Printer Friendly

Religion and the secularization of bioethics.

The occasion of this special supplement on religion and bioethics serves to remind me, once again, that the field of bioethics as we now know it is a creature of its time and history. It grew up during the 1960s and 1970s in an era of affluence and social utopianism, in a culture that was experimenting with an expansive array of newly found rights and unprecedented opportunities for personal freedom, and in the context of a national history that has long struggled to find the right place for religion in its public life. For medicine it was a time that combined magnificent theoretical and clinical achievements with uncommonly difficult moral problems, many of them bearing on the self-identity and goals of medicine. The story of contemporary bioethics turns on the way in which those problems intersected with, and whose understanding was shaped by, that larger temporal and social context.

The most striking change over the past two decades or so has been the secularization of bioethics. The field has moved from one dominated by religious and medical traditions to one now increasingly shaped by philosophical and legal concepts. The consequence has been a mode of public discourse that emphasizes secular themes: universal rights, individual self-direction, procedural justice, and a systematic denial of either a common good or a transcendent individual good.

Let me, if I may, use myself as an illustration of this trend, as well as an example of some considerable uneasiness left in its wake. When I first became interested in bioethics in the mid-1960s, the only resources were theological or those drawn from within the traditions of medicine, themselves heavily shaped by religion. one way, that situation was congenial enough. I was through much of the 1960s a religious person and had no trouble bringing that perspective to bear on the newly emergent issues of bioethics. But that was not to be finally adequate for me. Two personal items were crucial. My religious belief was by then beginning to decline, and by the end of the decade had all but disappeared. My academic training, moreover, was that of analytic philosophy, and I wanted to bring that work to bear on bioethics. Was it not obvious, I thought, that moral philosophy, with its historical dedication to finding a rational foundation for ethics, was well suited to biomedical ethics, particularly in a pluralistic society? Just as I had found I did not need religion for my personal life, why should biomedicine need it for its collective moral life?

The answer to that last question has been less obvious than I originally thought. If my life has been, in a way, relieved by the absence of religion as a guiding force, I cannot say that it has been enriched or that I am a better person for that, Nor can it be said, I think, that biomedical ethics is demonstrably more robust and satisfying as a result of its abandonment of religion. To say that of course is not to make a case for the validity of religion, which must be made on its own merits, not on its potential contribution to bioethics. Some nineteenth century thinkers, we might recall, came to think that, although religion was false as a way of understanding the world, it was socially useful to sustain as a source of discipline and political stability. There was always something slightly cynical in that view, and doubly so because it was meant to strengthen the hand of those in authority. Nonetheless, it is not necessary to entertain such a position to recognize that, whatever the ultimate truth status of religious perspectives, they have provided a way of looking at the world and understanding one's own life that has a fecundity and uniqueness not matched by philosophy, law, or political theory. Those of us who have lost our religious faith may be glad that we have discovered what we take to be the reality of things, but we can still recognize that we have also lost something of great value as well: the faith, vision, insights, and experience of whole peoples and traditions who, no less than we unbelievers, struggled to make sense of things. That those goods are part of a garment we no longer want to wear does not make their loss anything other than still a loss; and it is not a negligible one.

But need that be the end of the story? Can those of us who share my lack of belief still make use of at least some of the insights and perspectives of religion, even as we reject its roots? Or are they meaningless without their connection to those roots? Are there some questions about our lives and destiny that philosophy, science, or other secular disciplines can't help us get hold of with any telling force, and that only religion has been able to accommodate? Is it wrong, or a form of illogical sentimentality, to continue feeding off of religious traditions and ways of life that one has, in fact, rejected at their core? Does intellectual honesty demand that we have the courage of our convictions (or lack thereof) and construct our view of the world out of the whole cloth of unbelief, not borrowing to suit our own purposes those valuable bits, pieces, and parts of a garment we have thrown off. And of course there is another question that might be entertained: if we agree that religion, even if wrongheaded, provides ways of understanding not otherwise attainable, should we then never allow ourselves to close the door on the possibility of a renewed belief? Even if we have not the faintest idea (as I do not) about where that renewal might come from?

Those are some questions I have put to myself over the years. I will not try to answer them directly here, and do not in any event think I have good answers. I will instead say something about the unfolding of contemporary bioethics, inviting others to see whether that history provides some answers to the questions I have raised.

A Short History of Bioethics

Joseph Fletcher's book Medicine and Morals (1954) has often, and correctly, been cited as the first truly fresh manifestation of a growing interest in medical ethics in the post-World War II era. That Fletcher was at the time an Episcopalian theologian might easily lead one to think of the book as a "theological" contribution. Its contents, however, suggest a very different interpretation. By his emphasis upon "choice" as the heart of morality, his rejection of moral theories (particularly Roman Catholic) that would look to nature for ethical guidance, and his celebration of the power of medicine to open new opportunities for moral freedom, Fletcher was in fact opening a direct assault upon some long-standing religious constraints on medicine. That Fletcher's moral theory was based on what he called "situation ethics"-emphasizing the uniqueness of each moral choice and therefore the irrelevance of binding moral rules and principles-signalled all the more the depth of his attack on some characteristic religious values. The possibility also of detecting, just below the surface, an additional powerful strain of utilitarianism in Fletcher's book underscored the depth of the break he was working to engender.

Medicine and Morals did not, in the 1950s, have a great impact in the medical world, even if Fletcher's situation ethics had a telling appeal among many physicians whose clinical experience resisted general moral rules. But that was not an era when the writings of outsiders, religious or not, were likely to be taken seriously. It was not until the middle of the 1960s, in the controversies that developed over human subject experimentation, that those outside voices began to make themselves heard. The quick appearance thereafter of increasingly public struggles over the definition of death and the care of the terminally ill, genetic counseling and prenatal diagnosis, and organ transplantation, brought the field of bioethics into being. The Protestant theologian Paul Ramsey, first with The Patient as Person (1970) and then with other books in the 1970s, carried out one of the first comprehensive bioethical examinations of the newly emergent issues. James M. Gustafson added still another powerful theological impetus (even if, in what his writings actually said, the specific contribution of theology was rendered systematically ambiguous). All the while, Jewish and Roman Catholic theologians were carrying on the long-standing work of responding to medical advances and quandaries in light of their own traditions, though now with a new intensity. The writings of Seymour Siegel or David Feldman, from the Jewish side, or Richard McCormick and Charles Curran, from the Roman Catholic, provided evidence of that intensity.

Yet in many respects this early theological role in the emergence of the field was soon to decline. Part of the reason may be that the theological seminaries and departments of religion were in the 1970s drawn more to issues of urban poverty and race, and to questions of world peace in a nuclear age, than to bioethics. After a short burst of interest, the number of younger scholars drawn to the field seemed to decline as the decade came to an end (and many of those who were attracted seemed more comfortable speaking the language of philosophy than religion). No less importantly perhaps, once the field became of public interest, commanding the attention of courts, legislatures, the media, and professional societies, there was great pressure (even if more latent than manifest) to frame the issues, and to speak, in a common secular mode.

Here the philosophers and the lawyers came to take the lead. Samuel Gorovitz organized a 1974 conference on bioethics for philosophers at Haverford College, drawing a number of newcomers to the field, many of whom went on to considerable prominence. The Karen Ann Quinlan case in 1975 had a similarly potent effect on the law, making evident that bioethics would provide a steady stream of legal cases and a considerable body of unique issues for legal scholars. As the field of medicine became itself more engaged in the issues, it sought a way of framing and discussing them that would bypass religious struggles. Lawyers and philosophers were by no means seen as congenial allies of doctors, but they were preferable to theologians (especially those who spoke out of sectarian traditions). For all the steady interest of some physicians in religion and medicine, the discipline of medicine itself is now as resolutely secular as any that can be found in our society. It is a true child of the Enlightenment.

All of these trends were nicely epitomized in the two federal commissions established during the 1970s, the National Commission for the Protection of Human Subjects in 1974, and the President's Commission in 1979. Both the professional staffs of the two groups and those called upon to give testimony before them were drawn mainly from medicine, philosophy, the health policy sciences, and the law. The approaches and concepts commonly employed in their reports, moreover, showed not the least visible trace of religious influence. An ethic of universal principles-especially autonomy, beneficence, and justice-was given a place of prestige in the 1978 Belmont Report issued by the National Commission.

I do not want to imply that there was any outright hostility toward religion (even though I could detect that now and then in some philosophers I knew). On the contrary, it was for the most part bypassed altogether. Whatever place it might have in the private lives of individuals, it simply did not count as one of the available common resources for setting public policy. There was (and still is) a lurking fear of religion, often seen as a source of deep and unresolvable moral conflict as well as single-minded political pressure when aroused. For that matter, ours is a society extraordinarily wary of provoking fundamental debates about basic worldviews and ethical premises. Such debates are seen as more likely to produce destructive battles than illuminating social insights, more anger and intransigence than peace and compromise. Religious differences have commonly been seen as the most likely source of such struggles, and thus to be kept at arm's length-or, even better, off the political playing field altogether.

The Discontents of Secularization

Some important consequences of this general attitude seem apparent. It encourages a form of moral philosophy for use in the marketplace that aspires simultaneously to a kind of detached neutrality (what Thomas Nagel has called the "view from nowhere"), and a culture-free rationalistic universalism (which is suspicious of the emotions and the particularities of actual human communities). It is hardly surprising that the only theoretical debate taken to be of any great moral interest is that between deontologists (who can help the right trump the good), and utilitarians (who can allow a calculus of pleasures, pains, or preferences to trump both the right and the good). No less banished are more speculative forms of philosophy, especially those that might look to nature or organism for moral direction. Its worst failing may be its enormous reluctance to question the conventional ends and goals of medicine, thereby running a constant risk of simply legitimating, by way of ethical tinkering and casuistical fussiness, the way things are.

Another consequence is that it has either intimidated religion from speaking in its own voice, or has driven many to think that voice can be expressed with integrity only within the confines of particular religious communities. Time and again I have been told by religious believers at a conference or symposium that they feared revealing their deepest convictions. They felt the price of acceptance was to talk the common language, and they were probably right. Religious convictions are thought "personal" in two senses: they bespeak a particular cultural and ethnic background, and they reveal someone's inner life. Those of us who spend our time in the leading scientific and intellectual salons, and who have come to know the rules of the game, take great pains to conceal those features of our lives. I am no more enthused about letting my Irish-Catholic, parochial school background show (even if now put behind me) than I am to have a spot of gravy on my Brooks Brothers striped tie. (In fact the latter is preferable to the former; we all dribble from time to time, but not everyone has had a parochial school education-a tie can be cleaned in a way a psyche cannot be).

The net result of this narrowing of philosophy and the disappearance or denaturing of religion in public discourse is a triple threat. It leaves us, first of all, too heavily dependent upon the law as the working source of morality. The language of the courts and legislatures becomes our only shared means of discourse. That leaves a great number fearful of the law (as seems the case with many physicians) or dependent upon the law to determine the rightness of actions, which it can rarely do since it tells us better what is forbidden or acceptable than what is commendable or fight.

It leaves us, secondly, bereft of the accumulated wisdom and knowledge that are the fruit of long-established religious traditions. I do not have to be a Jew to find it profitable and illuminating to see how the great rabbinical teachers have tried to understand moral problems over the centuries. Nor will Jews find it utterly useless to explore what the popes, or the leading Protestant divines, have had to say about ethics. This seems an obvious kind of point to make; but few actually make it.

It leaves us, thirdly, forced to pretend that we are not creatures both of particular moral communities and the more sprawling, inchoate general community that we celebrate as an expression of our pluralism. Yet that pluralism becomes a form of oppression if, in its very name, we are told to shut up in public about our private lives and beliefs and talk a form of what Jeffrey Stout has called moral esperanto. The rules of that language are that it deny the concreteness and irregularities of real communities, that it eschew vision and speculation about goals and meaning, and that it enshrine the discourse of wary strangers (especially that of fights) as the preferred mode of daily relations.

With so many riches at our disposal, why have we ended in the name of social peace with a salt that has lost its savor?
COPYRIGHT 1990 Hastings Center
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1990 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Theology, Religious Traditions, and Bioethics: a Special Supplement
Author:Callahan, Daniel
Publication:The Hastings Center Report
Date:Jul 1, 1990
Previous Article:Medical joint-venturing: an ethical perspective.
Next Article:Religion and moral meaning in bioethics.

Terms of use | Copyright © 2017 Farlex, Inc. | Feedback | For webmasters