May 2017 Pulse
One of the reasons that the National Council of Churches of Singapore gave for rejecting physician-assisted suicide (PAS) and euthanasia in its 2008 statement is that these actions are “against the very ethos of medical practice”.
The betrayal of medicine’s noblest purpose that the growing acceptance of PAS and euthanasia signifies and accentuates is of course the result of many different but profoundly related developments.
The first of these is the subtle shift of the focus of medicine away from the patient.
According to Edmund Pellegrino, the Hippocratic Oath that has served European and American physicians since the dawn of modern medicine is now under attack both from without and within the medical profession. This is because some are of the view that the values it upholds are unable to address the complex ethical issues presented by emerging medical technologies.
But the rejection of the patient-centric tradition exemplified by the Hippocratic Oath exacts a heavy price because it changes the very character of medicine itself.
As philosopher Dianne Irving has rightly observed, once this tradition was weakened, “bioethics began to replace it with medicine practiced for the greater good of society rather than for the individual patient. That threatens patient welfare and denigrates medicine into a business rather than a profession”.
Another possible contribution to medicine’s betrayal is the secularisation of ethics, as a result of which moral reasoning is bereft of the very assumptions and principles that are supposed to govern it.
To be sure, some ethicists – like Leon Kass and Gilbert Meilaender from the Jewish and Christian traditions respectively – still regard human life as sacred and insist that physicians should be committed to the bodily life of their patients. But such views are gradually going out of vogue, supplanted by a utilitarian ethic couched in heady rhetoric about “the greater good” of society, and about individual autonomy and rights.
Edmund Pellegrino and David Thomasma offer a penetrating diagnosis of the modern predicament in medicine as well as in other fields when they write: “Much of the moral desuetude [state of disuse] into which we believe the professions – medicine, law, even the ministry – have fallen is the consequence of ethical claims without a moral philosophy on which to ground them.”
“Moral arguments based on utility, cost-benefit analysis, contract law, economic restraints, unbridled individualism are all symptoms of ‘moral malaise’,” they add.
Utilitarianism has indeed become the new orthodoxy in biomedical ethics.
“All [leading] bioethicists,” writes Anne Maclean, the perceptive critic of bioethics, accept “some version of utilitarianism”. University of Cambridge Law Professor John Keown agrees. In an interview, he asserts that “in modern bioethics, nothing is, in itself, either valuable or inviolable, except utility”.
Ethicists must therefore shoulder some responsibility for the erosion of moral acumen and for the betrayal of medicine’s noblest ideals.
Theologian Richard John Neuhaus put it starkly: “Thousands of ethicists and bioethicists, as they are called, professionally guide the unthinkable on its passage through the debatable on its way to becoming the justifiable, until it is finally established as the unexceptional.”
We see this happening in so many areas in biomedical ethics, from stem cell research to gene therapy, and from the criteria for ascertaining death to the hydration of PVS patients. We also see this in the debate surrounding PAS and euthanasia.
For example, Peter Singer and utilitarian ethicists like him are constantly pushing the envelope with regard to euthanasia.
Singer envisions an ideal world where all terminally-ill patients would be routinely euthanised. He writes: “Perhaps one day it will be possible to treat all terminally-ill and incurable patients in such a way that no one requests euthanasia and the subject becomes a non-issue; but this is now just a utopian ideal, and no reason at all to deny euthanasia to those who must live and die in far less comfortable conditions.”
For the Christian, medicine is a gift of God, the outworking of His common grace in this fallen world. The true goal of medicine is always to help and to heal, never to harm or to kill.
The utilitarian calculus that is so pervasive in the practice of modern health care is not only alien to the character of medicine. It has also seriously undermined and subverted medicine’s true and highest purpose.
Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor for the Ethos Institute for Public Christianity.