Bioethics In The Christian Perspective
1. The Questions In Bioethics Posed For The Church
The great progress in human biology and medical technologies, while opening up enormous possibilities for good, at the same time poses new and disturbing questions, in the face of which the biologist and the physician do not want to be left alone to decide and thus seek enlightenment and comfort in society from those felt to be more competent in regard to what is human.
How much legitimate space can be accorded the physician's artificial intervention in the sphere of procreation in order to remedy a couple's sterility? What are the ethical limits to intervention in human genetics seeking not only "radical" therapy for certain illnesses, but also having the chance to improve or, in any case, modify certain specific or individual characteristics? What are the criteria on the basis of which we can judge the application of special treatments to patients in particularly critical or terminal conditions? What response can be provided for the pain of people in these extreme conditions? How should we behave towards the possibility of diagnosing, even before birth, anomalies for which we are not yet in a position to offer therapeutic solutions? What criteria should be used in organ and tissue transplants, especially as regards respect for the donor?
The immediate concern of researchers, physicians, and health workers is to have precise ethical answers on what may or may not be done. Their admirable effort to make medical science progress at the service of man, their dedication, often totally unselfish, and their deep human sensitivity cannot be called in question by the abuses which some — under the pretext of medical progress or responding to dramatic, pained requests — commit against the very nature of medicine and against the respect due man's dignity. The request for ethical suggestions and the willingness to receive counseling themselves testify to the nobility and generosity with which most doctors live out their mission.
In the crisis of ethical orientations, the Church appears as the representative of a great moral tradition, capable of shedding light on values, but also of suggesting models for reasoning on difficult questions and finding adequate, articulated solutions to hard cases.
What does the Church offer, then, as a specific contribution which the Catholic faith can make to solving some of the most burning questions in bioethics, which emerge, above all, in the context of the current practice of medicine?
2. To The Roots Of A Difficulty In Comprehension
The answers proposed by Catholic moral teaching, however, frequently meet with difficulty in being understood — they sometimes seem to be inhumanly harsh. The situation thus presents itself as paradoxical. What is asked of the Catholic moralist or of the Church Magisterium itself as regards bioethics is precisely, moreover, what they are reproached for providing in all other spheres of human activity and also, paradoxically, what they are reproached for providing in the field of bioethics — definite rules, limits which could never be overstepped, rigorous prescriptions.
Why this difficulty in comprehension, just when there is great demand for enlightenment? The Church in fact speaks from a global perspective on life's meaning, and it is therefore not possible to thoroughly understand the particular responses she gives unless one is prepared to enter into the logic of that perspective.
Christian morality is reproached for taking away man's responsibility by prescribing absolute norms for behavior. But this very reproach directed at Christian morality depends on the fact that from the outset there has been a refusal to take responsibility for the ultimate questions she poses and really listen to the radical answers starting from which she indicates all the other specific ones. It is precisely and mainly in terms of the ultimate questions that she invites man to assume his full responsibility. In other words, when disconnected from the global perspective of faith and their moorings in a coherent image of man, the specific ethical replies of Catholic teaching can only become incomprehensible and be misunderstood.
We must thus grasp the intimate nexus joining applied ethics (understood to be the search for particular responses to specific moral cases) to morality (as knowledge on human action in relation to the ultimate meaning of freedom) and Christian faith, which takes in that very light which Revelation projects upon man, his supernatural vocation, and his responsibility.
3. "Limit Experiences" And The Temptation To Forget
The questions bioethics deals with refer to "limit experiences," not only in the sense that they concern the extremities of man's life — its beginning and its end — but also, and above all, in the sense that they always involve a man (the research scientist or the physician) placed before another man whose personality, whose "being a person," whose capacity for development appear not to be realized or to be wavering. In these limit situations the researcher or physician is faced with a human being who has not yet expressed the potentialities of his personal being or who, instead of tending to realize himself as a person, threatens to fall back into the simple state of a living being, a living organism, manipulable biological material.
Bioethics may also be said to always involve a man (scientist or physician) faced with another man whom he is tempted to not consider and not treat as a person, for reasons of utility which may even be noble, such as the welfare of other people. It is precisely here that the decisive moral question is posed — and it is for this question that the Christian faith offers its irreplaceable light.
The great scientific progress achieved in the domain of biology has been made possible by a methodological choice characterizing "modern science" as such since its origins: to take into consideration only measurable quantities in reality, arrived at through experiment, and seek to establish models of relation among them resembling mathematical laws.
This methodology, in itself perfectly legitimate, is effected by reducing the other, in his physicality, to an object of my observation — indeed, to an object, somehow constructed by methodological reduction, considered in only some aspects of its reality.
A further element to be recalled is the connection of this type of scientific knowledge with practical applications to solve specific problems. The great effectiveness of technology, achieved on the basis of modern science, constitutes its leading accreditation in the eyes of contemporary man. But it is precisely the emergence of disturbing questions on the possibility that biological discoveries will be transformed into terrible threats to humanity and new occasions for dominion over man which makes him aware of the need to situate the scientific knowledge of biology within more comprehensive knowledge about man which will regulate its use for his real benefit.
Dualism between technical reason capable of increasingly broad dominion and astonishing successes and a body reduced to the object of such activity intrinsically involves the temptation to forget. Man, who has gotten a technical grip on the beginning and end of his life, on the very structures constituting his physical organism, might be led to forget the mystery of being. The metaphysical experiences of birth and death, of pain and one's own limits, which refer us to the ultimate question of life's meaning, are thus easily censured and redirected from the realm of being to that of acting. Perhaps it is precisely to flee from these anguishing questions that man seeks to guarantee himself complete mastery over those key moments in life, harboring the illusion that he possesses himself through absolute freedom — he might achieve the ancient dream of making himself, not leaving anything to uncertainty, chance, or mystery.
In this perspective moral norms can appear only to be incomprehensible limitations dictated by irrational fear in the face of the marvelous possibilities which human reason creates for freedom.
But in reality the forgetfulness of being and of one's original experiences through technical activity reveals itself to be an illusion which may lead to destruction. In reality, life is not solely and above all the phenomenon the biological sciences successfully investigate — it is, first and foremost, an experience of the person, charged with exigency and promise. Without such dimensions of responsibility, recognized and accepted under their dramatic aspect, freedom is frustrated and the human subject disappears. And, accordingly, the benefits which technology ought to guarantee him prove senseless and vain. The moral question in this way regains its preeminent, decisive character from within biomedical practice itself.
4. Faith And The Question Of Ultimate Meaning
The radical question posed by the emergence of bioethical inquiries cannot, then, be avoided under pain of losing the possibility of comprehending the very replies of ethics as well. And such an inquiry is the one regarding the meaning of life itself, of the ultimate end, therefore, which reveals itself in the light of faith.
Through faith man discovers the limitless value of his personal being: God wishes to enter into communion with him; and he discovers, at the same time, the supernatural end for which he has been created, the only ultimate end for which he exists — to be united to God. The moral life can only be the dynamism by which man, in aspiring to this union, makes himself increasingly available for it.
All the secondary ends of man, including that which presents itself to him as connatural in the light of reason alone — to live happily on the earth — must thus be conceived of in the dynamism of this ultimate end, to which they are ordered. Christian revelation encompasses man's natural desire for happiness. St. Augustine confirms it at the beginning of his first systematic treatise on Christian morality, De Moribus Ecclesiae Catholicae: "What, then, will our starting point be . . .? Let us search through reason for the way man ought to live. Certainly, all of us want to live happily, and in the whole human race there is no one who does not fully agree with this affirmation even before it has been fully stated." Now, in revealing to man the ultimate end of his vocation to communion with God, faith at the same time teaches man that happiness is, in essence, something which is received and not something which is conquered. It shows him that we can never be happy alone, in the sense that the only thing an individual can do to be happy is to create the conditions for the happiness of others — i.e., to give himself to them unselfishly. As the Second Vatican Council affirms and the Holy Father loves to repeat, "Man is the only creature on earth that God has wanted for himself; he can find himself fully only through an unselfish self-giving" (GS, 24; RH, 13; MD, 7).
Happiness, even on earth, consists of a mutual, gratuitous gift which demands that each one seek not his own good, but the other person's good and that he seek it for the other person himself, treating the other according to his full dignity as a free person.
The realization of man's secondary ends and of his natural end as well belongs to reason. And yet the natural end is situated within the supernatural end. The natural end is to be happy, and that is not possible except by taking part in a common humanity, in a united human community — a community which is communion. And even God wishes to join to Himself not just each man individually, but all mankind in a fraternal communion. If man's natural end is union with other men in full reciprocity, this natural end is, as it were, attracted within the dynamic of the supernatural end.
To carry out its task validly in the field of morals, reason must let itself be enlightened by faith, which knows something more. Faith in fact knows the context in which the limited sector, in itself accessible as well to the rational faculty alone, is included. And since everything takes on meaning in terms of its context, this knowledge of faith is decisive.
Christian moral norms, which appear inhuman when they are separated from their context, in reality express the conditions for man's happiness, the conditions for the realization of his natural end, understood in the light of his ultimate end. They can only remain incomprehended and be rejected by whoever does not enter into the dynamism of the ultimate supernatural end and thus readily ends up erring about his natural and immediate ends as well. They remain incomprehensible for whoever does not sincerely take on responsibility for others and hence does not agree to enter into the logic of the gratuitous gift of himself, with a view towards the authentic good of the other person, the gift of himself so that the other may live.
But, from another standpoint, this self-giving is possible only on the condition that we discover firsthand that we have been the object of a radical, absolutely primary gift in terms of any response by ourselves. At bottom, I cannot give myself to another person if I fail to discover that God has been the first to give Himself to me. I can thoroughly take upon myself the risk of the other, the risk of accepting him just as he is, with his limitless value, but also with his defects and the unease he may possibly cause me, I can accept the risk of giving myself gratuitously to him only if I discover that God has been the first to take on the risk of my person-hood. God is the ultimate guarantee for the gift of myself, the ultimate guarantee making gratuitousness possible. Gratuitousness is in fact not possible except through confidence in God.
The mystery of redemption and forgiveness thus takes its place as the keystone of Christian morality.
In this light even suffering and death are no longer an incomprehensible enigma. They remain a trial for whoever experiences them firsthand, for whoever loves, and for the physician sharing in them, inasmuch as they reveal man's weakness and urgently and dramatically confront him with the question as to what makes living and dying worthwhile. They are an appeal for human company capable of understanding and accepting the depth of the question — within every question about health and healing a more radical question is always contained as well which at bottom concerns salvation — i.e., a question concerning one's ultimate destiny. When this question is accepted and meets with the light of faith, then suffering and death can be taken on and even transformed into occasions for the gift of oneself. The temptation to reject them, censure them, and, finally, the supreme temptation to remove, along with the disturbingly posed question, the subject asking it as well, can thus be overcome. Christian ethics' opposition to euthanasia finds its deepest justification in the light shed on all life by the mystery of the cross and resurrection of the Lord — there is no longer anything useless, not even suffering.
5. The Complete Dimensions Of Christian Morality
If morality appears as the reflective grasping of a dynamism and a vital option, ethics can be defined as the statement of principles deriving from this dynamism and this option.
Morality cannot be constructed on the basis of ethics — i.e., on the basis of the search for particular solutions — without being confronted with the basic choice sustaining and motivating all of them. Mere conventionality stipulating agreements on certain ethical questions is not capable of truly guaranteeing a global moral attitude of respect for man. In the extreme, it may be transformed into hypocrisy. From this standpoint Christian morality is the opposite of legalism — for legalism moral norms are only isolated expressions of the will of a legislator who has promulgated them; for the Christian, on the other hand, it is a question of truths on the good of the person which are rooted in being and grounded in God's creative wisdom and redeeming grace.
Nor can it be said that Christian morality is constituted by a list of beautiful principles deduced from an elevated anthropology, almost as if it were a matter of applying abstract knowledge mechanically to the diversified, dramatic situations in existence. Morality instead arises from knowledge of the value of the person, as is displayed by God's attitude towards man, by his limitless donation in Jesus Christ. It takes in all that God has done and does for each man; at the same time it derives man's value and the proper way to relate to him therefrom.
6. The Basic Rule Of Bioethics
Bioethics, when taken up in the Christian perspective, strives to keep its fundamental gaze fixed upon man and open to his complete truth. As already pointed out, in the face of the temptation to conceive itself simply as a technical relation to living beings, bioethics may be said to be called always to save the truth of the relationship of a person (scientist, physician) to another person who is in a condition of fragility, a person asking to be helped to realize himself in his personal potential.
At bottom, the basic rule of bioethics is not different from that "golden rule" always glimpsed by the wisdom of peoples and promulgated, in its definitive, positive formulation, by Jesus in person: "Do to men everything you want men to do to you" (Mt 7:12). A rule, which Kant translated as follows: always act in such a way as to treat humanity in yourself and in others as an end and never merely as a means.
The basic rule of bioethics is the basic rule of any ethics — it always treats man as an end. But this takes us back to the considerations we developed previously: to take someone as an end always means somehow to give oneself to him unselfishly. To a certain extent it is possible to understand this, even in the framework of a morality constructed simply in the light of reason. Indeed, if we reflect carefully, only on this basis can a society really function. And yet this unselfish gift is possible as a human response only on the basis of the gratuitous, redeeming gift of God. Aside from this gift, aside from this guarantee offered by God in the gift of his very own person, aside from this commitment by God to man which alone justifies limitless confidence, man is always tempted by a form of utilitarianism. By himself he cannot be thoroughly unselfish.
If man must guarantee his existence and future by himself, he cannot be completely unselfish. The other will always appear to him to some degree as a means for his happiness, a means for himself, to guarantee his existence.
Through an apparently strange, but at root very logical reversal, the ethical problem, when detached from its moral bases, will simply become the problem of establishing limits to this inevitable objectification of the other (for instance, by prescribing that an attempt not be made on his life when he has been born or when he is still in a conscious state), for the purpose of making life in society possible still. The logic of selfishness tends, however, to push the areas in which the logic of gratuitousness comes into play as far away as possible.
All of the problems of bioethics could be dealt with in this light, and in this perspective we could find the starting point for a judgment adapted to the interpersonal situation essentially qualifying them from a moral standpoint.
In separating the origin of new life from the marriage act, artificial procreation tends to regard the child simply as a response to the couple's desire; euthanasia refuses to help the other to suffer and to remain a person in suffering; genetic interventions are licit when they help the embryo to heal and develop his personal being; and so on.
7. The Identity Of Medicine
In the light of these considerations we can also grasp the importance of an ethics committee within a Catholic hospital. It will be called to provide answers on particular questions concerning the practice of medicine, in relation to the most advanced technologies available today. It should not limit itself, though, to working out merely casuistic solutions through rational coordinates restricted to practice of medical deontology in accordance with the principles accepted by Catholic morality. It must continually draw upon the major perspectives of meaning in Christian morality and faith as its own vivifying fount.
Precisely by doing so, in explicitly taking up the Christian vision of life and death, suffering, sexuality, and procreation, it will contribute to protecting the identity proper to the medical profession. Today the challenge moves in this direction as well. The doctor is called to watch over the original Hippocratic nature of his profession involving responsibility for man's health, which is intrinsically animated by an ethical dimension of respect for and promotion of the other person. He cannot limit himself to being a professional providing scientific competence at the request of the user (no longer a patient), free from ethical responsibilities, which would devolve exclusively upon the applicant, the services, or society.
To include scientific research on bioethics in a Christian perspective does not remove rationality or openness to dialogue with all on the part of this effort, but broadens horizons and roots reflection in truly important questions, those concerning which it is vital for ideas to be contrasted.
I would like to conclude with the words of one of the greatest pioneers in Catholic theology, Clement of Alexandria (ca. 215), who writes, "This is the most divine work by God and the one most worthy of the King of the Universe: to bring healing to humanity" (Paed. 1, 12, 100ff.) Christ, in this text, is regarded as the real Asclepius, the divine physician, the model and measure for every doctor. Christ's main title — Soter, savior — should be interpreted along these lines: the compassion of God towards us, realized in Christ's Passion, is our healing — a healing not only of the soul, but of man in his indivisible totality. As the ancient world had expressed at once the sacredness and rationality of medicine in the figure of Asclepius — its ethical as well as technical core, in the original sense of the word "technique" (i.e., 'art') — so the Christian religion now found all of these elements recapitulated in the figure of Christ.
The sacredness of human life: whoever touches human life enters into the reserved domain of what belongs to the divine, and the doctor's profession is thus not just any occupation, but a sacred one in a very deep sense. Sacredness implies ethical duty — i.e., it excludes the objectification of the person, who never becomes a thing available for purposes different from himself, but is always sacred. Sacredness also implies the duties of professionalness, the duty of art, and is opposed to all quackery. It was not an accident that the first medical schools sprung up around the sanctuaries of Asclepius. Tiber Island, which from 293 B.C. on was a sanctuary of Asclepius and a center for the medical art, offers us an example right here in Rome.
The more we begin to advance today on down to the deepest sources of human life, the more urgent and indispensable awareness of this sacredness of the medical art becomes. Purely technical, utilitarian action would eventually lead to the self-destruction of human dignity. When, on the other hand, the art, increasingly well mastered, becomes an expression and instrument of respect for the dignity of human life, the physician's action partakes of the dignity of the saving action of the divine physician, according to the words "This is the greatest and worthiest work . . . of God: to bring healing to men."
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