Fearfully and Wonderfully Made

I'm pleased that Dr Megan Best's book 'Fearfully and Wonderfully Made' has been released by Matthias Media. Like many people, I have been awaiting this book for some years. I was excited when I had the privilege of reading an advance copy. Megan Best is a bioethicist and palliative care doctor who lives and works in Sydney. She will be well known to many readers of this blog and to CASE associates. She has written for CASE many times, presented papers at our conferences and has been an associate and faculty member since the inception of the Centre in 2002. Some of us have also been sent briefing papers prior to government decisions on new legislation, and received passionate emails calling us to action. Dr Best has been one of the most effective Christian voices in this country on the ethics of life's beginning and end. As a result, many of us have also encouraged her to write this book on the ethics of the beginning of life (and we hope to see one on the 'end' of life in time).

It is a remarkable book written by a remarkable person. Megan Best has committed a large part of her life to understanding the beginnings of life and the moral and ethical issues that we face in relation to conception, birth, abortion, miscarriage, pregnancy, and reproductive technologies of all kinds. I doubt that there is another person who could have written this book, certainly not as well.

For those of us who want to understand the ethical and moral issues concerning the beginning of life, we have difficulty keeping up with the medical and technological changes, not to mention the many voices commenting on them. In the rapidly changing field of reproductive medicine, we need accurate and well-informed information. We also need to consider how this can be interpreted ethically within a sound biblical framework.

Dr Megan Best provides what is lacking in both of these vital areas. Built on extensive historical, biblical and medical research, 'Fearfully and Wonderfully Made' is the comprehensive, accurate, biblically based ethical handbook that many of us have been waiting for.

Dr Best has set out to write a book that will inform Christian and non-Christian’s seeking answers to the many issues and questions that face us concerning the beginning of life. She weaves together the best secular knowledge, ethical, moral and historical writings, medical research, public policy, law, personal experience and biblical wisdom. This incredible synthesis is done with a great sense of compassion and without judgement. This is a book that is written with humility, grace and understanding of the varied circumstances of the lives of those who face dilemmas and decisions to be made prior to conception, after conception and at time of birth. The facts and the pain of many are at times confronting. Few people will be able to read the chapters on abortion, miscarriage and infertility without tears.

This is a timely book that fills a great gap. It will inform, challenge, offer hope and give answers to the many people who struggle with the complex range of issues that face us, as we seek to understand and make decisions about the beginning of life. I commend it to you.

You can read all our previous posts on medical ethics HERE.

The Importance of Civility in Public Life

Mr Jones. Photo courtesy News.com.au

Australian readers of this blog will be well aware that the last 24 hours have seen the unfolding of a distasteful attack on the Australian Prime Minister Julia Gillard by media personality Allan Jones (details here). Mr Jones suggested that the Prime Minister's father, John Gillard, died recently of shame because his daughter, in Mr Jones' opinion, is a serial liar. The outrage from the Australian public has been strong, with a number of major sponsors dumping Mr Jones' program. As well, some regional radio stations will no longer air the program and a Facebook page has been set up to fight for Mr Jones' sacking. Mr Jones has admitted that his comments recorded at a Liberal Party function were "out of line" but has stopped short of an apology. The leader of the opposition, Mr Abbott has similarly stated that the comments were "out of line". This has led some to suggest that this appears to be an agreed Liberal party response.

I've been moved to write about civility in public life several times in recent years. Amazingly, on the last occasion Julia Gillard was again being attacked (here). As well, our last post by Dr John Quinn was also indirectly about civility (here).

Mr Abbott at the 2011 anti Carbon Tax rally. Photo credit: Alan Porritt (AAP)

Again I ask, does civility matter? The comments from another high profile public figure, suggest that it isn't valued as highly as it once was.  Civility isn't just good manners (though we could do with more of them), but rather behaviour between members of society that leads to a social code and foundational principles that help to shape a civilized society. This historically has been a major focus of political philosophers and has included concern with principles of justice, liberty, rights, freedoms, the law and the duties of citizens to government. The Carbon Tax protests in Canberra during 2011 set new low standards for public political debate. Mr Jones at a Liberal Party function has lowered the standard even further.

When people talk of civility today, they often mean the cultivation of character traits and virtues that are consistent with their own cultural and social practices. These at times simply reflect one's social class rather than well thought out ideas of civil society.  The distinction between practices that some see as demonstrating civility, and others that are uncivilised, can be based on the most tenuous of justifications.

Attempting to move beyond subjective debates about manners or a pretense of civility, requires us to return to the root of the word that is the opposite of civil. The word 'uncivil' comes from the Latin word incivilis, meaning "not of a citizen." To be civil, is to play one's part as a citizen in building a civil society. What any society needs to guard against is behaviour that runs counter to the well being of a society; that is, behaviour that strikes at the very structure and foundation of one's civil society. In the recent decades, many western democracies have seen the topic of civic virtue gaining attention. This has been particularly the case in relation to the good practices of government and the participation of citizens in relation to government. In my view, Mr Jones comments and the behaviour of others in relation to the Prime Minister have been uncivil.

In the 'The Case for Civility: And Why Our Future Depends On It', well-known Christian Os Guinness argues that civility needs to be rebuilt in western societies like the USA (and I'd add Australia) if they are to survive:

"Civility must truly be restored. It is not to be confused with niceness and mere etiquette or dismissed as squeamishness about differences. It is a tough, robust, substantive concept… and a manner of conduct that will be decisive for the future of the American republic" (p. 3).

Os Guinness's book points to the threat of individuals and minority groups like the Religious Right and the secular Left in the USA, arguing that there is a need to avoid privileging one interest group over another, including religious groups and influential figures who believe that they can set standards for society. High profile figures like Mr Jones', who seem to believe that their views on matters of public policy have greater weight than others, can be just as dangerous.

A mature civil society will need to enable minority groups and individuals to have a voice, but they must not be allowed to establish their position by yelling the loudest or the longest in ways that damage individuals, public office and democracy. Guinness reminds us that in a democracy all have a right to believe anything, but this does not mean, "anything anyone believes is right". We need to expect differences of opinion in a civil society and also to work out ways to discuss them and reach consensus for the common good. Christians have a part to play in such public discourse, participating openly as people of faith with godliness, humility and respect for the rights of others to participate as well.

Girl Guides Drop Queen & God from Pledge

The Australian Girl Guides movement has decided to modernise the pledge that its members give assent to. The changes are interesting. While the media has been quick to discuss the removal of any allegiance to God and Queen, it has overlooked what ultimately replaces the focus of their allegiance, the very foundation of their actions and life. The modern 10-14 year-old Aussie girl will now look largely to herself in order to judge the quality of their life and character.  Yes, they will 'serve their 'community' and 'country' and help others, but the test by which they will measure their life is by being 'true to themselves'. They will also 'develop my beliefs', but note that these don't guide. 

The pledge will no longer have any reference to God or the Queen, but will be a vow to serve country and community. The move follows about 18 months of consultations with thousands of members of the country's largest volunteer girl groups.

The national director of the Guide movement, Belinda Allen commented:

"We are open to girls of all cultures, all belief systems and we feel that to develop my beliefs is much more inclusive of our multicultural Australia".

The old Girl Guide pledge:

I promise that I will do my best.
To do my duty to God.
To serve the Queen and my country.
To help other people and keep the Guide law.

The new Girl Guide pledge:

I promise that I will do my best.
To be true to myself and develop my beliefs.
To serve my community and my country.
To help other people and keep the Guide law.

While in a diverse society like Australia it is understandable that some members (or perhaps more likely their parents) don't want to swear allegiance to God, this in my view is more reflective of a view that faith is seen as peripheral to the life of the individual, community and our country. There is a significant shift here in the commitment being made from the pursuit of virtue and the living of a 'good' life for the benefit of others and ultimately for God and Queen (representing the nation), to something that reflects the individualism of our age.

As MacIntyre reminds us in 'After Virtue', the modern man or woman is '...what I myself choose to be...'. But who we are, and what is for my good, is always to be for the good also of others, and take place in relationship to other inhabitants of varied life roles including daughter, cousin, citizen and servant of God (or some other god). Well, it certainly has been seen this way by diverse nations for over two thousand years. To ask these girls to swear allegiance to community and country while being true to 'self' is symptomatic of this age, where in western nations we see our responsibility as to self alone. In my view this is a sad day for the Guide movement.

Amazon's New 'Sneaky' Re-gifting Scheme: Is it ethical?

It seems that re-gifting might soon become even more common. Some have questioned the ethics of this practice in the past, but there will be stronger reasons to question it if a new approach by Amazon is implemented.

US Technology journalist Marshall Kirkpatrick has exposed a 'sneaky' new way to re-gift in an interview with the Sydney Morning Herald.

'First Amazon gave us the one-click-to-buy system. Now they're giving us the one-click-to-lie system....[With Amazon's newly patented system] we register our disinterest ahead and so what we have is Christmas helping us celebrate our limitations. It robs people of having the chance to have their horizons expanded and being surprised. It's social engineering of the worst type.'

Here's how it would work. Someone chooses a gift for you via Amazon and then Amazon sends the recipient a notification of the gift. The recipient then has a choice to accept the gift or convert it into an Amazon gift voucher, which they can then use to purchase something else. Some might not be worried so far, but there's more. The recipient then has the option to have Amazon send a thank you note to the giver for the ORIGINAL gift even if they've converted it. That's right, convert the gift that someone has (hopefully) thoughtfully chosen for you, and then lie by thanking them for the original gift.

While it's easy to see why this would be a convenient way to exchange a gift that you already had (that 2nd or 3rd wedding toaster!), or perhaps something that wasn't to your taste, the deception involved in thanking the giver for something that you didn't keep, would hopefully be seen by most people as unethical.

Kirkpatrick's outrage at this new way to shop and give (which presumably is soon to be released) is grounded not just in the deception, but the fact that the essence of gift giving is undermined. As he sees it, the approach would "....rob people of the chance to have their horizons expanded and being surprised. It's social engineering of the worst type."

While his comment about social engineering is a bit over the top, surely he's right in saying that there is something fundamentally wrong with this new practice.  You might question the practice on moral grounds because it involves deception and a lie, but it also does undermine the essence of gift giving. In this age often described as the 'me generation', it would feed the tendency to think only of what I want and miss the point of the original gift. A gift should be something that is given as an act of love or a desire to offer someone something that the giver thinks they need.  It should also be something given without expecting return. This new practice is an almost inevitable outcome in an age where we've lost sight of the essence of gift giving.

We've just celebrated Christmas and many gifts have been 'exchanged'. But exchange isn't something that is fundamentally part of giving. Amazon has probably hit on a winner; crafted to match the self-centredness of humanity that fails to grasp what gift giving is all about,

Other links

The Sydney Morning Herald article (HERE)

Previous posts on the ethics of shopping (HERE & HERE)

Life's End

Issue #25 of Case Magazine has the theme 'Life's End' and had its genesis in the 2010 CASE conference, 'Christian perspectives on the end of life'. In this issue you can read the papers of all speakers from the conference. The contributions include papers by Dr Megan Best, Dr Russell Clarke, Rev Rod Benson, Kate Bradford and Dr Frank Brennan.

There are many common threads running throughout the articles, but for me, three stand out:

• Society does not value all human lives equally
• The Bible teaches that death is not simply the end
• Death is both a curse and an opportunity for blessing

Each of the above themes has a relationship to one over-arching theme, they intersect in the idea and hope that it is possible to end life well. It is possible, even in one's death, to have an influence on others for good.

Dr Best reminds us that the word ‘euthanasia’ comes from two Greek words: 'eu' meaning ‘good’, and ‘thanos’ meaning ‘death’. Most people today link the word with the idea of taking someone's life in order to end their suffering. Ending the life of someone who is suffering is seen by some as the only logical or humane path. But all our writers stress that while death is a curse, it is also an opportunity for ultimate blessing for those who trust in Christ.

A number of the articles also speak about the way in which we too quickly make judgements about the relative value of life, and the dangers of thinking this way. The unborn of course have very few rights and seemingly, for many, no value. A life that cannot be lived exactly the way one wishes can also be seen as not worth living. This point was highlighted by Professor John Wyatt when he presented the 2009 New College Lectures.

Prof John Wyatt told the story of a couple at his church who, after a routine ultrasound, discovered that their unborn child had a tragic and rare chromosomal disorder which causes multiple malformations, severe mental impairment and a uniformly fatal outcome. In this condition nearly all obstetricians will recommend abortion. But the parents decided to continue the pregnancy and little Christopher was born.

Christopher lived for almost 7 months and in Wyatt’s words exercised ‘an extraordinary ministry’. The weakest member of the church exercised a strong, strange influence. ‘He became, in the end, almost public property.’ Wyatt concluded:

Christopher in his way was a God-like being, a flawed masterpiece. His life was an example of Christian theology in practice, and it was a privilege for me to know him. Here is a strange paradox. Sometimes we see the image of God most clearly, not in the perfect specimens of humanity, not in the Olympic athlete or the Nobel prize winner. We see Christ in the broken, the malformed, the imperfect. It is an example of the Easter mystery. God is revealed, not in glorious majesty but in a broken body on a cross.

Dr Megan Best, a bioethicist and palliative care doctor, considers the arguments for and against euthanasia, and presents a Christian ethical response to these arguments. Dr Best also presented a second conference paper evaluating the use of Advanced Directives – documents that state a patient’s preferences regarding medical care in the event they can no longer speak for themselves. This article is available on the CASE website together with an extended version of the euthanasia article published HERE.

Geriatrician Dr Russell Clarke provides biological and biblical perspectives on what it means to age. He explains why ageing and death are biologically inevitable, then considers how this sits with a biblical understanding of the topic, and the hope of renewal it offers (2 Corinthians 4:16-18)?

Rev Rod Benson reflects on how death is portrayed in Scripture. He begins by quoting Arwen’s words from Tolkien's 'Lord of the Rings' as Aragorn dies. For Arwen, the loss of Aragorn seems to leave her with little but memories, pain and loss, but in the Bible he explains, death is both a curse and a blessing (1 Corinthians 15).

Kate Bradford, Anglican Chaplain at the Westmead Children's Hospital presents a practitioner's perspective on the privilege of visiting and caring for seriously ill people. With compassion she gives practical advice on how to conduct such visits, taking into account the awkwardness we can feel as visitors, and providing insight into the fears and needs of patients.

Finally, Dr Frank Brennan discusses a number of ethical challenges arising within the area of palliative care, including transparency and withholding treatment. Drawing on his many years of personal experience, he uses case studies to show how ethical considerations can influence decision making in this difficult area.

The issue ends with two reviews. John Diacos looks at 'This Mortal Flesh' by Brent Waters, who assesses the potential impact of life-extending technologies, envisions what a society made up of long-lived people would look like, and asks how Christians should respond to these technologies. Rosemary Albert’s reviews a very different book, 'The Art of Dying'. In it, Rob Moll combines pastoral, theological and cultural considerations as he seeks to revive the Christian art of dying well. Christ should make a difference not only to how we live, but how we die.

For more information on how to obtain single issues of Case Magazine or to subscribe to receive the magazine quarterly, simply visit the CASE website.

Other resources and posts

Audio downloads of all lectures at the 2010 Medical Ethics Conference are available HERE.

Previous blog posts on Prof John Wyatt's 2009 New College Lectures HERE.

Dying Well

CASE had its latest conference on medical ethics on the 27th March 2010 titled 'Christian Perspectives on the End of Life'. It was a follow on from our first medical ethics conference in 2009, 'Medical Ethics: Perspectives on Life and Death'. The speakers were Dr Best, Dr Frank Brennan, Rev Rod Benson, Dr Russell Clark and Kate Bradford. 120 people attended it from varied backgrounds - health professionals of all kinds, students, carers, hospital chaplains and interested members of the public.

What they said individually?

The speakers all brought different messages looking at different dimensions to the topic 'End of Life'. There were common themes (which I'll come back to).

Rev Rod Benson an ethicist and public theologian began by quoting from the Tale of Aragorn and Arwen in Tolkien's 'Lord of the Rings', as Aragorn dies, for Arwen there seems little else but the cherish her memories. But the Bible's view of death is that it is both a curse and a blessing (1 Corinthians 15). He stressed that there is physical death, moral and spiritual death (Ephesians 2) and eschatological death (Revelation 21). He then spoke from Psalm 88 of the terrible experience of death and dying.

Dr Russell Clarke a geriatrician provided a medical perspective on what it means to age. He examined biological and biblical perspectives on the topic, and considered our attitudes to ageing and the biblical hope of renewal (2 Corinthians 4:16-18).

Dr Megan Best a bioethecist and palliative care doctor spoke on Euthanasia. She considered the arguments for and against Euthanasia, and finished with an ethical approach that she commended for Christians. Later in the day she spoke about Advanced Directives; documents that state preferences of the patient for medical care in the event they can no longer speak for themselves.

Kate Bradford (a former CMS missionary in Tanzania) works as an Anglican Chaplain at the Westmead Children's Hospital and offered a practitioner's perspective on visiting and caring for seriously ill people - helping to allay fears, being ourselves, respecting patient rights, the privilege of listening to seriously ill people.

Dr Frank Brennan, a Palliative Care Physician spoke about the need for more resourcing for palliative care and a right attitude to when to use it; it's not just to be used at the point of death, it needs to start earlier for many people. He spoke from personal experience of the need to communicate clearly with families and shared 'Stories from palliative care'.

A common theme - dying well

There were many common threads running through the various talks at the conference. For me three stood out, and all had a relationship to one theme:

• Society places different values on different human lives
• The Bible teaches that death is not simply the end
• Death is both a curse and an opportunity for blessing
  

These three ideas intersect in the notion that it is possible to die well; that is, it is possible even in one's death to have an influence on others for good.

Dr Best reminded us that Euthanasia is based on two Greek words that together mean "good death" ('eu' meaning good, and thanatos meaning death). Most people today link the word with the idea of taking someone's life at their request (or without it), because death is judged to be inevitable for this person, quality of life is judged to have gone, and the process of dying is causing such hardship and suffering that ending the life seems the only logical or humane path. But all speakers stressed that while death is a curse, it is as the Bible teaches, also an opportunity for ultimate blessing for those who trust in Christ. Furthermore, that irrespective of one's views on life beyond this physical life, that it IS possible to die well.

Frank Brennan shared a number of very moving stories from his book 'Stories from palliative care' that describe his own experience in dealing with people suffering as they died. He talked of the great privilege of easing people's pain in the final stages of life and of the way in which one's dying touches all that witness it.

A number of the speakers also spoke about the way in which we too quickly make judgements about the relative value of life, and the dangers of thinking this way. The unborn of course have very few rights and seemingly, for many, no value. As well, the life that cannot be lived exactly the way we would wish to lead it, is seen by some as not worth living. I would be less than honest if I didn't admit that I have my own fears about the terms on which I wouldn't like to end my days. But for me, the challenge at the end of life will be to die well, and that won't simply be a matter of me avoiding pain and suffering. Of course, I won't know how I will handle this until I'm there.

But I'm encouraged by the stories of others that offer testimony to dying well. When John Wyatt presented the 2009 New College Lectures he told the story of Alan and Verity who after a routine ultrasound scan at twenty weeks discovered that their unborn child had Edwards syndrome (Trisomy 18), a tragic and rare chromosomal disorder which causes multiple malformations, severe mental impairment and a uniformly fatal outcome. In this condition nearly all obstetricians will recommend abortion. After agonizing discussion and consideration they decided to continue the pregnancy and little Christopher was born. Everyone was surprised when he did not die straight away; he lived for almost 7 months. His life in Wyatt’s words exercised "an extraordinary ministry". The weakest member of the church exercised a strong, strange influence. “He became, in the end, almost public property.” When baby Christopher died he was still the same size as when he was born. One of Alan and Verity's friends commented that although “Christopher couldn't grow he helped other people to grow”. John Wyatt concluded this story with these words:

"Christopher in his way was a God-like being, a flawed masterpiece. His life was an example of Christian theology in practice, and it was a privilege for me to know him.

Here is a strange paradox. Sometimes we see the image of God most clearly, not in the perfect specimens of humanity, not in the Olympic athlete or the Nobel prizewinner. We see Christ in the broken, the malformed, the imperfect. It is an example of the Easter mystery. God is revealed, not in glorious majesty but in a broken body on a cross."

For me, the theme that stood out most at this year's Medical Ethics conference is that we must do more to offer people support in the final stages of life. Palliative care is not simply meant for the point of death, it is meant to ease pain and suffering and to help people lead the best life possible at the end of life. While the individual right to ask for treatment to be withdrawn is an important one, we must not forget that it is possible to die well. That is, to be a blessing and encouragement to others even in the face of death. How do we ensure that people don't simply see themselves as a burden and how can we reinforce that there is hope? I finish with the Apostle Paul's words to the church in Corinth:

So we do not lose heart. Though our outer self is wasting away, our inner self is being renewed day by day. For this light momentary affliction is preparing for us an eternal weight of glory beyond all comparison, as we look not to the things that are seen but to the things that are unseen. For the things that are seen are transient, but the things that are unseen are eternal (2 Cor 4:16-18).

Related Posts & Resources

MP3 files for download should be available on the CASE website in the next week (here).

Talks from the 1st Medical Ethics conference in first conference in 2009 'Medical Ethics: Perspectives on Life and Death'.

Talks by Dr John Wyatt at the 2009 New College Lectures titled ‘Bioethics and Future Hope’ (here)

Previous post on ‘Matters of Life and Death’ (here)

Other resources on medical ethics on the CASE website (here)

Case magazine on the theme 'Living and Dying Ethically' (here)

The Challenges of 'Assisted Suicide'

The British Prime Minister Gordon Brown has spoken out publicly about the dilemmas faced when a nation considers allowing greater freedom for assisted suicide and the rights of people to end their life when faced with suffering and pain.

Many times in the past 80 years, the British Parliament has considered - and rejected - the legalisation of assisted suicide. If, in the wake of revived debate on these matters, a new proposal were to come forward, I do not believe the outcome would be any different. Cases dominating the public arena make for harrowing reading, and the first and most obvious response is to say that something must be done. But when these complex, individual and distressing cases are considered in detail, a solution that at first might seem sensible - the right to die in a manner and at a time of one's choosing - swiftly becomes less straightforward and more worrying.

I believe people are drawn to support the right to assisted suicide because of fears about how they will be cared for when they are dying.

They ask themselves: Will I be left alone? Will I suffer pain? Will I lose my dignity and my individuality? Will there be no one there to care for me? Will I be kept alive and subjected to tests and treatments that will do little good and serve only to extend the process of dying?

I believe we should look more closely at such fears and what has been done to address them.

CASE Conference

"Here is a strange paradox. Sometimes we see the image of God most clearly, not in the perfect specimens of humanity, not in the Olympic athlete or the Nobel prizewinner. We see Christ in the broken, the malformed, the imperfect. It is an example of the Easter mystery. God is revealed, not in glorious majesty but in a broken body on a cross" (John Wyatt, Lecture 2, 2009 New College Lectures).

As indicated in my previous post on Euthanasia (here), we will be addressing this an other ethical issues concerning death and dying at our 2010 CASE conference 'Christian Perspectives on the End of Life' on the 27th March at New College.

Other Resources

More details on the conference HERE

Special issue of Case Magazine 'Living and Dying Ethically' HERE

New College Lectures by Dr John Wyatt HERE

You can read the full article by the British Prime Minister HERE

[HT: David McKay for pointing me to the article by Gordon Brown]

Failing to Understand Death & Dying

Dr Megan Best (a CASE Associate) will be one of the major speakers at a medical ethics conference being run by CASE on the 27th March 2010 titled 'Christian Perspectives on the End of Life'.

Due to the success of our first conference in 2009, 'Medical Ethics: Perspectives on Life and Death', we have decided to run a second Sydney forum in 2010 for those interested in Christian views on the end of life. Speakers will include Dr Best, Frank Brennan, Russell Clark and Kate Bradford.

Dr Best wrote an interesting titled ‘The truth about dying’ for ABC News online recently (8th Feb). Her piece serves as a foretaste of just some of the issues that the conference will deal with. The following is an extract of what Dr Best wrote.

The Extract

I am a palliative care doctor. I look after people who are terminally ill. Let me tell you about a patient I looked after many years ago, during my training. Due to the usual department rotations of medical training, I had been on the spot when he was diagnosed with lung cancer—a tall Lebanese gentleman with an impressive moustache, patriarch of a large immigrant family

I had not seen him for some time, and when he appeared in the ward again, I could see that things had not gone well.

He was a shadow of his former self, gaunt and grey, though the moustache valiantly lingered on. It was like seeing an old friend; any familiar face is welcome in such a setting.

We soon were able to control his symptoms of pain and breathlessness with the appropriate medication. He did, however, continue to suffer.

I asked him what had been the most difficult experience of his illness. His answer surprised me, back then, though it would not now. Despite the trials of discovering he had cancer, experiencing the ravages of chemotherapy, battling with pain and breathlessness and increasing debilitation, the thing that had been most difficult for him was his loss of position in his family.

He no longer ruled the clan, his illness had resulted in a demotion. He found this intolerable, he wanted his authority back, and he wanted more time with his family.

Like most of my patients, thoughts of euthanasia did not cross his mind as a response to his suffering. He wanted more time, not less.

I have always found striking the discrepancy between the public support for euthanasia (among those who are healthy) and my patients’ desire for continued life. I was informed of a recent poll which claimed that 87 per cent of Australians support legalisation of euthanasia.

Research done on palliative care populations, however, tells a different story. A study done some years ago in Sydney found that less than one per cent of those referred to a palliative care service made persistent requests for euthanasia.

My own observation is that things haven’t changed much since then. Why the disparity?

I think there are many reasons why this is the case. The absence of death in everyday life no doubt contributes - it is a remote event often occurring in hospitals, and many of us base our understanding of what really happens on hearsay. And hearsay, especially from the distant past, has some horrifying stories to tell.

Yet I think the main reason why our community voices such strong support for euthanasia is because it has been confused about some accepted end-of-life practices which are already legal, but poorly understood. These include withdrawal of life-prolonging treatment and symptom control.

The Conference

If you’d like to hear more from Dr Best or some of our other speakers please consider registering for the conference. You can find details on how to register HERE.

Related Posts

Talks by Dr John Wyatt at the 2009 New College Lectures titled ‘Bioethics and Future Hope’ (here)

Previous post on ‘Matters of Life and Death’ (here)

Other resources on medical ethics on the CASE website (here)

Case magazine on the theme 'Living and Dying Ethically' (here)

The Ethics of Shopping

This post is a repeat of one posted on the 22nd December 2008

Carmen and I spent some time in Singapore, Kuala Lumpur and Hong Kong about a year ago. On the Saturday before we left Hong Kong for home we did what many people do when they travel to Asian cities, we went shopping for a bargain in one of the well-known markets. We were mainly looking for Christmas presents for our grandchildren, but as we wandered up and down the rows of merchants there was one very consistent cry:

"Copy watch, you want copy watch sir?"

Typically this was a question asked of me and it occurred at just about every second stand. It was sometimes followed with statements like "We've got Rolex, copy Rolex out the back, you want one, very cheap".

I had no trouble resisting the pleas of the many sales people. For a start, I wouldn't want my friends and the residents of New College to see me wearing a watch that looked like it was worth $5,000 (even though it was only worth $20); I'm not one for bling! But I'm also strongly against people ripping off the trademarks and intellectual property of other individuals and companies. I'd thought this through as a Christian long before I started receiving 6-10 SPAM emails daily offering me similarly wonderful 'replica watches' as the spammers call them. This decision seems like an easy ethical dilemma to resolve. But this made me think, what other ethical shopping dilemmas will I face this Christmas season. And which ones am I not even aware that I'm facing? What does it mean to shop ethically? What guidance does the Bible give us?

The problem of selectivity

Part of the problem with thinking ethically about shopping is that we tend to focus on one area of concern. For example, I know people who act (quite rightly) as campaigners for Fair Trade. Their concern is driven primarily by their desire to see justice for workers and suppliers (fair pay for products as well as the labour that produced them). Others campaign to ensure that we don't encourage the sale of wooden products that destroy the environment. It's easy to pick some issues that you can quickly make an ethical decision about while missing other areas of perhaps equal ethical concern. I suspect that we face ethical decisions as shoppers every day. Here are a few examples:

• You are given too much change by the shop assistant - should you give it back?
• You wear a piece of clothing but decide you don't like it - you are tempted to take it back for exchange after wearing it (just once), but should you?
• You have to answer questions about your driving record when seeking a new insurance policy which will affect the premium you're charged - do you tell them the full story?
• You see products that have most likely been manufactured by workers who have not been treated justly, (often clothing, but also household items in wood or cane). The workers might have been poorly paid, child family members could have been forced to work long hours and may have been denied education (especially girls), slave labourers may have been used, staff within family sweat shops may have produced the clothing and so on. How do you assess this and should you buy the products?
• You have the chance to buy something that will tempt you or the recipient of the gift to break the law or act unethically themselves - e.g. police scanners that allow people to listen in on the police broadcasts, machines for multi-copying of DVDs and CDs, devices for detecting speed cameras so that you can speed in 'safety'. Should you buy such a device?
• You see a book, CD, video or clothing item that is obviously a copy of a well-known brand (like my 'copy watch'). Do you purchase it?
• You know that the seller is desperate for a sale (often this can occur in Asian countries) and you think you can drive the price even lower to the point that it is costing you almost nothing. Should you? I can well remember bargaining for a painting in a village in Indonesia about 5 years before I became a Christian and getting it for a ridiculous price. I recall later realising that it cost me 14 cents and feeling very guilty, as it was hardly a fair price.

This might all seem a bit much, you might think I'm going over the top! But am I? If you're a Christian reading this blog then like me you need to consider what the Bible has to say about ethical shopping. Even if you aren't a Christian it is important to think ethically about issues like honest shopping.

What the Bible has to say that can help us?

The easy part is that if your action or choice is going to lead you or others to break the law then you shouldn't do it. While we are to be obedient to Christ first, we are to be obedient to the laws of the land that are set by authorities appointed ultimately by God. So, a 'copy watch' is out, as is an illegal video, copied music etc. Romans 13:1-7, Titus 3:1 and 1 Peter 2:13 are helpful here, especially Rom 13: 1,2 & 7:

Let every person be subject to the governing authorities. For there is no authority except from God, and those that exist have been instituted by God. Therefore whoever resists the authorities resists what God has appointed, and those who resist will incur judgment....Pay to all what is owed to them: taxes to whom taxes are owed, revenue to whom revenue is owed, respect to whom respect is owed, honor to whom honour is owed.

But the Bible teaches more than simply obedience to the laws of the land; we are called to pay attention even to the 'spirit of the law' not just the 'letter of the law'. Jesus teaches about this in his Sermon on the Mount (Matthew 5:17-20) when he says:

Do not think that I have come to abolish the Law or the Prophets; I have not come to abolish them but to fulfil them. For truly, I say to you, until heaven and earth pass away, not an iota, not a dot, will pass from the Law until all is accomplished. Therefore whoever relaxes one of the least of these commandments and teaches others to do the same will be called least in the kingdom of heaven, but whoever does them and teaches them will be called great in the kingdom of heaven. For I tell you, unless your righteousness exceeds that of the scribes and Pharisees, you will never enter the kingdom of heaven.

Jesus is suggesting to the Scribes and Pharisees that the righteousness that he expects is nothing less than complete conformity to God’s law. Jesus is teaching that it is the heart not just the outward deed is that is ultimately most important. This is God-given righteousness; hearts transformed by the saving grace of Christ, not a righteousness of outward compliance. Jesus demands more than just an outward pretence of honesty while all the time acting unethically and unjustly by seeking some level of right action, to keep up appearances, but quietly pushing the boundaries of what is right in one area while trying in another.

I’m challenged by Jesus’ words for I know that in my heart I’m tempted constantly to ‘cut corners’ so to speak, hiding behind a façade of ethical action a heart that while viewed as free of guilt because of the righteousness of Christ, is still engaged in a daily war against the flesh. Jesus teaching is hard teaching here. What is expected of us? Mere token observance of the laws of the land? No much more than this. As Christians we must not relax “one of the least of these commandments” and what’s more I must flee the false righteousness of the Scribes and Pharisees that fails to satisfy the heart and the mind, that seeks to glorify self in our actions, that is self made, not reflective of a repentant and obedient heart.

The Incredible Value of Human Life

In Australia one of the biggest news stories of the last week has been the remarkable story of conjoined twins Trishna and Krishna who were successfully separated by a team of surgeons at the Royal Children's Hospital in Melbourne on the 18th November.

Two years ago the 'Children First Foundation' brought these two little girls from Bangladesh to Australia for surgery.

An aid worker first saw Trishna and Krishna in an orphanage in the Bangladeshi capital, Dhaka, when they were a month old. The aid worker contacted the Children First Foundation, which brought the girls to Australia for the operation. Their mother handed over her girls because she and her husband were unable to care for their special needs. The Children First Foundation also recognised that this was their only real chance of a longer life due to the nature of how they were joined at the skull.


Trishna and Krishna were joined at the top of their heads and shared brain tissue and blood vessels. They were gravely ill when they arrived, and underwent several preparatory operations over a period of almost 2 years before being separated. The doctors doing the surgery had warned that there was a 50 percent chance that one or both of the girls could suffer brain damage as a result. They were separated last week after a 32 hour operation by a team of 15 surgeons and over 70 medical staff working in shifts to complete the procedure. They left intensive care on Monday, are in stable condition, and the operation appears to have been a complete success.

The High Value of Human Life

People have applauded the remarkable doctors and people everywhere have been filled with great joy because the two little girls are now separated. Many have also praised (quite rightly) the woman who was responsible for bringing them to Australia (Moira Kelly). However, my wife Carmen put her finger on what is even more remarkable about this story. She commented over dinner through the week:

"You know what is so wonderful about this story? Moira Kelly and the doctors have shown how they put such a high value on human life."

In the second of his New College Lectures this year, Professor John Wyatt reminded his audience that the value of human life should never be linked to any judgements about the 'quality' of life, for such a judgement is hard to make. He shared the story of a little boy named Christopher who was part of his church and was born with Edwards syndrome. This is a tragic and rare chromosomal disorder that causes multiple malformations, severe mental impairment and a uniformly fatal outcome. He shared how this little boy had had a huge impact on his family and in fact the entire church, and how much his life had touched many and had been significant. In making sense of how this could occur in a world that seeks only perfection in people, he commented:

"....behind it all is the Christian conviction that even the weakest and most malformed human being has a life of unique value. Christopher in his way was a God-like being, a flawed masterpiece. His life was an example of Christian theology in practice, and it was a privilege for me to know him.

Here is a strange paradox. Sometimes we see the image of God most clearly, not in the perfect specimens of humanity, not in the Olympic athlete or the Nobel prizewinner. We see Christ in the broken, the malformed, the imperfect. It is an example of the Easter mystery. God is revealed, not in glorious majesty but in a broken body on a cross."

Though Trishna and Krishna were living their lives in bodies deformed and facing suffering and death, their lives were seen as having a high value by Moira Kelly, the 'Children First Foundation', supporters of the foundation and the large team of medical practitioners. As a result, they were prepared to go to extraordinary lengths to save them.

In a world so keen to use genetic screening to abort all but the most perfect foetus (see my previous post on 'Prenatal Genetic Testing), the story of these little girls is special. Psalm 139 helps us to understand that though these little girls may have been malformed in their mother's womb, they were known by God and precious to him:

For you formed my inward parts;
you knitted me together in my mother’s womb.
I praise you, for I am fearfully and wonderfully made. Wonderful are your works;
my soul knows it very well.
My frame was not hidden from you,when I was being made in secret,
intricately woven in the depths of the earth.
Your eyes saw my unformed substance; in your book were written, every one of them,
the days that were formed for me,
when as yet there was none of them.

Psalm 139:13-16

Praise God that these little lives were also precious to Moira Kelly and the medical team that has separated them.

Related posts

a) A mother praises God for her conjoined towns - In a similar case of conjoined twins, a mother raised eye brows in January this year when she greeted the news that she was to have dicephalous twins, the rarest known type of Siamese twins, with the comment:

"Some people might look at me and say, 'You're going to give birth to a freak' - but I don't care because I feel blessed......To me, my twins are a gift from God and we're determined to give them their chance of life."

Read the post HERE.

b) The latest on Trishna & Krishna - The girls are still doing well (HERE & HERE)

c) MP3s of Prof John Wyatt's lectures on 'Bioethics and Future Hope' (HERE)

d) All previous posts on medical ethics (HERE)

'Exclusion & Embrace' - Identity, otherness and reconciliation

In our next issue of Case magazine (#21) we will examine 'Otherness'. The issue will offer a theological exploration of a topic that has long interested philosophers, sociologists and psychologists. Being able to define the 'other' (someone not like myself) is part of how we define the self. It is also the basis on which individuals, groups, communities and societies in general reject or distance themselves from other people; we use perceptions of difference to exclude rather than to 'embrace' (to use Volf's term). Miroslav Volf's work is central to much recent discussion of the topic and hence is important to the theme that we address. In his book 'Exclusion & Embrace: A Theological Exploration of Identity, Otherness, and Reconciliation', Volf suggests that understanding the problem of identity and otherness and the conflict that results, can be approached from multiple perspectives including that of the 'universalist' who seeks to control difference and instead promote common values, the 'communitarian' who seeks to celebrate all difference and promote heterogeneity, and the 'postmodernist' who wants to flee both of the above and seek instead the radical autonomy of the individual. But Volf (1996, pp 20-21) suggests that a Christian examination of otherness should take us in a different direction:

These proposals [i.e. the above arguments] do entail important perspectives about persons who live in societies, but their main interest is not social agents, but social arrangements. In contrast, I want to concentrate on social agents. Instead of reflecting on the kind of society we ought to create in order to accommodate individual or communal heterogeneity, I will explore what kind of selves we need to be in order to live in harmony with others. My assumption is that selves are situated; they are female or male, Jew or Greek, rich or poor - as a rule, more than one of these things at the same time...often having hybrid identities...and sometimes migrating from one identity to another. The questions I will be pursuing about such situated selves are: How should they think of their identity? How should they relate to the other? How should they go about making peace with the other?

Volf suggests that our starting point in this journey of discovery should be the cross of Christ, for it is the starting point to understanding the character of the Christian self in relation to the other. He suggests that Moltman's work (e.g. 'The Spirit of Life' 1991) offers insight into our need for solidarity with those who suffer and are excluded - "the sufferings of Christ are not just his sufferings but are those of the poor weak, which Jesus shares in his own body and in his own soul, in solidarity with them". As well, Moltman points to the need for atonement for the perpetrators of injustice - "just as the oppressed must be liberated from the suffering caused by oppression, so the oppressors must be liberated from the suffering caused through oppression". But Volf suggests we need to go further, we need to consider "divine self-donation for the enemies and their reception into the eternal communion of God" (Wolf, 1996, p. 23). In doing this, Volf seeks to consider the social significance of the theme of divine self-giving. God does not abandon the godless to their evil. Instead, he gives the divine self for them in order to receive them into divine communion through Christ's atoning sacrifice. As a result, he argues, we too should embrace our enemies. The metaphor of embrace he suggests is helpful in moving us in this direction. He describes it this way:

'The will to give ourselves to others and 'welcome' them, to readjust our identities to make space for them, is prior to any judgement about others, except that of identifying them in their humanity. The will to embrace precedes any 'truth' about others and any construction of their 'justice'. This will is absolutely indiscriminate and strictly immutable; it transcends the moral mapping of the social world into 'good' and 'evil'." (Volf, 1996, p. 29).

Volf's ideas are personally challenging for me, living in the relative comfort of a western nation with stable government and in a pluralistic society that at least claims to embrace the isolated, the weak, the disabled, the alien, the oppressed. While I see myself as a person with a sense of justice and a heart for the oppressed, I'm repulsed at times by the inner attitudes of my heart to the 'other' that may manifest themselves in politely ignoring needs, avoiding those who I see as different, condemning those who do evil and so on. I find it easy to embrace those who share much in common with me, but in my community how would I deal with the paedophile, the alien of radically different faith, the severely disabled, the homeless, the drug addict and so on. What does my understanding of the divine self-donation of the Cross mean for the construction of my identity and my relationship with the 'other' under the varied conditions of life?

If you are interested in these issues then check out Case. Case magazine is published quarterly. Issue 21 is due out in December. For more information consult the CASE website (here).

Bioethics and Future Hope: An Eschatological View of the Future

A recap of Talks 1 & 2

Last night Professor John Wyatt presented his final talk in the 2009 New College Lectures - ‘Bioethics and Future Hope’. In his first talk (here) he described two alternative worldviews, one he termed materialistic which he suggested sees life as the result of random events with no underlying purpose; matter is all there is. He contrasted this with a Christian worldview that sees the cosmos as founded in the intentions of a Creator. Humans he argued are the creative work of God and are made in his image. Each worldview he argued leads to different views of personhood that shape our choices about life and death.

In his second lecture (here) he took this further and challenged the materialist’s view of life, that it is little more than well-evolved matter. He stressed that a worldview based on biblical understanding views humans as both physical and immaterial beings. He critiqued the language of ‘potentiality’ and the philosopher’s notion of a ‘not quite yet a person’ when applied to the embryo, or the ‘no longer a person’ judgement made of the terminally ill, demented or brain injured person in the final stages of life.

He also talked of the different views of pain and suffering, life and death that flow from these different worldviews. He pointed to the great fear of our time - loss of independence and autonomy - and the renewed acceptance of an old folly, seeing suicide and euthanasia as noble ways to die when faced with what is judged to be a less than human existence. Such a judgement he reminded us overlooks the fact that sometimes the image of God is seen most clearly in brokenness and the imperfect.

A Christian understanding of future hope

In his final talk he closed the circle by not only considering the end of life but our future eternal hope. The physical universe and our place within it have a clear purpose, hope and future. He argued that our future would not be a human construct, an artefact of our ingenuity and the ability to control our destinies. Instead, he suggested that the future is a reflection of the loving purposes of God. In Jesus we not only see God but the perfect human being, the one in whose likeness a new creation will spring.

Paul in writing to the church in Rome expressed our future hope this way:

For I consider that the sufferings of this present time are not worth comparing with the glory that is to be revealed to us. 19For the creation waits with eager longing for the revealing of the sons of God. 20For the creation was subjected to futility, not willingly, but because of him who subjected it, in hope 21that the creation itself will be set free from its bondage to corruption and obtain the freedom of the glory of the children of God. 22For we know that the whole creation has been groaning together in the pains of childbirth until now. 23And not only the creation, but we ourselves, who have the firstfruits of the Spirit, groan inwardly as we wait eagerly for adoption as sons, the redemption of our bodies. 24For in this hope we were saved. Now hope that is seen is not hope. For who hopes for what he sees? 25But if we hope for what we do not see, we wait for it with patience. (Romans 8:18-25)

The need for a biblical (NOT secular) eschatology

As he concluded the series Professor Wyatt challenged the audience to consider a biblical eschatology that speaks of the coming kingdom of God founded in and through Christ. This was our only hope, not a secular eschatology that places our hope in humanity's ability to reconstruct the future.

In pointing to the Bible’s eschatological view of the future (as both a Christian and a medical practitioner) he reminded us that in Christian thought, love is joined with the other virtues of faith and hope:

'And now these three remain: faith, hope and love. But the greatest of these is love’ (1 Cor 13:13)

“They are virtues which all point to the future. To use theological jargon, they are eschatological virtues, pointing towards the end times. When we love someone in the present, showing practical, empathic, respectful, sacrificial caring, we are also pointing them to the future, to the hope of the resurrection. We are treating someone now in the light of what they are going to be. This is why we can still respect and treat with dignity even the most tragically damaged of human beings. The malformed baby, the person in the persistent vegetative state, the profoundly demented individual are those who can, in God's grace, be transformed to become a new creation. So practical Christian caring for those with a degenerative condition like dementia is not a sentimental nostalgic reaction, treating someone with respect just because of what they once were. We treat them with respect because of the God-like image that, in his grace, they will display in the future. In fact, Christian love can only be intelligible in the light of the Christian hope.”

You can download all three talks as MP3 files from the New College Website (here).

Related Links

Post on Talk 1 - 'Bioethics and Creation' (here)

Post on Talk 2 - 'Bioethics and Redemption' (here)

Full details on the lectures (here)

All CASE posts on medical ethics (here)

Information on John Wyatt's book 'Matters of Life and Death' (here)

Bioethics and Redemption: Understanding pain, suffering and death

Prof John Wyatt presented the second of three public lectures in the annual New College Lectures last night. His second talk was titled "Bioethics and Redemption". Like his first talk (here) he spoke with humility and grace; treating a complex topic and difficult issues with great sensitivity and respect.

1. Christian thinking about the human embryo

He began once again with fundamentals – human development before birth – the “human embryo”, a unique type of being. Not a baby 'not quite born', nor a collection of genetic material. It is something unique, different in kind. He then went on to consider what it is to be human – a foundational ethical issue. In considering this, he spoke helpfully of two tensions. First, between the 'physical and the immaterial' - two aspects of 'being' locked together in humanity. Humans are fully physical and fully ‘immaterial’. He reminded us that 'materialists' (e.g. Peter Singer) would want to see humans as machines that have achieved a level of self-consciousness. The 'philosophical idealist' he suggested would see us as spiritual beings attached to bodies for a time. Alternatively he argued that the 'biblical anthropologist' denies both these positions and suggests that we are at one and the same time physical and spiritual beings. This tension he reminded us is seen in the incarnation (Jesus – fully human and fully God), the Bible (human writers divinely inspired), divine providence (God at work through the evil acts of men who crucify God’s Son).

The second tension he mentioned was between the ‘already’ and the ‘not-yet’. The Bible would suggest that we are already human beings but in Christ becoming something else. We are already made in God’s image, but we are being transformed into the likeness of Christ (2 Corinthians 3:18). He then critiqued the language of 'potentiality' and the philosopher's notion of 'not quite yet' a person when applied to the embryo. He suggested that we should stop talking of Human Embryos and begin talking of ‘Embryonic Humans’ that could sit alongside the use of terms like foetal humans, adult humans, geriatric humans and resurrected humans.

2. Conflicting views on evil, suffering and death

He suggested that to the 'materialist', all evil is a consequence of "meaningless molecular interactions". Hence the minimisation of suffering becomes the supreme moral good and suicide a noble death.

He offered new insights into the potential of stem cell research for good, but questioned the use of human stem cell research and the harvesting and creation of embryos for varied purposes. He pointed out that there are ethically acceptable alternative sources of stem cells, including adult bone marrow, skin cells and umbilical cord blood and tissue.

We then considered what I would call the major public ethical dilemma of the last few weeks in this Australia. We have felt the pain of Christian Rossiter, who wants to die and escape what he sees as “being a prisoner in his own body” (see reference to this story here). How are we to respond to these types of real life situations? There are challenges for all in the face of suffering, but this is more acute for a humanity that sees suffering, death and pain as things that are meaningless and that have no place in their worldview. He put his finger on one of the great fears of our time – loss of independence and autonomy. Suicide and euthanasia are increasingly seen as noble ways to die, when faced with what is seen as meaningless suffering and what is judged to be a less than human existence.

3. Christian perspectives on death and suffering

We then considered a Christian perspective on death and suffering as Prof Wyatt brought us back to the Bible. He argued that death is not natural and was not part of God's plan (some will want to challenge this view), and that for many, it can only be seen as the ultimate terror. But the Bible teaches that the Christian's attitude to death and suffering is to be different – it is not meaningless, for it comes from the hand of God and it produces endurance, character and hope (Rom 5:1-11). He then argued that in Christ (his incarnation, death and resurrection) we find the lens through which we must view our painful contemporary dilemmas. It is in the hope of Christ that we find peace, complete redemption, eternal joy and fulfilment in worship and praise of our God.

Professor Wyatt illustrated how the Christian hope can change the way we view suffering and death with stories of people from his own clinical and personal experience, who have gone where few of us have been, and where none of us would choose to go. And yet, in each case he pointed out, that the people who had suffered from degenerative disease, the birth of a child with a degenerative illness or disability, the evil of rape and a resulting pregnancy, had all seen God glorified and their lives enriched in the midst of pain and suffering. The ultimate paradox it would seem is that sometimes the image of God is seen most clearly in brokenness and the imperfect, with of course the cross being the ultimate example. Pain and suffering can be transformed by the grace of God and used for his purposes.

Finally, he challenged us to avoid judgement and stand instead with people who go where we would never want to go. We are to love and serve them as God works out his redemptive plan for their lives and in fact all of his creation. Whether it is through better palliative care, pregnancy support centres or support of families in crisis, we must offer alternatives that help people to deal with pain and suffering and point them to the hope of Christ. His 3rd talk tonight is titled 'Bioethics and Future Hope'.

You can download all three talks from the New College Website as MP3 files (here).

Related posts

Full details on the lectures (here)

Post on talk 1 in the series on 'Bioethics and Future Hope' (here)

Other CASE posts on medical ethics (here)

John Wyatt's book 'Matters of Life and Death' (here)