Jewish bioethics and medical genetics

Man has been aware of the science of genetics, i.e, how living things transport heritable traits to their offspring, since biblical times. However, knowledge regarding genetic disorders has increased greatly in recent years. Advances have been made with respect to both the methodology of genetic diagnosis and the treatment of genetic diseases. Both Jewish and secular ethicists, in general, approve of new genetic diagnostic techniques and genetic therapy if the risk/benefit ratio is favorable for humankind. However, all medical ethicists are still struggling with the ethical question: “To what extent should we tamper with the process of natural selection?”     

How Christian ethics became medical ethics: the case of Paul Ramsey.

Over the last century Christian ethics has moved from an attempt to Christianize the social order to a quandary over whether being Christian unduly biases how medical ethics is done. This movement can be viewed as the internal development of protestant liberalism to its logical conclusion, and Paul Ramsey can be taken as one of the last great representatives of that tradition. By reducing the Christian message to the 'ethical upshot' of neighbour love, Ramsey did not have the resources to show how Christian practice might make a difference for understanding or forming the practice of medicine. Instead, medicine became the practice that exemplified the moral commitments of Christian civilization, and the goal of the ethicist was to identify the values that were constitutive of medicine. Ramsey thus prepared the way for the Christian ethicist to become a medical ethicist with a difference, and the difference simply involved vague theological presumptions that do no serious intellectual work other than explaining, perhaps, the motivations of the ethicist.     

Suffering, sovereignty, and the purposes of God: Christian convictions and medical killing.

Despite a variety of "non-ecumenical" features in Christian arguments about suicide, assisted suicide, and euthanasia, there are obvious "ecumenical" aspects to be found in the general Christian prohibition of these practices. A fair reading of the Christian tradition requires that we acknowledge both the differences that distinguish particular perspectives and the fundamental themes that allow an identifiably Christian position to emerge in stark contrast to the secular discussion of these issues. Central to Christian interpretations of dying and death are an acknowledgment of God's sovereignty over human life, an understanding of suffering that stresses identification with Christ as the source of Christian hope, and the recognition that God's creative and redemptive purposes are generally (or always) at odds with the deliberate choice of assisted suicide or euthanasia.     

End-of-life decisions: Christian perspectives.

While legal rights to make medical treatment decisions at the end of one's life have been recognized by the courts, particular religious traditions put axiological and metaphysical meat on the bare bones of legal rights. Mere legal rights do not capture the full reality, meaning and importance of death. End-of-life decisions reflect not only the meaning we find in dying, but also the meaning we have found in living. The Christian religions bring particular understandings of the vision of life as a gift from God, human responsibility for stewardship of that life, the wholeness of the person, and the importance of the dying process in preparing spiritually for life beyond earthly life, to bear on end-of-life decisions.     

The empiricist as rebel: Jung,Freud, and the burdens of discipleship

However little they share in common, both Freudian and Jungian commentators have long agreed that Jung's theoretical development in the years following his psychoanalytic affiliation prompted an open “split” with Freud and the psychoanalytic movement. Careful examination of Jung's principal “rebel” works does not sustain this thesis, however, but rather indicates Jung's honest belief that his limited appropriation of certain psychoanalytic mechanisms and attendant theoretical modifications constituted full-fledged loyalty to psychoanalysis as he understood it. This perception receives significant support from the Freud-Jung correspondence which reveals Jung openly articulating the ground rules defining his loyalty to psychoanalysis as early as 1906, and Freud accepting, and even approving, his protégé's empirical reservations over the course of the next five years.     

Natural death and the work of perfection.

The historic or traditional Christian view of pain (suffering) and death, especially as preserved by the Christians East (i.e., the Orthodox), is radically opposed to the modern secular obsession with avoidance of pain. Everything about this life has its goal or aim in a mystical reality, the Kingdom of Heaven, for which earthly life is a preparation. While neither illness nor health are seen as ends in themselves, both are viewed as proceeding from the will of God for our benefit and have no ultimate meaning or purpose outside of eternal life. Death may be a relief or an ending of suffering, but in itself it is not "good" but evil. Because they are the embodiment of lived theology, saints' lives can be a sure guide to understanding how to die as a traditional Christian. To illustrate this, I have chosen some examples from the lives of relatively recent saints. I myself am from the Russian Orthodox spiritual tradition, so all but one of my examples come from pre-Revolutionary Russia. The question is not so much whether or not a traditional Christian can countenance physician-assisted suicide, but rather, what is the meaning or purpose of pain and suffering in general. Is it part of the "work of perfection" required of those who wish to enter the Kingdom of Heaven and therefore not to be completely denied?     

Christian Counseling: A Synthesis of Psychological and Christian Concepts

Strong describes an approach to counseling that synthesizes psychological processes of change with theological concepts of the Christian faith. Clients are assumed to be self-directing and responsible for their behavior, including the changes that counseling is intended to facilitate. The counselor's junction is to equip clients to enable them to change. The key objectives in Christian counseling are described and the counseling process is reviewed in the light of these objectives. The author discusses the place of justification, responsibility, forgiveness, grace, sin, responsible loving, and prayer in the counseling process. Francis Mc Guire makes a response to Strong's article from a perspective that views Zen Buddhism as an integrated psychospiritual system capable of offering a critique and a complementary viewpoint. Herman Slotkin 's think piece is an attempt to define and clarify some of the language and goals of moral education and propose a civic, nonsectarian perspective regarding value and moral awareness.     

Prolonging life: an Orthodox Christian perspective.

While Orthodox Christianity does not find explicit statements about the morality of prolonging life in the usual doctrinal sources, the Scriptures and the Fathers of the Church, there are elements in Tradition which bear upon the issue. These include Orthodox spirituality's emphasis on the "wholeness" of the human person, its liturgical and synergistic view of human life, and its understanding of our moral ambiguity as fallen human beings in a fallen world. This last point, in particular, means that we do not usually have a clear choice between right and wrong, and that we cannot always trust ourselves to know which choice is the right, or even the better one. Therefore, we must always approach decisions about death and dying with humility and in a spirit of repentance, aware of the imperfection of all we do and trusting in the mercy of God.     

Desperately Seeking Approval: The Importance of Distinguishing Between Approval and Recognition

Victoria Davion confuses seeking approval with the desire for recognition of and respect for one's difference. Ironically, when she asserts that the desire to please others provides an incentive to do well (and thus constitutes a positive aspect of competition) Davion undermines her argument that competition enhances one's sense of self. Rather than enhancing one's sense of self, striving to win approval from others sabotages one's ability to rely on her own judgment and take moral responsibility for herself.     

Germ-line gene therapy and the clinical ethos of medical genetics

Although the ability to perform gene therapy in human germ-line cells is still hypothetical, the rate of progress in molecular and cell biology suggests that it will only be a matter of time before reliable clinical techniques will be within reach. Three sets of arguments are commonly advanced against developing those techniques, respectively pointing to the clinical risks, social dangers and better alternatives. In this paper we analyze those arguments from the perspective of the client-centered ethos that traditionally governs practice in medical genetics. This perspective clarifies the merits of these arguments for geneticists, and suggests useful new directions for the professional discussion of germ-line gene therapy. It suggests, for example, that the much discussed prospect of germ-line therapy in human pre-embryos may always be more problematic for medical genetics than adult germ-line interventions, even though the latter faces greater technical difficulties.     

Physician-assisted death: doctrinal develoment vs. Christian tradition.

Physician-assisted suicide offers a moral and theological Rorschach test. Foundational commitments regarding morality and theology are disclosed by how the issue is perceived and by what moral problems it is seen to present. One of the cardinal differences disclosed is that between Western and Orthodox Christian approaches to theology in general, and the theology of dying and suicide in particular. Confrontation with the issue of suicide is likely to bring further doctrinal development in many of the Western Christian religions, so as to be able to accept physician-assisted suicide and euthanasia.