The tectonic plates underlying the cultural context of Western society are on the move. As with seismology, where it is possible to predict where such activity will take place but impossible to say when and with what velocity the activity will happen, so with society and cultural change. There are aspects to that change that we can observe and describe but the effects will be hard to predict with any accuracy. Let me try to describe some of these changes.
Materialism
By this I do not mean materialism in its popular sense, ie. the pursuit of human happiness by the acquisition of money and things, but materialism in its philosophical sense, ie. an explanation of the world without reference to a Supreme Being.
Patterns of churchgoing and belief are changing. Atheism is on the increase. Francesca Klugg, in her recent book Values for a Godless Society argues that the Human Rights Act, which came into force in October 2000, is a necessary moral charter for a society which no longer believes in God strongly enough to take its moral guidance from such a Supreme Being.
Similarly, Professor Peter Singer, in his book Rethinking Life After Death declares, 'after ruling our thoughts and our decisions about life and death for 2000 years, the traditional Western ethic about the sanctity of human life and the traditional religious view that all human life is sacrosanct is simply not able to cope with the array of modern medical dilemmas.' Singer goes on to replace what he considers to be an obsolete Judaeo-Christian ethic with his own five new commandments of bioethics:
- Recognise that the worth of human life varies
- Take responsibility for your own decisions (eg. acceptance of mercy killing)
- Respect a person's desire to live or die
- Bring children into the world if wanted
- Do not discriminate on the basis of species
As has been demonstrated recently in the case of Jodie and Mary, the Siamese twins, where the will of God-fearing parents was overruled by the press, the medical profession and finally the judiciary, we apparently end up with some kind of distorted utilitarian ethic having removed God from the scene.
For me, a belief in God would have at least the following consequences:
- It would affect the way I approached the moral maze of medical ethics; it would ask some fundamental questions about the Bible and its authority; it would give me some criteria to assess interventions such as Professor Singer's.
- It would mean that as a person treating the sick, I would not see myself as an autonomous person, but somebody who felt a sense of calling to care for and bring wholeness in body, mind and spirit to the sick and dying.
- It would affect my approach to people. I would not see them as apparently Richard Dawkins does, as merely genetic survival machines.
- I would see people with personality and hopes and fears and anxieties and with a God-given potential for a possibility of a life lived for ever in heaven.
Post-Rationalism
Much of the way our world thinks was fashioned by a rationalist, post-Enlightenment way of thinking. Sometimes it is referred to today as modernity. There is much that is good about this, although it has tended to elevate human reason above all else. In consequence, one of the authors of the 'movement' was the philosopher Descartes with the famous phrase 'I think therefore I am'. This worldview has inclined to give people faith in science, rather than in the God of Science; somehow it seems logical that the more questions science can answer the smaller God becomes.
John Wyatt, in his book Matters of Life and Death describes 'scientific reductionism' which has some very unhealthy outcomes, leading, for example to a machine view of humanity and suggesting a way of self-mastery or self-transcendence. The outcome is belief in pure chance, the lottery of life inevitably leading to a pessimistic fatalism.
However, it seems that there is today a kind of post-rationalism around, eg. the liberal quest for making Christian faith more relevant to a modernist mindset. Many Christian doctors and surgeons I have known have had a real sense of being guided, either in making a diagnosis or whilst performing an operation, in a way that has left them little doubt that there is a Supreme Being. Will this disillusionment with modernity impact some of the complex moral debates that are on the future agenda for medical ethicists?
Consumerism
Choice versus The God of Choice. Consumerism does not just affect the economic choices we decide on, it affects many different areas of human life. It is driven by marketing and creates a worldview in which, in Western society at least, the world is full of goods and services which are there to meet my deepest needs. In medicine, I suppose consumerism is at its most blatant in the area of cosmetic surgery and the future possibility of being able to manipulate the genetic coding of tomorrow's children to meet parental desires and aspirations. Biology, genetic cloning, and robotics are increasingly pooled resources that raise the spectre of spare part surgery to replace obsolete and worn out units. But does there come a point when this becomes out of proportion and, if so, where would that point be and how would we know when we have reached it?
Individualism
The triumph of the individual has been one of the coherent themes of the last half-century. Of course there are many good things about individualism, but it can lead to the undermining of human community. Health is affected by non-medical factors. Many a patient does not need medicine but someone to talk to. Individualism also leads to privatisation, that process by which I see myself as the centre of the universe. Privatised morality is a very worrying example of that process. Such privatisation leads very quickly to complication in relation to ethical debate. Without any accepted norms of morality, the feel is 'we can make it up as we go along'. The consequential dangers of arguing from the particular to the general are obvious.
Pluralism
The presence of people who bring very diverse cultural and spiritual values into a community poses some wonderful opportunities, and some potential problems. The way we go about treating people in the West is to some extent an expression of our culture. Hospitals are traumatising places enough to those whose background could be described as Western. What they must be like to people who do not share that cultural background, is hard to imagine. But, as pointed out by Bishop Michael Nazir-Ali in his excellent book Citizens and Exiles, pluralism brings with it a frightening by-product:
'It is also often the case that 'pluralistic' attitudes, while paying lip service to the equal validity of different systems of belief, actually marginalise all of them. Bishop Leslie Newbigin has pointed out over many years and in several books how pluralism consigns belief, worldviews and values to a private sphere from where they are not permitted to influence public policy.'
Fragmentation
By this I refer to the breakdown of the traditional units of human society. You can track this fairly clearly in the last century; 1900-1945, the era of the extended family; 1945-1980, the emergence of the nuclear family; 1980 to the present, the redefining of 'family'. What does all this mean to the practice of medicine? Let me mention but a few. We know that people's health is impacted by the social ecology in which they develop. It means that families find it harder to take responsibility for one another and therefore have expectations that the State, in its manifest forms, will take the responsibility for them.
De-personalism
All this, it seems to me, poses big questions about how as Christians we function in today's world. How do we match the grace of God [unconditional compassion] with the truth of God [the Bible]? It seems to me that we shall have nothing to contribute to ethical debate if we emphasise compassion alone. Compassion must always be refracted through the truth of God's Word. In the same way, were we to take only a truth-centered approach to these things, we should end up saying nothing that anyone would be able to hear.
Based on a talk at the CMF Oxford Day Conference, November 2000.
