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Central American University - UCA  
  Number 265 | Agosto 2003



The Challenges of Bioethics: What the Different Religions Have to Say

All religions postulate that human life is sacred, but not all have the same reflections and positions on bioethics. Learning about the different religions’ interpretations on cloning euthanasia, the use of in-vitro embryos and many other realities can only enrich our own reflections.

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We are increasingly accustomed to ethical questions related to issues such as in-vitro fertilization, clon ing or euthanasia, which can trigger passionate debates. Medical science continues advancing and new problems are added on an almost daily basis. According to Anne Fagot-Largeault, professor of philosophy of biological and medical sciences, “Bioethics was born out of indignation against abuses and novelties experienced as transgressions.” More concretely, the urgent need to reflect on these issues emerged following the first heart transplant in 1967 and after it was discovered that certain experiments had been carried out with human beings in the United States. In 1970, US cancer specialist Van Rensselaer Potter called for a science of life that he dubbed bioethics. The following year the first bioethics institute was created in the United States. Its founder, André Hellegers, proposed defining bioethics as “ethical reflection on biomedicine.” But it was not until the birth in 1982 of France’s first test-tube baby, Amandine, that a demand was generated in that country for more in-depth reflection. Today, half the states in the Council of Europe have a national committee to think about and decide on these issues and the tendency to organize such committees has become worldwide. The International Bioethics Committee was created as part of UNESCO in 1993 and in 1997 it drew up the Universal Declaration on the Human Genome and Human Rights.

A novel experience: ethical-religious consultancy

In the area of procreation, it is not always easy to reconcile the possibilities offered by the latest medical advances with religious faith. The first, and so far only, ethical-religious clinic in France is located in one of France’s state-of-the-art obstetric hospitals, the Antoine Bèclere Hospital en Clamart. Once a week on its premises, gynecologist Dr. Paul Atlan attends couples or single women faced with complex decisions.

Sometimes the urgency of the situation complicates matters even further, as in the case of a young Muslim woman Dr. Atlan treated. “That case alone gives you a sense of what my work involves,” he recalls emotionally. The woman in question suffered from a genetic illness that put her own health at great risk during pregnancy. After the birth of her second child, she ignored doctors who recommended that she have no more children and became pregnant again. As predicted, she had problems, and by the fourth month her blood pressure was dangerously high. The doctor attending her warned that she would only survive if she had a therapeutic abortion right away. The young woman rejected the idea and the helpless doctor sent her in an ambulance to Dr. Atlan.

After a 45-minute discussion, he persuaded her to let him ask the Paris Mosque for permission to interrupt the pregnancy immediately. An hour later, Dr. Dalil Boubakeur faxed back a report from the commission of theologians that he had called together. According to the report, the texts of the Sharia authorized the woman not to place her life in danger. After a further hour and a half of discussion, the sobbing patient finally agreed to a therapeutic abortion. Two days later, her blood pressure returned to normal.

Holding all the cards to make the right decision

Luckily, not all decisions are so dramatic. One morning a hesitant couple turned up at the clinic. In-vitro fertilization was finally offering them a way to have the child they wanted so much, but their tense faces betrayed their dilemma: the procedure required them to go to hospital on Saturdays, but as practicing Jews they could not travel to Clamart on a Saturday, the Jewish Sabbath. Should they give up the idea of having a child or transgress their religious law? On that occasion, Dr. Atlan did not have to resort to a rabbi to resolve the problem; he met with his colleagues, who decided to draw up a special plan for the couple so they never had to travel on a Saturday.

Patients’ situations do not generally have such an immediate practical solution and Dr. Atlan refuses to resolve it alone, “even when I know the answer a priori, because each case is personal and unique.” A summary of the couple’s problem is usually sent to a religious expert—a rabbi, priest or minister familiar with medical problems. When the answer is received, the couple is called back and presented with the religious authority’s opinion. “They always have the freedom to choose, but we want them to hold all the cards when making their choice,” stresses Dr. Atlan.

Why should religion play a part in a secular public hospital?

In this clinic, the principles of bioethics come up against concrete cases, meaning that bioethics leaves the confines of theoretical reflection and is applied in real life. It has been no small challenge to bring religious considerations into the secular bastion of a public hospital, but the medical authorities were convinced of the advantages of doing so by three arguments summed up by Dr. Atlan. “There are already chaplains and chapels in the hospitals,” he explains. “Meanwhile, patients may have religious convictions even though the hospital is secular, and there is no reason to exclude them from medical techniques because their convictions make them afraid of resorting to them. Furthermore, no doctor would reject the petition of a dying patient who asked for the extreme unction. So if we understand religious convictions at the hour of death, why not take them into account when birth is at stake?”
Since the clinic was created, it has been mainly attended by people of the Jewish and Muslim faiths. There have been few Catholics, even fewer Protestants and no Orthodox Christians. Dr. Atlan attempts to explain this in the following way: “Judaism and Islam are lived on a philosophical and religious plane as the application of a right. The believers of these two religions ask themselves if they have the right to do this or the other. In Catholicism, these questions are clarified based on strict principles: respect for life and natural order. And as practically everything to do with medical techniques for procreation is prohibited, it doesn’t seem necessary to reflect on each concrete case. Protestants, in contrast, do not place themselves on a legal or dogmatic level; for them it is just a matter of personal conscience. This explains the limited number of times that we have to resort to the opinion of a minister. As for Orthodox Christians, it could be that they don’t come because there are still not very many of them in France.” Dr. Atlan stresses that despite the existence of so many dogmas in their faith, Catholic couples that resort to medical practices officially prohibited by their religion are not anathematized by the people around them. “On the contrary,” he explained, “such couples are always accompanied and psychologically helped by their communities. This seems to me to be a real lesson in humility and life.”

The great divide

As a member of the French National Ethics Consultative Committee (CCNE), Professor Axel Kahn participates in many debates on science and ethics, on religious and scientific principles and on bioethics. The following are some of his reflections: “At the present time there is really no renovation of bioethical reflection, but rather important evolutions, an enrichment of bioethical conscience. The horrifying awareness of the atrocities committed by Nazi doctors and the Nuremberg Code form the basis of modern bioethical thinking.

“The great divide in society, in our National Assembly and in the Ethics Committee in which I participate is between two groups. The first is made up of those who consider that progress does not always bring ‘good’ to human beings and believe that truth and good are inseparable values. The other consists of progressives, who have a more scientific way of thinking. The French Republic is based on the idea that the progress of knowledge and the sciences intrinsically contains the promise of welfare for human beings.

“Where these two tendencies currently coincide is on the issue of reproduction through cloning: both believe it should be prohibited, or at least that a moratorium should be established. But the arguments behind this are diametrically opposed. In December 2001, an international hearing organized by the US National Academy of Sciences concluded that it was unnecessary to authorize reproduction by cloning because it was still a very uncertain method, a technique not sufficiently mastered, rather than because it was a bad thing. It was implied that there would be no reason not to resort to the technique once it is well controlled. It is a question of pragmatic, casuistic reasoning. This kind of moral philosophy evaluates advantages and disadvantages and if the benefits are greater, the technique is considered morally legitimate, without reference to any principle. For this utilitarian tendency, it will be morally legitimate to employ reproduction by cloning as soon as it is properly controlled, in well-chosen conditions. On the other hand, filiation is profoundly enlightening with respect to the principles of autonomy and liberty. This filiation is the space in which we experience our sense of the “other,” in which we experience change on a daily basis. Being reproduced as an identical being, and consequently childishly loving that twin, could be considered a notable narcissistic regression. To protect ourselves from this risk, it could be concluded that reproduction by cloning is morally illegitimate.

“On these issues there are more differences between progressive people and those who consider that truth and good are inseparable than between religious and non-religious people. In ten years on the Ethics Committee, I have seen few clashes between Marxist philosopher Lucien Sève and those who represent the different religions on the committee. I have seen more opposing criteria between the Catholic and Protestant representatives than between the Marxist and all of the other religions.

“Religions are a means of promoting reflection on the intrinsic value of the other and of creating rules for the way we behave in relation to others. We could say that in essence no religion is dedicated to promoting individualism. All religions include the notion of duty in relation to both the divinity and others. For me, the most evident definition of what we might term ‘good’ is ‘that which contributes to the care of others,’ those for whom I am indispensable and who are also indispensable for me.”

The different voices of religious tradition:
Catholics, Orthodox Christians and Protestants

All of the religions are interested in bioethics and most had begun reflecting on these issues long before the term was invented. Wondering whether bioethics raises questions for religions is like wondering if practices that challenge the sense of life raise such questions. “There have always been conflictive situations between the Law and everyday life and they need to be regulated,” says Rabbi Michel Gugenheim, director of the Israeli Seminary of France.

The evolution of medicine has generated new situations in which it is not automatically possible to apply the recommendations contained in the religions’ founding texts. “In the times of Buddha Sakyamuni, the disciples asked him questions and, in his omniscience, he gave them clear and precise answers. We have to continue doing something similar today; we have to interpret,” states Buddhist doctor Didier Chevassut, who is a pain specialist at the Marseille Hospital. But the interpretations are not the same in all religions and the methods with which they interpret and reflect reveal their particular essence. Catholicism is the only religious confession with a Magisterium, an organization responsible for establishing official teaching. Between 1949 and 1987 alone, Catholic teachings on issues related to bioethics covered around 500 pages, in addition to many other works from different groups, faculties and reflection arenas.

The Orthodox Church does not have such a profusion of position-taking and no members of the clergy can assume the right to speak on these issues in the name of the Church as a whole, which never takes official positions. Orthodox Christians express opinions based on tradition. “The teachings on problems are never general or categorical. We never say, ‘you can,’ ‘always’ or ‘never’... We just indicate whether or not an action distances us from God,” explained Dr. Dominique Beaufils, a surgeon who is head of palliative care at the Hirson Hospital and an Orthodox deacon in Belgium.

Protestants have been organizing consultations among their believers on such issues for a long time now. In France, the last such consultation involved issuing a text on cloning in December 2001 and inviting members of the five hundred associations belonging to the French Protestant Federation to reflect on the matter for several months to reach agreements. Along the same lines, Anglicans, Protestants, Orthodox Christians and old-style Catholics from 126 European churches created a European ecumenical commission in 1992 to reflect on issues of bioethics in a pluralistic way.

Islam, Buddhism and Judaism

Islam has been intimately linked to medicine since the beginning of its history. Experimental medicine owes a great deal to the great Muslim doctors of the 8th to 10th centuries, who were undoubtedly encouraged to seek treatments for illnesses by one of the Hadith, which proclaims: “Be assured that God has created no illness without having also created its cure.” Both the Hadith and the Koran take positions that we could qualify as bioethical in today’s language. Thus the prophet Mohammed advised people to avoid cities where the plague was wreaking havoc, but ordered people in those cities where the plague had been declared to remain there. Reflection on bioethical problems has been carried out for over two decades now in various institutions on different continents, including the New Delhi Islamic Academy and the Al-Azhar University in Cairo.

There is also broad Buddhist reflection on issues related to bioethics. Buddhism offers a predominance of advice, including orientation, but there is no international opinion. “We don’t envisage setting up a Buddhist council that expresses the different sensibilities in Buddhism, within individual schools and on the different continents, and comes up with a single opinion,” states Dr. Didier Chevassut.

There is a diversity of tendencies in Judaism. To resolve difficult bioethical questions, or any other question related to everyday life for that matter, they resort to the texts of the Torah or the Talmud and their interpretation “by certain authorities who enjoy the people’s recognition,” according to Rabbi Gugenheim. He considers that “there has always been bioethical reflection in Judaism, and there is no need to create a specific structure.”

Mother cells: Hope for life and healing

“Mother cells” are cells capable of forming any of the organism’s tissues. The cells of embryos have this capacity and there are also mother cells in adult organisms. Mother cells in adult bone marrow can produce blood cells, liver cells, muscle cells, heart cells and even neurons. The capacity to transplant cells from one organism to another to form new tissue allows us to hope that we can make the jump from reparative medicine to regenerative medicine. Will it be possible to combat diabetes, Alzheimer’s disease, myopathy and so many other diseases by replacing defective tissues with mother cells? The solution will lie in the ability to transplant mother cells or healthy tissue without them being rejected, which will be more likely if the mother cells are identical to those of the person we want to cure.

It is along these lines that specialists are imagining the idea of therapeutic cloning. This involves taking the nucleus of a cell from a sick person and placing it in an ovule that has no nucleus. Then, instead of placing this embryo into a uterus so that a child can be born, it would be left to develop for six days with the aim of transplanting into a person some of the embryonic cells that have formed. These cells would act like pluripotent mother cells, with a great capacity to regenerate any damaged or diseased tissue.

Both adult and embryonic mother cells have been used since the seventies to cure different illnesses. Bone marrow or skin transplants are frequently carried out and for ten years now embryonic cells have been taken from the umbilical cord of newly born babies without harming either the baby or the mother. These cells can be preserved until they can be used to cure types of leukemia, for example.

The new challenge in therapeutic cloning, the “ethical question,” lies in whether an embryo produced in the above way is human or not. There are different positions when it comes to accepting the use of this technique, all with their different nuances. We can summarize them in three main positions: utilitarian, cellular and prudent. For the utilitarians, the aim of curing makes it acceptable for these embryos to be “sacrificed,” while for the cellular group, therapeutic cloning does not create embryos, just cells, and thus there is no ethical problem. The prudent ones, meanwhile, feel that as we still do not know enough about the consequences of therapeutic cloning it is better to take mother cells from other sources, such as “supernumerary embryos”—surplus embryos resulting from non-implanted in-vitro fertilizations frozen in embryo banks. There are between 20,000 and 100,000 surplus embryos preserved in this way in France. While the use of mother cells from adults appears to generate no debate among the religions, both the production and use of embryonic mother cells generates a great deal of discussion because this technique confronts each religion with its particular definition of life, the status it confers on the human embryo and the virtue of solidarity with sick people.

What the religions say about cloning to obtain mother cells

Therapeutic cloning to produce embryonic mother cells has been approved by both Protestantism and Judaism, although for very different reasons. “Embryos must be treated with consideration and respect, but we reject all forms of ‘embryolatry,’” explained ethics professor Jean-François Collange from the Strasbourg Protestant Faculty. “It’s the moment of implantation into the maternal uterus that is decisive and not the fusion of the gametes. It’s the objectives that are important: if the cloning is destined for a therapy, then it is a sign of solidarity.” The Judaic viewpoint is based on prohibition. As therapeutic cloning does not transgress any prohibition—it doesn’t involve sperm and the embryo produced and used is not yet forty days old, when it would become a “person”—there is no underlying problem.

Catholics, Muslims and Orthodox Christians, meanwhile, are virulently opposed to this technique. But although they appear to coincide, each of these religions has its own particular reasons for rejecting this kind of cloning. According to the rector of the Paris Mosque, Dr. Dalil Boubakeur, “It seems like a moral perversion to want to divert the little ovules from their natural path.” For Orthodox deacon Dr. Beaufils, “A terminology that aims to separate reproductive cloning from therapeutic cloning is deceptive, and it is false to state that there is no fertilization in therapeutic cloning because ova are in fact used.” He adds that “on the theological plane, each person should ask whether human life is linked to implantation in the uterus or is a gift from God.” This point of view is shared by Catholics. “Utilizing cells from a five-day-old embryo is to use it like an object, failing to recognize its dignity and condition as a human being,” argues Father Patrick Verspieren. Pope John Paul II made a pronouncement on this matter in October 2000, stating that “cloning is not acceptable insofar as it supposes the destruction of embryos.” Somewhere between the pro and con positions are the Buddhists, who remain uncertain and call for discretion and prudence.

What do they say about surplus embryos?

If therapeutic cloning is not carried out, another source of embryonic mother cells can be used: frozen supernumerary or surplus embryos that were not used for in-vitro fertilizations. These remain in reserve banks and would only be destroyed if not used in therapy. Each religious tradition’s position on this reality is based on the status that it confers on such embryos. The idea of using such cells is rejected if it considers them potential human beings or understands human life to start at the exact moment of fertilization—as in the case of Catholics, Orthodox Christians and certain Buddhist tendencies. In fact, they go even further and condemn the practice even when the embryos already exist.

As Jews do not consider these embryos to be potential people because they were the result of in-vitro fertilization—not of sexual relations between a man and a woman—and because they have not reached the age of 40 days, they do not oppose use of their cells. Meanwhile, Protestants are positioned somewhere between these two opposite tendencies. Their reasoning has nothing to do with the status of the frozen embryo. More pragmatic, they question the use of this technique and conclude that as these embryos will only be destroyed if not implanted in a uterus, it is better for them to be of some use to someone than be used for nothing and destroyed.

A matter of life or death

In hospital neonatal reanimation services, children born disabled can either survive or die. In France, the medical team decides half of all neonatal deaths according to the state of the newborn child. Reanimation is not practiced on those born with serious mental disabilities. This is a very hard decision taken by the team of doctors and nurses after examining the evolution of the newborn. And the parents? “A medical team will never ask them ‘What do you want us to decide?’” explains Francis Gold, head of services at the Paris Trousseau Hospital and member of the French Federation of Neonatal Pediatricians’ ethics commission. “Our reflection is always secular. We cannot deduct the medical ethical principles we use to decide according to the parents’ faith. The same principle has to be valid for all, and the interests of the baby have to prevail, because if we reanimated it, it would be condemned to live with a terrible disability. It is a new ethics of compromise rather than convictions, which is thus a secular ethic.”
There are also fetuses and embryos that are stalked by death. Genetic problems or serious brain damage affecting a baby in gestation can be diagnosed from an ultrasound scan, the extraction of certain fetal cells or an analysis of the mother’s blood. All of the religions consider it valid to make such a diagnosis, but if it leads to elimination of the fetus through therapeutic abortion, certain religions reject such a decision, even more forcefully than if the therapeutic abortion were to save the mother’s life.

At what point does human life begin?

The same question lies behind all religious positions: at what point does a human embryo become a human being? Those who believe that qhuman life begins at the moment of conception allow no interruption of the pregnancy following a negative diagnosis. They also oppose the elimination of an embryo or fetus after what is known as a pre-implantation diagnosis, which is employed in the in-vitro fertilization procedure to ensure that only embryos devoid of pathological conditions are implanted in the mother’s uterus, while any with such conditions are destroyed and those surplus to requirements are frozen.

Judaism establishes differences between both techniques. It distinguishes between in-vitro embryos and those already lodged in a woman’s womb, considering that a test-tube embryo is not a potential human being. Not long ago in an Israeli hospital, a number of supernumerary embryos were in danger of being destroyed because the freezer in which they were being kept was damaged and it was a Saturday. What was better: to transgress the Jewish Sabbath law and work to save these embryos or respect the law, bearing in mind that the embryos were not human? The doctors did not hesitate and urgently repaired the machine. Later, the rabbis decided that the right thing would have been to respect the Sabbath.

Euthanasia, therapeutic cruelty and pain relief

With surprise, we are discovering that passive euthanasia is not as exceptional as believed. According to a recent survey by the French Reanimation Society of over 7,000 patients in intensive care, treatments essential for keeping these people alive were either not applied or suspended in 11% of cases.

Faced with the increasingly used concept of “dying with dignity” and the growing number of seriously ill people who demand the right to end their own lives, even taking the issue to court, the different religions have confirmed their opposition to both euthanasia and “therapeutic cruelty,” aimed at keeping terminally ill people alive at all costs. They do, however, agree with the application of “palliative care” to alleviate pain. In fact, such care has always been rooted in religious traditions. Thus in Orthodox liturgy, believers regularly pray to God for a peaceful end to Christian life without pain or humiliation. As Dr. Dominique Beaufils commented, “What this prayer is asking for could be a definition of palliative care.”

What do the religions say about the terminally ill?

The principle of fighting against pain is strongly present in the sacred texts of Judaism. It is a principle that the believer practitioner should balance with the commandment not to kill. For CCNE member Rabbi Michel Gugenheim, “This is about giving the right dose of morphine: alleviating pain as much as possible but without causing death.” Rejecting euthanasia, as in the case of Catholicism, does not imply accepting any medical procedure to prolong life. Catholicism does not support unreasonable treatments, meaning those whose disadvantages are greater than their benefits, including being extremely costly for either the patients or their relatives.

The positions of both Protestants and Buddhists are singularly different to these strong rejections. While certainly opposed to euthanasia, they leave room for individual cases. “We must consider the idea of allowing certain petitions to end a life as another example of ‘palliative care,’ since death is not the end of everything,” argues Protestant CCNE member Jean François Collange. For Buddhists, meanwhile, the key to tackling such difficult situations is compassion, which is an essential value in their religion. “If love is expressed by sharing the other’s happiness, compassion is expressed in the desire to see the other liberated from suffering,” explains Dr. Didier Chevassut, adding that compassion will allow “the personal aspects of each situation to be taken into account and favor a response adapted to each particular case.”
All of the religions believe life to be sacred and express this precious principle through rejection of euthanasia. But each religion has different nuances when it comes to death and physical decay. The following question, formulated by Orthodox deacon Dr. Dominique Beaufils, summarizes a logic shared by many believers from different religions: “Is the dignity of sick people respected by accepting their desire for an assisted suicide or euthanasia, responding to their will to escape from a test they fear they will not be able to pass? Would it not be better to respect their intimate relation with God, who through pain is giving them the chance to transform what appears to be decadence into a transfiguration?”

Each point of view has its own justness

The almost weekly development of science and medical techniques generates major challenges of conscience. A recent and much-debated case has been that of US movie star Christopher Reeve—best known for playing Superman—who was paralyzed after falling from a horse. He accused President George W. Bush and the Catholic church of hindering research into embryonic mother cells, which just might help him walk again.

There are so many challenges that they are leaving doctors and the whole of human society perplexed. Many people believe that the progress of human knowledge and of techniques is “in itself a promise of happiness for human beings,” as Axel Kahn puts it. And most people believe that while scientific progress is cumulative, no advance will definitively demolish the principles of morality. In the colloquium titled “Universal Solidarity? Ethical symbols following September 11,” held at UNESCO on September 10-11, 2002, philosopher Olivier Abel stressed that each generation needs to reinvent its own symbols. But how should the new collective knowledge be defined in the face of the new challenges? In the increasingly pluralist modern nations, no single religion or philosophical tradition could define what is “good” for all citizens. Only the faithful of a particular religion or philosophy would accept the rules it dictates.

It is for that reason that ethics committees are being set up all over the world. According to Axel Kahn, “Religions have their place in these committees, insofar as they express the ethical references of a social group within a pluralist democracy.” With respect to the prevailing medical techniques, one would think that the different religions have opinions that while not identical are at least convergent and are distinguishable from “secular” opinions. But as we have seen, this is not the case. It is surprising, for example, to note the abysm separating Catholic and Orthodox positions from those of the Protestants, despite the fact that these Christian churches have such closely linked dogmas.

All believers are tempted to state that what their religion says is “just” and what the others say is “erroneous.” This is a very frequent reaction. The truth is that each religious tradition tackles reality from a specific angle and thus each viewpoint has its own justness. Judaism is right in insisting on the importance of human filiation, Catholicism and Orthodox Christians are right to stress respect for life and Protestantism is right when it appeals to personal responsibility. By the same rule, Islam is right when relentlessly evoking the value of the order established by God in the Creation, and Buddhism is right when taking into account the motivations of those who resort to a particular medical technique.

The clash of these different view points—not to mention others not included as religions—contribute to what Axel Kahn calls “an enrichment of the bioethical conscience.” If each morality has its grandeur, however, it also has its perverse effects. As Olivier Abel argues, “We need the moralities to correct each other.” In this field, as in so many others, inter-religious dialogue does not just consist of being informed about the positions of the others; it also implies allowing oneself to be questioned by them.

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The Challenges of Bioethics: What the Different Religions Have to Say
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