Like the Men of Issachar (1 Chronicles 12:32) we need to be people who ‘understand the times and know what to do’. To do this we need to be ‘double listeners’ listening both to God’s World and God’s Word.

 1. Brief overview of the impact of technology

Legal abortion on a massive scale is a relatively recent phenomenon. Since the Soviet Union first legalised it in 1920, much of the rest of the world has followed suit: Scandinavia in the 30s, Asia beginning in the 40s and Western Europe from the late 60s. By 1982 only 28% of the world’s population lived in countries where abortion was largely illegal – mostly in Muslim countries, parts of Africa and Latin America. There are now estimated to be over 40 million legal abortions performed each year worldwide. In some Eastern European and former Soviet bloc countries there is a deliberate policy to decrease abortion rates because of their demographic effects (ageing population) and complications (infertility, psychological problems).In most countries the majority of abortions (>98%) are performed for reasons of unplanned pregnancy, social inconvenience, unplanned pregnancy or economic difficulty. In the UK only 1% are done for fetal handicap and 0.013% to save the life of the mother. Abortion is usually the direct consequence of sexual permissiveness.

In developed countries about one in seven couples are infertile largely as a result of increasing levels of sexually transmitted disease and delaying families beyond the most fertile period. Almost four million babies have been born using IVF and other assisted reproductive technologies (ART) since the world’s first IVF baby was born in 1978. Legislation variably allows embryo freezing, experimentation and disposal or egg or sperm donation. Many unmarried and lesbian couples have had IVF and AID respectively.

Prenatal diagnosis of congenital diseases by ultrasound, amniocentesis (16-20 weeks) and chorion villus biopsy (8 weeks) is now commonplace in the Western world. These two technologies are impacting on the numbers of children being born with Down’s syndrome, spina bifida, cystic fibrosis and other major abnormalities. Similar trends will be seen with more diseases in more countries as technology advances; as it is far cheaper to identify and destroy affected individuals than provide for their medical care. Pre-implantation genetic diagnosis (PGD) and disposal of abnormal embryos is increasingly being used in Western countries to screen out embryos with genetic diseases and is now also available for sex selection.  

The first draft of the human genome was published in February 2001 with 30,000 genes identified. Information on more than 8,000 disorders is already available on the Internet. The knowledge that the project promises to create has potential use in the screening, prevention and treatment of genetic disorders but only a handful of patients with very rare conditions have benefited thus far from somatic or germ-cell gene therapy. While there is potential promise, economic considerations and a growing desire for the ‘perfect child’ are driving us in the direction of prenatal eugenic ‘search-and-destroy’ strategies rather than to supportive or curative treatments. There is also more demand for DNA databases to be used by police, employers and insurance companies.

Reproductive cloning by cell nuclear replacement (CNR) has now been performed in mammals including primates. It is now thought that human reproductive cloning will be technically impossible because of genetic abnormalities and high mortality of cloned embryos. Therapeutic cloning and animal-human hybrids now both look unlikely to prove successful in producing patient-specific embryonic stem cells. The first clinical trials using embryonic stem cells have begun but in terms of finding treatments for degenerative diseases like Parkinson’s, Diabetes and Alzheimer’s there appears to be far more promise in stem cell treatments using adult, umbilical or induced pluripotent stem cells (iPs)

Barrier and hormonal contraception is now widely available throughout the world but its free availability has not curbed the rise in extramarital conceptions and abortions.  Governments are increasingly employing ‘harm reduction’ policies of making condoms and the ‘morning after pill’ (MAP) freely available believing that is impossible to encourage young people to abstinence or to delay onset of intercourse; but overall the policy is not working. Some forms of contraception act after fertilisation (eg MAP and progesterone-only pill) so they are technically ‘abortifacients’ (ie they abort early embryos)

2. The Medical and Philosophical Background

Medical ethical decision making is becoming more difficult for four main reasons. 

• Medical knowledge and technology have advanced astronomically. The healer is becoming the technologist.
• The influence of the mass media means medical knowledge is more accessible. The care-giver becomes the need-meeter. 
• Financial and resource constraints in the face of rapidly advancing technology mean more acute decisions of resource allocation to make. Medicine is more under state control.  
• The plurality of religious traditions, cultural backgrounds, world-views and ideologies makes any real ethical consensus impossible. Hedonism (We want it), technology (We can do it) and moral relativism (why not?) have created a deadly cocktail.

In the 19th century Darwin’s theory of evolution gave atheism intellectual respectability and undermined belief in God as creator and judge. Higher Criticism destroyed faith in the authority of Scripture and thereby the Judeo-Christian Ethic.

Christian theism embraces a meta-narrative of creation, fall, redemption and consummation as the backdrop for understanding the world and our role in it. Human beings are worthy of respect, wonder, protection and empathy because they are created by God, made his image (Genesis 1:27) for relationship with him and because Christ through the incarnation gave nobility to man. By contrast Secular humanism denies all these realities and sees human beings just as one advanced species, the product of matter, chance and time in a godless universe. Death is final and human intuition, choice or deduction replace revelation as the basis for morality.

As late as the mid 20th century there was a broad consensus about medical ethics based on historic codes such as the Hippocratic Oath (600BC), Declaration of Geneva (1948) and International Code of Medical Ethics (1949). These affirmed values such as recognition of a higher authority, respect and gratitude to teachers, respect for colleagues as brothers, impartial service to patients as first priority, respect for sanctity of life, respect for patient confidentiality, avoidance of economic or sexual exploitation and commitment to professional competence and independence. These have now been substantially amended to reflect contemporary secular values; in particular obligations to the state have increasingly taken precedence over obligations to the individual and respect for the sanctity of life has been eroded especially before birth.

In the last 30 years secular bioethics has emerged as a new specialty. Bioethicist Peter Singer suggests that to treat humans differently from animals is speciesist and that humans with lower levels of consciousness, intellectual capacity, rationality or capacity for relationship (including embryos, fetuses and brain-damaged people) are not persons worthy of full respect but rather potential persons or non-persons.

Traditionally ethics are described either as Consequentialist (consequence based) or Deontological (rule based).

There are three main problems with a consequentialist approach:

• It takes no account of ‘ends and means’ (and thereby encourages ‘doing evil that good may result’) (Romans 3:8)
• It fails to consider motives (and thereby encourages ‘doing the right thing for the wrong reason’)
• Consequences are difficult to predict (and so it is very easy to misjudge them and make the wrong decision for short term gain)

Deontological approaches get around these problems but you have to have the right rules (!) Judeo-Christian and Hippocratic ethics are deontological and based in ‘revealed rules’ but they have been recently replaced by the ‘four principle approach’ of Beauchamp and Childress: beneficence (doing good), non- maleficence (not doing bad), autonomy (respecting free will) and justice (being fair). This approach which increasingly dominates the secular bioethics literature has three main failings:

• The four principles are not clearly defined (eg. What is ‘doing good’ if there is no external frame of reference?)
• The four principles conflict in almost all situations so which should take precedence?
• This approach ignores the issue of ‘personhood’ (ie. What constitutes a person to whom we owe these duties?)

Christianity espouses the ethic of the strong laying down their lives for the weak, or making sacrifices on behalf of the weak (John 13:34,35; Romans 5:8; Galatians 6:2). But the ‘politicisation’ of Darwinism, as previously happened in Nazi Germany, makes survival of the fittest (and thereby non-survival the weakest) a public duty. It is generally cheaper to kill than to care, and cost-benefit analyses will favour euthanasia, selective abortion and prenatal eugenics in any cost-conscious society, especially when falling birth rates from abortion and increased life expectancy change the demographic profile to increase the proportion of ‘dependent’ people (esp the elderly) wage earners need to support.

3. A Christian Ethical Framework

A. Sharing the mind of Christ

We need first to adopt a biblical worldview:

• Creation – Man is made in the image of God
• Fall – Man is a flawed masterpiece
• Redemption – Man can be restored (but not enhanced) in this life and the next
• Consummation – Everything will be put right as God reconciles the world to himself through Christ

And embrace biblical principles:

• Stewardship (Genesis 1:26) – We have been delegated responsibility to manage the planet in a way that imitates and glorifies God.     
• Sanctity of life (Genesis 1:27; 9:6; Exodus 20:13) – To protect and preserve all human life and never intentionally to take it.
• Chastity (Genesis 2:24; Matthew 19:4-6; Ephesians 5:31-32) – To keep sex within marriage.
• Veracity (Deuteronomy 5:20) – To speak the truth and always use personal information to serve rather than to exploit others.
• Justice (Proverbs 31:8,9; Micah 6:8; Jeremiah 22:16; Isaiah 58:6-10) – To show no partiality in serving others, to speak up for those who have no voice and never to discriminate, especially against the vulnerable and marginalized.
• Compassion, grace and mercy (Mark 1:41, 8:2) – To love others as Christ himself did and give them the good they don’t deserve.

B. Holding the commands of Christ

• Christian ethics are summed up in the ‘law of Christ’(John 13:34-35;1 Corinthian 9:21; Galatians 6:2); which means loving as Christ loved and bearing one another’s burdens.
• All human beings are neighbours to whom we owe responsibility and obeying and loving God are inextricably linked (John 14:15, 21; 1 John 2:3-6, 3:23-24)
• The Bible is the standard against which all religious tradition, consensus opinion, human reason, conscience and prophecy should be tested.
• We need to work hard on our hermeneutics, applying God’s eternal commands in Scripture to contemporary ethical situations in the 21st century.
• We should never let the end justify the means for fear of bad consequences but should accept God’s wisdom rather than our own insight (Romans 3:8)

C. Having the character of Christ

Making right decisions will involve us increasingly sharing the character of Jesus Christ. It is one thing to recognise the right thing to do in a medical ethical dilemma. It is quite another to have the faith, patience, perseverance, courage and character to do it. We are rather often revealed in the context of the dilemma for what we are; lacking in the Spirit’s fruit of love, joy, peace, patience, kindness, goodness, faithfulness, gentleness and self-control (Gal 5:22-23) and our lives do not measure up to that description of love (which Christ fulfils perfectly) that is given to us in 1 Corinthians 13:4-6.

D. Carrying the cross of Christ

Jesus said that, ‘anyone who does not take up his cross and follow me is not worthy of me’ (Matthew 10:38). The call to follow Christ inevitably involves suffering just as his life involved suffering. Some of this comes from the inevitable persecution that we can expect as followers of Jesus which comes naturally to every believer who attempts to live a godly life (2 Timothy 3:12). But there is also suffering which results when we expend ourselves physically, emotionally and spiritually in serving and loving others, especially in bearing the burdens of our fellow believers (Galatians 6:2). This is carrying the cross of Christ – to suffer with him as we do his work. And we need to be ready to ‘endure hardship’ (2 Timothy 2:3) particularly ‘for the sake of the elect’ (2 Timothy 2:10).

4. Principles into practice

 4.1 Abortion

• Abortion has historically been regarded as unethical and is against the Hippocratic Oath and the Declaration of Geneva
• According to Scripture the embryo/fetus is a human being whom we have a duty to love, protect and respect (Psalm 139:13-16)
• Taking innocent human life is always wrong; but we have an obligation to love, help and support the mother in keeping her child especially in difficult cases of rape and congenital abnormality.
• Abortion harms women through pelvic infection, infertility, premature birth, psychological damage and increased risk of breast cancer.
• The demand for abortion would be minimal if there was no extramarital sex; so we should encourage abstinence before marriage and faithfulness within marriage.
• There are compassionate alternatives to abortion through supporting solo parents and adoption, which Christians should be involved in.
• Advances in neonatal technology and imaging mean that we are much more aware and respectful of intrauterine life.
• Health professionals should not be discriminated against for refusing to break the Hippocratic Oath and other traditional ethical codes.

 4.2  Artificial reproduction

• The demand for artificial reproduction has been fuelled by a rise in infertility (often caused by sexually transmitted diseases) and a fall in babies available for adoption (due to abortion and state benefits for unmarried mothers)
• Infertility is the cause of much heartache and we should seek compassionate and ethical solutions for it (Genesis 30:1)
• Success rates with IVF (in vitro fertilisation) are still low (about 20% per cycle) and expensive (US $4,000 per cycle)
• Donated gametes (egg and sperm) violate the marriage bond, introduce a third person into the parental equation and complicate family relationships
• Freezing, destruction or experimentation on human embryos is unethical
• We should therefore seek only therapies which preserve the marriage bond and respect human embryos
• IVF has opened a Pandora’s box of frightening possibilities including cloning/eugenics
• The rights and needs of any resulting children should take priority over parents’ wishes
• Strong commercial interests operate in this field and shape priorities

 4.3  Prenatal Selection

• No screening technique is 100% accurate and all carry a risk.
• Any information gained about an individual from screening should always be used to help and not to harm that individual or other members of the family.
• Prenatal screening is helpful if it helps parents avoid conceiving children with genetic abnormalities, enables therapeutic interventions to help the baby, helps parents prepare for a baby with special needs, is relatively safe and will alleviate rather than increase parental anxiety.
• Prenatal screening is wrong if the aim is to search out and destroy ‘abnormal’ individuals
• Prenatal search and destroy technology will lead eventually to changes in attitudes to children (seeing them as commodities), changes in attitudes to the handicapped (discrimination) and a slippery slope where it is employed for more trivial reasons.

4.4 Genetics and stem cells

• The human genome project should yield much information that will be helpful in developing new treatments but there is also much potential for abuse.
• DNA databases can be helpful in crime solving and to give accurate information to employers and insurers, but could be used to exploit and control individuals especially by corrupt governments.
• Gene therapy is greatly over-hyped but the results of somatic gene therapy are so far disappointing and germ line gene therapy is likely to be difficult to control. It is therefore likely that cheaper ‘search and destroy’ options will take precedence.
• Xenotransplantation (the use of genetically altered animal organs in humans) as well as being counterintuitive is fraught with problems including the danger of escaping retroviruses, immunological rejection and introducing transmissible genes.
• Therapeutic cloning is unethical because it uses embryos as a means to an end, unnecessary because therapy using adult or umbilical stem cells is a viable alternative, dangerous because of the ‘slippery slope’ to reproductive cloning, and is often motivated by prestige and profit rather than altruistic concern for others.
• Reproductive cloning is unsafe because most cloned mammals die early, dangerous because the effects are unpredictable, unethical because it makes children consumer products, socially undesirable because of damage to family relationships and unnecessary because alternative methods of artificial reproduction exist
• Animal human hybrids are unethical in that cross a rubicon in creating transpecies organisms and are used as a means to an end; furthermore the indication is that they will not work.  
• Stem cell research to find treatments for degenerative diseases theoretically holds real promise and has produced good results in other species. Adult stem cell cloning is more promising than previously thought and early human trials are yielding good results. It constitutes an ethical alternative to the use of embryos.

 4.5 Contraception

• The greater availability of contraceptives does not reduce abortions or sexually transmitted diseases (STDs) because ‘risk displacement’ operates. That is, people feel safer so they indulge in greater risk taking behaviour (ie. sex outside marriage). So prescribing to unmarried couples makes it more likely they will have sex.
• The failure rate (both user and method failure rate leading to pregnancy or STDs) for teenagers is very high
• Oral contraceptives do not protect against any sexually transmitted diseases and condoms do not protect against all STDs
• Some forms of contraception (esp MAP and IUCD) act after fertilization and so are technically ‘abortifacient’ (ie they prevent an embryo implanting in the womb)

 Glossary

Abortion – killing of the fetus within the womb

AID (Artificial insemination by donor) – sperm from a third party (not the husband) is placed in a woman’s womb to achieve pregnancy

Alzheimer’s disease – a degenerative neurological condition resulting in dementia and short term memory loss

Amniocentesis – a needle is passed into the womb at 16-20 weeks gestation to obtain fluid for examination and diagnosis of fetal abnormalities

Chorion villus biopsy – a tissue sample is taken from the opening of the womb at 8-10 weeks gestation for examination and diagnosis of fetal abnormalities

Consequentialist – ethical decision based on consideration of consequences of an action

Deontological – ethical decision based on conformity to a rule or principle

Down’s syndrome (Mongolism)  – a common genetic abnormality caused by an extra 21st chromosome

DNA database – collection of genetic information from many individuals stored to aid later identification of any of those individuals from a tissue sample

Fertilisation – union of egg and sperm to create an embryo

Gene Therapy (Germ Line)- treatment involving altering the genes in egg or sperm

Gene Therapy (Somatic) – treatment involving altering the genes in a somatic or body cell

IVF (In Vitro Fertilisation) – egg and sperm combine in laboratory and fertilized egg is returned to the womb to achieve a pregnancy. Usually used in cases of tubal damage

Parkinson’s disease – a progressive degenerative neurological condition characterised by tremor and rigidity

Pre-implantation genetic diagnosis (PGD) – a single cell is taken from an early embryo in the first days of life and examined for the presence of chromosomal or genetic abnormalities.

Reproductive cloning – production of a new individual genetically identical to an existing individual by replacement of the nucleus of an egg with the nucleus of a body cell

Spina bifida – A congenital abnormality of the spine resulting in varying degrees of paralysis and possibly mental retardation

Stem cells – Cells of either embryonic or adult origin with the therapeutic potential to replace tissue lost in degenerative disease.