A Christian’s View of Autonomy in Medical Ethics
Modern medicine, following along with the rest of society, has become increasingly focused on the right to self-determination. This principle of autonomy has risen above any other virtue in medical ethics to become one of the most decisive factors in health care. The idea that we have an innate right to decide our own future has become progressively problematic for issues concerning medical ethics.
Christians must be aware of how this principle became the dominant view in medical ethics and what its consequences are. Instead of idolizing self determination, health care should seek a balance with the other main virtues of healthcare: beneficence, non maleficence and justice. When autonomy oversteps its bounds in medicine, we should be informed and willing to seek change. Even if you are not a healthcare worker, do not turn a blind eye to these medical issues that harm the unborn, disabled and elderly members of our society. Today, physician-assisted suicide, abortion and the push for genetic modification in utero are some of the main issues in medicine where the appeal to self-determination has consistently won out.
Physician Assisted Suicide
Mayo Clinic defines assisted suicide as “another person providing the means or assisting someone with self killing.” In the United States, physician assisted suicide is currently legal in nine states and the District of Columbia. Several countries across Europe have also legalized this practice. According to the Belgium public health records, physician assisted suicide is permitted for both terminally ill patients and non-terminally ill patients who are suffering from a mental disease.
In Principles of Biomedical Ethics, Tom Beauchamp and James Childress summarize one of the main arguments for physician assisted suicide:
Aiding an autonomous person at his or her request for dying is, from this perspective, a way of showing respect for the person’s autonomous choices.
This clearly sums up why many people are willing and ready to support the right to this method of death. They view the physician’s assistance as a way of respecting the person who has a desire to die.
As Christians, showing respect for those who are suffering physically or mentally comes in the forms of compassionate care and advocacy. Instead of claiming that we respect people by allowing them to take their own life, we ought to recognize that life is valuable enough to protect and cherish. Psalm 139:16 says:
Your eyes saw my unformed substance; in your book were written, every one of them, the days that were formed for me, when as yet there was none of them.
God knows the number of days that each person will live so we should not feel a duty to help people take their own lives. Instead we should care for people in a way that gives testimony to the deep value of life. Joni Eareckson Tada, the founder of Joni and Friends and an advocate for life, sums this up perfectly when she writes:
The objective, biblical view holds that human life is God-given and should not be destroyed. Life is the fundamental and irreplaceable condition of the human experience and should be safe-guarded at all costs.
May we always remember this and act in a way that reflects it.
The pro-choice argument is centered around “a woman’s right to choose” and that it is an intrusion of privacy to keep a woman from aborting her baby. This is clearly seen in organizations such as Shout Your Abortion where pro-choice supporters desperately attempt to normalize abortion. Their website bluntly explains this mission on their front page by saying, “Abortion is normal. Our stories are ours to tell. This is not a debate.”
The pro-choice argument places total autonomy on the pregnant woman. It is quite literally called the “pro-choice” movement where one person’s choice trumps all. It does not consider the choice of that unborn child, the father of that child, or any other party. Overall, the pro-choice camp pushes the idea that if you do not support their self-determination in aborting a child you are against women’s freedom.
Perhaps the most devastating effect that has come from abortion is the tendency to “choose” a child based on his or her diagnosis or potential “quality of life.” In 2017, Julian Quinones and Arijeta Lajka wrote an article for CBS news concerning the abortion rates of children with Down syndrome which revealed that in the United States about sixty seven percent of children with Down syndrome are aborted; some European countries have rates in the nineties. Quinones and Lajka’s article also stated that Iceland has one of the highest abortion rates which tragically results in an average of only one or two children with Down syndrome being born each year.
Scripture reveals that someone’s abilities, cognitive function, or any external feature does not give anyone less value or worth. This is evident in John 9 after Jesus’ disciples ask, “Rabbi who sinned, this man or his parents, that he was born blind?” Jesus responds to this by saying:
It was not that this man sinned or his parents, but that the works of God might be displayed in him.
It is a shocking reality that so many unborn children’s lives are taken before they come into this world. It is vital that we not forget this tragedy, but instead stand up for both the unborn and the pregnant women who are told that abortion is the most empowering decision they can make.
Genetic modification in utero differs from the previous issues because it is a much more recent ethical issue and not a widely spread legal practice. Calum Mackellar explains in his article “The Gene Editing of Human Embryos and the New Eugenics”,
The possibility of editing the genome of human beings has become significantly more likely with the development of systems such as CRISPR/Cas9 and the announcement, in 2015, that Chinese scientists had become the first to gene-edit a human embryo.
This has given rise to many discussions and debates concerning genetic modification for medical reasons and the additional possibility of gene editing for cosmetic reasons.
The attempt to edit genes with germ cell therapy is again an arena of medicine where people could appeal to autonomy. It could easily become the choice of parents on which genes they want their child to have. Although this is not what is currently occurring, it is important to be wary of this possibility.
There are a few key reasons why Christians should be concerned by this recent development in medicine. First of all, there is no ethical way to test genetic modification that does not put embryos at risk. Furthermore, the embryo cannot possibly give consent for this genetic modification that could change the very essence of who they are. Finally, genetic modification does not just alter a single person. Instead, it changes the genetics for each of the following generations. Gilbert Meilander explains the dangers of this in his book Bioethics: A Primer for Christians by writing,
When we take up the project of shaping future generations in so fundamental a way, we cannot really know what good or ill we may accomplish—we cannot, that is, really know what project we are undertaking.
Changing the innate design of a person should not be in the hands of any human. In the article, “What’s Wrong with Designer Genes?”, Paige Cunningham and Michael J. Sleasman explain this accurately,
This type of direct intervention threatens to distort our understanding of children as gift[s] to children being treated as products of choice and intention.
This is a clear reminder of the incredible value of children and why we must not shift our perspective on the innate design of children.
A Closing Reminder
As Christians, it is vital to remember that humans are deeply broken and sinful in all aspects of life. This undermines the idea of autonomy because it acknowledges that even an “autonomous” decision does not mean that it is the right or even morally justifiable one.
In light of this, we must remember to cherish life and not settle for the argument of autonomy. As incredible technological advances continue in modern medicine, it is becoming more important to be aware of the ways in which human dignity can be overlooked, all for the right of self-determination.