Sundoulos - Spring 2009

Bioethics and the Pastor

by Scott B. Rae

Some time ago I was sitting across the lunch table with two Talbot graduates who were on the pastoral staff of a church in the area. They had brought a couple from their church to lunch that day—the couple wanted to discuss their ongoing problem with infertility. They had been trying unsuccessfully to become pregnant for the past 2 years. As they had their problem checked out by their physician, they came to understand that the reason for their infertility was that the man was sterile, producing no sperm. It turned out that he had had the mumps as a child and it was not treated properly, and sterility resulted. This turned the lunchtime into quite a counseling opportunity since his wife blamed him for their inability to become pregnant. As she put it, “We can’t have children and it’s his fault!”

There were other issues that made the situation complicated. The wife was adamantly opposed to adoption, insistent on “having their own child.” She was pushing her husband to accept a sperm donor, so at least they could have half a genetic connection to their child. But the husband was clearly uncomfortable with this alternative, understandably not wanting a “procreative pinch hitter.” The couple was at lunch with their pastors and me wanting to know what the Bible said about having a sperm donor. Had you been in my place, what would you have told them? And to complicate it a bit further, assume that the couple had been in agreement on having a sperm donor? Would your advice change?

Or take an example from the end of life. You are called to the ICU of your local community hospital to see a family who must shortly make decisions about terminating life support for their elderly mother. She has been ill for months but does not have any kind of advance directive expressing her wishes in writing and she has not talked in much detail with his children about what she wants at the end of life. As a result, they are very confused about what to do. They physicians are pressuring them for a decision about stopping all treatments and allowing death to take its natural course, but they are unsure about what to do. They sense that if they stop the ventilator support and remove the feeding tubes they are doing something wrong—they say that it sure feels like they are killing their mother, like they are doing something that violates their commitment to the sanctity of life. It feels to them like they are “playing God” with their mother’s life. They need your help to get them through this difficult end of life period, and they need to know which, if any, treatments they can stop. They are especially nervous about removing the feeding tubes since they have heard through the media in the case of Terri Schaivo that removing a feeding tube is tantamount to starving someone to death. If you were their pastor called into this situation, how would you advise them?

These two episodes illustrate the role that bioethics plays in pastoral ministry. It’s important to have some working knowledge of bioethics in order to read the newspaper intelligently and keep up with the changing technological landscape in this field. But bioethics is hardly just an academic discussion that is reserved for the seminary classroom. Bioethics is an important part of the equipment that pastors use in walking through life with the people to whom they minister. Bioethics is not just about public policy, though that is an important component. Bioethical issues come across the pastor’s desk more frequently today and when they do, they come at life-defining moments that open the door for significant ministry in people’s lives. Bioethics is also important because most pastors have ministry with men and women who serve in health care professions and who want to integrate their faith and the ethics of their faith into they way they serve their patients.

Here are some of the other types of bioethical issues that pastors might find coming across their desks (all of them have come across mine!):

  • A college student in your church’s college ministry has an unwanted pregnancy. She has questions not only about abortion but also about whether to marry the father (assuming he’s a stand-up guy) and about putting the baby up for adoption (if she ends up not marrying the guy).
  • A graduate student in your church hears about a new way to pay her graduate school tuition—by selling her eggs to another infertile couple. She wants to know if this is consistent with Scripture.
  • A woman in your church considers it her ministry to provide the “gift of life” to infertile couples by serving as a surrogate mother.
  • A woman in her mid-30’s with a strong desire for a child and no foreseeable prospects for marriage, wants to go the local sperm bank and conceive a child that she will raise on her own.
  • A couple with three girls wants to “balance their family” with a boy. They can select for gender by sorting the husband’s sperm and inseminate his wife with the sperm that will give them a high likelihood of producing a boy.
  • A couple comes to you having just received bad news back from prenatal genetic testing on their unborn child. The child will have Down’s syndrome and the couple is feeling pressure from their physician and their family to end the pregnancy and try again.

These are a sample of the types of issues that pastors face—and I’m sure you could probably add to the list (if you have faced cases like this feel free to email me a summary of the details at Resolving these issues gets complicated because the Bible doesn’t directly address most of them. Scripture does give us broad general principles that we can apply—I like to think of it as Scripture giving us a set of fence-posts that provide the boundaries, outside of which one cannot go without violating an important virtue or value.

Let’s start with the end of life. The Bible is clear that human life is God’s sacred gift by virtue of humans being made in God’s image. As a result, innocent human life is not to be taken—that is not a human prerogative. Further, there is a clear biblical obligation to protect the most vulnerable in the community, and the elderly, seriously ill and infirm surely are included. Biblically, death came about as a result of the general entrance of sin into the world (Rom 5:12, 1 Cor 15: 21-22)—death, though a universal experience was not part of God’s original design for human beings. But death is a normal and natural part of a person’s life under the sun (referring to this side of eternity, Eccl 2:14-16; 3:19-21; 5:15-16; 9:1-6), due to the pervasiveness and universality of sin. Death is thus both an enemy and a normal part of life. This suggests that the notion of “death with dignity” may be an oxymoron theologically. There is nothing inherently dignified about death—as death is clearly not a part of God’s original plan for humankind. Certainly one can approach and handle dying in a dignified manner, which is what most people mean by the phrase “death with dignity.”

However, the Bible also affirms that death is a conquered enemy (1 Cor 15: 54-57), having been vanquished by the cross and resurrection of Jesus. One of the many implications of this is that if death has been conquered, it need not always be resisted. That is, doctors need not always “do everything” to prolong life. When the patient’s prognosis is very poor and further treatment is futile, then death can be welcomed as the doorstep to eternity. This not a violation of the sanctity of life, since the sanctity of life does not obligate us to keep everyone alive at all time and at all costs. The view that life should be prolonged no matter what is known as vitalism—and it makes a very problematic theological assumption. If the sanctity of life obligates us always to prolong life, then it seems that we are assuming that earthly life is the highest good. But theologically, that’s not true. Our highest good is our eternal fellowship with God, as Augustine correctly expounded. Therefore, it is acceptable under certain conditions to stop treatments and allow death to take its natural course. That is not killing someone, since the underlying disease is the cause of death. Even with feeding tubes, which are a form of treatment, this is the case. Removing feeding tubes is no more starving someone to death than removing a ventilator is suffocating someone to death.

But under what conditions? Under the law, if a competent patient says to “stop” that request must be honored. Usually patients say “stop” when treatments are either futile or are more burdensome than beneficial. Often, patients lose their ability to make decisions at this point and a family member must step in and decide. Pastors can help here by giving the family the freedom to say “enough” of aggressive treatments and enable the patient to transition to hospice or to a regimen of pain management only. This is a time of such significant ministry in the lives of patients and families—since the main questions they deal with are not about medicine but about spiritual things and what kind of life they have lived. Getting relational closure is very important at the end of life, and pastors can help families achieve this by being there with them and helping them break through the common denial that the end of life is near.

But what about the beginning of life? What are the theological parameters that help guide us there? In establishing our parameters, we need to need to begin with the purpose of technology from a theological perspective. For the most part, technological innovations that clearly improve the lot of humankind and help alleviate the effects of the entrance of sin into the world are considered a part of God’s common grace, or his general blessings on creation. That is, medical technology is God’s good gift to human beings. That is our first “fence-post” that helps set parameters for reproductive technologies. As a part of creation and the mandate given to exercise dominion over the earth (Gen 1:26), God also gave humankind the ability to discover and apply all kinds of technological innovations. This would be particularly true of technologies that enable the human race to fulfill its mandate to multiply and fill the earth. It does not follow, of course, that humankind has the responsibility to use every bit of technology that has been discovered; all technologies must be assessed individually. But in general, God’s wisdom is embedded in the world through general revelation; He has given human beings the ability to uncover what He has revealed in His world (Proverbs 8:22-36). There is no biblical reason why medical technology, in general, cannot be used to treat infertility or a disease of the reproductive system, in the same way that medical technology treats malfunctions of the heart, liver, kidneys, or other organ system. That does not mean that all steps are morally acceptable, only that some technological options are morally appropriate.

The second and equally foundational “fence-post” in the Bible is that procreation was designed to occur within the context of a stable, heterosexual, permanent, monogamous marriage. Children are to be born into families constituted of a husband and wife who love each other, live together, and who commit themselves to care properly for their children. Continuity between procreation and parenthood is considered the norm for family life.

A third clear “fence-post” is the moral status of the unborn. If it’s clear that from conception forward there is a full person, then fetuses and embryos must be protected in any infertility procedure. This means that any technology that involves discarding embryos or terminating pregnancies falls outside the parameters the Bible has set up.

A fourth parameter is the notion of adoption as a legitimate rescue operation, fulfilling the biblical virtue of compassion for the most vulnerable. Adoption is the figure of speech used repeatedly in the Bible to describe the believer’s relationship to God (Eph 1:5), and the virtue that indicates that a person’s faith is genuine is a willingness to care for widows and orphans, figurative of the most vulnerable in the society (James 1:27). Any view of procreation that downplays adoption as alternative, or even rules it out, would appear to fall outside the biblical parameters. This would also include new ways of adopting children, such as adopting embryos that are left over from in vitro fertilization procedures.

Additional parameters that help put boundaries around the use of reproductive technology include the virtue of trust in God’s sovereignty. As applied to the desire of infertile couples to have a child, this fence-post is critical and can be applied to all reproductive technologies, regardless of where the genetic materials come from. That is, dependence on any technological option can undermine a couple’s trust in God’s sovereignty if it is motivated by desperation or becomes an obsession for the couple. An additional virtue that comes out this trust in God is that of contentment, as difficult as that is for infertile couples to hear. But the Bible is clear that we are to be content regardless of our station in life (1 Cor 7:17-28). This does not mean that couples are to accept their infertility passively, or that they are prohibited from using any technological means. Rather, it suggests that use of any reproductive technology could fall outside the parameters if its use is motivated by desperation.

The way the Bible views children is an important fence-post that helps establish the parameters for procreation. Throughout the Bible, children are viewed as a gift from God (Ps 127: 3-5), to be received open-handedly and without specifications. The virtue of gratitude naturally accompanies this important truth about children, and suggests that specifying gender or choosing traits of children are troublingly close to falling outside the biblical boundaries.

In terms of specific technologies, it would seem that those technologies that use the genetic materials of husband and wife are generally acceptable and those that involve third party contributors are problematic. Thus, intrauterine insemination (formerly known as artificial insemination) with the husband’s sperm would be acceptable (unless done in conjunction with high powered fertility drugs that leave the couple at risk for major multiple pregnancies). In vitro fertilization (IVF) would also be acceptable with the genetic materials of husband and wife, as long as no embryos are discarded (the moral equivalent of abortion) and selective termination of excess pregnancies is not practiced. The principle involved here is that every embryo created in the lab is owed an opportunity to mature in the womb. Couples that are finished bearing children and have embryos left over either should implant the embryos themselves, or put them up for adoption to other infertile couples. For the couple I counseled about a sperm donor, I suggested that they adopt an embryo—that way they would get the experience of pregnancy and giving birth, yet without the man feeling alienated from his family. Surrogacy is problematic for other reasons beside the employment of a third party in procreation: it may be baby-selling, and it encourages surrogates to detach from the children they are carrying—not a practice to be encouraged.

Our hope is that you will become better educated on these issues and as a result become a better equipped to walk through these difficult times of life with the tools to guide people through these complicated questions.

For futher reading:

Scott B. Rae, Moral Choices: An Introduction to Ethics, 3rd ed. (Zondervan, forthcoming in 2009).

Gilbert Meilander, Bioethics: A Primer for Christians (Eerdmans, 2004).

Paul Chamberlain, Final Wishes: A Cautionary Tale on Death, Dignity and Physician Assisted Suicide (InterVarsity Press, 2000).

Leon Kass, Life, Liberty and the Defense of Dignity: The Challenge for Bioethics (Encounter Books, 2004).

Other resources can be found at (The Center for Bioethics and Human Dignity, especially their Biobasics series) and (the site for the President’s Council on Bioethics)

Scott B. Rae (ThM, Dallas Theological Seminary; PhD, University of Southern California) is Professor and Chair, Philosophy of Religion and Ethics. Scott has written a number of books, including Moral Choices: An Introduction to Ethics, 3rd ed. (Zondervan, 2009), and Beyond Integrity: A Judeo-Christian Approach to Business Ethics, with Kenman L. Wong (Zondervan, 1996). He has published many articles, and lectured on ethical issues worldwide. Scott and his family live in Irvine and are active in Mariner’s Church.

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