Rewriting rulebooks in sex and medicine?

Viagra is an effective new oral treatment for male erectile dysfunction. Launched by Pfizer in the USA this March it became the fastest selling drug ever. A worldwide black market for performance enhancement as well as for treating impotence developed rapidly, but in September Viagra was licensed for prescription by doctors in Europe. The UK government has so far refused to allow it on the NHS, secretary of state for health Frank Dobson saying 'Media coverage of this drug to date has created expectations that could prove a serious drain on the funds of the NHS. If this were to happen, other patients could be denied the treatment they need.' [1]

There has been huge coverage in all the media. Viagra has provided a cover story for every lifestyle magazine at W H Smith, documentaries on all TV channels, and thousands of sites on the Internet (see 'CyberDoc'). Serious discussion has concentrated on safety (69 deaths in the USA between March-July, set against 3.6 million prescriptions 2 ) and the resources/rationing debate. But are there any Christian dimensions to consider?

Sex . . .

The foundation for understanding the biblical view of human sexuality is in the creation account [3] ' . . . a man will leave his father and mother and be united to his wife, and they will become one flesh'. This statement is endorsed by Christ [4, 5] and by St Paul [6,7] and from this one verse and the commentaries on it in the New Testament God's fivefold plan for human sexual relationships is seen. Marriage is to be:

• First, a publicly recognised commitment - 'will leave his father and mother'
• Heterosexual - 'man' and 'wife'
• Monogamous - 'a man' and 'his wife'
• Sexual - 'be united . . . they will become one flesh'
• Lifelong - see Jesus' commentary in his teaching on divorce [8,9,10]

This plan is phrased positively but is supported by prohibitions -fornication,[11] adultery,[12] homosexual acts,[13] incest,[14] bestiality,[15] and lustful thoughts [16] are all wrong.

This ideal is perhaps not seen very often, and Christian health professionals have to practise in a real world. But the ethics of Viagra inevitably involve the ethics of sexuality. Should we encourage the breaking of the maker's instructions? While some Viagra prescriptions could be inside God's plan, how many more would be outside it? And what adverse consequences might there be in terms of sexually transmitted infections and unplanned pregnancies?

. . . and drugs . . .

Because of its specific effect on erectile tissue, Viagra is also being assessed regarding female sexual pleasure. Given the market, Viagra will not be the last sexual performance drug - others are bound to follow. Alleged phrodisiacs have been around since the dawn of history, but the real pharmacology of sex has developed in the last 40 years. The oral contraceptive pill in the early 1960s allowed sex without pregnancy - procreation was separated from recreation. Now we can have sex without babies and (because of other developments) we can have babies without sex.

Christians debate this separation. Roman Catholic teaching believes the unitive and procreative aspects of sexuality must remain linked and recommends only 'natural' methods of birth control. Most Protestants see sex primarily as God's gift unitively to cement the marriage bond and would argue that provided the methods are not in themselves unethical, artificial contraception is in principle acceptable. Whichever, it could be argued that the 'Pill' was the first recreational sex drug! Thirty-something years on, the twenty-somethings and thirty-somethings in the club culture are using Viagra along with cocaine ('coke and poke') for recreational sex. There are more so-called 'lifestyle drugs' coming in other areas of human pleasure - drugs to reduce fat absorption so you can eat as much but lose weight, drugs to reduce wrinkling, drugs to boost memory. Will they all be banned on the NHS?

. . . and restoring the masterpiece . . ?

Is there a 'Christian dimension' to the resources debate? No easy answers certainly, but does our understanding that God has created all human beings 'in his image' [17] help at least with this challenge of the lifestyle drugs? John Wyatt uses the metaphor of the valuable painting, the 'Old Master'. Every patient bears the image of God, however marred. The privilege and obligation of healthcare is that we should try to 'restore the masterpiece'. We have no mandate to create a different picture.

Does this help set reasonable limits on the state's responsibility? God wants married couples to enjoy his creation gift, so should the NHS provide Viagra for impotent husbands? Should Viagra as a recreational sex drug for the hedonist be discouraged? As health professionals, should we be restorers of masterpieces or anarchic artists making strange creatures in our own image?