Contemporary society maintains a strangely ambivalent attitude toward the value of life. Life seems now cheap, now precious, on no clearly discernible principle.
For example, the British government saw nothing anomalous about including in its program of reform both the abolition of capital punishment and a wider freedom for abortion. And last year the Arts Council surrendered to public pressure and reprieved sixty catfish from a humane three-second electrocution, while in the same week the press gave considerably less publicity to the killing of two men and the injuring or maiming of twenty-seven others by a bomb planted in a Belfast public house.
Respect for life is naturally a subject of constant concern for every doctor—respect for the beginning of life (conception and birth), its continuance in growth to maturity, and its end in death. I am perhaps most hesitant to speak about the beginning of life since I read a comment quoted by Dr. Granville Williams in The Sanctity of Life and the Criminal Law (1958): “There seems to be something about the human reproductive system which throws the ecclesiastical mind off its balance.” Certainly the whole subject is immensely complicated, with legal, medical, social, and economic implications as well as philosophical and moral ones.
My concern is to ask whether Christian faith can supply a guiding principle to help us find our way through the labyrinth of medico-moral problems. I believe it can. Let me, then, plot out the territory we are to traverse.
First, I hope to isolate the essential principle as being not so much the sanctity of life in general as reverence for human life in particular.
Second, I mean to defend this principle by setting it on its true (theological) basis.
Third, I will try to apply the principle of reverence for human life to medical practice and to some burning medical issues.
The Principle Isolated
My text, fundamental to my thesis, is Genesis 9:1–6:
And God blessed Noah and his sons, and said to them, “Be fruitful and multiply, and fill the earth. The fear of you and dread of you shall be upon every beast of the earth, and upon every bird of the air, upon everything that creeps on the ground and all the fish of the sea; into your hand they are delivered. Every moving thing that lives shall be food for you; and as I gave you the green plants, I give you everything. Only you shall not eat flesh with its life, that is, its blood. For your lifeblood I will surely require a reckoning; of every beast I will require it and of man; of every man’s brother I will require the life of man. Whoever sheds the blood of man, by man shall his blood be shed; for God made man in his own image.”
These purport to be the words of the Creator, from whom all life (human, animal, and vegetable) takes its origin. After the judgment of the Flood, God renews his blessing to man. He confirms both man’s power of procreation (the command to be fruitful) and man’s dominion over the whole animal creation. “Into your hand they are delivered” he says. This animal creation may serve man for food. However, though man might shed animal blood, he was not permitted to eat it, since blood is the symbol of life and life remains God’s possession. And no animal or man might shed human blood with impunity: “Whoever sheds the blood of man, by man shall his blood be shed; for God made man in his own image.”
It is important to recognize that capital punishment was divinely authorized not because human life (the murderer’s) was cheap, but because human life (the victim’s) was precious. Capital punishment in the Mosaic legislation was intended to bear witness to the value, the sanctity, of human life. The context puts this beyond question. Animal life might be taken (for food and clothing). But human life might not be taken, because man bears God’s image. The only exception to this rule was the judicial execution of the murderer, whose life was forfeit precisely because he himself had violated the sanctity of human life.
The distinction between animal life and human life, between the permission to take the one and the prohibition against taking the other (except judicially), is the essential background to our discussion. It should protect us from either of two extreme positions. These extremes I will illustrate from two influential Germans who were contemporaries in the thirties and early forties.
Albert Schweitzer’s philosophy was in some ways a mixture of Christianity and Buddhism. Its fundamental principle was “reverence for life,” for all life. Schweitzer refused to distinguish between higher and lower forms, more or less valuable forms, because to do so (he said) would involve an entirely subjective judgment. How can we know, he asked, what significance any kind of life has? It was rumored that he would even decline to swat a fly in the operating theater at Lambarene.
That Adolf Hitler went to the opposite extreme I hardly need say. Millions of Jews were liquidated in his gas chambers, and more than a quarter of a million non-Jews in his compulsory euthanasia centers. Many more millions were killed in the war into which he dragged the world.
Christians who take the biblical revelation seriously could not follow either of these men—although, to be sure, Schweitzer’s philosophy is infinitely preferable to Hitler’s.
We cannot follow Schweitzer and declare all life sacrosanct. Certainly we acknowledge God as the creator and sustainer of all life; we recognize, as Jesus taught, that ultimately it is he who feeds the birds of the air and clothes the flowers of the field; and we should set ourselves against all wanton destruction of animal and plant life. But at the same time we acknowledge that God gave man dominion over the animal creation, so that we have liberty to eat animal flesh, to harness animal labor to our service, to perform controlled experiments on animals for man’s benefit, to exterminate harmful vermin, to put suffering animals painlessly to sleep.
At the other extreme, we cannot follow Hitler and declare no life sacrosanct. The compulsory euthanasia of the psychopath, the imbecile, or the senile on the ground that he is “useless” to society is abhorrent to us. Also abhorrent to many people is the contemporary pressure for unconditional abortion, and the tendency of many unmarried teen-age girls to regard abortion as, in one doctor’s description, “physically and morally no more serious than having a tooth out.”
But the fetus is not to be compared to a tooth. The fetus on the one hand and the psychopath on the other are at least to some degree human beings.
This, then, is the principle that our text isolates for us—not a reverence for life that regards all life as equally sacred, but reverence for human life. And reverence for human life is the result of reverence for man as a unique, indeed godlike, creature.
The Principle Defended
Respect for humanity, for human being and therefore human life, is (at least on paper) almost universal. For example, the Universal Declaration of Human Rights (1948) asserted in its preamble “the inherent dignity, and the equal and inalienable rights of all members of the human family.” The same year the Declaration of Geneva, adopted by the World Medical Association, included the pledge, “I will maintain the utmost respect for human life, from time of conception”—which is a positive version of the Hippocratic Oath dating from the fifth century B.C. “not to give a deadly drug to anyone.”
But what is the basis for this respect for human life? The humanist has no adequate answer. For if man is fundamentally an animal, why may we not treat him as we treat other animals? And if man is the present culmination of the evolutionary process why may we not adopt selective breeding, and the compulsory euthanasia of the physically and mentally defective, in order to give evolution a valuable shove and accelerate the development of the “super race” of which Nietzsche dreamed?
Yet almost everybody recoils from this. Is our reluctance to go this far an irrational prejudice of which we we should seek to rid ourselves? Or is it a true instinct, a recognition of man’s unique value? Do we shrink from treating man as an animal for the simple and sufficient reason that he is not an animal but a human personality, in consequence of which he is to be served and not manipulated, reverenced and not discarded?
Christians alone claim to have an adequate explanation for man’s self-conscious uniqueness. It is a theological explanation that depends on two great doctrines.
First, the doctrine of creation.
Whatever mode God employed in creation (and the mode is eclipsed in importance by the fact), God made man in his own image or likeness. Although the Bible nowhere spells out exactly what this means, the implications are clear. For everywhere Scripture assumes man’s qualitative difference from the animals, and rebukes or ridicules man when his behavior is more bestial than human in its irrationality or godlessness or selfishness.
The divine image in man is a complex of qualities that might be summarized as follows:
1. Man has an intelligence, a capacity to reason and even to evaluate and criticize himself.
2. Man has a conscience, a capacity to recognize moral values and make moral choices.
3. Man has a society, a capacity to love and to be loved in personal, social relationships.
4. Man has a dominion, a capacity to exercise lordship over creation, to subdue the earth, and to be creative.
5. Man has a soul, a capacity to worship, to pray, and to live in communion with God.
These capacities (mental, moral, social, creative, and spiritual) constitute the divine image, because of which man is unique.
Second, the doctrine of redemption.
The very word “redemption” presupposes that man has fallen from the condition in which he was made. He has become alienated from his original destiny. He needs to be remade in the divine image that has been distorted within him.
Christians believe that God so loved his creation, though spoiled by sin and hostile to him, that he sent his son Jesus Christ to effect the work of restoration. And the mission of Jesus shows plainly the value that God still puts on man, even on fallen man. “You are of more value than many sparrows,” Jesus said. And “of how much more value is a man than a sheep?” He exhibited his care for man by his ministry of compassion, especially to the dropouts of human society. Above all, he gave his life for us; so completely did he identify himself with our sin and guilt that he bore in our place sin’s grim penalty, death. And now, risen and exalted, he sends his Spirit actually to live within us and so to transform us into his own image.
So then, both creation (man’s distinctive capacities) and redemption (Jesus Christ’s birth, life, death, resurrection, and Spirit-gift) demonstrate, as nothing else does or could, the uniqueness of man in God’s mind and purpose. These are, as it were, the gold standard against which the value of the human currency is to be assessed. They also supply the rationale of all service undertaken on man’s behalf. If God made man in his own likeness, and humbled himself in Christ to serve and save him, it should be our honor to serve him too, and in particular to reverence his life. God says to us today, as Richard Baxter put it, “Did I die for them, and wilt not thou look after them? Were they worth my blood, and are they not worth thy labor?”
The Principle Applied
I am suggesting, however tentatively, that we have here the moral principle we need to guide us. Whether we are thinking of the embryo, the newborn baby, the youth, the middle-aged adult, or the elderly person, the essential question is: Is this a human being? If a patient is a human being made in the divine image, his life is to be reverenced, and the personal doctor-patient relation has to be preserved. For the patient is a human being, not an animal, and the medical attendant is a doctor, not a vet.
In trying to apply this principle, let us first consider the fetus, and the problem of abortion. Roman Catholics base their case against abortion on the premise that the fetus is a full human being, and that the decisive moment of humanization is conception. We must give them credit for being concerned about the right question (whether the human fetus is a human being or not) and, granted its affirmative answer to the question, its loyalty to logic and principle. But I cannot accept the premise on which the conclusion is based. Nor do I think we can draw a line at some arbitrary point called “quickening” or “viability” and declare the fetus to be human after that point but not human before it. It seems to me better and more biblical to think of the fetus throughout the gestation period as a potential human being, a human being in the making, but not yet an independent individual.
Then, if the choice has to be made, an abortion would seem morally permissible when the mother’s life (perhaps interpreted to include her physical or mental health) is gravely at risk. For then the choice is between an actual human being and a potential human being.
That brings me to a second case, babies born deformed. This issue came to the forefront of public attention as a result of the Thalidomide tragedy of the early sixties. Madame van de Put killed her eight-day-old daughter because she had been born with no arms or shoulder structure, and with deformed feet. She was tried at Liège and acquitted of murder. One can feel nothing but the deepest sympathy for the mother. Yet I think it correct to say that morally this was a murder. Little Corinne van de Put, though terribly deformed, was a human being.
The Bible says much about the severely handicapped, and about the respect due to the blind, the deaf, the dumb, the mutilated, the leper. Even sin has not entirely destroyed God’s image in man. If then the morally deformed are still said to be made in God’s image (James 3:9), the physically deformed certainly are. We have no liberty to say that a damaged, deformed baby is not a human being.
The case of so-called monster babies is, I think, different. Since there are many forms, one cannot generalize. I take as my example the anacephalic, born with a brainstem (and therefore able to breathe) but without any cerebral cortex (and therefore, it seems, entirely without any capacity to think or choose or love or in fact grow into a human being). One can argue, of course, that every creature conceived and born of human parents is human. It is significant, however, that the Roman Catholic Church is prepared to entertain a doubt and will baptize “monster” babies only conditionally, saying, “If you are a man, I baptize you.…” I understand that it is a widely accepted (and I think justified) medical practice not indeed actively to destroy these babies but not to stimulate or resuscitate them and so to allow them to die.
This brings me to the hardest case of all, those sometimes termed vegetables. As a result of brain damage due to accident, disease, or senility, they fall into a deep coma, and their life appears more like that of a vegetable than of a human.
May we say that such a person is no longer a human being? that because he can no longer exercise his distinctively human capacities to think, choose, love, or pray, he has lost the divine image and may be treated as a vegetable? I think not. There is a difference between the congenital “monster” who has never had the capacity to become human and the human being who has become deprived of human powers. There is also our ignorance about the state of the soul of such a person whose brain has been damaged, and the relation between the two. It is also not without significance that the relatives continue to think of such a patient as a “he” and not an “it.”
Nevertheless, if the brain has actually died, it would seem legitimate to allow the heart to die also, and not to keep activating it.
Further, if the brain (and/or body) has suffered such severe and irreparable damage that there is no hope of survival and in fact the process of dying has evidently begun, there comes a time in this case too when the patient’s life should not be prolonged by so-called extraordinary means, but should be allowed to die in dignity and peace.
Norman St. John Stevas in his book The Right to Life (1963) quotes Lord Horder as having said that “the good doctor is aware of the distinction between prolonging life and prolonging the act of dying.” Similarly, the useful report Decisions About Life and Death (1965) published for the Church of England Board of Social Responsibility refers to “a condition of artificially arrested death.”
In this connection Karl Barth went so far as to ask whether “this kind of artificial prolongation of life does not amount to human arrogance.” He goes on: “It is not now a question of arbitrary euthanasia [which he rejects]: it is a question of the respect which may be claimed by even the dying life as such.” In quoting Barth, Dr. Paul Ramsey of Princeton adds his own comment: “To die is one way of being a human creature, and to be allowed to die a precious human right.”
To recapitulate: the theological principle I have been trying to unfold and apply is that man is a unique creature, the object of God’s loving care in both creation and redemption. The reason the Bible forbids the shedding of human blood (i.e., the taking of human life), except judicially, is that it is the life of a human being with a divine likeness. Therefore in complex medico-moral questions of life and death, the fundamental question we have to ask is whether the person concerned is a human being, and whether the treatment (or non-treatment) proposed is consistent with our answer to this question.
In conclusion, I suggest there are two simple lessons for medical practice.
First, a doctor should constantly remind himself that his patient is a person—not an animal to be treated as a vet might treat a dog, nor an interesting case to be added to his medical records, but a person, a human being, made in God’s image. He is therefore, however annoying his temperament or repulsive his symptoms, to be cared for as someone of special value and worth.
Secondly, a doctor should respect and serve his patients accordingly. Vincent Edmunds and Jim Scorer in their book Ethical Responsibility in Medicine (1967) quote Joseph Lister, the pioneer of modern surgery: There is only one rule of practice: put yourself in the patient’s place.” I hope I may echo this without impertinence, for a pastor is also called to care for people, though in a different way. I find I need to say to myself: “God made him in his own image. Jesus Christ died to save him. It is an honor for me to serve him.”
I could not find a better illustration of all I have tried to say than that of Sir Frederick Treves’s thoroughly Christian way of caring for the “elephant man” he found in a vacant greengrocer’s stop opposite London Hospital in 1884. Treves describes him as “the most disgusting specimen of humanity” he had ever seen. He had an “enormous and misshapened head.” A mass of bone projected from both his brow and his upper jaw, giving him a somewhat elephantine appearance, while spongy and evil-smelling skin, which looked like fungus or brown cauliflower, hung in bags from the back of his head, his back, his chest, and his right arm. His legs were deformed, his feet were bulbous, and he had hip disease. His face was expressionless, his speech spluttering and almost unintelligible. His left arm and hand were, by contrast, as shapely and delicate as a woman’s.
To add to his suffering he was treated like an animal, hawked round the countryside from fair to fair and (though without police permission) exhibited to the curious for twopence a look. Treves writes: “He was shunned like a leper, housed like a wild beast, and got his only view of the world from a peephole in a showman’s cart.” He received less sympathy or kindness than a dog, and, terrified of staring eyes, he would creep into some dark corner to hide.
But Treves discovered he was a human being, John Merrick by name, age twenty-one, highly intelligent, with an acute sensibility and a romantic imagination. And when he was abandoned by the showman, Treves arranged for him to be cared for in a room at the back of the London Hospital, where three and a half years later he died in his sleep.
When first a woman visited Merrick, gave him a smile and a greeting, and shook him by the hand, he broke down into uncontrollable sobbing. But from that day his transformation began. He received many notable visitors, including Queen Alexandra, then Princess of Wales, and was enthralled by his visits to the pantomime and the countryside. Treves discovered him to be “a gentle, affectionate and lovable creature … free from any trace of cynicism or resentment … without an unkind word for anyone.”
Gradually he changed “from a hunted thing into a man.” But actually he had always been a man. It was Treves’s remarkable reverence for human life that enabled John Merrick to lift up his poor misshapen head and gain some human self-respect, as a man made in the image of God.
John R. W. Stott has been rector of All Souls Church, Langham Place, London, since 1950. He has the M.A. (Trinity College, Cambridge). He gave this message at the Service for Doctors held at All Souls in October, 1971.
