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Christian bioethics: a guide for pastors, health care professionals, and families.

CHRISTIAN BIOETHICS: A Guide for Pastors, Health Care Professionals, and Families by C. Ben Mitchell and D. Joy Riley, MD. Nashville, TN: B&H Publishing, 2014. 207 pages. Paperback; $24.99. ISBN: 9781433671142.

Patients, their supporters, and their caregivers are regularly confronted with new ethical issues or new variations of older ones in the light of new medical technologies. A variety of professionals and academics engage in bioethical reflection, expressing their views through the language of their own expertise. Gifted professionals with differing expertise do a valuable service to nonprofessionals by translating and articulating those reflections and positions into language and themes helpful to nonprofessionals directly affected by these issues. Christian Bioethics is cowritten by a theologian and a physician who directs a center for bioethics and culture. Organizing most chapters according to a specific case, the authors lead the reader through multidimensional aspects of each case as they apply to more general ethical concerns and realities. In so doing, they open up these dimensions by showing how Christian theology, ethics, and modern medical science interplay in real-life decisions that need to be made in clinical medicine.

All but the first two chapters are grouped following the rubric of Nigel Cameron wherein he distinguishes bioethical issues as those involved in taking life, making life, or remaking/faking life. In an effort to appeal to a broad target audience, including pastors, family members, chaplains, physicians, students, and patients, the authors' case-focused approach risks losing "the roots that sustain the trees" by giving less attention to the underlying beliefs and theories that ground ethical reflections and decisions in their clinical situations. The authors are attuned to this risk to some extent, providing, in very basic terms, their worldview-level starting points. Both authors are committed to the basic Christian beliefs codified in the Apostles' Creed. They affirm a Christian worldview that envisions the world as God's world, all aspects of which are intercompatible including faith and science and their expression in theology and medicine. The discussion section of most chapters is written as a dialogical exchange between the authors, a method that gives some down-to-earth character to the book but sometimes disrupts the flow of the reading when topics change from medical to theological and back. Each chapter also has excellent leading questions listed after the case. These are helpful starters for reflection and discussion about the case and about the authors' interpretive details that follow each case.

The first chapter highlights key historical elements of biomedical ethics, starting with the role of the Hippocratic Oath in ancient Greece up until the present. The authors make important points about the transformation of the Oath into Christianized versions and into gutted, secular versions that reflect modern medical allowance for practices forbidden in the Oath. While mentioning claims that the Oath was likely influenced by polytheistic Pythagoreans, they fall short of acknowledging further suggestions by scholar Ludwig Edelstein and by Cameron that Pythagorean ideals may have characterized a reform movement against common practices of abortion, suicide, and having sexual relations with patients. In addition, the authors note covenantal aspects in the relations between the Oath-taker and his mentor, but they do not mention the contrasting codal nature of specified prohibitions. This distinction is important since ethical guidance for modern medical practice also tends to emphasize codal "dos and don'ts" rather than relational aspects that form the ethical core of practice. A number of formative twentieth-century bioethicists from different Christian traditions are also highlighted. However, the reader may have difficulty understanding why some positions of professed Christians may resonate more with biblical themes and teaching than others, due to the short text devoted to each bioethicist. For example, the authors allude to the important influence of Joseph Fletcher's thinking on contemporary changes in the Hippocratic Oath. However, his situationalist approach also contributed to a paradigm shift in bioethical thinking, deemphasizing the influence of basic ethical beliefs while attaching greater importance to individual conditions and contingencies of bioethical situations. The authors conclude by favoring the covenantal approach of William F. May and the virtue ethics of Edmund D. Pellegrino and David C. Thomasma, positions strongly supported and promoted by this reader as well. However, they could have given more substance to the cases and discussions by including more intentionally the impact of these favored approaches on their own positions in the chapters.

Chapter 2 brings the basic premises of the book and the perspectives of the authors into sharper focus, perspectives grounded in biblical hermeneutics. They review popular views on the role of scripture in ethical reflection, themselves understanding the Bible as "canonical revelation of God's commands and Christian virtues." But they also rightly appreciate additional interpretive nuances for gaining insights from scripture for ethics. Citing Kyle Fedler, they note that scripture is diverse in its historical and cultural contexts, and in its literary character. Laws and commands under the old covenant must always be interpreted in the light of the new covenant which fulfills the former. The chapter concludes with very helpful suggestions on fostering good communications between patient, caregiver, and support persons and on using good analytical judgment in making medical decisions. The authors point out that, if needed, ethical committees and consultants are available in most care centers today to assist in making difficult decisions.

The remaining six chapters deal with cases involving a broad range of topics including abortion, end-of-life decision making, assisted reproductive technologies, organ donation, cloning, and technologies applied to transhumanist aspirations of life extension and immortality. In chapter 5, the authors present the science of reproductive methods in terms understandable to most laypersons and pastors. Here they weave in their own views as well, such as their nonendorsement of freezing surplus embryos after in vitro fertilization. The chapter on cloning and hybrids is laid out with similar detail and care, though the discussion of triple genetic parenthood among embryos created to prevent mitochondrial disease may not, despite the authors' laudable efforts, be appreciated fully by laypersons due to complicated subject matter. It was disappointing that induced plu-ripotent stem cell technology--and its theological and ethical implications--was not discussed as a possible alternative to embryonic stem cells for developing therapeutic biological therapies; it received only a fleeting mention in chapter 2. This relatively new technology involves the formation of cells that have many molecular and physiological qualities of embryo-derived stem cells but are developed through the dedifferentiation of mature, adult cells. Such cells are very promising as sources of biological therapies but, for many Christians, are associated with fewer, if any, ethical concerns compared to the stem cell derived from the destruction of human embryos.

While there is a growing number of books on bioethical topics now available for use in Bible studies and other discussion groups, I think this is a particularly well-organized book with a more focused application of the evangelical perspective of the authors than other books of its kind. The authors do a commendable job in leading their target audience of mainly nonprofessionals into topics whose technical and biological complexities are made far more understandable through the authors' sensitivities and interpretive skills. They show how scripture and science are complementary, yet both need to be understood and their nuances appreciated by Christians in order to develop biblically informed approaches to contemporary bioethical issues in the light of new technologies that affect medical care.

Reviewed by James J. Rusthoven, MD, PhD, Professor Emeritus, Department of Oncology, McMaster University, Hamilton, ON L8S 4L8.
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Title Annotation:ETHICS
Author:Rusthoven, James J.
Publication:Perspectives on Science and Christian Faith
Article Type:Book review
Date:Jun 1, 2016
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