BY GERALD R. WINSLOW
HE PHYSICIAN'S QUESTION CAUGHT me off guard. He asked if he could meet with me later that day for a consultation about ethics. It was the 1960s, and I was a newly graduated theology major filling in as a chaplain in an Adventist hospital before heading to seminary. When we met later that day, I was not prepared for the doctor's questions. What, he wanted to know, was the Seventh-day Adventist position on abortion? What official statements existed, and what did I think of them? The state of Oregon, where the hospital was located, had recently changed its laws on the permissibility of "therapeutic abortion." As a physician from a different faith community, the doctor wanted to know what guidance my church was offering this Adventist hospital and the physicians who practiced there. Beyond that, he wanted to know what I believed and why.
I realized quickly that nothing about my theological education had prepared me specifically for these questions. I promised the physician that I would study the matter and get back to him. I kept that promise. And, in the process, I discovered that little had been written about biomedical ethics by Adventists up to that time.
The Birth of Bioethics
Now, nearly four decades later, I am still studying this important area for Christian reflection. What the Oregon physician and I could hardly have foreseen during our brief "ethics consultation" was the astonishing growth in human control of life, at its beginning and its ending, in ways that would continually produce new and difficult ethical questions. We were, at that time, on the edge of what would come to be known as bioethics--the application of careful thinking about the ethical questions posed by new developments in human biology and health care. What difference should our faith make when it comes to the challenging questions posed by increased human power over our own biological destiny? How should we view these questions if we believe in the love and authority of our Creator? For a church as devoted as Seventh-day Adventists to the study and provision of health care, I concluded that we have a significant responsibility to address the questions of bioethics.
Already in the 1960s patients were beginning to be placed on artificial life support. But many of them would never again experience consciousness. And a new array of medical technologies made it possible to keep people alive who could not have survived before. Already questions had arisen about the quality of life with such interventions. I still remember the beautiful 3-year-old girl who had suffered a major brain injury because of being hit by a truck. She was kept breathing with the help of what was then a new technology, something that has come to be known as a ventilator. Her deeply religious family was awaiting a miracle. As the chaplain for the intensive care unit, I was asked to help the family understand that their daughter would not be able to awaken, and that a decision to withdraw the ventilator was needed. It was my first encounter with what has now become the most common question of bioethics: How do we know when enough is enough in the provision of artificial life support?
One of the most dramatic examples of new medical technology that awakened new interest in bioethics was the development of the artificial kidney in the 1960s. Dr. Belding Scribner said that he literally awoke in the middle of the night with a new idea about how to save patients dying from kidney failure.1
The resultant technology allowed Dr. Scribner and his colleagues to connect patients repeatedly to kidney machines that would mimic what patients' failed kidneys could no longer do. But Dr. Scribner soon realized that technological breakthrough, known as dialysis, was only a partial solution.
The problem was that there were far too many patients needing dialysis for the limited number of available kidney machines. There was also the problem of how to pay for these expensive treatments. So a committee that included physicians and community representatives was appointed to decide who, from the long list of candidates, would receive the life-saving treatments. Churchgoers and community leaders stood a good chance. Hippie poets and the unemployed were out of luck. This process of patient selection gained notoriety, as many people questioned the capacity of the committee members to "play God" by deciding who would live and who would not on the basis of patients' social value.
Eventually, most industrialized countries found ways to provide dialysis to all in need. But the invention of the kidney machine illustrates how some of our most notable innovations in medicine lead to some of our knottiest ethical questions.
Controlling Life's Edges
The Bible says, "For everything there is a season, and a time for every matter under heaven: a time to be born, and a time to die" (Eccl. 3:1, 2, NRSV). But advances in health care have often significantly altered the timing of life's commencement and its conclusion. Take, for example, the beginning of life. The first test-tube baby is now a grown adult approaching her thirtieth birthday. In order to help her parents overcome their infertility, her conception occurred in a British laboratory, and the resultant embryo was later implanted in her mother's uterus. It is estimated that more than 400,000 human embryos conceived in a similar fashion are currently being kept frozen in the United States,2 with a comparable number in the countries of the European Union. If couples who sought assistance with reproduction have given birth to as many children as they had wanted, then the embryos that remain frozen are often considered spares. Their time to be born might never arrive, or it might be postponed for many years or possibly even many decades.
At the other end of life, remarkable medical interventions have made it possible to extend countless lives beyond what could only be imagined just a few decades ago. Most of the time we celebrate these new developments, but sometimes life's extension comes with a heavy price, both financial and ethical. In the United States, for example, it is estimated that between 10,000 and 25,000 people are being kept alive in what is known as a persistent vegetative state.3 One such patient lived for more than 40 years in this condition before his demise. From the perspective of medical science, these individuals have little or no chance of returning to consciousness. Their tragic cases raise difficult questions about the ethical limits of life-extending treatments.
Adventists Respond
In 1981, recognizing our church's need to address such questions of bioethics, Neal C. Wilson, then General Conference president, called for action. In an address delivered at Loma Linda University, Wilson expressed his conviction that Adventist faith should empower us to exercise leadership in many aspects of health care. At the top of Wilson's list of examples was leadership in bioethics: "Since our purpose at Loma Linda University is to develop character, and it is done in a religious orientation, could we not become leaders in the area of Christian ethics as it relates to life and death issues today?"4 Wilson concluded, "I say to this body that we ought to be leaders in this area!"
Recently I spoke with Elder Wilson about his reasons for these remarks. He told me that "as Adventists we had steered away from this aspect of life."5 Based on his understanding of Ellen White's counsel, Wilson had become convinced that we would face increasingly difficult questions about bioethics as we approach the end of the great controversy. It is still his conviction that we should give leadership in these matters. "It remains," he said, "a burden of my heart today."
In response to Wilson's call for leadership, Loma Linda University established the Center for Christian Bioethics, which opened its doors in January 1984. The founding director of the center, the late Dr. Jack Provonsha, with the aid of his colleagues professors David Larson and James Walters, created a place in which scholars can pursue research in all sectors of bioethics. During its two decades of service, the center has sponsored numerous national conferences, published nearly a dozen books, distributed a newsletter received by thousands of readers, consulted with church and hospital leaders, and hosted scores of ethics presentations at the university and its medical center. Now it is even possible for students at the university to earn a master's degree in biomedical ethics.
Another important development for Adventist bioethics was the appointment by the General Conference of the Committee on the Christian View of Human Life in 1989. This committee brought together church members from many parts of the world and representing a variety of professions, including nurses, physicians, psychologists, ethicists, attorneys, and church leaders. It was led first by Dr. Albert Whiting, and later by his successor as head of the church's health ministries department, Dr. Allan Handysides. The committee worked for more than a decade to develop our church's statements on bioethics. Beginning with the conflicted topic of abortion, the committee went on to address the ethics of care at the end of life, assisted human reproduction, genetic engineering, human cloning, and a number of other issues in bioethics. The resulting statements are available on our church's Web site.6 For each topic the overarching goal was to set forth scriptural principles as understood by Seventh-day Adventists.
Fundamental to all of these principles is the belief that we serve a loving Creator who has made us in His own image (Gen. 1:27), with the power to be creative, make choices, and cooperate with Him. Because we believe in the wholeness of human life--body, mind, and spirit in dynamic unity--we accept the protection of embodied life as a spiritual responsibility (1 Cor. 6:19). Through our health-care ministry we have the opportunity to collaborate with God in preservation and restoration of the divine image in human beings. Finally, our Adventist faith teaches us that the ultimate hope for the future of human life does not depend on more clever technology but on the power of God to intervene decisively in human history.
Today, new developments in human biology and medicine continue to ensure a constant stream of new ethical questions. The current debates about physician-assisted suicide, research with human embryonic stem cells, the cloning of human embryos, and new methods of assisting human reproduction remind Adventists that we have a God-given responsibility to offer leadership in bioethics. It would be irresponsible of us to educate health-care professionals and operate health-care institutions with the highest possible levels of medical technology if we fail to address the ethical issues we encounter.
By His grace God has given us the resources we need to address today's bioethical questions from the perspective of the Adventist hope.
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1 This story is told more fully in Gerald R. Winslow, Triage and Justice (Berkeley: University of California Press, 1982), pp. 12-21. See also Albert Jonsen, The Birth of Bioethics (New York: Oxford University Press, 1998), pp. 211-217.
2Rick Weiss, "400,000 Human Embryos Frozen in U.S.," Washington Post, May 8, 2003, p. A10.
3 The Multi-Society Task Force on PVS, "Medical Aspects of the Persistent Vegetative State," part 1, New England Journal of Medicine, May 1994, vol. 330, pp. 1499-1508.
4 Neal C. Wilson, address delivered at Alumni Post-Graduate Convention, Loma Linda University, Loma Linda, California, March 3, 1981.
5 Telephone interview with Neal C. Wilson, January 23, 2005.
6 The Web addresses for the sites that have most of the statements developed by the Committee on the Christian View of Human Life are www.adventist.org/beliefs/statements/index.html and www.adventist.org/beliefs/guidelines/index.html.
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Gerald R. Winslow, Ph.D., is vice president for spiritual life at Loma Linda University Adventist Health Sciences Center.
