Bioethics and Bioethical Decision-Making

To start with the prescriptive, we can say very generally that as Christians we want to attune our purposes and actions with the purposes and actions of God in relation to us. Much more could be said in spelling that out, but let me move more specifically in the directions of bioethics. The next step is to suggest some midrange principles that stand about half way between the general imperative to live in harmony with God's purpose and actions and the specific facts related to bioethical issues. These principles will provide a framework for understanding how theologians relate general principles to particular cases. If we look at how Christians actual make decisions in this areas, it is helpful to think of them as reasoning on the basis of two different but complementary perspectives. Image two polar extremes with a continuum between them. One of these poles I will call the perspective from creatureliness, and the other I will call the perspective from creativity. Or we can look at the contrasts equally well by seeing that one starts with finitude, and the other starts with freedom.

This theological orientation starts with human finitude. It stresses human creatureliness. A given order has been established by God and is thus present in nature or in divinely established covenants. Our duty is to respect the divinely established order and not violate it. Human freedom must be exercised within prescribed boundaries. Care must be taken to avoid doing harm. Hence, this orientation will be cautious and reluctant to take risks. It tends to see death itself at the worst evil and life as the highest good. As long as there is a chance of recovery or at least minimal quality of life, we should do all we can to extend life.

This theological perspective starts with human freedom and creativity. People are co-creators with God. We have the duty and privilege of entering responsibly into reordering the givenness of nature. Reason and imagination can increase the range and depth of human happiness and fulfillment. The creation is unfinished. God invites us to participate in the creative transformation of human existence. Limits are to be transcended responsibly. Our duty is to make things better. This calls for a bold approach willing to take risks for the sake of achieving a greater good. The worst evil is not death but intense pointless, irremediable, long-term suffering. The highest good is a meaningful quality of life that makes existence worthwhile. Existing is the precondition for realizing other values -- enjoyment of life, usefulness to others, exercise of the full capacities of personhood, etc.

We can spell this out by looking at some of the more detailed features that follow from these two general orientations:
 

Perspective I		Perspective II
1. Creatureliness  2. Exercising creativity within the limits of moral freedom 3.Being dutifully obedient to prescribed norms 4, Doing no harm 5. Caution and risk-avoidance 6. Death as the worst evil		1. Creativity  2. Using creative freedom morally to invent novelty 3. Being creatively responsible contextually 4. Doing good 5. Boldness and risk-taking 6. Extreme, pointless suffering as the worst evil
Finititude		Freedom

1. These two perspectives define a continuum that runs between two extreme poles. A given person may combine these perspectives at any point along the continuum. Hence, an indefinite variety of outlooks may result.

2. Perspective I tends toward principles that are valid in all circumstances. Perspective II puts emphasis on the context and on freedom to make choices on particular occasions that are appropriate to the situation in the light of fundamental obligations and goals. Principles and context may be variously combined.
3. This scheme is most useful as an analytical tool to uncover the presuppositions that underlie moral positions that are actually taken. It is not sufficient or even necessarily helpful as a guide to constructive decision-making of a normative sort.

4. The examples given are typical positions that are to be found in the vicinity of the pole under which it is listed. Variations are possible. For example, Roman Catholic theory insists that every sexual act must be open to procreation. Paul Ramsey argues that it is not every sexual act but only the realm of reproduction that is not to be severed from intercourse between wife and husband. Hence, birth control may be used by married couples for rational family planning, but no reproduction is to take place outside married love. Hence, in vitro fertilization, artificial insemination by other than the husband, surrogate motherhood, etc. are immoral. At the other extreme, Joseph Fletcher would reject both of these positions, asking only what love requires or permits under given circumstances, and love requires or permits whatever maximizes human good, all things considered.

These perspectives can be illustrated by looking at some specific theologians. Paul Ramsey fits beautifully into the first perspective, the one that stresses finitude and creatureliness. With respect to reproduction, Ramsey says that sex has two purposes - the expression of married love and creating new life. These two functions are not to be separated. Hence, he goes on to argue that sexual intercourse is not to take place outside marriage, and procreation is not to take place outside the sphere of sexual love between two married partners. This union between sexual love and reproduction reflects the covenant between God and the world. In love God created the world. In love we are to create new human life. What God has joined should not be put asunder. He disagrees, however, with the Roman Catholic position that every sexual act must be open to life, and hence all unnatural or artificial forms of birth control are condemned. Ramsey says it is not every sexual act that is crucial but the connection between reproduction and married love. Hence, birth control in the interest of family planning is legitimate. Ramsey would, however, rule out artificial insemination when the husband is not the donor, test-tube fertilization, cloning, and genetic engineering. With respect to the last item, Ramsey distinguishes between the treatment of a specific genetic disease in an individual person and the attempt to improve the human race through selective breeding. The human race is not a patient. To try to redesign the human race through genetic engineering reflects a disdain with the world that God has actually created, and it violates the covenant between sexual love and reproduction. It is an attempt to play God by redesigning the race before we have learned to live as the human beings we were created to be. This form of genetic engineering is intrinsically forbidden by the divine covenant that sets limits to our freedom.

The perspective starting from creativity and freedom is nicely represented by Karl Rahner, a Roman Catholic theologian. Humanity, he says, is essentially "a freedom event." As created, humanity is unfinished. He imagines a world in which humanity is both the experimenter and the experiment. This is a long way from the way Paul Ramsey thinks. Perspective II is also represented by the Protestant theologian Joseph Fletcher. Humanity is most fully expressed in "rational creativity." As a product of rational creativity, a baby produced in a test tube would be, in that sense, more human than one produced the old-fashioned way. A perspective that starts with an emphasis on freedom and creativity will not be worried about playing God but will ask how we can use our reason and imagination to make things better, including the human race if we can learn how to do it safely and effectively. Ramsey appreciates science and technology, but human creativity must be employed within the limits God has placed upon us. Rahner and Fletcher will appreciate science and technology in more ambitious terms. They will be open to whatever science can come up with and what technology can do that will enable us to be co-creators with God in finishing the creation and improving life on this earth.