An Approach to BioEthics

INTRODUCTION

by
Gilbert Meilaender, PhD
Valparaiso University

As we embark on our discussion of Medical Ethics, we will begin with Dr Meilaender's introduction in his book, Bioethics: A Primer for Christians, which is one of the texts we will use for this course. Meilaender begins with Procreation versus Reproduction and ends with Human Experimentation.

The pace of medical advance in our world is so rapid that we may easily forget just how recent is the growth of bioethics as a distinct area of concern. In the minds of our children, organ donation and transplantation have become facts of life; yet the first successful kidney transplant took place in 1954 and the first heart transplant as recently as 1967. Our children may assume that a pregnant woman should have the health of her fetus screened in utero, should know before birth whether her child is male or female, and should consider abortion for any of a number of reasons; yet amniocentesis was first performed in 1966, and the Roe v. Wade decision is not even twenty-five years old. We may assume that it is good for us to draw up advance directives about how we want to be treated if we become unconscious or otherwise incompetent, but the first living will law in this country (in the state of California) was passed in 1976. Many people simply assume that feeding tubes should be withdrawn from permanently unconscious patients; yet that step was not even seriously considered by the Quinlan family in 1976 when they went to court seeking to gain control over the medical care given their daughter Karen.

Something that might be called "Medical ethics" has, of course, been present for a long time in the Western world. The Hippocratic Oath probably dates from the fourth century B.C., and physicians - even in ages when they had none of the modern techniques for healing - reflected on the demands of their calling. After World War II, because of the deep involvement of German physicians in the Nazi regime's program of human experimentation, eugenics, and genocide, the ethics of medicine received new attention. And, indeed, the Nuremberg Code that was formulated as a response to those abuses has today the status of international law.

However, only over the past quarter century has a discipline of bioethics developed, and only in these years have bioethical concerns become commonplace in our everyday lives. But as the concerns have become commonplace, they have also become the specialized possession of "bioethicists," a development that may not be wholly salutary. There was a time when philosophers and theologians, in their respective ways, thought about the moral life, and physicians reflected upon the moral meaning of their practice. Then ethics developed as a specialized branch of philosophy or theology. Now we have bioethics, one branch of what is often called "applied ethics." One of the things that happens in the course of this development is that bioethical reflection comes to focus more and more upon public policy - which in our society inevitably means a minimal, lowest-common-denominator ethic capable, it is thought, of securing public consensus. In this process, reflection upon the moral meaning of health and medicine becomes increasingly secularized - driven by the view that public consensus must exclude the larger questions about human nature and destiny that religious belief raises.

There is a place for such a minimalist bioethic, but this book aims at something different. I write as a Christian for other Christians who want to think about these issues. Anyone is, of course, welcome to "listen in" and consider what the world looks like from this angle of vision, but the discussion is not aimed at "anyone. " It is aimed at those who name as Lord the God of Abraham, Isaac, and Jacob - and who believe that this Lord lived as one of us in Jesus of Nazareth. The two testaments of Christian Scripture bear witness to this God and authoritatively (even if often ambivalently) shape the vision of Christians when they turn to the contemporary concerns of bioethics. It is obvious, of course, as a matter of empirical fact, that not all Christians agree with the judgments I make in this book. But when I attempt here to write Christian ethics, I do not mean that I have taken a survey of the opinions of Christians or written a history of their views. Rather, I have tried to say what we Christians ought to say in order to be faithful to the truth that has claimed us in Jesus. A person could not attempt to speak normatively on behalf of the church unless, in Karl Barth’s words, "in all humility he was willing to risk being such a Church in his own place and as well as he knew how."' That, I confess, I attempt here. The problems may often be new and driven by technological advance, but the search for human wisdom and faithful insight requires of us a longer memory and a more expansive vision.