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Bioethics: A Christian Primer
by Gilbert Meilaender
Grand Rapids: Eerdmans, 1996.
(120 pages, $10.00, paper)
Body, Soul and Bioethics
by Gilbert Meilaender
Notre Dame: University of Notre Dame Press, 1996.
(134 pages, $21.95, cloth)
reviewed by Allyne Smith
Gilbert Meilaender, professor of theological ethics at Valparaiso University, has produced two recent books for Christians in the increasingly important area of bioethics. Bioethics: A Christian Primer is, as its title suggests, an introductory work for the average reflective Christian. In addition to the specific issues discussed below, Meilaender considers genetic advances, prenatal screening, suicide and euthanasia, refusing treatment, organ donation, human experimentation, and sickness and health.
The writing is always remarkably clear and thought-provoking, and the chapter on organ donation, for example, has caused this reviewer to reconsider his own position. One criticism of Bioethics, however, is the scarcity of footnotes. The author actually may whet the reader’s appetite for more information, so suggestions for further reading would be a helpful addition.
Body, Soul and Bioethics is a different kind of book than his Christian primer: less general, with more attention to the current literature in the field, but no less accessible to the general reader. Here Meilaender begins with a chapter on methodology that introduces some of the writers and approaches that have shaped American bioethics over the last couple of decades—the four principles approach of Tom Beauchamp and James Childress, the revival of casuistry by Albert Jonsen and Stephen Toulmin, and the communitarianism of Ezekiel Emmanuel. He ends this survey with a criticism of the status quo that follows the analysis of another influential bioethicist, Leon Kass.
In the second chapter Meilaender criticizes secular notions of personhood that have shaped the development of bioethics, notions that tend to separate the body from the person. Preferring to speak of the person as both “embodied soul” and “ensouled body,” Meilaender offers the following as the alternative Christian view: “To have a life is to be a terra animate, a living body whose natural history has a trajectory. It is to be someone who has a history, not a someone with certain capacities or characteristics.” This conception developed, he suggests (following the Anglican ethicist Oliver O’Donovan), “when Christians had to make sense of the claim that in Jesus of Nazareth both divine and human natures were joined in one person.”1
The next chapter is a much needed look at how Christians should view the advances in reproductive technologies: every week seems to bring news of a new advance or new ethical dilemma in this field. Meilaender see the change of terminology from “procreation” to “reproduction” as symbolic of a tremendous shift in the perception of what is at stake.
In the parallel chapter in Bioethics, he examines the moral significance of the biological bond between parent and child, of assisted reproduction, of the use of third parties, and of surrogacy. He clearly rules out the use of third parties, whether through donation (of sperm or ova) or surrogacy, and also strongly suggests that we should be cautious even about assisted reproduction that does not involve third parties. Such techniques “instru-mentalized the body and use it in order to produce a child,” and so risk “a separation of person and body that demeans the body and makes of it a ‘thing’.”
They also present new problems. What are we to do with extra embryos? Recent headlines have brought us news of an incident in Britain involving the wholesale destruction of unwanted embryos. And as an example of fertility drugs resulting in many more embryos being conceived within the womb than can be successfully brought to term, he cites the case of a woman carrying nine children who was persuaded by a tabloid newspaper to attempt to carry all nine to term. (All of them died.) But can Christians rest any easier with the usual procedure in such a pregnancy—to eliminate most of the unborn children to increase the chance that one or two would survive? These dilemmas raise the fundamental question as to whether or not something should be done simply because it can be done and someone wants it done.
In the fourth chapter of Body, Soul and Bioethics, Meilaender examines the impoverishment of the public policy dimension of bioethics, citing as a prime example a report on human embryo research. The chapter’s last section provides a haunting comparison of the justification for embryo research with the ethical processes that underwrote Nazi medicine.
The concluding chapter on abortion is a brief but useful look at some of the pro-choice arguments that Meilaender believes Christians must reject. The parallel chapter in Bioethics is longer and covers more ground, but it is also problematic. He writes persuasively of how Christians ought to view the subsidiary issues of personhood and privacy, and in his concluding section on welcoming children he argues that we must “let our estimate of the child be shaped and formed by God’s.”
But Meilaender falters on two issues, the first being the question of when human life begins. Is it at fertilization, or later? The Bible, he says, does not answer the question for us, but nonetheless “directs our attention to the value of fetal life.” Citing Psalm 139:13-16, he suggests that what the psalm does is to
depict a God who does not value achievement more than potential, who cares even for the weakest and least developed of us. More important still, at least for Christians, has been the christological teaching that in Jesus of Nazareth God has lived and redeemed the entirety of human life, from its very beginnings to the death toward which we all go. . . . We have, therefore, good theological reason to affirm the continuity of life from its earliest beginnings to its last breath.
After this excellent beginning, which would suggest that Meilaender is going to affirm that human life begins at conception, he surprises the reader with an about-face, declaring instead that there are two good reasons why we should favor the notion of “delayed animation” (the idea that the early embryo is not a person because it has not yet received a soul) over “immediate animation” (which holds that the early embryo is a person from conception).
The first is that at least half of the ova that are fertilized do not successfully become implanted. If we believe that fertilized ova are persons, then we must also “conclude that half of the human race dies after a life of four to five days,” a result he deems possible but “counterintuitive.” There is no short answer to this other than to say it is a question for theodicy (theological attempts to reconcile the existence of suffering and evil with the existence of an omnipotent, omniscient and good God). There have, however, been a number of responses to this supposed dilemma, and it is unfortunate that Meilaender does not consider any of them.2
His second reason for accepting delayed animation is his claim that, “for the first fourteen days after fertilization, the individuality of the developing entity is not firmly established.” Here he is referring to the fact that during this period “the developing blastocyst can ‘segment’—that is, “twining’ can occur if the one blastocyst divides into two (or more) of the same genotype.” He concludes that because of this phenomenon, “it is difficult to argue than an individual human being exists prior to that point.” He does concede that if it can be shown that such segmentation is a result of genetic programming at the point of fertilization, “the facts would be different and fertilization would again be the decisive moment in the establishment of individuality.” As with the previous issue, Meilaender does not deal with the growing literature that argues that the facts are indeed different and that individuality should be understood as being decided at the point of fertilization.3
This is not of merely theoretical interest. Because he holds for delayed animation, Meilaender draws a practical conclusion that this reviewer must reject, namely, that all techniques and medications that prevent implantation of the fertilized egg (such as the IUD) should be construed as “more like contraceptive than like abortifacient procedures.”
The second issue has to do with the “exceptional” cases of abortion where pregnancy has resulted from rape or incest. Here Meilaender believes abortion is justified:
. . . in this instance, even though the fetus is, of course, formally innocent, its continued existence within the woman may constitute for her an embodiment of the original attack upon her person. . . . she may find the courage and strength to love and let live even the one whose presence embodies the attack of her enemy. But again, we cannot claim that such a decision would be the only way to follow Christ.
This conclusion, while certainly politically more palatable than the alternative, flies in the face of his arguments against abortion in the non-exceptional cases.
To answer Meilaender, first we need only reply as he did above, that as Christians we are to “let our estimate of the child be shaped and formed by God’s.” And second, consider the concluding section of this chapter that speaks, almost poetically to the exceptional cases at least as strongly as it does the unexceptional ones:
The unexpected—and even the unwanted—events of life are occasions and opportunities for hearing the call of God and responding faithfully. Sometimes, perhaps often, this will mean that we take up tasks and burdens we had not anticipated or desired, and they in turn may bring a certain measure of suffering. . . . To counsel the acceptance of the unwanted—acceptance even of the suffering it brings—is not to encourage mothers or fathers to be “victims.” Rather, it is to call for the strength that virtuous action requires. One need not be a Christian to agree with Socrates that it is better to suffer evil than to do it, but certainly Christians should understand such a claim. If we seek to save ourselves by doing away with the child who is unwanted, we hand ourselves over to the destructive powers of the world in an attempt to avoid them, and we act as if those powers are ultimately worthy of our worship, as if they could save. We take our stand, it is sobering to realize, beside King Herod after he heard the news the Magi brought. That is not, I think, where we finally want to be.
There is a more general issue that ought to be raised by such projects as these two works, that is, whether it is possible or even desirable to produce an ecumenical Christian bioethics. The fact that Meilaender is a Lutheran, for example, is nowhere in these books noted or noticeable. As he says in the introduction to Bioethics,
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. . . . 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.
Now on the surface this would appear to be a worthy ambition, especially to readers of a journal devoted to the notion of ecumenical orthodoxy. Meilaender is certainly not alone in this pursuit, as evidenced by the work of the Center for Bioethics and Human Dignity and their recent volumes, Bioethics and the Future of Medicine: A Christian Appraisal (1995) and Dignity and Dying: A Christian Appraisal (Eerdmans, 1996). Whatever the success of the larger theological project, I would argue, however, that the notion of a “mere Christian bioethics” is misbegotten. This is not to gainsay the value of reaching an ecumenical consensus on bioethical issues; there are many such issues on which traditional Christians agree.4 But there are at least three paths one might take in order to reach an ecumenical bioethics.
The first would be to write as if there is or ought to be a singular Christian bioethics without making the further (necessary) claim that there is or ought to be a singular authoritative Christian theological and ethical tradition. This would seem to be the tack that Meilaender takes, but it is doomed to failure without taking that further step. One need only to mention contraception in order to realize that conflicting theological, ethical and canonical traditions preclude one from presenting a “mere bioethics.”
A second possibility is to begin with a “thin” description of Christian bioethics, a minimalist approach that would attempt to build from the bottom up using what one imagines all Christians might agree to. This lowest common denominator approach has proved unsatisfying for ecumenism in general, and the prospects of its success in shaping a Christian bioethics are no better.
The third way is to give a “thick” description, i.e., a robust articulation of the bioethics of a particular Christian tradition (say, for example, the Orthodox or Roman Catholic ethical traditions). Once the different traditions have been described, they may then be fruitfully compared to discern areas of agreement in the results, if not in the methods for arriving at those results.
This approach is represented by the journal Christian Bioethics, the subtitle of which is “Non-Ecumenical Studies in Medical Morality.” The principal editors of the journal are Orthodox and Roman Catholic, and its advisory board contains many Protestants from diverse traditions. Here “non-ecumenical” certainly does not suggest a theological xenophobia or a lack of cooperation. Rather, one finds in its pages articles written from particular points of view on a given theme. The outcome of such an approach is a better understanding of one’s own tradition as well as those of others, and a richer method for discerning God’s will on these difficult and often divisive issues.
Despite this reviewer’s objections to the author’s methodology and a few of his substantive conclusions, both books are well worth reading. Both evidence the sincerity and depth of Meilaender’s theological convictions and, on the whole, are persuasive. The reader should not simply assume that the conclusions reached are an authoritative expression of what Christians generally ought to think and do, nor assume that the pursuit of such positions can be done apart from the context of a particular tradition’s reading of Scripture and Tradition.
1. For fuller and richer inquiries into the notion of personhood from the Orthodox Christian perspective, one may consult the work of Metropolitan John Zizioulas, especially his Being and Communion (Crestwood, NY: St. Vladimir’s Seminary Press 1985), and the recent collection of essays edited by John T. Chirban, Personhood: Orthodox Christianity and the Connection Between Body, Mind, and Soul (Westport, CT: Bergin & Garvey, 1996).
2. For an excellent survey of some of the literature on this question, as well as for an Orthodox assessment of it, see John Breck’s “Procreation and ‘The Beginning of Life’” in St. Vladimir’s Theological Quarterly, Vol. 39, No. 3 (1995), pp. 215-232. For a wider philosophical approach, see the forthcoming special issue edited by Lisa Sowe Cahill of The Journal of Medicine and Philosophy, Vol. 22, No. 5.
3. Fr. Breck’s article mentioned in the previous note can point the interested reader to this literature, which ranges from substantial book reviews to the 1991 Georgetown University dissertation by Dianne N. Irving, “Philosophical and Scientific Analysis of the Nature of the Early Human Embryo.”
4. Indeed, one may push the quest for such a consensus beyond the bounds of the Church. Peter Kreeft has recently argued (in his Ecumenical Jihad: Ecumenism and the Culture War) for cooperation with traditional Jews and Muslims and even Buddhists and Hindus. He mentions, for example, that all these groups are agreed in their opposition to “designer genes.”
Allyne Smith is an Orthodox priest and theologian and is currently Visiting Scholar in the Department of Theology at the University of Notre Dame.