Through a glass darkly: Coping with ethical and theological uncertainty

1. Through a glass darkly: Coping with ethical and theological uncertainty D Gareth Jones

2. The disconcerting world of modern medicine Has medicine gone too far? Have Christian drivers been replaced by a secular humanistic worldview? Makes for good polemical debate The science-faith divide is just beneath the surface of the rhetoric My general attitude towards medical technology is cautiously positive

3. The disconcerting world of modern medicine Is medicine intruding into divine centre of human existence, especially at beginning and end of life? Divine chance has been replaced by non-divine choice Sentiments about ever-increasing power of medical technology are rife with theological overtones

4. The disconcerting world of modern medicine Has the divine been displaced from everyday life? Prayer appears to fail but a drug is effective Temptation to maintain ethical and legislative status quo Cannot sit back and decide where we do or do not go No technology is perfectly developed

5. Where I am coming from A Christian searching for directions for medicine and for theological guidance How might theology contribute to a world dominated by biomedical intrusions? When to use technology and when to desist Dependence upon God and his direction

6. Where I am coming from ‘For now we see through a glass, darkly; but then face to face: now I know in part; but then shall I know even as also I am known.’ ‘Now we see only puzzling reflections in a mirror, but then we shall see face to face. My knowledge now is partial; then it will be whole, like God’s knowledge of me.’ 1 Corinthians 13:12

7. Where I am coming from We are walking in uncertain territory The ground we are covering was unknown to the biblical writers Assurance versus despair We do not see as clearly as we would like

8. Theological guidance . . . the use of the Bible is not a matter of selecting texts and of trying to apply them as though they were legislation for modern situations. . . . the Bible’s primary function is to bring us to faith and to keep us in faith. The faith which we confess is faith in a God who responds to human need, who justifies the unrighteous and who seeks the outcast. The Bible lays upon us imperatives that derive from the heart of our salvation, and our task is to work out those imperatives in the situation in which we find ourselves. John Rogerson

9. Theological guidance The Bible does not address in any direct manner the techniques available in modern societies ‘Include unborn children along with the defenceless and minorities whose task it is for the strong to defend’

10. Theological guidance Allen Verhey’sinterpretive rules: Scripture is to be read • humbly • avoiding interpretive arrogance • within the context provided by the Christian community

11. Theological guidance 1. Humble Not one of us has assured answers on every point raised by current bioethical debate 2. Avoid interpretive arrogance Questionable bioethical assertions that go way beyond any views that the biblical writers could possibly have had in mind

12. Theological guidance 3. No privatization of ethical deliberation We cannot determine a Christian response without reference to a wider Christian community We need each other within community of faith The strange world of sickness in Scripture

13. Theological guidance ‘In memory of Jesus and in hope the Christian community will delight in human flourishing, including the human flourishing we call “health”, but also be able to endure even the diminishing of human strength we call “sickness” with confidence in God’ Verhey

14. Theological guidance • respect for the embodied integrity of people • their freedom and identity • the need to nurture community • to support, care for and cure the sick Limited nature of our medical powers - we are not to have extravagant expectations

15. Theological guidance Not yet character of our life and medicine ‘The memory of Jesus does not provide any neat and easy resolution to such conflict. It does not usher in a new heaven and a new earth, either. Here and now there is ambiguity.’ Verhey Techniques should not become idols around which we create an alternative salvation-history

16. Theological guidance Ian Barns argues that: ‘the project of transcendence through technology is unsustainable and a destructive folly, and that human life needs to be lived gladly within the limits and diverse possibilities of our existing material condition’ We do not aim to project human power but trust God and become a suffering servant Address what it means to be human in a post-human(ist) culture.

17. Theological guidance Influence of Jesus felt in acts of healing, exorcism and control over nature To take seriously contribution of science and technology to Christian imperatives Provide guidance in face of dilemmas

18. Theological guidance Neil Messer - four diagnostic questions: • Is the project good news to the poor, powerless, oppressed or marginalized? • Is the project a way of acting that conforms to the imago dei, or is it an attempt to be ‘like God’?

19. Theological guidance • What attitude does the project manifest towards the material world (including our own bodies)? • What attitude does the project manifest towards past human failures?

20. Theological guidance The same principles will be interpreted in a variety of ways by different commentators None to be dismissed if seeking to faithfully reflect core principles ‘A more theologically adequate attitude to the physical will . . . recognize the material world as good and worth taking trouble over, yet flawed and in need to transformation and will not make the mistake of thinking that physical life in the present material world exhausts what humanity has to hope for.’ Messer

21. What sort of assistance does the Bible provide? Do the biblical writers provide any specific input? Possible approaches: • The Bible alone provides a complete guide to ways in which Christian decision-making should be framed, making scientific input irrelevant

22. What sort of assistance does the Bible provide? • The Bible is one of a number of sources of concepts and information, but is the major determinant whenever there is conflict or confusion • The Bible is one of a number of sources and helps to inform decision-making, but may not be the major source • The Bible is irrelevant and hence can provide nothing of any interest to scientists or ethicists

23. What sort of assistance does the Bible provide? A real life scenario A couple had two new grandchildren, first a girl who epitomized the delight of a gorgeous newborn, then a boy who turned out to have cystic fibrosis (CF) How should the grandparents respond as Christians?

24. What sort of assistance does the Bible provide? Their grandson with CF is intimately dependent upon a very high level of technological expertise • Science and technology at its most impressive, and in the service of humanity • Centrality of research: The life expectancy of those with CF has been transformed over the past 20-30 years

25. What sort of assistance does the Bible provide? The parents begin to contemplate the birth of a second child Options • Take a chance, and hope their next child will be unaffected. Continue the pregnancy whatever eventuates - the welfare of the child is in God’s hands

26. What sort of assistance does the Bible provide? • Take a chance and have an abortion as a last resort if the fetus turns out to be affected – a morally tainted path • IVF and PGD (pre-implantation genetic diagnosis). Only an unaffected embryo would be transferred; an affected embryo would be discarded - a very delicate and uncertain path spiritually

27. What sort of assistance does the Bible provide? They have to choose, and have to live with the repercussions and consequences Child with CF; child without CF; embryos/fetuses that will never live as children Parents cannot escape ethical decision-making and making choices that resonate with theological meaning

28. What sort of assistance does the Bible provide? Competing forces pit one life against another, and one set of values against another set Where does the Bible enter the picture? One answer: protect embryo or fetus at all costs • Is this perspective based upon unequivocal biblical teaching?

29. What sort of assistance does the Bible provide? How far does the Bible take us? Category 1 Difficult to see how the Bible taken in isolation of scientific input can possibly provide the only relevant input for decision-making in these circumstances

30. What sort of assistance does the Bible provide? Categories 2 & 3 More plausible Driving force is the balance between biblical and scientific inputs, and the extent of any biblical input Treatment will be scientific in nature Way in which science used will stem from Christian character of decision-making

31. What sort of assistance does the Bible provide? Option 1 (accepts what comes) Perfectly acceptable, but not self-evidently the only or even the ideal way for Christians • rejects some possibilities of scientific advance • Prepared to allow damaged individual into world when this could be prevented

32. What sort of assistance does the Bible provide? Option 2 (possible abortion of affected fetus) Most problematic • severe negative repercussions for parents • life-denying • no clear biblical warrant one way or the other • Need to assess interests of all involved

33. What sort of assistance does the Bible provide? Option 3 (use of IVF/PGD) • financial costs • invasive • choosing one embryo over another; inevitably destroying embryos • What resources do Christians possess?

34. What sort of assistance does the Bible provide? Theological perspectives • protect the defenceless and disenfranchised • importance of human flourishing • our ultimate dependence upon God • human life is not devoid of meaning simply because it is physically flawed

35. What sort of assistance does the Bible provide? • transformative power of the healing that Jesus brought and that can be experienced today • grateful for medical achievements bringing hope Uncertainty and ambiguity The limited nature of human powers should never be downplayed

36. What sort of assistance does the Bible provide? Balance conflicting interests: reflect relationships that characterize family, human and church communities Any decision will be an agonizing one (dispose of affected embryos?) Remain ignorant; take what comes Technology makes certain things possible, but with this come inevitable ethical choices

37. What sort of assistance does the Bible provide? Do we have biblical mandate for remaining ignorant? Is freely chosen ignorance a Christian virtue? Is this a denial of biblical mandate to be stewards of God’s creation? Is ignorance in-and-of-itself a moral virtue? Genetic advance forces us to confront and then make hard choices

38. What sort of assistance does the Bible provide? Paul and applied ethical issues (1 Corinthians 8) – eating food sacrificed to idols “Knowledge puffs up, while love builds up” Never resort to a technological solution withoutconsiderable reflection; put into broad human and divine framework A technological direction as an end-in-itself will end in dehumanization; ignorance as an end-in-itself leads to fatalism Trust in God as basis for all 3 options

39. Concluding comments There is guidance to be found in the Bible Guidance is at general level; leaves great deal to the judgement and discernment of individuals and communities Are there also more precise and finely honed directives in Scripture (world of rules and regulations, and cautious prohibitions)?

40. Concluding comments Simple formulae stem far more from extra-biblical thinking than from anything inherent within Scripture How does one act as a Christian in the midst of the tensions and pressures? Act as Spirit-led decision-makers using our God-given abilities and responsibility to be his people in a far from ideal world