|
|
2010 Baylor Symposium on
Faith and Culture
Thursday, October 28-Saturday, October 30, 2010
Baylor University, Waco, Texas
This page has navigational aids built into that use Javascript. If a security banner appears at the top of this page in Internet Explorer, click on it and select "Allow Blocked Content" in order to use these features.
Pippa Coulter Abston, MD, Ph.D.
Assistant Clinical Professor
University of Alabama School of Medicine
Who Is My Neighbor? A Christian Approach to Healthcare Reform
The parable of the Good Samaritan serves as a model for what healthcare could look like if approached from a Christian perspective. Traditionally, the debate about healthcare reform has centered on three parameters-cost, quality and access. I propose that the most important element has not been included-the element of vision. Without a vision of a just, compassionate model of care, any plan will fall far short.
The Christian vision of healthcare, as described by the Good Samaritan Parable, would work towards comprehensive, universal healthcare coverage which is equitable, compassionate, and of high quality. Such a model would view people seeking care from a whole person approach. Opponents of universal health care, who espouse a free market health system, are currently eliminating whole groups of us from their statistics on un-insurance, based on highly biased opinions of personal worth. As Christians, we must refuse to "unsee" any person, no matter what.
Once we have fully developed our vision, then we can address the other elements of cost, quality and access. Again, working from our parable, we must be able to reach the sufferer on the road, provide excellent care for him/her, and pay the innkeeper. I propose that the plan advocated by Physicians for a National Health Program (PNHP) would fulfill these criteria in the most effective manner. PNHP proposes a publicly funded national health insurance-an improved, expanded Medicare for All-paid for by a small payroll tax. Their credo is "everybody in-nobody out."
Universal healthcare is provided for in every other developed country on our planet. The cost in these countries is far less, per person, than the cost in the United States, but with more comprehensive delivery of care. Instead of approaching financing from a standard business model, a Christian model could see it from a stewardship perspective. The basic principle of health insurance as a risk pool is actually very Christian, once the unnecessary profit machinery of corporate insurance is removed. In the early Church, Christians pooled their resources and provided for each other based on need. Quality of care is also higher in those countries where care is universal, as evidenced not only by overall life expectancy but also by several measures of health status.
People of faith know that suffering and death will come to us all. There is no need to fear these experiences or to try and eliminate them from the world. And no human system of healthcare will ever be utopian. But knowing our duties to each other, we must do anything possible to ensure that no person suffers unnecessarily or dies an untimely death because of a lack of love.
When I give talks about healthcare reform, audience members often say that this approach is analogous to feeding a man a fish, instead of teaching him to fish. They are concerned that a national health insurance does not encourage personal responsibility in matters of health. While I agree that we must each work to care for our bodies appropriately, the Christian approach is different. To carry on the metaphor of fishing, Christ clearly told us to share our fish. In the Kingdom of God, we would teach men and women to fish, not so they could feed themselves, but so that we could all feed each other.
I see the Church as having been largely silent in our recent national debate around healthcare reform. It is time for us to take this up-to bear witness to needless suffering, and give voice to those who are voiceless.
Ibigbolade Simon Aderibigbe, Ph.D.
African Studies Minor Co-Coordinator
University of Georgia, African Studies Institute
Existentialist Christianity: A Model in the Redeemed AIDS Program Action Committee (RAPAC) Involvement in Combating HIV/Aid Scourge in Nigeria
Principles-based ethics has dominated biomedical ethics for more than three decades. Articulated and promoted most fervently by Tom Beauchamp and James Childress and coined principlism by some of its early critics, its moral grounding rests on the presumption of a common morality from which four groups of ethical principles (autonomy, non-maleficence, beneficence, and justice) can be distilled. Moral decision-making in this process-driven framework relies on the coherence of an ever-widening body of moral experiences to collect points of convergence, eventually resulting in a state of reflective equilibrium. Principles-based ethics is primarily intended to foster moral reflection among individuals of diverse basic moral beliefs. It claims moral justification grounded in faith in reason-driven consensus rather than in extratemporal authority. It is a syncretic byproduct of postmodern relativism and Jurgen Habermas’ vision of modernist renewal in which moral consensus can be achieved by genuine intention to achieve resolution by rationalization, leaving behind basic religious beliefs that may impede this process.
Christians from different traditions have responded to principlism in different ways. In an attempt to address perceived inadequacies of this framework, Edmund Pellegrino has acknowledged helpful contributions of the four principles to biomedical ethics while arguing that the principles need to be renewed in the context of a philosophy of medicine. Such a philosophy focuses on beneficence as care for the needy rather than the autonomy principle that tends to dominate principles-based ethics and on the virtues of the moral agent. From his Protestant tradition, William F. May agrees with this critique but has gone further to propose a covenantal ethic grounded in the covenantal relationship between God and humankind as revealed in the Word of God. Such an approach moves away from a focus on principles and gives priority to relationships that make up medicine and medical practice. This ethic promotes an intimate link between human personhood and human relationships in light of a covenantal relationship with God. However, May only incompletely addresses the underlying presuppositional and philosophical differences in basic beliefs that distinguish a covenantal and principles-based framework, does not provide a robust reassessment of the four principles within his covenantal ethical framework, and inadequately accounts for the impact and normative nature of the web of relationships in medicine outside that of the physician and patient.
When grounded in the biblical theme of covenant as interpreted in the Reformed Christian tradition, a covenantal ethical framework provides guidance for understanding the normative nature of relationships within the medical encounter. It lays claim to a creational basis for covenantal relationships through the gracious divine offering of a unique relationship between the Creator and all human beings. Such an ethic can reorient biomedical ethics toward the relationships that constitute medical encounters while modeling those relationships on the original divine/human covenant. Human participants derive their distinct value and moral worth from their created status as image-bearers of God, an endowed core of human identity that is missing in alternative covenantal models of the pagan Greek traditions. A robust Christian covenantal ethic encompasses relational duties and obligations inherent in covenantally-modeled relationships.
Each relationship has its own sovereign sphere of purpose and activity, yet each also intersects with other medical and non-medical relationships. With institutionalization of care and the increasing differentiation of care expertise and responsibilities into new types of caregivers, (e.g., physician assistants and nurse practitioners), the number and intersects of relationships continue to increase, preoccupation with process develops, and the risk of losing the patient-centred focus of these relationship increases. Working from a covenantal ethic can help to maintain both the normative integrity of each relationship as well as interactions between relationships. In addition, for each participant in medical relationships, a biblical covenantal ethic requires attentive vigilance to sustain the sovereignty and integrity of coexisting non-medical relationships.
A biblical covenantal ethic can be particularly helpful in working through the moral status of the unborn. For human embryos, for example, such an ethic recognizes their full and unique moral worth as image-bearers of God and their unique non-reciprocating relationship with those whose core responsibility for such embryos is nurturing. Additional enriching features of such an ethic for biomedical ethics will be presented.
Abdul Karim Bangura, Ph.D.
Professor of Research Methodology and Political Science
Howard University
E-clustering Health Care in Africa with Human Dignity: A Pan-African Ubuntu Approach
A literature search on health related issues and health care providers and services in Africa yields works on the devastating effects of HIV/AIDS on the continent, the continued devastation of malaria, how African hospitals are getting worse, and how China is building hospitals (and schools) across Africa. What is missing and sorely needed is a work that has a comprehensive listing of hospitals and other health care providers with their specializations and services across Africa. Two attempts at providing such a listing has not been quite fruitful. The first attempt is that by Stockholm Challenge which sought to develop a network of hospitals of Africa, the Indian Ocean and the Caribbean (RESHAOC) in order to share their human and material resources within the framework of an inter-hospital collaboration. Thus far, only nine countries comprising eight in Africa and one in the Caribbean have adhered to or expressed their intention to adhere to the RESHAOC call: (1) Burkina Faso, (2) Cameroon, (3) Gabon, (4) Mauritania, (5) Madagascar, (6) Mali, (7) Niger, (8) Chad, and (9) Haiti. In addition, only 15 hospitals are currently entered in the RESHAOC databank. The second attempt is the one by Medical World which is working to develop a comprehensive databank on hospitals across Africa. As of this writing, information is available on only six African countries: (1) Zimbabwe, 24 hospitals; (2) Uganda, 51 hospitals; (3) Tanzania, 15 hospitals; (4) South Africa, 31 hospitals; (5) Nigeria, 14 hospitals; and (6) Liberia, 13 hospitals. Evident from some of these works is that African countries face serious health challenges. With very few exceptions, citizens of the various African countries are being infected by the same diseases, most of which are now curable. Despite the challenging health problems, African countries spend relatively little on health care. Given these challenges, pooling their resources and their scientists engaging is serious collaborative research via a health cluster can help hospitals and other health care providers in a Pan-Africa framework to find cures for and effectively combat diseases. E-clustering health care in Africa with human dignity will be an innovative approach for health policy based on the concept known as "Cluster Building" couched within the tenets of Ubuntu. An E-health cluster for Africa will initiate the networking of all participants in a value-added chain. The objective is to bundle the potentials and competencies for increasing the innovation power and competitiveness of the partners in a cluster. Given Internet technology, even business and government networking in rural areas can obtain a driving force. Internet technologies such as infrastructure, applications, platforms, and broadband can enable the business processes between companies, academic institutions, research institutes and governments to be networked. E-business and E-government/E-administration cause fundamental structural changes of the private and public sectors. Given this reality, there is a need for a health and technology policy. This need is taken into account in E-clustering health care for human dignity. The various geographical areas in Africa in an E-health cluster can be networked by processes that are more standardized and so able to be supported by online applications. The E-health cluster will require a central infrastructure and services. Knowledge management, E-learning, E-marketplaces, personnel management and E-government/E-administration will be the main processes and services of this Pan-African E-health cluster.
Justin D. Barnard, Ph.D.
Associate Professor of Philosophy
Union University
Moral Complicity and Human Embryonic Stem Cell Use
Among those who maintain the intrinsic inviolability of innocent human life from conception forward, the prospect of developing new therapies from stem cell lines originating from disaggregated human embryos raises concerns about moral complicity. For example, to what extent, if any, would a patient who receives treatment for Parkinson's disease from a stem cell line directly produced by destroying human embryos be morally complicit in "cooperation with an evil act?" Whereas Roman Catholic casuistry contains conceptual resources to navigate such moral complexities, some Evangelicals either find the notion of moral complicity in such matters irreparably opaque or offer arguments regarding moral complicity that are inherently vague or insufficiently precise to make practical moral decisions. In this paper, I explore the issue of moral complicity in the development and use of therapies from human embryonic stem cells. I argue that considerations of timing and knowledge, while perhaps relevant to degrees of culpability, are red herrings in arguments about moral complicity. Further, I propose that Evangelical thinking about moral complicity might be better informed by principles drawn from Roman Catholic reflection on "licit cooperation in evil." I close by drawing out some practical implications such reasoning has for the development and use of therapies from human embryonic stem cells.
Robert Bayley
Pastor
John Knox Presbyterian Church, Seattle, Washington
"Why I am sick..." - Making Room for Religious Beliefs that Interpret Illness, and the Role of the Health Care Provider
For the future of health care to engage in the hard task of moving from a compartmentalized to an integrated model of patient treatment, to affirm the human dignity of patients through acknowledging belief systems that form the core of patient identity and through which they interpret illness, and for health care providers to engage in the even harder task of acknowledging the presence and role of their own beliefs, particularly for Christians, in the patient-provider transaction, the paradigms and principles set forth below will need to be seriously considered.
PREMISE: Every patient, without exception, brings a cosmology, a world view, a religious belief system to their illness and treatment, through which they interpret their illness and respond to their treatment, beliefs core to the patient's sense of identity, and beliefs that are accentuated in the face of life-threatening illnesses. Health care providers similarly bring a cosmology, a world view, a religious belief system that is core to their sense of identity, to their diagnosis and treatment of patients, whether articulated, acknowledged or not.
Because of the centrality and importance of these beliefs for both patient and health care provider, the future of medicine, if it is to respect human dignity and be wholistic in its approach, must insure intentional room for the role of religious beliefs in the process of treating illness. This premise will be viewed from two perspectives.
FIRST, with regards to PATIENTS, this paper will explore
various models of religious belief systems and some of the
ways in which these belief systems influence the way in which
patients interpret both dignosis and treatment.
Examples, from a larger number of models to be explored,
include:
SECOND, with regards to HEALTH CARE PROVIDERS, this paper will explore ways in which religious belief systems in general and Christian beliefs in particular on the part of health care providers, can interact intentionally with patient belief systems in the interpretation of illness and treatment.
This will include the following aspects of this interaction:
Janette Blandford, Ph.D.
Chair and Associate Professor of Philosophy
Belmont Abbey College
ERD 58: The Bishops' Revision of the Catholic Tradition on Providing Artificial Nutrition and Hydration to Patients in a Persistent Vegetative State
In November of 2009, the United States Council of Catholic Bishops voted to approve wording changes to the Ethical and Religious Directives for Catholic Health Care Services (ERDs), particularly Directive 58, which deemed as morally obligatory the provision of medically assisted nutrition and hydration for patients in a persistent vegetative state (PVS). Some in Catholic health care worry that this change will give rise to ethical conflict not only for those in the persistent vegetative state, but also for any patient who falls chronically critically ill, a problem that will affect both Catholics and non-Catholics given the preponderance of Catholic health care facilities in this country. This paper will examine the arguments made for continuing the Catholic tradition on forgoing medical treatment, particularly artificial nutrition and hydration for PVS patients, and those arguments that insist that such treatment constitutes morally obligatory care. This examination will conclude that the preponderance of evidence supports the tradition on this issue and that the tradition should be maintained. Failure to do so will, contrary to the bishops' intended end, result in the undermining of human dignity.
Elias K. Bongmba
Harry and Hazel Chavanne Chair in Christian Theology and
Professor of Religious Studies
Rice University
Responsibility in Global Health Issues: The Case of HIV and AIDS in Africa
In this paper I discuss the idea of responsibility at a time of crisis in global health. My specific focus will be responsibility in the African context. I will argue that at a time sever stress; responsible leadership invites serious reflection and decisive actions on controversial issues as part of the overall strategy to prevention. I will return to a familiar debate on the HIV AIDS crisis, the use of condoms, as a protective device and argue that the continued fetishization of condoms has slowed down prevention strategies. I will pursue this argument by briefly defining responsibility and its scope in philosophical perspective, its importance in both public and religious life, the determinants of responsibility, and its relationship to the global health crisis. I will then argue that in combating HIV and AIDS political and religious leaders in Africa have not assumed their responsibility on some important aspects of the fight against the virus because they have not only rejected condoms as one of the methods of preventing infections, but demonized condoms unfairly. In order to make this case, I will recount a recent conversation with the religious leaders of Uganda that took place in July 2010. I will contend that arguments against protective measures that include condoms are filled with misunderstanding and unjustifiable criticism leveled against the use of condoms by both political and religious leaders. Such resistance in my view demonstrates that the leaders have failed in that area to act in a responsible manner. I conclude by considering the arguments of Emmanuel Levinas on responsibility to the other, moral perspectives from Kierkegaard, and African views on personhood as a way to center conversations on these issues at a time when the global challenges of health continue to grow and threaten human wellbeing.
Wayne Brouwer, Ph.D.
Associate Professor of Religion
Hope College
Finding Fundamental Human Identity through Suffering –The Drama of Job
What can we learn about our existence from the drama of Job? Mechanistic worldviews belittle and reduce life, either by claiming that physical possessions and prosperity are the end product of right living, or that pain and suffering will automatically drive one away from God. The former forgets that God desires to have meaningful relationships with humans, even when they are flawed and sinful. The latter believes that atheism is a viable option in a world where things no longer make any sense.
According to the Bible, and certainly evident through the book of Job, this is a moral universe, though not all pain and problems are the direct result of our sinfulness. The normal or natural human identity involves acknowledging and worshipping God, but this worship cannot be coerced. The fundamental challenge to human living is that of continuing to be our truest God-worshipping selves even when the limited evidence of daily experience sometimes seems to speak to the contrary. Job neither gives in to his friends' reductionistic worldview, nor gives up in the face of insufficient evidence to confirm God's care or presence. In this Job remains truly human at its most fundamental level: he believes in God not for the sake of trinkets he might gain by that relationship, but because to lose that transcendent connection would be to deny his very self and its reason for existence.
Grattan T. Brown, S.T.D.
Assistant Professor of Theology
Belmont Abbey College
Not Refusing, but Caring for You: The Value of Conscientious Objection in Health Care
The current health care reform lacks significant conscience protections regarding legal yet morally controversial medical procedures, the most widespread of which is abortion. Coupled with government mandates to perform these procedures, this lack of conscience protection forces conscientious objectors into civil disobedience. Forcing conscientious objectors into this position will compromise the quality of future health care by further obscuring the moral debate that continues in our society over these procedures and by frustrating the development of alternatives to them.
Some people oppose conscience protection laws in health care because they view conscientious objection itself as an unwarranted pursuit of self-interest at the expense of others who request widely practiced, legal, but morally controversial medical procedures. Thus, they argue, legal accommodation of that objection is unwarranted. This view overlooks the social function of conscientious objection regarding those procedures. In this context, the conscientious objection of a medical professional intends not only to preserve the objector's moral integrity but also to seek the good of others, especially that of one's patient, and to argue for better alternatives to those procedures.
This paper argues that conscientious objection is not the mere pursuit of self-interest and in the health care setting may complement rather than conflict with the good of patients and society. Drawing upon the Personalist philosophy of John Crosby, the paper argues that judgments of conscience demand putting oneself in the position of the other. This regard of the other should not necessarily entail suspending one's professional conscience to provide the patient's desired outcome. Rather, it entails seeking to know the good of the patient by exchanging views and values within the patient-professional relationship, by placing oneself in the other's experience, thereby sharpening one's perception of the patient's good and forming a judgment about how to, and not to, realize that good through medical practice.
The paper concludes with practical implications for the future of health care. Adequate conscience protection laws will advance medicine by enabling a variety of clearly moral options to current controversial procedures. For example, existing medical procedures make one question to what extent abortion is ever clinically necessary to save the life and preserve the health of the mother. Allowing some health care professionals and institutions in society to adhere to a "pro-life" policy will undoubtedly improve the management of difficult pregnancies and reduce any perceived need for abortion throughout the industry. In addition, conscience protection laws preserve trust in the professional-patient relationship because patients can recognize as trustworthy those professionals who clearly state and act according to their consciences, even in the midst of disagreement. Inadequate conscience protection laws coupled with government mandates to perform controversial procedures will not only frustrate the advances described above but also undermine social order in many ways, and notably by forcing objectors into civil disobedience.
David H. Calhoun, Ph.D.
Associate Professor of Philosophy
Gonzaga University
Prospects for Human Dignity before and after Darwin
“today, more than a century after Darwin’s death, we still have not come to terms with [the Darwinian Revolution’s] mind-boggling implications. . . . Everyone has seen, dimly, that a lot is at stake” (Dennett 1995: 19)
Introduction
While the concept of human dignity plays a central role in contemporary ethical discourse, particularly in the subfields of biomedical ethics, politics, and international law, the term is, by complaint and admission of many scholars, ill defined.i Government and inter-governmental documents, for example, often invoke the concept without offering any clear account of its meaning. For example, the Universal Declaration of Human Rights, adopted by the United Nations General Assembly in Paris on 10 December 1948, asserts that “recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,” and appeals to the UN Charter’s affirmation of “the dignity and worth of the human person,” but makes no attempt to define or clarify the concept of dignity.ii
It is clear that a notion of human dignity must make some appeal to a regulative or normative conception of the human. Such appeals are, however, deeply problematic in modernity, in which philosophical anthropology, ethics, and religion are embedded in a “pluralism which threatens to submerge us all” (MacIntyre 2007: 226; see also Johnson 1991: esp. 1-48; Taylor 1992; Rescher 1993; Taylor 2007). One plausible conjecture is that the reticence in articulating the conceptual grounds for human dignity reflects a two-fold perception by modern human rights proponents, legislators, and ethicists: that a robust conception of human dignity is essential as a practical tool for establishing moral norms, especially in the wake of the horrors of the twentieth century, and that agreement on the theoretical grounds for such a conception is elusive, if not impossible. I hope to explore that conjecture in this chapter.
The wellsprings for the modern conception of human dignity can be found in the classical notion of human rationality as the pinnacle of natural functional capacities and in the Jewish-Christian notion of human beings as reflecting the image of God. Basic to these overlapping streams of thinking about dignity is the idea of distinctiveness, which asserts the value of persons against a comparative background of others who are of lesser worth. Initially the “others” are other human persons, ones against whom one “stands out” as exceptional,iii but the view that dignity is an inherent human quality in principle possessed by all began to develop early in the Christian era, was given philosophical articulation in the medieval period, flowered in the Renaissance, and found systematic expression in modernity. Human dignity represented a place in the Jewish-Christian worldview: the position “a little lower than the heavenly beings” (Psalm 8:5 NIV) became a position between angel and beast. While the emergence of mechanistic science in the seventeenth century threatened to collapse the distinction between humans and animals, especially in the works of thinkers such as Hobbes and La Mettrie, Descartes’ influential account of animals as physical mechanisms (Descartes 1993: 26-33) provided a rationale for human distinctiveness that was broadly embraced even by thinkers who rejected Cartesian metaphysics, including, ultimately, Kant. By the nineteenth century, two widely accepted claims grounded human distinctiveness, and consequently human dignity: (1) that humans were superior to all other living things, primarily due to the power of reasoning, and (2) that humans alone among the created order reflected the divine image. I will call the first the “human exceptionalism” criterion, and the second the “imago dei.” In essence, the two points blend into one another, for human powers of rationality, reflection, and choice are thought by Christians (and classical theists more generally) to concretely manifest the special divine stamp on human nature (Arieli 2002: 10-11; Ruse 2001: 74).
It is a truism that the concept of human nature on which any conception of human dignity must rest has been fundamentally altered over the last century and a half since the publication of Charles Darwin’s Origin of Species in 1859. In arguing for the continuity of all biological life, and in claiming common descent of all living things, Darwinism flattens the natural world and undermines the claim of any living organism to special standing. Looking back to the formative years of his theory of “transmutation of species” at the end of his life, Darwin noted, “as soon as I had become, in the year 1837 or 1838, convinced that species were mutable productions, I could not avoid the belief that man must come under the same law” (Darwin 1958: 130). Application of that law meant that human beings, like all other living things, are the products of natural biological mechanisms, and that human beings must be understood in continuity with nature.
Theodosius Dobzhansky has famously said that “nothing makes sense in biology except in the light of evolution” (Dobzhansky 1964:449). We might further add that no concept of human nature can exist in isolation from biology, and that therefore no concept of human dignity can stand apart from contemporary evolutionary biology. George Gaylord Simpson went so far as to say, regarding the question of human nature, that “all attempts to answer that question before 1859 [the publication of Darwin’s Origin] are worthless and that we will be better off if we ignore them completely” (Simpson 1966: 472).iv
What then are the implications of Darwinist evolutionary biology for a concept of human dignity? One rather famous answer to this question is offered by Sigmund Freud:
Humanity, in the course of time, has had to endure from the hands of science two great outrages against its naive self-love. The first was when humanity discovered that our earth was not the center of the universe, but only a tiny speck in a world-system hardly conceivable in its magnitude. . . . The second occurred when biological research robbed man of his apparent superiority under special creation, and rebuked him with his descent from the animal kingdom, and his ineradicable animal nature. This re-valuation, under the influence of Charles Darwin, Wallace and their predecessors, was not accomplished without the most violent opposition of their contemporaries” (Freud 1920: 246-47; see also Freud 1974: 139-40)v
Rémi Brague has recently argued (2009: 203-220) that Freud’s claim about the Copernican revolution exhibits serious misunderstanding of the medieval cosmology that Copernicus supplanted, and fails to recognize that geocentrism was a “humiliation” for man and heliocentrism a kind of “promotion.” By contrast, I will argue that Freud’s assessment of Darwin’s revolution is partially right: as Darwin himself said concerning the traditional view of human beings and human dignity, in the light of his theory “the whole fabric totters & falls” (Darwin 1987: 263). However, the assertion of human continuity with animals by common ancestry and the rejection of special divine creation were by themselves not devastating to human distinctiveness and therefore to human dignity. It was Darwin’s assertion of these ideas in the particular context of the nineteenth century, with its assumptions of a Cartesian radical dichotomy between humans and “brutes,” along with the materialist and mechanistic character of Darwin’s theory, that was so revolutionary. A consequence of this reading is that Darwinism need not dethrone human beings from distinctive place and thereby undermine human dignity. I will defend this view by considering several strategies to revive human dignity within a Darwinian framework, showing that several such attempts are deficient in important ways, while one, a neo-Aristotelian form of Darwinism, offers a path for regrounding human dignity post-Darwin.
Endnotes
Charles Camosy, Ph.D.
Assistant Professor of Christian Ethics
Fordham University
Human Finitude, Distribution of Healthcare Resources, and the Neonatal ICU
This paper is about the inevitable result of two universal aspects of the human condition:
A Christian understanding of the human person realizes that we cannot escape the tragedy of being unable to provide for everyone's health care needs anymore than we can escape human finitude. And though we must live with tragedy, we need not accept injustice. Indeed, our dysfunctional health care system has once again sparked a heated debate about what reforms should take place to make it more just. Many against expanding our already significant public option for health insurance cry out against the 'rationing' that would be done; but we are already rationing and we will never not be rationing.
This basic anthropological insight could apply to any area of medicine, but of central interest to this paper will be the clinical context of the neonatal ICU and the layer of complexity that the technological shift of our modern era has brought-especially in light of a point made by John Lantos:
Neonatal intensive care has become some of the most expensive in pediatrics. Before the advent of neonatology, it was inconceivable to spend hundreds of thousands of dollars to save a baby's life. Today it has become routine and routinely disturbing.
The paper will argue that in light of theological considerations (especially those espoused by the Church's social tradition on the finitude and intrinsically relational character of the human person), though we must never compromise on the fundamental truth that all newly born human infants have full moral status (regardless of disease or level of vulnerability), deciding whether particular treatments are beneficial or burdensome cannot be seen apart from consideration of complex social questions with regard to just distribution of resources.
Typical reactions to this argument include, 'we cannot put a price on life' and 'abstract arguments fail to respect the power of personal stories and experience.' But consider the story of Jerry from Tennessee who was recently dropped from Medicaid and can no longer afford his $400/month heart medication. Can we justify spending 30 million dollars of Medicaid money on a single NICU patient (this was the jury award in the famous 'Baby Sidney' case) while millions like Jerry need life-sustaining treatment? If we say 'no' we are not putting a price on life. We are not even saying that such monies must go somewhere other than toward the health care of babies. Indeed, the paper will show that (even in the coming federally-managed insurance exchange) we can get better outcomes for children by increasing our reimbursement rate for prenatal care (in some places as low as 30%) and lowering reimbursement rates for NICU care. Indeed, as the critics of such an exchange point out, health care reform will force us to confront the finitude of our nature and resources in a way we have never seen before.
Our hyper-autonomous culture finds it difficult to prioritize justice over and against personal freedom/autonomy/choice in general-but in the above way in particular. Some contend that medicine can consider only the contextless good of the individual patient; but those who accept a Christian understanding of the human person must be skeptical of this understanding of medicine. Human dignity cannot be seen outside of its social context; individual rights are connected to corresponding social duties. One of these duties is to use resources in proportion with the common good of the whole human family-our brothers and sisters under one God and Father.
Peter Candler
Associate Professor of Theology, Honors College
Baylor University
Outside the Church There Is No Death
According to classical Christian doctrine, the human body is not a container for the soul but its "form". In defending a form of this view, I suggest that the resurrected body of Christ represents the truth of human flesh. In the light of the resurrected and glorified body of Christ, who still bears his wounds, death can be understood as the loss of something irreplaceable and therefore mourned as a horrific deprivation of life; that is, because eternal life consists in the vision of God by our whole selves, and not just a separated soul, a proper Christian anthropology that began in some sense with the glorified body of Christ as the "truth of the physical" might suggest a very different biomedical practice than that with which we are familiar, which often proceeds from a methodological materialism underwritten by a dualistic metaphysics.
Samuel Chen
Graduate Student
Baylor University
From Hippocrates to Modernity: The Question of Treatment and Ethics in Medicine
Taken by most doctors, the Hippocratic Oath reflects a moral standard that all doctors are expected to uphold. However, an increasing number of medical school graduates, and consequently doctors, are no longer taking this pledge. Some take other oaths and many make no pledge at all. Even the Hippocratic Oath itself has gone under significant changes over the centuries, as many medical schools have their graduates take the modernized version of the oath.
The oath, however, raises a very important question in medical ethics-should a doctor be held to such standards and, if so, why? This question becomes pressing when the issue of medical treatment is discussed and a line, however thin, must de drawn between treating patients and treating self-interests-a line that raises the question of when does medicine begin?
The answers to these important questions dictate how medicine is practiced. Considering these questions, however, exposes a contradiction in how disabled persons are treated in today's society. As ethicist Hans Reinders astutely points out in his book The Future of the Disabled in Liberal Society, there is a fluent language of inclusion for such persons on the one hand while, on the other hand, there exists a drive to eliminate disabled lives.
This contradiction exemplifies what becomes common in a society that lacks a clear standard for medical practice. Without a lucid understanding of medicine, such a standard cannot exist. In attaining such an understanding and, thus, such a standard, it is important to distinguish between the medical conditions of impairment, disability, and handicap. Once these distinctions are made clear, it becomes evident what can and cannot justify medical treatment.
Thus, a line is drawn and a standard of medical ethics-both soundly reasoned and ethical-naturally becomes clear. Such a line then sheds light on the questions of what treatments are medically permissible and, ultimately, when medicine begins.
David C. Cramer
Adjunct Faculty of Religion and Philosophy
Bethel College, Indiana
Embodied Politics: A Free Church Approach to Health Care
In this paper I approach the question of the Church's role in health care from a "Free Church" (or "Believers Church") perspective, focusing specifically on the work of one of the most articulate defenders of the Free Church position, John Howard Yoder. Though Yoder is best known for his articulation of Christian pacifism in his "The Politics of Jesus", his work offers resources for approaching an array of ethical and political questions ecclesiologically. Devoting much of his work to refuting the Niebuhrian claim that the Free Church position is "sectarian," Yoder wrote a number of works articulating ways that the Church can engage society by serving as a prophetic sign or model of kingdom living, which can then be appropriated by other institutions. In his "Body Politics", for example, Yoder describes "five practices of the Christian community before the watching world," including binding and loosing, breaking bread together, baptism, the "fullness of Christ" and the "rule of Paul." Yoder describes how each of these practices (or sacraments or ordinances) can be viewed as a "first fruits" or prototype of social programs that can then be institutionalized by secular society. Thus, binding and loosing offers a model of conflict resolution, breaking bread offers a model of economic sharing, and baptism, the fullness of Christ, and the rule of Paul offer models of egalitarianism and empowerment of every member of the community. (Cf. his similar arguments in "The Christian Witness to the State", "The Priestly Kingdom", and "For the Nations".) Yoder does not explicitly address the question of health care, except occasionally in a passing manner; nevertheless, his Free Church approach to political issues can be fruitfully applied to the question of how the Church should approach health care issues. After explicating Yoder's general approach, then, I spend the second part of the paper developing a Free Church approach to health care. I argue that instead of developing a comprehensive plan for health care reform at the state level, the Church must first develop practices relevant to health care at the local, ecclesial level. In this way, the church can serve as a laboratory for experimental programs, allowing it to recommend in an ad hoc way programs that may be effective on a larger scale. In the conclusion of my essay I interact with some specific ecclesial proposals regarding health care recently offered by a self-described Yoderian theologian, Stanley Hauerwas (from his article "Finite Care in a World of Infinite Need," Christian Scholar's Review 38 [2009] and elsewhere), and briefly discuss what it might look like for the Church to implement such practices, arguing that until the Church addresses health care issues within its own body, its proposals to institutions outside the church body will lack authenticity and credibility.
Robert Paul Cutillo, MD
Medical Director, Inner City Health Center, Denver, CO
Assistant Clinical Professor, University of Colorado School
of Medicine
Medicine Unbounded in Superstitious World: Foundations for a Crisis in Health Care
Medicine has always held a revered place in society, yet never before has there been such success in healing disease, reducing disability and increasing longevity. Expectations continue to rise as medicine offers greater options to control our health. At the same time the cost of health care in the United States has exploded in the last 20-30 years, placing increasingly unsustainable demands upon public and private budgets. More and more people are forced outside the system of health insurance, rendering them vulnerable to the consequences of untreated illness for the most basic of problems.
The growing demand for medical services is closely connected to a modern culture that views life as controllable, from procreation to its prolongation. As part of the hyper-individualism that dominates our thinking, each person pursues life and health as both a right and a responsibility, with the powers of medicine as our most important ally. In order for us to pursue our personal agendas of life control we must reformulate our understanding of the body. No longer seen as intimately linked to the soul in our creation by God, the body becomes an object, infinitely malleable matter that we can manipulate to achieve whatever ends we desire. This Medical Gnosticism is a deep fracture line that is separating our medicine from our Creator, with grave consequences for society and the church.
Our worship of this life and its health and well-being ultimately demands surrender to biotechnological medicine as a power and principality that exercises enlarging control over our life choices. First we permit medicine to redefine our reality through a process called "medicalization". We no longer tolerate a range of normal but limit health to a small box that leaves little room for weakness or vulnerability. This effort to eradicate weakness, whether it be the mental restrictions of Down syndrome or the physical limitations of short stature, leave us with a judgmental society that does not tolerate disability or aging with gentleness and acceptance. Second, medicine offers to control our future through the removal of risk. The growing number of preventive medicine interventions reveals an irrational hope that we can eliminate future illness by controlling a disembodied but calculable current risk. Yet much is lost in the present in peace and focus when we anxiously worry about small but unknown possibilities for future disease. Thirdly and most importantly we join in a modern day denial of death, simultaneously fearful of its recalcitrant presence while living as if it can be indeterminately avoided.
A deeply significant effect of this idolatry of life and denial of death is a boundless demand upon medicine for deliverance from life's contingencies that allows no possibility to create a just health care system. For as we race for individual health we run from the gospel that calls us to care for our neighbor and demand justice for the most vulnerable members of our society. What is perhaps most concerning and perplexing is that the Christian community often acts in great similarity to those without faith when they encounter illness or are faced with choices amongst the myriad of medical options that they may use to control their lives, sometimes running ahead of others in their pursuit of this life and its control. What is left is a church that has little to say to a dark and lost world about the meaning of true life in Christ, neither understanding the significance of the cross nor the power of the resurrection. Is it too late for the church to regain its role as witness of the light to a world living in the shadow of death?
Dorothy Deasy
Graduate Student, Masters of Applied Theology
Marylhurst University
Jacob's Goats: The Relevance of God in a Transhuman Society
It is becoming clear as we move further into the 21st century that humanity has within reach the ability to alter the body human to such an extent as to give rise to a new post-human species. The transhuman trend (some call it an ideology ) is coming about with the convergence of several fields including genetic engineering, robotics, artificial intelligence, intelligence augmentation, nanotechnology and nanobiotechnology. What is less clear is whether our ethical, moral and spiritual development can keep pace with our technological prowess.
The coming biotechnological age will allow us to change our physical makeup at a genetic level. We will be able to not simply conceive children, but design which traits to enhance and which to eradicate. We will be able to change our genetic structure and to augment our intelligence with the merger of biology and technology. Neuropharmaceuticals will introduce the concept of, to use a term coined by Anjan Chatterjee, "cosmetic neurology" - wherein we'll be able to manipulate our personalities and cognitive abilities through the use of neuro-enhancing drugs.
As innovations unfold, the current trend in medicine that took us from simply treating illness to encouraging preventative wellness will continue. As pharmaceutical enhancements and technological augmentations become available, the trend in medicine (at least for those who can afford it) will be towards self-actualizing medicine.
The biotechnologies and neuropharmacological enhancements are not commerce neutral. They are being developed by for-profit entities and will no doubt be sold and marketed as other consumer goods. These technologies will transform patients into consumers, bringing into question which aspects of our personality make us human and which aspects, if we choose, we would eliminate. How will a profit motive associated with neurological and physiological enhancement influence the ethical concept of equal access? What are the social justice ramifications of neurological and biotechnological enhancements? Will we be creating a biological caste system?
These advances call us to explore what it means to be human and how that understanding informs our relationship with the Divine. After outlining some of the challenges, the paper will focus on the role of faith communities in preparing for and addressing the challenges associated with the transhuman trend.
This paper will take the point of view that modernity is perhaps on the verge of throwing the baby out with the bathwater. I'll draw on the theologian Alfred North Whitehead, Paul Tillich and Ted Peters. The paper will suggest that ethical and spiritual considerations will need to develop in lock-step with technological advances. Saying that a literal reading of the bible is not in keeping with scientific understanding does not automatically imply that what some call Holy Scripture is any less sacred. Critics of transhumanism are quick to quote the tower of Babel, yet gloss over that Jacob was perhaps the first person to put humankind on the path to transhumanism when he used genetic selection of the herds to build his own fortune. To date, many of our mainline Christian denominations have been slow to move the spiritual conversation beyond pre-modern interpretations of our scripture toward the deeper, fuller implications of our faith, and in the process risking making God obsolete in a transhuman world. God is necessary for the establishment of non-egoic knowledge. The difference between the tower of Babel and the Jacob story is in Babel, the edifice was created for the aggrandizement of those who would build it. Jacob used his understanding of genetics to lay a foundation for the establishment of a tribe. Human dignity needs to be valued alongside profit as new technologies come online.
As Christians our faith communities need to both educate and guide moral decision-making. One possible "unintended consequence" of the transhuman trend may be the obsolescing of morality and ethics as we know them today. Our faith communities are in a unique position to speak up for the need to hold both God and science together in our lives. What makes God as relevant or perhaps more urgently relevant is faith's unique ability to check human hubris and offset individual motives in exchange for ethical standards that support social justice.
Eva I. Doyle, MSEd, PhD, CHES
Director, MPH in Community Health Education
Baylor University
Beth Lanning, MSEd, PhD
Director, BSEd in Community Health Education
Baylor University
Shannon Thiel
Student, MPH in Community Health Education
Baylor University
Jennifer Moore
Student, MPH in Community Health Education
Baylor University
Renee Grohmann
Student, BSEd in Community Health Education
Baylor University
Practical Approaches to Engaging Churches in Community Health Promotion
Baylor offers a bachelor degree and a master of public health degree in Community Health Education. Professors and students in these programs partner with church leaders and volunteers to promote health and quality of life in their communities. These efforts often include developing church-led health promotion programs that integrate spiritual health components with practical training in exercise, healthy eating, stress management, and other aspects of a healthy lifestyle. The panel will discuss perspectives, experiences, and practical approaches to church-based health promotion partnerships in local and international settings.
Sister Catherine Joseph Droste, O.P., S.T.D.
Instructor
Aquinas College
Rediscovering Human Dignity in a Contraceptive World
This year marks the fiftieth anniversary...of the Pill.
But this golden anniversary is not as glamorous as some might
wish.
In 1921, prior to the development of the Pill, Margaret
Sanger, Founder of Planned Parenthood, proudly declared,
"Ours is the morality of knowledge." For Sanger,
the fight for the dignity of woman - the dignity of the human
race lay in knowledge - the knowledge of birth control. She
claimed that "within [woman] is wrapped up the future of
the race - it is hers to make or mar." In the 1930s
Sanger claimed that widespread use of birth control would
raise the general level of intelligence; improve quality of
life; and raise health standards for mothers and children.
And, according to Sanger, if the masses grow "wiser, . .
. the less immorality shall exist. For the more responsible
people grow, the higher do they and shall they attain real
morality."
But today in 2010 these hopes for the masses have been
shattered, along with prophecies that the Pill would solve
the problem of unwanted pregnancies and pregnancies that end
in abortion. Even supporters of the Pill acknowledge that
today approximately half of all pregnancies in the United
States are "unintended" and 22% of all pregnancies
end in abortion.
In the midst of these failed prophecies, there is silence in
the political arena and health care field regarding another
set of prophecies made about the Pill and its effect on
society and the dignity of man.
In 1968 Pope Paul VI enunciated four predictions regarding the widespread use of contraception. In the document Humanae Vitae the Pope noted that the "contraceptive mentality" would lead to:
At the time, people laughed - both non-Catholics and Catholics, medical professionals, and politicians. But a contemporary rereading and comparison of prophecies by Sanger Planned Parenthood and Pope Paul VI Catholic Church clearly demonstrates that the latter was on target, foreseeing the current state of marriage, family, and medical science - the loss of the sense of the dignity of man in Western society in the 21st century.
How do we regain this sense of dignity? Dare I say that Margaret Sanger offers a key? In the same 1921 address on knowledge, Sanger commented, "If we cannot trust woman with the knowledge of her own body, then I claim that two thousand years of Christian teaching has proved to be a failure." But the very knowledge Sanger claimed to promote has been obfuscated in our contraceptive society. Birth control has not helped women to know their body, but instead promoted ignorance among women (and men) of all races, cultures and ages, both the rich and poor. The last fifty years have produced generations of women ignorant of the normal function of the reproductive system; ignorant of the harm the Pill, IUD, Nuva-Ring, Depo-provera, and other forms of birth control cause not only to their reproductive system and endocrine system, but to their entire physical, psychological, and spiritual well-being; ignorant that many of the causes of marital infidelity, abortions, child abuse, and the many threats to the dignity of woman and the rights of the family have their origin in one little Pill.
In this paper I will argue that an honest assessment on this 50th anniversary demands a rediscovery of human dignity in the realm of sexuality. This rediscovery must be based in a true knowledge of the human person and of marriage which has as its "natural" ends both procreation and the unitive love of the spouses.
Two helpful tools include Pope John Paul II's "Theology of the Body", and authentic forms of Natural Family Planning, particularly the Ovulation Method, which provide a scientifically proven, accurate, and safe method for medical professionals to help married couples reclaim their dignity in the area of sexuality and fertility.
Jason Eberl, Ph.D.
Associate Professor of Philosophy
Indiana University-Purdue University Indianapolis
Foundation for a Natural Right to Health Care
Discussions concerning whether there is a natural right to health care may occur in various forms. The ultimate result of such discussions is one or more policy recommendations for how to implement any such right in a given society. But the health care policies of any nation in the modern world may be judged by internationally agreed-upon standards including, most especially, the United Nations' Universal Declaration of Human Rights (UDHR). Hence, it is fundamental to any health care policy analysis to review carefully the historical formulation of the UDHR and subsequent international declarations and treaties.
The rights enumerated in the UDHR were not conceived ex nihilo, but are grounded in traditions of moral theory represented by those who drafted or consulted in the drafting of the UDHR - such as natural law philosopher Jacques Maritain. Thus, a philosophical analysis of the most influential theories underlying the UDHR is necessary in order to adjudicate accurately the value of specific policies that may be devised so that particular societies may successfully enshrine in their laws and economic structure rights such as the right to health care. If, as is the focus of this paper, a human right to health care can be established in this fashion, then nations that have not fully embraced and enacted this right in its laws and policies can be rightly criticized for moral failure.
In this paper, I begin with a historical overview of the drafting of the UDHR and highlight the primary influence of natural law theory in validating the rights contained therein. I then provide a detailed explication of natural law theory by reference to the writings of Thomas Aquinas, who, in the 13th century, provided a detailed formulation of natural law which to this day has influenced both religious and secular moral theorists. I chart the progression from Aquinas's account of natural law to the concept of human rights as recognized in various international documents. I have elected to reexamine carefully the Thomistic origins of natural law theory due to its foundational role in the evolution of western human rights theory. By examining the fundamental principles Aquinas affirms, strategies may be articulated for health care reform in the U.S. that will inevitably involve contributions from government and the private sector, and which will result in a health care system that is more just and more capable of realizing the internationally recognized human right to health.
In addition to Aquinas's classical presentation of natural law theory, I discuss Martha Nussbaum's complementary "capabilities approach" to social ethics. Nussbaum's view accords with the Thomistic natural law ethic insofar as both (1) see individual and collective human flourishing as the ultimate goal of moral action, (2) understand this ultimate goal to be reached through the actualization of natural human capabilities, and (3) hold that such actualization is achievable through just interpersonal and social relationships defined in terms of our moral obligations to each other, which in turn is the foundation for rights and duties. I conclude that the development of the United Nations treaty system—beginning with the UDHR in 1948—represents a nearly international consensus about the major imperative animating health care reform: viz., that a fundamental human right to health care exists in international law and philosophical tradition, and societies are thus obligated to realize this right through fair and just implementation.
David Echelbarger
Graduate Student of Philosophy
Baylor University
Health Care as Distributive Justice: Personal Dignity and the Sin of Respecting Persons
This paper focuses on Aquinas' distinction between personal dignity and "respect of persons." Respecting personal dignity, requires considering what it is about that person that is worthy of respect. Respect of persons considers only a person's worth as a person. Each version of respect offers its own rationale for how to distribute common goods, which in turn, results in to two very different views of distributive justice. One the one hand, some individuals get more than others based upon some defining characteristic. While on the other hand, everyone gets an equal share As equality is highly celebrated within liberal-democratic nation states, it is not surprising that the respect of persons, and its promise of equal access, has played a prominent role in the recent health care reform. In contrast to today's liberal political theory, however, Aquinas claims that it is the respect for personal dignity that sets the due proportion for the distribution of common goods, while the respect of persons is a sin against distributive justice. As I shall argue, criticisms of the respect of persons need not stem from qualms with social equality. Nor are they in conflict with the idea that all human beings are of equal worth and thus deserving of care. Rather, I suggest that respect of persons fosters a way of life that ultimately undermines a community's ability to regulate and preserve the common good. Thus, by examining the faults of respect of persons within the context of healthcare we can see how it, and the societal conditions that are conducive to it, contribute to a misconception of distributive justice. With this misconception in mind, we can then see both the benefits and challenges of modeling a health care system after personal dignity.
Sally Elizabeth Erdel, MS, RN, CNE
Assistant Professor of Nursing
Bethel College, Indiana
Timothy Paul Erdel, Ph.D.
Assoc. Prof. of Religion & Philosophy
Bethel College, Indiana
Nazi Nurses, Mennonite Nurses: Teaching Professional Nursing Values with Case Studies from World War II
Nurses are the largest group of health care providers and potentially have the largest impact on how health care is delivered. Both the American Association of Colleges of Nursing (AACN) and the American Nurses Association (ANA) have identified human dignity as one of the core professional values and the development of professional values as an essential component of baccalaureate nursing education.
Perspectives in Nursing is a one credit course taken by pre-nursing students at Midwestern Christian college with roots in the Mennonite and Methodist traditions. One of the course objectives is "to identify values important to the Christian nurse." This paper describes a core writing assignment designed to stimulate students' thinking about the importance of values in nursing and the primacy of human dignity.
Two articles about the experiences of nurses during World War II, which first appeared in direct juxtaposition to each other [Nursing History Review 11 (2003): 129-146, 147-166], are assigned as background reading. The first historical essay focuses on nurses (some Nazi, some not) who worked in the Ravensbrück concentration camp (Benedict); the second discusses the experiences of Mennonite nurses who worked in Civilian Public Service camps in WWII (Hershberger). The pieces provide a startling contrast of values and actions.
Values are admittedly difficult to teach in a classroom setting, but reflective thinking offers a tool to help students develop an awareness of their own values as well as the values of a profession. Two class sessions are devoted to providing an historical context for reading the articles, to discussing how values are formed, and to reviewing the professional values described in the AACN Essentials of Baccalaureate of Education. A biblical basis for these professional values is also proposed.
The students are then given the assignment to read the two articles and to write a short paper comparing and contrasting the two groups of nurses in terms of the values they displayed in the situations they faced, recording the thoughts and feelings these articles evoke in them. They are also asked to respond to the prompt: "Does being a Christian make any difference in being a nurse?" Class discussion after the written assignment allows for further student expression of ideas and the opportunity to see the situations through others' eyes while re-examining their own viewpoints.
Striking misperceptions often emerge during this process, some due apparently to a very limited understanding of history. Logical non-sequiturs, false dilemmas, and various other confusions may likewise lead to somewhat astounding ethical claims. It is occasionally difficult to comprehend how persons from superficially similar backgrounds could react so differently to the same readings, though in fact professional nurses reacted very differently to the same war.
The presentation will highlight lessons learned by both faculty and students during the half-dozen years this assignment has been given. The authors of this paper are aware that there are various historical ironies that might further complicate the foregoing case study if it were presented in upper-level or graduate settings, including the fact that certain Mennonite communities strongly identified with the Nazi cause.
Toyin Falola, Ph.D.
Frances Higginbotham Nalle Centennial Professor in History
and Distinguished Teaching Professor
University of Texas
The Social and Cultural Paradigms of Human Dignity and Health Care in Africa
Western medicine in Africa has been integrated with African traditional and religious notions of health and well being: medicine is one thing, the mind and spiritual forces are another. Most people balance the reality of medication with those of cultural values: hospitals cannot replace the homes; families are more important than health and life insurance; and belief in prayer is regarded as superior to any other thing. Rather than be afraid of death, values and ideas have been created to "conquer" death, and to seek the means to become "ancestors" in afterlife. Drawing data from the Yoruba of Southwestern Nigeria, the lecture will discuss the following:
In connecting all the above, the lecture will conclude that ideas from traditions and religions need to be far more integrated with those of modern medicine
Larry E. Fink, Ph.D.
Professor of English
Hardin-Simmons University
The Dignified Moment: The Legacy of Street Photography
NOTE: This proposal is an outgrowth of a new course I am developing: "Street Photography: The French Tradition".
This PowerPoint lecture will address two topics listed in the Call for Papers: "Human dignity and human rights", "Educating doctors and medical students." If human dignity and human rights are to survive, they must constantly be asserted and affirmed by every means possible--perhaps, especially, through the arts. This presentation introduces the unique power of a particular artistic tradition to affirm human dignity. If medical professionals are to treat patients with respect, they must possess a broad, experiential appreciation of the human condition and human nature. The arts--literature, music, the visual arts--can engender this appreciation, perhaps as effectively as foreign travel.
THE DECISIVE MOMENT (1952) is the title of one of the most sought after books that reflect the history of photography as a fine art. The phrase, "decisive moment", connotes an approach to photography summed up in the following quote from Henri Cartier-Bresson, the artist most closely linked to this style: "To me, photography is the simultaneous recognition, in a fraction of a second, of the significance of an event as well as the precise organization of forms which give that event its proper expression." This rather clinical definition belies the beauty and emotional impact of Cartier-Bresson's--and other practitioners'--work. Some of these key figures are Andre Kertesz, Robert Doisneau, Willy Ronis, Brassai, and Edouard Boubat. These artists' works have more in common than the harmonious composition and exquisite timing that make permanent moments of ephemeral beauty. They also share a deep respect for their main subject, people. They implicitly affirm human dignity in the tradition of French humanism.
Briefly, street photographs are not portraits or news
shots or documentary pictures; for they emphasize not the
individual, the newsworthy, or the factual. Rather, they
expose the underlying wonder and beauty of human life
itself-beauty that is fleeting and easy to miss-seen against
a background of static, usually-urban, backgrounds. The
children, parents, readers, lovers, laborers, and strollers
in street photographs emerge as archetypes--usually
invisible--when the photographer was there, alert, waiting.
These pictures are often compared to poems that concisely
celebrate the beauty and wonder potentially present in the
most common events. They allow the viewer to see that
"There are no ordinary people", to quote C.S. Lewis
("The Weight of Glory").
This presentation will survey the golden age for this approach, from the 1930's until the demise of the large-circulation picture magazines in the last quarter of the last century, when advertising revenue moved to television. Many of these life-affirming images were made during and after some of the darkest events of the twentieth century. They have been credited with helping to restore the hearts, minds, and pride of the French people after the indignities of occupation and collaboration. I will argue--in the spirit of Lewis Thomas' 1978 essay, "How to Fix the Premedical Curriculum"--for the value of the broadest possible undergraduate curriculum, grounded in the liberal arts tradition. Thomas concludes, "Society would be the ultimate beneficiary. We could look forward to a generation of doctors who have learned as much as anyone can learn, in our colleges and universities, about how human beings have always lived out their lives." An entire course concentrating on this genre of art could have exactly the effect Thomas desired, exposing students to the inherent beauty and dignity of humanity.
Travis Ferrero Fletcher
Student, M. Div.
Fuller Seminary
Christian Ethics and Health Care: The Role of Community
The 2008 presidential debates were, for once, a study in different viewpoints within the American political system. Both candidates were capable and well-prepared, representing sides of the political spectrum which, when articulated with passion and energy, provided a framework for voters everywhere to engage in moral, philosophical, and ethical discussions of depth and meaning. During one of the more intriguing moments of the debate season, the moderator asked the following question: "Is health care a right, a privilege, or a responsibility?" Candidate McCain responded that it should be a responsibility, while Candidate Obama said it should be a right.
A convincing argument can be made for their positions, as well as for the option which neither candidate selected: that health care is a privilege of modern society, one which carries within it a high degree of personal and communal responsibility. This study will attempt to formulate a Christian perspective on the ethics of health care under the assumption that our "right" or "responsibility" for our personal health falls under the mercy and lordship of Jesus Christ. We will attempt to define the kerygmatic role of the church and the individual Christian in health care as surrendering our decision-making in prayerful discernment as we evaluate our health care options and decisions so that the created order can be restored within our bodies, minds, and hearts. A health care system which embraces this perspective will include a high regard for the imago dei and can locate a moral basis for care in the parable of the sheep and the goats from Matthew's gospel. Finally, our conclusions will be presented under the affirmation that the church must play a central role in both helping the community navigate health care and be prayerful beside community members in their medical decision-making.
The three primary components of an informed Christian perspective on the ethics of health care are prayerful submission of personal health decisions, discernment within the body of Christ, and upholding an elevated view of the imago dei. Restoration of creation, both internally with patients and externally with the community, is one of the most important goals of a Christian health care system. The willing and Spirit-led body of Christ can influence the reshaping of health care by upholding a higher view of human life, death, and the stages of life in between.
By offering compassion and grace, the "koinonia" function of the church is brought to greater fulfillment through health care. The church proclaims the mystery and beauty of Jesus Christ through affirming acts of mercy and miraculous healings which continue to occur in our modern world. The essential role of the body of Christ is to uphold the ethics, morals, and values which honor Christ and help re-shape our fractured health care system. Standing against the injustice of the current system, the faith community can also proclaim that "medicine [is] an activity that trains some to know how to be present to those in pain, then something very much like a church is needed to sustain that presence day in and day out (Hauerwas 73)."
Paul Lawrence Fortunato
Assistant Professor of English
University of Houston Downtown
Detective Fiction and Biotechnology Ethics: Lori Andrews' Novels and Charles Taylor's Philosophy
Our society is greatly in need of new vocabulary and new stories that can help us navigate recent biotechnologies. In the past, with the "pro-life" movement, there was a fairly straightforward type of argument that both had a philosophical basis and that was capable of being translated into easily understandable narratives. Today we can turn to the new terminologies that are emerging through the work of philosophers like John Milbank and Charles Taylor. We also must turn to the new stories being produced by such writers as popular fiction writer, Lori Andrews.
Unfortunately, today many people who are generally against abortion do not have good philosophical resources for discussing the ethics of new realities like performing genetic manipulation on human embryos. Witness the fact that IVF (in vitro fertilization) is almost completely accepted without question by many people who are against abortion. And yet the basic techniques for IVF seem to slide extremely easily into abortion-like practices. Moreover, these techniques also slide into practices that are eugenic-choosing "better" embryos, and rejecting less perfect ones. They also seem just a step away from altering genes, and thus "designing" babies.
When in the summer of 2001 President Bush enacted his policy regarding the use of human embryos for creating stem cell lines, he made a good effort to create an ethical policy, but he lacked reasoned arguments and a conception of the human person that would have backed up his decision. All he could do was state his decision to not fund more stem cell lines, but there was no reason given, nor was there any statement about limiting experimentation on human embryos in general. In fact, his decision did not prevent anyone from creating new stem cell lines but merely stated that the federal government would not fund such work.
The work of Charles Taylor and John Milbank are very useful in providing both a philosophical language and a persuasive set of ideas for making clearer arguments in the future about the ethics of many of these emerging biotechnologies. Milbank, in his book, Theology and Social Theory, argues against the conception of the human person that emerged in the Enlightenment and that still is dominant today. Such thinkers as Kant and Rawls have mistakenly defined the person as an autonomous, rational subject, one using a supposedly "neutral" reason. Taylor, in his book, A Secular Age, corrects for this vision by analyzing this conception as what he calls the person within the "immanent frame." Such a conception defines the human person as a buffered, disciplined self, one who "constructs" society rather than responding to a reality that must be discovered and received.
The last few years have witnessed the emergence of an important new fiction writer who is providing accessible stories that have the potential of helping large numbers of people understand the types of insights Taylor and Milbank provide. This writer is the law professor-turned detective fiction writer, Lori Andrews. She has produced three novels that are firmly in the melodramatic, page-turning genre of the detective story, but that explore ethical issues related to real, current biotechnologies. For example, in one story, the detective must figure out what is happening with a new "date rape" drug. Just this past month, pharmaceutical companies were making news with the so-called "female Viagra." As of this writing, the FDA has refused to allow its approval in the U.S., but it is only a matter of time till this and other such drugs reach the market.
In another story, Andrews' detective must work to prevent a private corporation from purchasing exclusive access to the DNA database that the military has been developing over recent years with blood samples from all military personnel. To date, American law has not figured out ways to protect such a collection of human material. Can a corporation own your DNA? How can we ensure that research conducted on such material be done in an ethical manner? Thanks to stories like Andrews', lay people can easily see what is at stake in otherwise esoteric, legal and ethical issues. Today's ethicists must utilize the work of philosophers such as Milbank and Taylor to come up with coherent language and theory, and use stories such as those of Andrews, in order to present cogent and easily-understandable ideas and narratives for our society.
Shawn Graves
Assistant Professor of Philosophy
Cedarville University
John White
Cederville University
On McMahan's Moral Individualism
In a recent paper, Jeff McMahan defends moral
individualism from several objections. According to McMahan,
moral individualism is the thesis that how we should treat
individuals is determined, not by the individual's group
memberships, but by properties intrinsic to the individual
and some special relational properties that the individual
has, if any. The anti-individualist objections McMahan
considers all have to do with one of moral individualism's
implications. Indeed, McMahan claims that most people
"vehemently reject" this implication. To highlight
that implication, McMahan has us consider the
following:
"Suppose that a certain animal lacks any
status-conferring intrinsic property that would make it
impermissible to kill that animal as a means of saving
several people's lives. Suppose further that there are no
relational reasons that oppose killing it-for example, it is
no one's pet."
McMahan presents the implication: "According to moral individualism, if it is permissible to kill the animal, it should also be permissible-again assuming no relational reasons apply-to kill, for the same purpose, a human being who also lacks any relevant status-conferring intrinsic properties." According to McMahan, most people reject this implication because "they believe that it would be seriously wrong to kill any human being as a means of saving several others no matter what intrinsic properties that human being lacks."
Presumably, those same people would not object to killing
the animal for the same reasons. All of the
anti-individualist objections McMahan considers are attempts
to defend this asymmetrical moral judgment that most people
make. The anti-individualist objections proceed either by
claiming that (1) mere membership in the human species is a
sufficient basis for having a higher moral status than any
animal, (2) all humans participate in a distinctively human
life and that alone is a sufficient basis for having a higher
moral status than any animal, or (3) there is some special
relation that all humans bear that confers upon all humans a
higher moral status than any animal. McMahan's defense of
moral individualism consists of arguing against
(1)-(3).
In this brief paper, we consider the merits of McMahan's
defense of moral individualism from these anti-individualist
objections.
Paul Griffiths, Ph.D.
Warren Professor of Catholic Theology
Duke Divinity School
Defending Life by Embracing Death: Caring for Health by Recovering the Ars Moriendi
The Christian attitude to death is double-faced: on the one hand, death is thought of as an enemy to be staved off, and on the other it is understood as a friend that leads to eternal life. This complex attitude to death, combining as it does lament and rejoicing, responds most fully to the human condition: it most deeply affirms human dignity. Cultivating it has effects upon how Christians think about and prepare for their own deaths. Among these effects is the possibility of learning to welcome death in such a way as to make diagnosis and/or treatment of life-threatening conditions inappropriate. Christians must sometimes, therefore, oppose and refuse the immortalism (everything possible should be done to stave off death) so characteristic of our culture, and so established in our medical practice.
Renate Viveen Hood
Associate Professor of Christian Studies
The University of Mary Hardin-Baylor
The Church and Healing: Restoration and Community Wholeness in the Gospel of Mark
Can the canonical gospels contribute to a twenty-first century understanding of the role of the Church in healthcare? Do the healing accounts for example in the Markan gospel merely inform a Christological viewpoint or do they facilitate an understanding of the mission of the Christian community in light of human dignity?
The Markan Jesus is primarily concerned with healing illnesses, rather than diseases. Illnesses disturbed the social networks. Those with illnesses often were ostracized, sometimes were considered ritually unclean, or were understood to bring shame upon the group. In all, community wholeness was disrupted.
The miracle and healing accounts in the Gospel of Mark are aggregated in the first eight chapters of the narrative. Two further healing accounts are found in chapter nine, following the transfiguration, and chapter ten, prior to the entry into Jerusalem. The healing account in chapter nine is a foil for the disciples' response to the transfiguration of Christ. The placement of the healing of blind Bartimaeus, however, is significant to plot resolvement.
David Rhoads claims that Bartimaeus' identification of Jesus as the son of David introduces the narrative of the entrance into Jerusalem. Recognizing that Marcan Christology and discipleship converge in the story of Bartimaeus in a manner critical to Marcan theology, Vernon Robbins maintains that the story introduces a transition in Christological nomenclature concerning Jesus' work. The healing account moves the Marcan narrative from the disciples following "in the way of the Son of man" (Mk. 8:27-10:45) towards Jerusalem to following "in the way of the Son of David" (10:46-12:44) into Jerusalem.
In this paper I will take the conversation a step further and postulate that healings in the Gospel of Mark must be understood in light of restoration and community wholeness. Individual healing accounts, when understood in light of the first-century Mediterranean context, reveal an emphasis on restoration and wholeness. Jesus forms a new, ideal community with dignity for all. Bartimaeus becomes a prototype of a healed individual who is restored to this new community, the community of which the pater familias is the healer.
Parallels and principles are seen and applied to today. What characters in the Markan story have access to community healthcare? Why? Who is deemed worthy? Is the Markan community still a model for today's Church in terms of restoration and community wellness? These and other questions are taken along in the form of a conclusion.
David Frank Horkott, Ph.D.
Assistant Professor of Philosophy
Palm Beach Atlantic University
Nietzsche's Philosophy of Quarantine as a Challenge to Christian Compassion
Most readers of Nietzsche are familiar with his penetrating insights into the spiritual maladies afflicting modern European culture. However, Nietzsche also devoted much space in his writings to the health of the human body. This paper will examine Nietzsche's comments on the dangers to public health posed by Christian morality.
This paper will be divided into three parts. The first
part will present Nietzsche's views on the necessity of
quarantine to protect the healthy from the sick. Nietzsche's
philosophy of quarantine is best viewed as part of a larger
project designed to undermine Christian morality. Central to
his task was his analysis of compassion. The second part of
the paper will examine how Christian compassion may pose a
health threat during pandemics. Christians, I will argue,
need to take Nietzsche's philosophy of quarantine seriously.
The tension between protecting the healthy from the sick
while simultaneously ministering to the needs of the sick is
especially problematic for Christians during a pandemic. The
final part of this paper will attempt to provide guidelines
for Christian compassion in the context of widespread
epidemics. The Church has faced extensive epidemics (such as
the bubonic plague) in the past, but can benefit from
Nietzsche's insights for developing public health policies
for the future.
Key words: Nietzsche, Quarantine, Epidemic, and
Compassion
Steven S. Ivy, M.Div., Ph.D.
Senior Vice President
Clarian Health, Indianapolis, Indiana
Sustaining the Vocation of Health Care Practitioners: A Healthcare System Approach
The vocation and dignity of health care practitioners requires consistent, programmatic, and well-grounded nurturing and development. If not sustained it is likely that burnout, disillusionment, and/or careerism will replace vocation and subvert dignity. Large institutions, such as contemporary American health systems, may be pressured by choices and demands which compartmentalize vocation to individual responsibility. The need for institutional sustainability may lead the organization to ignore and even undermine the spiritual dignity of the practitioners whom the institution employs. When health care organizations fail to appreciate the importance of human flourishing among those who serve, eventually patient experience, quality of care provided, and virtue of the health organization are all compromised.
This paper will explicate a foundational conceptualization of health care vocations as understood from a mainline Protestant articulation of human flourishing and will discuss how this conceptualization informs one organization's efforts to support and enhance the vocational engagement of physicians, nurses, and other health care practitioners. While this theological grounding contextualizes the discussion, it seeks to be inclusive through a broad integration of theological, spiritual, and philosophical approaches to the human person, community, and work. The arguments and illustrations will stay connected to the diverse people and perspectives that enter health care vocations. Thus, dialogue between fundamental convictions and a pluralistic public will be modeled.
Vocation as one element of human flourishing will be explored through the three primary dimensions of being human expressed within the health care context. First, the embodiment dimension includes how health care practitioners flourish within their own material experiences of contingency and finitude. Even though these experiences are present daily, sometimes constantly, to the health care worker, institutions may not take measures to assist with the likely emotional and relational consequences of such experience. Grief, inattention, and nihilism can and should be addressed. Wonder and awe nurture flourishing within this dimension. Second, the relational dimension includes experiences of individual and social engagement, including the "principalities and powers." Experiences such as failure ("error"), authority gradient, and lapses in teamwork require attention by the institution. In this frame, both forgiveness and conflict nurture human flourishing. Third, the transformative dimension includes experiences of de-centering and self-transcendence. Experiences of joy, meaning, and purpose can be professionally nurtured. Liberation and hope express human flourishing in this dimension.
Each of these dimensions will find professional expression in suffering, service, care, and humility. Health care professionals benefit when they reflect upon these core experiences and are given opportunities to grow in their expression. The employing institution bears substantive responsibility for creating a culture in which these expressions are recognized, rewarded, and amplified.
This paper demonstrates that each of the dimensions of personhood shape health care institutions' responses to vocation and dignity and reports a variety of methods for addressing these professional concerns. Some of these methods have been empirically evaluated while others are more experiential in their results. The subject organization is a large academic health system with a Protestant heritage (16 hospitals, 20,000 employees, 4,500 physicians).
Institutional interventions which attend to vocation and dignity include ethics conversations and debriefings, critical incident debriefings, spiritual retreats and resources, values-based narrative research, and building relationally sustained work teams. Formal evaluations of these efforts demonstrate the impact each has on the vocational experience of the participants and the care they extend to patients and colleagues. The paper articulates how a largely secularized health system utilizes a variety of approaches to express core convictions of the Christian faith as it furthers the deep vocations of health care professionals.
Paul I. Kim, M.Div., Th.M.
Assistant Professor of College of Christian Faith
Dallas Baptist University
Will Hospital Replace the Church: Retrieving the Church-Based Health Care
At the zenith of British social optimism in its health care system in late 1960s, D. Martyn Lloyd-Jones asked, "Will hospital replace the church?" To the growing social consensus that "as religious causes have waned and society has been secularized, it is the hospital which has succeeded and taken the place of the Church as the most important institution of our time," the internationally renowned preacher of Westminster Chapel and a consultant physician reminded of the fact that "in the Western Europe at least it was the church which founded the hospital." From the outset, health care has been an integral part of the Church's mission. When the medical mission of the Church is circumvented or neglected, the Body of Christ fails to embody its Savior's concerns to heal and nurture the humanity wounded by sin. This paper intends to retrieve the primacy for the medical mission of the local churches by reflecting on the biblical theological rationale and the historical precedent of healing ministry in the early church.
The churches should not esteem their health-care ministry inferior to the hospitals and clinics simply because they have less technical resources and professional medical personnel. As the World Health Organization defines health as a "state of complete physical, mental, and social well-being and not merely the absence of diseases or infirmity," the churches contribute to the holistic well-being of their congregation and people of the community in their own ways. Genuine health of individuals requires more than medicine and money. The church's commitment to restore everyone's relationship with God and others and oneself is akin to the broad definition of health as wholeness.
The theological ground of the church for her medical ministry is found in the creation account and the life of Jesus Christ. The divine command at creation (Gen.1:28) is the basis for all humanitarian work in society and for the comprehensive Christian stewardship. This protological call is closer to the Hebrew understanding of shalom, which means completeness and wholeness. Applied to individuals, shalom principally signifies health and good life. Restoration to health is restoration to peace (Isa. 38:17). Shalom occurs by God's favorable promise (Judg. 18:6) or by someone who cares for one's needs (Judg. 19:20). The divine intention of shalom for individuals and community was demonstrated by Jesus whose ministry evinces the integral connection between health and salvation. He came to heal broken relationships as well as broken spirits, broken bodies and broken hearts. With Isaiah 61, Jesus defined his role of the Servant-Messiah in dual functions as the Savior and Healer. The Gospels record forty healing miracles in a variety of circumstances; they represent about one-eighth of the description of Jesus' life.
The healing reality of God's salvific reign was faithfully carried out by the early Church. The way that early Christians treated the sick and their ideas about health care "constitute an important factor in the rise of Christianity itself." According to Ramsay MacMullen, "the chief business of religion [in the Greco-Roman world] was to make the sick well." As the main function of religions was defined in terms of providing health, Christianity made the greatest impact by introducing "the most revolutionary and decisive change in the attitude of society toward the sick." For instance, a number of innovative practices contributed to Christianity's attraction of many converts. First, the sufficiency of faith alone neutralized the problem of geographical access to therapeutic centers such as temples and certain water sources etc. The emphasis of faith also removed the temporal restrictions: Christians administered health care on any day of the week including the Sabbath and religious festivities. Third, Christians did not charge any money from the sick. As a result, more patients could receive treatment. Itinerant Christian healers could reach more people with "much less suspect." As this early Christian approach to care and cure was one of the primary factors in the rise of Christianity, the contemporary churches must inherit her medical ministry as a core of her identity and tradition. When the church responds to the desperate world with its healing love, it is the church that experiences the health and strength within itself.
Jeff Levin, MPH, Ph.D.
University Professor of Epidemiology and Population
Health
Baylor University
Jewish Biblical and Rabbinic Themes that Should Inform the National Health Care Discussion
In this talk, Dr. Levin will provide an overview of important themes that animate Jewish discussions of health policy and that would valuably inform the current national discussion on healthcare. First, he will briefly survey position statements and perspectives on healthcare rights and health policy from several Jewish denominations and institutions, prominent rabbinic poskim (decisors) within each Jewish movement, and leading academic Jewish bioethicists. Second, drawing on a theological perspective based on passages from Torah and Pirke Avot, he will outline important biblical and rabbinic concepts and themes (e.g., tzedek, chesed, pikuach nefesh, tikkun olam) that inform Judaism’s understanding of the centrality of justice for any discussion of healthcare. Third, he will discuss the policy, economic, political, and moral challenges that are faced in efforts to bring this Jewish perspective to the forefront of the current healthcare reform debate.
Daniel Robert MacDougall
Ph.D. Student, Health Care Ethics
Saint Louis University
Sphere Sovereignty and Subsidiarity in Health Care
Reform: The Difference Sin Makes in Social
Ethics
The principle of sphere sovereignty, propounded by reformed theologian and politician Abraham Kuyper, arose around the same time that the principle of subsidiarity arose in Catholic social teaching. Both principles have been understood to oppose, to varying degrees, centralization and state intervention in social organization. Despite this similarity, the bioethics literature contains little from a Catholic perspective citing social teachings to oppose federal intervention in health care, and little from a Reformed perspective on health care at all (either for or against centralization). This paper takes a critical look at the social teachings of subsidiarity and sphere sovereignty and asks whether they have clear implications for the health reform debate. I argue that, although the teachings appear similarly decentralizing at first glance, their implications become somewhat different when evaluated in light of their respective traditions' doctrines on the source and nature of state power. I argue that the Reformed tradition, and sphere sovereignty specifically, has understood state authority as arising after the fall of man and as being intended to correct problems arising from sin. Catholic social teaching, in contrast, has understood subsidiarity as a part of the natural order and state power as an inherently natural phenomenon. As a result, sphere sovereignty seems to shift the burden of evidence to those supporting state intervention, while subsidiarity does not. However, I conclude by arguing that, for a number of reasons, when sphere sovereignty is applied to the health care reform debate today, it does not unequivocally oppose further state intervention.
Stephen Paul Margheim
Junior Undergraduate
Baylor University
After (Unified) Virtue: Socrates and the Health Care Debate
The "moral schizophrenia" (Stocker) of our culture is due, on the one hand, to the incoherent language of morality-a problem which Alasdair MacIntyre has eruditely critiqued in After Virtue -and on the other hand, to the neglect given any consideration of the unity of virtue. It is this second point that I wish to discuss, specifically by analyzing the effects of beginning from a unified conception of virtue on an ethical consideration of the health care debate. That is, I use the contemporary health care debate as a concrete representation of the consequences of today's schizophrenic ethical approach. I base my analysis on Socrates' claim that "virtue is a unity, a single condition of mind and character" (Cooper). I argue that confronting this claim creates a space by which the primary question surrounding the health care debate-whether health care is a right-can be supplanted by the question of whether it is just to deny someone health care.
Therefore, I begin by presenting Socrates' conception of and argument for the unity of virtues, as found primarily in the Protagoras. Then, I demonstrate how such a foundation allows one to de-compartmentalize the ethical discourse surrounding the health care debate by examining two issues. First, in line with Socrates, I analyze the inter-relationship between justice and piety. Secondly, I examine how this unified conception of justice and piety affects contemporary discourse on the health care issue. I conclude that a conscientious ethical consideration of the health care debate, specifically from a Christian perspective, must begin by addressing the question of whether or not the virtues are co-instantiated. However, it is important to remember that this is not an argument for the unity of virtue, but rather that a unified rational consideration of the necessarily complex health care issue must begin by first dealing with this claim.
The first section presents Socrates' argument for the unity of virtues from the Protagoras. Here, Socrates specifically argues against Protagoras' claim that the virtues are distinct and independently possessed. This context makes the passage particularly apt for use in critiquing today's ethical schizophrenia. Socrates' argument rests on an understanding of virtues as powers or functions. That is, a man is just in that he possesses the power of justice, and the power of justice is such that it makes the acts which it produces to be just. He further argues that one acquires such a power by gaining primary knowledge of the principles underlying that particular instantiation of virtue. However, Socrates makes his argument for the unity of all virtues by claiming that the primary knowledge underlying a particular virtue necessarily includes secondary knowledge, which is merely the primary knowledge of the other virtues. Thus, "each virtue knows everything that each of the others also knows, but they order or arrange their knowledge in different ways" (Cooper). Socrates provides the examples of piety and justice, and it is here that we find a point of departure, from which we can address the health care debate.
By taking Socrates' arguments for the inter-relationship between justice and piety, I seek to return the dignity of the human person to the center of the health care debate. This requires, to some extent, a criticism of Rawls's conception of "justice as fairness." Indeed, extending the Socratic conception of justice as co-instantiated with piety necessarily critiques all accounts of justice which define it, in some way or another, as compliance with the law. This criticism, while necessarily under-argued in this paper, creates the space necessary to confront the question of whether it is just to deny someone health care. This question differs from the primary question of whether health care is a right slightly, but nonetheless importantly. The latter places the crux of the ethical consideration on external rights, while the former places the crux on internal duties. Today, rights and duties are understood as components of justice and piety respectively, and they are therefore placed in separate ethical compartments with the result that the discussion remains schizophrenic. However, by seriously engaging the issue of the unity of virtue, one is able to break down the compartmentalization and truly engage the full scope of the health care debate. Therefore, by examining how Socrates' argument for the unity of justice and piety affects the health care debate, I hope to shed some light on the route to resuscitating our ethical discourse.
James Marroquin, MD
Internal Medicine and Palliative Care Physician
Capital Medical Clinic, Austin, Texas
The Anatomy of Spirit
My presentation considers the spiritual issues that emerge during the experience of illness. I begin by presenting two stories of individuals confronted by illness--an elderly man who develops leukemia and a young woman with an ectopic pregnancy. I state that one way to understand these individuals' illnesses is to describe what is happening in their bodies. This physical conception of illness explains illness as the disruption of normal anatomical and physiological processes within the body. The man's development of leukemia is described as the proliferation of abnormal white blood cells resulting from a DNA mutation. The young woman's ectopic pregnancy is explained as the improper implantation of the embryo in a fallopian tube, a location where it does not have the space or nourishment to grow. As a physician, trained to understand illness in physical terms, I acknowledge the utility of this perspective. It often enables accurate predictions about the trajectory of an illness and sometimes facilitates efficacious therapeutic intervention. It may also provide enormous psychological comfort. When illness suddenly shatters the security and predictability of our lives, when our existence is revealed to be fragile and tenuous, we turn to the authoritative, trustworthy voice of modern science to make sense of our situation and turn back the tide of entropy.
Having acknowledged the benefits of the physical conception of illness, I go on to point out its limitations. A novel is not merely a combination of ink and paper nor is a kiss only the collision of oral mucosa. In similar fashion, even the most thorough and precise description of illness in physical terms captures only one aspect (albeit an important one) of what it is like to be sick. Illness is also experienced as a spiritual phenomenon; that is to say that it inevitably raises and requires responses to issues that are spiritual in nature. My presentation aims to systematically portray this process and consider how health care providers can most helpfully respond.
I organize this account of the spiritual experience of illness around an exposition of the concept of spirituality. Following the linguistic analysis of Ludwig Wittgenstein, I consider the term "spirituality" to be referring to a series of family resemblances rather than a unifying, single essence. By this I mean that while there is no uniform definition of spirituality, there are core components of spirituality that emerge in a study of the topic. Building upon scholarship in this area, I present a basic anatomy of spirituality as consisting of a) worldview, b) connection to sacred reality, and c) relationships and community. As I explicate these spiritual spheres, I will reflect upon the effect of illness on each of them.
Interacting with the work of Freud, Kuyper, James K.A. Smith, and Armando Nicholi, I briefly describe the history and meaning of the worldview concept. I then consider how the experience of illness impacts three crucial aspects of a person's worldview: values, identity, and causality/meaning. In my discussion, I incorporate scientific studies, multiple literary sources, and the stories of patients for which I have cared as an internal medicine and palliative care physician.
Besides addressing our intellectual orientation to the
world, spirituality is also concerned with a particular kind
of experience sometimes called connection to sacred reality.
One writer describes this component of spirituality as
"moments when we feel most deeply connected to our
world, when we feel least isolated inside our usual ego
boundaries." Ways that people connect with sacred
reality include music, art, immersion in nature, and
practices such as meditation, studying scripture, prayer, and
rituals. I discuss research suggesting that severe illness
tends to increase individuals' desire to connect with sacred
reality.
The final element of spirituality I address is the need for
relationships and community. We human beings long to connect
to each other, to feel that we belong, to have the security
of home. Through physical limitation and hospitalization,
illness often separates individuals from the communities that
provide their lives with meaning and coherence. This
ironically occurs when people are most vulnerable and in need
of loving fellowship. I discuss how the hospice movement
emerged in part as a response to this situation. I further
reflect upon the need for forgiveness, reconciliation, and
healing of broken relationships that often emerges in
seriously ill persons.
I end by considering how caretakers can best support ill individuals as they process spiritual issues. I present and interact with the work of Christina Puchalski and Harold Koenig in this area.
Michael Martocchio
Ph.D. Candidate
Duquesne University
Health Care and the Dignity of Personal Agency: The Principle of Subsidiarity and Distributive Justice
Of particular importance in contemporary politics and public policy debates is the issue of the distribution of health care. Contemporary Catholic social thought has come to consider access to health care a basic human right alongside such concerns as food and shelter. With this in mind, the question that is to be asked is how to ensure that access to basic health care is distributed justly in society. Some of the options include complete state intervention/control of the health care system, a complete free market approach, or a combination of the two.
One of the ethical principles that inform this discussion is the principle of subsidiarity. The principle of subsidiarity was introduced into Catholic Social Thought in 1931 by Pius XI in Quadragesimo Anno. The principle states that within society, larger entities ought not to accomplish for the individual or smaller entity what he/she/they can achieve for him/her/themselves. This simple principle is a guide for the intervention of the greater collectivity (often the state) within the lives of the individuals and small groups within this larger community. The intent behind this principle is to guard against collectivism and even totalitarianism. It is based on the idea that the individual's responsibility and moral agency should not be abrogated by the larger group. In other words, it is part of the dignity of the human person to be able to accomplish those things that he/she can do on his or her own. To provide for someone what he/she is able to provide for him/herself would undermine that person's dignity as a moral agent. Although, for John XXIII and later authors, the principle also serve as a standard to indicate when collective action is mandated, namely when the individual or smaller group cannot provide a basic good for him/her/themselves.
This paper will begin to apply this principle to the debate on the distribution of health care. It will argue that the principle of subsidiarity is one of the most useful principles in the contemporary debate. It can help to frame the debate about when state intervention is appropriate and inappropriate. The basic question to be asked is what it is reasonable to expect the individual or small group (family), etc. to provide for him/her/themselves. This can vary based on several sets of circumstances and might not be the same in all settings. Also, the principle of subsidiarity works hand in hand with the preferential option for the poor. In this regard, it highlights that special concern is to be taken for the poor and for those who cannot provide access to adequate health care for themselves with the resources at their disposal. Additionally, if and when state intervention is deemed necessary, the principle of subsidiarity can also help to frame the discussion on which level of government ought to provide for health care services. The principle of subsidiarity also leads one to insist that even under such circumstances, the individual ought to remain in charge or his/her medical decisions to the greatest degree possible.
Lawrence John McAndrews
Professor of History
St. Norbert College
Waiting Game: Carter, Catholics, and Health Care
The recent enactment of national health insurance by Democratic President Barack Obama climaxed a century-long struggle which had its roots in the Theodore Roosevelt Presidency. Three decades before Obama's successful effort, Democratic President Jimmy Carter failed in his bid for a national health program. Unlike Obama, Carter was unable to coalesce the Democratic majority in Congress behind his plan.
Carter's inability to unite Democrats mirrored his failure to unite Catholics. With its almost seven hundred hospitals and longstanding commitment to the poor, the Church hierarchy in the United States officially committed itself to comprehensive national health insurance. Catholic Democratic Senator Edward Kennedy of Massachusetts, whose advocacy of health care would become a lifelong crusade, joined the American Catholic bishops in promoting a comprehensive plan. But worried about inflation and seeking to increase his appeal among more conservative ethnics, Carter forsook his advocacy of a comprehensive plan for a cheaper, more modest hospital cost containment proposal. But Carter's failure to tame inflation helped alienate the ethnics, and his surrender on a comprehensive plan helped spur Kennedy to challenge him in the presidential primaries.
In the end, Carter's hospital cost-containment bill and his re-election bid ended in defeat. A plurality of Catholics chose Republican Ronald Reagan over Carter in the 1980 election, helping to certify that national health insurance would not arrive anytime soon.
Drawing upon a variety of secondary and primary sources,
including documents from the Jimmy Carter Presidential
Library and the United States Catholic Conference, this paper
examines how and why national health insurance did not become
law in the Carter era. Neither Carter nor Catholics could
overcome history, and proponents of national health insurance
once again would just have to wait.
Michael McGravey
Graduate Student: PhD in Systematic Theology
Duquesne University
Catholic Social Teaching, the Common Good, and Access to Health Care
In the United States, viewing health care as a right, remains a highly debated topic; one only needs to consider this past year's congressional debate in which the Republicans and Democrats debated and passed health care reform. Members in the House and Senate had, over the course of deliberations, noted two important factors that have continued to hold the media's attention: (1) the enormous costs of universal health care, and (2) the moral implications implied with providing health care, including access to public funds to "illegal aliens" and the unemployed or underemployed. Prior to the reform, those without access to adequate health care numbered approximately 46.3 million-approximately 15.4 percent of the total U.S. Population according to the U.S. Census Bureau. This impersonal number, however, failed to articulate was the overwhelming number of American minorities-Hispanics, African-Americans, Asian-Americans, and Native Americans-and those at or below the poverty line, lacked access to adequate health care.
Those most affected by the pre-reform health care system lacked recognition as a person, and were simply seen by the health care industry as an economic commodity. While present reform begins steps to amend such inadequacies, further reform is still warranted. Health care reform must include at minimum the following four principles, which are derived from Catholic Social Teaching: 1) the principle of human dignity, (2) the principle of respect for human life, (3) the principle of participation, and (4) the principle of preferential protection for the poor and vulnerable. Adopting these principles no longer makes the individual a statistic, but solidifies the individual as a unique person. Such statistics and principles, however, still evoke impersonal and categorical terms which lessen the human being to something other than a person.
In order to overcome such impersonal categorical descriptions of individuals, while still maintaining the importance of both the common good and Catholic Social Teaching, this paper intends to utilize the thought of Jean-Luc Marion and an understanding of the "ethical phenomenon" derived from Emmanuel Levinas. The person, therefore, is not reduced to mere categories, but is understood as a complex being whose reduced self calls out for life over death.
Gilbert Meilaender, M.Div., Ph.D.
Professor of Theology and Richard and Phyllis Duesenberg
Chair in Christian Ethics
Valparaiso University
Death and Dignity
The language of "dignity" is used in different ways, especially when we think and speak about subjects as inherently puzzling as death. We can distinguish two important senses of dignity, which may be called human and personal dignity. Neither taken by itself is sufficient to say everything that needs to be said about our dignity, and each is needed to reflect adequately upon a subject such as death.
Andrew Michel, MD
Assistant Professor of Psychiatry
Vanderbilt University School of Medicine
Psychiatry after Virtue: A Modern Practice in the Ruins
What would happen if the primary ends of medicine became unmoored from any deep reflectiveness on the proper end of human life? Some contemporary thinkers, such as Alasdair MacIntyre, have made just such a 'disquieting suggestion' about many of the institutions of post-modern life, including that of higher education and health care. If such a suggestion turned out to be even partially true, its effects would be especially evident in that subfield of medicine, Psychiatry, in which the problems of life are ambiguously situated between the material inner workings of the brain and the dynamic life of the will and mind. After all, things can go wrong with our bodies, and thereby brains. But even when all is right with our brains, things can go wrong in our thinking, willing, and feeling. It is actually the case that things go wrong in a myriad of complex ways involving the brain and will and mind at the same time. How would one know the difference? Can the psychiatrist wield his technology responsibly without reference to a notion of the human good deeper than biological functioning? Can the patient find healing outside of involvement in a community of discerners inquiring into what is wrong?
his paper contends that the dominant mode of modern psychiatric practice has a certain way of characterizing and defining humanity's "lapse" from human being (or dignity). This modern practice applies a particular notion (largely influenced by Enlightenment ideals) of scientific instrumentation to the human person in order to diagnose the ailment and manufacture a corresponding treatment in keeping with its hidden vision. Contemporary psychiatry's focus on human mastery via autonomous human reason, individualism, and overreliance on a certain conception of "science" (and psychotropic technology) will be highlighted. These values and hidden vision actually undermine psychiatry's current capacity to affirm and encourage human dignity.
Implicit in these contentions is that the more coherent and robust and full our understanding of human nature and the human telos, the more likely it is that we as personal agents and communities, and as a profession, can allow for that state of being characterized by eudaimonia. Features of such a practice would include a self-understanding of the psychiatrist who plays one humble role in a community of discerners engaged in healing. It would also involve a rejection of practices that perpetuate dualism, by focusing on only biomedical models of human nature or alternatively psychological models. Instead, a practice of psychiatry as ordered by the tradition of the virtues would require psychiatrists to cultivate practical wisdom toward suffering persons. This would involve active dialogue with neuroscience which sheds light on our biological nature (including psychopathology) but also attention to frameworks of meaning (including psychological, philosophical, and religious) that go beyond the biological.
Such a practice of psychiatry would find itself submitted to more global "communities of giving and receiving" that seek healing and transformation while "bearing with" brokenness and vulnerability. Having cut itself off from institutions which embody this way of life, psychiatry has become an independent power, overly reliant on its own important but limited capacity to bring healing.
But this reorientation would involve something larger than a simple reorienting of the practice alone. Because psychiatry, as well as all other practices, finds itself ordered by larger sociopolitical forces (especially economic ones), it is in ways at the mercy of these forces. We are back again to the troubling contemporary circumstances in which we find ourselves. Even a coherent moral practice of psychiatry requires a thriving moral context in which it can do what it is meant to do. Even if most all psychiatrists were aware of the tensions outlined herein, what is increasingly demoralizing is the inability to be anything other than the biomedically reductionistic psychiatrist (or MacIntyre's Therapist who treats ends as givens), even if one desired to be otherwise, simply given the social and economic determinants of the practice. A practice of psychiatry that is ordered by the external goods of efficiency and economics coheres differently than one ordered by internal goods aimed at excellence. Though there remains lip service given to the pursuit of excellence in practice, gone is the deep concern or infrastructure that would allow for it. There is hardly space any longer for the kind of physician-patient encounter where aspects beyond the purely biomedical could be attended to.
James O. Morse, MD
Retired Professor of Medicine
Texas A&M University College of Medicine
Producing Compassionate Physicians
Some physicians seem to have been blessed with a naturally pleasing personality and a home background that makes treating other people humanely an almost automatic response. Others of us, however, may need some help to smooth off the rough edges and possibly redirect our priorities. Premedical studies should provide the would-be medical student not only with the scientific knowledge needed to tackle medical school courses in the basic sciences but also with some skills in communication, some cultural sensitivity, and some understanding of human behavior.
Traditionally, medical schools have tended to rank applicants primarily on the basis of their grades in premedical science courses and their scores on the Medical College Admittance Test (MCAT). Although these measurements may have some value in estimating the student's performance in science courses in medical school, they have proved to be of little use in predicting the graduate's ultimate value as a practicing physician. Consequently, in recent years more attention is being given to some less easily measured characteristics such as motivation, humility, a capacity for empathy, respect for others, and an aptitude for interpersonal communication. Apart from reading letters of evaluation, admissions committees usually rely on interviews to obtain such information. Such interviews may be more productive if they are structured and the interviewers are trained. Some schools may even require psychological testing.
Once entered into the clinical years of medical school
even the best prepared students may find themselves having to
resist negative influences of an overworked faculty and house
staff which may have been driven to cynicism and lack of
respect for the feelings of patients. Efforts are being made
in some schools to counter this influence with special
courses designed to maintain or improve the students' humane
qualities. An actual change in the negative climate, however,
will require a change in emphases from the top down so that
faculty as well as students are evaluated for their skills in
human relations as well as for their intelligence, technical
skills, and research accomplishments. Success will be
measured by a change in atmosphere and a recognition by the
faculty itself that becoming an acceptable physician includes
having humanistic personal characteristics.
A spirit of altruism not only affects how physicians treat
their patients, it has an important influence on their choice
of which kind of patients they will treat and where they will
be willing to treat them. One of the major problems in
American medicine right now is the scarcity of physicians
willing to do primary care, especially in areas away from
population centers. Although changes in payment practices may
help somewhat in correcting this imbalance, unless more
physicians cease to rank a comfortable lifestyle and generous
financial compensation as their major priorities, the problem
is likely to persist.
Matthew Moser
Adjunct faculty
Baylor University
Jonathan Tran
Assistant Professor
Baylor University
Peter Candler
Assistant Professor
Baylor University
Panel: Re-Reading Death in the Light of Christ
This panel proposes to mine the Church's tradition for distinctly Christian accounts of death and dying by which the Church can witness to a transformative understanding of the meaning of death in light of Christian resurrection hope.
Jonathan Tran's essay, "The Death of Macrina: William May, Gregory of Nyssa and Death's Publicity" seeks an alternative to modern dealings with death, which we, following William May's classical formulation, understand to be locked on the horns of avoidance and obsession. We begin by relating a regrettable but familiar encounter between patients and their doctors, where the crushing pressures fomented by death and suffering make for the most awkward of interactions. By May's analysis, such experiences are all too common because ours is a society culturally predisposed to avoidance and obsession on matters of death. Within this milieu, facing death cannot help but be awkward since so few possess the fortitude to be present "when it comes." It is precisely this fortitude to be so present that we are concerned to delineate in this essay. As an alternative to obsession and avoidance, we turn to the early church theologian Gregory of Nyssa and his peculiar, by modern standards, portrait of death and dying. Gregory's Life of Macrina is mostly about the death of Macrina, and for Gregory this reflects how death is always already about life. In death, as Gregory tries to show through his sister's death, we are given a key through which to see lives, bodies, and mostly, God. This seeing permits a publicity we think helpful to a society locked on avoidance and obsession.
Matthew Moser's essay, "Death as Fruitfulness: Balthasar, Sacramentality, and the Ars Moriendi" examines Hans Urs von Balthasar's Christological interpretation of death. According to Balthasar, death stands at the center of the existential tragedy of humanity. All other religions of the world are attempts to escape the tragedy of death; only in Christianity does the divine actually enter into the tragedy, to swallow death in Life and, in so doing, causing "[a] complete transvaluation of death and its empire" which is, furthermore, "a transvaluation of human existence as 'being headed toward death'". In the Incarnation, death is the expression of God's love and through this death-as-love "dying can now be seen... to be the perfect surrender of oneself into the hands of the Father; death is now an opportunity for letting everything go and being free in God." Thus the divine entrance into the deathly tragedy of the human person is so transformative as to allow the individual to practice death as conformity and surrender to Christ. Yet the fruitfulness of death in Christ is not limited to a person's individual ars moriendi, their personal art of dying. A Christological reading of death-as-love is fruitful in giving birth to the sacramental practices of the Church, namely baptism and the Eucharist. These sacramental practices participate in the death of Christ and it is through sacramental practice that an ecclesial ars moriendi that proclaims to the world a Gospel founded on resurrection hope. It is this hope that reorients the Christian understanding of death. This reorientation, I shall conclude, demands the Christian ethicist to offer a theological critique of death-denying medical practices that deny the fruitfulness of death.
Arland Keith Nichols, M.Div.
Founding Faculty
Converging Roads
Authentic Human Progress: The Magisterial Vision of Pope Benedict XVI
Western culture has become so inundated with technology that an authentic human progress has too often been replaced by the exaltation and deification of technological advances. This presentation will explicate the vision of Pope Benedict XVI's magisterial teaching concerning the essential end of technological progress, and the proper role of the Church in evaluating development. Throughout his pontificate, his teaching encourages responsible ethical evaluation of technology, and ensures the true good of the human person.
Pope Benedict XVI argues that "Charity in truth...is the principal driving force behind the authentic development of every person and of all humanity." The reciprocal relationship between love and truth is necessary for development to be authentic, meaningful, and ethical. Truth and love are the source and end of all authentic development. As a "profoundly human reality," technology allows man to express his creative genius, to harness the created order, and to ensure the development of peoples. However, human beings have increasingly directed reason toward technological advances with scant reference to the transcendent. Recognizing this, Pope Benedict explicates a positive yet cautious approach to technological development. Technology must uphold the dignity of the individual and promote the common good because the origin and reason for its existence is the human person.
The Church does not possess the expertise to offer
technical solutions, but offers a threefold gift to the
world: 1) An encounter with love, 2) the encouragement and
means by which to be receptive to God, 3) and an authentic
vision of the nature of man.
1) Since "Love is the light - and in the end, the only
light - that can always illuminate a world grown dim and give
us the courage needed to keep living and working,"
authentic technological development will foster caritas in
the world. Technology can only accomplish what it proposes
when it is in keeping with His love and His truth. Perhaps
then, the most essential progress that we ought to pursue is
the progress in our capacity to truly love. (2) The creation
must be aware of the creator to truly flourish; an authentic
humanism requires this recognition. Unfortunately, too often,
science claims for itself the mantle of creator, savior, and
redeemer. The role of the Church is to kindle again our
receptivity toward God - to challenge a world that cannot
hear His promptings. (3) Common to all human beings, the
natural law is the universal basis for ethical evaluation of
all technological advancements. Unfortunately, in many
corners today, bioethics has the tendency to label almost
anything as good as long as the necessary verbal gymnastics
and requisite logical moves are done to create consensus. In
this milieu, Pope Benedict argues that the role of the Church
is to present cogent arguments to a scientific world that too
often acts as an impediment to genuine development by seeking
a progress that fails to recognize our nature as human
beings. When love is not the guiding light of development,
and when an authentic humanism is ignored, we run the risk of
technology becoming a treacherous creation that we serve - a
"god" that inevitably will violate the rights of
man.
Technical progress cannot overcome the limitations and sufferings of man in a society that prevents the goods of the soul from flourishing. An authentic progress is always directed toward God, is in accord with His truth, and encourages every individual and the community to flourish. Our failure to place and evaluate technological development within the context of love and truth will inevitably lead to infringement of the rights of man and the enslavement of man to his own creation. Pope Benedict's magisterial teaching serves as a reminder that it is not scientific progress that redeems man: man is redeemed by love and truth.
James Nichols
Professor and Chair, Biology
Abilene Christian University
Clinical Pastoral Education as a Window into Human Dignity and Health Care ("Foxhole Biomedical Ethics")
It is not breaking news to anyone that a large number of students entering universities today identify some area of "pre-health professions" as their major field of interest. Despite the fact that many of them are destined to have to re-orient their goals a lot or a little, many of them will continue into some professional activity in health care.
As a faculty member to a set of these students at a Christian liberal arts university, I have a keen interest in not only their scientific growth, but also in their emotional and spiritual growth. I believe health care is serious business and am interested in helping students move past the gloss of "television medicine" to a more realistic view of health care. I specifically believe that an introduction to biomedical ethics is important to student growth in this area.
Considering my own role in the ethical education of these students, I realized that one of the important components of this process is for students to have instructors, mentors, and guides who are, themselves, mature in their view of the realities of life, both the positive and seemingly negative. An exclusively academic introduction to these difficult topics is only marginally helpful to students. I have found involvement in units of Clinical Pastoral Education (CPE) to be extremely helpful to me in both expected and unexpected ways. CPE has supplied me with experience that has enabled me to aid students both academically and personally as they seriously consider the gray and ambivalent sides of medicine. In this presentation I propose to explain the process of CPE and discuss how this action/reflection method of education has broadened my knowledge base and my views of human dignity.
CPE programs are offered by many major medical centers in the United States. A national accrediting organization sets standards and the programs from medical center to medical center have many core similarities. CPE programs occur in "units" of 3-4 months full time effort (though there are different time frames) and the units can be stacked and can, if desired, lead to levels of certification for individuals as hospital chaplains (as well as chaplains in other settings such as prisons, the military, and industry). The units consist of about 75% effort in direct contact with patients, families, and staff and 25% effort processing those contacts with a peer group and one or more supervisors. Although there are clear didactic aspects to the units, the majority of the experience is unpredictable.
My own experiences with CPE have been quite helpful to me academically and personally. I have relished in the absolute religious ecumenical nature of CPE. Service on the regular hospital floors as well as specialty units (such as the trauma center and intensive care areas) has been scientifically fascinating and pastorally informative. I would specifically note these items that CPE has given me: (1) Experiences/stories I can use in my classes in biomedical ethics. I strongly believe in the power of stories in teaching and CPE has supplied me with an abundance of first-hand experiences with individuals in uniquely difficult times in their lives. (2) A more accurate view of the positives and negatives of the health-care system. (3) A great appreciation for the skills (though narrow) and compassion of most health-care workers. (4) An appreciation for the team approach to health care (physicians at different levels, nurses, technicians, EMS workers, chaplains, social workers, organ donation representatives, law enforcement and security personnel).
Because my CPE experiences have been so positive for me, I wish to encourage others to sample this world. It is a challenging and somewhat intimidating endeavor, but an excellent way (I have found) to push my own personal, spiritual, and academic boundaries in helpful ways. Because the units can be only 3-4 months long, they are a good fit for summer or sabbatical activity. I have found such units to be powerful influences on my views of human dignity and health care. I have profited academically by broadening my experiences and have grown emotionally, personally, and spiritually.
Raphael Chijioke Njoku
Associate Professor
University of Louisville
Between the 'Traditional' and the 'Western': The future of Health Care and the Consciousness of Colonization in Postcolonial Igboland (Nigeria)
This paper examines the dichotomy between what has been
today branded with the term “traditional” and
“western” in contemporary health care regimes, as
patients and health care professional continue to search for
solutions to a myriad of illnesses that have continued to
plague mankind. Among other things, the paper argues that
unless those forms of health care/medical services that have
been dismissed as traditional and therefore
“primitive” “magic” and useless are
revisited and researched on along with the western trends,
the future of mankind is at a serious risk of increasing
loss. This study uses a few specific examples of traditional
remedies for malaria, and diabetes in the pre-colonial Igbo
society of southeastern Nigeria to highlight the problem of
colonial impact on health care services and how creed and
religion interlocked with medical knowledge to create crisis
of trust and neglect for the indigenous knowledge system. The
consequence is that mankind is increasingly at loss for some
useful, cheaper and more accessible medical remedies in the
postcolonial order.
John O'Callaghan
Associate Professor Philosophy
University of Notre Dame
We Have Been Friends Together
We are here to discuss how to understand human dignity in the context of suffering at the end of human life. No doubt we are all familiar with the social and political pressures in Western culture to end either actively or passively the suffering of individuals who have some terminal disease, or are said to be in a “persistent vegetative state.” This situation is very paradoxical. In ordinary circumstances we might be inclined to say that human dignity is such that the suffering of individuals is no warrant for actively or passively destroying the one who suffers; on the contrary we think that human dignity is the warrant for doing what we can to either cure or at least ameliorate temporary or even chronic suffering. We are not horses, and we do not shoot people with broken legs. But we are talking about extraordinary circumstances at the end of life, or in a chronically debilitating state. And such circumstances lead to paradoxical reactions in both ordinary discourse and philosophical analysis.
Martina Iyabo Oguntoyinbo-Atere
Senior Lecturer
Lagos State University, Nigeria
The Healer and the Healed: An Appraisal of Luke 8:40-56 in the Nigerian Context
The sick person is haunted by fear, hopelessness, depression, depravity, sorrow and restlessness among others. Sometimes full of self pity and beggarly¸ some become faithless as their human dignity is being eroded.
Do the medical practitioners see the sick as deserving of care? How do they care for the sick in Nigeria? Are there hindrances? For we have proper and adequate medical facilities? Do we have care free care givers? Is there empathy or sympathy from the care-givers? Are these due to economic considerations? These are some of the issues we shall examine in this paper.
Luke 8:40 - 56, we have two cases of the sick being healed by Jesus. The ruler of the synagogue's only daughter was at the point of death, and the touch of Jesus was sought as it is customary for the Jewish prophets in conferring favours. Then came another sick woman whose disease had rendered her unclean. Hers was an incurable disease. She had expended all her property and grew worse. After touching Jesus, she was healed. Jesus silenced her fears and commended her faith. The presence of Minstrel and mourners in the house or environment of the dead is worthy of note and examination. This could be compared to the concept of Ekun Aaro "Special Morning Cry" in Ile-Ife, Osun State of Nigeria. This is a cultural issue and one wonders, if it is not an exhibition of pretence. How much care is really given to the sick before death? When he or she needed care? This exhibition of grief as a cultural issue will be critically examined. The spiritual dimension to the healing of the sick will be looked into. In the cases in this passage, the meeting of faith with the divine brought forth healing. No disease could be too hard for Jesus to heal. How has this been explored by both the sick and the ministers of the gospel of Jesus in Nigeria today?
In order to do justice to this topic, we shall use critical historical materials to elicit information on Luke 8:40 - 58. Interview will also be conducted. To be interviewed are some medical practitioners and care givers; some ministers of God on faith and healing and some culturally inclined people in Ile-Ife on the concept of Ekun Aaro "Special morning cry".
All these will no doubt combine to give us clues to the future of health care in Nigeria.
F. A. Olasupo
Faculty of Administration
Obafemi Awolowo University, Nigeria
Human Rights and Human Dignity: A Case Study for the Subjugation of Women’s Rights and Dignity in Africa by Colonial Authorities
The dignities and rights of African women’s leadership in governance and religion were highly valued and enhanced before the arrival of the colonial masters but all these began to diminish and extinct with arrival of the colonial powers. The call by the United Nations for the re- integration of women leadership in governance and religion, using the parameter of affirmative action (The Affirmative Action is about 30 percent life line for women in both elective and appointive posts) and “Political entrysm” (“defined as the process of emergence, participation and contest for political power by women”) is antithetical to what were the natural situations in pre-colonial days. In most communities in Africa and specifically in Nigeria, governance and leadership in religion of the communities or societies is shared along gender line. As there were communities where ruler ship is dominated by male, so are others where female only called the shot. In places where ruler ship is prerogative of male, crisis management especially at the demise of the king, is shouldered by female rulers who are installed the very day the male kings are installed in such communities, in anticipation of the crisis situation. Last but not the least is the communities with gender balance in governance and religion. In these types of communities, male rulers have their governing structure separate form female ones but are interfaced under certain circumstances such as the administration of the whole community or society, internal or external threats and during war situation. The male and female kings are conceptually husbands and wives in governance and religion with the people in the entire community or society serving as children and devotees of both.
It is not only in traditional governance this kind of arrangements exists, it also exists in traditional religions where male and female gods exist; and where female gods serve as wives to male gods. In Yoruba, Igbo and many other communities in Nigeria, women have, since pre-colonial days, created feminist political and religious institutions not just as counterweights but also wives to male gods. Some of them in Yorubland are Moremi (the wife of Oranmiyan: the sixth monarch to rule Ile-Ife), Olokun (the wife of Oduduwa, goddess of the sea, the giver of the children, healer of abdominal diseases), Oya (goddess of river) the wife of Sango, Yemoo, the wife of Obatala and the Osun. In African Traditional Religion therefore, women had always played active roles in religion not just as floor members but also mostly as leaders of variety of African Traditional Religions. African Traditional Religion not only permits women to be head of religious bodies but also permit them to have their own religion, separate from those of male. To some extent therefore, especially in Yoruba land, just as there are male and female rulers so are there male and female religious leaders, both of which complement each other.
With the arrival of colonial masters, their religions
(Christianity and Islam) and their concept of one indivisible
God, male rulers as well as male gods swallowed up their
female counterparts. And this was done in a rather
conflicting ways. In Christendom, women enjoy some measures
of freedom of association but they are yet to be permitted to
serve as pastors not to talk of been ordained as Rev. or
Bishop. In most churches, especially the Protestants, the
highest a woman could raise to become in the hierarchy of the
Church is Deaconess. In Islamic religion on the other hand,
women are permanently conditioned to play second fiddle role
and segregated life from their male counterparts. Happy at
this degrading situation, this international Muslim scholar
in Nigeria, Sheik Abubakar Gumi, boasted that “I do not
hope to see a woman leader in my life”. When a woman
however emerged as a leader (councilor) of the ward in which
Gumi was, he neither ran away from that ward not committed
suicide.
Given these backdrops what steps are the women rulers and
religious leaders taking to reverse the travesty of their
rights and dignity in this modern age of globalization of
human rights and dignity? This is what this paper set out to
explore.
Kelvin Okey Onongha, D.Min.
Deputy Vice President, Student Development
Babcock University
Health Care and the Church: A Mission Imperative
Concerns about the state of health care delivery have taken center stage in deliberations around the globe. Among the many issues confronting health care are infant and adult mortality, the scourge of HIV/AIDS and other sexually transmitted diseases (STD's), the resurgence of epidemics such as tuberculosis and polio, the rising profile of cancers, abortion and the various assisted reproductive techniques, and the role of primary healthcare in the health of the populace. The church has always played a central role all through human history as an agency for restoring wholeness to the ill and the sick. The church's prerogative is derived from a divine imperative that demands involvement in the work of restoration and redemption of the image of God in the fallen, weak, and sick in society. The church's mission theology drives its ministry to establish Christ's kingdom on earth, which translates to eradicating sin and sickness while at the same time in compassion and love working for the restoration of the image of God in humanity. Two key concepts in the Old and New Testaments, "shalom", and "sozo", capture God's desire for the health and healing of His people. Thus, in carrying the divine mission through, the church must engage in all the dimensions in which healing can be implemented, whether it be the establishment of medical institutions where health care can be dispensed in a climate of compassion, respect, dignity and love, or in preventive health care education programs which could drastically curb the multifarious range of lifestyle diseases such as cancers, stroke, heart disease, hypertension, and diabetes. Another dimension that the church can play a unique role is in the area of holistic health care, recognizing the powerful connection between the mind, body, and soul. Although in recent times health care has become largely the preserve of the state, its present lamentable state suggests that a more collaborative and holistic approach would yield better results. The task of this paper is to demonstrate the unique qualities that qualify the church to step up to a new level of involvement and commitment and to present the need for participation in the health care debate as an integral aspect of the church's commission. These include grassroots connectivity which provides the church a network that will make health care all-inclusive and accessible to the least in society. Also, the diversity and variety of talents the church affords enables it to harness and mobilize a great number of persons for the multifaceted work of health care delivery. In addition to this is the amazing volunteer and service potential that the church provides who are driven by a strong sense of mission and compassion. Another resource the church can deploy is its theology of the stewardship of life, which seeks to teach each individual o see their lives as a trust from God and to determine to abstain from harmful substances that can rob people of their health. Furthermore, in a world fragmented by race and religion, the church's health care programs can become bridges of peace as well as centers of healing. Finally, as governments all across the world embark on the privatization of institutions and establishments due to high management overheads and a dearth in commitment to quality service delivery, the church stands as perhaps the one institution that can provide the appropriate mix of service, sacrifice, and compassion in the discharge of health care. Health care in its totality must embrace more than the physical, but should also encompass mental, emotional, relational, and spiritual dimensions which only the church can adequately address.
Daniel P. Payne
Lecturer, J.M. Dawson Institute of Church-State Studies,
Baylor University
Deacon, Annunciation Greek Orthodox Cathedral, Houston,
Texas
Psychotherapeia in the Orthodox Tradition: The Healing of the Soul according to Metropolitan Hierotheos Vlachos
An important and understudied approach to Christianity and health has been the Orthodox approach to soul healing, or psychotherapeia. Within the Orthodox tradition, there has been a renewed appreciation for this concept since the late 1950s with the work of Fr. John Romanides and the discovery and cataloguing of the works of St. Gregory Palamas (1296-1359). Especially important for the recovery of the Orthodox psychotherapeutic approach to healing has been the work of Metropolitan Hierotheos Vlachos of Nafpaktos, Greece.
Drawing upon the Orthodox hesychastic or spiritual tradition, Metropolitan Hierotheos Vlachos, a contemporary hierarch of the Orthodox Church of Greece and an influential theologian, has rearticulated the Orthodox tradition of psychotherapeia, or healing of the soul. Metropolitan Hierotheos makes use of the hesychastic tradition as interpreted by Fr. John Romanides, who argued that institutional religion is actually the sickness of the soul and what is needed for its healing is a return to the neptic tradition of the Church Fathers. The neptic tradition according to Romanides and Vlachos teaches that the soul is healed to its proper state of communion with God through a tripartite process of purification, illumination, and finally deification or glorification. The chief means by which this process occurs is through the use of hesychastic practice of recitation of the Jesus Prayer and through keeping vigil and fasting. Through this process of healing the soul is able to control the bodily passions once again, leading the person to a state of perfection. For the Orthodox hesychastic tradition, the body too is involved in the healing process as it is disciplined through the processes of prayer, vigil, and fasting.
While the Orthodox psychotherapy of Met. Hierotheos has
been criticized for being Messalian and against the
institutional and sacramental practices of the Orthodox
Church, I will argue that this is not the case. Met.
Hierotheos like his teachers and the neptic Fathers before
him, all argued for the sacramental life of the Church as
being essential for the healing of the soul. Beginning with
baptism, which starts the process of purification and
illumination, the soul is set on the path of glorification.
The sacraments of the Eucharist and confession are essential
for the nurturance of the soul and its communion with the
Lord.
After analyzing the teaching of Met. Hierotheos's Orthodox
psychotherapy and evaluating it against some of its critics,
I will then offer an ecumenical appraisal for its use in the
larger Christian family.
Mary Anne Peters, Ph.D., RN CNE
Professor of Nursing
Eastern University
Welcoming the Stranger: Christian Hospitality—A Foundation for Nursing Practice
Patients expect to receive hospitable care when they enter the health care setting. They anticipate being welcomed and treated with respect and kindness. From the perspective of patients and their families, the hallmark of excellent nursing care is the hospitable interaction between the nurse, patient, and family (Kerfoot, 2008). Nevertheless, many nurses would be perplexed by the assertion that hospitality is essential to quality nursing care. The use of the word "hospitality" often evokes a vision of welcoming friends to one's home, providing a meal, polite conversation, and an evening of entertainment (Nouwen, 1975). On the other hand, one might envision a very good restaurant or a comfortable hotel as exemplars of hospitality and the hospitality industry. However, Christian hospitality embedded in the everyday experiences of nursing provides a moral compass for nurses struggling in a health care system that does not value the person. Hospitality in health care today, as it was in biblical times, is counter-cultural but can lead to significant change in the system. However, more importantly, it can lead to nurses making changes in the care of individual patients.
The overarching theme present in the Old Testament accounts of hospitality is the importance of hospitality as a moral foundation of ancient Israel. Furthermore, the practice of hospitality extends God's welcoming care to the stranger and God's law commands Israel to do just that. In the New Testament, one finds hospitality is the basis of the Christian experience. It is welcoming the stranger as Jesus would welcome them. Hospitality is a Christian tradition that incorporates acts of kindness and an ethic of care for the other and it is a criterion on which every Christian will be judged.
Unfortunately, there is limited discussion of the phenomenon of hospitality and its potential impact on the quality of health care in the nursing literature. Moreover, there are still fewer references to hospitality and its applicability to Christian nursing practice. The purpose of this essay is to explore the biblical phenomenon of hospitality and discuss the centrality of the phenomenon to nursing praxis within a Christian worldview.
References
Brandon J. Pierce
M.A. Candidate, History and Theology
Abilene Christian University
Cauterizing the Soul: Reading Ethics as Therapy in St. John Climacus
This essay examines the use of medical imagery and terminology in "The Ladder of Divine Ascent" by St. John Climacus as a theological example of medical dialectic. As Christian theology, Climacus' text stands in tension with the secular ideology of other Greco-Roman forms of therapeutic ethics concerning both the theoretical nature of virtue and what kinds of virtues properly function to heal the soul and how they accomplish such a therapy. This paper has two goals: (1) to illustrate one example of the way medical dialectic is adopted and reworked in ancient Christian ascetic theology; and (2) to offer critical suggestions on the role of medical dialectic as ethics in the contemporary theological ethical milieu.
Martha Nussbaum's book, "The Therapy of Desire", has been influential in recovering the medical motif as a method of ethics in Hellenistic thought. Nussbaum's book deals with her reading of the kind of ethical thought typical of Stoic, Epicurean, and Cynic schools of thought in some contrast to the Aristotelian and Platonic schools of thought. Nevertheless, Aristotle specifies ethics as a medical art (t????) whose aim is "soul therapy" (???? ?e?ape?a) just as physical medicine aims to remedy illnesses of the body. Equally for Plato, medical imagery is the dominant motif in approaching the philosophical sphere of ethics and politics, because of the way the concepts of ????? and ß??? are inseparably tied together. Although certainly none of these schools agreed about the precise role and nature of ethics (cf. Annas, 1993) the notion and practice of ethics as therapy in the ancient world was influential across the board.
The closest direct analogy in Christian ethical discourse to this method of ethics occurs primarily in the ascetic literature of the Christian East beginning in the 4th century with the "Apophthegmata Patrum" and other collections of "sayings" and "vitas" such as the "Gerontikon" or the "Historia Monachorum". (Although, it could be argued that the fundamental ideology established in this ancient Greek discourse is dominant also in the Biblical and Apostolic ethical traditions; nevertheless since we are only concerned with ascetic theology the question concerning the rest of the Christian tradition must be paced.) This body of literature in Egypt developed into the tradition of Christian ascetic theology which retains the notion of medicine as a method for ethical discourse. St. John Climacus' work "The Ladder of Divine Ascent" as well as another lesser-known work "To the Shepherd", written in the late 6th, early 7th centuries has been academically recognized as representing a work of synthesis in terms of ascetic theology in the Christian East (Chryssavgis, 2004), as well as offering unique insight into the ascetic virtues which was highly formative for Eastern Christian theology afterward. Thus Climacus is a prime candidate for examining the way in which Christian ascetic theology adopts and reworks the notion of ethics as a "medical art" for the soul.
The import of this study is two-fold: first, it demonstrates a method of Christian ethics not usual in contemporary discourse; second, it works to integrate the domain of "spirituality" into the sphere of ethics in which it certainly belongs but has become somewhat divorced. Although the sense that ethics is also concerned with the (re)formation of character has gained ground with the resurgence of virtue theory in the last century in philosophical and theological ethics, it has taken a largely theoretical direction and many writers have validly pointed out that virtue theories are still primarily concerned with questions of moral obligation under the alternative, subjective rubric of virtuous transformation. By reworking the medical dialectic of Hellenistic ethics through the lens of orthodox Christian theological and ascetic traditions, Climacus' ascetic theology presupposes basic moral obligations and uses the method of therapeutic ethics to discern a practical ethics fitting for the monastic vocation, yet certainly applicable with discernment for Christian life in general. To accomplish these tasks I will begin by summarizing the notion of medicine as a method for ethics in Aristotle, then spend a significant portion of space analyzing the way that Climacus adopts and reworks this method of ethics in his Christian ascetic theology through his use of medical terminology and analogies. After summarizing the continuities and discontinuities between Climacus and Aristotle, I will conclude by offering insight concerning the place of ascetic theology (in terms of therapeutic ethics) in contemporary Christian ethics.
Gregory S. Poore
Doctoral Student
Baylor University
A Double Take on Double Effect
Those who believe humans have a special dignity and worth generally agree that the harm of innocent humans is an evil. They therefore recognize strong prohibitions against causing such harm. Similarly, they recognize obligations to prevent, mitigate, and treat cases of human suffering and harm. This is part of a more general recognition that one should promote goods that are essential to human flourishing.
What are we to do when these two obligations - the obligation not to cause harm and the obligation to promote key human goods - seem to conflict? Among those committed to human dignity, a key question is "whether and how one can do good and avoid evil in circumstances inseparably joining the two" (T. A. Cavanaugh, Double Effect Reasoning). This is not a new question, but it is particularly pressing in the world of modern medicine and health care. While allowing unprecedented opportunities to do good, modern medicine and health care also create a host of morally complex situations where it is unclear "whether and how one can do good and avoid evil." For example, if one believes fetuses are persons, is it permissible to perform a hysterectomy on a pregnant woman in order to save her life? In an attempt to save someone's life, may a doctor perform a risky surgery that may result in that person's death? Christians have often employed the Principle of Double Effect (PDE) to steer their way through such moral quagmires, and many secular doctors and health care providers also appeal to the PDE to justify some of their practices. Unfortunately, the PDE is surrounded by a host of confusions and misunderstandings, especially within medical circles. Some of these misunderstandings also underlie various objections to it. Clearly, there is a need to reexamine the PDE and its applications in the medical professions.
The PDE is often supported and criticized by way of examples: the PDE seems to capture and support our intuitive judgments in certain cases, and therefore it is correct; or, the PDE is false because it rules contrary to our intuitive judgments, or because some other principle(s) actually justify our judgments. In this paper I attempt a careful analysis of the Principle of Double Effect itself. Exactly what is the PDE, and how is it best formulated? What are its presuppositions, and what is its internal logic? How is it distinct from other, similar principles and distinctions, such as that between causing and allowing? How should the PDE function in ethical decision making? What does it establish, and just as importantly, what does it not establish? Through a careful analysis of the PDE, I attempt to clarify a host of issues surrounding it and indicate problem areas that need further work by its defenders. This conceptual clarification will also help remove some of the murkiness surrounding many case-study approaches to the PDE by showing what is required for a case to either confirm or question the PDE.
Stephen Post, Ph.D.
Professor of Preventive Medicine and Director, Center for
Medical Humanities, Compassionate Care, and Bioethics
Stony Brook University
Compassionate Care, Human Dignity and the Future of Health Care
It is not a new idea that compassion should be an essential quality in medical care. Dr. Francis Peabody of Harvard wrote nearly a century ago, “The secret to the care of the patient is in caring for the patient.” In the absence of compassion, patients are dissatisfied and professionals lament a loss of meaning and gratification in their work. Compassionate care makes otherwise technically competent students real healers, motivates them to travel to Haiti after an earthquake or spend their Sundays providing free care for the uninsured, and ultimately makes their professional lives truly successful. Our healthcare systems need to take responsibility for the education of students and professionals in compassionate care through emphasizing professionalism, empathy, and caring for self and others, and by bringing to the forefront the new science of compassion as an evolved human capacity which has a clear impact on patient outcomes and professional flourishing. Dr. Post will present on the theme of human dignity, the problem of objectification, and the science and wisdom of compassionate care with regard to the flourishing of both patients and professionals. Post will refer as well to theological accounts from his new book, The Hidden Gifts of Helping, to be released in February 2011.
Lyn Prater, Ph.D.
Senior Lecturer and Undergraduate Clinical Coordinator
Baylor University Louise Herrington School of Nursing
Lori A. Spies, M.S.N.
Lecturer, Coordinator Family Nurse Practitioner Program and
Mission Coordinator
Baylor University Louise Herrington School of Nursing
Answering the Global Health Care Call: Baylor University Louise Herrington School of Nursing Responds
The Baylor University Louise Herrington School of Nursing
is committed to helping students examine the theological and
practical relationship between faith and the vocation of
nursing. Faculty collaboration with international
stakeholders in the global nursing community provides venues
for guiding nursing students to an understanding of life as
stewardship and work as vocation. As such we seek to prepare
professionals to take leadership roles in periods of change
and conflict wherever the need arises. The nurse who has
entered the profession in response to God's call applies
theories from multiple disciplines and is thus in a unique
position to guard human dignity. It is our mandate as faculty
at a Christian University to fully develop that call to
care.
In response to global health care needs and mindful of
Baylor's mission to expand international opportunities
multiple initiatives have been developed and implemented.
Faculty and students have been inspired, equipped and
mobilized to answer the global health care call for human
dignity.
Multiple global initiatives have been developed; for the
purpose of this paper four projects will be discussed as
exemplars.
The heritage mission trip of the LHSON is the Juarez Mexico
medical mission trip which began in 1976. This endeavor was
initiated by our former Dean, Dr. Geddes McLaughlin, a public
health nurse, who was a visionary in engaging students and
faculty in holistic service. This annual opportunity for
faculty and students to provide health care in Juarez
continued for thirty years and laid the foundation for our
present global perspective.
The first Africa Capstone trip for the family nurse practitioner students was undertaken in 2005. This trip is part of the final semester in a mission focused curriculum that prepares advanced practice nurses to work in low resource settings. The students provide holistic care and education in areas where consideration of human dignity is often lacking.
Missionaries from Cordoba, Argentina approached our
present Dean, Dr. Judy Lott, when they became aware of nurse
faculty needs at the University of Cordoba. The LHSON leader
of this effort focused on developing faculty to faculty
relationships while exploring scholarly and student focused
possibilities. From the initial request faculty and students
from both universities have had the opportunity to visit
their counterpart. Collaborative research and cross cultural
exchange for faculty and students have resulted.
Vietnam is the latest addition to the sites of the LHSON
Christian response to global health care needs. An
exploratory trip scheduled for August of 2010 will provide
faculty with the opportunity to examine ways to partner with
nurses and nurse faculty at Nam Dinh University and a rural
hospital in Chuong My province. Sustainable international
partnerships and cross cultural health care experiences in
the promotion of human dignity is the goal.
As faculty working side by side with our students and international colleagues a rich learning environment is provided where real health care needs can be met and life saving alliances formed. Compassionate care along with excellent skills enables nurses to answer the global health care call in a meaningful way. As we continue to forge these international alliances and understand the needs of our sisters and brothers around the world graduates of Baylor University LHSON are poised to answer God's call and empowered to protect the dignity of our patients and professional colleagues. Nurses, through care and collaboration are the heart and the future of health care.
Michael D. Robinson
Associate Professor of Christian Studies
University of Mary Hardin-Baylor
Divine Image, Human Dignity and Human Potentiality
Often Christian ethicists attempt to ground human dignity and certain core rights (such as the right to life) in some set of essential properties that biological humans possess or are. Often these properties are conceptually tied to notions like "image of God" or "personhood." Among the candidates of divine image-making or person-making characteristics are properties such as rationality, moral awareness, ability to interpersonally relate, etc. Perennial difficulties, however, emerge for attempts to ground human dignity and rights in such properties since the possession of these attributes often varies through the stages of a human organism's biological growth and decline. Further, often individual adult humans possess these properties in greater and lesser degrees, which seems to imply that the possession of human dignity, personhood, and perhaps divine-image may vary even among fully developed adult humans.
In this essay, I will defend the claim that human dignity and the possession of certain core rights results not from the actual possession of key person-making or divine image-making properties but from the potential possession of such properties. I will agree with what might be called a developmental perspective that personhood (and image of God) per se is something that develops or diminishes over time, that diverse biological humans possess these properties in greater and lesser degrees and, thus, (in a certain sense) some humans are more fully persons (and more fully image of God) than others. Nevertheless, I will insist that it is not the actual possession of these properties that establishes human dignity nor grants core human rights but rather it is the potential for possessing them that grounds dignity and core rights.
In turn, I will argue that such a "potentialist" understanding of human dignity and rights is consistent with the (admittedly vague) biblical understanding of humans as image of God. This is the case because the scriptural tradition affirms two broad notions of divine image in humans-one which sees divine image as something humans intrinsically possess, another which sees divine image as something toward which humans are moving but have not yet arrived.
I also will consider some of the implications of this potentialist understanding of human dignity for key issues in applied ethics (such as abortion, euthanasia, and stem cell research), as well as defend the perspective against a number of possible objections. Where appropriate I will acknowledge various earnest challenges to the position proposed.
It should be noted that the viewpoint defended in this essay is similar to but not identical to nor directly dependent on those perspectives espoused by Don Marquis in "Why Abortion is Immoral," Journal of Philosophy 86, no. 4 (April 1989) and Ted Peters in "Embryonic Stem Cells and the Theology of Dignity," in S. Holland, K. Labacqz, and L. Zoloth, eds., The Human Embryonic Stem Cell Debate (MIT Press, 2001).
James J. Rusthoven
Professor of Oncology
McMaster University
A Contemporary Biblical Covenantal Ethic: A Robust Christian Response to Principles-based Biomedical Ethics
Principles-based ethics has dominated biomedical ethics for more than three decades. Articulated and promoted most fervently by Tom Beauchamp and James Childress and coined principlism by some of its early critics, its moral grounding rests on the presumption of a common morality from which four groups of ethical principles (autonomy, non-maleficence, beneficence, and justice) can be distilled. Moral decision-making in this process-driven framework relies on the coherence of an ever-widening body of moral experiences to collect points of convergence, eventually resulting in a state of reflective equilibrium. This framework is primarily intended to foster moral reflection among individuals of diverse basic moral beliefs and claims moral justification grounded in faith in reason-driven consensus rather than in extratemporal authority.
Christians from different traditions have responded to principlism in many ways. In an attempt to address perceived inadequacies of this framework, Edmund Pellegrino has acknowledged helpful contributions of the four principles to biomedical ethics while arguing that the principles need to be renewed in the context of a philosophy of medicine. Such a philosophy focuses on beneficence as care for the needy rather than the autonomy principle that tends to dominate principles-based ethics and on the virtues of the moral agent. From his Protestant tradition, William F. May has agreed with this critique but has gone further to propose a covenantal ethic grounded in the covenantal relationship between God and humankind as revealed in the Word of God. Such an approach moves away from a principles focus and gives priority to relationships that make up medicine and medical practice. This ethic also promotes an intimate link between human personhood and human relationships in light of a covenantal relationship with God. However, May only incompletely addresses the underlying presuppositional and philosophical differences in basic beliefs that distinguish a covenantal and principles-based framework, does not provide a robust reassessment of the four principles within his covenantal ethical framework, and inadequately accounts for the impact and normative nature of the web of relationships in medicine outside that of the physician and patient.
When grounded in the biblical theme of covenant as interpreted in the Reformed Christian tradition, a covenantal ethical framework provides guidance for understanding the normative nature of relationships within the medical encounter. It lays claim to a creational basis for covenantal relationships through the gracious divine offering of a unique relationship between the Creator and humankind. Such an ethic can reorient biomedical ethics toward the relationships that constitute medical encounters while modeling those relationships on the original divine/human covenant. The identity of human participants derives its distinct value and moral worth from its created status as image-bearer of God, an endowed core of human identity that is missing in covenantal models of the pagan Greek traditions. A robust Christian covenantal ethic also encompasses relational duties and obligations inherent in covenantally-modeled relationships. Each relationship in medicine needs to keep its focus on the core purpose of the medical encounter; that is, addressing the needs of the ill and vulnerable.
To this end, each relationship has its own sovereign
sphere of purpose and activity, yet each also intersects with
other medical and non-medical relationships. With increasing
differentiation of care expertise and responsibilities into
new types of caregivers, (e.g., physician assistants and
nurse practitioners), the number and intersects of
relationships has increased, with the risk of losing focus on
patient needs. Working from a covenantal ethic can help to
maintain both the normative integrity of each relationship as
well as interactions between relationships. In addition, for
each participant in medical relationships, a biblical
covenantal ethic requires attentive vigilance to sustain the
sovereignty and integrity of coexisting non-medical
relationships.
The four groups of ethical principles will be
recontextualized through the covenantal ethical framework,
with a relational focus on agape love as the ordering
principle that drives beneficent caregiving while providing a
relational context for respect for human medical
decision-making in a pluralistic culture. A biblical
covenantal ethic can be particularly helpful in working
through the moral status of the unborn. For the human
embryos, for example, such an ethic recognizes their full and
unique moral worth as image-bearers of God and their unique
non-reciprocating relationship with those whose core
responsibility for such embryos is nurturing. Additional
enriching features of such an ethic for biomedical ethics
will be presented.
Joel Schwartz
Graduate Student
Baylor University
An Undervalued Image?: Wolterstorff's Unnecessary Step in Grounding Human Rights
Given the close connection that is typically seen between human dignity and human rights, a conversation that connects human dignity with health care will likely have an account of human rights based on the understanding of human dignity, and depending on how that account defines human dignity and human rights will dictate whether health care is considered to be a human right. My paper critiques a recent Christian account of human rights that is tied to human dignity, while giving brief reflections on how this account and the subsequent critique reflects the present discussion on health care.
In his recent work Justice: Rights and Wrongs, Nicholas Wolterstorff presents an account of human rights. For Wolterstorff, human rights are a matter of respect for the worth of human beings, which he admits could be called human dignity. To not respect that worth is to be unjust. Wolterstorff argues that the worth of human beings in which rights are grounded is a bestowed worth that comes from being loved by God. God loves all and only human beings, that is, all and only those who bear the imago dei, with an attachment love that bestows significant worth on each human from which these rights come. For Wolterstorff, a being that bears the imago dei is a being of the same nature as beings who when reaching maturity exercise dominion over creation. The imago dei is insufficient for giving the worth that is needed to ground human rights, so Wolterstorff argues that the worth must be bestowed on each human by God loving each human.
In my paper, I will argue that Wolterstorff does not consistently follow his own rubric for the grounding of human rights and makes an unnecessary step in his grounding of human rights. Specifically, I will argue that after giving his account of the imago dei, Wolterstorff wrongly discounts the possible value of being a bearer of the imago dei, and this move would render his argument for the necessity of bestowed worth a matter of overdetermination.
Wolterstorff argues that we must have a non-instrumental worth that grounds human rights in order to make sure that all humans, including those lacking capacities that are often used to ground rights, are included in the account of human rights. However, in making his case why being a possessor of the imago dei produces insufficient worth for grounding human rights, he cites a lack of what amounts to instrumental worth. Because the imago dei lacks that instrumental worth, we need God's love to bestow worth upon us in order to ground human rights.
While I agree that being a possessor of the imago dei would produce insufficient instrumental worth to ground human rights, it is unclear why the imago dei would produce insufficient non-instrumental worth. The imago dei does produce some kind of worth for Wolterstorff because it serves as the thing that distinguishes humans from non-humans. The worth is not instrumental, for bearing the imago dei does not mean that you have any particular capabilities, but rather are of a certain kind of nature. However, there is something worthwhile about being of that nature, since God loves all and only creatures who bear the imago dei in a particular way. It seems like it is a non-instrumental worth that is of great worth for Wolterstorff, even if he believes it is insufficient for grounding human rights.
I will finally argue it is likely that a case can be made that the value of bearing the imago dei is similar to the bestowed worth in which Wolterstorff grounds human rights. If such a case can be made, then Wolterstorff does make an unnecessary step in his account of the grounding of human rights and by making that step, he overdetermines the worth that grounds human rights.
I will end the paper with some brief reflections about how this account views health care, and what effect the critique has on the way the account connects with health care.
Patrick T. Smith
Assistant Professor of Theology and Philosophy,
Gordon-Conwell Theological Seminary
Ethics Coordinator, Angela Hospice Care Center, Livonia,
Michigan
Is Palliative Sedation Slow Euthanasia?: A Challenge to Some Equivalency Arguments
Christian health care professionals engaged in palliative care, have a responsibility to do everything possible within theological, ethical, and legal boundaries to medically treat their patients. One complex ethical issue in end-of-life palliative care is the use of palliative/terminal sedation to manage otherwise uncontrollable pain. Some claim that there is no real moral distinction between palliative sedation and physician-assisted death. The implications are clear. Physician-assisted death should be a legal and legitimate end-of-life treatment option for patients along with palliative sedation. If not, then palliative sedation should be prohibited as well. If this line of thinking is correct, then Christians who oppose physician-assisted death on biblical, theological, ethical, and, professional grounds should also oppose palliative sedation. This issue is not only important for health care professionals, but also for pastors, ethicists, Christian counselors, chaplains, and others, who may be called upon to support patients and their families concerning end-of-life treatment options. In this paper, I challenge this general kind of "Equivalency Argument." In this essay, I provide arguments for the conclusion that those health care professionals, Christian or otherwise, who oppose physician-assisted death while maintaining the appropriateness of palliative sedation in certain situations, are not acting inconsistently as some suggest.
Margaret Somerville, D.C.L.
Samuel Gale Professor of Law and Founding Director, McGill
Centre for Medicine, Ethics and Law
McGill University
Is Dignity a Useful, Useless, or Dangerous Concept?
The answer depends on what we mean by human dignity, what
we see as its basis – in particular, secular or
religious or both - , and how we use it. But there is no
consensus in these regards. Moreover, respect for human
dignity is overwhelmingly perceived as doing only good. Are
we, however, overlooking some accompanying harms and, if so,
what are they?
I will look at how dignity is defined and whether it is
connected with morality, religion or sacredness. In the last
context, I will introduce a concept which I’ve called
the “secular sacred.”
The role of dignity in bioethics will also be examined, including by exploring how the concept of dignity functions in specific cases: the sale of organs for transplantation; death and dying and the paradox that both pro- and anti- euthanasia advocates invoke the concept in support of their claims; reproductive technologies, in particular, in relation to using human embryos in stem cell research; and governance of the new technoscience, more generally, especially its use in the search for human perfection and perhaps immortality as proposed by the transhumanists.
I was recently asked by a newspaper editor to write a column on what is currently the world’s most dangerous idea. I responded, “the idea that humans are not ‘special,’ as compared with other animals or even robots, and, therefore, do not deserve ‘special respect.’” In other words, the world’s most dangerous idea at present is that we should reject the concept of human dignity.
Dennis Michael Sullivan, MD
Director, Center for Bioethics
Cedarville University
Human Free Will and Its Relationship to Bioethics
While most human beings believe they make free choices, rational scientific determinism claims that free will is an illusion. On this view, every effect has a cause, including human decision-making. The only influences on our choices are genetic endowments and environmental factors. Therefore, our views of law and ethics should change to accommodate the idea that our choices are constrained, and we should not be held morally accountable for our actions.
On the other hand, my position is that of free will libertarianism. Order, meaning, and purpose in the universe ultimately come from our Creator-God. While determinism is true to the extent that many events follow law-like principles, this does not mean that human nature is necessarily constrained by physical or chemical forces. Our free will is a reflection of God's volitional nature, who has given us the capacity and the responsibility to act for our own good and for that of those around us. Therefore, moral censure and moral praise make sense, and help to define our ethical lives.
This presentation will examine three areas of the free will versus determinism debate. First, the descriptive questions will define what we mean by determinism, and what we mean by free will. The substantive questions will ask if we in fact possess free will, and what is the evidence for this. Finally, the prescriptive questions will examine how all this affects our understanding of human personhood, the self, and bioethical decision-making.
Part of the impetus for this discussion came from a public debate between myself and Dr. William Provine of Cornell University, an atheist evolutionary scientist and hard determinist (March 13, 2010).
Daniel Sulmasy, MD, Ph.D.
Kilbride-Clinton Professor of Medicine and Ethics and
Associate Director of the MacLean Center for Clinical Medical
Ethics
University of Chicago
Dignity and Bioethics: Language Values, and Applications
The word 'dignity' is frequently invoked in discussions of bioethics, but its meaning is often unclear. In this talk, Dr. Sulmasy will review the history of the concept of dignity and distinguish three senses in which the word is used: as inherent in the person, as given by others, and as achieved through development. He will then argue that the first sense is the most important from a moral perspective, and provides a necessary foundation for resolving several particular bioethical problems.
John Swinton, Ph.D., RMN, RNMD
Chair, Divinity and Religious Studies and Professor,
Practical Theology and Pastoral Care
King's College, University of Aberdeen
The Sacrament of the Present Moment: Christian Spirituality, Dignity and the Care of People with Advanced Dementia
Dementia is assumed primarily to be a neurobiological condition which of course, at one level it is. But it is much more than simply neurological decline. The power of the explanatory story that neurobiology offers to us often blinds us to the fact that dementia is first and foremost a profound human experience that is deeply spiritual and theological. Dementia seems to tear away at the very essence of what it means to be a person and raises issues that force all of us to ask question about what it means to be human and to live humanly in the midst of deep forgetfulness. The deep forgetfulness of dementia raises fundamental questions: "What does it mean to love God when you have forgotten who God is?" "What does it mean when you can no longer love God?" "What does it mean to be 'you' when you no longer know who 'you' are?" "Which 'you' will be resurrected?" "Is the person really lost to the illness?" "How can we find salvation when we have forgotten whose we are?" Such theological questions have crucial practical significance. How we answer them will determine how we conceptualise and respond to persons with dementia. In this presentation I will offer a theological reframing of dementia that acknowledges the pain and suffering that this condition brings to sufferers and their families, but offers an alternative reading of the condition within which both hope and salvation remain even in the midst of deep forgetfulness. Beginning from a pastoral reflection on the doctrines of Creation and Resurrection, I will explore ways in which Christian practices that emerge from a specifically Christian spirituality can work towards a different understanding of the experience of severe dementia; such a revised understanding will focus on enabling all of God's people to love God and one another even in the midst of the storms of dementia. Despite the common assumptions that the person "has gone", I will argue that even the most severely demented person remains able to access and to give love. Such love forms the essence of dignity.
Kay Toombs, Ph.D.
Associate Professor Emeritus
Baylor University
Living and Dying with Dignity: A Reflection on Lived Experience
Considerations of human dignity figure prominently in discussions of health care and in the debate with regard to end-of-life care. For those living with incurable illness, considerations of dignity are not abstract. They are, at once, vivid, concrete and urgent and are central to the experience of illness and suffering. In this session I reflect on my experience as a person living with neurological disease (MS), and explore ways in which prevailing cultural values directly contribute to the loss of dignity that accompanies incurable illness and disability. My reflections have been further deepened by sharing the last six months of my husband’s life after he was diagnosed with cancer. I shall suggest that authentic Christian community offers an alternative culture with a radically different value system, one that necessarily enhances human dignity.
Matthew Rottier Voell, JD
Ethics Fellow
Providence Health Care, Vancouver, Canada
Dignity in Law and Health Care: A Canadian Perspective
With the disbanding of the President's Council on Bioethics in 2009 it is unclear what role the principle of dignity will play in American health ethics discourse in the years to come. In Canada the future role of dignity is much clearer. In a series of cases the Supreme Court of Canada has chosen not to employ dignity as the informative principle when adjudicating health care disputes. I argue that this is due to the tendency of the Supreme Court to decide health law cases on the basis of rights to life, liberty and security of the person, rather than the right to equal treatment; which is significant because Canadian equality provisions are traditionally applied with reference to dignity. These decisions have led to the prevalence of a particular conception of dignity in Canada, whereby dignity is employed to empower human rights rather than to constrain action, providing the basis, for instance, of autonomy and medical self-determination.
Assuming dignity continues to play a background role in Canadian legal and bioethical discourse, what does this mean for health care providers in Catholic health care institutions, where dignity has traditionally held a more prominent role? I argue that care providers can uphold the dignity of patients by focusing, like the Supreme Court, on the empowerment of human rights. Understanding dignity as empowering of rights rather than as a right unto itself enables health care providers to address each fundamental right in turn and in doing so ensure respect for the human dignity of each patient.
Brian Edward Volck, MD, M.F.A.
Adjunct Assistant Professor of Pediatrics
Cincinnati Children's Hospital Medical Center, Cincinnati,
Ohio
Body Politics: Medicine, the Church, and the Scandal of Borders
Scripture enjoins Christians to attend to the material needs of our neighbors. First Corinthians, chapters 11 through 13, uses the language of "discerning the body" in liturgical and ecclesial practices, Matthew 25 specifies corporal practices of mercy directed toward "the least of these," and Luke 10 illustrates how far one might be expected to go in recognizing and responding to the someone in need. In John 13, Jesus commands and demonstrates embodied service, washing the disciples' feet.
The technological, commodified and individualistic nature of North American medicine devalues and even obstructs such practices in a world burdened by massive early childhood mortality, resurgent infectious diseases and vast health inequities. It is imperative that Christians recover a theological language to describe and sustain health practices in service to the poor and recognize that the demand of mercy toward our neighbor crosses all borders: political, social, gendered, and religious.
The difficult task of reshaping our lives to meet the needs of the body, sometimes at real cost to ourselves, can only be sustained in community and through communal practices: worshipping regularly and well so that we may learn how to discern the body Christ gathers, resisting the power of medicine to render the poor and suffering invisible, and ceasing to pursue individual health in isolation, as if claims to autonomy and individual choice were true or that the people of God have nothing to say about the practice of medicine.
Myles Werntz
Graduate Student
Baylor University
Obscuring the Person: Dorothy Day and the Critique of Mass Charity
Dorothy Day's legacy has been mined for any number of reasons: her concern for the poor, her pacifist stance, her deep fidelity to the Catholic Church. But little explored is Day's understanding of the person, particularly as Day's concept of the person provides the cornerstone for her theological articulation of social concerns. For Day, there is manifold suspicion of "Mother State", particularly in those activities which the State undertakes for the physical benefit of its citizens. This suspicion is grounded in Day's conviction that "personhood" is the attention to the particular needs of an individual, an individual who must be in communion with others, in contrast to State-based aid which neglects the virtues essential to aiding the person become a person capable of being a person in communion with others.
This paper will explore Day's personalism, particularly examining her reticence to accept institutional funding and support, arguing that for Day, commitment to mass forms of aid and human health are incompatible with the nurture of whole persons. By contrast, Day's approach seeks to tend not to numerical quantities from a central base, but to multiply decentralized locales from which attention to particular needs can be met. Theologically for Day, this mode of decentralization is intrinsic to her understanding of person, as both a particular entity and an entity which must be in relation to others, in contrast to an understanding of 'person' as a centrally definable entity which may have accidental properties which make them different. Day's definition of person thus calls into question broad social aid programs with local branches, in favor of local entities which have happen to have a broadly agreed upon center.
Paz Zorita, MSSA, Ph.D.
Associate Professor, School of Social Work
Arizona State University
Social Work Professional Identity and Catholic Identity: An Exploration of the Source of Conflicts
Social work has deep roots in a Christian understanding of the human person, in fact, the social gospel inspired the vocation of many of its founders at the turn of the last century. Social work stated values of service to the needy, social justice and dignity of the individual continue to this day to attract Christians to the profession. There is a linguistic resonance between Christianity's self-understanding and social work's avowed values. And yet, many orthodox Christians, once they enter the professional culture, find themselves having to choose between their social work persona and their Christian identity. They find that the two identities do not mix well and that if they are not socially and mentally vigilant to keep them separate, they risk professional embarrassment or worse. Orthodox Christians often experience a profound alienation between the professional perspective and the Christian roots of their professional calling. The purpose of this presentation is to explore the origins of that alienation from a Catholic perspective.
The tension between Christianity and social work has most often been explored from the professional point of view. Even explorations from a Christian perspective have adopted the professional perspective as the point of departure, conceding to the professional side the field and language of the exploration. The result, I think, is that Christian scholars have responded with some self-reproach or more recently, defensively. Regardless of the value of those responses, I believe that the exploration can be moved to the Christian field, using its native tongue.
The exploration is more urgent than ever. For the longest stretch of social work history, many of the issues confronted by social workers, Christians or otherwise, were about feeding the hungry, clothing the naked, housing the homeless, receiving the stranger, and comforting the sad and lonely. The common ground was ample enough to accommodate any willing hand and the perspectives that motivated them seemed to matter less than the practical results of taking care of those in great need. Today, some common ground remains, but beyond it there is a huge area in which the professional self and the Christian identity of the professional are in deep conflict. Issues related to bioethics, human sexuality, autonomy, human rights, and the individual conscience of the professional are deeply contested areas and social workers are not mere bystanders. On purpose or by default they lend their hands to policies and programs that may conflict with their own sense of the good. It is necessary, therefore, to make explicit the source of those conflicts, not only for Christian professionals seeking their own moral integrity, but for non-Christians as well, whose own integrity would demand an account of themselves based not on straw arguments but on serious ones traceable to a respectable tradition. The clarification is also necessary for employers, who need to understand what it means to have a diverse labor force with Christians in it, Christians who may reclaim a voice in the work place. The clarification is even more important for consumers of social services, the most vulnerable of the professional chain, whose integrity is too often expropriated by bureaucracies they have not means of sidestepping.
The paper will explore SW Speaks as a basic document of social work self-understanding, particularly on themes related to individual autonomy, bioethics, and human sexuality. It will contrast the aspirations made explicit in the document with the understanding of the good life gleaned from a Christian anthropology, and will identify the points of friction at the same time that the origins of those conflicts become more clear.
Institute for Faith &
Learning
Baylor University
One Bear Place #97270
Waco, TX 76798-7270
(254) 710-4805 (phone)
(254) 710-4713 (fax)
IFL@baylor.edu
www.baylor.edu/ifl