Bioethics

"The use of fetuses as organ and tissue donors is a ticking time bomb of bioethics."

"It is important to acknowledge again how bioethics discussions within and among religious communities reveal features that generally distinguish them from self-consciously secular approaches to bioethics. While it is to be expected that different interpretations of text, tradition, method, and authority often lead to different conclusions among religious traditions in their respective judgments on particular topics, it seems equally clear that religious understandings, although nuanced differently among various faith communities, often reveal broadly shared characteristics that stand in stark contrast to the moral minimalism at work in many secular approaches. Such similarities should not be that surprising. For the convictions at work in religious this often eventuate in a discernible consensus among traditions that nonetheless remain distinct in their understandings of ecclesiology, method, and authority. Theological arguments characteristically function in a richer, more robust fashion than the lowest-common denominator, procedurally driven arguments at work in secular perspectives. While that robustness of vision poses challenges to the development of a common morality workable at the level of policy, it also invites a broader conversation about, if not a prophetic challenge to, the assumptions that undergird much of the conventional wisdom in bioethics discussion."

"[Bioethics] is "a phony branch of elite philosophy whose principle purpose seems to be to justify allowing badly ill or disabled people to die.""

"The aim of bioethics is to identify ethical problems raised by critical decision making in healthcare, and by genetic engineering and biotechnology research into microorganisms. Most of the key bioethical issues, especially the ones related to human life sprung from a debate between principles of morality, the development of science, and its potential contribution to ‘better living standards’, all framed within different cultural backgrounds. Bioethical research will thus take place interactively with other related disciplinary ethics. In the bioethical debate it is important not only to take on board the general perception of norms, but also to question until what extent bioethics will reshape those norm."

"Christian bioethics is a puzzle. The very name suggests an ethics other than one for humans generally. Can there be an ethics just for certain humans? Has a special ethics been given to Christians as the Torah was given to Israel? Can there be an ethics for all people, but which only some people can know or know fully?"

"An exploration of Christian bioethics at the beginning of the 21st century might with relief be regarded as anachronistic, as a matter of the past. This side of the Renaissance and the French Revolution, the once-Christian West is increasingly post-Christian. Though in some countries a particular Christianity is still established – in Germany, two – their role and force for public policy are progressively marginalized in the framing of law and public policy. There is no society that is unabashedly Christian, as Spain under Franco or Portugal under Salazar had been Christian."

"In many ways it is anachronistic to use this term prior to the 1970s, for the phenomenon of bioethics was in many ways associated with the deprofessionalization of medical ethics and its reconceptualization as a secular, philosophically oriented discipline independent of the health care profession."

"Secular bioethics emerged out of the Enlightenment hope to disclose a secular ethic that could transcend the multiplicity of Christianities and their moralities. This Enlightenment hope has persisted despite the bloodshed of the French and October Revolutions, leading among other things to the emergence of the medical humanities and the contemporary high expectations from a secular bioethics."

"The Roman Catholic medical-ethical handbooks and compendia of moral theology that emerged at the end of the 19th century and enjoyed a flourishing in the 1950s have a continuity with Roman Catholic moral theological reflections, reaching to the beginning of the 16th century and to the flowering of Western scientific interest in medicine and its foundational sciences. From the 16th century onward, moral theological interest in medicine was driven by the remarkable medical progress after the Renaissance. Even Descartes (1596-1650) thought he could extend life, given the promise of medical knowledge. Medicine claimed importance before it could convey much benefit. Though therapeutic benefits came later, there were striking advances in knowledge. From Vesalius to Harvey to Morgagni through Bichat and Virchow and the explosion of medical science in the 19th century. New construals of research and science altered the very meaning of medical knowledge. In contrast, in the wake of the Council of Trent (1545-1563) there developed a continuity in Roman Catholic moral theological reflections that extended unbroken into the early 1960s. Roman Catholic moral thought had a previous substantial change in its character when it passed from the pre-Scholastic to the Scholastic period. The pre-Scholastic era, which was pastoral in its character, was much loser in its theological spirit to that o the Church of the first millennium. The Scholastic period, which began in the 12th century and extended to the Council of Trent, was marked by a concern with discursive rational reflection and systematization. The modern period, which began with Trent, in great measure carried forward the Scholastic tradition, but now more fully developed. It was in this period that reflections on medicine became the focus of whole works and began to constitute a sub-discipline of moral theology. This post-Tridentine, medical-ethical, moral theological literature was insightful. It constituted much more than merely wooden applications of past reflections. This significant body of Roman Catholic medical ethical reflection and scholarship was characterized by its constituting a single coherent community of research."

"A common sense of doing Christian medical ethics or bioethics was available for Roman Catholics until the mid-1960s. As John Berkman observes, “The conceptual continuity in moral theology is clearly visible from the manuals themselves, which in 1950 maintained the same basic structure and categories of the manuals which begin in 1605.” There was a confidence in the ability of moral theological reflection to answer the questions posed by new technological and scientific developments."

"At the end of the 19th century, there was a significant increase in Roman Catholic moral theological investigations concerning matters medical. The moral theological handbook tradition turned to the needs of physicians, priests, and nurses. During this same period, new medical techniques were being developed and new understandings of etiology, pathogenesis, and therapy were gaining salience. A good proportion of contemporary surgical procedures trace their roots to this period, which enjoyed the combination of anesthesia with Lister’s asepsis. During this period the germ theory became well established and the first steps were taken in the development of antisera as medical treatments. The emergence of contemporary medicine motivated theological reflections. This was a period within which various aspirations to progress, secularization and modernization brought into question traditional Christian commitments. After the Second World War, there was continued acceleration in the tempo of scientific and technological progress. The response was a further development of the religious medical-ethical literature, to which not only Roman Catholics, but also Protestants and Jews began to make numerous contributions. Initially, the Roman Catholic response was both vigorous and in continuity with its manualist tradition. The Christian bioethics that took shape in the 1970s developed a character quite different from the Roman Catholic medical-ethical tradition of the past. It did not so much produce manuals or guides for the perplexed physician, nurse, or believer, as it did reports of theological perplexity. The guides were themselves often disoriented: the moral theologians on whom bioethicists might draw were frequently unsure as to the character of appropriate moral guidance. Roman Catholic bioethical scholarship took on the character of a moral science in confusion: moral theology was in search of its foundations. As Roman Catholicism passed through the aftermath of Vatican II, it became impossible to carry forward the tradition of medical-ethical reflection that had taken shape at the beginning of the 17th century. This rupture in the tradition of Roman Catholic bioethical reflections was associated with the religious changes that occurred in Roman Catholicism following Vatican II. Pope John XXIII (1958-1963) began a revolution as he sought to bring “ecclesiastical discipline into closer accord with the needs and conditions of our times.”"

"Christian bioethics as a family of bioethics had a brief and significant flowering. For some two decades it commanded a centrality in the public debate regarding the new medicine. It then receded from public policy discussions. This is not to deny that a rich and often thoughtful literature continued to grow, nurtured by authors from evangelical as well as other perspectives. Christian bioethics simply no longer commands the public notice it once enjoyed. During its flourishing, Protestant bioethicists such as Paul Ramsey and Stanley Haurwas claimed a prominent place for Christian bioethics. Their reflections garnered enough broad attention. Initially, the novelty of the debates was itself engaging, even as an old paradigm of Christian bio ethic collapsed, and many scholars energetically struggled to erect diverse new ones. During the 1960s and early 1970s the various Christian bioethics flourished at the vanguard of bioethical scholarship, so that in this period one could not have given an adequate account of medical ethics of bioethics without taking into account of the work of Christian thinkers such as Ramsey and Hauerwas. Yet, just as secular bioethics assumed an important role for public policy Christian bioethics receded in cultural significance and force. Christian bioethics served as an intermediate step in the emergence of secular bioethics. In part, this was due to Christian bioethics attempting to speak to the world in secular rather than in Christian terms. By discounting its particularity, Christian bioethics marginalized the importance of what it could offer. As Stanley Hauerwas had argued, this has been one of the major forces in the recent decline of Christian bioethics."

"Other factors were also influential in making a secular bioethics appear more attractive than a Christian bioethics. The secularization of the culture made the consideration of a Christian bioethics as a source of moral guidance unappealing. Reliance on traditional authority figures came to be regarded as pejoratively paternalistic, if not as an expression of a false consciousness. Traditional Christian morality interpreted by an authoritative hierarchy was at loggerheads with the view that society should be open, liberal, and pluralist. The very notion of a religious tradition as a source of moral judgment collided with an emerging sense of autonomy and individual rights. Indeed, traditional Christianity is not only hierarchical but robustly patriarchal. It takes seriously the declaration of St. Paul that “the head of the woman is the man” (1 Cor 11:3) and that “man was not created on account of woman, but woman on account of the man” (I Cor 11:9). Although accepting men and women as equally called to salvation, traditional Christianity recognized them in a hierarchy of honor and authority. Against the backdrop of the rights movements of the 1960s and their rejection of traditional claims of social authority, traditional Christian understandings were not only unacceptable and embarrassing, but to be positively rejected. Traditional Christian commitments came to be regarded as exploitative, thus driving a deep cultural wedge between traditional and post-Christianities."

"In an age that endorses diversity, while considering real disparities of belief as threatening, Christian bioethics, or at least traditional Christian bioethics, presented differences that matter, and that are therefore threatening. The Western history of religious wars and inquisitorial coercion encumbered Christian bioethics with a past that made its contemporary undertaking suspect. In a world bloodied by its response to difference, Christian bioethics offered to divide Christian from non-Christian, and Christian from Christian, seeming to endanger the fabric of a peaceable society. The particular content of Christian bioethics was a possible enemy off tolerance an a friend of conflict. Having engendered the religious wars of the past, Christianity of the mid 20th century was engendering the culture wars of the future. From the perspective of post-traditional Christians, and indeed in terms of many of the rights movements of the 1960s and 1970s, traditional Christianity was reactionary at best. It resisted progressive liberalism’s commitment to freeing persons and social structures from the constraining hands of the past. It saw in abortion and the emerging contraceptive ethos not avenues of liberation but roads to damnation. Rather than celebrating this ethos of choice as a liberation from the tyrant of biological forces, which has subjected women to men, traditional Christianity recognized in the secular revolutions affirmation of extramarital sex, the contraceptive ethos, and abortion, as only a further enslavement to the passions and chaos they bring. Disagreements about these matters within Christianity itself heightened the moral confusion of the time. Christian bioethics, rather than providing a means to resolve bioethical controversies and to achieve a general consensus concerning health care policy, fueled further controversy."

"T o summarize, when Christian bioethics turned to the challenges of providing moral guidance for the new high-technology medicine, it found itself unequal to the task. The difficulties were multiple and deeply rooted in contemporary Christianity. Christianity was divided into a diversity of Christianites; it could not give unambiguous guidance. Given the plurality of visions, one could disingenuously select within rather broad constraints the religious perspective to approve behavior one wanted to embrace (e.g., if one wanted to find religious approval of artificial insemination by a donor, one needed only to select the appropriate Christian theologian). The mainline Christian religions were themselves in disarray about what it mean to be Christian: from within many Christian religions unambiguous guidance was often unavailable because centuries-old approaches to resolving moral controversies had been abandoned or rejected. Just as Christian bioethics had the opportunity to provide guidance for contemporary health care policy, Christianity seemed unclear as to what ethics it should offer. In consequence,, the relevance of Christianity to the modern would could not be doubted. As if this were not bad enough, the surrounding couture had grounds to regard Christianity as a threat to a democratic and open polity for several reasons. First, traditional Christianity sought answers to moral problems within a hierarchical structure, rather than from individual reasoning and choice unfettered by constraints of the past. Second, Christianity hierarchical structure was patriarchal. Third, Christianity, by the particularity of its moral commitments, accented differences rather than encouraging the emergence of a moral consensus to which all could subscribe fourth, Christianity, insofar as it offered an ethics that contrasted with a secular ethics, could not provide guidance for public institutions or policy in the secular pluralist societies that had emerged in the West after the Second World War. The Christianness of Christian bioethics was itself problematic."

"In the wake of the Enlightenment, it seemed necessary to articulate a medical ethics not reliant on traditional Christian morality or its various expressions in informal codes of gentlemanly behavior. At the end of the 18th and the beginning of the 19th century medical ethical treatises of a secular nature became salient. Much of this occurred as codes of medical ethics of etiquette were crafted for the medical professions. There was the perceived need formally and secularly to determine the nature of proper medical behavior. As one entered the 20th century, there was a heightened recognition that old traditions could not guide and that a new medical morality was needed For example, a British secular medical ethics text published in 1902 acknowledges that “it is not sufficient to say, as some people do, that medical ethics may be summed up in the Golden Rule, or that a man has only to behave like a gentleman. The author recognizes that the guiding mores were changing so that “what was regarded as customary and even proper some years ago, has often come to be universally condemned.” It I as if the author protested to much in denying that “our conception of Christianity and chivalry had undergone a complete revolution within the same period.” Cultural, religious, scientific, technological, and economic developments were recasting th landscape of medical practice. Philosophy promised for health care in the 1960s, 1970s and 1980 what it had offered European societies in the 17th and 18th centuries: a rationally defensible ethics that can bid humans as such and justify in secular terms a content-rich account of human rights, duties, proper character, virtue, sentiments of care, etc. The medical humanities in the 1960s and 1970s recaptured the aspirations of the first, second, and third humanisms. The first humanism in the late 15th and 16th centuries claimed a basis for human dignity over against the emerging Christian religious divisions of the time. At the same time it reaffirmed classical Greek an Roman pagan ideals of paideia, philanthropia, and humanitas. The second humanism at the end of the 18th and beginning of the 19th centuries continues Enlightenment themes in promising a cultivation proper to human as such. The third humanism and so-called New Humanism, which surfaced at the end of the 19th an beginning of the 20th centuries, anticipated the medical humanities movements of the 1960s and 1970s. the humanities were invoked to place the new sciences and technologies within the context of immanent human values and to provide a moral unity for an increasingly secular culture. The medical humanities in the 1960s and later bioethics were engaged with similar expectations: to disclose the values and goals proper to humans, so as to bind all in a coherent and well-directed technological culture. There was an additional claim: medicine and the humanities were recognized as mutually supporting. Medicine as a project of human caring was itself construed as one of the humanities. Its fully self-conscious appreciation was sought in the humanities. On the other, hand, the traditional humanities found a concrete bond to the human condition through their contact with medicine. The humanities could strengthen the tie between medicine and human values. Medicine, for its part, could reconnect the humanities with the human condition, saving them from being isolated scholarly pursuits. The vision of medicine and the humanities found it epiphany in Edmund Pelligrinos perceptive and provocative rallying cry:” Medicine is the most humane of sciences, the most empiric of arts, and the most scientific of humanities.” The humanities, rejuvenated from contact with medicine, were not just an academic undertaking or a cultural achievement. According to Pellegrino, they were also to constitute a personal moral calling. The humanist must also be “authentic.” The medical setting requires that the humanist incorporate the values he or she professes an the character traits that are embodiments of the liberal arts teachings, to be human if not humane…truly, the humanist must be “holier than thou.”"

"The challenge of providing a secular foundation for bioethics can be seen as defined historically against three fundamental Western experiences of fracture and rupture: (1) the Reformation with its consequent fragmentation of Western Christendom into a plurality of Christianities and Christendoms, (2) the Enlightenment with its formation of a secular, intellectual culture, which aspired to transcend this diversity, and (3) post-modernity with its recognition that are returned to this diversity, given the Enlightenment's failure to justify a single, canonical, content-full morality by discursive reason alone. These experiences frame the moral geography for current debates regarding bioethics. They establish taken-for-granted expectations regarding moral diversity, the role of secular morality in spanning religious moral difference, and the contemporary experience of post-modernity. They account as well for a kind of nostalgia felt for the moral unity of the Western Middle Ages expressed in various hopes to see humans bound in a universal moral community governed by a global bioethics enforced legally across the world and in a persistent faith that discursive moral rationality can establish a universal ethic, despite its many failures."

"There is a continuity between the discursive, rational commitments of the Scholasticism that emerged in the 13th century and the Enlightenment project of providing rational account of proper moral probity. Although the Enlightenment attempted to give an account of morality undirected by revelation and ecclesiastical authority, thus involving a substantive break with previous moral assumptions, the Enlightenment as well as Scholasticism share a substantive commitment to reason’s abilities to provide outside of right worship and right belief a universal account of morality. Bioethics as it took shape in the 1970s reflected a late-Enlightenment attempt to provide a secular surrogate for the religious moral authorities that had once guided the West (Engelhardt, 2002). Secular and Western Christian bioethics have drawn on philosophical assumptions regarding the capacities of discursive reflection. They both have a penchant for attempting to identify moral truths with the deliverances of systematic moral reflections. In contrast, Orthodox Christianity lives in an understanding of morality uncompromised by Scholasticism, the Renaissance, the Protestant Reformation and the Enlightenment."

"Because Orthodox morality is primarily therapeutic, it is not juridical. The goal is not to do justice but to bring God’s mercy to the repentant. Although any falling short of the mark of saintly perfection is sinful, the response to sin is not punitive (e.g., penance is not punishment but treatment). Bioethics should be healing, aimed at restoring through repentance and purification the individual’s focus on God."

"Orthodox bioethics is not natural-law oriented. Unlike Western Christianity, which came to look for traces of God in nature, Orthodox Christianity approaches nature as an icon, as a window through which to see God, with the result that Orthodox Christianity is innocent of the natural-law theory of the West (Foltz, 2001)."

"Orthodox Christians hold that Christian bioethics is non-developmental in the sense of affirming the same moral commitments and insights that directed the Church of the first thousand years: it understands that all that has been essential for the appropriate moral life has been available since the time of the Apostles. This difference from Western secular and religious moral philosophical understandings is in part grounded in the Orthodox Christian recognition that truth is not merely a what (i.e., a set of discursive propositions referring to an objective truth) but a radically transcendent Who (i.e., the Trinity), with Whom since Pentecost right-worshipping Christians have had the possibility of a full relationship."

"In approaching new technological developments, the present is set within the now of the past. In addressing issues such as cloning, the use of embryonic stem cells, and germ-line genetic engineering, Orthodox Christians will not seek new moral insights. There will not be a search for new medical-ethical or bio-ethical principles, but the recall of a permanent possibility for epistemic insight grounded in the consequences of the Incarnation. The goal will be to provide an expression of an abiding truth in part guided by the writings of the Fathers but always crucially sustained by the presence of the Holy Spirit, so as to express in a new context the enduring moral consciousness of the Church."

"The obligation to become involved in sin (i.e., to engage in an activity that by itself falls short of the mark) to pursue salvation requires confronting moral issues within a value framework that at times does not produce black-and-white choices (through idolatry, sexual impurity, and murder of the innocent are always forbidden). Given this moral framework, the bioethics of Orthodox Christian physicians, nurses, families, and patients is often at odds with the reigning expectations of the surrounding secular society, as well as the moral views embraced by many Christians. This disparity of moral vision is expressed in competing understandings of proper professional conduct. For instance, Orthodox Christian physicians should not consider themselves obliged to be religiously and morally neutral in their care of their patients. Although they should avoid coercion of any sort (Caon CXIX of Carthage, A,D, 419), the ideal is to bring all who can be influenced into a life of right worship and right belief. For example, the Orthodox Church celebrates holy physicians such as St. Panteleimon (304) who took advantage off their professional role to convert their patients. Rather than regarding the patients’ vulnerability as a ground for not attempting to exert influence, Orthodox Christianity regards confrontations with pain, suffering, and death as opportunities to open the way to repentance and conversion. Traditional Orthodox Christianity does not affirm the abandonment by physicians of their Christian duties in favor of the norms of a secular medical ethics."

"The history of Roman Catholic bioethics is completely intermingled with that of Catholic morality more generally. Although that morality continues to be expounded and developed by moralists working in the Roman Catholic tradition, its overall history is largely unwritten. There is, of course, a large body of established scholarly work on the great figures of Roman Catholic moral theory, especially on St. Thomas Aquinas and St. Augustine there are also studies on the history of Catholic moral teaching on particular moral issues, including abortion (Connery 1977), the distinction between ordinary and extraordinary treatments (Cronin, 1989), and contraception (Noonan, 1965). Finally, there are systematic treatments of Catholic bioethics (Ashley & O’Rourke, 19889). But there is no comprehensive study of the history of Catholic moral theology, much less the history of Catholic bioethics. In particular, little has been done to trace the development of Catholic moral thought in the period most essential for the development of distinctive Roman Catholic positions in bioethics – that is, the period from the sixteenth century Spanish scholastics to the dominance of the moral manuals in the half century before Vatican Council II."

"There is an institutional explanation for the development of bioethics within Roman Catholic moral thought. Catholics, especially those in religious orders, have been institutionally involved in health care throughout its technological and institutional development. This is especially true of catholic involvement in hospitals over the last 150 years, the period in which health care developed into its present institutional form (Kaufmann, 1999). The moral questions raised in the institutional context of catholic health care, especially those involving difficult cases related to sexual morality, pregnancy, and end of life issues, provoked a pedagogical literature directed at nurses, physicians, and others. That literature is clearly continuous with, and an ancestor of, modern secular bioethics. Moreover, the institutional focus continues, for example, in the American bishops’ ‘’Ethical Religious Directives for Catholic Health Care Services (National Conference of Catholic Bishops, 1994 and 2001)"

"The vocabulary and leading ideas of Catholic bioethics have developed out of the moral work of the great scholastic theologians, most notably from the moral analyses of St. Thomas Aquinas. This tradition of moral thought is often called “natural law theory” or the “natural law tradition” after a dominant component of Aquinas’s time, with notable highlights in the work of the 16th century Spanish scholastics, the 17th century causists, the 18th century synthesis of St. Alphonsus Ligouri, and the revival of Thomistic study in the ate 19th and 20th centuries. The working method throughout this period has been a form of casuistry: new and difficult cases were compared and contrasted with clearer, paradigm cases to illuminate their morally important properties so as to allow their correct moral classification is compatible with the absolutism that characterizes catholic moral analysis: the morally important properties of actions, once revealed by casuistry shows a certain form of intervention in pregnancy involves an intention to end or, more precisely, to shorten the life of the fetus, then the intervention is excluded by the exceptionless prohibition against intentionally killing the innocent."

"As we have seen, Roman Catholic bioethics is a conceptually and institutionally mature set of inquiries. It has deep historical roots within catholic theology, doctrine, and canon law, and consequently a developed set of positions and methods of moral analysis. Although traditional authorities are accorded some respect by all engaged as Roman Catholics in bioethics, there are very significant disagreements among Catholic bioethicists. These disagreement reach so deeply into the fabric of moral life an thought that they suggest radical fissures within the Catholic community. These divisions of moral conviction would not be troubling if they were simply about new and difficult cases or about casuistical details; but, as the preceding summaries and citations indicate, they go to the heart of key norms themselves. The resolution of the most central of these disagreements is surely essential if the traditions of Catholic moralizing are to be effectively brought to bear on the bioethical perplexities facing the Roman Catholic community and others who may look to its riches for guidance."