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Technology versus humanity?

Professor John Wyatt’s address on the challenges of contemporary medical ethics from this year’s EMA Conference

Professor John Wyatt

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We live in confused and confusing times.

In my work as a paediatrician caring for extremely sick and tiny babies, I am often confronted with extraordinary dilemmas created by advances in technology. On the one hand, in the neonatal intensive care unit we were increasingly capable of ensuring the survival of babies born at the limits of viability, around 23 and 24 weeks, weighing little more than a pound. On the other hand, advances in antenatal ultrasound, MRI scanning and genetic technology are leading to increased ability to identify congenital abnormalities in unborn babies. In some cases the diagnosis was made when the baby was already at an advanced stage of gestation.

Abortion dilemma

It is not widely known that, according to the current abortion law in England and Wales, abortions are permitted at any time up to and including birth if there is a ‘substantial risk’ that the child might be born ‘seriously handicapped’. In such cases, doctors have a duty to inform parents that a late abortion would be legal, even if they themselves would not be in favour. Parents find themselves caught in a painful dilemma between their natural instincts to protect and care for their unborn offspring and a sense of responsibility to ‘prevent suffering’.

One mother, who had been informed that her infant who was approaching term gestation had a major brain malformation, bitterly complained to me that it would have been better if she had not been told. Now she had to choose between being responsible for the death of her unborn baby, or being responsible for ‘bringing a handicapped child into the world’.

In his book, The Perfect Baby, the secular philosopher Glenn McGee says: ‘There can be no question that a couple who find out that their infant is sure to suffer and die incurs special responsibilities… . From time to time genetic testing will suggest a duty to abort’.

God-like knowledge

As medical technology advances, it provides us with knowledge about our own human condition – and that of our children – that previously only God himself could possibly attain. But God-like knowledge leads to God-like responsibility. And it is not at all clear that as human beings we are morally and emotionally equipped to take on this awesome responsibility.

Some prominent modern philosophers, such as Professors Peter Singer and John Harris, have argued that both the foetus and the newborn baby cannot be regarded as a ‘person’ in the full sense of the word. To be recognised as a person it is necessary to be conscious of your existence and to be capable of making choices, exercising preferences. This will only become a reality sometime after birth, perhaps between the first and second years of life. Prior to this their lives should not be covered by the same protections; they are ‘human non-persons’.

Legal rights for apes

Alternatively some non-human animals, such as chimpanzees and dolphins, may be regarded as ‘non-human persons’. According to Peter Singer ‘There are many non-human animals whose rationality, self-consciousness, awareness, capacity to feel and so on, exceed that of a human baby, a week, a month or even a year old. An adult chimpanzee has more right to be described as a person than a newborn baby.’

The other end of life

At the other end of life, the media highlight a steady stream of tragic individuals who chose suicide because of a medical condition leading to dependence and loss of control. It is notable that public and media debates about whether medically assisted suicide should be legalised have been largely focussed on the right to self-determination. To many modern people it seems obvious that adults who are legally competent should have the absolute right to determine the timing and the manner of their death. Dependence, particularly that caused by dementia or stroke, is seen as the ultimate horror; a denial of all that human life should be.

How do we respond?

It seems to me that our first response to these troubling and confused developments should not be one of outrage or horrified condemnation, but one of empathy. As followers of Christ, we are called to enter into the experience of those who are despairing, to try to listen and to understand the deep fears and hopelessness that drive people to believe that suicide is the only compassionate alternative.

Ethical challenges old and new

The age-old ethical challenges are about the taking of human life, the destruction of vulnerable human beings – induced abortion, infanticide, euthanasia and assisted suicide. These issues have confronted the church for 2,000 years and they are still with us. But there are new ethical challenges brought by modern technology. These concern the making of human life, the shaping or manipulation of human life and the faking of human life.

Reproductive technology is spreading rapidly and an American expert has recently predicted that within the next 20 to 40 years the majority of babies in developed countries will be conceived in IVF clinics, allowing screening of the entire genetic code to be carried out, before being selected for transfer to a womb. Reproductive technology is also used for the creation of embryonic humans for research, including cloning, genetic ‘editing’ and creation of embryonic stem cells. At the time of writing, doctors at Moorfields Hospital reported a pioneering treatment for visual loss caused by macular degeneration, using stem cells obtained by destruction of a human embryo.

Technology designed to create interfaces between the human brain and machines is also advancing rapidly. Sophisticated brain implants enable paralysed individuals to control prosthetic limbs, and work is progressing on implantable ‘memory chips’ for brain injured patients. One of the biggest researchers in this area is the US military, actively working on various forms of human enhancement, including control of weapon systems by thought alone. In the prescient words of C.S. Lewis: ‘Man’s power over Nature turns out to be power exerted by some men over other men.’

Finally, the exponential rise in the power of artificial intelligence is leading to remarkable advances in the simulation by machines of many aspects of human intelligence, including cognition, speech and human-like emotional responses. Within ten years it is likely that robots will provide care and simulated ‘companionship’ to the elderly, the disabled and the young.

Double listening

There are no simple answers to the challenges posed by advancing technology to our understanding of what it means to be human. There is an urgent need for what John Stott called ‘double listening’ – attending to the ever-changing questions and challenges posed by the modern world at the same time as we listen to the voice of the Holy Spirit speaking through the ancient Scriptures.

In Christian thinking, biblical ethics – the way we are called to live – is rooted in biblical anthropology, the way that we have been made. In the face of technological advances we need to develop a richer and more nuanced biblical anthropology, a deeper understanding of our embodied human identity.

Much more than genes

One of the most important foundations of biblical anthropology is that human beings are not self-explanatory. We are derivative. We derive our meaning from outside ourselves; from the creator God in whose mysterious image we are made. We will never understand fully what it means to be human by analysis of our genetic code or the wiring of our brain cells. The values and purposes of our human lives, only make sense in the light of our creation in God’s image. We are God-like beings.

But the Genesis narrative also teaches us that we are made out of dust. In Hebrew, Adam is derived from Adamah, the ground. We are ‘groundlings’, created to be fragile, vulnerable, frail and contingent beings. Notice that this is part of the creation that God pronounced ‘very good’, not a consequence of the Fall.

Designed to be dependent

In fact it seems that we are designed to be dependent on others, we are designed to be a burden to one another. The life that we are called to live within the Christian community is one of ‘mutual burdensomeness’. Of course this is precisely why Paul says ‘Carry one another’s burdens and you will fulfil the law of Christ’. In an age that prizes self-determination, here is an opportunity for the Christian community to live in a profoundly counter-cultural manner, and provide a striking witness to a cynical world.

In Christian thinking, dependence is part of the narrative of a human life. We come as babies into the world, totally dependent on the love and care of others. Then we go through a phase when others depend on us. And most of us will end our lives totally dependent on the love and care of others. But this must not be seen as a degrading and inhumane experience. No, it is part of being human, to be accepted and even celebrated.

And most amazingly of all, the Creator God does not just teach us about dependence. In the Incarnation he enters fully into this experience. He chooses to make himself utterly dependent on the love and care of human beings. God in Jesus needs to be fed, washed and clothed! We are so familiar with the doctrine of the Incarnation that we lose its scandalous and paradoxical power. Yet the biblical faith teaches us that, at the very moment that Christ is totally dependent on the care of others, he is upholding the universe ‘by the word of his power’. His essential dignity and status as the Second Person of the Trinity is in no way impaired by his dependence. And the same is true for human beings too. However fragile and disabled we may become, our essential dignity as daughters and sons of the Most High is not altered. I will always be what God thinks of me.

‘It’s good that you exist’

In conclusion we must defend the preciousness of every human life – this is the form in which the God of the universe became flesh. Instead of seeking technological ways of manipulating our humanity, it seems that we should celebrate, defend and protect our original human design. Yes, we can and should use modern technology to restore humanity where possible, in line with the Creator’s intentions, but we do not have the right to change the design. We have to recognise that embodied dependence, fragility and vulnerability are part of the way that we are meant to be. Even in the New Creation we will not lose our creaturely dependence.

And instead of using technology to identify and destroy developing human beings who don’t match modern standards of perfection, we need to learn again what it means to say to every human person: ‘It’s good that you exist, it’s good that you are in the world’.

John Wyatt is Emeritus Professor of Neonatal Paediatrics at University College London. His book Matters of Life and Death is published by IVP. His new book Right to Die – Euthanasia, assisted suicide and end of life care will be published by IVP in November 2015.