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.     

Bioethics critically reconsidered: Living after foundations

Given intractable moral pluralism, what ought one to make of the bioethics that arose in the early 1970s, grounded as it was in the false assumption that there is a common secular morality that secular bioethics ought to apply? It is as if bioethics developed without recognition of the crisis at the heart of secular morality itself. Secular moral rationality cannot of itself provide the foundations to identify a particular morality and its bioethics as canonical. One is not just confronted with intractable moral and bioethical pluralism, but with the absence of a secular ground that can show why one should act morally rather than self-interestedly. The result is not merely the deflation of much of traditional Western morality to life-style and death-style choices, but the threat of deflating to political slogans the now-dominant secular morality, including its affirmation of human autonomy, equality, social justice, and human dignity. All of this invites one critically to reconsider the meaning and force of secular bioethics.     

Bioethics in the twenty-first century: why we should pay attention to eighteenth-century medical ethics.

Those of us who work in the field of bioethics tend to think that, because the word "bioethics" is new, so too the field is new in all respects, but we are not the first to do bioethics. John Gregory (1724-1773) did bioethics just as we do it, at least two centuries before we thought to do it. He deployed philosophical methods as sophisticated as our own. Indeed, Gregory took up the very best moral philosophy available to thinkers of the Scottish Enlightenment, namely, David Hume's moral philosophy and its core concept of sympathy. Gregory also responded in a conceptually powerful and clinically applicable way to the problems of his time, just as we do. I want here to outline Gregory's accomplishment and to identify some aspects of its importance for bioethics in the twenty-first century.     

Bioethics and natural law: the relationship in Catholic teaching.

In the discipline of Catholic moral theology, bioethics (traditionally described as medical ethics) has held a major place. The systematic development of bioethics has drawn principally upon a natural law ethic, supported by broader religious arguments. The purpose of this essay is to examine the status and role of natural law in Catholic teaching as it bears upon bioethics.     

Spanning our differences: moral psychology,physician beliefs,and the practice of medicine

Moral pluralism is the norm in contemporary society. Even the best philosophical arguments rarely persuade moral opponents who differ at a foundational level. This has been vividly illustrated in contemporary debates in bioethics surrounding contentious issues such as abortion and euthanasia. It is readily apparent that bioethics discourse lacks an empirical explanation for the broad differences about various topics in bioethics and health policy. In recent years, social and cognitive psychology has generated novel approaches for defining basic differences in moral intuitions generally. We propose that if empirical research using social intuitionist theory explains why people disagree with one another over moral issues, then the results of such research might help people debate their moral differences in a more constructive and civil manner. We illustrate the utility of social intuitionism with data from a national physician survey.     

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.     

Accounting for context: Future directions in bioethics theory and research

Many physicians have found that the traditional approach to bioethics fails to account for important aspects of their moral experience in practice. New approaches to bioethics theory are challenging the traditional application of universal moral principles based in liberal moral theory. At the same time, a shift in both the goals and methods of bioethics education has accompanied its “coming of age” in the medical school curriculum. Taken together, these changes challenge both bioethics educators and theorists to come closer to the details and nuances of real clinical encounters. The emerging trend emphasizes the importance of context in bioethics education and in the moral theory and research under-girding it. This article introduces one research approach examining the practical life contexts of medical students' ethical experiences and learning. It calls for increased attention to research and theory in bioethics that more adequately accounts for the ways different contexts produce significant changes in meaning and understanding in medical encounters.     

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.     

The ecumenical and non-ecumenical dialectic of Christian bioethics.

Non-ecumenical Christian bioethics will seem a strange category for many. The category relies on the recognition that bioethics mediates morality and ethics in healthcare. As such bioethics will have particular content. It is the content of a moral vision that both divides and unites. The enterprise of non-ecumenical Christian bioethics explores how Christians are both divided and united on the issue of bioethics. Non-ecumenical Christian bioethics is opposed to a facile ecumenism that reduces the content of Christian morality to the lowest common denominator.     

A theory of international bioethics: the negotiable and the non-negotiable

The preceding article in this issue of the Kennedy Institute of Ethics Journal presents the argument that "moral fundamentalism," the position that international bioethics rests on "basic" or "fundamental" moral prinicples that are universally accepted in all eras and cultures, collapses under a variety of multicultural and postmodern critiques. The present article looks to the contractarian tradition of Hobbes and Locke -- as reinterpreted by David Gauthier, Robert Nozick, and John Rawls -- for an alternative justification for international bioethics. Drawing on the central themes of this tradition, it is argued that international bioethics can be rationally reconstructed as a negotiated moral order that respects culturally and individually defined areas of nonnegotiability. Further, the theory of a negotiated moral order is consistent with traditional ideals about human rights, is flexible enough to absorb the genuine insights of multiculturalism and postmodernism, and yet is strong enough to justify transcultural and transtemporal moral judgments, including the condemnation of the Nazi doctors at Nuremberg. This theory also is consistent with the history of the ethics of human subjects experimentation and offers insights into current controversies such as the controversy over changing the consent rule for experiments in emergency medicine and the controversy over exempting certain clinical trials of inexpensive treatments for preventing the perinatal transmission of AIDS from the ethical standards of the sponsoring country.     

On the Structure of Bioethics as a Pragmatic Discipline

This article analyzes certain aspects of the structure of bioethics as a discipline. It begins by arguing that bioethics is an academic discipline of a pragmatic nature and then puts forward a classification of the main problems, issues, and concerns in bioethics, using this classification as a way to outline the limits and framework of the field. Pushing further, it contends that comprehensive treatment of any topic in bioethics requires that three normative dimensions (the ethical, the moral, and the political) be taken into account. It concludes that the classification of the issues and analysis of each issue's normative dimensions can provide valuable contributions toward understanding the sui generis structure of bioethics as a pragmatic discipline.     

"Phronesis" on tour: cultural adaptability of Aristotelian ethical notions.

How might bioethics take account of cultural diversity? Can practical wisdom of an Aristotelian sort be applied across cultures? After showing that practical wisdom involves both intellectual cleverness and moral virtue, it is argued that both these components have universality. Hence practical wisdom must be universal as well. Hellenic ethical thought neither depended on outdated theoretical notions nor limited itself to the Greek world, but was in fact developed with constant awareness of cultural differences, so it arguably works as well in other times and places when formulated. Even the eudaemonistic setting for practical wisdom is unproblematic.     

Theoretical and practical problems with wide reflective equilibrium in bioethics

Various theories have been put forward in an attempt to explain what makes moral judgments justifiable. One of the main theories currently advocated in bioethics is a form of coherentism known as wide reflective equilibrium. In this paper, I argue that wide reflective equilibrium is not a satisfactory approach for justifying moral beliefs and propositions. A long-standing theoretical problem for reflective equilibrium has not been adequately resolved, and, as a result, the main arguments for wide reflective equilibrium are unsuccessful. Moreover, practical problems that arise in using the method of wide reflective equilibrium undermine the idea that it is a viable approach for justifying moral judgments about cases and policies. Given that wide reflective equilibrium is the most prominent version of coherentism, these considerations call into question the coherentist approach to justification in bioethics.     

Fritz Jahr's 1927 concept of bioethics

In 1927, Fritz Jahr, a Protestant pastor, philosopher, and educator in Halle an der Saale, published an article entitled "Bio-Ethics: A Review of the Ethical Relationships of Humans to Animals and Plants" and proposed a "Bioethical Imperative," extending Kant's moral imperative to all forms of life. Reviewing new physiological knowledge of his times and moral challenges associated with the development of secular and pluralistic societies, Jahr redefines moral obligations towards human and nonhuman forms of life, outlining the concept of bioethics as an academic discipline, principle, and virtue. Although he had no immediate long-lasting influence during politically and morally turbulent times, his argument that new science and technology requires new ethical and philosophical reflection and resolve may contribute toward clarification of terminology and of normative and practical visions of bioethics, including understanding of the geoethical dimensions of bioethics.     

A theory of international bioethics: multiculturalism, postmodernism, and the bankruptcy of fundamentalism

The first of two articles analyzing the justifiability of international bioethical codes and of cross-cultural moral judgments reviews "moral fundamentalism," the theory that cross-cultural moral judgments and international bioethical codes are justified by certain "basic" or "fundamental" moral priniciples that are universally accepted in all cultures and eras. Initially propounded by the judges at the 1947 Nuremberg Tribunal, moral fundamentalism has become the received justification of international bioethics, and of cross-temporal and cross-cultural moral judgments. Yet today we are said to live in a multicultural and postmodern world. This article assesses the challenges that multiculturalism and postmodernism pose to fundamentalism and concludes that these challenges render the position philosophically untenable, thereby undermining the received conception of the foundations of international bioethics. The second article, which follows, offers an alternative model -- a model of negotiated moral order -- as a viable justification for international bioethics and for transcultural and transtemporal moral judgments.     

The mettle of moral fundamentalism: a reply to Robert Baker

This article is a reply to Robert Baker's attempt to rebut moral fundamentalism, while grounding international bioethics in a form of contractarianism. Baker is mistaken in several of his interpretations of the alleged moral fundamentalism and findings of the Advisory Committee on Human Radiation Experiments. He also misunderstands moral fundamentalism generally and wrongly categorizes it as morally bankrupt. His negotiated contract model is, in the final analysis, itself a form of the moral fundamentalism he declares bankrupt.     

Roles of moral philosophy in appropriated bioethics: a response to Baker and McCullough

Strong arguments support the notion that much of modern bioethics is a result of appropriation rather than strict application of traditional moral philosophy. Nevertheless, it is important to recognize these sources and approaches associated with them, even when working with appropriated theories, since traditional ethical theory does and should influence modern bioethics.