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On Miracles and Medicine: Negotiating View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Vanderbilt Electronic Thesis and Dissertation Archive ON MIRACLES AND MEDICINE: NEGOTIATING RELIGIOUS VALUES AT THE END OF LIFE By Trevor M. Bibler Dissertation Submitted to the Faculty of the Graduate School of Vanderbilt University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY in Religion December, 2014 Nashville, Tennessee Approved: Larry R. Churchill, PhD Victor A. Anderson, PhD Dr. Keith Meador Elizabeth Heitman, PhD Copyright © 2014 by Trevor M. Bibler All Rights Reserved ii To my family and all the people I love. iii ACKNOWLEDGEMENTS I owe a great debt to all of the scholars and teachers who have helped me become the person I am today. Faculty from the University of Northern Iowa’s Department of Philosophy and World Religions showed me the importance of critical thinking and historical understanding. The faculty at Vanderbilt Divinity School showed me how to ask good questions. And members of my dissertation committee reminded me that answering questions—or, at least trying to answer questions—requires not just careful thought, but nerve as well. I am also grateful for the love and support my wife and family have given. I can tell that they love and care about me. Every day I think about them. I have also been fortunate to make a number of great friends while in Nashville. I owe them thanks too. Whatever value this dissertation has is due to these remarkable, loving, and supportive people. iv TABLE OF CONTENTS DEDICATION.............................................................................................................................. iii ACKNOWLEDGEMENTS ........................................................................................................ iv INTRODUCTION...................................................................................................................... viii Orienting Questions and Objectives .................................................................................. ix Overview ............................................................................................................................ xi Methodological Commitments ..........................................................................................xv The Meaning and Use of “Miracle” in Clinical, End-of-Life Settings ........................... xxi Appealing to Philosophy of Religion ................................................................. xxii Appealing to Historical and Constructive Theology ........................................ xxiv Appealing to the Bible .................................................................................... xxviii Appealing to Etymology .....................................................................................xxx Appealing to Scientific Methods ..................................................................... xxxii Appealing to an Anthropological Analysis ..................................................... xxxiv Appealing to Methods in Pastoral Care ............................................................xxxv Appealing to the History of Medicine ........................................................... xxxvii Appealing to Quantitative Data ...................................................................... xxxix Appealing to Clinical Experience and Common Sense ....................................... xli A Concluding Thought .................................................................................................... xlii Chapter I. RESPONDING TO MIRACLE LANGUAGE: A CRITICAL REVIEW ...................1 An Orienting Example: Mrs. O’Shay .................................................................................2 Epistemic Inquiry ................................................................................................................3 Theological Negotiation ......................................................................................................8 Spiritual Assessments .......................................................................................................16 Table I.1. Maugan’s SPIRITual History ...............................................................18 Table I.2 Puchalski’s FICA ...................................................................................18 Table I.3 Pargament’s Brief RCOPE ....................................................................20 Empathetic Imagining .......................................................................................................23 Appeals to Professional Values ........................................................................................30 Respectful Rejection .........................................................................................................38 Concluding and Transitioning............................................................................................41 II. INTERROGATING AND EXCAVATING THE PRACTICAL RESPONSES .......43 The Clinical Imagination ..................................................................................................44 Epistemic Questioning: Foundational Ontological and Epistemic Values .......................46 v Well-Being and Self-Determination: On the Values and Duties that Found the Clinical Imagination’s Response to Miracle-Invocations ..............................................................54 The Duty to “Do No Harm” and the “Conscience Clause”: Two Arguments that Perpetuate the Futility Debate ...........................................................................................66 The Images of God Found in “Theological Negotiation” and “Spiritual Assessments” .............................................................................................77 Hollowness and the Skills and Knowledge Found in “Empathetic Imagining” ................90 The Two Central Concerns of “Respectful Rejection” .....................................................94 Concluding and Transitioning .........................................................................................101 III. ST. AUGUSTINE: A KEY TO UNLOCKING THE RELIGIOUS IMAGINATION ............................................................................................................103 Augustine’s Moral Ontology: Placing God at the Center of the Good Life ...................105 Diagram III.1. Augustine’s Scheme of Goods ....................................................108 From Ontology to Belief in Things Not See ...................................................................111 In What Should the Christian Faithfully Hope? ..............................................................115 Love of God and Charity (caritas) ...................................................................................118 From Morals to Miracles .................................................................................................121 St. Stephen’s Relics and Their Effect on Augustine’s Miracle-Concept ........................124 Making it Explicit: How Augustine Illuminates Clinical Miracle-Invocation ................128 Concluding and Transitioning .........................................................................................134 IV. A TAXONOMY OF MIRACLE-LANGUAGE: THE WORKINGS OF RELIGIOUS IMAGINATIONS ..................................................................................136 Diagram IV.1. Taxonomy of Miracle-Language ............................................................137 Returning To Mrs. O’Shay .............................................................................................139 Jan Patočka’s Ways of Believing ....................................................................................143 Diagram IV.2. Patočka’s Four Modes of Belief ..................................................143 Categorizing Miracle-Invocations ..................................................................................149 Unshaken Invocations: Doxological ...................................................................149 Unshaken Invocations: Political .........................................................................158 Existential Invocations: Pedagogical and Tragic ................................................162 Concluding and Transitioning..........................................................................................169 V. RESPONDING TO MIRACLE LANGUAGE: A CRITICAL REVIEW ...............170 The Goals, Tasks, and Skills of the Clinical Ethics Consultant ......................................171 The First Foundational Response: “Empathetic Imagining” ...........................................175 The Second Foundational Response: “Epistemic Inquiry” ..............................................180 Responding to Unshaken Invocators: Doxological .........................................................183 Responding to Unshaken Invocators: Political ...............................................................191 Responding to Existential Invocators .............................................................................193 Concluding Thoughts ......................................................................................................197 vi BIBLIOGRAPHY .....................................................................................................................201 vii INTRODUCTION To begin, a truism: the technological resources of contemporary western
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