CHRISTIAN MORAL REASONING
by G R Dunstan

Introduction

I am very happy to join with Professor Schenker and Professor Serour in presenting to you three related religious traditions. My intention is to sketch a method of moral reasoning central to the Christian tradition. It is rooted in Biblical Jewish theology and in Greek philosophy. There are differences of emphasis within it, mostly of an authoritarian character, resulting in some prohibitions not endorsed by all of us. I shall speak mostly of the central tradition, indicating where deviations occur. I distinguish moral reasoning from moral assertion.

Moral reasoning begins with a scrutiny of the empirical features of the subject considered: the given, the data, the facts of the case; and with a respect for them. We examine them. We ask, where in them are the points of moral claim, questions of obligation? What, then, are the relevant features in the practice of diagnosis and treatment of infertility today?

Empirical features:

i. clinical

In diagnosis, they are the methods available from today's science and technology: laparoscopy, ultrasound scans, biochemical tests, chromosomal analysis; gamete and embryonic research; studies of implantation; and more. Treatment includes assisted insemination, IVF and GIFT, now perhaps at the peak of effective development; cryopreservation; micromanipulation, with SUZI, ICSI and the like; the experimental culture of spermatids, spermatocytes and oocytes, some of the last taken from fetal ovaries, cadaveric or aborted. Prospectively we see attempts to forestall iatrogenic infertility where children will be rendered infertile by treatment for leukaemia, by preserving prepubertal testicular tissue for later spermatogenesis.

ii. human

These are the men and women for whom and on whom these procedures are undertaken. They have a natural capacity for parenthood. (The language of "rights" is unhelpful, and misleads argument). Where there is infertility, this natural capacity is frustrated in some way. It has therefore a proper claim on the medical art. It is a proper exercise of medical duty to seek causes in diagnosis, and to restore or enable natural functioning when possible.

Men and women are more than biological organisms in three respects. First, they are vulnerable, especially in emotion and feeling - the woman more so than the man. They are therefore exploitable, by medical hubris, for example, or for financial gain. (These emotional factors were well symbolised in an exhibition by forty contemporary artists at the London Riverside Studios in the summer of 1996. The catalogue, edited and published by Deborah Law and Sandra Penty, contains articles on the history of infertility treatment by Simon Fishel, and on its ethics by Fran¨oise Shenfield).

Secondly, men and women are morally free agents. Nothing may be imposed on them without their consent. Their vulnerability heightens the medical duty to assure that consent is valid and free.

Thirdly, medical intervention may result not only in satisfaction for them (and for the clinic) but also in the procreation of another human being, vulnerable and free, whose interest is paramount. That child is not an object to serve other ends - parental wishes or medical satisfaction - but a person in full right.

iii. principles, values, beliefs

These are corporately held in societies, communities, and are transmitted as part of their culture. These societies may be secular. The communities relevant to this discussion are religious, Jewish, Muslim and Christian. It is in the light of these beliefs that clinical procedures, diagnostic and therapeutic, are judged. When some principles are given absolute value in an authoritarian community, prohibitions follow. For example, when the "sanctity of life" is declared to be absolute "from the moment of fertilisation", some diagnostic and therapeutic procedures are forbidden to members of that community; embryo research in particular. Where, however, principles are given a high but presumptive value - that is where they have a paramount moral claim but it can be overweighed or rebutted by a stronger circumstantial moral claim - then, in communities where moral emphasis rests less on authority and more on reasoned appeal to conscience, the way is open for moral reasoning to establish the limits of liberty. These limits must be acceptable to the secular community if they are to secure authorisation within its laws. Acceptance may take time to win. Christian ethics is essentially a social as well as a personal pursuit.

The Christian moral tradition

I outline to you, therefore, a tradition of moral reasoning. I shall indicate where the main variants branch from the central stem. Its origin is in Jewish Biblical theology. There we are given a doctrine of God: the righteous creator, the fount of the created order and of moral order. We are given also a doctrine of man: of man/woman together made in the image of God: that is, capable of responding to God as a moral being; of searching out the created order and of working with God in creation in morally governed ways. We now call these ways "ethical". This stamp of divine dignity on man was confirmed for Christians by the Incarnation: God was made man in Jesus Christ.

It is from these theological principles that we derive our basic ethics of human dignity, the "sacredness" of human life, rational, social and free. Basic to infertility treatment is this presumption in favour of life.

Why a "presumption" only? Why not, in the central tradition, a commitment to the absolute, to absolute protection? The answer lies in another inheritance. Christians were heirs to the Greeks as well as to the Jews, as, in their turn, the great Arabs were also. From them we learned that moral theory must relate to fact, to reality as known. It must respect the empirical. Greek embryology left its traces in the later (Wisdom) books of the Bible. When Job cried out "Hast thou not poured me out like milk, and curdled me like cheese?" Job 10:10) he was quoting Greek descriptions of embryogenesis. It was Greek science which caused the rabbis in Alexandria to write into the Greek (Septuagint) version of Exodus 21:21 the principle that the protection due to the embryo/fetus advances step by step with its morphological development and growth - a change in the Greek version of the Law which passed into Christian philosophy, theology, morality and canon law - and hence into the Common Law also. It was the standard assumption and teaching in the Roman Catholic Church virtually until 1869, when Pope Pius IX ended it in favour of absolute protection from the moment of conception.

Protection matched to development is still the principle underlying the most recent United Kingdom law and almost all universal codes of practice governing embryo research and the treatment of infertility. The old threshold of forty days and upwards from conception has been brought back to fourteen days, because the new embryology has established this pre-embryonic period of cellular activity before which individuation - the establishment of an individual organism - cannot begin. There can be no personality without individuality. (Persona est individua substantia rationalis naturae. Boethius).

I have leapt selectively across two and a half millennia to establish some key points in the Christian tradition. The relevant ethics has been rooted in the relevant science, as known in time. The application of continuing, enduring principles has therefore changed as the science developed, as knowledge changed. The fashioning of an ethics of practice is the proper work of human reasoning, in fidelity to the given: the given principles on the one side, the given science on the other.

But reason has never had an easy passage. In the eleventh and twelfth centuries the Arabs brought into Europe works of Aristotle unknown there before. They caused trouble: they made men think anew. They were worked on by men whom we call the Scholastics: Albert the Great of Cologne and his pupils Roger Bacon and Thomas Aquinas, and by Giles of Rome, a thirteenth century embryologist. They began a revolution in scientific thinking in Europe. They restored search and enquiry, as the way to knowledge, in place of tradition, unexamined but buttressed by authority. The Apostle Paul, in Romans 1 and 2, had pointed the way before them, in defence of what we call "the Gentile conscience".

In Aristotelian philosophy the mark of humanity is rationality: man is a "rational soul". For the Scholastics, therefore, man, made in God's image, is bound to the exercise of reason: investigative reason ("All men by nature desire to know" was the opening sentence in Aristotle's Metaphysics); speculative reason, seeking to order, to make sense of, knowledge gained; practical reason, putting knowledge to work in invention; moral reasoning, to assure virtue, the just, the benevolent, in the pursuit and application of knowledge.

In the central Christian tradition, therefore, moral reasoning is the perennial task: to establish the ethical permissions and prohibitions attaching to new developments in science and technology, including the medical, the diagnosis and treatment of infertility.

The variants

Christianity does not speak with one voice on these things. What some would permit and regulate, others would forbid. Rome, because it puts absolute value on an unbreakable nexus between coitus and conception, forbids to its members all infertility treatment which bypasses the sexual union of man and woman. Rome, because it puts absolute value on human biological life from fertilisation, forbids all research and treatment which might cause the death of even the earliest pre-embryo. It rests these prohibitions on an authoritative declaration of what nature, God's divine order, requires. The authority cited is that given by tradition to the teaching office of the Church, supreme in the Pope.

But not Rome only. Some Evangelical churches are equally authoritative in their prohibitions. Their authority is the Bible, God's word revealed, with mandatory force attached to texts sometimes quoted without regard to their historical, social or literary context as analysed in critical scholarship. This approach puts the sovereignty of God's will over all the pretensions of human will and the pursuits of human reason. God's sovereign will is known by revelation through the Bible, just as for the Vatican it is revealed through the magisterial teaching of the Church. In consequence Catholics and Evangelicals are found together in Europe, opposing such regulated experimental research and practice in fertility as is permitted by the law of England, the Human Fertilisation and Embryo Act 1990. The liberty guaranteed by the Act, and the duties imposed, were won by hard argument, in Parliament as in the country. They were justified in the tradition of moral reasoning which I have outlined, with its principled, if also dangerous, reliance on the divine gift of reason.

There is no complacency in this tradition. An example is to hand. In May 1996 the General Assembly of the Church of Scotland (the Kirk, a Church in the Reformed tradition) promulgated its judgement on aspects of infertility treatment. It expressed opposition to any extension of the fourteen days' limit to research on human embryos. It expressed agreement that IVF may be right for married couples and even for unmarried couples living in a stable and long-lasting relationship. It opposed the donation of sperm and of ova for infertility treatment. It opposed surrogacy. It opposed sex selection, except to prevent the transmission of inherited disease. (The Tablet 250. 8130. 1st June 1996. p.741).

The Kirk (like the Established Church of England) does not impose these judgements on members or on the nation as matters of strict obedience, as prohibition. It issues them, after careful reasoned study, to guide members in making their own judgements in conscience. I think they would carry wide consent in the main British Churches, except the Roman Catholic - except perhaps that donated sperm might find wider acceptance now, especially for the avoidance of known genetic mutations.

The process of moral reasoning, and of gaining sufficient agreement in Churches, is necessarily slow. But that is better than instant gut reaction, issuing either blanket prohibition or an easy acceptance of anything, because it is novel and sensational. But the task continues. With straight IVF behind us, the same ethical analysis must be given to new developments, in gamete, embryonic and genetic research. The tradition will meet the demand.

Conclusion

The purpose of moral reasoning, as expounded, is not primarily to tell Christians what they may do or accept in infertility treatment - though they may learn from it, and do. It is not primarily to tell Churches what they may permit or must prohibit for their members - though they too may learn from it, and some do. Its purpose in the high tradition is to work out an ethics of practice: that is, to work with men and women of integrity in medical science and practice in their search for the truth of things in aetiology and diagnosis, and then, on the basis of knowledge, to develop the medical art in an ethical relationship with patients and with society.

Further, given the vulnerability of human nature - and that includes the capacity for error, self-deceit and corruption, even in the professional mind - the task is to work out with the appropriate authorities the means to regulate new practices as necessary in sensitive areas; and this, so far as possible, without the intervention of the criminal law. The goal of regulation must be to secure maximum freedom of research and practice compatible with the interest of patients and of the common good - that complex of moral values which constitutes a society. This is not a pragmatic statement only. It is a theological statement, grounded in belief.

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Professor Dunstan is Professor Emeritus of Moral and Social Theology in the University of London, and Honorary Research Fellow in the University of Exeter. He is a FRCOG ad eundem.
Ed.

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