Imposing our morality

Dionysius: Now as I recall we were going to discuss the ninth commandment.[1]

Nitpickerus: You were. ! wasn't happy that you'd dealt with 'imposing our morality'. You never moved beyond health education. All those statIstics about condoms. It was more like a public health lecture than a biblical discussion! Let's get down to the real issue. What do we do when instead of taking godly advice our patients insist on doing the opposite[2] and expect us to go along with it.[3]

Dionysius: Well, for a start, we can't refuse to diagnose and treat them just because they are sinners.[4] We wouldn't see anybody. Where could we draw the line?

Nitpickerus: It's not that which worries me. It's when they want us to help them do something which we regard as unethical[5]

Dionysius: Let's have a real example.

Nitpickerus: OK. A man wants you to write a doctor's certificate so he can be compensated for the time he's taken off work but you have good reason to believe he's been malingering. Do you write the certificate?

Dionysius: Certainly not! That would be deceitful[6] and fraudulent.[7] We are not rubber stamps Nitpickerus. We're not in the business of robbery.[8] How do we square that with the biblical injunction to obey the governing authorities?[9] Exactly the same would apply if a patient asked me for a lethal injection. It's illegal. l couldn't do it.

Nitpickerus: Maybe it's illegal now, but the law of the land doesn't always tally with God's law.[10] Crime and sin aren't synonymous Dionysius. Trespassing is a crime but it's not a sin.[11] Adultery is a sin but it's not a crime.[12] This is where the problem arises - when the patient wants you to help them sin and the law is on their side.

Dionysius: Can you give me a specific example?

Who's imposing whose morality?

Nitpickerus: A l6 year old girl presents having missed a couple of periods after a one night stand. The pregnancy test is positive and she wants an abortion on the grounds that she can't cope with the situation (steady boyfriend, mum doesn't know, A-levels coming up). You believe having thought the issue through biblically that abortion is wrong13 - so you give a good scientific explanation as to why fetuses are human beings (perhaps with photographs of normal embryology) and offer to help her with an alternative course emotional support, antenatal care, adoption. She won't listen and wants the abortion. What are you going to do?

Dionysius: Say that I can't help her do it.

Nitpickerus: But isn't that imposing your morality? She's not a Christian and she says you're imposing your morality on her.

Dionysius: Who's imposing whose morality? lsn't she imposing her morality on both myself and the baby?

Nitpickerus: As a Christian shouldn't you submit to her request - turn the other cheek and all that?

Dionysius: Not when it involves disobeying God.[14] We serve Christ - not evey whim of the patient.[15] Medicine is not some consumer service where the demands of the market dictate the ethics.

Nitpickerus: But isn't showing photographs just emotional blackmail? Dionysius: I thought blackmail was when you forced someone to do something wrong by threatening them. I'd be telling her the truth out of love and concern for both her and her baby.

Nitpickerus: But the law is on her side Dionysius.

Dionysius: I think that's debatable. The law says that in this situation abortion is only justified if 'the continuance of the pregnancy would involve risk of injury to the physical or mental health of the pregnant woman greater than if the pregnancy were terminated'[16]

Nitpickerus: But doesn't any legal abortion pose less risk to a woman's physical health than a normal deilvery?

Dionysius: 1 don't believe that was the intended spirit of the law Nitpickerus.

Nitpickerus: But it is the letter of the law - and you yourslf have said that we have a God-given responsibility to obey the law.

Dionysius: We do, but not when it conflicts with Christ's law[17] - not when to obey the law is to sin. of course it's not a particularly good example - as the current law on abortion has a let-out clause. There's no legal obligation to fill in the green form or to participate in the process at all - although there is an ethical obligation to refer the patient expeditiously to another doctor. according to the BMA.[18]

Shouls Christians ever break the law?

Nitpickerus: Granted, but what if it became a legal obilgation to refer patients to doctors who would authorise abortions? In such circumstances could we justifiably disobey the law?

Dionysius: Yes, ultimately we obey God not men.[15] There are plenty of biblical examples of people who chose to obey God rather than the governing authorities: the Israelite midwives[19] (this is particularly relevant to the abortion debate), Rahab,[20] Daniel,[21] Shadrach, Meshach and Abednego,[22] the prophets,[23] the apostles.[24] Jesus himself was crucified because he refused to submit to the governing authorities by lying about his true identity.[25]

Nitpickerus: Some of these people got into a lot of trouble Dionysius. Dionysius: Men and women of faith usually do. This is exactly why Jesus told people to count the cost before deciding to follow him.[26] Obeying God means that at some stage we will suffer persecution.[27] At some stage people will hate us for it[28] and it may cost us our reputations, our careers or even our lives.[29] Sometimes we can see these conflict situations arising ahead of time and defuse them - as Daniel did so masterfully early on in his career[30] (medical students take note!)- but on other occasions we simply have to make a stand and take the consequences. That's what carrying the cross is all about.

Nitpickerus: But by refusing abortion to a young woman in that (or worse) situation, aren't we forcing her to carry the cross? Can we really expect her to do this when she has not known God's grace for herse if?

Dionysius: Nitpickerus, don't forget that one day this young woman will stand before the Son of God[31] (who laid aside equality with God to die on a cross[32] and have to explain why she sacrificed her baby's life to preserve her reputation and career.[33] You make it sound virtuous to assist her in this. You're right that we can't force our patients to make godly choices - God himself never does this. We need to be prepared to act as mediators of God's grace ourselves[34] - but this mustn't involve giving tacit approval to sin. Jesus offered forgiveness for past mistakes and help to change (and so should we) but his response also included a firm call to a new lifestyle.[35]

But it was the woman!

Nitpickerus: But if she insists on an abortion, isn't it her choice and therefore her responsibility?[36]

Dionysius: But if you help kill someone else's baby, then aren't you an accessory to murder?[37] Don't you share the guilt?

Nitpickerus: Murder is an emotive word Dionysius.

Dionysius: It simply means 'the intentional killing of an innocent human being'.[38] Shouldn't that produce some emotion? I'm far more worried about those who can remain emotionally detached while dismembering a living person.

Nitpickerus: But the referring doctor isn't involved in that.

Dionysius: You don't have to wield the curette Nitpickerus. If you're part of the process, then you're involved.[39] It wasn't just those who turned on the gas at Auschwitz who were involved in the killing. Those who knowingly drafted the laws,[10] filled out the forms,[40]delegated others to do the killing, transported the prisoners,[41] stoked the ovens[42] and willingly received the tissues for experimental purposes - however noble their intentions - were all involved . They were all guilty - even those who signalled complicity only by their silence.[33,41,43]

Nitpickerus: But isn't saying no to a woman's request for abortion just washing our hands of the whole affair? How is it any better? Dionysius: You' re misusing the metaphor Nitpickerus. Pilate 'washed his hands' in refusing to use his God-given authority to free an innocent man.[44] I'd suggest that the real hand-washers are those who turn a blind eye and fail to exercise their responsibility to do something about it - for fear of causing offence to those invoived.[45]

How can we be more involved?

Nitpickerus: Isn't there a danger of just becoming an armchair critic?[46] Surely we have to do more than just shout from the sidelines?

Dionysius: We do. If we make a stand as Christians in any area of medicine (abortion is only one example) we need to be working for better alternatives. This will be different for each person depending on their gifts and position of influence but for abortion it may mean being engaged in counselling, helping to set up support networks for women who decide to keep their babies, lobbying to introduce legislation which will give more protection to the unborn, helping to provide for unwanted children, giving financially to those involved in all these sorts of work - as well as being firm in our resolve not to be a party to the shedding of innocent blood ourselves - be it intentional or by default.[47] This is part of carrying the cross too: using our time, talents and money in searching for compassionate Christian alternatives where the world offers diabolical quick-fix solutions - and if necessary, putting our careers, reputations and lives on the line.[48]

Nitpickerus: This discussion of protecting the innocent brings us back to the ninth commandment.[1]

Dionysius: Let's save it for the next issue of nucleus.