THEOLOGY AND BIOETHICS PHILOSOPHY AND MEDICINE Editors: H. TRISTRAM ENGELHARDT, JR. The Center tor Ethics, Medicine, and Public Issues, Bay/or College o[ Medicine, Houston, Texas, U.S.A. STUART F. SPICKER School of Medicine, University of Connecticut Health Center, Farmington, Connecticut, U.S.A. VOLUME20 THEOLOGY AND BIOETHICS Exploring the Foundations and Frontiers Edited by EARL E. SHELP Institute o[ Religion, and Center tor Ethies, Medieine, and Publie Issues, Baylor College o[ Medicine, Houston, Texas, U.S.A. Springer-Science+Business Media, B.Y. Library oe Congress Cataloging in Pulication Data Main entry under title: Theology and bioethics (Philosophy and medicine ; v. 20) IncJudes bibliographies and indexes 1. Medical ethics. 2. Medicine - Religious aspects. 3. Bioethics. 4. Science - Religious aspects. I. Shelp, Earl E., 1947- . II. Series. [DNLM: 1. Bioethics. 2. Ehics, Medical. 3. Religion and Medicine. W3 PH609 v.20/ W 50T391] R725.5.T57 1985 174'.2 85-11723 ISBN 978-90-481-8408-8 ISBN 978-94-015-7723-6 (eBook) DOI 10.1007/978-94-015-7723-6 All Rights Reserved. © 1985 by Springer Science+Business Media Dordrecht Originally published by D. Reidel Publishing Company, Dordrecht, Holland in 1985 Softcover reprint of the hardcover 1st edition 1985 and copyright holders as specified on appropriate pages within. No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from the copyright owner. T ABLE OF CONTENTS JAMES B. NELsoN / Foreword Vll EARL E. SHELP / Introduction XIll SECTION I: THEOLOGY, SCIENCE, AND BIOETHICS LERoy WAL TERS / Religion and the Renaissance of Medical Ethicsin the UnitedStates: 1965-1975 3 GEORGE P. SCHNER / Theology and Science: Their Dif- ference as a Source of Interaction in Ethics 17 CHARLES HARTSHORNE / Scientific and Religious Aspects of Bioethics 27 H. TRISTRAM ENGELHARDT, JR. / Hartshorne, Theology, and the Nameless God 45 WILLIAM K. FRANKENA / The Potential of Theology for Ethics 49 B ASIL MITCHELL / The Role ofTheology in Bioethics 65 H. TRISTRAM ENGELHARDT, JR. / LookingForGodandFind- ing the Abyss: Bioethics and Natural Theology 79 SECTION 11: FOUNDA TIONS AND FRONTIERS IN RELIGIOUS BIOETHICS RICHARD A. MCCORMICK / Theology and Bioethics: Christian Foundations 95 LANGDON GILKEY / Theological Frontiers: Implications for Bioethics 115 vi T ABLE OF CONTENTS DOUGLAS STURM / Contextuality and Covenant: The Pertinenee of Soeial Theory and Theology to Bioethies 135 MARGARET A. FARLEY / Feminist Theology and Bioethies 163 MARK J UERGENSME YER / Doing Ethies in a Plural World 187 SECTION 111: RELIGIOUS REASONING ABOUT BIOETHICS AND MEDICAL PRACTICE STANLEY HAUERWAS / Salvation and Health: Why Medieine Needs the Chureh 205 JAMES F. CHILDRESS / Love and Justiee in Christian Bio- medieal Ethies 225 RONALD M. GREEN / Contemporary Jewish Bioethies: A Critieal Assessment 245 DAVID H. SMITH / Medieal Loyalty: Dimensions and Problems of a Rieh Idea 267 PAUL LEHMANN / Responsibility for Life: Bioethies in Theo- logical Perspective 283 EPILOGUE : JOHN B. COBB, JR. / Does Theology Make a Contribution to Bioethies? 303 NOTES ON CONTRIBUTORS 309 INDEX 311 FOREWORD We who live in this post-modern late twentieth century culture are still children of dualism. For a variety of rather complex reasons we continue to split apart and treat as radical opposites body and spirit, medicine and religion, sacred and secular, private and public, love and justice, men and women. Though this is still our strong tendency, we are beginning to­ discover both the futility and the harm of such dualistic splitting. Peoples of many ancient cultures might smile at the belatedness of our discovery concerning the commonalities of medicine and religion. A cur­ sory glance back at ancient Egypt, Samaria, Babylonia, Persia, Greece, and Rome would disclose a common thread - the close union of religion and medicine. Both were centrally concerned with healing, health, and wholeness. The person was understood as a unity of body, mind, and spirit. The priest and the physician frequently were combined in the same individual. One of the important contributions of this significant volume of essays is the sustained attack upon dualism. From a variety of vantage points, virtually all of the authors unmask the varied manifestations of dualism in religion and medicine, urging a more holistic approach. Since the editor has provided an excellent summary of each article, I shall not attempt to comment on specific contributions. Rather , I wish to highlight three broad themes which I find notable for theological ethics. 1 The first is faith and ethics. While these pages note that, as a matter of fact, religious ethicists have contributed mightily to the emergence of bioethics as a discipline in the last two decades, the question persists: just what, if anything, does theological ethics have to offer to bioethics and to the practices of health care? Surely, one basic contribution is a critical analysis of the faiths which inevitably shape and guide our scientific and medical activities. By what faith do we perceive the meanings of health and disease? By what faith do we understand the purposes of medical practice? By what faith do we interpret the possibilities of new reproduc­ tive technologies? What faith shapes the decisions about the distribution of medical care? Indeed, there are no faithless ethics, no faithless moral actions. H. Richard Niebuhr gave this truth classic expression: vii E. E. Shelp (ed.), Theology and Bioethics, vii-xi. © 1985 by D. Reidel Publishing Company. viii FOREWORD The faith we speak of ... is not intellectual assent to the truth of certain propositions, but a personal, practical trusting in, reliance on, counting upon something .... Faith, in othcr words, always refers primarily to character and power rather than to existence .... Now it is evident ... that without such active faith or such reliance and confidence on power we do not and cannot live. Not only the just but also the unjust, insofar as they live, live by faith ([3], pp. 116 f.). We live byfaith because we cannotdo otherwise. Every moral decision as weil as every act of knowing depends upon some center of value, some power or worth, some object of devotion whose goodness and truth we cannot prove. Beyond all of the logical intricacies of the Is-Ought prob­ lem, most theological ethicists have recognized all of this. A common thread which runs through these pages is the commitment to assess criti­ cally those operating faiths which shape the biomedical enterprise. That is not only a major contribution of theological ethics to bioethics, it is at the same time a major step beyond one common dualism. A second common anti-dualistic theme in this volume is the urgent need to overcome the split between micro-ethics and macro-ethics. Thus far, ethical reflection has leaned most heavily toward the former, accent­ ing specific treatment decisions faced by patients, families, and medical professionals. If in this individualistic society such focus ought not sur­ prise us, neither is it adequate. It buys into the split between love and justice. It trivializes the pervasiveiy social nature of all personal exist­ ence. And it perpetuates the reigning model of our current system: dis­ ease cure rather than health care. If the language of 'crisis' currently is badly overworked, at the very least it is safe to say that America currently faces major systemic prob­ lems in health care. They can be seen in three large and visible factors: costs, quality, and accessibility. Costs of medical care have skyrocketed. While the quality of laboratory and crisis medicine is impressive, health and longevity statistics are distinctly unimpressive. Moreover, issues of accessibility and distribution approach anational scandal: in poverty areas chronic illness is 30% more frequent, infant mortality 50% higher, tuberculosis three times more prevalent, and diabetes, hypertension, and vision impairment 50% higher than among the economically seeure. Thus, the issues of macro-ethics are not simply those of the just dis­ tribution of currently available medical resources, important though such issues be. They are also questions of appropriate priorities within the health-care budget - artificial hearts or weIl-baby dinics? They are issues of priority between crisis care and preventive medicine, between investing more in sophisticated technologies for acute disease and pro- FOREWORD ix moting a healthy natural and soeial environment. Sueh issues obviously shade into the larger eontext of maero-ethies: what resourees should we put into health eare itself in eomparison with other soeial expenditures, e.g. edueation, soeial welfare, or defense? Coping with these maUers calls for careful understanding of factual (fata. We need to know, for example, that while our government recently stated that 'only by preventing disease from occurring, rat her than treat­ ing it later, can we hope to achieve any major improvement in the na­ tion's health', the vast preponderance of national expenditure was going to disease cure and only a miniscule percentage to preventive measures. We need to know that the major advances in health during the last hun­ dred years have been due much more to improvements in generalliving conditions than to developments in medical treatment itself. Beyond such factual data lie important questions for theological ethics: what is health? what is the value ofhealth relative to othervalues? is there a right to adecent minimum of health care? what is that decent minimum? The bridging of micro- and macro-ethics in this field is a matter of both theoretical integrity and practical urgency. That this anti-dualistic, holis­ tic ethical concern is present in so many of the pages which follow will be evident. And it is a cause whose time has come. At this moment an accelerated change in institutionalized medicine is underway.