Learn to live with what you are – 1

In Church we have this little meeting sometimes on a Sunday night called Forum. We sit in the office and drink dodgy coffee and try to work out some theological topic relevant to the contemporary world.

A few weeks ago, I led a discussion about end of life and theological implications following on from our involvment with modern medicine. This blog summarises a lot of my take on it.

Last night myself and Mrs Steffi Knorn were leading one on the interaction of ethics, theology and modern medicine in issues pertaining to the beginning of life.

What follows is not exactly the minutes of the meeting, more like how the discussion flowed from my point of view and my reactions to it. Be aware that it contains some very distinct Christian assumptions about image bearing, and protection of the powerless and voiceless in society.

Bottom line we seem pretty bewildered and confused on the whole thing. On a spectrum from where we believe life begins to what we do with extremely tiny premature babies we struggled to articulate an ethic or theology that was somewhat separate from what modern medical ethics tells us to do.

We retreat to defining what is good based on a balance of harms and benefits with a presumption that survival is the positive outcome to be chased and disability (in the case of extreme pre-term births) is a negative thing that sways us against active treatment.

When it comes to defining when life begins most of our discussions resolved around various different scientifically defined points. When I think of where life begins it takes me a while to realise that this is a poor question when it is abstracted from a theology of relationship, image bearing, sex and community.

I struggle to know what it means to care for an extremely low birth weight 24 week gestation infant. I struggle to know if active and invasive intervention is the best way to love them and honour their image-bearingness.

200 years ago an extremely low-birth weight infant was fairly easy to care for. You kept them warm and the you buried them.

We now find oursleves in a bit of a different situation.

The question I find myself asking is that if we can do something why should we do something?

Followed to its logical conclusion this is kind of a scary question, cause it throws virtually all medical interventions in the air.

Hargaden’s point (which he was making up as he went so see it as that, rather than a finely tuned postion) was this (forgive me if I make a hames of it) – if we accept that all life is holy (which is the orthodox Catholic positon as I understand it) then life is inherently good and worth preserving. Therefore we should fight to preserve life. This has particular relevance for the powerless and voiceless (infants and those with severe disabilities) because if we acknowledge their lives as holy then we have a duty to protect their lives as no one else will. There is a risk that the powerless are silenced by the powerful and wiped from the earth. It is our repsonsibility to fight on behlaf of the powerless.

Follow this out and it seems that if life is holy then the right thing to do is to fight to preserve it, aggressively if necessary.

The situation for those with a voice is somewhat different as they are able to acknowledge and choose that their lives are not of ultimate value and therefore they can choose to forgo life-saving treatment.

It is at this point that I struggle.

I find it hard that an ethic that is designed to protect the powerless results in us causing pain and suffering.

It breaks the golden rule (do onto others as…) or Kant’s categorical imperative. If i was a 25 week premie with massive IVH (bleed into the brain) and bilateral pneumos (punctured lungs on both sides) and florid sepsis (an overwhelming infection) and had already failed multiple treatments I would not want further life-preserving treatment. This would be my choice.

So this ethic seems to need refinement. We cannot fight to preserve life out of fear (a reasonable fear) that we will silence the powerless, because in preserving life we will end up doing violence to them.

Indeed perhaps the whole problem with this, why we find it so hard is because we don’t really know what life is for.

We reach for medicine as the framework to answer these questions by because we have no better answers.

Medicine will at least give us some kind of an answer (though we still find it hard to swallow) that life is most flourishing when we are conscious, without pain, autonomous, and have many years before us.

This question will remain unanswerable in the church till we become a people with an alternative definition that values and understands all the image bearers that this world is peopled with.

Comments, criticims and rants welcome.

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6 Responses to “Learn to live with what you are – 1”


  1. 1 Peter December 7, 2010 at 11:19 pm

    Careful Andy, you’re sounding more and more like a GP sometimes! Surely we do not fight to preserve life out of fear but simply because human life is worth preserving. Imago dei: we are made in the image of God. If you raise the ethic of avoiding any suffering or disability above that of preserving life then where do you stop? What about someone disabled after a car accident? MS? Schizophrenia? Ok I’m being extreme but surely it’s a slippery ethical slope?

    And it may break the golden rule for you but another person in the same premie situation above may want to stay alive whatever the ultimate cost. I know there are grey areas but without an ethical absolute – things become subjective.

    And finally, I see many young depressed and suicidal people every day in my East Belfast ghetto(!) who are “conscious, without pain, autonomous, and have many years before them”. It does not follow that their life is “flourishing”. At the same time I see others who are disabled, definitely in pain, dependent and even dying who are living life to the full. Suffering IS part of life. In my experience suffering may bring out our best. And it is sometimes through suffering that God comes closest. Not that we should prolong suffering or refuse to alleviate suffering, just that when it comes to life/death decisions we must hold the value of human life more dearly. I too am wondering what relevance the church should have in these questions.

    • 2 Andy Neill December 8, 2010 at 12:05 am

      Pete

      we need more and better GPs, not specialists, or even A&E doctors. I spend most of time doing primary care anyhow!

      my conclusion is that neither position seem satisfactory a) the preservation of human life because is bears God’s image and needs protection b) the avoidance of violence to those without a voice because we do not wish to cause suffering

      i am yet to find a way to reconcile those two positions and therefore I find myself in agreement with your criticism. i find both positons “slippery slopes” in that there is a great danger in both It is the uncertainty and lack of consistency that has prompted my points, i don’t take either “position” cause i don’t think either is satisfactory.

      my definition of human flourishing was something I made up on the spot and I would suggest that free from pain includes psychological well-being (one of the most if not THE most important determinant of health) – the medical definition of well-being is a failing myth and narrative precisely because it excludes those with disabilities.

      cheers for the comment and i’d love to hear more, I like hearing a view points of view from the medical side of things, sometimes i think i’m a bit out on a limb with this stuff!

      Hope the family are well! Have you got CH a drum kit yet?

  2. 3 Kevin Hargaden December 8, 2010 at 1:01 am

    Anachronism alert!

    “If i was a 25 week premie with massive IVH (bleed into the brain) and bilateral pneumos (punctured lungs on both sides) and florid sepsis (an overwhelming infection) and had already failed multiple treatments I would not want further life-preserving treatment. This would be my choice.”

    If you were a 25 week premie, you don’t have a choice. 🙂

    • 4 Andrew Neill December 8, 2010 at 9:46 am

      Of course i’m not a premature baby – the point wasto illustrate that it fails “do unto others” (not that that has to the most important thing)


  1. 1 Learn to live with what you are – 2 « Nelly And I Trackback on December 9, 2010 at 3:18 pm
  2. 2 Incarnation: implications of Christ as embryo « FaithinIreland Trackback on December 23, 2010 at 5:23 am

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