Medicine and Biotechnology

Psalm 139 is a prayer of wonder. 'For You formed my inmost being; You knit me together in my mother's womb. I praise You, for I am fearfully and wonderfully made' (139:13-14). The psalmist sees God's hand in the ordinary process by which every human body is formed, and his response is worship. That is the first thing a Christian brings to medicine: the body is not a machine that happens to work but a work of God, made with skill and care, and to heal it is to honour its Maker. The Human Dignity and the Image of God lesson in this track set out why every person, whatever their age, ability or condition, has a worth that does not depend on what they can do. Every question in this lesson stands on that ground.

The Bible does not treat medicine as a rival to God. Isaiah orders a poultice of figs for King Hezekiah's boil (Isaiah 38:21). The Good Samaritan pours oil and wine on the wounded man (Luke 10:34). Paul calls Luke 'the beloved physician' (Colossians 4:14) and tells Timothy to take a little wine for his stomach (1 Timothy 5:23). King Asa is criticised because 'he did not seek the LORD, but only the physicians' (2 Chronicles 16:12), and the weight falls on the word only. Jesus spent much of his ministry 'healing every disease and sickness among the people' (Matthew 4:23), and he counted care for the sick as care for himself (Matthew 25:36).

The church took that seriously from early on. Basil of Caesarea built a great complex outside his city around 369 to 372, with a hospital, a hospice for travellers and care for lepers, and it is often called one of the first hospitals in the Christian world. Monasteries kept infirmaries for centuries, and mission hospitals and clinics have served much of Africa and Asia for the last two hundred years, many of them still running today. Medicine practised as service is one of the oldest forms of Christian love.

Some churches, in Africa and elsewhere, have taught their members to refuse hospital treatment or medicine and to rely on prayer alone, and sometimes children have died as a result. The historic churches, Catholic, Orthodox and Protestant, have consistently rejected that teaching. James 5:14 tells the sick to call the elders to pray and anoint with oil, and the church should do that. But prayer and medicine are not rivals, and a pastor who forbids treatment to a sick child takes on himself a responsibility God has not given him. The question this lesson asks is not whether to use medicine, but how to use powers that now reach into the beginning of life and the shape of the human body itself.

The World Health Organization reported in 2023 that about one in six people of reproductive age worldwide will experience infertility at some point in their lives. In many cultures childlessness carries heavy shame, and the shame falls mainly on women, who are often blamed even when the cause lies with the husband. Women have been beaten, divorced, driven from homes and pushed to accept a second wife because they had no child. The church should say plainly that this is wrong. Scripture treats the barren woman with tenderness, from Hannah to Elizabeth, and the Lord 'settles the barren woman in her home' (Psalm 113:9). Isaiah 56:4-5 promises eunuchs, men who could have no children, a name 'better than that of sons and daughters' if they hold fast to God's covenant, which tells every childless believer that God's house has a place for them. A church that adds to the shame of a childless couple has failed them before any ethical question is asked.

In vitro fertilisation, IVF, means joining egg and sperm outside the body, in a laboratory dish, and then placing one or more of the resulting embryos in the woman's womb. The first child born through IVF, Louise Brown, was born in England on 25 July 1978, through the work of Patrick Steptoe and Robert Edwards; Edwards received the Nobel Prize in 2010. Since then millions of children have been born this way. In practice IVF usually produces more embryos than are placed in the womb at once, and the rest are frozen. Some are later used, some are given to other couples, some are given to research, and some are discarded. This fact lies behind most of the Christian debate, together with a deeper question about what it means for a child to be conceived in a laboratory.

Catholic teaching holds that IVF is morally wrong, even when only the couple's own egg and sperm are used and no embryo is destroyed. The instruction Donum Vitae (1987) and the later Dignitas Personae (2008) argue that the child has a right to be conceived through the act of love between husband and wife, and that God has joined the love-making and life-giving meanings of marriage so that they should not be separated. In IVF, they say, the child is brought into being by a technical procedure in which doctors and technicians take the place of the couple's union, and the child is in danger of being treated as a product rather than a gift. Catholic teaching also holds that the embryo is a human being from conception, so that freezing, selecting and discarding embryos is a grave wrong. It welcomes treatments that help the couple's own union to conceive, such as surgery for blocked tubes or treatment for hormonal problems, and it honours adoption. The strength of this position is its consistency: it takes the embryo's status seriously and refuses to let the longing for a child, however good, decide what means are acceptable.

Orthodox churches are also generally restrictive. The Russian Orthodox Church's Bases of the Social Concept (2000) rejects the use of donor eggs or sperm and surrogate mothers as violating the unity of marriage, and rejects any procedure that involves destroying surplus embryos, while being less absolute than Catholic teaching about some uses of a married couple's own cells: it accepts, for example, artificial insemination with the husband's sperm. Its reasoning is that marriage is a single union of two persons before God, so that a third party's cells or womb breaks into it, and that a child is a gift to be received rather than a right to be secured at any cost. The American Orthodox theologian John Breck, in The Sacred Gift of Life (1998), sets out a similar case. Other Orthodox churches and theologians differ in detail.

Protestants are divided, and three positions are common. Many evangelical ethicists, among them Scott Rae, hold that IVF using the husband's and wife's own egg and sperm is permissible in principle, because it helps a married couple have their own child, and medicine already helps nature in many other ways. But they insist on strict limits: create only as many embryos as the couple will transfer to the womb, freeze none or commit to using every one, never discard embryos or reduce a pregnancy by destroying some of them, and refuse donor eggs or sperm. Some encourage couples with frozen embryos to give them to other couples to carry, often called embryo adoption, which the American Snowflakes programme began in 1997. A second group, including the Anglican Oliver O'Donovan in Begotten or Made? (1984) and the Lutheran Gilbert Meilaender, is much more cautious: they argue that a child should be begotten, the fruit of a union, not made by technique, and that IVF moves conception into the world of production and control. In June 2024 the Southern Baptist Convention passed a resolution urging its members to consider the ethical problems of IVF, especially the destruction of embryos; its leaders later stressed that it did not call for IVF to end, and its own committee acknowledged that Southern Baptists hold both the limited view and the view that IVF is best not used at all. A third group, common in mainline Protestant churches, accepts IVF more broadly, including in some cases donor gametes and the use of early embryos for research up to fourteen days, the limit proposed in Britain by the Warnock Report (1984).

Notice what most of these positions share. Nearly all hold that the embryo deserves protection, though they differ on how far. Nearly all reject commercial surrogacy, in which a woman is paid to carry a child for others, and the buying and selling of eggs and sperm, both of which turn the body and the child into commerce. Nearly all honour adoption and urge the church to embrace childless couples. Where they divide is over whether a child may rightly be conceived in a laboratory at all, and on that question the Catholic position and the permissive Protestant position each have serious defenders who have read the same Bible.

Genetic tests can now show whether a person carries a gene for a disease, whether an unborn child has certain conditions, and, during IVF, which embryos carry a particular gene. Some tests are simple and widely accepted: screening newborns for treatable conditions, or testing an adult to see whether a family illness is likely. Others raise hard questions, because the main use of the result is to decide whether a child should be born.

For many students the most urgent example is sickle cell disease. It is a painful inherited blood disorder, common in Africa, the Middle East and India, and Nigeria has more children born with it than any other country. A child inherits the disease when both parents carry the gene. For this reason many churches in Nigeria and elsewhere ask engaged couples to know their genotype before marriage, and some will not marry two carriers. Christians defend this in different ways. Those who favour a firm rule argue that love for the children a couple may have requires preventing great suffering where it can be prevented, and that couples often fail to test unless the church insists. Those who prefer counselling to a rule argue that the church has no authority to forbid a marriage the Bible does not forbid, that carriers are stigmatised as if they were sick, that some carrier couples have healthy children, and that the decision belongs to the couple after honest advice. Both positions are held by serious pastors. What both reject is the shame sometimes heaped on people who carry the gene, and on parents of children who have the disease.

Testing during pregnancy is different. Tests can show conditions such as Down syndrome. Some parents use the results to prepare, to plan for care, or to treat the child early. But in many countries a large majority of pregnancies in which Down syndrome is found are ended. The Abortion lesson in this track set out the Christian positions on abortion. Those who hold that the unborn child is a person, the view of Catholic, Orthodox and most evangelical teaching, conclude that ending a pregnancy because of disability is a grave wrong. People with disabilities, and many of their families, have added a further argument: that routine screening to prevent their births tells people like them that it would have been better if they had not existed. A Christian who holds the minority pro-choice view would still have to face that argument.

Testing embryos during IVF, called pre-implantation genetic testing, lets doctors choose embryos without a disease gene. Catholic and Orthodox teaching reject it, because it involves creating embryos and discarding some. Protestants who reject IVF reject it too. Some Protestants who accept IVF accept testing to avoid a grave disease, while rejecting selection for sex or for traits that are not illnesses. Somatic gene therapy, which repairs genes in a living patient's own cells and is not passed on to children, is widely welcomed as treatment. In late 2023 regulators in Britain and the United States approved the first therapy using the gene-editing tool CRISPR, for sickle cell disease. But it was priced at around two million US dollars per patient in the United States, which raises a question of justice the next section returns to: a cure that only the rich can reach leaves the children of Lagos and Kinshasa where they were.

Here the historic churches largely agree. The Catholic Catechism calls organ donation after death 'a noble and meritorious act' (paragraph 2296), provided the donor or family has freely consented, and Pope John Paul II spoke of it as an act of love. Most Orthodox and Protestant churches likewise approve of donation, both from the dead and, with care, from the living, such as a person who gives a kidney to a relative. Jesus said, 'Greater love has no one than this, that he lay down his life for his friends' (John 15:13), and while giving an organ is not giving one's life, it shares something of that self-giving. 'It is more blessed to give than to receive' (Acts 20:35).

The agreement has conditions, and they are where the hard questions lie. First, consent must be free and informed: no one may be pressured, least of all the poor or prisoners. Second, death must be determined honestly. Since a Harvard committee proposed in 1968 that the irreversible end of all brain function can count as death, most countries have accepted brain death as a criterion, and Pope John Paul II, addressing the International Transplantation Society in 2000, accepted the neurological criterion provided it is applied rigorously. A minority of physicians and ethicists, Christian and not, have questioned whether brain death is truly the death of the person, and they ask that doctors who take organs be scrupulous. Third, organs must not be bought and sold. The Declaration of Istanbul (2008), agreed by transplant doctors from many countries, condemned organ trafficking and transplant tourism, in which the rich travel to buy kidneys from the poor. Very few Christian ethicists defend a market in organs, though a few secular ethicists argue for a regulated one, and Iran has for some years run a system of paid kidney donation.

Some Christians hesitate to donate because they fear it harms the resurrection of the body, or because their culture holds strong beliefs about burying the body whole. Pastors should take those fears seriously and answer them gently. The resurrection does not depend on the body being kept intact; the martyrs who were burned or devoured, and the faithful lost at sea, will be raised, as Christians since Augustine have said. 'The perishable must be clothed with the imperishable' (1 Corinthians 15:53), and that is God's work, not the undertaker's. At the same time, organ donation is a gift, not a duty, and a family that declines it out of grief or conscience should not be shamed.

Medicine has always aimed to heal: to restore a body to health. Enhancement aims to make a healthy body stronger, smarter, more beautiful or longer-lived than it would otherwise be. The line between them is not always sharp. Glasses correct a weakness, vaccines strengthen the body against diseases it has not yet met, and many treatments help a person do better than average. But the distinction still matters, and it is the centre of the Christian debate about where biotechnology is going.

The most dramatic case so far came in November 2018, when the Chinese scientist He Jiankui announced that he had edited the genes of twin girls as embryos, aiming to make them resistant to HIV. Because the change was made to embryos, it could be passed to their children. Scientists around the world condemned the experiment as reckless and unethical, and in December 2019 a Chinese court sentenced him to three years in prison. Editing genes that pass to future generations for the sake of enhancement is opposed by nearly all Christian traditions and by most scientists, at least for now. The debate is about what lies beyond that line.

One position holds that Christians should be deeply wary of enhancement. Catholic teaching in Dignitas Personae warns against a eugenic mentality and against altering human nature to make a new kind of human. Oliver O'Donovan and Gilbert Meilaender argue that children should be received as gifts, not designed to their parents' plans. The philosopher Michael Sandel, writing without theological premises in The Case Against Perfection (2007), made a related argument: the drive to master our own nature erodes our sense that life is a gift, and with it humility and solidarity with those less fortunate. Those in this line often point to Babel, where people sought to 'make a name for ourselves' (Genesis 11:4), and to the serpent's promise that 'you will be like God' (Genesis 3:5). They also warn that enhancement will deepen the gap between rich and poor, as wealthy families buy advantages for their children that others cannot.

A second position is more open. Some Protestant theologians, such as Ron Cole-Turner, and the Lutheran Philip Hefner, who described human beings as created co-creators, argue that God gave humans creativity and the command to subdue the earth, and that improving human abilities is not wrong in itself. On this view healing and improving lie on a continuum, and each proposed enhancement should be judged by its safety, its fairness, the consent of those affected and the purposes it serves, not rejected as a class. A small number of Christians go further and call themselves Christian transhumanists, holding that technology may be one means by which God transforms humanity. Their critics, including many in the second position, answer that the transformation scripture promises comes by resurrection, as God 'will transform our lowly bodies to be like His glorious body' (Philippians 3:21), not by technique.

There is one more form of enhancement that touches many students' communities directly: skin lightening. Creams and injections sold to make dark skin lighter are widely used in parts of Africa and Asia, and some contain mercury or high doses of drugs that damage the skin and the kidneys. Several African governments have banned some of these products. A Christian ethic of the body has something to say here before any question of genetics arises. Psalm 139 praises God for the body he made, and Genesis 1:27 says every person bears his image. A culture that teaches people their God-given colour is a defect has a sickness that no cream can cure.

Add a medical page to your casebook. Choose a case from your setting, made composite so that no real person can be identified: a couple facing infertility, a church's rule on genotype testing before marriage, a pregnancy in which a test has shown a condition, a family asked to consent to organ donation, a debate over skin-lightening products in your town, or a church that discourages its members from going to hospital. Do not write anyone's name, and do not include details that would let a reader recognise the family.

Write five short paragraphs. First, the facts: what the medicine actually does, what it costs and what is uncertain. If you do not know, find out from a doctor, nurse or health worker you trust, and note what they told you. Second, the people: who is affected and what each most needs, including the child who is not yet born or not yet conceived. Third, the positions: which of the Christian positions in this lesson apply, stated as their defenders would state them. Fourth, the shared ground: what all the positions agree on, such as rejecting shame, protecting the vulnerable and refusing commerce in bodies. Fifth, the pastoral response: what the church could do for the people in this case whatever position they take.

Then write one sentence on which position you find strongest and why, and one sentence on the best argument against it. Keep the page; the final lesson asks you to choose one case and work it through the whole method of the track, and a medical case is a demanding one to choose.