The term ‘culture wars’ has been used to describe deep, apparently intractable, disagreements between groups for many years. In contemporary discourse, it refers to disputes regarding significant moral matters carried out in the public square and for which there appears to be no way to achieve consensus or compromise. One set of battle lines is drawn between those who hold traditional Christian commitments and those who do not. Christian bioethics is nested in a set of moral and metaphysical understandings that (...) collide with those of the dominant secular culture. The result is a gulf between a moral life and an approach to bioethics framed in the face of a transcendent God and a final judgment versus a moral life and an approach to bioethics framed as if the world were without ultimate meaning and as if death were the end of personal existence. These approaches are separated by a moral and metaphysical gulf that sustains incompatible life worlds and incompatible understandings of bioethics. Attempts to bridge the gulf with secular reason are ineffective because there is no shared conception of reason or standard of evidence. Efforts to use the state to enforce a particular set of metaphysical and moral commitments, whether secular or religious, lead to public disputes with a war-like character. (shrink)

Public bioethics focuses on deliberating about, recommending, or establishing social policies or practices concerning health care and biotechnology. A brace of premises underlies much of the work of public bioethics. First, there is the view that, if one approaches reality and human life as if both were without ultimate significance, one will find that one shares a common public bioethics. That is, if one abstains not only from any religious concerns, but even from philosophical reflections on the circumstance that life (...) might have ultimate meaning, one will be able to articulate a common neutral moral perspective that all persons can share and that can be the basis of a common public bioethics. The second premise is that the controversies in bioethics arise from the presence of religious belief, especially Christian belief, which supports a set of moral commitments that generate controversies that make the framing of public policy difficult. The view is that there is significant disagreement among persons who hold religious positions, particularly Christians, and that in public bioethics we should strive to eliminate these controversies by relying on a neutral moral framework. This paper documents and challenges these premises. It demonstrates that Christian bioethics finds itself already embedded in the field of secular moral controversy before it adds the perspectives it brings. (shrink)

The term community in ethics and bioethics traditionally has been used to designate either a specific kind of moral relationship available to rational agents or, in contrast, the context in which any sense of rational agency can even be understood. I argue that bioethics is better served when both selves and community are expressed through a more processive language that highlights the functional character of such concepts. In particular, I see the turn to processive community in bioethics as a turn (...) towards method, contextualization, and narrative. In clinical practice, such a processive account demands that bioethics concentrate on methods of developing healthy dialogue and deeper understanding from within the problematic situation rather than trying to fix problems using ethical tools developed from outside the present situation. Community, I argue, is in and of the interactive processes of inquiry itself. Such inquiry, such communitying, requires that we engage individual patients in context; it demands more than simply gaining their permission or mere consent; it demands developing a supportive environment for participation. (shrink)

The national standards for clinical ethics consultation set forth by the American Society for Bioethics and Humanities endorse an “ethics facilitation” approach, which characterizes the role of the ethicist as one skilled at facilitating consensus within the range of ethically acceptable options. To determine the range of ethically acceptable options, ASBH recommends the standard model of decision-making, which is grounded in the values of autonomy, beneficence, nonmaleficence, and justice. H. Tristram Engelhardt Jr. has sharply criticized the standard model for presuming (...) contentful moral claims in circumscribing the range of ethically acceptable options, which, he argues, cannot be rationally justified in a pluralistic context. Engelhardt’s solution is a secular clinical ethics based on a contentless principle of permission. The first part of this article lays out Engelhardt’s negative claim, that reason cannot establish contentful moral claims, and his positive claim, that secular clinical ethics ought to be based on a contentless principle of permission. The second part critiques these negative and positive claims. The purpose of this paper is to defend secular clinical ethics expertise—defined as the ability of ethicists to offer justified moral recommendations grounded in consensus positions endorsed by the American Society for Bioethics and Humanities—from the radical critiques of Engelhardt, who argues that no moral or metaphysical claims, and hence no bioethical consensus, can be rationally justified. Engelhardt’s critiques have caused some to worry that secular clinical ethics is in a state of theoretical crisis; this article concludes that Engelhardt’s view is an unstable basis for that worry. (shrink)

McCarthy, Homan, and Rozier’s article seeks to bridge a gap between theological and secular bioethics. It should be noted that the “theological” emphasis in the a...

In this article, I argue that while Christians should share Engelhardt’s disappointment in how bioethics functions in the world, they should not share his exasperation. I begin by outlining the general argument in After God, its understanding of secularism, and of how such secularism has impacted bioethics. Next, I suggest that Englehardt appears to lean toward disengagement or at least an extremely suspicious sectarianism. Rather, I claim that it is possible for Christians to morally engage in a useful way with (...) others and still base their own moral activity on proper life telos. Such cooperation is not to serve a commonly-held ultimate purpose, but shared proximate ends. That said, the moral discourse with those outside the Church may be necessarily limited by shallow moral acquaintanceship. I argue that the concept of “middle axioms” can be used as a mechanism for engagement with others in this society. Importantly, this approach does not require abandoning distinctive Christian commitments and foundational assumptions. (shrink)

Public deliberation about health policy in the United States often hinges on two untenable basic assumptions about political legitimacy. The first assumption, common in public debate throughout the United States, is that federal oversight of health care is justified under a federal compact binding all citizens. This assumption is false because the federal compact precludes such oversight. Indeed, the ascendancy of national government (and demise of federalism) over the past 70 years was engineered through the subversion of the federal compact, (...) creating an expansive legitimation gap. The second assumption—that political legitimacy can be established through appeals to expert consensus about fundamental conceptions of justice or human rights—is prevalent among bioethicists. I argue that this assumption is illicit because it hinges on a weak, rationalistic form of majoritarian democracy that conflates public acquiescence with public approval. If the public mission of academic bioethics involves protecting the integrity of public deliberation, then these two basic assumptions should be challenged. (shrink)

This article describes and rejects three standard views of reason in secular clinical ethics. The first, instrumental reason view, affirms that reason may be used to draw conceptual distinctions, map moral geography, and identify invalid forms of argumentation, but prohibits recommendations because reason cannot justify any content-full moral or metaphysical commitments. The second, public reason view, affirms instrumental reason, and claims ethicists may make recommendations grounded in the moral and metaphysical commitments of bioethical consensus. The third, comprehensive reason view, also (...) affirms instrumental reason, but encourages ethicists to make recommendations grounded in the moral and metaphysical commitments of their private worldviews. A compatibilist view of public reason is then defended, which holds that each standard view captures an important role for reason in different aspects of secular clinical ethics. The article ends by identifying three implications for enduring theoretical debates in clinical ethics. (shrink)

The challenge in maintaining patient autonomy regarding medical decision-making and confidentiality lies not only in control over information transferred to and regarding patients, but in the ambiguity of autonomy itself. post-modernity is characterized by the recognition of not just numerous accounts of autonomy, but by the inability in a principled fashion to select one as canonical. Autonomy is understood as a good, a right-making condition, and an element of human flourishing. In each case, it can have a different content, depending (...) in part on whether it is given a nomological or a volitional construal. Different accounts of autonomy can lead to strikingly different understandings of appropriate behavior, including the argument that one ought on behalf of autonomy to liberate individuals from the sense of autonomy they themselves affirm. In the face of competing accounts of moral probity, autonomy in a secular morality and bioethics must by default be understood in terms of the permission of patients, which makes space for numerous moral accounts and different communal construals of free choice, which in turn will legitimate different practices of informing patients and maintaining confidentiality. (shrink)

The scope and role of theological bioethics has become a growing controversial topic. For instance, some bioethicists have adopted a strong stance on the meaning of “Christian bioethics,” as not ex...

In a spirit of critical appreciation, this essay challenges several core aspects of the critique of secular morality and the defense of Orthodox Christianity offered by H. Tristram Engelhardt in After God. First, I argue that his procedurally driven approach to a binding morality based solely on a principle of permission leaves morality without any substantive definition in general terms, in ways that are both conceptually problematic and also at odds with Engelhardt’s long-standing distinction between non-malevolence and beneficence. Second, I (...) question the accuracy or adequacy of Engelhardt’s critique of the Enlightenment project for his unwarranted privileging of a particular version of Enlightenment thinking at the expense of other Enlightenment perspectives less amenable to Engelhardt’s working generalizations. Third, I challenge the theoretical cogency of Engelhardt’s insistence on the ubiquity and intractability of moral controversies and his depiction of moral strangers and moral friends as, in effect, mutually exclusive terms. Finally, I question Engelhardt’s embrace of a divine command model of ethics as the appropriate resolution of Euthyphro’s dilemma and suggest that there may be intermediate approaches to the usual starkly drawn contrasts between divine command and naturalist accounts. (shrink)

In Bioethics and Secular Humanism: The Search for a Common Morality, Tristram Engelhardt examines various possibilities of finding common ground for moral discourse among people from different traditions and concludes their futility. In this paper I will argue that many of the assumptions on which Engelhardt bases his conclusion about the impossibility of a content-full secular bioethics are problematic. By starting with the notion of moral strangers, there is no possibility, by definition, for a content-full moral discourse among moral strangers. (...) It means that there is circularity in starting the inquiry with a definition of moral strangers, which implies that they do not share enough moral background or commitment to an authority to allow for reaching a moral agreement, and concluding that content-full morality is impossible among moral strangers. I argue that assuming traditions as solid and immutable structures that insulate people across their boundaries is problematic. Another questionable assumption in Engelhardt’s work is the idea that religious and philosophical traditions provide content-full moralities. As the cardinal assumption in Engelhardt’s review of the various alternatives for a content-full moral discourse among moral strangers, I analyze his foundationalist account of moral reasoning and knowledge and indicate the possibility of other ways of moral knowledge, besides the foundationalist one. Then, I examine Engelhardt’s view concerning the futility of attempts at justifying a content-full secular bioethics, and indicate how the assumptions have shaped Engelhardt’s critique of the alternatives for the possibility of content-full secular bioethics. (shrink)

This article examines the clergy sexual abuse crisis in the Roman Catholic Church from an ethical point of view. The article uses the RRICC values model of ethical decision making (i.e., responsibility, respect, integrity, competence, concern) to review the behavior of Catholic bishops and other religious superiors as they have tried to manage clergy sex offenders and their victims. Hopefully, the recent press attention and resulting policy changes on these matters from the U.S. Council of Catholic Bishops will increase the (...) chances that future decisions will be ethical ones. (shrink)

Kevin Wm. Wildes, S.J.; Religion in Bioethics: A Rebirth, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 8, Issue 2, 1 January 2002, Pa.

This essay reflects on 25 years since Christian Bioethics began publication and, in somewhat autobiographical fashion, engages two core concerns. First, although “non-ecumenism” may often appear a pretext for contention and division, I suggest that a respectful non-ecumenism may provide the opportunity for dialogue and the occasion for employing certain tools from religious studies. Second, although many are skeptical about the possibilities of identifying a “common morality,” a defense of that notion provides a plausible explanation for the development of limited (...) consensus on some issues in bioethics. (shrink)