'...not just the premier
Christian bioethics institute in Britain,
but one of the finest in the
world, Christian or secular'
Most Rev. Anthony Fisher O.P., Auxiliary Bishop of Sydney
Obstetrics and Gynaecology
in a multi-
cultural society:
The Catholic view
Luke Gormally
The following is the text of a talk given
last year to the Section of Obstetrics and Gynaecology of The Royal Society
of Medicine. It was one of a number of 15 minute talks on the theme of `The
practice of Obstetrics and Gynaecology in a multi-cultural society' which
were intended to inform practitioners of the beliefs of different `faith
communities' relevant to their practice.
A culture is a way of living, and in particular
a way of thinking, that is transmitted from one generation to another. A
multi-cultural society is supposed to be one in which different ways of
life, informed by distinct understandings of human life, can find a place
and can continue to flourish.
I have the uneasy feeling that I have been kindly
invited as a native witness to the beliefs of what may be seen as a somewhat
exotic subculture managing mysteriously to survive in a secularised society.
The feeling is an uneasy one for two reasons.
First, because I belong to a community, the Roman Catholic Church, which
has been around for 2000 years, and, though it may be in a somewhat enfeebled
condition in the UK, remains a community exhibiting plenty of vitality,
intellectual, moral and spiritual, in other parts of the world. Secondly,
the Catholic beliefs I shall highlight, as having a particular relevance
to the practice of Obstetrics and Gynaecology, are beliefs which in their
basic practical requirements were generally shared by all Christian bodies
up to the early part of the 20th century. As such, they were characteristic
beliefs of the dominant culture of Europe for many centuries and seemed
to many, who reflected on them, rationally defensible.
Confronted by this particular native witness,
many of you may feel inclined to adopt the characteristic posture of the
sceptical anthropologist, for whom native beliefs are never to be taken
at their face value. The 15 minutes allotted to me provides insufficient
opportunity to put a case for taking them seriously. But I would like to
suggest that if your scepticism is inspired by the now dominant secularist
mind-set of our culture, it is a mind-set which is taking Obstetrics and
Gynaecology in directions which need to be critically examined.
What are the key beliefs of a Catholic relevant
to the practice of Obstetrics and Gynaecology? The most fundamental belief
of the Christian is that the world has been created by God and exists in
a relationship of fundamental dependence on God. The world, and human beings
in particular, have been created for a purpose. Human beings have been created
for a life of friendship with God, and there is in consequence a built-in
goal-directedness to the nature of human beings. Human happiness depends
on our achievement of that goal.
Because we are equipped by nature with the radical
capacity to develop those abilities which are the precondition of our recognising
and freely accepting God's offer of friendship, human nature as such possesses
a great dignity. An individual human being in his or her earliest developmental
stages - as an embryo and then a fetus - is not, of course, already in possession
of those exercisable abilities to understand and choose which will normally
be involved in entering into the friendship which is the key to our happiness.
But we cannot make good sense of the acquisition of those abilities without
assuming an active capacity to acquire them, inherent in the individual
from the outset - in other words, from conception. The dignity which is
proper to our nature is what grounds our equality in dignity as human beings.
This equality in dignity is in turn the basis of our possession of fundamental
human rights. The most elementary of those rights is the right not to be
unjustly killed. Without that right it is obvious that human beings do not
possess the minimum condition for flourishing. It follows, therefore, that
abortions which of their nature or by intention kill the unborn child are
morally speaking - whatever the law may hold - acts of murder.
I have spoken of the radical developmental capacity
inherent in our nature in virtue of which we are able in the course of normal
development to acquire abilities to communicate, understand, choose and
act intelligently. But these abilities are not acquired outside a context
of sustaining and facilitating relationships. Of our nature we are dependent
creatures. Catholic Christians believe that the most fundamental relationship
we depend on within the created order (that is in God's designs for the
wise ordering of human life) is the marriage relationship. By the marriage
relationship is meant the unreserved, self-giving commitment of a man and
a woman to each other, in which each treats the other as irreplaceable.
Why is precisely such a relationship required for the begetting and nurturance
of a child? Because that kind of relationship is uniquely conducive to recognition
of the dignity of the child. How so? Recall that the dignity of the child
consists in the fact that he or she is a creation of God and is properly
seen as a unique, irreplaceable gift of God to the parents. The parents
then need to be engaged in a relationship which is open to receiving children
as gifts. This means that a married couple should not turn their sexual
relationship into one in which they set their hearts against children. One
can set one's heart against children in a number of ways, but one kind of
choice which denatures the marital relationship as a relationship essentially
ordered to the begetting of children is the choice to render one's sexual
intercourse infertile: one may choose to do this on a permanent basis (through
male or female sterilization) or on a temporary basis (through contraception).
The choice to do so embodies a decision to find sexual intercourse meaningful
in ways that depend on turning it into a non-generative kind of activity.
What is at issue here is the sense a couple have of the meaning of the sexual
relationship. The Catholic Church in effect teaches that the minimal condition
of a couple retaining an adequate sense of their relationship as essentially
ordered to the good of children is that their intercourse should be of the
normal generative kind. Of course most intercourse is not fertile, but it
remains a generative kind of activity providing it is not deliberately made
infertile when it might be fertile. This, very briefly stated, is the background
to the Church's teaching about the wrongness of contracepted intercourse
in marriage.
The basic objection to the use of contraception
outside marriage, to secure pregnancy-free intercourse, is that it destroys
in people the dispositions they need to make genuine marital commitment
seem possible or desirable. I have already explained what I mean by genuine
marital commitment: one which keeps alive a sense of openness to the child
as gift. A society which systematically undermines the disposition to marriage,
as ours is manifestly doing, is prescribing a destructive future for itself.
The Church's teaching about reproductive technologies
such as IVF and GIFT is the obverse of the teaching about contraception.
Of course there is an additional ground for objecting to much IVF, namely
that it involves the intentional destruction of embryos, either for experimental
purposes or as surplus to requirements. But it is at least possible to imagine
IVF without further destruction of embryos, and if it did exist, what would
the objection to it be?
The objection to contraception in marriage is
that sexual intercourse only makes for the unity proper to marriage if it
is the kind of activity which is generative, in other words if it is intelligible
as the kind of activity through which children are brought into being. Catholic
teaching about the principal reproductive technologies is the obverse of
this, in the sense that it holds that the only kind of activity through
which children should be brought into being is the activity expressive of
the self-giving proper to the marriage bond. Why should human generation
have as its human cause the kind of act which is expressive of the unreserved
self-giving of husband and wife? It is because when a child's coming-to-be
has its origin in such an act then the child enters the relationship of
husband and wife as the fruit of unreserved self-giving. It is precisely
and only that status which is adequate to the dignity of the child: for
truly unreserved self-giving carries with it a commitment to unreserved
acceptance of the fruit of that self-giving. The dignity of the child is
only adequately recognised in the acceptance and cherishing of him just
as he is. The disposition to that acceptance is protected precisely
by the teaching that what human beings do to bring a child into being should
be an action of the parents which is also expressive of that unreserved
self-giving which makes for marital unity. The rejection of that teaching
tends to undermine the disposition to accept children as they are given
to us, and as, therefore, the persons they are. That rejection has had
incalculable consequences, both in the fields of clinical practice and biomedical
research, and more broadly in society in people's attitudes to children.
The development of the `reproductive technologies' assumes the acceptability
of separating the generation of children from the sexual act expressive
of the unity of the parents. In consequence, human beings generated in
vitro have come to seem to be the manipulable products of
technical expertise rather than the fruit of unconditional self-giving.
In vitro embryos, rather like mass-produced objects, are subject
to quality control and discarded if deemed unfit for implantation; others,
as I've already noted, are generated solely for experimentation which is
destructive for them. There is work in the field of genetic engineering
which looks to a future in which designer babies will be produced to parental
specifications. All this, on top of abortion, reinforces a view of the child
as a conditionally acceptable acquisition rather than a gift to be unconditionally
accepted. It is seriously and dangerously at odds with the respect due to
the dignity of every child.
The Catholic Church does not see itself as in
the business of promoting short-term technical fixes for the problems created
by moral disorder. It would have lost its way if it did. At the heart of
what it teaches is, of course, a message of salvation from moral disorder.
In this short talk I've focused on those truths, of particular relevance
to the practice of Obstetrics and Gynaecology, which the Church teaches
about human destiny, about the great dignity which therefore belongs to
every human being, about the vocation and dignity of marriage and the requirements
attaching to the commitment of marriage, and about what is required to respect
the dignity and foster the good of every child. The Church is happy to see
any biomedical and clinical developments which are consistent with respect
for the dignity of the unborn human being, are consistent with respect for
the institution of marriage on which the good of children depends, and which
serve to sustain rather than sever the vulnerable bonds of dependence on
which each new generation depends.
I recognise that this moral vision will seem
not merely alien but inherently incredible to those of a secularist mind-set,
for whom God does not exist or, if he does, has no concern with human affairs.
Human beings are the chance product of an evolutionary process lacking inherent
purpose. They therefore lack any distinctive worth or dignity just in virtue
of being human. Value is a function of the human will. So it is only those
who have developed abilities for understanding and choice who are in a position
to endow their lives with the values they wish to attach to them. If a woman,
on whom the life of an unborn child depends, wishes to terminate that life,
there is nothing in the moral status of the child which could stand in her
way. If people choose to find valuable any form of sexual activity, medicine
can be co-opted to clear up the undesired consequences. If people claim a
right to have babies, or to have babies which are expected to meet certain
specifications, medical science is devoted to meeting those demands.
It is unsurprising that contemporary Obstetrics
and Gynaecology is so strongly influenced by the secularist mind-set of
the dominant strain in contemporary culture. Let me conclude by drawing
your attention to one consequence of this state of affairs.
Secularists commonly think of themselves as
liberals, tolerant of other bodies of belief and other ways of life. The
title of this evening's meeting speaks of the practice of Obstetrics and
Gynaecology in a multi-cultural society. Is there a practice of Obstetrics
and Gynaecology which accommodates committed Catholics? Nearly all the evidence
suggests the answer is `No'. The practice of abortion has largely closed
the profession to them. Can Catholic and other women, who look for an absolute
respect for the unborn life they carry, expect to find it? For the most
part no. Many, for example, are subjected to not inconsiderable pressure
to have abortions if there are grounds for thinking their child is handicapped.
So it would be an illusion to believe that the
secularist moral outlook accommodates a genuine multi-culturalism. It could
not do, because there is too much that it radically rejects in the traditional
understanding of human life.
