Christian bioethics, secular bioethics, and the claim to cultural authority.

Though the papers in this volume for the most part address the question, "What is Christian about Christian Bioethics", this paper addresses instead a closely related question, "How would a Christian approach to bioethics differ from the kind of secular academic bioethics that has emerged as such an important field in the contemporary university?" While it is generally assumed that a secular bioethics rooted in moral philosophy will be more culturally authoritative than an approach to bioethics grounded in the contingent particularities of a religious tradition, I will give reasons for rejecting this assumption. By examining the history of the recent revival of academic bioethics as well as the state of the contemporary moral philosophy on which it is based I will suggest that secular bioethics suffers from many of the same liabilities as a carefully articulated Christian bioethics. At the end of the paper I will turn briefly to examine the question of how, in light of this discussion, a Christian bioethics might best be pursued.     

Medical Ethics Research Between Theory and Practice

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illnesses of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.     

Beyond a western bioethics?

Like theology and ethics generally, bioethics has increasingly developed a global consciousness. Controversies over AIDS research and access to affordable AIDS treatment have generated new awareness about the importance of international collaboration as well as the difficulty of achieving moral consensus across economic, political, and cultural divides. Advances in scientific and medical knowledge through initiatives such as the Human Genome Project invite new questions about the nature of health care as a common good. This budding global consciousness serves as a starting point for examining contemporary challenges to the secular, principle-based Western bioethics that has dominated national and international debate for three decades.     

Human Rights,Cultural Pluralism,and International Health Research

In the field of bioethics, scholars have begun to consider carefully the impact of structural issues on global population health, including socioeconomic and political factors influencing the disproportionate burden of disease throughout the world. Human rights and social justice are key considerations for both population health and biomedical research. In this paper, I will briefly explore approaches to human rights in bioethics and review guidelines for ethical conduct in international health research, focusing specifically on health research conducted in resource-poor settings. I will demonstrate the potential for addressing human rights considerations in international health research with special attention to the importance of collaborative partnerships, capacity building, and respect for cultural traditions. Strengthening professional knowledge about international research ethics increases awareness of ethical concerns associated with study design and informed consent among researchers working in resource-poor settings. But this is not enough. Technological and financial resources are also necessary to build capacity for local communities to ensure that research results are integrated into existing health systems. Problematic issues surrounding the application of ethical guidelines in resource-poor settings are embedded in social history, cultural context, and the global political economy. Resolving the moral complexities requires a commitment to engaged dialogue and action among investigators, funding agencies, policy makers, governmental institutions, and private industry.     

Christian bioethics as non-ecumenical.

A community's morality depends on the moral premises, rules of evidence, and rules of inference it acknowledges, as well as on the social structure of those in authority to rule knowledge claims in or out of a community's set of commitments. For Christians, who is an authority and who is in authority are determined by Holy Tradition, through which in the Mysteries one experiences the Holy Spirit. Because of the requirement of repentance and conversion to the message of Christ preserved in the Tradition, the authority of the community must not only exclude heretical teaching but heretical communities from communion. Understanding Christian bioethics requires a focus on the content of that bioethics in terms of its social context within a right-believing, right-worshipping community. Christian bioethics should be non-ecumenical by recognizing that true moral knowledge has particular moral content, is communal, and is not fully available outside of the community of right worship. The difficulty with Roman Catholicism's understandings of bioethics lies not just in its continued inordinate accent on the role of reason apart from repentance (as well as in its defining novel doctrines), but in Roman Catholicism's not recognizing that the contemporary, post-Christian age is in good measure the consequence of its post-Vatican II failure to call for a return to the traditional pieties and asceticisms of the Fathers so that all might know rightly concerning the requirements of Christian bioethics.     

Whose tradition? Which Enlightenment? What content? Engelhardt, Hauerwas, Capaldo, and the future of Christian bioethics.

The development of a content-full Christian bioethics requires an analysis of the particular contents and traditions which different Christians bring to morality. For Hauerwas, the content of Christian ethics is the speech and practices of the community. For Engelhardt, only a content-full tradition, such as the Orthodox tradition, will be able to arrive at closure on the moral issues presented by the contemporary practice of medicine. Capaldi calls, in contrast, for a Kantian society of autonomous self-legislators whose responsible freedom is grounded in a cosmic order that must be explicated and retrieved in particular practices. The manner in which we view our own traditions and the shortcomings of modernity determine the content that Christianity brings to bioethics.     

Bioethics and Pastoral Concern: Some Possible New Directions in Pastoral Theology

This special issue of the journal is comprised of papers given at a conference in May 2011 at the University of Texas Health Science Center at Houston on the theme of “Social Justice and the Health Professions.” This article offers the following rationale for this special issue in particular and for pastoral theologians to contribute to bioethics in general: (1) two contemporary theological thinkers in bioethics, Karen Lebacqz and Lisa Cahill, argue that theological discussions of justice broaden and deepen discussions of justice in mainstream bioethics—thus the focus on social justice provides an area for interdisciplinary and intersectional work; (2) pastoral theologians have not, to a great extent, contributed to discussions of religion and bioethics—this has been the territory of theological ethicists, especially during the 1970s; (3) one influential pastoral theologian, Bonnie Miller-McLemore, has called for (a) a broader concern for health in pastoral theology beyond psychological health and (b) more disciplinary approaches within pastoral theology beyond psychology so as to attend to “the living human web”; and (4) one way to advance the theological contributions in bioethics is by inviting pastoral theologians to focus on matters of social justice (an established area of intersection) as identified by health professionals, thus providing (a) new areas for inquiry and (b) new theological perspectives in bioethics. This article also suggests that pastoral theologians can contribute to bioethics by focusing on both “macro” issues (issues relating to structures and groups) and “micro” issues (issues relating to persons and experiences) as a way of pursuing the topic of justice in bioethics. The bulk of this article focuses on “macro” issues, but, in closing, the author articulates how he has been addressing “micro” issues in his own work. The author argues that both of these approaches—“macro” and “micro”—are legitimate ways for pastoral theologians to express pastoral concerns in bioethics.     

Universalism, particularism and the ethics of dignity.

This paper explores the problem of universalism and particularism in contemporary ethics, and its relationship to Christian bioethics in particular. An ethic of human dignity is outlined, which, it is argued, constrains moral discourse in the broad sense--thus meeting the demands of universalism--but which is at the same time amenable to a variety of particularist interpretations--thus acknowledging the current shift toward historicism, traditionalism, and culture. The particularist interpretations that are of central concern here are those provided by historic Christianity. The eventual goal is to indicate how a Christian conception of human dignity can have universal normative relevance both as a standard against which to assess competing particularist conceptions, and as a practical guide for everyday living. A Christian conception of dignity will in turn have significant implications when addressing contemporary issues in bioethics. These are ambitious goals, and a full explication of the ideas presented will not be possible in this context. Nevertheless, there is value in getting a bird's-eye view of the landscape before one goes about scaling the mountains and exploring the valleys. The present essay is intended as a general geography of the moral terrain in which an ethic of dignity in general, and a Christian perspective on dignity in particular, can provide normative guidance.     

The "nation's conscience:" assessing bioethics commissions as public forums

As the fifth national bioethics commission has concluded its work and a sixth is currently underway, it is time to step back and consider appropriate measures of success. This paper argues that standard measures of commissions' influence fail to fully assess their role as public forums. From the perspective of democratic theory, a critical dimension of this role is public engagement: the ability of a commission to address the concerns of the general public, to learn how average citizens resolve moral issues in healthcare, and to monitor public opinion on the topics addressed in the commission. Such a public forum role is supported by the critical literature within bioethics, which has deemed some commissions successful, supported more generally by the history of bioethics as a reform discourse that has brought socially important values into the medical domain, and supported more generally still by the example of the great social issues commissions of the 1960s.     

Aboriginal Health Care and Bioethics: A Reflection on the Teaching of the Seven Grandfathers

Contemporary bioethics recognizes the importance of the culture in shaping ethical issues, yet in practice, a process for ethical analysis and decision making is rarely adjusted to the culture and ethnicity of involved parties. This is of a particular concern in a health care system that is caring for a growing Aboriginal population. We raise the possibility of constructing a bioethics grounded in traditional Aboriginal knowledge. As an example of an element of traditional knowledge that contains strong ethical guidance, we present the story of the Gifts of the Seven Grandfathers. We note a resemblance of this Ojibway teaching to virtue ethics in European traditions, but we suggest that there are also important differences in how these two traditions are currently presented. We hope that further engagement with a variety of indigenous moral teachings and traditions could improve health care involving Aboriginal patients and communities, and enrich the discipline of bioethics.     

“Suspended Animation,” My Mother’s Wife and Cultural Discernment: Considerations for Genetic Research among Immigrants

One of the most difficult contemporary issues facing the bioethics of clinical research is balancing the maintaining of a universality of ethics standards with a sensitivity to cultural issues and differences. The concept of “vulnerability” for research subjects is especially apt for investigating the ethical and cultural issues surrounding the conduct of genetic research among new immigrants to the United States, using the Sudanese Nuer and Dinka tribes, recently settled in the Midwest, as an example. Issues of cultural vulnerability arise for some immigrants, related to relationship to the earth and to kinship issues, that threaten the narrative richness of a subject's life as well as the way she situates herself in the world.     

Respecting difference and moving beyond regulation: tasks for U.S. bioethics commissions in the twenty-first century

This article focuses on two possible missions for a national bioethics commission. The first is handling differences of worldview, political orientation, and discipline. Recent work in political philosophy emphasizes regard for the dignity of difference manifested in "conversation" that seeks understanding rather than agreement. The President's Council on Bioethics gets a mixed review in this area. The second is experimenting with prophetic bioethics. "Prophetic bioethics" is a term coined by Daniel Callahan to describe an alternative to compromise-seeking "regulatory bioethics." It involves a critique of modern medicine. In the contemporary context, the areas of biotechnology and access to health care cry out for prophetic attention. The Council has addressed biotechnology; unfortunately, that experience suggests that the kind of prophecy that it practices poses risks to conversation. With regard to access issues, the article proposes an effort that unites themes of human dignity, solidarity, and limits in support of reform, while highlighting, rather than papering over, differences.     

Bioethics in a liberal society--political, not moral

This paper argues for the importance of the political context of a society for bioethics. In particular, I argue that in a liberal constitutional society, such as the one we find ourselves in, no particular moral perspective is granted a privileged position. Rather, individuals are allowed to live their lives according to values they adopt for themselves, and the rights granted to protect this ability "trump" social consensus, and place boundaries on the social application of personal moral beliefs and values.     

Medical ethics in Norway: Modern medicine — Traditional morality

In Norway, by tradition a Lutheran country, the puritan ethics of a “moral minority” has a strong influence on the development and manifestations of medical ethics. Those who exert this influence are found primarily among politicians, the clergy, and, last but certainly not least, among nurses and doctors. The focus of interest is not so much on problems of bioethical moral theory or the teaching of bioethics to students, but very much on attitudes and policies with regard to substantive issues traditionally regarded in Norway as burning bioethical issues, such as: medical research ethics, abortion, prenatal diagnosis, euthanasia, definitions of death, and reproductive technologies.     

Moral philosophy and theology: why is there so little difference for Roman Catholics?

The cardinal question in Christian moral theory and bioethics is whether the knowledge that Christians have (1) by grace and (2) by revelation (e.g., regarding the character of human and cosmic history as reaching from creation through the Incarnation and the Redemption to the Second Coming and the restoration of all things) makes a crucial contribution to understanding morality, as for example issues such as the good death and the morality of physician-assisted suicide and euthanasia. This article argues that such a contribution is made by grace and revelation. The reduction of Roman Catholic moral theology and bioethics to secular bioethics is explored, as well as the necessity of the unique knowledge possessed by Christians for adequate end-of-life decision-making.     

A proposal for teaching bioethics in high schools using appropriate visual education tools

Teaching bioethics with visual education tools, such as movies and comics, is a unique way of explaining the history and progress of human research and the art and science of medicine to high school students. For more than a decade, bioethical concepts have appeared in movies, and these films are useful for teaching medical and research ethics in high schools. Using visual tools to teach bioethics can have both interpretational and transformational effects on learners that will enhance their overall understanding of complex moral and legal issues in medicine and research.High school students are uniquely suited to learn bioethics because they will soon become legal adults. As adults, they will make moral decisions that may affect their health and wellbeing as well as that of their communities and societies.However, not all visual education tools are appropriate for bioethics pedagogy in high school. Bioethics film and comic producers must consider the specifics of student age, race, gender, belief, level of education, and sexual orientation. Such tools must not be dominated by either dystopic or utopic genres, must aim for objectivity, and must consider the complexity of ethical decision making. It is critical that the teacher, who is the final arbiter regarding the use of visual tools in the classroom, determines that the visual learning tool is acceptable for students in any particular education context. In addition, during the conceptualization and creation of these tools, bioethics film and comic producers must work harder to ensure that these visual tools are devoid of any form of stereotyping.     

Emergence and composition of the traditional-modern bicultural self of people in contemporary Taiwanese societies

In the present paper, a preliminary statement on the traditional-modern bicultural self in contemporary Taiwan was proposed and our presentation was organized in four parts. First, a theoretical and conceptual analysis was attempted to describe the emergence and composition of the traditional-modern bicultural self of the contemporary Taiwanese people. The cultural and social roots of such a bicultural self were explored, and its constituting elements delineated and their interrelations analyzed. Second, relevant empirical evidence pertaining to this particular model of the Chinese bicultural self was reviewed. Third, our present model was related and compared against various existing bicultural self models. Finally, directions and issues for future research on the Chinese bicultural self were discussed.