Medicalization has been a process articulated primarily by social scientists, historians, and cultural critics. Comparatively little is written about the role of bioethics in appraising medicalization as a social process. The authors consider what medicalization means, its definition, functions, and criteria for assessment. A series of brief case sketches illustrate how bioethics can contribute to the analysis and public policy discussion of medicalization.

This essay explores the claim that bioethics has become a mode of biopolitics. It seeks to illuminate one of the myriad of ways that bioethics joins other institutionalized discursive practices in the task of producing, organizing, and managing the bodies—of policing and controlling populations—in order to empower larger institutional agents. The focus of this analysis is the contemporary practice of transnational biomedical research. The analysis is catalyzed by the enormous transformation in the political economy of transnational research that has occurred (...) over the past three decades and the accompanying increase in the numbers of human bodies now subjected to research. This essay uses the work of Michel Foucault, particularly his notion of docile bodies, to analyze these changes. Two loci from the bioethics literature are explored—one treating research in the United States and one treating research in developing countries. In the latter, we see a novel dynamic of the new biopolitics: the ways in which bioethics helps to create docile political bodies that will police themselves and who will, in turn, facilitate the production of docile human bodies for research. (shrink)

This article critically evaluates the conception of conscience underlying the debate about the proper place and role of conscience in the clinical encounter. It suggests that recovering a conception of conscience rooted in the Catholic moral tradition could offer resources for moving the debate past an unproductive assertion of conflicting rights, namely, physicians’ rights to conscience versus patients’ rights to socially and legally sanctioned medical interventions. It proposes that conscience is a necessary component of the moral life in general and (...) a necessary resource for maintaining a coherent sense of moral agency. It demonstrates that an earlier and intellectually richer conception of conscience, in contrast with common contemporary formulations, makes the judgments of conscience accountable to reason, open to critique, and protected from becoming a bastion for bigotry, idiosyncrasy, and personal bias. (shrink)

Augustine’s legacy, particularly his view of marriage as being primarily procreative and the sin of mutually desired non-procreative sex, has had a lasting impact on sexual theology and ethics in the Catholic Church. Yet indulging in the Augustinian legacy without reflection and regarding children as the end goal of marriage has led to the unchallenged assumption that children are needed in every marriage. I will examine the problematic concept of matrimony as a necessary producer of children through a variety of (...) ethical lenses – the environmental, the feminist, and the bioethical – and provide an alternative to the procreative norm of sexual expression. By focusing on the unitive aspect of marital love instead of the procreative, partners are liberated to realize their union as fully mature, regardless of biological generation thus addressing ethical concerns and providing a theological alternative to the procreative marriage. (shrink)

With the rapid progress and considerable promise of nanobiotechnology/neurosciences there is the potential of transforming the very nature of human beings and of how humans can conceive of themselves as rational animals through technological innovations. The interface between humans and machines (neuro-digital interface), can potentially alter what it means to be human, i.e., the very idea of human nature and of normal functioning will be changed. In this paper, I argue that we are potentially on the verge of a paradigm (...) shift in terms of the ends and goals of techno-science and its applications in the biomedical sciences. In particular, the development of brain-computer interfaces could reconceptualize the very notion of what it means to be human. Hence, we should not limit our reflections of applications in terms of therapy and enhancement but also include an examination of applications aiming at the alteration of human nature. To this end I will first delineate the potential paradigm shift and then map out four distinct clusters of concerns in relation to the brain-computer interface. Finally, I argue that our moral and philosophical reflections should follow a procedural model based on managed consensus due to our pluralistic context. (shrink)

Transhumanism is an ideology that embraces the use of various forms of biotechnology to enhance human beings toward the emergence of a “posthuman” kind. In this article, I contrast some of the foundational tenets of Transhumanism with those of Christianity, primarily focusing on their respective anthropologies—that is, their diverse understandings of whether there is an essential nature shared by all human persons and, if so, whether certain features of human nature may be intentionally altered in ways that contribute toward how (...) each views human flourishing. A central point of difference concerns Transhumanists’ aim of attaining “substrate independence” for the human mind, such that one’s consciousness could be uploaded into a cybernetic environment. Christian anthropology, on the other hand, considers embodiment, with its characteristics of vulnerability and finitude, to be an essential feature of human nature—hence, Christians’ belief in bodily resurrection. Despite Christianity and Transhumanism having fundamental differences, I contend that Christians may support moderate forms of enhancement oriented toward supporting our flourishing as living, sentient, social, and rational animals. (shrink)

Current philosophical and legal bioethical reflection on reprogenetics provides little more than a rationalization of the interests of science. There are two reasons for this. First, bioethicists attempt to address ethical issues in a “language of precision” that characterizes science, and this works against analogical and narratological modes of discourse that have traditionally provided guidance for understanding human nature and purpose. Second, the current ethical and legal debate is framed by a public/private distinction that banishes robust norms to the private (...) realm, and leaves a minimalist public discourse of harm avoidance that is insufficient for regulating the science. In this essay, I argue that Mark Hanson's account of anxiety provides a valuable starting point for addressing deficiencies in the current philosophical and legal debate, and it highlights the need for a theological discourse on genetic enhancements. Through an assessment of Joel Shumann's criticism of the public/private distinction, I show how the needed theological discourse should be situated in the context of robust communities, and how such a communitarian inter-ethic is compatible with a variant of liberalism. Finally, I critically assess James Keenan's account of virtue and perfection, in order to outline what a sufficient discourse on reproductive and genetic enhancements requires. (shrink)

In her effort to recast moral realism in the style of the later Wittgensteinian philosophy of language, Sabina Lovibond seeks to ground moral knowledge in a historical community and its rules of language. In Stanley Hauerwas’ writings, we find an account of Christian ethics that is similarly modeled on Wittgensteinian realism. The main problem with Wittgensteinian moral realism, as it is appropriated by both Lovibond’s and Hauerwas’ society-dependent accounts of morality, is that they are unable to resolve difficult issues created (...) by epistemic relativism. Both thinkers are vulnerable to epistemic relativism in two ways. First, with its contextualist approach to the justification of moral beliefs, their conception of moral realism makes any historical community the ultimate authority in all matters of morality. Second, their conception of moral realism also turns moral truth into a social property of a historical community, while denying the exclusive ownership of truth by one particular community. (shrink)

In the mid-1970s, the biomedical model of medicine gave way to the biopsychosocial model of medicine; it was billed as a more comprehensive and compassionate model of medicine. After more than a century of disentangling medicine from religion, the medicine and spirituality movement is attempting to bring religion and spirituality back into medicine. It is doing so under a biopsychosociospiritual model. I unpack one model for allowing religion back into medicine called the RCOPE. RCOPE is an instrument designed to categorize (...) religion and spirituality as psychological coping mechanisms. I explore how such instruments are related to the history of statistical measurement and demonstrate the political impetus that governs such enterprises. The biopsychosociospiritual medicine is billed as a more holistic and comprehensive model. This new model of medicine offers total care. However, I demonstrate how this total care becomes totalizing, indeed totalitarian, admitting religion and spirituality back into the fold of medicine under a new secularized medical control. (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)

Christian bioethics springs from the worship that is the response of the Church to the Gospel of Jesus Christ. Such worship is distinctively political in nature, in that it acknowledges Christ as Lord. Because it is a political worship, it can recognize no other lords and no other prior claims on its allegiance: these include the claims of an allegedly universal ethics and politics determined from outside the Church. However the Church is called not just to be a contrast society, (...) but also to witness to the freeing of the world from salvific pretensions in order that it may embrace its proper temporality. The implications of this for the distinctiveness of Christian bioethics are brought out in three movements: first, the Church's itself learning how it is to conceive bioethics; second, the Church's role in unmasking the idols of secular bioethics; and third, the Church's witnessing to the freeing of medicine from idolatrous aspirations. (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.

A selection of recent sociological literature dealing with bioethics, concentrating particularly on its interface with research ethics, is reviewed to reveal that the two disciplines of bioethics and sociology have tendencies to approach subject matters from opposed perspectives. These differences in approach have now been generally recognized, accepted and accommodated by proponents of both disciplines. A turning point in the relationship between the two disciplines may have been reached which augers greater mutual respect, appreciation and even learning.

This paper offers an assessment of the prospects for Christian engagement with public bioethical debates in a contemporary British context. One recent example, the debate provoked by proposed legislation for research involving human admixed embryos, is examined briefly. It is argued that this debate has some problematic features that are characteristic of public ethical debates in this context. Next, a proposal is offered as to how such bioethical questions may be approached from within a Christian theological tradition (specifically, a Reformed (...) Protestant tradition). This proposed approach makes use of four “diagnostic questions” to assess whether technological proposals and practices such as the creation of human admixed embryos can be consistent with the distinctive Christian narrative of creation, sin, salvation through Christ, and promised future hope. The final section offers some reflections on how Christians and churches might engage, on the basis of this theological approach, with public ethical debates such as the one about admixed embryos. (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)

I argue here that Weberian disenchantment is manifest in the triumph of instrumental reason and the expansion of analytic enquiry, which now dominates not simply those sciences upon which medicine depends, but medical practice itself. I suggest ways that analytic enquiry, also referred to here as anatomical reasoning, are part of a particular ideology—a way of seeing, speaking about, and inhabiting the world—that often fails to serve the health of patients because it is incapable of “seeing” them in the moral (...) sense described by Iris Murdoch and others. I use the work of James Elkins and Wendell Berry to call for the recovery of a way of seeing the human body as both other and more than an object of scientific enquiry and social control. (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)

Complementary and alternative medicines (CAM) have become increasingly popular over recent decades. Within bioethics CAM has so far mostly stimulated discussions around their level of scientific evidence, or along the standard concerns of bioethics. To gain an understanding as to why CAM is so successful and what the CAM success means for health care ethics, this paper explores empirical research studies on users of CAM and the reasons for their choice. It emerges that there is a close connection to fundamental (...) principles of medical ethics. The studies also highlight that CAM’s holistic ontology of health and illness has an empowering effect on people in caring for their health, and on an even deeper level, safeguards against biomedicine’s reducing image of oneself as biological body-machine. The question is raised what lessons bioethics should draw from this emancipatory social movement for its own relationship with biomedicine. (shrink)