Genetic Counselling and the Death of Medical Compassion

The very first requirement in a hospital is that it should do the sick no harm. —Florence Nightingale

The appearance of Edwin Black’s War against the Weak: Eugenics and America’s Campaign to Create a Master Race a decade ago was a milestone in modern publishing. Informed by historical evidence gleaned by a team of researchers, the book drew the curtain on a dark period of US history while also revealing Transatlantic links to the systematised brutality of totalitarian regimes in early twentieth-century Europe.

While an appreciation of the past is valuable, a more critical question is whether the prejudices that marked the earlier eugenics movement persist today. Posing this question risks trespassing upon some sacred terrain, but for some of us, these matters are not simply of academic interest. For my family and me, this question is vital to our future in a world grown less friendly upon the proliferation of hospital-based “genetic counselling clinics” offering prenatal diagnostic services to expectant mothers. Maternity hospitals throughout Australia and abroad include on their payrolls genetic researchers whose vocational mission seemingly includes the in utero identification and eradication of people like my father, my daughter and me. We have a strong stake in clarifying the extent to which unvanquished eugenics attitudes towards the weak and congenitally frail dictate daily activities in these facilities. For all its brilliance, The War against the Weak largely tiptoed around such impolite questions.

The reticence towards such matters in scholarly circles likely reflects the dominant presumption that no relationship exists between early twentieth-century eugenicists and the genetic counselling movement of today. Perhaps this sunny optimism prevails because genetic counsellors have learned the lessons of history, and deftly avoid the baggage of polarising rhetoric that hampered their intellectual forebears: gone are such brazen slogans as “Human Betterment via Selective Breeding” or “Improve Our National Future by Eliminating Undesirable Races”. The genetic counsellors of today—the neo-eugenicists, if you will—instead promote their mission using the benign language of modern biotechnology and the market economy: their clinics offer non-invasive genetic technologies and embryonic screening as a service to families to ensure the birth of stronger, healthier babies. Surely persons of good will everywhere would laud such noble goals.

Like many Australians, I long assumed that the crude eugenics beliefs of yesteryear had gone the way of Auschwitz, Josef Mengele and the Third Reich. Perhaps they have. Yet I will shortly relate my experiences of a decade or so ago which led me to suspect that analogous attitudes now lurk—under a cheerier guise—in modern maternity hospitals, here in Australia. During an unplanned and unwanted appointment with a genetic counsellor, I learned that this profession consigns my relatives and me to a “genetic underclass” which in their opinion is best eliminated.

Before relating that story, however, I would like to describe some medical history of my very ordinary West Australian family. One much prefers to keep such matters private, but I have chosen to contravene my standards of public propriety in the hope that our story will reveal the dubious assumptions commonly used to sanction genetic counselling.

I will also show that this shadowy enterprise proceeds upon expectations that are increasingly implausible given Human Genome Project findings that reveal that every member of the human species—including Olympic athletes, Test cricketers, concert violinists, bioethicists and even genetic counsellors—is a walking genetic junkyard. Any hope that eliminating “defective” people like me will purify the human genome is nigh on delusional.

Perhaps I should first explain why a middle-aged academic, struggling amidst a career grown unbearable due to the inexorable decline of working conditions in Australian medical schools, should risk making his career prospects even worse by stating a strong position that is at odds with the prevailing establishment view. Discovering I belong to a class of people who are targets of the genome-sanitising efforts of genetic counsellors ought to have been motivation enough, but in my case, it took a recent “Road to Damascus” experience to crystallise my thinking on this topic.

Last year I agreed to participate in annual “Open Day” activities at my university. Normally I enjoy these opportunities to meet prospective students and their parents. As in recent years, I was due to promote my discipline in mid-morning and late afternoon public lectures. During the intervening hours, I was scheduled to join postgraduate students and academic colleagues in meeting prospective students in the medical school display area.

Heading to my faculty display after the morning lecture, I was surprised to pass several people wearing plaster casts on their forearms. I gave them little thought, assuming the “pointy end” of the winter sports season was nigh and that competition for finals places must have been intense. On reaching the venue, a more mundane and, to me at least, disorienting explanation emerged: the centre of the building housed a gaggle of medical students seated at tables, applying plaster-of-Paris bandages to healthy members of the public. The dressing was in the form of a “double-slab” that could be discarded by the wearer once the novelty of wearing it passed. I suppose this exercise allowed students to practise their first-aid skills, yet for me it was a revelation: as I will shortly explain, the defining attribute of the genetic condition from which I suffer is a propensity to breaking bones. I spent a good bit of my youth with one limb or another encased in plaster.

A primary reason neo-eugenicists offer for eliminating genetically diverse people like me is to avoid the economic cost of treating us. I suppose this goal carries emotive weight in our economically straitened times. Yet here is the nub of my dawning realisation from that damp August afternoon: Genetic counsellors wish to eradicate people like me to save the purchase costs of trivial items that are given away freely at university open days, destined to be thrown into a trash can after an hour or two of pointless use by healthy individuals. If there is a better way of encapsulating the deep missional crisis afflicting modern medicine in the wake of the neo-eugenicist revival then I am yet to discover it: on their reckoning, people like me are of less intrinsic value than a cheap, disposable commodity. Clearly, the profound negation of human dignity implicit in this view is fatal to the compassionate healthcare tradition that once distinguished Western civilisation.

When my tiny paternal grandmother Jessie and her husband Percival Christmas Burcham migrated from Yorkshire to Western Australia almost a century ago, she carried within her genome a mutated gene that she transmitted to some of her offspring, including my father and me.

As far as inherited mutations go, the mutant gene received from Jessie is quite benign, although its disruptive effect was unmistakable to my childhood peers. Those who know me as an adult are mostly ignorant of this medical history, although an orthopaedic surgeon worth his or her salt could detect the effect our rogue gene exerts on my eye colour, cranium shape and skeletal morphology. My powerful hearing aids would also be a giveaway!

The wonky gene afflicting some members of my family likely disrupts our ability to manufacture collagen, the structural protein that confers strength on bones, tendons, connective tissues and skin. Scientists have found hundreds of congenital mutations within a cluster of genes that directly or indirectly influence the quantity or quality of collagen in human tissues. Many of these mutations confer clinical conditions just like our own, although for some unfortunate individuals the disease phenotype is severe.

The clinical name for our condition is osteogenesis imperfecta (OI) or, in common parlance, brittle bone disease. Although my form of OI is mild, it was bad enough to make my childhood and teenage years quite challenging. And our mild familial form of OI is sufficiently serious for genetic counsellors to seek our permanent eradication from the human gene pool. All up, I probably experienced fifteen or so fractures in my youth. Known throughout high school as the loser kid who was always breaking bones, I received from my classmates such winsome nicknames as “Fragile Phil” and “Brittle Burcham”. Most of my fractures were minor, although some left permanent deformities in my skeleton.

Nowadays, recalling boyhood fractures can elicit amusing memories. Once in Year 9 a schoolyard punk “borrowed” a football I was kicking to some mates. When I headed off to retrieve it, he tripped me over, breaking my left upper arm. A week or so later, with left arm bulkily encased in plaster and sling, I engaged in a clandestine arm wrestle in the back row of a poorly supervised geography class. While straining for mastery over my opponent, my right arm suddenly snapped, releasing a sound like a gunshot. My elbow soon swelled like a rockmelon. To this day, I cannot bear to watch arm-wrestlers! However, students of chemistry will appreciate a humorous side to this episode: we were learning the Periodic Table in science classes at the time, and a mate invented a handy mnemonic to help our adolescent brains recall the valency of lead cations: Phil Burcham, two broken arms! (Pb²⁺)

The toughest aspect of OI for me has been the hearing loss. Our rogue gene wreaks havoc on the tiny bones that transmit vibrations from the ear drum to the inner ear, thereby disrupting the transmission of sound to the hearing centre in the brain. Wearing bulky hearing aids from the age of thirteen did little for the masculine pride of a teenage boy coming of age in 1970s Western Australia. I gained some respite from these contraptions in early adulthood after a talented ear-nose-and-throat surgeon performed a stapedectomy on my left ear—an amazing procedure that replaced my soft, nonconductive stapes with a harder synthetic “bone”. The surgeon said my stapes had the consistency of cheesecake and had disintegrated in his forceps. The surgery worked a treat for my Dad and his siblings, but was less effective in my case.

After high school I graduated from university with a PhD in science and continued preparations for an academic career by completing post-doctoral work in the USA. While in America, I met my wonderful wife who beneficially happened to be a nurse. A few years after our marriage, Libby gave birth to a beautiful and energetic little girl. One day, when she was ten months old, our petite daughter was trying to pull herself up using a lounge chair for support. As she struggled to hold her balance, my wife heard a popping sound and a scream as our daughter flopped back onto the floor. X-rays later indicated she had snapped a tibia—the first sad indication that she had inherited our OI gene.

I was distraught when Libby phoned me at work to relate the mishap. As a scientist, I knew OI is transmitted as an autosomal dominant trait, hence our daughter had a fifty-fifty chance of inheriting my disorder, but I hoped that despite her small frame, she had escaped the OI gene. Yet I drew solace from the likelihood that our form of OI is less disruptive to females than to males. With a wonderful OI-affected aunt—among the kindest human beings I have ever known—as well as having an OI-affected sister and female cousins, I knew our daughter could lead a happy life in spite of OI.

Libby was utterly undaunted by the prospect of caring for an OI child. Before migrating to Australia, she had worked in an understaffed renal transplant ward in an inner-city medical centre. Many of her patients were “high-maintenance” indigents, receiving “new” Medicaid-financed kidneys after their own were irreversibly damaged by cocaine or other street drugs. Compared to such demanding work, caring for occasional fractures in a tiny, good-natured daughter was a cakewalk.

We took our distressed daughter to the ER of the nearby children’s hospital. Her leg expertly encased in plaster, she was soon on her way to a full recovery. Yet on learning of the disorder affecting my family, before we left the ER, attending staff told us an appointment was available with a gifted doctor who knew a great deal about OI. With positive memories of the orthopaedic surgeons who cared for me in my youth, I was keen to have the consultation. Also, as a pharmacologist by training, I knew that the bisphosphonates—a class of drugs developed for osteoporosis sufferers—were then undergoing testing in OI patients. I hoped the doctor could provide an objective opinion concerning their potential to help our child.

At the appointment a few weeks later, the misguided nature of these expectations became clear: the doctor had little interest in the clinical management of paediatric OI patients and knew nothing of bisphosphonate efficacy testing in this cohort. As the consultation commenced, the doctor and attending nurse engaged us in small talk, but the intentions beneath the chattiness soon emerged: they wanted to know if we hoped to have another baby. When my wife replied in the affirmative, angry grimaces passed between doctor and assistant. “If that is the case,” said the doctor, turning towards me, “we will need to obtain blood samples from some members of your family to allow DNA testing.” Thinking my family might take some persuading before agreeing to become part of a research project, I naively asked why the genetic data was required. Waving a dismissive hand towards our daughter—who until this point had tried her darnedest to win the doctor’s attention with grins and giggles—the genetic counsellor coldly declared, “We want to make sure you don’t have another one of those!”

The trajectory of my emotions now resembled those of Hansel and Gretel at the point of their rude awakening in the famous Brothers Grimm story. Like the saccharine treats fastened to the witch’s cottage, the sugary assurances from the ER staff had lured us to the den of a neo-eugenicist who wished to push any of my future OI-affected offspring into her oven. Libby had awoken to the same reality, and in one of the most galvanising moments of our marriage, with steady voice she informed the doctor that she would never abort a child in her womb. This interjection quickly ended proceedings and we were shooed from the room. In my wife’s vivid recollections, this was just as well since the doctor’s demeanour had grown distinctly uncordial. 

Other members of my extended family have had more harrowing “healthcare” encounters, but the brief episode nevertheless had lasting ramifications for my wife and me. My respect for the medical profession has yet to resume the heights it enjoyed before that day. I personally know some fine clinicians, secular and religious, who still uphold the high standards of compassion their healing profession traditionally embraced. Yet for me, that unsettling meeting with a doctor on a mission to destroy my offspring ruptured the sacred bond of trust between physicians and patients that underpins any humane healthcare system. My wife also marks the day as a watershed in the evolution of her own attitudes. During her nursing career, Libby proudly worked alongside several highly esteemed members of the US medical community. Yet our glimpse of the dark underbelly of modern medicine diminished her regard for the profession she once admired.

My respect for hospitals also took a bullet. I suppose it is hard for able-bodied people to grasp the significance of hospitals to OI-affected families: I can recall family gatherings from my youth where we discussed hospital staff in the same way other families probably chat about revered schoolteachers, soccer coaches or piano tutors. Dad often praised his favourite orthopaedic surgeon, a giant of a bloke who was built like a bear yet had oh-so-gentle hands when tending injured limbs. Dad’s siblings would then wax lyrical concerning the ear-nose-and-throat surgeon who miraculously restored their hearing. If I could get a word in edgeways, I might pipe up to extol the wonderful nursing sister in the plaster room of the hospital where I spent too much of my youth. In my fracture-prone teenage years, I admired this remarkable woman almost as much as I loved my mother: she had a happy knack of cracking jokes, immobilising broken limbs and administering pain-killers in a way that sent a downcast lad safely on his way thinking he could face the world again.

Because we knew they cared for our welfare, we grew to love these hospital staff. It never, ever, crossed our minds that they would have intentionally harmed or misled us. Why would it? Our reverence for hospitals had accumulated over generations of a shared family experience of living with OI. Yet my high regard for hospital staff eroded substantially following our brief visit to the genetic counselling clinic: the slick, manipulative workers encountered there were unrecognisable from the heroes of my youth. A “healthcare revolution” of far-reaching significance had clearly occurred during the twenty or so years since I last needed orthopaedic assistance. 

While unpleasant at the time, our experiences helpfully exposed several questionable assumptions that likely underpin the provision of prenatal genetic counselling services in modern hospitals. Critical engagement with these assumptions is important, since those involved in these practices rarely, if ever, publicly enunciate or defend the operational principles that guide their daily work.

First, the assumption that the termination of defective infants will provide net benefits to either the families involved or to Australian society as a whole is highly contentious. I will return to some scientific aspects of this problem below, but will first argue that the negative impact abortion would undeniably have exerted upon my own family tree confirms that no physician on earth could possibly foresee the life achievements of future descendants of frail or handicapped parents. After my grandmother Jessie arrived in Australia nearly a century ago, few doctors would have looked at her tiny stature, fragile frame and abominable hearing—or at the quiet and reserved gardener by her side—and rated the prospects of their offspring very highly.

Yet for the sake of argument, let us imagine Jessie Burcham fell under the spell of the same neo-eugenicist my wife resisted, and aborted her three OI-affected offspring—Lloyd, Mabel and Cyril—while retaining her firstborn Laura as her sole “genetically pure” child. How precisely would eliminating Lloyd, Mabel and Cyril in utero have made West Australian society “stronger”?

With the benefit of hindsight, aborting Jessie’s three frail babies would not have achieved anything other than exacerbate the protracted skills shortage afflicting the West Australian economy, for we would have lost numerous hard-working individuals who have contributed widely to the social and economic wellbeing of our booming state. The following list of Jessie’s descendants who would have been flushed away is incomplete but includes a doctor, a medical student, several nurses and a greater number of teachers, a headmaster, two scientists, a systems engineer, a musician, an occupational therapist, a dental technician, a physiotherapist, a draftsman, many devoted homemakers, some pastors, as well as several skilled tradesmen. All of them have been socially engaged, responsible citizens without a criminal conviction between them; none has depended on the state as welfare recipients during their productive working years; and virtually all have been or remain selfless contributors to various social groups or religious bodies in Western Australia. The loss of human and social capital to our state had Jessie Burcham aborted her three OI-affected offspring would have been substantial.

How then do things look on the other side of the neo-eugenicist’s cost-benefit ledger? They allege families like mine are an intolerable “burden” on society, implying that eliminating us in utero would save the healthcare system substantial “costs”. How often are such blithe assumptions subjected to interrogation? To return to my family story: what would the West Australian healthcare system have saved in monetary terms had my father and his two OI-affected siblings experienced death before life? The answer to this question is pitiful indeed: in retrospect, I would estimate an upper limit of some 100 fractures was prevented, a back-of-the-envelope estimate of the total number of broken bones sustained by Jessie’s three children and their affected offspring. Treating a fracture is among the least expensive interventions in modern medicine: perhaps the local healthcare system would have saved the cost of several cartons of plaster-of-Paris bandages, a few dozen calico arm slings and some boxes of radiography film. Moreover, for the small proportion of fractures that required surgical correction, we could have saved the cost of a dozen or so short-term hospital stays and associated theatre costs.

Surely, for a wealthy state like ours, these costs add up to a trivial sum indeed. Yet within the strange moral horizons of today’s neo-eugenicists, it is an open-and-shut case that the economic and social benefits conferred by the law-abiding, industrious members of my extended family of Brittle Burchams can never tip the scales in our favour against the modest costs of our medical treatment.

Second, while neo-eugenicists would have us believe that their selection of congenital mutations that mark foetuses for elimination is based upon rigorous scientific reasoning, thanks to the explosion of genetic knowledge in recent years this belief is increasingly insecure. In fact, one could argue that the emerging picture of human biology provided by ultra-fast “Next-Gen” DNA sequencing technology is rapidly consigning neo-eugenicist assumptions to the dustbin of history: we now know that the genome of every individual human harbours millions of DNA sequence aberrations. While the vast majority are inconsequential, recent Seattle-based research suggests that each human on average carries 313 rare disease-causing mutations. This high number of deleterious mutations helps explain why we all succumb to frailty and degenerative disease in old age.

This continually expanding database of human mutations raises the sharp question of which specific DNA sequence aberrations will be used to earmark individual embryos for destruction. Presumably, genetic counselling clinics maintain a file of “undesirable disease genotypes” which lists mutations of this kind. Yet since medical researchers are publishing new findings every day, who decides whether newly discovered mutations are included on the neo-eugenicist’s list? Should we, for example, include mutations that double the risk of breast cancer, cause premature balding, or predispose individuals to anxiety or depression? As a Type 1 OI-sufferer, I was shocked to find my mild genetic condition on lists of undesirable diseases. How precisely was that decision made, and who made it? What other genetic disorders—mild or otherwise—are included on these lists? When assembling them, do genetic counsellors consult patient advocacy groups or other stakeholders? Are open meetings held to allow comment by interested community groups? Indeed, are these lists even in the public domain? My family for one would be grateful if lists of diseases deemed undesirable were downloadable from maternity hospital websites: it would make choosing our hospitals easier if we knew up-front whether we were likely to face harassment or not.

Lest these concerns strike readers as paranoid, remember that the increasing penetration of Next-Gen DNA sequencers into hospital diagnostic labs will ensure that the day is near when the entire genome of every unborn human could be routinely determined. If the powers of the gatekeepers of this technology are not circumscribed, genetic counsellors will gain extraordinary coercive powers over human reproduction. After all, when confronted with a long list of deleterious mutations found in their offspring—and recall that Next-Gen sequencers can detect hundreds of such DNA aberrations in the genome of each of us—unwary mothers could easily be persuaded that an entirely normal child in their womb is a grotesque genetic monster. 

After nearly two decades of marriage, my wife has learned she must pay heightened attention if she sees me retrieving the chainsaw from our garden shed: she fears I belong to the school of enthusiastic tree loppers that sees every free-standing garden object as a problem awaiting solution. An inattentive afternoon on her part can leave our front yard as treeless as the Nullarbor Plain. Yet while the trees that fall victim to my chainsaw usually make a swift recovery, a genetic counsellor armed with a Next-Gen sequencer can inflict permanent damage upon entire family trees. Yet as far as I am aware, Australian legislators have introduced few guard-rails to curtail their potential waywardness.

Third, even if a genetic counsellor is convinced that a particular mutation is deleterious, the fogs of human biology render it impossible to confirm that the plight of every individual foetus carrying this mutation is inevitably bleak. Given the complexities of embryonic development and prenatal gene expression, no available technology can reveal how severely affected an individual embryo will be in adulthood, even if a deleterious mutation is detected via prenatal diagnosis. To recall, our daughter’s OI-phenotype was unconfirmed until she was ten months old, a common outcome for many patients with congenital disorders. This is why pro-infanticide “bioethicists” hideously propose to deny all infants the right to life until they are twelve months of age or older.

Compounding this situation is the biological reality that the observable signs and symptoms—the so-called phenotype—for even monogenic disorders can vary considerably even among family members who inherit the same mutation from their forebears. I, for example, have several relatives who carry Jessie’s deleterious gene but who have normal hearing and have suffered only one or two minor fractures. Their only sign of carrying the OI gene is the possession of “blue sclera”—namely a blue-grey tint to their eyeball. (In most people, a thick layer of white collagen-containing tissue obscures ocular vessels carrying bluish deoxygenated blood.) Yet since the genotyping tests used by genetic counsellors only detect a mutation within the DNA itself and cannot assess the phenotype of an embryo, these procedures would target mild OI-patients for abortion just as cruelly as they condemn people like me who exhibit a broader disease phenotype. Here then is this concern in a nutshell: if neo-eugenicists had their way, some of my mildly affected family members—mostly women—would be dismembered in utero simply for possessing blue-tinted eyeballs. 

Fourth, has our society truly sunk to the level where the belief that some humans command a favoured right to life simply because of their physical strength is now unassailable orthodoxy? Like most Australian males, I can draw great pleasure from the on-field achievements of those who make a living from sport, but if this is the only form of human achievement we celebrate then we are a spiritually, artistically and intellectually impoverished generation indeed. Once upon a time in the Western world, people drew inspiration from biographies of Helen Keller, Louis Braille and others who transcended disabilities to display the unbreakable power of the human spirit. Yet if the neo-eugenicists have their way, in the future only bimbo celebrities and sport-adept jocks will be allowed to inspire us.

What a sad truncation of human potentiality this new outlook implies. I can recall individuals from my youth who displayed great strength and sporting prowess as teenagers, but on navigating the turbulent waters of adulthood failed to cope as their lives ran aground on the reefs of drug and alcohol abuse or family breakdown. On the other hand, as one born congenitally frail, I have come to respect this mysterious disorder called osteogenesis imperfecta, and even give thanks for how it prematurely confronted me with my frailty and mortality. By forcing me to find the fortitude to transcend repeated bouts of medical adversity, and in requiring me to choose a vocation in which success did not depend on brute strength, OI paradoxically made me a stronger and more compassionate individual who could better withstand the vicissitudes of adulthood. Nowadays, as a university academic, I am touched by the number of students who report on their teaching evaluations that they rate me among the best lecturers on my campus. If genetics counsellors had their way, I could never have performed this social role.

Fifth, it is likely that compared to some families, my wife and I were unusually well equipped to survive bruising encounters with imperious neo-eugenicists. With five or six tertiary degrees between us, and having taught on university campuses in Australia and America, we can usually speak up for ourselves. Libby’s varied experiences in US hospitals doubtless gave her confidence to politely resist the genetic counsellor’s overtures.

Yet how do women from less privileged backgrounds, newly arrived migrants or refugees with limited English skills fare when ambushed by neo-eugenicists? In the absence of quality data, we probably have no way of knowing. This highlights another question: Why is so little information available in the public domain concerning the types of women who incur abortions upon the “advice” of genetic counsellors? In most medical schools today, diligent public health researchers pick apart disease incidence and demographic data like ancient soothsayers studying the entrails of unfortunate animals: it is widely believed that trends in the prevalence of particular diseases can reveal the subtle influence of gender discrimination, socioeconomic deprivation, or healthcare resource misallocation. Yet such concerns are strangely put aside when it comes to termination statistics. Where are the population health researchers studying the growing plight of harassed sufferers of congenital disease? 

While we have highlighted their impact on families, one cannot help wondering if neo-eugenicist attitudes are re-booting the entire ethos of Western medicine and thereby debasing the tone of our whole society. Some hints concerning the social consequences accompanying medical totalitarianism emerge from the writings of Dietrich Bonhoeffer, the brilliant Lutheran scholar who opposed the dehumanisation of the Jews in eugenics-obsessed Nazi Germany. Bonhoeffer explored the influence of the anti-democratic impulse on healthcare in his famous unfinished work, Ethics. As he sensed his cruel execution approaching, Bonhoeffer grasped that a commitment to the intrinsic value of every human life is basic to a humane civil order. In such a society, the strong must vigilantly resist the temptation to lord themselves over the weak. By delivering this exhortation to the physically strong, Bonhoeffer concluded that the Judeo-Christian tradition had unleashed a powerfully humanising force within Western societies: 

[The] weak man’s need will lead the strong man towards new tasks; it will lead him to develop his own social value. The strong man will see in the weak man not a diminution of his strength but a stimulus to loftier achievements. The idea of destroying a life which has lost its social usefulness is one which springs from weakness, not strength.

Bonhoeffer also dismissed arguments that invoke financial savings to justify destroying people with hereditary diseases:

From the economic point of view, a people’s standard of living will never be seriously impaired by providing for these sufferers. A people’s expenditure for the care of patients of this kind has never come near to equalling the sums spent on articles of luxury.

Knowing that Nazi callousness had deeply polluted German hospitals, Bonhoeffer reflected upon the mysterious link between the values prevailing in the healthcare sector and the pro- or anti-civilisational forces at work in the wider community:

We cannot ignore the fact that precisely the supposedly worthless life of the incurably sick evokes from the healthy, from doctors, nurses and relatives, the very highest measure of social self-sacrifice and even genuine heroism; this devoted service which is rendered by sound life to sick life has given rise to real values which are of the highest utility for the community.

It is sobering to consider that analogous prejudices towards the weak and frail that Bonhoeffer felt obliged to contest in the Third Reich are now enshrined in the genetic counselling clinics that dot the modern medical landscape. How, for goodness sake, did we find ourselves in this position?

Our predicament partly reflects a myopic disregard for the Judeo-Christian heritage that is entrenched throughout the chattering classes in Australia and abroad. For too many hasty commentators, Christian theism did nothing for our world but foster intolerance, violence and ignorance. Yet a strong counter-argument is found in the writings of Dietrich Bonhoeffer: for all its follies and distressing failures to live up to its own moral vision, the Christian Church performed a feat of supreme social importance—it bequeathed a priceless gift upon the Western medical enterprise in the form of an ennobling, over-arching missional vision. On this view, since every human being bears the imago dei, hospital and healthcare workers are obliged to show high professional regard for every patient, irrespective of genetic endowment, ethnic background or socioeconomic status. Upon this egalitarian foundation was the entire compassionate Western healthcare edifice erected.

The classic 1985 study by Professor Timothy Miller, The Birth of the Hospital in the Byzantine Empire, is a useful introduction to the role Judeo-Christian values played in the shaping of pre-modern nosocomial institutions. The very name assigned to these entities shows how strongly the Judeo-Christian ethic influenced their development—hospitals were to offer hospitality to all. This compassionate vision sustained these primitive institutions through the long centuries in which their clinical knowledge, diagnostic technology and arsenal of effective drugs were limited indeed.

How can this understanding explain our present predicament? With the benefit of hindsight, it seems obvious that the emergence of genetic counselling and its flotilla of prejudices towards the weak and the frail occurred only in the wake of the abortion revolution of the 1960s and 1970s. This culture-wide repudiation of long-standing taboos against abortion drove a lethal stake into the compassionate, egalitarian heart of Western medicine: I suspect we have yet to experience the full social consequences flowing from this cataclysmic event. In Australian medical schools, for example, we assumed that excising the embarrassing anti-abortion paragraph from the Hippocratic Oath taken by graduands was a trivial amendment without far-reaching implications. Yet several decades later, it seems likely this change has lastingly injured the entire ethos of modern medicine.

As with other vocations, medicine needs a unifying ethical vision to sustain its multifaceted professional activities: upon accommodating abortion, this vision is racked by unresolved tension between the “doctor as healer” and “doctor as killer of unwanted or defective children”. My wife and I discovered that the ascendant medical model easily degrades doctors to the status of decadent Roman emperors, slouching in the amphitheatre whilst giving arbitrary thumbs-down signals to individuals in the arena below who are afflicted with genetic diseases which embarrass the proud and the strong.

In his recent book, Why We Should Call Ourselves Christians, Marcello Pera, a former President of the Italian parliament and a modern secular thinker, concludes that “the West today is undergoing a profound moral and spiritual crisis, due to a loss of faith in its own worth, exacerbated by the apostasy of Christianity now rife within Western culture”. The bold title of Professor Pera’s book refers to an essay written by the secular philosopher Benedetto Croce during the Second World War. Along similar lines to the conclusions reached by Croce, Pera contends that only Christian theism can secure European freedoms against the suffocating soft totalitarianism now emanating from Brussels.

Yet such tensions are not unique to Europe, nor are they quarantined to the political sphere. A comparable crisis afflicts modern healthcare institutions, the recognition of which poses a key question: How long can modern medicine limp along under the influence of its present Multiple Personality Syndrome? Can our hospitals long prosper in a social setting shorn of a Judeo-Christian understanding of personhood?

From my own vantage point, having spent two decades experiencing the excruciating decay of Australian medical schools from within, the form medicine will assume in coming decades is far from clear. Yet one cannot help wondering if this decline partly reflects the loss of a coherent missional vision in the wake of the abortion revolution. Like tiny weeds that pop up in my backyard vegetable patch after early winter rains, perhaps the genetic counselling movement is a portent of more aberrant medical adventurism in coming decades.

For the well-being of future generations, we should uproot these intruders now before they overrun the garden of Australian medicine. Alternatively, if there is no appetite for closing our wretched genetic counselling clinics, let us at least rename the soulless glass-and-concrete edifices that house them. If they persist in withholding their compassion from some of us, we must surely call them something other than hospitals.