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ss nucleus - autumn 2002,  Ethical Enigma - introduction

Ethical Enigma - introduction

In this new column I intend to stimulate your mind, challenge your brain cells and encourage you to think biblically about some of the clinical situations you will come across as you go on in your medical career. Each issue will have a new question to be puzzled over and a response from the previous one. So this does not become a one-way process I thought that you could e-mail your ideas to me between issues and we will try to publish a small selection of them in the next issue alongside my answer. You will need to get your answers in within about a month of receiving your copy of Nucleus if you want them to be considered.

What then is the point of ethical deliberations? I believe it is important to have considered the theory before being confronted with the reality of having to make a decision. If you have not come to a definite decision in your head about which side of the fence you sit with a particular issue, it is very likely that you will either (i) cave in and compromise or (ii) make a decision that you later feel to have been wrong when you’ve had the time to think about it afterwards. Better then to think first and act later with a clear conscience. Beware though: unless you have considered it both carefully and prayerfully you may well be sincere in your actions, but sincerely wrong.

In today’s NHS doctors are increasingly encouraged to pay heed to the patient’s right to be involved in the decision-making process. This has led to a culture in which the doctor is not always seen to be right and certainly isn’t deemed to know best. Whilst in many ways this is good, it can cause its own problems. It is part of the culture of no absolutes and we may often have difficulty convincing patients and colleagues that any grounds for truth exist. But that is what we are called to do. ‘If the salt loses it saltiness...it is no longer good for anything, except to be thrown out and trampled by men.’ (Mt 5:13) In order to be effective Christians in a fallen world we must be prepared to stick our necks on the line. However, we must also make sure that our feet are on solid rock. Faith must be built on a good knowledge of the Bible: head knowledge and heart knowledge are both necessary.

Once you have the theory sorted out, how do you apply it? In 1 Peter 3:15 he writes, ‘Always be prepared to give an answer to everyone who asks you to give the reason for the hope that you have. But do this with gentleness and respect.’

Getting your point across is important but more important is conveying the love of God. This should be done with gentleness and respect. Like it or not you will need to listen to the other person’s viewpoint and acknowledge their worth in God’s eyes by doing so. You may even have to agree to disagree on some things rather than allowing the relationship to break down completely. Do not, however, cross the line of compromise where you find yourself doing something to another human being that you are not comfortable with ethically. A good principle is, ‘when in doubt, leave it out’.


Enigma 1

A couple comes to see you in your GP surgery. They have been married for five years and despite an active sex life they have been unable to conceive. They have seen a fertility specialist and have had all the usual tests done; they were within normal limits. After a one-year course of ovarian stimulation they have still not been able to conceive. They now want your advice about what to do next and are keen to try IVF. How will you respond to this couple?

There are many issues for debate in this area so have a good think about it. In particular I recommend you consider:

  1. the status of the embryo
  2. the consequences for the child produced
  3. the costs involved for the parents
  4. the chances of success and consequences of failure
  5. the research that led to the availability of IVF
  6. the emotional state of your patients
  7. where God fits into it all

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