H. Tristram Engelhardt, Jr.; Bioethics after the Enlightenment, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 8, Issue 3, 1 January 20.

The essays in this issue of JMP are devoted to critical engagement of my book, The Anticipatory Corpse. The essays, for the most part, accept the main thrust of my critique of medicine. The main thrust of the criticism is whether the scope of the critique is too totalizing, and whether the proposed remedy is sufficient. I greatly appreciate these interventions because they allow me this occasion to respond and clarify, and to even further extend the argument of my book. (...) In this response essay, I maintain that the regnant social imaginary of medicine is the regnant social imaginary of our time. It is grounded in a specific ontotheology: where ontology is a power ontology; where material is malleable to the open-ended organization of power and dependent only on working out the efficient mechanisms of its enactment; where ethically it is oriented only to the immanent telos of utility maximization in the short run, and ultimately to some posthuman future in the long run. This ontotheology originates in the anticipatory corpse and is ordered toward some god-like posthuman being. The entire ontotheology finds enactment through the political economy of neoliberalism. This social imaginary constantly works to insulate itself from other social imaginaries through the use of its institutional power, through marginalization, circumscription, or absorption. The modern social imaginary of neoliberal societies marginalizes and politically isolates other social imaginaries, or transforms them into something acceptable to the neoliberal imaginary. Yet, these other social imaginaries could influence the larger social imaginary in novel ways, sometimes through withdrawal and sometimes through challenges. These other practices—again, usually practices ordered according to different ontological and teleological purposes—might serve as a source of renewal and transformation, but only if the practitioners of these other social imaginaries understand the ontotheological powers that they are up against. (shrink)

Engelhardt’s critiques of “generic chaplaincy” rely on the argument that chaplains are secular; however, professionally certified chaplains must maintain ordination with an ecclesial body. Engelhardt’s concerns are better directed at the academic subfield that supports and trains chaplains: pastoral theology. That field is somewhat guilty of forced ecumenism because it attempts a universal theology rooted in experience and the social sciences rather than the authority of creeds, ecclesial bodies, or traditions. Pastoral theology makes too many sacrifices to the authority of (...) the behavioral sciences without sufficient appreciation for sacramental theology and the spiritual bonds that rituals effect in communities of shared belief. In this model, ritual is reduced to its instrumental value in addressing the emotional needs of patients rather than viewed as efficacious spiritual care. Chaplains should take a holistic approach to theology so that they can better identify the duties and scope of interfaith spiritual care. (shrink)

Appeals to the miraculous are common in healthcare, and arguments about end-of-life decision-making can quickly become theological. Assessments of hope have been recommended within the biopsychosocialspiritual model of medicine, but these assessments fail to account for the theological dimension of hope. Examples of failed assessments include recent efforts in palliative care and classic works, such as On Death and Dying by Elisabeth Kübler-Ross. To adequately address the patient’s and family members’ hopes without patronizing or harming the patient, assessments must be (...) done by a person trained in theology. (shrink)

The current manner of practicing chaplaincy in health care is one which prizes the multi-faith chaplain. When one asks multi-faith chaplain, “To whom are you beholden?” they will respond, “The patient.” This is evident in the way that chaplaincy is currently practiced and taught, which prizes the use of psychology over recourse to theology. Chaplaincy’s recourse to practices whose aims are directed toward the efficient rather than the eternal challenges its original telos. This paper looks at this question by blending (...) a Catholic and Engelhardtian approach to conclude that chaplains should recognize that they are beholden to God, rather than to patients’ autonomy. (shrink)

In this issue of Christian Bioethics, we invite chaplains and theologians to examine the role of the hospital chaplain in the contemporary institutional setting of the hospital. The simplicity of the chaplain’s role is often taken for granted; yet, this role is actually multivalent, with duties and loyalties pulling from many different sides. Chaplains are people of faith, ordained and/or endorsed ministers, and pastoral care professionals; they are at once beholden to God, to their own faith expression, and to their (...) sense of vocation, to the hospital, and to the patient. With various loyalties and responsibilities in mind, we must ask the question, “To whom is the chaplain beholden?” The responses in this issue critically and constructively examine this question, providing theological resources that call chaplaincy away from the dominant modes of medicine. Whether through a primary loyalty to their calling, to God, to Divine presence, or to the spiritual formation of the patient, the authors in this special issue aim to help chaplains find theological resources to faithfully withstand the tensions they face in modern medical institutions. (shrink)

Spiritual care is a profession in transformation. It is evolving from a denominationally bound profession into a specific kind of healthcare profession. In the Netherlands, as elsewhere, debates are going on about the introduction of standards in public services such as health care. Many spiritual counsellors oppose standardization of spiritual care. Most importantly, standards seem to conflict with their sanctuary position as well as with the ?theory of presence? that many spiritual counsellors adhere to. A questionnaire was distributed among spiritual (...) counsellors asking them about the nature and number of standards they work with and the positive and negative effects of these standards on their daily work. This exploratory study shows that only a few spiritual counsellors work with standards. It also reveals that those who work with standards are neutral to positive about the ways in which standards influence their work. In particular, spiritual counsellors working with standards state that doing so does not conflict with their sanctuary position, nor with their ?being present?. The responses suggest that it does not seem to be standards as such but rather the social setting within which the standards are used that determines the effects that standards have on the content and quality of spiritual care. The paper concludes with some recommendations and suggestions for further investigation. (shrink)

Secular bioethics fails to grasp the central moral and spiritual realities of medicine. As the authors in this issue of Christian Bioethics argue, contemporary healthcare practice is often based on the false premise that medical science can secure the safety of human life. Yet, the standard “biopsychosocial model” of medicine fails to grasp the theological dimensions of healthcare often harming patients and their families in the process. Indeed, as the articles explore, all too often secular bioethics manipulates medicine to achieve (...) immoral purposes, such as active euthanasia of the sick or elderly. Such spiritual decay is acutely manifested in the pressure put on patients to accept an economically efficient and medically expedient assisted death as well as in how society often treats the human body as mere res—a thing unimportant in itself apart from animation as a living person. Together the articles illustrate that without careful religiously grounded advice modern medicine is often spiritually disorienting for both patients and practitioners. (shrink)