Editorial: Bioethics - Challenges for the Church

The gift of life from its beginning - conception, human reproduction, reproductive technologies, the gift of life in its simplest form - the cell, the gene, the molecule, the gift of life in its most complex form - the human genome, the genetic blueprint, the genetic map of our uniqueness, the gift of life in community - in biodiversity and in humanity, the gift of life at its most vulnerable - the care of the disabled, the care of those who suffer physically, mentally, chronically,the gift of life at its end - the terminally ill, the elderly, the dying.

The field of bioethics covers the ethical issues surrounding the gift of life in all these stages.

The Catholic Bioethics Centre opened on 1 May 1999. It was established by the New Zealand Catholic Bishops' Conference and was named The Nathaniel Centre, after Nathaniel Knoef, the first-born son of my cousin Martine and her husband Stephen. At his birth he was diagnosed with incurable health problems and in the seven and a half weeks of his life Martine and Stephen faced many ethical issues associated with his care. Their story clearly highlighted the need that ordinary people have for access to support in dealing with the growing number of ethical issues surrounding the gift of life.

The story of Nathaniel acts as a pointer to similar issues in bioethics and also reflects deeper issues. In naming the Bioethics Centre after Nathaniel, we are committing ourselves to ordinary people, particularly those who are most vulnerable in complex ethical situations. Equally, we are committing ourselves to communicating in a credible and intelligent manner so that the issues in bioethics may be understood by everyone.

From its inception in the 1960s/1970s, the evolution of bioethics into an interdisciplinary science was the result of the interplay between historical, cultural and scientific factors. In part, its development can be seen as the response of a culture increasingly sensitive to certain ethical dimensions, particularly to the rights of the individual and the potential abuse of these rights by powerful institutions such as medicine, law and religion. Its development was also a response to the burgeoning growth of technologies in medicine and the more recent development of biotechnologies. These technologies offer many possibilities of enhancing life in many directions.

In the use and application of new biomedical technologies, at least to the casual observer, it would seem that the field of bioethics is primarily concerned with technological innovation. A quick tour through the complex issues in the field supports such a view. Assisted reproduction, genetic engineering, abortion and the use of fetal tissue for transplants, the Human Genome Project [the 100,000 genes on the 46 human chromosomes in 3 billion arrangements], and the allocation of healthcare resources are all issues in the field of bioethics. However bioethics encompasses more than technological innovation.

Applications of biotechnology represent new horizons. To navigate such horizons requires sound reference points and a means of taking bearings from these reference points. Herein lies the precise challenge for the Church. But which reference points and whose reference points? Which framework or paradigm should be used? Whose moral and ethical principles should guide the discussion?

For ourselves at The Nathaniel Centre the principles out of which we operate flow from the Catholic moral tradition. This tradition has long recognized that ethical issues have a generic quality about them, that is, they are common to all peoples even though the specific shape of the ethical issue may differ. That is why the Catholic tradition places such importance on the lived wisdom of the faith community. Theology is described as faith seeking understanding and also as the clothing of the faith experience in Christ. Part of that clothing, part of that seeking, is the recognition that there are central threads, or principles, that can nurture and protect the gift of life. These central threads or principles give guidance and a credible shape to the Church's participation in bioethical debate.

The moral dilemmas facing bioethics are not new and are not confined to medicine. However, they are brought into sharper focus and receive new shape through the fact that modern biomedical technology takes us to the very horizons of possibility with life and death, and simultaneously to the horizons of vulnerability. Bioethical issues raise fundamental questions about what it means to be human; what it means to live and relate in society. Life has an inherent dignity. All of creation reflects interdependence and relatedness. However, the movement from this pure level of science into the applied is difficult and has a certain messiness which must be worked through. It is precisely on this horizon of vulnerability and possibility that the Church and Bioethics can most fruitfully inform each other, both at the level of theoretical debate and practical application, because it is within the complexities of ethical issues that the seeds of resolution lie.

We all have some idea of biomedical possibility and find that relatively easy to talk about -the possibility of a child, perhaps, for an infertile couple; the possibility of a fetal-tissue transplant to cure a great-aunt's Parkinson's disease; the end of a school friend's suffering from terminal disease. At the heart of biomedical possibilities are very real people, family and friends, whom we know and love. Some argue that these technological possibilities are simply new ways of applying a time-honoured principle from the Hippocratic tradition, the goal to relieve suffering in all its forms.

What, then, are we to say of, or even think about, the downside? For example, the technological breakthrough of in vitro fertilisation exposes a more fundamental issue with regard to the storage of so-called spare embryos. What do we do about the shadow side of technological innovation? This must be addressed, but in an interdisciplinary way which takes account of the person in his or her total particularity. To treat the body as a mere focus of disease or technological possibility is to devalue the person. Equally, these issues must be addressed in a way that is respectful and transparent. The good of society demands such courtesy.

One of the central challenges for the Church, then, is to show how the insights from the Catholic moral tradition are fundamental to any discussion that seeks to explore the full implications of current bioethical issues. Our brief can be stated simply: to know the history; to be thoroughly grounded in science; and, to carry the moral and ethical wisdom of the community with us as we do so.

When a horizon is viewed as something fixed and definite, the response tends to be static and controlled by fear of the unknown. When a horizon is viewed as something changing and developing, the response to it can also develop as one seeks to understand this new and evolving situation. To understand evolving and complex issues requires a journey into the unknown, and that requires courage and wisdom. And, because good navigation is always done by cross-reference, there is a need for companions [from the words cum-pani, those with whom one breaks bread]. Companions are those people who have an ability to look at the same problem from different angles. They enable the navigator to locate his or her position on the journey, as well as identifying for the co-traveler what is needed to successfully complete it. Companions also enable the traveler to interpret the principles provided by one's compass and other travelers. Companions are people who carry others in their heart in prayer in a spirit of reverence and openness.

Such companions may be found in far off places, or side-alleys, and they may well be labeled counter-cultural, but I am reassured by the profoundly wise moral theologian, the late Richard McCormick, who said that there is no contradiction between being counter-cultural and yet culturally intelligible. It is my belief that, because we have been richly blessed in Christ, we can have great confidence in the call to communicate openly and courageously in bioethics to a broader society as well as within the Church.

Rev Michael McCabe, PhD
Director
The Nathaniel Centre