Editorial: In search of a consistent ethic of life
I was recently asked to participate in a series of talks designed to stimulate reflection on our responsibility to be stewards of all creation. The topic of my talk was euthanasia.
A friend thought it interesting and even unusual that I should be invited to offer a talk on euthanasia as part of a series focussed on the environment. The question she posed: ‘What has a human moral issue like euthanasia got to do with environmental ethics?’ I find her reaction interesting and instructive.
Her reaction draws attention to a key assumption that shapes contemporary thinking; an assumption that has its origins in the intellectual movement we know as the Enlightenment, a movement that prioritised human reason above all else. The Enlightenment came about as a direct result of scientific insights into the marvellous secrets of nature. But, at the same time, it led us to see the world in a more objectified way. It also led to us seeing ourselves more and more as rational beings separate from, rather than deeply connected with, the rest of God’s creation. In particular, it has fostered a degree of disdain for the natural rhythms of life.
My friend’s question would not have made sense in pre-Enlightenment times because the question itself is an expression of the shift in human thinking that followed the Enlightenment period. While she is actively concerned about the environment and while she recognises that the current crisis is very much a result of human irresponsibility fuelled by a sense of ‘hubris’ based on an inflated sense of our entitlement and power, nevertheless, the separation that exists in her mind between human and environmental ethics buys into and perpetuates the idea that, because of our ability to reason, we humans are essentially separate from the rest of creation.
A recent example of this disconnection was highlighted in a news report about a new law banning the practice of “inducing” cows. Narelle Henderson writes:
“Each year, farmers buy bulls whose job it is to get their cows pregnant. Nine months later, calves are born, and the cows are given about a month to recover, before the two-month mating window opens up again. Now, occasionally a cow or two gets pregnant a little late. That puts it out of sync with the rest of the herd, and makes things difficult for the farmer. They are left with the choice of killing the calf and rebooting the cow's cycle, or killing the cow. Aborting the calf is cheaper and easier” (see http://www.stuff.co.nz/dominion-post/news/politics/10602636/Greens-induced-law-is-kinder-to-cattle).
This practice is undoubtedly appalling. Those who have fought to bring about the law change are to be commended. At the same time, many of the people directly responsible for this campaign continue to advocate for more liberal laws surrounding ‘human induction’. For example, one of the key campaigners against the induction of cows who is on record as describing it as “inhumane and cruel” is also on record as stating that “it’s incredible that abortion is still such a contentious and divisive issue.” Henderson puts it well: “perhaps it is contentious for the same reason calf inductions were; that there is something special (particularly in humans) about this thing called life; that we therefore all (not just doctors and vets) have a duty of care towards it; and that there is hardly any justification for breaching that duty of care. I mean, cows are precious, but surely people are too.”
It’s a classic case of an inconsistent ethic of life.
It is the anthropocentric notion that we are separate (as opposed to ‘distinct’) that has provided the powerful ethical justification for the destructive behaviour that we humans have wreaked upon the environment; it is this notion that has driven our desire to ‘control’ nature and provided the excuse for removing so many of the traditional limits that shaped the interaction between humans and the environment, limits still evident in the rituals, behaviours and cultural and religious beliefs of certain cultures, including our own Maori people.
These days people are, thankfully, increasingly more inclined to act to limit human autonomy in the name of giving due respect to other living things. Yet, paradoxically, people also seem increasingly inclined to leave the ‘moral’ questions about human well-being to people’s individual choice. When it comes to matters of human ‘ecology’ it seems that a different philosophy applies – human autonomy before all else. Ethically speaking, this paradox demands our continued commitment to the destructive idea that humankind is separate (as opposed to distinct) from the rest of creation.
Human reason calls us to be consistent in our ethical reflections. To the extent that we are prepared to see ourselves as deeply connected with all of creation, then questions related to abortion and euthanasia must also be seen as deeply ecological issues – as matters of ‘human ecology’.
We must pay closer attention to the inconsistencies that pervade our deliberations on ethical matters rather than addressing issues relating to the environment and issues relating to human well-being as if they exist in separate ethical silos.
Dr John Kleinsman is director of The Nathaniel Centre.
We have categorized our bioethical articles into 6 categories, select the area which is of interest to see further subcategories and a list of the categories articles.
HDC Consultation on research involving adult participants who are unable to give informed consent.
By The Nathaniel Centre
We note and endorse the idea that “The right to make an informed choice and give informed consent before receiving health or disability services, including participating in research, is the cornerstone of New Zealand’s Code of Health and Disability Services Consumers’ Rights (the Code)”, (HDC Consultation Document, p. 1). In a similar vein, we have previously written about the critical importance of informed consent, advocating that all people have a right not to be experimented on without their knowledge or consent, whatever the nature of the research.i
It is broadly accepted that the history of ‘informed consent’ in human research goes back to the Nuremberg Code of 1947. This Code was developed after the Nuremberg trials at the end of the Second World War which exposed the unethical nature of research carried out by many Nazi researchers. The lesson learnt from this and other well-known instances of unethical research, such as Tuskegee and Willowbrook, is that justifying research on the basis of its potential benefits or outcomes alone, and without reference to the inalienable rights and dignity of human participants, all too easily leads to human exploitation and harm. Upholding informed consent is one of the key ways in which the rights and dignity of research participants can be protected.
In New Zealand, current thinking and practices around ethical review and the centrality of informed consent have been informed by our own instances of unethical research, including the removal and retention of organs from deceased babies without parental consent and the ‘unfortunate experiment’ on patients with cervical cancer carried out at National Women’s Hospital.
The current Code of Health and Disability Services Consumers’ Rights allows research on a person who is unable to give consent totake place only if participation in the research is in the person’s best interests. It thus reflects a strong commitment to the principle of informed consent. It also reflects a commitment to ensuring that the interests of the person must not be subsumed to those of society. In other words, it embodies a rejection of the main premise underpinning utilitarianism, the idea that ‘the greatest good for the greatest number’ is a sufficient measure of what is ethically acceptable.
If there are to be changes to the parameters which currently proscribe non-consensual research on adults, it is critical that our society’s commitment to the notion that the best interests of the person must ultimately always outweigh those of society (Consultation Document, p. 44, n.3) be upheld and not eroded in any way.
We have previously argued that there can be legitimate exceptions to the requirement that informed consent be obtained from research participants in certain exceptional circumstances. Thus, in 2015 we wrote that the “only exceptions to this are in circumstances where (i) the research is strictly observational or (ii) participants are, for various reasons, unable to give consent, in which case consent must be sought from someone legally entitled to provide consent for them.” In the same article we alsostated: “In exceptional circumstances, limited disclosure may be justified or consent might be obtained retrospectively, for example because of the need to avoid a biased response. It is also possible to seek a waiver of consent where the risk is low and where there are strong reasons why it would not be practical or possible to obtain consent.” We then added: “… in these situations, the ethical rider is that such research must always be held up to close scrutiny by an appropriately accredited and independent review body.”ii
We note that current practice in New Zealand, by allowing consent to be waived in circumstances when it is deemed to be in the person’s best interests, already constitutes an exception to the principle of informed consent, albeit a very narrow one. This debate, therefore, is about the scope of such exceptions in New Zealand and, more specifically, whether they might now be broadened to include some situations where research on a person unable to give consent is justified on grounds other than being in their personal best interests.
Our overall position is that we are not in principle opposed to broadening the parameters which regulate non-consensual research on adult participants.
Our response to the two fundamental questions posed in the Consultation document (“Are New Zealand’s current laws regarding non-consensual research [involving adult participants] appropriate and, if not, how should they be amended?”(Consultation document, p.2)) reflects our belief that it is, in theory, both possible and ethical, in certain proscribed circumstances with adequate scrutiny and safeguards, to broaden the circumstances in which consent for adult participants in research might be waived.
We add the qualifier “in theory” because we believe that any moves to broaden the parameters around non-consensual research would only be acceptable within a system of robust, accredited and independent ethical overview. Given the experience of two of the writers of this submission who have previously served as members of a HDEC Ethics Committee for a combined period of 11 years, our concern is that some of the more recent restructures of New Zealand’s HDEC ethical review system have contributed to a less comprehensive and less robust system than was previously the case – fewer committees and fewer members as well as a significantly narrower set of criteria for determining when research requires HDEC review.
Any moves, therefore, to change the current law must, in our mind, first be considered against the current effectiveness of ethical review committees in New Zealand. In which case, a decision in principle to broaden the criteria for non-consensual research might be considered unworkable or unsafe in the current context of ethical review. The decision might, therefore, be made not to proceed with any changes for pragmatic reasons even while it was otherwise considered ethically acceptable in theory.
In the event it was deemed practically acceptable to broaden the parameters, it is our firm belief that, because of the inherent risks in non-consensual research, such applications should require an additional layer of scrutiny to what is already currently available by a group under the auspices of the Health and Disability Commissioner’s Office that includes representatives of, or people able to speak on behalf of or advocate for, the group of persons on whom the research will be carried out.
When reflecting on why it might be ethically acceptable to allow non-consensual research on a person when it is not in their best interests and when it will introduce an element of risk, the obvious answer is that there will be benefits for others, whether persons in similar circumstances or, perhaps, society in general. Herein lies the greatest danger in broadening the parameters of non-consensual research because any such move inevitably opens the door to the sorts of utilitarian arguments and premises that have characterised unethical trials such as Tuskegee and Willowbrook.
This danger reinforces for us the need to de-lineate three other parameters when evaluating non-consensual protocols: (i) ‘the interests of the person must always be assumed to outweigh those of society’; (ii), in situations where this is not clear for a specific person, the ‘precautionary principle’ must be automatically invoked which dictates that the person not be included and (iii), any expression of dissent (“whether by showing signs of resistance or otherwise” – Mental Capacity Act 2005 (England and Wales) as quoted in Consultation Document, p. 43) from a potential participant incapable of giving consent should be regarded as sufficient reason for them not to be included (see also Declaration of Helsinki, as quoted in Consultation Document, p. 58).
In addition, as we highlighted in our submission to the National Ethics Advisory Committee (NEAC) on “Cross-sectoral Ethics Arrangements for Health and Disability Research” (February 2015), we see that it is a significant weakness of the current system of ethical review in New Zealand that there is no mechanism for checking that a particular study is carried out according to the agreed protocol. We believe that such follow up should be mandatory for all non-consensual research projects, something that will require a specific mechanism to be created and funded. This requirement, we note, is stipulated in Paragraph 24 of the Declaration of Helsinki under the heading of Research Ethics Committees: “The committee must have the right to monitor ongoing studies.”
Whereas some might see such requirements as creating unnecessary barriers for researchers, we see that they will ensure that non-consensual research proceeds only when it is absolutely required, and that non-consensual research is undertaken with a strong focus on ethical practice.
An Adjusted Framework for Non-consensual Research on Adult Participants:
Our suggestion is that an adjusted New Zealand Code follow and reflect the relevant sections of the Declaration of Helsinki which address the question of non-consensual research:iii
28. For a potential research subject who is incapable of giving informed consent, the physician must seek informed consent from the legally authorised representative. These individuals must not be included in a research study that has no likelihood of benefit for them unless it is intended to promote the health of the group represented by the potential subject, the research cannot instead be performed with persons capable of providing informed consent, and the research entails only minimal risk and minimal burden.
29. When a potential research subject who is deemed incapable of giving informed consent is able to give assent to decisions about participation in research, the physician must seek that assent in addition to the consent of the legally authorised representative. The potential subject’s dissent should be respected.
30. Research involving subjects who are physically or mentally incapable of giving consent, for example, unconscious patients, may be done only if the physical or mental condition that prevents giving informed consent is a necessary characteristic of the research group. In such circumstances the physician must seek informed consent from the legally authorised representative. If no such representative is available and if the research cannot be delayed, the study may proceed without informed consent provided that the specific reasons for involving subjects with a condition that renders them unable to give informed consent have been stated in the research protocol and the study has been approved by a research ethics committee. Consent to remain in the research must be obtained as soon as possible from the subject or a legally authorised representative. (Our emphasis added).
In summary, we argue that the key points of an adjusted Code which would broaden the parameters within which non-consensual research could be carried out in New Zealand are:
The research cannot otherwise be carried out using participants capable of providing informed consent and …
The research will directly promote the health of the group represented by the potential subject and …
The research entails only minimal risk and minimal burden and …
The potential subjects’ dissent, however it is expressed is respected absolutely and …
The research may be done only if the physical or mental condition that prevents giving informed consent is a necessary characteristic of the research group and …
Informed consent is sought from a legally authorised representative and …
The research is given a full review by the appropriate accredited HDEC Committee and …
The research is subject to an additional layer of scrutiny by a group that is overseen by the Office of the Health and Disability Commissioner, a group which includes representatives of, or people able to speak on behalf of or advocate for, the group of persons on whom the research will be carried out and …
There is ongoing, independent, effective and active monitoring of the research project while it is being carried out and …
The participants’ confidentiality is absolutely respected and …
In cases where a participant regains consciousness after having been included in a trial, they are given the option of having their data withdrawn where that is possible and …
Any data that is retained after a study is only able to be used for further research in an aggregated or totally anonymous form unless separate independent ethical consent is sought.
We are in principle open to the parameters of non-consensual research being broadened within New Zealand in line with the World Medical Association Declaration of Helsinki that we have outlined above. What we are proposing would involve moving from the “best interests framework” that characterises current practice in New Zealand to one that takes account of and permits a degree of minimal risk and minimal burden to participants.
The key questions in moving to an approach that tolerates a degree of risk are ‘Who decides?’ and ‘How will assessments about “minimal risk” and “minimal burden” be made?’ For this reason, we have argued that there must first be a degree of confidence in the current system of ethical review in New Zealand. That is, a determination must be made that the HDEC review committees are adequately resourced and adequately trained to foresee and prevent the sort of excesses that have characterised research on vulnerable persons throughout the 20th Century in numerous places around the world including New Zealand.
While broadening the parameters of non-consensual research carries inherent attitudinal risks because it can dispose society to the dangerous excesses of utilitarian thinking and make certain actions which undermine the inherent dignity of persons seem morally acceptable, we think this risk can be safely managed by the introduction of an additional layer of ethical scrutiny that is carried out under the auspices of the Office of the Health and Disability Commissioner.
Sue Buckley (PhD) has been involved in social and health research over the last 16 years in both government and university contexts.
Associate Professor John France (PhD, DSc, FAACB) is a reproductive scientist (now retired). He is a former member of the Auckland Health and Disability Ethics Committee and former member and Deputy Chair of the Northern Regional Health and Disability Ethics Committee.
John Kleinsman (PhD) is director of The Nathaniel Centre and a former member and Deputy Chair of the Central Region Health and Disability Ethics Committee. He is a current member of two Institutional Research Ethics Committees.
i Kleinsman, J, and S. Buckley. "Facebook Study: A Little Bit Unethical but Worth It?" Bioethical Inquiry 12, no. 2 (2015): 179 - 82.
iii Declaration of Helsinki. 64th WMA General Assembly, Fortaleza, Brazil, October 2013. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/
Fairness [SYNOPSIS ONLY]
By Greg Coyle
In this article, Greg Coyle reflects on the question of ‘fairness’. New Zealand, a society that once prided itself on offering ‘a fair go for all’, is more divided than ever in its approach to fairness. After discussing several approaches to justice as fairness, the article offers a framework for a better understanding of what is ‘fair’ for New Zealand families today.
The full article is available by subscription to The Nathaniel Report
The History of Eugenics [SYNOPSIS ONLY]
By Petrus Simons
Petrus Simons offers a succinct history of the eugenics movement. Beginning with Francis Galton’s definition of eugenics as the use of selective breeding for desirable traits to improve a species, the article describes how this idea was adopted and applied to humankind. While it is a well-known feature of the Nazi regime, the article argues that the spectre of eugenics remains.
The full article is available by subscription to The Nathaniel Report
Editorial - The Many Faces of Human Dignity
‘Dignity’ is one of those rich terms we encounter often but its precise meaning can be difficult to pin down. Consequently, we find people using the term to justify very different and even opposing behaviours.
As an example, people with differing views about assisted suicide claim equally to be promoting human dignity. The only way of making sense of this is to conclude that many employ the term in a very shallow and broad way. If, for instance, it means nothing more than treating people ‘well’, or treating people with ‘respect’ according to the particular way each of us happens to define that notion, then the concept of dignity provides very little in the way of consistent ethical guidance.
For those wanting to grapple with a deeper and more precise meaning of human dignity, the distinctions between ‘intrinsic’ and ‘extrinsic’ dignity provide a useful way of unpacking the significance of the term as well as the differing moral duties that ensue depending on which understanding one is committed to.
An extrinsic approach ties dignity to the circumstances one finds oneself in, or to the way persons see themselves or are seen by others. According to this understanding dignity can be conferred or taken away, something akin to the clothes people wear; able to be removed, changeable according to fashion and existing in differing states of ‘finery’ conveying a socially constructed ‘judgement’ about the worthiness or non-worthiness of the lives of certain persons or groups of persons. Extrinsic dignity is essentially variable, shaped by the particular stories about human meaning and flourishing that exist at any point in time and thus susceptible to the vagaries of the social matrix of family, culture, society and religious and institutional traditions.
Critically, the understanding of human dignity in a cultural milieu such as ours, with its (over) emphasis on individuality, independence and productivity, takes on a strongly ‘functionalist’ flavour – to be dignified is to be strong, fit, self-reliant, healthy and productive. Conversely, where this approach dominates, it follows that one of the greatest ‘sins’ against human dignity is for a person to become a ‘burden’ to others or society. The increasing hold of the functionalist mind-set within New Zealand society is evidenced by the growing social isolation being experienced by large numbers of elderly in New Zealand – a continuation of the practice, throughout history, of societies marginalising those it perceives as socially unacceptable or unworthy.
By contrast, the United Nations Universal Declaration on Human Rights1 notes that “recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.” This gives rise to two insights: (i) the claim that dignity is “inherent” or intrinsic and (ii) the critical role this concept plays in upholding human freedom, justice and peace.
What exactly do we mean by saying that dignity is intrinsic? The philosopher Immanuel Kant speaks of the formula of the end in itself: “Act so as to treat people always as ends in themselves, never as mere means.” We ought, in other words, to treat each and every person as having a value that is all their own; we must treat everybody as being valuable in and of themselves no matter what.
According to this approach, human dignity is a quality that inheres in each and every person by virtue of the simple fact that they have a human nature. It demands a scrupulous respect for all human life, whatever the situation or context, and it rails against the instrumental or functional view which reduces the person to being an instrument for various socially determined interests – invariably the interests of the powerful, healthy and well-resourced.
Considering the second insight that arises from the Declaration on Human Rights, John Dickson gets to the very heart of things when he argues that society needs a solid intellectual ground for caring for those who are no longer productive or functional. “Ancient Greece and Rome … had little by way of philosophical reasoning that could guarantee the inherent worth of those lacking rational capacity or social utility. So infanticide was common and social welfare for the aged and dying was virtually non-existent. Christianity changed all of that. It inherited from Judaism a theology of human dignity and a program of social welfare [grounded in the belief] that Christ had died for all, even for the lowly and neglected.”
It is my contention that only the concept of intrinsic human dignity inherited from Judaism and Christianity and enshrined in the United Nations Declaration of Human Rights is ultimately capable of bearing the weight of an inclusive, free, just and caring society. This should make us all extremely alert to the dangers posed by the growing acceptance of an extrinsic understanding of human dignity.
In the light of this threat it is urgent that we seek to defend an intrinsic approach to dignity in the broad court of societal opinion. To that end, this issue offers a number of key ‘witnesses’ who present some of the many faces of such a dignity.
Dr John Kleinsman is director of The Nathaniel Centre
 See http://www.un.org/en/universal-declaration-human-rights/, accessed 31 October 2016.
Losing and Finding Dad in Dementia
By Julie Guirgis
Dementia can be spiteful and cruel – when I reflect on who my Dad was before, it helps me separate him from the illness.
Article available online at: http://www.eurekastreet.com.au/article.aspx?aeid=49521#.WDSZmeZ961t
The Dignity and Power of Education [Synopsis Only]
By Anne Tuohy
When the role of education is degraded, the intrinsic value of society and its members can likewise be diminished.
The full article is available by subscription to The Nathaniel Report
Dignity in a Digital World
By Colin MacLeod
I love digital technology! I love being able to read e-mails from a smart-watch, connected to my phone via bluetooth while watching a movie because the same phone is pushing video and sound from the internet to my TV through a dongle in its USB port. As a teacher I love the accessibility of information, the ability to collaborate and create, and the simple, practical ease of retrieving files and storing work electronically. What’s not to love about technology?
But it’s not really about the technology. The best and worst of human behaviour is played out in the electronic realm. People can be friended or un-friended with a click of an icon on a screen. We can post words of comfort and support or vitriolic rhetoric to persons whose faces we will never see. We can donate money immediately to those in need on the other side of the world and not know our neighbours’ names. We can share photos which celebrate humanity with millions and find images no family would ever want in their albums. We can maintain relationships with ease across the whole world, and be utterly alone while doing so. And all the while a new ‘normal’ and relentless ‘change’ unfold to tell us who we are and who we are not, impacting on human dignity in positive and negative ways.
There is a dignity in parenting that seems lost at the sight of a parent pushing a pram with a child inside chattering and pointing, while continuously gazing at a phone. There is dignity in the profound beauty of the human form, and the desire within us to connect with one another, that is utterly broken by addiction to pornography and associated fear of real human contact. Dignity is found in defining our identity, as we grow up through challenges, failures and successes, but it can easily be actively crushed by children who bully someone into becoming suicidal through social media. The dignity of family itself is undermined when a home no longer has a family table because all meals are eaten by individuals in their own spaces with their heads in their own devices. And, at a global level, even the dignity of our planet is at risk through the mountains of scrap dumped by yesterday’s devices and tomorrow’s BYOD.
I read an article some 30 years ago which reflected on the possibility of machines becoming sentient. While I’ve forgotten most of the content, one idea from the reading has always remained and challenged me. “What happens when a machine can choose its favourite colour? Not because of programming, but because of personal choice. Will it then have a soul?”
It challenges me because, in the 80s, the question felt more of a mental exercise in theology, or science fiction, than an actual possibility but, as the years have progressed, the concept looms likely. From Apple to Zuckerberg we are surrounded (and perhaps swamped) by machines and electronic information. Always more, better, smarter. Literally exponential growth as reflected in Moore’s Law.
So far, none of this technology comes close to sentience, despite predictions. Technology does not care about us. It does not reflect on its purpose. It does not love us back and it neither respects nor understands human dignity. Technology cannot choose to serve humanity - it is created by human beings and marketed in ways and forms designed to impact on our lives and generate profits. Unfortunately, it seems that the latter is the driving force of the digital age, and economic forces rarely place human dignity ahead of profit – the rise in job-loss through technology replacing people is an obvious example of this.
Rather, we are the ones made in the image of God. It is our decisions that are changing the world, not technology. We create, choose and use intentionally. My mother-in-law was incensed to get a letter from an aid agency saying they’d prefer her to set up an automatic payment for her $12 per year donation because it would save money on postage and processing. Reasonable enough, I thought. “Do they mean to say that even our giving now has to be thoughtless!” was her reply, in a long, hand-written letter to the organisation. (The extra $2 was always intended to pay for the processing of her $10 donation.) Making thoughtful choices goes to the core of what it means to be human.
A student once asked me what Jesus would do with technology. Would he have time to blog or catch up with Facebook friends? Would he be instagramming? Maybe, but I doubt it would be an obsession for him - he’d still be busy reaching out to real hands, eating physical food, speaking actual words.
You see, we don’t actually live in a digital world, it doesn’t exist. We live in this world, making choices within a myriad of blessings, distractions and challenges. We have dignity because we are made in the image of God, called into relationship with God and each other. And technology is just one of those blessings, distractions and challenges. It’s up to us.
At least until the first machine chooses its favourite colour.
Colin MacLeod is a husband, father and member of Mercy Parish, Dunedin. He recently took on the role of Director of the National Centre for Religious Studies after two decades as DRS at Kavanagh College.
Art, Dignity and the Human Spirit
By Rachel Kleinsman
In the words of John Ruskin, art is an “expression of the vitality, inventiveness, heart, thought and spirit of humanity”. Art has the potential to offer insight into the human condition and exists as a cultural repository for the expression of our spirit and spirituality. It provides a means of connecting us with the oneness of the human experience.
The rich and varied tapestry of art history reveals a number of approaches to the expression and validation of human dignity. The Cambridge dictionary’s definition of dignity as: “the importance and value that a person has” offers a basic, albeit interesting starting point from which to consider that which characterises the relationship between dignity and art.
The great Abstract Expressionist Mark Rothko proposes a useful framework for navigating this relationship. In 1958, Rothko gave a lecture to New York’s Pratt Institute during which he identified a number of ingredients as collectively comprising the “recipe of a work of art”. One of these proposed criteria was that in art “there must be a clear preoccupation with death – intimations of mortality”.
Depictions of the dead have long been considered a fitting way of honouring the lives of individuals and affirming the enduring dignity of humanity after death. Renaissance art, in particular, facilitates an intriguing dialogue. Piero della Francesco, for example, painted the diptych portrait of Federico da Montefeltro and Battista Sforza after Battista’s death, her corpse serving as a life-model for the portrait (a point which seems evident in her pallor). In this vein, the Victorian tradition of post-mortem photography is also of note, combining photographs of deceased loved-ones with such memento as locks of hair and flowers. Similarly, John Everett Millais’ magnificent Ophelia painting of the body of this Shakespearean tragic heroine being carried down the river compels the viewer to confront the wrenching tragedy of her suicide and lost love, and the deepest questions of our human experience.
In exploring the relationship between art and human dignity, there is a certain tension which goes to the heart of the philosophical debate: What is art and what, if any, purpose should it serve? Is expression in and of itself the end goal, or is the artist obligated to contribute to a more complex framework of social responsibility?
On the one hand, the idea that art is valuable in its very own essence – l’art pour l’art – is compelling. The Kantian invocation that we should “act so as to treat people always as ends in themselves, never as mere means”, might lead one to think that art should serve no purpose other than to honour the individual through representation. However, historically, art has been an incredibly vital socio-political tool, one of protest and revolution, which has sought to affirm the dignity of underprivileged individuals. Eugene Delacroix’s Liberty Leading the People was a vital revolutionary voice in France and Gustave Courbet’s Stone Breakers, a protest against poverty and cry for the rights of the peasant class. Centuries later, Judy Chicago’s Dinner Party gave a voice to the previously-silenced cultural accomplishments of women. In terms of our own national identity, Ralph Hotere’s oeuvre comprises a politically-complex colonial protest defending the dignity and rights of Māori. There is no doubt that art’s role in ‘dignifying’ those of lesser privilege is significant.
In light of the above, it’s clear that artists have a role to play in crafting a broader social narrative which both affords and shapes human dignity – their role is not merely a documentary one. But there is a potentially problematic aspect to this representation also. The photographs taken by psychiatrist Hugh Welch Diamond of patients at the Surrey County Lunatic Asylum in the 19th century are one such example. These extant records of mentally-ill patients are valuable in that they capture something essential of their lives and spirits while affording a real sense of dignity and individuality. However, because they were taken with the intention of contributing to the physiognomy argument, they were ultimately damaging to both perceptions of these individuals and mental illness on the whole. A further example is the problematic nature of colonial depictions of kaumātua by Gottfried Lindauer and Charles Goldie; resplendent in their beauty and historic significance, the portrayal of Māori as a dying race through an overtly colonial lens is well-documented.
The essence of the relationship between human dignity and art is one of dualistic tension. It is incorrect to reduce art’s role in the expression of humanity to a purely utilitarian function. On the other hand, in order to be effective and afford respect to individuals it must “treat people always as ends in themselves”. The greatness of art through the centuries has the power to move us, to facilitate a spiritual connection and emotional response. Most importantly, it resonates with another criterion of note which Rothko laid forth in his consideration of art and life: that religious and divinely-eternal notion of hope, the ability of art to uphold human dignity through its power, properly used, to “make the tragic concept more endurable”.
Rachel Kleinsman is a freelance art researcher and writer based in Wellington. She has a Bachelor of Arts (Art History and Modern Languages, Victoria University of Wellington) and a Master of Arts (Art Business, Sotheby’s Institute of Art).
Culture, Human Dignity and Economic Rationalisation
By Gerard Burns
Cultural understandings of human dignity are culturally generated expressions of the perceived worth of human life at different ages and stages – they witness to the way persons are valued, honoured, esteemed and respected. While every culture has its own ideas and practices surrounding human dignity, the way that this dignity/worth is recognized varies from culture to culture and also undergoes change. The practices by which worth is recognized (or denied) reveal the culture’s values and beliefs about human life. This anthropological approach, starting as it does from observation differs from the philosophical approach of official Catholic teaching which brings a trans-cultural and meta-physical dimension to the discussion.
A simple definition of culture is to see it as the sum of the ideas, customs and social behaviour of a particular people or society. It includes morals, codes, traditions, dress, language and religion. Two simple examples from my own early years (Pakeha Irish-Catholic and middle-class, growing up in NZ in the 1960s) around the teaching of 'good manners' are illustrative.
The first example is the instruction: 'Don't eat with your mouth open because it’s impolite'. Here 'impolite' seems to mean it is insulting and ungraceful to show how you chew food. Perhaps implied is that eating is a semi-private or personal activity? Practically speaking, this instruction helps avoid food falling out of your mouth when eating. That would be wasteful of the food, inelegant in terms of tidiness and potentially mess-making on clothes, tables or floors. The values of respect for others and for oneself are to the fore.
A second example: We were told by our Catholic school teachers that when the priest or any adult came into the class, we were to stand up. This was a way of recognizing the presence of an important person. Standing up recognized the adult’s superior status and 'dignity'. Wrapped in this are certain cultural and hierarchical values, namely the value of the adult over the child. In the Catholic world the priest had a theologically superior status of a 'holy' man. If the priest was not ‘holy’ by behaviour then he was holy because he dealt with 'holy' things. Respect and dignity were ascribed not simply because of the priest’s personal qualities, but because of his role.
Hierarchies appear in all cultures and societies. In some Pacific cultures, one way of recognizing you are in the presence of 'more important' people (for example, chiefs) is to keep one's head below the level of the chiefly person. So you will see people bending over as they pass the chief to symbolically recognize their relative status. In Anglo-Saxon tradition the curtsy or bow before a royal personage served a similar role.
Value or worth can be intrinsic (such as simply by being born into a royal line), or gained through achievement (such as in battle or through academic qualification). In many traditional societies one's worth grows as one ages. The older person is seen as a source of wisdom and an asset even if requiring more assistance from family and neighbours. The honouring of kaumatua in the Māori world exemplifies this.
Are there universal values/practices which go beyond cultural variations? Anthropologists have looked for common practices in human behaviour but have not seen a common ethic. Such an ethic needs reflection on the commonalities and on the philosophical question of what is good for human beings. Hans Kung's work on a global ethic is part of that search.
One significant factor flowing from particular cultures but influencing world culture is what Pope Francis (among others) has outlined in ‘Laudato Si’: the 'technocratic paradigm' (LS.106) that has brought damage to the earth and its people. This worldview combines the influences of modern technology and industrial capitalism to shape social and economic practice.
Max Weber analysed this paradigm to some extent in his book the “Protestant Ethic and the Spirit of Capitalism’ (1930). In ascribing the foundations of modern society to Puritanism he underestimated other factors. Nevertheless, it is true that the mind-set behind the economic and technological development in Europe and North America was significantly influenced by the religiously-inspired exploration of the mind of God by Copernicus, Mendel, Newton and others.
Gradually this exploration sought to distance itself more from religious belief (secularisation) and the idea of ethical constraints on new technology lessened. The classical economics of Adam Smith and David Ricardo, along with utilitarian philosophies, has gradually brought theories of marginal utility and the model of 'homo economicus' to the fore.
This model saw ‘rational behaviour’ as that of a ‘man’ carefully calculating what will bring increased profitability to himself. It is a model based on individualism and self-interest. Smith proposed that if every actor worked on this self-interested basis then all of society would benefit as if moved by an 'invisible hand'.
In practice, this approach, especially its more recent form of neoliberalism (Reagonomics, Rogernomics, the ‘Washington Consensus’) has been largely discredited by the Global Financial Crisis. However it is still the basis for much contemporary macroeconomic practice (for example, stock markets, etc). The pragmatism of this paradigm increasingly influences views about who and what is useful to society.
One consequence of this is a cultural shift in the perception of ‘worth’. Where in many traditional societies to be old was to be valuable, in fast-moving, mobile and pressured technological societies, what is valued is the capacity to handle the latest technology. This favours the young and quick-adapters.
However, with the favouring of the young and the quick, comes a devaluing of the old and the sick. Hence a push for euthanasia for 'humane' reasons, and individuals not wanting to be a burden on society or their families. The economic aspect of culture can shape more general values. The defence of human dignity in a Catholic sense relies on a philosophy (shaped by the doctrines of incarnation and redemption) that explains the broad basis for what is good for individuals and our societies.
Gerard Burns is a priest of the Archdiocese of Wellington, currently Vicar-General and working in Māori pastoral care. He has lived and worked in South America and has a Master in International Relations from Victoria University.
Dignity and the Environment
By Jonathan Boston
The concept of dignity is often thought to be restricted to humanity. Only human beings, some believe, possess true or genuine dignity. Theologically, this is because human beings are distinctive, indeed unique, within the created order. Only human beings bear the special mark of their Maker; only they are bearers of God's image or likeness (Gen 1:27). Hence, amongst all God's creatures, only human beings enjoy a deep, transcendent and intrinsic worth: they alone are sacred; they alone possess inherent and inalienable rights; they alone are ends in themselves rather than means; and they alone share an abiding dignity in equal measure. All other species, it is argued, are different. They lack any God-given dignity. So, too, does the non-living or physical environment – whether here on Earth or elsewhere in the universe.
But is this argument theologically and morally justified? Is not the whole creation, in all its extraordinary diversity, richness, vastness and beauty, endowed with dignity by God?
There are, of course, robust theological reasons for claiming that human beings enjoy a unique, particular or special dignity – indeed, an 'infinite dignity'.1 As bearers of God's image, humanity can claim a distinctive and elevated moral status in relation to the rest of creation. A person is more precious than other creatures. Accordingly, we need stronger justifications for harming a human being than we do for harming non-human species.
But an equally strong theological case can be made that every part of creation – every aspect of the entire universe, no matter how little or large – possesses a certain God-given dignity; it thus has some inherent or intrinsic value. That is to say, all non-human species and physical objects are of value in themselves and for their own sake; they are not merely of instrumental or extrinsic value. To quote Saint John Paul II:
Respect for life and for the dignity of the human person also extends to the rest of creation which is called to join man in praising God (Ps 148:96).2
Likewise, Pope Francis in Laudato Si, speaks of the 'intrinsic dignity of the world',3 and appeals to every person to respect and care for all God's creatures and humanity's 'common home'.
The theological basis for the proposition that the non-human world enjoys an inherent dignity lies, fundamentally, in the claim that God is ultimately the creator of everything that exists and that God values, and rejoices in, every aspect of the creation. Every part of it has worth; every part deserves respect. For everything that God has made, according to Genesis, is 'good'.
That does not mean, of course, that everything is of equal value, let alone infinitely precious. Nor does it imply that any form of human interference with the natural or physical environment is unjustified. But it strongly suggests the need for wise, responsible and sustainable management of the environment.
When people degrade and defile what God has made or cause irreversible damage, they violate their distinctive calling to exercise stewardship and guardianship. Moreover, in bringing destruction, rather than healing, they threaten their own dignity. In part, this simply reflects the fact that everything is interconnected and interdependent. Despoiling the environment destroys the ecosystem services and resources on which humanity depends. It thus reduces the capacity of human beings to meet their needs and ultimately robs them of their dignity. Human flourishing in a devastated wasteland is a contradiction in terms, as is living well in an ecological desert.
Taking the intrinsic dignity of the environment seriously requires urgent and systematic reform. Currently, human greed, poor planning, inadequate regulation and irresponsible economic policies are contributing to enormous ecological damage. Globally, we are exceeding critical planetary boundaries and time is running out to rectify the problem.4 We are already in the early stages of a mass extinction event, one in which a substantial proportion of all this planet's species will be destroyed. We are also rapidly warming the Earth through the unregulated burning of fossil fuels and massive deforestation. Not only will this bring dramatic changes to the planet's climate, but it will also contribute to severe, widespread and, in many cases, irreversible damage to critical biophysical systems.
Nationally, our water quality is deteriorating, our carbon footprint is growing, our land-use management and marine governance are weak, and many native species face extinction. Since human settlement about 800 years ago, we have lost 85% of our indigenous forests, over 90% of our wetlands, and more than 50 bird species. We have significantly polluted more than half of our rivers and many of our lakes, and we are losing soil at about 10 times the average global rate. Hence, claims that New Zealand is 'clean and green' lack substance.
In summary, humanity is currently suffering a chronic 'nature deficit disorder'. Our ecological footprints are far too large. We are borrowing from the future and leaving our children and grandchildren a dreadful legacy – a huge, unsustainable ecological debt and colossal, irreparable damage. As Pope Francis puts it:
We have come to see ourselves as ... [nature's] lords and masters, entitled to plunder her at will. The violence present in our hearts, wounded by sin, is also reflected in the symptoms of sickness evident in the soil, in the water, in the air and in all forms of life. This is why the earth herself, burdened and laid waste, is among the most abandoned and maltreated of our poor; she "groans in travail" (Rom 8:22).5
God calls us to show kindness to His good creation, to treasure its diversity, to care tenderly for its creatures, to tread gently upon the land, and to be good stewards of its resources. Indeed, we are summoned to love what God has made, just as God loves and cares for it. In so doing we both protect its intrinsic dignity and honour our calling as creatures who bear God's image.
Jonathan Boston is Professor of Public Policy at Victoria University of Wellington.
1. Pope John Paul II, Angelus in Osnabrück (Germany) with the disabled, 16 November 1980: Insegnamenti 3/2 (1980), 1232.
2. Pope John Paul II, 'Peace with God the Creator, Peace with All of Creation', For the celebration of the World Day of Peace, 1 January 1990.
3. Pope Francis, Encyclical Letter: Laudato Si' – On Care For Our Common Home, Rome, 2015, p.86.
4. See, for instance, Johan Rockström, et al., "A Safe Operating Space for Humanity', Nature, 461, 24 September 2009, 472-475; John Rockström, et al., "Planetary Boundaries: Exploring the Safe Operating Space for Humanity", Ecology and Society, 14, 2.
5. Pope Francis, Encyclical Letter: Laudato Si' – On Care For Our Common Home, Rome, 2015, p.3.
Immanuel Kant on Dignity
By William Michael
“Dignity” in talk of “the dignity of human beings” ascribes to humans a kind of worth that is supposed to be of the highest significance for how humans are treated and which all humans share in equally. We are maybe so used to this idea that we don’t find it puzzling. But how can it be true? And if it were, how would we know? Kant’s philosophy provides answers to these questions.
For Kant, our moral lives are an aspect of our ordinary lives that should astonish. In this mood he wrote (Critique of Practical Reason):
Two things fill the mind with ever new and increasing admiration and reverence, the more frequently and persistently one's meditation deals with them: the starry sky above me and the moral law within me.
We’ll soon get to “the moral law within,” in the form of the Categorical Imperative, but for now let it stand for the whole of the moral, which it almost does for Kant.
Kant was deeply moved by humans acting purely for the sake of (moral) duty. His idea of the moral is very pure and for him acting for the sake of duty has nothing to do with psychology, even “nice” psychology like empathy, let alone anything neurotic, or the motive of gain or advantage. Doing one’s duty is a pure matter of willing (here meaning choosing) the good because it is good.
To find the meaning and reality of moral acts, Kant did philosophy. His philosophy teaches that moral acts disclose something real about the beings that can act morally: namely, that they are free, reasonable and rational beings. The thought is that only free, reasonable and rational beings would be able to act purely for the sake of duty.
The concepts “free” and “reasonable and rational” are difficult, and understanding Kant’s conception of “free, reasonable and rational beings” is difficult too. However, we have already come across a clue as to what he meant. The purity he finds in the motivation behind moral actions can be thought of as freedom from psychological determination. To be free in this sense is to be, as it were, master in one’s own house. At the same time, to be free in a related sense is to be determined only by that which is in agreement with, not foreign or alien to, one’s true nature. That nature is reasonable and rational, and so to be free is to act for reasons and from reason.
This is why for Kant morality is practical reason. (Practical reason – what I have reason to do – not theoretical reason: what I have reason to believe. Practical reason not sentiment or tradition, to name two key contrasts. It is notable that Kant did not oppose reason to religion. He was a committed Lutheran throughout his adult life.)
Kant’s idea that morality is practical reason is a general idea in need of specific content. “Be reasonable and rational” is not awfully useful guidance. We need some meaningful rule or law – “the moral law within” perhaps. The specific content Kant gives morality is found in the Categorical Imperative (CI). Here I’ll consider the CI to better understand “dignity”. The CI reads (in its second version in Groundwork for the Metaphysics of Morals):
Act in such a way that you always treat humanity, whether in your own person or in the person of any other, never simply as a means, but always at the same time as an end.
If we think about the meaning of “dignity” using the CI, it suggests that we understand that always treating persons as ends and never simply as means is a fitting way to treat beings that have the kind of “inner worth” (Kant’s words) called “dignity”. Seeing this connection we gain a richer, deeper and more useful notion of dignity. We could keep thinking: The CI suggests that my own dignity is important, and not for selfish motives but as a result of the “humanity” in me. And so on…
We can now see how Kant’s philosophy answers the questions opening this essay. If there are free, reasonable and rational beings, then they possess a special kind of worth unlike anything else in the world. The word “dignity” – why not? – is used to express this worth.
How can all humans share in dignity equally? There is no guarantee that any human will act from their nature as a free, reasonable and rational being, but since they are such a being, they could, and in that, each of us is the same. Indeed, given the many ways humans are different – in upbringing, IQ and EQ, talents, tastes, looks, status etc – then perhaps there is no other cogent interpretation of the thought, so important to the modern world, that we are all equal.
Finally, I know all this how? It is disclosed to me in my experience of acts done purely for the sake of duty. Knowing Kant’s philosophy, I understand this.
William Michael studied philosophy and law at Otago and Auckland universities in the 90s … and, for better or worse, has never really stopped thinking about such stuff.
Editorial: The Zika virus and contraception: Has Pope Francis changed the rules?
Growth in the numbers of people affected by the Zika virus, spread predominantly by mosquitos, has been described as an “explosive pandemic”. While relatively harmless for most people, the virus is now strongly suspected (though not yet definitively proven) of being linked to a serious fetal malformation known as microcephaly. In light of that, various government health ministries in the most severely affected areas are warning women to avoid getting pregnant.
While returning from his recent visit to Mexico, Pope Francis was asked by a journalist about the dilemma this situation poses for couples and, more specifically, whether “abortion” and “avoiding pregnancy” (in the context clearly a reference to contraception) might be a legitimate moral response.
Pope Francis’ immediate reply was to reiterate in the strongest possible terms that abortion could never be a morally legitimate means: “It is a crime, an absolute evil.” In saying this he would have been aware of the intense debate in many South American countries about using abortion as a way of dealing with fetal microcephaly.
Unpacking the Pope’s endorsement of the moral legitimacy of “avoiding pregnancy” is less straightforward. It is clear from the language and examples offered by the pope that he was thinking specifically about the use of artificial contraception rather than the “regulation of births” – the right of couples to space births – which is an accepted part of Catholic teaching on marriage and sexuality (see Catholic Catechism n. 2368). His analogous reference to the situation in the Congo, a 1960’s debate about giving oral contraceptives to religious sisters in grave danger of being raped, points to this. However, any doubts about the precise meaning of his words were dispelled just days later by official Vatican spokesperson, Fr Federico Lombardi, who clarified that “the Holy Father was indeed speaking of ‘condoms and contraceptives’ when on the flight back from Mexico.”
Further explaining the pope’s response, Lombardi added: “The contraceptive or condom, in particular cases of emergency or gravity, could be the object of discernment in a serious case of conscience. This is what the Pope said.”
Pope’s Francis’ brief comments have raised questions about Catholic teaching on the use of artificial contraception. Some have gone so far as to suggest that it potentially heralds a reversal of the long-standing Catholic position. I am not in a position to read or know Pope Francis’ mind but, as a moral theologian, I wish to offer three points as part of my own reflection on this debate.
1) The Pope’s response reminds us that whatever one’s beliefs about the use of artificial contraception (and we should recall that the backdrop to the question was a debate about the Zika virus and abortion involving a broad audience rather than a specifically Catholic one), the use of contraceptives is morally different from abortion in terms of its gravity – different because abortion involves the destruction of an already formed human life. At the same time, and in line with Lombardi’s reference to a “serious case of conscience”, this insight does not undermine the seriousness associated with the use of contraception.
2) Many have pointed out that Pope Francis’ reference to the use of oral contraception by religious sisters in the Congo reflects a very different moral situation to that of married couples. The situations differ because permission in the Congo case is neither a dispensation from the Church’s teaching nor an exception to it. Why? Because Catholic teaching on contraception speaks only to intercourse freely entered into by married couples.
Why then would the Pope appeal to this case? It illustrates that he has in mind a truly extreme situation. In doing so he is simply appealing to a fundamental tenet of Catholic moral teaching – the exceptional case does not nullify the ongoing validity of a particular law or teaching outside of the extreme situation. Evidence of this tenet appears in multiple places in Catholic moral teaching which address the different types of conundrums generated by extreme situations, including Aquinas’ discussion of ‘epikeia’, the ‘principle of the lesser evil’, and the role of conscience in helping perplexed persons find moral certainty in the face of a conflict of duties.
In other words, the possibility of couples making contraception an “object of discernment” in an emergency situation does not “reverse” Catholic teaching on the methods of regulating births. The Pope’s comments about the Zika virus need to be understood alongside his previous comments about the ongoing validity and prophetic nature of Humanae Vitae’s teaching on contraception rather than in opposition to them. As he noted in 2014: “Church teaching on contraception does not need to change but it must be applied with mercy.”
3) The reference to ‘mercy’, a defining theme in the pontificate of Francis, leads to the third point. Laws and teachings must always be applied with mercy if we are to avoid an extreme form of rigid moral legalism that stifles human flourishing. By his ‘spontaneous’ teaching on the Zika virus the Pope, with the instincts of a good pastor has, once again, reminded us that at the heart of Christian teaching lies the all-important idea of mercy.
Dr John Kleinsman is the director of The Nathaniel Centre
The Right to Freedom of Conscience
A recent post from Terry Bellamak, new president of the Abortion Law Rights Association of New Zealand (ALRANZ), questions why health professionals such as doctors and nurses should be legally able to use the claim of freedom of conscience in refusing to provide contraceptive or abortion advice or services. (http://wp.me/x1XY6w-z1, 14 Sep 2015). Bellamak likens this to the case of Kim Davis, county clerk of Rowan County in Kentucky, who was recently gaoled for refusing to issue licences for same-sex marriages. She fails to see why these two apparently similar cases should have such different outcomes; imprisonment in one case and privileged protection in the other.
There seem to be a number of flaws in Bellamak’s argument. I will examine three of these. The first is that a legal challenge on these grounds has already been laid and dismissed. The second is that the role of health professionals differs significantly from that of a county clerk. Finally, many historical examples show us the great evils that can arise when the grounds of freedom of conscience are overridden.
In 2009 the Medical Council of New Zealand sent out a draft statement entitled ‘Beliefs and Medical Practice’, touching especially on the area of reproductive health service provision. A group of health professionals known as the New Zealand Health Professionals Alliance Incorporated (NZHPA) applied to the High Court for a juridical review of this statement on the grounds that it contravened S174 of the Health Professionals Competence Act 2003.
Justice MacKenzie found in favour of the NZHPA, ruling that where a practitioner held a conscience objection in these areas he or she was not required to formally refer their patient onto another practitioner who would either provide or facilitate the service – it was required only that they inform their client that such a service could be obtained from another health provider or a family planning clinic. The Medical Council of New Zealand decided not to appeal this ruling and withdrew its statement. When commenting on this decision, the NZPHA stated that its members should not be compelled to do things that they believed to be ethically wrong, clinically inappropriate or against a patient’s best interests.
This last statement leads to consideration of the status and role of health professionals. In her argument Bellamak refers to health professionals as ‘providers of a service’. This is redolent of a mind-set common in the United States where the doctor/patient relationship is viewed as being more like that of a salesperson/customer or petrol pump attendant/car-driver. The nexus is a financial and individual contract. Underlying this vision is a significant philosophical shift, marked by a move from a sense of the common good (the well-being of the entire society) to individual rights and involving the deconstruction of social bonds to the lowest common denominator of financial contract and obligation.
Bellamak glides over this critical distinction by reducing all conscience objections to ‘moral’ grounds, thereby insinuating a basis of religious belief, whereas the more neutral term ‘ethical’ can cover religious, personal or social considerations. An excellent example of this is seen in the debates over euthanasia in the British House of Lords and in Canada in the course of which a number of health professionals, avowedly agnostic or even atheistic, objected to euthanasia solely on the grounds of deleterious social and medical consequences. Closer to home, a further example is the 1977 longitudinal study of 1265 children born in Christchurch conducted by Professor David Fergusson who pointed to later psychological difficulties faced by women who had undergone abortions in their youth. It is data such as this which can and should inform health professionals who wish to embrace a wider vison of the role and responsibility of their profession rather than adopt the individualised and contractual stance referred to above.
The stance I am advocating for is not novel. We see it in the famous speech by Edmund Burke to the electors of Bristol in November 1774. Burke, after acknowledging that an MP must have the highest regard for the views of his constituents, looking out for their interest with the greatest of diligence, then notes: “But his unbiased opinion, his mature judgment, his enlightened conscience, he ought not to sacrifice to you, to any man, or to any set of men living. These he does not derive… from the law or constitution. They are a trust from Providence, for the abuse of which he is deeply answerable.” He then goes on to speak of the role of Parliament in terms which could be aptly applied to the medical profession; “… Parliament is a deliberative assembly of one nation, with one interest, that of the whole, where not local purposes, not local prejudices, ought to guide, but the general good, resulting from the general reason of the whole.” (The Founders’ Constitution, volume 1, chapter 13, document 7.)
The importance of this stance is well borne out in history. Sometimes laws are passed which seem to meet the needs of the time and the approval of the populace. Such were the racial purity laws enacted by the Nazi government in Germany in the 1930’s, one result of which was the Shoah, the slaughter of six million Jews in slave and concentration camps. What is most frightening about these laws is that they were endorsed as scientific and sound by the leading professors of biology in German universities; theories of eugenics were embraced at every level of society. In passing, it is interesting to note that Margaret Sanger, one of the heroes of the women’s reproductive rights movement, was a leading member of the American Eugenics Society, frequently berating the Catholic Church for opposing eugenic legislation and ideology. One presumes that ALRANZ has completely stepped away from such advocacy on the basis of an ethical judgment, reinforced by scientific findings.
In summarising this reflection I would argue that the model of professional care embraced by the president of ALRANZ is strongly influenced by individualistic and commercial elements that reduce health professionals to mere service providers and too easily overlook the common good of the wider society. Such an understanding also ignores the lesson of history that suppression of the rights of individual conscience can so easily walk hand in hand with oppressive policies born of the social and political bias of a particular age … Stand up Archibald Baxter, Franz Jagerstatter, Mahatma Ghandi, Martin Luther King, Nelson Mandela and innumerable others.
In the words of Dietrich Bonhoeffer: “Conscience comes from a depth which lies beyond a person’s own will and reason and it makes itself heard as the call of human existence to unity with itself.”
Rev Dr Neil Vaney is a Marist priest who taught in the field of moral theology at Good Shepherd College in Auckland and is presently vicar-provincial for the Order, living and working in Wellington.
When scepticism goes viral
This article by Michael Rozier uses the example of the anti-vaccination movement in the United States to raise questions about the role that scientists themselves might have played in the rejection by some sections of society of well-established scientific facts. He suggests that a debate that includes values and morals alongside science might do better at changing minds than simply ‘throwing more science at the problem’.
Available online at: http://americamagazine.org/issue/vaccine-wars
The abolition of Capital Punishment in New Zealand
Staff of The Nathaniel Centre
Capital Punishment and euthanasia have the manifest similarity that both concern the deliberate and state-sanctioned ending of life, which is why both also, quite rightly, are controversial issues. While the euthanasia debate is still current and appears in the media on a regular basis, Capital Punishment was finally abolished in New Zealand in 1961. The question this article raises is what we might learn from the way in which Capital Punishment was abolished that might enlighten the current euthanasia debate.
Much of the following history is drawn from a comprehensive study by Pauline Engel published in 1977, which tells the story of the abolition of Capital Punishment in New Zealand.
Abolition of Capital Punishment
There had been little questioning of Capital Punishment in New Zealand before the 1920s, and it was not until the election of the first Labour government in 1935 that the issue became political. The Labour Party was officially opposed to the death penalty and while the Labour Government did not immediately introduce legislation to abolish the death penalty it commuted all death sentences while in office.[a]
However, criticisms soon arose concerning judges sentencing people to hang while knowing it would not be carried out, leading to the government being accused of 'circumventing' the law. Then in 1940, a particularly brutal crime led to four men being sentenced to flogging. While the humanitarian elements in the Party found it unthinkable that such a sentence should be carried out, the Attorney-General was reluctant to remit the sentences without bringing forward legislation which he felt would have to cover both corporal and Capital Punishment. That an appeal against the severity of the sentence failed at the time is described by Engel as an indication of the adversity of the climate for abolition at this stage. However, with the caucus overwhelmingly in favour of a law change, a Bill was eventually introduced for the erasure of both flogging and hanging from the penal code.
Engel notes 'the reaction of the newspapers was almost universally unfavourable' and that 'almost every provincial daily pontificated in its editorial columns on the government's action in removing Capital Punishment and corporal punishment from the Statute Book, and scarcely any were complimentary'. Nevertheless, the Bill was passed entirely along Party lines, with no Government members speaking in favour of Capital Punishment and no Opposition members speaking in favour of abolition. Engel describes the debate as 'neither lengthy nor distinguished for anything save the incredible bathos of speakers on both sides of the House'. While most arguments against abolition focused on the deterrent value of Capital Punishment, one of the arguments against was that it could mean 'the menfolk might have to take the law into their own hands'.
Reintroduction of Capital Punishment
When the National Government came to power in 1949, there was immediately pressure to repeal. Engel suggests that the restoration of the death penalty by this Government in 1950 was not simply a matter of a more conservative, authoritarian government favouring Capital Punishment, but a more complex interweaving of social and political factors. There had been relatively few murders during Labour's first six years in office, but the murder rate had increased in the post-war years, culminating in the 'notorious Mt Victoria murder which appalled the Wellington community in 1948'. Grand juries throughout the country had been calling for the reinstatement of the death penalty and popular sentiment was in favour of it; it was widely held that the increase in murders was a direct consequence of abolition.
Although the Minister of Justice had called for a 'comprehensive report which would include statistics, philosophical and religious arguments for both sides of the case', Clifton Webb, the Attorney-General, made it clear that Capital Punishment would be reinstated without waiting for the contents of the report. In the debate on the Bill to reinstate Capital Punishment, Webb focused on the deterrence argument while H.G.R. Mason, the former Minister of Justice, concentrated on the moral aspects, rejecting the argument that hanging was necessary for the protection of women and suggesting that the move back to a retributive justice was a 'spiritual and moral relapse'. The Bill passed with members voting on Party lines, except for J. R. Hanan, the lone National Government member to speak against the Bill.
Nevertheless, when within a few months the Executive was faced with its first death sentence, it appeared anxious to find a reason for a reprieve. Fortunately for the government, the reports on the case suggested the prisoner's mental development was at a level to suggest he was not fully responsible. However, public reaction and the media suggested that 'if ever there was a case for hanging this is it', and the government was roundly accused of having 'cold feet'. When the next death sentence was imposed, 'the Executive could not risk a second retreat', even though it was clear that this case actually presented a weaker argument for execution. Commenting on this second case, one newspaper argued that while the prisoner was 'obviously a man of subnormal mentality', this was no reason that 'such an individual should survive as a burden on society'.
Over the next five years there were another seven executions as well as a number of reprieves, and Engel suggests it was often difficult to understand why, when murder cases were compared, some were not reprieved. In one case of a young man described as a 'bodgie'[b], tried and later executed for murder, the decision of the Executive to execute was considered to be influenced by reports that the 'bodgie lifestyle was an idle, violent and promiscuous one' and that it was necessary to make an example of this young man. Organised opposition to the death penalty over this time led to the development of a National Committee in 1956, partly as a consequence of one particular case where the prisoner's 'childish qualities and his socially deprived background' highlighted the inconsistencies around the reprieval decision-making process . Around the same time, a "Truth" article appeared, describing an execution in detail, ostensibly for the purpose of promoting the deterrent aspects of hanging, but having an ulterior motive of conveying to the public 'the sordid reality of hanging and to indicate the effect it had on many of those responsible for carrying it out'. The final paragraph of the article stated:
'Criticism of the method is not an argument against Capital Punishment. Murderers may deserve to die. It may be that the prospect of death does deter would-be murderers. What happens to them does not matter; what can happen to the people who have to hang them does.'
Effects of hanging on those involved
It was commonly claimed that the older prison officers who had been involved in and experienced hangings saw their participation as part of their duty; a duty which, while unpleasant, did not affect them deeply. One of these described himself and his generation of officers as having 'lived through the depression, seen active service overseas for some years during the last war, and been in German prison of war camps', experiences that 'toughened the spirit as well as the flesh'. In particular, Engel notes that 'they did not become emotionally involved in the execution process because they did not feel responsible for the decision which had been made to hang that particular person, although their professional position obliged them to carry out that decision. They did not feel that they were "inhumane" or "hardened", any more than a nurse or doctor who had become inured to much unpleasantness which would make the average lay person squeamish.'
However, while these officers were reportedly able to carry out their duty without too many after-effects, even if it took the experiences of a depression, war service and prison of war camps to achieve this, Engels notes that for the 'lay' officials the story was quite different; for at least some people, including sheriffs, prison psychologists, chaplains, and the prison Superintendent, the hangings had serious psychosomatic effects.
The first two sheriffs had breakdowns, due at least partly to their participating in executions; the prison doctor threatened to resign rather than participate in further executions; the prison psychologist wrote that his own feeling was one of 'complete revulsion' and that as he left the execution yard, felt that the hanged man was 'the only actor in the drama who came out of it clean'. The prison chaplain was infected 'with a peculiar horror so that he felt an almost irresistible urge to get as far away from the prison as possible at the time of a hanging – something he was rarely able to achieve'. The Superintendent of Mount Eden Prison had officiated in eight executions and although he was described 'as rough as guts, as tough as they come', resorted to drinking to get through the hangings and eventually suffered a major psychological breakdown.
From the mid-fifties, there was an increase in activity from the abolitionist movement and a referendum was proposed. This was opposed by some abolitionists on the grounds that the issue was too 'volatile' and too complex for a straight yes or no answer. J.R. Hanan and E.P. Aderman, the known abolitionists in government, and J.R. Marshall, a strong supporter of Capital Punishment, all supported a referendum, both sides thinking the public supported them. The two Wellington daily newspapers opposed a referendum, the Evening Post stating the question was 'not a subject for a decision by mass vote' and it would be 'wrong, clumsy and unsuitable' because many would wish to qualify their answers. The Dominion suggested that to conduct a referendum on any issue subject to emotion was bad policy: 'Impassioned appeals by abolitionists could stir up a fever far beyond the merits of their arguments. Similarly, a particularly fiendish or callous crime just before the poll could cause a public revulsion much stronger than the merits of the case for retention'. These sentiments, along with letters to local papers and submissions to Government led to the Prime Minister calling off a referendum. It would, if re-elected, legislate to provide the death penalty for 'the worst cases of murder' only.
Engel argues that a referendum would have without doubt supported Capital Punishment. 'Public opinion polls, except in Scandinavian countries, were consistently in favour of the death penalty' and in 1969 a United Kingdom survey reported that 'a substantial majority of men and women favoured the return of the death penalty for certain types of murder'. She suggests that New Zealand voters in 1957 would not have 'proved themselves more enlightened than their European and North American counterparts'.
After Labour won the 1957 election, the Attorney-General announced that it would follow its former policy of commuting the death sentence to life imprisonment. The Crimes Bill, introduced by the National government at the end of its term in 1957 and that dealt with Capital Punishment was shelved. When Labour then lost the 1960 election, the National Government that came in had abolitionist J.R. Hanan as Minister of Justice and Dr J L Robson, who also opposed to the death penalty, as Secretary for Justice. Hanan requested that Robson proceed with a ministerial report setting out the case for the complete abolition of the death penalty.
The report attacked the deterrence theory; suggested the death penalty ignored the principle of all punishment which was the reform of the offender; discussed the risk of an error in justice which could cause the execution of an innocent man; and stressed the 'great strain the process of execution imposed on officials, and detailed breakdowns in health which had occurred as a result'. The moral arguments against the death penalty were rounded off by John Bright's dictum that 'the best means of cultivating respect for human life were to refrain from taking it in the name of the law'.
When it was initially introduced, the Crimes Bill included a compromise clause which stipulated different degrees of murder. The intention behind this was that the death penalty would apply only for deliberate and premeditated murder, for homicide in the course of another crime or in flight from the law, where there was a previous conviction for murder, or a second murder. Hanan, however, argued that there was no 'compromise clause' that could be drafted that did not have serious flaws and indicated that another Member (Aderman) would be moving an amendment for total abolition of the death penalty which he would support. This amendment was subsequently passed with the support of the Opposition and ten Government members crossing the floor.
Engel notes that the reason for the Government Members crossing the floor was often attributed to the fact that they wanted to see the end of 'hanging by politics'. However, she suggests that this was not the real reason; Hanan and Aderman were long-term abolitionists whose motives needed no explanation. She suggests the others voted for a variety of reasons, including that the death penalty was not a deterrent to murder; that it was seen as 'the natural instinct of outrage, anger and the desire for revenge' (Muldoon); that it did not make sense when murder in 'the heat of the moment' received the death penalty or life imprisonment but when 'through inattention, carelessness or drink' someone kills in a motorcar, the event is not treated very seriously (Macintyre); the possibility of execution of an innocent person (Pickering); and that murder was usually the result of a 'twisted mind' that did not qualify for the death penalty (Talboys).
Steiner claims that in its 1961 report, the Justice Department recommended abolition primarily on the basis that the state could not legitimately take life as it could not be shown that its actions had a deterrent effect on the murder statistics. The report emphasised the comments of the (1958) Massachusetts Commission on Capital Punishment:
"The only moral ground on which the State could conceivably possess the right to destroy human life would be if this were indispensable for the protection or preservation of other lives. This places the burden of proof on those who believe that Capital Punishment exercises a deterrent effect on the potential criminal. Unless they can establish that the death penalty does in fact protect other lives at the expense of one, there is no moral justification for the State to take life."
In the years following the 1961 abolition of the death penalty there was little public enthusiasm for its reinstatement. Steiner mentions two National Party conference motions, one in 1961 to reinstate the death penalty, and another in 1976 to reintroduce flogging, which were both easily defeated. However, Steiner also notes that a number of opinion polls over the period 2004-2007, which may not be particularly reliable, appear to indicate that a significant number of New Zealanders would support reinstatement of the death penalty for some crimes. He notes that 'The continued sensationalisation of crime by the media has a lot to do with these findings. People are bombarded by images of the raw emotion from the victims and their families and informed of every sickening detail of the crime. The harsh reality of Capital Punishment is a million miles away from public consciousness, and it is easy to see why retributivist support for its practice lingers.'
Staff of The Nathaniel Centre
[a] There were a number of reasons for legislation not being introduced: the Labour Government had a full legislative programme, there were relatively few murders between 1936 –40 and, as it transpired later, the Prime Minister, Peter Fraser, was actually opposed to abolition.
[b] 'Bodgie' - a youth, especially of the 1950s, analogous to the British Teddy boy; often viewed as delinquent, 'bodgies' adopted particular clothing styles and frequented 'milk bars'.
 Engel, Pauline F. "The Abolition of Capital Punishment in New Zealand 1935 – 1961". Department of Justice, Wellington, 1977, p. 19.
 Ibid., p.23
 Ibid., p.21
 Ibid., p.22
 Ibid., p.27
 Ibid., p.39
 Ibid., p.56
 Ibid., p.56
 Ibid., p.56
 Yska, Redmer "All Shook Up. The Flash Bodgie and the Rise of the New Zealand Teenager in the Fifties". Penguin Books, Auckland, 1993, p.192.
 Engel, op.cit., p.58
 Ibid., p.59
 Ibid., p.60
 Ibid., p.60
 Ibid., p.60
 Ibid., p.61
 Ibid., p.61
 Steiner, op.cit., p.33
 Engel, op.cit., p. 72
 Ibid., p.73
 Ibid., p.74
 Ibid., p.74
 Ibid., p.80
 Ibid., p.81
 Ibid., p.99
 Steiner, op.cit., p.25
 Ibid., p.49
Editorial: Euthanasia, democracy and public policy – lessons from the abolition of capital punishment
When capital punishment was finally abolished in 1961 (see article in this issue), the abolitionist cause represented a minority view in New Zealand; fewer than one-third of people supported it. As Leon Gotz proclaimed: “In demanding the punishment for these vile crimes should be the forfeiture of the offender’s lives, I am expressing the opinion of the majority of New Zealand.”1
Robert Muldoon was one of ten National MPs to cross the floor and support abolition. At the time he acknowledged: “Abolishing capital punishment was contrary to popular opinion and the majority of people in New Zealand are not ready to accept it. However, Parliament should give a lead to public opinion.”2
Controversial issues such as capital punishment, and in our time euthanasia and assisted suicide (EAS), give us pause to reflect on the nature of democracy and, specifically, the role of MPs in shaping public policy. Gotz and Muldoon represent two very different approaches to understanding the nature of parliamentary leadership: (i) following closely the opinion of the public and voting according to popular opinion (taking the lead from one’s constituents) and (ii) voting according to one’s carefully formed and well researched views, taking account of but not being swayed by the opinion of the majority while being willing to vote against public opinion if one’s conscience dictates.
Put simply, the latter approach is premised on a belief that the formation of public policy should not be reduced to measuring public opinion. To paraphrase Muldoon: there are times when MPs should give a lead to public opinion. In a democracy such as ours, where 64 out of the 120 seats are electorate seats, this second approach to leadership is potentially costly at election time and will, therefore, demand of our MPs a high level of personal integrity and courage.
Reflection on the issues and challenges that MPs faced when dealing with the issue of capital punishment generates valuable insights for the current debate about EAS.
- Proponents of EAS repeatedly appeal to public opinion as a reason for changing the law. Their assumption is that majority public opinion is enough to determine public policy. In 1956, the Prime Minister Rt Hon Sydney Holland proposed that the issue of capital punishment be submitted to a referendum as a solution to the continued politicisation of the issue: “let us trust the people … Let us take it out of the hurly-burly of politics”. In response, Labour argued strenuously that capital punishment should be left to parliamentary responsibility; the issue was too complex and required dispassionate consideration. Many argued a referendum was inappropriate because emotions could be stirred up by a particularly brutal or nasty crime just before a referendum creating a serious bias. In a similar way, presentation of the high-profile, difficult cases can generate emotions that obscure people’s ability to take full account of the broader questions relating to the legalising of EAS.
- As was the case with capital punishment, media presentation of the issues surrounding EAS shows a distinct bias towards legalisation. Just as particular crimes became a focus for those arguing against abolition, so the media stories surrounding EAS have mostly focused on the single, emotive cases. For a more balanced and robust discussion to happen, there needs to be a deeper and more balanced exploration of the likely effects on society as a whole. The Justice Department report on capital punishment finally argued a ‘moral’ case against the death penalty; that on balance respect for human life was best protected when the law forbade it. The same argument can be made about EAS.
- The reinstatement of the death penalty in 1950 meant that the effects on those involved in the hangings began to be noticed; for many the impact was significant, taking an emotional and physical toll. These side effects were not necessarily immediate. Likewise, when considering the case for EAS, we must take into account the impact on those who would have to facilitate it, including the negative effects it would have on the medical profession and the doctor-patient relationship.
- Many MPs were persuaded by the fact that if the justice system was subsequently discovered to have wrongly convicted someone, there could be no going back. In New Zealand we now know that at least one innocent person would have been hanged if capital punishment had not been abolished - Arthur Allan Thomas who was convicted of murder in 1971 but received a Royal Pardon in 1979. With EAS there is a high possibility that a diagnosis and/or prognosis will be wrong. The argument that one innocent life lost is sufficient to justify the abolition of capital punishment is even more relevant to the euthanasia debate because of the risk of large numbers of lives being prematurely ended.
We hope that the Health Select Committee investigation into EAS enables the sort of robust debate and parliamentary leadership that was exemplified by the MPs who dealt with capital punishment.
Dr John Kleinsman is the director of The Nathaniel Centre and Sue Buckley is a researcher at The Nathaniel Centre.
Euthanasia polls: What do they really tell us?
In recent years, various polls seeking the views of the New Zealand public on euthanasia and assisted suicide have consistently reported that 60-70% of people support their legalisation,1 leading Horizon researchers, for example, to conclude that “Supporters of end of life choice … form a strong majority”2 in New Zealand and the Voluntary Euthanasia Society (VES) to state with confidence that “most New Zealanders support aid-in-dying legislation.” 3
The terminology and questions used in such polls are, however, rarely analysed and the results of these polls are rarely dissected or challenged. All of which means that the conclusions we draw from them need to be treated with caution. As Marcoux et al noted in 2007: “… the use of the argument that public opinion is in favour of euthanasia to support changing laws must be critically examined. There are methodological problems in the wording of survey questions that can bias responses, and the validity of responses may be compromised by pervasive misunderstandings of what euthanasia means.” 4
This article will seek to shed some light on the strengths and limitations of a number of polls carried out in New Zealand and around the world with a view to offering a more nuanced analysis.
A number of overseas polls have shown that people’s willingness to support the legalisation of assisted suicide and/or euthanasia depends on the language employed in the questions – specifically whether ‘softer’ or euphemistic descriptions such as ‘medically-assisted dying’ are used rather than those containing alternative technically correct terms such as ‘suicide’.
For example, a 2005 poll carried out by the Pew Research Center for the People and the Press reported: “The survey found that 44 percent of respondents favored making it legal for doctors to ‘assist terminally ill patients in committing suicide’ when the question was worded this way. But support for the practice rose slightly, to 51 percent, when people were asked if they favor making it legal for doctors to ‘give terminally ill patients the means to end their lives.’”5 A 2005 Australian study which investigated cancer patients’ views on euthanasia and physician-assisted suicide likewise concluded that “professed support can depend upon the individual’s own definition, the language used in questions and the specificity of questions.” 6
Similarly, a 2013 Gallup poll found “70% of Americans in favor of allowing doctors to hasten a terminally ill patient's death when the matter is described as allowing doctors to ‘end the patient's life by some painless means.’ At the same time, far fewer – 51% – support it when the process is described as doctors helping a patient ‘commit suicide’.”7
A lack of consistency in the terminology used, as well as a propensity by of many pollsters to use softer language, characterises many New Zealand polls.
The 2005 Australian study referred to above also demonstrates that many poll respondents who profess support for assisted suicide and/or euthanasia do not understand the distinctions between these and withholding or withdrawing treatment. “Researchers need to be circumspect about framing and interpreting questions about support of ‘euthanasia’, as the term can mean different things to different people, and response may depend upon the specifics of the question asked.”8 In this study, interestingly, “79% of patients said they supported the idea of euthanasia, and 70% agreed ‘a doctor should be able to assist a patient to die’, [yet] 80% did not agree that ‘doctors should be able to kill their patients’.” 9
When terms such as ‘medical aid in dying are used’ the confusion is even greater. A 2013 Canadian survey by Ipsos Marketing, for example, specifically set out to assess what was understood by the people who supported ‘medical aid in dying’. This survey showed one third of Quebecers interpreted the phrase as being a patient’s request for lethal injection by a medical professional, while nearly 30% understood that it meant relieving symptoms through palliative care. Finally, nearly 40% of those surveyed associated it with a discontinuation of intensive medical treatment, or with assisted suicide. The researchers then concluded: “It is therefore essential to clarify applicable terms and tangibly convey the true definition of euthanasia, and avoid using even vaguer expressions such as ‘medical aid in dying’.” 10
Real World Scenarios
A further challenge when interpreting public opinion polls arises from the fact that the nature of the question or questions asked means that the views of respondents are often based solely on hypothetical scenarios.
Emanuel et al11 illustrate this clearly in their 2000 investigation into the attitudes of terminally ill cancer patients. While 60.2% of the participants supported euthanasia in a “hypothetical” situation, only 10.6% indicated that they would seriously consider euthanasia or physician assisted suicide for themselves. This result accords with an earlier study in which it was noted that people’s responses change according to the amount of detail they are given about personal circumstances – the proportion of the general public who agreed with euthanasia for unremitting pain was 66% but this dropped to 49.2%, 36.2% and 29.3% respectively for the categories “functional debility”, “burden on family” and “view life as meaningless”.12
Similarly, in a 2014 Comres/CARE poll carried out in the UK, 73% of those polled indicated support in principle for a Bill designed to enable mentally ill competent adults in the UK who are terminally ill and with a clear and settled intention the right to be provided with assistance to commit suicide by self-administering drugs.13 However, when those who supported assisted suicide in principle were offered a series of practical considerations (such as people feeling pressured so as not to be a burden and the steady rise of numbers in jurisdictions where it is legal), a large proportion, 42% of them changed their minds on the basis of at least one of the arguments. When these figures were added back into the original sample, aggregating all who opposed as a result of the arguments presented while incorporating all who still supported assisted suicide in spite of the arguments, the final result was 43% in favour, 43% opposed and 14% don’t know.
Meanwhile in New Zealand, close scrutiny of the 2012 Horizon Poll already referred to (which shows that 62.9% would support “mentally competent adults in New Zealand to receive medical assistance in ending their life if they are suffering from a terminal illness or an irreversible physical or mental condition that in their view renders their life unbearable”) reveals that people’s support is heavily premised on the need for, and belief in the effectiveness of, strict controls. As the researchers note: “The need for strict controls, like those measured in the survey, is demonstrated by support for them exceeding support for end of life choice overall.”14 As far as this poll goes, therefore, the more adequate and honest conclusion to draw is that 62.9% of New Zealanders believe in receiving medical assistance to end their life on the assumption that harms to others can be prevented by strong and effective safeguards. In the face of international evidence that safeguards are problematic and ineffective15, it is less than honest to use this poll to claim, as the Voluntary Euthanasia Society of New Zealand do, that most New Zealanders would in reality support euthanasia or assisted suicide legislation.
The 2012 Horizon Poll demonstrates that the willingness of New Zealanders to support euthanasia or assisted suicide in New Zealand is premised on an assumption that strict and effective controls can be put in place. Overseas research challenges this assumption; moreover, when polls include additional information about the complexities and risks, the numbers of people prepared to support a law change drops significantly. Overseas research also shows that people often fail to understand the terminology being used as well as the ethical distinctions between euthanasia and/or assisted suicide and withdrawing or withholding treatment.
Because most of the New Zealand polls relied on and quoted by proponents of change have failed to provide the level of nuanced questioning and information that would be required to confidently say their results are reliable, it is incorrect to say that “most New Zealanders support aid-in-dying legislation”16 or to assume that this reflects people’s informed views on euthanasia.
As our Prime Minister Hon John Key, who has previously declared his personal sympathy for a law change, noted recently: “Striking the right legislative balance with both clear definitions and adequately strong protections is an extremely difficult task, and that no bill has yet passed on this issue is testament to that.” 17 A true indication of New Zealanders’ support for euthanasia or assisted suicide will only be possible if and when polls take proper account of people’s understandings of the definitions and complexities associated with the practice of euthanasia and/or assisted suicide.
Dr John Kleinsman is the director of The Nathaniel Centre
 See “Legalisation of Euthanasia in New Zealand: Surveys in New Zealand” at http://policyprojects.ac.nz/jasonrenwick/surveys-in-new-zealand/
 See, for example, Horizon Research, "New Zealanders' views on End of Life Choices," (Auckland, New Zealand2012). at http://www.horizonpoll.co.nz/attachments/docs/horizon-research-end-of-life-choices-survey--1.pdf, accessed 1 May 2015.
 Marcoux, Isabelle, Brian L Mishara and Claire Durand (2007) “Confusion between euthanasia and other-end-of-life decisions: Influences on public opinion poll results” Canadian Journal of Public Health 98: 238.
 See: “The Right-to-Die Debate and the Tenth Anniversary of Oregon’s Death with Dignity Act” at http://www.pewforum.org/2007/10/09/the-right-to-die-debate-and-the-tenth-anniversary-of-oregons-death-with-dignity-act/, accessed 17 August 2015.
 Parkinson L et al. Cancer patients’ attitudes towards euthanasia and physician-assisted suicide: the influence of question wording and patients’ own definitions on responses. J. Bioethical Inquiry 2005, 2: p. 88.
 Gallup, "U.S. Support for Euthanasia Hinges on How It's Described," (Washington2013). at http://www.gallup.com/poll/162815/support-euthanasia-hinges-described.aspx
 Ibid., p. 82.
 Ibid., p. 88.
 Ipsos Marketing, "Survey among the Canadian population about end of life issues," (Canada: Ipsos Marketing, 2013), p. 5.
 Emanuel EL, Fairclough DL & Emanuel L. “Attitudes and desires related to euthanasia and physician assisted suicide among terminally ill patients and their caregivers.” JAMA 2000 284:2460–2468.
 Emanuel EJ, Fairclough DL, Daniels ER, Clarridge BR. "Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public." The Lancet 347(1996).
 ComRes, "Care - Assisted Suicide Poll," (United Kingdom2014). at http://www.comres.co.uk/wp-content/themes/comres/poll/Care_Assisted_Suicide_Poll_July_2014_(with_summary_table).pdf
 Ibid., p. 4, emphasis added.
 See, for example, Golden M, and Zoanni T. "Killing us softly: the dangers of legalizing assisted suicide," Disability and Health Journal 3, no. 1 (2010); Dr David Jeffrey quoted in Health and Sport Committee, "Stage 1 Report on Assisted Suicide (Scotland) Bill," The Scottish Parliament, http://www.scottish.parliament.uk/S4_HealthandSportCommittee/Reports/her15-06w.pdf at para. 175;Barron H. Lerner and Arthur L. Caplan, “Euthanasia in Belgium and the Netherlands. On a Slippery Slope?” JAMA Intern Med. Published online August 10, 2015.
 Email sent to writer on behalf of the Prime Minister,
Creating Welcoming Churches: a disability resource for faith communities
Rev. Vicki Terrell
Whether someone comes to church as a casual visitor or is part of the regular congregation, the environment needs to be welcoming. “Creating Welcoming Churches a disability resource for faith communities” (CWC) is a practical guide on how to make church environments more accessible to all people including people living with disability. It was launched in Auckland and Wellington late last year, 2014. The book was made possible through funding from the Joint Special Project Fund of the Association of Presbyterian Women and Methodist Women’s Fellowship in 2013.
CWC was produced by the Disability, Spirituality and Faith Network Aotearoa New Zealand which has strong links both in the church and the disability communities. Most people within the network have (lived) experience of disability. We are passionately committed to making the church a place where all people are affirmed as having gifts to share because we are all made in the image of God.
CWC came from the desire to have a practical book about access to help churches become more welcoming to disabled people. Originally it started with someone asking whether the“Holy, Wholly Accessible” document, produced for the Anglican Diocese of Wellington in 1998, could be reproduced for other churches.
While agreeing in principle that this was good idea, the project grew as we realised that there had been other books published since 1998and the thinking around disability had changed rapidly in the last 15 years. The challenge thenbecame what would make this book new as well as useful for faith communities.
The rise of the social model of disability (as opposed to the medical model) and the United Nations Convention on the Rights of People with Disabilities, have helped people to understand thatmany barriers faced by disabled people are in the environment and in theattitudes of others. These barriers hinder the full and effective participation of people with disability in society on an equal basis with others.
For many in the group, much of the traditional theology linking disability with healing was problematic. Some people in the group wanted the book to reflect current thinking in the disability sector that communities need to be inclusive environments where all people are welcomed and valued for who they are. In the introduction to CWC the writer interweaves current thinking on disability and inclusion with theological reflection.
The theology of accessibility underpins the entire book. The two basic tenets are
- All people are made in the image of God
- People who follow Christ are called to serve and be served as members of Christ’s body.
The challenge becomes how does the church welcome and enable each member to fulfil their ministry.
The “Information, attitude, action” section has lots of practical suggestions for making buildings, liturgy and community events accessible. While assisting disabled people, many of the suggestions help other people, particularly children and immigrants, to participate more fullyin ministry.
There is advice on interacting with people with disabilities, their equipment and service animals. Much of this information was gathered from people active in the church who have a lived experience of disability. Becoming totally accessible is hard and the book may have errors and shortcomings and we invite critical comments so we can incorporate new learnings in further editions.
Real (life) experiences are highlighted in the book through quotes from disabled people about their experiences in a particular church. There are also stories of churches being welcoming to disabled people. Some are about physical changes which have been made and others reflect on the presence of disabled people in their congregations.
The book has been well received by churches because it addresses theology and practical issues in a clear and concise way alongside personal stories. Many people have commented on the clear layout and how easy it is to follow. There are alreadysigns that some people are thinking differently because of the book. It gently challenges some of the patronising attitudes and encourages a respectful engagement with disabled people as people made in the image of God.
I have been pleasantly surprised by the enthusiasm of the disability sector for this book. It has sparked interesting conversations and people working on disability/accessibility areas outside the church have asked for copies. The time spent in careful consideration of the changes in disability thinking and the emphasis on inclusion has paid off because it has credibility in the disability community. There is a real gap in practical resources for community groups who want to become more accessible to all including disabled people. The usefulness of this book goes beyond the church and it maybe a gift to other community groups who are trying to become more accessible to all people particularly disabled people.
Rev Vicki Terrell is an Anglican priest in the Diocese of Auckland and the writer and researcher for Creating Welcoming Churches. Her commitment comes from the two main strands in her life: Christian faith and lifelong impairment.
Copies cost $15 including postage.
The Trans-Pacific Partnership and issues of social justice
That a marvelous order predominates in the world of living beings and in the forces of nature, is the plain lesson which the progress of modern research and the discoveries of technology teach us. And it is part of the greatness of man that he can appreciate that order and devise the means for harnessing those forces for his own benefit... Yet there is a disunity among individuals and among nations which is in striking contrast to this perfect order in the universe.1
– Pope John XXIII
In theory, patent law 'harnesses the forces' of knowledge and innovation by creating an incentive to invent and by providing for both the protection and dissemination of information, for the benefit of society. Indeed, translating an invention into a patentable product can be a long, complicated and expensive process. Imitating or replicating the product of invention, on the other hand, is relatively cheap and easy, and undermines this innovation process. Therefore, by imposing temporary restrictions on access to and use of information and ideas, patenting gives people an incentive to innovate and to publish their invention. The assumption is that because this stimulates research and development and enriches the public domain with knowledge and technology, it is to the benefit of all.
In reality, however, a property-based understanding of justice and an emphasis on patentability rather than practicality creates 'disunity among individuals and among nations'. Goods and services, including medicine and health care, become transactional resources, and socio-economic development becomes a disturbing reproduction of inequality, as resources are available only to those (individuals and/or nations) who can afford them. Our existing international agreements perpetuate these problems. The proposed Trans-Pacific Partnership Agreement (TPPA), as leaked, will exacerbate them even further.2
So what exactly is the problem with a property-based conception of justice? According to John Locke, "The great and chief end...of men's uniting into commonwealths, and putting themselves under government, is the preservation of their property."3 Preceding Locke, Galileo foresaw the importance of this preservation of property specifically in the context of innovation: "It does not suit me that the invention, which is my property and as created by me with great effort and cost, should become the common property of just anyone..."4. Therefore, the concept of exclusive property is central to our sense of society and individual freedom, indeed even justice.
However individual rights are never absolute, and to claim that a patent confers upon the owner an absolute and unfettered right to use its intellectual property (IP) as it wishes, "is no more correct than the proposition that use of one's personal property, such as a baseball bat, cannot give rise to tort liability"5. Herein lies the central problem. A property-based conception of justice legitimises inequalities, on the basis of a welfare maximisation calculus that does not account for different circumstances, nor issues of accessibility and redistribution. Rather, this calculus assesses feasibility in terms of a net increase to welfare and to the quality of health care; indiscriminate as to whom this increase benefits or disadvantages and, as a result, it is the underprivileged that continually miss out.
To qualify for protection as a patent, an invention must be new, non-obvious and useful. The modern emphasis on technological advancement has, however, encouraged legislators, IP offices and the courts to interpret this so as to maximise eligibility for patenting and, therefore, further foster innovation. Thus, these rights become both easier to obtain and more readily sought, and their quality and value diminishes. It leads to premature patenting of whole gene sequences and genetic substances, for example, in exchange for information that is limited and incomplete. Ultimately, this overcompensates patent-holders and undermines technological and social development, which is the supposed rationale for patenting.
The emphasis on patentability, and patent protection as the ends, also creates inefficient races between potential patent-holders, particularly in profitable areas, leading to unnecessary duplication of research, and wasted resources. More significantly, this reflects the fact that profitability is the stimulus for innovation, such that medicines for rare diseases, and for those among lower socio-economic groups are not developed. This creates classes in terms of the availability of medicine and health care, and increases inequalities. Patents become a tool for large corporations to advance their economic growth and establish market dominance, rather than an incentive for socially valuable research.
This represents an inequitable bargain between society and patent-holders, one that is inevitably in favour of powerful stakeholders and their private economic interests. The principles of social justice, on the other hand, dictate that we should treat property and IP not as the foundation of society and justice, but as a tool for achieving a sustainable society of justice and equality. In practical terms this means accounting for different needs and circumstances through flexibility, and restricting the power and control of patent-holders, whereby their rights are confined within fixed parameters and better balanced with their duties.
The existing Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), an international agreement on minimum IP standards, attempts to reach a compromise between developed and developing countries, providing for the flexibility and fixed parameters envisioned above, at least on paper. The problem is, it assumes free and informed consent on the part of all its members as if they all have equal negotiating power, and as if the interests of all members are communicated by effective and representative democracies. It also assumes that members will be able to use these measures for flexibility freely, and without fear of tariffs and trade sanctions. Moreover, it assumes that future trade agreements will not further undermine these measures.
In reality, however, these [measures] are given the absolute minimum consideration by the community of people who interprets them. Developed countries and multinational corporations are putting strong pressure on developing countries wanting to use TRIPS' flexibility and, above all, are negotiating bilateral and regional free-trade agreements to impose more severe and contingent IP standards than those outlined in TRIPS.6
The Doha Declaration, in response, offers a more equitable and truly flexible approach to TRIPS and international IP law, with a domestic needs perspective. But this is only another step in the right direction. And now, the proposed TPPA threatens to negate these steps towards a more fair and sustainable approach. It does not do so by imposing stricter standards on those developing countries considered above (they are not party to the TPPA), although it will have the effect of putting pressure on them, but rather by undercutting TRIPS and its value for these countries, and by increasing the power of those (countries and corporations) whose interests subordinate these countries.
The first (leaked) draft of the TPPA omitted any mention of the Doha Declaration, and the second (leaked) draft makes only brief and heavily qualified reference to it, which does not inspire confidence. This is particularly concerning in light of the proposed expansion of the scope of patenting. Such expansion, as proposed largely by the United States and Japan, could prevent parties from denying protection if "the product [does] not result in an enhanced efficacy of the known product when the applicant has set forth distinguishing features"7. This is cause for more concern in terms of the quality and value of patents. More fundamentally, however, a wider scope for patent protection does not by any means create any further opportunities for developing countries to enjoy the benefits of IP and innovation. Instead it again favours those who already have the wealth and resources to expand, reinforcing the existing inequalities.
The good news is that, according to the leaked documents, New Zealand opposes proposals (such as that above) for significant expansion of patent protection8. The bad news is that our representatives, and those of the other parties, continue to discuss the TPPA behind a shroud of secrecy that thwarts public discussion and participation. Further bad news is that these negotiations, like those concerning TRIPS, are characterised by a typical disparity in bargaining power that ultimately serves the interests of the more powerful (countries and corporations). To the extent that this subordinates the interests of developing countries and stifles their economic growth, our involvement only supports such injustice.
A number of commentators have highlighted the fact that the TPPA poses potentially serious consequences for New Zealand, in terms of pricing and availability of medicine and health care, and bargaining power for purchasing pharmaceuticals. While this is a real concern, we should indeed be equally (if not more) concerned about the significant threat to global health care and equality, or at least the steps already made towards equality. The clear emphasis on property, patentability and profit ignores those whose needs are not voiced by purchasing power and instead serves those whose interests are largely private and economic.
By individualizing creation, by disembedding it from the social milieu from which all knowledge is drawn, intellectual property rights deny the importance of the public realm, and by doing so reward only a small group of rights holders rather than the carriers of social knowledge, and, more importantly, ignoring the social welfare benefits of those excluded from use, not by ignorance or lack of interest, but by their poverty.9
While it might be argued that we need more empirical evidence to prove the positive correlation between patent protection and innovation, we need no further evidence, as Pope Francis reminds us, for the fact that "each meaningful economic decision made in one part of the world has repercussions everywhere else; consequently, no government can act without regard for shared responsibility"10. We must understand the ramifications of the TPPA not just for New Zealand but also and above all for developing countries that are not party to this agreement. We must encourage our government to act with transparency and integrity, and with regard for the significant global concerns for which we share responsibility.
Daniel Kleinsman LLB, completed his Law Degree at Victoria University of Wellington in 2014. He has experience in the area of intellectual property law.
John XXIII, Pacem in Terris, http://w2.vatican.va/content/john-xxiii/en/encyclicals/documents/hf_j-xxiii_enc_11041963_pacem.html. Accessed 20 March 2015.
WikiLeaks, https://wikileaks.org/tpp-ip2/, accessed 20 March 2015.
 John Locke, Second Treatise of Civil Government: The Ends of Political Society and Government (1690), Chapter IX.
 Cited by R Hewitt Pate, Competition and Intellectual Property in the US: Licensing Freedom and the Limits of Antitrust, p 60.
United States v. Microsoft Corp., 253 F.3d 34 (D.C. Cir. 2001).
Louise Bernier, Justice in Genetics: Intellectual Property and Human Rights from a Cosmopolitan Liberal Perspective (Edward Elgar, 2010), p 139.
Wikileaks, https://wikileaks.org/tpp-ip2/, Article QQ.E.1: Patents / Patentable Subject Matter
Ibid., (see also Paper submitted by NZ on IP Proposal: http://www.citizen.org/documents/NZleakedIPpaper-1.pdf).
Louise Bernier, Justice in Genetics: Intellectual Property and Human Rights from a Cosmopolitan Liberal Perspective (Edward Elgar, 2010), p 111.
Francis, Evangelii Gaudium: http://w2.vatican.va/content/francesco/en/apost_exhortations/documents/papa-francesco_esortazione-ap_20131124_evangelii-gaudium.html. Accessed 20 March 2015
Facebook in ethics face-off
Sue Buckley and John Kleinsman
The publication of a research paper that investigated the "emotional contagion" of 700,000 randomly selected Facebook users received extensive publicity recently because of the methods used by the researchers.
Two groups of Facebook users had their news feeds manipulated with a view to assessing its impact on their emotions. In one group, exposure to friends' positive emotional content in their News Feeds was reduced; in another group exposure to friends' negative emotional content was reduced. The effect on the participants was then measured by examining the emotionality of their status updates.
In explaining their project, the researchers stated that they used word-counting software, which meant that original posts were not viewed by them. As such, they considered that it was consistent with Facebook's Data Use Policy to which all users agree. They further claimed that the Data Use Policy precluded the need to seek additional consent from the study group. In addition, it was later claimed that as the experiment was conducted by Facebook for internal purposes, there was no obligation to "conform to the provisions of the Common Rule" which protect human research subjects.
However, there has been widespread questioning and criticism on the grounds that the researchers failed to obtain adequate informed consent from the unknowing participants. In response, one of the research authors appealed to the need for the research to take place: "We felt that it was important to investigate the common worry that seeing friends post positive content leads to people feeling negative or left out. At the same time, we were concerned that exposure to friends' negativity might lead people to avoid visiting Facebook." He also stated: "... our goal was never to upset anyone. I can understand why some people have concerns about it, and my coauthors and I are very sorry for the way the paper described the research and any anxiety it caused."1 However, he conveniently fails to address the issue of informed consent.
So, if the intention of research is never to upset anyone, if there is little reason to expect that it might be harmful and if there is a good reason for undertaking it, why is it important to gain informed consent? In answering this question it must be remembered that the Facebook researchers were not just observing behaviour but were specifically aiming to manipulate the emotions of the participants by an intentional intervention. As one commentator noted: "The study harmed participants, because it changed their mood".2
It is a well-established principle within research ethics that any research involving an intervention requires fully informed consent and should be overseen by an ethics committee independent from both the researchers and the organisation or company instigating the research. This means that participants should (1) know they are being experimented on; (2) be given clear information about the research; and (3) be informed of both the risks and benefits. The only exception to this would be in circumstances where, for various reasons, participants are unable to give consent, in which case consent must be sought from someone legally entitled to provide consent for them.
The history of 'informed consent' in research goes back to the Nuremberg Code of 1947, developed after the Nuremberg trials at the end of the Second World War. These trials exposed research by Nazi doctors on Jews which included the murder and torture of the participants, all done without consent. Since that Code was developed there have been numerous and serious instances of unethical research where consent was not obtained, including the 'Unfortunate Experiment' at National Women's Hospital in Auckland where the conventional treatment for carcinoma in situ (CIS) was withheld from some women without their knowledge. It is worth noting that the researcher, Dr Herbert Green, had no intention of harming anyone and felt it was important to test his theory that women were being over-treated.
Even if Dr Herbert Green's theory had been right, the fact remains that his research would still have been unethical because informed consent was not obtained. Participants in research always have a right to know the risks they are exposed to and, even more fundamentally, a right to know that they are involved in interventional research. There was also a lack of independent oversight of Green's research.
Research can never be judged to be ethical on the basis of its intended outcome alone. Neither does a good outcome justify an unethical research process. Good research is always ethical from its inception. No interventional research should ever be undertaken without informed consent. The Facebook research clearly went beyond benign, anonymous, observational monitoring, which meant it required informed consent. Neither was it subject to any sort of independent scrutiny. Even if it is true that the risks for the Facebook experiment were low, there is an important principle at stake here, which must be upheld.
In the same way that stealing is stealing no matter what amounts are involved, so we all have a right not to be experimented on without our knowledge whatever the nature of the research.
Sue Buckley is a researcher for The Nathaniel Centre and John Kleinsman is director of The Nathaniel Centre
1. Kramer, Adam D.I. Facebook post, June 30th 2014. https://www.facebook.com/akramer/posts/10152987150867796
2. James Grimmelmann, professor of law at the University of Maryland, quoted in the Guardian, 30 June, 2014. http://www.theguardian.com/technology/2014/jun/30/facebook-emotion-study-breached-ethical-guidelines-researchers-say
Election 2014: A statement by the Catholic Bishops of New Zealand
A statement by the Catholic Bishops of New Zealand
“The goal of economics and politics is to serve humanity, beginning with the poorest and most vulnerable wherever they may be, even in their mothers’ wombs.”
Election year debates are an opportunity for taking our faith into the public arena; for discussing and debating our deepest hopes and values for a better society; for challenging complacency in the face of injustice; for deepening our understanding of issues that affect our neighbours and for forming our consciences. Our deepest and most important values are reflected in the way we participate in elections.
Elections do not begin with the tick we make on a ballot paper, but with the way we engage with the political process.
Even people stirred in different ways by the world’s injustices sometimes see elections as a purely cynical exercise, and feel their participation is insignificant to the final outcome. Some commentators dismiss these attitudes as apathy; but they may also be seen as a sign of disengagement and a loss of faith in political leaders and the political process. This election year we urge all New Zealanders to see election year debates not as marketing exercises, but as an urgent opportunity to argue for and build a society based on the good of each and the good of all.
In many parts of the world, voting is not a free or fair process, or it is not safe to express a political opinion or to participate in political debates. We should rejoice in our right to participate in a fair election process and in free political discussion.
The Catholic Church does not tell people who to vote for. Your bishops will not tell you how to vote.
Catholic teaching advises us on how to think about who to vote for. This takes a bit more work, and a lot more thinking and talking.
No political party or political platform represents the totality of the Church’s teaching, which values human life from conception to natural death; strongly defends and champions the needs of the poor and vulnerable; promotes development which is good for people; demands that we care for the outcast and stranger; and calls us to protect the natural gifts of the environment.
Pope Francis has renewed with vigour and his own personal example the Church’s mission to the poor, with a call for an end to an economy of exclusion, in which people are not just exploited, but discarded and cast aside. In New Zealand disparities between rich and poor have become entrenched in a society that once regarded itself as egalitarian. Struggling families with empty cupboards sometimes live only a few streets away from others for whom the provision of food and other basics is no problem. It is particularly concerning when people live in ignorance, and even indifference, to how their neighbours are faring.
Protecting the most vulnerable members of society is the responsibility of every one of us.
Sometimes there is a tension between issues in an election year. We may feel that we have to choose between important issues – for example, prioritising a politician’s or a party’s position on euthanasia or poverty. Catholic teaching does not trade off the wellbeing of vulnerable groups of people against one another. We seek political outcomes that protect the lives and wellbeing of all vulnerable people.
We have a special responsibility to engage with the political party that we intend to support in an election, and to speak up for the poor and the vulnerable through the whole political cycle. This means challenging all politicians and political parties, especially the one for whom you decide to vote.
Sometimes election year concerns are presented as a list of issues detached from the lives of the real people affected by them. The issues are someone’s reality. We are all challenged as voters to place first in heart and conscience those whose lives are potentially affected by decisions we make as voters. Our fellow New Zealanders matter, and in a world of complex relationships and interdependence, our obligations also extend beyond our own shores.
People living in poverty: It is a matter of shame that many people live in situations of material deprivation in a country like New Zealand which has the resources for all its citizens to live in dignity. We also have a responsibility to reach out to our neighbours in the rest of the world who do not have what they need to survive.
People living with pain, illness or approaching the end of their lives: Each person is precious and valuable at every stage of his or her life. Everyone should receive the healthcare they need, including palliative care at the end of their lives. A life unnaturally cut short through euthanasia or assisted suicide is not death with dignity.
Unborn children: Every child is welcome, no matter the circumstances into which he or she is born.
Abortion is not the answer to poverty, disability, or disruption of lifestyle. Deprivation of life is never a solution.
Refugees, asylum seekers and migrants: Rejection of some groups of new New Zealanders because of their ethnic origins is unacceptable, whether in our own parishes and communities, or as political rhetoric. Millions of people around the world are fleeing violence and conflict. They are simply people seeking help and sanctuary. They have the same right to safety and security as we all have. In a global world, our responsibilities do not end at our own shores.
People in prison: Too many offenders experience New Zealand’s justice system only as punitive and dehumanising, rather than as an opportunity for repentance and restoration. Too many people are in prisons because of unmet mental health needs. No crime is without a victim, and victims of crime deserve the care and support of the community.
People without a vote: Decisions made in the New Zealand election and New Zealand political process affect many others, including those who do not have the ability to take part. Even though they cannot vote, the opinions and experiences of children and young people under the age of 18 are just as important as the views of older people. Prisoners cannot vote, and their needs should be taken into account. Future generations of New Zealanders are also important, as their well-being will depend upon the decisions we make today about the use of the earth’s resources.
Election years are times of significant political choices. Question, discuss, debate, pray, be involved, and speak out for the poor and vulnerable among us as you decide how to cast your vote.
• John Dew, Archbishop of Wellington
• Patrick Dunn, Bishop of Auckland
• Denis Browne, Bishop of Hamilton
• Barry Jones, Bishop of Christchurch
• Colin Campbell, Bishop of Dunedin
• Charles Drennan, Bishop of Palmerston North
• Peter Cullinane, Emeritus Bishop of Palmerston North
Letter to a first time voter
Congratulations on reaching 18. As far as the law is concerned, your mother and I are no longer your legal guardians, you can purchase alcohol, fireworks and buy a Lotto ticket and obtain your own credit card. You can now also vote for the first time. It strikes me that many young people are selective about which new rights they claim and show little interest in the right to vote. I find that sad, particularly when it is a consequence of apathy.
Your great grandfather Daniel and grandfather Owen put their lives at great risk to protect the right to political self-determination. They, along with many other New Zealanders, went overseas to fight for the democracy we have long enjoyed. The right to vote is at the heart of that democracy. Some of them were, like you, just 18 years of age.
When he was your age, your Opa Gerhardus lived under a violent totalitarian regime that denied him many basic human rights including the right to vote, play sport, freedom of association, free speech, listen to a radio and access education – talk to him sometime about what that was like. Then, having come to New Zealand as an immigrant in 1955, he was denied the right to vote until 1978 when he was 52. His first vote was also my first vote!
Reflecting on history helps us recall the importance and privilege of exercising our democratic responsibilities. Your right to vote has been earned for you by your forbears and it bears the stain of blood spilled. When you vote you honour them and their commitment.
The issues we face today are many and can seem overwhelming: global warming, refugees, immigration, child poverty, family violence, growing inequality, support for beneficiaries, euthanasia, abortion, health-funding, racism, education, housing and prison reform, just to name some of the ‘neon-light’ issues. I hear you ask: “How can I possibly deal to all of these issues?”
It’s hard to summon the energy needed when we have not stood in the shoes of those who experience disadvantages. But it is even harder for them. By comparison, you have had a privileged up-bringing and they need your help. As Edmund Burke said: “For evil to succeed, it only needs good people to do nothing.”
Continue to learn and think about those whose experience of life is different from yours, especially those who struggle for the basic things that you might not think twice about. In Catholic Social Teaching we refer to this as taking a ‘preferential option for the poor’, something grounded in the biblical tradition and exemplified in the life of Jesus. Study the party policies and reflect on how they either help or hinder those most disadvantaged. Cast your vote always with them in mind rather than your own well-being.
You enjoy the outdoors and feel strongly about the environment. You also care about other big life issues, including euthanasia and abortion. It gets confusing when, within parties, there are inconsistencies and even contradictions in their policies. Politics is complex and messy. Firstly, resist the temptation to see things as ‘black and white’. Secondly, within our current voting system, you get two votes; one for the party and one for the electorate. An approach I recommend is to cast your electoral vote for the candidate who will best represent your views on the issues on which there should be no compromise – often described in parliament as ‘conscience votes’ – and to give your party vote to the party you think has the better policies regarding the bigger-picture social issues which can allow, or even require, a bit of give and take.
Even then, it is likely you will find yourself having to make compromises by voting for a politician or party at odds with certain beliefs you hold dearly. In which case, remember that it is possible to influence MP’s thinking after the election through information and political lobbying. Not being able to vote for the ideal doesn’t necessarily mean compromising your beliefs or commitment to greater justice. In other words, see your ‘right’ to vote as being more like a ticket that gives you life-long entry to the stadium of political engagement rather than a one-off happening every three years – i.e., be an active voter.
Lastly, believe that your involvement in the political process, insignificant as it seems, can make a real difference. Pope Francis writes that we are “small, yet strong in the love of God”. I like that. He has also said that we are each called to watch over the world in which we live. As Catholics we stand for certain things, and we also need to stand-up for certain things. Voting and getting involved in political advocacy is an important way for you to live out your call to follow Jesus.
Grace, having turned 18, you are now being invited to play your part in making our country and the world a better and more just place … and I know you are ready to do that.
Your loving Dad
Dr John Kleinsman is the director of The Nathaniel Centre
Promoting good discussion on public issues
For the last four years I have been building and directing New Zealand’s first Centre for Theology and Public Issues. Based in the Department of Theology and Religion at the University of Otago in Dunedin, the centre is one of several ‘public theology’ institutions around the world, with a remit to contribute to thinking on current issues from a Christian theological perspective. As well as seeking and responding to opportunities to do this through the media, the Centre also undertakes research and teaching, and runs a busy programme of public lectures, forums and conferences.
The discipline of public theology is premised on a conviction that the resources of the Christian faith – primarily Scripture but also the teachings of the Church and the writings of individual theologians and thinkers – contain a wealth of insights, visions, teachings and narratives that, with careful exegesis and due regard to changing contexts, can enable fresh light and wisdom to be shed on the many challenges we face globally, nationally and locally.
The idea that theology might have anything interesting or worthwhile to say about public issues will strike many people as odd, particularly in a proudly ‘secular’ country like New Zealand. No one objects to people having religious beliefs – that’s a basic human right – but the idea that public thinking or government policy might be influenced by opinions based on a religious world-view is, for many people, deeply troubling. A draft document released by the New Zealand Human Rights Commission in July 2010 summed up this view quite neatly when it stated that ‘matters of religion and belief are deemed to be a matter for the private, rather than the public, sphere’. This document also made it clear that this demarcation between the public sphere, in which religion has no place, and the private sphere, the proper place for ‘matters of religion and belief’, is what essentially defines New Zealand as ‘secular’.[i]
One can readily understand the rationale for such a position, since religious people do often like to impose their views on others, even when they’re in the minority. And the language and line of reasoning they adopt can sometimes be incomprehensible, or simply unacceptable, to those not sharing their beliefs. No-one would argue that discourse in the ‘public square’ shouldn’t employ vocabulary, principles and reasoning which are intelligible to any reasonable person and based on public canons of validity. But this narrow understanding of ‘secularism’ also means that the genuinely-held differences people might have on moral issues remain hidden, as well as discriminating against those who want to offer religiously – or ideologically –rooted opinions in a non-dogmatic way. Hence a more ‘inclusive’ interpretation of the term ‘secular’ has been advocated by both religious and non-religious intellectuals and commentators in recent years, one which recognises that the quality of public debate can be enhanced when all voices are granted a hearing, provided none is privileged over the others.
Public theology is acutely aware of the marginal position that religion has in today’s world, and the implications this has for the way it needs to offer its perspective in the public square. Yet it also wants to stress the value of that perspective because of the fresh and constructive nature of the insights it can bring to sometimes rather stale and circular public debates. For example, asserting that, despite the radically different contexts in which they emerged, Scriptural insights into the nature of humanity, the ‘gifted-ness’ of Creation, the importance and nature of ‘justice’ and the purpose and meaning of markets, have much to teach us in the 21st century.
Public theology is also concerned about the language it uses to make its contribution, recognising that it will need to find a way to talk about concepts like ‘the sanctity of life’ or humankind having been ‘created in the image of God’ in ways that will be readily understood without devaluing their deep and unique (and theological) content.
One notable way in which our Centre at Otago contributes to ‘public issues’ is by creating the space for informed, respectful and balanced conversation. Given that debates in Parliament often generate more heat than light, and that our (now all commercially-driven) television channels give low priority to serious ‘current affairs’ programmes, universities seem increasingly to be filling the gap by generating reflection on public issues. In one sense this is to be expected, given their statutory obligation to be ‘critic and conscience of society’.[ii] Nevertheless, at Otago we have found a high degree of interest in the public forums our Centre has organised, often in collaboration with other similar centres based at the university. TV producers (and the advertisers whose revenue they need) are probably right in thinking that serious discussion of public affairs is only a minority interest, but there is certainly an appetite for it, and not just in Dunedin.
The main limitations on our Centre’s work in this field are time and resources: there is certainly no shortage of ‘public issues’ crying out for serious, intelligent analysis. Some observers query how issues like the partial sale of state-owned assets, or the global financial crisis, or MMP (all topics we have covered in public forums in the past eighteen months) can be ‘theological’, but of course they are in the sense that theology has much to say and deep questions to ask. Questions about: the nature of our society and the values underpinning it; how and in whose interests markets operate; how we elect our representatives; how natural resources are owned and distributed; and how serious we are about pursuing the common good. Among the more ‘obviously theological’ issues we have tackled in recent years are care of the planet, our treatment of children and older people, and the nature of our secular society. We have also explored wider issues such as the global food shortage, the situation in the Middle East and lessons from the Breivik trial in Norway. Interestingly, these ‘international’ forums have been among our most popular and valued.
The paucity of quality public debate in our country has huge implications for the shaping of public opinion – and public policy – on bioethical issues. One topical example is the debate about legalising euthanasia and assisted suicide., While our television, radio and newspapers will devote considerable air-time and column inches to reporting, often in a quite sensational way, notable cases of one individual helping another to die, relatively little time or space by comparison will be allocated to exploring the issues surrounding these cases. And while readers may often be left with the impression that the punishment meted out to a person responsible for hastening their friend or relative’s death was harsh or unjust, and that therefore the law needs changing, little effort may have been made to provide commentary or expert opinion to help them to think in a critical or balanced way about the deeper issues. Given that a private member’s bill to legalise certain end-of-life options is currently in the mix, it is not overstating things to say that we face the very real prospect of significant changes in the law relating to euthanasia and assisted suicide being passed with only minimal public consideration of the profoundly important issues and implications at stake.
Last year our Centre sought to avoid this scenario by staging what has so far been its most influential public forum. Titled ‘Euthanasia and Assisted Suicide: A discussion we need to have', the panel featured Nathaniel Centre director, John Kleinsman; medical-ethicist and neurosurgeon Professor Grant Gillett; Labour List MP Maryan Street, the proposer of the putative ‘End of Life Choice Bill’; and Professor Sean Davison, the South African-based academic who was sentenced to a period of home detention in 2011 for assisting the death of his mother in October 2006. We were fortunate to secure the attendance of Professor Davison in the short period between the completion of his sentence and his return to South Africa, and undoubtedly his presence contributed to the profile our event secured (which included coverage on TV3’s ‘Campbell Live’ and Radio New Zealand National’s ‘Morning Report’). The fact that some 300 people turned out for two-hours of discussion and debate, including a 20-minute presentation by theology student Thomas Noakes-Duncan on how the debate on euthanasia and assisted suicide has been conducted in New Zealand in recent years, shows our preparedness to properly inform ourselves and engage in meaningful debate about serious issues.
Indeed, one striking feature of this event was the quality of the questions and comments from the floor, particularly from students in the medical faculty. (For a podcast of this event see the Centre’s website - www.otago.ac.nz/ctpi/resources/podcasts
Feedback from this event suggests that it has helped in a modest way to stimulate serious thinking on a highly important topic. Indeed, I would say that even making it known that we held such an event is important in terms of reminding people that issues like euthanasia and assisted suicide need much more than the ‘sound-bite’ treatment they sadly often only attract. Democracy, we need to remind ourselves, involves far more than the casting of a vote once every three years, and as both Amartya Sen and Michael Sandel have argued in recent works, it is public reasoning, more than elections, which defines what it is essentially about.[iii]
I hope that our Centre can continue to promote more ‘public reasoning’ around the challenges we face, including those we might categorise as quite literally ‘issues of life and death’.
Andrew Bradstock is Howard Paterson Professor of Theology and Public Issues at the University of Otago and Director of the University’s Centre for Theology and Public Issues.
[i] NZ Human Rights Commission – Accessible HTML Document, ‘The right to freedom of religion and belief - Te tika kia watea ki te whai whakapono, ki te whai haahi - Draft for discussion’. <http://www.hrc.co.nz/hrc_new/hrc/cms/files/documents/25-May-2010_14-47-52_Right_to_freedom_of_religion.html> [accessed 16 July 2010].
[ii] Under Section 162 (v) of the Education Act (1989) a university is required to ‘accept a role as critic and conscience of society’.
[iii]Amartya Sen, The Idea of Justice (London: Penguin, 2010) 321-37; Michael Sandel, Justice: What’s the right thing to do? (New York: Farrar, Straus and Giroux, 2009).
O blessed fault; an evolutionary reflection on original sin
Not long after the appearance of The Catechism of the Catholic Church (1992) scholars made nuanced calls on its contents. Some sections were seen as a happy synthesis of tradition and new insights; others were regarded more as summaries of tradition. The coverage of original sin came very much into the latter category. It was as if the writers looked at all the developing insights in this area, saw them as too difficult to locate in a new synthesis so simply summarised what had come out of the Council of Trent.
The last sixty years, however, have produced so much knowledge that can no longer be ignored that a new synthesis is needed. This is not simply to vindicate the traditional sense of Catholic belief but even more to make it a strong and useful instrument for catechists and apologists in explaining the state of contemporary society. A brief list of such advances would include the findings from the mapping of the human genome, the similarities and differences between humans and the great apes emerging from primatology; our new vision of the role of climate changes in world history and how these link to the numerous hominids now extinct (and how homo sapiens very likely came near to extinction about 70,000 years ago); finally, but far from least, the crucial document “The Interpretation of the Bible in the Church” (1994) from the Pontifical Biblical Commission. This document marks a definitive acceptance not merely of the very diverse literary genres of the Bible but also how these must be read in the light of the author’s intention and cultural situation. Many scholars would now accept that the same criteria should also be applied to historical documents such as the decrees of the Council of Trent.
This essay is a modest attempt to begin such a study of original sin
A. Beginning From Intimate Relationships
My project begins with a study of the work of two very different writers, Harville Hendrix and Rene Girard. Both deal with anthropology, Hendrix in the field of marriage relationships and Girard in social and cultural anthropology. The former is a popular writer working out of personal narratives, the latter a more academic and controversial figure whose theories embrace literary criticism as well as social and political theory.
Perhaps Hendrix’s central work is Getting the Love You Want: a Guide for Couples (Simon and Schuster, London, 2005). His central theme is stated very succinctly in his preface:
We are born in relationship, we are wounded in relationship, and we can be healed in relationship. Indeed, we cannot be fully healed outside of a relationship. (xix)
After the break-up of his first marriage, Hendrix, a committed Christian, wanted to uncover the dynamics of this failure. His theory arose out of interviews with hundreds of couples. The imago therapy which has arisen from this research has restored and reinvigorated many failing marriages.
The first and more theoretical part of his work examines why couples fall in love. Using modern knowledge of the different sections of the brain he explains how many of our key childhood reactions such as separation, abandonment and betrayal are stored in the primitive areas of the brain, not accessible by conscious effort. The sense of total oneness that we felt with our mothers also remains a profound yearning despite the many knocks it endured as we matured into separate identities. Inevitably we are subject to hurtful and repressive pressures which we strive to contain, so fragmenting our personality into disconnected parts: a lost self, shaped out of society’s demands, a false self – the face we show to the world – and the disowned self, negative parts of our false self which others have found objectionable so we have disowned them.
According to Hendrix’ s research lovers, when choosing a life partner, unconsciously seek someone carrying both negative and positive characteristics of their caregivers, especially the former. This is a reparative instinct, an attempt to reconnect with our lost selves by linking up with a partner bearing similar defects. Unconsciously we create an image (imago) of the perfect partner to bring us back to wholeness. This helps to account for the rosy glow of romance when we see our beloved as the one who meets our needs perfectly and renews our energies.
As the deeper intimacy of marriage develops, however, love seems to cool and anxieties grow. First we notice that our partners have the same negative characteristics as our parents, so stir up old wounds. Suppressed feelings well up, old childhood hurts are rekindled, and our words and behaviour become increasingly defensive. We try harder and harder to get our needs met, resorting to dishonest questions, nagging, even verbal or physical violence.
Reflecting theologically on this theory it is not difficult to see how it engages deeply with the Christian vision of humans (male and female) being together the image of God. Just as the persons of the Trinity reside totally in one another, somewhat similarly we do not have any identity apart from relationship.. God calls us to spiritual and emotional wholeness, but that cannot take place without becoming whole in relationship with others. It is the turning inwards in self-possession and protection that is the basis of egotistic self-diminishment or sin.
B. The Role of Violence; the Work of Rene Girard
Girard’s initial field of research was cultural and social anthropology. Fascinated by the similar structures of violence that he encountered in widely diverse societies, he began to search for the roots of such behaviours. This led him back to the Bible and to rediscover his Catholicism. His work can be classified under three headings: mimesis, the scapegoating mechanism, and the role of religion and violence in societies and how this has been transformed by Jesus Christ’s death and resurrection.
Girard’s first insight focuses on how all infants learn by imitation, not merely of behaviours but also of affects or feelings. We discover love by being loved. This makes of learning a triangular process: the thing learned, the learner and the teacher. This seems to be hardwired in the human brain even before understanding, e.g. the way infants learn speech and language. This Girard labelled mimesis. It leads humans to imitate a desired figure and their qualities; such desires then shape the reactions of others, giving rise to rivalry because of competition for the loved one’s response. This process is holistic, spreading to every area of life. Here we see many points of contact with the work of Hendrix.
When entire societies become wracked by issues of such anger and hatred for which there are no obvious solutions, many resort to a type of ‘magical thinking’ seeking someone or some group to carry the blame. Often these figures are outsiders, marked by a diverse culture or refusal to integrate, such as the ‘witches’ executed in Salem in 1692, or the millions of Jews wiped out in the shoah. Such common action against a perceived enemy (scapegoating) often unites and strengthens a society e. g. Londoners during the blitz. When, as always happens, this sense of solidarity weakens and frictions begin to re-emerge, then societies may turn to ritual re-enactments to re-awaken feelings of union and deliverance, as in the apprentices’ marches in Northern Ireland. In our time scapegoating has become ever more subtle e. g. depicting all Islamic discontents as the fruit of terrorists and extremists.
Girard has also noted how often the state has co-opted religion to shore up its own authority. This often happens in time of war. Sometimes authority will condone violence to avoid what it sees as an even greater evil e.g. when Caiaphas proclaims that Jesus must die for the sake of the entire Jewish people (Jn 18.14). Because it is the winners who are the usual chroniclers of history, victorious states use such techniques to justify their violent acts. Girard, however, stresses that the Bible, especially the New Testament gospels, portray history from the viewpoint of the victim. Though Jesus is the scapegoat par excellence his free acceptance of death, refusal to retaliate, and subsequent resurrection, unveil the hidden nature of political violence, so undermining the power of the state.
Girard notes that dominant powers have become much more subtle, for instance in promoting liberation from stifling institutions such as the Church or the traditional family in the name of freedom. In the name of such freedom the state itself has become more oppressive e.g. the USA condoning the use of torture and the wholesale monitoring of social media
In conclusion, we can see that Girard, like Hendrix, sees relationship and its failures as the fundamental dynamic in shaping a human sense of completion and fulfilment. Moreover, he goes further in elucidating the mechanisms by which these dynamics shape society, morphing into political structures. In this way they shape family and clan relationships, national and international life – our way of existing in the world.
In the Garden of Eden story both Adam and Eve try to shift the blame for their refusal to trust in God onto another, in Eve’s case, onto her mate; on his part, onto a scheming third party. Cain goes even further in denying any responsibility for his own brother’s life. Here we see original sin at its fountainhead: blame and distance from the other. The work of both Hendrix and Girard shows how this same trend continues writ large in our own society.
C. Original Sin Seen through the Lens of the Hendrix and Girard Paradigms
Midwives point out how babies come into the world wet, hungry and angry. For this is the most traumatic journey they face till they meet death. In many ways the perils of birth are but a prelude to the fragility of life. What highlights such fragility is that humans have achieved their seeming domination over nature and other animal species by their mutual cooperation – yet other humans are also their most deadly foes. We stand in utter need and dread of one another.
It was St Augustine in his battle against the Pelagian heresy who linked original sin closely with sexuality. Reflecting on his own life and inability to use reason to control his sexual passions led him to see the vast bulk of humanity as a massa damnata, carrying not just the consequences of Adam’s sin but its guilt as well. This interpretation had a huge impact on medieval theology, right through to the Council of Trent. Here we seem to have a clear case of the need to draw upon the insight of the Biblical Commission in its 1994 document. Fifth century Western anthropology was marked by great pessimism, especially about the human body, which clearly coloured Augustine’s reading of scripture. Today popular culture has swung to the other extreme but we still need to acknowledge how much Augustine’s view of original sin was the fruit of his own life experience, reinforced by the dominant mood of his age.
In the light of what we now know of our biology and evolution, might it not be more helpful to see original sin in terms of our innate relationality? The more consistent temptation is surely our inclination to renege on such relationality, acting out of the belief that we can completely control our life and destiny by our own efforts. Conversely, assenting to our essential relationality means accepting that we came into being, are sustained, and will eventually perish in ways beyond our control; we are utterly contingent. We have been summoned from nothing; we receive all while meriting nothing.
The Adam and Eve story is clearly symbolic. We know there was there was much suffering and death, many proto-humans before the first homo sapiens came to a moment of moral choice. Scripture scholars point out that the Garden of Eden story is but one of a sequence of incidents (Cain and Abel, the great flood, the tower of Babel) pointing to growing resistance to God’s gift of life. Each one of these calamities results from a failure to trust, a desire to dominate and control others.
As Girard points out, blaming and scapegoating mechanisms also evolve, becoming more subtle over the ages. A clear instance appears in the development of attitudes in physical science. Early astronomers such as Galileo and Kepler saw their work as a deeper penetration of God’s knowledge, and elements of religious awe permeate their reflections. Such attitudes increasingly give way to motivations of power and control over nature, Francis Bacon being a clear example of such a stance. As we in modern nations have moved from an organic to a more organised society we have also seen an even deeper concentration on production, the assimilation of nature into human desires, and material gain as dominant themes. Accompanying this is a drive towards individualism, the prevailing of personal desires even against wider environmental health and conservation. As A. J. Conyers notes: “In modernity, the new version of original sin is that we are born into a human family. Salvation consists in the struggle to escape it.” (The Listening Heart, Baylor University Press, Texas, 2009, 104). Under the onslaught of deconstructionism all narratives of religion, patriotism and human solidarity have come under suspicion. What has taken their place is the domination of the market, around which so much work, recreation and aspirations for the good life now centre. The sole value now universally recognised is the value of exchange, seen concretely in commodifiable options, with arbitrary free choice the greatest good. All other value systems and beliefs are cast into the realm of personal choice and foible.
Religion itself is now subject to commodification. The dominant God of western culture is a therapeutic deity, all notions of truth or virtue becoming decidedly uncool. While decline in friendship and lasting marriages continues, there is still immense desire for healing and new life. Nowhere is this more evident than in the USA where the number of professional caregivers has risen a hundredfold since 1950. (Ross Douthat, Bad Religion, Free Press, NY, 2012, 240).
Contrary to this is a vision of every human being as an icon of God, one tiny facet of God’s unlimited beauty and goodness. Each of us is the result of God’s totally free creativity and playfulness in creation. Our endless variety is a masterpiece of creation, parallel to the way in which each gene is constructed from only four chemical bases repeated and connected in a myriad of combinations, modified and reshaped constantly over the course of evolution. It is in accepting and loving the other purely as other, not as an extension of our personal needs and fears, that freedom from original sin lies. This is precisely what we see in the life of Jesus Christ the sinless one. But with the coming of Christ, and through his power continually transmitted by the Holy Spirit there is a new creation in grace that is far greater than any putative original innocence. Whereas original sin is a turning away from relationality and creaturehood, assimilation in Christ becomes a celebration of relationality, a joyous acceptance of being a frail but deeply loved creature.
This insight could have many applications in moral fields. I point to just one bioethical issue – euthanasia. Two of the justifications for physician assisted suicide are freedom of choice and the growing cost of maintaining life for a rapidly ageing population. Based on the work of Hendrix and Girard, we might see elements of avoidance of responsibility and the domination of economic goods over human needs, hidden beneath such justifications. More positively, we might point to the time of dying as a privileged moment in which thanks for the gift of life and the healing of family rifts would be points of growth and new hope for families that still live on.
Dr Neil Vaney is a Marist priest who has specialised in moral theology. His doctoral research is in the areas of environmental ethics and the theology of nature. He is presently a resource person for pastoral and spirituality ministry in Hawkes Bay. He will be joining the leadership team of the Society of Mary in Wellington in 2014.
Editorial: The Church (and bioethics) in the (post) modern world
It is 50 years since the Second Vatican Council opened in Rome. For Catholics, the Council marked a significant transition in self-awareness – from a Church which saw itself as largely set ‘apart’ from the world to one which is deeply connected with – literally ‘in’ – the world.
Nowhere is this better exemplified than in the Council document “The Church in the Modern World” which sets out how the Church should conceive its activity in the world, scrutinising and interpreting “the signs of the times” in the light of the Gospel.1 It admonishes Catholics who would shirk their “earthly responsibilities” in favour of seeking “a city to come”; rather, authentic faith means they are more obliged than ever to measure up to their secular duties and activities (n. 43).
Importantly, the document acknowledges that the Church has profited richly from the experience of past ages, the progress of the sciences, and the treasures hidden in human culture (n. 44). While the implications of this would have astounded many Catholics of the 1960’s, they are hardly radical today. Yet, they remain incredibly challenging in the post-modern world in which we live: Christians do not have the monopoly on the truth but are joined with all of humanity in searching for it (n. 16); the presence and grace of the Holy Spirit are not confined to the Church, but work in an unseen way in the hearts of all (n. 22).
In addition, the document offers a sober reminder that we are all weak beings who often do things we should not and fail to do what we should (n. 10): “It does not escape the Church how great a distance lies between the message she offers and the human failings of those to whom the Gospel is entrusted” (n. 43). Recent events in the Catholic Church have forcibly reminded us again of this fact – the scandals of sexual abuse mean we should dare to witness to our faith only with a real sense of humility grounded in an awareness that the weaknesses of human nature run through the Church and all its members. If prior to the Council it was the Church that presented itself as a perfect society and was in certain ways hostile to the world, now, at least partly because of the current scandals, it is the world that has become more hostile to an imperfect Church – a situation that is both understandable and regrettable.
Consequently, many Catholics wishing to bring a faith-based perspective to the social and political realms are experiencing a new antagonism; when we speak, we can no longer expect that what we offer will always be welcomed or seen as credible. This state of affairs is surely one of the signs of our time that we are obliged to scrutinise, interpret and respond to. The question arises: ‘How can we best articulate our faith-based perspective in the post-modern world in which we live?’
There are great insights to be gleaned from “The Church in the Modern World”: we must strive to understand the world in which we live (n. 4); we must promote “a living exchange between the Church and the diverse cultures of people” (n. 44); we need to acknowledge that the Church requires the special help of those who are versed in the different institutions and specialties (n. 44); we must extend respect and love to those who think or act differently than we do in social, political and even religious matters and strive deeply to understand “with such courtesy and love” that we enter into real dialogue with others (nn. 21, 28).
Further, taking to heart the document’s claim that nothing genuinely human should fail to raise an echo in the hearts of Christians (n. 1), we need to show that the power of the Catholic moral/ethical tradition lies in the way our teachings are themselves signs – signs pointing to the truth about human existence and allowing that truth to be more deeply penetrated and better understood for human advantage (n. 44). As the document itself notes, faith throws a new light on everything, ultimately directing the mind to solutions which are ‘fully human’ (n. 11). There is, in other words, an intrinsic link between faith and human flourishing (n. 43).
For those engaged in Catholic bioethics there is a clear onus to first listen so as to understand and learn from others while facilitating the conditions for honest and sincere dialogue. Then, within that dialogue, we must convincingly articulate the wisdom of the Catholic tradition in terms of its relevance for constructing a world more genuinely human, all the while using language intelligible to the current generation (n. 4) and remaining faithful to the “befriending Spirit” (n. 3) that animates and guides us all.
50 years on, I find much wisdom and hope in a document that was promulgated before I could even read.
John Kleinsman is director of The Nathaniel Centre
1. "Pastoral Constitution on the Church in the Modern World." In Vatican Council II: The Conciliar and Post Conciliar Documents, edited by A Flannery. Collegeville, Indiana: The Liturgical Press, 1965, n. 4.
The hidden ideology of technicism
We have come to rely heavily on science and technology. As a result we find ourselves heavily dependent on technical things such as aeroplanes, cars, roads, cell phones, computers, chemical fertilisers and pesticides, power stations, domestic appliances and more. Technology shapes our lives to a major extent. We enjoy its benefits daily.
Such benefits notwithstanding, technology also presents us with significant challenges, many of which raise questions of a bioethical nature. This article seeks to stimulate critical reflection on the meaning of modern technology and our responsibility for its on-going development.
The evolution of technology
Technology can be defined as the activity by which people give form to nature for human ends by means of tools (Schuurman, 1980: 5).
In the past such activity was largely the domain of artisans who used relatively basic tools and worked with materials found in nature. Today it has become much more complicated; we rely largely on scientists and engineers who use already existing technical objects to design the tools and processes to make things. Furthermore, many contemporary materials, such as plastics, are not found in nature.
Many people seem to operate out of an unquestioned belief that technology evolves naturally for the benefit of humankind. According to this view the world is itself an evolving piece of machinery and technology develops as if it were part of nature. As an example of this thinking, the Expo 2000 World Fair held in Hannover (Germany) portrayed the course of technology as an ever widening river meandering through history and bringing forth, naturally, developments such as modern nuclear technology in our age. Thus, nuclear energy has arrived at the precise time when oil runs out, the Internet has come about so that we can cope with the complexities of the modern world and genetic technology will enable us to cure diseases that have so far proved to be incurable. (Assheuer, T. 2011: 44).
The fundamental belief that underpins this understanding of technology is the notion that technological developments are inevitably beneficial for humans. It is not that those who think along these lines don't accept that new technologies may cause unforeseen problems and accidents. However, in line with their unshaken trust in the benevolence of technology, they hold that the challenges created by technological developments are the means that will, in turn, inspire the development of further new and improved technologies.
While there is a core of truth in this stance, inasmuch as new technologies build on preceding ones and yield many benefits, the most basic problem with this view of the world is that it minimises human responsibility for technological developments. This may be seen most starkly in the light of nuclear accidents.
Nuclear power was made possible once scientists had figured out how atoms could be split. By aiming neutrons at Uranium 235 a chain reaction is triggered which releases huge amounts of energy. However, ever since the first nuclear power stations were built in the 1950s, no-one has managed to solve the problems associated with the accumulation of dangerous radioactive wastes or the fall-out of radioactive pollution as has occurred from time to time. The explosions of the Fukushima nuclear reactors are the most recent example of this.
In March this year the tsunami that followed the 9.1 earthquake in Japan crippled the nuclear reactors of a power plant in Fukushima, resulting in the release of radioactive materials. As a result, agricultural land close to the plant has been contaminated for hundreds of years, whilst radioactive water has been spilled into the ocean. Other major mishaps include the 1979 incident in Harrisburg (USA) and the 1986 massive explosion which destroyed reactors at Tchernobyl (Ukraine), causing many deaths and widespread cancer as well as taking a large swath of fertile land out of production.
Assheuer (2011:44) is of the opinion that the recent explosions of the Fukushima nuclear reactors have begun to shake human belief in the notion that technological development is naturally friendly to human well being. While renewed caution in regard to the use of nuclear power is understandable and timely, the key question is whether such caution ultimately challenges the dominance of the metaphor that shapes people's attitudes to technology – namely the idea that the world is an evolving piece of machinery.
The link between science and technology
Scientists, to use yet another metaphor, might well be described as people who use microscopes to focus in on the smallest of details, isolating from the broader context the thing they want to analyse in depth. This process is known as 'abstraction'. The scientists' aim is to present a precise logical account of how things work. Then, armed with such precise knowledge, they find themselves in a position to develop and make new things. This approach typically involves four abstractions, as pointed out by Schuurman (2003: 96-102). Scientists:
- Seek knowledge that is universally valid, abstracting (ignoring) from what is concrete.
- Analyse functions, generally focussing on one function, rather than things in their entirety.
- Ask what sort of law applies to the phenomena under investigation. How do they make sense?
- Abstract from their private interests in the interests of truth.
For example, rather than giving thought to the fact that real cows function in many different ways, scientists might focus on the question of how they digest their food, or how they process grass into milk. Equally, scientists may focus in on the question of how humans learn to speak (lingual function) or how we act economically (economic function).
As a way of illustrating the process of 'abstraction' Schuurman (2003: 98) uses the example of giving four apples to four children. From a theoretical perspective the solution seems easy. In practice, however, because children prefer particular apples, the outcome can be much more complicated. In reality everything is unique, multi-functional, connected to everything else and in a state of change.
The process of analysis and abstraction is enormously powerful. It has led to the development of many of the technical wonders of our age. However, because the world consists of concrete things, plants, animals and humans, rather than abstractions, we must all continuously exercise great care and responsibility in the application of new technologies.
As abstractions are projected into the development of increasingly complex modern technology, the technical objects we use become highly functional and uniform and are typically fabricated in large numbers. Laptops and mobile phones are essentially the same everywhere. In the field of agriculture, where cows are bred to become efficient milking machines, we also find ourselves moving towards more uniform monocultures, a trend which potentially threatens the biodiversity which is so essential for life.
While scientific technology has been seen as the key to controlling and exploiting the world since the 17th Century, we now need to seriously question the ideology of technological progress.
The responsible use of science and technology in a multi-faceted and complex world of interconnected concrete realities requires that we apply our discoveries with a critical attitude. It is a matter of technology being at the service of humankind rather than vice-versa.
Unfortunately, such prudence tends to be lacking. In a world in which technical innovations are often developed by business corporations with significant financial interests, science and technology are too often deployed as instruments to achieve material benefits regardless of the long term human and environmental consequences.
Schuurman uses the label 'technicism' to describe the use of scientific technology to control and subdue the earth for human purposes:
Technicism is the pretension of humans, as self-declared lords and masters using the scientific-technical method of control, to bend all of reality to their will in order to solve all problems, old and new, and to guarantee increasing material prosperity and progress (Schuurman, 2003: 69).
I would argue that technicism exists as one of the hidden ideologies of our time. As an ideology it acknowledges no limits. We are currently experiencing the influence of technicism in all areas of life, including human inter-relationships. The use of telephones and/or computers in rural areas in certain countries for diagnosing medical conditions is a ready example of this.
If it is true, as I believe it is, that many of our problems today have been brought about by the hidden ideology of technicism, then we must seek a more responsible way of developing and using technology.
Technicism can be avoided if we abandon the metaphor of the earth as a machine and replace it by the Biblical metaphor of a garden-city (Schuurman, 2003: 165-168).
A garden is a peaceful, beautiful place, full of variety, in which plants, paths, animals and humans all have their rightful place. In the Bible, the narrative begins in the book of Genesis with a garden and it ends in the final chapter of the Book of Revelation with a city in a garden setting. The biblical view is clear; there is a rightful place for science and technology within the world in which we live.
The reference in Revelation 22 to the river of life-giving water flowing through the new Jerusalem with the tree of life growing on either side whose leaves serve as a medicine for the nations, provides a powerful reminder of the interconnection between the health of the environment and human well-being. Among other things this should inspire us to clean up polluted rivers and waterways, such as the Manawatu and to take all possible steps to minimise the future risks of oil pollution from ships such as the Rena.
There are already many examples that point towards the possibility of a basic renewal of our technological culture. The garden-city metaphor challenges us to use biological science and methods in agriculture in a way that does justice to nature. For example, farmers who have changed from milking twice a day to once a day have discovered that the costs saved make up for the somewhat smaller volume of milk produced. In addition there are encouraging developments in sustainable ways of generating and using energy.
While this path is certainly not easy, it is, nevertheless, full of promise.
New scientific technological developments should be carefully evaluated before they are put into practice. Too often we try to do this only after problems have become apparent.
If we continue without questioning the concept of the world as a huge machine we may seriously endanger life and the planet's ability to feed and house humankind. When king Midas was granted his wish that everything he touched would become gold he died. Similarly, our sophisticated technology has the potential to stifle life on our planet.
The challenge we face is to think and behave as if our society and the earth we inhabit is a garden that is progressing to a peaceful garden-city.
Petrus Simons is a retired economist, with a PhD in philosophy.
Assheuer, T.H. 2011. Tausend Sonnen; die nuklearen Katastrophen von Tschernobyl und Fukushima haben das Vertrauen in eine menschenfreundliche Evolution der Technik zerstört. Die Zeit (Hamburg) no. 17, 20 April, p.44.
Schuurman, E. 1980. Technology and the future; a philosophical challenge. Wedge, Toronto, trans. H.D. Morton.
Schuurman, E. 2003. Faith and hope in technology. Clements, Toronto, trans. J.Vriend.
Lisa Beech on the social welfare debate in New Zealand
On a very different topic Lisa Beech highlights a disturbing shift that is occurring in debates about the provision of social welfare in New Zealand. It would seem that the idea that poverty and other social problems can be solved by controlling who is and who is not born, a long favoured idea of the eugenics movement, is now being actively considered by some. There should be no place for this sort of thinking in New Zealand's social welfare system.
Editorial: Bioethics and the Paradox of the Human Condition
Issue 33, April 2011
Humankind and the world we are a part of are defined by paradox; we constantly experience life in ways that highlight the contradictory nature of our existence .
The recent earthquakes in Christchurch and Japan serve to remind us of the fragility of human life in the face of the brutal and amoral forces of 'Mother Nature'. Photographic images of the devastating aftermath are permanently etched into our minds as we watched, appalled, the breaking news. We are confronted by our utter powerlessness.
Address of His Holiness Pope Benedict XVI
Issue 30, April 2010
Address of His Holiness Pope Benedict XVI to the Assembly of the Pontifical Academy for Life about the issues that revolve around the theme of bioethics.
Editorial: Nathaniel (Hebrew: "Gift of God")
Issue 30, April 2010
Nathaniel Liam McCabe Knoef was born on December 12, 1998 and died on February 2, 1999. He lived for seven and a half weeks. At his farewell Mass I offered the following reflection on his short life:
...Nathaniel you have shown us with Martine and Stephen that Christ is not separate from the rhythm of life and death but is present – so totally present that all suffering and disappointment can be redemptive. What does that mean?
Reflections of a Pastor
Monsignor John Carde MBE
Issue 29, November 2009
As I write there is uproar about funding being withdrawn from severely handicapped children. We admire the efforts of parents who care for their handicapped child – what courage they show over the long haul.
Families – Why the Families Commission Chose Function over Form
Issue 28, August 2009
In July 2004, the New Zealand Families Commission came into existence and I, along with five others, was appointed as a Commissioner. The interview process was demanding and exhaustive and amongst many questions we were asked our views on marriage and "family form". Interestingly, each of us was a partner in long standing marriages, and all of us were committed to our various faiths. A reasonable inference to be drawn therefore is that we all believed in marriage as an institution and that we all had Christian values. This is ironic given that the Families Commission is strongly criticised by some because it has never defined families as "married father and mother and the children". In fact, it has never defined family form at all. Why not?
Address of His Holiness Pope Benedict XVI to the New Zealand Envoy
Issue 28, August 2009
"It is From God That Men and Women Receive Their Essential Dignity"
The following is the address Pope Benedict XVI gave in writing to Robert Carey Moore-Jones, the new New Zealand ambassador to the Holy See.
Let Justice Flow Like a River
The Historical and Doctrinal Roots of Catholic Social Teaching
Rev Dr Neil Vaney
Issue 28, August 2009
Catholic Social Teaching (CST) is always hard pressed to respond to the innovations of technology or the rapidly changing economic climate. Current examples of this occur in the debate over the experimental use of cells from human zygotes, and the responsibility for the collapse of huge financial institutions in the United States of America over the last two years. The technical nature of such discussions causes non-experts to lose sight that at the base of such disputes are values - such as the dignity and call of each human being by God - that go back to the earliest biblical passages. The aim of this essay is to show how the massive corpus of CST of roughly the last one hundred and twenty years is firmly rooted in the earliest biblical writings which were then elaborated upon in patristic and medieval teaching.
Living Persons and Natural Bodies
Rev Dr Gerald Gleeson
Issue 27, April 2009
While preparing this lecture I was struck by the following headline: "Natural and healthy pushing ethical and green off the shelf". The story reported that:
The most frequently used word on new products in the last year was 'natural'... Natural appeared on nearly one in four products...a 9 per cent increase on the previous year (The Sydney Morning Herald, 5th Feb 2009, p. 24)
As a Catholic ethicist, I was struck by this story because an understanding of what is 'natural' has long been at the heart of our Catholic ethical tradition, which is rightly known as a Natural Law tradition. In this lecture I will explore a common objection to Catholic moral teachings, and to the recently developed "Theology of the Body", namely, that Church teachings exaggerate what is supposedly "natural", at the expense of what is good for us as persons.
Speaking to a Secular Age
Issue 26, November 2008
Battles in the public square are won with words - but which ones?
Recently, Professor Margaret Somerville gave an opening address at the 2008 Catholic Media Convention, "Proclaim it from the Rooftops", held in Toronto, Canada. Following are some of the themes and issues she raised in her speech.
Editorial - Hope and Bioethics: The Power of Narrative
Issue 26, November 2008
Hope is the virtue that enables us to look to the future with real confidence. It is not to be reduced to wishful thinking. We can all pass the time daydreaming, imagining a future that has nothing to do with reality. Wishful thinking has no bounds: it admits of no limitation; it is not criticized by what is actually possible...Hope is grounded in life...Hope is not limitless; it is limited by real possibility. Hope needs help if it is going to go beyond the expression of desire...Without help; hope remains an orphan – abandoned in the nursery of the mind..."
--Dennis McBride, CSSR.
In 1984, while a member of the Chaplaincy team at Wellington Hospital, I recall meeting a remarkable priest, Father Gerard Bourke, CSSR. When I met him he was a patient in the Orthopaedic Ward and was in traction. Early each morning I would take him communion and he would ask me to give him an intention for his prayers each day. Over the weeks I gradually got to learn something of his remarkable story.
Among other things, he had been a Chaplain in the Second World War and was imprisoned for some time in the infamous Changi Prison, Singapore. He built a little Church in the prison camp and dedicated it to Our Lady of Perpetual Succour after the previous Church had been destroyed by bombing. Father Gerard accompanied work parties into Singapore city and ministered for a time in several of the other prison camps before that was disallowed by his Japanese captors.
He spoke vividly about the pain and destruction caused by war and hatred and how the lives of many Allied Soldiers and civilians ended so brutally. In all of this suffering he continued to minister to the many. On one occasion he told me, "this time in Changi Prison was the lowest ebb of my life – spiritually, emotionally and psychologically..."
As a newly ordained priest and newly appointed hospital chaplain who was struggling to make sense of the pain and suffering that I was encountering on a daily basis, his words felt like the voice of an angel. Perhaps that was why my reply was a little inelegant, resonating as it did with my own experience of helplessness. "Well then", I asked, "how did you survive? How did you remain a priest in the face of such suffering?"
He did not seem to mind the question, and with a gentleness born of great pain, he said, "every time I could not stand the suffering and bloodshed anymore, and every time I wanted to go AWOL, the Lord would send someone into my tent who needed help. This soldier would inevitably pour out all his troubles and suffering to me. I was always so moved by these stories that I knew I had to stay because I could make a difference to these soldier's lives. In truth, these soldiers made a difference in my life, because they gave me hope...so much so I am still a priest!"
Embedded within the suffering of each of us are deeper layers of meaning. This meaning, when we embrace it, can be a rich and powerful source of hope to both the sufferer and caregiver alike. This is the irony of hope - it can only be discovered with the help of others and by taking the risk of love and compassion.
Thomas Aquinas links hope with love and describes hope as the virtue that causes and increases love and uplifts the human spirit. "Hope causes, or increases, love; sometimes by virtue of the emotion of pleasure, which it arouses; and sometimes by virtue of the emotion of desire, which it intensifies; for without some hope there is no strong desire." [Summa Theologiae I-I, 27, 4.] "Hope adds to desire a certain drive, a buoyancy of spirit about winning the arduous good." [Summa Theologiae I-I, 25, 1.]
In his 2007 Encyclical Letter, "On Christian Hope", ["Spe Salvi"], Pope Benedict XVI speaks similarly when he says that, hope enables a person to face "the present, even if it is arduous." [n.1] He describes hope as a distinguishing mark of Christians because it is based on the "fact that they have a future." Even though they do not know the details of what awaits them, "they know in general terms that their life will not end in emptiness." [n.2] Even so, discovering hope remains somewhat elusive and challenging, not only for those without a faith or belief in the transcendent, but also for those with the gift of faith.
Cultures and professions can communicate hope in the way they engage the gifts of individuals and communities. Environments can reflect hope in the way in which they assist in uniting the world of the sufferer with the world of beauty and transcendence. However, while good structures enhance the future, they are not of themselves enough for the presence of hope. Hope requires others. The other – be that an individual, a community, and ultimately God – provides the "scaffolding" for hope to occur and for it to be maintained at a communal and personal level.
The late Cardinal Joseph Bernardin once described the Church as a "community of hope" and also referred to the healthcare profession as a "witness to hope." Human life cannot be lived in isolation and hope is diminished when people are reduced to commodities in healthcare or deprived of the witness of the community. That is why the need for hope can perhaps be seen most clearly at the beginning and end of life, and why the interdisciplinary field of bioethics has the responsibility to be a carrier of the community's hope. As Pope John Paul II reminded us, bioethics represents a "meeting place" where many different voices can be creatively and respectfully present.
Perhaps more than anything our very presence at this meeting place will remind those of us who minister in the field of bioethics of our own need for hope; hope in the professions, hope in society, and hope in the future? To paraphrase Father Gerard Bourke, even amidst dwindling and limited possibilities, and even against the backdrop of deep existential suffering, it is possible to discover a meeting place whereby hope is reborn. Often that meeting place will be a simple conversation with our neighbour in which personal stories are shared.
Rev Michael McCabe, PhD
The Nathaniel Centre
Using the Internet to Research Bioethics: A Resource
Staff of The Nathaniel Centre
Issue 25, August 2008
In order to understand adequately the issues in bioethics from a Catholic perspective we must combine the insights of history and science with the insights of our Catholic moral tradition. This approach reflects the multidisciplinary nature of bioethics and also assists in discovering the rich complexity of the issues.
If we are to bring a Catholic perspective to the public debate on key bioethical issues in a way that enables meaningful dialogue with others, it is also important to be familiar with the questions and perspectives of other people who think differently from ourselves.
The Wisdom of Enough
Issue 25, August 2008
In Old Testament Hebrew there is no word for charity. The word used instead was Tzedekah – or Tsedaqah – meaning Justice. Now there's a concept that is not always comfortable to live with. If we were to see our personal or corporate giving as justice, rather than charity, then perhaps we can let go of our notions of generosity and come to the same conclusion as St Augustine who said, "He who possesses a surplus possesses the goods of another."
Giving and Receiving: An Alternative Framework for Discerning the Good. Revisiting the Question of Physician-Assisted Suicide
Issue 24, April 2008
... a person does anything and everything he or she does only because that thing at least 'appears' to be good. Even when I choose something that I know is bad for myself, I nevertheless choose it under some aspect of good, i.e. as some kind of good. (McGee, 1999, http://www.aquinasonline.com/Topics/natlaw.html)
Guest Editorial: The Stories We Live By
Dr Ron Hamel
Issue 24, April 2008
Every day, people within our health care organizations make a myriad of decisions. Some of these may be clinical or patient/family related. Others may have to do with strategic planning, business development, finance, human resources or the common interactions between and among employees. Each of these decisions – to greater or lesser degrees – express the moral character of the individuals making the decisions and, in some cases, express the moral character of the organization.
Editorial: Principles and Process: Lessons from Winter
Issue 22, August 2007
"The principles of partnership, participation and protection of resources contained in the Treaty of Waitangi cannot be ignored in any debate which brings us so close to the heart of human existence and our relationship to the whole of nature..."
--New Zealand Catholic Bishops' Conference Submission to the Royal Commission on Genetic Modification – 2000
In the opening address of his November 1986 tour of New Zealand Pope John Paul II described culture as "the first voice of the sacred." As shared systems of meaning and as rich templates for the celebration of life and death, birth and ritual, worship and service, cultures become the wellspring or soil into which the Gospel is received. Ideally such a process is mutually enriching and beneficial.
The increased use of Māori phrases is a reality in everyday conversation, in media reports, in cultural events and in sacred liturgy. This was clearly evidenced throughout Aotearoa in the use of "Te Reo - the Māori language" in the annual Māori Language Week recently, leading several commentators to remark that New Zealanders are becoming "more comfortable" with our bicultural heritage.
Such heritage and cultural sensitivity are increasingly in evidence in clinical practice in our nation's healthcare. For example, the ethical principles of partnership, protection and participation, which originate from New Zealand's Treaty of Waitangi, play a central role in the use of innovative treatment and in all healthcare research.
While "language weeks" help to raise awareness of possibility, and remind us of their necessity the effect of these events can remain cosmetic and superficial. Similarly ethical principles, which provide a necessary framework for healthcare delivery and for ethical practice in healthcare, require application if the culture of medicine is to be renewed and enhanced. Medicine is a science as well as an art. The ethical and cultural principles of participation, protection and partnership provide a rich backdrop for the healer's art when they are integrated into best practice.
Those coming to terms with a terminal or chronic illness may be overwhelmed by feelings of abandonment and hopelessness. In these circumstances particularly, communication and the giving of bad news requires great sensitivity. When truth-telling is done with sensitivity it becomes a model of partnership in practice. The truth can be harsh and shattering for patient and family alike. Nevertheless the telling of it need not be brutal!
Similarly the care of those living with chronic illness or diminished decision-making capacity, when done with sensitivity and compassion, becomes a form of protection in practice. The need for such protection is especially apparent when the elderly and terminally ill are admitted to an emergency department. Protection in practice not only includes thorough diagnosis, but also, and equally, adequate referral. Even given the pressures on the healthcare system in New Zealand, a two-three day stay in an overcrowded emergency department does not equate with the protection afforded by an in-patient hospice or designated palliative care bed.
In healthcare the ethical and cultural principles of partnership, protection and participation must be expressed in practice at the interface between the patient and healthcare system. This will only happen if adequate attention is given to them at all levels, from public consultation to allocation of resources and personnel.
Rev Michael McCabe, PhD
The Nathaniel Centre
Conscience and the Second Vatican Council
Issue 21, April 2007
Conscience features often in the documents of the Second Vatican Council. The Council declared that:
- All are bound to seek, embrace and live the truth faithfully;
- Conscience is experienced as an inner sanctuary or tribunal, rather than something external, yet it mediates a universal and objective moral law which is given rather than invented;
Issue 21, April 2007
Deep within our conscience we discover a law which we have not laid upon ourselves but which we must obey. Its voice, ever calling us to love and to do what is good and to avoid evil, sounds in our heart at the right moment. . . . For we have in our heart a law inscribed by God . . . Conscience is our most secret core and our sanctuary. There we are alone with God whose voice echoes in our depths. (Gaudium et Spes n. 16)
The Eloquent Voice of Conscience: Notes from a Conference
Issue 21, April 2007
"A voice was raised and the desert receded."
In February 2007 the Pontifical Academia Pro Vita Congress was held at the Synod Hall in Vatican City Rome. The Congress theme was "The Christian Conscience in Support of the Right to Life". A variety of international theologians presented papers on the centrality of conscience and, in particular, its vital role for bioethical issues.
A Letter to ACART from Father James B Lyons
Fr J B Lyons
Issue 21, April 2007
Can human gametes and embryos be used for research in New Zealand? I believe that is the question you are considering. While I have no doubt you are aware of the enormous responsibility given you in this task, and that you seek only the best and truest outcomes, I wish, as an ordinary New Zealander, to stress my concern that what you are considering has, as yet, unforeseen consequences for all life.
Editorial: Bioethics and Theology in Conversation
Issue 21, April 2007
Every academic discipline has its own language, jargon and way of understanding reality. It can take the novice and undergraduate some considerable time and more than a little concentration before he or she becomes even remotely familiar with the various contours of a particular field. Once that familiarity has been achieved it can then be a relatively short step before the scholar or student finds him or herself enclosed in a comfortable academic bubble split-off from the lived reality of people's lives and concerns. Such an unwitting split is an ever-present danger in academic, scientific or theological study and discourse.
Impact and Challenge: 25 Years of Bioethics
Issue 20, November 2006
Where There Is No Vision, The People Wander (Proverbs 29:18)
Let me begin by expressing my immense gratitude to Archbishop John Dew and to Father Michael McCabe for inviting me to deliver the Catholic Foundation Lecture on the occasion of its Silver Jubilee. I am truly humbled and honored, especially given those who have preceded me in giving this lecture. I would also like to thank all of you for being here this evening.
The title of this evening's lecture is Impact and Challenge: 25 Years of Bioethics. However, I have also sub-titled this reflection using a text from Proverbs: Where There Is No Vision, The People Wander (Pv 29:18), because I believe that much of what I will be speaking about this evening has to do with vision an inadequate vision in much of bioethics and a corrective vision that can be offered by elements of the Catholic faith and theological tradition. By the way, I should mention that the text from Proverbs is sometimes translated more ominously as: Where there is no vision, the people perish. I will leave it to you to choose the translation you prefer!
What I wish to do this evening is to reflect with you on some of the major contributions of bioethics toward enhancing dimensions of human life, as well as some of the more trenchant challenges it poses to all of society, but particularly to the community of faith. For better or worse, I do this out of my own social location, namely as an American theologian and bioethicist, for I can only speak of the bioethics that I know and experience. My genuine hope is that something I have to say will resonate with your experience of bioethics in New Zealand either your experience of American bioethics (what you read or hear about), or of New Zealand bioethics, or both.
Before proceeding with the main portion of the lecture, let me say a word about what bioethics is. I would describe bioethics as a multidisciplinary field of study that examines various ethical dimensions of developments in medicine and the life sciences at the individual, organizational, and societal levels. The ethical dimensions I am referring to are threefold. First is the question "What should we do?" This is the domain of conduct or action and is concerned with whether we should proceed with or employ x, y, or z technology. Much of bioethics is concerned with this dimension of ethics. It is generally the most interesting. Second is the question "Who should we be?" This is the domain of character. What kind of individuals, organizations, or societies are we becoming in and through our decisions, practices, and policies? This is less of a concern to bioethics, unfortunately. And, third is the question "How do or should we see?" — This has to do with the beliefs, values, attitudes, intentions, and motives that we bring to any issue. — These shape our vision and vision affects what we see. Vision is critical, but most often neglected. It is that dimension of ethics and bioethics that I will be focusing on this evening.
In 1981, when the Foundation was first established, bioethics was still something of a fledgling field of study, approximately 13 years of age, depending on when one dates the birth of bioethics. As young as it was, bioethics had already addressed a wide range of issues prompted by relatively rapid advances in medicine and the life sciences. Among these issues were abortion, new reproductive technologies (e.g., in vitro fertilization and embryo transfer), genetic engineering (e.g., gene therapy, recombinant DNA research), genetic counseling and screening, prenatal diagnosis, research on human subjects (including the mentally ill, prisoners, children and embryos), organ transplantation and the definition of death, allocation of scarce medical resources (e.g., dialysis machines) psychosurgery and behavior control e.g., electronic stimulation of the brain (ESB) and electroconvulsive therapy (ECT), the right to refuse life-sustaining treatment as well as the right to execute advance directives, euthanasia, and, finally, the health professional-patient relationship (e.g., the right to self-determination, informed consent, confidentiality, and truth-telling). This is an impressive array of issues for a field that was so young and unformed. With regard to many of these issues, bioethics succeeded in forging a social consensus, often enshrined in laws or guidelines. These in turn, together with the on-going discussions, altered thinking and practice in health care delivery and research, most often, but certainly not always, for the better.
Twenty-five years after the inception of the Catholic Foundation, the field of bioethics has reached some degree of maturity. It is a flourishing area of study worldwide with its own practitioners, its own journals and extensive body of literature, institutes and centers around the world (such as The Nathaniel Centre), degree programs, courses in educational institutions, national and international conferences. It has a presence in and to many governments (in the form of Commissions and the like, such as the Toi te Taiao — The New Zealand Bioethics Council) as well as in a vast number of health care institutions and research organizations around the world (in the form of ethics committees or ethics consultants). It is a very frequent topic of media attention. Bioethics has truly become a powerful presence and force in many societies.
In addition to its expansive growth and to its continued work on many of the issues noted above, bioethics in the past twenty-five years has had to grapple with major advances in science and medicine. Perhaps most significant, because of their implications for the future, have been the completion of the Human Genome Project, stem cell research, and cloning. Other issues also stand out—the AIDS epidemic, physician assisted suicide (PAS) and euthanasia, terminal sedation, futile treatment, artificial nutrition and hydration, especially for patients in a permanent vegetative state, xenotransplantation, genetic modification of food, and the threat of pandemics. Indeed, bioethics touches almost every dimension of human life and, in some way, the lives of almost every person on this planet. It is difficult to imagine any other field of study that is so pervasive in scope and that deals with such fundamental dimensions of human life and, hence, that is so potentially influential. What are instances of that influence? What has been the impact of bioethics?
The Impact of Bioethics: A Few Examples
There can be little doubt that bioethics in its nearly 40 years of existence has had a significant impact on social beliefs, practices and policies around the world. In very many instances, this has been a positive impact. In other instances, however, its influence raises serious concerns and challenges. I wish to begin with what I see as a few of the positive impacts of bioethics (though even these have their shadow side).
First, bioethics has had a significant impact on the way in which health professionals and patients relate, at least theoretically and, to a considerable degree, actually. The change is often characterized as a shift from paternalism, where the physician is the primary decision maker, to patient autonomy, where the patient is the primary decision-maker. Patient autonomy recognizes the individual's right to make decisions about his or her health and life in accord with that person's beliefs and values. It places the patient at the center of health care and research decisions, bringing some greater balance to the relationship. Ideally, patient autonomy fosters a more collaborative relationship where health professionals and patient work together for the patient's healing and health. At times, however, it can foster an adversarial relationship where the patient pits his or her will against the physician's.
Several other considerations follow from this emphasis on patient autonomy. If the patient is the prime decision maker, then he or she needs to be adequately informed about his or her medical condition (and, hence, truthfulness is necessary) as well as the potential benefits and burdens of various treatment alternatives. In addition, the patient's consent is required, a consent that must not only be informed, but also be free of undue influence and coercion. Patient autonomy or self-determination requires that patients take more responsibility for their health and their health care. This is a positive good, an important development.
While secular bioethics frames this in the language of liberalism, the fundamental concepts are not foreign to our religious beliefs. We might approach this from the perspective of respect for inherent human dignity and what is required to respect that dignity in the professional patient relationship. Or we might approach it from the perspective of stewardship. Human life and the human body are entrusted to us for our use, our care, and development. One's health is the responsibility of the individual. In the words of the Australian Code of Ethical Standards (1.2): The primary responsibility for safeguarding and maintaining one's health so far as that is reasonable belongs to each person in his or her own right. It follows that each person is primarily responsible for making decisions concerning his or her own health.
I believe that recognizing the responsibility of the patient for his or her health and the centrality of the patient in health care decision making, together with the accompanying notions of informed consent and truth-telling, is one of the most significant and positive contributions and impacts of bioethics.
A second positive impact of bioethics has been its transformation of the way in which people die, particularly in those countries with high tech medicine. To a large degree, bioethics was born in response to rapidly developing medical technologies that were capable of prolonging life ventilators, dialysis machines, organ transplants as well as cardiopulmonary resuscitation and new drugs and surgeries. While in some instances, these new developments saved lives, in other instances they merely prolonged the dying process, sometimes to the point of subjecting dying patients to something close to torture. Too often medical technology at the end of life was doing something to patients instead of doing something for them.
Gradually it came to be realized that dying patients or those who represent them ought to be the ones making decisions about what life-sustaining treatments should be employed and for how long. At least in the American context, it was the combination of respect for patient autonomy or self-determination, together with the Catholic principle of ordinary and extraordinary means that lead to the moral and legal recognition of a dying patient's right to refuse life-sustaining treatment. The right was often tested in the courts and almost each time the courts affirmed and re-affirmed it. While there are still abuses of life-sustaining technology and some disputes about what is morally and legally permissible (e.g., the Terri Schiavo case), there generally is a more tempered use of measures at the end of life. Together with the hospice movement and the spread of palliative care, dying has become more humane. Bioethics has contributed to significant advances in end-of-life care.
The shadow side of this contribution, however, is that the right to refuse treatment has become for some the right to demand specific treatments (e.g., "I want everything done") or, conversely, the right to end one's life (PAS) or to have one's life ended (euthanasia).
A third impact of bioethics in the past 25 years in particular is that it has popularized advances in medicine and biotechnology. What I mean by that is that it has brought these issues into people's homes and schools and churches and places of employment. What might have remained unknown or little known now becomes the subject matter of news reports and table conversations. Bioethics over the years has succeeded in bringing the issues to light and in generating conversation and debate about them. People are generally better informed about these issues that are vital to their own lives and, often, they are engaged in debates about policies, laws or practices. This too is a positive impact.
There are many other areas that we could point to where bioethics has had a significant impact—protection of human subjects in research and organ transplantation, for example. But at this point, I wish to turn to a different kind of impact, those that are less positive, those that pose challenges for individuals and societies and, in a particular way, those that pose challenges for the church, the community of faith, and for theological bioethics going forward. These challenges all in one way or another have something to do with how we see, with our vision. How we see very much determines what we do. The concern is not that the people have no vision (to return to the sub-title of this reflection), but rather that the vision they do have is faulty or inadequate. Such visions lead to practices that are harmful or destructive of individuals and societies. I believe that the future of our societies will depend greatly on how successfully we address these challenges.
Twenty-Five Years of Bioethics: Some Challenges
There are very many challenges which bioethics poses to our societies and to our communities of faith. I wish to highlight only a very few, none of which is particularly new to you, but which I increasingly find to be troublesome as I scan the horizon of issues with which bioethics is engaged. I will consider four: attitudes toward human life, an overemphasis on autonomy, an inability to accept finitude and limits, and a marginalization of religion and theology.
Attitudes toward Human Life
The first is societal attitudes toward human life. Here I fear two extremes. On the one hand, are those who have diminished respect for human life, at least at some stages (usually the beginning and the end). This is evidenced in the high rates of abortion worldwide and in increasing efforts in many countries to legalize PAS, euthanasia, or both. These developments are surely of grave concern. But what I find even more troubling and potentially dangerous is the devaluing of human life in debates about embryonic stem cell research and cloning. Proponents of these technologies either accord no value to beginning human life or not enough value as to prohibit it from being destroyed. Of further concern is that proponents of these technologies are willing to destroy early human life for our purposes. Early human life is considered to have little or no value in itself, but is accorded instrumental value. It is or may be useful for us. It can be destroyed to benefit us (and in the case of cloning, it can be created and destroyed to benefit us). This attitude seems to cross a new threshold.
The other development that is troubling moves in the opposite direction in the direction of vitalism (i.e., life itself is considered to be the highest value and must be sustained at all costs). This is evidenced particularly in several statements made over the past thirty years by a few bishops, local bishops' conferences, and Vatican offices about medically administered nutrition and hydration (MANH). It was further evidenced in the address of Pope John Paul II in March, 2004 and in subsequent responses to the papal allocution.
As you may know, John Paul II's remarks were directed at patients in a permanent vegetative state. Among other things, the Pope stated his belief that medically administered nutrition and hydration are "In principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have achieved its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering." Since the allocution, at least in the United States, we are seeing some people extend — the Pope's remarks to all patients unless those patients are imminently dying (i.e., death is a few hours away). We are also just beginning to see the application of this approach beyond MANH to other life-sustaining measures, e.g., cardio-pulmonary resuscitation.
This is a troubling development for a number of reasons. It is a departure from the Catholic tradition around forgoing treatment, a tradition that has been in place and has remained constant for almost five hundred years. It accords physical, biological life a status that is not consistent with the Catholic tradition where we consider human life to be sacred, but not absolute. It medicalizes the dying process and plays into the hands of the technological imperative (i.e., if we have the technology, we must use it). It will dramatically reshape the way we care for the dying and move us back to where we were in the early days of bioethics. It will create enormous problems for Catholic health care and place Catholic health care where it exists at odds with the standard of care and with the law, at least in many countries. It will inadvertently foster PAS and euthanasia. And it seems to contradict our belief in the resurrection.
For centuries, the Catholic tradition of forgoing treatment has walked a middle path between prolonging dying and hastening death. As the Australian Code of Ethical Standards states (5.3): [T]wo extremes should be avoided: on the one hand, an insistence on futile and overly-burdensome treatments which merely obstruct death, on the other hand the deliberate withdrawal of treatment in order to bring about death. Since good medicine treats a person rather than a condition, respect for persons requires that they neither be under-treated nor over-treated; rather, when people are dying they should have access to the care that is appropriate to their condition. The two developments I have noted, if they take hold, would likely shift this balance with potentially unfortunate if not tragic consequences.
Overemphasis on Autonomy
Another challenge spawned by bioethics, at least in the United States, is an excessive emphasis on the individual, on individual rights, and on individual choice. Autonomy is a cornerstone of much of the bioethics literature and bioethical analysis. The emphasis on autonomy has had a profound impact on the development of bioethics as well as the practice of medicine. I wish to point to a few consequences of this emphasis (which, by the way, represents a particular way of viewing the human person) and the challenges they raise.
First, this conception of human beings is at minimum truncated and more probably deficient and even false. It leads people to think and act as if they were isolated and detached entities, self-sufficient islands as it were, and fails to recognize that social life is an essential dimension of the human person. In fact, we are social by nature and we are able to exist and flourish only in relationships with others. Relatedness to others is not a matter of autonomous choice, but an intrinsic dimension of what it means to be human. Because of this inherent sociality, we not only have individual rights, but also responsibilities to others. The exercise of individual rights and the pursuit of individual goods must always be balanced by social considerations. A sense of connectedness to others, together with a concomitant sense of responsibilities to them is seriously underdeveloped in much of contemporary bioethics.
Second, the emphasis on the autonomous individual elevates choice as the defining characteristic of the person, and gives individual choice a status that is extremely problematic. The choice of the autonomous person is often regarded as trumping all other considerations. In other words, the very act of choosing something makes it right regardless of what is chosen. We see this most clearly exemplified in some arguments regarding abortion, PAS, and euthanasia. What is chosen is not central to the choice, the decision making process, or the moral argumentation (if there is any). The fact of choosing eclipses all else. This leads inevitably to relativism and to a privatization of issues—relativism because idiosyncratic preferences and the choices based upon them are all that matter, and privatization of issues because there is little or no consideration of the consequences of one's choices upon immediate others and upon the common good (e.g., euthanasia).
Third, and very problematic, the emphasis on individual autonomy has curtailed the scope of bioethics. So much of bioethics has to do with individual rights and their protection. Issues tend to be addressed almost exclusively from this perspective—individual problems to be addressed on an individual level. It is largely patient-focused. For example, in the early days of the AIDS epidemic, the central questions had to do with whether it was necessary to obtain informed consent to test an individual, whether test results could be passed along to public health authorities, maintaining the privacy and confidentiality of those with AIDS, and whether health care professionals could refuse to care for a patient with HIV-AIDS. What has been missing from so many discussions in bioethics is attention to questions of social justice that go beyond the individual. As Catholic moral theologian Lisa Cahill has noted in her book, Bioethics and the Common Good:
[W]hen AIDS first came to the attention of Catholic moral theology, its analysis was closely connected to the morality of personal sexual behavior. Gradually, awareness grew that the impact of AIDS on the health of populations around the world is dire.
AIDS began to move out of the category of a sexual problem and into that of a global health problem. It is also a problem of appropriate medical and social responses to suffering and death. Broader social issues began to be examined, including more effective means of preventing transmission (the debate about the use of condoms), the inequities of wealth and power that contribute to the spread of AIDS, the need of resource redistribution to treat all those with AIDS with antiretroviral drugs, and the obligation to care for communities afflicted by AIDS (especially AIDS orphans) as falling on the international community, especially its wealthiest members. AIDS has become a problem of bioethics and the global common good. (Lisa Sowle Cahill, Bioethics and the Common Good, 2004, pp. 67-68).
What Cahill suggests is that an overemphasis on autonomy and the individual has resulted in a lack of concern for the common good, and a neglect of the social dimensions and implications of developments in medicine and biotechnology. Hence, what is needed, and this can be a major challenge, is a reorientation of perspective, a transformation of vision. It means seeing the nature of human beings and approaching developments in medicine and the life sciences differently, with different assumptions, different categories, and different questions. This re-orientation entails not only the individual, but the individual-in-community; not only choice and individual rights, but also justice and responsibilities to the common good, including the global common good; not only the questions relevant to the developed world, but those as well relevant to the third world, or the two-thirds world.
Such a reorientation would likely bring to the forefront the reality that much of the world does not benefit from the advances in medicine and biotechnology. In the words of John Paul II:
[There is a] very serious and unacceptable gap that separates the developing world from the developed in terms of the capacity to develop biomedical research for the benefit of health care assistance and to assist peoples afflicted by chronic poverty and dire epidemics— It is essential to realize that to leave these peoples without the resources of science and culture means to condemn them to poverty, financial exploitation and the lack of health care structures, and also to commit an injustice and fuel a long-term threat for the globalized world (Address to the Pontifical Academy for Life, 2003).
The challenge here is enormous. It is especially pressing for Catholic bioethics, which is not immune from a focus on issues as they affect individuals. It is critical that we do more bioethics from the perspective of Catholic social ethics bringing to bear our fundamental commitments to human dignity in the context of community, the common good, solidarity, and justice.
Finitude and Limits
Another critical challenge is the need to recover or, perhaps, acquire a sense of finitude and limits. We are finite beings, pure and simple. We will all die. Our lives are marked by pain, suffering, disease, disability, and countless other limits. We will never fully overcome our finitude and all that that entails. This reality does not mean that human beings ought to be passive before the various manifestations of finitude. That is simply not human nature. In fact, human history can be viewed at least in part as an on-going attempt to overcome limits of various sorts. We would be remiss if we did not employ our God-given intelligence and creative abilities to improve upon our lot and to bring ourselves and creation to fuller development.
But are there limits to this effort? Or can anything and everything be justified in the process of curing disease and delaying death? The latter very often seems to be the case among the scientific community as well as the general population. There seems to be a sense that with adequate time, money, and effort, particular diseases can be conquered and death itself can be overcome. The American philosopher and bioethicist Daniel Callahan puts it this way:
Medicine, I believe, has implicitly defined its central purpose as an all-out fight against death. [E]very cause of death is taken to be contingent, a matter of chance. By contingent and chance I mean that it need not exist, that there is in principle and in medical theory no reason why any particular disease cannot be overcome. Death is in some sense biologically programmed, but not particular causes of death. Just as smallpox was eliminated and diphtheria and typhoid and typhus all but eradicated, so cancer and Alzheimer's can also be done away with. This is the abiding faith of scientific medicine. No cause of death has been declared beyond hope; none could be. All of the known causes of death can, in principle, be picked off, one by one. All of the wars against disease can eventually be won, not only those that kill us but also those that weigh us down our aging (Daniel Callahan, The Troubled Dream of Life, 1993, pp. 74-75).
The belief that all diseases and even aging can be conquered along with death is often coupled with a belief that there is a moral obligation to use whatever means are possible to pursue this goal. Again, in the words of Daniel Callahan:
The advent of effective medicine, the kind that can save and extend life, changed the perspective on death as an evil. As it became increasingly possible to manipulate the conditions of dying, fatalism was rejected and a moral dimension was added. That dimension soon took the form of a simple principle: since death is an evil in human life, we have a moral obligation to use medical means to combat it. What can be done to struggle against death ought to be done. (Daniel Callahan, The Troubled Dream of Life, 1993, p. 75).
Those who choose not to do everything possible to overcome disease and stave off death are considered to be blameworthy. This is the kind of rhetoric, for example, that we hear, at least in the United States, with regard to the pursuit of embryonic stem cell research. One proponent of the research puts it this way: What excuse will we offer this young woman should we fail her now? What might we tell her children? Or the millions of others who suffer? That when given an opportunity to help, we turned away? That facing political opposition, we lost our nerve? That even though we knew better, we did nothing No, no, we owe this young woman and all those who suffer we owe ourselves better than that.
Part of what fuels such thinking seems to be a belief that there are no limits to human ingenuity and to medical progress. Again, in the words of Daniel Callahan:
[W]e must understand that it [the dream of medical progress] is, in modern hands, open-ended and expansionist. The dream of medical progress does not have any logical or obvious endpoint or any intrinsic constraints. Nor is it at all clear just what would count as a full realization of the dream. The eradication of all suffering? The cure of every disease? An endless old age? Immortality?
Precisely because modern medicine's unspoken goal is simply more, there are no limits to what can be hoped for and sought. The very absence of any more clearly and precisely articulated goals fuels the entire enterprise. In modern medicine's dream of progress, there are no set boundaries to what societies and individuals can desire, nor to what may be done to satisfy those desires. (Daniel Callahan, False Hopes, 1998, p. 52).
The challenge here it twofold: we need to recognize that not everything is justified in the attempt to cure horrible diseases that plague the human condition and, second, we need to learn to live with our finitude and some of the limitations that we encounter. We need to understand that we are creatures and not God. The maddening reality that we must accept is that we can never fully overcome ourselves. This is what it means to be finite. While we can and should strive to overcome human limitations, a complete transcendence of them through technological means will never be possible. Yes, we should attempt to alleviate human suffering and its causes and even seek to prevent premature death, but within limits, recognizing that there are other needs and other goods to be pursued, that there are moral constraints, and that there are realities called the common good and the global common good. Viewing human endeavors in biotechnology against the backdrop of our finitude can help us temper unrealistic expectations and use our creativity more constructively. Again, we need to see differently, we need to correct our vision, and then perhaps we will choose differently.
Recovering the Voice of Religion and Theology
A further challenge (and this is the final one I will address this evening) posed by much of contemporary secular bioethics and many practitioners within the field is the marginalization of religious and theological contributions to bioethics. This may be a challenge more troubling in the United States than elsewhere because of my country's strong tradition of the separation of Church and state, the reality of religious pluralism, and concerns over the views and tactics of the religious right. However, I suspect the problem may exist elsewhere, but for somewhat different reasons (such as secularism, anti-clericalism and the like).
It is well known that the first practitioners of modern bioethics were theologians. It is also well-known that there is a long history of attention to medical-moral matters within Catholicism. For a variety of reasons, however, shortly after the birth of bioethics in the late 1960s and early 1970s, philosophy and law came to dominate and define the field. It was then that the "Georgetown mantra" came to exist the four principles of autonomy, beneficence, non-maleficence, and justice that originated at Georgetown University. Each of these was understood individualistically and focused on protection of individual rights. These philosophical concepts were seen as offering a more neutral and objective mode of moral analysis in a pluralistic society, especially with regard to the formation of public policy. Religion was deemed to be partisan and as imposing solutions upon society derived from a religious perspective that was not shared by the general populace. Within a very short time, religious and theological voices were relegated to the margins of bioethical debates and policy formation. In response, in order to —remain in the game,— many theologians began to adopt the language and categories of secular bioethics abandoning their own theological traditions, concepts, and symbols. They began to function as philosophers, employing the Georgetown mantra, focusing on the individual, individual autonomy, and individual rights.
This development, I believe, has lead to a great impoverishment of secular bioethics. Deprived of religious and theological voices, bioethics has operated out of a very inadequate notion of the individual, society, and justice. It has resulted in a narrowing of the scope of bioethical concerns. It has permitted bioethics to focus excessively on the impact of new technologies on individuals primarily, as well as on individual choice and individual rights. And it resulted in many of the underlying meaning questions not being addressed, such as, the meaning of finitude, limits, dependency, parenthood, procreation, health, medical progress, life and death and the like.
In recent years, the place of religion and theology in bioethics has improved somewhat, but there is still much room for improvement. Going forward, I believe that communities of faith and theological bioethicists have a critical role to play. I would like to suggest six ways in which religion and theology can contribute to bioethics. First, and rather obviously, it can provide a far richer understanding of what it means to be human than what is currently operative in much of Anglo-Saxon bioethics and public policy formation. An understanding of the human person that has breadth and depth that goes beyond an emphasis on the individual, on autonomy, on choice, and on individual rights could lead to a bioethics and a public policy that will better contribute to the flourishing of individuals and society.
For example, in the embryonic stem cell debate, the moral status of the embryo is surely a primary consideration. But this is not the only consideration. A fuller theological understanding of the human person would also want to underscore our social nature and the duties we have toward and responsibilities we have for one another, including nascent human life and those who suffer from disease and disability. This includes what we become as individuals and as a society in and through the choices we make. What will be the impact on us and on those who come after us if we accept the destruction of nascent human life? What will be the impact on us if we acquiesce to using nascent human life for our purposes? — We would want to consider what we owe one another in our various social interactions, that is, what justice requires of us. Who will benefit from the cures, if any, developed from embryonic stem cells? Who will have access to such treatments? Will we ensure fair access and equitable distribution?
Such a theological understanding of the human person would likely consider the fact that human beings are finite, that limitations of various kinds are an ultimately inescapable part of our life experience. It would also likely consider human sinfulness, that fact that so often we pursue and choose to do what is contrary to respect for human dignity and human flourishing . It would underscore the fact that often we pursue the wrong goals, or the right goals for the wrong reasons or in the wrong ways. Power, greed and hubris are powerful forces that can lead us off the mark.
A second and very much related contribution is that religious and theological voices in bioethics can lead to an expansion of the considerations that enter into discussions of developments in biomedicine and public policy. As previously mentioned, bioethics discussions often become narrowly construed, focusing on rights, for example, individualistically understood, or procedures to ensure non-interference, or the pragmatic results and benefits of particular technologies. The embryonic stem cell debate is focused on the moral status of the embryo, the hoped-for benefits of the research, a presumed obligation to pursue this research for the benefit of others, and an unfettered pursuit of knowledge. These are undoubtedly all critical considerations. But there are more, as was suggested above in identifying some aspects of a theological understanding of the human person and some of their implications for embryonic stem cell research. By broadening our considerations, by paying attention to more of what is at stake, one would hope for public policies that have taken account of the complexities of these situations and, hence, become a more fitting response for the good of society.
Third, theological approaches to bioethics of necessity raise questions of meaning. In bioethics and public policy discussions, questions of meaning are there invariably, but they are most often not recognized or, if recognized, are not engaged. Cultures marked by classical liberalism and a hyper-sensitivity toward pluralism are not inclined to take on questions of meaning. But this is to the detriment of public policy and society. It results in thin discussions, inadequate readings of what is going on and of what is at stake, and, often, responses to biomedical developments and public policy that reflect this. Part of this broadening of the agenda and considerations of bioethics is, as Lisa Cahill observes, "to make sure the debate addresses the needs and concerns of all, to ensure that the needs of the voiceless are given voice, and to ensure that the marginalized are protected and thus enabled to make their contribution to society" (Cahill, Theological Bioethics, p. 20).
In the embryonic stem cell debate, the meaning questions go beyond the moral status of the embryo. They encompass such other things as how we understand illness, disability and death, our finitude and how we deal with limitation as well as the drive to overcome it, our obligations to others and to future generations to seek and provide cures for disease and disability, the common good, scientific progress, and the pursuit of knowledge. Attending to these issues could result in richer more adequate deliberations, responses and policies.
Fourth, theological approaches to bioethics could serve a prophetic function in bioethical discussions and with regard to public policy. They could remind society of critical dimensions that are not being considered; challenge beliefs and values that ultimately do not contribute to human flourishing; point to the consequences for individuals and society of certain values, conviction and choices; and call society to be and become more. Theology, for example, could invite society to reflect on its attitude toward nascent human life and its obligations toward that life and all the vulnerable in our midst. It might call into question a mentality and a practice that is willing to sacrifice the most vulnerable for the benefit of many and, concomitantly, the use of a utilitarian calculus in the development of public policy. It might call for examination of the assumption that we must pursue every avenue available to us in the great desire to relieve pain and suffering. In their prophetic role, religion and theology might challenge the technological imperative and might raise up for consideration the variety of motives behind the drive to make use of embryonic stem cells, including profit, prestige and power. They might hold up for reflection and debate the possible impact of our choices about this issue on our very humanity and upon the kind of society we become.
Fifth, theological approaches to bioethics have the potential for transforming the community of believers. All of us operate out of a particular world view, a particular way of seeing and interpreting reality. That worldview affects what is seen and not seen, what is valued and not valued, what is valued more and what is valued less. All of us bring these values, beliefs, dispositions, intentions, motives and sentiments to our deliberations and our judgments. One of the primary contributions of religion and theology to bioethics is to influence the worldview of members of the faith community who in turn can influence public debate and influence the shaping of public policy.
This contribution of religion and theology, however, hinges on at least two things. One is education or formation, the gradual shaping of the character of individual believers. How is this done and done deliberately, consistently and successfully? The other is dialogue, communities of believers functioning also as communities of moral discourse, exploring moral issues in light of their faith and their theological understanding of what it means to be human. If these two things can occur successfully, it is more likely that theology will have some effect on bioethical deliberations and the formulation of public policy.
Sixth, and finally, theological bioethics should lead to action, to the transformation of those situations related to advances in medicine and biotechnology that are unjust. In the words of Catholic moral theologian Lisa Cahill:
[T]heological bioethics is not just about talk. It is about action. The 'truth" and viability of the vision of Christian theological bioethics is warranted not just by cogent theory or argument but by the emergence of transformative practices that join with other movements in global civil society to encourage human solidarity, empower "the poor," and motivate the powerful to change.
[B]ioethics in the twenty-first century must in every case be social ethics, not just as theory but as engagement. This is particularly true in light of globalization.
[T]heological biooethics must go beyond decrying injustice, beyond taking a "prophetic" stance against social practices that commercialize human beings, the human body and its processes, or important human relationships. It must even move beyond painting a vision of a more egalitarian and solidaristic future. Theological bioethics must critically reflect on and make normative judgments about, theoretically account for, and ultimately take part in a global social network of mobilization for change. (Lisa Sowle Cahill, Theological Bioethics, 2005, pp. 2, 3).
The challenge to theological bioethics as well as to people of faith is to enter bioethical debates true to their own theological convictions, bringing them to bear in appropriate ways to the issues at hand, while, as Lisa Cahill suggests, "seeking common cause and building a common language with all who are similarly committed to health care justice" (Cahill, p.18).
Looking back on twenty-five years of bioethics, there is much to be pleased with. It has accomplished much for the benefit of individuals and, to a considerable extent, for the good of societies as a whole, though less so for some of the marginalized, especially in underdeveloped countries. In pursuing and bringing about these benefits, however, bioethics, at least in some of its expressions, has contributed to beliefs, values and attitudes that seem not to contribute to the ultimate flourishing of individuals and communities. It has contributed to a vision of human beings and human purposes that in some cases is inadequate and in others, harmful. If I might paraphrase the text from Proverbs: "Where there is a faulty vision, the people wander, and they might perish." Or, in the words of Father Michael McCabe:
In exploring the possibilities of biotechnology there is an ever-present danger of losing our way, of taking ourselves and future generations into territory or an environment which is fundamentally harmful to human life. The irony is that we are most likely to do this as we search for ways of sustaining life, relieving suffering and improving our quality of life" (Michael McCabe, "Bioethics and Decision Making," The Nathaniel Report, April 2001, p. 3).
As we begin the next twenty-five years of bioethics, it is critical for people of faith and for theologians who do bioethics to attend not only to the advances in medicine and biotechnology, the dilemmas, but also to the vision or visions that accompany debates about them. It is perhaps here that communities of faith and theological bioethics can make their greatest contributions and where their contributions are most needed. — As Joseph Cardinal Bernardin pointed out in a talk to the United States Conference of Catholic Bishops on health care reform:
[This is] a time of testing and a moment of opportunity for the Church. We will be tested on how our teaching contributes to the moral framework for reform. Our tradition can illuminate important aspects of the debate, illustrating the potential of the Catholic social vision for contemporary issues" (Joseph Cardinal Bernardin, "The Right to Healthcare: A Test and an Opportunity for the Catholic Community," 1993).
Ultimately, the vision ought to be a transformational vision. Our vision of the person-in-community, the common good, solidarity, justice, and the option for the poor is inherently oriented toward change, change in personal attitudes and behaviors, change in social attitudes, policies, practices and structures, change in how we view and deal with old and new developments in medicine and biotechnology. This will lead to a different kind of bioethics. The vision that grounds it, however, is difficult to achieve and realize in so many respects. But that is our challenge as we take bioethics into the future.
The Catholic Foundation Silver Jubilee Lecture was delivered by Dr Hamel at St Joseph's Catholic Church, Mount Victoria, Wellington on October 18, 2006.
Ron Hamel, PhD, is Senior Director, Ethics, for The Catholic Health Association of the United States of America
Editorial - Taking a Deeper View
Issue 20, November 2006
In recent years the New Zealand Government has spoken often about one of its central goals, namely, the transformation of New Zealand into a knowledge-based economy and society. Towards that end it recently released a document entitled The New Zealand Curriculum: Draft for Consultation 2006 as part of a comprehensive review of the country's curriculum for primary and secondary schools. The draft curriculum document states that at Level 8, students will use relevant information to develop a coherent understanding of socio-scientific issues that concern them and to identify possible responses at both personal and societal levels.
Guest Editorial: Concerning Information, Knowledge and Wisdom
Bishop Peter Cullinane
Issue 19, August 2006
When the Second Vatican Council spoke of "familial relationship" between the laity and the pastors" (LG 37), it was making the point that each learns something from the other when it comes to understanding, interpreting and applying the Church's teaching.
The practical implications of this were later spelled out in c.212, which emphasises both the rights of the laity and the respect due to the teaching ministry of pastors. But more than that, good collaboration in practising and presenting the Church's teaching is rooted in the relationships proper to a community of Jesus' disciples. Their learning from each is qualitatively affected by friendship between them.
A little learning
If before the Council it was the insights and the rights of the laity that were often neglected, perhaps today it is the ministry of the pastors that is being disrespected – not by careless Catholics, but by zealous Catholics, who seem to be very sure of themselves. Of whom was the poet speaking when he said: "a little learning is a dangerous thing"?
The harshness and sarcasm to which pastors are sometimes treated does not come from those family relationships the Council describes, and not from the Holy Spirit.
Adequately presenting the Church's teaching involves much more than just getting information, even from the best of sources. Information on its own is not knowledge. Much less is it wisdom. Someone has rightly asked: whatever happened to wisdom that it got buried in knowledge; whatever happened to knowledge that it got buried in information?
Information is only the raw material for knowledge. It needs to be processed through the methods proper to theology. In this way we see individual teachings in the light of each other and in the light of the whole. This involves years of study.
At the time the Catechism of the Catholic Church was issued, Cardinal Ratzinger emphasised the importance of "mediating" the Catechism. This is something more than merely drawing conclusions for local application, and it is more than merely repeating the text. It involves a process of internalising, interpreting and re-expressing the text in other ways. He even said the Catechism "is not and cannot be the only possible way, or even the best way, of giving a catechetical re-expression to the Christian message". It belongs to the ministry of bishops and bishops' conferences to oversee these processes of "mediation" and ensure faithfulness to the apostolic tradition.
In a private discussion with two of New Zealand's bishops during the 1989 Synod, Cardinal Ratzinger confirmed that bishops and bishops' conferences have a similar role in interpreting and applying Instructions issued by Roman Congregations for the Universal Church.
How did Cardinal Ratzinger get it so wrong, if it is sufficient just to repeat what can be read in the Catechism or in an Instruction?
What would be left of the charism and vocation of theologians if the ability to read the internet or the Catechism were all that is needed, without the need for years of theological study?
And what would be left of the teaching ministry of bishops if it were reduced to merely repeating what anyone could pick up from the media?
These are the kind of questions that must be faced by those who use information (albeit accurate information) in isolation from theological method and independently of the teaching ministry of bishops.
They might also notice that according to the Council, the factors which give rise to ongoing development and growth in the Church's understanding of its faith are rooted in the lived experience of the faith (DV n.8) – and therefore in the life of the Church at every local level.
The need for bishops to speak up
That is why the charism and responsibility for authenticating Catholic teaching belongs to the whole episcopate, including and especially the Bishop of Rome. Regional bishops would be acting in an un-Catholic way if they were not to assume their share of responsibility for how the Church's teaching continues to be clarified and expressed.
If the reaction of some Catholics to a recent explanation of the Church's teaching on contraception and avoiding the spread of infection proved anything, it proved the need to say what was said. Otherwise, people really will think that clarifications such as those recently offered by at least two Cardinals and a consultor to the Congregation for the Doctrine of the Faith amount to a "change" in the Church's teaching. It was important to explain why this is not so.
It is also required of pastors that they hold the torch for those thinking Catholics and others who know instinctively that some of the Church's teachings have been inflated beyond what the Church actually teaches.
Beyond knowledge is wisdom. Knowledge is its raw material still being processed through prayer, reflection and life-experience. Of course, it is also a gift. Those who are least likely to feel the need for wisdom are those who are most sure of their own knowledge. Lots of information and easy access to it have become their power-base. (The power-base in society used to be with those who hold wisdom).
Some of those who rely heavily on information would probably find Cardinal Ratzinger's remarks on mediating and on the role of bishops' conferences bewildering – even if they are not so long out of the seminary.
The Catholic laity are entitled to pay more attention to those who have heard more confessions, visited more homes, worked with more addicts, failed more often, and experienced their own vulnerability over a longer period of time. They seem to know something that is not taken from the internet. (I used to feel scandalised by these priests – I had learned the books very well. I was yet to learn humility.)
An increasing need
Legislation on social, economic and industrial issues, and ethical questions arising from bio-technology, are just some obvious areas in which pastors and laity need each other for a proper understanding of how the Church's teachings apply. This will become more so, not less so. How shall we put in place the structures needed to facilitate friendship?
Bishop Peter J Cullinane is Bishop of Palmerston North Diocese and New Zealand Bishops' Conference Deputy for The Nathaniel Centre.
From CD to MP3 for Free? The Principle of Moral Cooperation
Issue 17, November 2005
Having carefully saved his pocket money, my thirteen year old son recently purchased a new music CD. One of his friends immediately wanted to borrow the CD so that he could copy the songs - at no cost - onto his MP3 player, something that is a clear breach of copyright. "Heaps of people do it Dad, but I don't think it is right. What do you think?" I had to agree with him. "Could you tell him that he can borrow it to listen to, but that you don't want him to copy it," I ventured to suggest. "Yeah right, Dad. We both know that he will copy it anyway."
The Pursuit of Wisdom
Dr Anna Holmes
Issue 17, November 2005
There is in her a spirit that is intelligent, holy, unique, manifold, subtle, mobile, clear, unpolluted, distinct, invulnerable, loving the good, keen, irresistible, beneficent, humane, steadfast sure, free from anxiety, all-powerful, overseeing all, and penetrating through all spirits that are intelligent, pure and altogether subtle.
--Wisdom of Solomon 22-23
We live in a knowledge economy and access to information is power. Those who do not have access to information are disempowered. We live in a world that values scientific knowledge but pays scant attention to wisdom. Indeed it tends to discount any knowledge that cannot be measured and tested by scientific method. Knowledge gained through experience is also often ignored. This trend has been escalating in the past century as scientific understanding of the world has increased. It is almost as if the more we unravel about our physical being and world the less we really understand our real selves and relationships.
Personhood and Human Dignity
Issue 17, November 2005
"During the next 35 years, the traditional view of the sanctity of human life will collapse under pressure from scientific, technological, and demographic developments. By 2040, it may be that only a rump of hard core, know-nothing religious fundamentalists will defend the view that every human life, from conception to death, is sacrosanct."
--Peter Singer, 2005
In the September/October 2005 edition of the magazine, Foreign Policy Professor Peter Singer from Princeton University wrote an Op-Ed piece entitled The Sanctity of Life: Here Today, Gone Tomorrow. In it he argues that, because of significant scientific and technological developments, the belief that life is sacred from conception to death has become, in 2005, untenable. To support his argument Singer cites two examples one at the beginning of life, the other at the end of life.
Earlier this year scientists from South Korea successfully replaced the nucleus of an unfertilized human egg with the nucleus of a human cell. Such a development appears to confirm that any and every human cell contains the genetic information required to create a new and independent human being. The possibility of cloning from the nucleus of an ordinary cell, Singer argues, undermines the idea that embryos are precious because they have the potential to become human beings. For Singer while the life of a human organism begins at conception, the life of a person that is, at a minimum, a being with some level of self-awareness does not begin so early. Similarly, he argues that personhood can end long before an individual dies.
When patients have suffered such irreversible brain trauma from which they will not recover, then, Singer argues, a decision to remove a feeding tube will be less controversial, because it will be a decision to end the life of a human body, but not of a person. For Singer a patient in this condition has already ceased to be a person and only his or her body remains.
While Singer is right that the development of sophisticated technology will increase our ability to make sound judgments about the limits of curative treatment, the leap in judgment that patients who have lost even a minimum of or considerable self-awareness, are no longer persons is disturbing to say the least. While we argue that the unborn, infants and the cognitively impaired have an innate dignity and a profound moral connection to the community, it is clear from the above argument that not everyone agrees.
The implications of Singer's argument are disturbing, not least because such views are not uncommon in secular bioethics.
For example, in his book The Foundations of Bioethics, H. Tristram Engelhardt outlinea the philosophical basis for such an understanding of personhood in general secular morality and, by extension, in so-called secular bioethics. He lists four fundamental elements of personhood: the ability to be self-conscious; rational; have a minimal moral sense and be free. To the degree that a human being is conscious, able to make autonomous choices, and perform actions which benefit society, his or her life has value and the status of personhood. When these qualities are lacking, so is their personhood. Engelhardt states:
not all humans are persons. Not all humans are self-conscious, rational, and able to conceive of the possibility of blaming and praising. Fetuses, infants, dhe profoundly mentally retarded, and the hopelessly comatose provide examples of human nonpersons. They are members of the human species but do not in and of themselves have standing in the secular moral community. Such entities cannot blame or praise or be worthy of blame or praise; they cannot make promises, contracts, or agree to an understanding of beneficence. They are not prime participants in the secular moral endeavor. Only persons have that status. (Engelhardt, 1996, pp.138-139)
Engelhardt argues that such definitions highlight and reflect the tension between general secular morality and traditional Judeo-Christian morality and the bioethics that it, in turn, supports. Inevitably different philosophical starding points lead to a painful gulf between general secular and content-full morality. (1996, p.140)
The logical outcome of the current trends in secular bioethics regarding personhood is a society divided into persons and non-persons. Non-persons would include those who are cognitively disabled in some way, through genetics, accident, or disease. The requirement to exhibit certain cognitive capacities means that some bioethicists do not see newborns as being persons.
The human rights of those declared to be non-persons would be severely curtailed. Some bioethicists have already speculated as to whether they could be used as non-voluntary sources of organs.
From a Catholic perspective the intense philosophical debates about personhood occurring in secular bioethics give cause for considerable concern. Human dignity is the source of rights in Catholic thinking, not a slippery concept of personhood which can be defined and redefined so that some people are designated as non-persons. It is hard to escape the conclusion that in some cases this is being done for utilitarian purposes.
There is reason to be very afraid if this philosophy should make further inroads into public policy in New Zealand, as it is already doing in other parts of the world.
H. Tristram Engelhardt. (1996). The foundations of bioethics. (2 nd ed.). New York: Oxford University Press.
Singer, P. (September/October 2005). The sanctity of life: here today, gone tomorrow. Foreign Policy.
Smith, W.J. (2000, April 3). Is Bioethics Ethical? The Weekly Standard.
Rev Michael McCabe, PhD
The Nathaniel Centre
Guest Editorial: Decisions, decisions...
On an Intrepid Journey programme on television recently a group of Turkish carpet makers gave a mesmerizing demonstration of their craft. With incredible speed they pulled each tuft into the carpet, changing colour without hesitating as they created an intricate pattern.
The carpet makers provided a visual analogy with life. We make many small decisions every day, often without a lot of thought. These decisions are like tufts in the carpet, collectively creating a pattern in our lives. We would be hugely burdened if we were to pay too much attention to them, so we create routines to simplify our daily decision-making processes. Routine saves us from expending unnecessary energy on making minor decisions.
Christian Moral Argument and Natural Law "Faith and Reason" or "Faith vs. Reason"
Issue 16, August 2005
In America, and now in New Zealand, an increasing number of strong and powerful "religious" voices are emerging in the political arena to debate the moral issues of our time. A number of these Christian voices employ an approach to morality that appeals strongly and at times exclusively to the authority of God in Scripture.
Guest Editorial: Morality and Reality
Issue 16, August 2005
In 1984 Cardinal Joseph Ratzinger gave an address entitled "Bishops, Theologians and Morality" to the Annual Bishops Workshop run by the National Catholic Bioethics Centre in the United States.
Editorial: Beyond Slogans
Anne Dickinson, Michael McCabe, John Kleinsman
Issue 15, April 2005
Slogans and bumper stickers are a popular feature of modern life. They offer us messages which are memorable for their precision and conciseness. That is why we love them.
We live in a world of ever-increasing complexity which may explain, in part, why there is a tendency to think we can grasp bioethical principles and ethical solutions in simple one-liners such as the right to choose and the right to life. For all their power and attractiveness and kernel of truth slogans can trap us into thinking that we can come to an adequate understanding of an issue via one perspective alone.
Editorial: Engaging with Society
Issue 13, August 2004
"Economic, technological, systemic and medical realities are not enemies. Rather it is to them that we bring our ministry of Christian hope."
--Cardinal Joseph Bernardin
On 14 September 1965 the fourth session of the Second Vatican Council opened in Rome. In the three months that followed the Council Fathers finished their work on Gaudium et Spes (The Pastoral Constitution on the Church in the Modern World). This landmark document was to change the way in which the Church related to the world. It is as relevant forty years later as it was when it was first made public.
Toi Te Taiao: The Bioethics Council
Issue 9, April 2003
The New Zealand Catholic Bishops' Conference Submission to the Royal Commission (2000) on Genetic Modification analysed the debate around genetic modification. The Bishops recommended there be an ethical framework for decision making and suggested the following as a way forward:
In order to prevent unethical or unwise use of GM, oversight of its use by appropriate bodies, established by regulation, is a moral imperative. We strongly believe that a framework of ethical principles is needed to assist individuals and the community to make informed decisions about the profound issues associated with genetic modification....
Editorial: Listening to the Culture
Issue 9, April 2003
When people think about bioethical issues they inevitably bring their own human needs and fears into the process. Without a deeper and more distanced knowledge the only way an individual can respond to the complexities of an issue is through their feelings and emotions.
Exploring the Role of Health Professionals in Truth Telling: A Nursing Perspective
Issue 7, August 2002
Truth telling (veracity) is a key factor in the relationship between patients, their families and health professionals. The Oxford dictionary defines truth as: a quality or state of being true, genuine, loyal, faithful; in accordance with fact or reality, exact, accurate.
Surveying a Catholic Approach to Bioethics
Issue 7, August 2002
"Healthcare ethics is about the medical art of curing where possible, and the human art of caring always."
--Richard C. Sparks
The Catholic moral tradition emphasises that life is a free and totally unsolicited gift from God. An appreciation of this fact engenders an attitude of profound gratitude and thanksgiving. When we look at life like this, Christian morality is nothing other than our response to the unconditional and amazing love of God: 'How ought we who have been so gifted by God to live?' Like any special gift, we instinctively feel that life is something to be treasured and to be used in a responsible way. This is the starting point for any Catholic approach to bioethics.
The absolute dignity accorded human beings in Catholic teaching reflects the biblical message that each person is created in the image and likeness of God (Genesis 1:26-31). The belief that human life is a reflection of God's own nature means that personal worth and human dignity are inherent or innate characteristics; that is to say, our worth comes from 'inside' the human person rather than from anything 'external'. Human dignity is absolutely independent of our value to others, our ability to function, our age, health, gender, race or economic status. The belief that dignity is innate explains why the Catholic moral tradition upholds, absolutely, the teaching that persons may never be used by others as a means to an end, no matter how worthwhile the end may be.
Acknowledging God as the author and giver of all life calls us to recognise the sacredness of, and our interconnectedness with, all of creation. In other words, human persons are fundamentally relational beings. The person is always person in relation to the totality of reality; self, other people, all created reality and God. Due recognition of this highlights the responsibility we have of living in "right relationship". Often expressed in the biblical terminology of "stewardship", our interconnectedness is not, however, to be confused with "absolute dominion". Instead, the interconnectedness of all life demands recognition of, and respect for, the fact that there are limits to what we as humans should do. Our responsibility to protect and enhance the integrity of all relationships is the key to identifying what the limits are.
These limits have been, and continue to be, well traversed (even if not always agreed on) in regard to our responsibilities towards other human beings. That we are fundamentally social beings means that the human person, adequately considered, is a cultural person. Our ability to function in autonomous ways and to develop as individuals is always dependent upon our identity with a particular cultural group. Such a perspective nurtures a broad vision of the human person as called to live within caring communities. We find our fulfillment as committed individuals bound in kinship, friendship, and fellowship to our families and our neighbours. Yet the Gospel reminds us that we owe loyalty not only to those whom we readily choose as friends, but also to strangers and even to enemies. In Catholic language the term "common good" is used to describe the fact that our individual welfare and flourishing is inextricably connected with the welfare of others.
At the very heart of Catholic respect for human life is a special and persistent advocacy for those who depend on others for survival itself. Indeed, Jesus Christ teaches that the moral heart of any society may be measured by how well it provides for those who are most vulnerable and dependent. The beginning and end of life are areas of special interest and concern in bioethics because people are particularly vulnerable at these stages of their life journey.
The limits of human freedom have perhaps been less well delineated in regard to the relationship between humans and the rest of the created order. As recently as 1999, Pope John Paul II, in an address given to the WTO Conference in Seattle, Washington, has talked about the need to address the ecological crisis: "Faced with the widespread destruction of the environment, people everywhere are coming to understand that we cannot continue to use the goods of the earth as we have in the past ... [A] new ecological awareness is beginning to emerge ... The ecological crisis is a moral issue."
Our own New Zealand Bishops have also written that it is "in keeping with the traditions of the Māori of Aotearoa that we need to respect the sacredness of creation, as partners in life with the earth, the oceans, the lakes, the animal world, the mountains, the fish of the sea and the birds in our forests and gardens. From such sources, balanced by the infinite hand of God we draw all life and nourishment."  The integrity of all creation needs to inform our bioethical discussions with regard to the lengths to which we humans are prepared to go in order to delay death or to improve the quality of our life.
Recognition of the need to respect limits itself calls for a certain approach to understanding personal freedom, one that may be at odds with the way in which freedom is sometimes understood. Freedom can never mean the experience of simply exercising choices or options for action. A Catholic-Christian approach upholds an understanding of autonomy (the idea that we are the authors of our own fate) that includes the notion of our inter-dependence with others. We act freely when we act in ways that help us to flourish according to our deepest needs and yearnings, including our need to be in caring community. "Human nature" is a term sometimes used in Catholic teaching to refer to that which is in keeping with our deepest human yearnings.
A further principle that underpins a Catholic-Christian approach to bioethics is the belief that faith informed by human reason can discern the good. This means that, in their endeavour to determine what is appropriate human conduct, Catholics are committed to dialogue with all the sciences. In the words of John Paul II: "Faith and reason are like two wings on which the human spirit rises to the contemplation of truth."
From the above broad and general vision of the goodness and sacredness of the created order the following set of key moral and ethical principles inform a Catholic-Christian approach to the interdisciplinary science of bioethics:
- The sanctity of life
- The dignity of human persons
- The relief of suffering
- The duty to care for one's own health
- The duty to care for those who are sick – in body and in spirit
- The existence of limits, including the limit to provide treatment
- The promotion of the 'Common Good'
- Respect for culture
- A preferential option for those who are most vulnerable and deprived
- Respect for the integrity of all creation
- Justice – the equitable distribution of risks and benefits
- A commitment to truth telling
- A consistent ethic of life
- Respect for autonomy
While the above principles are identifying of a Catholic-Christian approach, it will be obvious that they are not uniquely Catholic and that they resonate with the values of all other people of good will. That this is so is not at all surprising since the Gospel values of Jesus Christ, upon which these principles are based, ultimately point us to what is most truly and deeply human and to what will lead the whole of the created order to flourish: "I have come that you might have life and have it in abundance." (John 10:10)
(Previous editions of the Nathaniel Report have explained the implications of some of these principles as understood in the Catholic moral tradition.)
For further reading see:
Beauchamp, T.L., Childress, J.F. (1994). Principles of Bioethics. Fourth Edition. New York: Oxford University Press.
Brody, H. (1989). Transparency: Informed Consent in Primary Care. Hastings Centre Report 19:5, pp.5-9.
De Dios Vial Correa, J., Sgreccia, E. (Eds.) (1998). Human Genome, Human Person and the Society of the Future: Proceedings of Fourth Assembly of the Pontifical Academy for Life. Vatican City: Libreria Editrice Vaticana.
De Dios Vial Correa, J., Sgreccia, E. (Eds.) (1999.) The Dignity of the Dying Person: Proceedings of Fifth Assembly of the Pontifical Academy for Life. Vatican City: Libreria Editrice Vaticana.
Gormally, L (Ed.). (1999). Issues for a Catholic Bioethic. London: The Linacre Centre.
The Hastings Center. (1987). Guidelines on the Termination of Life Sustaining Treatment and the Care of the Dying. Bloomington: Indiana University Press.
New Zealand Catholic Bishops' Conference. (1997). A Consistent Ethic of Life – Te Kahu-O-Te-Ora. Wellington: Catholic Communications.
O'Rourke, Kevin D. & Boyle, Philip. (1993). Medical Ethics: Sources of Catholic Teachings. Washington, D.C.: Georgetown University Press.
The Pope John Center. (1989). Conserving Human Life. Braintree, Massachusetts: Pope John XXIII Medical-Moral Research and Educational Center.
John Kleinsman teaches Moral Theology at the Catholic Education Centre in Wellington and is also a part time researcher for The Nathaniel Centre
 New Zealand Catholic Bishops' Conference. (1997). A Consistent Ethic of Life – Te Kahu-O-Te-Ora. Wellington: Catholic Communications.
The Principles Revisited
Issue 7, August 2002
In June 2002 Anne Dickinson was a participant in the Kennedy Institute of Ethics 28th annual Intensive Bioethics Course (IBC XVIII) at Georgetown University, Washington DC. Here she writes about the part of the course which focused on the principles of bioethics.
The Restoration of Trust
Bishop Peter Cullinane
Issue 7, August 2002
The relationship between professionals and those they serve implies of its very nature a certain need, and therefore vulnerability, on the part of those who seek help. It is this vulnerability and sense of dependency that can become deep hurt and insecurity when trust is betrayed by the professional. To whom does one go when those that one trusted have become the threat and the danger?
Editorial: Ethics and Trust
Issue 7, August 2002
"Trust is most problematic when we are in states of special dependence – in illness, old age, or infancy or when we are in need of healing, justice, spiritual help, or learning. This is the situation in our relationships with the professions that circumstances force us to trust. We are forced to trust professionals if we wish access to their knowledge and skill. We need the help of doctors, lawyers, ministers, rabbis, priests, chaplains, or teachers to surmount or cope with our most pressing needs. We must depend on their fidelity to trust and their desire to protect rather than exploit our vulnerability."
—Edmund Pellegrino and David Thomasma 
The concept of community is a central motif in bioethics. It is based upon the belief that the human person is fundamentally a social and cultural being who lives in relationship, and finds meaning in and through those relationships. The term "the common good", for example, illustrates the belief that the welfare of the individual is inextricably connected with the welfare of others.
A profession can be viewed as a "community" which exists for the purpose of meeting a human need, and which is based upon a body of knowledge and a particular set of skills. Professions have unique educational and socialisation processes, together with codes of ethical practice, which help to guarantee and shape the integrity of relationships both within the profession and between the professionals and those they serve. Professional codes of ethics help to establish accountability and to preserve the ethical boundaries within which the nurturing and continuation of trust can happen. When professional obligations are neglected or exploited by some members of a professional community, the sense of belonging can be undermined for others in the community. Members of a profession can feel isolated and let down by the unethical actions of fellow professionals.
Recent experiences in the medical and teaching professions and in the Church could lead to a deep-seated ambivalence about involvement with professionals in various fields, and relationships in general. Because people require the services of the caring professions when they are at their most vulnerable, a betrayal of trust exacerbates this sense of vulnerability, eroding a sense of security for the injured individual, the community and the particular profession itself. This feeling of heightened vulnerability, the consequence of very real hurts and grave injustices, may lead us to become even more cautious and diffident in our relationships with others, and possibly deter us from seeking professional help when it is needed. In these circumstances such diffidence in relationships becomes a form of self-protection.
When trust is removed or lacking in human relationships the ability to live fully in society and the ability to attain the essentials of a satisfying life are diminished. Possibilities of growth and fulfillment are restricted. Loss of trust inevitably impacts on the transcendent dimension of life for individuals and for communities, namely, in the ability to be creative and in the ability to anticipate the future in a hope-filled manner. Ultimately, the withdrawal of trust removes the very possibility of healthy community life.
Trust entails risk. As Pellegrino and Thomasma note, to trust and entrust is to become vulnerable and dependent upon the goodwill and motivations of those we trust. In times of conflict and hurt, such as in the betrayal of professional trust, whether individually and/or institutionally, the ability and willingness to risk trusting requires even greater courage. While the withdrawal of trust can be justified as a form of self-protection, personal growth is only fully achieved within community and will always involve taking risks.
The restoration of trust cannot be achieved without the building and maintenance of clear boundaries. Neither can it be restored without fulfilling the requirements of justice. In the Catholic tradition justice is prior to charity, which means relationships cannot be fully restored while any injustice remains.
It is possible that talking about the betrayal of trust may only further erode an already battered professional confidence, and threaten the fragile relationships between professionals and those they serve. That is a risk for those involved, and it is a real risk. But the damage that will ultimately be done by silence or concealment is a much greater risk. Renewed wisdom and potential healing can only emerge with honesty and with courage. Silence prevents both reconciliation and growth and provides conditions for multiplying the harm. That has been the lesson at the heart of recent events in the Catholic Church.
In recent months the actions of medical personnel at Green Lane Hospital provide an illustration of how trust can be rebuilt. Following revelations of organs being retained without consent by hospitals in Great Britain and in Australia, Green Lane Hospital initiated its own self-review of procedures. Subsequently, they accepted responsibility for the fact that certain actions of hospital staff, the result of both individual decisions and systemic processes, were both unacceptable and unethical. Most importantly, in the face of uncertainty over the current laws in New Zealand relating to post mortems, they have not sought to hide behind legal ambiguities but have acknowledged the need to do things differently. Significantly, the ability to move ahead and the potential that now exists for trust to be re-established between the caregivers and patients at Green Lane Hospital is a result of the honesty and courage to name and discuss the issues. Painful as this process has been, the openness with which the discussions have taken place has allowed both the deep hurts and pain to be expressed and a more ethical practice to emerge. In my view this is a wonderful example of rebuilding trust so that patient care and respect, high quality research, and professional practice are all enhanced.
Rebuilding trust has profound implications for those who have broken a trust, be they individuals in the professions, or within the institution itself. Even after this has been achieved, and it will inevitably be a very painful process, the rebuilding of trust will also have implications that are personal, communal and institutional. Nevertheless, to rebuild trust is to reinvest in a hope-filled future.
 Pellegrino, E., Thomasma, D. (1993) The Virtues in Medical Practice. New York: Oxford University Press. p. 65.
Rev Michael McCabe, PhD
The Nathaniel Centre
Xenotransplantation: Issues and Challenges
Issue 6, April 2002
In Rome the Pontifical Academy for Life has given qualified approval to xenotransplantation. In New Zealand the Ministry of Health has declined approval for an Auckland company to carry out clinical trials involving xenotransplantation. What are the issues raised by this emerging form of biotechnology?
Autonomy and Community Care: Are They Compatible in Aged Care?
Issue 6, April 2002
"What occurs at the cellular level inevitably affects the structures of which the cells are the basic unit, and their physiological performance, with consequent effects at all levels of human existence. Accordingly, the process of aging manifests itself in the body, the behaviour, the attitudes, the feelings and the self-image; it has large social consequences on social relations, performance and on the economic condition of the individual and the community in which he or she lives."
—Abbot John Bamberger
Ethics and the Internet
Nathaniel Centre Staff
Issue 6, April 2002
On February 22, 2002, the Pontifical Council for Social Communications released a document entitled "Ethics in Internet". A summary of this article is presented below.
Follow Your Conscience
Issue 5, November 2001
The doctrine of conscience lies at the very heart of Catholic moral teaching. The Catechism of the Catholic Church stresses that we have a right to act in conscience and in freedom so as to make moral decisions, and that no-one should be forced to act contrary to his or her conscience. [i]
Pastoral Letter on Conscience
Issue 5, November 2001
The following article is a paraphrased version of a Pastoral Letter on the topic of Conscience issued by the Irish Catholic Bishops' Conference in spring 1998. Read the full letter.
When we approach an important decision we go to great lengths to ensure that we make the right choice. Everyone knows the experience of looking back regretfully on decisions taken after the most serious reflection and saying, 'If only I had realised...'
Editorial: Making Connections - The Consistent Ethic of Life
Issue 5, November 2001
How does one begin to think coherently about the many assorted issues that threaten and diminish the gift of life? How can we enhance our reflection and examination of the complexities in issues affecting the gift of life?
Striking a Balance in Truth Telling
Issue 4, August 2001
The obligation of veracity is the obligation to tell the truth and not to lie or deceive others. Even though veracity is an essential part of the relationship between healthcare professionals and their patients, and an indispensable feature in establishing goals of care at the end of life, many codes of medical ethics frequently ignore rules of veracity and have little or nothing to say about deception and when or whether it is ever justified. The Hippocratic Oath, for example, does not mention this principle.  Ethicist, Sissela Bok, in her germinal book, "Lying; Moral Choice in Public and Private Life" suggests the reason why little is said about truth telling in codes of ethics is because, "reasons to lie occur to most people quite often. Not many stop to examine the choices confronting them; existing deceptive practices and competitive stresses can make it difficult not to conform. Guidance is hard to come by, and few are encouraged to consider such choices in schools and colleges or in their working life."  The principle of veracity and its allied virtue of truthfulness are expressions of the fundamental obligations contained in the primary principles of bioethics - respect for autonomy, justice, beneficence (to do the good) and non-maleficence (first do no harm).
The Complexities of Cloning
Issue 3, April 2001
The lack of legislation in New Zealand relating to human cloning has been highlighted recently by the announcement that a team of scientists from Italy, Israel and the United States is seeking to use cloning to create human embryos, as a means of assisting infertile couples to have children.
Informed Choice and Consent
Issue 3, April 2001
"The voluntary consent of the human subject is absolutely essential". In the practice of human experimentation, this is the first of the basic principles to satisfy moral, ethical and legal concepts, as laid down in the Nuremburg Code 1947. The Code is the concluding statement of the judgment in the trial of the Nazi doctors who were accused of crimes against humanity by conducting criminal scientific and medical experiments on concentration camp prisoners. The Nuremburg Code has become part of international law and it serves as the basis for many formulations of the ethics of research with human subjects.
Understanding Ethical Issues: The Clinical Ethics Model
Issue 3, April 2001
"Clinical ethics is a practical discipline that provides a structured approach to decision making that can assist physicians and family members to identify, analyse, and resolve ethical issues in clinical medicine."
—Jonsen, Siegler & Winslade
Healthcare professionals frequently contact The Nathaniel Centre asking for advice on a particular issue in clinical practice, or an issue concerning treatment options for a family member. We thought it would be helpful, therefore, to provide a brief outline of a model to assist these readers understanding of some of the ethical issues in healthcare practice. This particular model comes from Jonsen, Siegler & Winslade's book, "Clinical Ethics".
"When is a rose not a rose?" : Reflections on Moral Decision Making
Issue 3, April 2001
We live in a time of increasing complexity, some would even say "chaos." Quantum technological advances are for the first time enabling us to envisage such possibilities as human cloning and designer organs, possibilities hitherto only dreamed of. In the light of these developments we are confronting questions and challenges never before faced by the human race. Yet, somewhat paradoxically, it is my perception that many people remain very certain about their judgements of what is right and wrong. Why is this?
Editorial: Bioethics and Decision Making
Issue 3, April 2001
Making decisions about the use of biotechnologies has become increasingly complex. The speed of technological development is tending to overwhelm our moral and ethical decision making.
Editorial: Bioethics and Poverty
Issue 2, November 2000
"Fear ... has a definite object ... which can be faced, analyzed, attacked, endured. One can act upon it, and in acting upon it participate in it – even if in the form of struggle. Courage can meet every object of fear, because it is an object and makes participation possible... One could say that as long as there is an object of fear love in the sense of participation can conquer fear."
—Paul Tillich, The Courage to Be
A foundational insight of the interdisciplinary science of bioethics has been the belief that no single discipline was considered adequate to address the challenges brought about by the rapid development in medical technology and by a growing awareness of individual rights and the potential for the abuse of these rights. An interdisciplinary approach enables an appreciation of the fact that ethical issues centre on competing goods. Equally, it provides a richer context for debate on the complex issues in healthcare and the life sciences. Nevertheless, it is still relatively easy in bioethics to lose sight of the person so much so that the individual can appear quite isolated and removed from any ethical discussion.
Ethics and The Treaty of Waitangi
Issue 1, August 2000
The Treaty of Waitangi is regarded as the founding document of New Zealand. In signing the Treaty the Crown agreed that, within our society, the values and traditions of both cultures (Māori and British) would be reflected in society's customs, laws, practices and institutional arrangements. There was also an agreement to share control of resources and decision-making. The Treaty guarantees Māori equal status and power within New Zealand society, and it also legitimates the rights of Pakeha New Zealanders. This concept was explained by Judge Eddie Durie at his Waitangi Day address in 1989: the Treaty of Waitangi is not just a Bill of Rights for Māori. It is a Bill of Rights for Pakeha too. It is the Treaty that gives Pakeha the right to be here. Without the Treaty there would be no lawful authority for the Pakeha presence in this part of the South Pacific. The Pakeha are the Tangata Tiriti, those who belong to the land by right of that Treaty.
The Biotechnology Debate: A Way Forward
Issue 1, August 2000
In late June this year President Clinton and Prime Minister Blair jointly announced the completion of the first phase of the Human Genome Project. They compared the significance of this achievement to Gallileo's discoveries, the landing of a man on the moon and the first circumnavigation of the earth. There was extensive media coverage of this achievement in New Zealand, with many questions being asked about its implications.
Editorial: Bioethics - Challenges for the Church
Issue 1, August 2000
The word bioethics was coined in 1972 and is derived from two Greek words: bios meaning life and ethos meaning ethics, principles or mores. Bioethics is the interdisciplinary field which encompasses all the ethical issues surrounding life from its beginning to its end.
[Synopsis Only] Mind the Gap: Every Pregnancy Needs to be Celebrated
This true story of one woman’s experience of an unexpected pregnancy, offers personal insights into the social and cultural challenges women can face. As this case reveals, the response of those within the Catholic community can vary. Catholic faith communities should be the safest place in New Zealand for a woman to be pregnant, whatever the circumstances of the conception.
The full article is available by subscription to The Nathaniel Report
[Synopsis Only] Reasons Women Seek Abortions
Cynthia Piper highlights the reasons why women seek abortions, something that is not often explored. Women facing an unexpected pregnancy are inevitably frightened and distraught. The prevalence of socio-economic drivers indicates the need for adequate and independent pre-decision counselling and support to empower women to make real choices.
The full article is available by subscription to The Nathaniel Report
Review of the Abortion Laws in New Zealand: Submission to the Law Commission – May 2018
Joint submission by the New Zealand Catholic Bishops Conference & The Nathaniel Centre
The Status of Unborn Human Life: Our Position
The debate about when human life begins is uncontroversial. As reported by the Royal Commission on Contraception, Sterilisation and Abortion (1977): “From a biological point of view there is no argument as to when life begins. Evidence was given to us by eminent scientists from all over the world. None of them suggested that human life begins at any time other than conception.”
The ethical questions around abortion and research on embryos centre on the sort of respect or protection we should accord human life; in particular, whether it is ethically consistent to accord a different level of respect to humans in the earliest stages of life, as well as whether there are ever factors that mitigate the respect due to human life at any stage of development.
Most people, whatever their position on issues such as abortion or embryo research, agree that human life deserves a ‘special’ status even if they do not accord unborn human life the same moral status as human life post-birth. The belief held by some that the life of a human embryo matters less than other human life at a more developed stage may reflect the fact that it is largely unseen. However, an embryo is not simply a collection of cells that happen to be contiguous. These cells are a human embryo, a new human individual and part of the human family. Embryos and foetuses become children just as children become adults, not by some addition to what they are, but simply by developing further as the kind of beings they already are.
The common understanding of ‘person’ in our culture has, latterly, been shaped by an emphasis on self-consciousness as the mark of personhood. A much older understanding of person, however, locates personhood in the dignity of a being's rational nature, irrespective of whether that being is even ‘conscious’ at a particular phase in his or her life. According to this traditional view, there is nothing problematic about saying that an unborn child or a persistently unconscious patient is a person, for they are truly our fellow human beings.
Recognising that the status of the human embryo or fetus flows from their inherent connection to the human family is key to understanding why Catholic teaching holds they ought to be treated with unconditional respect whatever the stage of development – a life is begun which is neither that of the mother nor the father. It is already the human being it will always be and will only grow in size and complexity. Mothers instinctively recognise this by invariably referring to the embryo or foetus within the womb as their baby.
On that basis, embryos and foetuses are entitled to be granted a place in the human family and treated with the same respect as persons. As the Royal Commission stated: “The unborn child, as one of the weakest, the most vulnerable, and most defenceless forms of humanity, should receive protection.”
There is a lack of clarity that has led to confusion in the community about the precise meaning of the brief that has been given to the Law Commission by the Minister of Justice. We are assuming that the wish to treat abortion as “a health issue that is a reproductive choice for women”1 centres around a wish to provide for ‘abortion on demand’ in New Zealand – that is, a wish to make it a decision solely between a woman and a doctor as is the case for reproductive choices involving contraception. However, this is nowhere clearly spelled out, something which makes it difficult to comment on your brief in a truly informed way.
If our assumption is correct, then what the Law Commission is being asked to do represents a significant policy change. As we understand it, the current law, as set out in the Contraception, Sterilisation, and Abortion (CS&A) Act 1977 and the Crimes Act 1961, sets up a ‘tension’ between the needs and desires of the woman and the rights of the foetus/unborn child and seeks to balance both. Making abortion solely “a health issue that is a reproductive choice” would ignore this tension, removing any requirement to consider the rights of the unborn child.
Meanwhile, we note that in public comments explaining your brief,2 you state that the Law Commission will not be commenting on policy issues.
In our minds there is a degree of incongruity between the brief and your public comments. In which case we interpret your comments about policy to mean that it is not part of your task to recommend that any changes be made to the eligibility criteria for abortion or to promote any alternative approaches as preferable to the existing policy approach.
The public and other interested parties have a right to be fully consulted on any changes to the current policy approach, including eligibility criteria. It concerns us that the Law Commission could potentially be cooperating in a policy change by stealth.
That your brief falls short of the “full review of the legislation” that Justice Minister Andrew Little was reported as saying “would first take place” adds to our concern about a lack of proper process on what is a critically important piece of legislation.3
In line with the Catholic position stated above, we are opposed to any change in the law which would either lessen or, worse, totally remove the (limited) rights the current law accords to the unborn child. The changes we would advocate for (and which would not constitute a policy change) are those which would (i) ensure continued consideration of the rights of the unborn child and (ii) promote the well-being of women, including better processes to ensure adequate informed consent.
Indeed, along with the 65% of New Zealanders identified in the 2017 Curia Poll,4 we would like to see changes implemented that would further reduce the number of abortions occurring in New Zealand.
We understand that under current law there is no ‘right’ to have an abortion in New Zealand and that administering (or supplying the means for procuring) an abortion is unlawful except when certain eligibility criteria are met as spelt out in Sec 187A of the Crimes Act 1961. The current situation is arguably well-described as providing for ‘abortion on request’ insofar as any discussion about abortion must be initiated by the woman but ultimately depends on two appointed doctors being satisfied that critical eligibility criteria are met.
We note that there are certain groups and individuals pushing for change who claim that the current law criminalises women. Sec. 183 of the Crimes Act 1961 specifically states that “a woman (or girl) shall not be charged as a party to an offence against this section” (the relevant section being that which describes “unlawful abortions”). We therefore regard such claims as both inaccurate and mischievous – under current abortion legislation, women are not liable for prosecution except in situations where they attempt to procure their own abortion, something we comment on below.
Our Key Arguments:
The ‘tension’ that we believe characterises the current regime (see above) is revealed in the legislation in several places:
It is spelt out in Section 30(5) of the CS&A Act which stipulates that the appointment of members to the Abortion Supervisory Committee should have regard to views ‘incompatible’ with the tenor of the CS&A Act. The views described as ‘incompatible’ are:
(a) that an abortion should not be performed in any circumstances:
(b) that the question of whether an abortion should or should not be performed in any case is entirely a matter for the woman and a doctor to decide.
It is also evident in the longer title of the CS&A Act: An Act … to provide for the circumstances and procedures under which abortions may be authorised after having full regard to the rights of the unborn child…
That the unborn child has a status that gives it rights is also upheld in Section 182 of the Crimes Act (“Killing unborn child”) which, we note, you have been instructed need not be reviewed (Letter from Minister of Justice Hon Andrew Little to Hon Sir Justice White QC, 27 February 2018 – letter released under the Official Information Act). Logically speaking, the ongoing existence of Section 182 andthe existence of a parallel law making abortions solely a matter between the woman and her doctor, would set up an inherent contradiction between two laws.
Making abortion solely a health issue, in the sense of making it merely a matter between a woman and her doctor, will deny many women the chance to manage the tension that lies at the heart of all abortion decisions. That is, it will deny women the chance to deal with abortion as a significant ‘moral issue’ involving the ending of a human life. This, we argue, would not be in women’s interests. As the feminist writer Naomi Wolf has stated: “I will maintain that we need to contextualise the fight to defend abortion rights within a moral framework that admits that the death of a foetus is a real death: that there are degrees of culpability, judgment and responsibility involved in the decision to abort a pregnancy; that the best understanding of feminism involves holding women as well as men to the responsibilities that are inseparable from their rights…”.5
Most women understand that an abortion, whatever the reason they are contemplating it, has significant moral implications. This is signified, among other things, by the way women who have had abortions commonly speak of their ‘child’ rather than using terms such as ‘the products of conception’. In a peer-reviewed qualitative exploration of women’s needs and preferences in clinical care during the process of having an abortion, one of the strong themes to emerge was that women want to be recognised as “grappling with a real-life moral decision”; to be affirmed as “moral decision-makers”, something that only occurs “when medical personnel recognized this conflict and affirmed the decision as moral …”6
Using language which either denies what is happening or which disguises the complexity and moral dimensions of abortion, is ultimately not in the interests of women. Equally, and even while it might be presented as empowering women to make their own decisions without interference from the State or others, creating an altered legal regime that frames abortion as being solely about the well-being of the mother will potentially undermine women’s sense that abortion is a serious moral issue and, consequently, their moral agency. Were that to eventuate, the State would be party to undermining the true ‘moral’ dimension of abortion and would be potentially contributing to poorer outcomes for many women.
It is our considered and strongly held view that the tension that characterises the current legal approach must be retained. To be retained, it must be reflected in the legal framework governing access to abortion.
There are three other important reasons for retaining certain provisions relating to abortion in the Crimes Act that we wish to highlight:
Under the current law, there is protection provided to women from unscrupulous abortion providers. This needs to remain and it is proper that the Crimes Act continue to spell out sanctions to prevent and/or punish such actions.
The increased use of medical abortifacients and their ready availability from other countries via the internet, means that some women may seek to import such drugs and take them without proper medical supervision. This is particularly a risk for young women who feel the need to keep their pregnancy and abortion decision secret. Whether they import the drugs directly or fall prey to unscrupulous providers, it is for the protection of these women that the importation of such drugs must be restricted in law.
If treating abortion as a ‘health issue that is a reproductive choice’ means, as we suggested above, ‘abortion on demand’, then this allows for abortion for any reason, including gender selection and disability. These reasons for abortion are highly contentious. We note here the Curia poll of 1,000 New Zealand residentswhich found that only 9 percent of respondents supported sex selective abortions, and 90 percent were opposed. For females, only 1 percent supported sex selective abortion while 94 percent opposed it.
For all the reasons spelled out above, we argue that abortion needs to be treated as both a justice and a health issue. We argue this requires legislation which clearly and precisely specifies the circumstances under which abortion remains unlawful and under which abortion providers will be prosecuted for unlawful abortions.
In support of our position we note that the Abortion Supervisory Committee (ASC) has notbeen advocating for a significant change in the way that abortions are administered in New Zealand. In the 2017 Report to Parliament’s Justice Select Committee, the ASC stated that: “The ASC does not propose amendments that would change the original intent of the Act.”
Furthermore, and importantly, in the same 2017 Report it is written that “[T]he ASC recognises the merit in having a robust pathway in place, which requires certifying consultants to assess and certify patients and to ensure counselling is offered.” While there are some who argue that the current law disempowers women because it makes what should be a personal decision subject to external interference, to cumbersome and intrusive legal and procedural obstacles, we argue that choices are always limited by the constraints of knowledge and by context, including coercion,.8,9 As The Nathaniel Centre has previously stated:
Many women, after the event, report feeling that they had no other option at the time but to proceed, often because of pressure from parents, partner and/or peers. At times this pressure is also experienced as coming from staff at the Termination of Pregnancy Units. For other women, the pressure they feel is generated by employment or social factors. In the words of another commentator, in such situations, the decision for an abortion is best described as a tragic response to lack of choice.10
It is therefore in the interest of free and informed consent that all women should be offered independent counselling that (i) addresses the coercive realities surrounding many abortions and (ii) canvasses the other options that exist. The law has an important role in ensuring that women are given the opportunity to understand and work with the complex moral, personal, family and social contexts within which they find themselves contemplating an abortion. ‘Abortion on demand’ will not achieve this. In other words, it is important to keep in place carefully considered eligibility criteria as well as providing a robust pathway of options that is clearly laid out in law.
Furthermore, reducing abortion decision-making to ‘a reproductive choice for women’ denies the fact that many others are involved in and/or impacted by the decision. As Germaine Greer has written:
Pregnancy is unlike other patient-doctor relations in that there are two other individuals involved - the father-to-be and the child-to-be … What women ‘won’ was the ‘right’ to undergo invasive procedures in order to terminate unwanted pregnancies - unwanted not just by them but by their parents, their sexual partners, the governments who would not support mothers, the employers who would not employ mothers, the landlords who would not accept tenants with children, the schools that would not accept students with children.11
Women are reported in the literature as taking into account a range of persons and factors when contemplating an abortion including “the woman herself, the potential child, her sexual partner, existing children, the extended family, and financial matters.”12 Women contemplating an abortion are well aware of the broader ramifications of such a decision and it would be a moral and social disservice to them if the language and regulatory frameworks around abortion conveyed something different. The legal model for regulating abortions in New Zealand must acknowledge and account for this broader reality. A narrow framework focussed solely on the mother will not achieve this.
If the law is to protect and promote genuine informed consent, then women contemplating abortion must be given the time and support required to make a genuine decision. A decision for an abortion can only be described as a truly ‘free’ choice if the woman knows there is tangible support (familial, financial, emotional, social) that enables her to choose to keep the child. This requires a parallel review of the social support structures that our society offers to women who are pregnant.
We note that the health risks associated with an abortion are widely acknowledged in the research literature. While there is some disagreement in the research literature about the extent of the negative health consequences of abortion for women, the negative effects on some women are incontestable. This provides a further reason in our minds for clearly laid out and robust processes, including the funding and availability of independent counselling provided by an individual or organisation otherthan the abortion provider.
Referring again to the 2017 ASC Report, as well as the 2016 Report, we do agree that some of the language used in the present CS&A Act is outdated and clumsy and needs to be reviewed.
Public awareness of the complexities of this issue is illustrated in the Curia Poll13 referred to above. Some of the findings of this poll include:
52 percent of respondents ‘generally support abortion’ but 29 percent ‘oppose’ and 19 percent were ‘unsure/refuse’;
Of respondents aged 18 to 40 years, only 47 percent ‘support’ abortion, with 34 percent opposed and 19 percent ‘unsure/refuse’.
65 percent of respondents agree that society should work together to reduce the number of abortions; only 17 percent disagree;
Of those who generally support abortion, 63 percent agree we should reduce the number of abortions.
Only 9 percent of respondents support a time limit of 20 weeks (the current legal limit); 4 percent support time limits over 20 weeks; 41 percent support time limits of 15 weeks or less.
It is noteworthy that in New Zealand, abortion numbers and rates have been declining since 2007. That is, the numbers of abortions, the ratio of abortions (number of abortions per 1000 pregnancies) and the rate of abortion (number of abortions per 1000 women aged 15-44) have all declined. While the reasons for this are not understood, those on both sides of the divide can agree this is a good thing. We suggest that while the reasons for this decline are not understood, it is a precarious time to tamper with the law. Any proposed changes should be considered keeping this in mind.
Conclusion: ‘Abortion is both a health and a justice issue’
Human life begins at conception and is entitled to the full protections offered to human persons from that point forward.
The inherent dignity of human life from conception means that the starting presumption should always be in favour of human life, whether born or unborn. It’s on this basis that we oppose establishing a ‘right’ to abortion. This being so, it is appropriate that the unborn enjoy the same fundamental protections the Crimes Act provides for all other human beings. Therefore, if the State is to continue providing abortions in certain situations, the law should only ever provide for abortion as an ‘exception’ to the fundamental right to life.
Our considered view is that abortion is both a health and a justice issueand it should be treated by the law as such.
There is much at stake in a review of the abortion laws; it is a deeply moral issue involving the future of a human life as well as the well-being of the woman and her family. The State has an essential responsibility to protect and care for allhuman life. It would abdicate this responsibility by making abortion solely a matter between a woman and her doctor.
We need legislation which clearly specifies the circumstances under which abortions remain unlawful and under which abortion providers will be prosecuted for unlawful abortions.
We do not support changing the original intent of the Contraception, Sterilisation, and Abortion Act 1977. The current law acknowledges and upholds a ‘tension’ between the effect of the pregnancy on the woman and the rights of the unborn child. This must not be lost in any review of the current laws.
The changes we would advocate for are those which would (i) further recognise the rights of the unborn child, (ii) promote the well-being of women, including better processes to ensure adequate informed consent and (iii) lead to fewer abortions occurring in New Zealand.
We want to see the law provide a more “robust pathway” governing abortions in New Zealand, one that acknowledges women’s need for full and independent information and support in order that genuine informed consent can take place. To this end, we want to see the provision of independent and publicly funded counselling for all women considering an abortion.
1 Letter from Rt Hon Jacinda Ardern to Hon Andrew Little, released under the Official Information Act – not dated.
2 Radio New Zealand, Sunday 22 April, “Commissioning Changes”. Interview with Hon Sir Douglas White, QC, Law Commission. https://www.radionz.co.nz/audio/player?audio_id=2018640535
3 See Craig McCulloch, “No abortion changes until ‘well into next year’”, 2 November 2017, https://www.radionz.co.nz/news/political/342899/no-abortion-changes-until-well-into-next-year, accessed 17 May 2018.
4 Curia Market Research. Abortion Poll, February 8, 2018, https://www.curia.co.nz/2018/02/abortion-poll-2/
5 “Naomi Wolf on Abortion: ‘Our Bodies, Our Souls’". New Statesman 27 January 2013http://www.newstatesman.com/politics/politics/2013/01/naomi-wolf-abortion-our-bodies-our-souls
6 Altshuler, A. L., Ojanen-Goldsmith, A., Blumenthal, P. D., & Freedman, L. R. (2017). A good abortion experience: A qualitative exploration of women's needs and preferences in clinical care. Social Science & Medicine, 191, 109-116.
7 Curia Market Research. Abortion Poll, February 8, 2018, https://www.curia.co.nz/2018/02/abortion-poll-2/
8 Jones, R. K., Frohwirth, L., & Moore, A. M. (2013). More than poverty: Disruptive events among women having abortions in the USA. The Journal of Family Planning and Reproductive Health Care, 39(1), 36: “More than half (57%) of the women obtaining abortions experienced a potentially disruptive event within the last year, most commonly unemployment (20%), separation from a partner (16%), falling behind on rent/mortgage (14%) and/or moving multiple times (12%).”
9 Hall, M., Chappell, L. C., Parnell, B. L., Seed, P. T., & Bewley, S. (2014). Associations between intimate partner violence and termination of pregnancy: A systematic review and meta-analysis. PLoS Medicine, 11(1): “Among women who underwent TOP, reported rates of IPV in the preceding year ranged from 2.5% to 30%, while lifetime rates of IPV in this population varied from 14% to 40%.” (TOP refers to “termination of pregnancy” and IPV refers to “intimate partner violence”.)
10 Piper, C. and Kleinsman, J. Editorial – Why are abortion advocates afraid of informed choice? The Nathaniel Report, 51, April 2017.
11 Greer, Germaine. The Whole Woman. Black Swan. London. 2011.
12 Kirkman, M., Rosenthal, D., Mallett, S., Rowe, H., & Hardiman, A. (2010). Reasons women give for contemplating or undergoing abortion: A qualitative investigation in Victoria, Australia. Sexual & Reproductive Healthcare, 1(4), p. 152. See also Biggs, M. A., Gould, H., & Foster, D. G. (2013). Understanding why women seek abortions in the US. BMC women's health, 13(1), 29.
13 The full results for this poll can be found at: https://www.familyfirst.org.nz/wp-content/uploads/2018/01/Abortion-Poll-Results-January-2018.pdf
Abortion Law Reform and the State’s Interest in Protecting Unborn Life [SYNOPSIS ONLY]
In the wake of the current debate about abortion laws, Ian Bassett briefly outlines the legal history surrounding the protection of human life in all its forms – from our tradition of English common law through to more recent statements by the New Zealand judiciary. The long-standing protection of life is put at risk by the latest moves to remove abortion from the Crimes Act. The gravity of what is being proposed should initiate a broad and informed public debate.
The full article is available by subscription to The Nathaniel Report
Proposed Abortion Law Reform in New Zealand
The request from the Minister of Justice that the Law Commission review the abortion laws centres on the Government’s stated desire “to make changes to ensure New Zealand’s abortion laws are consistent with treating abortion as a health issue that is a reproductive choice for women, rather than as a criminal issue” (Letter from the Prime Minister, Rt Hon Jacinda Ardern, to Minister of Justice, Hon Andrew Little – not dated).
In response to the question of whether the current legal framework needs to change we offer the following points for consideration.
Abortion is best treated as both a justice issue and as a health issue. The starting presumption should always be in favour of human life, no matter the stage of development of that life. Any decision to end a human life should only be granted as an ‘exception’ to the principle that all members of the human family have an inherent dignity. This principle, spelled out in the United Nations Declaration of Human Rights, is meaningless if it is not enshrined in the law. The Contraception Sterilisation and Abortion Act 1977 holds the rights of the child and the rights of the mother in tension, having due regard for both. This should not change.
In every abortion there are two human lives involved and at least one life is at stake. Our present laws reflect the fact that human life should not be taken without good reason. Making abortion solely a ‘health issue’ places the fundamental right to life, something that should be a presumption for all human life, outside of any law and making the rights of the unborn child totally dependent on the choice of the mother. This which would potentially allow for abortion for any reason, including gender selection. We need legislation which clearly specifies the circumstances under which abortion remains unlawful and under which abortion providers will be prosecuted for unlawful abortions.
Any change in legislation needs to ensure women are free to make informed choices, including the choice to continue their pregnancy. Abortions have been shown to cause psychological and mental harm to some women, affecting their physical and emotional well-being. What is required are better processes that support women and allow them access to unbiased information and adequate safeguards by way of independent counselling. In the face of evidence which shows that many women choose abortions under duress – whether from a partner or family or because of financial or social reasons – the introduction of mandatory independent counselling will allow them greater control and choice while minimising the risks to health and well-being that often follow.
The current law does not make criminals of women – a fact often misrepresented by those proposing change. Any woman in New Zealand who procures an abortion within the current regulatory framework is not committing an illegal act. The law does, however, protect them from unlicensed and unscrupulous abortion providers. “Unlawful” providers can be prosecuted under current legislation but the woman seeking an abortion cannot be prosecuted. Sec 183 of the Crimes Act specifically states that while the person who “procures” the miscarriage is liable for imprisonment, the “woman or girl shall not be charged as a party” to any offence.
Submission to ACART on Proposed Changes to Donation Guidelines and Surrogacy [SYNOPSIS ONLY]
Staff of The Nathaniel Centre
The full article is available by subscription to The Nathaniel Report
Have your say on proposed abortion law reform
The Law Commission has been asked to provide advice on the possible changes to New Zealand's law concerning abortion. The Law Commission will conduct a review and report back to the Minister of Justice.
The Law Commission is inviting feedback from the public about the law change. Input can be provided until 5pm on 18 May 2018.
Information about the current law is available at: http://abortionlaw.lawcom.govt.nz/
The link to online feedback is: http://abortionlaw.lawcom.govt.nz/views/
A submission guide is available at: http://www.chooselife.org.nz/wp-content/uploads/2018/04/Law-Commission-Submission-Guide.pdf
Abortion and Women's Health: https://www.spuc.org.uk/~/media/Files/Abortion-and-Womens-Health_April-2017.ashx
Abortion Supervisory Committee Annual Report 2017: https://www.justice.govt.nz/assets/Documents/Publications/ASC-Annual-Report-2017.pdf
the Buttons Project
P.A.T.H.S. Post Abortion Trauma Healing Service
Pregnancy Counselling Services
The Buttons Project – Towards healing from abortion
Marina and Peter Young
The Buttons Project aims to create an opportunity for those affected by abortion – mothers, fathers, grandparents, siblings and friends – to share their stories. It was launched in 2008 by a couple, Marina and Peter, who had themselves experienced the grief and healing of abortion and wanted to do something to help others heal after their abortions.
Their dream was to encourage those affected by abortion to send in a button in order “to commemorate the babies we never met”. Why buttons? They are easy to find and send; each one can be unique; they are long-lasting; buttons symbolise closure; and buttons join, they ‘bring together’ - ‘we are not alone’.
Marina explains that people who have had an abortion can no longer hold their baby and tell that lost child what they want to say, but they can hold a button. A button allows people to share their stories and to also create a memorial for their babies lost to abortion.
Marina and Pete tell the stories of their own abortion journey in a booklet The Unforgotten Babies. In Marina’s words: “I have walked a long road of grace, forgiveness and healing. But how do others find some closure and healing? Where do they turn for help? Abortion is often a taboo subject, no one wants to talk about it or acknowledge the aftermath of abortion. So, to avoid judgement, too many struggle on their own. It becomes a deep dark secret which affects who they are … My dream was – and remains – to collect thousands and thousands of buttons to create an amazing memorial. It will be a place to visit without judgement, a place to remember, to imagine, to grieve, and to then move on from with some peace and healing … For many, abortion is a life-changing event. Abortion can harm women and yet there are individuals and groups who refuse to acknowledge this, or minimise it, seeming to place the right to obtain an abortion at a higher priority than the long-term health and welfare of women. There is much I could discuss with those people, and much we would probably disagree on, but I do want to say this: ‘Whatever your beliefs are, we need to walk gently in people’s lives as we do not know the journey someone has travelled, or the choices the woman had to choose from, that brought her to having an abortion’.”
Peter tells his own story of experiencing abortion and the different way in which he managed or tried to manage his own reaction to it: “… we thought it was the best thing to do: do it, then leave this unfortunate incident behind us and get back on our road to future happiness. I was completely naïve to what was about to unfold … I realised I needed to acknowledge my failings, admitting my mistakes and seeking Marina’s (and Hope’s) forgiveness, for not being their support and their protector in that situation … The Buttons Project is the beauty from the ashes in our life.”
Over 20,000 buttons have been sent to the Button Project, some arriving anonymously, some carefully wrapped, and many with stories and comments. The Buttons Project website, https://www.buttonsproject.org/ includes picture of some of these buttons with their personal messages. While most messages are from the mothers, many are from aunts or siblings of those lost to abortion as well as from friends of the mother, persons whose grief is either not recognised or forgotten.
Marina and Peter have named their baby ‘Hope’: “The button and her name represent hope for the future, peace now, and freedom from the past. It is for closure, and to commemorate something that was part of us.”
Editorial - Allowing Grace to Catch Up
At the 2015 Synod on the Family held in Rome, there was considerable reflection on the moral principle of gradualism, a principle whose roots lie in the thinking and writing of Blessed Paul VI and which has been further developed by Saint John Paul II in Familiaris Consortio (nn. 9 & 34) and Pope Francis in Amoris Laetitia (nn. 295 & 300).
Simply put, people grow in different ways and at different times on their faith journey – and that is just as true for each community as it is for each person. The personal and pastoral challenge for each of us is living with that reality; living with ourselves and living with it in our relationships, our families, our faith communities and society.
The key moral question is how to retain compassion and charity towards those who think and act differently to us? Do we run away? Do we seek out a like-minded group? While flight is necessary for our soul’s growth at times, it does not always lead to growth, compassion, better understanding or wisdom simply because we may be avoiding a deeper issue.
The Gospel passage about the two sons, Matthew 21:23-32, provides a picture of gradual growth:
‘What do you think? A man had two sons; he went to the first and said, ‘Son, go and work in the vineyard today.’ He answered, ‘I will not’; but later he changed his mind and went. The father went to the second and said the same; and he answered, ‘I will go, sir’; but he did not go. Which of the two did the will of his father?’ They answered, ‘The first.’
In his commentary on this Gospel passage, Father Michael Hayes, tells the story of a Catholic High School teacher who was running into difficulty presenting the Catholic position on abortion to her class. The students seemed to be rejecting the viewpoint that she was presenting, so she asked the school’s guidance counsellor for help. He began his presentation to the students by saying how difficult the practical decisions surrounding abortion can be. The counsellor also spoke of the need for compassion and charity when people make decisions we cannot accept.
At that point the students seemed to change their response. They had no difficulty in acknowledging the objective wrong of abortion. But, unbeknown to their teacher, the issue that had tied them in knots was a classmate who had recently had an abortion – they did not want to turn their back on their friend.
So what seemed to be a ‘No’ for an issue of faith and morality actually contained a ‘Yes’ hidden within – a ‘Yes’ to compassion and charity.
Reading that story reminded me of a couple who called the Presbytery one Saturday morning. The woman, from Europe, was in the early stages of pregnancy. I agreed to meet her and her partner in the chapel. They wanted to talk with me about having an abortion. Their relationship had ended and she was returning to Europe the following week and had already booked into Auckland Hospital for an abortion on the Monday morning. I listened to them both and we prayed. I then asked if I might give them both the Sacrament of Anointing. They agreed to that. The woman told me that this sacrament would not change her mind. It would be her decision, and hers alone. I simply replied, as I have in similar cases, “I pray, that whatever you decide, and fully respecting your conscience, that this child will be a blessing to you both…”
They both cried during the anointing and asked me to leave them in the chapel. That Saturday, a grey wet day, I later saw them out walking and I again prayed for them and their baby.
The woman called me later that week to thank me. She had flown to Auckland to have the abortion. While on the gurney, waiting to go into the theatre, she hopped off the trolley, went back to her room, got dressed, and discharged herself. She had decided to keep the baby. Her former partner had promised to help her raise it, even while they both acknowledged their relationship was finished. She was returning to Europe. She then said, “I never want to see you again but I do want you to know how grateful I am for your time and for the Sacrament of Anointing.” She added that she still felt “very raw” and faced an “uncertain future” but knew she had “made the right decision" and was at peace.
So, what looked like a ‘No’ was actually a ‘Yes’ masking as a ‘No.’
In the Gospel parable, the first son changes his mind. In other words, he allows God’s unfailing grace to catch up with him.
I think it was the same for that woman and her former partner. Likewise with the High School class and likewise for ourselves. In reaching out to those on the peripheries, and in our own moral development, the gradual responding to grace takes time and requires great wisdom.
Rev Michael McCabe (PhD) is founding director of The Nathaniel Centre and Parish Priest of Our Lady of Kapiti Parish
Abortion Trauma, Grief and Healing
It is argued by some that the politics surrounding abortion have contributed to the lack of consensus in in the literature regarding post-abortion experiences, in particular whether some women’s subsequent mental health struggles were connected to other factors in their lives rather than their experience of having an abortion (see Dawn de Witt, Issue 51 of The Nathaniel Report).
One of the risks of denying post-abortion trauma is that it can add to the shame and stigma women might already experience and it can leave them with unacknowledged grief, a grief they may be told or may feel, is unreal. “At present health professionals are not being trained to diagnose, treat or prevent abortion trauma, and are generally reluctant to investigate when problems arise subsequent to an abortion, offering at best, symptomatic treatment (or worse, further traumatizing and isolating the sufferer). Therapists who are concerned about abortion trauma, not unreasonably fear being professionally attacked or isolated (particularly from those with a ‘personal investment’ in the safety of abortion) if they speak publicly or professionally of their concerns. Consequently, most women and men traumatised by abortion, have no access to the professional help they need”.1 Moreover, as pointed out in the same article “abortion referral agencies and institutions, because of their role in facilitating denial and dehumanising the unborn, have a conflict of interest, and are inappropriate venues for abortion grief therapy”.
Many women are at risk of experiencing long-term emotional, spiritual, psychological, and relationship difficulties post-abortion but the lack of recognition of these experiences means they are unable to access the support they need.
Some agencies that specialise in providing support are listed below.
- “Post Abortion Syndrome. The Silent Suffering” available at: https://www.abortiongrief.asn.au/abortion-trauma.php
Project Rachel is a confidential ministry for anyone who desires healing after being impacted by abortion. This includes the mothers and fathers of children lost to abortion, grandparents and other relatives, health care providers, and many others. Abortion crosses all boundaries of religion, race, age and socio-economic position.
Project Rachel's mission is to provide a confidential and compassionate ministry that offers resources for spiritual, emotional, and psychological healing to anyone who has been impacted by abortion regardless of faith background. We strive to convey God's forgiveness and mercy in order to restore and empower lives.
0800 111 811 (free call)
or text/call: 027 299 9815
Practical support and advice to prepare for parenthood te tautoko me te tohutohu awhina mō te mātuatanga.
PO Box 12000
P.A.T.H.S. Post Abortion Trauma Healing Service
0800 728 470
Pregnancy Counselling Services
0800 773 462
Text: 021 289 8727
Abortion and God’s Mercy and Grace
By Amanda Bradley
I have been an Anglican Priest for many years, also a contributor to Project Rachel in the form of counseling those who wish to come for reconciliation following a termination of pregnancy.
Over the years, I have spoken with, and listened to, many young women, and some men, for whom the experience of an abortion is new and raw. However, I have also met those for whom the experience is years old but has never gone away. One such meeting was with a woman of 93, in a Rest Home, who was very much afraid to die. I had been called by staff of the Home to speak to her because of her fear of dying.
She felt that God could never forgive her for a ‘sin’ she said she had committed more than 75 years previously. As an 18 year old student she had met a 20 year old man and they had fallen in love. She had become pregnant.
She did not know she was pregnant until after she experienced bouts of nausea and had fainted several times at her home where she lived with her father and stepmother. The doctor was called and the pregnancy was subsequently discovered.
The decision was then made that the doctor would carry out a termination at home and nobody would be any the wiser. This was carried out, she was forbidden to see the young man again and she was told, by the stepmother, that she would be going to hell for killing a child.
Some 4 years later this woman met her young man again, married him and they had many happy years together, as well as 5 lovely, successful children who, at the time I met her, were all middle aged.
Neither her husband nor her children knew about her abortion. Neither did this woman share her burden with anyone else. She lived all those years with the fear of a vengeful God waiting for her when she died. We talked at some length about the nature of God and of God’s forgiveness, mercy and grace. Eventually she agreed to tell her daughter in law, a school counselor, about her experience of so long ago. This she did, along with others in the family. Her family were all very supportive and sad that their mother had had to carry this burden alone for so long.
She died soon after, peacefully and unafraid.
Before she died she gave me permission to tell her story to anyone whom it might help.
I buried her, moved out of the family’s lives and changed parishes but I have often recalled this woman and given thanks that I can freely share her story to assist others.
During my next period of ministry, I attended a large church gathering of clergy and lay people where the subject of abortion, among other things, was raised. Some very judgmental opinions were voiced by a number of attendees and various punitive measures proposed by some. Eventually, I felt called to go to the microphone to tell the audience of my experience of Project Rachel. I reminded them of forgiveness, reconciliation, redemption and the mercy of God.
At lunch three women approached me. Two were tearful, admitting that they had each had an abortion when very young. The other shared sending her 16 year old daughter to Australia via SOS (Sisters Overseas) to terminate her pregnancy.
The four of us missed the next session as we talked together. All three expressed their gratitude that, after living for many years in silence, they had at last found an opportunity to tell someone about their regrets. I reminded them, as I gave them the prayerful absolution they craved, that God was waiting in the wings for them to turn to him in prayer and always had been. We then shared a time of prayer and while I felt gratitude that I had helped these women move on, yet I was saddened to see that all three had removed their name tags, not fully trusting me with who they were.
These were women who were very active in the church, in responsible positions, purporting to bring the love of God to others, yet they still could not fully trust God with their regrets or a priest working for Project Rachel with their identities. Work in the church-yes; prayers for others-yes; abortion details- yes; reveal their names- no.
It makes me think: ‘Just how many more women and men are out there living needlessly with such burdens?’
Rev Amanda Bradley is an Anglican priest who has worked as a nurse, taught at university, was a foster mother to seven children, and has worked with and counselled men and women post-abortion. Amanda and has been associated with Project Rachel for a number of years.
Editorial - Why are abortion advocates afraid of informed choice?
The polarising issue of abortion has come to the fore again, triggered by the Abortion Supervisory Committee’s annual report to Parliament. Despite the ASC chairwoman saying that the committee had no opinion on major reform of the abortion laws – that it was solely a matter for parliament – many commentators who want further liberalisation have taken the opportunity to lambaste the current law, labelling it a legal obstacle course, archaic, hypocritical, a charade, cumbersome, and intrusive.
The simple solution, they say, is abortion on demand – no need to ask any questions. As articulated by David Seymour MP: “The right thing to do is reform abortion law to reflect what actually happens: women exercise choice for their own reasons.” He and others argue that the current law disempowers women. As one blogger wrote: “At the heart of it all is a distrust of women, innit? … a failure to understand that women are full moral adults.”
The debate that has ensued highlights an important point: the current abortion law is being consistently undermined by the way in which it is being implemented. This is what undoubtedly leads supporters as well as some opponents of abortion to label the present regime as hypocritical.
While the debate raises many interesting questions, the one critical question not often asked is whether removing the procedures that are part of the current law will in fact lead to better choices and better outcomes for women contemplating an abortion.
Our choices are limited by the constraints of our knowledge and context. These constraints generally take two forms: (i) a lack of proper information and (ii) the presence of coercion. Informed and free consent based on full, balanced and factual information, while allowing time to adequately consider that information, is the ‘sine qua non’ for making quality choices.
Research into the potentially negative health effects of abortion is characterised by claims and counter-claims. For example, research reported by the Health Research Council of New Zealand (by Professor David Fergusson of the University of Otago’s Christchurch Health and Development Study, 2008) suggests “women who undergo an abortion face a 30 per cent increase in the risk of developing common mental health problems such as depression and anxiety.” Conversely, other overseas studies have concluded that the rates of mental health problems for women with an unwanted pregnancy were the same whether they had an abortion or gave birth. Academically speaking, the question of potential harm to women remains a contested one.
The strongest evidence that there are real negative health effects following an abortion arises out of the day-to-day work done by clinical psychologists and counsellors. Their consistent experience is that they encounter many women whose mental well-being has been adversely affected on a number of levels by their experience of abortion.
Further reflection on “what actually happens” to women who have had abortions highlights the reality of coercion. Many women, after the event, report feeling that they had no other option at the time but to proceed, often because of pressure from parents, partner and/or peers. At times this pressure is also experienced as coming from staff at the Termination of Pregnancy Units. For other women, the pressure they feel is generated by employment or social factors. In the words of another commentator, in such situations, the decision for an abortion is best described as a tragic response to lack of choice.
Section 14 of the Contraception, Sterilisation and Abortion Act, which details the functions of the Abortion Supervisory Committee, states that they are “to take all reasonable and practicable steps to ensure that sufficient and adequate facilities are available throughout New Zealand for counselling women who may seek advice in relation to abortion.” When women repeatedly recount they were offered five to ten minutes with a social worker before the abortion ‘if you want it’, and when there is reliable evidence that abortions are signed off by some consultants over the phone with no face-to-face interview, it is hard to argue that this provision is being properly implemented.
In which case, it becomes impossible to argue that the current New Zealand practices surrounding abortions consistently promote informed and free choice.
There is surely no greater expression of “distrust of women” than society paternalistically deciding, whether through law reform or the inadequate implementation of its current laws, to censor the information provided to women contemplating an abortion. Equally, it is surely also a failure of care to neglect to put in place mechanisms that can help women contemplating an abortion to recognise and deal positively with any feelings of ambivalence as well as the actualities of coercion.
It is in the interest of free and informed consent and empowerment that all women are offered independent counselling that addresses the coercive realities surrounding many abortions and which makes them aware of all the risks as well as all the options they have. Honest reflection on what is actually happening only reinforces the fact that abortion on demand will not achieve this.
If as a society we truly want to respect choice, then why would we be afraid of promoting free and informed consent?
Cynthia Piper has over 20 years’ experience as a trained volunteer lay counsellor working with pregnant women and teens and their families, and with Project Rachel, a post-abortion healing and support service.
Dr John Kleinsman is director of The Nathaniel Centre.
Please do not make a hole in the dike
ORAL PRESENTATION to Health Select Committee Inquiry into Ending One’s Life in New Zealand
18 November 2016
Today it is forty-nine years ago since I arrived in New Zealand from the Netherlands. I was welcomed by a very friendly society. Migrants have a unique opportunity to compare the society they hail from with the one that has welcomed them. Often, this gives us a unique perspective on things.
Sadly, as I tried to keep up with events in my old country, I became aware of a trend towards euthanasia which culminated in 2001 in a bill to legalise it, after the courts had allowed doctors to practise it under conditions that were steadily made less strict. I note also that until the legalisation of euthanasia in 2002, Belgium had proportionately more people aged 100 years than the Netherlands had. This is likely to change as Belgium has adopted the same legislation and has become even more aggressive in applying euthanasia and assisted suicide.
In my younger years, in the early 1960s an older colleague had a child who was completely handicapped intellectually. No one in the family ever received one glimpse of recognition from her. Yet, they cared for her 24/7 with a love they had never believed they were capable of. When they were mourning her death after 13 years, they realised that that was precisely the precious gift they had received from that child.
Currently, parents in such a case would be under enormous pressure to get the child killed at birth as one believes this to be more efficient and useful, although one would use the word ‘compassion’. I maintain that the sick, the fragile and the vulnerable enable us to love, by caring for them, whether as doctors, nurses, friends or family.
The current law acts as a boundary which doctors and nurses know they should not cross. It enables them to provide loving appropriate care. It also allows them to stop applying highly technical medical procedures when they can only protract the dying process and when palliative care is called for instead. The boundary is like a dike which keeps the sea at bay and enables life to go on inside the polders.
The boundary, the dike, is necessary to ensure that medical efficiency remains focussed on preserving and caring for life, without a cold calculation of utility and disutility. Without the boundary, one goes down the road of killing efficiently as it might appear to provide the greatest utility to the vulnerable and to society. This would not be the friendly New Zealand I have come to know and love in my 49 years here.
No matter what sort of bill would be written to enable assisted suicide and/or euthanasia, it will make a hole in the dike. Inevitably, such a hole will get larger and larger till the dike ceases to exist.
Please do not make a hole in the dike.
By Dr Petrus Simons
Dr Petrus Simons is a retired economist with a PhD in philosophy.
Reflections on Post Abortion Care
Dawn de Witt
Around 2000 I joined a small group of women to explore the merits of the Victims of Choice post abortion recovery programme from the United States. At the time, it struck me that I had very little knowledge of abortion issues despite my professional studies. In New Zealand, a termination of pregnancy is available through the public health system and is promoted as a safe medical option for those who do not wish to continue a pregnancy to term. The experience of the group was that there existed a real need for healing and reconciliation after abortion - and we wanted to make that possible.
The literature confounds
My interest in the issue prompted me to do a literature survey. This opened a Pandora's box for me. There were conflicting findings, heated debate, fierce criticism of unsound methodologies, vehement argument and counter argument. I was disappointed. The scholarly articles and debates seemed to be immersed in the politics and polarities surrounding abortion that were prevalent in American society, unable to transcend them. The title of the 1998 monograph of the American Psychological Association, The New Civil War: The Psychology, Culture, and Politics of Abortion1 appears to confirm that.
There was no consensus on the impact of abortion. In some reports, it was construed as just another stressful event. For others, it was a significant trauma associated with mental health issues and symptoms similar to Post Traumatic Stress Disorder (PTSD). The notion of Post Abortion Syndrome (PAS) was raised and rejected.
The American Psychological Association (APA) consistently asserted that the incidence of negative responses after abortion was low (19902, 19923). In 2006, a task force was assigned to evaluate the evidence.
The American Psychological Association Report on Abortion and Mental Health
In 2009, in their Report on Abortion and Mental Health4, the APA concluded that:
1. Most adult women who terminate a pregnancy do not experience mental health problems. Some women do, however.
2. The evidence regarding the relative mental health risks associated with multiple abortions is more uncertain.
3. Some women experience sadness, grief and feelings of loss following an abortion, and some may experience "clinically significant disorders, including depression and anxiety." 5
4. No evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors." 6
The results related to the experience of a single abortion as opposed to multiple abortions. The Report noted factors that may be predictive of more negative psychological responses following first-trimester abortion among women in the United States:
• perceptions of stigma
• need for secrecy
• low or anticipated low social support for the abortion decision
• a prior history of mental health problems
• personality factors such as low self-esteem and the use of avoidance and denial coping strategies
• characteristics of the particular pregnancy, and the extent to which the woman wanted and felt committed to it.
Here was clear acknowledgement that some women were experiencing grief and mental health issues after an abortion. Yet, despite the report warning about the dangers of making globalising statements, the message disseminated was: Abortion Has No Impact On Women's Mental Health. This message persists today.
To better understand the impact of abortion, I undertook to listen to those who were seeking help after abortion.
Impressions from the field
The deepest of sorrows
The most poignant learning has been the depth of grief and sorrow I encountered. This is no ordinary grief. It is complex and complicated. There are multiple losses; complex personal and social narratives; intense emotions; and some level of responsibility in the death. The grief is disenfranchised. It is socially unrecognised, unacknowledged and unsanctioned. There are no socially accepted rituals for mourning. At its heart is a death of a baby.
In those seeking help, this sorrow seems universal. It has presented in men and women; in relationships that are secure or in more tenuous, uncommitted or even undesirable relationships; whether there had been full responsibility or coercion; where there is faith and where there is no faith; where there have been pre-existing mental health issues and where there has not; in cases of secure attachment histories and in those with histories of insecure attachments; whether the pregnancy was unwanted or wanted; and whether there was a sense of connection with the foetus or not.
Anger is a part of grieving. Coupled with bitterness and resentments, it can become intense. It may be directed towards God, oneself or others. At times, we see that anger directed at 'the State', the 'system', or society at large; this anger is about unrealistic societal expectations, mixed messages from society, insensitive processes and a lack of information about the risks.
Four areas of wounding have emerged from my own listening and reading: the wound to the child; the wound to self (primarily for being implicated in the termination, intentionally or by default); wounded relationships (with others involved in the abortion) and wounded spirituality. Healing entails reconciliation(s) in each of these areas.
The feminine face of coercion
The incidence of coercion is high, consistent with that reported by the Elliot Institute.7 The classic picture of threats, intimidation, ultimatums, stand-over tactics and/or violence is seldom reported. More prevalent is the subtle psychological pressure applied by others, usually female, to compel a woman to terminate a pregnancy against her will.
Younger women, not yet fully individuated, still dependent on their parents and lacking the confidence to challenge parental authority, tend to fall victim to the female face of coercion - a mother, sister, or grandmother may persuade, cajole or harass, the subtle use of a position of trust, power and influence in a close relationship. Youth, obedience to parents and respect for authority add to the pressure to comply.
The message 'I know what's best for you' masquerades as care and may go unnoticed by the professionals involved. Reports include not being listened to by medical personnel; not being given an opportunity to be seen alone; and being sidelined while the dominating figure conducts the conversation. Passivity is easily misconstrued as consent and the process quickly moves to completion. Powerlessness, isolation and a sense of abandonment ensue. Violated boundaries, betrayals of trust and the losses of abortion give rise to anger and rage which, if internalised, may trigger depression.
Family stories underpin decisions to terminate a pregnancy.
Fathers shape their daughters' perceptions and expectations of men. A daughter observes her father's care for her, for her mother and how he relates to his wife/partner in pregnancy. The absence of a father may prompt a daughter to exchange sex for love. In my experience father narratives have been less prominent than mother-daughter narratives.
A woman's relationship with her mother is seen as central and ambivalence in the mother-daughter relationship is significant. Themes and patterns of behaviour are noted over three generations of women as they respond to trauma, life events, societal and familial attitudes to women and sociocultural trends.
Narratives passed down inform womanhood and produce powerful, often subconscious, beliefs about motherhood, for example, 'Once you're a mother, your life is not your own'. Injunctions like 'be successful' and 'do something with your life' subtly undermine the value of motherhood. Mothers who have been disappointed or who have struggled with motherhood subtly communicate this to their daughters.
Presence of historical sexual abuse was not surprising and is well documented in the literature.8 What is surprising is the high incidence I've noticed in peer support groups with whom I have been involved – over 80% on one occasion.
Lack of information
It is surprising that reports of insufficient information are regularly heard. With some dismay, women say: 'Nobody told me'; 'I didn't know'; or 'I never expected this'.
The Code of Ethics for Psychologists 9 states that obtaining informed consent from those with whom they are working is "a fundamental expression of respect for the dignity of persons and peoples."
A psychologist needs to:
1. provide "as much information as a reasonable or prudent person, family, whānau, or community would want to know before making a decision or consenting to an activity" (para. 1.7.6)
2. take reasonable steps to ensure that the information is understood (1.7.7)
3. take all reasonable steps to ensure that consent is not given under conditions of coercion or undue pressure from them (1.7.4)
4. "have an increased responsibility to protect and promote the rights of those who were vulnerable because they have lesser power" (1.7.1)
5. give sufficient time for the recipients to respond to the information (1.7.7).
The omission of informed consent in the protocols around abortion may, in part, reflect the fact that the Contraception, Sterilisation, and Abortion Act 1977 was promulgated before there was any developed notion of informed consent.
The fact that other health care professionals operate under equivalent codes of ethics regarding information and consent is not borne out in the stories I have consistently heard from women.
Experience confirms that abortion is a significant life event that can cause considerable loss and grief. The circumstances of the decision and the factors that influence the decision are diverse and complex. Simplistic restatements of research findings, without elaboration, do women a disservice.
Full and accurate information about risks and effective screening for coercion by way of independent and neutral counselling, and enough time to consider her response to an unwanted pregnancy, is every woman's basic right. As psychologists and healthcare professionals, it is our responsibility to ensure that.
I am deeply grateful to those men and women who have shared their stories with me and I thank them for enabling me to grow in this field.
Dawn de Witt is a Counselling Psychologist with a background in general practice, relationship counselling and family therapy. She presently co-ordinates Project Rachel in the Catholic Diocese of Hamilton, New Zealand and is on the retreat team of Rachel's Vineyard Retreats.
1. http://www.apa.org/search.aspx?query=the new civil war retrieved on 2 February 2017
2. Adler, et al. 'Psychological responses after abortion'. Science 06 Apr 1990: Vol. 248, Issue 4951, pp. 41-44. http://science.sciencemag.org/content/248/4951/41 accessed on 21 March 2017
3. Adler, et al. 'Psychological factors in abortion: A review'. American Psychologist, Vol 47(10), Oct 1992, 1194-1204. http://dx.doi.org/10.1037/0003-066X.47.10.1194 accessed on 2 February 2017
4. http://www.apa.org/pi/wpo/mental-health-abortion-report.pdf accessed on 2 February 2017
5. APA Press Release. http://www.apa.org/news/press/releases/2008/08/single-abortion.aspx accessed on 20 March 2017
7. http://www.theunchoice.com/articles/howcommoniscoercion.htm accessed on 20 March 2017
8. Boden, Joseph M; Fergusson, David M; & Horwood, L. John. 'Experience of sexual abuse in childhood and abortion in adolescence and early adulthood'. Child Abuse & Neglect, Volume 33, Issue 12, December 2009, pp. 870–876
9. Code of Ethics for Psychologists. Para 1.7 http://psychologistsboard.org.nz/cms_show_download.php?id=235 accessed on 6 March 2017.
Bioethics in the News A brief introduction to two recent developments in bio-technology – gene or genome editing and Non-invasive Prenatal Testing.
Gene or Genome Editing
While gene editing technologies have been around for several years, a new technique has recently been developed that is cheaper and more efficient than earlier technologies. Known as CRISPR-Cas9, this technique enables faulty sections of DNA to be located, then ‘cut’ out and either replaced with a healthy copy or inactivated. Gene editing could in future be used to treat single gene inherited conditions, such as cystic fibrosis and sickle cell anaemia, and in the treatment of diseases such as HIV and cancer. It also has the potential to be used with crops, for example to develop disease resistance or to increase crop yields that use less water, and in livestock to improve certain advantageous traits.
Recently it was reported that scientists in China had edited the genomes of human embryos, and earlier this year researchers in the United Kingdom were given permission to modify human embryos in order to better understand the causes of miscarriages. However, there is some disquiet about the use of these techniques for humans. Apart from concerns regarding the unknown effects of germline modification on later generations, there is concern that gene editing will be used to ‘enhance’ humans. Scientists and bioethicists are debating whether or not there should be some moratorium on human gene modification until safety issues are resolved, and there has been a thorough examination of the broader social and ethical issues concerning human ‘enhancement’, such as ableism and disability, as well as economic and health inequalities.
In 2000 the New Zealand Catholic Bishops noted in their submission to the Royal Commission on Genetic Modification that human dignity must be ordered to the integral good of the human person as well as respecting the integrity of other species and of all creation. They specifically noted that they did “not see the technology of genetic modification to be in conflict with ethical values“ so long as “safety issues are resolved within acceptable limits of risk.” These limits include proper respect for the innate dignity of human life which excludes all forms of destructive research involving human embryos.
Non-invasive Prenatal Testing
While prenatal screening is currently available in New Zealand, the development overseas of a maternal blood test known as NIPT (non-invasive prenatal testing) that can more accurately detect some foetal chromosomal abnormalities has raised the issue of whether it should be publicly funded in New Zealand (it is currently available privately for payment). NIPT is able to analyse the small amount of cell-free DNA in maternal blood that comes from the placenta, and which mostly (98% of cases) matches the DNA of the foetus. This has meant that a blood sample taken from the mother can be analysed for the presence of certain chromosomal abnormalities, which include trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome) and trisomy 13 (Patau syndrome).
The test is a screening test, not a diagnostic test, as it indicates only the probability of a trisomy pregnancy and a follow-up invasive test is still required to confirm results. It also has certain limitations: It was originally validated on a population of high-risk women so the sensitivity of the test on the low-risk population is unknown. For this reason it is usually offered only to women who are in the ‘high risk’ group. It is also known to be less accurate when maternal weight is high and its accuracy in multiple gestation pregnancies is unknown. The ease of use and safety of non-invasive testing is likely to lead to increased requests for testing and potentially the provision of free national screening. Because there is no ‘cure’ for these conditions, the reasons for informing mothers are to either enable them to begin to adjust to and make plans for living with a child with a disability, or for eugenic purposes, that is to enable them to seek a termination of the pregnancy.
The very availability and use of such screening carries an implicit message that raising a child with a disability is a burden both on the family and society, one that can be avoided. In France, the United Kingdom, Spain and Italy, between 90 and 95 percent of foetuses affected by Down syndrome, detected using current prenatal diagnostic techniques, are aborted. One of the consequences of the increasing use of pre-natal testing is that it introduces ‘eugenics’ by stealth, that is, without a proper debate taking place about the desirability or ethics of preventing the birth of babies with certain detectable conditions.
Submission to ACART on Informed Consent and Assisted Reproductive Technology
Our approach to the moral/ethical issues associated with the use of assisted human reproductive technologies is based on a number of beliefs. Of those that are particularly relevant to this Consultation Document unconditional respect for human life at all stages of its development is the most important. Catholic teaching holds that without exception the living embryo has, from the moment of fertilisation, an absolute right to life. A unique human life is begun - it is already the human being it will always be and will only grow in size and complexity. On that basis all embryos are entitled to be treated with the same respect as persons.
Secondly, whatever people believe about the acceptability of IVF, a clear moral distinction exists between homologous IVF (where the gametes are sourced from both partners within the relationship) and heterologous IVF (where one or both gametes are sourced outside of the commissioning couple). This distinction rests on the fact that homologous IVF conserves the natural links between parenthood, family and genetic origins. Our sense of personal well-being is linked with a healthy self-identity, something that is intimately tied in with a lived knowledge of our biological ties. On this basis we believe that children have the right to grow up within the family networks that are generated by our biological ties. This right should only ever be compromised in situations where it is clearly in the interests of the child involved.
In previous ACART Discussion documents we have recognised and complimented ACART on the fact that there were real attempts to consider the ethical issues from a perspective that actively considers the rights and well-being of the child that is to be conceived. However, we are disappointed to note that, apart from Appendix 2, the term “potential offspring” arises only once in this document. While this might be understandable given the document’s specific focus on “informed consent”, in our view it highlights the serious short-comings of an “informed consent” approach for dealing with the ethical issues associated with the use of human assisted reproductive technologies. As we have previously stated: “An over emphasis on the sufficiency of individual informed consent … reflects a failure to acknowledge the wider impact of technological interventions.”
- Access to information that must be disclosed to patients and donors prior to consent: We note that the Code of Health and Disability Consumers’ Rights upholds the right to be fully informed. We further believe that information provided to couples using heterologous IVF should summarise research on the importance of biological connections for the well-being of potential offspring.
- Form of consent: We agree with the arguments set out in the document supporting the need for consent to be in writing.
- Donor consent to use gametes or embryos for training purposes: We support the need to obtain consent from donors for the use of gametes or embryos for training purposes, as is consistent with Right 6 of the Code of Health and Disability Consumers’ Rights.
- Placing conditions on donor consent: We support donors’ rights to place conditions on their consent. We consider that gamete and embryo donations are different from blood or organ donations because they create on-going relationships. However, we agree that gamete or embryo donors should not have the right to limit the decisions of prospective parents after an embryo has been created, or after a donated embryo has been transferred to a uterus.
- Ongoing information for donors on the use of their gametes: We agree that gamete donors should be given the option of receiving ongoing information if the gamete is about to be used and on the outcome of the donation. Our status as relational beings demands respect for the genetic, gestational and social dimensions of human procreation. Providing on-going information to donors is consistent with the relational responsibilities that flow from human procreation and, in the situation where an embryo has been created from donated gametes, provides the best chance of maximising the possibilities of an on-going relationship between the potential offspring and their biological parent. While the law in New Zealand does not permit anonymous donation, it strikes us that information relating to a child’s biological origins still depends to a significant extent on the attitudes and willingness of the adults involved in the process.
- Withdrawal or variation of consent by donors: We agree that donors should be able to withdraw or vary consent to the use of their gametes up to the point of fertilisation.
- Consent of a partner, family or whānau to donation or use of donor gametes: We do not agree that the consent of partners should not be required. A spousal type relationship is based on a high level of trust and intimacy. In addition, it is of the essence of such relationships that they have a parental dimension. Direct involvement in parenting a child outside of such a relationship without disclosing it to one’s spouse/partner is arguably a violation of the trust, as well as the sense of exclusivity, that lies at the core of any permanent couple relationship – it has the potential to destabilise such a relationship, including commitments to any children that a donor might already have with her or his partner or might have in the future. We consider that although consent of family or whānau to the donation or use of a donor’s gametes should not be required, it is best, in the interests of transparency and relational integrity, that individuals be encouraged to consult their family or whānau (as happens generally with whāngai arrangements, for example). However, we do not think this should be mandatory.
- Couple disputes about the future use of embryos: We agree there should be a ‘cooling off’ period of twelve months where one party in a couple disputes the future use of embryos that have been created for them. We reiterate our belief that embryos have their own ‘intrinsic’ dignity which exists independently of the wishes and desires of any related adults and that giving time to resolve any dispute is consistent with this dignity. It is our hope that adults would have access to counselling in this situation and that counselling would include presenting a case in favour of life from the perspective of the embryo. We do not agree that if the couple cannot resolve the dispute in that time, the embryos should be disposed of. Allowing embryos to die if the dispute cannot not be resolved effectively gives power of veto to the non-consenting party, while ethically the rights of both parties should carry equal weight. We suggest that in these cases the existing 10 year storage limitation period set out in the HART Act should apply. Framing conflicts about the future of embryos in terms of whose interests should prevail – whether the male partner or the female partner – inevitably takes couples into a legal and therefore adversarial forum. We need to avoid an adversarial approach to conflicts over embryos because they are effectively based on (patriarchal) assumptions of ‘ownership’. A non-patriarchal and more child-centred approach is premised on the idea that parents have responsibilities towards their offspring, including embryos, rather than rights over them. A responsibility-based approach is more likely to bring about a satisfactory resolution without, even unwittingly, reinforcing the ‘ownership’ paradigm wherein the rights and dignity of embryos are too easily lost to view. We further suggest that all couples need to be counselled about the possibility of such a conflict occurring before they consent to any procedures that will result in the creation of embryos.
- Form of requirements for informed consent: We agree that the requirements for informed consent should be set out in regulations.
- Final comments: We are concerned about the language used, specifically the reference to embryos being “disposed of”. In general parlance we dispose of ‘things’ – usually things that have no value to us and that are seen as ‘rubbish’. The presence of this language in the Consultation Document highlights for us one of the dangers inherent in the use of assisted reproductive technologies; replacing what is a very human and personal act (the conjugal act) with one that is of a more technical nature (IVF), no matter the motivation behind such a decision, means that the risk of commodification lies but a small step away. While not a step that is logically necessary, it can be a step we take without realising it. This step is often revealed by the language we find ourselves slipping into, including terms such as ‘dispose’. The presence of this language in the Consultation Document is further evidence of a lack of awareness in practice of the rights of any “potential offspring”, as was highlighted in our introductory remarks.
Staff of The Nathaniel Centre
Abortion, feminism and disability
As a human rights practitioner, and a former human rights commissioner I clearly understand the status of the unborn child in human rights law. My standpoint is that of human rights, and in particular disability rights, as codified in the CRPD (the United Nations Convention on the Rights of Persons with Disabilities). New Zealand played a major role in developing this human rights standard and ratified it in 2008.
There are disability issues around abortion that make it a very difficult and nuanced issue for disabled feminists. For many feminists this is a really clear cut issue. For us, not so much.
Abortion is not a simple issue of choice for disabled women, especially given that for many of us our choices are more constrained than those of non-disabled women. Many disabled women do not have control over their own bodies, never mind their reproduction and sexuality. For example, over generations thousands of disabled and other “undesirable” women all over the world have been sterilised without their consent and disabled women are still sometimes sterilised without their consent.
As a disabled, feminist, prospective mother I had to contemplate whether or not any children I might bear would share my impairment. I didn’t know. It was a leap in the dark. But I had decided that my life was very much worth living and so would theirs be. That is a critical part of the issue: Whose lives are worth living?
There are a number of threads to this issue for us, but they are rarely explored in an environment where we feel safe enough to honestly discuss our concerns about some of the implications. The ‘caring’, disability support, and health professions are well populated with women, yet it is paradoxical that disabled women’s voices struggle to be heard and attended to on this and other issues that are important to us.
Eleanor Lisney, Sisters of Frida (a disabled women’s cooperative), described this struggle: “In the discourse of feminism, disabled people are seldom included … Disabled people are often seen as a ‘burden’ on the feminist from before birth to the older parent often portrayed as with dementia. The decision of aborting a disabled child is seen to be totally understandable, disabled people need caring for – usually by low paid or unpaid carers where women sacrifice themselves as carers.”
Disability is often seen as a ‘fate worse than death’. It arouses a fear of what is unknown and not understood and carries social stigma as well as social and medical pressures.
Questioning whose lives are worth living led to the ‘hidden holocaust’of World War II where over 200,000 disabled people were exterminated; this holocaust began with a German father asking the Nazi regime to kill his infant son. This was the logical culmination of the eugenics movement. But eugenics did not disappear with the end of that regime; it is still alive and well and living in New Zealand in the form of pre-natal testing which leads to some babies not being born because of their ‘abnormalities’. Would we tolerate birth selection on the grounds of race or gender? I hope not.
The crunch point for me is contained in the phrase ‘bearing a child she doesn't want’. How is that ‘doesn't want’ constructed? Is it because she is afraid and faces negative social and medical pressure? Is it because support services are woefully inadequate in some cases, and parents of disabled children can be isolated and unsupported?
And is this because of society’s fear of disability, and the eugenicist move to eliminate certain impairment groups? Is the mother afraid of social and economic sanctions if she goes ahead with the pregnancy?
However, many impairments are not detectable before birth and even when a child is born “perfect,” they may not stay that way. What then? Medical and other science may not always be able to cure, and not everybody wants to be fixed, and while there are ways of ameliorating conditions that were unheard of even a generation ago, an accident or illness can result in lifelong impairment. Imperfection and impairment are part of who we are as humans.
Abortion should not be used as a tool for eugenics. Disability cannot be eliminated this way. Disability is part of the human condition. Just think about the message this gives to people already living with the impairment – it says you are of no value – your life is worthless and your birth should have been prevented. They might be living lives they see as definitely worth living, not a fate worse than death. I have witnessed this very direct pain in people I know.
Abortion on the grounds of disability devalues disabled lives.
Robyn Hunt, ONZM, is a former Human Rights Commissioner, Disability leader and activist, writer, and a founder of Not Dead Yet Aotearoa (New Zealand).
This piece is based on an address given by the author to the Abortion Law Reform Association of New Zealand.