People have always had to make decisions about how best to live as physical creatures. About 2400 years ago, members of the Hippocratic tradition, in contrast to other itinerant healers, swore not to aid patients in obtaining their own death or abortion. In the Middle Ages, people realized that amputating a limb with gangrene improved the chances of the patient’s survival. Was there an obligation to undergo the gruesome procedure of sawing off a limb with crude tools, infections, and no anesthesia? They were advised by the Church of their day that such an extraordinary measure was a matter of individual conscience.
Bioethics now, as specifically an academic, professional, and public discussion, was triggered in the 1970s by the Tuskegee Syphilis Study. The US National Health Service wanted to understand syphilis in hope of curing it, or even better, preventing it. They sought a county in the US that already had a high rate of the disease. A doctor in Macon County Alabama volunteered that he had many such patients and the backing of a prestigious institute to do a long-term study of how the disease naturally progressed. Implementing the study, a whole series of decisions were made that did not take the welfare of the subjects as the first priority. The study was never secret from the medical establishment, but when the public heard of the lies and withholding of valid treatment that had compounded over forty years, there was horror. Congress passed a law requiring Institutional Review Boards to oversee all human subjects research, and the standards of legal and moral informed consent were developed. Over time these were extended from research protocols to all clinical decisions, and were supported by newly formed hospital ethics committees and officers. Now each patient is the primary decision maker for how he or she will be treated. This makes it possible for patients to protect themselves and to pursue their values and those of their communities. Many of the most influential writers as these standards and expectations were developed, were theologians such as Paul Ramsey. In the years since, philosophers and sociologists have come to dominate bioethics discussions.
So is there still a Christian perspective for bioethics? How is Jesus Christ the Lord of bioethics, as all else? The Christian is convinced of the claim in John that “the Word of God became flesh and tabernacled among us.” God, remaining God, became a particular human being. The incarnation reveals that the human body is compatible with God’s presence, and that in Jesus of Nazareth we can not only meet God face to face, but also what human beings are meant to be. Fulfilling the Old Testament offices of prophet, priest, and king, Jesus not only reconciled us with God and each other (priest), but also taught us how to live (prophet), and guides and empowers us daily (king). As prophet he taught by example such as in washing his disciples’ feet and healing the physical afflictions of many. He taught principles such as to love God, and your neighbor as yourself, and a consistent worldview that in reality only two things last. If you want to make a difference, invest your life in God and people. He told how to do this with a transformation of attitude in the beatitudes, and a growing habit of how to perceive and act that we call character.
God the Father, Son, and Spirit are still at work directly and through the body of Christ, God’s people, the Church. Human beings are broken, but capable at the direction of God’s Holy Spirit. Christian ethics then is not just a set of rules. It is not legalistic, and not licentious. It is a way of life in Christ and in community. That includes caring for physical life, as Jesus did. The body is not the ultimate point. Death is no longer feared, but physical life is where we live and serve now. Suffering should be relieved. We are called to care for the physical world, to help it flourish, and in it to become who we are meant to be.
So what does this look like as we seek to discern how best to live our bio-medical decisions? Five discussions seem most contentious right now.
1. “Bio” means life and so bioethics is broader than medical ethics. As we come to appreciate the beauty and intricacy of the creation that God loves (John 3:16), how do we help all creation to flourish? Human beings are described as being placed in a garden, not a wilderness. A garden requires decisions such as whether to support the aphids or the roses. It is God’s garden, but human beings have a unique position in God’s image to carry out God’s care for God’s creation. What should that look like from how we treat animals to the global climate.
2. In medical ethics, over the last fifty years we have seen a dramatic swing from doctor knows best, to patients as the customer who is always right. Are medical care providers merely instruments, or does their conscience matter too? Can they be compelled to provide a treatment that they think is harming their patient? The law currently allows medical care providers to refrain from patient demanded treatment, that they deem non-beneficial/futile for the patient. Yet Ontario (Canada), currently threatens physicians with losing their license if they do not provide patients with lethal medication to die when the patient asks for it. The ideal should be to act when there is agreement between the patient who knows their body and personal goals, and care providers who bring their own best expertise, experience, and conviction.
3. The Roe v Wade decision did not resolve different perceptions of life in the womb. The implications of these convictions are heightened by the rapid expansion of medical treatments that are largely determined to be appropriate or not, by when one recognizes that a fellow human being is present in the womb. For example, the morning after pill, pre-natal genetic diagnosis, IUDs, and IVF are all medical treatments that are substantially justified or not, depending on the status of the human individual developing in the womb.
4. At the other end of life, there is “medical aid in dying” as it is called and legal in Canada, and in seven American states as physician assisted suicide. The goal of relieving suffering and protecting personal choice is admirable, but there are also concerns about people having to justify to themselves and others, the receiving of care when they are most vulnerable, and slippery slopes as ‘lives not worth living’ expands. The hospice movement, initiated by Christians, is an alternative pursuing comfort, clarity, and company for the patient to well live one’s last days.
5. At the start and all through life, we now have CRISPR. CRISPR is a defense that naturally occurs in bacteria to fight off viruses. The recent discovery is how to direct it to make specific desired changes (gene editing), in the DNA of anything that is alive. That encompasses all of life from malaria parasites to food grains to milk cows, to us. What is so new is that this technique is accurate, quick, and inexpensive. It is already being used in countless research studies and trials to relieve disease. Should we use gene editing to treat only a presenting patient, or also to deliver their children from the affliction? Should we only correct disease, or also seek to enhance? If we are correcting a patient’s tendency to keep getting cancer, should we bring their immunity up to average, or the best that occurs naturally in some people, or to the best that we can?
One does not have to tackle these challenges alone. There are two types of Christian organizations that have risen to help. Some like the Center for Bioethics and Human Dignity (CBHD) have gathered around specific commitments to particular bioethics judgments. There are other bioethics resource groups such as the American Scientific Affiliation (ASA) and the Canadian Scientific and Christian Affiliation (CSCA), that welcome conversation among Christians on bioethics challenges without requiring particular conclusions. In regard to pregnancy for example, see Perspectives on Science and Christian Faith articles such as “The Changing Face of the Science-Faith Dialogue in a Biomedical Arena” 68:3 and “In Vitro Fertilization and the Destruction of Embryos” 67:3, both by D. Gareth Jones. These and many more articles and book reviews are available free of charge by searching the index. At both CSCA and ASA all are welcome to make their best case for a Christian perspective, with no exclusion of what can be said.
We live our earthly lives as physical bodies on one tiny planet. This is where we have our decisions as individuals, communities, and society. May Christians work together in bioethics, faithful in Jesus Christ.