The language of our popular and professional cultures has a profound influence on the way we talk of God. Margaret Atkins, a regular columnist for the Independent newspaper and lecturer in theology at Trinity and All Saints College, Leeds, examines these cultures and concludes that not only do students need to be made familiar with Christian language, but the secular world needs to be challenged 'for it is far more vulnerable than it realises'. Luke Gormally, who is director of the Linacre Centre for Health Care Ethics in London, urges the need to respond to the corrosive effects of secularism on contemporary medicine with an integral Catholic understanding of what respect for human dignity requires. A Catholic bioethic within a Catholic ethic
'Bioethics' is the name (more common in the USA than the UK) given to the systematic study of the ethical issues which arise in connection with clinical practice and biological research. It includes both medical ethics and nursing ethics. 'Catholic bioethics' approaches the study of this topic-area on the basis of a Catholic understanding of the moral life and in the light of those principles which the Church teaches should govern our choices.
In the Catholic vision choice plays a decisive role in securing our fulfilment, a fulfilment which is only achieved in the Kingdom of heaven. Heaven is not an extrinsic reward for a way of life in which human choice bears no intrinsic relationship to the reality of heavenly life. On the contrary, those human goods which give point and purpose to our choices Ñ goods such as truth, play, inner harmony, justice, friendship and peace in community, a right relationship to God Ñ will find their transformed realisation in heaven. Respect for those goods in this life and an upright dedication to their achievement serve both to build up the Kingdom and to shape a heart properly open to the fulfilment for which we were made.1
Moral norms are the requirements our choices must satisfy if what we choose to do is to make for the fulfilment for which God intended us both in creating us with the kind of natures we have and in redeeming us. God is therefore not indifferent to our observance or non-observance of moral norms; our observance of them is intrinsically related to the realisation of God's own purposes. Hence, the 'fear of the Lord' and reverence for his law are the beginning of wisdom.
Our capacity consistently to choose and act in ways which make for our fulfilment, and to sustain a common life conducive to everyone's fulfilment, has been gravely impaired by sin. And so we are in need of salvation. That salvation comes to us in the New Covenant which has been sealed in the death and resurrection of Jesus, whose Spirit is poured out in our hearts to give us a heart of flesh responsive to the will of God. That will is not merely the requirements of the natural law but the task each Christian has in the mission of the Church to manifest to the world the true character of human destiny and to communicate the grace which makes its realisation possible. Receipt of the promised benefits of the New Covenant, like receipt of the benefits of the Old Covenant, is made dependent on our fidelity to the demands of the Covenant. Since those demands are not arbitrary but intrinsically related to our fulfilment, their freely chosen rejection is the rejection of that fulfilment; hell is the direct consequence of our own choices.
Contemporary bioethics is concerned with issues such as abortion, allocation of resources, contraception, diagnosis of death, embryo experimentation, euthanasia, genetic engineering, gene therapy, informed consent, in-vitro fertilisation (and similar techniques), research on the incompetent, transplantation, withdrawal of treatment and care, and so on. A Catholic bioethic approaches these issues in the light of a particular understanding of the dignity of the human person which requires respect for the good of life and the good of health, for the good of justice, for the good of marriage and the virtue of chastity, and for the responsibility of the competent person for living according to the requirements of his or her calling. Respect for human dignity in the Catholic vision is tied to a substantive conception of what makes for human fulfilment. And that conception in turn is tied to a body of norms; both negative norms which absolutely exclude certain choices as radically subversive of the fulfilment of persons (such as choices to kill the innocent, as in abortion and euthanasia; choices to contracept; choices to generate children independently of normal marital intercourse), and positive norms (such as those enjoining care for the sick and the weak, and those enjoining disclosure of the information people need to make the choices for which they are responsible).
A secularist society2
A secularist society is to be distinguished from a secularised society. A secularised society is one in which political authority is exercised independently of religious authority, since the two are acknowledged to involve distinct kinds of competence. A secularist society is one in which a particular ideological mind-set is prominent and influential. Central to this mind-set is either the belief that God does not exist, or the belief that if God does exist he has no concern with human affairs, or the belief that God's concern is vaguely benevolent, and involves no specific requirements rejection of which would entail radical and potentially final alienation from him.
A secularist mind-set either rejects or has lost understanding of any intrinsic connection between chosen human behaviour and a transcendent human destiny to which God in his providence directs us (through both our reasoned and his revealed understanding of his will). In consequence a substantive conception of human flourishing slowly drops off the map, particularly any conception the realisation of which requires respect for absolute negative norms. Practical reasoning comes to confine its horizon to an inner-worldly terrain, where the fulfilment available to us is insecure. It makes doubtful sense to heighten this insecurity by being an absolutist about, for example, the negative requirements of justice. When justice is abandoned as a guiding conception, convenience becomes the governing preoccupation of practical reflection about one's relations with others.3 But if certain human beings are to be treated as dispensable it is as well to have some plausible rationalisations for their treatment. What this means for a secularist bioethic I shall come to shortly.
At this point, however, we need to recognise the fact that secularism is not to be identified as a purely extra-ecclesial phenomenon. It is indeed manifestly widespread outside the Church, but it is also discernibly present within. Think of all those requiems at which priests confidently describe the recently departed (including misers, calumniators and adulterers) as already enjoying heavenly beatitude. If heaven is a sure-fire goal it hardly matters how one chooses to live. A shallow and frivolous attitude to divine providence radically obscures the significance of human choice for our lives. Hence the importance of Pope John Paul II's question: 'Is not hell in a certain sense the ultimate safeguard of man's moral conscience?'4
A secularist mind-set poses challenges for a Catholic bioethic both in the domain of public policy and within the Church.
Bioethics as a secular discipline may be said to have had its birth in response to the problem of devising public policy on issues arising in clinical practice and research as a result of social change and biomedical innovation. The problem is acute, because the legacy of secularism in ordinary moral consciousness is subjectivism and something close to an absolutising of autonomy. This makes for an intractable pluralism.
There are two dominant philosophical strategies in Anglo-American bioethics for coping with pluralism: one based on a utilitarian ethic (predominantly the UK approach5), the other on a 'procedural ethic' (predominantly the US approach). Broadly speaking, one might say that each approach rests for its appeal as an ethic appropriate to the formation of public policy on a different perception of the significance of pluralism.
Utilitarianism can accommodate a subjectivist view of value, and, in enjoining us to make those choices the consequences of which will maximise 'utility' or 'welfare', commonly interprets 'utility' or 'welfare' by reference to the desires or preferences people happen to have. The injunction to maximise satisfaction of desires or preferences goes with the view that the values at issue in choice are essentially commensurable. The utilitarianism which aspires to rationalise public policy has its appeal precisely because it claims to deal with the problem of widely diverse desires and preferences by letting them all count as commensurable units in the calculus of choice. The picture of this exercise in aggregating desires or preferences is of course a fantasy, since there is no common measure for them. In practice, therefore, what matters is whose desires or preferences get counted and the 'weight' given to them. And that depends on who does the counting.
Those who advocate a procedural ethic tend to think that what makes pluralism difficult is precisely the incommensurability of values and of different ways of life in a society. On this view of our situation, the problem of public policy formation is the problem of being neutral between diverse and incommensurable doctrinal viewpoints and ways of life. Neutrality in this regard is held to be required because of the fundamental importance to persons of their freedom to decide what makes life worthwhile and how to live it, i.e. their freedom to decide on their conceptions of the human good. On this view, autonomy is not the exercise of the capacity to choose in the light of norms which direct us in accordance with an objective understanding of the human good; instead autonomy is thought of as somehow exercised in deciding what is the human good. And so it is held that the public domain should provide a neutral framework for the play of competing interests, and afford fair procedures designed to ensure that persons have equal opportunities to choose and pursue whatever ways of life they think worthwhile.
It is unsurprising that both approaches to public policy fail to provide a framework of justice. This failure can be well illustrated precisely from contemporary secularist bioethics where both approaches tend to agree in excluding a number of categories of human beings from the category of 'patients to whom doctors owe duties of care'.
Mainstream utilitarianism is an ethic of the satisfaction of desires or preferences. A procedural ethic is designed to secure fairness for 'rational' choosers. Each ethic has tended, therefore, to count as having moral status only those presently capable of forming and articulating desires or preferences or rational choices. Only human beings so equipped are to be called 'persons' and only 'persons' are subjects of justice (i.e. possess basic rights). Your interests as an immature or senile human being Ñ if you are recognised as having interests Ñ are deemed subordinate to the desires, preferences, or choices of 'persons'. In this way rationalisations are advanced for abortion, embryo experimentation, non-voluntary euthanasia, and the withdrawal of treatment and care from patients with advanced senile dementia or who are persistently unconscious.
It is not difficult to show the unreasonableness, and indeed injustice, of the discriminatory job done in secularist bioethics by the distinction between 'persons' and human beings. One may do so on the basis of an intuition about justice which I think is very widely shared: the intuition that who are the subjects of justice should not be determined in an arbitrary fashion. For to do so is to subvert the very possibility of justice. But in making moral status hang on the possession of exercisable psychological abilities secularist bioethics is involved in arbitrary discrimination. The arbitrariness is most evident in determining how developed the relevant abilities have to be in an individual before he or she qualifies as a subject of justice. If one says that one necessary ability is 'understanding', what exercisable mastery of concepts is required? Wherever one draws the line in determining some requisite mastery of concepts, there will be some human beings who fall below the line only marginally in developmental terms, in the sense that they will be close in time to achieving the same level of ability. And yet in falling below the line at a particular point in time they are deemed not to be subjects of justice!
The only escape from such arbitrariness is a return to the assumption of traditional morality that every human being, simply in virtue of being human, is a subject of justice Ñ in other words, possesses basic human rights. If this assumption were taken seriously there would clearly be no place for practices such as abortion, embryo experimentation and euthanasia.
It is one thing to unmask secularist bioethics as devoid of a defensible understanding of justice, and as advancing rationalisations for the preferences of the powerful; it is another thing to gain acceptance on philosophical grounds for a sound ethic for our common life. One should not, of course, despair of the desire human beings have for truth (and so one should seek to advance as full an account of moral truth as shared assumptions will allow). At the same time one also has to recognise the investment so many people have in falsehood, and the systematic propaganda it enjoys through the media. Our societies and the dominant public culture are in what Lonergan called a cycle of decline, and to break out of this decline we need to make influential a different and more adequate understanding of our common life, and the role of medicine in it. But as Lonergan also noted, when people are in the grip of false ideologies (which of course serve to shape moral character) they rarely achieve intellectual conversion without prior moral conversion. And since moral conversion concretely means the overcoming of habits of sin, moral conversion itself requires religious conversion. It is in the light of this statement of the general character of our need that I finally turn to brief consideration of the role of a Catholic bioethic within the Church.
The Church in a secularist society
In face of a secularist society, which in its laws, practices and institutions increasingly embodies a decisive rejection of the values characteristic of the Christian tradition, the urgent task of the Church is to preach the gospel of our salvation from sin and from its consequences in ideological delusion and moral impotence. The grace of Christian conversion frees us from error and empowers us to live the truth. The integral proclamation of the Christian message includes the moral demands of the gospel. Work in the framework of a Catholic bioethic has a contributory role to play in elucidating and communicating the moral truths which should inform the practice of medicine, nursing and work in the biomedical sciences. All these fields of practice include Catholics who are capable of giving a potentially transformative witness to moral truth in their work. But secularism is already strongly influential in the minds of many Catholics Ñ an unsurprising fact, since it is not without influence on the minds of some of their pastors. A commitment to working at the exposition and development of a Catholic bioethic which is faithful to the teaching of the Church's Magisterium is likely to encounter distinctive difficulties within the Catholic community. None the less, that commitment is needed by both the Church and the world.
Let me end by trying to illustrate that last claim by reference to the item of authoritative church teaching which has been most widely rejected over the last thirty years: the Church's teaching on the wrongness of chosen contraceptive intercourse. Humanae vitae teaches that chosen intercourse should be marital intercourse which is both unitive and generative in its significance. Here I would like to highlight some implications of the rejection of that teaching for key issues in the field of bioethics.
Why does unitive sexual behaviour have to have a generative significance? Because we need human beings to be well disposed to the good of children in their sexual activity, and not to seek to make sense of it to the deliberate exclusion of openness to children.6 Why does generative behaviour have to have a unitive meaning? Because human generation needs to have its human cause in the kind of act which is expressive of the unreserved self-giving of husband and wife. If a child's coming to be has its human origin in such an act then the child enters the relationship of husband and wife as the fruit of unreserved self-giving. It is precisely and only that status which is adequate to the dignity of the child: for truly unreserved self-giving carries with it a commitment to unreserved acceptance of the fruit of that self-giving. The dignity of the child is only adequately recognised in the acceptance and cherishing of him or her just as he or she is. The disposition to that acceptance is protected precisely by the teaching on the inseparability of the unitive and procreative meanings of marital intercourse. The rejection of that teaching does not simply undermine commitment to marriage, but inherently undermines the disposition to accept children as they are given to us Ñ for the persons they are. That rejection has had incalculable consequences for clinical practice and biomedical research. The development of the so-called 'reproductive technologies' assumes the acceptability of separating the generation of children from the sexual act expressive of the two-in-one-flesh unity of their parents. In consequence the newly-generated human being has come to seem to be the manipulable product of technical expertise rather than the fruit of unconditional self-giving who is to be unconditionally accepted. In vitro embryos are subject to quality control and discarded if deemed unfit for implantation; others are generated solely for experimentation which is destructive in character. Much work in genetic engineering looks to a future in which designer babies will be produced to parental specifications, and perhaps even state specifications (at least in the sense that the State will refuse any support to parents who are committed to accepting and caring for their handicapped children). The root of these developments, which are so deeply at variance with what is required for recognition of the dignity of children, lies in the rejection of the teaching that children should be begotten as the fruit of marital intercourse which is integrally unitive and procreative in its significance. Adherence to the teaching that chosen sexual activity should always be marital in that sense is the only stance which allows a coherent and radical resistance to the powerful eugenic tendencies in contemporary medicine and society.
The Church's teaching both on the sanctity of life and on human sexuality are of fundamental importance to the understanding and defence of human dignity, and to establishing a society and a culture conducive to the fulfilment of every human being. The most important task for a Catholic bioethic, both within the Catholic community and in society, is to work for the reappropriation of those truths which will help medicine and biomedical science to serve human beings and to cease being the vehicles for destructive assaults on human life and human dignity.