This is a long-awaited book. Its author is one of the best-known young scholars within English speaking Catholic bioethics and certainly the best-known bishop (excepting the Pope) currently writing on bioethics. Nevertheless, while he is often invited to give key-note lectures (such as the Anscombe Memorial Lecture in Oxford in 2012), he has published relatively few books – in the last twenty years just two co-written volumes.
Most of the chapters in this, his first collection of papers, have been published before in some form, but often in places where they are difficult to get hold of, and an effort has been made to update all the essays. As a book I would place it alongside the themed collections of Leon Kass (Toward a More Natural Science) or Stanley Hauerwas (Suffering Presence): it is a real treasure chest. To my mind not all the chapters reach this high level, but there are enough that are excellent to put it on any reading list for religious bioethics.
As it is a themed collection rather than a continuous narrative there is some unevenness in the style within and between chapters. Nevertheless, there is a real unity of vision here and the coherence emerges gradually through engagement with different issues in different ways, like an image refracted through different lenses. The occasionally jarring difference between chapters also illustrates the diversity of topics and voices that constitutes the mongrel discipline of bioethics. Bioethics is a hybrid, a chimera, more an indiscipline than a disciple. It is an uneasy marriage of sciences and humanities, combining biology, medicine, law, philosophy and sociology, and, from the first, theology, no longer the universally acknowledged queen of the sciences but still a persistent and perceptive voice.
The title of this volume invites a question: how can there be a Catholic bioethics? Do non-Catholics have a different biology or a different ethics? Do they not have knowledge of a moral law within them? The answer to this is twofold: in the first place the word Catholic reminds us that conversations happen in a context and the history and community of the Church certainly brings a distinctive context. In the second place the good news of the Gospel brings with it at least some ‘new things’ that could not have been known had God not revealed them, including, for example, the promise of the resurrection. Much of the argument of these chapters is philosophical, based on an appeal to natural reason, as for example the philosophical account of ‘why the unresponsive still matter’ (p. 218 and following). Yet even here theology is never far away and is revealed by an occasional quotation, making explicit a spirit that shapes the philosophical thought. So a reflection on the link between patients and patience is illuminated by a quotation from Cardinal Ratzinger from the funeral homily for Pope John Paul II: ‘The world is redeemed by the patience of God. It is destroyed by the impatience of man’ (quoted on p. 226). It is not only the words that are important here but also the context: words of a future pope on his saintly friend who lived and died so patiently, words given meaning by a life.
The content and tone of the book is very much ‘official’ Catholic bioethical thought, as it were, which many will disagree with, but the style is commendably clear and I can imagine people using chapters (again the usefulness will be in terms of this or that chapter) as a foil when teaching the for-and-against of different topic areas. Two I would single out are chapter 4, ‘Beginnings: When do People Begin?’ and chapter 8, ‘Artificial Nutrition: Why do Unresponsive Patients Matter?’.
Chapter 4 is an extended critique of a book by Norman Ford, When Did I Begin? This book was extremely influential in promoting the idea that the human person comes into existence around 14 days after fertilisation. It was written between the Warnock Report of 1984 and the Human Fertilisation and Embryology Act 1990 (which legalised experimentation on human embryos). Ford’s book was endorsed by Mary Warnock and it remains perhaps the most cogent philosophical defence of the ‘14 day’ rule. Even though Ford has subsequently modified his own stance, there are others who still appeal to Ford’s book and Fisher’s chapter is a masterful presentation of the counterarguments.
Chapter 8 ventures into the vexed territory of clinically assisted nutrition and hydration. While some commentators have alleged that the teaching of Pope John Paul II on this question marked a complete break from the tradition, Fisher shows the reasonableness of the case that ‘we should ordinarily feed patients’ (p. 247) if they can no longer feed themselves, and that their being unresponsive is no reason not to. This is not to deny that ‘it will sometimes be appropriate to withhold, reduce or withdraw assisted nutrition and hydration’ (p. 232) as when death is imminent. However, this judgment rests on the usefulness or burdens of the intervention, not the worthwhileness of the life of the patient. Any reader who imagines Fisher has adopted his view only to defend a rash papal declaration should compare this chapter with his excellent article in New Blackfriars in 1993, ‘On Not Starving the Unconscious’. There he anticipates by more than a decade the teaching of Pope John Paul II on the issue. He does not so much follow the Pope as share a common mind, a Catholic mind.
The reader should not expect every bioethical topic to be treated in this collection (there is no chapter, for example, on healthcare allocation, while the controversy over ‘brain death’ – whether neurological criteria are adequate for the determination of death – is touched on only in a footnote, albeit a hefty one, note 18 on p. 198). Nevertheless, as Samuel Johnson said of his dictionary, ‘In this work, when it shall be found that much is omitted, let it not be forgotten that much likewise is performed’. Attempts at comprehensiveness can easily lead to shallowness, whereas here we have a series of attempts to reflect deeply on questions that are both intellectually and emotionally difficult.
These chapters show how the resources of the Catholic moral tradition can be brought to bear on novel and difficult bioethical problems. They will be of great use not least to those who wish to engage with a range of perspectives before coming to their own conclusions. I could think of no better or more thoughtful introduction to the discipline of Catholic bioethics.
The reviewer, David Albert Jones is the Director of the Anscombe Centre, Research Fellow in Bioethics at Blackfriars Hall, Oxford, Visiting Professor at St Mary's University College, Twickenham and is Vice Chair of the Ministry of Defence Research Ethics Committee.