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Interview: John Wyatt, Emeritus Professor of Neonatal Paediatrics, Ethics and Perinatology

09 December 2022

‘None of us can avoid fundamental questions about what it means to be human. These issues are far too important to be left to doctors’

I studied physics at university, with the aim of becoming a research scientist. During my first year, I underwent a spiritual crisis, and out of periods of searching came a new experience of the love and presence of God.

Rather to my surprise, I had a growing sense of a vocational call to medicine, and I started training at St Thomas’s.

I gained experience in a number of fields, including intensive care, adult internal medicine, and then general paediatrics. I was drawn to neonatology, because I loved children, and it was a rapidly developing and exciting speciality. It combined a logical and rigorous scientific and technical element, but also required compassion, excellent communication skills, and emotional sensitivity.

I joined my colleagues in a programme of scientific research intended to combat brain injury in babies, because this remained the major unsolved problem in neonatology, causing death and devastating lifelong disability for many children and families. After more than 20 years, and collaboration with scientists around the world, our research led to an experimental new treatment, therapeutic hypothermia, for babies who’d been exposed to oxygen deprivation at birth.

My greatest surprise was that it turned out to be successful, reducing death or severe disability for babies treated with hypothermia over the first 72 hours after delivery. It’s now become a standard treatment in hospitals around the world.

Looking back, it does feel as though we were guided by divine providence, learning how to use a natural protective biological mechanism that was already there in creation. I’ve always loved Johannes Kepler’s “I was thinking God’s thoughts after him.”

I went into neonatology because I loved children, and only later realised that I was in the midst of an ethical maelstrom. We were making extraordinary advances in keeping babies alive, but was it ever right to switch off the life-support machinery? Brain scans were getting much better at detecting brain injury shortly after birth, but what should we do with the information? And how could I reconcile our ability to keep babies alive at 23 and 24 weeks of gestation with the fact that late abortions were being carried out in more mature babies in the same hospital? I felt increasingly called to engage with these desperately difficult and controversial ethical dilemmas.

These issues are far too important to be left to doctors. My aim’s always been to encourage informed and thoughtful dialogue. I’ve always enjoyed the challenge of trying to communicate complex scientific and medical ideas to ordinary people in a way that is clear, accurate, and non-patronising.

None of us can avoid fundamental questions about what it means to be human: pregnancy, infertility, childbirth, illness, ageing, and death. The Covid pandemic meant that many people were bombarded with dubious information about treatments and immunisation, and I’ve tried to provide thoughtful, accurate, and nuanced information from both a medical and a Christian perspective.

My book Matters of Life and Death: Human dilemmas in the light of the Christian faith is an attempt to illustrate the range of challenging ethical issues that technologically advanced medicine raises, and provide thoughtful and practical responses from a mainstream Protestant Christian perspective. To my surprise, the book’s been translated into more than ten languages, and it’s turned up in many surprising places — even as a bioethics textbook in Moscow State University.

I have a personal website, johnwyatt.com, which contains a wide range of resources for free download. Together with my son Tim, I put out a weekly podcast, “Matters of Life and Death”, under the Premier Unbelievable brand, which is available from all podcast providers.

In general, I’ve been encouraged by positive responses from lay people and medical colleagues. Many people are tired of the highly polarised and toxic public debates about medical ethics, and welcome a more nuanced approach. Having said that, I’ve been startled by hostile and aggressive verbal attacks occasionally, from people who passionately disagree, and clearly perceive me as some kind of threat. If I’m being attacked by people from both ends of a polarised debate, I’ve probably got it about right. . .

I’m afraid that the quality of public debate around abortion has markedly deteriorated since the 1990s. Much of this seems to come from the US, where abortion has become part of toxic and unpleasant culture-wars politics. It often seems as though activists on both sides lob verbal grenades at each other with no attempt to understand the other or to have any dialogue or meeting of minds; so women with unplanned pregnancies become victims in a toxic debate between political activists who seem to care little about their genuine interests.

The law is a very blunt instrument when it comes to dealing with a complex, emotive, and multifaceted issue like abortion. I’m much more in favour of the approach that says: “Our goal is not to make abortion illegal, it is to make it unthinkable. . .” The real question is why, despite universal sex education and the availability of universal free contraception, at least in the UK, the demand for abortion is continuing to rise.

To me, a much more positive response is that of Christian pregnancy centres which provide compassionate, non-judgemental support and counselling for women with unplanned pregnancies, including practical and emotional support for those who choose to continue the pregnancy. I’m proud to be associated with the growing movement of more than 80 independent pregnancy centres across the UK.

There’s absolutely no necessity for there to be tension and conflict between clinical teams and parents. In my experience, the large majority of cases similar to Archie Battersbee’s can be decided in private with collaborative, respectful, and compassionate dialogue between the parties. I’ve tried to promote the concept of an expert-to-expert collaboration between doctors and parents. Parents are experts, too — in their history, family background, philosophy, and beliefs. Expert-to-expert relationships work where there’s mutual respect, listening, and trust. Sadly, it appears that a collaborative relationship like this was never established in Archie’s case.

History shows differing Christian responses to the age-old questions of abortion and euthanasia, and I’ve always tried to engage thoughtfully and respectfully with the varying views that sincere Christian people have taken on these issues, while arguing positively for the conclusions that I’ve come to. Thankfully, at least in the NHS, financial costs are almost never a factor when it comes to individual ethical decisions about whether to continue or stop treatments — but of course, in many low-resource countries, issues of cost cannot be avoided, and Christian doctors frequently have to take agonising treatment decisions as a result.

AI is advancing so rapidly that it’s not possible to predict where it is going. It’s certainly raising some genuinely novel and challenging ethical questions for all of us, including Christians. I think AI will become increasingly effective at simulating many of the most precious aspects of being human, including love, compassion, empathy, friendship, and spirituality, and the question will be: “If you can’t tell whether you are engaging with a living person or a very clever simulation, does it matter?” My deep intuition as a Christian is, yes, it does matter. Truth and authenticity matter, but there are many people who argue that simulated relationships are as good as the real thing, and the way forward in a world of lonely people.

I’m not naturally an angry person, but I do have a deep instinct to try to respect and protect the most vulnerable members of our society, and I’m angered when they’re treated with abuse or neglect. I’m also angered by doctors who appear incompetent or uncaring, because there’s really no excuse for either.

I’m happiest playing with young children and watching them smile. Their spontaneous laughter is my favourite sound.

The covenant faithfulness and compassion of the motherly Father gives me hope — which I can see not only in the goodness of the creation, but also being lived out day by day in human society and in his people, despite all their many failings.

I pray to know the heart of God better.

I would love to spend a few hours locked in a church with C. S. Lewis. As someone who’s tried to communicate Christian perspectives in a secular academic environment, I find his combination of spiritual profundity, creativity, and clarity utterly compelling.

Professor Wyatt was talking to Terence Handley MacMath.

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