BCC Ethics Tuskegee Study Karen Ann Quinlan & Global Violence Discussion

  

Read and give your opinion in writing of the following cases. Your opinion must be at least be a well formed paragraph.

Page 69. Tuskegee Study

Page 70 Death of Karen Ann Quinlan

Page 71. Surrogate Mother

Page 86-87. Drugs Devices and Disclosures

Page 89. Steve Jobs Liver Transplant

Page 116. Unmarried in Saudi Arabia

Page 120 Egyptian Doctor

Page 132 Global Violence Against Women

Attached below is the book to use.

Bioethics in a Cultural Context
Philosophy, Religion, History, Politics
VINCENT BARRY
Professor Emeritus of Philosophy, Bakersfield College
Australia
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Bioethics in a Cultural Context: Philosophy,
Religion, History, Politics
Vincent Barry
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1 2 3 4 5 6 7 14 13 12 11 10
To Jen-Li Rose at 12,
keep that breathless charm
Contents
PREFACE
xx
Introduction: Bioethics, Schiavo, and Cultural Politics
Bioethics 2
Ethics 2
Normative Ethics
Metaethics
2
3
BIOETHICS ACROSS CULTURES
Canada’s Terri Schiavo
4
Making Sense of Moral Conflict
Issues
5
5
BIOETHICS ACROSS CULTURES
Religion and HIV/AIDS in Africa
6
Adversaries 6
About This Book 9
CASES AND CONTROVERSIES
Reproductive Flashpoints
Refusal Legislation
10
Religion and Terminal Care
References
PART
I
9
11
11
Two Enduring Traditions
13
Introduction: Sacred and Secular Foundations
iv
13
1
CONTENTS
Chapter 1
Medieval Religion and Enlightenment
Science 15
Welcome To Technopia 15
The Medieval Church
16
The Authority of the Bible 17
The Biblical Account of Creation
17
Human Nature 17
The Relationship and the Covenant
The Problem of Evil 18
The Augustinian Theodicy
17
18
The Doctrines of the Fall and Depravity
19
Moral Failure and Illness 19
Bi-level Conception of Sin 20
Medicine and the Supernatural
Illness as Salvific 21
20
Role of Government and Law
21
Enlightenment Science
21
BIOETHICS ACROSS CULTURES
Buddhism, Health, and Disease
Scientific Method
24
Rene Descartes
24
22
The Emergent Scientific Medicine
Mechanism 25
25
BIOETHICS ACROSS CULTURES
Islamic Science 26
Implications for Religion
Deism 27
Anthropic Mechanism
27
28
Personhood as Consciousness
The Problem of Evil 29
Conclusions
28
29
CASES AND CONTROVERSIES
What Doctors Think about Religion and Health
Faith Flags
31
Criticism of Science and Its Method
31
The Life and Death of Jane Tomlinson
References
32
32
30
v
vi
CONTENTS
2
Religious and Secular Ethics
Divine Command Theory
Scriptural Basis 36
Natural Law
35
36
36
The Doctrine of Double Effect
Secular Natural Law 38
37
Legal and Moral Rights 38
Social Contract Theory 39
Kant’s Thought and Ethics 41
Philosophy’s “Copernican Revolution”
41
God, Morality, and the Problem of Evil
Moral Choice 42
The Categorical Imperative
41
42
Social Interests 43
Moral Rights 43
Utilitarianism 44
Utility Principle
45
Moral Rights and the Harm Principle
45
BIOETHICS ACROSS CULTURES
Bentham in Bhutan 46
Social Interests 47
Preference Satisfaction
Conclusions
47
47
BIOETHICS ACROSS CULTURES
Spain Extends Rights to Apes
48
CASES AND CONTROVERSIES
The Jodie and Mary Twins’ Tragedy
Life vs. Law
50
51
Crossing the Border to Sell Blood
51
Is Vaccinating Part of the Social Contract?
References
PART
II
53
Origins and Context of Bioethics
3
55
Introduction: Triumph of Secularism
55
The Birth of Bioethics 57
The Emergent Patient Consciousness
57
52
CONTENTS
BIOETHICS ACROSS CULTURES
Africa Still Waiting for “The Sanitary Revolution”
The New Frontier of Medicine 58
New Technology and Treatments 59
Advances in Reproductive Technologies
Scientific Research
59
60
BIOETHICS ACROSS CULTURES
Globalization of Clinical Research
Court Decisions
61
61
Law at the Beginning of Life
62
Law at the End of Life 62
The Pioneers and Their Mind-Set
The Theologians
The Philosophers
63
63
64
Points of Difference 65
Common Ground 65
Utility and Autonomy
66
Faith in Rationality 66
A National Religious Identity
The “Jeffersonian Compromise”
Conclusions 68
66
67
CASES AND CONTROVERSIES
The Tuskegee Study
The Death of Karen Ann Quinlan
70
Surrogate Mother Elizabeth Kane
71
References
4
69
72
The Basic Principles of Bioethics
Hippocratic Paternalism 74
The Belmont Principles
75
BIOETHICS ACROSS CULTURES
Transcultural Human Rights
Autonomy 77
Moral Limits
78
Secular and Religious Appeal
Nonmaleficence 79
BIOETHICS ACROSS CULTURES
Cross-Cultural Care
Beneficence
81
76
81
79
74
58
vii
viii
CONTENTS
BIOETHICS ACROSS CULTURES
Traditional Medicine for the Hmong
Justice 84
Conclusions
83
86
CASES AND CONTROVERSIES
Drugs, Devices, and Disclosure
86
Medical Workers Involved in C.I.A. Interrogations
The Steven Jobs Liver Transplant
References
5
88
89
90
Applications 93
A Patient’s Bill of Rights
Truthtelling
93
94
BIOETHICS ACROSS CULTURES
East Asian Autonomy
95
Informed Consent 96
Deliberation 96
Voluntariness
97
BIOETHICS ACROSS CULTURES
A Japanese Woman with Aggressive
Leukemia
98
Kinds of Informed Consent
98
Advance Directives 99
Participation in Medical Research
100
BIOETHICS ACROSS CULTURES
A Slow Dying in Nigeria
Privacy and Confidentiality
101
102
DNA: The Genetic Fingerprint
103
BIOETHICS ACROSS CULTURES
Baseball’s Genetic Testing in Latin America
Conclusions
104
105
CASES AND CONTROVERSIES
The Merenstein Case of Informed Consent
106
Jaffee v. Redmond (1996): Safeguarding Patient
Communication 106
Jesse Gelsinger: The First Gene Therapy Death
References
109
108
CONTENTS
6
Beyond Principlism I: Autonomy Under Attack
111
Feeling Betrayed by Principlism 111
The Critique of Autonomy 113
Patient Autonomy as Impoverishing Bioethics
113
Patient Autonomy Disallows Conscientious Objection
113
BIOETHICS ACROSS CULTURES
Unmarried and Pregnant in Saudi Arabia
116
Autonomy As Overriding Professional Judgment
117
Suggested Offsetting Principles 117
The Ecological Principle 117
The Vital Institution Principle
The Theonomy Principle
118
119
BIOETHICS ACROSS CULTURES
Egyptian Doctor’s Honesty Backfires
Participated Theonomy
120
121
CASES AND CONTROVERSIES
When Plan B Doesn’t Work
Guarded about Gardasil
122
122
Benitez v. North Coast Women’s Care Medical Group
References
7
125
Beyond Principlism II: Alternative Perspectives
Virtue Theory 127
Feminist Ethics of Care
Justice
128
128
BIOETHICS ACROSS CULTURES
Buddhist Virtue
Care
124
129
129
The Emergence of Feminist Bioethics
BIOETHICS ACROSS CULTURES
Global Violence Against Women
130
132
Existential and Spiritual Dimensions of Illness
Narratives 135
Narrative Theology and Ethics
136
BIOETHICS ACROSS CULTURES
Bioethics in the Twenty-first Century
Conclusions
139
138
133
127
ix
x
CONTENTS
CASES AND CONTROVERSIES
Forever Small: The Ashley Treatment
139
Dax Cowart: Burn Victim Wants to Die
Gatekeepers Without Empathy
References
PART
III
140
141
142
Issues at the Beginning of Life
145
Introduction: Headlines for Reproductive Ethics
References 148
8
145
Conceptual Matters in Abortion and Reproductive
Technology 149
Banning Abortion in South Dakota 149
Developmental Sequence of Human Life 150
First Trimester
151
Second Trimester 151
Third Trimester 151
The Ontological Status of the Unborn
The Meaning of Human Life 152
152
The Meaning of Personhood 153
When Ontological Status is Attained 154
Hominization and Ensoulment
155
BIOETHICS ACROSS CULTURES
Jewish Beliefs about Personhood
Moral Status of The Unborn
Religious Views 156
156
156
BIOETHICS ACROSS CULTURES
Islamic Understanding of Fetal Development
Secular Views
157
Scientific Views about when Life Begins
The Genetic View 158
The Embryological View
158
159
The Neurological View 159
Additional Views 159
BIOETHICS ACROSS CULTURES
Buddhism, Personhood, and Abortion
Conclusions
161
160
157
CONTENTS
CASES AND CONTROVERSIES
The Language of Embryology
161
Is Commander Data a Person?
162
Fetal Life and Personhood
References
9
163
163
The Abortion Debate I: Pre-Roe
The Murder of Dr. George Tiller
A Brief History 168
166
166
Life Matters Most: The Conservative Religious View
169
Religious Natural Law and the Principle of Double Effect
170
BIOETHICS ACROSS CULTURES
Early Induction in Ontario
Scriptural Teachings
171
171
The Mobilization of Pro-Choice Consciousness
173
BIOETHICS ACROSS CULTURES
Abortions in Kenya 174
Philosophical Analyses of Abortion
175
BIOETHICS ACROSS CULTURES
A Young Muslim Woman with a Complicated Pregnancy
Religious Social Teaching and Activism
178
CASES AND CONTROVERSIES
Sherri Finkbine and the Thalidomide Tragedy
Grisworld v. Connecticut (1965)
The Pre-Roe “Bad Old Days”
References
179
180
182
182
10 The Abortion Debate II: Roe and Beyond
Choice Matters Most: The Roe Decision
The Religious Liberty Principle 185
Privacy 187
Roe and Cultural Conflict
188
Current Religious Sentiment
189
BIOETHICS ACROSS CULTURES
Outrage in Brazil
190
Choice Under Attack 192
Culture of Life 192
BIOETHICS ACROSS CULTURES
Mexico Legislates Personhood
193
The Creation of the Fetal Citizen
193
185
185
178
xi
xii
CONTENTS
BIOETHICS ACROSS CULTURES
Abortion Around the World
Conclusions
196
197
CASES AND CONTROVERSIES
Gonzales v. Carhart (2007)
The South Dakota Script
200
Redefining Pregnancy
References
199
201
202
11 The Assisted Reproduction Debate I: Principled
Considerations 205
Test-Tube Babies 205
Assisted Reproductive Technology
206
Surrogacy 207
Ethical Debates 207
Rights 208
Procreative Liberty
208
Life 208
Respect for Human Life
210
Unity of Marriage, Sex, and Reproduction
Religious Views
211
211
BIOETHICS ACROSS CULTURES
Sunni and Shi’ a Views of Reproductive Technology
Secular Views
214
Gender Liberation and Self-Determination
BIOETHICS ACROSS CULTURES
ARTs and Women in India
216
CASES AND CONTROVERSIES
Dahl v. Angle: Who Owns Frozen Embryos?
What to Do with Frozen Embryos?
Love, Sex, and Marriage
References
215
217
217
218
219
12 The Assisted Reproduction Debate II: Empirical
Considerations 221
The Commerce of Reproduction
Questions of Lineage 222
BIOETHICS ACROSS CULTURES
Wombs for Rent in India
223
221
212
CONTENTS
Religious Considerations
224
Legal Considerations 225
The Meaning of Family and The Well-Being of
Offspring 225
BIOETHICS ACROSS CULTURES
Dead Men To Father Children in Israel and England
Conclusions
227
228
CASES AND CONTROVERSIES
In re Baby M: First Surrogacy Case
229
Jacob v. Shultz-Jacob: Three Adults with Parental Rights
Wanted: A Few Good Sperm for Choice Mothers
References
232
13 The Prenatal Testing Debate I: Embryo Screening
The Boy in the Plastic Bubble 235
Medical Uses of Pre-Implantation Genetic Diagnosis
236
Having Healthy Children 237
Creating Compatible Donors 237
Generating Embryonic Stem Cells
238
The Ethical Debate 238
Embryo Creation and Destruction
238
Trait Selection
239
BIOETHICS ACROSS CULTURES
Eugenics Around the World
240
BIOETHICS ACROSS CULTURES
Biotechnology in China 241
CASES AND CONTROVERSIES
The Genetic Information Nondiscrimination Act
The Genetic Matchmaker
242
243
Growing a Baby with a Disorder
References
231
231
244
245
14 The Prenatal Testing Debate II: Sex Selection
Proper use of Technology 248
Pre- vs. Postconception Technology
Sexism 249
248
Sex Ratios in Local Populations 250
Commodification of Reproduction 251
247
235
xiii
xiv
CONTENTS
BIOETHICS ACROSS CULTURES
Chinese Bias for Baby Boys
251
BIOETHICS ACROSS CULTURES
Clinics’ Pitch to Indian Émigrés
Consumer Eugenics
Conclusions
252
253
255
CASES AND CONTROVERSIES
Genetic Risks: To Disclose or Not To Disclose?
Made-to-Order Babies
257
Slouching Toward Gattaca?
The Creation of “Synthia”
References
256
258
259
259
15 The Stem Cell Debate I: Background and
Terminology 262
Loosening the Stem Cell Binds 263
Embryonic and Non-Embryonic Stem Cells
Differentiation
Lines 265
264
265
Obtaining Stem Cells
266
Pre-Implantation or Spare Embryos
Created Embryos 266
266
BIOETHICS ACROSS CULTURES
Japanese Create Fatherless Mouse with Three Mothers
Reprogrammed Stem Cells
267
267
BIOETHICS ACROSS CULTURES
ESC Research in Iran 268
Cloning
268
CASES AND CONTROVERSIES
The Pernkopf Anatomy
Irreconcilable Differences
The Missyplicity Project
References
269
270
271
272
16 The Stem Cell Debate II: The Ethics of the Science
Personal Ethics 274
Research Ethics 275
Destruction of the Early Embryo
275
274
CONTENTS
BIOETHICS ACROSS CULTURES
Embryonic Stem Cell Research Worldwide
278
Spare versus Created Embryos 278
Alternatives to Embryo Destruction 280
Social Ethics
282
Disruption of Traditional Understanding
283
BIOETHICS ACROSS CULTURES
Human-Animal Hybrid in Britain
Threats to Social Justice
Conclusions
284
285
286
CASES AND CONTROVERSIES
Cloning and Cultural Conflict
NIH ESC Guidelines
286
287
Frozen Embryos: The Personal Decision Behind the
Public Controversy
References
PART
IV
288
289
Issues at the End of Life
Introduction: Jack’s Back
References
291
291
292
17 Definition and Criteria of Death
293
DCD and The Death of Ruben Navarro
Traditional Heart-Lung Definition 295
Whole-Brain Death Definition
293
296
Challenges to the Whole-Brain Formulation 297
Return to the Heart-Lung Formulation 297
Adopt a Higher-Brain Formulation 297
Adopt a Brainstem Formulation 298
The Biological vs. Psychosocial Debate: Organisms vs.
Persons 298
Death of the Organism: A Biological Perspective 299
BIOETHICS ACROSS CULTURES
Japan’s Organ Transplantation Law
300
Death of the Person: A Psychosocial Perspective
BIOETHICS ACROSS CULTURES
A Cross-Cultural Perspective on Brain Death
Lingering Questions about Brain Death
Definition or Permission? 305
305
301
304
xv
xvi
CONTENTS
Help or Harm?
306
Event or Process?
Conclusions 307
306
CASES AND CONTROVERSIES
Terry Wallis: The Man Who Woke Up After Nineteen
Years 308
Baby Theresa
309
In the Conservatorship of Wendland
References
310
311
18 Conceptual Issues in Suicide and Euthanasia
The Assisted Death of Piergiorgio Welby 313
Suicide: The Problem of Definition 314
Self-Sacrificial Deaths
Coerced Deaths
Euthanasia 316
314
315
Definition: Narrow and Broad Interpretations
Killing vs. Allowing to Die 317
316
BIOETHICS ACROSS CULTURES
Suicide Tourists
318
A Distinction with or without a Difference?
Voluntary and Nonvoluntary Decisions
Voluntary Decisions 323
321
323
BIOETHICS ACROSS CULTURES
“Compassionate Murder” in Canada
Nonvoluntary Decisions
Conclusions
324
324
325
CASES AND CONTROVERSIES
Pope John Paul II: Life-Sustaining Treatments
and Vegetative State
326
The Boston Declaration on Assisted Dying
Barney Clark’s Key
References
327
328
328
19 Suicide in the West: A Brief History
The Suicide of Isadore Millstone 330
330
BIOETHICS ACROSS CULTURES
Al-Qaida and Suicide Terrorism
332
Suicide as an Offense to God, Neighbor, Self: Plato
and Aristotle 332
313
CONTENTS
Suicide as a Rational Act: The Stoics
333
Suicide as Sinful: Augustine and Aquinas 334
Suicide as Beneficial to Self and Others: Hume
On Suicide
334
335
Suicide as Violating Moral Responsibility: Kant
The Argument from Free Will 336
336
The Argument from Human Nature 336
The Argument from Autonomy 337
The Argument from Divine Will 338
Suicide as a Social Utility: Bentham and Mill
338
BIOETHICS ACROSS CULTURES
Field of Tears in South Korea
Conclusions
339
340
CASES AND CONTROVERSIES
The “Rational” Suicide of Carolyn Heilbrun
Final Exit Network
341
The Suicide of Garrett Hardin
References
340
342
343
20 The Assisted Death Debate I: Individual
Morality 345
The Assisted Death of Velma Howard
Principles 346
Utility/Happiness
345
346
Respect for Persons 349
Divine Command 351
BIOETHICS ACROSS CULTURES
Englaro Case Tears Italy Apart
Virtue
354
355
Roles and Professions
357
BIOETHICS ACROSS CULTURES
The Groningen Protocol
358
CASES AND CONTROVERSIES
The Coup de Grace
360
Hurricane Katrina: Mercy Killing When Disaster
Strikes 361
Does Responsible Care Include Assisted Dying?
References
363
362
xvii
xviii
CONTENTS
21 The Assisted Death Debate II: Social Policy
and Law 366
The Final Campaign of Booth Gardner 366
Individual Rights
368
Human or Moral Rights
Welfare Rights 371
368
BIOETHICS ACROSS CULTURES
YouTube Plea from Australia
Equality
372
373
Disparate Impact 373
The General Welfare 375
State Paternalism
376
BIOETHICS ACROSS CULTURES
World Legal Opinion on Assisted Death
Conclusions
378
380
CASES AND CONTROVERSIES
Oregon’s Death with Dignity Act
Dying and the War on Drugs
Baxter v. Montana
382
383
The “Euthanasia Underground”
References
381
384
385
22 Rationing Health Care at the End of Life
The Death of Barbara Wagner
388
389
Health Care Rationing 390
Arguments for Age-Based Rationing
391
The Fair Innings Argument 392
The Prudential Lifespan Account 392
Arguments Against Age-Based Rationing
The High Cost of End-of-Life Care
Rationing by Medical Futility 394
393
394
Physician Beneficence vs. Patient Autonomy
Arguments for a Judgment of Futility 396
Professionalism 396
Responsible Stewardship
397
Arguments Against a Judgment of Futility
BIOETHICS ACROSS CULTURES
QALY in the UK 398
395
397
CONTENTS
No Consensus about the Definition of Futility
Uncertain Prognoses/Mistaken Diagnoses
Social Contract 400
Conclusions
400
401
CASES AND CONTROVERSIES
The Case of Helga Wanglie
401
Gilgunn-Massachusetts General Hospital
The Death of Toddler Emilio Gonzales
References
398
402
403
404
Conclusion: Bioethics, Religion, and Liberal Democracy
Religious vs. Secular Bioethics
Liberal Democacy 410
408
Rethinking the “Jeffersonian Compromise”
Unprovable First Principles of All Worldviews
Double Standard 412
No Common Ground for Dialogue 413
Toward an Overlapping Consensus 413
BIOETHICS ACROSS CULTURES
Cross-Cultural International Bioethics
Religion in Public Bioethics
415
CASES AND CONTROVERSIES
The Battle Over Bioethics
417
References
INDEX
421
419
414
411
411
408
xix
Preface
T
he seeds of this book were sown in the spring of 2005 when Congress intervened in the matter of Terri Schiavo, a patient described by physicians as
“vegetative.” The widely publicized case pitted the wishes of Terri’s husband,
Michael, who wanted his wife’s feeding tube removed, against the objections of
her birth family, the Schindlers. The courts and prominent bioethicists framed the
conflict as a dispute over what Terri wanted and who should say. Mainstream media used it to show how politicized bioethics had become. Largely left unexamined,
it seemed to me, were deeper, philosophical questions stoking the controversy.
Schiavo passed but not its hold on me. The more I thought about it, the more
the case struck me as paradigmatic for what frequently happens whenever we go
beyond the procedural aspects of bioethical decision making and think deeply
about the decisions themselves. We come to realize that controversial ethical issues
often are not about ethics at all but about other more philosophical concerns, such
as our understanding of human nature and destiny, truth and authority, meaning
and value, or the proper relationship between individual and society. Indeed,
many of the controversial moral problems of today’s biological science and medicine are like this. It is not so much that they invite opposed moral viewpoints but
that they evoke irreconcilable answers to profound, underlying questions:
What is a human being or a person?
When does human life begin and death come?
How do medicine and the broader culture situate death in human life?
Are illness, pain, suffering, and death evils to be defeated, or can they have transcendent value?
What kind of universe do we occupy—one with meaning and purpose or a universe
utterly indifferent to human affairs, including our pain and suffering?
What is the ideal society? What practices does it allow and prohibit?
xx
PREFACE
How are we to know all these things—on whose authority? Must we, in the end, rely
totally on ourselves or is there some higher knowledge?
Such questions suggest that much of the controversy in bioethics is traceable
to perennial philosophical debates.
Is there any value in placing today’s bioethical dilemmas in their ancient
philosophical context? I think there is. It can depoliticize them and put them at
a more human level. We see that these dilemmas play out in bioethics but they
are not limited to this and addressing them in bioethics requires addressing them
elsewhere as well.
Reflections such as these inspired Bioethics in a Cultural Context—Philosophy,
Religion, History, Politics. BCC offers a fresh approach to introductory bioethics
by examining the subject through a wider lens than the customary issue analysis.
Yes, the text covers all of today’s hot-button bioethical controversies related to
life’s beginning and end. But rather than merely scanning views with their supporting argumentation, the text places the issues in cultural and historical context
and delves into the philosophical and religious subsoil that makes them so divisive and, daresay, so interesting. BCC, in brief, endeavors to enrich the material
that is generally considered in introductory bioethics by going beyond today’s
most polarizing bioethical controversies to show how they have arisen and why
the answers are important.
STRUCTURE
BCC is divided into four parts, with introduction and conclusion.
The introduction sets the theme, provides a road map for the book as a
whole, and helps students make sense of moral conflict.
PART I SACRED AND SECULAR FOUNDATIONS provides a survey
of the major historical influences on Western bioethics and its practice.
PART II ORIGINS AND CONTEXT OF BIOETHICS surveys the
figures, thought, and events that contributed to the founding of modern
bioethics; it also discusses the field’s basic principles, the contemporary
critique of them, and several alternative perspectives.
PART III ISSUES AT THE BEGINNING OF LIFE extends understanding of the foundations, origins, and context of bioethics to notable issues in
reproductive medicine.
PART IV ISSUES AT THE END OF LIFE joins the main controversies
that surround personal decisions and public policy at life’s end.
The conclusion gives unity to the text as a whole by reviewing its key
concepts and controlling idea in the context of the divide between secular
and religious perspectives in modern bioethics.
xxi
xxii
PREFACE
ORGANIZATION
The central notion around which BCC is organized is that controversial bioethical issues and cases raise ultimately persistent questions whose origins are not really unique to bioethics and whose answers have implications ranging far beyond.
A lively introductory chapter sets this theme by using Schiavo as a focal point for
showing that, while many biomedical issues are new, the fundamental differences
they raise between ways of knowing and understanding are as old as Western
civilization itself.
Given its historical sensibilities, the text turns immediately in Chapter 1 to
the West’s two major traditions of knowing and understanding: medieval religion and Enlightenment science. Chapter 2 shows how these different ways of
perceiving the world led to different and enduring ways of doing ethics, with
particular regard to divine command theory, religious and secular natural law,
Kant’s ethics, and utilitarianism. Taken together, Chapters 1 and 2 provide rarely
given but valuable background for understanding the historical tensions between
the religious/theological and the secular/philosophical that came to shape the
conception of bioethics and were ultimately resolved in favor of secularism,
only to reassert themselves in the bioethical and political controversies that today
surround issues of birth and death.
Discussion of the philosophical and religious roots of bioethics sets up in
Chapters 3 through 7 a presentation of the field’s origins and context. Chapter 3
shows how Enlightenment-bred values and ideals of secular modernity characterized the intellectual milieu that formed after World War II and peaked at the
dawn of modern bioethics. It surveys the social climate, medical advances, and
court rulings that contributed to the urgency for bioethics in the late 1960s and
early1970s; it also profiles many of the philosophers and theologians who pioneered the field. Given that the groundwork of these trailblazers ultimately took
the form of the so-called Belmont principles of 1979, Chapters 4 and 5 take a
close examination of these comprehensive standards of bioethics and their applications. Although these foundational principles remain influential, Chapter 6 shows
why a perceived overweening attachment to one of them, individual autonomy,
has invited assorted criticism. Chapter 7 considers alternative perspectives, including feminist ethics of care and narrative ethics.
Having traced the development of bioethics from its origins to current state,
the book then turns to the two predominant kinds of bioethical issues that tax us
today. Chapters 8–16 cover the major controversies at the beginning of life—
abortion, embryo screening, surrogate mothering, commercial egg donation, genetic testing, prenatal sex selection, and stem cell research. Chapters 17–22 take
up the major controversies that surround the end of life, as they pertain to the
definition and criteria of death, suicide, assisted suicide, euthanasia, and judgments of medical futility as a means of rationing health care. The coverage reprises the book’s linchpin idea by showing how these issues owe their inherent
controversy to fundamentally different ways of knowing and understanding, specifically to opposed views about the definition of human life and personhood,
PREFACE
the purpose for existence, the reach of personal liberty, and the nature of the
ideal society.
The text’s concluding chapter invites further discourse by discussing the
concept of individual autonomy and rights in the liberal democracy. It addresses
the challenge to bioethics posed by trying to balance, on one hand, Western
concepts of rights with, on the other, religious concepts of divine sovereignty
or commitment to religious principles that may conflict with individual
autonomy.
FEATURES
I wrote BCC mindful of a general audience unfamiliar with bioethics as a subject
and activity. The text had to be accessible and substantive, with a good range of
topics and issues that were contextualized, clearly explained, and sparked with
copious examples and real-life cases. Here are some of the text’s features that
aim to give students with varying learning styles and experiences opportunities
to understand the moral implications of the dramatic changes occurring today
in American health care.
1. Introductions to Parts Helping give the work a sense of unity and
coherence, each part has its own introduction that ties the forthcoming
material thematically to the book as a whole.
2. Conversation Starters Chapters begin with an event, a situation, a case, or
an illustration that draws attention to the chapter’s main point of interest.
3. Conclusions Chapters close with some judgments and opinions suggested
by their contents.
4. Examples and Illustrations Liberal use of popular and public materials are
designed to make the content clear and the narrative compelling.
5. Bioethics Across Cultures Scattered throughout the text, these fifty-four
inserts are intended to impart cross-cultural awareness and appreciation of
how different religions and cultures work to resolve complex issues in
bioethics. Some of these global excursions feature individuals who, though
perhaps obscure in the United States, have headlined bioethical imbroglios
abroad—Eluana Englaro in Italy, Angelique Flowers in Australia, and
Richard Latimer in Canada, for instance. Following all of the cross-cultural
presentations are questions as diverse as
“What’s the morality of drugs not being available in the country where
the drug trials are taking place?”
“Is the value of a person’s life in an impoverished developing nation the
same as the value of an affluent Westerner’s life?”
“Is Major League Baseball morally justified in conducting genetic testing
on promising young Latin American players?”
“Does feminist bioethics offer a unique perspective on global violence
against women?”
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PREFACE
“Is it right for the United States to withhold aid from foreign reproductive care agencies that discuss or offer abortion services?”
“What moral issues are involved in outsourcing surrogacy?”
“What are the principal differences between Buddhist understanding of
illness and suffering and that of Judaism, Christianity, and Islam?”
6. Cases and Controversies Several real-life cases and controversies with
questions for analysis appear at the end of every chapter, seventy-four in all.
Well-toned and neutrally presented, this mix of classic and contemporary
material, of suitable length for classroom use, provides an opportunity to
extend the ideas and principles laid out in the chapters, while encouraging
self-examination and critical analysis. Sometimes showcased are famous
events or court decisions, such as the Sherri Finkbine thalidomide tragedy,
the Baby M surrogate motherhood ruling, and the Griswold v. Connecticut
birth control decision. Just as often, however, it’s a fresh case or controversy,
including:
medical workers’ involvement in C.I.A. interrogations;
the Steve Jobs liver transplant;
conscientious objection to selling the morning-after contraceptive pill;
the 2009 Benitez decision involving denial of artificial insemination
based on marital status;
selling blood across the U.S.-Mexico border;
mandated vaccination with Gardasil;
the first gene therapy death;
mercy deaths during Hurricane Katrina; and
the creation of “synthetic life.”
7. Multidisciplinary Coverage Besides the philosophical and religious, this
text strives to include diverse clinical, academic, historical, legal, and scientific perspectives. This accounts for the uncommon treatment of some familiar material and the inclusion of unique topics. For example, as a prelude
to issues at the beginning of life, Chapter 8 treats conceptual issues in reproductive technology, including scientific views about when life begins and
whether they’re compatible with traditional religious teaching. In Chapters 9
and 10, the usual arguments for and against abortion are interwoven with a
narrative about the philosophical/religious thought, medical advances, social/political activism, and legal landmarks in reproductive rights that led up
to and have followed Roe. Chapter 19 overviews the intellectual history
surrounding suicide in the West and shows how this mix of religious and
secular opinion, modified by cultural conditions and demands, has come to
shape contemporary law, morality, and feeling about physician-assisted
death. Chapter 22 places medical judgments of futility in the economic
context of health care prioritization. And the aforementioned conclusion
takes up the challenge of navigating the chasm between secular and religious
PREFACE
bioethics in the liberal democracy. Typically ignored or downplayed in
bioethics texts, these disciplines help illuminate today’s bioethical debates,
placing what may be unfamiliar content into more familiar contexts.
8. Extensive Documentation Numerous online resources provide opportunities for convenient reference and research.
WAYS OF USING THE TEXT
Recognizing the wide range of ways for teaching bioethics, I’ve tried to make
BCC easy to customize without losing its individual voice. The book’s tidy organization, myriad topics, and numerous cases should give instructors great flexibility in how they use the text and structure their courses.
BCC can be broken into parts for abbreviated courses and for additions or
omissions. Easily digestible sections allow a similar adaptability within chapters.
As the chapters themselves are relatively self-contained, they generally can be
assigned in any order without loss of coherence. Common sense exceptions
would be the introduction and conclusion and chapters dealing with conceptual
matters (e.g., Chapters 8, 17, and probably 15).
Because many instructors prefer to dwell only on some parts of a lengthy
book and assign others for outside reading, it’s important that the text be clear
and accessible to a wide variety of readers. This is especially true with controversial
content of a philosophical and religious nature. I’ve tried to address this challenge
by presenting the material in a frank and respectful tone, and in a style plain
enough to serve both those who need background and those ready to engage
the serious biomedical issues facing society. The brevity of each section and, I trust,
the fair and balanced explanations should appeal to a wide breadth of readers.
Like many texts, this one can be taught cover to cover. Where time constraints or other factors prevent this, the text as a whole can be conveniently
tailored to meet individual preferences. Instructors eager to get to the issues, for
example, can skip immediately from the introduction to Parts III and IV, perhaps
assigning select chapters from the earlier parts for outside reading. Alternatively,
those wanting to introduce basic bioethical principles before proceeding to the
issues could move immediately to Chapters 4, 5, 6, and 7, after the introduction.
It’s also possible to focus exclusively on the cases and, perhaps, cross-cultural inserts, with the text assigned as background. Ideally, most of the chapters are
crafted such that a lecturer or seminar leader would have little additional work
to do in preparation to teach the material.
Chapter 1 warrants a special word because it offers something singular for a
bioethics text: a concise history of Christian religion and the intersection of secularism. How one uses this chapter, if at all, largely depends on how much attention one wishes to pay to the intellectual history of Western civilization from
the rise of Christianity to the Enlightenment, with specific regard to such crucial
matters as our views of human nature and personhood; our understanding of
illness, suffering, and death; and our conception of science and medicine and
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PREFACE
their relationship to religion. In general, those inclined to make the inclusion of
theology and cross-cultural religious perspectives more explicit in their teaching
of bioethics probably would assign all of Chapter 1, whereas those disinclined
would pick and choose or even skip it entirely, again without loss of textual
coherence.
My personal feeling is that it’s very difficult, if even possible, to engage bioethics in the United States today without seriously acknowledging the formidable influence of religion on social policy and clinical practice. It’s a sure bet that
many students who read this book, not to mention the instructors who teach
from it, hold sincere, religiously inspired moral opinions on such matters as abortion, preconception sex selection, stem cell research, suicide, or assisted death.
And those who don’t are no less affected by the highly influential religious voices
and opinions of those occupying seats of institutional or political power. Add to
this (1) the contribution of religious thinkers some forty-odd years ago to the
nascent field of applied medical ethics, and (2) the current tensions between religious and moral interests in the making of national science policy, as doctors and
patients must weigh the issues and the options.
It seems to me, then, that the inclusion of the sacred alongside the secular in
treating bioethics in the context of culture is not only felicitous today but also
imperative. At the very least, it can show students how they’ve come by their
beliefs and that religious approaches to difficult, ethical questions are not purely
monolithic but are themselves diverse and even at odds with one another. It can
also inform them of the historical relationship between religion and philosophy,
and how religious ideas can influence ideas we later come to define as philosophical ones, nowhere more so than in bioethics. Finally, it can take students to the
next level: a critical examination of the role of religious belief in shaping bioethical policy and practice. These observations notwithstanding, I realize that some
instructors will more lament than welcome the inclusion of religious perspectives
in a bioethics text. Again, they can freely adapt BCC to their tastes without
sacrificing coherence.
ACKNOWLEDGMENTS
The abundant end-of-chapter citations suggest the profound debt I owe to the
great many scholars and writers whose thought and work helped shape this
book. For the humbling opportunity to tap into their knowledge and wisdom,
my sincere thanks to sponsoring editor Joann Kozyrev. For her scrupulous attention to the details of production, my gratitude extends to Sushila Rajagopal. And
for their generous commentary and encouragement, I gratefully acknowledge
the following reviewers:
Joseph Aieta III, Lasell College
Kem Barfield, Three Rivers Community College
Barbara Bellar, DePaul University
Nancy Billias, Saint Joseph College
PREFACE
David Boersema, Pacific University
Paul Boling, Bryan College
Kae Chatman, Arkansas State University, Beebe
Mary Giegengack-Jureller, Le Moyne College
Brian Glenney, Gordon College
Paul Haught, Christian Brothers University
Mitra Huber, The College of St. Elizabeth
Phil Jenkins, Marywood University
Jeffery Johnson, Eastern Oregon University
Joel Martinez, Lewis & Clark College
Michael McKeon, St. Gregory’s University
Mark McLeod-Harrison, George Fox University
Rolland Pack, Freed-Hardeman University
Hannah Love, Pacific Lutheran University
Roger Russell, University of St. Francis
J. Aaron Simmons, Hendrix College
Les Stanwood, Skagit Valley College
Cindy Wesley, Lambuth University
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Introduction
Bioethics, Schiavo, and
Cultural Politics
O
n the evening of March 19, 2005, the US Congress did something it had
never done before. With time running out on how much longer she could
remain alive, Congressional leaders announced that they would allow the parents
of a 41-year-old Florida woman to petition the federal courts to have a feeding
tube replaced for their brain-damaged daughter. The next day President Bush
flew back to Washington from his Texas ranch to sign the emergency legislation.
Two days earlier the president had told the nation:
The case of Terri Schiavo raises complex issues. Those who live at the
mercy of others deserve our special care and concern. It should be our
goal as a nation to build a culture of life, where all Americans are
valued, welcomed, and protected—and that culture of life must extend
to individuals with disabilities.1
It was in 1990 when Terri Schiavo (1963–2005) incurred severe neurological damage when a chemical imbalance stopped her heart, cutting the oxygen
supply to her brain. The then 26-year-old was left in what physicians term persistent vegetative state (PVS), capable of breathing on her own but unable to eat
or speak. No fewer than seven board-certified neurologists said her condition
was permanent and irreversible, though not terminal. With proper care Terri
could live many years, a fate her husband and legal guardian didn’t think she
would want. So Michael Schiavo requested that doctors stop the artificial feeding. When his wife’s Catholic parents objected, the stage was set for a lengthy
legal battle that culminated in a court order to remove Schiavo’s feeding tube.
Once the feeding tube was removed, evangelical Christian conservatives,
who had helped reelect President Bush in 2004 and swell Republican majorities
in Congress, requested and obtained the unprecedented emergency legislation
allowing the Schindlers to petition federal courts to resume tube feeding. But
1
2
INTRODUCTION
their legal tactic failed, and Terri Schiavo died on
March 31, nearly two weeks after the removal of
her life-sustaining feeding tube.
In a message to supporters and media shortly
after her death, Terri Schiavo’s brother said,
“Throughout this ordeal we are reminded of the
words of Jesus’ message on the cross: ‘Forgive
them for they know not what they do.’”2 Bobby
Schindler’s biblical allusion was to the bitter feud
between the Schindlers and Michael Schiavo. But
his words were suggestive of something larger, for
Schiavo wasn’t only about a divided family. It was
also about a divided country. As widely depicted,
Schiavo was a dramatic battle in the struggle to define
America known popularly as the “culture war.”
Over the past two decades, the term culture
war (or culture wars) has become a catchphrase
for a variety of polarizing political and social issues:
teen pregnancy, sex education, pornography, drugs,
gun control, same-sex marriage, funding for the arts
and public broadcasting, feminism, immigration,
multiculturalism, environmentalism, judicial nominations, religion in public life. Although the issues
touch almost every aspect of social life, in no field
are they more numerous or contentious than in
medicine and health care. It is there that matters
at life’s beginning and end invite especially passionate debate and irreconcilable positions.
In the case of Terri Schiavo, public opinion
was divided, albeit not evenly, on the question of
proper treatment for PVS patients. Advances in
medical science and technology have contributed
to like disagreement in other areas: abortion, infertility treatment, prenatal testing, preconception sex
selection, organ transplantation, and stem cell
research, to name a few. All have forced upon us
difficult choices in our personal and professional
lives, as well as in public policy. This book deals
with these matters and the spirited social debates
they have triggered. It’s about bioethics in the
context of culture, including philosophy, religion,
history, and politics.
BIOETHICS
Etymologically, bioethics consists of two Greek
words: bios for “life” and ethos for “character or
custom.” From ethos comes “ethics,” which suggests
the view of bioethics as an application of ethics to the
life sciences, especially medicine and health care. For
this reason bioethics is sometimes called biomedical
ethics. So conceived, bioethics derives its content
largely from biology and medicine and its theory
and guiding principles from the larger field of ethics.
ETHICS
Ethics may be defined, broadly, as the general term
for the philosophical study of morality or, simply,
moral philosophy. This label says something important about what ethics does and how it does it: It
studies morality philosophically.
To say that ethics studies morality means that it
is concerned with an individual’s or culture’s standards of character and conduct. Consider that in
growing up we absorb from our families and societies all sorts of notions about good and bad, right and
wrong, rights and responsibilities. Later we may
think philosophically about what we’ve inherited:
We may critically examine and test our acquired
moral values and standards by closely inspecting the
reasons for and against them. When we undertake
this close inspection of our inherited moral customs,
we’re doing ethics, specifically normative ethics.
Normative Ethics
Normative ethics is the area of ethics or moral
philosophy concerned with judgments and theories about obligation and value, good character,
well-being, and right action. It is basically interested
in answering two “ought questions.” One is a
question of conduct: “What ought I do?” The
other is a question of character: “What ought I
BIOETHICS, SCHIAVO, AND CULTURAL POLITICS
be?” In both instances, normative ethics seeks prescriptions, that is, authoritative rules or directions,
for right action and good character. Its prescriptive
interest distinguishes normative ethics from fields
with merely a descriptive or scientific interest in
ethics, such as cultural anthropology or sociology.
Cultural anthropologists sometimes give accounts of permissible cultural practices that our
society finds objectionable, including polygamy,
arranged marriages, suicide as requirement of
widowhood, killing for honor, severe punishments
for blasphemy or adultery, and female circumcision,
or genital mutilation. The anthropologist generally
is interested in reporting and culturally explaining
these practices, not judging them. As a scientist she’s
simply saying what is, rather than what ought to be,
the case. The normativist, on the other hand, wants
to know whether such practices are preferable,
whether they are ever moral, and on what grounds.
The anthropologist’s interest in morality, then,
concerns how things are, whereas the ethicist’s interest concerns how things should or ought to be. The
sociologist, to take another example, is more interested in how people assign credit and blame than
when it’s right to do so. In describing, the anthropologist and sociologist engage in descriptive or nonnormative ethics. In prescribing, the ethicist (or moralist) does prescriptive or normative ethics.
Frequently today prescriptive, or normative,
ethics extends to specialized areas such as the environment; or to professions such as business, government, law, or medicine. What is thought of value
and obligation, in general, is applied to specific
areas, practices, or activities. Bioethics is like this.
It often analyzes what moral standards and judgments ought to drive health care matters. Thus:
What ought we do in a case like Schiavo? What rules,
guidelines, or principles are we to follow? What should we
most honor in deciding—the patient’s biological existence?
The quality of her life? Her wishes? If she hasn’t left
“clear and convincing” evidence of what she would
want, how are we to proceed? Other circumstances
elicit similarly normative questions. What principles,
standards, or norms are we to use in matters involving
human cloning, stem cell research, or genetic screening, as
examples?
3
Trying to answer questions like these gives bioethics its normative edge. But Schiavo wasn’t only
about what Terri wanted and who was to say, and
neither is bioethics. Schiavo was also about something that often happens whenever we go beyond
procedural aspects of bioethical decision making
and think deeply about the decisions themselves.
It is then that we confront some of the most basic
questions we can formulate about ourselves and our
destiny. What is a human being? What is a person?
What is the meaning of life and suffering? What is death
and when does it come? What do we owe those who,
though not dead nor dying, are profoundly disabled and
dependent? And perhaps the most important question of all: How are we to answer these questions?
What guidelines do we follow? Inquiries such as these
bear directly on judgments of value and obligation,
and they indicate another area of ethics relevant to
bioethics. It’s termed metaethics.
Metaethics
Of importance to many modern theorists, metaethics is the branch of ethics that goes beyond the interests of normative ethics into the origins of ethical
concepts. For example, whereas normative ethics is
interested in knowing what things are morally good
and bad, metaethics ponders the meaning of moral
goodness. Trying to understand the nature of ethical
properties and evaluations requires an exacting study
of the meanings of moral terms like good and bad, the
sentences in which they appear, and the methods of
reasoning involved in making moral evaluations.
Additionally, metaethics often is drawn into the
orbit of highly speculative questions. For instance,
whereas normative ethics asks what is right and
wrong, metaethical theory seeks to determine
whether we live in the kind of universe where there
is anything that is right or wrong apart from what
any of us thinks, feels, or believes. In other words,
metaethics, in part, seeks an answer to the question:
Is there or is there not anything objectively right or wrong
independent of human opinion? A related metaethical
question involves whether some things are always
moral or always immoral. Are there discoverable absolute
standards for determining right and wrong? Or do right and
4
INTRODUCTION
BIOETHICS ACROSS CULTURES
Canada’s Terri Schiavo
In October 2007, Grace Hospital in Winnipeg, Canada,
admitted 84-year-old Samuel Golubchuk with multiple
organ failure. Earlier, in 2003, Golubchuk had part of
his brain removed after a fall. His condition deteriorated rapidly while in the hospital, and Grace doctors
told the family they wanted to take him off life support. The family balked, citing their Orthodox Jewish
faith. To do so, they said, would be contrary to their
father’s wishes and his religious beliefs as an Orthodox
Jew who held life to be sacred. “Doctors don’t know
everything,” Golubchuk’s son told Canadian Television
News, “God is the major doctor.”
The family went to court and obtained an injunction forbidding the hospital and doctors “from removing the plaintiff … from life support care, ventilation,
tube feeding, and medication”—an order that if violated could lead to fines or imprisonment. Rather than
obey the court order, Dr. Anand Kumar, a critical care
specialist, resigned, as did two other Grace physicians.
In explaining his decision, Dr. Kumar said: “If we honestly attempt to follow the court mandate to focus on
keeping Mr. Golubchuk from his natural death, we will
likely have to continue to surgically hack away at his
infected flesh at the bedside in order to keep the infection at bay.” Calling further treatment “tantamount
to torture,” Dr. Kumar protested: “This is grotesque. To
inflict this kind of assault on him without a reasonable
hope of benefit is an abomination. I can’t do it.”
Golubchuk, the man whom conservative groups in
the United States took to calling “Canada’s Terri
Schiavo,” died of “natural causes” at Grace Hospital on
June 24, 2008.
Question
Do you think Dr. Kumar did the right thing in resigning, or should he have followed the court order? In the
wrong depend on context or consequence? These questions
are of theoretical interest. But more than that, they
suggest why cases such as Schiavo, and bioethics, itself, can be so controversial.
Consider, for example, that many people today
believe that some things are always right or wrong,
regardless of their context; others believe that right
and wrong always depend on cultural or individual
midst of the Golubchuk affair, an article appeared in
the Canadian Medical Association Journal, co-authored
by its editor-in-chief, responding to the charge that
physicians were trying to “murder” Golubchuk. It
stated in part:
If this is murder, many of Canada’s
doctors belong in jail. Legally, doctors are
practitioners of a duty of care. An obligation
to provide extraordinary care to dying
patients, including patients who are minimally responsive, forces one to breach the
everyday duty of care, which is to provide the
best balance between probable harms and
foreseeable benefits. That is why an
approach that excludes the option to withhold or withdraw life-sustaining care is
unworkable.
Do you agree that in cases like these physicians
should have the authority to make medical decisions
to withhold or withdraw life-sustaining treatment
from a patient without the consent of the patient or
the patient’s family? Or do you agree with the Golubchuks, that competent religious authority should be
permitted to make crucial decisions in the event of
incapacitation?
(SOURCES: Amir Attaran et al, “Ending Life with Grace and
Agreement,” CMAJ, April 22, 2008, pp. 1115–1116. Retrieved March 15,
2009, from http://www.pubmedcentral.nih.gov/articlerender.fcgi?
artid=2292789); Sam Solomon, “End-Of-Life War Outlives Golubchuk,”
National Review of Medicine, July 2008. Retrieved March 20, 2009,
from www.nationalreviewofmedicine.com/issue/2008/07/5_patients_
practice_07.html; The College of Physicians and Surgeons of
Manitoba, “Statement Withholding and Withdrawing Life-Sustaining
Treatment.” Retrieved March 17, 2000, from www.cpsm.mb.ca/cgi-bin/
perlfect/search/search.pl?q=withholding; Hillary White, “Samuel
Golubchuk Dies Naturally,” LifeSite News, June 25, 2008. Retrieved
March 20, 2009, from http://www.lifesitenews.com/ldn/2008/jun/
08062504.html.)
preference. Obviously, these basic beliefs clash; they
can’t both be true. They represent radically different
ways of making sense of life. An action that is acceptable according to one belief may not be acceptable
according to the other. Individuals or groups holding
these opposed beliefs are said to be in moral conflict.
Moral conflicts occur when disputants are acting
within different beliefs about how the world
BIOETHICS, SCHIAVO, AND CULTURAL POLITICS
operates. Schiavo was an example of a moral conflict.
But Schiavo was hardly unique. Indeed, no field today
is driven more by moral conflicts than biomedicine.
MAKING SENSE OF MORAL
CONFLICT
Many scholars have attempted to make sense of the
moral and cultural conflicts that continue to confront us. One of the more careful overviews comes
from James Davison Hunter, a professor of sociology
and religious studies at the University of Virginia.
Writing in the 1990s, Hunter suggested that the
United States was locked in a competition to define
social reality that involved a unique realignment in
American politics based upon conflicting beliefs
about what we are as human beings and who we
are as a nation. Unlike past cultural clashes, typically
fought along class, religious, or political party lines,
the contemporary one, according to Hunter, was
being waged along unfamiliar lines defined by conceptions of reality and transcendent values. He described it as a struggle to define America, or more
precisely: a struggle to define what and who we are.
Although Hunter was not talking about bioethics
specifically, his conception of the cultural struggle’s
issues and adversaries is worth sketching because it
provides a window into the nature of the moral conflicts that often make bioethics so divisive today.
Issues
Briefly, Hunter frames the competition to define
what we are as a struggle to define such fundamental
matters as human nature and destiny, good and evil,
truth and authority, meaning and value. Despite
their complexity, we might initially express the
clashing cultural views about these subjects simply
as oppositions. For example:
On one hand, the belief that we are here on
earth for a reason and with some ultimate
destination such as heaven; on the other, the
belief that we live in an indifferent universe,
that life has no more or less defined meaning
than what each of us makes of it
5
On one hand, the belief in the sanctity of life,
that every human life is inherently valuable
regardless of its state or circumstance; on the
other, the belief in the quality of life, that life
has value so long as it is meaningful and
enjoyed
On one hand, the belief that we are persons
from when we are unborn to when we die; on
the other, the belief that only after birth do we
become persons, which we may cease to be
before death
For Hunter, opposed perspectives such as these
speak to the struggle to define social reality.
Given the bulk of its content—ultimate reality,
human nature and destiny, the meaning of life, the
ultimate sources of knowledge—the question of
what we are is largely speculative. Hunter’s next
question—the who we are question—is, by contrast,
more practical. It has political overtones, because
it’s about social relationships involving power, authority, and social policies. It also has moral and
religious import, because it’s about the standards
that will guide those relationships and policies.
The who we are question is about how we as Americans will order our lives and govern ourselves. It’s
about the limits of public and collective life, about
what we will permit and prohibit. Who we are, in a
word, is about something that has vexed human
beings through all of recorded history: the notion
of the ideal society.
What is the ideal society? Is it the one that permits, limits, or prohibits: gay marriage and adoption;
“obscene art”; prayer, sex education, and the teaching of intelligent design in public schools? In the
realm of bioethics: Is the ideal society the one that does
or does not permit access to “morning after” birth control
pills, mandatory vaccinations, medical marijuana, stem cell
research, experimentation on early stage embryos, preconception trait selection, noncoital reproduction, assisted
death, compensation for human tissue donation, and research cloning? Does the ideal society largely permit freedom
of research and individual action in these biomedical areas,
or does it restrict and even deny such freedom at home and
actively discourage it abroad? Does the ideal society mandate health care services to everyone or doesn’t it?
6
INTRODUCTION
BIOETHICS ACROSS CULTURES
Religion and HIV/AIDS in Africa
In January 2006, Ambassador Randall Tobias, who
served as President George W. Bush’s global AIDS
czar, issued written guidelines that spelled out the
Bush administration’s conservative religious
approach to preventing HIV/AIDS in Africa. Groups
that received US funding, Tobias warned, should
not target youth with messages that presented
abstinence and condoms as “equally viable,
alternative choices …” in their sex education
programs. Meanwhile, groups that supported the
president’s conservative religious agenda started to
receive money that traditionally went to more
experienced organizations. One such group, the
Children’s AIDS Fund, received roughly $10 million
to promote abstinence-only programs overseas.
FreshMinistries, a Florida organization with little
experience in tackling AIDS, also received $10 million.
A Bush administration directive further said that
two-thirds of global AIDS-prevention money was
to go to promoting abstinence and fidelity, and
before overseas groups could receive US funding
they were take a “loyalty oath” to condemn
prostitution.
Supporters of the program said it was working,
and two months before leaving office President Bush
was recognized for his international efforts in the fight
against the spread of AIDS. In presenting him with the
International Medal of PEACE, California megachurch
Adversaries
Hunter gives substantial coverage to the sides locked
in cultural and moral conflict. He defines them in
terms of where they stand on the issue of what and
who we are. Today approximately 15 to 20 percent
of the nation considers itself profoundly religious and
staunchly conservative; another 15 to 20 percent considers itself profoundly secular and staunchly liberal.3
These groups fall within the cultural adversaries that
Hunter terms orthodox and progressivists. The labels
don’t matter, but what they signify does, for it throws
light on some of the most influential voices in today’s
public debates about bioethical issues.
According to Hunter, orthodoxy is committed
to a view of reality that is “independent of, prior to,
pastor Rick Warren said, “No world leader has done
more for world health than President George Bush….
Literally millions of lives have been saved in the last
five years.” But AIDS experts told a different story.
They claimed that the preoccupation with abstinence
was handicapping the fight against the deadly virus.
Health workers saw the influence of America’s
Christian Right in the chastity message and believed
the Bush administration was using its financial might
to pressure them into accepting evangelical ideology
at the expense of public health. They encouraged
the new Obama administration to rethink Bush’s
policy.
Meanwhile, Pope Benedict XVI came in for
criticism when, during a March 2009 trip to Africa, he
reaffirmed his predecessors’ long-standing opposition
to condoms. “You can’t resolve [the spread of AIDS]
with the distribution of condoms,” the pontiff told
reporters. “On the contrary, it increases the problem.”
Health workers battling the epidemic on the front lines
reacted much as they did to the president’s program.
They said the Pope valued religious dogma above the
lives of African people. The British medical journal
Lancet (3/28/2009) weighed in, calling on the Pope to
retract is statements:
When any influential person, be it a religious
or political leader, makes a false scientific
statement that could be devastating to the
health of millions of people, they should
and more powerful than human experience.”4 It is
inclined to believe in “an external, definable, and
transcendent authority” from which we come to
know what is true and good, how to live, why
we are here, and where we are going. For the orthodox, this objective, higher authority defines, at
least in the abstract, “a consistent, unchangeable
measure of value, purpose, goodness, and identity,
both personal and collective.”5 Orthodoxy, in
short, deals with the issue aspect of cultural conflict
by telling us once and for all what and who we are.
Not for all but for the great many orthodox, the
superior authority is the God of the Bible. These religious orthodox believe in a higher knowledge that
comes from faith, revelation, Scripture, or religious
BIOETHICS, SCHIAVO, AND CULTURAL POLITICS
retract or correct the public record. Anything
less from Pope Benedict would be an
immense disservice to the public and
health advocates, including many thousands
of Catholics, who work tirelessly to try
and prevent the spread of HIV/AIDS
worldwide.
The Catholic Church teaches that fidelity
within marriage and abstinence are the best ways
to stop AIDS.
On the other hand, The New York Times’
Nicholas D. Kristof has written of “many Catholic
nuns and priests heroically caring for AIDS patients—
even quietly handing out condoms.” Indeed, a
growing number of conservative Christians have
expressed concerns about evangelicals so preoccupied
with sexual morality that they seem to forget or
ignore the poor, needy, and ill. Richard Stearns,
head of World Vision in the United States, a Christian
organization with evangelical roots, asks, “Where
were the followers of Jesus Christ in the midst of
perhaps the greatest humanitarian crisis of our time?,”
the AIDS crisis in Uganda, which records the highest
proportion of AIDS orphans in the world, many of
whom head families or are parts of communities
without any adult supervision. “Surely,” writes
Stearns, “the Church should have been caring for
these ‘orphans and widows in their distress.’
(James 1:27).”
tradition. (In far fewer numbers are secular, or nonreligious, orthodox, who find transcendent authority
and objective values and truth in something other
than God and the consolation of revealed truth, perhaps in nature, the social order, or human evolutionary development.) Hunter counts among the
predominant religious orthodox: evangelical Protestants, orthodox and neo-conservative Jews, and conservative Roman Catholics. Also included would be
social conservatives, a political label for those who generally believe that government has a role in enforcing
traditional values, such as the importance of the biological family and respect for human life from conception to natural death.6 Social conservatives are
overwhelmingly Christian.
7
Question
“The evangelicals are absolutely right: abstinence is the
best way of preventing the spread of HIV/AIDS.” So
says Sigurd Illing, who specializes in providing diplomatic advice for disadvantaged and marginalized African nations such as Somaliland. “But,” the Bavarian
diplomat is quick to add, “some people aren’t receptive. We need an end to this bedevilling of condoms by
people who take a high moralistic stance and don’t
care about the impact that this has on reality.” Do you
agree with Illing? Or do you think that sexual-based
morality has a place in the formation of public health
policy? Discuss the controversy in the context of moral
and cultural conflict.
(SOURCES: Geraldin Sealey, “Epidemic Failure,” Rolling Stone, June 2,
2005. Retrieved March 10, 2009, from http://www.rollingstone.com/politics/story/7371950/an_epidemic_failure/; NA, “Public Health and Religion:
AIDS, America, Abstinence,” The Independent, June 1, 2006. Retrieved
March 15, 2009, from www.independent.co.uk/news/world/africa/publichealth-and-religion-aids-america-abstinence-480593.html/; Brittney Bain,
“President Bush Awarded For Fight Against AIDS,” December 1, 2008,
The PEW Forum on Religion & Public Life. Retrieved March 16, 2009, from
http://pewforum.org/news/display.php?NewsID=17044/; NA, “Vatican Defends Pope Condoms Stand,” Reuters, March 18, 2009. Retrieved March
18, 2009, from http://www.reuters.com/article/worldNews/
idUSLI43220920090318; Carol Hilton, “Lancet Calls for Pope’s Repentance
on HIV Comments,” March 30, 2009. Retrieved March 30, 2009, from
http://www.medicalpost.com/news/article.jsp?content=20090224_171348_2428/; Nicholas D. Kristof, “Learning From the
Sin of Sodom,” The New York Times, February 28, 2010, p. 11;
Richard Stearns, The Hole in Our Gospel: What Does God Expect of Us?,
Nashvile: Thomas Nelson, 2009.)
It wasn’t surprising to find many of the
orthodox—evangelical Christians, traditional Jews
and Catholics, social conservatives—bitterly outspoken in their condemnation of withholding artificial
nutrition from Terri Schiavo. Members of these
groups variously likened the withholding of food
and water to letting a helpless infant starve to death
or to “cruel and unusual punishment.”7 The Vatican,
through its newspaper L’Osservatore Romano, even
compared Schiavo’s situation to that of an innocent
person sentenced to capital punishment, a view largely
shared by US bishops and Muslim authorities.
For these religious and social conservatives,
Terri Schiavo’s life plainly had value regardless of
her condition, because they believe that life’s
8
INTRODUCTION
worth doesn’t depend on “what a person can do,
experience or achieve,” to quote The New York
Times politically conservative columnist David
Brooks. Rather, Brooks explained at the time,
they believe that “[t] he life of a vegetative person
or a fetus has the same dignity and worth as the life
of a fully functioning adult.”8 This makes life’s
value absolute. Life is a sacred or divine gift that
the ideal society recognizes by treating Terri
Schiavo’s life as worthwhile as her husband’s,
yours, or mine. The ideal society protects the unconditional value of life by prohibiting deathhastening policies and decisions at the end of life
as well as at life’s beginning. Such a view inspires
prohibitions on what otherwise would be freedom
of action or self-determination, whether of individual or scientist.9
In opposition to cultural orthodoxy, Hunter
sets cultural progressivism, which does not tell us
once and for all who we are but subscribes to a
reality, truth, and authority that are ever unfolding.
For cultural progressivists, there is no higher or
transcendent authority of good and bad, right and
wrong. Such matters are for us humans to determine. So is defining ultimate truth. This doesn’t
mean that the progressivists lack or are indifferent
to standards of conduct. But unlike most of the
orthodox, who overwhelmingly source notions of
goodness and badness to divine higher authority,
the progressivists mainly attribute them to human
beings. They believe that people set the ground
rules of conduct, personal and social. This makes
those guidelines and directives debatable, flexible,
and changeable.
For the progressivists, the view that lives such
as Terri Schiavo’s must be preserved at all costs is
wildly unrealistic, even cruel, given the advanced
state of medical technology today, which can blur
the distinction between living and merely existing.
It isn’t life that counts, the progressivists tend to
say, it’s life’s dignity or quality. Like Terri Schiavo’s,
life can pass into mere existence, and it’s up to the
individual and family to say when that happens. For
many progressivists, therefore, the ideal society
recognizes the conditional value of life and honors
it, perhaps by permitting death-hastening policies
and decisions at the end of life. It also allows the
individual and scientist a large measure of freedom
of action, or self-determination, at the beginning
of life.
Predictably within the progressivist camp
Hunter numbers various secularists, or those without religious beliefs. But, significantly, he also includes reform Jews and liberal Catholics and
Protestants. Thus, some religious progressivists described the withdrawal of Schiavo’s artificial feeding
as appropriate. A prominent rabbi, for example, said
that artificial nutrition was not food but medical
treatment; and, therefore, he said it could be withdrawn, given the medical hopelessness of Schiavo’s
condition. He also urged people to accept their
mortality, as he said the Bible makes clear. Even
some evangelicals agreed, saying that feeding tubes
are like breathing machines, which would make
removing them no more starvation than removing
ventilation is suffocation. A professor of Christian
ethics at an evangelical university thought that
withdrawing the feeding tube would be appropriate
if that was what Schiavo wanted. And, taking aim
at the Vatican and US bishops, a professor at a
leading Catholic university, Daniel C. Maguire
of Marquette, said that both were out of step
with “mainstream Catholic theology against extraordinary measures to sustain life.” Maguire
called Schiavo a “15-year atrocity” that represented
a tendency to idealize physical life and forget the
natural process of death.10 For his part, Catholic
theologian and priest Richard McBrien of Notre
Dame attacked the Vatican’s capital punishment
analogy as “theologically erroneous—and irresponsibly so, given the highly public nature of this
controversy.”11
Cultural historians can judge the merits of Hunter’s culture war concept. For us it serves as an appropriate entrée to our study, because it brings out the
philosophical differences and disputants that largely
drive today’s spirited cultural discourse in bioethics.
This book takes the position that contemporary bioethics is less about specific issues and more about their
subterranean moral conflicts. Certainly, Schiavo was
controversial. But the view here is that, ultimately,
Schiavo owed its controversy, as does bioethics itself,
9
BIOETHICS, SCHIAVO, AND CULTURAL POLITICS
not to procedural matters but to fundamental disagreements about which of opposed conceptions of
reality, truth, and goodness will mainly shape society.
ABOUT THIS BOOK
Over 2,000 years ago, in his dialogue Euthyphro,
Plato (427–348 BCE) posed the question: Is it the
case that something is good because God approves it, or is
it the case that God approves what is good? If the former, then ethics is properly understood as an aspect
of religion and theology. If the latter is the case—
that God approves what is good—then ethics is
properly understood as moral philosophy, or a rational study of moral values and rules independent
of religion and theology.
Plato’s question cannot be settled to everyone’s
satisfaction. This partly explains the irresolvable
moral tensions and conflicts in a culture such as
ours, that inherits both moral traditions, the sacred
and the secular. These fundamentally different ways
of doing ethics especially show up in bioethics,
which engages content of the highest religious interest and value, such as what makes a human being, when life begins and ends, and how properly to
determine human sexuality and make a baby.
To tap the ancestral lines of these interlacing
perspectives, as we do in Part I, Sacred and Secular
Foundations, is to begin to understand the historical
influences that still resonate in today’s moral
conflicts and debates in bioethics. Also to be discovered in the past, and the more recent, are the
signal political events, scientific advances, and social
developments, along with the religious, political,
and philosophical thought that profoundly shaped
the founding of modern bioethics in the 1960s
and early 1970s. These we’ll sketch in Part II,
Origins and Context of Bioethics. Parts III and IV
will extend our understanding of the foundations,
origins, and context of bioethics to Issues at the
Beginning of Life and Issues at the End of Life,
respectively.
The often-wrenching personal decisions at
life’s beginning and end, together with their related
divisive social policies, are made today in a medical,
social, and political environment that’s quite different from the early days of modern bioethics. Of
special note is the biblically inspired bioethical
vision of the religious conservatives that currently
is challenging the field’s dominant secular construction. A prominent US religious figure has even suggested that civil law should support a “Christian
bioethical vision.”12 Should it? Does religion have
a role in public bioethics? Do arguments based on
religious principles have a place in society’s debates
about bioethical policy? Such questions, which
speak to the relationship of religion, medical science, and public policy are an increasingly important part of the cultural discourse in bioethics. The
book’s Conclusion, Bioethics, Religion, and Liberal
Democracy, addresses these matters.
CASES AND CONTROVERSIES
Reproductive Flashpoints
The new reproductive technologies that allow people
to begin life outside the womb or prevent it—or end
it—the “morning after” have produced intense bioethical debates. Here is a handful of culturally divisive
issues that we’ll examine in detail elsewhere in this text.
Many people are concerned that we are acting as
if it is a right to have children. Religious people
generally say that children are a gift from God, a
privilege, not something that is ours by right. Is
infertility a medical problem to be overcome, or
are children a gift we can’t demand?
In order to maximize the chances of a successful
pregnancy, many ova are collected and many
spare embryos are made. But what to do with the
spares? They can be thrown away, frozen for
future attempts, used for medical research, or
even put up for “adoption.” Religious and social
conservatives are especially unhappy with the
(Continued )
10
INTRODUCTION
CASES AND CONTROVERSIES (CONTINUED)
destruction of embryos, as they believe that life
begins at conception and to experiment on or
destroy life is morally wrong. What do you think is
the best use of the estimated 400,000 frozen
embryos stored in the United States?
octuplets after taking fertility drugs. What does your
faith tradition say about the Suleman case? Is it an
example of science being properly used in the cause
of new life, as desired by a woman who sees bringing
new children into the world as her highest good?
Many religions teach that sex has a dual purpose—
to unite the couple and to procreate. Some of
them, such as Roman Catholicism, are concerned
that treatments for infertility separate the two
purposes, and they would say that infertility treatments are therefore wrong. Many Christians, however, including Catholics and Protestant and
Anglican denominations, as well as Jews and Muslims, say that as long as infertility treatment isn’t
used to replace sex within marriage it’s permissible.
What do you think the purpose of sex is? Do
infertility treatments interfere with its purpose?
The pregnancy rate among 15- to 19-year-olds
increased 3 percent between 2005 and 2006—the
first jump since 1990–before dropping 2 percent
between 2007 and 2008. Abortion also inched up
for the first time in a decade, according to 2006
data. Teen pregnancy and abortion have long
been among the most pressing social issues and
have triggered intense political debate over sex
education. According to a landmark study
reported in 2010, sex education classes that focus
on encouraging children to remain abstinent can
convince a significant proportion to delay sexual
activity.13 Should the federal government fund
programs that encourage abstinence until
marriage or focus on birth control?
In January 2009 Nadya Suleman, an unmarried
mother on public assistance with six children, was
dubbed “Octomom” when she gave birth to
CASES AND CONTROVERSIES
Refusal Legislation
“Right of Conscience” bills, also known as health care
refusal measures, were introduced in several states’
legislatures in 2008. In a later chapter we’ll take a
closer look at such legislation. Suffice it here to point
out that these measures generally immunize facilities
and providers from any form of liability for choosing
not to inform, refer, or provide health care services of
which the provider or facility has a religious, moral, or
ethical objection. The measures are promoted by the
“Medical Right,” a term coined to show the
connection of religiously influenced medical
organization to the “Religious Right,” a political force
primarily comprising fundamentalists in the Protestant
and Roman Catholic traditions. The Christian Medical
and Dental Society, the Catholic Medical Association,
Americans United for Life, and Pharmacists for Life
International are among the organizations active in
advocating for health care refusal clauses. About half
of the proposals would shield pharmacists who refuse
to fill prescriptions for birth control and morning-after
contraceptive pills because they believe the drugs
cause abortions. Many of the proposals are far broader
measures that would shelter a doctor, nurse, aide,
technician, or other employee who objects to any
therapy. Included might be in vitro fertilization,
physician-assisted suicide, embryonic stem cells, and
possibly even providing treatment to gays and
lesbians.
Questions for Analysis
1.
To their critics, refusal measures represent the triumph of religious ideology over the full range of
legal medical services. Do you agree?
2.
Julian Savulescu, former editor of the prestigious
Journal of Medical Ethics, says that conscience has
little place in the delivery of modern medical care.
If individuals are not prepared to offer legally
permitted, efficient, and beneficial care to a
patient because it conflicts with their values, the
Oxford University professor says they shouldn’t
be doctors. “Doctors should not offer partial
medical services or partially discharge their
obligations to care for their patients.” Is Savulescu
correct?14 ,15
BIOETHICS, SCHIAVO, AND CULTURAL POLITICS
11
CASES AND CONTROVERSIES
Religion and Termial Care
For many patients and their physicians, avoiding the
pain and suffering of a terminal disease is top priority.
This is not necessarily the case, however, with very religious patients. One study that followed 345 cancer
patients to their deaths found that patients who
wanted aggressive care and received it had lower ratings of physical distress.16,17 According to Betty Ferguson, a registered nurse who studies end-of-life issues,
“We’ve had patients who said, ‘Well, God suffered.
Jesus suffered. So if I suffer, it’s going to make me
more like God.’” Ferguson’s Orthodox Jewish patients
often express the belief that life is worth living no
matter how debilitated they are.18 What does your
faith tradition teach about the meaning and purpose
of suffering, pain, and death? What in your view is a
“good death”? Do you think doctors should talk to
their patients about their patients’ religious views to
determine what is motivating their preferences for
aggressive care?
REFERENCES
1. President’s Statement on Terri Schiavo, March 17,
2005. Retrieved July 23, 2008, from http://www.
whitehouse.gov/news/releases/2005/03/200503177.html.
2. “‘May God give grace to our family,’” CNN.com,
April 1, 2005. Retrieved July 23, 2008 from http://
www.cnn.com/2005/US/03/31/schiavo/.
3. E. J. Dionne, Jr., “Why the Culture War Is the
Wrong War,” The Atlantic Monthly, January/February 2006. Retrieved August 4, 2008, from http://
www.theatlantic.com/doc/200601/culture-war.
4. James Davison Hunter, Culture Wars: The Struggle
To Define America, New York: Basic Books, 1991,
p. 120.
5. Ibid., p. 44.
6. Tim Rutten, “War, After the Smoke Clears,”
Los Angeles Times, January 17, 2007, p. E8.
7. Teresa Watanabe and Larry B. Stammer, “Diverse
Faiths Find No Easy Answers,” Los Angeles Times,
March 24, 2005, p. A21.
8. David Brooks, “Arguments of Morality and Reality,” The New York Times, March 29, 2005, p. A1.
9. Mark Mellman, “Another Country,” The New York
Times, September 17, 2008, p. A27.
10. Tim Rutten, “Schiavo Case Bares Political Sea
Change,” Los Angeles Times, March 26, 2005, p. E18.
11. See note 7 above.
12. Francis Cardinal George, “The Need for Bioethical
Vision,” in Cutting-Edge Bioethics: A Christian
Exploration of Technologies and Trends, John F. Kilner,
C. Christopher Hook & Diann B. Uustal, eds.,
Grand Rapids, MI: William B. Eerdmans Publishing.
2002, p. 97.
13. John B. Jemmott III, Loretta Jemmott, and Geoffrey
T. Fong, “Efficacy of a Theory-Based AbstinenceOnly Intervention Over 24 Months: A Randomized
Controlled Trial With Young Adults,” Annals of
Pediatric and Adolescent Medicine, February 2010,
pp. 152–159.
14. Rob Stein, “Health Workers’ Choice Debated,”
Washington Post, January 30, 2006, p. A1.
15. Julian Savulescu, “Conscientious Objection in
Medicine,” BMJ, February 4, 2006, pp.2294–2297.
16. Andrea C. Phelps et al. “Religious Coping and Use
of Intensive Life-Prolonging Care Near Death in
Patients With Advanced Cancer,” JAMA, March 19,
2009, pp. 1140–1147.
17. Roni Caryn Rabin, “Study Links Religion and
Terminal Care,” The New York Times, March 18,
2009, p. A18.
18. Karen Kaplan, “For Many, Faith Leads to Aggressive
Treatments,” Los Angeles Times, March 18, 2009.
Retrieved March 24, 2009, from www.spokesman.
com/stories/2009/mar/18/for-many-faith-leads-toaggressive-treatments.
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P A R T
I
Two Enduring Traditions
INTRODUCTION: SACRED AND
SECULAR FOUNDATIONS
For centuries thoughtful people have pondered and disagreed on basic questions
about human nature and destiny, suffering and death, truth and meaning, and right
and wrong. Placed in an historical context, then, the deep cultural divisions evident in a case like Schiavo are not new. Rather, they can be viewed as part of an
ongoing dialogue—sometimes civil and muted, sometimes uncivil and strident—
that extends back into the distant past. Many of the issues, of course, are fresh,
certainly those in biomedicine. But the fundamental differences between ways of
knowing and understanding are as old as Western civilization itself.
This part of the book surveys the West’s two great traditions of knowing
and understanding. Chapter 1 deals with the legacies of medieval religion and
Enlightenment science, while Chapter 2 examines their enduring moral and
political endowments. The theme of Part I is that these two distinct and venerable ways of knowing and understanding—one sacred, the other secular—are
active philosophies helping to shape today’s bioethical controversies.
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Chapter 1
Medieval Religion and
Enlightenment Science
T
he Institute on Biotechnology & the Human Future in Chicago offers assessments of the scientific benefits and risks of new developments in biotechnology, while at the same time analyzing their cultural and ethical
significance.1 One of the Institute’s fellows is C. Ben Mitchell, an associate professor of Bioethics and Contemporary Culture at Trinity International University
in Deerfield, Illinois, just north of Chicago. Mitchell is also a consultant with the
Center of Bioethics and Human Dignity at Johns Hopkins University and editor
of Ethics & Medicine: An International Journal of Bioethics. The widely published
Mitchell, who holds a doctorate in philosophy with a concentration in medical
ethics, has a name for the present age. He calls it “Technopian” for its daunting
list of technologies that worry as much as thrill him.
WELCOME TO TECHNOPIA
In the brave new world of “Technopia” Mitchell forecasts, we can expect to
enjoy:
the ability to clone humans and predetermine the sex of children and their
genetic makeup;
drugs tailor-made to the genetic makeup of individual patients;
genetically derived therapies for the prevention and cure of most cancers,
heart disease, AIDS, and other diseases, including new strains of vaccineresistant ones such as malaria;
the ability to “program” out of human genes the propensities to contract
various diseases and illnesses;
repair of damaged brain cells, spinal cord, and other diseased or damaged
human tissues;
animals that grow replacement organs for the 50 percent of humans who
currently die before getting a transplant organ from a human donor; and
15
16
CHAPTER
1
a “smart mouse” that points the way to eliminating aging in humans.
“Clearly,” Mitchell admits, “the future may
reap great benefits from biotechnologies such as genetic engineering, cloning, cybernetics, nanotechnology, and a litany of other neologisms yet to be
invented.” But Mitchell, a Christian bioethicist
who consults on matters of public policy, is quick
to add: “The future may also portend tragedy, a loss
of human dignity, and a world which is increasingly
hostile to concerns which transcend the world of
contemporary scientific research.”
For Mitchell and many others,2 one of those
concerns is “to re-establish what, exactly, it means
to be human.” After all, as he explains, “[I]f being
human is all about the brain, then supercomputers
might be able to contain all the information in the
brain and then be designated as ‘human’.” That
possibility especially horrifies religious and social
conservatives. They say that the Bible establishes
profoundly different criteria for humanhood and
offers a moral vision that, strictly speaking, does
not include many of the wonders of modern biotechnology. (Biotechnology refers to the application of biological research techniques to the
development of products and processes to improve
human health.)
This scriptural outlook, which is associated
with but not limited to religious fundamentalism
and social conservatism, provides millions of Americans with a religious framework for understanding
human nature, knowing human destiny, interpreting misfortune, finding meaning, relating to others,
and evaluating government. It also helps shape their
opinions about social policy, particularly in bioethics. The roots of this highly influential scriptural
view trace back to Christian-dominated Europe in
the millennium between approximately 500 and
1500 CE, known as the Middle Ages.
THE MEDIEVAL CHURCH
Established as the state religion in 391 CE, the
Roman Catholic Church became the most powerful
organization of the time following the collapse of the
Western Roman Empire in the fourth and fifth centuries. Embracing most Western Europeans, the
Church offered to the spiritual lives of people what
the feudal and manorial system offered to their
political and economic lives: unity, solidarity, and
security.3 In a time of tumult and uncertainty, the
medieval Church gave assurance and hope of a better
life to come. Its theological orientation, summarized
as follows, left no doubt as to the meaning of life and
death
[T]he stretch on earth is only a short interlude, a temporary incarceration of the
soul in the prison of the body, a brief trial
and test, fated to end in death, the release
from pain and suffering. What really matters is the life after the death of the body.
One’s existence acquires meaning not by
gaining what this life can offer but by
saving one’s immortal soul from death and
eternal torture, by gaining eternal life and
everlasting bliss.4
Surrounding this view was a constellation of
biblical stories considered to have profound explanatory or symbolic significance.
Descriptively, these scriptural narratives and
their interpretations accounted for human origin,
nature, and destiny, as well as for the presence of
evil in the world, including illness, suffering, and
death. They helped people understand what and
who they were, where they were going, and why
they faced so much adversity along the way. Prescriptively, they told people how they should live,
including how to structure such social institutions as
marriage, family, and government.
Crucial to the development and expression of
this biblical perspective were the views of the
Church’s most brilliant and influential of writers
and thinkers, Saint Augustine (354–430) and Saint
Thomas Aquinas (1225–1274). Although separated
by 800 years, and despite many sharp differences
between them, Augustine and Aquinas both treated
the Bible as the ultimate source of knowledge about
humankind’s origin, nature, destiny, and relationship with God. Millions of people still do.
MEDIEVAL RELIGION AND ENLIGHTENMENT SCIENCE
THE AUTHORITY OF THE BIBLE
The Bible, which contains the sacred writings of all
Christian religions, includes the Hebrew Scriptures,
termed Old Testament (written between 1400 and
400 BCE), and Christian Scriptures, or New Testament, (completed and preserved between 50 and
100–150 CE). Significantly, the word testament
comes from the Greek diatheke meaning “covenant.”
For believers, the Bible remains a sacred covenant,
or agreement, between God and his people, in
which God reveals himself, makes certain promises,
and requires certain behavior in return. For both
Augustine and Aquinas, as well as for people generally during the Middle Ages, the Bible was the
chief, if not exclusive, source of knowledge and
understanding about themselves, their world, and
the fate of both.
But early Christians also recognized that the
Scriptures could be obscure and difficult. The imperfect, fallible human mind could misunderstand
and be led astray by them. To correct for this possibility, according to its founders, God established
the Church as his representative on earth.
As the Bible’s infallible interpreter, the Church
existed to make revelation rational. It also functioned to spread biblical truth, which included suppressing heresy, or opinions at variance with official
teaching. In this way, the early Church strove to
avoid confusion and safeguard the sum of truths
revealed in the Scriptures.
THE BIBLICAL ACCOUNT
OF CREATION
“In the beginning God created the heavens and the
earth” (Gen. 1:1). With these primordial words,
the first book of the Bible asserts the existence of a
single, unchanging, divine sovereign who created the
universe. This monotheistic belief is regarded as Judaism’s unique contribution to the ancient religions of
the Mediterranean, all of which—Egyptian, Babylonian, Assyrian, Greek—subscribed to polytheism, the
belief in many gods, often quarrelsome and typically
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indifferent to the world and its inhabitants. The God
of Genesis, by contrast, is one and personal, righteous,
and loving. By expressing himself in creation, this
biblical God gives to the world unity and meaning,
and to its inhabitants intrinsic value and significance.
Human Nature
Of the human aspect of creation, Genesis records
that the first human, Adam, was made a “living
being” or psycho-physical self by the “breath” or
spirit of God: “The Lord god formed man of dust
from the ground, and breathed into his nostrils the
breath of life; and man became a living being”
(Gen. 2.7; cf. Ps. 104. 29–30; Job 34.14–15). The
first human, then, was both corporeal and spiritual;
a unity of a material body and a spiritual, animating
soul. Being imago Dei, made in the image of God,
he shared something of the divine intellect and will.
Through the intellect he could know that a single
God exists, and through the will he could choose
and act to love God. This uniquely human capacity
to choose and act was fundamental to the covenant
between God and Adam.
The Relationship and the Covenant
According to Genesis 3:2–3, God commanded
Adam: “You may freely eat of every tree of the
garden, but of the tree of knowledge of good and
evil you shall not eat, for in the day that you eat of
it you shall die.” Clearly, then, the first human is
depicted as naturally free to obey or disobey, to do
good or evil, to choose life or death. Thus is established the relationship of God’s lordship and the
human’s subservience.
The essence of this covenant or contract was
that Adam would use his God-given faculties properly. In the classical Greek construction, proper use
of uniquely human faculties basically meant rational
development. Through reason, the Greek philosophers taught, one was to control destructive impulses, discover moral law in the universe, and find
meaning in life. In the biblical view, by contrast, the
unique human faculties of intellect and will characterized the first human as a beloved and compliant
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child of God. According to the biblical covenant,
Adam could expect from a righteous God love,
mercy, and justice; God, in turn, could expect of
him fidelity and obeisance. Man, in brief, must act
responsibly, that is, to choose to do right, not as he
saw it, but as God willed it. In this way, order and
harmony were established in the divine-human relationship and in creation, generally.
Signifying the station of this completely good
creature, the Creator then crowns the first human
with “glory and honor” (Ps. 8.5) by giving him
“dominion over all the earth and everything in it”
(Gen 1.26). God then completes man’s happiness
by placing him in a divine garden, Eden, and creating Eve to be Adam’s wife. (Gen 2:21–22)
Given this idyllic account of creation, the earliest theologians, and later ones, faced what is called
“the problem of the existence of evil.”
why is there evil; and if God is all powerful, why does he
permit it? Must it be concluded that God is not all good or
not all powerful? An attempt to answer this question
is sometimes called a theodicy (from the Greek theo
meaning “god” dike meaning “justice or order”).
Theodicy is the traditional theological term for a
reasoned attempt to vindicate God’s goodness and
power in the face of evil. Theologically, a theodicy
tries to establish the compatibility of evil and divine
justice so that the existence of evil cannot shatter
our trust in the world, forcing us, unaided, to make
sense of the seemingly senseless. Although Augustine
didn’t invent the term—the German philosopher
Gottfried Leibniz (1646-1716) did in his book Theodicy (1710)—Augustine did attempt to reconcile the
existence of evil with the existence of an omniscient,
omnipotent God. His explanation is an important
aspect of the medieval religious view that still has
wide appeal, especially in many people’s feelings
and attitudes toward illness, suffering, and death.
THE PROBLEM OF EVIL
The Augustinian Theodicy
We generally think of evil as being either “natural”
or “moral.” Natural evil refers to an apparent malfunctioning of the physical world, whereas moral
evil is human made. Natural evil includes not only
so-called disastrous acts of nature such as storms and
earthquakes, but also illness, disease, pain, suffering,
and ultimately death. Moral evil includes destructive behavior by humans toward others, such as
lying, cheating, and killing.
While perceptions of evil may vary, evil always
threatens our ability to act in the world and to
understand it. Church historian Walter Sundberg
puts it this way: Evil “raises the fundamental human question of intelligibility. If we cannot order
evil, then both practical and theoretical reason are
threatened.”5 In her book on the subject, philosopher Susan Neiman even goes so far as to call this
fundamental question of intelligibility raised by evil
the guiding force of modern thought.6 In any
event, for theologians the “intelligibility” that the
presence of evil threatens is the belief in an allgood, all-powerful God. Expressed as a question,
then, the problem of evil is this: If God is all good,
Consistent with the Bible, Augustine’s theodicy involved man’s fall from grace, or state of divine influence and sanctification. The biblical basis of the fall is
two passages from Genesis. The first—“God saw all
that he had made and saw that it was very good”
(Gen. 1:31)—establishes a divine creation free of
evil. The second describes the human’s first recorded
act, an act of free choice proposed by the serpent,
who, addressing Eve, contradicts God’s admonition
to man: “You shall not die. For God knows that
when you eat of it your eyes will be opened and
you will be like God, knowing good and evil” (Gen.
3.4–5). Succumbing to pride, Adam is persuaded by
Eve to betray his creaturely position and, figuratively, make of himself God, thereby breaking the
sacred relationship and covenant.
Because of this misu…
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