At the End of the Day

Brendan McCarthy

• Publisher: Church House Publishing
• Year: 2014
• Print ISBN: 9780715144534
• eBook ISBN: 9780715144558
• Topic: Theology & Religion
• Subtopic: Christian Ministry

From assisted suicide to basic standards of nursing and residential care, debates around end of life issues are rarely out of the news. This succinct guide represents current thinking in the Church of England and offers a framework for ethical decision making and the highest standards of pastoral care in often complex and challenging situations.

1. The Church of England and medical ethics: Identifying an ethical framework

Brendan Mccarthy

Shortly after I took up my position as the Church of England’s national adviser on medical ethics and health and social care policy in 2009, I was tasked with preparing briefings on amendments brought to the Coroners and Justice Bill that sought, under certain conditions, to legalize assisted suicide. Hot on the heels of this debate the General Medical Council conducted a consultation on end of life care, and I was responsible for preparing an initial draft submission on behalf of the Church. In both cases it was a relatively simple undertaking to trace relevant policy statements made by General Synod or outlined by various boards or committees, and to weave them into the respective responses.

I was also aware, however, that I was not able readily to identify a clear ethical narrative running through the Church’s various policy statements, particularly one that sought to describe the relationships between theology, ethics and public policy. That is not to say that such a narrative did not exist, but I could not easily identify a clear and consistent articulation of it; I suspected I might not have been alone in struggling with this. I began, therefore, to map out a theological and ethical ‘back story’ to the Church of England’s policy statements on end of life (and other) issues, keeping in mind the Church’s engagement with other social commentators and activists as well as with Parliament. What eventually emerged, through discussions with various individuals and groups both inside and outside the Church, was a template for engagement that I have found useful, not only in the context of end of life issues but also in a wide range of issues associated with medical ethics. I have employed it in numerous discussions, debates and consultations, and it has formed the backdrop to a number of recent contributions that the Church of England has made, at a national level, in the field of medical ethics.

There are, of course, varying Christian perspectives on medical ethics, reflecting the differing beliefs, principles and practices that undergird them. The Church of England celebrates theological and ethical diversity more than most, so it is not possible to construct a framework for ‘public theology’ that will gain the support of all. Indeed, since the Church encourages its members thoughtfully to explore issues for themselves and to make their own personal ethical decisions, diversity of opinion is to be expected and welcomed. While biblical and theological reflection, especially on the life and teaching of Jesus, play an important role in many individuals’ decision making (and certainly in that of General Synod and other official organs of the Church), others base decisions more loosely on a mixture of their Christian background, their personal experience and daily interaction with people and current ideas. It is not possible, therefore, to present a definitive Christian, or even Church of England, perspective on medical ethics, but it is possible to identify a number of commonly agreed features that contribute, consciously or subconsciously, to the perspectives many Church members hold.

Seeking to discover, and then to utilize, theological and ethical consensus ought not to be seen as an attempt to apply the lowest common denominator to any given issue; it is not an exercise in reducing the Church’s position to the blandest shade of beige. Rather it is to recognize that diversity can be built on a common foundation that is both true to the Church’s teaching and shared by a significant number of Christians.

At the most fundamental level of any ethical system lie core beliefs – in the case of the Church, about the nature and character of God and about God’s relationship with creation, particularly with human beings. From these core beliefs stem guiding principles that promote positive ethical decision making, reflecting commitment, for example, to justice and love. These principles in turn find expression in particular policies and practices. The movement from core beliefs, through guiding principles to particular policies and practices holds true not only for Christians but for all individuals and groups that are ethically engaged with the world around them.

It is an important feature of Christian ethics that both Christians and others can share the same guiding principles even though they may arrive at them from different starting points, from within different belief systems. For example, I do not have to be a Christian to believe that justice is an essential principle to follow in good ethical decision making. Similarly, particular practices may be agreed by people of differing religions or none – shared core beliefs are not necessary for shared ethical action. It is, I believe, particularly important to recognize this as it is usually at the levels of principle and practice, rather than core beliefs, that the Church contributes to social and political debates on medical ethics. A simple appeal to biblical teaching or to religious authority ought seldom, if ever, to be made in the mainstream of public debate even though, as I have noted, these will no doubt have played a part in helping the Church as a body, as well as many individual Christians, to develop the guiding principles they bring to a discussion.

A Christian contribution to ethical debates within society may be unashamedly Christian, but at the same time it will seldom seek to be exclusively Christian. While recognizing that key theological beliefs form the foundation on which the Church develops its guiding principles as well as its practices and policies, it is important that these principles and practices be debated in their own right, and not simply viewed as adjuncts to faith. As I noted earlier, it is often the case that the same, or similar, principles and practices emerge from varying underlying core beliefs. Most people, regardless of their theological beliefs (or lack of them), will agree, for example, that compassion ought to be at the heart of a mature and cohesive society, so the promotion of this and similar principles upheld by Christians ought not to be seen as ‘forcing faith’ on others or as an attempt to impose a ‘Christian society’ on the United Kingdom.

In principle, in a genuinely inclusive society, faith of whatever sort ought to be accepted as providing as valid a foundation for ethical debate as any other under-girding philosophy. It is not necessary to agree with a particular religious faith, or even to believe that religious belief is tenable, in order to accept that faith can provide a basis for careful ethical reflection and the promotion of good ethical principles. Secularism, which seeks to marginalize faith-based contributions in public debate, attempts, in effect, to impose its own particular philosophy on others. Continued Christian engagement in debates on ethics and public policy can help to highlight the narrowness of that stance. Inclusion, not secularism, is the sign of a healthy, tolerant and progressive society.

Core Christian beliefs relevant to medical ethics

Some of the Church’s core theological beliefs are shared with other religions, some are distinctive to Christianity. While identifying these core beliefs is an essential undertaking in understanding the theological and ethical basis for the Church’s engagement in public debates, I want to emphasize again that these beliefs do not usually form the interface between the Church and the rest of society in such debates. As outlined above, that interface is normally found at the level of the guiding ethical principles that these core beliefs undergird. Nonetheless it is important that Christians are able to identify which core beliefs are most relevant to medical ethics, both to enable them to understand better the relationships between theology, ethics and public policy and to explain, if asked, this process to interested parties. There is no question of the Church ‘hiding’ its theology from public scrutiny; rather it is a matter of finding the appropriate place for engagement with others in debates on public policy.

In the following paragraphs I outline very briefly the salient Christian beliefs that are most relevant for medical ethics. This is not an exhaustive list but it forms a basis for understanding the theological origins of the Church’s ethical principles.

God the life-giver: the creation of the universe is a free and loving act of God, as a result of which the gift of life is given to human beings. While we share this gift with many other creatures, the Christian faith teaches that we are unique; of all the varied forms of life, we alone are made in God’s image. The ‘image of God’ is not something that we possess; it reflects something that we are. This means that Christians understand human beings to have a particular status within earthly creation and that our innate dignity comes from being bearers of God’s image, enabling us to relate to God and to one another in a manner that reflects God’s own being.

God as Trinity: God is a personal being, but however we might struggle to articulate our theology, God ought never to be understood as merely being a ‘bigger’ version of us. As the personal origin of all that is, God is unique; God is the archetypal ‘person’. Our concept of what it means to be a person ought to come from an understanding of God, not the other way around. The Christian belief in the ‘communal’ unity of the Trinity, in which complete mutual love and knowledge are infinitely shared, indicates that relationship lies at the very centre of God. Consequently, relationship is intrinsic to the very concept of what it means to be a person.

God incarnate: in becoming one with humanity through incarnation in Jesus, God demonstrates selfless love, care and responsibility for humans. Metaphysical reflections on the nature of the incarnation are secondary to understanding its significance: relationally, God is with us, not apart from us. The incarnation also indicates that the physical and the spiritual are not two separate unbridgeable realms but that they are part of a continuum that reflects the reality of God. Creation is not something that exists ‘separated’ from God; rather at every level it is sustained and infused by God’s presence.

God the redeemer: in the Christian doctrine of the atonement, variously expressed by a number of overlapping theories and illustrations, God takes personal responsibility for human beings and our attendant sinfulness. God freely offers eternal life through Jesus’ identification with sinful humanity, demonstrated ultimately in his death on the cross. Grace, by which humans are freely given the gift of eternal life, is the hallmark of God’s relationship with us and hence ought to be the hallmark of our relationships with one another. One aspect of the resurrection of Jesus is that it demonstrates God’s desire to bring humanity to ‘fulfilment’. As Oscar Wilde put it, ‘Every saint has a past and every sinner has a future.’

God and justice: Jesus taught that our treatment of the poor, the oppressed and the vulnerable has a greater importance than we might often realize: as well as being significant in its own right, our treatment of the vulnerable is viewed by Jesus as our treatment of him. The themes of love and justice run throughout the Scriptures and are demonstrated powerfully in the life and teaching of Jesus. His identification with the vulnerable and the oppressed provides the backcloth for subsequent Christian social action.

God and community: as outlined above, a Trinitarian understanding of God indicates that relationship lies at the heart of what it means to be a person. Human beings seldom live in isolation from one another – we are bound together by ties of family, friendship and community. This is reflected in the New Testament concept that followers of Jesus are organically united in the Church, often described as the Body of Christ. We are joined to him and to one another in spiritual union. Individual, personal actions ought to be understood in this wider context – what we do affects others and this in turn affects us in a spiral of relational interaction.

Guiding ethical principles

The core beliefs outlined above form a theological ‘reservoir’ from which the Church may draw resources, enabling it to formulate ethical principles relevant to medical ethics. It is essential that this reservoir of knowledge and reflection exists, but in discussions with government, Parliament and other bodies with regard to public policy, the contents of the reservoir will seldom become a focus for debate. I wish to underline, again, that this is not because the Church wishes to hide its theological convictions; rather in seeking to contribute to the creation of public policy it is essential that the Church finds an appropriate interface for discussion: an appropriate space in which it can make a meaningful contribution. That place is seldom going to be at the level of theological debate, but it will frequently be appropriate to engage others in discussion on the basis of ethical principles, based on theological beliefs. These or similar ethical principles may emerge from a variety of theological or philosophical belief-systems, from an eclectic mixture of reason, intuition and experience or from various amalgamations of all of these. The important point is that regardless of whichever foundational core beliefs individuals and groups might hold, these beliefs will find some expression in ethical principles. It is therefore possible for the Church to engage in constructive debate with all other interested parties in the fields of medical ethics and public policy without having either to promote or defend its distinctive theological beliefs.

With regard to medical ethics and public policy, I suggest that four overarching principles may usefully be distilled from the Church’s theological reservoir. These form the crucial interface for debate and discussion with others. They also complement one another, displaying an order of precedence, the effects of each principle ‘cascading’ to succeeding principles. This is an important point to note as the principles themselves are perhaps likely to gain wider support than the concept of applying them in a particular order. The principles, listed in order of priority, are: affirming life; caring for the vulnerable; building a cohesive and compassionate community; respecting individual freedom.

Affirming life

This principle has often in the past been expressed in terms of ‘the sanctity of life’, but that phrase not only carries with it overtly religious overtones, it also fails to indicate what recognizing ‘sanctity’ entails. ‘Affirming life’ acknowledges that both ‘the right to life’ and subsequent legal protection of life, form the foundations not only of human rights law but also of much of our criminal code. Indeed, it goes further: to affirm life is to accept that each individual life has purpose, value and meaning, even if some individuals doubt that for themselves. It also entails striving to attain the highest quality of life possible for every person, regardless of the circumstances in which they may find themselves.

There are, of course, many ways of ‘valuing’ life and it is important to explore these if we are to understand how and why life ought to be affirmed. It is certainly part of the Christian tradition to believe that every person’s life is of intrinsic value, although this idea has come under attack from some quarters. It is easy to see how belief in the intrinsic value of every life flows from the concept that every human being is made in the image of God. It is also possible, however, to come to the same conclusion from a different starting point. Those who wish to diminish the role that this belief plays within our society must ask themselves what the consequences would be if it were to be removed from our thinking. Much...

Table of contents

• Copyright information
• Contents
• Foreword
• About the authors
• Preface
• 1. The Church of England and medical ethics: Identifying an ethical framework
• 2. Physician-assisted suicide
• 3. Organ donation
• 4. Healthcare issues towards the end of life: A chaplain’s perspective
• A selection of key Church of England documents on end of life issues
• Some key terms used in the debate on assisted suicide
• Timeline of significant events related to assisted suicide