Some Life-and-Justice Issues for the 1990's

SOME LIFE-AND-JUSTICE ISSUES FOR THE THE 1990s

By Anthony Fisher, O.P. CompuServe ID 76711,1340

1. Introduction

Our generation has probably witnessed more dramatic changes in the nature of family life than all previous generations put together. One major contributor to these changes has been medical technology. Amongst other things it now allows us with various degrees of success to:

* monitor and control fertility and thus the number and spacing of children conceived;

* correct infertility in some, and circumvent it in others by producing children for them in the laboratory;

* treat or dispose of children while still in the womb relatively safely;

* introduce third parties such as donors of eggs, sperm or embryos, surrogate mothers and technologists, into the child-bearing process;

* choose or at least detect some of the characteristics of children before birth and prevent the further development of those with undesirable characteristics;

* save large numbers of children and their mothers who might previously have died, or help those children to die soon after birth if they are handicapped; and

* extend life considerably or end it with unprecedented sophistication.

These and many other breathtaking advances in medicine offer many exciting new opportunities for co-creating and supporting human life, rededicating ourselves to human dignity and all that is most noble in our vocation, and nurturing these sacred values within their most successful context, the family. On the other hand, they also present new occasions for the expression of the more macabre and violent side of human nature. Most often these advances have come well before any widespread community reflection on their desirability or morality.

I would like to explore some aspects of three life-and-death issues which have major implications for social justice and which will be even more significant in the 1990s: abortion, infanticide and in vitro fertilization.

What are we likely to see happening with these three procedures in the next decade? Abortion is available pretty well on demand here in Australia and is now one of our most common surgical procedures, with particular clinics and practitioners specializing in the art of relatively cheap, relatively safe abortion. It is likely that abortion numbers in Australia will continue much the same in the 1990s, having now more or less stabilized at rates around double that per capita in Britain and similar to those in the US. The possible introduction of pills to induce early miscarriages, further blurring the line between contraception and abortion, may, however, increase the abortion rates still further. Infanticide, though less widely recognized, is now a commonplace for severely handicapped children: the 1990s may well see an increase in the range of conditions deemed sufficiently serious to warrant the killing of newborns.

At the very time when practices such as abortion-on-demand have made it very difficult to adopt a child, we suffer from an infertility epidemic, affecting about one in ten couples. IVF, the making of tiny human beings outside the womb in the laboratory, is still only twelve years old. Yet Australia already has over 20 IVF clinics, has produced a few thousand test tube babies, and prides itself on many `world firsts' in the field. Australia is also a world leader in human embryo experimentation: we have chopped up hundreds of human embryos, allowed many to die, crossed rat ova with human sperm, and even tried to fertilize and implant a human embryo in a sheep's womb. Even more stunning prospects in the future include: cloning (making genetic copies of people); controlling characteristics of children, such as sex; using machines, animals, female corpses or men to carry children; obtaining knowledge for new drugs and cures; and the wider and wider use of IVF for people and purposes other than infertile couples (e.g. non-marital families, spare parts, experimentation). Already IVF firms are looking to extend their market in various ways. Of the three reproductive technologies reviewed here, IVF and its associated practices such as embryo experimentation, will most accelerate in frequency in the 1990s.

For the Christian confronted with the human tragedies which so often occasion the desire for abortion, infanticide or IVF there can be a real division of heart. On the one hand, we are called to be compassionate as our heavenly Father is compassionate: to love and support the despondent woman who is unwillingly pregnant, the distraught couple unable to cope with their child's handicap, and the childless couple desperately trying everything to have a child. For these people we feel enormous sympathy. We also recognize humbly that most of us do not know how we would feel in their situation. Because we do not know what they are suffering, and how truly free and informed they are in their choices, we do not pretend to judge them. On the other hand, we are called to be prophets, to practice and preach the good news values of life and love. I think issues like these are the crucible in which our claim to be prophetic is tested today: are we willing to give witness - to be martyrs, as it were - for issues such as these in our daily lives, or do we so privatize our morality as to invite a moral laissez-faire?

Confronted with these medical technologies the Christian asks justice questions like:

* what values are presumed and enacted in this process?

* is it consonant with our understanding of sexuality, relationships, marriage and the family?

* how will this affect respect and support for the institution of the family in our society?

* is it sufficiently respectful of early human life?

* does this respect the dignity of all the parties involved (especially the women)?

* is it a just use of scarce medical resources?

2. Justice towards our youngest brothers and sisters The Judeo-Christian tradition supports a very high view of the value of the human person. With this comes the basic principle that every human being must be respected as a person, for themselves and not just their usefulness to others, and accorded rights and dignity equal to all other persons. A long list of the basic conditions for human flourishing, which we call human rights, can thus be enunciated - of which the most basic right, upon which the others depend, is the inviolable right to life.

There is not time or need here to rehearse the debate over whether early human life should be accorded such respect. Elsewhere I have argued at length that revelation and reason both support an affirmative answer to that question: human life deserves our profound reverence from its very beginning at conception. According to this view, abortion deliberately kills a tiny, innocent human being - one every seven minutes in this country. That makes it the largest cause of death in this country, accounting for two in five known human deaths. I think that is the single most significant human rights issue of our time. Add to this the deliberate failure of major public hospitals to feed or adequately treat many newborn or even older children if they have serious disabilities - and we must face the fact that the worst forms of child abuse are not the preserve of overtaxed parents or psychological deviates, but a regular part of some medical practices. These are not primarily matters of private sexual morality or religious beliefs: they are above all issues of justice, which must therefore be faced by any society concerned to be just to all.

If Christian respect for the sanctity of human life extends all the way back from the aged, through adulthood, adolescence and childhood, to the youngest members of the human family soon after conception, then Christians must be gravely concerned not just about abortion or infanticide. Respect for human life raises a whole range of contemporary concerns from deaths of aborigines in prisons to child poverty, substance abuse and the road toll.

IVF is one such a lethal activity. It kills early human beings. Tens of thousands of human embryos have died in an effort to achieve a few births: well over 9 out of 10 so far have died. For many this has been in the preliminary (and still now continuing) experimentation to make IVF possible and better; for others it has been in the actual practice of IVF. With the use of hyperstimulatory drugs, multiple egg collection and fertilization, far more embryos are created than are actually intended to be brought to term. The lucky ones are chosen and implanted; others are frozen, experimented upon or simply discarded. More are implanted than it is intended will be brought to term: some, it is hoped, will miscarry; abortion might be used if too many implant or if any is handicapped. IVF is fraught with danger for the child from the beginning: death before birth or soon after is still the most likely outcome; over one in four are born prematurely (a major cause of retardation); more than a third have low birth weight; half again as many as non-IVF infants suffer major handicaps; and while the psychological dangers are as yet unknown, identity problems and other traumas are predicted for some of these children.

I believe that at the heart of the problem with abortion, infanticide and IVF there are two distortions: a distortion of values and a resulting distortion of relationship. In all three processes young human beings are depersonalized, reduced to the status of commodities, which can either be manufactured and manipulated to supply a demand, or disposed of because of an over-supply or quality defect. The consumer mentality so characteristic of our society, has profoundly affected the way children are viewed. Promoters of abortion run their campaign in terms of who `owns' the woman's body or the unborn child within it, and the consumer demand for total choice in reproduction and life-style. Promoters of IVF also talk of embryo ownership, quality control, demand and supply, `take home baby rates', patents, `rights' to a child and so on. The focus here is so often on the perceived needs of would-be and wouldn't-be parents, rather than the welfare of the children. And a range of elitist and discriminatory assumptions, such as that the handicapped are better off never born or, if they are born, better off dead, characterizes these campaigns.

The resulting distortion of relationship allows for the domination, exploitation and even elimination of the youngest members of the human family. The unborn and newborn are placed in a position of radical inequality, profound subordination, vis-a-vis their parents and doctors, who decide whether they live or die. A dynamic of violence, domination and pragmatism, no doubt largely unconscious, features in all these procedures. The unprecedented scale and brutality of violence which has marked our century, still colours our daily lives in the rate of brutal crime, the dangers to women walking our streets at night, the high incidence of domestic violence and child abuse, violence in entertainments, and so on. With the aid of medical technology, even the family sanctuaries of crib and womb are no longer exempt. Indeed, as the Australian bishops have observed, the womb has become the most dangerous place for an Australian to live.

3. Justice towards women

Women, too, suffer from both abortion and IVF. We have long known that abortion can have physical side-effects from the very common bleeding and infection to the more serious problems such as cervical incompetence and infertility. More and more evidence is now accumulating about the psychological ill-effects. Some priests, psychologists and social workers now specialize in post-abortion grief counselling.

Unlike abortion, IVF is a very unsuccessful technology: top clinics offer only a one-in- ten live birth rate per IVF cycle. Women can, of course, keep going back, but not without great personal cost and most will still never gain a child through this gruelling process. There are real risks for women from the huge doses of fertility drugs, the other procedures, and the dramatically increased chance of multiple or ectopic pregnancy, miscarriage, premature labour, and caesarian section. The few available studies to date suggest serious psychological ill-effects for many, especially for the women whom these new biotechnologies fail. The next generation may well witness the advent of the post-IVF grief counsellor to parallel the work on post-abortion grief. The women's movement has offered a damning critique of the underlying assumptions and motivations, and the overall effect of IVF on women, suggesting that women's bodies are being used as living laboratories for prestigious research. Whether or not one shares all the assumptions of these critics, their identification of the dangers to women must be of concern to us all.

4. Developing an adult justice ethic

Many scientists, activists and reporters seem to follow an `adolescent ethics' while developing or admiring an `adult science'. A `results are all that count' principle is widespread in the practice and rhetoric of abortion and IVF promoters. Thus abortion is justified by its life-style results or other perceived good consequences. Thus, too, higher IVF success rates or other research goals are willingly achieved through higher embryo death rates, greater risks to women and society, or ethically controversial procedures, without reference being made to means and intentions.

Sometimes I am confronted with the question: "How could you be opposed to these wonderful test-tube babies?" Of course I am not opposed to those babies, or their parents for that matter. I love babies. I love parents. Of course I agree that it is good for childless couples who want children to have children. But not all ways of supplying that desire are ethical: stealing someone else's baby from a pram, for instance, would satisfy the same end but would not be just. As a human being and a Christian, I am convinced that certain goods (such as life, truth, friendship and justice) are so fundamental that it is never ethical to choose against them, even for some very good result; that some human rights are `inalienable'; that no human being should be reduced to a means to other people's ends; and thus that the how and why of moral acts is as important as what is achieved. There are ethical norms which transcend the childish and pragmatic calculus of costs and benefits. Another `adolescent ethic' displayed by some is the so-called `technological imperative': that if technologically a thing can be done, it should be done. All scientific advances - however attained - and their applications are presumed to be self-justifying, and any opposition to these programmes dismissed as 'backward' or superstitious. Yet in the areas of nuclear science, resources and the environment we are more aware than ever before that 'value free' technology 'pursuing its own goals without external interference of law, morality, religion etc.' is ethically naïve and socially irresponsible.

A social justice issue raised by the technological imperative is the question of the proportion of scarce medical resources being allocated to IVF - a relatively unsuccess- ful but high-kudos technology. Australians are the highest per capita `consumers' of the new reproductive technologies in the world: there are more IVF cycles and clinics here than in Britain where IVF began and where the population is several times ours. We spend more on IVF each year than on the whole national community health budget, and it will cost something like $1,000 million to provide it for all Australians who might benefit. The World Health Organisation, however, suggests that for every one IVF child born perhaps one hundred women could be prevented from becoming infertile in the first place. Meanwhile research into the causes and efforts to prevent our infertility epidemic are severely underfinanced; almost nothing is being done to get to the cause of and prevent the problem which IVF seeks to address only by relieving a symptom; there are insufficient prenatal and neonatal resources to save existing lives; Australia still has a scandalously high aboriginal baby death rate; and babies all over the woprld are dying every minute for lack of appropriate care. Thus IVF presents a classic example of a serious misallocation of research and medical resources and thus a major social justice issue.

A third inadequate ethic is the babies-(only)-on-demand principle characteristic of contemporary consumer societies. The culture of the me-generation, of `looking out for number one', of `yuppies 'and `dinkies', encourages us to want and have children only at the appropriate time (if at all), in limited numbers, carefully spaced, and genetically perfect. Our self-evaluation and the love we offer the next generation becomes conditional on their arriving on schedule and being perfect. The imperfect and the unexpected are eliminated, like old stereos or unsolicited goods; children become a consumer item, chosen in so far as they add to the personal satisfaction and growth of their individualist consumer-parents. Hence the ease with which our society disposes of so many; hence the almost frenzied efforts to fulfil the demand for a child. Babies-on- demand allows the medical and technological establishment on behalf of society to do what on face value seems an absurd contradiction: kill thousands of our youngest brothers and sisters in one ward, while creating thousands of others in another.

Christians are not opposed to the use of many medical technologies to assist the co- creation and nurturing of human life. Nor are they naïve about the ethical complexities involved in the application of new scientific knowledge. Nor do they underestimate the pain and anguish which the authentic application of gospel values occasions for many people. But they continue to ask all would-be parents and the medical profession to respect the dignity and goods of the human person, and the moral values which safeguard these.

5. Towards a just response

In abortion, infanticide and IVF we meet such hard questions as: What kind of people do these choices make us? What kind of persons do they say we are? Are these activities really consistent with love and respect for persons? Are they really the most just and compassionate response?

Women with unwanted pregnancies, the parents of unwanted handicapped infants, and involuntarily childless couples, all cry out for some response from a loving community. In them the suffering Christ challenges us: what are you doing for these (Mt 25)? Individually and as a community we must:

* fight the causes of unwantingness, such as unjust social structures, popular attitudes and personal relationships that make child-bearing and rearing so bur- densome for some;

* combat the causes of Australia's copulation (rather than population) explosion and infertility epidemic;

* call for a juster use of medical resources and social services;

* offer to the childless real opportunities for life-giving, fostering, child-caring and similarly fulfilling experiences;

* extend tender understanding and any appropriate relief and consolation we can give;

* supply counselling, education, support of many kinds, respite, and real alternatives;

* proclaim the value of the family and the vocation of parenthood, while resisting any deprecation or degradation of the single mother, the handicapped or the childless couple; and

* preach and witness to the dignity of every human life.

I think we must also face head-on the spirituality of suffering, for the meaning of suffering is the fundamental bioethical question for our anæsthetic society which cannot cope with suffering of any kind and demands immediate pain relief for all conditions.

For all the benefits for individual patients and the medical profession, abortion, infanticide and IVF also threaten some basic human values. Christians do not pretend to judge those involved. But like anyone else we can ask: Do we need these procedures? Do they serve the civilization of life and love? Are they really the most just and caring - the most compassionate - answers to problems with unwanted or wanted children. There is an urgent need for a prayerful, intelligent and loving appraisal of life-and-justice issues such as abortion and IVF, more honest and critical than the sensational assessments often offered so far. The 1990s invite such an effort.

Anthony Fisher, O.P.

Adapted from a paper delivered by at the Victorian State Conference of the Teams of Our Lady in Melbourne on 17 March, 1990. Fr Anthony is a Dominican preist now studying at Oxford University.Most of my sources, and much fuller argumentation and documentation, are cited in Anthony Fisher and Jane Buckingham, Abortion in Australia: Answers and Alternatives (Melbourne: Dove Communications, 1985) and Anthony Fisher, O.P., IVF: The Critical Issues (Melbourne: Collins Dove, 1989).