Editorial: Bioethics and Poverty

Michael McCabe
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.

Recently at a workshop in bioethics the question was asked, "What is the interface between bioethics and poverty?" The immediate response to this profound question was a comment about the obvious inequities in healthcare delivery and about the limited influence of bioethical thought on the topic of healthcare resource allocation. The impact of poverty in healthcare delivery in New Zealand is readily apparent and in these circumstances bioethics can seem quite irrelevant to the lived reality of peoples lives. In the presence of poverty and poor health the field of bioethics can appear to be an academic luxury that has little impact on their experience.

Subsequent reflection reveals a further link between bioethics and poverty, namely, the poverty that results from being unable or unwilling to participate in complex discussions. Sometimes the inability to participate comes from a lack of knowledge and from a lack of understanding of very complex issues, as, for example, in the subject of genetic modification. In any analysis of GM the maelstrom of data and facts can so easily overwhelm that we withdraw from the discussion or retreat into simplistic black and white answers, when the challenge is to understand the complexities of the issue. That is a form of poverty.

Poverty then is not only reflected in the inequities of healthcare delivery. It is also reflected in an unwillingness or inability to participate in the complex discussions that we face as individuals and as a country. The institutional, systemic, communal and personal realities of this form of poverty can easily overwhelm us – the issues are too hard, too far away from us, too difficult to understand and too many in number.

Perhaps the real reason for non-participation lies not in the issues, but within us. It takes courage to participate in these debates. To paraphrase Tillich, courage is not so much the power to overcome, as the power to understand and the power to transcend. Courage forms the basis of participation and love. Courage enables us to take the risk of involvement.

In my experience, there is one continuing source of the courage needed to participate in all the complexities and difficulties of bioethical debate. As well as having a communal focus, bioethics also focuses on individuals and their life stories. It is about accompanying individuals as they journey through the lived reality of the issues that the wider community debates at a much more detached and generic level. This grace of accompaniment, being a companion, provides a source of the courage required for participating in ethical debate. To accompany is not only to let go of fear, it is to understand its power and then to transcend it.

Participation means courageously searching for ways to make a difference for the good of others. The more bioethics is able to focus on the individual it is called to serve, the more bioethics will be understood as ministry, not just as an academic discipline. To make a difference in one person's life makes involvement in bioethics not only worthwhile but also essential and vital for the wellbeing of the community.

Rev Michael McCabe, PhD
The Nathaniel Centre