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
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
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
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
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
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
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]