Chapter One
Christian Vision
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Although a great deal of the best work in bioethics has involved
the application of certain ethical principles - such as respect for
autonomy, beneficence, and justice - to particular issues of concern,
there is no way to apply principles in a vacuum. How we understand
such principles, and how we understand the situations we encounter,
will depend on background beliefs that we bring to moral reflection - beliefs
about the meaning of human life, the significance of suffering
and dying, and the ultimate context in which to understand our being
and doing. Our views on such matters are shaped by reasoned argument
and reflection less often than we like to imagine. Our background
beliefs are commonly held at a kind of prearticulate level. We
take them in with the air we breathe, drink them in from the surrounding
culture. It is, therefore, useful sometimes to call to mind simply
and straightforwardly certain basic elements in a Christian vision of
the world - to remind ourselves of how contrary to the assumptions
of our culture that vision may be. Hence, before we turn in the following
chapters to complicated issues in bioethics, we do well to reflect
briefly upon some of our background beliefs.
Individuals in Community
Bioethics talk is often talk about rights. Such talk is absolutely essential
in many contexts. To ignore it is to ignore the just claims of others
upon our attention and our care. But for Christians the relation of individual
and community is too complex to be dealt with by such language
alone, and I therefore begin with a different language.
In baptism we are handed over to God and become members of
the Body of Christ. That is language about a community; yet, perhaps
paradoxically, the first thing to note about baptism is that it is a deeply
individualizing act. Our parents hand us over, often quite literally
when sponsors carry us as infants to the font. Deeply bound as we are
and always will be to our parents, we do not belong to them. In baptism
God sets his hand upon us, calls us by name, and thereby establishes
our uniquely individual identity and destiny.
We belong, to the whole extent of our being, only to God, whom
we must learn to love even more than we love father or mother. What
makes us true individuals therefore is that God calls us by name. Our
individuality is not a personal achievement or power, and - most
striking of all - it is established only in community with God. We are
most ourselves not when we seek to direct and control our destiny but
when we recognize and admit that our life is grounded in and sustained
by God.
If the first thing to say about baptism is that it establishes our individual
identity, we must immediately add that it brings us into the community
of the church - with all those whom God has called by name.
It is utterly impossible to exist in relation to God apart from such a
bond with all others who have been baptized into Christ's Body. We are
called to bear their burdens as they are called to carry ours. Sometimes
we are reluctant to shoulder theirs. At least as often, perhaps, we are reluctant
to have them shoulder ours, so eager are we to be masterful and
independent. That others within the Body should burden us and that we
should burden them is right and proper if the life of the Body is one. Nor
should such mutual burdensomeness be ultimately destructive, since
Jesus has been broken by these burdens once for all.
If baptism is the sacrament of initiation into Christian life, it
should inform our understanding of "individualism." We should not
suppose that any individual's dignity can be satisfactorily described by
the language of autonomy alone - as if we were most fully human
when we acted on our own, chose the course of our "life plan," or were
capable and powerful enough to burden no one.
There will still remain - and should remain - a place within the
political realm for the language of independent individualism. Christians
should recognize that, in a world deeply disturbed by sin, great
evil can be done in the name of community. Herbert Butterfield, the
distinguished British historian, once suggested - only somewhat with
tongue in cheek - that one could adequately explain all the wars
fought in human history simply by taking the animosity present
within the average church choir at any moment and giving it a history
extended over time. Because sin distorts every human relationship, because,
in particular, it leads the powerful to abuse and diminish the
weak and voiceless in the name of high ideals or the common good, every
individual's dignity must be protected. Because every person is
made for God, no one is - to the whole extent of his or her being - simply
a member of any human community.
Freedom and Finitude
A fuller understanding of our person requires an appreciation - and
affirmation - of the created duality of our nature. That is, we are created
from dust of the ground - finite beings who are limited by biological
necessities and historical location. We are also free spirits,
moved by the life-giving Spirit of God, created ultimately for communion
with God - and therefore soaring beyond any limited understanding
of our person in terms of presently "given" conditions of life.
This duality should not become a dualism, as if the person werereally only the spirit or only the body. On the contrary, the person simply
is the place where freedom and finitude are united. Body and spirit
cannot be separated in our understanding of human beings; yet, because
of the two-sidedness of our nature, we can look at the person
from each of these angles.
Drop me from the top of a fifty-story building, and the law of
gravity takes over, just as it does if we drop a stone. We are finite beings,
located in space and time, subject to natural necessity. But we are
also free, able sometimes to transcend the limits of nature and history.
As I fall from that fifty-story building, there are truths about my experience
that cannot be captured by an explanation in terms of mass and
velocity. Something different happens in my fall than in the rock's fall,
for this falling object is also a subject characterized by self-awareness. I
can know my self as a falling object, which means that I can to some degree
"distance" myself from that falling object. I cannot simply be
equated with it. I am that falling object, yet I am also free from it. Likewise,
I am the person constituted by the story of my life. I cannot simply
be someone else with a different history. Yet, I can also, at least to
some degree, step into another's story, see the world as it looks to her
- and thus be free from the limits of my history. That freedom from
nature and history is, finally, our freedom for God. Made for communion
with God, we transcend nature and history - not in order that
we may become self-creators, but in order that, acknowledging our
Creator, we may recognize the true limit to human freedom.
Understanding our nature in this way, we learn something about
how we should evaluate medical "progress." It cannot be acceptable
simply to oppose the forward thrust of scientific medicine. That zealous
desire to know, to probe the secrets of nature, to combat disease - all
that is an expression of our created freedom from the limits of the
"given," the freedom by which we step forth as God's representatives in
the world. But a moral vision shaped by this Christian understanding
of the person will also be prepared to say no to some exercises of human
freedom. The never-ending project of human self-creation runs
up against the limit that is God. It will always be hard to state in advance
the precise boundaries that ought to limit our freedom, but we
must be prepared to look for them. We must be prepared to acknowledge
that there may be suffering we are free to end but ought not, that
there are children who might be produced through artificial means
but ought not, that there is valuable knowledge that might be gained
through use of unconsenting research subjects but ought not.
In short, an ethic shaped by Christian vision will, in its general
form, be what moralists term "deontological." Such an ethic does not
evaluate actions only in terms of progress, only in terms of beneficial
goals that might be achieved. It encourages us to exercise our freedom
in search of such goals - but always within certain limits. It reminds
us that others can be wronged even when they are not harmed. The only
freedom worth having, a freedom that does not finally trivialize our
choices, is a freedom that acknowledges its limits and does not seek to
be godlike. That freedom, a truly human freedom, will acknowledge the
duality of our nature and the limits to which it gives rise.
Person and Body
Suppose a child is born who, throughout his life, will be profoundly retarded.
Or suppose an elderly woman has now become severely demented.
How shall we describe such human beings? We might say, as
many will today, that, although they may be living human beings, they
are not persons. But we might also say - and, I think, should say - that
they are severely disabled persons, the weakest among us.
It has gradually become common in our society to define
personhood in terms of certain capacities. To be a person one must be
conscious, self-aware, productive. The class of persons will widen or
narrow depending on how many such criteria we include in our definition
of personhood. But in any case the class of human beings will be
wider than that of persons. Not all living human beings will qualify as
persons on such a view - and, we must note, it is persons who are
now regarded as bearers of rights, persons who can have interests that
ought to be protected.
One might argue that such a viewpoint follows from the duality
of our created nature. If the body dies, we no longer think that the living
person is present. Why not reach the same conclusion if the spirit
seems to have died - or never to have been present? If a human being
lacks the capacities that make self-transcendence possible, why not
conclude that here also the living person is not present?
The logic of this suggestion is not, however, as neat as it seems. For
one thing, the duality of our nature is such that we have no access to the
free spirit apart from its incarnation in the body. The living body is
therefore the locus of personal presence. More important, our personal
histories - precisely as histories of embodied spirits - do not require
the presence of "personal" capacities throughout. Our personal histories
begin in dependence - first within our mother's womb and then
as newborns. Often our life also ends in the dependence of old age and
the loss of capacities we once had. Personhood is not something we
"have" at some point in this history. Rather, as embodied spirits or inspirited
bodies, we are persons throughout the whole of that life. One
whom we might baptize, one for whom we might still pray, one for
whom the Spirit of Christ may still intercede "with sighs too deep for
words" (Rom. 8:26) - such a one cannot be for us less than a person.
Dependence is part of the story of a person's life.
Those human beings who permanently lack certain empowering
cognitive capacities - as well as all human beings in stages of life
where those powers are absent - are simply the weakest and most
needy members of our community. We can care for them and about
them only by acknowledging the living bodily presence that they have
among us - seeking to discern in their faces the hidden spirit, the call
to community that their bodily presence constitutes, and the face of
Christ.
Suffering
At the heart of Christian belief lies a suffering, crucified God. Yet, in recent
years some have argued that Christian emphasis upon a suffering
Jesus is dangerous, that it gives rise to an ideology that encourages
those who suffer oppression simply to accept that suffering. There are
more things wrong with this argument than I can take up here, but it is
not surprising that such arguments should arise in a culture devoted to
self-realization. In such a setting, the cross must always be counter-cultural.
Suffering is not a good thing, not something one ought to seek
for oneself or others. But it is an evil out of which the God revealed in
the crucified and risen Jesus can bring good. We must therefore always
be of two minds about it. We should try to care for those who suffer,
but we should not imagine that suffering can be eliminated from human
life or that it can have no point or purpose in our lives. Nor
should we suppose that suffering must be eliminated by any means
that is available to us, for a good end does not justify any and all means.
Unless we are thus of two minds, understanding suffering as an
evil which can, nonetheless, have meaning and purpose, medicine is
likely to go awry. It seeks health - but not Health. The doctor is a caregiver,
but not, we must remind ourselves, a savior. Ultimately, all of
medicine is no more than the attempt to provide care for suffering human
beings. That care, however, cannot by itself offer the Health and
Wholeness we ultimately need and desire. If we respect the moral limits
that ought to bind us, we will not always be able to give people what
they desire. We may not be able to give the infertile couple a child, the
elderly man an old age free of dependence, the young woman freedom
from the child she has conceived, parents the healthy and "normal"
child they had wanted, the terminally ill patient a painless death. But
we can and should assure them that the story of Jesus is true - that the
negative and destructive powers of the universe are not the ultimate
powers whom we worship.
Part of the pain of human life is that we sometimes cannot and at
other times ought not do for others what they fervently desire. Believing
in the incarnation, that in Jesus God has stood with us as one of
us, Christians must try to learn to stand with and beside those who
suffer physically or emotionally. But that same understanding of incarnation
also teaches us that to make elimination of suffering our highest
priority would be to conclude mistakenly that it can have no point
or purpose in our lives. We should not act as if we believe that the negative,
destructive powers of the universe are finally victorious. Those
who worship a crucified and risen Lord cannot give themselves over to
such a vision of life.
Disease and Healing
In chapters 14-16 of 2 Chronicles we read of Asa, one of the kings of Judah.
His reign, not surprisingly, was a mix of good and bad, but, in the
eyes of the Chronicler, it ended badly.
Continues.
