
Westminster Abbey, August 2011
Wait a minute– what about NOMA?
In his book Rock of Ages, Stephen Jay Gould (1999) argued for the concept of non-overlapping magisteria (NOMA), that science and religion covers different fields of study, and to force one discipline over the other would diminish both. However, there are certain aspects of science that cannot be answered by science alone.
Before I get into some detail, let me define what I mean by science, and what I mean by religion.
Science, in this case, involves explaining natural occurrences by naturalistic methods. Such methods ideally should be falsifiable, repeatable and reliable.
Religion on the other hand, seeks truth by revelation, and explanation of the world by that revelation.
Do note that the although philosophers do debate about the distinction, I will be using the above definitions for this post.
There some areas where they do overlap, but I will use biological and medical ethics as an example.
“Or to put it more simply, science will tell me that if I put cyanide in my grandmother’s tea, it will give her a pretty rough day. But science cannot tell me whether I should do it or not to get my hands on her property.” — John Lennox (2007)
It is not always easy to apply science. As the quote from John Lennox suggests, science is silent on the issues of morality and ethics. Now we may just say we should do the most good for the most people when it comes to medicine, but it isn’t always clear-cut, as I will list some case studies from Wyatt (2009). Please note that ALL these cases are real, and not made up.
Case Study 1: Persistent Vegetative State (PVS)
In 1989, eighteen year-old Liverpool fan Tony Bland was a victim in the Hillsborough disaster. His body had been crushed against the metal perimeter, leading to severe oxygen deprivation. Although Bland survived, he was in a coma state known as PVS. His basic bodily functions were still working– he could still digest food and breathe. The lower part of his brain (the brain stem) was still working. However, his cerebral cortex (the part of the brain essential for conscious activity) was damaged. His life was maintained by an artificial pump that inserted liquid food into his stomach.
After three years of treatment, Bland still showed no signs of recovery. His devoted parents and doctor petitioned to cease life support for Tony. This led to a debate in the House of Lords (one part of the British parliament), and it was decided that Bland was not consciously aware of his surroundings and the continuation of his treatment brought no “therapeutic, medical or other benefit”. Artificial feeding was withdrawn, and Bland died a few days later.
While some applauded this decision as a common sensical solution, others raised the issue that the British Courts had stopped respecting the traditional principle of the sanctity of human life. For the first time, the courts had knowingly sentenced an innocent man to death.
Case Study 2: The right to refuse treatment
In 1999, Mrs. B suffered a haemorrhage to her spinal cord. She made a ‘living will’ that treatment should be withdrawn is she became severely disabled. However, her health improved, and the 41-year old returned to work.
In 2001, B suffered from progressive weakness, and soon became paralysed from the neck down. She soon became dependant on a mechanical ventilator to breathe. Despite repeatedly asking the doctors to cease treatment, she was refused. The medical staff insisted it was their professional duty to prolong her life.
This case was brought to the British High Court, where the presiding judge, Dame Elizabeth Bulter-Sloss deemed Mrs. B mentally sound enough to decide her fate. Mrs. B was then transferred to another hospital where treatment was withdrawn.
This case was seen as a landmark in English law– the judge had allowed a competent patient the right to refuse life-sustaining treatment. Did this judgement legalise euthanasia in England? Were the doctors who switched off her life support murderers?
Case Study 3: The keeping of conjoint twins
In 2000, Rina Attard gave birth to twins (Mary and Jodie) in a hospital in Manchester. Mary’s condition was poor and her well-being was supported by the shared aorta. The doctors concluded if the twins were separated, Jodie would live, but Mary would die. If they were left conjoint, both twins would weaken and die.
The parents refused to allow the doctors to separate the twins, refusing to ‘play God’ according to their Roman Catholic beliefs. The parents could not bring themselves to kill Mary to save Jodie. In the end, the courts decided to overwrite the parents’ choices and asked the doctors perform the separation.
Did the courts have a right to overrule the sincere convictions of the parents? Did Jodie’s right to life trump Mary’s? Were the doctors ‘playing God’?
Ahhh! They are not easy questions to answer, what do you recommend?
As expressed, any well-meaning answer is controversial. Yet they cannot be avoided. I will list some principles that some ethicists abide by, and as a further note, I will write on how Christians may think about such issues (I will write on only Christianity as I am most familiar with it among all religions).
View 1: The ‘four principles’ approach
Regarded highly among ethicists, Beauchamp’s and Childless’s (2008) Principles of Biomedical Ethics is often cited as the Bible for bioethics. Beauchamp and Childless (2008) argue that in order to have an ethical system in modern societies, we must find the lowest common denominator values (or ‘common morality’) that everyone can agree on. Arguing that we can infer a common set of values in today’s pluralistic age, the duo reduced this common morality to four fundamental principles:
1) Respect a person’s desire for autonomy (principle of individual freedom)
2) Inflict no harm on others (principle of non-maleficence)
3) Act in best interests of others (principle of beneficence)
4) Ensure healthcare is distributed in a fair and equitable way (principle of justice)
Although it may seem perfect and uncontroversial, there are limitations to this approach. For instance, take the case of abortion of a fetus with Down’s Syndrome. For the principle of individual freedom, whose autonomy should we respect? The doctor’s, the mother’s or the fetus’s? Does the fetus’s right to autonomy make any sense? What about the fetus’s future right to autonomy?
The principle of non-maleficene seems to be violated here as the fetus is clearly killed. Some ethicists would argue that allowing one to live a disabled life is a greater evil than having no life. Thus, the best thing would be to allow the fetus to die as quickly and painless as possible.
Finally, what does the principle of justice say about this (Brock and Wyatt, 2006)? In the interest of fairness, should we offer abortion to mothers carrying fetuses with Down’s Syndrome? What about people in our society who already have Down’s Syndrome? Would it be fair to discriminate against them?
View 2: Liberal Individualism
The difficulty in finding a moral consensus has led some philosophers and ethicists to be more radical. One such person is Richard Dworkins (1995), who argued that “Freedom is the cardinal, absolute requirement of self-respect”. In other words, to Dworkins, liberty involves the right to define one’s own existence.
Being a constitutional lawyer, Dworkins appeals to two fundamental concepts of liberal societies. Firstly, the importance of religious tolerance. Dworkins argued that the ethical questions, especially those involving life and death are essentially religious questions (even if one is atheist). He suggested that the atheist might have a set of principles in the place of an “orthodox belief in God”. As such beliefs about ethical questions are down to individual conscience, we should respect and tolerate everyone’s autonomy in this area.
Secondly, he appeals to the constitutional right of privacy. He draws a distinction between the private and public sphere of life. While the state should govern the public arena of human behaviour, the issues of private morality should be withdrawn.
In other words, Dworkins (1995) has reduced the 4 principle-approach by Beauchamp and Childress (2008) to one basic principle– respect everyone’s desire for autonomy, with all its implications. However, many ethicists have argued that this philosophy would lead to a sense of alienation and isolation so prevalent in Western society today (Wyatt, 2010). Such a liberal society would consist of egocentric individuals reconstructing their own values and goals. Although sounding poetically utopian, it portraying that human dependence as dehumanising as it threatens autonomy. In other words, to be seriously ill is to be less human as your lifestyle depends on others.
View 3: The five commandments
The field of bioethics also provides opportunities to challenge the orthodoxy. The controversial Peter Singer (1995) is one of the most enthusiastic activist in his philosophy of bioethics. Insisting that the era of Judeo-Christian dominance has ended, he suggested we must abandon the idea of the sacredness of human life in order to operate in today’s world.
First, he argues that the worth of human life varies from person to person. In his view, people suffering from dementia and long-term coma are obviously of no value to anyone. A disabled child is far less valuable than an able-bodied one. In other words, a value of a human being is determined on his/her potential contribution to society. People without a fully functional cerebral cortex (including fetuses) are deemed to be less than human.
Second, Singer adds that traditional prohibition of taking an innocent life should be replaced with an acceptance for mercy killing (a.k.a. euthanasia). He argues that it is the responsibility of society to end lives that are ‘not worth living’.It may lead to a colder and less cohesive world, but he accepts it as a price to pay for a modern society.
Third, he advocates for the individual’s desire to live or die. He argues that to kill a fully functioning human being against his/her will is a worse crime than to end a disabled person’s life. However, if the fully functional person wants to die, we should oblige him as painlessly as we can.
Fourth, he argues that children should only be brought forth into the world if wanted (Singer and Kuhse, 1985). He is in favour of contraception and abortion in an overpopulated world, but goes one step further– Singer recommends medical infanticide for deformed and unhealthy fetuses. In Singer’s view, it is more irresponsible to waste medical resources on such infants in a crowded earth.
Fifth, we should not discriminate based on species. Singer states that society should not discriminate based on attributes that lacked moral significance. By his definition, he argued against sexism, ageism and racism. He extents this reasoning to the species level, stating that rats and dogs are more self-aware than fetuses, and should be regarded as more valuable. Although sounding fair, ethicists have pointed out that Singer is discriminating against individuals with less functional cerebral cortexes, and Singer is not as just as he puts himself out to be (Wyatt, 2009).
View 4: Human Enhancement
The last, secular view I want to cover is Professor John Harris’s (2008). Acknowledging that human beings are an accident of evolution, he advocates the use of technology to direct and enhance our capabilities however we choose. He also extends the argument to that it would be a moral duty to enhance children in order to stay competitive in future world. Not enhancing our offering would be the moral equivalent of making our kids disabled. The only legitimate argument against enhancement is that if it is shown such enhancement would be presently harmful to others (rather than the harm being future and speculative).
This sounds very abstract….
Yes it does. It may sound like complete ivory-tower nonsense that eggheads academics are paid to produce. However, these views are very real, and these views are not only sought after by philosophers and doctors, but also politicians and technologists.
What are some guidelines to think about for the Christian?
Now that I have briefly covered the popular secular views, let’s go on to the religion I am the most familiar with– Christianity. One may ask, what can the Bible, which was written in a pre-scientific and dominantly agricultural age, say about modern ethical issues? However, historical, trinitarian Christianity can only retain its significance by staying close to Scripture. A Christian cannot pretend the Bible says nothing about contemporary about ethical issues, but he/she cannot interepret the Biblical message to make it more platable to today’s ears.
Let’s get one thing clear first– the Bible is NOT a set of moral rules, telling Christians what they should do it a series of quotations. What the Bible reveals is a comprehensive view of the history of the world, and it’s future. For an summary, I will follow Wyatt’s (2009) view on how Christians should view ethical issues. Wyatt (2009) suggested four issues that Christians should think about:
1) Creation
Human beings are made in the “image of God” (Gensis 1:27). This not only affirms sanctity and equality of human life, it also implies that humans were made to be relational. In other words, humans are a reflection of another reality– being an image means that humans are radically dependent. While liberial individualism oftens sees dependence as a handicapp, the Biblical view recognises dependence as a part of being human.
2) Fall
Although made in God’s image, humanity is doomed to suffering, decay and death due to original sin (Genesis 3: 14- 19). Christian health professionals have to recognise that all humans will die despite our best medical efforts. At the same time, death is not just to be seen as a consequnce of original sin, but as a “severe mercy” (Lewis, 1964) to prevent humaity from being trapped in a decaying body.
3) Redemption
Yet God provides a promise of redemption for mankind (Genesis 3:15). God encourages care for the widowed, orphaned and needy (eg: Deuteronomy 10:17-19; Jeremiah 22:16). He came into the world via Jesus Christ as a baby, supporting the idea of dependence. In Christ, the sick were healed. But he also went deeper– he healed spiritual sickness too. In Christian theology, Jesus also took the sins of mankind and died for them.
This not only challenges the notion that the sole goal of medical science of extending human life, but it encourages to care for their emotional and spiritual needs, and sympathy.
4) Future consummation
But the death and resurrection of Jesus Christ is not the end of the story. Humanity is promised a new heaven and a new earth, and will inherit new bodies (Revelations 21:1). Humanity will not lose its dependence, but will be restored to the likeness it was intended to bear. This portrays (if I am allowed to use analogies) humanity as a flawed, artisitc masterpiece that will eventually be restored to show the original image.
For the Christians…
In the light of these statements, Christian medical professions have to wonder what their theology informs them on such issues. For instance, should they reject transhumanism to improve the human condition, in the same way an art restorers do not “improve” a masterpiece, but only restores it?
Conclusion
These questions, although tough and controversial, are extremely important to answer. As shown from the above secular and religious grounds, these questions rely on non-scientific methods to guide scientific actions.
References
Beauchamp, T.L., Childless, J.F. (2008) Principles of Biomedical Ethics (6th edition)
Brock, B., Wyatt,. J. (2006) Studies in Christian Ethics. 19, 153-168
Dworkin, R. (1995) Life’s Dominion
Gould, S.J. (1999) Rock of Ages
Harris, J. (2008) Enhancing Evolution
Lennox, J. (2007) God’s Undertaker: Has Science buried God?
Lewis, C.S. (1964) Mere Christianity
Singer, P., Kuhse, H. (1985) Should The Baby Live?
Singer, P. (1995) Rethinking Life and Death
Wyatt, J. (2009) Matters of Life & Death (2nd edition)