Publicly Accessible Intuitions: "Neutral Reasons" and Bioethics

This article examines Leon Kass's contention that a choice forphysician-assisted suicide is "undignified." Although Kass isJewish rather than Christian, he argues for positions that mostChristians share, and he argues for these positions withoutpresupposing the truth of specific religious claims. I arguethat although Kass has some important intuitions, he too readilyassumes that these intuitions will be shared by his audience,and that this assumption diminishes the force of his argument.An examination of the limitations of Kass's argument is helpfulinsofar as it illustrates the real challenge faced by religiousbelievers who wish to defend their beliefs in the "public forum."For it illustrates that what needs to be made "accessible" isthe Judeo-Christian understanding of man and his place in theworld. While I do not wish to claim that this task is impossible,I do think that it is far more difficult than most realize.Like all important tasks, however, unless we wrestle with thedifficulties it raises, our arguments will strike many as unconvincing.     

探析美国国家生命伦理学委员会--历史沿革及启示

在一个没有单一国教或价值权威能全盘解决科技政策与价值问题的多元社会中,由政府设置公共论坛性质的政策咨询委员会,是一项值得采纳的作法.美国先后设立过6个国家生命伦理学委员会,探析它们的建立与变迁,可以为我国类似组织提供参考.     

Christian bioethics and the Church's political worship.

Christian bioethics springs from the worship that is the response of the Church to the Gospel of Jesus Christ. Such worship is distinctively political in nature, in that it acknowledges Christ as Lord. Because it is a political worship, it can recognize no other lords and no other prior claims on its allegiance: these include the claims of an allegedly universal ethics and politics determined from outside the Church. However the Church is called not just to be a contrast society, but also to witness to the freeing of the world from salvific pretensions in order that it may embrace its proper temporality. The implications of this for the distinctiveness of Christian bioethics are brought out in three movements: first, the Church's itself learning how it is to conceive bioethics; second, the Church's role in unmasking the idols of secular bioethics; and third, the Church's witnessing to the freeing of medicine from idolatrous aspirations.     

How Christian Norms Can Have an Impact on Bioethics in a Pluralist and Democratic Europe: A Scandinavian Perspective

This article assesses the similarity and difference betweenthe Western European style of doing bioethics and the Scandinavianone. First, it reviews the introductory article by the editor,C. Delkeskamp-Hayes in the first issue of Christian Bioethics(2008), devoted to the possibility of a specifically Christianbioethics in Europe. Second, it analyses bioethics debates inScandinavian today. In light of Delkeskamp-Hayes' article, themain similarity is that both regions are facing secularizationas a threat to basic Christian values, for example, to the Christianview of the sanctity and dignity of the human life. But theScandinavian tends to reduce Christian bioethics to Luther'sconcept of the worldly kingdom, supposed to foster a dialoguebetween Christians and non-Christians on controversial ethicalissues. Despite the positive value of the dialogue, this strategyrenders Christian ethics powerless. Third, from an evangelicaltheological standpoint, it proposes some strategies for enhancingthe influence of Christian commitments on bioethical laws andpolicies.     

Biothics, the Christian Citizen, and the Pluralist Game

The ascendancy of Christian activism in bioethical policy debateshas elicited a number of responses by critics of this activism.These critics typically argue that the public square ought toembrace Secular Liberalism (SL), a perspective that its proponentsmaintain is the most just arrangement in a pluralist society,even though SL places restraints on Christian activists thatare not placed on similarly situated citizens who hold moreliberal views on bioethical questions. The author critiquesthree arguments that are offered to defend SL: (1) the goldenrule contract argument, (2) the secular reason argument, and(3) the err-on-the-side-of-liberty argument. The author concludesthat each of these arguments fail to support SL.     

生命伦理与制度伦理冲突的终结--"非典"事件的伦理学审读

SARS事件可以为生命伦理与制度伦理历史冲突的终结提供佐证;公民享有的健康权必须平等。应大力矫正医疗与预防的关系,必须重视发展公共卫生事业;应重新思考中国的卫生事业改革,中国医疗改革不能实行市场化,卫生经济伦理学的研究证明,中国的卫生制度改革重点在农村,“适者生存”的原则不适用于卫生事业。创构灾疫伦理学是生命伦理学的一项使命。     

全球生命伦理学:共识的瓦解(上)——对全球性道德的探求:生命伦理学,文化战争和道德多样性

探究道德差异的核心问题以及哪种道德意见被我们采纳,比如为了建立医疗保健伦理模式与决策方法比较传统与后传统、家族本位与个人本位之间的关系。考虑到以道德多元化定义当代人类处境,关于卫生保健政策和生命法则的反思是明智的。这个反思强调了俗世伦理学的道德多元化和为对自由和责任进行俗世化思考的结论之间分歧的意义。     

The bioethics of care: widows, monastics, and a Christian presence in health care.

At the beginning of the twenty-first century, with vocations to the Christian religious orders of the West in marked decline, an authentic Christian presence in health care is threatened. There are no longer large numbers of women willing to offer their life labors bound in vows of poverty, chastity, and obedience, so as to provide a real preferential option for the poor through supporting an authentic Christian mission in health care. At the same time, the frequent earlier death of men leaves a large number of widows, some in need of care and some able to provide care. Drawing on the role of widows sketched in 1 Timothy 2, one can envision Christian widows entering a life of prayer and service in health care settings. As female monastics, such widows could reintroduce a salient Christian presence in health care. How one ties this response to the message of 1 Timothy 2 will depend on one's understanding of the status of Scripture, the significance of tradition, the nature of theological epistemology, the meaning of theology, the nature of the Church, and the ontology of gender. The position taken on these issues will define the character of a Christian bioethics of care.     

Understanding the Trusted Doctor and Constructing a Theory of Bioethics

This paper offers a constructivist account of bioethics as an alternative to previous discussions that explained the ethics of medicine by an extrapolation of principles or virtues from ordinary morality. Taking medicine as a higher and special calling, I argue that the practice of medicine would be impossible without the trust of patients. Because trust is a necessary condition for medical practice, the ethics of the profession must provide the principles for guiding physician behavior and the profession toward promoting trust and being trustworthy. In a phrase, that principle is “seek trust and deserve it.” I sketch out how the concept of trust provides a different justification for common sense principles of bioethics and explain how the concept of trust provides reasonable guidance for resolving moral conflicts within medicine. The trust-seeking approach provides a new and unexpected ordering of some traditional medical values, it reveals the weightiness of previously undervalued bioethical precepts, and illuminates the centrality of some largely ignored obligations of medicine. It also has the power to guide clinical practice and to inform the profession about standards for medical institutions. This revised version was published online in August 2006 with corrections to the Cover Date.     

There is no moral authority in medicine: response to Cowdin and Tuohey.

Central to the Cowdin-Tuohey paper is the concept of a moral authority proper to medical practitioners. Much as I agree with the authors in refusing to degrade doctors to the status of mere technicians, I argue that one does not succeed in retrieving the moral dimension of medical practice by investing doctors with moral authority. I show that none of the cases brought forth by Cowdin-Tuohey really amounts to a case of moral authority. Then I try to explain why no such cases can be found. Developing an insight that is common to all the major moral thinkers in the philosophia perennis, I show that doctors are professionally competent with respect only to a part of the human good; morally wise persons are competent with respect to that which makes man good as man. I try to show why it follows that a) professional expertise has no natural tendency to pass over into moral understanding, and that b) doctor and non-doctor alike start from the same point in developing their understanding of medical morality. It follows that the authors fail in their attempt to de-center the moral magisterium of the Church by setting up centers of moral authority outside of the Church.     

Christian Bioethics in Europe: In Defense against Reductionist Influences from the United States

Christian ideas have continued to inspire European bioethicsuntil now. The central thesis of this essay is that the open-mindednessof Roman Catholic and other Christian denominations in Europeis crucial for understanding why Christian ethics is so wellintegrated in the European culture. The essay describes firstthe institutional frameworks in which these Christian mainlyRoman Catholic ideas are developed. It analyzes further thedifference between the secular Anglo-American and European bioethicsas it has been influenced by these Christian ideas. It finallysummarizes the challenges to which Europe's Christian bioethicalidentity is presently exposed to. The essay states that theChristian inspiration of European bioethics is mainly connectedwith the ideologically moderate, tolerant, and dialogical participationof Christian bioethicists in the bioethical debate in Europe.     

A Christian philosopher's view of recent directions in the abortion debate.

From the standpoint of a Christian philosopher, heeding the teaching and exhortations of Pope John Paul II and previous popes, I examine three directions in which the recent philosophical debate has developed. In the last seven or eight years there has been 1) a renewed focus on the biological issue of when a human individual comes to be, 2) new arguments for the proposition that personhood is a characteristic acquired after birth, and 3) refinements of the early argument of Judith Thomson. Replying to these developments, I defend, on philosophical grounds, the pro-life position. I argue that a distinct, whole (though immature) human individual comes to be at conception, that he or she is a person, with full moral worth, from the moment he or she comes to be, and the mothers and fathers have a special responsibility to their children which entails (at least) that they ought not to choose to abort them. I conclude by briefly indicating, from the standpoint of Christian faith, why Christian philosophers should vigorously pursue this debate.     

My place,your place,and no place: Behavior settings as a risk factor for HIV-related injection practices of drug users in Baltimore,Maryland

Information is sparse on the social context of illicit drug injection behaviors and their relationship to HIV infection. This study examined relationships between injection settings, injecting with others, and HIV risk behaviors of sharing needles and not cleaning contaminated needles in a sample of 630 inner-city injecting drug users in Baltimore, MD. Through open-ended interviews, five primary settings of injection behavior were identified. These settings included one's own, friends' and mother's residence, shooting galleries, and semipublic areas. Most participants reported injecting in their own residence (92%) and friends' residence (86%) in the prior 6 months. In a multiple regression analysis, injecting at friends' residence, in shooting galleries, and in semipublic areas and frequency of injecting with others were significantly associated with frequency of sharing uncleaned needles, “slipping” (i.e., failure to disinfect shared needles), and not always cleaning used needles before injecting. Results suggest that interventions may benefit from targeting settings as well as behaviors to reduce the spread of HIV. This research was supported by grants DA04334, DA05911, DA06313, and DA08985 from the National Institute on Drug Abuse.     

Pluralism and ethical dialogue in Christian healthcare institutions: the view of Caritas Catholica Flanders.

In this article, the place and the nature of an ethical dialogue that develops within Christian healthcare institutions in Flanders, Belgium is examined. More specifically, the question is asked how Christian healthcare institutions should position themselves ethically in a context of a pluralistic society. The profile developed by Caritas Catholica Flanders must take seriously not only the external pluralistic context of our society and the internal pluralistic worldviews by personnel/employees and patients, but also the inherent inspiration of a Christian healthcare institution. This article concludes with ten general orientations that could shape the ethical dialogue from a Christian inspiration in a pluralistic context.     

Liberalism,Citizenship, and the Private Interest in Schooling

Schools in liberal societies are responsible for producing liberal citizens. However, if they have too robust a view of citizenship, they may find themselves undermining the view of good lives held by many pacific and law abiding groups. Here I argue against treating citizenship as an educational good that simply trumps private values when they conflict and in favor of a view that seeks a context sensitive balance between such conflicting goods. The paper explores Rawls's distinction between two moral powers as a way of understanding the character of some of the private interests in schooling.     

Widows, women, and the bioethics of care.

Widows, women, and the bioethics of care must be understood within an authentic Christian ontology of gender. Men are men and women are women, and their being is ontologically marked in difference. There is an ontology of gender with important implications for the role of women in the family and the Church. The Christian Church has traditionally recognized a role for widows, deaconesses, and female monastics, which is not that of the liturgical priesthood, but one with a special relationship to care and therefore with particular implications for health care and a Christian bioethics of care in the twenty-first century. In the shadow of early male mortality, women as wives should turn to support their husbands and as widows to support those in need. Widows, in becoming authentic Christian monastics, can bring into the world an icon of rightly ordered women providing rightly ordered Christian care for those in need. They can enter the moral vacuum created by misunderstandings of the place of women and the service vacuum created by a disappearance of religious nuns in Western health care facilities with a presence that is at one with the Church of the Fathers.     

Moral knowledge: some reflections on moral controversies, incompatible moral epistemologies, and the culture wars.

An authentic Christian bioethical account of abortion must take into consideration the conflicting epistemologies that separate Christian moral theology from secular moral philosophy. Moral epistemologies directed to the issue of abortion that fail to appreciate the orientation of morality to God will also fail adequately to appreciate the moral issues at stake. Christian accounts of the bioethics of abortion that reduce moral-theological considerations to moral-philosophical considerations will not only fail to appreciate fully the offense of abortion, but morally mislead. This article locates the bioethics of abortion within the theology of the Church of the first millennium, emphasizing that abortion was prohibited, whether or not one considered the embryo or fetus to be ensouled.     

The Institute on Human Values in Medicine: Its Role and Influence in the Conception and Evolution of Bioethics

For ten years, 1971–1981, the Institute onHuman Values in Medicine (IHVM) played a keyrole in the development of Bioethics as afield. We have written this history andanalysis to bring to new generations ofBioethicists information about the developmentof their field within both the humanitiesdisciplines and the health professions. Thepioneers in medical humanities and ethics cametogether with medical professionals in thedecade of the 1960s. By the 1980s Bioethics wasa fully recognized discipline. We show the rolethat IHVM programs played in defining thefield, training faculty and helping schools todevelop programs. We review the beginnings ofthe IHVM in the crucible of social andtechnological change that led to theestablishment of the IHVM's parentorganization, the Society for Health and HumanValues. We then turn to the IHVM programsthrough which Faculty members receivedfellowships to explore new crossovers betweenthe humanities and the health professions. Wehave not only described the Fellows Program asit existed in 1973–1980, but have completed asurvey of the fellows a quarter of a centuryafter they held their fellowships. We describeother IHVM programs designed to facilitate theinitiation and development of new humanitiesprograms, to explore conceptual issues betweenmedicine and five humanities fields, to conductissue driven or educational method conferencesand to advance humanities programs intograduate education through the Directors ofMedical Education.