Matters of Life and Death
Wyatt (John)
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Introductory Notes

  1. I intend to make extensive notes on this book as I read it (as of November 2022).
  2. In due course, I’ll create papers for each Chapter, but for now I’ll proceed ad hoc.
  3. So, … a section of Notes on the Forward, and some footnotes to the first few paragraphs of the Introduction, as I scanned this in 10 years ago. Then more Notes.

IVP Book Description
  1. Matters of Life and Death examines a range of pressing contemporary ethical concerns raised by advances in medical and scientific technology. It addresses issues at the beginning of life, including reproductive technology, embryo1 research, stem cells, genetic screening, abortion2 and the care of sick newborn infants. It also deals with issues at the end of life, including euthanasia and assisted suicide, dementia and palliative care.
  2. The book engages with a range of contemporary secular perspectives on these complex subjects and provides Christian responses based on orthodox biblical theology. It illustrates how these principles may be applied in practice, and highlights the roles that Christians, both health professionals and lay people, are playing in finding practical solutions to these complex challenges. The book is intended for medical and scientific professionals, for Christian leaders and teachers, and for lay people who are affected by these matters.
  3. Orthodox Christian thinking about human existence, birth and death is facing unparalleled challenges from advances in medical and scientific technology and from recent developments in secular liberal thought and in legislation. The book argues that a historic biblical understanding of creation order, of the human person and of the Christian gospel, provides an intellectually coherent and practically relevant framework for engaging with these complex issues at the beginning and end of life. Christians have a unique contribution to make in current debates and in demonstrating practical and effective solutions to current bioethical problems.
  4. The first edition of Matters of Life and Death was based on the London Lectures in Contemporary Christianity. … The new edition has been extensively revised and updated to address recent developments in science, technology and ethics, and incorporates a range of new material and theological perspectives.
  5. See (Broken Link3) for extra material: These PDFs contain extra information about specific topics covered in Matters of Life and Death. They are a valuable resource for anyone wanting to read more widely, and include links to relevant websites as well as material by the author.

Contents
  1. Foreword by John R.W. Stott – 11
    Acknowledgments – 13
    Introduction – 15
  2. What's going on? Fundamental themes in health care and society – 25
  3. Biblical perspectives on humanness – 51
  4. Reproductive technology and the start of life – 83
  5. Fetal screening and the quest for a healthy baby – 107
  6. Brave new world: biotechnology and stem cells – 121
  7. Abortion4 and infanticide: a historical perspective – 135
  8. When is a person? Christian perspectives on the beginning of life – 157
  9. The dying baby: dilemmas of neonatal care – 179
  10. A good death? Euthanasia and assisted suicide – 191
  11. A better way to die – 215
  12. The Hippocratic tradition and the practice of modern medicine – 239
  13. The future of humanity – 265
    Glossary – 277
    Notes – 281
    Index – 295
    We invite you to visit our website: (Broken Link). This symbol Q in the text indicates further information and resources relating to a topic or topics which you may wish to explore.

Notes: on the Forward by John R.W. Stott:-
  1. p. 11: relating the ‘Christian worldview’ to the ‘complexities of the modern world’. Is there really a ‘Christian worldview’? Christians disagree on many matters, and the Bible is, at best, progressive revelation that is hardly univocal (I would say).
  2. p. 11: ‘No issues ducked and no glib solutions’. Good: but does Wyatt ever admit a conflict between ‘the Bible’ and ‘Science’. Is he like some other Christian philosophers who admit that their free enquiry is circumscribed by their religious beliefs?
  3. p. 11: The ‘liberal assault’ on ‘traditional Christian doctrine and ethics’. I’m sure in the early Enlightenment days it was an ‘assault’, by way of necessity in order to free thinkers from religious shackles. But is it still an ‘assault’, or just felt to be such by some Christians? Do ‘liberals’ care anything for religious beliefs or thinks that ancient texts are worth consulting on scientific or moral matters? Also, can Christians not learn anything from ‘liberals’ – maybe to better consider ‘traditional doctrines’ in the light of new knowledge. Even to consider what is ‘tradition’ and what is truly ‘Biblical’?
  4. p. 12: The ‘professional assailants’ to be resisted include Peter Singer, Richard Dawkins, Ronald Dworkin and John Harris.
  5. p. 12: Man as God’s ‘flawed masterpiece’. How did the flaw get in? What are the flaws? Moral or physical? Are they relevant to neonates?

Introduction5
  1. When I was a medical student in London in the 1970s, I received just one lecture on medical ethics in my six years of undergraduate professional training. I was taught that all the practising doctor needed to know about the subject could be summarized under five A's: Abortion6, Adultery, Alcoholism, Association (with non-medically qualified physicians or `quacks') and Advertising. Of these evils, which the General Medical Council was dedicated to stamping out, it was widely held that the most objectionable was Advertising.
  2. But the world has changed. Medical ethics has been transformed from an obscure and unimportant branch of professional practice into a high-profile media activity. `Shock horror' tabloid journalism and highbrow television documentaries have brought the issues to a world audience. A single medical case can now achieve the same media prominence as the latest disclosure about the British royals or a soap opera scandal.
  3. What are the underlying forces behind the modern transformation in medical ethics? And how can people who wish to be faithful to the historic Christian faith respond to the challenges and the opportunities of recent and dramatic medical progress?
  4. This book attempts to formulate a Christian perspective on a number of central ethical dilemmas raised by modern medical practice. While writing from my individual perspective as a practising clinician and Anglican layperson7, I have tried to reflect a broad theological position of historic or ‘foundational' Trinitarian Christianity, a theological position which takes a high view of Scripture and of the doctrines of the ancient creeds and councils of the Early Church. I am not a professional philosopher or theologian. For most of my professional life I have been a practising paediatrician and a Christian believer who has had to face some of these agonizing dilemmas as part of my daily medical practice. What I do have to offer is a view from the coalface. It is a view which has been created in my personal struggle to understand what is going on in the world of modern medicine and the attempt to develop an authentic Christian response.
  5. These questions are not just matters for an interesting academic debate, of the sort that philosophers, ethicists and students love to engage in. These dilemmas touch us at the most intimate, painful and vulnerable part of our lives. Many of the people who read this book will be carrying secret sorrows which they cannot share with others. The statistics show that more than one couple in seven will suffer from some form of fertility problem, and many will never be able to have children naturally. Some parents who pick up this book will have watched their child struggle and die, or will have given birth to a stillborn baby. Some will have had an abortion8, although even their closest friends and relatives may not know. Some will have watched a close relative die in pain or emotional distress. A few will know that they suffer from a major genetic disorder which is likely to curtail their life, and they are wondering how they and their families will cope with the future. Many more of us are unknowingly carrying genes which may result in major illness, disability and death later in life: diseases such as Alzheimer's, stroke or breast cancer. Virtually all of us are carrying the genes for devastating illnesses which we might pass on to our children. Many people who pick up this book, for instance, will be carrying the gene for cystic fibrosis, though they are completely unaware of it.
  6. So these are not just ethical issues `out there': they touch us at the core of our being. Nobody is immune: we all share in a common humanity, a physical nature which is painfully vulnerable and deeply flawed9. As you read the following case histories, you may well find them disturbing and painful, as indeed I have done. A French philosopher of the Enlightenment once said that `death, like the sun, should not be stared at'. Yet that is precisely what we shall be doing in this book: staring at death and at the questions and fears that it raises.
  7. The vision behind the London Lectures in Contemporary Christianity is the Christian task which John Stott has termed ‘double listening'.' First, our task is to listen to the modern world in order to try to understand the real issues. Next, our task is to listen to the unchanging historic Christian faith in order to develop an authentic Christian perspective. Finally, our task is to build a bridge which spans these two foundations: the modern world and the authentic biblical Christian faith. The task of biblical Christians is to understand the modern world in the light of the Bible, and to understand the Bible in the light of the modern world10. Unless our bridge is securely rooted in both foundations it will be unable to bear the weight demanded of it.
  8. Of course, bridge-building is a perilous art. My father was a structural engineer, and I have a vivid memory of watching with him as a child while a concrete bridge he had designed was being tested by huge weighted lorries. I embark on my process of bridge construction with due trepidation. I have made no attempt to be exhaustive, as I lack the expertise and the experience to span the vast range of ethical issues raised by modern medical practice. Instead, I have concentrated on the ethical dilemmas surrounding the twin ‘edges of life': the start of life and its end.
  9. These are not easy matters. I have no simple answers — indeed, there are no simple answers. Yet I do have a deep conviction that the historic Christian faith, the faith of the Bible and of the Church Fathers11, gives us a way forward as we approach these agonizing dilemmas. It is a way forward that is intellectually coherent and satisfying12, and also immensely practical and down to earth. The historic Christian faith does have something vital to say to the world of the Human Genome Project, the intensive-care unit and the palliative care specialist. As I have researched and written this book, I have had a continuing sense of optimism, hope and confidence in the answers which the Christian faith provides.
  10. To set the scene, I will outline a number of important and influential medical cases which have hit the headlines. My purpose is to illustrate some of the technical possibilities and human dilemmas which modern medical technology has created, before we attempt to analyse the fundamental trends and social forces which underlie them.
  11. Sections
    • Mary and Jodie: conjoint twins13
    • Dr Anne Turner: a case of assisted suicide
    • Joanna Jepson – late abortion14 and the law
    • Ms B – the right to refuse medical treatment
    • Zain Hashmi – the hope of a saviour sibling
    • Diane Pretty – the right to die
    • Tony Bland and the persistent vegetative state15

Notes: on the Introduction:-
  1. First 10 paragraphs (pp. 16-17): see footnotes from the above text.
  2. The seven cases below are highly complex, and a ‘taster’ for the book as a whole. All I can do at the moment is have a quick scurry on the web to determine the background, provide a few links, and set down my initial reactions (intuitions16 / prejudices).
  3. Mary and Jodie: conjoint twins17:-
    • This case is covered again very briefly on pp. 185-6.
    • There’s a lot on-line18 about this case. It’s been worth my while reading the following couple of papers on the legalities – and to a lesser extent the morality – of the case:-
      1. "Walker (Robert) - Mary And Jodie – The Case Of The Conjoined Twins", and
      2. "Paris (J.J.) & Elias-Jones (A.C.) - Do we murder Mary to save Jodie?".
    • I’ve applied copious annotations to these papers, but I doubt I’ll ever have time to write them up. So, a few ‘take-aways’:-
      1. Both papers focus on the legalities of the case. As such, they cover all sorts of wheezes so that what seems like the rational approach can be argued to be legal. Whether – and how vigorously – this is done seems to depend on the moral (rather than legal) intuitions of those involved.
      2. One wheeze – which ultimately didn’t get much traction – was to consider the case as one of removal of life support – with the healthy twin supporting the other.
      3. The second paper – from the Postgraduate Medical Journal – is sceptical of the whole approach, in particular the overriding of the parents’ wishes. The authors suggest that if the hospital hadn’t raised / forced the issue it would have been completely normal to have respected the parents’ wishes and ‘let nature take its course’, even if this resulted in the death of both twins in a matter of months. The ‘normality’ of this situation seems to depend on the religion of the parents: it’s noted that JWs aren’t legally allowed to refuse blood transfusions for their children. Surely this whole issue is tangled up in medical negligence? Failing to apply tried and tested remedies would be negligence, while there may be room for choice in more risky or experimental cases.
      4. The conflict between the interests of the parents and of their children receives prominence. I often think that saying it’s ‘in the interests’ of a person to be dead – while often true when it cannot be acted on – is often used to avoid having to admit that the main argument is wastage of resources.
      5. There’s some discussion about which hospital should have undertaken the surgery and doubts over whether Manchester had a successful track record. My suspicions are that the procedure was somewhat experimental and that there’s much necessary moral and legal obfuscation involved in moving medical science along. One can’t admit to patients being guineapigs, even though – where the treatment is the only hope – they – or their guardians – are agreeable so to be.
    • The issues that John Wyatt thinks important are:-
      1. Should the Courts have overridden the sincere convictions of the parents?
      2. Did Jodie’s right to life trump Mary’s interests?
      3. Were the doctors and the Courts ‘playing God’ or acting responsibly?
    • The legal worries were more along the lines of whether effectively terminating one of the twins would have been murder. Legally, that is.
    • My initial thoughts on the author’s worries are:-
      1. Parental ‘rights’ – let alone ‘wishes’ – are circumscribed; the child’s well-being always ultimately takes precedence, though a lot of latitude is allowed. In this case it’s the viable child’s rights that take precedence. Also, I note here there’s a tension with Abortion19 where Christians tend to deny the (non-)parent to be’s rights.
      2. This is as written but seems to be the wrong way round. Jodie (real name Gracie Attard) is the ‘viable’ twin, so I’d have put it as ‘Should Mary’s right to life have trumped Jodie’s interests’. Basically, if Mary had not been excised, both twins would have died in infancy. Medically and ethically (as in lots of these conundrums) the situation seems clear; it’s only the legal tangles that worry the medics.
      3. The notion of ‘playing God’ is absurd, as it could be applied to any medical intervention and much else besides. It’s obvious (except to those who cherry-pick from their favourite religious texts) that God (or ‘God’) is very ‘hands off’ and leaves us to sort things out responsibly. Doing nothing is a dereliction of duty. Also – I might add – no-one has a ‘right’ to something it’s impossible (practically or logically) to grant them.
  4. Dr Anne Turner: a case of assisted suicide:-
    • The author returns to this case on p. 192 and p. 204.
    • To quote from Dr. Turner: “Doctors should be able to help people to die … I had a cat, and I had him put down because he was riddled with cancer, but we cannot do this with humans now.”
    • See:-
      → Wikipedia: Assisted Suicide
      → Wikipedia: Dignitas (Swiss non-profit organisation)
    • For a dramatization, see Wikipedia: A Short Stay in Switzerland
    • Wyatt quotes BBC: Clinic assists doctor's suicide
    • Wyatt’s comments / concerns are:-
      1. Was Dr. Turner’s way of death a model for modern people?
      2. Is this the best way to die?
      3. Should the law be changed to allow medically assisted suicide?
      4. Is the prohibition of medical killing an outdated taboo from a previous era?
    • My initial responses:-
      1. No. But it should be an option in appropriate circumstances and should be available locally. The trouble at the moment is that – because assistance is illegal – people have to take their own lives much earlier than they would like, while they are still capable.
      2. Absurd question. The best way is to die in your sleep ‘full of days’, but this option isn’t available to many – maybe most – people. Also, it’s not the dying itself that’s the issue, but the process leading up to it.
      3. Yes. With appropriate safeguards.
      4. Tendentiously put. Medical killing should never be routine, but an option in extreme circumstances. The Hippocratic Oath (see Wikipedia: Hippocratic Oath) is often mentioned, in particular the ‘do no harm’ clause. But – surely – what a doctor should do is what is in the patient’s best interests and if – in the direst of circumstances – this is a painless death, then so be it. The patient is not then ‘harmed’. I might add that a common objection to ‘mercy killing’ – that hospice care is available – while right to a degree (in the case of rapid decline to death) doesn’t take into account, in the case of very protracted incapacitation, the degree of boredom, frustration and loss of dignity / autonomy on the part of the patient.
  5. Joanna Jepson – late abortion20 and the law:-
    • The author returns to this case briefly on p. 149.
    • See Wikipedia: Joanna Jepson.
    • Wyatt cites a news page on the CPS website, but it no longer seems to be extant.
    • The case seems to be clear, at least morally. A cleft palate isn’t a sufficiently severe abnormality to justify a late abortion. Whether the doctors who recommended the abortion, or the police who failed to prosecute them, should have been prosecuted is a moot legal question I’m not much interested in.
    • The same should apply, I think, to Downs Syndrome – though I’m less clear on the case for an early abortion in that situation. The cases differ because a cleft palate is easily fixed, and some21 born with such have led successful careers in the public gaze. Downs Syndrome cannot be ‘fixed’ but doesn’t necessarily lead to an unhappy or unfruitful life.
    • Wyatt’s questions are:-
      1. Under what clinical conditions should a late abortion be carried out?
      2. What does the practice say about our attitude to disabled children and adults in our society?
    • In response:-
      1. The first question is highly complex, but as – these days – most severe abnormalities are diagnosed early, it should only be where such a situation is missed, or some major mishap occurs later in the pregnancy. I’d like to say that late abortions should only be performed when the feus is either dead or non-viable, or the life of the mother is seriously at risk.
      2. Well, it says a lot about how parents want their children to be. No parent wants their child to start off with a disadvantage, particularly one that cannot be ‘fixed’. There’s therefore the temptation to terminate and have another go. Whether this is legitimate depends on the status of the fetus at its various stages. As for what this parental desire shows about society’s attitude to the already existent disabled: it shows an ‘ablist’ prejudice that it’s better to be able than disabled. And isn’t this attitude correct? That – even in a rich society that can afford to support, care for and provide fulfilling opportunities for disabled people (however inadequately) – things in general go better for the able than for the disabled? Once born into the world people of all abilities and disabilities are part of society and deserve support to the degree that society is able to provide, taking into account its other responsibilities.
  6. Ms B – the right to refuse medical treatment:-
    • The author returns to this case briefly on p. 194.
    • See Wikipedia: Ms B v An NHS Hospital Trust.
    • This seems a very reasonable case, but it’s surprising that the English law allowed the refusal of treatment (given that those on hunger strike seem often ultimately to be force-fed). I suppose the legal question is whether the hospital – in withholding medical treatment – is assisting a suicide.
    • Wyatt’s questions are:-
      1. Does this legal judgement – confirming the right of competent patients to refuse life-sustaining treatment – effectively lead to the legalisation of euthanasia in England?
      2. Were the doctors who switched off the life-support machinery responsible for her death?
      3. Why should Ms B have a right to die whereas Dr Turner, who also wished to die, could not be assisted?
    • In response:-
      1. The most absurd suggestion so far in this book! How is dying without treatment supposed to be a ‘good’ death? Surely, euthanasia would be speeding up the process with a quick and painless death? Rather – as I’ve said above – it might be considered to be assisted suicide. This is difficult, though, as it’s an omission rather a commission. What’s the situation where a husband – say – doesn’t call the emergency services on finding his wife has taken a fatal overdose, but could be ‘saved’ by prompt action? Would he have assisted a suicide?
      2. This is rather an extreme form of ‘withdrawal of medical treatment’, in that – presumably – death was quicker than the PVS case of withdrawal of food and water. But I suppose that we have to say that the switching-off of life-support was a cause of Ms B’s death (the primary cause of which was her medical condition). Yet, it’s not as direct a cause as a lethal injection or providing and allowing her to drink a lethal cocktail. Would it make a moral or legal difference if she herself was allowed to switch off the life support?
      3. Well, the difference is – as just noted – between removing the means of life-support as against providing a means of dying. Morally, there’s no real difference (other than that some medical practitioners might be more sensitive to the acts / omissions distinction). The difference is primarily legal. Even so, Wyatt is right that the difference is not great – Ms B does seem to have been give ‘assistance’ in fulfilling her desire for death.
  7. Zain Hashmi – the hope of a saviour sibling:-
  8. Diane Pretty – the right to die:-
  9. Tony Bland and the persistent vegetative state22:-


In-Page Footnotes ("Wyatt (John) - Matters of Life and Death")

Footnote 3: Footnote 5: Footnote 7: Footnote 9: Footnote 10: Footnote 11: Footnote 12: Footnote 18: Footnote 21:
Book Comment

2nd Edition, November 2009. Paperback.


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