Bioethics: A Primer for Christians, 4th ed.
By Gilbert Meilaender
Eerdmans, pp. 172, $19.99
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Review by Gerald McKenny
Bioethics textbooks typically have three characteristics. They are written for health care professionals. They focus on abstract moral principles. And they make for dull reading. On all three counts, Bioethics: A Primer for Christians is a welcome exception.
Although parts of it are aimed at professionals, it is written for all Christians who seek to live faithfully amid illness and imperfection. It focuses not on moral principles but on Christian convictions about our creaturely nature, suffering, and redemption. These convictions are applied to reproductive and genetic technologies, abortion, assisted suicide and euthanasia, refusal of treatment, organ donation, and clinical and biomedical research. Last but not least, it is a delight to read.
The major theme of the book appears in the first chapter. Alluding to Genesis 2, Meilaender considers our dual nature: We are finite beings made from dust, limited by our biological nature. But we are also free, God-breathed spirits who, to some extent, transcend the conditions of our nature. Ideally, we would do justice to both aspects of our creatureliness.
But as Meilaender notes, many people today cherish freedom to the detriment of finitude. We see this in the tendency to identify personhood with capacities such as consciousness and self-determination that are proper to our freedom and to regard those who lack these capacities as not truly persons. On this view, abortion and the production of embryos for research are permissible, as embryos and earlier-stage fetuses lack the capacities that make them persons. The withholding of life-sustaining treatments, such as feeding tubes, from those who lack consciousness but are not terminally ill is also justifiable, as these patients no longer have person-constituting capacities.
Meilaender also finds devaluation of finitude in our disregard for the biological ties that bind parents and children. Examples include reproductive technologies that make use of sperm or ova from third parties or arrange for surrogate mothers to carry a child to term on behalf of the rearing parents (who may or may not be the biological parents). The significance of the parent-child bond is also compromised, Meilaender thinks, by prenatal genetic testing, which encourages a merely conditional commitment of the mother to her developing child.
Finitude is also devalued when we treat the body as a mere instrument. Here, Meilaender criticizes certain organ procurement practices for reducing the living body to a “useful pre-cadaver” in the quest to increase the supply of transplantable organs. And of course, the ultimate assertion of freedom over finitude occurs in physician-assisted suicide and euthanasia.
Meilaender’s objections to these practices raise two questions. First, does he commit the opposite error, cherishing finitude to the detriment of freedom? Meilaender does prioritize freedom in justifying contraception, somatic cell gene therapy, and the refusal of burdensome treatment. And he qualifies the importance of biological bonds by permitting abortion in certain rare cases and justifying some forms of organ donation or participation in clinical research, both of which benefit strangers, not biological kin.
But he is most concerned to do justice to finitude. He wants us to see that we are persons throughout the entirety of our embodied life, not only during those phases of it when we can exercise cognitive and volitional capacities. Our personal histories begin without those capacities and may also end without them, yet we are the persons we are all the way through. As for those who lack such capacities or lose them, the question is not whether they are persons but how we can best care for them as the persons they now are.
Second, does Meilaender see only what contemporary health care does wrong, not what it does right? Meilaender gratefully acknowledges medicine as God’s gift, but he also thinks Christians should not look to medicine to overcome infertility, guarantee us perfect children, end our lives at our request, or make good every tragedy.
His empathy for people tempted to do so is unfailing. But as he frequently reminds us, God deals with our suffering by taking it into God’s own life in Jesus Christ, and in response we bear one another’s burdens as members of one body through baptism. Surely that must be our ultimate hope in the face of illness and imperfection, whatever penultimate hope we place in medicine.
In the end I question whether the moral life consists of a tension between finitude and freedom. But there is no better introduction to bioethics for Christians. Whether in adult education classes or college and seminary classrooms, readers will find it accessible, informative, illuminating, and edifying.
Dr. Gerald McKenny is the Walter Professor of Theology at the University of Notre Dame.