Religion And Moral Meaning In Bioethics

·期刊原文
Religion And Moral Meaning In Bioethics

C.S Campbell
Hastings Cent Rep

Vol.20 No. 4 Jul-Aug.1990

Pp.4-10

Copyright by Hastings Cent Rep

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RELIGION AND MORAL MEANING IN BIOETHICS

Few experiences in life seem more pointless, more suggestive that our lives
are subject to powers that are arbitrary, abusive, and destructive, than
the suffering and death of children. What possible account could be given
to explain, let alone give meaning to such an event? Several years ago, I
developed a friendship with a young couple who were anxiously awaiting the
birth of their first child. What transpired, quite unexpectedly, was every
prospective parent's nightmare their child was born with serious congenital
abnormalities, evidenced visibly by facial disfigurement and substantial
respiratory difficulties. Following a short stay in an NICU, the
neonatologists indicated that though they could not be sure when death
would occur, they were certain that the child's prognosis was terminal, and
asked the parents for their preferences regarding continuing or stopping
treatment.

How might we think about such a problem in contemporary bioethics? We might
invoke a benefits versus burdens calculation or a best interests standard,
or take procedural recourse to an ethics committee, perhaps recommending
withdrawal of life support. Or, we might consider the cogency of arguments
supporting active killing as a compassionate act to spare the child what
would inevitably be a painful life, whatever its duration. But the parents
did not ask those kinds of questions; they instead brought to that very
difficult situation an understanding that our lives are subject to ultimate
powers which are creative, nurturing, and redeeming, and a way of
construing the world shaped decisively by a set of religious convictions
about the purpose of life, the meaning of death, and ultimate human
destiny. Within that moral vision, Angela was not seen by her parents as a
tragedy to be prevented (by prenatal diagnosis and abortion) or an unwanted
burden whose life could easily be shortened, but instead as a girl in need
of care. With minimal medical support, my friends took Angela home to begin
their family life bound together, and over the next few months gave devoted
and unceasing care until she died.

I do not relate this story to say the parents' choice to care for their
daughter at home rather than let her die in the hospital was ethically
tight or justifiable. I am still unsure about that choice, even though the
subsequent care Angela received was to me an exemplary witness of how we
should collectively treat the vulnerable and voiceless in our midst.
Rather, my point is that a world view provided meaning in a situation that
seemed pervaded by arbitrariness and cruelty, a meaning that could not be
supplied or sustained by our conventional bioethics maxims about "best
interests" or "substituted judgment." The tragedy seen by others, including
myself, was transformed into a girl. "Suffer the little children... for of
such is the kingdom of God."

Religion offers an interpretation or revelation of reality that responds to
what Max Weber referred to as the "metaphysical needs of the human mind" to
seek order, coherence, and meaning in our lives, to understand ultimate
questions about our nature, purpose, and destiny. Yet, in our common
endeavor to do bioethics within the limits of reason alone, the discourse
necessary to sustain the traditions of moral insight and meaning embedded
in the practices and values of religious communities may be characterized
as "private" and so considered largely irrelevant to the overriding
objectives of bioethics. Indeed, prominent scholars have given serious
consideration to whether traditions of theological ethics may
constructively contribute to bioethics and to the practices of health care,
and the conclusion on several accounts may often be that such a moral
resource is dispensable "Bioethics, where it succeeds, shows where it does
not need theology."(n1)

The tensions between religious discourse and bioethics pose dual challenges
of accessibility and meaning. Insofar as the incorporation of moral claims
from a specific religious tradition or community is deemed to undermine the
possibilities for a generally accessible bioethics discourse, the
significance of religious perspectives may be very limited. Yet the
criterion of accessibility may limit the moral richness of bioethics, for
the costs of conformity to public discourse requirements may be the loss of
meaning and content about ultimate concerns embedded in a particular
tradition, whether religious (as illustrated by the story of Angela's
parents) or professional (for example, medicine or nursing).

The Public Limits of Religious Discourse

If it was premature to pronounce "the death of God" in the 1960s, it seems
equally mistaken to begin doing post-mortems on the demise of theological
and religious perspectives in bioethics. There are nevertheless several
problems posed for religious thinkers by the criterion of a generally
accessible bioethics discourse, as succinctly identified by Leon Kass:

Perhaps for the sake of getting a broader hearing, perhaps not to profane
sacred teachings or to preserve a separation between the things of God and
the things of Caesar, most religious ethicists entering the public practice
of ethics leave their special insights at the door and talk about
"deontological vs. consequentialist," "autonomy vs. paternalism," "justice
vs. utility," just like everybody else.(n2)

A first limit on religious discourse in bioethics, then, has to do with
constructing a moral language appropriate to an interdisciplinary and
public audience. Religious thinkers no longer converse only with members of
a particular religious community affirming a common set of assumptions. The
audience of bioethics is instead comprised of a broad range of academics
and professionals, who likely do not share the same moral, let alone
theological, language and concepts. In this setting, the substantive but
private insights of a particular tradition may need to be translated into
concepts that have public significance.

The linguistic compromises required to gain a "broader heating," however,
risk substantive compromises, since the common discourse of bioethics may
not be sufficiently rich to convey the full meaning of relevant religious
language. For example, the biblical concept of the "image of God" expresses
a transcendent and relational understanding of the self that may be
diminished by proposed equivalents of "personhood" or "autonomy," while
both the motivational and substantive elements of "covenant" seem only
minimally conveyed by the language of "contract." Moreover, though the
principle of "beneficence" may be in the bioethics lexicon, even at its
most morally demanding it is a very diluted form of "neighbor-love."

The problem of translating religious discourse into a common bioethics
language, without attenuating or transforming its meaning, has for some
religious thinkers illustrated the potential for cooptation involved in
addressing a secular world on its terms and in its concepts. Rather than
"profane sacred teachings" as Kass puts it, the alternative to this
perceived compromise may be to affirm an ethic of an exemplary community
that witnesses to the integrity of its religious convictions primarily in
practice rather than discourse. Stanley Hauerwas, for example, has
maintained that appreciating "the integrity of Christian
discourse--[entails] that Christian beliefs do not need translation but
should be demonstrated through Christian practices...."(n3)

There is, to be sure, an important vocational reason for retaining the
integrity of religious discourse. Unlike moral philosophers, for example,
theologians do have a particular audience or constituency to whom they are
accountable, namely, their various religious communities, whose historical
traditions of reflection may be inadequate for the new questions of
practical ethics raised by contemporary biotechnology and medicine. Part of
the theological concern with addressing a public audience on generally
accessible grounds, then, is that it may compromise not only a vocational
responsibility to speak out of a particular religious tradition, but also a
responsibility to speak to the tradition embodied in an identifiable
community of believers.

Yet a third consideration to which Kass alludes is the church-state
controversy, or the societal interest in preserving a wall of separation
between religious and public concerns. This limit may be particularly
significant in those settings where a specific kind of public bioethics is
required--the articulation of public or institutional policy by advisory
commissions or committees. The institutionalization of bioethics can
reinforce the necessity for a generally accessible language, not only to
facilitate ethical discourse among members of such commissions, but also so
that they can explain and defend their recommendations to the public on
grounds accessible to all.

In the process of public policymaking on bioethics issues, for example,
religious themes are typically acknowledged, either through the appointment
of particular commission members as representatives of a certain tradition
or in public hearings in which invited representatives from a tradition
present position statements. These statements may at times articulate
distinctive conclusions on the issues under consideration based on the
moral reasoning of a religious tradition, as exemplified by the testimony
opposing the use of human fetal tissue for purposes of transplantation by
Roman Catholic and Jewish scholars presented to an NIH panel in 1988. In
other instances, the arguments of religious traditions may be "essentially
the same" as the conclusions supported by secular moral reasoning.(n4)

Whatever the contributions of religious traditions to the policymaking
process, given the particular constitutional configurations of our polity
the outcomes and conclusions need to be articulated and defended publicly
on nonreligious, generally accessible grounds. That is, the constitutional
requirements of a secular purpose for legislation and the constitutional
restrictions on appeals to religious grounds as authorization for
legislation impose political limits on the scope of religious
argumentation.(n5)

The sense that the contributions of religious discourse to contemporary
bioethics are limited by these interdisciplinary, theological, and
political parameters assumes of course that religious traditions have
something substantively distinctive to communicate to a public, secular
audience. But where might we locate these distinctive or special insights?
I want to suggest that the answers to the conventional bioethics questions
of "who should decide?" or what should we do?" often--if we felt free to
allow them to do so--would push back to fundamental issues that require a
substantive account of the purpose of human life and destiny. These are
common questions of meaning that religious communities have devoted
considerable attention to in their theologies, rituals, and practical
ethics.

The Anomaly of Suffering

The nature of the accessibility-meaning dichotomy can initially be
illustrated by attending to some very contested questions in contemporary
bioethics. Two examples will suffice.

In an influential discussion of the moral status of animals, one
philosopher explains his neglect of religious argumentation for the concept
of the "sanctity of life" because such views do not provide "reasoned
explanation." Moreover, even sanctity of life proponents typically appeal
to nonreligious reasons, since "[religious] doctrines are no longer as
widely accepted as they once were."(n6) Another has observed that religious
arguments prohibiting active killing in medical practice have limited scope
in the secular domain; even if one "eschews euthanasia on religious
grounds, there will be the challenge of establishing in' general terms why
a secular society compassing a plurality of moral viewpoints may forbid
euthanasia."(n7) The constraints on religious discourse are in part its
sociological inadequacy (because in our secular age purely religious
appeals will not be sufficient for public moral reasoning), and in part its
logical inadequacy (because the arational nature of such appeals will be
unsatisfactory as a foundation for moral reasoning). For the sake of
general accessibility, then, we may be tempted to do bioethics without
recourse to important sources and traditions of meaning in our culture.

Yet if we consider what is driving moral debate on both "animal rights" and
euthanasia, we are likely to find what has historically been deemed a
question of religious meaning right at the core, for it is difficult to
discuss either of these issues without invoking the notion of "suffering."
The central question in attributing moral status to animals, in Jeremy
Bentham's classic formulation, is, "Can they suffer?," while arguments on
euthanasia often turn on the availability of alternatives to "relieve
suffering." Our moral disagreements in bioethics over whether animals
should be used in research or over appropriate care of the dying may thus
reflect not only (if at all) differences in moral norms, but also various
understandings of the place and meaning of suffering in our lives.

Even prior to its significance for such controversial issues, the concept
of suffering seems central for the most fundamental concerns of bioethics.
Suffering is in part constituted by the experience of a profound assault
upon or threat to our sense of self and identity that we are unable to
control. It is the experience of the inexplicably arbitrary and typically
destructive, of what Weber referred to as the "ethical irrationality of the
world." It is perhaps such a perception of illness and disease that lies
behind the Latin root (pati) of our "patient," meaning "the one who
suffers."

Religious traditions do not have a monopoly on discourse about suffering,
nor is there a univocal understanding of suffering common to all religions.
It is nevertheless the case that the meaning of suffering has long been a
central concern of much theological reflection and many religious
communities. If such a concept is a central presupposition of both basic
conceptual (what is a "patient"?) and controversial pragmatic problems in
bioethics (the human treatment of animals), the traditions of religious
discourse about suffering would seem to present a rich resource for
substantive insights. Some conceptual comprehension of "necessary
suffering" is needed, for example, to make sense of moral arguments, let
alone current public referenda proposals in Oregon and Washington that
would sanction active euthanasia in cases of "unnecessary" suffering.

A Journey of Meaning

Suffering is not of course an end of religious experience but a problem
demanding interpretation. Religious traditions have historically tried to
give meaning to suffering by placing the experience in a context of broader
questions about ultimate purpose in life, and even human destiny beyond
life. The "ethically irrational" is typically explained by the construction
of a theodicy that reconciles the presence of evil and suffering within a
concept of salvation. Inr' example, suffering may be descriptive of life
within the cycle of karma. In some Western traditions, suffering has been
construed as having punitive, pedagogical, or redemptive purposes in human
experience, though the incompleteness of all such constructions is
suggested by the paradigmatic biblical story of the suffering of Job and,
in our time, by the experience of the Jews in the Holocaust. Whether
suffering does have a "point" and what that point may be will vary among
religious traditions. My claim, however, is that the moral intelligibility
of suffering is dependent on some account, theological or philosophical, of
human nature and ultimate human ends; any conception of bioethics,
therefore, that purports to take suffering seriously will likewise have to
consider such ultimate questions.

The substantive responses of religious traditions to questions about our
origins, who we are, what the nature and purpose of life is, and what
constitutes our ultimate ends, account in part of course for the practical
and moral differences among traditions. While acknowledging tiffs diversity
and complexity, I want to illustrate, by drawing on one fairly common
interpretation of lift in religious traditions, how such ultimate
perspectives can present important implications for our models of
bioethics. For many traditions, a fundamental metaphor for life is that of
a journey or pilgrimage. The meaning of the journey is derived in part from
its rebus, the promise of passage or deliverance, including deliverance
from the ills and adversity encountered in life, and which also gives point
and purpose to morality as the requirements of character and action
necessary to transform the kind of people we are (human nature) into the
kind of people we ought to be (human destiny).

The life given to us by powers that are ultimately creating, sustaining,
and redeeming is not without its thickets and thorns, yet it is precisely
through the encounter with human (evil and sin) and natural (disease) forms
of opposition that progress in the journey is possible, for such
experiences shape decisively the identity and Character of the moral self.
Thus participation in the journey is intrinsically valuable, a source of
meaning through experience of oppression, adversity, and perhaps even
suffering. That meaning is constructed and explained, clarified and
communicated, in stories and narratives of creation, alienation, and
reconciliation told to others and retold as part of an ongoing tradition.
The journey is thus as well a communal experience that involves the making
of covenants and promises, the mutual binding together of former strangers
for common purposes and ends, through which moral responsibilities are
mediated.

This teleological account of human experience can reveal several features
to us about the character of contemporary bioethics. It is part of our set
of cultural assumptions that meaning is created (or not) by the autonomous
individual. Consider, for example, how we understand our pervasive concern
with "dying with dignity" in bioethics. A conventional explanation is that
this involves returning to the patient control over his or her dying. But,
as Kass has observed, it is far from clear that "dignity will reign only
when we can push back officious doctors, machinery, and hospital
administrators."(n8) Dignity must be informed by meaning, and it is perhaps
the case that we will achieve dying with meaning only as we understand the
place of death within a notion of a meaningful life.

Moreover, within the vision of life as a journey, the hard cases,
quandaries, and dramatic scenarios of bioethics are disclosed as but a
time-slice in the narrative of a person's moral quest. A devotion to
problem-solving both reflects and reinforces a cultural tendency to excise
an individual from the social and temporal ties, from community and
history, that present sources of meaning in the moral life.

Accommodating questions of meaning in bioethics will require that we
broaden its scope beyond our current fixation with problem-solving, for
some problems cannot be solved but must still be faced. This broader vision
involves directing attention not only to the means of medicine, such as
procedures for obtaining informed consent or the regulation of research
protocols, but also the purposes of medicine within the context of a life
conceived as a journey. For on such an account, health will be valued not
merely for its own sake, but for the ends it allows us to pursue, while
sickness and illness may signify not only inconvenient interruptions, but
also teachers whose meaning we share with others through stories.

The journey metaphor, because it presupposes a conception of human ends,
directly confronts us with questions about the moral pre-suppositions of a
medicine wedded to technology and conquest of the endless frontier of
scientific research. Formulating what these questions are, let alone
answering them, is a task made more complex by the very successes of
technological medicine, which may render prior, longstanding moral or
religious concepts inadequate or in need of reinterpretation. For example,
the suffering for generations associated with the experience of
infertility--often reinforced culturally by religious worldviews--may now,
through various technological interventions, be transformed into an
instance of unnecessary suffering.

Is suffering such an unmitigated evil, and its perduring presence such a
concession to failure, that medicine ought, as many have argued, to aspire
to its elimination? Or does suffering require the compassion of persons who
embody the meaning of care? Such matters are particularly acute in debates
over active euthanasia, where eliminating suffering involves eliminating
the person who suffers. Yet a medicine that aspires to achieve such a
purpose may conflict with specific religious perspectives that see
suffering as less a problem to be solved than as an unavoidable part of
one's journey, and which assumes meaning in the context of that journey.
For example, Paul Ramsey once rhetorically inquired whether "the purpose of
modem medicine is to relieve the human condition of the human condition,"
by which Ramsey had particularly in mind the illness, disease, and
suffering all persons experience as their mortal lot. Such an objective not
only commits medicine to an impossible task, but one that risks
dehumanizing its practitioners and patients.

To the extent that medicine is not morally bounded, or transforms
conceptual boundaries, it may summon a theological critique essentially
concerned with the theme of idolatry, of making of health an absolute, the
end of the human journey, rather than a value whose meaning is intelligible
only within some broader account of human nature and destiny. Such a
critique will thus be directed against the assertion of an unbounded
dominion expressed in some definitions of health, which threaten to
transform every human problem into one that is or eventually can be
susceptible to medical resolution, It is directed as well against
pretensions to unbridled authority and control, and unlimited knowledge in
the medical context, and against the well-intentioned aspiration to
alleviate the common problems of the human condition in a way that is
dehumanizing. Such pretensions and aspirations frequently converge in
contemporary medicine's ongoing battle with the enemy of death.

In a culture void of meaning, death must appear as the crowning surd. Its
power in our culture is disclosed in the ways we seek to evade it. The vast
majority of persons now die in alien environments, institutions such as
hospitals and nursing homes, which shelter the living from personally
confronting death and may isolate the dying from all that has comprised
their journey, including, at times, their families. For the living,
moreover, our culture increasingly holds out a promise of technological
deliverance, through the medicine of resuscitation or organ
transplantation, for example, together with empirical data on "the risk,"
factor--typically the probability of contracting a disease or developing a
condition that has some statistically significant correlation with
death--of almost every conceivable activity. We seek to evade this ultimate
assault on the self and yet, as Camus's Dr. Rieux comments, it organizes
our lives and medical activities. "The order of the world is shaped by
death.(n9)

The value of life conveyed in the journey metaphor likewise implies that
religious traditions cannot (and do not) look upon death with indifference.
Indeed, on some accounts, death may be perceived as the pervasive sign of
the intruding presence of evil. Life is a fundamental, even if not an
absolute, good; the tragedy that we ascribe particularly to premature or
"untimely" death from illness or accident is in part attributable to a
sense that a person's journey has been interrupted.

Yet for all the shadows cast by death, we may also respond to it not as
intruder but as deliverer from a completed mortal journey. That response
underlies the interpretation of death as a "blessing" found in some
traditions of religious ethics, often reflected in support for practices of
only caring for the dying rather than prolonging life through unceasing
technological support. The issue is not so much whether we can be delivered
from death, either through relying on technological sustenance or
institutional isolation, but rather how we might be delivered from
meaningless death. The latter requires contextualizing death in a broader
vision of human life, or as passage to ultimate destiny beyond life, and
through practices of ministering to the dying in a community of care. In
this respect, the traditions of religious discourse witness to a conviction
that death is not the overriding power that governs our lives, but is
itself subject to powers that are ultimate and supreme.

The nature and purpose of life, and the place of health, medicine,
suffering, and death within a vision of human nature and destiny, while
integral to religious discourse, are common human questions of meaning that
often seem peripheral in the quandary,centered concerns of bioethics. A
central contribution of religious traditions may therefore be to broaden
our moral vision by raising issues of existential interest that are not
typically addressed in contemporary bioethics. Precisely because these are
human questions, they require examination, lest our assumptions about
pluralism and ethics consequently compartmentalize our moral lives.

Priests and Prophets

We value bioethics in a pluralistic moral culture in part because of its
capacities for peaceably resolving moral conflict at)out difficult
practical dilemmas and hard cases. The success of bioethics in
problem-solving is displayed in its increasing institutionalization in
health care through the establishment of hospital ethics committees, ethics
consultation groups, institutional review boards, and advisory commissions
at state and national levels. In these various forums, bioethics discourse
is prominently shaped by an ethic of principles--autonomy, beneficence, and
justice--that seems well-suited as a method of conflict resolution because
such norms are deemed to command general acceptance.

In managing and regulating the moral issues that arise in the delivery of
health care, bioethics provides an important service for patients, their
families, and clinical practitioners. Yet, while this "priestly" role (as
it might be viewed in a religious perspective) is a necessary dimension of
bioethics, it is not sufficient, for bioethics should be not only a source
of solutions but also a source of problems.

Part of the responsibility of bioethics is to be "prophetic," challenging
to accountability the institutional and professional presuppositions of the
health care system and the society of which it is a part. No ethics
committee can resolve the scandal of 31.5 million medically indigent
persons in this country who may not have access to any institution to begin
with. The prophetic responsibility of bioethics necessarily entails probing
beneath the visible manifestations of the crisis to identify the root
causes of the problem and articulating an alternative vision of the health
care system based on ideals of justice in community that may be only
approximated in practice. Religious traditions can enhance recognition and
implementation of this responsibility, for it is the indicting message of
the biblical traditions of this culture that the poor are not to be
excluded from the community of moral concern.

Moreover, religious traditions can, in several respects, be significant for
reminding us of the lira;rations of an ethic of principles. The normative
principles of bioethics are not, for example, self-applying or
self-interpreting, but instead require a context of application and a
content informed by moral traditions--professional, secular, and religious.
In this dialogue among traditions, religious discourse can illuminate and
acknowledge the validity of a moral principle, even while challenging its
conceptual presuppositions.

For example, central convictions of theological anthropology in biblical
traditions, such as that human beings are created in the image of God,
support the notion of intrinsic human dignity and respect for personal
choice conveyed in bioethics discourse by the principle of autonomy. Yet
such a principle will always appear theologically limited to the extent
that its conceptual assumptions reflect an isolated individual severed from
community and history. The scope of autonomous choices may be limited by
the relational and narrative nature of the self, whose moral identity and
character are forged in process of a temporal journey rather than in
discrete instances of dramatic decisionmaking.

It would, moreover, be theologically narrow to focus on the moral self as a
"decisionmaker" or "chooser." Human beings are more than the aggregate of
their choices; the "person" whom one respects is an embodied self and the
correlative attitude of "respect" must be holistic, acknowledging the moral
significance of the bodily organism as well as concerns about liberty of
action and freely willed decisions. The self is more than one's capacities
for rational, cognitive activity just as the body is more than personal
property. In addition, it may be misleading to understand autonomy as a
moral ideal for human beings, since freedom of choice may be seriously
compromised not only by illness, but also by what biblical traditions have
typically designated as "sin," a condition that even Kant believed was so
common and radical as to compromise the very conditions for autonomous
choice.

An assessment of beneficence and justice can evoke similar kinds of overlap
and critique. Beneficence. conveys a sense of moral obligation and
responsibility for the welfare of others, but its content and scope may
seem minimalistic placed alongside norms of love of neighbor Moral
philosophers have often maintained that, beyond the fundamental requirement
not to harm others, positive actions on behalf of the welfare of other
persons are frequently discretionary, as suggested by the language of
"imperfect duties" or "supererogation," or mediated by professional roles,
such as those assumed by health care practitioners. The substantive
requirements of love of neighbor, however, will often demand exceeding
minimal or role responsibilities. The themes of self-sacrifice, assuming
personal inconvenience and risk, and active seeking of the welfare of
others beyond one's conventional community of concern, as displayed
paradigmatically in the Christian narrative of the Good Samaritan, may
entail that the discretionary takes on the character of the obligatory.

The sense that health care is a special kind of good has been an important
conceptual underpinning for egalitarian schemes of allocating health care
resources. This approach can be supported by the anthropology of the image
of God, but it also may be qualified by a historically informed conception
of preferential justice towards the poor, the oppressed, and the stranger.
Justice may thus require more than a self-interested egalitarianism,
namely, a commitment to give special priority to the health care needs of
people and groups who have historically experienced oppression and
marginalization in our culture. The preferential qualification of
egalitarian justice reflects an attempt to redness inequalities stemming
from natural and social "givens" with particular attention to the most
vulnerable and voiceless in our society.

While religious traditions can point to the questions that need to be asked
about the meaning and application of a moral principle, they can also
inform judgments about what an ethic of principles neglects. For example,
such an ethic assumes a sociology of strangers who share little in the way
of common values and ends, and there are instances in medicine where such a
situation obtains. It would be a mistake, however, to encompass all human
relations, and thereby all human choices, under such a model. A richer
sense of special moral relationships, embodied in families, friendships,
congregations, or in professional collegiality, can attest to the moral
significance religious traditions have historically placed on themes of
community and covenant.

Nor do the normative principles of bioethics, to the extent that they focus
our moral vision on questions of what should be done in a situation, give
sufficient attention to the issue of what kind of people moral agents
should be, or what kinds of virtues are necessary to sustain us in our
temporal journey beyond the moment of decisionmaking. The moral teachings
of religious traditions speak to matters of meekness, mercy, and purity;
knowledge, temperance, and patience; gratitude, courage, and kindness;
faith, hope, and love; issues of moral character and identity beyond the
scope of decision-oriented principles. A comprehensive bioethics may find
in religious discourse about virtues and dispositions an important source
of moral correction and balance, one that places our decisions about health
care within the context of a fuller account of purpose and meaning in life.

Acknowledgments

I wish to thank several persons who gave me helpful criticism and needed
encouragement, particularly my colleagues at The Hastings Center, Daniel
Callahan, Kathleen Nolan, Susan Wolf, and Michael Zeik, all of whom read
prior versions of this article; Rabbi Marc Gellman, Ronald Green, Stephen
Lammers, Richard Neuhaus, Philip Turner, and Alan Weisbard, who
participated in a project meeting on Religion and Bioethics where another
version of this article was discussed; and James F. Childress at the
University of Virginia.

References

(n1) H. Tristram Engelhardt, Jr., "Looking for God and Finding the Abyss
Bioethics and Natural Theology," in Theology and Bioethics Exploring the
Foundations and Frontiers, Earl E. Shelp, ed. (Boston D. Reidel Publishing
Company, 1985), 88.

(n2) Leon R. Kass, "Practicing Ethics Where's the Action?," Hastings Center
Report 201 (January/February 1990), 6-7.

(n3) Stanley Hauerwas, "The Testament of Friends," The Christian Century
1077 (February 28, 1990), 213.

(n4) President's Commission for the Study of Ethical Problems in Medicine
and Biomedical and Behavioral Research, Splicing Life (Washington, D.C.
U.S. Government Printing Office, 1982), 54.

(n5) For a more detailed account of this issue, see Kent Greenawalt,
Religious Convictions and Political Choice (New York Oxford University
Press, 1988).

(n6) Peter Singer, Animal Liberation A New Ethics for Our Treatment of
Animals (New York Random House, Inc., 1975), 21.

(n7) H. Tristram Engelhardt, Jr., "Fashioning an Ethic for Life and Death
in a Post-Modern Society," Hastings Center Report 191 (January/February
1989), Special Supplement, 8.

(n8) Leon R. Kass, "Averting One's Eyes, or Facing the Music?-On Dignity in
Death," Hastings Center Studies 22 (May 1974), 69.

(n9) Albert Camus, The Plague (New York Vintage Books, 1948), 121.

~~~~~~~~

by Courtney S. Campbell

Courtney S. Campbell is associate for religious studies at The Hastings
Center and editor of the Hastings Center Report.
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