Kimbell Kornu offers a thoughtful elaboration of the counterintuitive claim first popularized by Jeffery Bishop—that contemporary medical practice is practically organized around the transcendental absolute of death. He elaborates how this metaphysic is well described by Heidegger even though Heidegger’s own account also finally collapses into a death-fixation. Kornu supplies a theological corrective by appeal to a rival teleological metaphysics of death-from-life that he draws from Maximus the Confessor.
I am largely in agreement with the general thrust of Kornu’s argument, and so will make two additional observations that I think, in the end, open up subtle but far-reachingly different theological ethic than the one Kornu points toward. My main aim will be to drill further into Kornu’s most developed practical example, prenatal testing. I will then suggest that Kornu has not quite gotten Heidegger’s eschatology right. By reading Heidegger’s account of technology more closely we discover a theological repair that might, perhaps, offer Christians a more practically illuminating theological vantage point from which to negotiate the lived experience of modern medicine.
The Nihilism of Prenatal Testing
Many pregnant women in highly medicalized western societies feel strong, sometimes coercive, resistance to their decisions not to abort a genetically anomalous new one. This is one of the practical realities of medical nihilism—that it presses toward the elimination of human lives that it is assumed cannot be made useful. Over the last few decades sociological studies have helpfully described in more detail how the dominant medical “common sense” in this domain actually works.
If we agree with Kornu that prenatal testing is a scene in which the nihilisim of medicine can be tangibly encountered, we have to say that the conflict between a Christian view of reality and the nihilism of medicine takes place in a darkened room between a pregnant woman and a sonographer.[1] When a pregnant woman enters the exam she knows her body in one way, and certain aspects of the new one’s body hidden and in many respects unknown within her.[2] The bodily self-knowledge derived from the woman’s own sensation will now be overlaid with visual imagery. The body-within-the-body will be given new, more independent standing. Since all parties will now focus not on the new one’s body itself but on an image of it on a screen, this is a cyborg experience that will in important respects overshadow the earlier forms of relating to the new one.[3] This visualization of the new one takes place in western societies in which visual images, especially live video, have become the dominant medium for proving that something “really” happened.
Rayna Rapp, a sociologist of prenatal testing, takes this visualization of the new one to be reality-bending for all parties, as well as a lightning rod for the polarization of medical professionals and the pregnant woman.
“Visualizations are presented on a monitor quite similar to the ubiquitous television screen, and their impact is instantaneous. They hold a powerful place in women’s narratives, and are recalled far more vividly than the ‘caterpillar stick figures’ of karyotype photographs. In the cases where spina bifida, anencephaly, or life-threatening heart, lung, and kidney problems were visualised, women from diverse sociocultural backgrounds…told virtually the same story: ‘Pretty soon, it was a regular doctors’ convention in there. At some point, I must have had eight doctors muttering over that screen. I said to myself, my God, something is terribly wrong here, because they keep calling other people to come in and take a look. … But they wouldn’t say anything to me.’”[4]
We live in a society in which the ritual of parents viewing moving real time images of the new one are viscerally powerful. We also live in a society that is increasingly obsessed with “taking home baby’s picture” and in which the showing of such pictures initiates a public quickening that transforms the social reality of parents. Such visual proof is publicly intelligible proof that a fetus is now a viable baby who can be welcomed without qualms.
Sonographic images are not self-explanatory, being visually cryptic anatomical cross-slices. The mother can often see the screen as the scan progresses as may the partner and even children or a grandparent who are often in attendance. As the sonographer produces the ultrasound scan he or she is thus traversing highly complex social, emotional and evaluative territories. Because the imagery is live during scanning and the mother and the sonographer in intimate bodily proximity, the sonographer has to keep up a patter of reassuring conversation. The woman with the probe pressed to her belly must be calmed as the sonographer looks for anomalies in an environment where long periods of silence can easily be interpreted as ominous. One father explains the fright produced by silence.
“Early ultrasounds had indicated serious concerns; we had come to learn how best to prepare for his arrival. Our slim hopes were assaulted by the silence that crept into the room as she [the sonographer] surveyed for signs of defects, for indicators of all the ways in which our son was already broken. Initially friendly and open, she stopped inviting questions about what she perceived; she did stop to point out his severely clubbed feet. And then she was done. With a sigh, she made her announcement. Trisomy 18. Lethal. Inevitable. Death. Would we Terminate?”[5]
In the theatre of the sonography room we can see how finely woven together the pastoral and evaluative tasks are for the sonographer. On one hand the sonographer must reassure the pregnant woman in the course of the scan in order to promote bonding with a “normal” child in the womb. This is usually done by utilizing descriptions that emphasize its vigor and personality. The new one’s representation on the screen is often described in terms of parental, gendered and child-like personality traits (“Look, she’s excitable like dad!”). Should an anomaly be uncovered, however, the task immediately shifts to the much more fraught work of directing attention away from a “fetus” about whom a “termination” will now have to be discussed while quickly assessing whether or not this is what the mother wants.[6]
The ultrasound test’s reconfiguration of the relationship between the parent and the new one has been called the “one-two punch of birth in the technocracy.”[7] The examination first separates a mother from her initial sense of knowledge and bond with her own body and that of the new one. Th scan generates an image of someone who is genuinely other, whose interests might now conflict with the mother’s. It is precisely because this potential conflict has now become a discursive reality, that the sonographer becomes an indispensable part of the bonding process between mother and new one. The decisive hermeneutic threshold between nihilism and any substantively Christian metaphysic is thus in play within the first minutes of the ultrasound scan.
Interlude on Heidegger
I have elsewhere argued a case much like Kornu’s, that understanding Heidegger’s account of technology depends on noticing that his philosophy is a secularized eschatology.[8] What I think Kornu misses is that Heidegger’s eschatology is messianic or advental. Heidegger is intentionally and explicitly not working within the neo-platonic exitus-reditus teleological eschatology of Maximus. This complicates any merger of the projects of the two thinkers.
Heidegger’s eschatology is most obviously on display in the role he gives art in his account of technological change (developed in “The Origin of the Work of Art”). Heidegger had an abiding interest in how unexpected revelatory experiences can reorient people’s existential self-understanding and pre-reflective perception of the material world. His perennial question could be summarized as, “How does something outside of me come to me and reconfigure me in its likeness?” I would propose that this question can best be reconnected to Christ not by a metaphysics in which the logos functions to orient teleological motion, but by asking, “How does Christ come to us and meet us, transforming our being and action by making us subjects in his image?”
I will suggest, in conclusion, that this advental tradition is able to respond to the conflict of the Christian confession with medical nihilism in much more concrete ways than the metaphysics of teleological progress, more classically called the exitus-reditus tradition.
Adventus and Nihilism
To restate the metaphysical question at stake: is the new one in the womb a silent resource for human manipulation aiming to defeat death (as active nihilism has it)? Or is God somehow calling to humanity through this newly created being who comes from God’s hand?
It was the annunciative character of a genetically anomalous new one that shattered the ideological certainties of Raya Rapp, making her into a genuine inquirer. She ends her sociological study with this elegiac dedication to her aborted offspring.
“Mike named the fetus XYLO, or X-or-Y for its unknown sex, LO for the love we were pouring into it. Together, we watched XYLO grow; together we chose to end his life after a prenatal diagnosis of Down’s. My personal pain and confusion as a failed mother led me to investigate the social construction and cultural meaning of amniocentesis…. XYLO’s short life pointed me toward these vital concerns; his ending marked the beginning of my search for contextualized knowledge. If the work accomplished in this book helps others to think about these evolving issues, his short life will have been a great gift.”[9]
In the light of God’s self-annunciation from the manger in Bethlehem, the Christian is enabled to say in faith—without the intervening and instrumentalizing “if”—that XYLO was indeed a great gift. His appearance should be narrated theologically as an apocaplysis or krisis drawing back the curtain on a wide swathe of the shameless lies covering a society’s collective decision to refuse him entry into life with his parents. XYLO is a repeater of the angel’s message to Mary and the shepherds: “Fear not.” Such an annunciation threatens the active nihilism that seeks to erase human beings considered too burdensome or insufficiently productive.
To be steeped in another metaphysic is to have a different experience of the material world.
“Annunciation—a sign. Even when that to which it points is unwelcome, it can be a grace. Whether it becomes a grace depends, in part, upon whether we possess the humility and grace to receive the message well. Witness Mary, a young girl, probably not older than fifteen… Perhaps she did not understand what submission to this scheme would cost her. She would have to bear his [Jesus’] death. Could she have grasped the great sorrow of watching Him die? …All of heaven and earth waits to hear her response. And Mary speaks, “Let it be to me according to your word.” She would bear God, she would give him her flesh. …We did not receive our annunciation from a messenger of God. And the message signaled nothing good. …Trisomy 18. Lethal. Inevitable. Death. Would we terminate? Annunciations can be intrusions. They leave us expecting the already inevitable but not yet.”[10]
That group of human beings who are seen as “defective” or “not normal”—whether born or unborn—announce an end to the need to draw boundaries between them and us. Their living and moving and growing are gestures insistently repeating that human community is not maintained by violence, but by openness to being surprised by the birth of the unexpected—messianic—new beginning.[11] Such annunciations continually hold out to us concretely new ways of living in the midst of enculturated apparatuses of death.
Brian Brock is an ethicist at the University of Aberdeen and is author of the recent Wondrously Wounded.
[1] There are two notable variations in practice and nomenclature here. North Americans and Europeans typically label the technology ultrasound (the term ultrasound refers to the technology used to produce an image, the sonogram being the image produced). In Britain the more common nomenclature is sonography. In Britain this work is typically conceived as routine “hands off work” and delegated to technicians (except in cases expected to be complicated) while in North America it is seen as the domain of the expert, and is usually staffed by doctors trained in genetics. Gareth M. Thomas, Down Syndrome Screening and Reproductive Politics: Care, Choice, and Disability in the Prenatal Clinic (Abingdon: Routledge, 2017), ch 3. Mara Buchbinder, “Down’s Syndrome screening and reproductive politics: Care, Choice and Disability in the Prenatal Clinic,” New Genetics and Society (2017). DOI: 10.1080/14636778.2017.1368375.
[2] The incompleteness of this knowledge has direct implications for the shape and meaning of pregnancy. James Mumford, Ethics at the Beginning of Life: A Phenomenological Critique (Oxford: Oxford University Press, 2013), ch. 1.
[3] On cyborgs as a technically mediated human body see Bruno Latour, “Body, Cyborgs and the Politics of Incarnation,” in The Body, eds. Sean T. Sweeney and Ian Hodder (Cambridge: Cambridge University Press, 2002), 127-141.
[4] Rayna Rapp, Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America (New York: Routledge, 2000), 221.
[5] Aaron D. Cobb, Loving Samuel: Suffering, Dependence, and the Calling of Love (Eugene: Cascade Books, 2014), 11.
[6] Thomas, Down Syndrome Screening and Reproductive Politics, 98-100. 143.
[7] For an anthropological account of the “cyborgification” of ultrasound and the “one two punch” see Mitchell, Lisa M., and Eugenia Georges. “Cross-Cultural Cyborgs: Greek and Canadian Women’s Discourses on Fetal Ultrasound.” Feminist Studies 23.2 (1997): 373-401.
[8] Brian Brock, Christian Ethics in a Technological Age (Grand Rapids: Eerdmans, 2010), 62-65.
[9] Rapp, Testing Women, Testing the Fetus, 318.
[10] Cobb, Loving Samuel, 9-11., 195.
[11] Hannah Arendt, The Human Condition (Chicago: University of Chicago Press, 1958), ch. 6.
Kimbell Kornu offers a thoughtful elaboration of the counterintuitive claim first popularized by Jeffery Bishop—that contemporary medical practice is practically organized around the transcendental absolute of death. He elaborates how this metaphysic is well described by Heidegger even though Heidegger’s own account also finally collapses into a death-fixation. Kornu supplies a theological corrective by appeal to a rival teleological metaphysics of death-from-life that he draws from Maximus the Confessor.
I am largely in agreement with the general thrust of Kornu’s argument, and so will make two additional observations that I think, in the end, open up subtle but far-reachingly different theological ethic than the one Kornu points toward. My main aim will be to drill further into Kornu’s most developed practical example, prenatal testing. I will then suggest that Kornu has not quite gotten Heidegger’s eschatology right. By reading Heidegger’s account of technology more closely we discover a theological repair that might, perhaps, offer Christians a more practically illuminating theological vantage point from which to negotiate the lived experience of modern medicine.
The Nihilism of Prenatal Testing
Many pregnant women in highly medicalized western societies feel strong, sometimes coercive, resistance to their decisions not to abort a genetically anomalous new one. This is one of the practical realities of medical nihilism—that it presses toward the elimination of human lives that it is assumed cannot be made useful. Over the last few decades sociological studies have helpfully described in more detail how the dominant medical “common sense” in this domain actually works.
If we agree with Kornu that prenatal testing is a scene in which the nihilisim of medicine can be tangibly encountered, we have to say that the conflict between a Christian view of reality and the nihilism of medicine takes place in a darkened room between a pregnant woman and a sonographer.[1] When a pregnant woman enters the exam she knows her body in one way, and certain aspects of the new one’s body hidden and in many respects unknown within her.[2] The bodily self-knowledge derived from the woman’s own sensation will now be overlaid with visual imagery. The body-within-the-body will be given new, more independent standing. Since all parties will now focus not on the new one’s body itself but on an image of it on a screen, this is a cyborg experience that will in important respects overshadow the earlier forms of relating to the new one.[3] This visualization of the new one takes place in western societies in which visual images, especially live video, have become the dominant medium for proving that something “really” happened.
Rayna Rapp, a sociologist of prenatal testing, takes this visualization of the new one to be reality-bending for all parties, as well as a lightning rod for the polarization of medical professionals and the pregnant woman.
“Visualizations are presented on a monitor quite similar to the ubiquitous television screen, and their impact is instantaneous. They hold a powerful place in women’s narratives, and are recalled far more vividly than the ‘caterpillar stick figures’ of karyotype photographs. In the cases where spina bifida, anencephaly, or life-threatening heart, lung, and kidney problems were visualised, women from diverse sociocultural backgrounds…told virtually the same story: ‘Pretty soon, it was a regular doctors’ convention in there. At some point, I must have had eight doctors muttering over that screen. I said to myself, my God, something is terribly wrong here, because they keep calling other people to come in and take a look. … But they wouldn’t say anything to me.’”[4]
We live in a society in which the ritual of parents viewing moving real time images of the new one are viscerally powerful. We also live in a society that is increasingly obsessed with “taking home baby’s picture” and in which the showing of such pictures initiates a public quickening that transforms the social reality of parents. Such visual proof is publicly intelligible proof that a fetus is now a viable baby who can be welcomed without qualms.
Sonographic images are not self-explanatory, being visually cryptic anatomical cross-slices. The mother can often see the screen as the scan progresses as may the partner and even children or a grandparent who are often in attendance. As the sonographer produces the ultrasound scan he or she is thus traversing highly complex social, emotional and evaluative territories. Because the imagery is live during scanning and the mother and the sonographer in intimate bodily proximity, the sonographer has to keep up a patter of reassuring conversation. The woman with the probe pressed to her belly must be calmed as the sonographer looks for anomalies in an environment where long periods of silence can easily be interpreted as ominous. One father explains the fright produced by silence.
“Early ultrasounds had indicated serious concerns; we had come to learn how best to prepare for his arrival. Our slim hopes were assaulted by the silence that crept into the room as she [the sonographer] surveyed for signs of defects, for indicators of all the ways in which our son was already broken. Initially friendly and open, she stopped inviting questions about what she perceived; she did stop to point out his severely clubbed feet. And then she was done. With a sigh, she made her announcement. Trisomy 18. Lethal. Inevitable. Death. Would we Terminate?”[5]
In the theatre of the sonography room we can see how finely woven together the pastoral and evaluative tasks are for the sonographer. On one hand the sonographer must reassure the pregnant woman in the course of the scan in order to promote bonding with a “normal” child in the womb. This is usually done by utilizing descriptions that emphasize its vigor and personality. The new one’s representation on the screen is often described in terms of parental, gendered and child-like personality traits (“Look, she’s excitable like dad!”). Should an anomaly be uncovered, however, the task immediately shifts to the much more fraught work of directing attention away from a “fetus” about whom a “termination” will now have to be discussed while quickly assessing whether or not this is what the mother wants.[6]
The ultrasound test’s reconfiguration of the relationship between the parent and the new one has been called the “one-two punch of birth in the technocracy.”[7] The examination first separates a mother from her initial sense of knowledge and bond with her own body and that of the new one. Th scan generates an image of someone who is genuinely other, whose interests might now conflict with the mother’s. It is precisely because this potential conflict has now become a discursive reality, that the sonographer becomes an indispensable part of the bonding process between mother and new one. The decisive hermeneutic threshold between nihilism and any substantively Christian metaphysic is thus in play within the first minutes of the ultrasound scan.
Interlude on Heidegger
I have elsewhere argued a case much like Kornu’s, that understanding Heidegger’s account of technology depends on noticing that his philosophy is a secularized eschatology.[8] What I think Kornu misses is that Heidegger’s eschatology is messianic or advental. Heidegger is intentionally and explicitly not working within the neo-platonic exitus-reditus teleological eschatology of Maximus. This complicates any merger of the projects of the two thinkers.
Heidegger’s eschatology is most obviously on display in the role he gives art in his account of technological change (developed in “The Origin of the Work of Art”). Heidegger had an abiding interest in how unexpected revelatory experiences can reorient people’s existential self-understanding and pre-reflective perception of the material world. His perennial question could be summarized as, “How does something outside of me come to me and reconfigure me in its likeness?” I would propose that this question can best be reconnected to Christ not by a metaphysics in which the logos functions to orient teleological motion, but by asking, “How does Christ come to us and meet us, transforming our being and action by making us subjects in his image?”
I will suggest, in conclusion, that this advental tradition is able to respond to the conflict of the Christian confession with medical nihilism in much more concrete ways than the metaphysics of teleological progress, more classically called the exitus-reditus tradition.
Adventus and Nihilism
To restate the metaphysical question at stake: is the new one in the womb a silent resource for human manipulation aiming to defeat death (as active nihilism has it)? Or is God somehow calling to humanity through this newly created being who comes from God’s hand?
It was the annunciative character of a genetically anomalous new one that shattered the ideological certainties of Raya Rapp, making her into a genuine inquirer. She ends her sociological study with this elegiac dedication to her aborted offspring.
“Mike named the fetus XYLO, or X-or-Y for its unknown sex, LO for the love we were pouring into it. Together, we watched XYLO grow; together we chose to end his life after a prenatal diagnosis of Down’s. My personal pain and confusion as a failed mother led me to investigate the social construction and cultural meaning of amniocentesis…. XYLO’s short life pointed me toward these vital concerns; his ending marked the beginning of my search for contextualized knowledge. If the work accomplished in this book helps others to think about these evolving issues, his short life will have been a great gift.”[9]
In the light of God’s self-annunciation from the manger in Bethlehem, the Christian is enabled to say in faith—without the intervening and instrumentalizing “if”—that XYLO was indeed a great gift. His appearance should be narrated theologically as an apocaplysis or krisis drawing back the curtain on a wide swathe of the shameless lies covering a society’s collective decision to refuse him entry into life with his parents. XYLO is a repeater of the angel’s message to Mary and the shepherds: “Fear not.” Such an annunciation threatens the active nihilism that seeks to erase human beings considered too burdensome or insufficiently productive.
To be steeped in another metaphysic is to have a different experience of the material world.
“Annunciation—a sign. Even when that to which it points is unwelcome, it can be a grace. Whether it becomes a grace depends, in part, upon whether we possess the humility and grace to receive the message well. Witness Mary, a young girl, probably not older than fifteen… Perhaps she did not understand what submission to this scheme would cost her. She would have to bear his [Jesus’] death. Could she have grasped the great sorrow of watching Him die? …All of heaven and earth waits to hear her response. And Mary speaks, “Let it be to me according to your word.” She would bear God, she would give him her flesh. …We did not receive our annunciation from a messenger of God. And the message signaled nothing good. …Trisomy 18. Lethal. Inevitable. Death. Would we terminate? Annunciations can be intrusions. They leave us expecting the already inevitable but not yet.”[10]
That group of human beings who are seen as “defective” or “not normal”—whether born or unborn—announce an end to the need to draw boundaries between them and us. Their living and moving and growing are gestures insistently repeating that human community is not maintained by violence, but by openness to being surprised by the birth of the unexpected—messianic—new beginning.[11] Such annunciations continually hold out to us concretely new ways of living in the midst of enculturated apparatuses of death.
Brian Brock is an ethicist at the University of Aberdeen and is author of the recent Wondrously Wounded.
[1] There are two notable variations in practice and nomenclature here. North Americans and Europeans typically label the technology ultrasound (the term ultrasound refers to the technology used to produce an image, the sonogram being the image produced). In Britain the more common nomenclature is sonography. In Britain this work is typically conceived as routine “hands off work” and delegated to technicians (except in cases expected to be complicated) while in North America it is seen as the domain of the expert, and is usually staffed by doctors trained in genetics. Gareth M. Thomas, Down Syndrome Screening and Reproductive Politics: Care, Choice, and Disability in the Prenatal Clinic (Abingdon: Routledge, 2017), ch 3. Mara Buchbinder, “Down’s Syndrome screening and reproductive politics: Care, Choice and Disability in the Prenatal Clinic,” New Genetics and Society (2017). DOI: 10.1080/14636778.2017.1368375.
[2] The incompleteness of this knowledge has direct implications for the shape and meaning of pregnancy. James Mumford, Ethics at the Beginning of Life: A Phenomenological Critique (Oxford: Oxford University Press, 2013), ch. 1.
[3] On cyborgs as a technically mediated human body see Bruno Latour, “Body, Cyborgs and the Politics of Incarnation,” in The Body, eds. Sean T. Sweeney and Ian Hodder (Cambridge: Cambridge University Press, 2002), 127-141.
[4] Rayna Rapp, Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America (New York: Routledge, 2000), 221.
[5] Aaron D. Cobb, Loving Samuel: Suffering, Dependence, and the Calling of Love (Eugene: Cascade Books, 2014), 11.
[6] Thomas, Down Syndrome Screening and Reproductive Politics, 98-100. 143.
[7] For an anthropological account of the “cyborgification” of ultrasound and the “one two punch” see Mitchell, Lisa M., and Eugenia Georges. “Cross-Cultural Cyborgs: Greek and Canadian Women's Discourses on Fetal Ultrasound.” Feminist Studies 23.2 (1997): 373-401.
[8] Brian Brock, Christian Ethics in a Technological Age (Grand Rapids: Eerdmans, 2010), 62-65.
[9] Rapp, Testing Women, Testing the Fetus, 318.
[10] Cobb, Loving Samuel, 9-11., 195.
[11] Hannah Arendt, The Human Condition (Chicago: University of Chicago Press, 1958), ch. 6.
-->