Participatory Theological Bioethics of Lisa Sowle Cahill and Its Relevance to End-of-Life Care in Hong Kong LAW, Wai Yan A Thesis Subtnitted in Partial Fulfilltnent of the Requirements for the Degree of Master of Philosophy . In Religious Studies The Chinese University of Hong Kong July 2010 Thesis/Assessment Committee Professor LAI, Chi Tim ( Chair) Professor KUNG, Lap Van (Thesis Supervisor) Professor LAI, Pan Chiu (Committee Member) Professor TRAM, J oseph (External Examiner) 論文評審委員會 黎志添教授(主席) 龔立人教授(論文導師) 賴品超教授(委員) 譚傑志教授(校外委員) Abstract of Thesis entitled : Participatory Theological Bioethics of Lisa Sowle Cahill and Its Relevance to End-of-Life Care in Hong Kong Submitted by LAW, Wai Yan for the degree of Master of Philosophy in Religious Studies at The Chinese University of Hong Kong in July 2010 Abstract This thesis evaluates participatory theological bioethics of Lisa Sowle Cahill and its relevance to end-of-life care in Hong Kong. The thesis is divided mainly into two parts. The first part is to investigate the Cahill's participatory theological bioethics. With emphasizing on the theological anthropology, Cahill's Christian ethics is derived from the Catholic tradition -and feminist concern. Despite there are some internal incoherencies of Cahill's participatory theological bioethics, it not only provides a moral framework concerning with human dignity, common goods and subsidiarity, but also offers helpful resources for theorizing and advocating a normative, activist and transformationist Christian bioethical stance. The second part is to explore the relevance of Cahill's participatory theolgoical bioethics for the end-of-life care in Hong Kong. The end-of-life care service in Hong Kong is analyzed by multi-disciplinary approaches and Cahill's participatory theological ethics. The contributions of participatory theological bioethics are mainly in two aspects. Firstly, the end-of-life care ethics is reframed in both personal and social ethics. Secondly, the decision making of end-of-life care should be considered into the personal, relational and spiritual dimensions. The intercultural dialogue between Hong Kong context and Cahill's suggests that taking familial relationship as a starting point to participatory. 論文摘要 本論文主要討論 Lisa Sowle Cahill í 參與的神學生物倫理」及其對香港臨終 照顧之相關性。本論文分兩部份。第一部份是探討 Cahill 之「參與的神學生物 倫理」。首先研究 Cahill 基督教倫理的進路及方法，從而對 Cahill 之「參與的 神學生物倫理」作出內部評估。 Cahill 之「參與的神學生物倫理」主要是扎根於 天主教社會訓道，其中特別關注人類尊嚴及公共利益兩大方面。雖則， Cahill 之「參與的神學生物倫理」有其內部矛盾及不足之處。然而，她提供了一個檢 視當下生物倫理框架，透過主動的參與，期望帶來社會的轉變。第二部份則是 評估 Cahill 之「參與的神學生物倫理」對香港臨終照顧之相關性。首先，對香 港臨終照顧之處境作跨學科的分析 。 繼而，再以 Cahill 之「參與的神學生物倫 理」的框架檢視香港的臨終照顧。本文之貢獻除呼籲我們思考生命之意義，檢 視香港臨終照顧服務及醫療制度，並重構當下對臨終照顧之倫理。最後，本文 屬於一個跨文化的對談，以香港的經驗詮釋 Cahill í 參與」的意思，建議香港的 臨終照顧之倫理應由「家庭式的參與」為起始點。 11 Table of Contents ABSTRACT .......................................................................................................................................... .. 1 gffij:xm~ ............................................................................................................................................... IT TABLE OF CONTENTS ...................................................................... ... ..................... ........................ III CHAPTER 1 INTRODUCTION ............................................................................................................ 1 CHAPTER 2 LISA SOWLE CAHILL'S THEOLOGICAL BACKGROUND ...................................... 5 2.1 INTRODUCTION ............................................................................................................................. 5 2.2 CAHILL'S THEOLOGICAL APPROACH TO CHRISTIAN ETHICS .......................................................... 5 2.2.1 Catholicism .......................................................................................................................... 6 2.2.2 Feminism .............................................................................................................................. 9 2.2.3 Theological Anthropology .................................................................................................. 16 2.3 MORAL METHODOLOGY ............................................................................................................. 21 2.3.1 The Bible ............................................................................................................................ 21 2.3.2 Tradition .......................................................................................................... ................... 22 2.3.3 Normative Accounts of the Human .................................................................................... 24 2.3.4 Descriptive Accounts of the Human ................................................................................... 25 2.4 CONCLUSION .............................................................................................................................. 26 CHAPTER 3 LISA SOWLE CAHILL'S PARTICIPATORY THEOLOGICAL BIOETHICS ............. 28 3.1 INTRODUCTION ........................................ ........................................................................... ........ 28 3.2 CAHILL'S PARTICIPATORY THEOLOGICAL BIOETHICS ............................. ....................... .. ............ 28 3.2.1 Principle of Analysis ......................................................................................................... 29 3.2.1.1 Ordinary and Extraordinary means of life support ............................................................. ........ 30 3.2.1.2 Principle of double effect ..................................................... .............................................. ....... 31 3.2.2 The common good and bioethics ........................... ................ ............................................. 34 3.2.3 Theological bioethics and Social Transformation .............. .. .............................................. 38 3.2.4 Summary .................................................................... ........................................................ 40 3.3 EVALUATION AND DIALOGUE WITH CAHILL'S PARTICIPATORY THEOLOGICAL BIOETHICS ........... 41 3.3.1 Catholicism .................................................................................................. ...................... 41 3.3.2 Feminism .......................................................................... .................................................. 42 3.3.3 Common Good ...................................................................... .................................. ........... 44 3.4 CONCLUSION ................................................................ ............... ...... ................ .. ................. ...... 46 CHAPTER 4 END-OF-LIFE CARE IN HONG KONG ...................................................................... 47 4.1 INl'RODUCTION ..................................................................................................................... ... ... 47 111 4.2 END-OF-LIFE CARE IN HONG KONG ............................................................................................. 48 4.2.1 Decline and dying in Hong Kong ....................................................................................... 48 4.2.2 Ethical judgments by the health care professions ............................................................... 50 4.2.3 Advance directive ............................................................................................................... 54 4.2.4 Patients or family's participation ........................................................................................ 54 4.2.5 Chinese culture and Bioethics ............................................................................................ 56 4.3 CHRISTIANITY ENGAGEMENT IN THE END-OF-LIFE CARE IN HONG KONG .................................... 59 4.3.1 Christian communities ....................................................................................................... 59 4.3.2 Theology bioethics ............................................................................................................. 60 4.4 CONCLUSION .............................................................................................................................. 61 CHAPTER 5 PARTICIPATORY THEOLOGICAL BIOETHICS IN HONG KONG .......................... 63 5.1 INTRODUCTION ..................................................- ......................................................................... 63 5.2 THE SIGNIFICANCE AND RELEVANCE OF PARTICIPATORY THEOLOGICALBIOETHICS .................... 63 5.2.1 Both individual and social ethics ....................................................................................... 64 5.2.1.1Who is/are the poor? ................................................................................................................... 64 5.2.1.2 Inequalities in access to end-of-life care ..................................................................................... 66 5.2.1.3 Medical paternalism ................................................................................................................... 71 5.2.2 Transcendent meanings of life ............................................................................................ 73 5.3 INTERCULTURAL DIALOGUE OF PARTICIPATORY THEOLOGICAL BIOETHICS ................................. 74 5.3.1 Familial relationship as a starting point ............................................................................