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.

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