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Christian Bioethics

Agneta Sutton
T&T Clark, 180pp

Christian BioethicsBiomedical science is raises ethical questions that previous generations have not needed to think about. We are faced with unprecedented choices, often concerned with the ability to manipulate human life. Many people are perplexed about these issues. What actually is going on? What principles can we employ in deciding whether a particular activity is right or wrong? Does a religious faith help in this decision making?

Dr Sutton certainly sets out her stall very clearly. She states firmly that in our ethical thinking about (bio)medical issues, ethics that was developed within a traditional Hippocratic/Christian framework has been replaced by ethics developed in a purely secular context. The former majors on the sanctity of life, and embodies a strong duty, amongst other things, not to hasten the end of a patient's life. The latter, exemplified by the four principles of medical ethics - autonomy, beneficence, non-maleficence and justice (set out by the American medical ethicists Beauchamp and Childress) - is, Sutton says, a utilitarian ethics in which quality of life trumps the sanctity of life.

There is much that could be said here but I will confine myself to three comments. First, I am a little uneasy about the ready conflation of Hellenistic and Christian thought, despite their apparent congruence in this area. Secondly, I do not think that as a general rule, quality of life overrides sanctity of life in current medical ethics. Thirdly, far from representing a utilitarian position, many ethicists, including myself, believe that the 'four principles' of modern medical ethics should be understood as a virtue-ethics position.

Leaving those reservations aside, how does the author apply her thesis to modern bioethical issues? The bulk of the book covers the more controversial topics in modern medicine, including beginning of life issues, genetics and eugenics, stem cells, cloning and end of life issues. In reading these chapters I am reminded of a longstanding church member who was asked 'I suppose you've seen many changes in this church' and replied 'Yes, and I've opposed every one of them'. The reader is left in doubt about what Dr Sutton regards as the Christian view: it is the traditional Roman Catholic position with very little room for manoeuvre. From that standpoint, most of the developments that she discusses are wrong. I acknowledge that for some of these issues, conservative Protestant Christians will agree with her, but in general it seems too simplistic to present her conclusions as the only Christian perspective. Other viewpoints espoused by Christians of other traditions barely get a look in - not until p78 is there a hint that other Christians may think differently about these topics. The bibliography confirms the one-sidedness of the text: there is large hole in the range of Christian authors quoted in this book.

I must also say that many of the arguments are not convincing and in some places the logic seems confused. I cite two examples. The first is her discussion of the Tony Bland case where she states, 'Tube feeding was withdrawn ... with the express intention that he should die. Tony Bland was deliberately killed by means of euthanasia by omission. For the first time British courts allowed doctors to bring about the death of a patient.' She fails to point out that one reason the Law Lords gave permission to withdraw Bland's feeding and hydration was specifically because they were not benefitting him. And yet she writes, 'Few disagree with the view that there may come a time when neither food nor fluids should be provided, because the treatment is overly burdensome for the dying patient or because his body can no longer benefit from it.' It seems that some very fine hairs are being split here.

Secondly, I refer to the discussion of cybrids. These are embryos generated by somatic cell nuclear transfer ('cloning') but where the recipient cell is the egg of another mammal rather than a human. The recipient cells still contain their sub-cellular particles called mitochondria which contain about 20 genes. These genes, which make up less than 0.1% of the total gene number, have the same function as the equivalent genes in humans. Sutton writes 'if you believe that humans have a different moral status than animals, you will surely consider it an insult to create a ... human who is part animal and who might therefore be described as sub-human'. Leaving aside the fact that these cybrids are created not for reproduction but in order to generate embryonic stem cells (another activity regarded by the author as morally objectionable), this view seems to contradict her statement, 'The recipient of a pig heart or a pig kidney would surely remain as human as the rest of us, since these organs perform mechanical functions not specifically related to our humanity.' A person with a pig heart contains many more non-human genes than a person with rabbit mitochondria.

The book moves to less 'hot' topics. 'How to Treat and Not to Treat Animals' is a welcome inclusion, often ignored in books for a more general Christian readership. Sutton's treatment of the topic is uncontroversial although some readers may think she leans too strongly to one position. 'Ecology and the Guardians of Creation' is another welcome inclusion in a bioethics book, especially because the term 'bioethics' was originally coined in relation to the need for an ethics that encompassed the environment. Unfortunately however, this chapter is brief with several different environmental issues crammed in, so the treatment is rather superficial. Nevertheless, it is a welcome reminder that we are mandated to act as responsible stewards of this planet.

Even those readers who agree with most of Dr Sutton's conclusions need to be aware that there are several factual errors. Some of these are merely annoying to a biologist. Others however are misleading. For example, it is not true that 'in a fully differentiated cell ... only a few genes are switched on'; it is actually several thousand. It is not true that Monsanto are marketing 'high-yielding cereal varieties that self-destruct after one generation'. 'Terminator technology' is not being used commercially by any company. Further, no-one has marketted a specifically high-yielding GM cereal (or indeed any crop) although the effects of GM traits such as pest- or disease-resistance lead indirectly to higher yields. It is not true that 'Darwin's world is one of brutal fight for life in a hostile environment'. It was mostly the commentators on The Origin of Species who put that slant on it.

So, if you read this book, be aware that for the most part it presents a very selective account of Christian attitudes to bioethical issues. You will need to read it with your mind open, and ask whether you are being told what to think or enabled to think for yourself.

John Bryant