Bioethics and the Christian Life E-Book

David VanDrunen

• Herausgeber: Crossway
• Kategorie: Religion und Spiritualität
• Sprache: Englisch

Seitenzahl: 465

Veröffentlichungsjahr: 2009

Beschreibung

Just about everyone will face a difficult bioethics decision at some point. In this book a theologian, ethicist, and lawyer equips Christians to make such decisions based on biblical truth, wisdom, and virtue. Though a relatively new discipline, bioethics has generated extraordinary interest due to a number of socially pressing issues. Bioethics and the Christian Life places bioethics within the holistic context of the Christian life, both developing a general Christian approach to making bioethics decisions and addressing a number of specific, controversial areas of bioethics. Clear, concise, and well-organized, the book is divided into three sections. The first lays the theological foundation for bioethics decision-making and discusses the importance of wisdom and virtue in working through these issues. The second section addresses beginning-of-life issues, such as abortion, stem-cell research, and infertility treatments. The third section covers end-of-life issues, such as living wills, accepting and refusing medical treatment, and treatment of patients in permanent vegetative states.

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“David VanDrunen’s stimulating book on bioethics is a great help to us as we wrestle through some very difficult issues in our day. Discussing everything from cloning, contraception, and stem cell research to health care for the incapacitated and how to decide if treatment should be pursued, VanDrunen shows himself an able guide and wise mentor. These are difficult issues, but he addresses them in a thoughtful and accessible way. One of the most promising aspects of this book is VanDrunen’s consistent engagement in fresh biblical exegesis, while also drawing from a natural law tradition, all the while maintaining a focus that is both churchly and relevant for today.”

—Kelly M. Kapic, Professor of Theological Studies, Covenant College

“Bioethics and the Christian Life provides a much-needed guide to the difficult area of Christian clinical bioethics. While many well-meaning Christians present bioethics for marionette puppets (with God pulling the strings) and secularists claim that we are the masters of our fate and captains of our soul, VanDrunen does the hard work of guiding his reader to exercise autonomy responsibly within God’s revealed will in the Bible. Here is rich guidance to help the patient, family member, pastor, or clinician to think Christianly and find biblically sound answers to the vexing problems of bioethics.”

—Thomas W. Ziegler, Former Clinical Professor of Medicine, University of California San Diego and VA Medical Center, San Diego, California

“Dr. VanDrunen adds significantly and positively to the bioethical conversation in ways that will help every pastor and every thoughtful Christian to think through issues of life and death. He interacts with contemporary biotechnology and bioethics and asks the difficult questions, giving thoughtful, nuanced answers based on sound orthodox theology and Christian virtue. What distinguishes this book is that particular issues are not approached in isolation from the biblical goal of a well-lived Christian life. Fixed moral truths of God’s law do not always yield clear answers to every ethical question, but biblical wisdom enables the Christian to navigate the difficulties and avoid facile answers. VanDrunen is firm in his conclusions when scripture speaks clearly, but he is wisely wary of being dogmatic where scripture is silent. I highly recommend this book. As a primer in Christian ethics it should be the text for a required Christian education course in every church.”

—Gregory Edward Reynolds, pastor, Amoskeag Presbyterian Church, Manchester, New Hampshire; author, The Word Is Worth a Thousand Pictures: Preaching in the Electronic Age; editor, Ordained Servant: A Journal for Church Officers

Bioethics and the Christian Life: A Guide to Making Difficult Decisions Copyright © 2009 by David VanDrunen

Published by Crossway Books a publishing ministry of Good News Publishers 1300 Crescent StreetWheaton, Illinois 60187

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopy, recording, or otherwise, without the prior permission of the publisher, except as provided for by USA copyright law. Crossway® is a registered trademark in the United States of America.

Interior design and typesetting by Lakeside Design Plus Cover design by Josh Dennis First printing 2009 Printed in the United States of America

Unless otherwise indicated, Scripture quotations are from the ESV® Bible (The Holy Bible, English Standard Version®), copyright © 2001 by Crossway Bibles, a publishing ministry of Good News Publishers. Used by permission. All rights reserved.

Scripture quotations marked at are the author’s translation.

All emphases in Scripture quotations have been added.

Trade Paperback ISBN: 978-1-4335-0144-9 PDF ISBN: 978-1-4335-1265-0 MobiPocket ISBN: 978-1-4335-1266-7 ePub ISBN: 978-1-4335-2183-6

Library of Congress Cataloging-in-Publication Data VanDrunen, David, 1971– Bioethics and the Christian life : a guide to making difficult decisions / David VanDrunen.p. cm.Includes bibliographical references and index.ISBN 978-1-4335-0144-9 (tpb) 1. Medical ethics—Religious aspects—Christianity. 2. Bioethics—Religious aspects— Christianity. 3. Christian ethics. I. Title.

R725.56.V36 2009174.2—dc22                                              2009003977

CONTENTS

Preface

Introduction: The Christian Confronts Bioethics

Part 1: Foundations of Bioethics

1. Christianity and Health Care in a Fallen World

2. Theological Doctrines

3. Christian Virtues

Part 2: The Beginning of Life

4. Marriage, Procreation, and Contraception

5. Assisted Reproduction

6. The Human Embryo

Part 3: The End of Life

7. Approaching Death: Dying as a Way of Life

8. Suicide, Euthanasia, and the Distinction between Killing and Letting Die

9. Accepting and Forgoing Treatment

Conclusion (with a Bibliographic Essay)

PREFACE

The origins of this book date back several years, to a period when I received an unusual number of requests in a short period of time from churches wishing me to teach on bioethical issues. Though I had done some study and a little teaching and writing on the subject before that time, I never intended to devote a concentrated period of research to or to write a book about bioethics. But the experience of teaching those church seminars and Sunday school classes revealed how many serious questions thoughtful Christians have about life and death issues in general and about the moral questions surrounding new technologies in particular. Those Christians prompted me to do more study on these problems and eventually convinced me—unknowingly to them—that a book like this one might be helpful. I am grateful for Allan Fisher’s initial enthusiasm for this project and for the fine experience that I have had working with him and his colleagues at Crossway in bringing this book to publication.

I wish to express my thanks to a number of others as well. First and foremost, to Katherine and Jack for so many things, and especially their ongoing appreciation of and support for the scholarly life. I am also very grateful to the board, faculty, students, and staff at Westminster Seminary California for continuing to provide such a congenial environment for exploring the kinds of theological and pastoral issues that are discussed here. Thanks to those who were willing to read parts or the whole of the manuscript while it was still very much a draft: Matt Tuininga, John Fesko, Tom Ziegler, Lana Korniyenko, Kelly Kapic, Jack Davis, and Calvin Van Reken (and his anonymous assistant). Not long after I drafted the chapters on death and dying that comprise Part 3 of this book, my grandmother, Grace VanDrunen, died on her ninety-fourth birthday. Those who knew her are grateful for her life and I am thankful that my son, her great-grandchild, participated in the final (very brief) conversation that she had on this earth and thereby witnessed a wonderful example of a Christian who died well.

Readers will note that I have written the text without footnotes. A bibliographic essay in the Conclusion provides information about works that I refer to in the text and it lists some other literature that I think is especially noteworthy. Readers are encouraged to see this essay in the Conclusion if they wish to follow up on any sources or to pursue further study of issues considered within.

Introduction

THE CHRISTIAN CONFRONTS BIOETHICS

Human beings have been pondering ethical questions about life and death from a religious perspective for a very long time. Millennia before the advent of fertility drugs God’s Old Testament people wrestled with barrenness and sought various solutions, from prayer to concubines. Christians in the early church confronted and rejected the common Greco-Roman practice of abortion, infanticide, and suicide. Medieval- and Reformation-era Christians had no access to modern life-sustaining technology yet wrote numerous treatises on how to die well.

The kinds of questions evoked by the new academic discipline of “bioethics” are therefore perennial. Yet the harvest of new medical technology in the past generation has brought issues of life and death to a level of difficulty, importance, and promise never before seen in human history. The new technology holds great promise because it offers possibilities for treating ailments and prolonging life in previously unimaginable ways. Great enemies of human flourishing— disease and death—remain undefeated, but they seem increasingly manageable. There has never been a better time to get sick than the present. But with the benefits of human ingenuity come the eerie forebodings of a future that is less humane, not more. The same powers that provide remedies for infertility enable researchers to create embryos as a disposable source of pluripotent stem cells. The ability to manipulate the human genetic code can be harnessed not only for keeping inheritable diseases from the next generation but also for producing designer babies destined to be taller, faster, and smarter than their classmates. Techniques for treating life-threatening illnesses that can restore people to health can also preserve people in vegetative states for decades at great emotional and financial cost to family and society. Many proponents of the new technology denounce those who would stifle research and rob society of its benefits because of quaint moral scruples. Others issue dire warnings about a frightening brave new world that will emerge if scientific technology is not constrained by ethical boundaries. Battles are waged on ballots and in courts about what activities to ban and which research to fund. Families are divided about whether to pursue in vitro fertilization and whether to pull the plug on grandma.

Where do Christians stand in relation to such volatile matters? What difference does Christian commitment make to one’s perspective on these issues of life and death? For many Christians of a traditional, conservative bent such bioethical controversies rouse strong feelings and inspire social activism. Like the early Christians we sense our entrenchment in a so-called culture of death and seek to renew respect for all human life, even in its earliest and latest stages. Against the subtle and overt forms of moral relativism that chip away at the foundations of humane civilization we proclaim to the world that many activities are simply wrong.

But the relation of Christian conviction—even of traditional and conservative variety—to contemporary bioethics is in fact much more complicated than suggested in the previous paragraph. Many Christians firmly committed to moral absolutes and troubled by attempts to blur distinctions between right and wrong have found themselves genuinely puzzled by ethical choices that medical technology has thrust in their path. However clear certain matters of abortion or assisted suicide may seem to them, they have found decisions about remedying infertility or discontinuing treatment for a dying relative to be ethically confusing. Under the surface of several high-profile and seemingly easy bioethical issues are a host of matters that appeal to cherished values in conflicting directions and therefore offer no immediately obvious moral answers.

Most Christian couples, for example, have no qualms in principle about seeking medical help when they are unable to conceive children over an extended period of time. These same couples, however, usually also have a sense—even if they struggle to articulate exactly why—that there are boundaries beyond which the quest to have a child should not go. But what precisely are the moral issues at stake, what are these boundaries, and what are the ethical consequences of transgressing them? Most Christians concur that assisting a suicide is morally evil, but they also shrink from the conclusion that they are obligated to do absolutely everything to preserve their own or others’ lives as long as possible. But where does one cross the line between allowing death to take its natural and inevitable course and becoming complicit in someone’s death due to failure to fight for life? Scripture provides no explicit instruction for making such determinations, and oftentimes trusted pastors and counselors offer conflicting advice. In such situations moral action is doubly difficult: Christians need not only the courage to do what they know is right but also the insight and wisdom to figure out what is right in the first place.

The Purpose of This Book: Bioethics in the Midst of the Christian Life

The present book is written to address these problems. It explores how ordinary Christians, in the midst of the lives that they are called to live in Christ, may come to a better understanding of how to respond to the bioethical questions that confront them, their families, and their fellow believers in the church. This book is not a diatribe against contemporary woes such as the culture of death or the dehumanization of medicine (however much of a concern these things are). Neither is it a rousing call to social and political action on the part of Christians concerned about troubling cultural trends (however beneficial such action might be). I will be grateful if this book proves helpful for understanding contemporary bioethics culture wars and useful for those involved in public debates about bioethics, but these are not its chief concern. Instead I hope first and foremost to offer encouragement and guidance for Christians who seek, in the face of the morally confusing options presented by modern medical technology, to grow in the knowledge of Christian truth and in their practice of the Christian life in ways that prepare them to make personal bioethical decisions with godliness and wisdom.

In light of this I hope to address several overlapping audiences. This book is for all sorts of thoughtful, ordinary Christians who seek to be faithful as they confront issues of life and death in their individual and family lives. It is also intended to help pastors, elders, and counselors who will be increasingly solicited for help in making bioethical decisions. I have also written to facilitate moral reflection among physicians, nurses, and other Christians who work in the health-care system, for whom some of these issues are professional as well as personal. Finally, I hope that this book will be useful to students who are being introduced to the discipline of bioethics.

In treating bioethical issues within the context of the broader Christian life, I am trying to avoid the tendency to confront these issues as discrete moral problems. In other words, I am resisting the temptation to deal with bioethical issues as stand-alone dilemmas isolated from the many moral choices that precede and follow them. Questions are often posed in the abstract: Should a woman pregnant with quadruplets selectively abort two fetuses in order to give the other two a better chance of survival? May an unmarried woman eager to have children let herself be artificially inseminated with the sperm of an anonymous donor? Must a caregiver administer antibiotics to fight an infection in his comatose father when his father is already dying from cancer? Such questions, I argue, should not be considered in the abstract, apart from a person’s broader moral life.

This is true, first, because our lives are a connected whole, and the decisions that we make in one situation often determine the kinds of choices that we will face later and affect the way that we resolve those choices. This book certainly does not promise that a little proactive conduct will prevent the necessity of making difficult bioethical decisions. But on some occasions particular bioethical dilemmas are a direct result of previous choices that were either overtly sinful or at least risky and foolish. On other occasions making the wrong decision in the midst of a bioethical crisis leads to another, and even more difficult, crisis later. What sorts of decisions in response to infertility, for example, may have created the moral and emotional hardship of having four struggling fetuses in utero or of having to decide what to do with ten frozen embryos whose mother has suddenly died? Proverbs 22:3 counsels us to take cover when we see danger approaching. Wise action now may prevent a bioethical crisis later.

Second, and closely related to the previous matter, is the importance of virtue. One of the chief reasons why we ought to examine individual moral decisions in the light of our broader moral lives is because each one of us has a certain character. People facing difficult bioethical dilemmas face them not as blank slates but as people with certain virtues and vices, that is, with various character traits that orient them toward good or evil. Today ethics is often reduced to a concern about external actions. Through most of Western history, however, ethicists believed that questions of virtue are just as important as rules of conduct, and this is also the biblical perspective. People tend to act according to character. Two individuals may agree in theory that running into a burning building to save a child is the morally proper action, but if one is a man of courage and the other is a coward then most likely only the former will carry out the deed. To put it simply, those who wish to conduct themselves in an externally excellent way must strive to become internally excellent people.

The ramifications for bioethics are profound. Consider a woman diagnosed with an advanced stage of cancer and wrestling with whether to pursue a long-shot, experimental, and burdensome treatment or to let the disease take her life and to die peacefully at home. She confronts that question as a particular kind of person, whose character has been formed through a lifetime of moral experience. Is she a person of contentment? Of courage? Of hope? How does the presence or absence of these virtues bear upon her decision, determining both how she evaluates the attractions of each option and whether she will actually do what she determines is right? Perpetual discontentment, habitual cowardice, and constant despair tend to distort a person’s response to a frightening diagnosis and to impede the ability to make a clearheaded and godly decision about treatment.

Hence the present book explores not only what is the right thing to do when confronted with such a difficult bioethical decision, but also what sorts of virtues we should cultivate in order to be prepared to make such choices well. Becoming a morally responsible bioethics decision-maker is the task of a lifetime and cannot be reduced to figuring out the right answer at a particular moment of crisis. Bioethical decisions must be made within the context of lifelong growth in Christian maturity.

Third, this book examines bioethics in light of the broader Christian life rather than as a series of discrete moral problems because many bioethical decisions simply do not have one absolutely binding right or wrong answer. Such decisions depend upon the wisdom and judgment of a particular person acting within a unique set of life circumstances. A good example is the scenario presented above concerning the woman facing experimental and burdensome cancer treatment. The immediate reaction of some readers may have been strongly in favor of pursuing the treatment: the small chance of recovery overrides the burden of the procedure. Conversely, other readers may have felt instinctively attracted to the choice of forgoing treatment and dying peacefully at home: prolonging life at every cost is not the highest good. Two Christians with similar theological convictions may find themselves inclined in opposite directions and be compelled to admit that there is no simple correct answer that one of them could impose upon the other’s conscience.

How should a person make a responsible decision under such circumstances? Even when no universally applicable correct answer exists, many factors may make a particular decision better or worse in particular circumstances. One choice may be more beneficial for the patient’s family, church, or spiritual well-being. One choice may better allow the patient to live—or to finish living—in a way that is consistent with the life that she has lived thus far in her study, work, play, and worship. Thus, faced with the choice whether to receive experimental cancer treatment, she may need to ponder at what stage of life she finds herself: does she have meaningful projects left to accomplish, young children needing her care, or significant responsibilities at church or work? She may also need to consider whether her inclination to pursue one choice over the other is an inclination of courage or of cowardice, of hope or of despair, of love or of selfishness. These and other factors, taken together and reflected upon with wisdom, will contribute to making a morally sound and responsible decision.

Thus far I have tried to elucidate one distinctive aspect of this book: considering bioethical issues in the context of the broader Christian life. One other distinctive aspect of this book deserves mention. As I seek to articulate the nature of Christian faith and life in the chapters that follow, I do so from a Reformed theological perspective, as summarized in documents such as the Westminster Confession of Faith and the Heidelberg Catechism. This should not deter readers with different theological convictions. Most of the doctrines and virtues that play an important role in the forthcoming discussions—such as the image of God, divine sovereignty, resurrection, and faith, hope, and love—will be familiar to Christians from many traditions. Throughout the book, furthermore, I seek to show how all of the doctrines and virtues are grounded in Scripture. In light of this, I aim to reach a wide audience and to be helpful to people from various backgrounds. Nevertheless, one conviction that drives this book is that having a firm and knowledgeable theological foundation is crucial for living the Christian life well, and hence for making bioethical decisions responsibly. This book aims to explain that theological foundation as it emerges from Scripture; and that foundation reflects my Reformed convictions.

The Structure of This Book

The following chapters seek to present many clear and forthright answers, from a biblical Christian perspective, to a number of controversial bioethics questions. Perhaps more importantly, however, they offer Christians a way of thinking and a way of approaching these questions. No book can anticipate every single bioethical problem that a person will face and thus be a comprehensive handbook of bioethical answers. Much more useful, I believe, is a book that trains Christians how to think better about the moral life and how to become people of better Christian character and virtue—so that they will be better prepared to make their own decisions in a messy and complicated world.

Part 1 lays the theological and ethical foundation for thinking well about bioethics and the Christian life. Chapter 1 addresses the general perspective that Christians should take toward the healthcare practice and bioethical debates of the broader world. Christians have a sense that their religious commitments should cause them to think distinctively about bioethics, but what are the ramifications? Should Christians participate in the mainstream health-care system or establish their own Christian medical institutions? Should they participate in public debates about bioethics with non-Christians and, if so, how can they do this faithfully and effectively? Chapters 2 and 3 reflect the fact that Christians will not be prepared to make morally responsible bioethical decisions in their personal lives if they are ignorant of relevant theological truths and fail to pursue the requisite Christian virtues. Chapter 2 discusses a number of Christian doctrines that are particularly pertinent to bioethics. Among these doctrines are divine providence, human nature, suffering, death, and resurrection. Chapter 3 then considers many virtues that should mark the Christian life: faith, hope, love, courage, contentment, and wisdom.

Part 2 concerns issues pertaining to the beginning of life, one of the major general areas of bioethics controversy. Chapter 4 focuses upon matters of marriage and procreation. What is the place and importance of marriage for the Christian life? Is being unmarried a good thing, or is it simply a prelude to marriage? How should Christians understand the good of bearing children? May Christians seek not to have children and, if so, which means of doing so are morally acceptable? Chapter 5 then turns to the question of assisted reproduction. What sort of attitude should Christians take toward infertility, which is such a trial for so many people? Should Christians pursue fertility treatments and, if so, which ones are morally acceptable? What should Christians think of standard procedures like in vitro fertilization and exotic dreams like cloning? Chapter 6 concludes Part 2 with a lengthy discussion of the value of unborn human life. When does life begin and to what sort of protection are unborn human beings entitled? What should Christians’ attitudes be toward socially divisive issues such as abortion and stem-cell research?

Part 3 turns to bioethical issues at the end of life, another general area that has provoked difficult and controversial moral questions. Chapter 7 considers the Christian attitude toward death in general, an attitude that should shape the concrete moral choices that arise as death approaches. What does death mean for the Christian in light of the death and resurrection of Christ? How should Christians look at their entire lives as a preparation for death? What concrete steps should Christians take so that death does not take them unawares? Should Christians agree to become organ donors? In chapter 8 I explore whether Christians may ever actively seek their own death or the death of others. How should Christians view suicide? Is the distinction between killing and letting die a helpful and valid ethical idea? Is there a place for Christians to support euthanasia, that is, the practice of assisted suicide? Finally, chapter 9 considers the very trying questions of accepting and forgoing medical treatment as death approaches. After laying out some basic considerations for approaching this subject, the chapter explores several concrete cases. How should a person decide whether to pursue a treatment that has very low probability of success when there are no other treatment options? Is it ever morally proper to forgo life-sustaining treatment for a chronic illness because the treatment itself is so burdensome? What are our moral obligations toward people in a persistent vegetative state (PVS)?

There are many other interesting and challenging bioethical issues that I do not address, of course, including middle-of-life issues such as cosmetic surgery, performance enhancing drugs, anti-depressant medication, and eating habits. This book, however, by setting forth the theological and moral foundations for bioethics and examining many of the most common and controversial bioethical issues of the present day, aims to provide Christians with a guide for difficult decision making that will equip them for faithful service to God in all matters of health and illness and life and death.

PART 1

FOUNDATIONS OF BIOETHICS

Like all other people, Christians get sick and injured, deal with physicians and insurance companies, and confront death and dying. As they do so, Christians face bioethical issues not as machine-like decision makers but as individuals with personal histories, as members of various communities (such as families, churches, and nations), and as religious believers with certain convictions about God, this world, and the way that they ought to conduct themselves. Those histories, communities, and convictions will play a profound role in the way that Christians make their decisions when they face bioethical crises— whether they realize it or not. What does a Christian think about his place in the world, including the health-care maze? What does a Christian believe about God’s sovereignty, the image of God, and human suffering? What virtues is a Christian pursuing as she grows in the grace of Christ by his Spirit?

Part 1 explores foundational issues such as these in order to make us better equipped to deal with the concrete bioethical issues discussed in parts 2 and 3. In chapter 1 we consider the Christian’s relationship to this world and to the medical system. Believers ought to have a distinct perspective on bioethics in light of their Christian faith, and yet they continue to have responsibilities to participate in the bioethical debates and medical care of the broader world. Chapter 2 presents a number of important theological doctrines that are crucial for the Christian’s bioethical decision making, including divine providence, the image of God, the nature of death, and the challenge of suffering. Finally, in chapter 3 we consider a number of virtues to which Scripture calls Christians and which form Christians into the sort of people who can live, suffer, recover, and die well.

1

CHRISTIANITY AND HEALTH CARE IN A FALLEN WORLD

This book focuses primarily on personal bioethical decisions that Christians must make for themselves or for loved ones. As such it does not focus on bioethics in the public square, that is, upon the economic, legal, and political dimensions of bioethics. The fact that the book has this particular focus, however, does not imply that the public dimensions of bioethics are unimportant or that Christians should be uninvolved with them. If I am to set forth a Christian view of bioethics, then I must provide at least a general perspective on the relationship between the believer’s Christian commitment and his life in the broader—and largely unbelieving—world of health care. This is because thoughtful Christians who seek to be faithful in their private bioethical decisions will necessarily confront important issues that involve the public dimension of bioethics. Should Christians participate in the mainstream health-care system or should they establish their own Christian hospitals, medical schools, and insurance companies? Are Christians’ biblically shaped convictions on matters such as abortion or euthanasia unique to Christianity, or are they also binding upon non-Christians? Are believers able to have morally meaningful discussions with unbelievers and, if so, how should these discussions take place?

In this chapter I argue that, though readers should strive to attain a perspective on bioethics and to make private health-care decisions in ways that are consistent with their distinctive Christian life (the focus of this book), they should do so while continuing to participate in the mainstream health-care system and making appropriate contributions to public policy debates about bioethics.

Christian Bioethics and Secular Bioethics: Contemporary Approaches

To describe important contemporary perspectives on the relationship of Christianity to the public dimensions of bioethics, I use the terms Christian bioethics and secular bioethics. By “secular” bioethics I do not mean “evil” or “godless” bioethics, but simply the discussions and debates about bioethics that take place in the broader world where there is no universally shared religious faith. Where do Christians stand in relation to the broader world of health care, and how should they participate in the bioethical debates that take place within this world? Bioethicists from a variety of theological and philosophical persuasions have attempted to answer such questions, with a remarkable divergence of opinion.

Five general approaches to the relationship of Christian bioethics and secular bioethics can be found among contemporary writers: (1) secular bioethics only, (2) Christian bioethics only, (3) secular and Christian bioethics identical, (4) secular and Christian bioethics radically different, and (5) secular and Christian bioethics distinct but legitimate.

Secular Bioethics Only

Writers who represent the first category, secular bioethics only, make morally serious arguments about bioethical issues for society as a whole and do so through philosophical or pragmatic argumentation. Though some of these bioethicists are religious people, their writings are non-theological, and they seek to address all people in a way that appeals to their moral sensibilities no matter what their religious convictions. The influential framework for bioethics espoused by Tom Beauchamp and James Childress, often called principlism, falls into this category. Beau-champ and Childress argue for the existence of a “common morality” that is shared by all morally serious people in all cultures. This common morality is not a theory of ethics but a set of principles and norms of conduct. Beauchamp and Childress acknowledge that there are also moralities specific to particular communities and that some people in all cultures refuse to live by aspects of the common morality, but they believe that the common morality provides a means for cross-cultural critique of immoral practices in particular communities. Beauchamp and Childress derive four fundamental principles from the common morality that ought to guide the professional ethics of health-care providers: respect for autonomy, nonmalificence, beneficence, and justice. Through application of these principles in concrete circumstances, Beauchamp and Childress aim to provide an ethical standard for medical practice in a health-care system that encompasses people from a range of communities and creeds.

Another example of a secular bioethics only approach is that of Robert Veatch. Veatch argues against a medical ethics derived solely from within the medical profession and advocates instead a medical ethics that emerges out of a social contract or covenant among all the members of society—medical professionals and nonprofessionals, those with social power and those without it. Though Veatch determines the content of bioethics in a way different from Beauchamp and Childress, the two approaches agree in seeking to develop a universally applicable bioethics governing a medical system comprised of people from all communities and faiths.

Christian Bioethics Only

A starkly different alternative to the secular bioethics only perspective is the Christian bioethics only approach. Adherents to this approach set forth a bioethics derived solely from their theological convictions and wish their distinctively Christian approach to bioethics to control all health-care practice. John Frame’s Medical Ethics provides an example. Appealing to the doctrine of sola Scriptura, Frame sets out to answer various bioethical questions through application of biblical teaching. He notes the deficiencies of secular bioethics, but never discusses whether secular bioethics is a legitimate enterprise in any respect, nor does he acknowledge the legitimacy or usefulness of any nonbiblical source of moral knowledge (such as a concept of natural law known through God’s general revelation). For Frame, society-wide bioethical questions are simply to be solved by applying biblical principles. Should the child of a Jehovah’s Witness be given a blood transfusion against the wishes of her parents? Frame states that the Bible considers people “competent” who obey God’s will, and therefore since Jehovah’s Witnesses have a false view of God, they are not competent to make such decisions for their children. Civil courts should order the transfusion against their objections. What if a physician becomes concerned about the question of confidentiality? Frame says that he should require his patients to agree to “biblical principles of confidentiality.”

Other examples of a Christian bioethics only approach may be found in various visions of the Christian transformation of modern health care. Marsha Fowler’s contribution to a volume of essays on Christian engagement in society’s bioethical debates is illustrative. Appealing to the convictions of her own denomination (Presbyterian Church [USA]) and to her interpretation of the broader Reformed tradition, Fowler argues that the church is to be actively involved in transforming the health-care practices of the world. The church should have a prophetic voice in society and engage in political action and critique. Through an “incarnational ministry” that “embraces the whole of life,” the church must seek to usher in the biblical vision of shalom. As an example she points to her own congregation’s “health ministry,” which offers aerobics classes, walking groups, and free blood pressure screening for church members and the community.

Secular and Christian Bioethics Identical

A third general approach is what I call the secular and Christian bioethics identical perspective. This approach differs from the secular bioethics only approach because it seeks to bring religious and theological considerations to bear upon bioethical discussions. It also differs from the Christian bioethics only approach in that it refuses to see theological reasoning as the only way to resolve bioethical questions and does not attempt to impose a distinctively Christian vision upon the broader society. This secular and Christian bioethics identical approach is probably best exemplified by a number of prominent Roman Catholic bioethicists. These writers refer to a concept of natural law in order to identify sets of goods, values, and experiences that are common to all people, promote general human flourishing, and provide a foundation for a universal and cross-cultural morality. Bioethics, then, ought to develop in conformity with this universal morality.

For such writers, Christianity and theological truth contribute little or nothing substantive to bioethics, but serve to reinforce and enrich natural law bioethics in various ways. For the late Richard McCormick, “the Christian tradition only illumines human values, supports them, provides a context for their reading at given points in history. It aids us in staying human by underlining the truly human against all cultural attempts to distort the human.” For Lisa Sowle Cahill, theology can contribute to bioethics by raising awareness of the importance of justice and social solidarity and “explicitly religious narratives and symbols can also have a public role in widening the moral imaginations of people from diverse traditions and faiths.” James Walter and Thomas Shannon argue that religion, and specifically their Roman Catholic tradition, illumines or “adds value to” certain aspects of issues that are often overlooked, such as inclusive concern for all people through ideas of the common good, justice, and human dignity. For all of these Roman Catholic ethicists, theology serves primarily to clarify, reinforce, and inspire adherence to truth about bioethics that is generally known and applicable to all people apart from Christian conviction.

Secular and Christian Bioethics Radically Different

Almost diametrically opposite this last perspective is the secular and Christian bioethics radically different approach. The most well-known advocate of such an approach is H. Tristram Engelhardt, a physician and philosopher who converted in mid-career to Eastern Orthodox Christianity. Engelhardt takes a very pessimistic view of the possibility of genuine moral discourse in a pluralistic secular society. In the post-Enlightenment world, Engelhardt argues, there are no commonly held metaphysical or theological convictions that could serve as a basis for substantive moral conversation and agreement. Some common, secular bioethics is possible, but it is procedural only, not substantive. In other words, secular bioethics is simply a set of procedures and rules that people agree to live by. This is what Engelhardt calls the “principle of permission” that binds people who are moral strangers to one another.

Yet Engelhardt also describes a Christian bioethics that is as substantively rich as secular bioethics is substantively poor. Engelhardt believes that traditional Christianity (particularly in its Eastern Orthodox expression), through its theological teaching about life, grace, and union with God, provides the basis for a profound bioethics that binds communities who adhere to these teachings. Hence Christian bioethics must be radically distinct from the secular bioethics that rests only upon the bare will of individuals consenting to live with one another in a certain way. Not surprisingly, Engelhardt encourages Christians to develop their own medical-care system in order to put into practice their distinctive moral convictions.

Secular Bioethics and Christian Bioethics Distinct but Legitimate

I label the final approach to these issues secular bioethics and Christian bioethics distinct but legitimate. Unlike the first two approaches, this approach seeks to account for both a Christian, theological inquiry into bioethics and a common, secular inquiry in which people from various religious convictions can participate. Unlike the secular and Christian bioethics identical approach, this approach does not simply equate secular and Christian bioethics, but recognizes that Christian bioethics rests on theological truths unknown to the broader world and hence cannot be substantively identical to secular bioethics. Finally, this approach differs from the secular and Christian bioethics radically different approach in believing that secular bioethics is not simply procedural but can involve genuine and meaningful moral discussion.

We find examples of the distinct but legitimate approach in both Roman Catholic and Protestant sources. Among Roman Catholics, for instance, Edmund Pellegrino and David Thomasma have written two books whose very titles hint at their approach: The Virtues in Medical Practice (1993) and The Christian Virtues in Medical Practice (1996). In the first volume, they use a philosophical conception of virtue in order to set forth an “internal morality of medicine” (i.e., a medical ethics derived from the goals that the practice of medicine seeks to attain, not a medical ethics derived from the principles of a general theory of ethics). In the second volume Pellegrino and Thomasma argue that these philosophical virtues, when combined with (Roman Catholic) Christian commitment, are transformed to a level of grace. Christian commitment brings “charity” into the picture. Charity gives new insight into the virtues and “perfects” philosophical morality through transcending the possibilities of nature. A Christian ethic of medicine, therefore, imposes obligations that are purely optional or supererogatory from a naturalistic perspective.

Among evangelical Protestants, John Jefferson Davis, Scott Rae, and Paul Cox offer examples of this distinct but legitimate approach but in a different vein from the Roman Catholic perspective of Pellegrino and Thomasma. These three evangelical writers believe that Christians must operate within the broader health-care system and participate in its bioethics debates, and they encourage Christians to utilize arguments from general revelation (or natural law) rather than exclusively from Scripture in order to be as persuasive as possible when dealing with unbelievers. Nevertheless, they also recognize that Christians’ knowledge and experience of redemption in Christ, as revealed in Scripture, provides crucial perspective on bioethics that shapes a Christian approach to bioethics in significant ways. From a different angle, but also representing a distinct but legitimate approach, is the recent work of Joel Shuman and Brian Volck. These authors argue that modern medicine is among the “powers” ordained by God, but that it is also prone to abuse its power in god-like fashion. Therefore Shuman and Volck believe that Christians should continue to access the mainstream health-care system—with appropriate caution and detachment from its false promises. But Christians should also learn to care for one another holistically in the church through giving counsel to one another in their medical decisions, helping the poor to gain access to health care, and practicing hospitality.

Christianity, Secular Bioethics, and Mainstream Medicine: A Proposal

These few simple categories illustrate the variety of approaches to the question of Christian involvement in the health-care system and of Christian theological contribution to the bioethics enterprise. I believe that the most theologically sound and balanced approach is a version of the last: secular bioethics and Christian bioethics are distinct but legitimate. Christians should participate in the mainstream healthcare system and contribute to its bioethical debates, while recognizing that their Christian faith has radically transformed their perspective on many important issues of life and death.

According to this approach, God has ordained a common cultural task for all human beings to pursue together, and the practice of medicine and the protection of life fall within this task. Christians may therefore participate freely in the secular health-care system with people of many different religious beliefs. The common cultural task, as God-ordained, is not morally neutral (even though it is not uniquely Christian), and thus Christians can pursue meaningful moral conversations with non-Christians in regard to bioethics in modern medicine. Within the context of this general, secular bioethics that concerns all people in their common life, Christians must also shape their individual and communal views of bioethics in accord with their distinctive theological convictions. The range of Christian truth about matters such as the image of God, suffering, death, and resurrection cannot help but mold their perspective on bioethics. Scripture’s teaching should aid Christians in understanding the kind of bioethics that should govern all people in the public realm. But the knowledge and experience of God’s grace in Christ should also instill a range of virtues and a perspective on life and death that will transform Christians’ attitude toward bioethical issues and transform the way that they make decisions about a host of matters for which there are no universally binding moral rules.

The Christian’s Identity in the World

God created human beings in his own image and likeness (Gen. 1:26–27). This rich theological truth, to be explored in more detail in the next chapter, is foundational for bioethics in establishing human beings as creatures of great dignity and honor, called to life and threatened with death only as a curse and punishment for disobedience to God. After the fall into sin, God placed this curse upon the human race and consigned human beings to return to the dust from which they were taken (Gen. 3:19). Alongside this curse came the first proclamation of the gospel, promising that a seed of the woman would crush the head of the serpent’s seed (Gen. 3:15). The human race would be a divided race, therefore, comprised of those who cling by faith to this coming Savior and those who persist in rebellion against God. The early chapters of Genesis describe Cain and his progeny and the builders of the tower of Babel as examples of the latter group, but also point to Noah and Abraham as members of the remnant who worshiped the one true God and clung to his promises. God made a covenant with Abraham that set him and his family apart from the world yet promised that through him blessing would come to all the peoples of the earth. Augustine, in his famous The City of God, identified these two groups of human beings as constituting two cities that live in conflict and enmity with one another.

Augustine also noted that the people of these two cities mix in this world. Though the two cities have different destinies in the age to come, they live side by side here and now. Though God placed a curse on the human race, he did not let it sink into complete chaos. Many sorts of people—both believers and unbelievers—live law-abiding lives in society and make productive contributions to culture. This is evident in several ways already in Genesis 4. God put a “mark,” or oath, upon Cain (Gen. 4:15) in order to indicate that a system of justice will exist on earth (however imperfectly). Cain went on to build a city (Gen. 4:17), and three of his descendents, Jabal, Jubal, and Tubal-Cain, became the fathers of three great areas of culture: agriculture, music, and metallurgy (Gen. 4:20–22). After the flood, God entered into a covenant with Noah and through him with “every living creature” (Gen. 9:10, 12, 15–16). This covenant made no promise of forgiveness of sins or eternal life, but did assure all creation that God would uphold the order of nature, that family life would continue, and that a human justice system would be operative (Gen. 8:22; 9:1, 5–7). Genesis 4:15 and 9:6 are particularly relevant. In both of these texts God ordained a system of human justice not as the sole possession of those who believed in him but as the common possession of the human race. In both texts the particular crime that prompts the need for justice is murder, the ultimate dishonoring of human life. Genesis 9:6 even reminds readers that God created man in his image:

Whoever sheds man’s blood, By man shall his blood be shed, For in the image of God He made man.

Protection of life in the human justice system takes place because of the enduring dignity and honor of human beings as the pinnacle of God’s creation.

These opening chapters of Genesis, therefore, indicate that though God has called out a people for himself from the world and promised them salvation from their sins, he has also ordained that all people, whatever their religious convictions, must live together as divine image bearers entrusted with the continuing tasks of human culture: having children, building cities, planting farms, making music, forging metal, and especially securing justice against wrongdoers. Of course the religiously mixed societies of this world will often fail miserably at these tasks. Biblical accounts of the flood, Babel, and Sodom and Gomorrah testify about particularly egregious failures, and history is littered with stories of cultural perversions small and great. Yet cultural achievements and just judgments also fill the pages of history, and God’s people have rightly participated in and benefited from this work. Though set apart unto salvation by a divine covenant, Abraham did not isolate himself from the world, but made covenants with its civil leaders (Gen. 21:27–34), participated in its commerce (Gen. 23:10–20), fought in its wars (Gen. 14:1–16), and engaged in meaningful moral discussions about questions of justice (Gen. 20:8–13). For a time, and for particular purposes in his larger plan of redemption (see Gal. 3:19–24), God set aside Old Testament Israel from the world in the promised land of Canaan. In the land, Israel was to continue pursuing basic human cultural pursuits such as childrearing, agriculture, music, and justice, though it did so not with the world but separated from the world. Even Old Testament Israel, however, exercised cultural camaraderie with foreigners and unbelievers outside of the land (e.g., 1 Kings 5:1–12), and this was particularly evident when they were exiled in Babylon (Jer. 29:4–9).

The New Testament instructs God’s people to conduct themselves similarly to Abraham and the exiles in Babylon. The New Testament church is not like Old Testament Israel, an ethnically defined people living in one small geographical area, but is a multiethnic people residing throughout the world. Like Abraham, members of the New Testament church are pilgrims and sojourners in lands where they live side by side with those who do not know the one true God (Heb. 11:8–10, 13–16; 1 Pet. 1:1; 2:11). Significantly, Revelation 17–18 describes the church as living in Babylon, like the Jewish exiles of old. This Babylon, representing the cities of this world, is a place of commerce and cultural achievement. Its promises of wealth, honor, and security are deceptive and fleeting, and God warns believers to be on guard against its allures. Believers must be separate from the world in purity (2 Cor. 6:14–18), must be zealous for the holiness of the church (1 Corinthians 5), must strive to take every thought captive to Christ (2 Cor. 10:4–5), and must be transformed in the renewing of their minds (Rom. 12:2). In short, the ancient conflict of Genesis 3 between the seed of the serpent and the seed of the woman is alive and well, and Christians must be on guard against the assaults of Satan (1 Pet. 5:8). Yet this is not the entire story of the New Testament. Paul reminds his readers that though the church is to be a holy community, it is not called to leave the world, but must continue to associate with the wicked in their daily lives (1 Cor. 5:9–10). It will purchase and use the things of this world, though never becoming engrossed by them (1 Cor. 7:29–31). The civil authority that God implicitly gave to kings and governors in Genesis 4:15 and 9:6 still holds sway, and believers must submit to their work of bearing the sword for the enforcement of justice (Rom. 13:1–7). Though they are not of Babylon, they must continue for a time to live in Babylon and participate with unbelievers in a range of cultural pursuits.

This biblical overview of the relation of Christians to the broader culture is of the greatest relevance to questions about Christianity and bioethics. For one thing, Christians must be aware of the ongoing conflict between themselves and the seed of the serpent described in Genesis 3:15. Satan was a “murderer from the beginning” (John 8:44), and thus Christians should not be surprised to find the forces of a “culture of death” present in society. Believers must be vigilant and bear testimony in their evangelism and apologetics to the truth that is in Christ and to the value of life over against the spirit of the world.

Bioethics as a Common Task

In addition to this important task of bearing testimony for Christ over against the evil forces of this world, however, Christians have another crucial responsibility: pursuing medical progress and thinking morally about health care alongside and in common with this world. If bioethics at the most general level concerns moral issues related to the protection and promotion of life, then Christians cannot treat bioethics as if it is their concern alone and as if they have a monopoly on thinking through bioethical problems. As noted above in relation to biblical texts such as Genesis 4:15, Genesis 9:6, and Romans 13:7, the protection of life is a task that God entrusts to the whole human race through its civil officials. By his own appointment, God calls Christians to protect human life and to promote its flourishing in concert with people who do not share their faith. If raising children, farming, making music, forging metal, and pursuing justice are common tasks, then the art of medicine must be too. As Christians and non-Christians alike study ways to make their crops grow better and to make their music more beautiful—and share the fruits of their learning with each other—so Christian and non-Christian researchers, physicians, and patients together should seek to care for the body and to heal its ills. When evil forces intervene and lovers of death undermine the value of human life, Christians alongside unbelievers are called to seek just resolutions.

For such reasons Christians have no compelling reason to abandon the mainstream health-care system or to seek medical care from Christians only. Community hospitals, medical schools, insurance companies, and medical practice groups are legitimate expressions of the common cultural task that God bestowed upon the human race as a whole. Immoral things happen within such institutions, of course. Within all cultural institutions people (sometimes professing Christians themselves) perpetrate terrible things, but this does not strip these institutions of their God-ordained legitimacy. The Roman government toward which Paul commanded obedience in Romans 13:1–7 was far more brutal than any contemporary Western government. The so-called culture of death is indeed at work in today’s health-care establishment, but a culture of life is vibrantly present there as well. Today more than any other time in history the practice of medicine is able to alleviate pain, heal diseases, and hold death at bay. Many readers of this book would not have survived infancy had they been born two hundred years ago, and most of the others would have lived with severe discomfort that a simple trip to Walgreen’s or the dentist can now easily cure. For Christians to cut themselves off from the amazing progress of modern medicine is to do disservice to the cause of life and its flourishing.

Likewise, Christians have good reason to participate in bioethics discussions and debates in the public square, and to do so in ways that respect the God-ordained character of its cultural life. Most bioethical issues are social and political issues in some respects. Society as a whole, and civil government in particular, is entrusted with the protection of life and the enforcement of justice against those who threaten it. Thus issues such as abortion, stem-cell research, fertility methods, and assisted suicide, insofar as they concern important and controversial questions of life and death, demand some sort of political resolution. Political decision—by action or nonaction—must determine whether such practices are to be permitted or forbidden. Bioethical questions also arise in nonpolitical social settings such as hospitals and medical schools and in the development of professional responsibility codes for health-care workers. Christians and non-Christians alike have a stake in these debates, and Christians have no privileged place in the public square, the realm where God wills Christians and non-Christians to live in common. Thus Christians have an obligation to engage in these bioethics discussions in ways that respect the fact that the public square is meant for Christians and non-Christians together. To this extent Christians have an interest in “secular” bioethics.

This Christian interest in secular bioethics does not mean that believers are ever to give up their Christian presuppositions or to set aside Scripture as their highest authority. Christians’ commitment to Scripture must define their views of human nature, suffering, death, and resurrection in ways that will always be determinative for their moral thinking. Yet since God has established civil society in its many dimensions as a common realm, believers cannot demand adherence to the Christian Scriptures as a condition for participating in debates in the public square. Christians may be grateful that God has revealed himself and his law in nature as well as in Scripture. This is often referred to as natural revelation