What Is the Purpose of Bioethics? – An Excerpt from the Dictionary of Christianity and Science
Our new resource engaging the intersection between science and faith, The Dictionary of Christianity of Science, gives you access to key terms, theories, individuals, debates, and much more to help you engage in these important discussions. In today’s excerpt, we give you a sampling of an article about bioethics by the moral philosopher Francis J. Beckwith.
BIOETHICS. Bioethics is an interdisciplinary endeavor primarily involving the study of moral issues in health care and the life sciences for the purpose of providing ethical guidance for practitioners in clinical and research settings.
Work in bioethics can be found in a variety of academic and professional fields, including medicine, philosophy, biology, theology, psychology, and law. The reason for this is that so many of the questions in bioethics overlap several fields of inquiry. For example, the question of whether a physician may assist in a patient’s suicide is not merely a medical or biological question, even though a physician is a medical doctor trained in the biological sciences and may use certain medicines to carry out his patient’s wishes. Rather, it is primarily a moral question about the rightness or wrongness of intentionally willing another’s death, even when the one being killed is requesting it. Thus, answering this moral question requires the conceptual tools of philosophy and/or theology.
Other disciplines also play a part in the making of such judgments. For example, whether a patient is competent to choose a particular course of treatment requires the insights of psychology (or psychiatry), and whether there are governmental statutes or regulations on what a physician may or may not do to her or his patient requires the assistance of legal counsel. However, because bioethics is primarily concerned with answering moral questions — rather than medical, legal, or biological ones — all of the answers, even when they are inconsistent with each other, either employ the categories of philosophy and/or theology or they presuppose those categories in one way or another. This can be seen in the debates about some of the most contested questions in bioethics.
Beginning of Human Life
What one thinks about the morality of abortion, human cloning, embryonic stem cell research, or reproductive technologies will often be determined by what one thinks about the nature of nascent human life and/or the proper function of our sexual powers. If, for example, one believes that a human embryo or fetus lacks full moral status because it cannot engage in certain types of mental activities (e.g., have a self-concept, desire a right to life, have a life plan; Tooley 1983), then practices such as abortion and embryonic stem cell research, which virtually always result in the death of prenatal human subjects, will not seem to be serious moral wrongs (or even wrongs at all). Of course, a different view of nascent human life, one consistent with Christian anthropology, entails that these acts are gravely immoral (George and Tollefson 2011). The latter position, unlike the former, connects a human being’s full moral status to his nature (what he is) rather than to the maturation of those powers that flow from his nature (what he does).
Alternatives to ordinary human reproduction (e.g., cloning, in vitro fertilization, surrogate motherhood, artificial insemination) often raise additional questions, though they are no less philosophical or theological than the question of the prenatal human being’s full moral status. For example, is it morally right (and/or consistent with God’s plan for marriage) to bring children into being apart from the marital act and in ways that seem more like manufacturing than begetting? Christians offer differing answers to this type of inquiry because they take contrary positions on the moral permissibility of extramarital reproductive technologies. Some argue that none of them are licit (Austriaco 2012), while others maintain that some are not immoral (Rae 1996).
End of Human Life
Bioethical decisions at life’s end primarily involve answering questions about what constitutes appropriate treatment, the withdrawing or withholding of it, and proper administration of palliative care. For virtually all Christian bioethicists (Austriaco 2012; Keown 2002), a physician may not intentionally kill her patient. However, that does not mean that one is obligated to keep a patient alive at all costs. A physician may act in a way that advances her patient’s good by relieving substantial burdens even if she knows that such action will shorten whatever time remains in the patient’s life. So, for example, a physician may increase her patient’s intake of morphine in order to better manage his pain, even though the physician knows that it will likely hasten death.
There are, however, some secular bioethicists who maintain that because a patient’s autonomy and understanding of what is in his best interests are paramount in assessing a physician’s responsibility to her ailing patient, there are cases in which physician-assisted suicide is justified if the patient is rational, fully informed, and freely consents (Quill 1991; Smith 2012). This is not to say that Christian bioethicists deny that patient autonomy should play any role in bioethical decision-making. Rather, they argue that patient autonomy cannot be exercised in a way that requires the physician to cooperate with immoral ends (Austriaco 2012; Keown 2002).
Conscience Protection and Professional Responsibility
As secular bioethics increasingly becomes the dominant way that medicine understands its moral obligations, conscientious objection among religiously observant health professionals will likely increase. This is because secular bioethics relies heavily on a school of thought known as principlism (Beauchamp and Childress 2013). It maintains that health professionals should assess the morality of their clinical judgments on the basis of four principles — autonomy, nonmaleficence, benevolence, and justice — while at the same time excluding from their judgments contested metaphysical beliefs about the nature of the human person that are usually tightly tethered to religious traditions. Thus a patient’s good is determined almost exclusively on what he chooses to believe is in his interests and what fulfills his preference satisfaction.
Under a medical establishment shaped by principlism, there will be religiously observant health professionals who will decline for reasons of conscience to participate in, or refer a patient to physicians who are willing to provide certain procedures (e.g., abortion, euthanasia, sex reassignment surgery) that the patient believes are necessary for his wellbeing as he understands it. Some argue that such health professionals, with limited exceptions, should be viewed as acting in an unethical manner (Dickens 2009). Others, however, argue they should be accorded strong conscience protection, since the procedures are not contested for medical reasons, but rather for reasons having to do with deep and differing philosophical and theological positions for which the architects of modern liberal societies had promised tolerance (Kaczor 2012).
Francis J. Beckwith is Professor of Philosophy and Church-State Studies, and Co-Director of the Program in Philosophical Studies of Religion in the Institute for Studies of Religion, at Baylor University in Waco, Texas.
REFERENCES AND RECOMMENDED READING
Austriaco, Nicanor Pier Giorgio. 2012. Biomedicine and Beatitude: An Introduction to Catholic Bioethics. Washington, DC: Catholic University of America Press.
Beauchamp, Tom L., and James F. Childress. 2013. Principles of Biomedical Ethics. 7th ed. Oxford: Oxford University Press.
Dickens, Bernard M. 2009. “Legal Protection and Limits of Conscientious Objection: When Conscientious Objection Becomes Unethical.” Medicine and Law 28:337 – 47.
George, Robert P., and Christopher Tollefsen. 2011. Embryo: A Defense of Human Life. 2nd ed. Princeton, NJ: Witherspoon Institute.
Kaczor, Christopher. 2012. “Conscientious Objection and Health Care: A Reply to Bernard Dickens.” Christian Bioethics 18:59 – 71.
Keown, John. 2002. Euthanasia, Ethics and Public Policy. Cambridge: Cambridge University Press.
Quill, Timothy. 1991. “Death and Dignity: A Case of Individualized Decision Making,” New England Journal of Medicine 324:691 – 94.
Rae, Scott B. 1996. Brave New Families: Biblical Ethics and Reproductive Technologies. Grand Rapids: Baker.
Rae, Scott B., and Paul Cox. 1999. Bioethics: A Christian Approach in a Pluralistic Age. Grand Rapids: Eerdmans.
Smith, Stephen S. 2012. End-of-Life Decisions in Medical Care: Principles and Policies for Regulating the Dying Process. Cambridge: Cambridge University Press.
Tooley, Michael. 1983. Abortion and Infanticide. Oxford: Oxford University Press.