This article looks at the question of sin and disease in bioethics with a spiritual-theological analysis from the book of Job. The biblical figure Job is an innocent and just man who suffered horrendously. His dialogues with others—his wife, his friends, and God—can give many valuable insights for patients who suffer and for those who interact with them. Family, friends, physicians, nurses, chaplains, and pastoral workers can learn from Job how to communicate properly with sufferers. The main question for Job (...) was how to maintain the tension between God’s justice and God’s mercy and not yield to the temptation of cursing God but to speak well of Him in moments of difficulties. (shrink)

This article explores enchantment, disenchantment, and re-enchantment in reference to modern medicine’s view of the body. Before considering Weber’s enchantment paradigm, I question some core assumptions regarding sociology as methodologically scientific and value-free. Furthermore, I draw on Jenkins who helps to illustrate the difficulty of rooting terms such as enchantment, disenchantment, and re-enchantment; the question remains “which” historical and cultural period is employed as the basis for such sociological terms. Such questions are critical, but not entirely dismissive of modern medicine (...) as “disenchanted”; with some more explicit foundational and presuppositional context, disenchantment can be a helpful notion for approaching questions of the “new body.” St. Gregory Palamas’ Christian materialism and mystical anthropology present such an explicit foundation. Moreover, this Patristic foundation moves past the postmodern aporia of emphasizing either immanence or transcendence—two polar attractions that factor heavily in the way modern medicine views the body. (shrink)

This article will examine the Catholic concept of global justice within a health care framework as it relates to women's needs for delivery doctors in the developing world and women's demands for assisted reproduction in the developed world. I will first discuss justice as a theory, situating it within Catholic social teachings. The Catholic perspective on global justice in health care demands that everyone have access to basic needs before elective treatments are offered to the wealthy. After exploring specific discrepancies (...) in global health care justice, I will point to the need for delivery doctors in the developing world to provide basic assistance to women who hazard many pregnancies as a priority before offering assisted reproduction to women in the developed world. The wide disparities between maternal health in the developing world and elective fertility treatments in the developed world are clearly unjust within Catholic social teachings. I conclude this article by offering policy suggestions for moving closer to health care justice via doctor distribution. (shrink)

Modern concepts of vocation often refer to some ambiguous understanding of personal occupation or religious life. These interpretations appear to be in tension with the Christian understanding of vocation as the call of God given to a community to a certain way of living. Christian physicians live into this communal vocation when they remain present to the suffering as a sign of God’s faithfulness. This vocational practice of medicine is threatened by a distorted understanding of the body that stems from (...) what Max Weber called the “disenchantment” of the world. By bringing an understanding of the medicine that stems from Weber’s disenchantment into conversation with the language and beliefs of the church, this essay will seek to explore practices that might serve to re-enchant an understanding of the body and the practice of medicine as a form of Christian vocation. (shrink)

In essays written throughout his career, Stanley Hauerwas has unfolded a Christian vision of the marriage bond and the presence of children that seeks insistently to place these seemingly natural bonds within the new family of God that is the church. I examine his understanding, aiming to appreciate the Christian vision displayed while also suggesting that his emphasis on the new thing God does in the church is sometimes allowed to absorb and thereby lose the distinctive significance of the created (...) bonds of marriage and family. (shrink)

Following the revival of virtue theory, some moral theorists have argued that virtue ethics can provide the basis for a radical politics. Such a politics essentially departs from the liberal model of the moral agent as an autonomous reason-giver. It instead privileges an understanding of the agent as conditioned by her community, and in the case of social oppression and marginalization, communal virtues may become a vehicle for social change. This essay compares political appropriations of virtue theory by Christian theologian (...) Stanley Hauerwas and secular feminist thinkers Lisa Tessman and Margaret Urban Walker. Hauerwas and feminist theorists both embrace a kind of embodied vulnerability as a political virtue, arguing that it enables more genuine social recognition. The virtue feminist critique is more robust than Hauerwas's, however, insofar as it understands mutual recognition to involve acknowledgment of social difference and the concomitant pursuit of justice. (shrink)

Responding to Max Weber’s modern diagnosis of nature, science, and medicine as disenchanted, this article aims to reenvision nature and medicine with a sense of enchantment drawing from the Christian themes of creation, Christology, suffering, and redemption. By reenvisioning nature as enchanted with these theological themes, the vocation of medicine might be revitalized in terms of suffering presence, healing care, and works of mercy toward the neighbor in need.

What is Christian about Christian bioethics? The short answer to this question is that the Incarnation should shape the form and content of Christian bioethics. In explicating this answer it is argued that contemporary medicine is unwittingly embracing and implementing the transhumanist dream of transforming humans into posthumans. Contemporary medicine does not admit that there are any limits in principle to the extent to which it should intervene to improve the quality of human life. This largely inarticulate, yet ambitious, agenda (...) is derived first in late modernity's failed, but nonetheless ongoing, attempt to transform necessity into goodness, and second the loss of any viable concept of eternity, thereby stripping temporal existence of any normative significance. In short, medicine has become the vanguard of a profane attempt to save humankind by extracting data from flesh. In response, it is contended that an alternative Christian bioethics must be shaped by the Incarnation, the Word made flesh. This assertion does not entitle Christians to oppose the posthuman trajectory of contemporary medicine on the basis of any natural or biological essentialism. Rather, it is an evangelical witness to the grace of Christ's redemption instead of the work of self-transformation. It is Christ alone who thereby makes the vulnerability and mortality of finitude a gift and blessing. Specifically, it is maintained that the chasm separating necessity and goodness cannot be filled but only bridged through the suffering entailed in Christ's cross, and through Christ's resurrection eternity becomes the standard against which the temporal lives of human creatures are properly formed and measured. Consequently, Christian bioethics should help us become conformed to Christ rather than enabling selftransformation. (shrink)

In this paper I aim to show why pediatric suffering must be understood as a judgment or evaluation, rather than a mental state. To accomplish this task, first I analyze the various ways that the label of suffering is used in pediatric practice. Out of this analysis emerge what I call the twin poles of pediatric suffering. At one pole sits the belief that infants and children with severe cognitive impairment cannot suffer because they are nonverbal or lack subjective life (...) experience. At the other pole exists the idea that once child suffering reaches some threshold it is ethical to eliminate the sufferer. Concerningly, at both poles, any particular child vanishes from view. Second, in an attempt to identify a theory of suffering inclusive of children, I examine two prominent so-called experiential accounts of suffering. I find them both wanting on account of their absurd entailments and their flawed assumptions regarding the subjective experiences of people who cannot communicate expressively. Finally, I extend arguments found in Alastair MacIntyre’s Dependent Rational Animals to argue that child suffering can be understood only as a set of absences—absences of conditions such as love, warmth, and freedom from pain. An evaluation of these absences reveals the exquisite dependency of children. It also discloses why pediatric suffering is necessarily a social and political event. Unlike adults, children will never be either the authors or the mitigators of their own suffering. Rather, children must rely wholly on others in order to resist suffering, grow, and flourish. (shrink)

Scripture is somehow normative for any bioethic that would be Christian. There are problems, however, both with Scripture and with those who read Scripture. Methodological reflection is necessary. Scripture must be read humbly and in Christian community. It must be read not as a timeless code but as the story of God and of our lives. That story moves from creation to a new creation. At the center of the Christian story are the stories of Jesus of Nazareth as healer, (...) preacher of good news to the poor, and sufferer. The story shapes character and conduct and enables communal discernment. (shrink)

Persons of diminished capacity, especially those who are still legally competent but are de facto incompetent should still be able to participate in moderately risky research projects that benefit the class of persons with similar diseases. It is argued that this view can be supported with a modified communitarianism, a philosophy ofmedicine that holds that health care is a joint responsibility that meets foundational human needs. The mechanism for obtaining a substituted consent I call ``community consent,'' and distinguish this from (...) the usual family or surrogate consent for treatment. Care givers are included in the community that might consent for an individual who has no identifiable family members. (shrink)

To set medicine within the context of a good or faithful life requires virtues that give physicians and patients the skills to understand and practice the kind of care medicine is capable of giving. We begin with a prayer that names some of these virtues. We then show how the language of medicine impedes these virtues by fostering the illusion that medicine will free us from illness and mortality. While Aristotle’s account of virtue and happiness seems capable of telling us (...) how to live with finitude, Jonathan Lear shows how it involves another fantasy of escape from it. We then show how Karl Barth’s account of health offers physicians and patients a language by which both the capabilities and the limitations of medicine may serve rather than undermine a good life. 1. (shrink)

This article questions the notion of a disembodied theology which can provide ultimate answers about an absolute God. It places this questioning within the truly challenging arena of mental health. While issuing challenge to theology the author calls for a pastoral theology that is willing to cross boundaries, those that were perhaps not even previously imagined. This is a daring, moving and embodied challenge to the more constraining and controlling areas of theology and pastoral care.

When physicians today appeal to “conscience,” it has been alleged such exercises pejoratively reflect “conscience without consequence” as contemporary practitioners are said to be insulated from the consequences of such decisions. It has also been implied these physicians avoid traditional professional responsibilities—including providing charity care and making house or night calls. The assertions demand clarification. Fundamentally, what traits constitute an integrated professionalism specific to Christian physicians? Historical evidence verifies sanctity-of-life affirmations by Christian physicians throughout Church history. However, surveying Christian medical (...) practices in the initial centuries of the Common Era, and more recently in the United States, supports integration of conscience with philanthropy and a rigorous definition of a medical vocation. These suggest there may be deterioration in a holistic commitment to medicine in the United States. Reclaiming an integrated professional paradigm—wherein conscience, philanthropia, and vocation are combined—is essential to an authentic contemporary witness. (shrink)

This article retraces progression of Engelhardt’s work so as to place After God in broader context. In The Foundations of Bioethics, Engelhardt argues that given the moral pluralism that is at the core of postmodernity, only a merely formal morality of permission can bind moral strangers in peaceful coexistence. In The Foundations of Christian Bioethics, Engelhardt presents a bioethics that binds Orthodox Christian moral friends. After God shows itself more pessimistic about the possibility of a merely formal morality of moral (...) friends and calls traditional Christians to wage a culture war. These reflections close with some criticisms of Engelhardt’s philosophical-theological project. (shrink)

In The Anticipatory Corpse, Jeffrey Bishop claims that modern medicine has lost formal and final causality as the dead body has become epistemologically normative, and that a singular focus on efficient and material causality has thoroughly distorted modern medical practice. Bishop implies that the renewal of medicine will require its housing in alternate social spaces. This essay critiques both Bishop’s diagnosis and therapy by arguing, first, that alternate social imaginaries, though perhaps marginalized, are already present within the practice of medicine. (...) And second, the essay argues that alternate social imaginaries in medicine can be reclaimed not through separatist communities but in the re-narration of conceptually underdetermined practices. Given Bishop’s invitation for theology to engage medicine, this essay then draws from theologian Dietrich Bonhoeffer for the kind of diagnosis and therapy currently needed, concluding with a contemporary example of how an alternate social imaginary is being instantiated in modern medicine. (shrink)

In his 1917 lecture “Science as a Vocation,” Max Weber challenged current and aspiring scholars to abandon any pretense that science bears within itself any meaning. In a disenchanted age, he argued, science could at best offer “knowledge of the techniques whereby we can control life... through calculation,” and any meaning or moral direction to scientific research—including religious meaning—must be imposed on it from without. Weber presciently anticipated that many present-day health care practitioners would struggle to find meaning for their (...) work within complex “state-capitalist” health care systems, along with predictable quasi-religious responses. But how are Christian practitioners to practice faithfully in a disenchanted age? The authors of this special issue lean deeply into the loci of Christian theology and Christian practice, some challenging the views of the body and of nature that informed Weber’s theory of disenchantment, and all offering resources and paths by which practitioners might “look the fate of the age full in the face” with courage and wisdom. (shrink)

When thinking about the intersection of care and Christian bioethics, it is helpful to follow closely the account of Ruth, who turned away from security and walked alongside her grieving mother-in-law to Bethlehem. Remembering Ruth may help one to heed Professor Kaveny?s summoning of Christians to remember ?the Order of Widows? and the church?s historic calling to bring ?the almanahinto its center rather than pushing her to its margins.? Disabled, elderly and terminally ill people often seem, at least implicitly, expendable. (...) By hearing the scriptural account of Jesus? steadfast great-grandmother, readers may recall another way. One may read Ruth?s care for Naomi as a performative, prophetic act of faith. Ruth?s faithful resolve, when set next to Orpah?s prudent way, challenges the notion that a bioethic of care is innately feminine, and may further call women and men corporately to participate in a kind of care that is strenuous work. My thanks to Cathleen Kaveny for allowing me to play off the title of her insightful essay. Thanks also to Willie James Jennings, whose 1998 baccalaureate sermon on Ruth inspired and much informed this essay. I wish also to thank Ellen Davis, who taught me to read Hebrew, and to read Ruth. (shrink)

Every day around the country, patients are discharged from hospitals without difficulty, as the interests of the hospital and the patient tend to align: both the hospital and the patient want the patient to leave and go to a setting that will promote the patient’s continued recovery. In some cases, however, this usually routine process does not go quite as smoothly. Patients may not want to leave the hospital, or they may insist on an unsafe discharge plan. In other cases, (...) there may simply be no good place for the patient to go. These complex hospital discharge situations often involve ethical, legal, financial, and practical considerations, but the ethical issues inherent in these dilemmas have received only sporadic attention from clinical ethicists at best, leaving patients, providers, administrators, and caregivers unsure about what to do. When the ethical issues are in fact brought to light, analysis usually proceeds based on a consideration of the principles of autonomy, beneficence, nonmaleficence, and justice. However, principled analysis often fails to present patients and providers with a satisfactory solution, as the principles inevitably conflict. In this paper, I argue that difficult discharges are ethical dilemmas worthy of scholarly attention that goes beyond principlism, and I argue that providers and those involved in discharge planning ought to cultivate what philosopher Alasdair MacIntyre calls “virtues of acknowledged dependence” in order to care for these patients and their families. I first trace the current conversation about difficult discharge and show that the principled approach to resolving discharge dilemmas is not sufficient. I then argue that a new approach is needed, and to that end, I offer practical ways in which MacIntyre’s account of the virtues of acknowledged dependence may help patients, providers, and family members to navigate issues of difficult discharge. (shrink)