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Theology and bioethics.

Theology and Bioethics

As we enter neighborhood homes, many of us have been quickened with the peculiar hospitality of a sign that reads: "Beware of dog." There are doubtless many people around who believe that an analogous sign is in place when a theologian is present to discuss the ethical dimensions of biomedicine. Theologians just may bite. Or perhaps worse, they may not. At their worst they are seen as extremely dangerous. At their best, they are harmless, that is, useless. For these reasons they should preferably be out of sight, or at least on a short leash. Perhaps Alasdair MacIntyre had something like this in mind when he observed:

Theologians still owe it to the rest of us to explain why we should not treat their discipline as we do astrology or phrenology. The distinctiveness and importance of what they have to say, if it is true, make this an urgent responsibility.(1)

Clearly implied in MacIntyre's ultimatum is the conviction that theologians have not successfully articulated the "distinctiveness and importance of what they have to say." Faintly implied--unless I misread him--is the assertion that they really cannot because they do not have that much to say. An urgent task is thus transformed into an impossible one--and under threat of relabeling as disciplina astrologica. I like neither the odds nor the possible outcome. But to avoid the latter I must risk the former.

Theology and Faith

Both terms is my title need explication and narrowing if I hope to avoid unthreatening generalizations and verbal incontinence. First, then, theology. Theology starts when faith begins reflecting on itself. This pirates the definition of Anselm of Canterbury: fides quaerens intellectum (faith seeking understanding). Two things should be stated at the outset. First, there are different faiths (for example, the Catholic faith, the Jewish faith, the Muslim faith). Second, the communities in which these faiths originate exist in history and therefore must continually reappropriate their inheritance in changing times and diverse circumstances--often with different purposes in view. On the first count it is clear that there can be radically different theologies, and on the second that there can be many theologies within an individual faith community. This means, of course, that how theology is said to relate to bioethics can vary from community to community, and within the same community at varying times.

Let me narrow the proportions of my "urgent responsibility" by saying, first, that I will speak as an adherent of the Catholic faith (it is the only one I know from experience) and therefore will understand theology as reflection on that faith only and second, that I make no claims that my reflections are the only theology of that faith. Rather my reflections should be seen as one possible way of approaching the subject, and are not meant to detract from the validity or beauty of any other faith or theology.

But such narrowing is not enough. I must make explicit the implications of the statement that theology is reflection on faith. There is the danger in our time that the term "faith" will be collapsed into a bloodless, intellectualistic acceptance of credal statements. When "I believe" is sterilized into mere affirmation of propositions, faith has lost its heart and soul. In this sense Johannes B. Metz states: "Christ must always be thought of in such a way that he is never merely thought of."(2) Merely to "think of" Christ is to trivialize Him, to reduce Him to one more (among many) observable historical event, to an example of humane benevolence. For the person of Christian faith, Jesus Christ is God's immanent presence, His love in the flesh.

Let me borrow from the late Joseph Sittler at this point.(3) Sittler has noted that the theme of the biblical narratives is God's "going out from Himself in creative and redemptive action toward men." He refers to "God's relentless gift of Himself," "the undeviating self-giving God," "the total self-giving God." Jesus Christ is no less than God's self-giving deed. The response of the believer to this person-revelation is the total commitment of the person known as faith.

For the believer, God's self-disclosure in Jesus is at once the self-disclosure of ourselves and our world. The response to this personal divine outpouring is not a dead and outside-observer "amen." It is a faith-response empowered by the very God who did the redemptive and restorative deed in Jesus Christ and is utterly and totally transforming--so much so that St. Paul must craft a new metaphor to articulate it. We are "new creatures," plain and simple. Faith is the empowered reception of God's stunning and aggressive love in Jesus.

Faith, then, is the proper term "to point to the total commitment of the whole person which is required by the character of the revelation."(4) When I speak of theology (as relating to bioethics), it is theology as reflection on that sense of faith that I speak. I emphasize this because there are many influences tempting us to treat theology primarily as reflection on credal statements hammered out as communicative and protective vehicles of a more profound and original happening (God's self-communication and our response to it). For one thing, it is much easier to deal with credal statements, since faith itself, being a response to God, exceeds the reach of human language. For another, the historical religious communities that provide the context of the faith-response have myths and symbols that differentiate them and there is the temptation to confuse these with faith itself. Finally, the temptation becomes almost irresistible when these myths and symbols lead to distinct ethical codes.

Theology and Ethics

My second introductory qualifier concerns bioethics. Bioethics is a subspecies of ethics. There has been a tendency to equate ethics with "quandary ethics."(5) Symbols of this abound. We are fascinated and fixed by the tangled casuistry of plugpulling, palliation decisions, proxy determinations. Cases are newsworthy eye-catchers and amenable to legal resolution. Thus courses in bioethics are loaded with Quinlan, Jobes, Fox, Storar, Conroy, Baby M, pregnancy reduction, testing for seropositivity, triage decisions, dilemmas about confidentiality. Test me by picking up any issue of the Hastings Center Report. It is no diminishment of casuistry to say that it does not all of ethics make, especially an ethics that calls itself Christian, most especially one that claims to be theological.

An ethic that claims to be theological will root itself in God--God's actions and purposes. Its primary referents will be God's relation to us, and ours to God. The prime analogate of the term "morality" will be this relationship. The most basic language--not the only--of theological ethics builds around goodness and badness, not rightness and wrongness of actions, since goodness-badness is basically vertical and has its aortal lifeline to the God-relationship.

In slightly different words, a Christian theological ethic is founded on the fact that something has been done to and for us, and that something is Jesus. There is a prior action of God at once revelatory and response-engendering that provides the entire grounding and meaning of the Christian ethic.

When I mention Christian theological ethics, I think primarily of those foundations that deserve the name theological. These foundations can be summarized in a systematic way with six assertions.(6)

God's self-disclosure in Jesus Christ as self-giving love allows of no further justification. It is the absolutely ultimate fact. The acceptance of this fact into one's life is an absolutely originating and grounding experience.

This belief in the God of Jesus Christ means that "Christ, perfect image of the Father, is already law and not only lawgiver. He is already the categorical imperative and not just the font of ulterior and detailed imperatives."(7)

This ultimate fact reveals a new basis or context for understanding the world. It gives it a new (Christocentric) meaning. As a result of God's concrete act in the incarnation, "human life has available a new relation to God, a new light for seeing, a new fact and center for thinking, a new ground for giving and loving, a new context for acting in this world."(8)

This "new fact and center for thinking" that is Jesus Christ finds its deepest meaning in the absoluteness and ultimacy of the God-relationship. Outside the God-relationship efforts to know ourselves and be ourselves fully are doomed to falter.

This God-relationship is already shaped by God's prior act in Jesus (self-giving). The Christian moral life therefore is a recapitulation in the life of the believer of the "shape of the engendering deed" to use Sittler's language.

The empowered acceptance of this engendering deed (faith) totally transforms the human person. It creates new operative vitalities that constitute the very possibility and the heart of the Christian moral life.

I stress these points because there has been, and still is, a tendency to conceive of Christian ethics as norms derived from Jesus' pronouncements. There are such sayings recorded in the New Testament. But to reduce Christian ethics to such sayings is to trivialize it. When the Christian thinks of Christian ethics (or moral theology--I treat them as identical here), he or she thinks primarily of what Jesus has done to and for us, and therefore of who we are.

In and through Jesus we know what the God-relationship is: total self-gift. For that is what God is and we are created in His image. To miss this is, I believe, to leave the realm of Christian ethics.

Levels of Ethics

There is another aspect to the notion of "ethics" (and therefore bioethics) that needs mentioning. There are four levels at which the term can be understood where rightness or wrongness of conduct is concerned.(9) These distinctions are not often made but I think them critical if we are to gain precision in speaking of the relation of theology to bioethics.

First, there is what we might call an essential ethic. By this term we mean those norms that are regarded as applicable to all persons, where one's behavior is but an instance of a general, essential moral norm. Here we could use as examples the rightness or wrongness of actions of killing, contracts, or promises, and all actions whose demands are rooted in the dignity of the person.

Second, there is an existential ethic. This refers to the choice of a good that the individual as individual should realize, the experience of an absolute ethical demand addressed to the individual. For instance, an individual might conclude that his or her own moral-spiritual life cannot grow and thrive in the health care environment, hence that this work ought to be abandoned. Or, Because of background, inclination, talent, etc., an individual might choose to concentrate time and energy on a particular aspect of health care.

Third, there is essential Christian ethics. By this we refer to those ethical decisions a Christian must make precisely because he or she belongs to a community to which the non-Christian does not belong. These are moral demands made upon the Christian as Christian. For instance, to regard fellow workers as brothers and sisters in Christ (not just as autonomous, to-be-respected persons), to provide a Christian education for one's children, to belong to a particular worshipping community.

Fourth, there is an existential Christian ethics--those ethical decisions that the Christian as individual must make, for example, to undertake the ministry of the priesthood.

The Task of Theological Ethics

With these introductory notes on faith and ethics as background, I want now to consider whether theology really makes any difference--beyond moral philosophy--in bioethical discussions. Let me begin by citing James Gustafson:

For theological ethics...the first task in order of importance is to establish convictions about God and God's relations to the world. To make a case for how some things really and ultimately are....(10)

I agree with Gustafson's description of the first task of theological ethics, though it is clear we would disagree significantly about "how some things really and ultimately are." How, then, are they, "really and ultimately?" In its Declaration on Euthanasia the Congregation for the Doctrine of the Faith made reference to "Christ, who through his life, death and resurrection, has given a new meaning to existence."(11) If that is true (and Christians believe it is), then to neglect that meaning is to neglect the most important thing about ourselves, to cut ourselves off from the fullness of our own reality.

If Christ has given "a new meaning to existence," then presumably that new meaning will have some relevance for key notions and decisions in the field of bioethics. At this point it is a fair question to ask: what is this new meaning?

Theological work in the past decade has rejected the notion that the sources of faith are a thesaurus of answers. Rather they should be viewed above all as narratives, as a story. From a story come perspectives, themes, insights, not always or chiefly direct action guides. The story is the source from which the Christian construes the world theologically. In other words, it is the vehicle for discovering and communicating this new meaning.

Let me attempt to disengage some key elements of the Christian story, and from a Catholic reading and living of it. One might not be too far off with the following summary.

God is the author and preserver of life. We are "made in His image." Thus life is a gift, a trust. It has great worth because of the value He is placing in it.

God places great value in it because He is also (besides being author) the end and purpose of life.

We are on a pilgrimage, having here no lasting home.

God has dealt with us in many ways. But his supreme epiphany of Himself (and our potential selves) is His Son Jesus Christ.

In Jesus' life, death and resurrection we have been totally transformed into "new creatures," into a community of the transformed. The ultimate significance of our lives consists in developing this new life.

The ultimate destiny of our combined journeys is the "coming of the Kingdom," the return of the glorified Christ to claim the redeemed world.

Thus we are offered in and through Jesus Christ eternal life. Just as Jesus has overcome death (and now lives), so will we who cling to Him, place our faith and hope in Him, and take Him as our law and model.

This good news, this covenant with us has been entrusted to a people, a people to be nourished and instructed by shepherds.

This people should continously remember and thereby make present Christ in His death and resurrection at the Eucharistic meal.

The chief and central manifestation of this new life in Christ is love for each other (not a flaccid "niceness," but a love that shapes itself in the concrete forms of justice, gratitude, forbearance, chastity, etc.), especially for the poor, marginal, sinners. These were Jesus' constant companions.

For the Catholic Christian, this is "how some things really and ulitimately are." In Jesus we have been totally transformed. This new life or empowerment is a hidden but nonetheless real dimension of our persons, indeed the most profoundly real thing about us.(12) I have already suggested the integrating shape of our lives from this faith-perspective: the self-gift of agape. But what does all of this have to do with bioethics? I want to reject two possible extremes from the outset. The first extreme is the faith gives us concrete answers to the problems of essential ethics.

The second extreme is that faith has no influence whatsoever on bioethics. It would seem strange indeed if what Sittler calls "the invasion of the total personality by the Christ-life" had no repercussions on one's dispositions, imagination, and values.

How, then, does faith exercise its influence? I will take my lead from Vatican II. In an interesting sentence, "The Constitution on the Church in the Modern World" states:

Faith throws a new light on everything, manifests God's design for man's total vocation, and thus directs the mind to solutions which are fully human.(13)

The nature of this "new light" is that it reveals human existence in its fullest and most profound dimensions. The effect of this new light is to "direct the mind." To what? "Solutions which are fully human." The usage "fully human" I take to mean a rejection of any understanding of "a new meaning to existence" that sees it as foreign to the human, and radically discontinous with it.

Reason Informed by Faith

The Catholic tradition has encapsulated the way faith "directs the mind to solutions" in the phrase "reason informed by faith." Reason informed by faith is neither reason replaced by faith, nor reason without faith. It is reason shaped by faith.(14)

"Reason informed by faith" is shorthand for saying that the reasoner (the human person) has been transformed and that this transformation will have a cognitive dimension through its invasion of consciousness. I think it true to say that the more profound the faith, the greater and more explicit will be the Christian consciousness--which is a way of saying that how faith (and theology) affects ethics can be seen best of all in the saints. But even we nonsaints ought to be able to give an intelligible account of theology's influence. That account is destined to be more or less incomplete because the transformation worked by faith is at a very profound level not totally recoverable in formulating consciousness.

With that in mind, I suggest that theology can relate to bioethics in three distinct but overlapping ways. I shall call these ways protective, dispositive, and directive.

Protective. Moral philosophers, following St. Thomas, have identified basic inclinations toward goods that define our well-being or flourishing. Even though these inclinations can be identified as prior to acculturation, still they exist as culturally conditioned. We tend toward values as perceived. And the culture in which we live shades our perceptions of values, a point made by Philip Rieff, who refers to "reasons that have sunk so deeply into the self that they are implicitly understood."(15) He argues that decisions are made, policies set not chiefly by articulated norms, codes, regulations, and philosophies, but by these "reasons" that lie below the surface. Our way of perceiving the basic human values and relating to them is shaped by our whole way of looking at the world.

An example from bioethics will help here. As Daniel Callahan has pointed out, several images of human beings and their relation to the basic human values are possible.(16) First, there is the power-plasticity model. In this model, nature is alien, independent of humans, possessing no inherent value. It is capable of being used, shaped, and dominated by humans. We see ourselves as possessing an unrestricted right to manipulate it in the service of our goals. Death is something to be overcome, outwitted. Second, there is the sacro-symbiotic model. In its religious forms, nature is seen as God's creation, to be respected and heeded. Nature is a trust; we are not masters, but stewards. In secular form, humans are seen as a part of nature. Nature is a teacher and we must line in harmony and balance with it. Death is but a rhythm of nature, to be gracefully accepted.

The model that seems to have sunk deep and shaped our moral imaginations and feelings--and our perception of basic values--is the power-plasticity model. We are corporately homo technologicus. The best solution to the dilemmas created by technology is more technology. We tend to eliminate the maladapted condition (defective newborns, retarded persons) rather than adjust the environment to it; this is our cultural bias.

It can be persuasively argued that the peculiar temptation of a technologically advanced culture such as ours is to view and treat persons functionally. Our treatment--at least all too often--of the aged is a sorry symptom of this. The elderly are probably the most alienated members of our society. More and more of them spend their declining years in homes for senior citizens, in chronic care hospitals, in nursing homes. We have shunted them aside. Their protest is eloquent because it is helplessly muted and silent. But it is a protest against a basically functional assessment of their persons. "Maladaptation" is the term used to describe them rather than the environment. This represents a terribly distorted judgment of the human person.

I want to argue that faith can be protective against such a collapse. It should and, I believe, does sensitize us to the meaning of persons, to their inherent dignity regardless of functionability. In this sense it aids us in staying human by underlining the truly human against cultural pressures to distort it. Faith exercises this protective function by steadying our gaze on the basic human values that are the parents of more concrete norms and rules.

Let me put this another way. I have noted that the single, dominating, all-pervasive vitality in Jesus was the God-relationship. The human goods that define our flourishing (life and health, maiting and raising children, knowledge, friendship, enjoyment of the arts) while desirable and attractive in themselves, are subordinate to this structural God-relationship.(17) Yet it is the characteristic of the redeemed but still messy human condition to make idols, to pursue these basic goods as ends in themselves. This is the radical theological meaning of secularization: the loss of the context that relativizes and subordinates these basic goods and prevents our divinizing them. The goods are so attractive that our constant temptation is to center our being on them as ultimate ends, to cling to them with our whole being.

Jesus' love for us is, of course, primarily empowerment. But it is also, in its purity and righteousness, the standard against the type of collapse known as idolatry. Whatever He willed for us and did for us, He did within the primacy and ultimacy of the God-relationship. His love, as standard, suggests the shape of our Christian love for each other. It is conduct that reminds others of their true dignity, of their being and destiny, and therefore that pursues, supports, and protects the basic human goods as subordinate.

Dispositive. The Christian of profound faith will reflect in his or her dispositions the very shape of that faith. That shape, as I have noted, is the self-gift we call charity, love of God in others, charitable action. In an illuminating study, Edmund Pellegrino shows how the central dynamism of charity can shape moral choice within medicine.(18) He argues that charity will influence (1) the way the three dominant principles of medical ethics (beneficence, autonomy, justice) are interpreted; (2) the way the physician-patient relationship is construed; (3) the way certain concrete choices are made. For instance, where beneficence is concerned, Pellegrino claims that some form of benevolent self-effacement (arguable on mere philosophical grounds) is a minimum obligation in an agapeistic ethic. The Christian physician sees him- or herself called to perfection, to imitate Jesus' healing. In this perspective appeals to exigency, fiscal survival, self-protection, or the canons of a competitive environment are morally feeble, even totally unacceptable. Similarly, where justice is concerned, faith-full Christians will go beyond the strict calculus of duties and claims and exercise a "preferential option" for the very ones whose moral claims on society are difficult to establish: the poor, the outcasts, the sociopaths, the alcoholic, the noncomplaint in the care of their own health.

When he turns to the physician-patient relationship, Pellegrino argues that a charity-based ethic would reject notions of health care as a commodity transaction, of the physician as a businessman. It would reject likewise the relationship as one of contract for services, or as one primarily for profit. The covenantal model is most consistent with the perspectives and dispositions generated by charity.

Let me take another aspect of an ethic rooted in Christian faith, an aspect that may also be considered dispositive. It is the pascal mystery, the death-resurrection of Christ. Christians are accustomed to viewing aging, suffering, and dying within these perspectives.

Take aging as as example. Perhaps the most prominent quality of the lives of the elderly is dependence. Yet, as Theodore Minnema points out, we are notoriously resistant to the idea of dependence.(19) Our National consciousness is shaped by the Declaration of Independence. And similar perspectives frame our individual attitudes. Dependence is vulnerability. Independent autonomy is exalted as a key marker of dignity. On this view there is a certain negativity that attaches to the passive virtues (meekness, humility, patience). Yet Christ's supreme dignity was manifest in dependence: "Not my will, but thine be done."

For this reason Drew Christiansen has developed a "theology of dependence."(20) For most of our adult lives we ignore the dependence that ties us to other men and women. Christiansen sees this avoidance of dependence as mistaken. Dependence is an opportunity, a call to let ourselves go, to open up to God, to cling in trust to a power beyond our control, to see more clearly than ever the source and end of life.

Dependence on others should be a sign of our more radical dependence on God. Since our freedom is intended to lead us to a deeper union with God, it is an interesting paradox that our deep dependence on God establishes our own radical independence: independence in dependence.

Thus from a theological perspective, dependent old age should represent a flowering not a wilting.

Very similar things can be said about suffering and dying. From the perspective of faith, just as aging is not mere dependence and weakening, so suffering is not mere pain and confusion, dying is not merely an end. These must be viewed, even if mysteriously, in terms of a larger redemptive process: as occasions for a growing self-opening after Christ's example, as various participations in the paschal mystery. Such perspectival nuances may not solve clinical dilemmas nor are they in any way intended to glorify suffering and dying. But they powerfully suggest that in approaching such realities healing can never be seen as mere fixing; autonomy is not a mere material provision, but a "being with" that reinforces a sense of worth and dignity; dying can never be seen as "cosmetized passing" whose dignity is measured by the accumulation of minutes.

Directive. The biblical materials or stories that pass along the events that are the occasin of faith yield certain perspectives or themes that shape consciousness, and therefore constitute faith's informing of reason. I have attempted elsewhere to identify some of the themes that structure our ethical deliberation in biomedicine as the following: Life as a basic, but not absolute value; the extension of this evaluation to nascent life; the potential for human relationships as that aspect of physical life to be valued; the radical sociality of the human person; the inseparability of the unitive and procreative goods in human sexuality; and permanent heterosexual union as normative.21

Let me take just the first to illustrate the "directive" influence of theology on bioethics--life as a basic but not absolute good.

The fact that we are pilgrims, that Christ has overcome death and lives, that we will also live with Him, yields a general value judgment on the meaning and value of life as we now live it. It can be formulated as follows: life is a basic good but not an absolute one. It is basic because, as the Congregation for the Doctrine of the Faith worded it, it is the "necessary source and condition of every human activity and of all society."22 It is not absolute because there are higher goods for which life can be sacrificed (glory of God, salvation of souls, service of one's brethren, etc.). Thus in John: "There is no greater love than this: to lay down one's life for one's friends."23 Laying down one's life for another cannot be contrary to the faith or story or meaning of humankind. It is, after Jesus' example, life's greatest fulfillment, even though it is the end of life as we now know it. Negatively, we could word this value judgment as follows: death is an evil but not an absolute or unconditioned one.

This value judgment has immediate relevance for care for the ill and dying. It issues in a basic attitude or policy: not all means must be used to preserve life. Why? Pius XII in a 1952 address to the International Congress of Anesthesiologists stated: "A more strict obligation would be too burdensome for most people and would render the attainment of the higher, more important good too difficult. Life, health, all temporal activities are in fact subordinated to spiritual ends."24 In other words there are higher values than life in the living of it. There are also higher values in the dying of it.

What Pius XII was saying, then, is that forcing (morally) one to take all means is tantamount to forcing attention and energies on a subordinate good in a way that prejudices a higher good, even eventually making it unrecognizable as a good. Excessive concern for the temporal is at some point neglect of the eternal. An obligation to use all means to preserve life would be a devaluation of human life, since it would remove life from the context or story that is the source of its ultimate value.

Thus the Catholic tradition has moved between two extremes: medicomoral optimism or vitalism (which preserves life with all means, at any cost no matter what its condition) and medicomoral pessimism (which actively kills when life becomes onerous, dysfunctional, boring). Merely technological judgments could easily fall into either of these two traps. The medically effective could begin to define the humanly beneficial.

Thus far theology. It yields a value judgment and a general policy or attitude. It provides the framework for subsequent moral reasoning. It tells us that life is a gift with a purpose and destiny. Dying is the last or waning moments of this "new creature." At this point moral reasoning (reason informed by faith) must assume its proper responsibilities to answer questions like: What means ought to be used, what need not be? What shall we call such means? Who enjoys the prerogative and/or duty of decisionmaking? What is to be done with now incompetent, or always incompetent patients in critical illness? The sources of faith do not provide concrete answers to these questions.

The directive importance of such general themes can be indicated by an example. Several years ago, in Louisville, I participated on a panel on the artificial heart. The panel included the mandatory Protestant (Robert Nelson), Catholic, and Jew (the late Isaac Franck) along with Dr. Allan Lansing, medical director of Humana Heart Institute. The question arose as to whether the artificial heart works. Dr. Lansing stated: "When Bill DeVries and I decide that it doesn't work, the program will stop." I jumped on that and asked: "If the artificial heart gives you only an extra ten hours of life, or ten days, does it work?" Somewhat to my surprise--but not really as I look back on the incident--my colleague and friend Dr. Franck mumbled audibly, "it works." Theology was only thinly disguised in such a reaction. I do not believe the Christian story would support such a response, however, for it views life and death in light of the paschal mystery and this has a relativizing influence on both.

What I am proposing, therefore, is that theology can influence bioethics in very important ways. Its function is not a direct originating influence on concrete moral judgments at the essential level--but on "morally relevant insights" in the words of Franz Bockle.(25) On this view faith and reason compenetrate to produce a distinct consciousness, a consciousness with identifiable cognitive dimensions or facets. I have tried to identify three such dimensions, overlapping as they are, as protective (or corrective), dispositive, and directive.

Cumulatively, such influences attempt to show how faith informs reason. I believe the outcome of such "informing" is a distinct--though not utterly mysterious--way of viewing the world and ourselves and of hierarchizing values. To claim that such distinct outlooks and onlooks (theology) have nothing to do with bioethics is either to separate faith from one's view of the world (which is to trivialize faith by reducing it dualistically to an utterly other-worldly thing), or to separate one's view of the world from bioethics (which is to trivialize bioethics by isolating it from the very persons it purports to serve). (1)Alasdair MacIntyre, "Theology, Ethics and the Ethics of Medicine and Health Care," Journal of Medicine and Philosophy 4 (1979), 435-43. (2)Johannes B. Metz, Followers of Christ (Ramsey, NJ: Paulist, 1978), 39-40. (3)Joseph SIttler, The Structure of Christian Ethics (New Orleans, LA: Louisiana State University Press, 1958). (4)Sittler, Structure of Christian Ethics, 46. (5)Cf. Edmund Pincoffs, "Quandary Ethics," Mind 80 (1971), 552-571. (6)I have taken these from my earlier essay "Theology and Bioethics: Christian Foundations" in Earl E. Shelp, ed., Theology and Bioethics (Dordrecht: D. Reidel, 1985), 95-113. (7)Enrico Chiavacci, "The Grounding for the Moral Norm in Contemporary Theological Reflection," in Readings in Moral Theology No. 2, Charles E. Curran and Richard A. McCormick, S.J., eds. (Ramsey, NJ: Paulist, 1980), 291-292. (8)Sittler, Structure of Christian Ethics 18. (9)I take these distinctions from Norbert Rigali, S.J., "On Christian Ethics," Chicago Studies 10 (1971), 227-247. (10)James M. Gustafson, Ethics From a Theocentric Perspective. V. II Ethics and Theology (Chicago: University of Chicago Press, 1984), 98. (11)Sacred Congregation for the Doctrine of the Faith, Declaration on Euthanasia (Vatican City: Vatican Polyglot Press, 1980); Origins 10 (1980), 154-157. (12)Karl Barth, The Knowledge of God and the Service of God According to the Teaching of the Reformation (London: Hodder and Stoughton, 1938), 95. (13)The Documents of Vatican II (New York: America Press, 1966), 209. (14)Vincent MAcNamara, Faith and Ethics (Washington, DC: Georgetown University Press, 1985), 117-121. (15)Philip Rieff, The Triumph of the Therapeutic: Uses of Faith After Freud (New York: Harper and Row, 1966). (16)Daniel Callahan, "Living with the New Biology," Center Magazine (July-August 1972), 4-12. (17)Cf. Richard A. McCormick, S.J., Health and Medicine in the Catholic Tradition (New York: Crossroad, 1984), 37-38. (18)Edmund Pellegrino, "Agape and Ethics: Some Reflections on Medical Morals from a Catholic Christian," forthcoming in Catholic Perspectives on Medical Morals: Foundational Issues, v. 34 (Kluwer Academic Publishers). (19)Theodore Minnema, "Human Dignity and Human Dependence," Calvin Theological Journal 16 (1981), 5-14. (20)Drew Christiansen, S.J., "The Elderly and Their Families: The Problems of Dependence," New Catholic World 223 (1980), 100-104. (21)Cf. Richard A. McCormick, S.J., "Theology and Biomedical Ethics," Logos 3 (1982), 25-43. (22)Declaration on Euthanasia. (23)John 15:13. (24)Pius XII, AAS 49 (1957), 1031-32. (25)Franz Bockle, "Glaube and Handeln," Concilium 120 (1976), 641-647.
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Date:Mar 1, 1989
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