Walter Osswald

Bioethics in the light of Christian Faith / Bioéthique à la lumière de la Foi Chrétienene/ A Bioética à luz da Fé Cristã

The involvement of the Church in health care is both formidable and ancient. There is certainly no need to remember the audience about the feats of Christian people in attending the sick, in abetting the ills, in receiving, comforting, treating and sometimes curing those marked by disease, suffering in body and soul. There is no need to give examples, from remote antiquity to the present day, of this irrefutable fact: people who try to live a Christian life cannot ignore the face of the suffering Christ in each and every person suffering from illness.

If this has been always the case and continues to be present in the world of to-­‐day, it should be clear that Christian thought could not have ignored the birth of Bioethics, almost fifty years ago. In fact, if it is true that only inappropriate reductionism can identify Bioethics with medical ethics, it is also evident that ethical questions pertaining to attitudes and treatments of sick persons still represent an important part of all bioethical problems and of the endeavors to solve them. This being so, it was unavoidable for the Church to get involved in research and teaching of this new composite discipline, Bioethics.

But let us be very clear about this involvement, because this was not a last moment decision of an institution which, surprised by a powerful new concept, decides to join the already speeding up train in order not to be left behind. On the contrary, Christian personalities and Christian institutions were of paramount importance in the launching, getting known and consolidation of this new realm of the spirit, Bioethics. To demonstrate this, I will not resort to the factual evidence given by the profound interest of Moral Theology in questions concerning human health and lack of it, pathologies and sexuality. Voluminous books on the matter give material proof of this assertion, but our intention is to call the attention to more intimate associations and to show that the Christian sources of Bioethics are irrefutable.

The fact that the word itself, which would later on attain worldwide interest, was coined in 1927 by a Lutheran cleric may have only symbolic significance. Anyway, it is interesting to ask ourselves why Fritz Jahr wrote an article, to be published in Kosmos, about the duty of every person to deal in an ethical way not only with other people but also with all living beings. I guess that it was the Christian belief of Jahr which told him that every bit of the creation has the imprint of its Maker and therefore has to be met with respect and treated in an ethical way.

The pre-­‐history of Bioethics gives us other examples of the commitment of Christians in the building of what would become this accepted new section of human knowledge. Let us focus two very different personalities who had a profound impact in medico-­‐moral thinking. One is Pope Pius XII, who established a sound moral doctrine, still unabated, on many questions arising from technological innovations in the world of health care; one fundamental contribution of Pius XII as early as 1952, was the need of doctors to give information to and obtain consent from patients in every day’s practice and not only in medical research. A couple of years later, it was the turn of episcopalian theologian Joseph Fletcher to publish a widely read book on Morals and Medicine. These two contributions made clear that the ethical aspects of medical practice had ceased to be the exclusive province of health professionals. These had done a tremendous work through their Catholic organizations, like FIAMC and its regional Federations and also by the corresponding organizations of nurses and pharmacists. The European and World Congress of Catholic doctors always discussed medico-­‐moral questions and where attentive to technological advances poising new ethical problems. The many journals published by Catholic doctors’ guilds are an easy accessible proof of this assertion (look for example at volumes of Linacre Quarterly orAcção Médica published in the thirties and you will be surprised!).

It was also deep religious feelings that drove Cicely Saunders to launch the movement now universally known as palliative care through the foundation of St. Christopher’s Hospice (1967). In 1968, it is the American Philosopher Daniel Callahan who founds the first institution to devote itself to medico-­‐moral studies; Callahan was at that time a very intent and dedicated Catholic activist and recognizes, even today, that the Catholic faith of his wife and himself was the motor force for the launch of what is now the worldknown Hastings Center.

If the record of the pre-­‐historic period of Bioethics is thus permeated with Christian endeavor to find answers to urgent ethical questions raised by our changing world and the technological surge of the second half of the last century, what is considered as the birth of Bioethics proper has also a Catholic godfather. In fact, the years 1970-­‐1971 are crucial for the independent and recognized life of the new discipline, Bioethics. Two pioneers gave independent being to it: one, the biochemist and researcher Van Rensselaer Potter, coined the word and defined it as “science of survival” and “bridge to the future”, having in mind the threat of the profound changes in population and ecosystems happening at the time; the other was the obstetrician André Hellegers, a Catholic who served as councilor to Pope Paul VI when the encyclical Humanae Vitae was being prepared. It was the Kennedys, a well-­‐known Catholic family, who subsidized and made a reality the biggest bioethical research and teaching institute which now goes by the name of Kennedy Institute, directed by Hellegers and installed in the (Jesuit) Washington University.

Soon there was an array of institutions devoted to Bioethics more or less based on the model of the Kennedy Institute. The first to be founded in Europe was the Borja Institute, in the outskirts of Barcelona, due to the initiative of Francesc Abel, a Jesuit father and obstetrician who had learnt his Bioethics at the Kennedy Institute. A large number of newcomers to the field were centers and institutes belonging to or intimately related to academic and cultural Catholic institutions: Rome, Milan, Louvain, Paris, Porto, Manila, Buenos Aires, Santiago de Chile, S. Paulo etc. became centers of renown and prestige, contributing to research, teaching and popular diffusion of concepts of prime importance for public awareness of the crucial importance of the then new discipline of Bioethics. So many were the institutes which followed this type of activity that the Sacro Cuore University Institute of Bioethics decided to organize a sort of web of Catholic inspired institutes or centers under the designation of International Federation of Centers and Institutes of Bioethics of Personalist Inspiration, known under the acronym of FIBIP and linking over 40 institutions in all continents.

The influence of the collaborators of all these institutions is difficult to fathom, but it must be considerable, since they research, present their results in scientific meetings and publications and write theses and books. Some of these, like the monumental treaty of Monsignor Elio Sgreccia or the volumes by Javier Gafo are largely read and respected, even by people of very diverse beliefs, because their intrinsic quality is recognized. We may add that in our country (Portugal) the only extant manuals of Bioethics reflect the Catholic stance in Bioethics, although they do not adopt a confessional attitude. One of the authors was Jesuit father Luís Archer, the first to discuss the ethics of genetics, both fields being research areas of his.

It is clear and results from a dispassionate view of the ongoing history of Bioethics, obviously a contemporary one, that the contribution of Catholic research and thought to Bioethics in general has been and still is more than the advances due to the effort of individuals or teams. Some general notions are certainly due to this specifically Catholic contribution, widely accepted and therefore to-­‐day more or less undisputed. These notions can be identified as the recognition of the artificialization of life, denial of the alleged axiological neutrality of scientific progress and definition of the essential values to be respected, namely life, dignity, freedom, identity of mankind and preservation of nature.

Due to aforementioned facts, which clearly point out to a long-­‐lasting and close association of Christian, v.g. Catholic thought and magisterium with the bioethical world, one could expect contemporary Bioethics to be largely in accordance with magisterial teaching and Catholic views of values and virtues. However this is not so and we recognize that mundane or worldly bioethical approaches and advices dominate the field. In order to be clear about this question, let us affirm that independently of the intrinsic value of arguments what at the end of the day defines decision making ability is politics. It is thus understandable that in moral questions regarding critical phases of human life, like abortion, medically assisted reproduction or even euthanasia, countries of the so-­‐called democratic western world, common opinion and to a large measure legal framework tend to adopt very liberal attitudes, far from those defended by the Church.

Confronted with this situation, believers and non-­‐believers alike are divided into different fields. Some – and between them it is fair to single out Tristram Engelhardt Jr., a respected philosopher and author – some accept the superior role to be attributed to religion as a basic element for moral reasoning; while others, more numerous, defend a lay Bioethics, which should be as separate from any religious influence as the democratic state actually became. Another current of opinion looks at this monumental question in still another perspective, which could perhaps be described as a humanistic-­‐personalistic one. Following this avenue of thought, one arrives at the conclusion that Bioethics owes a lot to the moral doctrine of the religions of its founders, and especially to the Christian outlook, but that different voices have to be heard in this concert and that the challenge of a transdisciplinary area, which Bioethics surely is, lies in debating with openness, acceptance of the other, wish to find the truth and the most convenient answers to moral questions. In such a scenario the Catholic researcher should have no difficulties to argue and to advance solutions which respect dignity and life of the human being. However this does not mean that it is always possible to find common ground and to arrive at consensual solutions, as amply demonstrated in the irreconcilable positions in questions of beginning and end of life.

In face of this situation it is tempting to suggest that Catholic bioethicists and their centers should organize themselves and create a sort of alternative to lay Bioethics, a confessional one. This would however result in a kind of particular or specific discipline which would not attain the heart and the intelligence of non-­‐ Christians; a conceptual ghetto would be reserved for Catholic people governed by moral rules which would apply exclusively to them. We have argued that this sort of retreat into a conceptual fortress, leaving the vast outside world to those who do not share our beliefs and views is both erroneous and disastrous. What we are invited to do is to keep our presence in the debates, to intervene with valid arguments and to demonstrate that respect for life, dignity and liberty of all is best attained by following the humanistic-­‐personalistic approach favored by us. On this fundamental structure, which can certainly be accepted by most people of good faith and common virtues (being truthful, trying to help others, looking for justice and benevolence), we, Christian believers, have to build additional features of following our Lord in all alleys of the world and doing what he commands us to do in every circumstances of life. Here, of course, we cannot count on the company of all those who did agree with us in accepting the major tenets of our approach to Bioethics.

Let me give an example of a situation occurring recently in an intensive care unit, the direction of which lies in the hands of a Catholic doctor. A patient in very poor condition and thought to die in less than a week suddenly developed kidney failure. In face of the dilemma – proceed to kidney dialysis or give only palliative care – the members of the team (doctors and nurses) were asked to proffer their opinion. Most thought that it would be useless to start dialysis, which could postpone death by a few days and one person said that due to the fact that the chief doctor was a firm Catholic he would certainly order dialysis to take place, because the doctrine they defend is to protect life at all costs. He was surprised to hear from his boss that extraordinary means to prolong for a short time and with heavy technological involvement a faltering life is not magisterial and everyday doctrine, since Pius XII already. In this case, letting die in peace, with preservation of the dignity and bodily integrity of the patient is the most appropriate solution and is agreeable to both believers and non-­‐believers. The person who had asked the question confessed that this was very important news for him and showed Catholic doctrine in a new (and nicer) light to him.

What I mean is that we do not have to retrench ourselves in a little well-­‐kept garden of Catholic Bioethics, confronted with diverse patches of other religious kinds of bioethical work and with large extensions of so called lay Bioethics. What we aim at, and we are happy to share this view with many of the predominant currents of bioethic thought, is to have a Universal Bioethics, as proposed by UNESCO some years ago. A Bioethics which is founded on universally accepted values, like freedom from coercion, respect for life and dignity of every person, loving attention to all living beings and to our earth. You have certainly read Pope Francis’ encyclical letter Laudato si and thus may recognize in my last words a reflex of this splendid document, which is not an ecological manifesto but a novel and passionate invitation to make the world better, more peaceful, more human, more ethical. Let us heed this advice and join brains and hearts in this wonderful task!