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For life

Ethics at the beginning of life is ever-more complicated.

-Megan Best talks to Peter Hastie-

First Published in Spring 2013 Edition

Dr Megan Best trained in medicine and has worked both as a palliative care physician and a bioethicist. She is passionate about the value of human life and has been involved at both state and federal government levels in the development of Australian legislation regulating the treatment of unborn children. She lives in Sydney and is married to John, with whom she has two daughters. She has written an acclaimed work on bioethics entitled Fearfully and Wonderfully Made, which Professor Don Carson has described as a “must-read”. She is pursuing a PhD on spirituality at Sydney University.

Megan, why did you write your book on bioethics, Fearfully and Wonderfully Made?

As a doctor, I was faced with a range of “beginning of life” issues some years ago through being involved with several different government committees. Essentially, we were trying to find ways to regulate new technologies that affected the earliest stages of human life. I soon realised that there was a real tension between what some doctors were offering to people who were struggling with issues like infertility and what was permissible for Christians.

“Once you separate personhood from biology, the actual point of where personhood begins becomes a moveable feast.”

I found that many Christians were confused by the advice they were receiving from doctors and there was a real shortage of factual and ethical information available to guide them. Even Christian GPs told me they had trouble understanding how some of the drugs and technologies worked. I decided to compile a handbook, which contained factual information and ethical principles, so Christians had a reliable basis for making informed decisions that were consistent with the Bible. And the more research I did, the bigger the book became.

Many Christians are rather confused about how to deal with unborn life. Why is there so much confusion around this issue?

One of the difficulties that we face in this area is that the science involved in these issues, such as stem cell technology, is all very new and complex. The new technology allows us to manipulate unborn humans in ways we’ve never done before. This means that we are facing a lot of ethical issues that are difficult to understand and which no one has ever had to confront in the past.

I remember an occasion when a group of my colleagues and I were told that animal and human genetic material were being blended to produce embryos, and we were asked how we were going to work out the moral status of a mixed “human animal”. We struggled to think through what kind of paradigm we would use to resolve this question. One of the things I’ve tried to do in my book is develop an ethical framework that allows us to think about particular technologies in the light of the moral principles that we find in the Bible.

Do medical scientists agree about when human life begins?

They certainly agree in a biological sense. It’s not even vaguely controversial that life begins at fertilisation, when the egg and the sperm join. That is very well established, and recent biological research has shown that organisation of the embryo starts as soon as the sperm enters the egg. The idea that the embryo is just a lump of cells has been absolutely disproven. The disagreement arises over the point at which human life should be protected.

However, a great deal of confusion has occurred among medical people since 1982 when a group of doctors in America changed the definition of the timing of conception. They decided to say that conception took place at implantation (where the embryo is connected to the blood supply of the mother) rather than at fertilisation (when the egg and sperm joined together), which was a week earlier.

“The moral worth of individuals is not based on how they appear. It’s just not relevant.”

Why did they do that? Essentially, it was for commercial reasons. They were trying to market a new contraceptive that, by definition, had to work before conception actually took place. This meant that by moving conception back a week they could market a broader range of drugs. They created this new definition purely for the sake of making money. And the change was made by doctors, not embryologists, who are the experts. However, the altered (wrong) definition is still found in medical textbooks.

Does it matter that a human being in this very early stage doesn’t have the normal things that we associate with human life such as arms, legs, and a head?

No, it doesn’t matter. Mind you, an embryo does develop arms, legs, and a head very early on. But what something looks like doesn’t have any moral implications. The moral worth of individuals is not based on how they appear. It’s just not relevant. The fact is that none of us look the same as we did when we were born. We all look different at different ages, which is quite appropriate.

Some philosophers suggest that, just as we don’t value an acorn in the same way as a massive oak tree, so we shouldn’t value an embryo in the same way as a mature human. How do you respond to this claim?

First, we need to be clear that oak trees and human beings are not moral equivalents. The reason we value humans is because they are made in the image of God. And it’s not due to anything that human beings can do, or what they look like.

We value oak trees for their characteristics – what some people call their accidental characteristics. For example, the reason we value an oak tree more than an acorn is because it provides shade, and it’s quite beautiful.

Human beings have accidental characteristics too which develop with age. Obviously, the kind of relationship that you can have with a full-grown human being is quite different from the relationship you can have with an embryo. So the characteristics of each are quite different, but the fundamental value of a human being doesn’t lie in those characteristics. It’s because all human beings are made in the image of God that they are precious and have a dignity and value that plants and animals do not possess.

How do you explain the shift in attitudes towards unborn human life that has taken place over the last 60 years in Australia?

Well, in 1952 an ethicist, Joseph Fletcher, revived an ongoing debate on the nature of personhood. Throughout history, people have generally considered that what makes us human is our rational nature. It’s our rationality that constitutes us as “persons”.

Now Fletcher was in favour of legal abortion and he advanced his position by saying, “It’s all very well to say that a human being has a rational nature, but in order to be a real person you need to be able to express that rational nature, not just have it innately.” Of course, it’s easy to see where his argument leads: embryos can’t be persons because they cannot express their rational natures; nor, for that matter, can foetuses. Fletcher also accepted that on the same criteria even newborn infants would not be persons. So he also accepted infanticide.

A lot of people now think, “Well, if it’s legal it must be OK”.

But Fletcher had an agenda. He wanted to legalise abortion. However, in the process he did something that had far-reaching consequences. He blurred the definition of personhood. Once you separate personhood from biology, the actual point of where personhood begins becomes a moveable feast.

We now have the situation where some argue that personhood begins at fertilisation and others say at the implantation of the embryo or the activation of the genome, or when the mother can feel the baby moving inside her, or when the baby is born, or when it can feel pain – there are lots of different positions. We no longer have a definite answer to the question of whether just being a human being is enough to justify being born. Once you no longer have clear guidelines about what constitutes personhood, the laws relating to unborn life begin to reflect that. And that’s where we are today. Further, to add to the confusion, people tend to think that if a thing is legal it is also ethical because the law tends to have an educative role. A lot of people now think, “Well, if it’s legal it must be OK”.

What are your major concerns about the new technologies, especially in the area of human reproduction?

My main concern, especially in the area of reproduction, is that new technologies are having a greater role in decision -making and that the ethical issues are taking a back seat. This now affects the way we view children. It is becoming increasingly common to see children as commodities that can be produced, moulded and discarded at will.

Any pregnant woman understands what I am talking about. Today we have a range of tests available to check on the development of the unborn child. All of these tests (which claim to give women more freedom and choice) are becoming more and more of an obligation. One of the problems is that the tests that determine whether the mother and child are healthy are done at the same time as others that screen for abnormalities.

Often the mothers – and even some GPs – aren’t quite sure what all the tests are for and the first time they find out is when they are told that there is something wrong with the baby. At this point, even women who would be reluctant to terminate a pregnancy often feel pressured to end theirs when tests indicate that their unborn baby may be genetically impaired. Now, if you haven’t thought about that in advance, it’s a very confronting situation to be in.

If you have a doctor or an ultrasound technician who says, “We recommend that you abort this child”, often people will feel that they don’t have a choice. Certainly, I was told when I was found to have a problem with one of my pregnancies that I should have an abortion. And if I hadn’t thought it through beforehand, I wouldn’t have been able to say as confidently, “No, I’m not going to”.

One of the helpful things about my book is that I’ve explained which tests are for which option, so you can know what’s going on. I should also point out that it’s not necessarily wrong to have tests that check whether there’s a problem. Knowing in advance that there may be complications means that doctors can care for the mother and unborn child more carefully.

What happened in the case of your unborn child?

Well, it turned out that my daughter did not have the problem that they thought she had. So if I had aborted her, I would have been aborting a normal child, which in fact happens regularly in this scenario.

To what extent has the introduction of the contraceptive pill changed the way that men and women now think about sexual relations?

I think it’s had a huge effect in lessening people’s sense of responsibility for their actions. Unfortunately, the arrival of the pill led people to believe that contraceptives are infallible. They thought they could have “sex without kids” just by using contraceptives and believing that they were acting responsibly.

“It is becoming increasingly common to see children as commodities that can be produced, moulded and discarded at will.”

However, they ignored the fact that there is no contraceptive method, apart from permanent sterilisation, that is one hundred per cent effective. So whatever contraceptive you use, if you’re sexually active, you still have a chance of having a child. It’s a lie that by using the pill you can completely control your own fertility. There are many examples of women who have conscientiously taken the pill and still become pregnant. So the idea that you can have sex without children is, in fact, untrue.

Do you think Christians should practice contraception?

This is an ethical issue as well as one that calls for wisdom. Christians should aim to have children, especially if they are well and able to care for them properly. However, raising children is a great responsibility. If you want to have children within your marriage – and it’s possible for you to do so as a couple – it’s permissible to use contraceptives to some degree.

For instance, there are some medical situations where it may be dangerous for a mother to bear children. Again, there may be some political or financial situations where it might be inadvisable to have large families. Some families may need to care for a severely disabled child and the amount of care they need to give could potentially limit how many more children they have.

So I think there are circumstances where it’s wise to take advantage of appropriate contraceptives. On the other hand, I think that it’s wrong and selfish to use contraceptives to avoid having children simply for the sake of an easier life. But if you are not doing it for a selfish motive, I think the use of contraceptives within marriage can be justified to control the timing and number of children.

Should we have any problems in Christian circles with the idea that it’s okay to have “sex without children” as well as “children without sex”?

I think we definitely should have problems with those kinds of ideas. They are based on the falsehood that we are the ones who have control of our lives and our fertility. One of the more popular ideas around today is that you’re not a mother or father until the child is born. People think that between conception and birth they have the right to decide whether they want to be a mother or father, when in fact they are either a mother or father as soon as the conception of their child occurs.

If we want to work out whether sex without children and children without sex are okay, we need to look at the broader scope of biblical teaching in terms of the spiritual significance of human relationships and the role sexual love in marriage. Sexual relations in marriage have both a unitive and a procreative function.

We have an obligation to raise these children to honour the Lord and to become responsible stewards of the creation.

While they always have a unitive function there is a limited period within a marriage when they can fulfil a procreative role. What we need to remember is that if we engage in sexual relations when procreation is possible, we ought to be prepared for the responsibility of nurturing and raising any children from that union. That’s part of the deal. According to the Bible, our responsibilities as parents go way beyond providing eggs and sperm. We have an obligation to raise these children to honour the Lord and to become responsible stewards of the creation.

So clearly, sex without children in marriage is fine in certain circumstances. Children without sex – that is, conceiving children through assisted reproductive technology – may also be permissible, but only if human life is protected in the process.

Even if it’s possible to create life in a test-tube, do married couples have a right to have children?

The Bible certainly doesn’t say that we have a “right” in in that sense. If you have a right to something, there has to be a way in which that right can be fulfilled. Some people, however, are infertile. And we shouldn’t forget that women are unable to bear children after menopause. So, biologically, we can’t say that everyone is able to have children. So you can’t say there’s a right. The Bible talks about responsibilities of parents, not rights.

If a Christian friend was having difficulty trying to conceive what would you say to her?

I would encourage the couple to seek some medical advice. If you are not using contraception and something hasn’t happened within six to twelve months, then you might want to see a doctor. It is not always easy to fall pregnant. Some couples may go two or three years without contraception – and sometimes longer – before the wife conceives. So sometimes what we think is infertility is just impatience, and we have to wait a bit longer.

“The Bible talks about responsibilities of parents, not rights.”

But sometimes people are sub-fertile because of medical problems that have nothing to do with reproduction, and by having a medical screening and finding out if they’re in good health can make the difference between whether they can have children or not. If you want to have children and nothing is happening it would be appropriate to have a medical checkup to see if anything is wrong.

What should they do if their doctor says that their only hope is IVF?

It’s possible to do IVF as a Christian and to follow biblical ethical principles, but you are going to be identified as a troublemaker if you do. So you need to really prepare yourself before you go down that track.

You mean doctors will get frustrated with you?

They’re going to be frustrated with you, because you’re not going to go with the regular program. What you will do is that you will make sure you don’t discard human embryos through the procedure. You will make sure every embryo that is created is given a chance at life. That is the Christian thing to do. So that will mean that you will want to have a limited number of embryos created in the first place, which will be seen as foolhardy, and you will want to use all embryos, regardless of quality ratings. The technology is there to help you but don’t be surprised if some of the doctors who want to help you become frustrated and impatient with your wishes. They will find it difficult to appreciate the Christian position that whatever embryos you and your spouse produce should be given a chance at life by being transferred to a womb.

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