Mitchell, C. Ben, and D. Joy Riley. Christian Bioethics: A Guide for Pastors, Health Care Professionals, and Families. B&H Studies in Biblical Ethics. Daniel R. Heimbach, Series Editor. Nashville: B&H Academic, 2014. 207+xiv pages. ISBN 978-1-4336-7114-2.
Christian Bioethics: A Guide for Pastors, Health Care Professionals, and Families, by C. Ben Mitchell (Ph.D. and professor of Moral Philosophy) and D. Joy Riley (M.D. with Bioethics M.A.), is described by its publisher (B&H Academic) as a “needed guide for pastors, clinicians, students, and laypeople” (back cover) that hopes “to help readers discover how biblical theology, Christian ethics, and contemporary science and medicine intersect in the real world where people are making life-changing decisions” (2). Unlike some collaborations, this one maintains a distinction between each author’s contributions by adopting a dialog format said to “let readers eavesdrop on their conversation” (back cover), though some readers may find the format contrived in places (if my reading experience is any indicator). For instance, at one point, Riley concludes her survey of “a part of the medical landscape” with a series of questions for Mitchell, one of which is “What does the Bible say about the nature of human life?” (54) Now, Mitchell is a Professor of Moral Philosophy whose University of Tennessee Ph.D. study included “a concentration in medical ethics” (back cover); he does not (so far as the text indicates) teach Theology or Biblical Studies. Neither readers nor Riley seem to have a reason to assume Mitchell knows more about what the Bible teaches on this subject than Riley does. Yet this transition in the text has Riley deferring to Mitchell as though his greater biblical expertise can be assumed. This makes the dialog format feel contrived.
(Please note that my only point here is to highlight the occasional unnaturalness of the dialog format. I don’t mean to call into question either author’s right to argue from Scripture. The Bible is God’s communication to all believers, which we can assume he wrote and preserved in such a way as to ensure and maintain its ability to communicate, not a text meant to be understood only by specialists, assumptions of contemporary scholarism and expertism notwithstanding.)
Christian Bioethics is part of the B&H Studies in Biblical Ethics series, edited by Daniel R. Heimbach. This series, Heimbach relates, aims to help meet today’s “critical need for scholarship, instruction, and application of Christian ethics in ways that equip Christian men and women to engage the surrounding culture in prophetic moral witness,” a need created by an environment of “widespread moral confusion and denial of moral authority,” where “claims to objective moral authority and understanding are openly contested…more than any other aspects of Christian faith and witness” (xi). While I do not always find the dialog format effective, and though I am not perfectly satisfied with Mitchell and Riley’s arguments at every point, I can recommend the text as a solid, helpful survey of (and introduction to) bioethics.
The text begins with introductory and foundational material, comprising the Introduction (1-5) and first two chapters (9-42; Part I of the text, entitled “Christian Bioethics”). The Introduction notes Mitchell and Riley’s starting assumptions (Christian worldview, historic orthodoxy, necessary coherence between Scripture and science because “all truth is God’s truth”) and explains the book’s organization (inspired by Theologian Nigel Cameron), which divides treatment of issues in bioethics into “Taking Life” (Part II; chapters 3-4), “Making Life” (Part III, chapters 5-7), and “Remaking/Faking Life” (Part IV, chapter 8). (A Conclusion follows these main sections.) Sufficiently strict Biblical Creationists, those inclined to challenge proposals of “gaps” in the Genesis genealogies, may be uncomfortable with the statement that “surgical interventions date back to around 9000 BC” (1), which takes secular dating methods for granted. Such persons might even be mildly uneasy with the failure of Mitchell and Riley to note Scripture’s primacy (the ultimateness of Scripture’s authority) when they describe “science and faith, medicine and theology” as “realms of knowledge” or “sources of truth” (5).
Some remarks on each chapter follow, under headings for each of the text’s larger divisions (parts).
Part I: Christian Bioethics ^
Chapter 1, “Which Doctors? Whose Medicine” (9-23), like remaining chapters in the book, begins with a case study, followed by “Questions for Reflection” (9-11). Here, the case study concerns a doctor who gives a patient a dose of morphine that the doctor knows will have “the inevitable…effect” of killing that patient in a situation where the patient’s desire for or consent to such an “assisted suicide” is ambiguous. Discussion of this case leads to reflection on the Hippocratic Oath, which is little used today, and the history of the Oath and of medicine in the Christian West (how the Oath was Christianized by the tenth century, how Christian faith motivated care for the ill and the founding of hospitals, and so on) and of related ethical debate and the development of a separate field of bioethics. Mitchell and Riley, finding common metaphors for physicians (parent figures, warriors against illness, technicians engaged in curative problem solving) unsatisfactory, propose seeing physicians as primarily persons necessarily of good character (who have learned and manifest the virtues of compassion, prudence, justice, fortitude, temperance, integrity, and self-effacement) in trust-based relational covenants with their patients. They advocate a return to “the higher moral ground” once exemplified by the Hippocratic Oath; only through such a return, they maintain, can we “achieve the proper ends of medicine” (22).
Chapter 2, “From Ancient Book to the Twenty-First Century” (25-42), discusses how to apply the teachings of Scripture to ethical questions arising out of contemporary life science developments that Scripture’s original recipients could scarcely have imagined. After rejecting possible approaches to Scripture that would be too one-dimensional and simplistic (treating it as solely a collection of rules, “eternal laws,” to follow; treating it as a repository of universal moral principles only; and viewing it exclusively as “a grand narrative, a sacred story” that calls for “situating oneself in the story and living accordingly”), Mitchell and Riley propose a composite view that combines the insights of all the one-dimensional approaches, recognizing that “God’s moral instruction comes to us in the form of commands and principles and is also revealed [through the biblical narrative] in Christian virtues and examples.” They label this approach “The Bible as Canonical Revelation of Divine Commands and Christian Virtues” (31). One particularly noteworthy statement in the chapter is Mitchell’s description of the meaning of 2 Peter 1:3: “In other words,” he writes, “God has not left his people without guidance in every area of life. Although the Bible is not a science textbook, its message speaks to the deep underlying values that can guide decisions about scientific matters Although the Bible is not a manual of medicine, its truths may be applied to medical decision making” (28).
The chapter includes basic discussion of hermeneutics, bringing to readers’ attention such common principles as “whenever possible Scripture should be read in its historical and cultural context” (33; hermeneutical discussion in this chapter relies heavily on Kyle D. Fedler’s Exploring Christian Ethics: Biblical Foundations for Morality [Louisville: WJK, 2006]). Readers worried by the Introduction’s failure to emphasize the primacy of Scripture will welcome the statement here that “Scripture is primary, normative, and authoritative,” even if they are unexcited by reiteration that the Bible “is not our only source of guidance and wisdom” (33). The chapter’s conclusion, however, may revive such readers’ discomfort. The authors write: “Christians must read and interpret two books of revelation: the book of God and the book of nature….God has made himself known in Scripture and in nature….Thus, in order to understand God’s revelation most fully, we study both the Bible and nature, written revelation and created revelation” (40-1). Further: “At the end of the day, we affirm the coherence of truth; all truth is God’s truth. Christians have nothing to fear from truthful science, and science has nothing to fear from faithful biblical interpretation” (41). While there is certainly nothing objectionable about seeing Scripture and nature as in some ways analogous, the identification of both Scripture and nature as “books” does risk implying that Scripture (which is verbal) and nature (which is not verbal) are equally clear and that information humans derive from Scripture has no greater authority than information they (believe they) derive from nature. Such “two [equally clear] books” thinking has led some individuals, on the basis of their “reading” of the “book” of nature, to impose upon portions of Scripture interpretive schemes that would never have occurred to its original recipients (and that often seem strained and bizarre). I discern no evidence of such error in Mitchell and Riley’s discussion, but I would welcome more careful emphasis on how the clarity and authority of God-breathed Scripture surpasses the nonverbal ambiguity and “mixed signals” of fallen nature.
Part II: Taking Life ^
Chapter 3, “The Sanctity of Human Life and Abortion” (45-65), describes the various types of abortion, explains the meaning and implications of belief in the sanctity of human life, and shows how that belief is justified and informed by the scriptural teaching that humans are made in the image of God. The bottom line: “the witness of Scripture and the testimony of the early church are that every human being, from conception through natural death, is to be respected as an imager of God whose life has special dignity” (59). In addition to the church history alluded to in this quotation, the chapter looks at some pre-Christian Hebrew thought and summarizes the history of abortion legalization that reached it permissive peak with the U.S. Supreme Court’s 1973 Roe v. Wade and Doe v. Bolton rulings.
Overall, this is a solid and helpful chapter. Mitchell’s description of the metaphorical use of reins or kidneys (“inward parts”) in Hebrew poetry particularly catches my attention: “In Hebrew poetry,” he writes, “the inward parts were typically understood to be the seat of the affections, the hidden part of a person where grief may be experienced (Job 16:13), where the conscience exists (Ps 51:7), and where deep spiritual distress is sometimes felt (Ps 73:21)” (57). At first blush, the implication seems to be that “inward parts” parallels popular English usage of “heart” (in contrast to Hebrew usage, where “heart” includes what English usage calls “head” or “mind,” at least if Proverbs 23:7, which places thinking in the “heart,” is any indicator). However, though Mitchell does cite Psalm 51:7, he does not discuss Psalm 51:6, which indicates that the “inward parts” may also house “truth” and “wisdom,” which would seem to require some “head” or “mind” cognitive capacity in the “inward parts.” None of this is central to the point of the chapter, but this disconnect between the Bible’s picture and our modern way of thinking, with its distinction between (metaphorical) “heart” and “head,” merits reflection.
In one of his other contributions to the chapter, Mitchell makes an interesting reference to “the person of the trinitarian God.” This reference to the Trinity as a single “person” appears on the same page as reference to “the person of Jesus” (54). If the reference to the Trinity is not a typographical error where “persons” or “personhood” or “personal nature” is meant, we have here the suggestion that the triune God is one person who is at the same time three persons, an idea much less obviously coherent than the more standard “three persons, one God” (as a shorthand for “three distinct personal subsistences, one divine essence” or the equivalent; see W.E. Ward, “Hypostasis,” Evangelical Dictionary of Theology 2 ed. [Grand Rapids: Baker Academic, 2001], 583).
Chapter 4, “Human Dignity and Dying” (67-104), addresses end-of-life issues, most notably “euthanasia.” Though once called “passive euthanasia,” the “removal of life-sustaining treatments like breathing machines and technologically or ‘artificially’ administered nutrition and hydration” is now “a separate category in ethics discussion” since “most people recognize that a time can come for removing technology, with proper consent, so that the dying process can proceed” (91-2). Forms of euthanasia still generally called such are “voluntary active” (physician assists at patient’s request), “nonvoluntary” (physician effects without patient input), and “involuntary” (physician kills patients against patient’s wishes) (Ibid.). While noting that “early theologians were consistent in their insistence that suicide was sub-Christian at best because hope and love sustain patience” in the midst of suffering (102), the chapter fails to directly address what seems to me the most fundamental issue in debates over suicide, euthanasia, and other end-of-life issues: Who owns humans’ bodies and lives? The biblical answer would seem to be that God, their creator, does. The dangers that what begins as voluntary may become involuntary (97), and that healers who also function as killers could hardly be trusted (98), do not provide nearly so certain a foundation for opposing euthanasia and suicide as does uncompromising affirmation that humans do not own their lives and bodies (or the lives and bodies of others), but are only stewards of them for the God who made them and who places strict limits on how they may be used. The former dangers call for safeguards (a “euthanasia provider” career separate from healing medical practice, laws to ensure consent); the latter affirmation forbids willful life-termination, with or without consent, unless authorized by God himself (as in Genesis 9:6, for example).
Because advocates of euthanasia generally justify it as a way to relieve suffering, a fair portion of the chapter is committed to clarifying what is meant by “pain” and “suffering” and to developing a theological and philosophical understanding of “the problem of suffering” or “the problem of pain.” Two aspects of this discussion leave me less than entirely satisfied. First, while laying out a “Taxonomy of Suffering” (based upon work by Daniel P. Sulmasy), Mitchell (presumably following Sulmasy) seems to confuse finitude and fallenness. For instance, “pangs of conscience, remorse, and guilt” are described as an “experience of personal moral finitude” (79). (Note that it would be better to speak of “awareness of guilt” as the thing causing “pangs.” Guilt is a judicial state: one has done wrong and merits punishment. Whether one has any “pangs” about it or not, one’s state of guilt remains unchanged.) Scripture does not teach that being finite, being created beings rather than God, is in itself sinful. Moral failure owes to fallenness (a corrupt will, corrupt inclinations, leading to corrupt actions), not to finitude. No doubt there are times when humans feel “pangs” about such things as “limited individual capacity for good” (80), but moral understanding (understanding of what thoughts, feelings, and actions are right and moral or wrong and sinful) is not enhanced by labeling non-sinful results of finitude “moral failure.”
The other unsatisfying aspect of the discussion is the attempt at theodicy (justifying God’s ways to humans). The chapter offers the standard “free will” defense of God’s justice: “The consequences of the fall into sin being what they are, any day without suffering is a day of grace and mercy….If one begins with the assumption that suffering is endemic to the human condition, then there can be no such thing as ‘pointless’ suffering. [How it is that something being “endemic to the human condition” means it cannot be “pointless” is unclear.] This is not to argue that suffering is to be sought but that suffering is deserved. God is just in allowing suffering. In other words, the important question is not, Why do bad things happen to good people? But, Why do good things happen to bad people?” (82) Or, in the words of Philosopher Peter Kreeft, suffering (and sin and death) “are from us, not from God; from our misuse of our free will, from our disobedience” (81, quoting from Peter Kreeft’s Making Sense of Suffering [Cincinnati: Servant Books, 1986]). This approach to suffering has long been very popular. I confess, however, that it hasn’t worked for me for some time. If one is comfortable making human free will ultimately determinative of whatever comes to pass, if one doesn’t mind treating God’s sovereignty as something that works with or works around free creaturely decisions over which God has no control, and if one is comfortable embracing a justification of God’s ways to humans that Scripture itself never teaches and in fact (in the book of Job) seems to suggest goes beyond the prerogative of creatures, one might find the “it’s all about human free will” explanation satisfactory. If, on the other hand, one believes that God is truly and completely in control, that his sovereign eternal decree includes free creaturely decisions (that creaturely freedom is secondary and derivative, not ultimate; that “freedom” as commonly conceived does not exist for created beings), one will not be so satisfied.
Even if one doesn’t find the argument objectionable because of how it seems to limit God’s sovereignty, the book of Job still looms. While it is no doubt true that humans in general are sinful and that sinfulness merits suffering, it is evident to the God-given (though fallen and so not always reliable) moral sense of almost everyone, and it seems clearly taught in the book of Job, that some people suffer more (and some less) than justice would dictate. Of course, any sin against our infinite and perfectly holy God seems to merit infinite suffering, so that it would be impossible for any human to suffer more than, or even as much as, deserved. Still, Job suggests this line of thinking may be inadequate: Rather than inspire a theodicy justifying his ways to humans, God chose to inspire a book that essentially says, “Where do you created beings get off asking for a theodicy?” (See also Romans 9:19-24)
Part III: Making Life ^
Chapter 5, “Infertility and Assisted Reproductive Technologies” (107-27), discusses such things as in vitro fertilization (IVF), use of donor sperm and eggs, and surrogacy. It grapples with the ethical issues resulting from these developments in terms of the already-developed understanding of the sanctity of every human life and the awareness “that pregnancy occurs at fertilization rather than at implantation [of the new life in the uterine wall]” (113). This is an informative and useful chapter. Since the reality that sacred human life begins prior to implantation is emphasized, in order to show the wrongness of “reproductive technologies” that end up never implanting and finally destroying “excess embryos,” the chapter might have taken a few sentences to note how “the abortion pill” is not the only medication that can end a pregnancy already in progress, since this is also how some standard “contraceptives” can end up working. (Never mind that this contradicts the “contraceptive” label, presumably used because the drugs do prevent conception or fertilization some of the time.)
Chapter 6, “Organ Donation and Transplantation” (129-48), discusses ethical issues related to organ donation. Because most organ donation (donation of non-paired organs) requires a dead donor (at least for now), this is the chapter where questions about when and how to label someone “dead” are addressed. Whereas prior to ability to measure brain activity the standard for determining death was cessation of heart and lung activity (nicely comporting, one notes, with the biblical idea that “the life of the flesh is in the [circulating] blood” [Leviticus 17:11]), cessation of brain activity (either of the whole brain or only of areas deemed essential to human consciousness) has more recently been considered an acceptable standard. One particularly interesting revelation of the chapter is that it is not unheard of for persons declared “brain dead” by multiple doctors to recover (135-6).
Chapter 7, “Clones and Human-Animal Hybrids” (149-65), discusses cloning, including that involving placing nuclei of one species into the enucleated (nucleus removed) eggs of another species to create “hybrids.” (Whether experimentation retaining nuclear material from two species has also been attempted is not clear from the chapter.) This chapter especially well illustrates the morally confused thinking dominant in contemporary secular culture, since the legal environment sees no problem with creating human embryos (or human-animal hybrid embryos) through cloning for experimental purposes or medical use (“therapeutic cloning”) but (so far) tends to strongly condemn and forbid implanting cloned human embryos in human wombs to live and mature (“reproductive cloning”). One especially interesting item discussed in the chapter is the creation of embryos from gametes of three persons (what the chapter calls “Embryos with three parents”) as a way “to avoid mitochondrial diseases” (160). Since mitochondria are passed from mothers to children separate from the nuclear DNA to which both parents contribute, one could prevent inheritance of mitochondrial defects from a mother with a mitochondrial disease by transferring the nucleus of the mother into the egg of a donor (whether this would be done before or after fertilization is not stated). “The resulting child,” Riley summarizes, “would have the chromosomes (nuclear DNA) of his/her mother and father and the mitochondrial DNA of the egg donor [“second mother” if one accepts the “three parents” description]” (160-1). Mitchell and Riley see this as ethically problematic and fear a “slippery slope” to “designer children” (161), but I confess it sounds to me closely analogous to organ transplantation. The blueprint of what makes a person a person, and makes a given individual the “child” of two other individuals, would seem to be the nuclear DNA; “transplant” of the rest of the cell from an unfertilized egg with healthy mitochondria doesn’t (at present) strike me as ethically problematic or as creating a child with “three parents.” In any case, Mitchell and Riley believe that “all human cloning should be forthrightly banned,” as should creation of “human-animal hybrid embryos” (165), and their case against most aspects of these practices seems sound.
Part IV: Remaking/Faking Life ^
Chapter 8, “Aging and Life-Extension Technologies” (169-83), discusses efforts to extend the human lifespan or, more audaciously, to achieve immortality and to surpass other human limitations (mental, physical), through various means (health maintenance through nanotechnology, slowing or arresting the process of “growing old,” transfer of human consciousnesses into robots or virtual environments, technological enhancement of human mental and physical capabilities beyond natural limits, etc.). In the chapter, Mitchell sets forth the position that “Aging is not a disease to be cured but a reality of the human condition to be celebrated,” offering Proverbs 16:31 as support for this view (179). I’m not sure I’m entirely convinced by this line of reasoning. In our fallen context, where the only alternative is to die young (perhaps because one does not follow the longevity-friendly “way of righteousness”), living to a gray- or white-haired old age (perhaps as a result of following “the way of righteousness”) is indeed something to be celebrated. But this fact doesn’t quite identify any of the “negative” aspects of aging as preferable to (were it possible) retention of the optimal capacities of one’s “prime” for a longer time. Whereas some transhumanist aspirations doubtless violate Christian morals (and will be proven incompatible with humans’ created nature), the quest to extend lifespan, to slow or stop (or reverse or repair) the negative effects of aging, does not strike me as fundamentally different from the broader efforts of medical and related sciences to reduce the effects of the fall on human life and health.
One reason I think the discussion goes astray is that “aging” is used so freely today as a shorthand for the negative (degenerative) effects of aging. Thus, the chapter can conclude by lamenting how our culture “has come to loath every facet of aging” (183). Is this true, though? One facet of aging is the acquisition of experience and, ideally, of wisdom. Does our culture, does anyone, really “loath” this? Even those who most pine away for lost youth dream of reliving it “knowing what they know now.” The other facet of aging is the deterioration that results as bodily self-repair falls progressively behind degenerative processes. Those who dream of “curing aging” probably shouldn’t use the term “aging,” since they have no desire to eliminate growth in experience and wisdom. For instance, the late Roy Walford (died 2004) thought degeneration and death unfortunate because acquiring the experience and wisdom to live well takes so much time: “It’s a shame to die so young, because it takes so long to learn how to live” (Foreword to Brian Delaney and Lisa Walford’s The Longevity Diet [New York: Marlow & Company, 2005], xiv). Trying to figure out why bodily self-repair inevitably falls behind degeneration, and to determine if there are ways to keep self-repair ahead of degeneration for a longer time or indefinitely (by “fixing” whatever aspect of the human organism prevents self-repair from keeping up or by supplementing self-repair with technology, as in speculations about what could be accomplished by “nanobots”), may indeed be a quest destined to fail (177), but it does not strike me as dehumanizing or necessarily unbiblical. Degeneration and death are results of the fall, not essential qualities of being human. Scripture does suggest, of course, that physical death, and so the degenerative processes that bring it about, is a mercy: living forever in our fallen state, it appears, would not be a good thing (Genesis 3:22-24). Still, there is nothing in this to suggest that much longer lives would be a problem (the long lives in Genesis are never identified as problematic simply because long), and many Christians might rather wait to be translated at the Second Coming than endure degeneration and death.
The Conclusion, “Preserving Our Humanity in a Biotech Century” (185-97), offers some final thoughts, such as endorsement of pregnancy care centers as a way to oppose abortion by making it easier to “choose life” (191). In their plea for “Humanity over Efficiency,” Mitchell and Riley set forth the strange claim that “When we rob ourselves of all opportunities to find social meaning in social eating, we rob ourselves of our humanity” (193). Apparently, there is a whole book dedicated to this argument (Leon R. Kass, The Hungry Soul: Eating and the Perfecting of Our Nature [Chicago University Press, 1999]; cited on 193). I can’t help thinking there must be better examples of ways to affirm our “embodied” God-given human nature than social eating, but that’s the example Mitchell and Riley chose to emphasize. Whatever.
The book, as a whole, makes persuasive arguments on most points and provides adequate coverage of the range of issues in contemporary bioethics. It is worthwhile reading, particularly for those who have not previously studied the issues. Its use as an introductory text is enhanced by a listing of “Additional Resources” at the end of each chapter. Finally, those seeking information about specific topics will appreciate the name and subject indexes (199-207).
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