paul.
“If it is possible. But here, it’s not possible.”
“Because Jamal cannot understand,” said Job. “He doesn’t understand about the genetic inheritance patterns, ventral septal defects, the failure to adequately oxygenate blood. He can’t even know about adequate hydration and the need for a needle stick and IV fluids, let alone the complexities of cardiothoracic surgery. ‘Informed consent,’ requires that a person understand at least the very basics of their condition and the procedure. Jamal, being a newborn, cannot understand these things. His father must make the decision for him.”
“So you think that when someone cannot give informed consent, the decision should fall to another?”
“Yes. In this case, the father is clearly the one who has the responsibility to care for him and to make decisions on his behalf until he is old enough to make his own decisions.”
“So now imagine,” said Paul, “that it’s four years down the road, and though he should be cured, Jamal’s case is complicated and he needs one final surgery. He’s now old enough to fear hospitals and hate doctors. Jamal’s father tells him, ‘Jamal, we need to go to the hospital again to get you healthy.’ This time Jamal pleads, ‘No! I won’t go! It hurts! Why are you hurting me, Daddy?’ What could the father reply? After the reply, what should he do?”
“There isn’t much he could say that would satisfy Jamal. He could say, ‘Jamal, I know it hurts, but it is what is best for you. Do not worry, because I will be there with you, and I will suffer with you.’ And then, whether Jamal likes this answer or not, he should still take him for the surgery.”
“So even in this case when Jamal has clearly against the idea, his father should do his best to explain it, promise to be with him, and do it anyways.”
“So,” said Paul, “We have established that because a child lacks understanding, certain decisions should be made on his behalf. Now what if Jamal asked, ‘Daddy, if I have to go, can you ask the doctors to make it hurt less?’”
“The father should reply, “Jamal, they are already doing everything they can to make it hurt less. The cure for your sickness requires a lot of pain. If there were a better cure, don’t you think I would have chosen it?’”
“So long as the father is minimizing pain in his attempt to reach a good end for his son, he is justified in causing it. Is Jamal capable of knowing if a given needle stick is a required part of his medical care?”
“Of course not,” said Job.
“What about the number of surgeries? Can he know by the apparently gratuitous number of his surgeries that his father is actually not loving?”
“It would be impossible. Such a question is difficult for health policy experts, let alone for four-year-old children.”
“It this is impossible, wouldn’t it also be impossible for him to then to know that his father loves him?” Paul asked.
“No. Jamal can see it. He can feel it. Most of all, when he sees his father suffer with him. When he cries at a prick, his father’s face looks as if it were hurt. The promise I put in the father’s mouth at the beginning, that he would always be with Jamal, is perhaps the greatest proof of love when it is fulfilled.”
“But can he prove that his father loves him?”
“Love is not the sort of thing that can be demonstrated by mathematical or scientific proof. It is something that is sensed on a deeper level. Jamal can know it, but he cannot prove it.”
“So,” said Paul, “We’ve established that the father should act in Jamal’s best interest, regardless of how painful it might be.”
“And we’ve agreed that Jamal would have no adequate understanding of his condition to make any judgments.”
“And finally, we’ve shown that even though he lacks understanding, he can still know that his father loves him through his pain.”
“Now allow me to tell the story in a different way,” said Paul. “What if instead of a newborn named ‘Jamal’ we were talking about an adult named ‘Job.’ And instead of an earthly father, we were talking about God. A physical birth defect in the heart becomes a spiritual one. Jamal suffers for four years to gain 70 of life; Job suffers for 80 years to gain a millennium of life and more. Job, how is your position any different from Jamal’s?”
Job was silent for several minutes. His eyes darted to and fro, searching for an escape but finding none. Finally, with a reluctant tone, Job said, “I see your point: I am Jamal. I will have to reflect on this.”
The three of us walked along the road together, enjoying the warm sun and bright blue sky.