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Obstetrics and Gynaecology in a multi-cultural society: The Catholic view


Is there a practice of Obstetrics and Gynaecology which accommodates committed Catholics? Nearly all the evidence suggests the answer is `No', says Luke Gormally. A pdf is available here.

The following is the text of one of a number of 15-minute talks given to the Section of Obstetrics and Gynaecology of The Royal Society of Medicine on the theme of 'The practice of Obstetrics and Gynaecology in a multi-cultural society' which were intended to inform practitioners of the beliefs of different 'faith communities' relevant to their practice.

A culture is a way of living, and in particular a way of thinking, that is transmitted from one generation to another. A multi-cultural society is supposed to be one in which different ways of life, informed by distinct understandings of human life, can find a place and can continue to flourish.

I have the uneasy feeling that I have been kindly invited as a native witness to the beliefs of what may be seen as a somewhat exotic subculture managing mysteriously to survive in a secularised society.

The feeling is an uneasy one for two reasons. First, because I belong to a community, the Roman Catholic Church, which has been around for 2000 years, and, though it may be in a somewhat enfeebled condition in the UK, remains a community exhibiting plenty of vitality, intellectual, moral and spiritual, in other parts of the world. Secondly, the Catholic beliefs I shall highlight, as having a particular relevance to the practice of Obstetrics and Gynaecology, are beliefs which in their basic practical requirements were generally shared by all Christian bodies up to the early part of the 20th century. As such, they were characteristic beliefs of the dominant culture of Europe for many centuries and seemed to many, who reflected on them, rationally defensible.

Confronted by this particular native witness, many of you may feel inclined to adopt the characteristic posture of the sceptical anthropologist, for whom native beliefs are never to be taken at their face value. The 15 minutes allotted to me provides insufficient opportunity to put a case for taking them seriously. But I would like to suggest that if your scepticism is inspired by the now dominant secularist mind-set of our culture, it is a mind-set which is taking Obstetrics and Gynaecology in directions which need to be critically examined.

What are the key beliefs of a Catholic relevant to the practice of Obstetrics and Gynaecology? The most fundamental belief of the Christian is that the world has been created by God and exists in a relationship of fundamental dependence on God. The world, and human beings in particular, have been created for a purpose. Human beings have been created for a life of friendship with God, and there is in consequence a built-in goal-directedness to the nature of human beings. Human happiness depends on our achievement of that goal.

Because we are equipped by nature with the radical capacity to develop those abilities which are the precondition of our recognising and freely accepting God's offer of friendship, human nature as such possesses a great dignity. An individual human being in his or her earliest developmental stages - as an embryo and then a fetus - is not, of course, already in possession of those exercisable abilities to understand and choose which will normally be involved in entering into the friendship which is the key to our happiness. But we cannot make good sense of the acquisition of those abilities without assuming an active capacity to acquire them, inherent in the individual from the outset - in other words, from conception. The dignity which is proper to our nature is what grounds our equality in dignity as human beings. This equality in dignity is in turn the basis of our possession of fundamental human rights. The most elementary of those rights is the right not to be unjustly killed. Without that right it is obvious that human beings do not possess the minimum condition for flourishing. It follows, therefore, that abortions which of their nature or by intention kill the unborn child are morally speaking - whatever the law may hold - acts of murder.

I have spoken of the radical developmental capacity inherent in our nature in virtue of which we are able in the course of normal development to acquire abilities to communicate, understand, choose and act intelligently. But these abilities are not acquired outside a context of sustaining and facilitating relationships. Of our nature we are dependent creatures. Catholic Christians believe that the most fundamental relationship we depend on within the created order (that is in God's designs for the wise ordering of human life) is the marriage relationship. By the marriage relationship is meant the unreserved, self-giving commitment of a man and a woman to each other, in which each treats the other as irreplaceable. Why is precisely such a relationship required for the begetting and nurturance of a child? Because that kind of relationship is uniquely conducive to recognition of the dignity of the child. How so? Recall that the dignity of the child consists in the fact that he or she is a creation of God and is properly seen as a unique, irreplaceable gift of God to the parents. The parents then need to be engaged in a relationship which is open to receiving children as gifts. This means that a married couple should not turn their sexual relationship into one in which they set their hearts against children. One can set one's heart against children in a number of ways, but one kind of choice which denatures the marital relationship as a relationship essentially ordered to the begetting of children is the choice to render one's sexual intercourse infertile: one may choose to do this on a permanent basis (through male or female sterilization) or on a temporary basis (through contraception). The choice to do so embodies a decision to find sexual intercourse meaningful in ways that depend on turning it into a non-generative kind of activity. What is at issue here is the sense a couple have of the meaning of the sexual relationship. The Catholic Church in effect teaches that the minimal condition of a couple retaining an adequate sense of their relationship as essentially ordered to the good of children is that their intercourse should be of the normal generative kind. Of course most intercourse is not fertile, but it remains a generative kind of activity providing it is not deliberately made infertile when it might be fertile. This, very briefly stated, is the background to the Church's teaching about the wrongness of contracepted intercourse in marriage.

The basic objection to the use of contraception outside marriage, to secure pregnancy-free intercourse, is that it destroys in people the dispositions they need to make genuine marital commitment seem possible or desirable. I have already explained what I mean by genuine marital commitment: one which keeps alive a sense of openness to the child as gift. A society which systematically undermines the disposition to marriage, as ours is manifestly doing, is prescribing a destructive future for itself.

The Church's teaching about reproductive technologies such as IVF and GIFT is the obverse of the teaching about contraception. Of course there is an additional ground for objecting to much IVF, namely that it involves the intentional destruction of embryos, either for experimental purposes or as surplus to requirements. But it is at least possible to imagine IVF without further destruction of embryos, and if it did exist, what would the objection to it be?

The objection to contraception in marriage is that sexual intercourse only makes for the unity proper to marriage if it is the kind of activity which is generative, in other words if it is intelligible as the kind of activity through which children are brought into being. Catholic teaching about the principal reproductive technologies is the obverse of this, in the sense that it holds that the only kind of activity through which children should be brought into being is the activity expressive of the self-giving proper to the marriage bond. Why should human generation have as its human cause the kind of act which is expressive of the unreserved self-giving of husband and wife? It is because when a child's coming-to-be has its origin in such an act then the child enters the relationship of husband and wife as the fruit of unreserved self-giving. It is precisely and only that status which is adequate to the dignity of the child: for truly unreserved self-giving carries with it a commitment to unreserved acceptance of the fruit of that self-giving. The dignity of the child is only adequately recognised in the acceptance and cherishing of him just as he is. The disposition to that acceptance is protected precisely by the teaching that what human beings do to bring a child into being should be an action of the parents which is also expressive of that unreserved self-giving which makes for marital unity. The rejection of that teaching tends to undermine the disposition to accept children as they are given to us, and as, therefore, the persons they are. That rejection has had incalculable consequences, both in the fields of clinical practice and biomedical research, and more broadly in society in people's attitudes to children. The development of the `reproductive technologies' assumes the acceptability of separating the generation of children from the sexual act expressive of the unity of the parents. In consequence, human beings generated in vitro have come to seem to be the manipulable products of technical expertise rather than the fruit of unconditional self-giving. In vitro embryos, rather like mass-produced objects, are subject to quality control and discarded if deemed unfit for implantation; others, as I've already noted, are generated solely for experimentation which is destructive for them. There is work in the field of genetic engineering which looks to a future in which designer babies will be produced to parental specifications. All this, on top of abortion, reinforces a view of the child as a conditionally acceptable acquisition rather than a gift to be unconditionally accepted. It is seriously and dangerously at odds with the respect due to the dignity of every child.

The Catholic Church does not see itself as in the business of promoting short-term technical fixes for the problems created by moral disorder. It would have lost its way if it did. At the heart of what it teaches is, of course, a message of salvation from moral disorder. In this short talk I've focused on those truths, of particular relevance to the practice of Obstetrics and Gynaecology, which the Church teaches about human destiny, about the great dignity which therefore belongs to every human being, about the vocation and dignity of marriage and the requirements attaching to the commitment of marriage, and about what is required to respect the dignity and foster the good of every child. The Church is happy to see any biomedical and clinical developments which are consistent with respect for the dignity of the unborn human being, are consistent with respect for the institution of marriage on which the good of children depends, and which serve to sustain rather than sever the vulnerable bonds of dependence on which each new generation depends.

I recognise that this moral vision will seem not merely alien but inherently incredible to those of a secularist mind-set, for whom God does not exist or, if he does, has no concern with human affairs. Human beings are the chance product of an evolutionary process lacking inherent purpose. They therefore lack any distinctive worth or dignity just in virtue of being human. Value is a function of the human will. So it is only those who have developed abilities for understanding and choice who are in a position to endow their lives with the values they wish to attach to them. If a woman, on whom the life of an unborn child depends, wishes to terminate that life, there is nothing in the moral status of the child which could stand in her way. If people choose to find valuable any form of sexual activity, medicine can be co-opted to clear up the undesired consequences. If people claim a right to have babies, or to have babies which are expected to meet certain specifications, medical science is devoted to meeting those demands.

It is unsurprising that contemporary Obstetrics and Gynaecology is so strongly influenced by the secularist mind-set of the dominant strain in contemporary culture. Let me conclude by drawing your attention to one consequence of this state of affairs.

Secularists commonly think of themselves as liberals, tolerant of other bodies of belief and other ways of life. The title of this evening's meeting speaks of the practice of Obstetrics and Gynaecology in a multi-cultural society. Is there a practice of Obstetrics and Gynaecology which accommodates committed Catholics? Nearly all the evidence suggests the answer is `No'. The practice of abortion has largely closed the profession to them. Can Catholic and other women, who look for an absolute respect for the unborn life they carry, expect to find it? For the most part no. Many, for example, are subjected to not inconsiderable pressure to have abortions if there are grounds for thinking their child is handicapped.

So it would be an illusion to believe that the secularist moral outlook accommodates a genuine multi-culturalism. It could not do, because there is too much that it radically rejects in the traditional understanding of human life.