Broken Bodies Redeemed

Bioethics & the Troublesome Union of Body & Soul

by Gilbert Meilaender

The body’s a downer.” So, according to a recent article (“Boomers Bringing Personal Touch to Their Funerals”) in the Chicago Tribune, says Mark Duffey, an entrepreneur with an idea, who recently started “what he calls the first nationwide funeral concierge service.” Evidently clergy blood pressure will soon be raised not only by those annoying wedding planners but also by funeral planners.

According to Duffey, Baby Boomers are eager “to control everything, from the food to the words to the order of the service. And this is one area where consumers [!] feel out of control.” One family, for example, reflecting upon the fact that their now deceased father had spent Sunday mornings on the golf course rather than in church, planned a memorial service on the 18th green of his favorite course.

A significant factor in making services “less somber” is the rapid growth in cremation. Not having a dead body around is liberating. “If the body doesn’t have to be there, it frees us up to do what we want.”

Mr. Duffey is likely to make a good living off his idea, but one fears that he is trapped in layers of self-deception. A dead body testifies that we are no longer in control—and perhaps that we never really were. Being freed up to do what we want is exactly the kind of pretension that death cuts short.

There is something pathetic about wanting to be in control of the event that announces our lack of control. Still more, we deceive ourselves if we want to celebrate the things we enjoy in this life without the presence of the body—the place of personal presence, without which none of those enjoyments is possible.

Live Bodies

An inability to think seriously about the significance of the dead body is likely to go hand in hand with uncertainty about the meaning of the living body. And we live in a world that constantly challenges us to think about what difference it makes that our identity is inextricably tied to the body. One arena in which such challenges regularly arise is the set of problems taken up under the rubric of “bioethics.”

Bioethics deals with bios, that is, with the body and earthly life. Taken seriously, therefore, it deals not just with a variety of important problems but also with the deeper questions of human “being” that—whether fully articulated or only taken for granted—shape what we think and say about particular problems. Without ignoring the issues that seem so pressing, we do well, then, to step back occasionally and give some attention to perspectives that are less immediately urgent—or, perhaps better, to think about particular issues in relation to our understanding of what it means to be human.

One of those understandings is often expressed still today by saying that human beings are composed of both body and soul. There are various angles from which one might assert this; I will be considering specifically Christian uses of such language, and the high value Christians place upon the body, affirming even that it will be raised to new life at the end of history.

We can, I think, imagine a being who is pure spirit—an angel, say, or the god of the philosophers. We can also imagine a being who is limited to the body—whose anima, whose life principle, has no capacity to transcend the limits of nature and history.

When we think of a human being, however, we have to think of one who is neither god nor beast, neither pure spirit nor simply body, but, somehow, the union of both. We are these strange, two-sided beings simply because that is the way we have been created. The sort of being we are is utterly contingent—at least from our perspective, though not, perhaps, from the perspective of God. We simply find it to be the case that God chose to create not only birds of the air and fish of the sea, but also the human being, made in his image and likeness.

Disastrous Picture

At any rate, the human person, we are accustomed to saying, is the union of body and soul. When, however, we try to articulate what that means, we may think of this person as a composite of two things that are in principle separable, that are temporarily glued together in this life, that will, by God’s grace, be separated in such a way that the person continues to live even after the body has died, and that will one day have these two parts reunited. If pressed, we may have a hard time saying why, apart from the fact that the Church has taught it, this reunion of parts should really matter, if the person lives on even after death.

That picture is, I am shortly going to suggest, disastrous for bioethics. And even here at the outset, it may be good to have in mind also a slightly different image of the human person, an image that I borrow from C. S. Lewis. For the moment, I simply set it before us, to give it a chance to sink in.

Think of a knight mounted on his horse. But now, think of these as so wholly one that “the two together make rather a Centaur than a mounted knight.” You can’t shoot the horse out from under and have the knight survive unscathed. And you can’t imagine the living horse apart from the knight, as if it were “just” an animal. The centaur is a real union, the union of man and beast—as the human person is the union of nature and spirit, body and soul.

It is this person whom God will one day raise. Not a body. Not a soul. Not a body and a soul glued together. But the person whose living body can be living only because animated by a soul. And the person whose soul needs the body for the unfolding of its life, whose soul cannot, as Aquinas says, “possess the perfection of its own nature except in union with the body.”

In thinking about what it means to be human, and about ways in which we may go wrong—ways in which we may fail to honor and uphold our created nature—we can discern, therefore, two general directions in which we might go wrong. We could think of human beings as just bodies: a complicated animal to be sure, but one for whom the animating principle is, finally, complex chemical interactions of the brain, as neuroscience studies it.

Or we could picture the real person as just soul: an immaterial consciousness that is not essentially embodied and that may one day be able to cast off the biological substrate upon which it currently depends and achieve a kind of intelligent immortality that is not dependent on the body.

If the human being is made by God to be the union of body and soul, then either of these wrong paths must lead toward what would be, to borrow a title from a book by Francis Fukuyama, a “posthuman” future.

The Body Alone

There are many different angles from which we might examine currents in bioethics that invite us to think of human life as a matter of the body alone. For example, consider the fact that between 1994 and 2001 psychotropic drug prescriptions for teenagers increased by 250 percent, or that (in 2001) one in every ten doctor’s office visits by a teenage boy resulted in a psychotropic drug prescription.

However many reasons we may give in explanation of this phenomenon, one is surely a tendency to believe that behavior and mood are simply a matter of chemical states in the brain—and that altering those states is more consequential than moral formation or developing a capacity for disciplined persistence or delayed gratification. Fundamental human experiences, such as sadness or sickness, are emptied of psychic and spiritual significance and turned into matters of body chemistry.

Or, to take a very different sort of case, the enormous push to carry out research on embryos that uses and destroys those embryos in the process is fueled, at least to some degree, not by any homicidal drive, but by a great concern for life. The aim, sincere in at least many cases, is to relieve human suffering and extend life.

But, hoping for no life other than this perishable, earthly one, we must grab for all the gusto we can get and ask of our mortal bodies more than they can deliver: the full meaning and joy for which we long. Driven by that love for life—but for this bodily life alone—we demand so much of it that we become willing to use and sacrifice the weakest and least of our fellow human beings in what we take to be the service of life.

This is a tragically misplaced love of life; for, after all, more of the kind of life we now enjoy, or even an enhanced and happier version of the life we now enjoy, cannot be the object of resurrection hope. St. Paul is clear, we should remember, that, when Christ returns in glory and the perishable nature puts on the imperishable, even those who have not yet fallen asleep, who are alive on that great day of the Lord, will themselves have to be changed and transformed. They will not simply continue living the life they are then living—as if, in their case, it just continued on without the sort of interruption the dead have experienced.

There is always a discontinuity between our created life as a person who is the union of body and soul, and the resurrected life, when that same person shares mysteriously in God’s own kind of life, given by the Spirit of the risen Jesus. The object of Christian hope is not more of this same life, but a qualitatively different life; redemption is more than the restoration of creation.

Thus, in attending to the mistake of picturing ourselves as “just body,” we might think about the uses of pharmacology to alter and enhance life, or we might think about the drive to make progress through research, even if conducted at the expense of the most vulnerable human beings. I want, though, to focus briefly on what may seem—and perhaps is—a less significant concern, but one rather closely related to the topic of resurrection of the body.

Uncanny Donations

In our desire to relieve suffering and extend the life of those who are experiencing failure of an essential bodily organ, we have turned to organ transplantation. Because of the troubling moral questions that surround taking organs from those who are alive—and because, of course, some organs, such as the heart, simply could not rightly be taken from one still living—we have turned first to cadaver donation.

Even taking organs from (newly) dead bodies is not unproblematic, however. The body, even the dead body, seems to be more than simply matter. Even the dead body is not “just body.”

There is, after all, something uncanny about a corpse, for it is someone’s mortal remains, from which the animating spirit is now absent. We would, I think, worry about a medical student or a mortician who felt no need to stifle within himself a deep reluctance and contrary impulse the first time (or the hundredth time) he handled or cut open a human corpse. Reverence for the dead body is not (we think and hope) entirely incompatible with using it for a good purpose; yet, even that use should be pervaded and governed by a certain awe.

If we really freed ourselves entirely of such awe and reverence, we could without hesitation develop the “bioemporia” filled with “neomorts” that Willard Gaylin envisioned more than thirty years ago: repositories of brain-dead but breathing, oxygenating, and respiring bodies available for countless uses (medical training, drug testing, experimentation, harvesting of tissues and organs, and manufacturing). That few of us would be prepared to turn in such a direction indicates, again, that certain deep human impulses must be overcome before we use the dead body, even for the best of purposes.

Moreover, the language of procuring “cadaver” organs for transplant is in some respects misleading. This is not the sort of cadaver upon which medical students hone their skills. Cadaver donation has generally meant taking organs for transplant from bodies which, though brain-dead and sustained entirely by medical technology, do not look dead. (Hearts still beat, blood still circulates, respiration continues.)

It is striking, for example, that when organs are taken from a brain-dead but heart-beating corpse, the dead body is first anesthetized, lest its blood pressure rise precipitously. Even the brain-dead body seems to manifest certain integrative functions.

This does not necessarily mean we are wrong to take organs from such dead bodies, but it ought to give us pause. A brain-dead body is not just a resource. Even if this body with its heart still beating is a corpse, we would not bury it until it had “died all the way” (a formulation which, even if inexact, captures some of the ambivalence we ought to feel).

What our culture may lose here—in its rush to declare an organ shortage that must be solved—is a humane death. Indeed, death itself becomes a kind of technicality—an obstacle to organ procurement, which obstacle must be surmounted in order to obtain the body’s parts and achieve our worthy goals.

Planned Deaths

This is also evident in recent attempts, motivated again by a sincere desire and a supposed imperative to overcome an organ shortage, to plan the deaths of patients in such a way as to procure organs almost immediately after the cessation of heart and lung activity. A dying patient on life support is prepared for surgery, taken to the operating room, given drugs that will protect the viability of his organs after death, removed from life support, declared dead two minutes after cardiac arrest—at which time his organs are removed for transplant.

Thus, in an age that has worried greatly about having death occur in the dehumanizing context of machines and technology, our desperate sense that it is imperative to procure more organs and extend life has led to precisely what we condemned: the loss of a human death and acceptance of what Renée Fox once called a “desolate, profanely ‘high tech’ death.”

We are all in favor of extending and saving life. But in the process of pursuing that laudable aim, we should not train ourselves to think that even the dead body is “just body”—or to think of the body as a handy resource, rather than the place of personal presence. That the no-longer-animated body from which an organ is taken for transplantation is someone’s mortal remains (and not just a collection of readily available organs) is indicated by how hard it is for us not to think that the presence of a transplanted organ (or at least of certain organs) somehow brings with it the presence of the person from whom that organ was taken.

Just such psychological complexities are at the heart of Richard Selzer’s profound and provocative short story, “Whither Thou Goest.” When Hannah Owen writes to Mr. Pope seeking permission to listen for an hour to the heart of her deceased husband, which now beats in the body of Mr. Pope, she does so, as she puts it, because of “the predicament into which the ‘miracle of modern science’ has placed me.” She professes no interest at all in Mr. Pope himself other than as the one who houses something she used to know well and longs to hear again.

Such is the mysterious connection of body (or even bodily part) and person, however, that a reader may wonder about this when, after finally receiving permission to listen to the heart now beating in Mr. Pope, Hannah is “nervous as a bride.” For her, at any rate, the heart now beating in Mr. Pope’s chest continues to carry the presence of her husband.

Mortal Unity

Thus, we should not too quickly assume that transplantation of organs even from a dead body is unproblematic. Those mortal remains retain the “look” of a person’s life: not just a mechanism whose parts work together well or badly, but the unity of an individual life.

We can see this truth in a horribly negative mode if we ask ourselves why an al Qaeda-led group in Iraq would have released footage of two corpses that it said were those of US soldiers killed in June 2006. The video showed a decapitated body and several dead bodies being stepped on. This dishonoring of the corpses could have no point were not even the dead body still a reminder of personal presence.

The mortal remains signify the history of a life in all its connections, especially with those to whom the person now dead was closely attached. It is not bad—indeed, it is highly desirable—that they should honor their shared history and mourn their loss by demonstrating reverence for that embodied life, and such reverence is quite a different thing from parceling out the component parts of a corpse for the sake of achieving desirable goals.

In order to relieve suffering or save life, some of us may overcome these considerable reasons for reluctance to give organs for transplant after death, but it would be deeply troubling if we experienced no reluctance that needed overcoming—if our thinking and acting were governed solely by the sense of an organ shortage that needed to be solved. “There is,” as William F. May once put it, “a tinge of the inhuman in the humanitarianism of those who believe that perception of social need easily overrides all other considerations.”

This body that marks out my place in the world is not just a thing I inhabit, as if the real me were elsewhere. It is never “just body,” not even when my soul has ceased to animate it. That is why, as mortician-poet-essayist Thomas Lynch has written, “Ours is the species that keeps track of our dead.”

Philosophers and bioethicists—even some theologians—may emphasize that the human species is marked by certain capacities: consciousness, self-awareness, reason. Criteria such as these are too often used to exclude some human beings from the scope of our moral concern, to narrow the circle of moral obligation.

How much better—because it captures something of the personal significance of the body—is Lynch’s criterion: “Ours is the species that keeps track of our dead.” How could we not—if the One who from eternity is the image of the invisible God has a body, and if the Spirit who raised him from the dead will one day give life also to our mortal bodies?

The Soul Alone

We shift our angle of vision now in order to think of the other way in which we might go wrong, might fail to honor and uphold our created nature. It is a characteristic of our gnostic age that we can shift easily from thinking of ourselves as “just body” to envisioning our true selves as “just soul.” Here, too, there are many different angles from which we might examine currents in bioethics that invite us to think of human life as, finally, a matter of the soul alone.

Even well short of “trans-humanist” visions of downloading one’s brain onto a computer, becoming pure mental energy, or halting the process of aging—which are attempts to overcome or leave entirely behind the limits of bodily life—the astonishingly rapid advances in genetics now tempt us to think of human beings as indefinitely free to make and re-make themselves. As we aim at genetic manipulation, germline intervention, or even the addition of artificial chromosomes, we learn to think of genes as resources, rather like the pages in a loose-leaf notebook, that can be shuffled and reshuffled—even, perhaps, across species lines—in an ongoing process of shaping and designing ourselves and succeeding generations.

We will think of this as progress, and, to be sure, it will—should it happen—be an astonishing and impressive display of human freedom and mastery. Nonetheless, such achievements, for which the body becomes little more than a prosthesis used by the real self, can be simultaneously impressive and dehumanizing, for they undermine that two-sided created nature that is at the heart of our humanity. Nor, unfortunately, is it clear how beings who are simply bundles of resources will find the standards by which to determine whether such changes are good or evil.

Creating our own standards of good and evil will be part of what it means to think of ourselves as “just soul.” Thus, when Gregory Stock, for example, writes that we are on the cusp of being able to “replace the hand of an all-knowing and almighty Creator with our own clumsy fingers and instruments,” he can assume that this would be moral progress rather than the abolition of our humanity only because he is moved by an image of the human being as “just soul,” as free self-creator.

Or, from a slightly different angle, consider how our age has transformed procreation into reproduction, the child begotten into the child produced. In the passion of sexual love a man and a woman step out of themselves and give themselves to each other. Even if they very much desire a child as the fruit of their love, in the act of love itself they set aside all projects and desires. They are not any longer “making” a baby—as if they were exercising control and mastery. They are stepping out of themselves, out of their plans and projects, and giving themselves in love.

And, hence, the child, if a child is conceived, is not the product of their willed creation; for in this act they have neither plans nor projects. The child is not the product of their rational will but a gift and a mystery, springing from their bodily embrace. That understanding of the child as begotten but not made by us, as a gift given us rather than one whom we control or design, is unlikely to be sustained by those for whom the body is not really the place of personal presence.

Persons Who Are Not

Thus, in attending to the mistake of picturing ourselves as “just soul,” we might focus our attention on advances in germinal choice technology, on the search for a kind of immortality, or on the transformation of the child into a product. Any of these could lead us to see ways in which we may think of ourselves less as embodied human beings than as free self-creators. For the moment, though, I will consider briefly one problem that raises similar questions about the meaning of the living human body: the puzzles that surround care for certain severely disabled patients.

If the human person really is a union of soul and body—more like the centaur than like the knight mounted on a horse—then (on the one hand) the soul needs the body for the unfolding of its life, and (on the other hand) there could be no living human body not animated by a soul. If, by contrast, we come to think of soul and body as essentially separate entities attached for a time to each other—like horse and rider—the body is no longer the place of personal presence. It is an animal body, taken up for a while into the life of the person who is, really, something other than body.

Then, when soul and body have been thus detached, when the living body is not necessarily the place where the real person, the soul, is present, we have to look for some other way of describing what it means to be a person. And that is precisely what modern thinkers have often done. They have looked for characteristics or capacities—self-awareness, consciousness, ability to feel pain, a sense of having a history over time—that would mark off those living human beings who are persons from those living human beings who are not.

To see this is to see how, for example, embryos and fetuses, those (such as Terri Schiavo) in a persistent vegetative state, or (perhaps) those with advanced dementia may no longer be regarded as human persons—even though they are clearly living human beings. In this way, to lose the sense of our created nature is, as I put it earlier, disastrous for bioethics.

We can reflect for a moment on the case of Terri Schiavo. It received enormous publicity—indeed, probably more publicity than is conducive to careful thought. If at any point a patient’s body is shutting down, if he is going to die regardless of whether he is given high-caloric tube feedings, then surely we can discontinue feeding without thinking that we are abandoning him in his dying or aiming at his death.

But the Terri Schiavo case was not really like that. For in that case we were faced with a patient who might have lived another decade if fed. Such a person is certainly severely disabled, but it would be counterintuitive to call her a “dying” patient. She is not irretrievably dying, perhaps not even terminally ill. And if she is not dying, it will be difficult to characterize a decision not to feed her as simply “letting” or “allowing” her to die.

We simplify matters considerably, of course, if we tell ourselves that the real person is no longer there—as if there could be a living human body no longer animated by a soul, as if the rider could have simply dismounted and left behind nothing but an animal. This may simplify matters, but only at the cost of losing the real union of body and soul that constitutes a human person.

The Oldest Old

As striking and highly charged as a case such as Terri Schiavo’s may be, however, in the coming years a different sort of case—far more common—will pose a much greater challenge both to our understanding of the human person and to our capacity for caregiving. Blessed as we have been by the medical advances that have increased life expectancy (from 47 years for the average American in 1900 to 77 years in 2000), we are going to pay the price for this greater longevity in the decades that lie just ahead of us.

The “oldest old” (those 85 years and over) are currently the fastest growing segment of our population in this country. And along with that demographic reality, unless medical advance can overcome the problem it has produced, will come a rapidly growing number of people suffering from various stages of dementia. Right now, about 4 million Americans have Alzheimer’s disease. Without some medical breakthrough (of cure or prevention), that number is estimated to reach between 11 and 16 million by the year 2050.

When these patients—some of them us, of course—no longer know or can tell us who they are, when every face they see or paper they pick up (even if for the hundredth time) is a strange and new experience, will we still retain the human wisdom—the philosophical and theological resources—to affirm that such a living human body is also and still a place of personal presence? Or will we be eager to find ways to stop treating them—ways that will not seem directly to cause death but will, nonetheless, provide a means to that desired end?

These are hard and puzzling cases. Certainly I cannot solve them all here—or anywhere else, for that matter. But many people suffering from dementia will have other medical needs that can be met by minimally invasive care—a need for antibiotics, or a pacemaker, for example. This is care we would surely try to give to those who are not demented; yet, we may well be tempted to refrain in these cases.

For we may have learned from our culture—and even from some distortions of our theological tradition—to suppose that the real person, being “just soul,” is no longer present as the animating form of that still living body. Rather than doing what we can to benefit the life this ill and disabled person still has, we will be sorely tempted to look for a way to orchestrate his death.

Personal Presence

There is more—no doubt, much more—that could and should be said about the topics in bioethics that I have touched upon. But I hope I have done enough to illustrate how badly our bioethical reflection needs what Pope John Paul II called “the affirmation of the inseparable connection between the person, his life, and his bodiliness.” The horse needs the rider; the rider needs the horse; the union of the two—more like the centaur—is the place of personal presence.

We are not likely to think adequately about birth or death, about medical treatment or medical research, unless we have done our best to think of human beings as neither “just body” nor “just soul,” but as body-and-soul: living beings who are personally present only as animated bodies.

To be sure, there is much about our nature that must remain mysterious until the day comes when we see more clearly than is possible for us now. And we are assured in the New Testament that such a day will come, when the risen Lord comes with the clouds and “every eye will see him.” He will come as what St. Paul calls the “man of heaven,” whose image we will bear. Moreover, “when he appears we shall be like him, for we shall see him as he is.” No longer “in a mirror dimly, but . . . face to face.”

We should, I think, try to learn once again to take these promises seriously. We will see him face to face. As the neurologist-psychologist Erwin Straus once wrote, the truth that “only with eyes can we see” does not mean that we see with the eyes. On the contrary, it is the person, the unified living being, who sees. “Seeing is,” as Straus put it, “located neither in the eye nor in the retina, nor in the optic nerve . . . the brain does not see.” It is the living person, the union of body and soul, who sees.

C. S. Lewis was right, therefore, to suggest that we need to renew the virtue of hope for a heaven that is truly a new creation. The God in whom we hope is, after all, “the God of corn and oil and wine. He is the glad Creator. He has become Himself incarnate.” And, having a body himself, he has, for reasons beyond our ken, made us also to be personally present in the body—not just here and now, but also there and then.

As Lewis put it, drawing out and refining the image I borrowed from him at the outset:

These small and perishable bodies we now have were given to us as ponies are given to schoolboys. We must learn to manage: not that we may some day be free of horses altogether but that some day we may ride bare-back, confident and rejoicing, those greater mounts, those winged, shining and world-shaking horses which perhaps even now expect us with impatience, pawing and snorting in the King’s stables.

Not that the gallop would be of any value unless it were a gallop with the King; but how else—since He has retained His own charger—should we accompany Him?

Gilbert Meilaender holds the Duesenberg Chair in Christian Ethics at Valparaiso University and is a member of the President?s Council on Bioethics. His most recent books are the second edition of his Bioethics: A Primer for Christians (Eerdmans), and the just published Oxford Handbook of Theological Ethics (Oxford University Press), of which he is the co-editor. He is a Lutheran.