L OMA L INDA U NIVERSITY C ENTER FOR C HRISTIAN B IOETHICS UPD AT E JUNE 2011
CLINICAL BIOETHICS AND RELIGION : ROBERT ORR ’S MEDICAL ETHICS AND THE FAITH FACTOR
Review FORGING A PATH FOR CHRISTIAN ETHICS Daniel P. Sulmasy, MD, PhD
linicians and clergy alike deal with Cconcrete cases. Theological erudition 2012 Jack W. Provonsha can contribute to an understanding of Lecture opens the Alumni cases, and important cases can provide important feedback for theological theory. Postgraduate Convention Nonetheless, when the rubber of ethics Mark your calendar for Friday, March 2, meets the road, it is always traversing the 2012, when the Center for Christian Bioethics cobblestone of cases. presents the Jack W. Provonsha Lecture, Robert Orr has assembled an impres - “International Medicine and Human Rights .” sive array of concrete cases in this book. Dr. Gilbert Burnham, co-director of the Center Unlike most casebooks that are assembled for Refugee and Disaster Response at Johns by theorists and are designed to evoke con - Hopkins, will deliver the lecture. troversy and provoke debate, Dr. Orr’s Dr. Burnham has an extensive background cases are moral quandaries, not dilemmas. and experience in both national and interna - The book provides a compendium of the tional emergency preparedness and response, real cases that clinicians and patients com - particularly as it pertains to humanitarian needs monly face, and about which clergy are plexity, the drama, and the pathos of real- assessment, program planning and needs evalu - often asked to provide advice, whether as life clinical ethics. While adhering in each ation of vulnerable populations, and the devel - pastors or as chaplains. This collection is case description to a general need for opment and implementation of training thus extremely useful from the perspective brevity and employing a uniform structure programs. One of his current activities is the of practical pedagogy—because rather for ease of reading and cross-reference, Dr. reconstruction of health services in than posing intractable and unanswerable Orr describes the uncertainty regarding Afghanistan. problems, Dr. Orr presents cases for which diagnosis, treatment and prognosis, the All are invited to attend the lecture and the there really are best answers. disagreements among consultants, the panel discussion that will follow. Continuing I cannot overemphasize how valuable arguments among family members, the medical education (CME) credit will be offered it is that the cases he presents are drawn clashing of secular and religious world - for the lecture. More information will be com - from real clinical cases. They are not views, and the twists and turns that charac - ing, or you can contact the Center for Christian trimmed down to the bare abstract essen - terize real cases. So, for instance, in Bioethics at [email protected]. tials, but full of the uncertainty, the com - Please turn to page 2
Update • Volume 22, Issue 4 • Page 1 EDITORIAL in 1990, to Loma Linda University, a ance of the book coincides with his receiv - LET US NOW PRAISE faith-based health care univer sity. ing the Servant of Christ Award from the By the time he came to Loma Linda Christian Medical & Dental A G OOD MAN University, ethics had already become Associations. The focus on Robert Orr’s work in established and highly visible in the med - During the last two years, Dr. Orr has this issue of UPDATE honors both Dr. Orr ical school. Jack Provonsha, an MD, an again led clinical ethics at the Loma Linda and clinical bioethics carried out from a reli - ordained minister, and a PhD in ethics, had University Medical Center and helped gious perspective. Dr. Orr’s career is inter - created ethics courses on campus and held direct the Center for Christian Bioethics. It twined with bioethics, clinical ethics, the first Bioethics Grand Rounds in the has been a joy to know Bob both as a col - religious traditions, and Loma Linda medical school. With the help of two league and friend. This July, he completes University’s early involvement with all three. young PhDs in Christian ethics, David his second tour of service at the center and In his 1971 book Bioethics , the author Larson and James Walters, Dr. Provonsha moves to new responsibilities. Van Rensselaer Potter claimed that he had carried on informal consultations on clini - The center is delighted to devote this just invented a new word and a new acade - cal cases, establishing the Center for issue of its publication, UPDATE , to the mic discipline. Many of the early writers in Christian Bioethics in 1974. work of our distinguished colleague. We the field were theologians, such as Paul Dr. Orr’s arrival at Loma Linda are honored to include a review of his latest Ramsey, Albert Jonson, Richard University (LLU) from the University of book by one of the founders of both med - McCormick, and James Childress. Roman Chicago brought greater visibility to clinical ical humanities and bioethics, Edmund Catholics established the first two principal ethics. He became not only clinical co-direc - Pellegrino, MD, director of the Center for centers of bioethics in the United States: tor of the Center for Christian Bioethics, Clinical Bioethics and a former director of The Hastings Center, established by Daniel but also the first director of clinical ethics at the Kennedy Institute of Ethics, both at Callahan, and the Kennedy Institute of LLU Medical Center. For a decade, Dr. Orr Georgetown University, and a former pres - Ethics, begun by Andre Hellegers. Quickly, led an expanding number of formal ethics ident of the Catholic University of philosophers joined the discussions. consultations with physicians in the services America. Dr. Pellegrino is joined as a As early as 1973, a sub-specialty of the medical center, and he helped clini - reviewer by Daniel P. Sulmasy, MD, PhD, emerged. Mark Siegler and his mentor, cians and others earn MA degrees in bio - the present associate director of the Alvan Feinstein, both at the University of medical and clinical ethics. MacLean Center for Clinical Medical Chicago, developed the term “clinical During Dr. Orr’s first decade at Ethics at the University of Chicago, one of ethics,” to describe moral analysis a) Loma Linda University, and in the years Dr. Orr’s alma maters. focused on medical cases, and b) based on since, he has written and lectured widely. Dr. Robert Orr has enriched Loma “the nature and goals of medicine rather The most recent of his six books, Medical Linda University and the field of than from ethical theory based on philos - Ethics and the Faith Factor , not only draws bioethics by combining clinical and reli - ophy, theology, or law.” During 1989- on the theological resources that nurtured gious perspectives. 1990, a physician from New England, the beginnings of bioethics, but as its sub - Robert Orr, joined Dr. Siegler for a year’s title indicates, has been written as A Roy Branson, PhD study of clinical ethics. From there, Dr. Handbook for Clergy and Health-Care Director, Center for Christian Bioethics Orr, a lifelong churchgoer, went directly, Professionals . Appropriately, the appear - Loma Linda University
describing an agonizing case of a patient ing shows no blood flow to the brain, it Ethicists might call this high casuistry. with schizophrenia whose family wants to would be permissible to declare him brain Anthropologists might call it “think make him an organ donor, and who dead and proceed to retrieve the organs description.” I would characterize it the appears to meet all the criteria for brain even though he does not fit the letter of the cinéma vérité of bioethics. death save for the fact that he might still law’s definition for brain death. After this The book is divided into 15 chapters. have sedatives in his system—but knowing decision is made, however, we then find Chapters 1 and 2 describe the moral and that the time necessary for the effective that the deceased man is precluded from theological framework that Dr. Orr brings retrieval of organs would not permit wait - donating his organs because the transplant to the work of clinical ethics. In Chapter 15 ing for the drugs to clear from his system— team uncovers evidence that he might be he describes his view of the theological Dr. Orr argues that, in this case, since test - harboring asymptomatic tuberculosis. Please turn to page 3
Page 2 • Update • Volume 22, Issue 4 notion of the priesthood of believers and remarkably sensible approach the author scope of what I would call “biomedical” how this relates to his own work as a clini - takes to these cases. Assembled in these rather than what he calls “physiological” cal ethicist. The bulk of the book, consisting pages one finds a career’s worth of clinical futility even though we both reject the of Chapters 3-14, presents an astounding ethics consults, drawn from the experience qualitative or subjective standard of futility. array of medico-moral quandaries—134 of one of the masters of the practice. The But these are really quibbles around the cases in total. They run the complete gamut man himself comes through—subtly but edges, affecting perhaps three or four of the of topics, from artificial reproduction to clearly—in his compassion, his humility, 134 cases he presents. That’s not bad for pregnancy, neonatology, pediatrics, psychia - his integrity, his piety, and above all, his convergent validity! try, neurological disease, end-of-life care, wisdom. Dr. Orr is truly what Aristotle Dr. Orr’s book should prove extremely and organ transplantation. They also cover would call a phronimos—a man of great useful to the audiences he sets out to a wide range of technologies, from ventila - practical wisdom in the world of clinical serve—clinicians and clergy. But it might tors to dialysis to feeding tubes. ethics. The only disappointment for most also prove useful to family members and As he states, only a reviewer will be readers will be that they will have to rely on patients as well, struggling to make the right inclined to read this book cover to cover. It his book when they would rather have the decision when asking the “Should we?” is meant to serve more as a reference book man himself at their sides as a consultant. question. As medical progress provides an to be used to explore cases that might be The answers he provides are sound. ever-growing list of “we coulds,” the ques - similar to a situation the reader is currently He forges a path for Christian bioethics in tion of whether we should will loom even facing in clinical or pastoral practice. the secular world of U.S. medicine and law. larger in the future. This book provides The writing is clear and remarkably He and I might have a few very minor dis - sound guidance for navigating that future. free of jargon. Where necessary, he supplies agreements in the actual decisions he superb explanations of medical terms for makes. For example, Dr. Orr seems a bit Daniel P. Sulmasy, MD, pastors and of ethical terms for clinicians. more tolerant than I would be of assisting PhD, is the Kilbride- The six-page glossary is an excellent terminally ill patients who are still able to Clinton Professor of Medicine and Ethics and resource. And the case-index cross refer - eat in voluntarily stopping eating and associate director of the ence appendix will be key to the fruitful, drinking; he worries, but does not see the MacLean Center for practical use of the book. problems I see in surrogate motherhood; Clinical Medical Ethics One must be impressed by the and I would be a tiny bit more liberal in the at the University of Chicago.
Review A P ASSIONATE , F AITH -I NSPIRED PHYSICIAN –ETHICIST Edmund Pellegrino, MD
his is a handbook dedicated to assist - The author is more than amply qualified central question; 2) a case history; 3) a dis - Ting physicians, health professionals, for the task he has set himself. He has been cussion of the issues; 4) the author’s rec - and the general public—to all who must a respected contributor to the field of ommendations; 5) a follow-up of the make ethical decisions associated with Christian bioethics as teacher, practitioner, clinical course; and 6) a closing comment. medical and health care. The author’s and author for many years. Crucial points are often printed in bold - expressed hope is “… to assist people of The author has chosen a wide variety faced type. faith as they seek satisfactory resolution of of cases illustrating the major ethical chal - The author’s opinions are personal difficult ethical dilemmas.” lenges presented by serious illness in every and open to further discussion. They clearly The first two parts of the book pro - major organ system of the body, as well as reflect the author’s long and broad experi - vide synopses of the ethical and theological the neonatal period, children, pregnancy, ence as a compassionate, faith-inspired foundations on which the author grounds reproductive technology, organ transplan - physician-ethicist. He often expressed his his ethical analyses of the cases he presents. tation, and cultural and religious beliefs. opinions informally in such terms as “ethi - These two introductory sections occupy Each case is presented in clear, reader- cally appropriate, ” “e thically problematic, ” 29 of the book’s 483 pages, making this a friendly language, and analyzed in an “m orally obligatory, ” “a morally valid deci - casebook derived principally from the unusually orderly manner. Thus, each case sion, ”“ ethically troublesome, ” etc. author’s vast clinical and ethical experience. is discussed under six headings: 1) posing a Please turn to page 4
Update • Volume 22, Issue 4 • Page 3 The author’s faith commitment as a tion. These differences do not in any way This book will be valuable to clini - Protestant is set forth from the beginning. depreciate the value of a volume dedicated cians as well as bioethicists. The combina - There is little formal argumentation, how - to careful clinical and ethical analysis, one tion of careful ethical analysis, and ever. Reference to his particular Christian which could be read with profit by anyone unusually orderly discussion, with a foun - perspective is intermittent and more by indi - interested in careful ethical reasoning. dation in extensive clinical experience, rection than formal argument. The book A few suggestions for making this should be a valuable reference for all who can be approached for its impressive clinical book more useful seem to be in order: 1) an confront ethical issues in medical and wisdom and responsible ethical analyses, as index would make this case book more health care. well as its faith centered orientation. accessible as a ready reference for clinicians; This reviewer will make no attempt to and 2) closer connection between a particu - Edmund Pellegrino, subject the author’s case analyses nor his lar resolution and a particular case would MD, is professor emeri - ethical opinions to criticism. Many of his assist in clarifying the author’s reasons for tus of medicine and med - ical ethics at the Kennedy opinions would be congenial to this his recommendations. These reasons could Institute of Ethics and reviewer; others might not, particularly in advance his aim of assisting people of faith interim director, Center the sections relating to pregnancy, repro - to appreciate the way the author’s faith for Clinical Bioethics, at ductive technologies, or organ transplanta - commitment shapes his recommendations. Georgetown University.
Excerpts MEDICAL ETHICS AND THE FAITH FACTOR A Handbook for Clergy and Health-Care Professionals
Preface training, often focused on the fine art of be individuals whose primary training is in haplains, pastors, priests, rabbis, and prognosis. But the “Can we?” questions are another field (philosophy, law, theology) Cother people of faith frequently inter - often insufficient, and answers to these who have, in addition, some experience in act with individuals and families who are questions are often inadequate. or exposure to clinical medicine. facing life-threatening illness, chronic ill - Increasingly we must address the The ethicist, in an attempt to resolve ness, or disability. The conversations stimu - “Should we?” questions. Just because we can conflict or bring clarity to the ambiguous lated by such life events and conditions may use a ventilator to postpone death for a few questions, will often inquire about the per - include crucial questions of faith, God’s more hours or days in a man dying of lung sonal and religious beliefs of the patient. will, the meaning of life and death, and eter - cancer, should we? Are there other consider - This often leads to a recommendation to nity. Many believers are prepared for and ations —patient comfort, social interac - discuss the difficult value-laden question comfortable with such discussions. tions, spiritual matters —that might help to with the patient’s clergyperson or other However, these conversations often answer the various questions? Not infre - spiritual advisor. Many clergy are not fully include questions that make clergy and quently different individuals answer the informed on such ethical questions. Indeed, other people of faith distinctly uncomfort - “Should we?” questions differently, based on health care professionals themselves cannot able —questions they are not typically pre - their own experience or values. Health care be expected to keep abreast on all the ethi - pared to answer, such as: “Should we use a professionals are increasingly encouraging cal nuances relevant to such value-laden feeding tube for Mom?” “Is it OK if I stop patients and families to discuss these decisions. Their devotion, after all, is pri - dialysis and die?” “What should we do for “Should we?” questions with an ethics com - marily to the“Can we?” questions. our baby who is about to be born with life- mittee or a specialist in clinical ethics, who This book is intended to help fill the threatening anomalies?” “Dear God, what is often referred to as an ethics consultant, a information gap so clergy and health care should we do?” clinical ethicist, or simply an ethicist. professionals can become more comfortable These questions of ethics are usually Clinical ethics is a relatively new disci - with these questions in clinical ethics. The first posed to physicians and other health pline within medicine, generated primarily core message of the book is that questions care professionals. Physicians are usually by such“Should we?” questions. Those who in clinical ethics are not beyond the purview able to address the “Can we?” questions, serve as ethics consultants may be clinicians of religious leaders or health care personnel. which are generally questions of fact, laced (physicians, nurses, social workers) with In fact, they are manageable if you know the significantly with matters of experience and additional training in ethics. Or they may Please turn to page 5
Page 4 • Update • Volume 22, Issue 4 medical facts; if you know the principles of patients who have lost the capacity to do so; are generally given top priority. Scripture and of clinical ethics; if you know the use of advance directives; do-not-resus - Part IV includes five chapters that the values of the patient and his or her fam - citate orders; dealing with uncertainty; the focus on ethical issues encountered in ily; and in the Christian tradition, if you rely understanding that there is no difference patients of a specific age or condition on the leading of the Holy Spirit. between withholding and withdrawing (neonatal issues, other pediatric issues, It is not my intention that each reader treatment; conflict resolution; and more. pregnancy), or patients faced with deci - will serve as an ethics consultant. Rather, Chapter 2,“A Theological Foundation,” out - sions about the use of specific technolo - my hope is that the reader will become lines an approach to decision-making in gies (assisted reproductive technology, somewhat familiar with the clinical issues, clinical ethics that is consistent with teach - transplantation). will recognize the moral questions raised by ing in the three monotheistic faith tradi - In Part V, the chapter titled “The those issues, and will then be able to apply tions, including discussion of God’s Priesthood of Believers” explores ways that religious or spiritual tenets from his or her creation and sovereignty; the sanctity of family members, clergy, counselors, and own tradition to the pertinent questions. If human life; quality of life; free will; domin - friends can assist patients and families as this is accomplished, I believe the reader ion and stewardship; boundaries; caring for will then be of great assistance to patients, others; miracles; and more. “The ethicist, in an attempt to families, and clinicians. Part II will look at some of the more I am a Christian, and my faith is common issues encountered when a patient’s resolve conflict or bring clarity important to me. Some of the patients and life is threatened by failure of one or more families I have interacted with share my organ systems. Chapters 3 through 8 focus to the ambiguous questions, faith and beliefs. Some, however, are on different clinical issues that raise ques - will often inquire about the Christians whose teaching or beliefs are tions about what should be done when a somewhat different from my own. And a patient encounters failure of his or her heart, personal and religious beliefs significant percentage of the situations lungs, kidneys, gastrointestinal tract, brain, or of the patient.“ where I have been involved in ethics discus - mind. Of course, not all dilemmas in clinical sions, including many of the cases reported ethics are about life-threatening issues. in this book, involve people from different Woven into these chapters are also cases of they struggle with these difficult decisions, faith traditions or different cultures. nonlethal conditions in these organ systems emphasizing the priesthood of believers I believe the clinical information, the that often lead to ethics consultation. and the importance of prayer for God’s wis - principles, and precepts of clinical ethics Each of these chapters includes back - dom and peace. presented here are equally applicable in all ground information about the condition or The story in the introduction is true. these situations. I do not expect the reader treatment modality that will increase a non - Dave’s family has given me permission to to agree with each recommendation made professional’s understanding of the issues. share the story with pastors, students, and in every case discussed. But I hope that the In addition, each includes some discussion other people of faith in an effort to make a discussion that ensues will help clergy and of how personal values, professional stan - bit easier the journey through complicated chaplains, students and clinicians, profes - dards, legal precedents, and biblical perspec - dilemmas in clinical ethics. The other sto - sionals and laypersons, as they delve into tives may influence decisions in these cases. ries in this book are also true, or they are dilemmas in clinical ethics. The bulk of each chapter consists of several based on actual cases, sometimes represent - The introduction tells a personal story case discussions, each with a story, discus - ing a synthesis of two or more stories. about treatment decisions for a dear sion (ethical analysis), recommendations, However, names and some of the nonperti - friend—decisions that were exceedingly dif - follow-up, and comments. nent details have been changed to protect ficult, but at the same time remarkably easy. Part III (chapter 9) is about specific the identity of those involved. Part I will look at the foundations of ethical dilemmas that arise because of dif - It may be tempting for some readers to contemporary clinical ethics. Chapter 1, fering cultural or religious beliefs. An think that the resolution of these cases rep - titled “An Ethical Foundation,” gives a brief attempt is made in each case to understand resents “the answer,” since the reports are overview of treatment decision-making, the values and beliefs of the various individ - written by a person of faith. Let me refute including the role of ethics consultations. uals involved, and to identify common that notion right at the outset. I do not Principles, precepts, and precedents of clin - ground that might allow resolution of the claim any particular wisdom in these cases. ical ethics are described including patient dilemma or conflict. When compromise is I do believe that most were resolved in a autonomy; surrogate decision-making for not possible, the patient’s values and beliefs Please turn to page 6
Update • Volume 22, Issue 4 • Page 5 manner consistent with religious principles Most of the information in these references It is my hope that the content and for - as understood by the individuals involved at is of high quality and representative of con - mat of these discussions will assist people of the time. Some readers may disagree with temporary secular clinical ethics. Some of faith as they seek satisfactory resolution of the recommendations or with the resolu - the information or opinions, however, are difficult ethical dilemmas. Perhaps they will tion of the issue. In fact, I personally dis - not consistent with the theological founda - gain a better understanding of the clinical agree with the choices made by some of the tions addressed in chapter 2 of this book, situation. Even more important, I hope they patients, families, and professionals; I try to and some may even be in direct opposition. will gain an understanding of the moral point these out in the “Follow-up” or Such references are included to give the dilemma in light of the personal and reli - “Comment” sections of the case reports. My reader a better understanding of the depth gious beliefs of the patient, family, and pro - purpose in offering these examples is to and scope of modern clinical ethics. fessional. Most important of all, I hope the show that biblical principles, personal val - The glossary in appendix 1 is intended reader will come to a greater reliance on the ues, and denominational tenets play a vitally to define terms used in the text that may leading of the Divine in the given situation. important role in the resolution of difficult not be familiar to readers. The first time God bless. ethical dilemmas at the bedside. that terms, defined in the glossary, or their Most of these consultations were done cognates, are used in a chapter or case study, Introduction in secular hospitals. Some of the patients they are printed in the text in boldface type. t was one of those life-defining events were people of faith, some said they were Some unusual terms that are used only Ithat becomes indelible in your memory. not. Some of the health care professionals once or only in one chapter may not appear I had just returned from a Saturday morn - involved in their care were also people of in the glossary but are instead defined in the ing council meeting of the Vermont faith, but some were not. These reports text or in a footnote. Medical Society and my wife, Joyce, met me were written for the benefit of professionals, The case index in appendix 2 is a at the door. I could tell from the look on her patients, and families, regardless of their cross-reference tool to help readers find face that she had terribly bad news: “Dave cases with similar issues in various chapters. Pollock is critically ill in Vienna.” For example, while all cases in chapter 6 will Dave and I had been friends since col - “It was one of be about the use or non-use of artificially lege, more than forty years earlier. Our those life-defining administered fluids and nutrition, the issue families had been very close for many in a particular feeding tube case may be the years. I was his family physician and rac - events that interpretation of a written advance direc - quetball competitor for eight years when becomes indelible tive, or resolution of conflict between family our families lived in the same community. in your memory.” members, or a question of futility, or caring Joyce worked as his office manager for for someone with severe cognitive impair - those eight years. He had been involved in ment, or a host of other issues. The case international ministry with missionary index will allow the reader to find similar families for 25 years and was in Vienna to faith traditions. You will find few, if any, the - discussions and analyses in cases involving speak at a conference of Christian educa - ological terms or scriptural references in the differing diagnoses or treatment modalities, tors. The news was now fourth-hand, so I text of the consultations. But the discus - thus offering broader assistance. had to hope some of the details were sions and recommendations are designed to This book is intended to be a reference wrong: sudden abdominal pain; hospital - fit within professional and personal bound - book. While I would not discourage a goal ized; gallstone blocking his bile duct caus - aries of acceptable practice. of reading it from cover to cover, my expec - ing pancreatitis; stone successfully At the end of most chapters, I have tation is that people using this book will removed; unexplained cardiac arrest 36 listed other cases in the book that address read chapters 1, 2, and 15 for a foundation, hours later; successful resuscitation, but similar conditions or treatment modalities. and thereafter peruse or read chapters that now, another 12 hours later, Dave was These may be reviewed to expand the dis - are focused on specific clinical issues. unconscious, in the intensive care unit cussion of that chapter. I have also included Alternatively or in addition, the reader may (ICU), on life support. a few references at the end of most chapters find cases listed in the case index focused on What a mixture of responses. The that might be of value for readers particu - a specific problem. For this reason, many of optimistic doctor in me said,“Well, since he larly interested in that subject. Most of the the discussions in the case studies will be is on a ventilator, the doctors have probably references come from the secular literature repetitive or redundant, since a reader may given him heavy sedation and he’ll awaken 1 1 without specific focus on the faith factor. be reading only that one case. Please turn to page 7 . 9 k 2 j r d
Page 6 • Update • Volume 22, Issue 4 when it wears off.” The cautious clinical most difficult. I had alerted my closest pro - extreme hubris. ethicist in me said, “This does not sound fessional colleague before I left Vermont I got the idea and the courage to good. Betty Lou and their three children that I would probably be on the phone ask - undertake this daunting task while speak - will probably have some difficult decisions ing for his help. ing at a conference at West Virginia to make in the next few days.” The friend in At the same time, this was one of the me said,“I’ve got to get to Vienna.” easiest ethics consultations I have done. It took about 48 hours for me to The medical facts were clear and unam - “There are many rearrange my schedule and get to Dave’s biguous —there was virtually no possibility bedside. I cried as I hugged his family and that Dave would recover to a level of func - opportunities for conflict especially as I held Dave’s flaccid hand. We tion he would find acceptable. He had made of interest…Academic spent the next six days praying, talking with his personal preferences known, both in doctors and nurses, waiting for test results. writing and in conversation with his wife medical centers are The five of us talked, reminisced, laughed, and each of his three children. The stan - increasingly dependent and cried. We vacillated between hope and dards of medical ethics, though somewhat despair.“Our God is a great God. He can do different in Austria, had fairly clear bound - on industry support for what is humanly unexplainable.” “Dear aries of permissible options. And the five of God, what should we do?” “It is very, very us standing around Dave’s bed were united education.” rare for someone with this amount of brain in one Spirit, knowing he was poised to damage after a cardiac arrest to have any enter God’s presence. meaningful recovery.”“We can always hope.” Nine days after his cardiac arrest, he University in 1994. The title of the confer - I shared with them Vaclav Havel’s concept did just that. His condition deteriorated ence was “The Spiritual Dimension of of hope: “Hope is not the conviction that suddenly, and God made the decision the Illness, Suffering, & Dying.” Leaders in things will turn out well, but the certainty five of us were dreading. God took Dave medical ethics from these three monotheis - that things make sense, regardless of how home on Resurrection Sunday 2004. tic faith traditions were invited to share they turn out.” 1 We began our grief process. their perspectives on issues at the end of life. What was my role in this situation? As A Theological Foundation I left the conference exhilarated because I a physician, I explained to Dave’s family the riting this chapter seems like an came to realize that more foundational ele - mechanism of brain injury from lack of oxy - Wexercise of hubris —a nontheolo - ments unite us than divide us. What a gen, and how this has a much worse outlook gian trying to demonstrate to readers, many breath of fresh air! than brain injury from trauma. I was inter - of whom may have far more theological I suspect that my own Christian tradi - mediary and spokesperson between the training and expertise than he, that contem - tion will be visible between the lines here, family and the intensive care team and neu - porary clinical ethics has a unifying theolog - but my intent is not to be a Christian apol - rologist. As a clinical ethicist, I talked with ical foundation. Certainly there are many ogist or an evangelist. Rather, I hope to the family about Dave’s personal values and books written on this topic already, some of show that, in spite of significant differences previous conversations about his wishes in which are listed at the end of this chapter. I in our understanding of our relationship the event of overwhelming illness. He had would encourage you, the reader, to explore with and obligations to the Divine, we share clearly and repeatedly said he did not want those that come from your own theological some fundamental beliefs about who we are to survive with the aid of machines or tubes tradition. and how we should care for each other. if he would be permanently unable to inter - But I am going to try to do more than I have patterned the outline for this act with his loved ones. I also helped them that. I hope to show that the three chapter and borrowed some of the content understand how medical decision-making monotheistic faith traditions —Judaism, for it from the small book that came out of was somewhat different in Europe than in Christianity, and Islam —share some basic a 2004 Lausanne Forum in Thailand: the United States. As a friend, I kept deny - theological beliefs that are foundational for Bioethics: Obstacle or Opportunity for the ing this was really happening, hoping I our thinking about these clinical issues. Gospel? 1 While this small treatise comes would awaken from this horrible dream at This should help to focus our understand - from a Christian perspective, the points I any moment. ing of how this basic theological approach have chosen to underline here are generally Of the nearly 1,500 ethics consulta - differs from the nontheistic worldview that consistent with my understanding of tions I have been involved with in my sec - is so common in contemporary clinical Judaism and Islam in many regards. 1 1 . ond career as a clinical ethicist, this was the ethics. This is perhaps an example of Please turn to page 8 9 k 2 j r d
Update • Volume 22, Issue 4 • Page 7 What does it mean to be human? image, should offer protection and care to may allow suffering to bring glory to eople of faith believe that a divine the sick, the disabled, the very young, and Himself. People of faith may be able to PBeing —Yaweh, God, or Allah — the aged. intellectually accept these statements of created the heavens and the earth, and It is interesting and noteworthy that purpose in suffering, but let’s face it, no one specifically that He created humankind in the concept of the sanctity of human life is likes to suffer. His own image, the imago Dei . We may dif - not absent from a secular worldview. The In contrast, the secular worldview fer on our understanding of that concept, term is often used in a nontheistic context to almost always sees suffering as bad —and it and I don’t pretend to know exactly what it indicate the value of human life. In my way is. Though some may see some benefit in means. But it does seem clear that God of thinking, it is difficult to explain the gen - suffering (“no pain, no gain”), the majority views created humans as different from the esis of this understanding without invoking of secularists seek to eliminate all suffering. rest of creation. We have been given stew - the creation narrative. In fact, some discus - I believe the relief of suffering is noble, and ardship over the rest of His creation, and we sants of medical ethics from an atheistic per - in fact is part of the calling of the ministry are able to be in relationship with Him. spective recognize this difficulty. For of healing. At the same time, we must rec - example, Peter Singer calls the unwavering ognize that sometimes our efforts will be protection of human life“speciesism,” and he inadequate. Most people of faith believe “Occasionally suffering asserts that“progress” will not be made in the there is a limit here. In the process of reliev - public policy arena (e.g., on issues like ing suffering, we are not allowed to destroy is corrective, that is, as euthanasia) until the notion of the sanctity human life. of human life is eliminated. 4 C.S. Lewis says, pain is The quality of life God’s megaphone, a way The fall, suffering, and death he concept of the sanctity of human or centuries, philosophers and theolo - Tlife is inviolable from a theistic per - to get our attention. ” Fgians have struggled to explain the spective. But what’s all this talk about qual - presence of evil, suffering, and death in a ity of life? Many people of faith get hives world created by a loving and merciful God. whenever the phrase is mentioned. But A secular worldview does not, of My simple understanding is that it was not because the fall of humankind brought suf - course, consider the imago Dei , but rather intended, but was permitted by God. fering and death into the world, we must focuses on personhood. Proposed criteria God created humans in His own admit that individual human lives have for personhood have varied over the past image, placed them in an idyllic setting, and varying quality. Some have limited func - few decades, from the 14 characteristics of gave them dominion over His creation. But tional or intellectual capacities. Some have neocortical function proposed by Joseph the prospect of being like God proved to be chronic pain or suffering. In spite of this, Fletcher 2 to the single concept of self-aware - too tantalizing; temptation gave way to sin. each individual human life is of inestimable ness espoused by Michael Tooley. 3 This Adam and Eve disobeyed God. This worth because each bears the image of God. leads to the difficulty of defining which resulted in punishment from God —the It is very appropriate to be wary of dis - humans are persons and which are not, necessity to work by the sweat of one’s brow, cussions about quality of life. Secular ethi - which deserve protection and care, and the pain of childbirth, and the prospect of cists often use quality of life as the yardstick which do not. It may even allow some non - sickness, suffering, and death. Thus the the - to determine whether an individual’s life humans to be considered persons. istic worldview includes not only the sanc - should be preserved. They may espouse tity of human life, but the finitude of that someone who is severely demented, or The sanctity of human life human life as well. severely developmentally delayed, or has he imago Dei present in each human Suffering is allowed by God. It is not sustained severe brain damage, has such a Tis a gift from a loving Divine Creator. without purpose, however. Even though poor quality of life that society has no oblig - He considers human life to be set apart some suffer in vain, that is not God’s pur - ation to protect or even preserve that life. from the remainder of creation, to be pose. Occasionally suffering is corrective— One thing I think we can all agree on, sacred. And because of this, He has that is, as C.S. Lewis says, pain is God’s however, is that an individual’s quality of life enjoined us from shedding the blood of megaphone, a way to get our attention. is a subjective determination that only he or innocent human beings. Further, his love is Suffering may be developmental, to help us she can make. Repeated studies have shown extended especially to the weak and vulner - grow toward maturity, to make us more like that both professional and personal care - able, implying that we, too, as bearers of His Christ, or to draw us closer to Him. He Please turn to page 9
Page 8 • Update • Volume 22, Issue 4 givers underestimate the quality of life per - are recorded in their respective sacred scrip - omniscient and omnipotent. Translated ceived by the patient. tures. But do miracles still occur today? into the realm of clinical ethics, this would For some theists, sanctity of life always Some say yes, and some say no. mean that He ultimately determines trumps quality of life. This leads to what is Unfortunately, the words “miracle” or whether an individual lives or dies. called a vitalist stance —if it is possible to pre - “miraculous” are often trivialized so that Different traditions vary on the human serve life, it must be done, regardless of its phenomenal recovery from a serious illness component here. This raises the issues of quality. However, we must first recognize or injury or the use of a powerful new drug dominion and stewardship. that human life is finite. In addition, human is often incorrectly made to sound like a The fact that God gave dominion to lives have varying quality. One of the pressing supernatural intervention. Such occur - humankind implies His sanction of the sci - questions before us as we contemplate dilem - rences may be the wonderful application of entific enterprise including medical care, mas in clinical ethics is to try to determine medical knowledge, brought about by the when the quality of life is so low that there is diligent use of human intelligence, and no moral obligation to preserve that finite allowed by Providential grace, but they do “How does the health care life. I suspect we will not all agree on where not qualify as miraculous unless they truly professional respond when a patient, that line should be drawn, but let us at least defy human logic. Even this qualifier is sus - accept that we must try to draw the line. pect since human logic is admittedly limited or more often a family member, and imperfect. requests that treatment be continued The ministry of health care How does the health care professional and the hope of eternity respond when a patient, or more often a … because the family is praying for ivine love, mercy, and compassion family member, requests that treatment be and expecting a miracle? ” Ddictate that we, the bearers of God’s continued —treatment felt to be inappro - image, should reach out to care for those priate by the professional —because the who are ill and suffering. We should try to family is praying for and expecting a mira - prevent and alleviate the ills of the fallen cle? Should the response be different if the research, and the development of medical world. At the same time, we must realize professional is also a person of faith? technology. But the balancing tenet of stew - the limits of our current situation. We will A belief in miracles need not cripple ardship implies that we are responsible and not be able to eliminate suffering and death. the practice of medicine, nor even have a accountable for how we use our knowledge We still have to deal with terminal illness major impact on our decisions. A colleague and technology. We have liberty, but only and death, and do it as compassionately as once said to me, “God is not ventilator within the moral boundaries established by we can. But almost all theistic faith tradi - dependent.” The implication is that the the Divine. tions believe in an eternity with the Divine, patient’s life may be dependent on the use of Even those in medical ethics who do free from suffering and death. The pathway external support, but God’s omnipotence not seek the will of God recognize bound - and requirements vary, but the faithful can and sovereignty are greater than that. If He aries. They often say,“The ability to act does joyously look forward to paradise. decides that an individual should go on liv - not justify the action.” And they seek other Many people in health care and clini - ing, in spite of life-threatening illness and guidance to determine where those bound - cal ethics—even those who do not person - dependence on human technology, then He aries are or should be—for example, the ally hold a theistic worldview—respect is able to intervene in a supernatural way — accepted principles of beneficence (doing these beliefs when expressed by patients or without our help. This line of reasoning good), non-maleficence (doing no harm), families. Not infrequently, however, differ - may or may not give some solace to family and justice (treating people without dis - ences of belief system will lead to conflicts, members. It does not, however, satisfy those crimination). But far and away, the domi - often dealing with moral obligations or with few who believe that God will not perform nant principle in secular medical ethics hoped-for supernatural intervention in nat - a miracle unless that praying individual has today is autonomy—the patient’s right to ural events. sufficient faith to continue human efforts self-determination. Deferring to the will of awaiting God’s intervention. the individual rather than to the will of God Miracles allows the acceptance of some deci - ll three of the monotheistic faith tra - God is sovereign, but humans sions/procedures that are disallowed by Aditions support a belief in Divine have dominion and are stewards consideration of the other theological con - supernatural intervention in the course of ost individuals coming from a theis - cepts and precepts outlined above. For human lives. Specific instances of miracles Mtic worldview believe that God is Please turn to page 10
Update • Volume 22, Issue 4 • Page 9 Comparative and Historical Study of the example, relying on parental autonomy tice often goes on to focus on the protection Jewish Religious Attitude to Medicine and its might be seen by some to justify termina - of personal autonomy, and as we have dis - Practice. New York: Bloch, 1975. tion of a pregnancy because it has been dis - cussed above, the predominance of auton - Kilner, J.F. Life on the Line: Ethics, Aging, Ending Patients’ Lives and Allocating Vital Resources. covered that the developing fetus has Down omy is antithetical to a theistic worldview. Grand Rapids: Eerdmans, 1992. syndrome, whereas relying on the theologi - With these fundamental theistic pre - Lammers, S.E., Verhey, A. (eds.) On Moral cal concept of the imago Dei would be seen cepts in mind, let’s begin the walk through Medicine: Theological Perspectives in Medical Ethics 2nd ed. Grand Rapids: Eerdmans, by most to preclude such a decision. muddy water. Let’s look at some ethical 1998. dilemmas encountered by patients, families Meier, L. J ewish Values in Health and Medicine. Justice and health care professionals, and try to New York: University Press of America, ustice is a complicated issue with many apply some of the foundational principles of 1991. Meileander, G. Bioethics: A Primer for Christians Jperspectives and nuances. But for the clinical ethics and theology. 2nd ed. Grand Rapids: Eerdmans, 2005. sake of this discussion, let us define justice Organization for Islamic Learning. as getting what we deserve. Many faith tra - Introduction references “Encyclopedia of Bioethics: Islam.” Available at http://www.islamiclearning.org. See ditions include a concept of deserved pun - 1. Vaclav Havel, Disturbing the Peace (New York: Vintage Books, 1991). other articles on the Web site. ishment for those who do not seek God’s O’Rourke, K.D., Boyle, P. Medical Ethics: will or follow His commands. In the Sources of Catholic Teachings. Washington D.C.: Georgetown University Press, 1999. Christian tradition, we look beyond justice A Theological Foundation footnotes Rahman, F. Health and Medicine in the Islamic to God’s mercy (not getting what we 1. Bioethics: Obstacle or Opportunity for the Gospel? ed. R. Chia et al., Lausanne Tradition: Change and Identity. New York: deserve) and His grace (getting what we do Occasional Paper no. 58, Lausanne Crossroad, 1987. not deserve) for those who have sought and Committee for World Evangelism (2005). Steinberg, A. Rosner F. Encyclopedia of Jewish Medical Ethics. Jerusalem: Feldheim found personal redemption. 2. Joseph Fletcher, Humanhood: Essays in Biomedical Ethics (New York: Prometheus Publishers, 2003. From a secular worldview, justice Books, 1979). means treating equals equally, without dis - 3. Michael Tooley, Abortion and Infanticide crimination. This is certainly consistent (Oxford: Clarendon, 1983). Robert Orr, MD, CM, 4. Peter Singer,“The Sanctity of Life,” Foreign Policy, is associate director at with theistic teaching. But this view of jus - September-October 2005; available at the Center for Christian www.utilitarian.net/singer/by/200509--.htm. Bioethics at Loma CENTER Linda University and Theological Foundation References VIDEOS ONLINE director of clinical ethics Ashley, B.M., deBlois, J., O’Rourke K.D. at Loma Linda Healthcare Ethics: A Catholic Theological University Medical Center. Analysis , 5th ed. St. Louis: The Catholic Dr. Orr served as clinical co-director of the The Center for Christian Bioethics Health Association, 2006. Center from 1990 –2000. He returned to records all of its programs, in an Brockopp, Jonathan E. (ed.). Islamic Ethics of Life: Abortion, War, and Euthanasia . Loma Linda in 2009, again as director of attempt to provide them to as many Columbia: University of South Carolina clinical ethics and to direct a clinical ethics people as possible, whether they are on Press, 2003. fellowship. Other books Dr. Orr has been campus or not. Cahill, L.S. Theological Bioethics. Washington, involved with include: Aging, Death, and DC: Georgetown University Press, 2005. Here is a short list of some of the the Quest for Immortality (Grand Davis, J.J. Evangelical Ethics: Issues Facing the Rapids, MI, and Cambridge, UK: most recent programs … enjoy. Church Today . Phillipsburg, N.J.: William B. Eerdmans Publishing Presbyterian and Reformed, 2004. Company, 2004); Basic Questions on Is San Bernardino Going Up In Dorff, E.N. Matters of Life and Death: A Jewish Approach to Modern Medical Ethics. Healthcare: What Should Good Care Smoke: A Case Study in Include? (Kregel Publications; Grand Environmental Justice Philadelphia: The Jewish Publication Society, 2004. Rapids, MI; 2004); The Changing Face www.vimeo.com/16841068 Feldman, D.M. Health and Medicine in the of Health Care (Grand Rapids, MI: Jewish Tradition . New York: Crossroad, William B. Eerdmans Publishing Adventist Advocates 1986. Company, 1998); and Life and Death www.vimeo.com/12112281 Harakas, S.S. Health and Medicine in the Decisions (NavPress, 1990, Colorado Eastern Orthodox Tradition . New York: Springs). A revised edition was also Crossroad, 1990. Quid Pro Quo Vadis released in two volumes: Life and Death Relationships Between Academia and Hathout, Hassan.“Medical ethics: An Islamic point of view.” Available at Decisions (1996) and More Life and Industry—A Journey Death Decisions (1997) by Baker Book www.vimeo.com/9091591 http://www.islamonline.net. Jakobovits, I. Jewish Medical Ethics: A House, Grand Rapids, MI.
Page 10 • Update • Volume 22, Issue 4 First-place 2010 essay winner CLARITÁS WHITE COATS : PU RPLE PENS Gregory A. Lammert, School of Medicine, Loma Linda University
s developing health care profession - geon to use a small purple permanent Aals, we are constantly under pressure marker to identify the site on the patient’s to simultaneously be a “good student,” as body where he or she plans to operate, well as a “good doctor.” Those expectations prior to entering the surgical suite. While E SSAY C ONTEST can be daunting at times, but we do our this is principally done to ensure the proper best to succeed and to impress those that operating site, it also serves as a way to pro - undue pressure to go and mark the site as we train with. Medical students can be sub - vide discussion between the patient and asked. What makes this situation interest - jected to particularly intense pressure from the physician for any final concerns, ques - ing is that it violated the student’s con - attending physicians that act more like dra - tions, or comments. This is a practice that science; it was not his responsibility to goons controlling troops than benevolent has greatly reduced the number of mark the patient for surgery. Students are teachers of medicine. Thus, medical stu - improper operations and has markedly asked all the time to do things that might dents are at risk of facing situations where improved patient safety. A portion of the not seem like situations that warrant dis - we must act as “good students” but forget guidelines state that this marking must be cussion in a bioethics context, but it is that we must fulfill a duty to be“good doc - done by the operating surgeon or, at the important to understand potential issues tors.” This occurs when our own profes - very least, the senior resident on the team. that face medical students on a daily basis. sional standards of integrity, honesty, and In the busy department of surgery, time is This is a situation that violated both moral character somehow come into con - of the essence for surgeons, residents, and the integrity of the senior resident and flict with our daily duties. students. In an effort to save time, the stu - attending who asked the student to mark When most people think about dent in this example was asked to go locate the site, as well as the student’s integrity to “claims of conscience” the most poignant the upcoming patient in pre-op holding follow through with such a request. issue that comes to mind is that of abor - and mark the surgical site. Beauchamp and Childress suggest that tion. Several fellow students that I know On the surface, this student should be “integrity is the primary virtue in health have stated quite clearly that they do not jumping at the opportunity to aid the team, care” (Beauchamp, 41). The policing of our wish to ever be part of training or even individual integrity is manifested externally observe such a procedure. However, this a and internally as what we define as our topic that has such a plethora of emotion “The most important conscience. This would suggest that, if the attached to it that a discussion here would operating surgeon did not feel the need to last for numerous pages. I would argue that set of rights in this be present to mark the site, despite it being while the abortion debate is the classic dis - example is the rights of required, the conscience should have been cussion of opting out due to a claim of con - alerted that something was amiss. science, I find it to be a rather rare the patient. ” I find this lack of conscious objection occurrence, even in the life of a medical stu - to reflect negatively on the surgeon’s dent. I will share an experience that was integrity. Furthermore, this suggests that related to me this past summer that meet the patient, and help the surgery the student violated his own integrity. By prompted me to address issues of obliga - schedule run smoothly. All of these things agreeing to perform such a task, the stu - tions and rights, and when medical stu - make a “good student.” However, the stu - dent has outwardly expressed that he does dents should hold onto their integrity and dent relayed to me that he felt uncomfort - not have a conscious objection to marking not do something that they find to be able going to mark the site, as he knew that a surgical site, when he knew it was wrong objectionable. it was against the national patient safety to do so. This erodes his integrity at a very The story begins with a student that goals, even though the resident told him early level of professional development. was rotating through the surgery depart - that it was okay. Due to the power differ - This event is a perfect demonstration of ment at the VA hospital. The adopted ential that exists between residents and the battle between being a “good student” national patient safety goals state that it is students, the student complied. In this sit - and a “good doctor.” On one hand, the stu - standard procedure for the operating sur - uation, it is possible that the student felt Please turn to page 12
Update • Volume 22, Issue 4 • Page 11 dent wanted to helpful, while on the other, directly against each other. objections occur every day, and many of us was feeling pressure from the surgical team The most important set of rights in are conditioned to ignore them. For if we to be a “team player.” This desire to be a this example is the right of the patient. It mention them, we fear we are at the risk of team player can at times be in conflict with is the patient’s right to understand his or being a “bad” or “annoying” student who is what is truly best for patient. In this situa - her care, to understand the surgery, and not a team player. If you are labeled as not tion, I believe that the patient would be best to understand and trust that the surgeon being a “team player” on any medical ser - served by the operating surgeon marking will provide the best care. This begins vice, life becomes quite difficult and you the surgical site, not a medical student. with marking the surgical site. To have fear that your end-of-rotation evaluation Medical students are often pulled anyone else mark the site is doing a dis - might be at risk. between wanting to be a“good student” and service to the patient. I recognize that a In a field that is as competitive as being a“good doctor.” This is a unique situ - great majority of the time, there would be medicine, we are pulled between two ation that does not fit into a posi - no problem with the practice of having a ideals: being a “good student” and being a tive/negative rights framework, but it does medical student mark the site, is it worth “good doctor.” In an ideal world, these two fit into the frame of obligations. We are the risk of a “sentinel event,” of a wrong should never be in conflict. Thus, should told as medical students (usually from res - site/side surgery, for the attending sur - we just be a “good student” and mark the idents) that one of our main duties is to geon to save an extra few minutes to mark site as asked without question, or should work hard so the resident is able to go the site? we be a “good doctor” and openly express home more quickly. We try to do things Patients have come to expect high- that the attending surgeon fulfill his or her that make the resident’s day easier, and if quality health care, and we are in the busi - obligations and the rights of the patient? good patient care happens simultaneously, ness of providing a high-quality service. it is usually by some miraculous accident. Marking an individual for surgery is a Gregory Lammert is a On one hand, we are obligated to provide minor example in the vast array of claims of student in the School of high-quality, safe, effective care; on the conscience cases, but it is important to real - Medicine at Loma Linda University. other we are obligated by the physician’s ize that claims of conscience do not have to oath to respect our teachers and those that involve decisions of life and death, abor - came before us. This situation puts the two tion, or withdrawing care. Conscious
DENTAL ETHICS AT LOMA LINDA UNIVERSITY Titled “Engaging Students in Professional Identity Formation,” it has been proposed he Center for Christian Bioethics include a continuing education course, by Muriel Bebeau, PhD, University of Thas been involved with the American “Culture and Dental Ethics,” that was Minnesota, School of Dentistry, and Society for Dental Ethics (ASDE) since offered at A. Dugoni School, San Francisco, Marilyn Lantz, DDS, University of 2004. ASDE is dedicated to promoting August 12, 2011. Michigan. They will be joined in making ethical responsibility and conduct for den - ASDE will present its next course in presentations by medical colleague Kathy tal health care professionals. the individuals program of the professional Faber-Landendoen, MD, Upstate Medical The executive director for ASDE is ethics initiative at the America College of University. Anika Ball, MA, RDH, who received her Dentists annual session in Las Vegas, in For more information visit master’s degree in bioethics at Loma Linda October 2011.
Page 12 • Update • Volume 22, Issue 4 NON -V IOLENT REVOLUTION : B LESSED ARE THE PEACEMAKERS Roundtable discussion at Loma Linda explores ethical paradigms for peace and war
ore than 200 people in were in atten - Mdance for the roundtable presentation, “Non-Violent Revolutions: Blessed are the Peacemakers,” led by Roy Branson, PhD, direc - tor of the Center for Christian Bioethics. The roundtable began with Glen Stassen, PhD, the Lewis B. Smede Professor of Christian Ethics at Fuller Theological Seminary. He outlined Left to right: Ayman Ibrahim, PhD candidate; Najeeba Sayeed-Miller, JD; Roy Branson, PhD; Glen Stassen, PhD; Mumtaz Fargo, PhD; and David Augsberger, PhD the 10 practical steps for Glen Stassen, PhD “Just Peacemaking: The is founder and director of the Center for throughout the Middle East. New Paradigm for the Ethics of Peace and Global Peacebuilding at Claremont School David Augsberger, PhD, professor of War.” The two standard ethical paradigms of Theology. She has also seen firsthand pastoral care and theology at Fuller for the ethics of peace and war are pacifism the results of just peacemaking in her inter - Theological Seminary, opened his remarks by and just-war theory. They focus on debat - national experiences at The Hague, in the recalling a conversation he had with H .M.S. ing whether or not a war is just. Every one Netherlands, and locally between gangs in Richards. According to Dr. Augsberger, of the 10 practical steps of just peacemak - the streets of Pasadena. Pastor Richards identified Adventist atti - ing, Dr. Stassen argued, have proven effec - Ms. Sayeed-Miller said that according tudes toward war with those of the peace tive at preventing wars and making peace. churches such as the Mennonites. Dr. With the groundwork of just peace - Augsberger emphasized that one who is rad - making laid, the panelists discussed its ically committed to following the teachings of involvement in peacemaking, starting with just peacemaking could encounter persecu - the most recent occurrence of struggling tion—persecution as suffered by Jesus. peace, Egypt. As a member of the Coptic Dr. Branson started the question-and- Orthodox Church, Ayman Ibrahim (a PhD answer period of the panel by asking Dr. candidate at Fuller Theological Seminary), Augsberger, a theologian in a peace church, Ayman Ibrahim, PhD candidate (left); spoke with passion about the February Najeeba Sayeed-Miller, JD (right) if he thought just peacemaking was really a 2011“Twitter revolution” where the citizens third way to peace—a genuine alternative of Egypt let the world know they were tired to the Prophet Mohammad, “The greatest to both the pacificist and the just war tradi - of decades of authoritarian rule. jihad is speaking truth in the face of an tions. Dr. Augsberger thought that it was. Despite reports of military overreac - unjust ruler.” And that, she argued, is what Just peacemaking is teaching the world to tion, the “revolutionaries” manned their has happened in what has been called the do peace better by avoiding the debate of phones, computers, and tablets to advance Arab Spring. Citizens gathered for non- whether a war is justified or not, and dis - democracy, human rights, and religious lib - violent demonstrations and protests cussing peacemaking instead. There needs erty via non-violent action, enacting two of throughout the Middle East. to be dialogue, he insisted, among all, and the principles of just peacemaking. Mumtaz A. Fargo, PhD, professor an acknowledgement, too, of what we have Najeeba Sayeed-Miller, JD, assistant emeritus of history at Montana State done to create the problem. professor in interreligious studies, and University –Billings and an expert on The audience members were then senior advisor for Muslim relations at United States policy in the Middle East, invited to pose questions to the panelists. Claremont School of Theology, spoke on gave a brief overview of the Ottoman You are invited to watch the entire pre sen - the tradition of peacemaking in the Empire. He mapped out the timeline of the tation including the questions and answers Muslim religion. Ms. Sayeed-Miller’s work Ottoman Empire and how that relates to online at
Update • Volume 22, Issue 4 • Page 13 CONVERSATION WITH AUTHORS
he center will continue T“Conversations with Authors,” hosted by David Larson, PhD, this com - ing 2011 –2012 school year. The first of the school year, October 1, will feature Richard Rice, PhD, author of The Openness of God , a book that launched a theological movement within evangelical Christianity in America. The sessions will take place six weeks apart at 3:00 p.m. Saturday afternoons, in a 98-seat amphitheater (3111) within the LLU Centennial Complex. During the 2010 –2011 school year, death for a few days, should we? Johnson, a fellow Norwegian philoso - the Center for Christian Bioethics pro - The next conversation, February 12, pher, and theologian; Graham Maxwell, duced and recorded five hour-long 2011, featured Bernard Taylor, PhD , the whose lectures he heard during medical “Conversations with Authors.” Dr. scholar-in-residence at the Loma Linda school at LLU; and Richard Hayes, a Larson, a founder and former director of University Seventh-day Adventist New Testament scholar at Duke the center, and a professor in the LLU Church and a professor at LLUSR. Dr. University. School of Religion (LLUSR), created Taylor is a world authority on the The most prolific author at LLUSR and hosted the conversations. Dr. Larson Septuagint , a commentary on the Hebrew is its dean, Jon Paulien, PhD . Dr. Larson makes each conversation feel like a fire - Scriptures. In 1994, he authored the first invited Dr. Paulien on June 4 to briefly side chat by asking authors about them - Analytical Lexicon to the Septuagint . An describe the volumes he has contributed selves as well as their writings. He invites expanded version of his lexicon was pub - to commentaries of the Bible—particu - the audience to also pose questions to the lished in 2009. In it, Dr. Taylor analyzes larly the book of Revelation—and his author. the form of every Greek word in the books explaining the Bible to informed In the inaugural conversation, Septuagint. Dr. Larson not only led Dr. laypersons. Many of the books have been December 4, 2010, Dr. Larson asked Taylor into describing the staggering translated from English into a variety of Robert Orr, MD , associate director of work of creating the computer program languages. Dr. Larson elicited from Dr. the Center for Christian Bioethics, what that made his lexicon possible, but he also Paulien that he actually enjoys the with - inspired him to write Medical Ethics and made certain the audience learned what drawal from administrative and family the Faith Factor , a clinical ethics hand - sort of person combines landmark schol - responsibilities that writing requires. book for clergy and health care profes - arly achievement with pastoral care. In the final conversation of the sionals. Dr. Orr revealed that he had been The conversation on April 23 was school year, June 18, Dr. Larson carried the first physician invited by the C.S. with a New Testament scholar and social on spirited exchanges with his long-time Lewis Foundation to be a scholar-in-resi - activist who is also a physician: Sigve friend and fellow-ethicist Charles dence at The Kilns, the former home of Tonstad, MD, PhD , an associate profes - Scriven, PhD , president of Kettering one of the most widely read Christian sor at the LLUSR. Dr. Larson spot - College of Medical Arts. A prolific essay - apologists in the English language. Dr. lighted Dr. Tonstad’s books exploring the ist and lecturer, Dr. Scriven was happy to Orr seized this unique opportunity by two convictions captured in the name focus on his latest book, The Promise of writing six hours a day. At the end of Seventh-day Adventist—his recent vol - Peace . He was clearly delighted that Dr. three months at The Kilns, he had writ - ume The Lost Meaning of the Seventh Day Larson appreciated the style of this ten 12 of the book’s 15 chapters. Dr. Orr and his earlier book, Saving God’s work—non-technical, yet profound. Dr. said that in his book he focused on those Reputation, that draws on Dr. Tonstad’s Larson quoted from memory a phrase questions he categorized as “Should we?” scholarship on the book of Revelation. recurring throughout the book: “We live, questions. Just because we can use inter - Dr. Larson also drew Dr. Tonstad into all of us, in the space between our dreams ventions (i.e., a ventilator) to postpone reflections on mentors, including Carsten and disappointments.”
Page 14 • Update • Volume 22, Issue 4 CENTER FELLOWS SERVE LLUMC Clinical ethics consultants represent the institution well
ina Mohr, MD, director of palliative Gcare, as of July 1, also assumes the directorship of the clinical ethics consulta - tion service at Loma Linda University UPD AT E Medical Center (LLUMC). Dr. Mohr JUNE 2011 completed two years as a fellow of the Center for Christian Bioethics, working DIRECTOR under the supervision of Robert Orr, MD, Roy Branson associate director of the center, and the Pictured left to right: Marquelle Klooster, Tae ASSOCIATE DIRECTOR Robert Orr founder and director of the clinical ethics Kim, Katja Ruh, Robert Orr, and Grace Oei EDITORIAL ASSOCIATE service at LLUMC. Dustin R. Jones At a graduation dinner held June 9, care of a particular patient. Consultations ADMINISTRATIVE 2011, in the home of Carolyn and Ralph result in a written report describing the COMMITTEE Thomson, MD, longtime supporters of the medical condition of the patient, the eth - Jon Paulien— Chair Brian Bull—Vice Chair center, Dr. Orr handed each of the fellows ical issues raised by the case, and the Becky Bossert certificates for completing their two-year judgment of the consulting physician- Roy Branson fellowships. During that time, fellows had ethicist. The director of the service works Beverly Buckles Ron Carter attended bi-monthly seminars, partici - closely with each consultant and chairs Garry FitzGerald pated in weekly case conferences, delivered the weekly case conference, which reviews Richard Hart Billy Hughes bioethics lectures, and written a scholarly each report. At each case conference, a Craig Jackson article. confidentiality pledge is signed by each Odette Johnson President Richard Hart, MD, attendee, which sometimes include Leroy Leggitt Tricia Penniecock DrPH; Provost Ron Carter, PhD, Vice LLUMC physicians and administrators Carolyn Thompson President Gerald Winslow, PhD; other trained in bioethics, ethics professors Gerald Winslow leaders of LLU, and members of the from the School of Religion, university Anthony Zuccarelli board of the center congratulated the fel - attorneys, and medical and graduate stu - SCHOLARS lows and thanked Dr. Orr for his many dents studying bioethics. Roy Branson—Director Ivan T. Blazen years of nurturing clinical ethics at LLU. • Issues that can lead to requests for Mark Carr He is stepping down from both the center ethics consultations include: Debra Craig and the clinical ethics consultation service • Decision-making for a possibly Andy Lampkin David R. Larson to assist Dr. Winslow in a new clinical incompetent patient who lacks a Robert Orr—Associate Director bioethics consulting project. family or designated surrogate. Richard Rice In addition to Dr. Mohr as director, • Decisions about limitation of James W. Walters Gerald R. Winslow Dr. Tai Kim will be associate director of treatment. the clinical ethics consultation service and • Interpretation of written advance lead the LLU School of Medicine clinical directives (i.e., durable powers of ethics elective course offered to fourth-year attorney for health care, and living medical students. Dr. Marquelle Klooster wills). For more information, contact: and Dr. Katja Ruh will also continue as • Management of infants born with E-mail: [email protected] members of the consultation service. Dr. life-threatening anomalies. Website: bioethics.llu.edu Grace Oei will concentrate on completing • Clarification of ethical issues in Phone: (909) 558-4956 her pediatric intensive care fellowship. conflicts among health care FAX: (909) 558-0336 Health care providers at LLUMC providers, patients, or family mem - Letters to the editor may ask the clinical ethics consultation bers regarding possible courses of and comments may be sent to: 24760 Stewart St., Loma Linda, California 92350 service for a consultation involving the treatment.
Update • Volume 22, Issue 4 • Page 15 NONPROFIT ORG. U.S. Postage PAID Tecumseh, Michigan 11234 A NDERSON STREET Permit No. 12 LOMA LINDA , C ALIFORNIA 92354
Change Service Requested
How to Support UPDATE ONLINE
The success of the center is YOUR The center is going green and saving money at the same time! If we success. It is your support, your energy, your foresight, and your long-range vision can send UPDATE to you via e-mail rather than snail mail we can save that we celebrate each and every day. For this we thank you and for your continued trees and fossil fuels in the publication and transportation of UPDATE , contributions to the center. Here are some activities you have and we will save money in publication and postage costs. Just send us an helped support: • Conversations with Authors e-mail at [email protected] and we will add your name to the electronic • Publication of Jack W. Provonsha essays (being compiled and edited mailing list. No waiting at the mailbox for your next issue. by David Larson, PhD) • Publication of 2008 Jack W. E-mail your first and last name to [email protected]. It’s that simple. Provonsha Lecture Series, Moral Status of the Human Embryo • Roundtables • Thompson Ethics Library • UPDATE Please feel free to contact the Center for Christian Bioethics at [email protected], or (909) 558-4956.