Bioethics in India: Proceedings of the International Bioethics Workshop in Madras: Biomanagement of Biogeoresources, 16-19 Jan. 1997, University of Madras; Editors: Jayapaul Azariah, Hilda Azariah, & Darryl R.J. Macer, Copyright Eubios Ethics Institute 1997.

28. Christian Perspectives in Medical Ethics

M. Gnanapragasam, S.J.
Jnana Deepa Vidyapeeth, Pune.

1. Introduction

All of us are aware, I am sure, of the latest controversy created by Dr. Dhani Ram Baruah from Guwahati, the surgeon who transplanted the pig heart in the 32-year old Purna Saikia, and by two of his associates, Dr. Jonathan Ho of the Hong Kong based Prince of Wales Medical Institute and Dr. C.S. James, perfumery. All three were arrested on 9 January 1997, for the alleged violation of the Organ Transplantation Act, 1994, as the entire episode attracted world-wide attention not only local newspapers (1).

The wrenching debate over whether the terminally ill have the right to commit suicide with a doctor's help went to the US Supreme Court on 8 January, 1997, in what could be its most important case in over twenty years. Throngs of protesters from both sides gathered outside the imposing marble court. Opponents of medically-assisted suicide, many chronically ill or disabled, chanted "We are not dead yet," while supporters waved picket signs asking for the "right to die with dignity" (2).

As we know, AIDS has become the Global Epidemic. The grand total of HIV infected children up to the year 1996 is 830,000 out of whom 400,000 were infected only in the year 1996. The total of HIV infected adults and children is 22,600,000 out of whom 3,100,000 were infected only in the year 1996. AIDS is tightening its grip on the developing world - where the costly new drugs won't do much good at all, says Andrew Purvis, in the latest issue of Time (3).

There are so many other medical issues such as abortion, human experimentation, contraception, and experimentation on animals which the modern world faces. In this situation, what is the position of Christianity? What are the views of Christian ethics on such medical issues? Has the Christian tradition anything to offer to the world of today? Are Christian perspectives in medical ethics relevant today?

One should note here that we shall be looking into the Catholic tradition only, as we cannot do justice in this paper to the tradition of every section [sect] of Christianity. Besides, since medical ethics is like a vast ocean covering so many areas and issues, it is impossible for us to consider all the medical issues. We shall attempt to cover some selected issues.

2. Basic Assumptions and Beliefs of the Christian Tradition

Before one considers the Christian perspectives in medical ethics, it would be better and helpful if one understands the various basic assumptions and beliefs of the Christian tradition, as they form the basis and foundation of the Christian views and perspectives regarding medical issues and problems. Hence, let us briefly spell out the basic Christian assumptions and beliefs.

[i] There is one God who is the creator and source of life.

[ii] Human beings have been created by God in His image and likeness.

[iii] God is the ultimate foundation of moral order.

[iv] The life of human beings is a gift of God, and hence sacred.

[v] Human beings are the centre and steward of the universe.

[vi] Human beings are ends - in - themselves, and not objects; they are not just animals; they have been endowed with rationality; they are bodied-souls; their souls are eternal;

[vii] There is life after death.

[viii]Human beings are the temples of God. He dwells in them.

[ix] As temples of God, their body is to be treated with respect and dignity.

[x] Life of a human being is to be respected from the first moment of conception till death.

[xi] Life on earth is to be valued; one must take reasonable care to preserve and save it.

[xii] No one has a right to take away the life of one's own or of others.

[xiii]Health is a gift of God; but suffering and sickness too have a value.

[xiv] This God [the God of Love] has revealed Himself/ His Love in and through Jesus Christ on the Cross.

In this context, it is worth referring to one of the latest articles on the Christian tradition. Lucius Nereparampil, in his article `Life and its Value in the Christian Perspective', analyses the following aspects: `Life as Precious Gift of God'; `Life is to be Enjoyed in Full Measure'; `Death Destroys Life'; `Life is fragile'; `Life is Sacred'; `A Glimpse of a Life Beyond Death'; `Life is Eternal'; `Life is the Very Life of God'; `Life Culminating in Resurrection' (4).

3. General Orientations In General And Medical Ethics

After considering some of the important assumptions and beliefs of the Christian tradition, one could now try to understand its general orientations in medical ethics (5).

3.1. Every Patient as a Person

Fr. George V. Lobo says in his book, Current Problems in Medical Ethics, "The patient is not a `case' or `a bed number' but a person with a unique character, a unique destiny and a unique problem." (6). One needs to note that it is not so much a question of an organ malfunctioning or of an abnormal rise in temperature, but of a person suffering.

3.2. Person-Centred Morality

The fact that it is a person who is suffering and not just an organ which is malfunctioning calls for a method of treatment that is person-centred. The person-centred treatment meets the unique need of a particular person experiencing a particular problem.

The person-centred morality of the Christian tradition calls every Christian and the medical professionals to consider their profession as a personal call and vocation to be men and women for others, and to be persons of selfless service, like Jesus Christ. This, in turn, invites us to become persons of responsibility. Speaking of responsibility, George V. Lobo says: "It is the exercise of responsibility, being responsive in the inter-personal dialogue between God and man, and between each man and his neighbour. Responsibility is the same as response-ability or capacity to respond by cultivating one's potentialities and freeing oneself from inhibitions and the shackles of selfishness." (7) The basic call to [person-centred] morality, according to the Christian tradition, is not an obligation thrust on us, but rather a gift offered by the divine Spirit who dwells in us. Thus it is both a gift and a task. Doctors and nurses are to give importance, in their life and work, to the fruits of the Spirit such as love, joy, peace, patience, kindness, goodness, faithfulness, gentleness and self - control [cf.Gal.5 : 22]. If and when they follow these virtues in their life and work, their duty and task can be transformed into joyful service (8). One could easily notice that the Christian tradition is not in favour of act-centred morality. Beyond all individual acts and choices, there is the fundamental option, the self-commitment of a person which should be stressed. Of course, the person-centred morality gives importance to all the three aspects of morality, namely, the intent of an action, the intention and motive and purpose of the agent, and the circumstances of the action.

3.3. Primacy of Love

The Christian morality regards love as the highest moral value, which all other religions and the humanists too stress as the most basic and important value in life. Jesus tells his disciples that people would know that they are His disciples by their love for one another. The only commandment ["a new commandment"] which Jesus gave His disciples was : "You ought to love one another as I have loved you." This love is not just an emotional feeling or an infatuation or lust, but a real concern and respect for others, for their person, dignity, and well-being. It is a self-sacrificing service, understanding, acceptance, tolerance, and forgiveness. Love does not consist of mere words; love, if it has to be called authentic love, has to express itself in actions of goodness, generosity, service, and kindness. No Christian can say that he loves God when he does not love his brothers and sisters, especially the sick, the needy, and the marginalized. There is a profound unity between the love of God and the love of neighbour.

3.4. Natural Law

One is aware of the fact that there is so much misunderstanding with regard to natural law. Though we cannot explain this concept in detail in this paper, we must admit that the concept of natural law is basic to the Christian morality. This becomes clear from the teaching of Vatican II. For instance, speaking of the means of the birth regulation, the Second Vatican Council says: "... it must be determined by objective standards, based on the nature of the human person and his acts." (9) The concept of natural law, according to some Christian theologians like Bernard Haring, is the crux of Christian theology and philosophy and of medicine (10).

Many have explained the concept of natural law and interpreted it in their own way. We shall consider one such understanding of it. George Lobo explains natural law as follows: "Nature in ethics does not refer to physical or biological laws. It refers to the essential quality of man as man. The expression `laws of humanity' in the International Code of Medical Ethics is equivalent to natural law. Natural law is the mode of behaviour demanded of man as the `image of God,' as personal and free being. It is the same as `the law written in our hearts' {Rom.2,15}." (11).

3.5. Guidance of the Church

Apart from natural law which is basic to the Christian ethics, there is one more aspect in the form of the guidance of the Church which also plays a vital role in the understanding of moral issues. Of course, guidance of the Church is not above natural law which is the divine law written in human hearts. With regard to certain issues, e.g. contraception, there is no sense in speaking of the guidance or law of the Church. Still, according to the Second Vatican Council, it is the duty of the Church, as the teacher of the truth, "to declare and confirm by her authority those principles of the moral order which have their origin in human nature itself." (12). If the Church defines a doctrine regarding any specific moral question as an infallible doctrine, then absolute assent of faith is due to it. To doctrines of non-infallible teaching, the Christian faithful are expected to adhere, with a religious assent of soul, which implies openness to the teaching office of the hierarchy and the readiness to accept it loyally (13).

3.6. Sanctity of Personal Conscience

In the Christian tradition, one's personal conscience has always been recognized as the supreme norm of morality on the subjective level, though, some Popes and others have tried to minimize its importance. Vatican II describes the nature of conscience thus: "In the depths of his conscience, man detects a law which he does not impose upon himself, but which holds him to obedience. Always summoning him to love and avoid evil, the voice of conscience can when necessary speak to his heart more specifically: do this, shun that. For man has in his heart a law written by God. To obey it is the very dignity of man; according to it he will be judged. Conscience is the most secret core and sanctuary of a man. There he is alone with God, whose voice echoes in his depths. In a wonderful manner conscience reveals the law which is fulfilled by love of God and neighbour (14).

Conscience, the core of the personality, as everyone is aware of, is a most complex reality where several , often conflicting forces are at play. They are one's spontaneous drives and the introjected pressures from society [`super - ego'] on the level of instinct, an interior law as a function of self-development on the rational or ethical level, and the pull to transcend from the limited self-growth to loving and total self -gift to God and one's fellow human beings (15). Each one of these factors should be carefully evaluated in order to have and form a right conscience.

According to the Christian tradition, in doubt as to the lawfulness of an action, one is to follow the principle of Probabilism. In other words, in doubt, the individual is free to choose whichever side he prefers. Needless to mention that the individual should always be inclined to that where he thinks he can do greater good or service. In moments of perplexities and conflicts, one is bound to follow the principles of the lesser evil and the greater or superior duty. In all these, an individual is bound to follow the dictates of his clear and sure, and genuine conscience.

3.7. Principle of Totality

The principle of totality has evolved in the Christian tradition. Traditionally, the principle of totality was understood thus: "Any treatment, including mutilation, is licit if it is necessary for the saving or the well-being of the whole individual organism (16)." In other words, the principle was restricted to the somatic aspect of life. Because of the weakness inherent in the traditional notion, the principle has now been expanded by many recent authors to include not only the somatic good of the human organism, but also the person's spiritual well-being. For instance, Bernard Haring affirms: "The main criterion is the principle of totality -- not a totality of mere organic functions but a perspective of wholeness that considers the total vocation of the human person. It is not just a question of the meaning of the bodily organism; the most urgent issue relates to the meaning of an integral human life in response to man's earthly and eternal values." (17) After affirming thus, he defines the principle of totality in the following way : "The dignity and well-being of man as a person in all his essential relationships to God, to his fellowmen and to the world around him." (18)

3.8. Principle of Double Effect

The Christian tradition, as seen above, stresses the aspect of the human person's responsibility. The responsibility of an individual person extends not only to what his act directly tends towards, but also to the unintended consequences which he foresees will result from his act. The latter is called indirect voluntary act vis-à-vis the former which is called direct voluntary act. In daily life, many a time a person faces moral conflicts. The person intends to do good [only good]; but his act would necessarily cause some bad effect too. That is, not only a good effect but also an evil effect would ensue his act. The person wants to avoid the bad effect, but he is unable to do so. And there is no other alternative than this particular act. The person is reasonably sure that a proportionate reason is there to permit the evil effect. What shall and should the person do in such a situation? In such a situation, according to the principle of double effect of the Christian tradition, the individual can go ahead in doing the act, provided that the good effect is not achieved through the evil effect and that he really wants and intends to avoid the bad effect, which is impossible in this case.

4. Implications and Consequences of these Assumptions, Beliefs and General Orientations

So far we have tried to understand the various assumptions, beliefs, and general orientations of the Christian tradition. Now we could proceed to make an attempt into the implications and consequences of these assumptions, beliefs and general orientations. As mentioned earlier in the introduction of this paper, we shall consider only a few cases in medical ethics such as euthanasia, terminal care, abortion, organ transplantation, and experimentation on humans and animals.

4.1. Euthanasia

Euthanasia is the taking away the human life either of one's own or of another; the person whose life is taken must be someone who is suffering from a serious illness or injury from which recovery cannot reasonably be expected; and the action of taking away the life must be deliberate and intentional (19).

Since life, according to the Christian tradition, is a gift of God, comes from God, is sacred, and has a value, and since a human being is not the author of life, he has no right to take away the life of his own or that of another. No one should play God. "Catholic theology has traditionally condemned euthanasia because human beings do not have full dominion over their lives. God is the creator and giver of life, and we are stewards of the gift which we have been given." (20)

Hence, it is morally wrong to resort to euthanasia. Every human being should try his best to preserve his life and others' life as far as possible, should try to save life and not to destroy it. As a responsible steward, everyone has a duty to take reasonable care of his health and to use the necessary means to preserve life. He is obliged to use the `ordinary means' and not the extraordinary means of preserving the life. Gerard Kelly offers the standard definition of the ordinary means. They will include "not only normal food, drink and rest but all medicines, treatments and operations, which offer a reasonable hope of benefit for the patient and which can be obtained without excessive expense, pain or other inconvenience." (21) Note that in medical parlance, `ordinary' is generally understood as whatever means are standard and well established.] No one is obliged to use the extraordinary means of preserving life. "Extraordinary means have been defined as those means not commonly used in given circumstances, or those means in common use which this individual in one's present physical, psychological or economic condition cannot reasonably employ or, if employed, will not give a definite hope of proportionate benefit. The casuistry involved in understanding and applying this principle is most interesting. If a particular procedure or operation is too painful or too expensive or would cause us to be away from family and hearth for an inordinately long time, there is no obligation to use it." (22) When God calls the person to the `other-life' -- the life after death, the person must be ready to die. The individual himself cannot put an end to his life. Just because the illness is terminal or unbearable and painful, one cannot ask for or resort to, or help another to resort to euthanasia. "Direct killing, by whatever name it is called, violates God's sovereign dominion over the human life. Hence the request of the patient to put an end to his life, even if it were free, is objectively wrong, since it contradicts the meaning of death as the final surrender of oneself to God and so the doctor may not accede to it. It would not be true love of the patient." (23) It is more accurate, in the Christian tradition, to speak of `the right to die with dignity' rather than `the right to die'.

Sickness, though in itself is an evil, has a redemptive value. George V. Lobo, speaking of meaning of sickness, affirms: "Hence, it is not at all strange that patients often reveal hypersensitivity and irritability. ... So sickness can prove to be a time of trial and temptation. But sickness can also prove to be a time of grace. ... The Christian should try to see the adversity of sickness in the light of the paschal mystery of the death and resurrection of Christ. Suffering then prepares the way for the approach of eternal life." (24) Suffering and sickness do not necessarily take away the quality of life. Often this quality of life is misunderstood by quite a few persons; and because of sickness, they think their quality of life has greatly suffered and hence they prefer death to their so-called `poor' life. "This raises the further question about the ultimate meaning and value of human life. Yes, medical science should try to overcome physical suffering, alleviate sickness and even contribute to the betterment of the individual and the race if possible, but the problem of suffering and evil must be faced on a deeper level." (25).

4.2. Terminal Care Therapy

Since life is a gift from God, since God is the Creator and source of life, since health is a gift of God, and since sickness and suffering can become periods of grace and liberation both for the patient and those who take care of him, the medical professionals and the dear ones of the patient who is terminally ill must, first of all, do all they can to cure him, to heal him, to preserve his life. They should offer him love, concern, affection, sympathy, understanding and service which he requires. The patient must be treated by them till the end with respect, honour and dignity of a person. He must be treated as a person, and never as `a case', `a bed number', `an object'. Their treatment and therapy must be holistic. G. V. Lobo rightly affirms: "In the same perspective, therapy will not focused onesidedly on physical suffering or defect but on redemptive liberation in a holistic vision." (26).

Those who take care of the terminally ill must not easily give up. They must fight till the end to save the patient. They must never accede to the demand or request of the patient to resort to euthanasia. They themselves should never take away the life of a patient who is terminally ill. They are not the creator of life. They should not administer euthanasia on the terminally ill, just because the patient is acutely suffering from a serious illness, or just because the patient is asking for death, or just because the patient has become `useless', `a nuisance', `an inconvenience' in the eyes of others. The principle of primacy of love demands that they care for the patient till the end, even when is no more `useful' and that they care for him in good times and in bad. It is their duty to help the patient accept the terminal disease with courage and to die with dignity. They and the patient are invited and expected to experience the redemptive value in and through the terminal disease and suffering. "A proper emphasis on improving the quality of human life and human existence must never lead to lessened respect for the handicapped, the retarded, the deformed, the aged, the institutionalized and all those others who are most in need of our compassion." (27) The medical professionals and the dear ones and relatives are to cultivate the Christian attitude towards life, health, sickness and suffering and to get rid off the utilitarian attitude which promotes only usefulness, utility, productivity, progress and achievements, and which considers sickness as a burden. "In our rightful quest of improving the quality of human existence, there is always the danger that we will write off as not human those whom we deem too much of a burden for themselves, or who perhaps more exactly, create too much of a burden for us." (28)

4.3. Abortion

Abortion, as one knows, is the expelling of a non-viable fetus with the certain consequence of the deprivation of its life. The Declaration of Geneva of the World Medical Association, Sept. 1948 clearly affirms: "I will maintain the utmost respect for human life, from the moment of conception." Abortion is a highly debated topic in the world. There are anti-abortionists, and pro-choicers who want to choose and decide what they want to do with the fetus. For quite a few, abortion is not an issue at all. Without any qualm of conscience, they abort the fetus in the womb of the mother. Many countries have legalized abortion.

But the Christian tradition has been consistently and vehemently opposing abortion, as it upholds the sanctity of human life from the first moment of conception. The Church has, down the centuries, condemned it tooth and nail, in spite of the strong opposition from nations, people, and women in particular. According to the Christian tradition, once there is actual human life, however incipient, it is inviolable; in other words, it may never be destroyed. This doctrine has been strongly supported by Vatican II. Vatican II states: "From the moment of its conception life must be guarded with the greatest care, while abortion and infanticide are unspeakable crimes." (29) What is not clear here is when human life begins. And there are controversies regarding the moment of hominization. Most of us may be familiar with Pope Paul VI's Encyclical Humanae Vitae which was written about thirty years ago. This encyclical too very powerfully defended the sanctity of human life from the first moment of conception, and condemned abortion. This position of the Church is in keeping with the Biblical tradition. The Bible holds that God has a special care for the infant in the womb. [cf. Job 10:10-12; Ps. 139:13-16] These passages tell us that God is sovereign in shaping the physical form as well as the life destiny of the child already existing, but yet to be born.

One could note that the Church does not allow abortion, except for therapeutic reasons. The following can be cited an example of therapeutic abortion (30). Abortion may be permitted if a woman is unable to sustain a pregnancy because of coincidental diseases like weak heart, severe anemia, pulmonary tuberculosis, diabetes mellitus, renal disease and epilepsy. Using the principle of double effect, the Church permits therapeutic abortion. The Church does not accept abortion for the sake of other reasons such as unwanted pregnancy, low income, inability to take care of more children, curtailing population, child born out of wedlock, etc.

4.4. Organ Transplantation

For the modern medical world, organ transplantation has become a delicate issue. Patients, more often than not, need organ transplants. But there are quite a few ethical problems involved in this issue. All of us are aware of the abuses of organ transplants that have taken place in our country and elsewhere. "The ethical judgment regarding organ transplants concerns first of all the recipients and the donors, -- and thereafter the doctors and their responsibilities. Further, the cultural and social effects of this ethic, as well as its legal provisions, must be taken into account." (31) Without modern medicine many persons would have died. At first some Catholic theologians had difficulty in justifying transplants because the only accepted justification of medical operations or mutilations {as they were called} was the good of the individual as incorporated in the principle of totality. But others, on the basis of charity and love for the patient or on the basis of an expanded version of the principle of totality were willing to justify transplants, especially in the case of paired organs, provided there was no disproportionate harm done to the donor (32).

From the point of view of the recipients, the advantage hoped for has to be weighed against the possible dangers. Transplants should preserve, prolong and improve life; they should be able to diminish certain sufferings and heal certain illnesses. As far as the recipient is concerned, there must be a solid hope of an advantage and benefit proportionate to the gravity of the operation and the risks involved. But nobody has a claim on organs or tissue of any person, living or dead. The patient, i.e. the recipient should accept the tissue and organs freely offered by others as a gift.

"We have an auto-graft when the tissue is taken from the body of the receiver itself. There is an homo-graft when the tissue is taken from a different subject, but of the human species. The operation is called a hetero-graft when the tissue or organ is obtained from an animal." (33).

The morality of auto-grafts is simply to be judged from the total welfare of the person concerned. While we considered the principle of totality, we have already stated that every aspect of the well-being of the patient must be taken into account. Any treatment, including mutilation, must not only include the somatic good of the human organism but also his psychic health and spiritual well-being. So this principle is to be followed by everyone involved in organ transplants. Hetero-grafts, according to the Christian tradition, do not pose any moral problem from the point of view of the subject from which the tissue or organ is obtained since the finality of lower animals is to be entirely ordained to the good and well-being of humans. But the transplantation of the sexual organs from the animal to man is considered immoral, as sex hormones would have a very strong influence on the whole organism and personality of the human person and would likely produce undesirable changes of personality, and as such transplantation might create the possibility of cross fertilization (34). Here we could once again recall to mind the controversy that has surrounded the `pig-to-man' heart surgery performed by Dr.Dhani Ram Baruah of Guwahati. Every one , including the Assam government and medical association, has condemned this transplant as unethical.

One could now consider the case of organ transplants from the donor's point of view. "But most theologians agree that there are limits to what one can do for another, and great problems exist when the donor is a child who cannot freely and fully consent. Is the parent able to give consent for the child in such a case?" (35) Besides, transplants do illustrate how one individual can be harmed or exposed to risks in order to help others. In the Catholic tradition, blood transfusions, once they became safe, have always been approved and even appreciated. The only problem that can arise is concerning the freedom of weak persons induced to donate blood for monetary considerations. Financial recompense may be received provided the spirit of solidarity and brotherly love are not lost sight of. Pope Pius XII, in his address on 9 October, 1948, praised blood donors for their charity and love, which is an important principle of Christian ethics. On another occasion, he said: "It is creditable for the donor to refuse recompense; it is not necessarily a fault to accept it."(36) Similarly certain other organ transplants [e.g. donation of skin for grafts] have also been approved of. What about donating one's heart? We all know that removal of the heart could be very fatal to the person concerned. Hence organ transplantation of the heart from the point of view of a living donor may never be permitted (37).

After the death of the `donor', this could be performed. In general, the removal of organs from a diseased person is to be preferred to a donation by a living person, since in such circumstances no harm is inflicted on the person [donor]. Transplants from cadavers, i.e., from human corpses, have been approved of, provided certain precautions are observed. Of course, the respect due to the human body. "The human body was the carrier of the human person during life. Therefore, any disrespectful treatment is to be prohibited." (38) The following conditions must be fulfilled for the transplant of tissue and organs of a dead person: The possible removal of an organ must not hinder or restrict the efforts made to save the donor's life or to treat the donor; the death of the donor must be established beyond any doubt before organ removal; the legal conditions for the organ removal must be fulfilled; the intervention must preserve the dignity of the deceased person and take into consideration the feelings of the dear ones and relatives (39).

4.5. Experimentation on Humans and Animals

Without experiments, modern science and technology and medicine would not be what they are today. By having conducted so many experiments, modern medicine has advanced so much and has contributed to the survival, health, happiness and well-being of individuals and to humanity as a whole. And medicine should continue to conduct experiments for the welfare of humanity.

Recently, there was a news item regarding the former Chief Minister's security. When Miss Jayalalitha was in prison, the food served to her in the central prison was first tested for poison by serving it to cats (40). We, human beings, constantly experiment on animals in order to find new medicines and make progress in the medical world. We do use animals and experiment on them so that we, humans, may live and live well, and live happily. The Christian tradition does not have any objection with regard to experiments on animals. As mentioned earlier in the section on `organ transplantation', the finality of lower animals, according to the Christian tradition, is to be entirely ordained to the well-being of human persons.

Are the medical professionals permitted to experiment on human beings? "Above all, special problems exist for those whose freedom is limited or even nonexistent -- children, prisoners, institutionalized persons. Often these people form the best control group from the viewpoint of scientific experimentation, but one must be very careful about abusing their freedom." (41) According to the Christian tradition, the answer to the question depends on a number of factors. Experimentation [on the patient] for the good of the patient himself may be permitted, provided the inconvenience or risk should not be disproportionate to the benefit that is hoped for. Besides, the expense for the patient must be taken into account. Above all, the patient should never be treated merely as a means and as an object to manipulated. "Even though scientific progress might suffer, there are times when `no' must be said to scientific possibilities in the name of a Christian and truly human understanding of morality." (42) The patient too or any other person for that matter, has no right to allow himself to be experimented upon merely as a means and as an object.

But as has been noted above, medical science can progress only by experimentation, Every patient receives the benefit of this science which has grown and improved because of its past experience and history. Hence, he too should be ready to make his contribution to the alleviation of the sufferings of humanity. Within reasonable limits, he must be willing to be the subject of observation, of trial, and of research, though he cannot and should not become an object. Certain norms which have been drawn up and approved by the Declaration of Helsinki have also been accepted by Pope Pius XII and others (43). The following are the norms that have been stressed by the Declaration of Helsinki:

[i] The nature and purpose and the risk of clinical research must be explained to the subject of experimentation who must be free to fully exercise his power of choice.

[ii] Clinical research must conform to moral and scientific principles that justify medical research and must be based on laboratory and animal experiments or other scientifically established facts.

[iii] Every precaution must be taken against harm and injury.

[iv] There is a need for a careful assessment and evaluation of inherent risks compared to the benefit that is foreseen.

[v] Any experiment that involves a possibility and probability of death should be avoided; and special caution is to be taken when the person is liable to be altered by drugs of experimental procedures.

[vi] The subject or guardian should be free to withdraw at any time from the experiment.

5. Relevance and Implications of the Christian Perspectives in Medical Ethics

After understanding the assumptions, beliefs, general orientations and perspectives of the Christian tradition, it may be useful to see their relevance and implications. Do they have anything to contribute to the modern world? In this section, we shall make an attempt to briefly bring out some implications of the Christian perspectives and their relevance.

Respect for life is not just a Christian term; but it is a phrase that is frequently used by our society today. Its implications are manifold. The areas of life to which it is applied include many significant issues such as abortion, capital punishment, war, the poor, the elderly, the sick, and the retarded. So, using prudence, we shall make only a few implications and applications.

The dignity of and respect for human life, according to the Christian tradition, come from the creation of the individual by a loving God, from the special relation of the human being to the life-giving act of God, and from the destiny of each person. Charles E. Curran states: "Creation of the individual, who is destined by a loving God for the fullness of life, constitutes the basis, although not the total explanation, of the dignity and respect for human life." (44) Of course, the Catholic thought not only appeals to revelation, but also to reason and natural law. Using arguments from all the three sets, it emphasizes the uniqueness of the human. This reasoning has had an impact on many others. "One example of this reasoning acknowledged by all {as often pointed out by Catholic authors} can be found in the International Declaration of Rights proposed by the General Assembly of the United Nations in 1948." (45) One can see that the Catholic thought thus recognizes that one does not have to be a believer to affirm the dignity of human life.

This simple but profound thought that the dignity of and respect for human life come from creation and the destiny of the individual has a vital significance for us today. "The simple but profound Christian insight that the dignity of, sanctity of, and respect for human life come from the fact of creation and the resultant destiny to the fullness of life runs counter to many commonly accepted notions in our society. In the eyes of many, personal dignity and respect depend on what one does, makes or accomplishes." (46) We normally judge people on the basis of not only what they do and make or accomplish, but also what they have. Unfortunately, success, possessions, and accomplishments have become, for most of us, the basis of human dignity and respect. The poor, the retarded, and the weak are not given red-carpet treatment either by us or by governmental structures. "Our work-conscious and pelagic mentality only tends to exaggerate the role of works, success and accomplishments as the basis for the respect and dignity accorded to the human person. That is why there is a tendency to forget about the elderly, the retarded, the poor, the sick and the institutionalized. If individuals are not contributing members of society, then too all easily they can be written off. Here the difference from varying views on the basis for the dignity and respect for human life becomes evident. How does a society treat the oppressed, the poor and the weak?" (47) Thus we can clearly understand that the poor, the needy, and the oppressed who have always occupied an importance place in the language, if not in the practice, of Christian love of God and of neighbor should occupy an important place in the life of each human person, whether he is a Christian or non-Christian, whether he is a believer or a non-believer in God, just because they are human persons created by God in His image, and because they have their own dignity and destiny.

In this connection, it is very necessary to point out a possible danger in stressing the aspect of life as a gift from God. The danger is that the role and place of the human response could be easily underplayed, though the Catholic tradition, in contrast to the Protestant tradition, has always insisted on the human response that should be expressed in concrete actions of love, mercy, kindness, service, etc. Life is both a gift from God given us, and a stewardship entrusted to us.

Our stewardship, according to the Catholic tradition, is to be exercised in a reasonable way. "But the Catholic tradition has generally acknowledged that our stewardship is to be exercised in a reasonable way, so that one does not have to do everything possible to keep human life in existence. In the Catholic tradition there arose the principle that no one is obliged to use extraordinary means to preserve human life in existence." (48)

A credible witness of the respect for life must apply this respect for life to all areas. For instance, one can never imagine or think of raping someone, if one has real respect for the life of the other. Another consequence that follows from this respect for life is the prohibition of murder and direct abortion. In the case of abortion, the concept of respect and dignity that is based not on what one does, has and accomplishes, but on the creation and destiny of the individual plays an important role. "Even in the womb the fetus is considered a human being with all the dignity and respect for human life, for such dignity depends primarily on God's gracious gift. The question of abortion seems to illustrate quite well the differences that can emerge when there are differing views of the basis for the dignity of human life. Just because the fetus is not seen, or because it produces nothing or contributes nothing to society does not mean that it has less dignity or value than other human beings." (49) The same author stresses the equality of all human beings, in the same book elsewhere. "On a more theoretical level the quality of life raises serious questions. On the basis of the quality of life, should the conclusion be drawn that some lives are more valuable than others? The basic Christian thrust admits the equal value of all, but the quality of life, if poorly employed, could be used to differentiate among various human lives. Christian and human ethics, in my judgment, under ordinary circumstances {triage being an exception} should uphold the basic equality of all human beings." (50)

Another implication of the dignity and respect for life based on creation and God's gift concerns the fundamental understanding about the common destiny of the goods of creation. We have seen that the Catholic tradition holds that lower forms of creation are meant to serve the humans, and that God the Creator intends that the goods of creation exist for all human beings. Vatican II in the document `The Pastoral Constitution on the Church in the Modern World' maintains that God intended the earth and all that it contains for the use of every human being. "On this basis, the document affirms that the right to have a share of earthly goods sufficient for oneself and one's family belongs to everyone." (51) But our present culture does not seem to promote such a concept of sharing one's goods for the well-being and thus for the dignity and respect of the have-nots. "Here again there are some attitudes in our present ethos and culture that work against this basic implication of the meaning of respect for life based on creation. The emphasis on individualism, acquisitiveness and consumerism in our society all seem to work against the basic understanding that the goods of creation are destined for all human beings. People seem to accumulate wealth and power for themselves without any thought of others." (52)

Similarly, the common destiny of goods of creation demands of all of us that we have respect for nature and our mother earth which continually nourishes us and protects us. But environmental concern has become a serious issue. We humans have polluted the environment so much that our very survival is at stake. "Likewise, the present ecological crisis reminds us that our narrow and selfish use of the goods of creation gives no concern to other existing human beings or to those who will come after us." (53)

6. Conclusion

As has been pointed out in the introduction, we have only made an attempt to understand some of the Christian perspectives in medical ethics. We have seen the views of the Christian [Catholic] tradition regarding some vital issues and problems from the vast ocean of medical ethics. One can certainly affirm that the Christian perspectives in medical ethics, if they are properly understood by humanity, would do a lot of good to humanity. It may be at times difficult to put into practice the values proposed and promoted by these Christian perspectives. But they are very practical and valuable guidelines which the world cannot afford to lose. If all of us appreciate at least its view on respect for and dignity of life, and practice it, come what may, the world would be a heaven on earth.

1. Maharashtra Herald {newspaper}, Pune, 11th Jan. 1997, p.5.
2. Gretchen Cook, `US SC debates mercy killing', Indian Express {newspaper}. Pune ed., 10th Jan. 1997, p.6.
3. Andrew Purvis, `The Global Epidemic',Time {magazine}, December 30, 1996 - January 6, 1997, Vol. 148, No.27, p. 40.
4. Nereparampil, Lucius: `Life and its Value in the Christian Perspective', Journal of Dharma, Vol. XXI, No. 3, July - Sept. 1996, pp.239-249.
5. George V. Lobo, Current Problems in Medical Ethics, 3rd ed., St.Paul Publications, Allahabad, 1980, pp.20 - 34.
6. Ibid., p.20.
7. Ibid., p.21.
8. cf.Ibid., pp.21-22.
9. Constitution on the Church in the Modern World', Art. 51, d, in {General editor} Walter M. Abbott, The Documents of Vatican II, Guild Press, New York, 1966.
10. Bernard Haring, Medical Ethics, St.Paul Publications, Slough, 1972, p.42.
11. G.V.Lobo, op.cit., p.25.
12. Declaration on Religious Freedom', in {General editor} Walter M.Abbott, The Documents of Vatican II, Guild Press, New York, 1966.
13. cf. G. V. Lobo, op.cit., pp.26 -28.
14. Constitution on the Church in the Modern World', Art. 16, a, b, The Documents of Vatican II, 1966.
15. See `Constitution on the Church in the Modern World', Art. 16, c., The Documents of Vatican II, 1966 ; also see G. V. Lobo, op. cit., p.29.
16. G.V.Lobo, op.cit., p.31.
17. Bernard Haring, op.cit., p.62.
18. Ibid.
19. J. Gay-Williams, "The Wrongfulness of Euthanasia", in Stephen Satris, {ed.}, Taking Sides : Clashing Views on Controversial Moral Issues, 3rd ed., The Dushkin Publishing Group, Inc., Guilford, USA, 1992, p.284.
20. Charles E.Curran, Issues in Sexual and Medical Ethics, University of Notre Dame Press, Notre Dame, 1978, p.62.
21. Gerard Kelly, Medico-Moral Problems, Catholic Hospital Association, St.Louis, MO, USA, 1958, p.130.
22. C.E.Curran, op.cit., pp.201-202.
23. G.V.Lobo, op.cit., pp.62-63.
24. Ibid., pp.47-48.
25. C.E.Curran, op.cit., p.63.
26. G.V.Lobo, op.cit., p.48.
27. C.E.Curran, op.cit., p. 63.
28. Ibid., p. 64.
29. Constitution on the Church in the Modern World', in {General Editor} Walter M. Abbott, The Documents of Vatican II, GuildPress, New York, 1966.
30. See G.V.Lobo, op.cit., p.115
31. Christians and the Ethics of Organ Transplants', Excerpts from the Joint Declaration by the German Bishops' Conference and the Council of the German Evangelical Church, Catholic International, Vol.2, No.8, April 15-30, 1991, p.373.
32. See C.E.Curran, op.cit., p.64.
33. G.V.Lobo, op.cit., p.85.
34. See Ibid., pp.85-86.
35. C.E.Curran, op.cit., p.64.
36. Pope Pius XII, Address to Eye Specialists, May 14, 1956, A.A.S., 48 {1956}, 465.
37. See G.V.Lobo, op.cit., p.89.
38. Christians and the Ethics of Organ Transplants', op.cit., p.376.
39. See ibid., p.376.
40. See `Cats pay the price for Jaya's security', The Times of India {newspaper}, Mumbai edition, 25th December, 1996, p.7.
41. C.E.Curran, op.cit., p.65.
42. Ibid.
43. See Address of Pope Pius XII to Histopathologists, September 13, 1952: A.A.S., 44 {1952} 787-89; and his discourse to the World Medical Association, September 30, 1954 : A.A.S., 46 {1954} 590-95. Also see G.V.Lobo, op.cit., p.102.
44. C.E.Curran, op.cit., p.199.
45. Ibid.
46. Ibid.
47. Ibid., p.200.
48. Ibid., p.201.
49. Ibid., p.204.
50. Ibid., pp.62-63.
51. Pastoral Constitution on the Church in the Modern World', par n.69, in {General editor} Walter M.Abbott, The Documentsof Vatican II, Guild Press, New York, 1966.
52. C.E.Curran, op.cit., pp.206-207.
53. Ibid., p.207.

Additional bibliography
Dwyer, John C.: Foundation of Christian Ethics, Paulist Press, New York, 1987.
James, Emmanuel E. : Ethics: A Biblical Perspective,Theological Book Trust, Bangalore, 1992.
Lepp, Ignace, The Authentic Morality, (Trans. by Bernard Murchaland), The Macmillan Company, New York, 1965.
Gay-Williams, J.: "The Wrongfulness of Euthanasia", in Stephen Satris, {ed.}, Taking Sides : Clashing Views on Controversial Moral Issues, 3rd ed., The Dushkin Publishing Group, Inc., Guilford, USA, 1992, pp.284-287.
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