Thank you for inviting me to introduce today’s dialogue between faith and medical ethics. I’ll try to do this by outlining two currently controversial areas of medical ethics, and then by asking how faith might help our understanding of such issues. But first, why we are talking about medical ethics at all today? Not so long ago, ‘medical ethics’ meant what doctors discussed privately among themselves. Why is it now the subject of so much public discussion, in the media, in politics, in education?

One reason is that Medicine itself is now vastly more effective than in the past. From childbirth and infancy, to extreme old age, lives can now be saved or prolonged, and health restored, by advances in medical science and technology unimaginable to our grandparents. But also unimaginable to our grandparents, are the difficult choices now faced, when it is technically possible to save the life of a very premature baby, for example, or to prolong the life of a elderly person with severe dementia, but when it is not clear that the quality of the life saved or prolonged will be in the best interests of that baby or that elderly person. Who then decides what is in their best interests? In the past, doctors decided: but today it is increasingly appreciated that these are not simply medical questions. What do the baby’s parents believe would be best? What can the family or friends of the person with dementia tell about what the person themselves would have wanted? And how does society believe that such questions should be decided, by patients, by doctors, by the law, by politics? The achievements of modern Medicine, in other words, have greatly enlarged the circle of decision-making in medical ethics

That is one reason why medical ethics is now the subject of so much public discussion. But another is that we now live in pluralistic and democratic society. In the past, when doctors decided, they did so against the background of a broadly agreed moral consensus. In Britain, this was based on what was seen as traditional Christian morality. But then, just as the advances of modern medical science and technology were raising difficult new questions, the old consensus was breaking up, to be replaced by a whole spectrum of different religious and moral views, from the most conservative religious, to the most libertarian secular. In modern democratic politics and law moreover, the rights of the individual and the views of minorities, provided they do not harm others, must be respected. How can this be done, when there are now so many different and often conflicting views? One answer, increasingly heard in our society, is that ‘We need to have an ethical debate about the issues.’ The idea here is that an ethical debate is one in which the different arguments, for and against, are each given an impartial hearing, and weighed up over against one another, by reasonable people, who then agree on which of the arguments is the most persuasive. Such agreement sometimes can be achieved. But often it is not, and so the debate goes on, and on. Medical ethics is the subject of so much public discussion today, in other words, because in a pluralistic and democratic society, when there is no agreed answer to such difficult questions, the only alternative to ‘war-war’, as Churchill put it, is ‘jaw-jaw’. We feel the need to go on worrying about the issues, in the hope, faint but not entirely irrational, that agreement, or a better compromise, someday might be achieved. This seems to be true of two currently controversial areas of medical ethics: the ethics of regenerative medicine research and the ethics of euthanasia.

Regenerative medicine is one of the most exciting prospects in medical research today. It is based on the genetic manipulation of stem cells – cells which can produce all the other cells in the body. The hope is that this will make it possible to understand the currently unknown causes of many diseases, to find effective drugs for preventing or treating them, and even eventually to use stem cell technology to repair or regenerate diseased or damaged parts of the body. All the research involved in this is still at a very early stage however, and there are at least two ways in which it is ethically controversial.

Firstly there are the risks of what is sometimes called ‘biological engineering’: an engineer working with iron or steel should be able to predict his results; but a biological engineer does not always know how the complex living systems he is modifying will react, or what unexpected and unwanted side-effects genetic modification may have. In the laboratory, or with experimental animals, he may be able to control things. But that is less easy, and perhaps impossible, with the yet unknowable long-term side-effects, in humans, or on the environment. In Britain, for example, such concerns are regularly raised about genetically modified crops, and the fear of creating serious new infectious diseases has already held back the development of xenotransplantation – transplanting pig organs into humans. Pessimists with long memories, moreover, will recall no less high hopes once held out for nuclear energy or for thalidomide. How do you ethically weigh up the benefits and risks of the ‘unknown unknowns’?

Research in regenerative medicine also is ethically controversial, because at this early stage it involves the experimental use of human embryos, and also the insertion of human genetic material into animal embryos. Both of these procedures are highly offensive to people who believe that human rights begin at conception, and that it is wrong to create human-animal hybrids; and while their objections have not prevented the UK Government from permitting this research, they continue to be made, and the ethical debate continues. Is a laboratory-created human embryo really a person or merely a bundle of human cells? If the genetic difference between humans and chimpanzees is only 2%, and many human genes are shared with mice or worms, what is wrong with inserting a few human genes into an experimental animal embryo? But then again, if we are so genetically similar to other animals, what right have we to use them in ways we would not use humans – for food and clothing as well as for research?

Let me leave those questions open for discussion and very briefly outline the arguments about the other controversial area in medical ethics, that of euthanasia. In some respects, this also has arisen as a result of medical progress. In modern life, from childbirth to old age, medicine is now able to relieve much physical and mental pain and suffering. Pain and suffering are no longer regarded as inevitable or to be borne with religious resignation: so why not also relieve the pains of dying? Specialists in hospice care point out that they already do this. But others argue that even the best medical pain relief does not always work; and in a pluralist, democratic society individuals should have the right to decide for themselves when it is time to end their lives. And then others again reply that a right to die is not a right to demand that a doctor kill you; and that once society starts down that road, it is on the ‘slippery slope’ to killing elderly people who have a treatable depressive illness, or who feel they should ask for euthanasia so as not to be a ‘burden’ to their families. Both sides of the euthanasia debate today, clearly, have strong moral arguments, and sometimes it seems as if they are equally strong.

But again let me leave these questions open for further discussion, and come now to the question of how faith might help our understanding of these issues. There are, I think, two different ways in which it can do this. The first is that of those who believe that the Christian view is authoritatively expressed in clear statements of the Church’s teaching: for example that because humans are special in the eyes of God, all human embryos have full human rights from the moment of fertilisation; or again that because God has forbidden killing, all intentional killing of innocent humans, except in self-defence, is always wrong. This way of thinking, I believe, is based on deep insights: but when it is applied to the most morally difficult issues – the laboratory-created embryo which will never develop into a fetus, the last hours of life when suffering cannot be relieved – it tells us only one side of the story we need to hear.

Now the other way in which faith can help our understanding of these difficult issues does not reject the deep insights on which the first is based. We are special in the eyes of God – not however because we are genetically members of the human species, but because we were created and are loved by God, as indeed in their own way all God’s creatures are. ‘Thou shalt not kill’ is God’s command – but God has taken the risk of allowing us to work out for ourselves what that commandment means, not least in the light of the great commandment to love our neighbour as ourselves. Faith, in this second sense then, helps us, not by giving us infallible answers to these difficult questions, but by inviting us to think out our own fallible human answers in the awareness of God’s presence as our light, and our loving judge.

That again, of course, leaves many questions open for discussion. But let me end with an observation by the philosopher Charles Taylor which relates to our gospel today. Nowadays, Taylor suggests, we often tend to think of human imperfection in terms less of sin than of sickness, and so we tend to place exaggerated hopes in what medical progress can do for us as individuals, or for future generations. We may even begin to think of ourselves as more like patients than sinners. But someone who thinks of themselves as a patient, Taylor argues, ‘has less dignity’ than someone who thinks of themselves as a sinner. When I think of myself as a patient, that is, I am no longer thinking of myself as a person with a part to play in life, to the very end. Modern medicine recognises that, when it now talks of the patient as a person and a partner in health care. But daring more, faith calls us to be partners in God’s care for creation and for one another. To really hear that call however, is also to know how far and frequently we fall short of that partnership. That is what the tax collector in today’s gospel knows - and so rises to his true human dignity. By acknowledging how far he falls short, he is enabled to accept forgiveness and turn to life again. Modern Medicine can do great things for us and will no doubt do even greater things in the future. But it can never relieve us of the part only we can play in making life worth living, for others as well as ourselves. Faith encourages us to play that part. It does not provide us with easy answers to the difficult questions of medical ethics. But it can help us to see them in proportion, in the light of eternity as well as time, and so, even when no answers are forthcoming, never to lose hope.