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Written by Douglas Milne
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Reformed Ethics - Bioethics

The publication of The Oxford Handbook of Bioethics (OUP, 2009) in paperback is an opportunity to educate ourselves as concerned Christians about the latest developments in bioethics, and to learn the philosophical views being expressed in their support and defence. The book consists of 30 sizeable articles, each by experts in the field. For the sake of this review article we will select those topics that particularly challenge Christian beliefs and ethical principles.

As the editor remarks, “Methodology has been a central theoretical issue since the very beginning of bioethics.” There was the hope that one normative ethical method would apply across the discipline but most bioethicists have resigned themselves to the plurality of methods now used. These include utilitarianism, natural law, virtue ethics, feminist ethics, principlism, and deontology. These are largely secular methods that do not take religious beliefs into consideration in spite of the strong representation by theologians in the early years of bioethics (a fact acknowledged by the editor). As a result, an increasing number of evangelicals are adopting some form of natural law theory as a way of gaining a foothold in the public debate, especially in America.

Of the generally recognised moral principles in bioethics, none has exercised so great an influence as autonomy. This can be simply defined as the patient’s right to choose and refuse treatments. Autonomy has had a disproportionate influence over issues like abortion (the right of the mother to choose), reproductive technologies (the right of infertile couples to create, lose or freeze embryos), and physician-assisted suicide (the right of the patient to choose death).

A moral equilibrium requires autonomy to be restrained by other equally deserving principles like justice and benevolence. Then the immediate interests of the individual would not override the long-term interests of the group and other interested parties. The writer concedes: “If there is a danger inherent in bioethics today – and I am convinced that there is – it comes from an excessive emphasis on autonomy and too little appreciation of human interdependence and mutual responsibility.”

One controversial expression of autonomy appears in the call for genetically enhancing our children through biological interventions that would make them stronger,smarter,more gifted and perhaps even more sociable. Julian Savulescu argues that enhancement is a moral obligation since we ought to make choices that make it possible for individuals to live a better and more gratifying life.

In the near future it will be possible to make genetic changes on embryos and so secure a better and brighter future for our children. For Savulescu, this is rational evolution and an acceptable form of modern eugenics. “To be human is to be better.” Genetic enhancement, however, is qualitatively different from other types of physical and environmental enhancement that the author chooses to use as parallels. Genetic enhancement is intervention in human nature itself and invites decisions about the kind of people we want ourselves and our children to be.

The subject of death figures largely in the Christian faith for a number of reasons. Death came into God’s good creation due to the entrance of sin (Rom. 5:12); the gospel finds its centre in the death of the Founder of Christianity (1 Cor. 1:18), and through His resurrection Jesus Christ has put an end to death for all His people (1 Cor. 15:56-57).

The Bioethics Handbook raises three separate issues relating to human death and dying. First, there is the modern medical difficulty of defining death, deciding what physical criteria constitute death and whether we need to look for new terminology to accommodate the complexities of life and death in the modern intensive care unit.

The biblical, Christian view is that death occurs whenever the spirit leaves the body. In previous times this was signaled by the failure of the leading organs (heart, lungs and brain) which normally happened simultaneously. Because of modern medical powers of resuscitation, artificial ventilation and other interventions death and dying are no longer so straight-forward. The ability to transplant organs from one person to another, and the growing worldwide waiting-list for such organs, has further complicated the issue.

 

One result has been the new criterion of “brain death” which is when the cognitive and integrative functions of the brain have ceased. The brain-dead person breathes artificially and will never wake up. Is that person dead in the religious sense and how can it be proved?

Second, there is the question whether through anti-aging drugs it may become possible to defer death and significantly extend the human lifespan well beyond present averages. Secular bioethicists call this “earthly immortality” to differentiate it from religious immortality that necessitates belief in an after-life.

The related question is whether this would be a good thing to do or to choose (were it to become possible). Since Christians are called to alleviate, in ethical ways, the suffering of the world, does this mean that they should support the medical research that would lead to extending human life, and avoiding death with its many horrors, perhaps indefinitely?

Third, philosopher Gerald Dworkin gives a new twist to the case for legalising physician-assisted suicide. The basis of his case is the present law, which is now deeply embedded in medical practice, which gives patients the right to refuse further life-sustaining treatment (food and water). How does this right to die differ morally from physician-assisted suicide? They are both grounded in the moral principle of patient autonomy, both are open to abuse by other parties and in both cases the physician makes a decision that results in the death of the patient.

In response, it needs to be pointed out that there is a large body of literature of both a philosophical and a non-philosophical kind, that argues that all taking of life (assisted or not) of innocent persons is morally wrong. From a Christian perspective, physician-assisted suicide or euthanasia is a moral failure to entrust our selves, body and soul, into the hands of a faithful Creator (1 Pet. 4:19).

Perhaps no subject is of more far-reaching ethical significance in bioethics than the status of the human embryo. The view a person takes on this subject will determine their attitude to embryonic stem cell research that destroys embryos in the interests of future, possible cures for crippling and life-threatening diseases and disabilities like Parkinson’s disease.

In the interests of such research, and making use of utilitarian reasoning, a majority of bioethicists argue that even the promise of life-saving cures justifies the large-scale expenditure of embryos. This is not to say (so the argument goes) that we may treat these embryos as mere tissue that we can experiment with or dispose of as we choose. Rather, we should treat human embryos with respect in the same sort of way that we respect human remains, for their symbolic value as memorials of human existence. In the case of human remains this is a remembering of a person who has gone; in the case of embryos there is a looking forward to a person who will be.

 

The writer Bonnie Stock recognises the contribution of the Judeo-Christian moral and legal tradition in the West that has given worth to all human beings as God’s image-bearers. However, as a secular thinker, Bonnie Stock, who is also the editor of the Handbook, chooses to distinguish between a biological human being (an embryo) and a human organism with sentience, interests and rights (an adult person).

She argues against the belief that conception is the starting-point of the human organism because of the complexity of conception and the possibility of twinning up to fourteen days after conception. In response we may argue that conception is not so complex that we cannot identify syngamy when the two gametes have fused into a single cell embryo, twenty four hours or so after the penetration of the egg by the sperm, as the point of human animation. And in spite of the mystery of twinning, we may at least speculate that the original embryo, in effect, clones itself to form a second self.

The following sentences from the same writer might well have been written in praise of the full humanity and selfhood of the early embryo. “A human embryo is something special, and a source of awe, precisely because it contains within itself the capacity to develop into a complete human being.” “Moreover, human embryos are part of the human story, because every living human person began life as an embryo.” “If the entire life of a human being has intrinsic value, then it is reasonable to accord value to the very beginning stages of that life.” The answer to embryonic stem cell experimentation is a more noble and ethical view of the embryo, and the pursuit of alternative sources of totipotent stem cells.

Some other issues and questions of great interest treated in this volume are mental disorder and moral agency, policymaking in pluralistic societies, organ transplantation, feminist dilemmas over payments for reproductive labours, biobanking, therapeutic cloning, pharmacogenomics, animal experimentation and bioterrorism.

Several general lessons emerge from reviewing this publication. One is the growth of bioethics to include global issues like health and pandemics, which is something of a return to the original environmental concerns of bioethics in the 1970s.

Second, we need to appreciate the inter-disciplinary nature of bioethics, as a common field of interest and participation by scientists, lawyers, health-professionals, social scientists, philosophers, ethicist, even theologians.

However, third, and chiefly, it is the secular epistemology and beliefs that pervade this Handbook that make the most lasting impression on the reader. Religious views are sometimes mentioned but they are largely discounted as a source of moral wisdom. More favoured is a rational and pluralist approach that frees bioethics from the unwanted restrictions and controversies of religious dogma. Here lies the main challenge of the Handbook as well as the field of bioethics, for concerned Christians.

Dr. Douglas Milne is principal of the Presbyterian Theological College in Melbourne, Australia. This article was printed in AP magazine of the Presbyterian Church of Australia and is republished here with permission.