Religion and Medical Ethics: Looking Backward, Looking Forward
Edited by Allen Verhey
Eerdmans, 160 pages, $18

As bioethics has gained coherence as a discipline in recent years, it has given rise to a number of attempts to take stock of the nature and health of that discipline. Perhaps this is natural, since the birth of bioethics is now more than a quarter century behind us. Among the questions that call for attention is the role of religion and theology in bioethical discussion and argument, and the essays collected in this volume make helpful contributions to that question.

In 1968, rather near the birth of bioethics, the Institute of Religion in Texas sponsored a conference on Ethics in Medicine and Technology at which major addresses were given by well-known religious thinkers”Robert Drinan, Joseph Fletcher, Paul Ramsey, and Helmut Thielicke. In 1993, to remember and celebrate the twenty-fifth anniversary of that occasion, the Institute of Religion sponsored another conference. Where the first conference simply featured a number of religious thinkers as speakers, this conference focused on the increasing (or at least increasingly perceived) “marginalization” of religious voices in public discussion of bioethical issues. How shall religious voices best enter into public discussion of bioethics? This volume collects the major essays presented at the conference”by David H. Smith, Stephen Lammers, Karen Lebacqz, Stanley Hauerwas, James Gustafson, and Warren Reich.

How should religious voices enter publicly into bioethical discussion? As James Gustafson points out, some religious thinkers may enter on their own terms, defending the unique contribution of religious language to public reflection, and refusing to “translate” this language even for purposes of public discussion. Others may adopt a contrasting approach”seeking to make their views understandable by translating them into terms that seem to carry less religious freight and are thought to be more intelligible by the general public. These contrasting positions are, of course, simply the echo of views that have contended with each other at different points in Christian history and have been a staple of argument over the last several decades within the academy.

A third position delineated by Gustafson is harder to characterize. Although warning labels should probably be used whenever one proposes to use the word “dialectical,” this third position is characterized by Gustafson as a “dialectical interaction” that seeks “to move from intelligibility to some kind of justification.” That is, one might attempt to enlarge the scope of religious language”neither insisting on carrying one’s traditional religious talk into public discussion nor simply translating it into what may be the common currency of discussion. Hence, one seeks to use religious language in public argument, but it is already a language that has been broadened in ways that may make it more intelligible to those who are not themselves traditional believers.

I take Warren Reich’s essay as an attempt to do the sort of thing Gustafson’s third approach depicts. Developing a rich phenomenological understanding of moral experience, Reich seeks to erase the distinction between philosophical and theological ethics. The distinction between them “breaks down in the arena of the public search for moral meaning.” Rich as the essay is, however, one wonders whether its complications are really all that promising as a contribution to public discussion of medical ethics.

Several of the other papers come down roughly on the side of one or the other of Gustafson’s first two options. Stanley Hauerwas (in addition to providing a witty characterization”for those who knew him”of the late Paul Ramsey) argues that Ramsey’s attempt to enter into public argument in bioethics compromised his religious convictions. He simply carried a Christian understanding of agape (love or covenant fidelity), relatively detached from its theological context, into medical ethics and then used this love as a principle by which to evaluate and transform the covenants already present in the world of medical care. I myself think this critique misses some ways in which Ramsey’s thought is rooted in Genesis 1-11 and John 1, but Hauerwas’ essay is nonetheless a forceful presentation of a position something like Gustafson’s first option.

Stephen Lammers depicts religious voices in bioethics as somewhat marginalized both in the academy and in the worlds of medicine and public policy. He does, however, discern a critique of this marginalization beginning to appear at some places in the academy, a critique still largely unknown in the medical world. While Hauerwas seems almost to recommend such marginalization, Lammers does not necessarily see it as cause for celebration. It is a price that may sometimes have to be paid for religious integrity, but it need not be sought on general principles. The larger worry for Lammers”and it is a worry worth pondering”is that religious voices in public may be heard simply as another “interest group.” The good they accomplish may be outweighed by the loss of their peculiar identity.

David Smith is less inclined to think religion has been marginalized in bioethical discussion, although that may be because he works with a general notion of correlating religious concepts with key terms more generally used in public debate. This move places him in the second option outlined by Gustafson, and I am not sure Smith develops his notion of “paired concepts” in sufficient detail for us to decide how useful (or dangerous) such an approach may be. His essay does, however, offer a quick but helpful sketch of some of the religious thinkers who were major players in the early years of the growth of bioethics.

The essay by Karen Lebacqz is harder to classify in Gustafson’s terms; perhaps it is actually an extended example of the kind of correlation Smith recommends. She analyzes Helmut Thielicke’s concept of “alien dignity” and notes the paradox that we may be more secure with an alien dignity than with one we think we have earned. In particular, she nicely develops the ways in which a concept of alien dignity protects us, because it is a dignity that does not have to be earned and cannot be lost, and equalizes us, because it is bestowed by God upon all. In my judgment she is quite successful in demonstrating how such a distinctively religious concept may still have public purchase and intelligibility.

Those who wonder whether a religious voice can speak religiously in public might ponder Allen Verhey’s concluding meditation on Psalm 88. Distinctively religious, the meditation had its place in a worship service. It affirms that “the last word is not darkness,” but it does so without denying the depths of human experience of suffering. I do not see why one could not or should not say this in public.

Gilbert Meilaender holds the Board of Directors Chair in Christian Ethics at Valparaiso University.