Two patients, or one?

Dr. Darrell Cass recently led a successful pre-birth surgery on a child at 23 weeks:

Cleveland Clinic has successfully performed its first in utero fetal surgery to repair a spina bifida birth defect in a nearly 23-week-old fetus.

A multispecialty team of clinicians performed the surgery in February, and the baby, a girl, was later delivered by caesarean section near full term June 3, making it northern Ohio’s first surgery of its kind. Mother and daughter are doing well. …

Spina bifida is a birth defect that is most often discovered during the routine anatomy scan typically performed when a fetus is around 18 weeks old. The condition affects the lowest part of the spine and occurs when the neural tube does not fully close, causing the backbone that protects the spinal cord not to form as it should. This often results in damage to the spinal cord and nerves and can even lead to brain damage.

Spina bifida can affect a child’s lower leg strength and their ability to walk and run, as well as their ability to go to the bathroom and urinate adequately. According to the CDC, approximately 1,645 babies are born with spina bifida each year in the United States.

During the fetal repair surgery, a caesarean section-like incision is made and the mother’s uterus is exposed. An ultrasound is then used to locate the placenta and fetus. The uterus is opened 4.5 cm and the back of the fetus is exposed, showing the spina bifida lesion. The surgeons then carefully suture several individual layers of tissue (myofascia, dura and skin) in order to cover the defect. After the uterus is closed back up, the fetus remains in the womb for the remainder of the pregnancy and is ultimately born by caesarean section.

“By successfully repairing the defect before birth, we’re allowing this child to have the best possible outcome and significantly improve her quality of life,” said Dr. Cass.

When a member of the human family, like this child, is wanted by her mother, we call this child a patient—and our physicians care for the child as a patient whose worth is equal to mother and father. But when a member of the human family is unwelcome, we call that child a fetus—and sometimes even a parasite—and our physicians do not care for the child as a patient, but instead intentionally kill in order to enforce the demands of the comparatively powerful over the comparatively weak. This describes not a humane or compassionate society, but rather one wherein violence has come to be seen as acceptance and even ethical.

If we only have worth because we are wanted, then none of us possess any inherent value. And if this is true, there is no coherent basis for such a thing as human rights.

There are always two patients in the case of a mother pregnant with her child. What varies is not the reality or unreality of the second patient; what varies is our interest in acting as if human rights were either real, on the one hand, or merely a sometimes convenient fiction, on the other.

Alone and wandering about

Robert Cardinal Sarah spoke last month in Paris at Église Saint François-Xavier as part of his tour for The Day is Far Spent, his latest book:

To refuse God the possibility of entering into all the aspects of human life results in man condemning himself to solitude. He becomes nothing but an isolated individual, without origin or destiny. He is doomed to wander the world like a nomadic barbarian, without knowing that he is the son and heir of a Father who created him in love and calls him to share eternal happiness with him.

Behold modern man: alone, wandering about in a field of ruins. This is what I found yesterday when I visited Notre-Dame in ruins.

The spiritual crisis I describe involves the entire world. But its source is in Europe. Rejection of God was conceived in Western minds. The current spiritual disaster thus has distinctively Western features. In particular, I would like to emphasize the rejection of fatherhood. Our contemporaries are convinced that, in order to be free, one must not depend on anybody. There is a tragic error in this. Western people are convinced that receiving is contrary to the dignity of human persons. But civilized man is fundamentally an heir, he receives a history, a culture, a language, a name, a family. This is what distinguishes him from the barbarian. To refuse to be inscribed within a network of dependence, heritage, and filiation condemns us to go back naked into the jungle of a competitive economy left to its own devices.

This understanding of dependence and transmission was deeply etched into the hearts of those who built Notre-Dame. They worked for decades and centuries, for their descendants, in many cases without seeing the end of their work for themselves. They knew they were heirs and wanted to transmit their heritage.

Because he refuses to acknowledge himself as an heir, man is condemned to the hell of liberal globalization in which individual interests confront one another without any law to govern them besides profit at any price.

Artena, a human-centered place

Marlo Safi writes on Artena, a small town in Italy about 25 miles from Rome:

The beauty of Artena is in its organic simplicity, and its rebellion against the capricious whims of technology that have influenced city planning and development everywhere else. Its streets are narrow, walkable, and not perfectly paved with cement or painted with traffic signs. And, similarly to Rome, it’s inspiring.

Artena is “human-centered,” Stefano Serafini says. Serafini is a director of the International Society of Biourbanism, a group headquartered in Artena that focuses on our urban environments as an organism, and, through research, aims to realize optimal environmental enhancements for cities based on human needs. What that looks like in practice is at the heart of the Biourbanism Summer School, a week-long event I will attend and report on next month. I won’t be the only foreigner in attendance — the school is attracting a diverse group of writers, architects, artists, politicians, economists, and citizens from across the world. Serafini describes the variety of attendees each year as a “unique and different symphony.” …

While communication at the school will primarily be in Italian and English, perhaps the most important language is the unspoken one of the built environment — the one Artena will use to speak with attendees. This theme of language is central to the school, and more generally, architecture, Serafini insists. Post-modernity, with its severe geometry, unnatural dimensions, and alienating scale has stripped us of local vernacular and rootedness…

I expect this summer school to be one that reminds me, as someone who has grown resigned to American cities designed with seemingly little thought to the human desire for identity and attachment, that solutions exist. They exist in places such as Artena, rebuilt in the 15th century, which rebels against the hegemony of the car and its demands on our cities, encouraging those who walk through the streets to unburden themselves of the modern world’s baggage.

“The school wants to open our eyes on what really matters,” Serafini says. “Which in architecture means knowing what is right and what is wrong when designing a place for ourselves, our human fellows, and other creatures, and the common environment.”

The International Society of Biourbanism, and its Biourbanism Summer School, seem like cousins of what Strong Towns is doing domestically.

A place needs to be lovable

Charles Marohn asks, “If we’re not going to maintain what we have, then why bother building anything new?”:

It was Steve Mouzon who first told me that a place needed to be lovable, that we only maintain that which we love. I never learned anything about “lovability” in my undergraduate course on concrete structures, and I know of no engineering manual that references it, yet I’ve found Steve’s insight to be an undeniable truth.

I love my house—and have deep respect for the resources that went into building it, as well as the amount of effort it will take to retire my mortgage—and so I maintain it. I don’t wait for concrete to fall apart before patching it. I don’t wait for the siding to rot before repainting it. I don’t wait for the roof to leak before maintaining it. …

Local governments suffer from a dual set of challenges when it comes to maintenance. The first is that most of what we’ve built is not lovable, at least not broadly lovable. The asphalt cul-de-sac has some functional appeal to the people who live on it, but the broader community is not going to demand it be maintained. The same with those DOT-specified streetlights the city purchased in bulk. The plastic park equipment may be sanitized and safe, but even it is unlikely to endear.

For the most part, the Growth Ponzi Scheme has put our cities on a path of quantity over quality. We build a lot of stuff, all of it to a finished state. That stuff then sits and rots—perhaps with some nominal maintenance from time to time—until it falls apart, at which point we put together a huge project to replace it with something new built to a finished state. …

What this means is that nearly all public investments—infrastructure, buildings, parks and other facilities—have a predictable life cycle. Initially they are shiny and new. Then they start to wear, fray, and show signs of decline. Then they start to fail to various degrees, finally followed by either a complete failure or a major reconstruction project (generally using debt financing).

Throughout this process, the public grows used to decline and decay—almost comes to accept it as normal—while the world around us becomes less and less lovable each day. This is, for example, how the richest cities in North America—New York City, San Francisco, Washington D.C.—suffer with escalators on their transit systems out of service for years. These things are not difficult to fix when maintenance is prioritized, but when it’s not, just wait for the next large maintenance bond and fix it all at once. …

This enables the second challenge local governments face, that of low expectations. …

This is part of what I was trying to speak to when I asked, “Who’s responsible for a place like this?

‘I found delight in the human race’

A few years ago my friend Ben Novak shared his playful theory of Christ’s sacrifice with me, and today’s scripture on the solemnity of the Trinity reminded me of Ben’s “layman’s theory” as to why God had to send his son to earth to become a man to die for us:

The Solemnity of the Most Holy Trinity
Reading 1 Prv 8:22-31

Thus says the wisdom of God:
“The LORD possessed me, the beginning of his ways,
the forerunner of his prodigies of long ago;
from of old I was poured forth,
at the first, before the earth.
When there were no depths I was brought forth,
when there were no fountains or springs of water;
before the mountains were settled into place,
before the hills, I was brought forth;
while as yet the earth and fields were not made,
nor the first clods of the world.

“When the Lord established the heavens I was there,
when he marked out the vault over the face of the deep;
when he made firm the skies above,
when he fixed fast the foundations of the earth;
when he set for the sea its limit,
so that the waters should not transgress his command;
then was I beside him as his craftsman,
and I was his delight day by day,
playing before him all the while,
playing on the surface of his earth;
and I found delight in the human race.”

American Pelagianism

Sen. Josh Hawley writes that American culture has become dominated by a false philosophy of liberty:

For decades now our politics and culture have been dominated by a particular philosophy of freedom. It is a philosophy of liberation from family and tradition, of escape from God and community, a philosophy of self-creation and unrestricted, unfettered free choice.

It is a philosophy that has defined our age, though it is far from new. In fact, its most influential proponent lived 1,700 years ago: a British monk who eventually settled in Rome named Pelagius. So thoroughly have his teachings informed our recent past and precipitated our present crisis that we might refer to this era as the Age of Pelagius.

But here is the irony. Though the Pelagian vision celebrates the individual, it leads to hierarchy. Though it preaches merit, it produces elitism. Though it proclaims liberty, it destroys the life that makes liberty possible. …

Pelagius was born sometime between A.D. 350 and 360 in Britain, possibly Wales. Highly educated, unusually gifted, a scholar of both Latin and Greek, he made his way to Italy and then to Rome. There he became famous for his teaching on Paul’s letters.

Pelagius held that the individual possessed a powerful capacity for achievement. In fact, Pelagius believed individuals could achieve their own salvation. It was just a matter of them living up to the perfection of which they were inherently capable. As Pelagius himself put it, “Since perfection is possible for man, it is obligatory.” The key was will and effort. If individuals worked hard enough and deployed their talents wisely enough, they could indeed be perfect.

This idea famously drew the ire of Augustine of Hippo, better known as Saint Augustine, who responded that we humans are not achievement machines. We are fragile. We are fallible. We suffer weakness and need. And we all stand in need of God’s grace.

But Pelagius was not satisfied. He took his stand on an idea of human freedom. He responded that God gave individuals free choice. And he insisted that this free choice was more powerful than any limitation Augustine identified.

Augustine said that human nature was a permanent thing, but Pelagius didn’t think so. Pelagius said that individuals could use their free choice to adopt their own purposes, to fix their own destinies—to create themselves, if you like.

That’s why a disciple of Pelagius named Julian of Eclanum said freedom of choice is that by which man is “emancipated from God.”

Now as you might expect with followers who say things like that, Pelagius was condemned as a heretic by the Council of Ephesus in 431.

But his philosophy lived on in late-20th-century America. And if you listen closely today, you can hear it almost everywhere—in our fiction and our film, in our school curricula and self-help books. …

Perhaps the most eloquent contemporary statement of Pelagian freedom appears in an opinion from the United States Supreme Court, in a passage written by former Justice Anthony Kennedy. In 1992, in a case called Casey v. Planned Parenthood of Southeastern Pennsylvania, he wrote this: “At the heart of liberty is the right to define one’s own concept of existence, of meaning, of the universe, and of the mystery of human life.”

It’s the Pelagian vision. Liberty is the right to choose your own meaning, define your own values, emancipate yourself from God by creating your own self. Indeed, this notion of freedom says you can emancipate yourself not just from God but from society, family, and tradition.

The Pelagian view says the individual is most free when he is most alone…

Hawley concludes by connecting the problem of American Pelagianism with the opportunity to recover not only an American sense of grace, but also one of solidarity, too.

Knights of Columbus Charitable Fund

Knights of Columbus has announced the launch of the Knights of Columbus Charitable Fund, which is modeled on community foundations like The Cleveland Foundation or Silicon Valley Community Foundation. Knights of Columbus Charitable Fund will serve as a way for Catholics to create charitable funds and direct charitable giving on an individual, family, or community level. There’s nothing quite like this, and I expect it will become a major part of the culture of Knights of Columbus:

Knights of Columbus, one of the largest Catholic philanthropic organizations in the world, today announced a new affiliated vehicle for donors called “Knights of Columbus Charitable Fund” (KCCF). KCCF allows donors to open donor-driven accounts, recommend charities to which donations can be sent through a safe, secure and confidential portal.

Carl Anderson, CEO of Knights of Columbus, said, “Catholics today are looking for opportunities to demonstrate their faith and to support organizations that reflect their values. They want to direct their charity to organizations easily and efficiently.”

The addition of a donor-advised fund option satisfies a unique customer and market niche that is a powerful tool for maximizing philanthropic impact on organizations that align with Catholic values and teachings. Donor-advised funds have become the fastest-growing segment of charitable-giving vehicles due to their flexibility and simplicity. Assets in the donor-advised fund are invested tax-free with no distribution requirements, excise taxes, or other reporting requirements for the individual donor. Donors can make a current charitable contribution, receive an immediate potential tax benefit, and then recommend grants from the fund over time. And tax-free investing over time can result in larger ultimate gifts for charities.

New Columbia

Since moving to Washington, I’ve been loosely following the push to transform the District of Columbia into America’s 51st state.

I think it that making the District a state would be bad for both the District and the country, and that if the status quo is unacceptable, it would be simpler and better for the District to be absorbed back into Maryland, just as the District’s western fringe was absorbed back into Virginia.

David Schleicher wrote “Welcome to New Columbia: The Fiscal, Economic and Political Consequences of Statehood for D.C.” in 2014, and I saw it after Tyler Cowen recently shared it. It’s worth checking out if you’re following this topic:

This Essay sketches some of the long-term economic and political consequences of making Washington D.C. the 51st State. The statehood debate has overwhelmingly focused on the same set of issues: the impact of statehood on the federal government’s structure. But if D.C. becomes a state, the most impactful change in its citizens’ lives would not be their new ability to elect members of Congress; it would be the dramatic shift in economics and politics that would come with the transition to having a state rather than city government. On the day “New Columbia” enters the Union, it would bear a constellation of features unprecedented in the nation: the only state wholly part of one metropolitan region, the only state without local governments, and the only wholly urban state. These features have deep implications for the advisability of statehood when compared to the alternatives of retrocession or the stateless status quo and also furnish a blueprint for steps to mitigate the risks and exploit the benefits that statehood would offer. Part I of the Essay will discuss the special fiscal and economic conditions that New Columbia would face. On one hand, statehood would better allow D.C. to take advantage of periods of economic success. In particular, a state of New Columbia would likely be free of the restrictive confines of the Height of Buildings Act, allowing for greater growth when demand for living in D.C. is high. Moreover, the District would likely also gain greater taxing power (although it would lose some forms of generous federal funding). Yet such benefits come at a price: as a single-city state, New Columbia would face drastic risks in times of downturn. The fact that New Columbia would be entirely in one economic region, and the fact that it would exclusively be the center city of that region, would mean almost necessarily that the state would face substantial financial risks in the case of regional and urban-form related shocks. This pro-cyclical effect makes the case for retrocession stronger, and also suggests reforms like a mandatory rainy day fund if statehood is achieved. Part II discusses the implications of New Columbia’s unique internal politics. As noted, New Columbia would be the only state without local governments. The absence of separate spheres for local and state elections would have at least two major implications for New Columbia’s politics and policy. First, as a state composed of an overwhelmingly single-party city, New Columbia’s elections would likely be decidedly uncompetitive. Even in the status quo, this absence of party-level electoral competition is a likely cause of many of the pathologies in D.C. politics, from excessive restrictions on growth to its persistent problems with corruption. To ensure the state of New Columbia does not share these defects, any move towards statehood should include reforms aimed at introducing more political competition. Second, and more optimistically, the unprecedented marriage of a city and a state government offers a powerful change for innovation. Historically, the relatively circumscribed legal power of cities has prevented them from pursuing a number of effective policies because such powers are the exclusive province of states. Further, big cities are often losers in state political fights. In this context, New Columbia’s fusion of city and state would provide many opportunities for policy flexibility and discovery unavailable to most big cities.

Noa Pothoven’s suicide

Ross Douthat writes on the suicide of 17 year-old Noa Pothoven:

In the Netherlands, a depressed teenager … committed suicide at home, starving herself while parents and doctors offered palliative care. …

It remains shocking that a young woman’s parents and doctors would give up on treating her at seventeen and let her kill herself. And it remains shocking that Western nations are normalizing euthanasia for mental illness among otherwise healthy adults. …

When such a system emerges as a seemingly organic feature of the liberal order, what then should be your attitude toward liberalism itself? …

Liberalism has never done as well as it thinks at resolving its own crises. America’s gravest moral evil, chattel slavery, was defeated by an authoritarian president in a religious civil war, not by proceduralism or constitutional debate. The crisis of the 1930s ended happily for liberalism because a reactionary imperialist withstood Adolf Hitler and a revolutionary Bolshevik crushed him. The liberal peace that followed may depend on fear of the atomic bomb.

All of which hints that a genuinely post-liberal politics might, indeed, someday be required — to save liberal civilization from dystopia or disaster. The post-liberalisms presently on offer are not as serious as either their advocates hope or their critics fear. But if you cannot imagine ever being a post-liberal, left or right, you are not being serious either.

It couldn’t be clearer to me that the logic behind pro-suicide laws in the United States, which claim to be interested only in permitting suicide for those near death and with a terminal illness, will in time result in lawful suicide for practically anyone, in any condition. When a teenager’s suicide is affirmed and facilitated by both her family and the state, that’s a good indicator that the society has lost its ability to distinguish justice from injustice.