Editorial: Bioethics and Decision Making

Michael McCabe
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.

In biotechnology many boundaries between issues have either disappeared or are in the process of doing so. This process has altered ethical perspectives in society and raised new ethical and moral questions. For example, five years ago ethical, moral and scientific agreement was almost universal in its opposition to the cloning of human embryos. There was little apparent benefit in such cloning and a widespread repugnance to cloning. Recently, the cloning of embryos has become an integral part of stem cell research and offers potential benefits in the treatment of a number of medical conditions. With the prospect of these therapeutic benefits there is no longer universal agreement that cloning of human embryos should be banned.

Stem cells derived from embryos now offer the opportunity to treat adult–onset diseases, such as Alzheimer's and Parkinson's disease, thereby linking the care of adults with the creation and use of embryos. The use of assisted reproductive technology has created thousands of so called "spare embryos, the storage and use of which pose serious moral dilemmas. The use of these embryos in stem cell research is considered by some to be a way out of this dilemma. In the United States of America these embryos are now being put up for adoption. It is argued that this is preferable to their destruction, their use in research, or their use as a source of stem cells. There is a growing realisation in the United States of America that the framing of adoption legislation will need to take into account the adoption of embryos. Similarly, in New Zealand it is becoming apparent that new adoption legislation must take account of the use of surrogacy.

Responding to these issues on a one by one basis can obscure the links between them and therefore the possibilities for identification of the key ethical and moral issues underlying the use of biotechnology. How can the Catholic Church respond in a manner, which assists society to positively address these issues? The insight of Cardinal Joseph Bernardin provides guidance, "the Church's social policy role is at least as important in defining key questions as in deciding key questions."

Identification and articulation of key moral and ethical issues is a first step. This process must take into account the linkages between the issues if we are to achieve a consistent and comprehensive ethical and moral response. For example, the status of the embryo is fundamental to any discussion about human cloning, the use of embryonic stem cells for research and the adoption of "spare embryos".

The use of in vitro fertilisation, genetic testing, genetic modification and cloning, have increased our ability to select the characteristics of human beings as well as giving power as to whether or not they come into existence. We now have a power over human diversity, which potentially allows for the shaping of future generations in unforeseen ways. 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.

Biotechnology deals with our biology, and constantly risks disconnecting the physical aspects of our human nature from the non-physical and spiritual, reducing what is holistic in our nature to a single focus on what can be achieved physically. This disconnection has had to be faced in end of life care. The overuse of technology began to dominate the end of life with the processes of growth and healing, natural to the end of life, being subjugated to the technological push to prolong life. The rise of the hospice movement and the development of palliative care has helped to restore this balance in the care of the dying. Traditionally Western society has struggled with death as the ultimate limit, blurring the boundary between extending a life and prolonging a death.

At the end of life there is now a greater acceptance of limits in the use of technology, and greater appreciation of the fact that these limits are often found in the non-physical aspects of our being. We are much more than our biology, and we suffer when due recognition is not given to the spiritual, psychological, emotional and social aspects of our human nature. That understanding is a fundamental tenet of Catholic healthcare. In working with Catholic aged care facilities I have been privileged to be involved with people whose understanding of the holistic needs of those they care for is profoundly intuitive and well-grounded. Their approach and that of the hospice movement offer models, which contain the seeds of resolution for the complex problems emerging in the use of biotechnology.

Recognition that there is a natural balance between the different aspects of our human nature provides us with a starting point in discussing the limits of biotechnological intervention involving the beginning of life. The glittering possibilities offered by biotechnology have not yet been tempered by a close examination of their effects on other aspects of our human nature, which, at the end of life, has clearly demonstrated that use of biotechnology alone is not sufficient in the provision of holistic care.

There are many key ethical and moral questions to be answered, but the over-arching question is simply "Where are the limits to the use of biotechnology?" The linkages emerging between issues such as cloning, stem cell therapy, genetic modification, genetic testing, the creation and use of embryos, surrogacy, and adoption are leading us into deeper questions about individual identity, parenthood, families, human equality and the rights of future generations. We are developing new powers to create and alter human life, to determine who comes into existence and by what means. There is the concomitant possibility that in the use of these powers to address the immediate needs of individuals, we may, in the long term, create an environment that does not nurture life in its fullest and most holistic sense.

Rev Michael McCabe, PhD
Director
The Nathaniel Centre