Saturday, January 05, 2013

When did Bonhoeffer know? and how?

I'm not going to say anything in particular about the recent mass shooting that everyone else is talking about in the last month, except to say I don't know what needs to happen to prevent things like this from happening.  In fact, I don't know how we'd know if such a tragedy was prevented.

Consider the following scenarios:  All assault weapons are banned, old ones turned in, in a specific community.  If a mass shooting doesn't happen in THAT mall, or one of THOSE schools, was it the ban that prevented it?  Say someone comes into a large group of people threatening them with a weapon, and someone with a CCW shoots and kills him before he can act on his threats.  Did a "law abiding citizen" with a gun stop a mass shooting? Say the gun was definitely loaded.  The "attacker" never actually shot anyone.  Maybe he would have just shot one.  Maybe he was a lousy shot and would have missed everyone.  Maybe he would have realized he didn't want to do this evil deed and thrown his gun down.  Bottom line is, we can't predict  the future.

We have this problem in mental health when we try to measure changes in suicide rates.  If the rate goes down, can we take the credit?  If it goes up, is that our fault?  We've never quite been able to get a post test done, for some reason or other.

I was thinking about this the other day and my thoughts naturally went to Nazi Germany (doesn't that happen to everyone?  You're just minding your own business, thinking about suicide--others', not your own-- and BOOM! your attention is suddenly riveted on the SS and concentration camps!) and, in particular, the attempted assassination of Hitler.  Dietrich Bonhoeffer, theologian and minister, whose writings reveal a committed Christian, dedicated to the Lord, was identified as one of the conspirators, and was hung along with 3 others in Berlin shortly thereafter.

The question, "How did Dietrich Bonhoeffer decide that, in this one, singular case, murder was justified?" frequently comes up in Christian circles.

In hindsight, of course, it's easy to say, "Well, he must have known Hitler was so evil!"  But remember that before the end of the war, much about the Nazi atrocities was yet unknown.  It was only when the Allies began liberating the concentration camps, for example, that solid evidence regarding the slaughter of Jews was really available to American and British readers of papers and viewers of newsreels.  Bonhoeffer certainly would have heard rumors about these atrocities, but acted before he could see, hear or touch the evidence.

I wonder if Bonhoeffer would today be seen as less of a saint, if such evidence had never become available.  If  Hitler wasn't so narcissistic and his followers obsessive enough to save every record, every photograph, and every piece of evidence with which they damned themselves (perhaps the one good thing about the Third Reich is that it saved a lot of time  by having kept such good track of the evidence against itself.)  If someone could say, "Yeah, Bonhoeffer thought Hitler was doing all those things, but we don't know that for sure", or "Stalin was just as bad or worse"  (actually, now it's starting to look like Stalin was just as bad or worse, but those who have preserved Bonhoeffer's papers, and people such as Martin Luther King who were deeply influenced by him, didn't know that.)

We are told Bonhoeffer prayed long and hard before deciding to help the group who made the assassination attempt, and I believe that.  But I understand when non-Christians are confused about violence in which Christians are involved.  Would they have seen Bonhoeffer as someone "using" his religion to justify a murder?  When someone who is nominally a Christian, but in their life has practiced hate, bombs an abortion clinic or kills one of the doctors practicing there, the press and the Homeland Security Office point to that as signs that someone's fundamental Christianity makes them more likely to do these things.  "But I don't think that person could have truly been a Christian, with Christ in his heart."  "But he said he was!" "Well you can say that but...." " We don't have time to look into all that.  The important thing is, people calling themselves Christians are running around committing acts of terror."  Etc. So would the attempted attack on Hitler be considered a "Christian" act, in particular by the secular world,  if we weren't at war with him in the Anglophone world?  At a time when we didn't have all the facts before us concerning the concentration camps and round-ups?

Don't get me wrong.  I'm not at all insinuating that Bonhoeffer's actions were not praiseworthy.  In fact, while the assassination did not occur, the tumult it caused when the saboteurs did succeed in convincing some of Hitler's minnions that he actually had died was still a nail in the coffin of the Reich.  And that is not a bad thing.  And I don't know if Bonhoeffer knew the depth of Hitler's depravity, but the fact that there remained a contingent of Germans who knew his actions were evil to the core gives me a sense of hope.    I'm just using  Bonhoeffer's experience as an example of how we can never predict the effect of an action on stopping evil; nor can we know in the future  whether such an action as Bonhoeffer's would have had any effect at stopping the evil.  Arguably, it didn't do enough, since Hitler ultimately survived till he killed himself a year later.

But at some point, the pious Bonhoeffer, who was seen as a brilliant theologian even in his twenties, must have decided that either God had removed the sanction of murder for this one person (Adolf Hitler....which, you have to admit, probably is the best person for him to remove the sanction on); or that despite God's will, he was going to sin anyway and get mixed up in this thing.  When was that?  Did he learn something that specifically drove him to that conclusion?  Had he meditated and prayed about it for just so long, long enough to conclude this was the right thing to do?  We Christians believe that the New Testament nullified many Jewish proscriptions, such as circumcision of all males, and not mixing meat and dairy.  But "murder" is not one of the things we get a pass on.  Even if we believe that a person is evil.  Even if half the world believes that person is evil.  My personal guess is that Bonhoeffer did experience some kind of communication with God that allowed just this one act.

Maybe Bonhoeffer is not the best example, though, at expressing my hopelessness at identifying what can stop mass murderers, since we'd probably all commend him on his choice here in the future, where we reside.   So let me think of something else, something I know a lot about.  Let's go back to suicide.

Experiencing the suicide of others and its effect on survivors is, very unfortunately, an occupational hazard of mine. One of the frequent outcomes of this is that we get sued often, sometimes for what seem to be good reasons, sometimes just for guilt by association.  I have been in a deposition room testifying about a suicide that occurred when I was working elsewhere, the suicide of someone seen as primarily my responsibility.  I was dropped from the case some time after my deposition.  The attorney for the plaintiff made a point of pointing out that I, and a coworker helping me the day before, had "went above and beyond the standard of care" for that patient.  Great, but what exactly does it mean?

What it means is that, in the legal world, and at least in the case of a patient's suicide, there is no definite way to determine an action caused a death, or a lack of action made that death probable.  So they lean instead on a nameable, measurable standard of care.  Say someone dies of a drug reaction in a hospital when they are given the wrong drug.  Who is culpable? Anyone who has strayed from the standard of care (maybe something like, have written orders, repeat orders given back to the ordering doctor, label the vials correctly, etc.) A nurse may have given the patient the wrong medication, but in addition, other people might be named in the suit.

A different example might be someone dying in the operating room.  And let's say the patient had been  advised beforehand what his or her chances of surviving the operation, and to make it more interesting let's say the person was 75 years old and in ill health anyway, so the risks of death were greater.  Suppose to that, if waiting wouldn't likely cause further harm, the operating doctor also gave the patient and family time to think about and discuss the risks.  For whatever reason, the patient still wanted the operation and was in a firm mind enough to make that decision on his or her own.

Also, in this case, this was a particularly careful surgeon doing the operation, in a hospital that had levels of built-in redundancy (bad in English, but GREAT in hospitals) ensuring things were triple checked and instruments in appropriate shape and cleaned.  The anesthetic was applied correctly and all procedures followed by the book.

Then the family decides to sue.  If everything goes the way the legal system would have it, they lose the suit.  Even though the worst possible outcome occurred (death), the hospital staff followed the standard of care.  Their actions at least met the criteria that other staff in other hospitals would consider necessary in order to ensure the optimum health of the patient.

Well, what about changing the above scenario?  Let's say the risks hadn't been fully discussed with the patient and family.  In fact, perhaps this surgery is successful in 99% of the patients who have it.  Hmm, while I'm at it, let's change the conditions of the patient from 75 and ill to 30 and in good health, except for whatever is being cut.  And suppose the operating room is so modern and well equipped that something measures or videotapes everything you do.  Say the surgeon or a nurse or the anesthetist makes one mistake; the nurse hands the surgeon the wrong instrument and then fumbles to find the right one for a minute.
They can argue all they want that this  was unrelated to the patient's cause of death; nonetheless, whoever made that mistake will almost certainly be held culpable.  The hospital may too, having not fully informed the patient about even the 1% risk of death they faced.

As you may imagine, mental health experts spend an awful lot of time trying to find ways to predict suicide and prevent it.  I went to a rather scary conference three or four years ago, given by our state mental health agency, where presenters were insisting that we had to monitor everyone closely who showed any of the "risk signs" of potential suicide, going to their house periodically, uninvited; taking not only their guns but any non-prescribed medication in the house; coming back to give them their doses of medication.  I can understand the desparation expressed and the constant hope that maybe we'll be able to prevent suicide someday, but throwing away the Bill of Rights shouldn't be on the table.

But wait!  you say.  If throwing  away the Bill of Rights prevents even one suicide,  isn't it worth it?

My point is, there would be know way of knowing whether throwing the Bill of Rights, or prescribing a particular medication, or putting someone on 1:1 watch the rest of their lives, or doing a rain dance will prevent a suicide.  Mental health pros might look into his record 10 years after the patient's death from natural causes, and see that one or all of those things were done after which he never made a suicide attempt, but maybe he wouldn't have ever made a suicide attempt again anyway.  Maybe he made a suicide gesture, was hospitalized, decided in the hospital that life was worth living, and followed through on a promise to himself never to do that again.  Maybe it wasn't the axing the Bill of rights/medication/1:1 watch/rain dance that was as effective at keeping him alive as was. say,  a repaired relationship with a relative he'd been having difficulties with.  There is no way of knowing, for absolute certain, whether increased monitoring prevented a suicide, and there is now way to determine (at least immediately) whether it actually increased the risk of suicide, and the patient had survived despite it.

In the same way, if you ban guns on school grounds and no mass shootings occur, or if you arm every teacher and principle and no mass shootings occur, since mass shootings are such a rare event, you will never have enough data to soundly conclude that either of these actions help or hurt your desire to keep the place free from mass murderers.

That doesn't mean that we should not do whatever we can to stop them, but it's important that we make any decisions calmly and with the understanding that if such a horrific event occurs, it may or may not have been made more likely to happen by whatever we did to prevent it.  

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