Update on Life Issues - March 1997

What qualifications do you need to make wise decisions in medical ethics and practice?  Are a few degrees, a smart suit and a TV personality sufficient?  Or, is the proper response to most of life’s perplexing ethical issues encompassed by that grand, secondary Christian precept - “love your neighbour as yourself”?  If only evangelical churches had more brave, good Samaritans, then life would undoubtedly be more straightforward.  Doubters, read on.

Mrs Diane Blood and Posthumous Fatherhood.  Back in November 1996 the Human Embryology and Fertilisation Authority (HFEA) refused permission for Diane Blood to be artificially inseminated with her husband’s sperm because he had not given written permission before he died suddenly from meningitis (see Bulletin No. 38).  Then, on 7 February 1997, the Court of Appeal granted her permission to undergo artificial insemination, as long as it was performed outside Britain.  Finally, on 27 February, the HFEA changed its mind and agreed that there were “no strong public policy objections” to this course of action.

What are we to make of this extraordinary episode?  What a charming, courageous woman Diane Blood seems to be - she certainly has generated enormous public sympathy.  First, she was committed: she remortgaged her bungalow in Worksop in order to pay her estimated £70,000 legal fees.  Second, she was moral: she and her husband were apparently committed Anglicans.  They had been married by the 1662 Book of Common Prayer service with its strong endorsement of procreation as one of the purposes of marriage.  Third, she was astute: she had stated, “The authorities appear more keen to destroy life than create it.  If I had been pregnant when my husband died and I had wanted an abortion, nobody would have cared what he thought.”

But, but, but.  Are such admirable personal qualities sufficient grounds for proper decision-making?  Consider six disturbing issues surrounding this case.  1] Taking sperm samples from a man with meningococcal septicaemia is probably not wise - they may be damaged, or they may even carry the disease.  2] Professor Ian Cooke of Sheffield was involved in the decision to take sperm - he was then a member of the HFEA.  He must have known this would become a tangled case.  Why did he not consult the HFEA?  After all, if no sperm samples had been taken, there would be no dilemma.  3] Why (after about three month’s deliberation) does the HFEA now think that export of sperm is acceptable?  4] It was maintained in court that sperm was just another bodily component that can be disposed of by the next-of-kin, like corneas and livers.  But this argument ignores the special generative properties of sperm.  Otherwise, why is it that we have specific legislation for sperm donation in the case of artificial insemination by husband?  5] Of all the countries that have legislated on artificial insemination only Spain allows posthumous insemination.  Austria, the United States, France, Sweden, Australia all ban it - Germany applies penal sanctions against it.  6] Lord Winston and Baroness Warnock, the media king and queen of moral relativism, and who were both in favour of the destruction of thousands of human embryos last summer, both supported this case of posthumous insemination - enthusiastic support from such quarters should alone make us doubt its propriety.  Finally, can any reader think of one or two arguments from this case that support the HFEA’s epigram by which it judges most issues, namely “the best interests of the child-to-be”?  Answers on a postcard to.......

Caesarean Sections Without Consent.  All is not well on the childbirth front. The numbers of caesarean sections performed in Britain in the last few years have been rising at a quite alarming rate - now they occur in as many as 20% of all births, and every 1% increase in this figure costs the NHS over £5m.  Much of this increase has to do with doctors fearing litigation if injury occurs during natural childbirth.

Caesarean sections have created additional unease recently because courts have been ordering such procedures to be carried out on women against their express wishes (see Bulletin No. 38).  The High Court in London has ordered at least six such operations in the last year as a result of emergency applications by hospital authorities.  The women have not been represented in court and the question of their competence to make informed decisions has often been ignored or skated over.

Now the Court of Appeal has ruled that courts cannot authorise doctors to perform caesarean sections on a mentally competent woman against her will.  Thus a competent woman now has the right to refuse such intervention, even if she puts her own life or health, and that of her unborn child’s, at risk.  

Thus a court no longer has the authority to order an operation to protect an unborn child.  We already have laws to uphold a woman’s decision to take the life of her unborn child.  And we also have laws to protect from prosecution the doctors who perform such abortions.  Obviously, 1997 is not a good time to be in utero.

 Euthanasia In, Euthanasia Out.  On 22 September 1996, Bob Dent, a 66-year-old carpenter with prostate cancer, became the first person in the world to die under euthanasia law (see Bulletin No. 38).  This occurred in the Northern Territory of Australia under their Right of the Terminally Ill Act.  Meanwhile, another three Australians have ended their lives with the aid of Dr Philip Nitschke and his computer-controlled euthanasia system, which injects patients with a lethal cocktail of drugs.

At first, Mr Dent’s action was enthusiastically supported by his son, Rob.  But, less than three months after the event, he (Rob, certainly not Bob) changed his mind.  After reflection he has decided that the right solution to this dilemma was that “his father needed access to proper palliative care.”

These events caused an ethical storm across Australia and this euthanasia law was overturned in March by its Parliament.  Somewhat bizarrely, both sides of the ethical divide have now joined forces in calling for increased funding for palliative care.  Ah, the application of sanctified common-sense!  Loving your neighbour is always a better response than killing him.

Cloning Sheep and Humans.  Earlier this year a sheep was seen on the BBC’s Nine O’Clock News.  She looked like an ordinary sheep, but she was not.  She was in fact the fruit of the experiments of Ian Wilmut and his colleagues from the Roslin Research Institute, Edinburgh.  Ethical shockwaves erupted because Dolly, the animal in question, was a clone.  But she was not an ordinary clone.  Clones of animals, indeed, clones of humans, are created by the splitting, either naturally or artificially, of an embryo early in its development - we usually call them identical twins.  But Dolly was quite different, and some of the evangelical press has not appreciated this.  She was created from a sheep’s ovum from which the genetic material, the DNA, had been removed and replaced with the DNA from a mature cell (in this case, from the mammary gland) of another sheep.  The resulting embryo was then brought to term in a surrogate sheep.  So Dolly was an identical twin of her mother.

Dolly epitomises science racing ahead of our moral, legal and sociological understanding and judgements.  She is another striking example of the clash between the “is” and the “ought”.  Because cloning “is” possible, “ought” we to do it?

Some see Dolly as a way of using animals to produce human medicines or human spare parts - perhaps everyone could have a reserve of their own cells to enhance cures of, say, future cancer, or degenerative disorders, or skin grafts for burn victims.  Grieving parents could be given a copy of their fatally-injured child.  Others, including the popular press, wondered if Hitler, or Elvis, or even Alan Shearer could be cloned.  Dr Wilmut told a House of Commons Select Committee that the technique could be used to clone humans “within two years”.

President Clinton promptly banned the use of US federal funding for “cloning human beings”.  The science journal, Nature, called for a moratorium.  Others, including the European Parliament, demanded a total and definitive ban of such experiments.

What Dolly has clearly demonstrated is that adult mammals can be cloned in a completely asexual fashion.  This undermines our current definitions and understanding of terms like embryo, gamete and fertilisation - an embryo is no longer necessarily the fertilisation product of male and female gametes.  Applied to the human race, it could mean that men are no longer required for reproduction.  That alone should cause Christians to fear - what will this mean for the future of marriage, the family and society?

What about using human cloning to circumvent infertility or sterility?  Would it be controlled by authorities, perhaps like the HFEA?  Could human creators generate people in their own likeness?  But, let us remember, that human life is more than passing on genetic material; children are not simply biological products.  Individuals are not determined by their genetic material alone.  Family, cultural and social environment have powerful “humanising” influences on us all.  Part of the dignity and individuality of human beings lies in the uniqueness and unpredictability of their beginnings and development.  Sexual intercourse, that “great lottery of heredity”, protects us against any biological predetermination by third parties, including parents.  One of the great blessings of children is their inevitable difference from their parents - thus we should love them for who they really are, rather than for what they have, or what we want them to be.

So what can a sheep teach us?  Dolly should cause us to face up to our responsibilities.  Current technical problems will probably not prevent human cloning.  Opposition must be based on moral arguments, which rest upon the very basis of our dignity.  The world, which has largely forgotten God and His precepts, can no longer construct a convincing argument for the dignity of man.  The Christian, armed with Biblical truth and its absolutes - the fact that we are made in the image of God - is onto a winner here.  Who can argue these issues better than a Bible-believing Christian?  

Persistent Vegetative State.  Persistent vegetative state (PVS) is a dogdy condition.  It came to the attention of the general public after the 1989 Hillsborough football ground disaster.  Tony Bland will forever be remembered as the first PVS patient for whom the courts allowed food and drink to be withdrawn, thus allowing him to die in 1993.

Last year there was a disturbing report about PVS from Dr Keith Andrews, director of the Royal Hospital for Neurodisability, Putney.  After examining 40 patients, who had been diagnosed as suffering with PVS, he found that 17 had been misdiagnosed.  

Now comes the case of Andrew Devine, also a victim of the Hillsborough tragedy.  Mr Devine, a former postal worker, now 30-years-old, began tracking moving objects with his eyes about three years ago.  With the aid of a touch-sensitive pad, he can now answer “yes” (one press) and “no” (two presses).  When asked if Liverpool are the best football team, he presses once!  Mr Devine is, according to Dr Andrews, not an example of misdiagnosis, but rather the first person to emerge from PVS after a period of more than five years.  

This event has rekindled grave misgivings about the series of High Court cases in which judges have allowed the withdrawal of food and water from PVS patients so that they may slowly die.  We should always be wary of hasty decisions - and for victims of PVS, five years seems to be far too hasty.

A New Hippocratic Oath?  For more than 2000 years, the Hippocratic Oath, together with the high moral teachings of the Bible, has undergirded the ethics and practice of Western medicine.  Within the last 50 or so years both have been largely ignored by the medical profession.  Now the World Medical Association is producing an updated version of the Hippocratic Oath for inclusion in the Geneva Declaration, the international code of medical ethics, which celebrates its 50th anniversary next year.  

Originally the pagan Hippocratic Oath was a beefy set of statements.  Not only did it warn doctors “to do their patients no harm”, but it also contained the following: “I will give no deadly drug to any, though it be asked of me, nor will I counsel such, and especially I will not aid a woman to procure abortion.”  Readers will probably not be surprised to learn that the new version states: “I recognise the value of human life, but I also know that the prolongation of human life is not the only aim of healthcare.  Where abortion is permitted, I agree that it should take place only within an ethical and legal framework.”  Roll over Hippocrates!  And have mercy on us Lord of life!

Scientists and Belief in God.  None can doubt that science is in the ascendant.  No longer is it the artisan or the minister of religion who challenges society with the great ethical questions - now it is the scientist.  What sort of men (and women) are they?  Do any believe in God?  In 1916 there was a famous survey conducted in the USA by James Leuba in which he asked 1,000 scientists that very question.  The answer was, 40% did.  Leuba predicted that this proportion would decrease as education increased.  Now, 80 years on, the results of a similar survey have been published in a recent issue of Nature and they have confounded Leuba’s prediction.  The result: 40% of scientists still believe in a personal God and an afterlife.  Also unchanged in both surveys were the proportions of scientists who were atheists (45%) and those who were agnostics (15%).  

Readers of this Bulletin will, of course, question what is meant by a “personal God” (defined in the survey as “a God to whom one may pray in expectation of receiving an answer”).  We would also recognise that the nature of religious belief has changed dramatically over the past 80 years - it is no longer synonymous with orthodox Christianity.  Nevertheless, it is interesting to note that science, for all its commendable qualities, has yet to satisfy all human needs.  On the other hand, the survey shows clearly that most scientists have no time for, or serious thoughts of, God.  Such widespread unbelief is probably no different from the population as a whole.

But, the unbeliever can be persuaded.  You, dear reader, are an excellent example of this very truth.  Furthermore, many can be persuaded that coherent Christian doctrines and credible Christian living can be the very best guide for ethical decision-making.  The real problem for us is that we have rarely been brave enough to express this in sufficiently cogent terms and winsome ways.
“Be on your guard; stand firm in the faith;
be men of courage; be strong. 
Do everything in love.”  
[1 Corinthians 16:13-14]