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Theological Medical Ethics: a Virtue Based Approach

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Theological Medical Ethics: a Virtue Based Approach Theological medical ethics: A virtue based approach Author: Hoa Trung Dinh Persistent link: http://hdl.handle.net/2345/bc-ir:104403 This work is posted on eScholarship@BC, Boston College University Libraries. Boston College Electronic Thesis or Dissertation, 2013 Copyright is held by the author, with all rights reserved, unless otherwise noted. BOSTON COLLEGE THE GRADUATE SCHOOL OF ARTS AND SCIENCES DEPARTMENT OF THEOLOGY THEOLOGICAL MEDICAL ETHICS: A VIRTUE-BASED APPROACH A DISSERTATION BY HOA TRUNG DINH S.J. SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY SUPERVISOR: PROF. LISA SOWLE CAHILL READERS: PROF. JAMES F. KEENAN S.J. PROF. DANIEL J. HARRINGTON S.J. SPECIAL ADVISOR ON EAST ASIAN THOUGHT: PROF. JAMES T. BRETZKE S.J. May 2013 © copyright by HOA TRUNG DINH 2013 ABSTRACT The Nuremberg trials ushered in a new era in which the four principles approach has become progressively the norm in Euro-American biomedical ethics, while the concepts of virtue and character become marginalized. In recent decades, the AIDS pandemic has highlighted the social aspects of health and illness, and the individualistic nature of the four principles approach proves inadequate in addressing the social causes of illness and poor health. At the global level, the promotion of the four principles approach as the universal norm can lead to the displacement of local values and customs, and the alienation of people from their cultural heritage. In this dissertation, I argue that although principles are indispensable, the virtue-based approach is more adequate in addressing these needs. The dissertation demonstrates that a virtue-based medical ethics informed by the gospel vision of healing would support models of health care that take seriously the social determinants of illness, and advocate action on behalf of the poor and the marginalized. At the global level, virtue-based medical ethics also allows the coexistence of the universal values and the local norms, and encourages cross-cultural dialogue. This dissertation develops a virtue-based medical ethics grounded in the Aristotelian teleological structure, and integrating insights obtained from the historical critical study of the healing narratives in Luke-Acts. It also provides a correlative study of the love command in Luke and the virtue of humaneness in the medical ethics of eighteenth century Vietnamese physician Hải Thượng Lãn Ông. The concluding chapter brings these elements together in a discussion of the work of the Vietnamese Catholic AIDS care network. Some points need to be made on my approach and methodology. First, my perspective on many issues in medical ethics has been shaped, to a significant extent, by my own experience as a physician who worked in Australia and Timor Leste. My primary concern in this dissertation is the role of the physician, and more specifically, the role of the Christian physician in the world of health care. In the following chapters, I defend the view that in today’s context, especially in the fight against the AIDS pandemic, physicians not only have a crucial role in patient care but also a leadership role for social justice on behalf of the most disadvantaged. Contrary to the common perception that virtue is largely individualistic, I argue that the virtue-based approach, built upon the Aristotelian structure and informed by Luke’s theological view of healing, strongly supports models of health care that take seriously the social determinants of illness and health, and advocates action on behalf of the poor and the marginalized. Second, I am a person of Vietnamese origin, and Confucianism has been a significant part of my cultural heritage. In today’s Vietnam, the force of globalization is working to promote the four principles approach (usually termed “principlism”), understood to be the Western biomedical model, as the norm for Vietnamese medical practice, while the Confucian values and virtues are being questioned. My work on Lãn Ông’s medical ethics, the first to apply the historical method to Lãn Ông’s texts, is a response to this tendency. Though I discuss both Aristotle’s virtue ethics and Lãn Ông’s virtue-based medical ethics, I use the Aristotelian structure as the framework for integrating the insights from Luke’s healing narratives, and I use Lãn Ông’s work for correlation. As will become clearer as the chapters unfold, the virtue-based approach does not try to resolve the differences between cultures and traditions, but highlights the distinctiveness of each, and calls for dialogue amidst diversity. i Table of Contents Acknowledgements ......................................................................................................................... v INTRODUCTION: VIRTUE IN MEDICINE ................................................................................ 1 Twentieth Century Developments in Virtue-Based Medical Ethics ............................... 6 Jesus' Healings in Luke and the Healing Art in Hải Thượng Y Tông Tâm Lĩnh ........... 15 A Vietnamese Confucian Physician on the Healing Art ............................................... 18 Theology in Cultural Context: Dialogue Vs Displacement .......................................... 23 Structure of the Dissertation ......................................................................................... 28 Chapter I: VIRTUE AND CHARACTER IN MEDICAL ETHICS ............................................ 30 1.1. INTRODUCTION: VIRTUE AND THE MEDICAL PROFESSION IN NORTH AMERICAN CONTEXT ............................................................................... 30 1.2. ON THE THEORETICAL GROUNDING OF MEDICAL VIRTUES ............ 36 1.2.1. JAMES F. DRANE: A PATIENT-ORIENTED VIRTUE ETHICS .......... 38 1.2.2. PELLEGRINO AND THOMASMA: A COMMUNITY-BASED APPROACH ............................................................................................................. 66 1.2.3. JAMES F. KEENAN AND THE GROUNDING OF THE VIRTUE OF JUSTICE ................................................................................................................... 84 1.3. THE RELATIONSHIP BETWEEN VIRTUES AND PRINCIPLES .............. 87 1.4. THE UNIVERSALITY VERSUS CULTURAL SPECIFICITY OF THE VIRTUES ...................................................................................................................... 93 1.5. CONCLUSION .................................................................................................. 98 Chapter II: JESUS' HEALINGS IN LUKE AND THEIR MORAL IMPLICATIONS ............. 100 2.1. THE BIBLE AND VIRTUE ETHICS ............................................................. 100 2.1.1. Through the Lens of Virtue Ethics - Joseph Kotva ................................... 100 2.1.2. Richard Burridge and the Imitation of Christ ........................................... 102 2.1.3. William Spohn and the Analogical Imagination ....................................... 103 2.1.4. Point of Convergence – The Imitation of Christ ....................................... 105 2.2. LUKAN TEXTS ON HEALING: AN INTRODUCTION .............................. 107 2.2.1. A Virtue Ethics Approach to the Healing Narratives ............................... 109 2.3. THE GOSPEL ACCORDING TO LUKE: SOME BASIC ISSUES ............... 111 2.3.1. Authorship................................................................................................. 111 2.3.2. Date of Composition, Setting and Purpose ............................................... 114 ii 2.3.3. Style, Structure and Themes ..................................................................... 115 2.4. JESUS’ HEALINGS IN LUKE: THE BACKGROUND ................................ 118 2.4.1. The Historical Context – Healing Practices in Jesus’ Time ..................... 118 2.4.2. Jesus’ Healings - A New Dawn in Human History .................................. 121 2.4.3. Inauguration of Jesus’ Ministry Luke 4:14-30.......................................... 123 2.4.4. The Poor and the Excluded in Luke .......................................................... 127 2.5. AN EXEGESIS OF LUKAN HEALING TEXTS ........................................... 131 2.5.1. Healing of a Leper – Luke 5:12-16 (Mk 1:40-45/Mt 8:1-4) ..................... 131 2.5.2. A Woman with a Bent Back Healed – Luke 13:10-17 ............................. 138 2.5.3. Cure of the Blind Man of Jericho – Luke 18:35-43 (Mk 10:46-52/ Mt 20:29-34) ................................................................................................................. 145 2.5.4. Healing the Servant of the High Priest – Luke 22:47-53 .......................... 150 2.5.5. Healing in Jesus’ Name: Cure of a Crippled Man at the Beautiful Gate – Acts 3:1-10 .............................................................................................................. 152 2.6. JESUS’ HEALINGS - IMPLICATIONS FOR TODAY ................................. 156 2.6.1. Luke’s Holistic View of Health and Healing ............................................ 156 2.6.2. Mercy, Compassion and Hospitality ......................................................... 160 2.6.3. The Imitation of Christ and the Interior Transformation .......................... 166 2.7. CONCLUSION ................................................................................................ 168 Chapter III: THE VIRTUOUS PHYSICIAN FROM AN EAST ASIAN PERSPECTIVE: VIRTUE IN THE MEDICAL TEXTS OF HẢI THƯỢNG LÃN ÔNG .................................... 170 3.1. INTRODUCTION ...........................................................................................
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