Reflections on the Doctor in Society

Two families both facing the ultimate reality that confronts us all. The one had lost an older man, long retired, suffering from a stroke and in the fulness of years. The other deprived of an active working man—husband, father and leader in the community. I met them in turn as a young resident hospital doctor whose job it was to meet the relatives of any patient who died on the ward where I worked. The first woman, whose elderly husband had died, was accompanied by her sister. She was distraught, angry and full of recrimination against the hospital, the nurses, her dead husband and herself. No words of comfort from her sister nor my attempts to calm the bitter outbursts of her grief impinged at all. The second family—a mother and her children—what of them? I was prepared for desolation, despair and bitterness, and there was deep grief in their faces but also a calm and peace. As I endeavoured to explain the catastrophic and untreatable episode that had suddenly removed the head of the family the widowed woman said, ‘It’s all right, doctor, we understand. You see we know that he is with the Lord, and we have the comfort of Christ’s presence with us.’

This episode apparently has little to do with the ethics of medical research, but it does illustrate one of the fundamental issues in the practice of medicine today. As we struggle with the implications of in vitro fertilisation (IVF), the question of abortion and the ethics of health care it is essential that we understand the nature of the conflict between good and evil, and are clear as to the basis of our own stand. If there is to be a clear Christian witness in the medical field it can only come from those with an underlying commitment to obey God. This is not just a nebulous concept, but is rooted in the realities of life, as shown by these two contrasting bereaved families—and equally real for the general practitioner facing a crowded surgery with a patient broken by a partner’s infidelity, a promiscuous youngster or a housebound incurable in a crumbling tenement. It must also be the reference point for the hospital gynaecologist expected to do abortions as part of his normal hospital work.

In the field of medical research, opinions, reports, conferences and papers are spawned from the surging sea of controversy on ethical issues. What are we Christians to make of them? Should we try to influence the progress of medical research, and what is our authority for doing so? Can we affect legislation that changes the whole framework of human relationships in the family?

The objective of this journal is to encourage, inform and support Christians concerned about ethical issues, whether as patients, nurses, doctors or research workers. It also aims to provide an understanding of the principles behind ethical issues that confront us.

There are many different motives for undertaking research, and one of them is the satisfaction of the purely academic pursuit of knowledge. One of the rewards of a successful research programme is the sense of power it gives to those involved—not only power to control environment but to change it as well. There has always been a realisation of the moral responsibility of scientists. This has led at times to agonising questions over the use of scientific discoveries. For example, Nobel had many qualms about the use of explosives, but in the end felt he was a researcher primarily and others had to decide the use to which his discoveries were put. The question becomes of a different order when we consider research not on man’s environment, but on man himself. The injunction to do ‘no harm’ is still a guiding principle of ethical committees who have to approve medical research programmes. But what of research into the human embryo? What is ‘harm’ in this context? How do you argue with those who are committed to a mechanistic view of man, and who regard ethical considerations in medical research on adults as a tiresome restriction and irrelevant to research on the foetus? It is here that Christians have a prophetic role, to proclaim the authority of God as Creator and the need for obedience to Him and His Laws. This may seem a broad generalisation, but nothing else will do as a starting-point in our modern, pagan, pragmatic society. Once we have made clear that obedience to Almighty God is an essential condition for clear thinking and wholeness then there is a strong, certain base for defining the ethical issues that confront us. We may doubt if any researcher whose basis for life is obedience to the Lord would contemplate continuing research on embryo cultures in the laboratory knowing that at fourteen days the majority would be discarded.[1]

The justification for such research is often said to be the provision of babies for infertile couples. However, where individuals are prepared to accept their circumstances in the providence of Almighty God the demand that every desire, including that of children, must be necessarily fulfilled ceases to be of primary importance. The party that is answerable to God can have a firm assurance that its activities, including scientific research, will be directed towards fulfilling God’s law and for the benefit of society in general. This has been appreciated by a number of eminent scientists such as Michael Polanyi, Professor of Physical Chemistry and Social Studies at the University of Manchester. In his book, Science, Faith and Society, he points out the devastating effect of an amoral, godless society in which expediency is put before principle in the use of science for purely utilitarian ends. On the other hand, the firm base for progress in scientific research comes from a belief in God and acknowledgement of that moral absolute.[2] Indeed it is probable that without such a basis science degenerates into the mere accumulation of data without coherent meaningful progress. Historians who have recorded the progress of science have often come to this conclusion.[3] The individual seeking the meaning of life is lead to belief in some form of absolute, whether it is the party for the Marxist, the destruction of social fabric for the anarchist, or the realisation of the Kingdom of God for the Christian. As Jacques Ellul has pointed out, our age is characterised by non-meaning and a dissociation between man and society where obedience to God is discounted.[4] One consequence of this is the view of science which treats it as an almost autonomous force, and speaks of science as the search for truth with the implication that this justifies any direction that research may take because ‘the truth is surely a good thing’. This is a mis-conception. It is true that the founders of modern science were men of strong principle with a high regard for truth—but they regarded this as an overall governing principle of their lives, and did not confuse it with the process of scientific discovery, the observation and interpretation of phenomena. Francis Bacon is often quoted as calling this ‘thinking the thoughts of the Creator after him’.

Behind all social systems in the world stand certain moral absolutes that are universally acknowledged, and in fact are a presupposition of religion. This is the ‘categorical imperatives’ of Kant. So it is not enough that we should seek to return to Christian ethics or persuade others to do so. Rather it is a question of a return to Christianity, not as a system of ideals and ethical injunctions, but rather to find forgiveness and freedom from guilt with the power of God through Christ to enable us to fulfil moral laws. It is of course important to proclaim strongly the fundamental moral absolutes in the world and always with a parallel proclamation of the Chris tian faith.

As C. S. Lewis pointed out, Christianity did not bring any new ethical code to the world, but a demand for repentance and an offer of forgiveness which is based on the assumption of a moral law that had been both known and broken.[5] Once this is clearly understood, we can return to the dilemmas posed by the advance of medical science and the expectations of society, with a message of hope and good news which enables the individual (whether doctor or patient) to find an ultimate peace and security. This offers a firm basis from which the practical problems can be tackled, an alternative to desperately manipulating the options confronting us with no hope of a solution.

The final subject is that of communication between doctors and society. Those of us who are doctors have a security in our status which seems to be threatened by such a dialogue. In fact such openness is essential if we are to have any continuing credability as professional people. This was well explained by Ian Kennedy, the Reith Lecturer in 1981, and I for one was impressed by his advocacy of a more open dialogue between doctors, society, and lawyers, where ethical questions were concerned. He recently put his arguments succinctly in an article in The Times.[6] Such communication will help doctors to find their own moral base, and as this is understood by society will avoid arbitrary regulation of issues such as the prescription of contraceptives to underage girls by edicts from the DHSS and recommendations from the BMA or General Medical Council. These tend to reflect the expedient view of bodies who really have no right to make what is virtually legislation, which will have profound implications for both individual morality and the family in society.

I believe that an open communication between doctors and their patients is also essential as a basis for the ‘medicine of the whole person’, in the phrase of Paul Tournier. He advocated this approach by doctors to their patients long before ‘holistic’ medicine became popular. If we set out to meet the emotional and spiritual needs of our patients, we have to be prepared to be known as the people we are, and with the beliefs that we truly have. There is consequently a demand on our emotional and spiritual resources, with a risk that we may lose objectivity. But this is not a threat to the doctor who has resources beyond himself, found in a faith in the Living God.

[1] Warnock Report.

[2] Michael Polanyi, Science, Faith and Society
University of Chicago Press, 1964.

[3] Herbert Butterfield, The Origins of Modern Science,
G. Bell & Son, London.

[4] Jacques Ellul, Ethics of Freedom,
Wm. B. Eerdmans, Grand Rapids, Michigan, P. 461.

[5] C. S. Lewis ‘On Ethics’, in Christian Reflections
Wm. B. Eerdmans, Grand Rapids, Michigan, 1967.

[6] Ian Kennedy, The Times, Tues. Sept. 8th, 1981,
‘Where Doctors and the Law Meet’.