A Christian framework for medical ethical decision-making

How should Christians make ethical decisions? Should we use secular decision-making systems that are deontological (rule-based) or consequentialist (outcome based)? Or can we derive an ethical framework from the Bible?

Christians are called to imitate God (Ephesians 5:2), imitate Christ (1 Corinthians 11:1) and to walk as Christ walked (1 John 2:6). We are to be holy because God himself is holy (Leviticus 19:2; I Peter 1:16).

We might say that this is impossible but we forget three things – that through Jesus death and resurrection God has granted us repentance (Acts 5:31), given us a new nature (2 Corinthians 5:17) and placed the Holy Spirit within in us to empower us to live lives which are pleasing to him (Romans 8:9-11). This is why it is possible for us both to ‘put off’ ungodly thoughts and actions and to ‘put on’ godly attitudes and behaviours (Ephesians 4:22-24).

So how are we then to make Christ-like ethical decisions? I would suggest that doing so involves four elements: sharing the mind of Christ, holding the commands of Christ, showing the character of Christ and carrying the cross of Christ.

Let’s consider each of those in turn.

Sharing the mind of Christ

To share the mind of Christ, we first need to have a Christian worldview. We need to think about the world in the way that Jesus does and in the way the Bible teaches; in terms of creation, fall, redemption and future hope.

We are created by God in his image for an eternal relationship with him. But we have also, individually and collectively, fallen from grace. We are sinful and this sin has every aspect of our beings; our bodies, our emotions, our relationships, and our moral decision making. We are masterpieces created by the grand master, but we are flawed masterpieces in need of redemption.

God has initiated his great plan of redemption through his dealings with Israel and ultimately through the sending of his Son Jesus Christ, through whose death and resurrection we can be reconciled to God through repentance and faith.

We now have a hope that is certain, guaranteed by God himself, that we can have confidence for the day of judgment because of what Jesus has done for us, and will live together with God and fellow believers forever in God’s presence in a new heaven and new earth.

Sharing the mind of Christ involves having that linear view of history and that confidence about the future. 

Holding the commands of Christ

Holding the commands of Christ means being guided by his word in the way we make ethical decisions. Jesus said that if we love him we will obey his comands (John 14:15, 15:14). But what are his commands?

What starts in the Old Testament as the Old Covenant, the Ten Commandments and the 613 laws of the Pentateuch is, of course, a shadow prophetically pointing to the person of Christ, who will be the only one who is able to fulfil them (Colossian 2:17; Hebrews 10:1).

In the New Testament, specifically in the Sermon on the Mount (Matthew 5-7), we see Christ going beyond the mere external legalities of Old Testament law to the very spirit of love that underlies it. 

He says (Matthew 22:37-40) that the most important commands in the law are to love God with all one’s heart, soul, mind and strength (Deuteronomy 6:5) and to love one’s neighbour as oneself (Leviticus 19:18).

Jesus also gave his disciples a new commandment, to love one another as he had loved them (John 13:34,35).

But we are told that all Scripture is inspired (literally breathed) by God and profitable for teaching, correction, reproof and training in righteousness (2 Timothy 3:16,17). So, we need to work hard at deducing biblical ethical principles to apply to today’s ethical dilemmas.

Here are some key biblical principles:

Stewardship: we are given skills and abilities, not in order to exploit the earth, but to be its vanguards and its stewards, caring for the earth and for each other in the same way that God would care (Genesis 1:26). We are God’s delegated vice-rulers. This obviously applies to the scientific knowledge and technology that he has given to us. In fact, we see the beginnings of science, in Adam naming the animals (taxonomy) (Genesis 2:19,20) and technology with Jubal and Tubal-Cain developing musical instruments and metal tools (Genesis 4:21,22).

The sanctity of life: every human being is precious in God’s sight because every human being is made in the image of God (Genesis 1:27). It is because of this that human beings cannot be unjustly killed (Exodus 20:13; Deuteronomy 5:17). God will hold us accountable for the shedding of innocent blood (Genesis 9:5,6).

Chastity: sexual faithfulness. As we learn, ultimately, in the New Testament, the pattern of ‘one man, one woman, for life’ (Genesis 2:24) is a beautiful picture or metaphor of Christ’s marriage with the Church (Ephesians 5:31,32) and points, eschatologically, to the New Jerusalem, and the new Heaven and the new Earth (Revelation 22:17).

Veracity: the telling of truth (Exodus 20:16; Leviticus 19:11; Deuteronomy 5:20), because God is truthful and tells no lies (Numbers 23:19; Titus 1:2).

Justice: both at an individual and corporate level, so that vulnerable people are protected from exploitation. So much of the Old Testament law, of course, is about guarding the weak (Proverbs 31:8,9).

Grace: giving people what they don’t deserve (Matthew 5:43-48).

Mercy: not giving people what they do deserve, so that we are called to share the mind of Christ, both from a worldview and ethics (Micah 6:8).

Having the mind of Christ and keeping the commands of Christ are crucial, but we are also called to show the character of Christ because Christian ethics is not just about what we do, but also about how we do it. 

Showing the character of Christ

This brings us back to Plato’s idea that in order to act virtuously, one has to be a virtuous person. One can only act virtuously, in a Christian sense, by being born again, and then transformed by the Holy Spirit so that one develops the fruit of the Holy Spirit: love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control (Galatians 5:22,23).

It is one thing to know the right thing to do. It is something else altogether to have the character to do it.

Standing firm in making correct ethical decisions requires great wisdom, patience, perseverance and courage.

Carrying the cross of Christ

Carrying Christ’s cross means two things in a world hostile to Christian faith and values. It means, first of all, that we are prepared to fulfil the ‘Law of Christ’.

The Law of Christ is an interesting concept. It is mentioned twice in the New Testament. The first mention comes in 1 Corinthians, where Paul says, ‘I am not under the law, but I am under Christ’s law’ (1 Corinthians 9:21). Then, in Galatians, we have the command: ‘Bear one another’s burdens and so fulfil the law of Christ’ (Galatians 6:2).

This lines up with Christ’s words to his disciples at the Last Supper: ‘A new commandment I give to you: love one another as I have loved you’ (John 13:34,35).

If you like, it is the very opposite of the Darwinist ethic of the weak being sacrificed for the strong. It is instead the strong making sacrifices for, or laying down their lives for, the weak.

This is the guiding ethic for everything we see in the New Testament. For example, with the ethics of giving: ‘Christ, who was rich, became poor so that you might be rich’ (2 Corinthians 8:9). Why? In order that we ourselves might then become poor so that we can make others rich. We are called to emulate Christ in making sacrifices, or laying down our lives, for the weak (Romans 5:8).

Additionally, part of carrying the cross in a society hostile to Christian faith and values is that we are prepared to speak and act in godly ways, even when it is tremendously costly to do so; in other words, even when it leads to great opposition. This is part of the cross.

Christ bore the burdens of others and carried out great acts of compassion of healing and love. But he wasn’t crucified for these acts of compassion. It was actually his words that led to his death (John 7:7). It was when he spoke unpalatable truth about his own identity (John 5:18) and when he spoke prophetically about the nation in which he was placed (Matthew 26:63-68). That was when persecution really came to bear.

As Christ’s people living in this age we are called to carry the cross of Christ (Matthew 16:24; Luke 9:23, 14:27). That involves both sacrificial service and also faithfully speaking the truth, regardless of the cost, whether it is preaching the Gospel or speaking moral truth in the public sphere.

So there we have it – we can be imitators of Christ by having his mind, holding his commands, showing his character and carrying his cross.

Why many British evangelicals are not that bothered with ethics

'If I profess with the loudest voice and clearest exposition every portion of the Word of God except precisely that little point which the world and the devil are at that moment attacking, I am not confessing Christ, however boldly I may be professing Him. Where the battle rages there the loyalty of the soldier is proved; and to be steady on all the battle front besides, is mere flight and disgrace if he flinches at that point.’

This famous quote has been attributed to Martin Luther, by Christian commentators as illustrious as Francis Schaeffer but, as argued convincingly by Carl Wieland, it actually comes from a 19^th Century novel referring to Luther by Elizabeth Rundle Charles, called The Chronicles of the Schoenberg Cotta Family (Thomas Nelson, 1864).

However, according to Wieland, Luther did actually say something very similar. He said that if people were publicly open about every other aspect of their Christian faith, but chose not to admit their belief on some single point of doctrine (for fear of what might happen to them if their conviction on that one point became known) they were effectively denying Christ, period.

As Christians we are fighting in a spiritual battle, but Martin Luther’s point is that not all God's truth is equally under attack at any one time. In any culture and generation there are certain truths which are more under attack than others.

As Christians in 21st century Britain we need to be aware of which Christian truth is most under attack, and ensure that we are faithful in standing for that truth.

There are some Christian causes, which in Britain today are politically correct. If you campaign, for example, to end child poverty, to care for trees in the Amazon rainforest, to fight cancer, to clamp down on loan sharks, or to curb human trafficking you will find yourself in a large like-minded company of both believers and unbelievers.

This does not mean that these are not important causes for which Christian should fight. They are. But my point is that few if any will publicly oppose you for making a stand on them. Especially in the church, you will find many allies who will stand alongside you.

It’s terribly important that Christians and churches, particularly at a time of economic recession, are moving into food bank provision, debt counselling and street pastoring. The needs are great and we should be involved.

But if we restrict ourselves to those areas of Christian service that our society applauds, then we are actually being selective in our discipleship. Luther would even say we are denying Christ.

Most unbelievers are very accepting of Christians who support popular causes and it is tempting to imagine that if we are being good and faithful Christians everyone will like us, but Jesus actually said exactly the opposite (Luke 6:22).

The Bible reminds us that everyone who genuinely seeks to live a godly life in Christ will be persecuted in one way or another (John 16:1-4; Matthew 24:9-14; Mark 13:9-13; Luke 21:12-17; 2 Timothy 3:12). It was the false prophets, Jesus said, whom everyone spoke well of (Luke 6:26). We must ensure that our only offence is that of the Gospel but often in the Christian walk opposition is a sign that we are doing a good job rather than a bad job (Matthew 5:10-12).

Many people hated Jesus simply because he spoke truth that people did not want to hear – that is precisely why he was crucified. Likewise when we speak the same truth some people will hate us too (John 7:7).

Persecution began for the early church when Peter, John and Stephen opened their mouths and started to speak. We must of course speak the truth in love (Ephesians 4:15), but how often do we use 'sensitivity' simply as an excuse for cowardice, when our real underlying motive is actually to avoid being persecuted for the cross of Christ? (Galatians 6:12).

The high profile cases involving Christians getting into trouble with the law or governing authorities, with which we are all familiar, tend to involve a limited number of issues. Homosexuality is a particularly common theme – whether it is a couple running a bed and breakfast who wish to ensure their clientele sharing a double room are married, or street preachers addressing moral issues, or an Oxford student making casual remarks about a policeman’s horse.

When it comes to Christian doctors being hauled up before their NHS trusts, or being complained about to the General Medical Council, or being the subject of court proceedings, it is similarly a small number of issues that tend to feature.

If a Christian doctor wishes to opt out of abortion or gay adoption, or expresses views about these issues, or attempts to share the Gospel with a patient or colleague there are risks of losing one’s reputation, job or even licence to practise.

If you publicly express biblical views on subjects like abortion, euthanasia or sex you can become very unpopular indeed. Last year, in response to direct questioning on twitter, I expressed in simple terms what I regard to be an orthodox Christian view of sex. I said ‘All people are sinners (Romans 3:23) and also all sex outside marriage is morally wrong’ and ‘Sex between two people of the same sex - male or female - is always wrong’.

My responses were then retweeted by an atheist doctor (who was also gay!) to several thousand of his followers and I was buried for several hours under a barrage of the most unpleasant abuse you can possibly imagine.

I was recently out for a meal with a friend, with whom I have a great deal in common, who told me that he disagreed with me about three things.

While I was inwardly shaking my head with astonishment at ‘only three’ (!) my friend informed me that the three things in question were abortion, assisted suicide and homosexual practice.

My own view, as you might guess, is that abortion, assisted suicide and homosexual practice are not good ideas.

But the friend in question, an evangelical Christian and Bible college lecturer, felt strongly that there was a place for Christian involvement in all three. These views are not unusual.

The Evangelical Alliance surveyed 17,000 ‘evangelicals’, mainly at conferences like New Wine and Spring Harvest, in 2010 and published the results in January 2011 (See here and here).

Amongst the questions were one on each of abortion, assisted suicide and homosexuality. A wide range of views were expressed.

• 63% of British evangelicals did not agree that abortion can never be justified
• 40% did not agree that assisted suicide is always wrong
• 27% did not agree that homosexual actions are always wrong 

Remember that these are conference-going evangelicals and probably represent therefore a more committed section of the evangelical population.

Richard Dawkins' Foundation for Reason and Science (UK) found in a poll published last year that of those who called themselves ‘Christians’:

• 62% favoured a woman's right to have an abortion within the legal time limit
• 46% did not disapprove of sexual relations between two adults of the same sex
• 23% believed that sex between a man and a woman was only acceptable within marriage
• 74% believed that religion should not influence public policy

Why is it that so many Christians now have views on these issues that would have been considered anathema just a generation ago?

First, and perhaps obviously, the prevailing culture has shifted hugely on these questions. The so-called mountains of culture – parliament, universities, institutions, law, science, media, arts, entertainment – are increasingly dominated by people with an atheist world view. This new ‘liberal elite’ believes that God doesn’t exist, that death is the end and that morality is relative to each individual. But in practice most adopt the ethics of secular humanism. Undoubtedly this cultural change has affected the church.

Second, as I have already alluded to, taking a traditional view on these issues now carries a cost that it did not have a generation ago. In 2012, Christians in Parliament, an official All-Party Parliamentary Group (APPG), chaired by Gary Streeter MP, launched an inquiry called ‘Clearing the Ground’, which was tasked with considering the question: ‘Are Christians marginalised in the UK?’ Its main conclusion was that ‘Christians in the UK face problems in living out their faith and these problems have been mostly caused and exacerbated by social, cultural and legal changes over the past decade.’ There is loss of reputation, job and income to consider with certain Christian beliefs and behaviours.

Third, some Christian leaders with large followings, have changed their position on these issues. The Bishop of Liverpool, James Jones, and Baptist minister Steve Chalke are two examples of prominent Christian leaders who have come out this year in support of the church affirming monogamous gay (sexual) partnerships. There is intense speculation that the Church of England’s Pilling report is about to be published recommending the same thing.

Fourth, there has been a huge decline in Bible reading and study generally and in Bible teaching specifically. In particular there is very little teaching in our churches about ethical issues. This year, I was asked for the very first time in 20 years of ministry with CMF, to lead a seminar on abortion at a leading London evangelical church. We were told that it was being widely advertised through home groups and through the over 30 full time workers in a congregation of over 1,000. Twelve people turned up. I learnt later that the poor attendance was due to the fact that the leadership had not thought it important enough to advertise. Last week I was asked by the editor of a major denomination’s ministers’ magazine to write an article on the biblical case against euthanasia. He was concerned that many ministers in his (well known) Bible-believing denomination were of the view that euthanasia in hard cases was a genuine act of Christian mercy.

But, whilst these four factors play a part in accounting for what I would call ethical drift amongst Christians, I think the real reasons are more deeply theological. I would attribute them to two destructive heresies – one infecting liberal evangelical congregations and one infecting conservative evangelical ones. In both groups are many who actually know their Bibles very well, but who are increasingly adopting ethical views that are much closer to that of the prevailing culture than those held historically by the church.

I have recently reviewed each of these in turn on this blog. I’ll call them the new liberal heresy and the new conservative heresy, although, as we will see, neither of them is actually new. They are a rerun respectively of what Joseph Fletcher called ‘situation ethics’ and what Dietrich Bonhoeffer called ‘cheap grace’.

Divorcing love from morality - the New Liberalism infecting British Evangelicalism

The Old liberalism had its roots in the radical biblical criticism of the 19^th century. Old liberals doubted core Christian doctrines like the incarnation, Christ’s death and resurrection, his ascension and second coming, the authority of Scripture, justification by faith, the day of judgement, the sovereignty of God, and so on.

The New liberalism is actually orthodox on these things. New liberals will gladly tick the boxes of the church creeds and the doctrinal basis of the Evangelical Alliance and many of them know their Bibles well.

They are liberal not on what we might call the core beliefs of Christianity, but on ethics (for examples of the wide range of views on ethical issues amongst British evangelicals see here). They would argue that ethical issues are in the category of what Paul, in passages like 1 Corinthian 8 & 10 and Romans 14, called ‘disputable matters’.

‘Disputable matters’ are things on which Bible believing Christians can legitimately disagree whilst remaining in fellowship with one another. If you like they are in the same category as debates about the timing and amount of water to be used in baptism, the modus operandi of the Lord’s supper, the sequence of events around the return of Christ, forms of church government and the place of Israel.

I see this view as a revival of what in a previous generation was called ‘situation ethics’.

Situation ethics is a Christian ethical theory that was principally developed in the 1960s by the then Episcopal priest Joseph Fletcher (pictured).

Fletcher taught Christian Ethics at Episcopal Divinity School, Cambridge, Massachusetts, and at Harvard Divinity School from 1944 to 1970 and wrote ten books and hundreds of articles, book reviews, and translations.

Situation ethics basically states that other moral principles can be cast aside in certain situations if love is best served; as theologian Paul Tillich once put it: ‘Love is the ultimate law’.

The moral principles Fletcher was specifically referring to were the moral codes of Christianity and the type of love he is specifically referring to is ‘agape’ love.

Fletcher believed that in forming an ethical system based on love, he was best expressing the notion of ‘love thy neighbour’, which Jesus Christ taught in the Gospels.

He believed that there are no absolute laws other than the law of ‘agape’ love, meaning that all the other laws are only guidelines on how to achieve this love, and could be broken if an alternative course of action would result in more love.

In order to establish his thesis he employed a number of examples of ‘situations’ in which it might be justified to administer euthanasia, commit adultery, steal, tell a lie etc.

But in effectively divorcing ‘agape’ love from moral law Fletcher was steering a subtly different path from Jesus himself.

Jesus indeed said (Matthew 22:34-40) that the most important commands in the Old Testament Law were love of God and neighbour (Deuteronomy 6:5 and Leviticus 19:18). In fact he said these two commandments summed up the whole of Old Testament Law (Matthew 22:40 and Luke 10:25-28). Furthermore he criticised the Pharisees for obeying the less important parts of the law (tithing mint and cumin) whilst neglecting the ‘more important matters of… justice, mercy and faithfulness’.

But he also said that ‘anyone who breaks one of the least of these commandments and teaches others to do the same will be called least in the Kingdom of heaven’ (Matthew 5:19) and reproved the Pharisees by saying that they should have ‘practised the latter’ (important commandments) ‘without neglecting the former’ (lesser commandments).

Certainly there is no place in the Gospels where Jesus implies that those commandments which deal with the shedding of innocent blood and sexual immorality (numbers six and seven of the Ten Commandments) should be disobeyed.

By contrast he exhorts his disciples in the Sermon on the Mount to go beyond the mere legalities of ‘you shall not murder’ (6) and ‘you shall not commit adultery’ (7) to embody the very spirit of love which undergirds them. Not only no murder or adultery but no hate or lust either! (Matthew 5:21-30).

It is this more exacting moral standard that also underlies the ethical teaching in the epistles. Christians are exhorted to be imitators of Christ (1 Corinthians 11:1) and God (Ephesians 5:1&2), to walk as Christ walked (1 John 2:6) and to ‘abstain from sinful desires’ (1 Peter 1:11).

In short we are to live by the law of Christ (1 Corinthians 9:21 and Galatians 6:2) and to love one another as he has loved us (John 13:34-35). And love of Jesus means obedience to Jesus (John 14:15,21 and 15:12). In fact Jesus famously answered one of the Devil’s temptations in the wilderness by quoting from Deuteronomy, ‘Man shall not live on bread alone, but on every word that comes from the mouth of God’. Note every word.

So whilst we may say that there are situations where choosing not to shed innocent blood or to carry out a sexually immoral act requires great grace, courage, restraint and self-sacrifice, there are no situations where one may choose to murder or to do something sexually immoral and claim to be acting in love.

If Christ had been directly tempted in such a way, and indeed he must have been if he was ‘tempted in every way, just as we are’ (Hebrews 4:15) as we are told he was, we can imagine him answering as he did in the wilderness, ‘It is written, “you shall not murder”, “you shall not commit adultery”’.

By my reading Situation Ethics is a distortion of biblical ethical teaching. It is, in short, heresy. But it is a heresy that appears to be very much alive and well amongst British evangelicals in the 21st century. No more clearly is it evidence than in the shifting views and lack of clarity amongst evangelicals about sexual morality and the shedding of innocent blood.

Interestingly, Fletcher later identified himself as an atheist and was active in the Euthanasia Society of America and the American Eugenics Society and was one of the signatories to the Humanist Manifesto. When he started out, his position was barely distinguishable from orthodoxy. But he finished up in a very different place altogether.

This is exactly what happens when we define ‘love’ in a different way from the way it is defined in the Bible. 

What does the Bible actually say about life before birth?

The Bible does not support the view that some human lives are worth less than others. All are made in the image of God and all are equally precious.

Devaluing or discriminating against any group of human beings is therefore inconsistent with God’s justice. He does not show partiality.

The heart of Christian ethical teaching is that we must love as Christ himself loved (John 13:34), that the strong should make sacrifices for the weak and if necessary lay down their lives for the weak (Philippians 2:5-8, Romans 5:6-8). 

So to suggest that the weak might be sacrificed in the interests of the strong is simply not biblical morality.                                              

But what about human life before birth? Do these principles apply here too?

It is striking just how many references there are in Scripture to human life in the womb.

Perhaps the most famous of these is Psalm 139. The Psalmist, looking back to the beginning of his life declares:  

‘For you created my inmost being; you knit me together in my mother’s womb.

I praise you for I am fearfully and wonderfully made; your works are wonderful...

My frame was not hidden from you when I was made in the secret place...

your eyes saw my unformed body. All the days ordained for me were written in your book before one of them came to be.’ (Psalms 139:13-16)

John Stott has argued that this passage affirms three important things about the human life before birth.

First, it affirms that the preborn baby is God’s creation. It is God who knitted him together. The Hebrew word used by the Psalmist for ‘knit’ (other versions translate it as ‘weaved’) is raqam, a comparatively rare word in the Old Testament, which is used almost exclusively in texts that describe the curtains and veils of Israel’s wilderness tabernacle and the garments of the high priest.  

To say that an unborn child is ‘roqem’ is therefore to say something about the cunning skill of the weaver and about the beauty of his fabric. The tabernacle was the place where the presence of God dwelt. The high priest acted as the mediator between God and man and was the only one able to enter the Holy Place. He also pointed forward to Christ, the true mediator and great High Priest to come who would deal with our sins once and for all (Hebrews 7:26-28).

With its allusions to the 'roqem work' of the tabernacle, the Psalm implies not only that God has made the infant in the womb, but also that the infant is being woven into a dwelling for God himself.

Next, God is in communion with the preborn baby. At this stage the baby in the womb can ‘know’ nothing and is in fact not even aware of its own existence. But this is not important. The key point is that God knows it. It is God’s love for the psalmist during his time in utero that gives him significance. We see echoes of John’s first epistle here, ‘This is love: not that we loved God, but that he loved us and sent his Son as an atoning sacrifice for our sins’ (1 John 4:10). God’s relationship with the baby is a relationship of grace to which the baby itself contributes nothing. It is not its own attributes that give it value. It is the fact that God knows and loves it.

Finally, the Psalmist affirms the continuity between life before and after birth. The baby in the womb is the Psalmist, the same person, not a different person and not a non-person.

These three themes of creation, communion and continuity are seen in many other Old and New Testament Scriptures.

God calls the prophets Isaiah and Jeremiah before birth (Isaiah 49:1, Jeremiah 1:5) and  before they are capable even of hearing or understanding his call. He forms Job ‘in the womb’ as well as bringing him out of it (Job 10:8-9, 18-19).  

The Isaiah reference is particularly noteworthy because it comes from one of the so-called ‘Servant Songs’ and therefore speaks prophetically of Christ himself. Jesus was also called from the womb.

Many other references to life before birth in the Bible reinforce these principles (eg. Genesis 25:22-23, Psalm 22:9,10, 51:5, 71:6,  119:73,  Ecclesiastes 11:5,  Isaiah  44:2,24, 49:5, Hosea 12:3, Matthew 1:18, Luke  1:15,  41-44).  

In Genesis 25, Esau and Jacob wrestle in the womb, displaying the beginning of the competitive and combative behaviour that would later characterise their family life. In Psalm 51 David talks about being ‘sinful from the time my mother conceived me’ and says that God ‘desired faithfulness even in the womb’ and ‘taught me wisdom in that secret place’.

The Psalm 22 and the Genesis 25 references also look forward prophetically to Christ. Jesus’ suffering is clearly foretold in the Psalm and he actually quotes its words from the cross to emphasise that his death was to fulfil its prophecy. The Genesis passage reminds us that Jesus is the new Israel.

In addition there are over 60 references which mention the event of conception explicitly underlining its importance.

One of these is Matthew 1:20 in which an angel tells Joseph, referring to Mary the mother of Jesus, that ‘what is conceived in her is from the Holy Spirit’.

Particularly striking are the verses describing Jesus conception and inter-uterine development in Luke 1. Here we see Elizabeth, the mother of John the Baptist, prophesying over Christ in his first month of gestation, and the baby John ‘leaping’ in her womb.

The timing is given in some detail. It was in the sixth month of Elizabeth’s pregnancy that the angel visited Mary (Luke 1:26). She then went to visit Elizabeth who gave the prophecy accompanied by her baby leaping (Luke 1:41). As we have already noted, a baby’s movement cannot be felt until about 18 weeks but ‘in the sixth month’ means at very least 22 weeks gestation.

The Scriptures record that, ‘Mary stayed with Elizabeth for about three months and then returned home’ (Luke 1:51), and that Elizabeth gave birth after that (Luke 1:57). Given that pregnancy lasts nine months we can deduce from this that Mary must have left to see Elizabeth almost immediately after the angel’s visit and that Jesus must have therefore been in the very first few weeks, if not days, of pregnancy at the time of the prophecy.

Why is this relevant? It is important because Jesus’ humanity tells us something about our own humanity. We know that in order to act as our substitute on the cross, Jesus had to be ‘made like his brothers in every way’ (Hebrews 2:17). He had to be like us in his humanity so that he could take our place. So it follows that if Jesus was alive in the womb in the first month of pregnancy then so were we.

To deny the humanity of the human embryo is therefore to undermine not only the doctrine of creation, but also the doctrine of the atonement, Christ’s taking the punishment for sin on our behalf.

Although it does not state it explicitly, the Bible points very strongly to the conclusion that human life begins at conception, a process that we know from science begins with fertilisation, the point at which a new individual human life comes into being.

At very least then, should we not be giving the human embryo the benefit of any doubt?

The strong biblical testimony about life before birth points to the conclusion that human life, from the time of conception is, like other human life, made in the image of God and worthy of the utmost respect, wonder, protection and empathy.

Showing this degree of love respect to human beings before birth may in some circumstances be very costly for us personally. This brings us back again to the foot of the cross, and the willingness to walk in the steps of the master who gave himself fully for us and who calls us to love one another as he has loved us (John 13:34,35).

Euthanasia - what does the Bible say?

There are two instances of euthanasia in the Bible. In the first, Abimelech, believing himself to be fatally wounded (with a fractured skull after being hit on the head by a millstone), asks his armour-bearer to kill him to spare him the ‘indignity’ of being killed by a woman (Judges 9:52-55). In the second, an Amalekite despatches the mortally injured Saul, still alive after a failed attempt at suicide (2 Samuel 1:6-9).

These two cases demonstrate the two main arguments for euthanasia, autonomy (‘death with dignity’) and compassion (‘release from suffering’).

The Bible tells us that human beings are unique amongst God’s creatures in being made in the image of God (Genesis 1:26) and it is on this basis, after the flood, that God introduces to all humankind the death penalty for murder (Genesis 9:6,7).

The prohibition against killing legally innocent people is later formalised in the sixth commandment, ‘You shall not murder’ (Exodus 20:13; Deuteronomy 5:17). The Hebrew word for ‘murder’ is ratsach (Greek phoneuo) and its meaning is further defined in four main passages in the Pentateuch (Exodus 21:12-14; Leviticus 24:17-21; Numbers 35:16-31; Deuteronomy 19:4-13).

These passages resolve any ambiguity for us and give a precise definition of what is prohibited, namely the ‘intentional killing of an innocent human being’ (Exodus 23:7; 2 Kings 21:16; Psalms 106:37,38; Jeremiah 19:4). Euthanasia clearly falls within this biblical definition. There is no provision for compassionate killing, even at the person’s request and there is no recognition of a ‘right to die’ as all human life belongs to God (Psalms 24:1). Our lives are not actually our own. Suicide (and therefore assisted suicide) is therefore equally wrong.

Jesus taught in the Sermon on the Mount that that we should go beyond the mere letter of the sixth commandment  to fulfil the very spirit of love on which it is based (Matthew 5:21,22) . We are called to walk in Jesus’ footsteps, to be imitators of God, to love as he himself loved (1 John 2:6; Ephesians 5:1,2; John 13:34, 35).

Sadly, however, many Christians today are confused about euthanasia and fall prey to emotive hard cases and false dichotomies.

It is often argued that we have only two equally undesirable alternatives to choose from - either ‘living hell’ or the euthanasia needle – both of which are imperfect and unloving solutions.

But there is a third way - the way of the cross. It calls us to give our whole selves to the love and service of others by expending our time, money and energy in finding compassionate solutions to human suffering (Matthew 22:37-40; Mark 8:34; Philippians 2:4-11; Galatians 6:2, 10). It has found practical shape historically in the hospice movement and in good palliative care - pioneered in large part by Christian doctors and nurses. When a person’s physical, social, psychological and spiritual needs are adequately tended to requests for euthanasia are very rare indeed.

But perhaps the most powerful Christian argument against euthanasia is that death is not the end. God’s intervention through Christ’s death and resurrection for our sins (Romans 5:8; 1 Corinthians 15:3) means that through the eyes of faith we can look forward to a new world after death with God where there is ‘no more death or mourning or crying or pain’ (Revelation 21:4). For those, however, who do not know God euthanasia is not a ‘merciful release’ at all. It may rather be propelling them towards a judgement for which they are unprepared.  It may be the worst thing we could ever do for them! (Hebrews 9:27; Revelation 20:15)

Euthanasia is wrong because God says it is wrong. Instead he points us to a better way, offering hope, love and compassionate care. 

New journal on ethics of human biotechnology offers free access to online content

In August I highlighted the launch of a new journal, The New Bioethics, which focuses specifically on the interface of technology and the human body.

The first edition contained nine articles, two of which, the editorial by Trevor Stammers and Matt James, and a guest editorial by Aaron Parkhurst, are available free on line.

Abstracts from the second edition are now available and well worth reading.

The first, by CMF Head of Public Policy Philippa Taylor, studies the long- term psycho-social effects of abortion on women using in-depth, face-to-face interviews.

Some women experienced persistent negative reactions to the abortion that remained ongoing for years; others were positive or neutral immediately post-abortion but experienced varying negative reactions some time later. All expressed sadness and/or regret of some sort. 

Fabio Bacchini, for the University of Sassini in Paris, explores themes in Farewell Waltz, a novel by Milan Kundera, which features a doctor from a female infertility centre in Czechoslovakia who reveals himself to be a secret promoter of eugenics. Kundera is warning about the trap of only being morally concerned about abstract super-individual entities like ‘humanity’ whilst being unable to have the well-being of single individuals at heart.

Joseph Tham, from the Pontifical University in Rome, analyses the underlying tendencies and attitudes towards reproductive medicine borrowing the Nietzschean concepts of nihilism. He argues that when liberty becomes absolute and technology unchecked, as it is in our postmodern societies, transhumanism is the logical outcome. 

Yasemen Erdin, of St Mary’s University College in Twickenham, returns to Alan Turing’s vigorously debated question of whether machines could think and argues that intelligence is not a guarantee of personhood or agency.

If you want to dig more deeply than the abstracts, but are not sure you want to commit yourself to paying for content, then the publishers are offering free access to the journal between 15-29 November. You can sign up on line.

I note that some of the contributors, and both editors, are committed Christians who are also academics in bioethics.

This journal should be a valuable resource for Christian doctors, ethicists and all who have an interest in this rapidly advancing field, where often the technology is upon us before we have had a chance to think critically about it. 

New Bioethics journal launched focussing on interface of technology and the human body

A new journal in the rapidly expanding field of bioethics has been launched this week.

The New Bioethics seeks to reclaim bioethics as a diverse and multidisciplinary project. It provides a space for dialogue between different perspectives on biotechnology and offers the chance to find new kinds of common ground.

The journal is not concerned primarily with the traditional professional ethics of doctors such as confidentiality and data protection, but will focus specifically on the interface of technology and the human body. 

It covers issues such as assisted reproduction, genetics, regenerative medicine (including the use of stem cells), cognitive enhancement and those technologies that have allowed human tissue to be taken, stored, manipulated and used for biomedical purposes.

The journal invites contributions from a range of perspectives, from the social and political sciences, from feminist perspectives, from the traditions of European Continental philosophy, Anglo-American analytic philosophy and Eastern philosophies and diverse religious perspectives.

The new journal is the successor to Human Reproduction and Genetic Ethics (HRGE).There will be two issues per year.

This first edition contains nine articles two of which, the editorial by Trevor Stammers and Matt James, and a guest editorial by Aaron Parkhurst are available free on line.

Stammers and James write:

‘We hope that these papers will not only engage and interest the readers of the parent journal but also attract an even wider readership as we maintain our emphasis on a wide multidisciplinary approach but expand the range of bioethical areas under discussion.’

As Aaron Parkhurst explains, most of the nine papers from the first edition come from a one-day conference ‘The 21st Century Body’.

I note that some of the contributors, and both editors, are committed Christians who are also academics in bioethics.

I wish them well and look forward to the new journal’s contributions to vital debates on new biotechnologies. 

The moral status of the human embryo – when is a person?

The moral status of the embryo is one of the key pressure-points in ethical debates about post-coital contraception, therapeutic cloning, pre-implantation diagnosis, artificial reproduction, embryo research and cloning.

The issue, which has profound implications for medical practice as doctors, has divided people for centuries and remains controversial.  

It is a fundamental principle both of Christian teaching and also of natural justice that human beings deserve utmost respect.

Christians believe that human beings have been individually created by God and derive their integrity and worth from the fact that they are made in the image of God - regardless of genotype, age, size, location or degree of dependence and disability.

The presence of a disability, either inherited or acquired, does not detract from a person 's intrinsic worth. All human beings are thereby worthy of the utmost respect. They must never be treated as means to an end. At the heart of the Christian ethic is self-giving love, whereby the strong make sacrifices for, and if necessary lay down their lives for, the weak.

Historical medical ethical codes, recognising the power and strength of doctors, have enshrined a view similar to the Christian one.

The Declaration of Geneva (1948) stipulates that doctors should ‘maintain the utmost respect for human life from the time of conception’.

In like manner, the International Code of Medical Ethics (1949)says that a doctor 'must always bear in mind the obligation of preserving human life from the time of conception until death'.

The Declaration of Helsinki (1975) says that in biomedical research:

 'the interest of science and society should never take precedence over considerations related to the well-being of the subject '.'In any research upon human beings,each potential subject should be adequately informed of the aims,methods, anticipated benefits and potential hazards for the study...'and 'the subjects should be volunteers '. 'It is the duty of the doctor to remain the protector of the life and health of that person on whom biomedical research is being carried out.'

By contrast the emerging view amongst contemporary ethicists (such as Peter Singer) is that human beings are nothing but the product of matter, chance and time; merely highly specialised animals.

The value of individual human beings is determined by their level of rationality or self-consciousness, physical attributes or capacity for relationship. Human life that has fewer of these qualities is of less value and can be disposed of. This 'Darwinian ethic 'with its aim of 'survival of the fittest 'places the demented, mentally handicapped, brain-injured and unborn (particularly the human embryo) in great danger.

The Human Fertilisation and Embryology Act (HFE Act) starts with a presupposition that has never been properly established - that the human embryo is not a human being with rights, and can therefore be treated as a means to an end.

In keeping with this foundation the Act sanctions embryo freezing, research and destruction along with abortifacient contraception and the disposal of abnormal embryos after genetic testing -practices that we would not countenance for human beings at any other stage of development.

Any biology textbook tells us that human development is a continuous process beginning with fertilisation; essentially the only differences between zygote and full term baby are nutrition and time.

Biologically the human embryo is undoubtedly human; it has human chromosomes derived from human gametes. It is also alive, exhibiting movement, respiration, sensitivity, growth, reproduction, excretion and nutrition.

It is therefore most accurate to speak of it as a human being with potential, a human being in an early stage of development or a potential adult; rather than a potential human being.

Philosophers, biologists, politicians and even theologians, however, have advanced arguments to undermine the status of the human embryo.

Here are three of the main ones with my responses:

1. Human embryos are not human beings worthy of respect because they lack rationality or capacity for relationship

This was the thinking behind the Warnock Committee’s recommendation of no embryo research beyond 14 days, as the neural crests first form 10 days after fertilisation. Others have suggested that breathing movements (12 weeks), or 'quickening' (20 weeks), or even the first breath of air should be the end point. It has even been argued that newborn babies are not persons since they lack 'self-awareness'.

But the development of the nervous system is a continuous process beginning at fertilisation and choosing an arbitrary point on this continuum discriminates between human lives on the basis of neural function. It is therefore 'neuralist '. Neuralism varies from racism and sexism only on the basis of the non-morally significant quality selected as the basis for discrimination. It is simply another form of ageism.

Our value as human beings does not consist in our capacities or attributes but in the fact that we are human. Arguing that the value of any human life depends on its place of residence (uterus, fallopian tube or petri dish) or degree of independence similarly discriminates on the basis of non-morally significant characteristics.

2. Human embryos are not human beings worthy of respect because they have a high mortality; about 40-70% don't reach maturity

But the value of human beings is not contingent on their survival rates. We don't say that refugees in Africa, flood victims in Asia or people with cancer are less important simply because they have a high mortality. 

Similarly, if survival rates at any stage of development are low this does not justify us actively ending life. The general strategy of medicine is rather to save and preserve life. The figure of 40-70%may well be an overestimate anyway. No one really knows how many early embryos die as there is no biochemical marker for fertilisation, as opposed to implantation.

3. Human embryos are not human beings worthy of respect because many embryos that do spontaneously abort have a high incidence of genetic (particularly chromosomal) abnormality

But all of these abnormal embryos have formed from the union of two human gametes. Aren't they therefore just human lives with severe disabilities, human lives with special needs? We would not argue in any other sphere that the value of any individual human life was contingent on how ‘normal’ it was; far less that abnormality justified killing by 'disposal '.

Conclusions

The arguments used for devaluing the status of the human embryo are both unconvincing and discriminatory. The human embryo should instead be given the benefit of any doubt regarding its status.

We have a choice: we either act to ensure the protection and survival of the most vulnerable members of our society by endorsing the Christian ethic of the strong making sacrifices for the weak; or we continue to ensure the ‘non-survival of the weakest’ by politicising the 'Darwinian ethic '.

The HFE Act has politicised Darwinism by enshrining in statute law discrimination against the weakest and most vulnerable members of the human race. It is built on a fundamental presupposition that has never been established logically, philosophically ethically or morally.  

Obama and Romney compared and contrasted on bioethics issues – new report

The Hastings Centre in Washington DC has run a useful comparison of Obama and Romney on a range of bioethics issues.

Some excerpts below on cloning, abortion, conscientious objection, contraception and stem cells:


Cloning

President Barack Obama

“[W]e will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong and has no place in our society, or any society.”

Source: The White House website

Governor Mitt Romney

“During my time in office, I stood up to those who wanted to call into question the very definition of life. I vetoed a bill that would have opened the door to cloning and embryo farming.”

Source: CPAC Speech

Reproductive Health: Abortion

President Barack Obama

President Obama believes a woman’s health care choices are personal decisions, best made with her doctor—without interference from politicians. He continues to support a woman’s right to choose under Roe v. Wade.

Source: Campaign website

Governor Mitt Romney

“Mitt believes that life begins at conception and wishes that the laws of our nation reflected that view. But while the nation remains so divided, he believes that the right next step is for the Supreme Court to overturn Roe v. Wade…With Roe overturned, states will be empowered through the democratic process to determine their own abortion laws and not have them dictated by judicial mandate... Mitt supports the Hyde Amendment, which broadly bars the use of federal funds for abortions. As president, he will end federal funding for abortion advocates like Planned Parenthood.”

Source: Campaign website

Reproductive Health: Conscience Clauses, Contraception, and Family Planning

President Barack Obama

The Obama Administration’s Department of Health and Human Services has issued an Advanced Notice of Proposed Rulemaking that “guarantees women access to recommended preventive services including contraception without cost sharing, while ensuring that non-profit religious organizations are not forced to pay for, provide, or facilitate the provision of any contraceptive service they object to on religious grounds.”

Source: Department of Health and Human Services website

Governor Mitt Romney

“Romney opposes the January 2012 HHS rule requiring Catholic Hospitals, charities, and universities to purchase health insurance for their employees that includes coverage of contraception, abortifacents, and sterilization, in violation of their religious principles. He has vowed to waive this requirement in all 50 states, that he claims “compel religious institutions to violate the tenets of their own faith.”

Source: Campaign website

Stem Cell Research

President Barack Obama

“Today, with the Executive Order I am about to sign… we will lift the ban on federal funding for promising embryonic stem cell research. We will vigorously support scientists who pursue this research. And we will aim for America to lead the world in the discoveries it one day may yield…Medical miracles do not happen simply by accident. They result from painstaking and costly research – from years of lonely trial and error, much of which never bears fruit – and from a government willing to support that work… As a person of faith, I believe we are called to care for each other and work to ease human suffering. I believe we have been given the capacity and will to pursue this research – and the humanity and conscience to do so responsibly."

Source: Executive Order Signing

Governor Mitt Romney

“Stem cell research is a great scientific frontier, and it must be pursued with respect and care. When confronted with the issue of stem cell research as governor of Massachusetts, Mitt Romney chose to support life by vetoing a bill that would have allowed the cloning of human embryos. Quite simply, America cannot condone or participate in the creation of human life when the sole purpose of its creation is its sure destruction. Adult stem cell research and alternative methods to derive pluripotent stem cells, such as altered nuclear transfer and direct reprogramming, are scientific paths that carry much promise and avoid raising ethical concerns. As president, Mitt will focus his energy on laws and policies that promote this kind of research to unlock the medical breakthroughs that our loved ones so desperately need."

Source: Campaign website