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As western culture moves ever deeper into the period characterized in the mid-twentieth century by historian Christopher Dawson as "secularized Christendom, " the emerging interdisciplinary field that since 1970 has gone by the name bioethics can be understood only as a microcosm of the whole. In certain defining respects the impact of the Enlightenment of the eighteenth century was felt uniquely in the closing decades of the twentieth, in effects good and bad. The effacing of religious discourse from the public square, and the steady fragmentation of the professions under the reductionist pressures of economic and other social forces, show this delayed impact in contexts that have radically shaped the possibility of a bioethics rooted in the Christian vision of the western tradition. If religion is removed from the metaphor of public affairs, it is only in translation that the Christian worldview retains any opportunity to shape the public institutions of the culture. The predicament of Christianity in bioethics at the cusp of this third millennium C.E. lies precisely here. Yet at the same time, the subject matter of bioethics could hardly be of greater moment to those who hold the Christian view of the world.

The core question of which every bioethics issue is ultimately derivative is that of human nature. The vision of human beings defined by their creation in the image of God sets the Christian agenda, to be addressed within public and professional contexts in translation. As has been somewhat ruefully observed (Verhey and Lammers), the exercise of translation has itself led to the marginalization of religion. Stephen Lammers notes it at the micro level: The ubiquitous hospital ethics committees, often established under the tutelage of chaplains or other religiously-motivated professionals, immediately take their place in the secular institutional life and language of even religious hospitals. At the macro level, as the ebb tide of the sea of faith runs fast, it has become standard practice to translate Christian moral argument into secular language for public purposes. As a communications strategy in a changing culture, this is perhaps as inevitable as it is estimable. Yet the strangely invidious position in which it places the Christian religion has profound consequences for Christian engagement in bioethics. So it is worth exploring at more length the dynamics of bioethics on "Dover Beach" (Matthew Arnold's elegy on the collapse of the Victorian age of faith).

History of Bioethics

The half-century history of bioethics is emblematic of the relations of Christianity and the culture of the west. Arising as an interdisciplinary field in the aftermath of World War II, still in its old name of medical ethics, it focused the new ethical uncertainties of the generation of Joseph Fletcher. The promulgation of the Declaration of Helsinki by the World Medical Association (WMA) was intended to re-assert Hippocratic medical values as the foundation for the reconstruction of medicine in light of the Nazi horrors revealed in the so-called "Doctors' Trial" at Nuremberg. Yet its supplanting of the Oath (a pagan document that was nonetheless powerfully theistic in orientation and had long sustained the theological ethics of the Western medical tradition) with a Declaration (that could of course be revised by vote, as it would be in response to liberal abortion) set the scene for the reconstruction of medical values on fresh, open-ended, terms. Powered by the continuing cultural weakness of the Christian religion and a succession of new scientific and technical achievements (and corresponding dilemmas) in medicine in the second half of the twentieth century, bioethics has emerged as the quintessentially ambiguous gift of the church to a culture struggling to free itself from the entailments of Christendom. The general failure of a Christian bioethics to take hold even within the churches and their educational and medical affiliates has led to a blending of religious and secular in a manner that, for all the good intentions of religious contributors, has tended to extinguish their distinctive character and give primacy to the secular debate and its categories. Thus the most prestigious American graduate program in bioethics is located at an institution of the Society of Jesus (Georgetown); yet its programmatic importance for the development of the discipline is focused in its advocacy of the principlism epitomized in Tom Beauchamp and James Childress's influential Principles of Biomedical Ethics , the embodiment of secular bioethics.

In Europe, by contrast, where the pattern of religious observance is in general substantially lower than in the United States, Christian participants in the bioethics community tend to be more distinctive in their approach, and in turn the community more accepting of religious perspectives. For example, the Roman Catholic university of Louvain (in the Netherlands) is overtly religious and theological in its approach; and the European Association of Centers of Medical Ethics, the major institutional network, includes a significant minority of explicitly Christian institutions, Catholic and Protestant. The explanation of this contrast lies in wider European–United States differentia, including assumptions about church–state issues and the public legitimacy of religious speech, and the more tradition-conscious nature of European debate, in which medical ethics remained for a generation the default term and bioethics was often noted as an Americanism; though the Council of Europe established in the 1980s an Ad Hoc Committee on Bioethics (CAHBI), its major fruit was the European Convention on Human Rights and Biomedicine (a favored European term). In parallel, in Europe the continuance of the idea of bioethics as an interdisciplinary field, in which theology is a legitimate participant, can be observed; this stands in marked contrast to the increasing specialized and reductionist approach to bioethics in the United States as a secularized quasi-discipline of its own.

The magisterium has given clear guidance to faithful Catholics on many of the questions of bioethics, but there has not emerged a major school of Roman Catholic writers within or even over against the bioethics community. By the same token, the substantial growth of conservative Protestantism in the United States during this period, despite its influential political stance on the question of abortion, has failed to initiate a commensurable intellectual movement in bioethics. The tendency of Protestant and Catholic participants has been to aggregate themselves to the secular bioethics mainstream, as they have played their own ironic part in the marginalization of the dominant tradition of western medical ethics (their own). Harder to explain is their failure to develop in parallel serious centers of intellectual gravity for their distinctive bioethics agendas, especially in the United States. This is more surprising in the case of the Roman Catholic church, possessed as it is of research universities and an extensive system of hospitals that have generally maintained stronger connections with their Catholic roots than their Protestant equivalents. As Albert R. Jonsen comments, even "theologically trained bioethicists … remain, in their bioethical analyses, outside the faith" (p. 58).

Christian Theology and Bioethics

From its beginnings, Christianity has displayed an interest in questions of health and healing that has verged on preoccupation. The gospels tell the story of one who went about doing good often in the form of miraculous interventions in the form of healings (throughout the Gospels) and, in certain cases, resurrections (e.g., Lazarus). In the ensuing story of the church the care and healing of the sick has had a special place, and medical missions have often been at the heart of the church's missionary thrust. In light of what is often taken to be a Christian focus on the life to come and the transitory nature of life in this world, this enduring theme of Christian service to health here and now may seem curious. Though Christian traditions have differed markedly in their approach to miraculous healing understood as a spiritual gift—denied absolutely by some, ignored by many, practiced as central to their faith within the Pentecostal and related traditions—the practical focus on medicine and nursing has led to the development of major hospital systems in the United States as well as mission hospitals in many centers of the developing world. Jesus's ministry focus on healing, evidence of miraculous healing in the early church, and the fact that much of the New Testament (Luke, Acts) was written by a physician, lie in a theological context that is not widely understood but sets the place of medicine at the heart of the Christian vision. Within orthodox Christian theology, explicated first and most fully in the Pauline corpus in the New Testament, the origins of human death and the disease that presages mortality are treated as fundamentally unnatural, the consequence of divine judgment on human sin (Romans 5). By the same token, among the benefits of the new order in Jesus Christ, who has stood in as representative and substitute and taken our death penalty as his own, will come not simply the resurrection but, specifically, the redemption of the body (Romans 8) as the final undoing of sin and its dire effects. This readily explains the focus on healing, as anticipatory of the final redemption; and the dramatic resurrections even of those who would die again like Lazarus. Whatever else these statements mean, they serve as object lessons in the faith that grant a sampling of the kingdom that is to come.

Behind these concerns lies the question that is emerging with increasing candor as the subject matter of contemporary bioethics conversation, the nature of human being. Within the Judeo-Christian tradition the answer has been unambiguous and, in the context of Western culture, profoundly influential. Human beings are constituted by their bearing the divine image (imago Dei ), and from that fundamental fact flows their unique and inviolable dignity as persons. As the agenda in bioethics shifts from discussion of conditions under which human life may be taken (abortion, euthanasia, embryo experimentation, in the context of what we call here Bioethics 1) to our employment of the fresh manipulative powers that biotechnology is urging into our hands (cloning, inheritable genetic modifications, cybernetics—Bioethics 2), the relevance of this fundamental understanding grows markedly. Whether the churches and their theologian-ethicists will find it within themselves to rise to these immense challenges remains to be seen.

In light of the imago Dei question, and a historic commitment to the questions of sickness and healing, it is extraordinary that the distinctively Christian contribution to bioethics has, after an initial firm beginning, rapidly lapsed into a desultory state in which Christian and secular interpreters are generally indistinguishable; only a minority report offers trenchant engagement from within the "distinctive vision" of the Christian worldview. This is all the more surprising since the two most influential figures in the first generation of bioethics were theologians, who actually wrote explicitly theological ethics (from very different perspectives): Joseph Fletcher, whose innovative book Morals and Medicine (1954) framed the questions and sought radically fresh approaches in the 1950s, in effect seeking from the inside to subvert the Christian tradition at every key point and prepare the way for the post-Christian bioethics to come; and Paul Ramsay, whose work in the 1960s and 1970s set out a massive defense of Christian ethics even as he engaged the philosophy and emerging jurisprudence of his day.

As commentators have widely noted (Verhey and Lammers; Jonsen), the tendency has been for Christians writing in bioethics to be accommodated to the secular mainstream that since the waning of Ramsay's influence has set the tone for American bioethics. Across Catholic and Protestant thought alike we may note a spectrum of responses. At one end are writers who have essentially been absorbed by the categories and conclusions of the secular bioethics flow. In the center are others who while generally adopting the terminology of secular bioethics have sought to influence or restate it in terms that reflect Christian convictions; or, perhaps, to translate key components in the new bioethics into terms that are related to Christian theology. At the other end are those who take a classical approach from within the Christian tradition. While they sometimes use the public speech of secular bioethics, they are translating distinctively Christian ideas that are developed in explicit theological categories.

Throughout the second half of the twentieth century— from Joseph Fletcher on—much of the bioethics debate focused substantively on the question of the sanctity of human life (abortion, euthanasia, the use of human embryos in research, protocols for organ transplant, definition of death, scare resource allocation, and others), and procedurally on autonomy as the organizing principle of the new bioethics (centered on the role of the patient in decision making, and symbolized by the advanced directive and its culture of individualism in end-of-life choices). Indeed, the movement of bioethics has tended to be from substantive to procedural, and the bioethics literature is little focused on the rights and wrongs of such questions as abortion. The euthanasia debate, potentially of vast significance though on the sidelines of bioethics as a public policy concern, is encapsulated in the focus on physician-assisted suicide, which essentially turns substance into protocol. The sanctity of life, long the central feature of our civilization's medical values though seen by many in the bioethics community as perverse, is rarely a locus of bioethics debate; its central place in a Christian bioethics, stemming from the Judeo-Christian doctrine of the creation of human beings in the image of God, has had slight impact on the bioethics mainstream. Peter Singer's speciesist challenge—an upending of the image Dei that suggests it is as irrational and as unethical as racism—has evoked little Christian response.

The Future: Emergence of Bioethics 2

A similar spectrum of responses from those writing within the Christian tradition is already evident as the questions of Bioethics 2 begin to focus discussion. The advent of in vitro fertilization in the late 1970s heralded a developing agenda in which the focus would cease to be on the old clinical ethics with its dilemmas grouped around the sanctity of life and move to the new manipulative powers of biotechnology. However, one decisive difference is now evident. As a range of fundamentally new questions is raised for biomedicine and the human good, the Christian mind is one generation removed from the influence of Ramsey and still further from the older tradition of candid theological engagement with the earlier issues of bioethics. The prospect of cloning and germline genetic interventions, coupled with crucial policy issues focused in patent law, reveal the paucity of Christian resources since the fundamental questions of anthropology that are at stake in these debates have been comprehensively neglected by theologians and Christian bioethicists alike.C.S. Lewis's prophetic essay The Abolition of Man is widely quoted in the near-absence of more recent and more detailed theological reflection on what is widely agreed to be the most serious set of questions ever to have confronted the human race.

These unfolding questions raise the most profound concerns, both for the Christian understanding of human procreation and of human nature itself. The significance of such basic theological themes as the nexus of marriage/sexuality/family and the nature of human being itself are at stake, as the frontiers of the debate move from whether and when life may be taken to the logic of procreationreproduction and the manipulative capacities of biotechnology to re-make human nature. It is for Christians an open question whether it is worse for life that is made in God's image to be taken, or for life to be made in an image of our own devising, in a wholly fresh assault on the sanctity and dignity of human being. There is no greater need than for fresh exploration of the significance of both the imago Dei and the incarnation of Jesus Christ for our human nature in light of the new, emerging powers of biotechnology and cybernetics. The challenge to Christian theology is both to articulate the distinctive implications of the Christian understanding of human nature for Christians themselves, and then, with equal vigor, to translate that understanding into public terms, drawing on the common language and values of our cultural tradition and engaging in arguments from natural law. Christian thinkers have so far shown little appetite for either of these tasks.

nigel m. de s. cameron

SEE ALSO: Abortion, Religious Traditions: Roman Catholic Perspectives; Abortion, Religious Traditions: Protestant Perspectives; Death: Western Religious Thought; Ethics: Religion and Morality; Eugenics and Religious Law: Christianity; Double Effect, Principle or Doctrine of; Medical Ethics, History of: Europe; Medical Ethics, History of: The Americas; Population Ethics, Religious Traditions: Roman Catholic Perspectives; Population Ethics, Religious Traditions: Protestant Perspectives; Population Ethics, Religious Traditions: Eastern Orthodox Perspectives


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