Bioethics book report - Essay Example

Bioethics: A Primer for Christians, second edition by Gilbert Meilaender In the current age, with the rapid strides made in human reproductive technologies, cloning, organ transplants, contraceptive technologies, and abortifacients, it has become imperative to provide clear moral answers to these ethical questions that face medical science today. Gilbert Meinlaender’s Bioethics provides an ethic based on Christian principles, as he proceeds by looking at life essentially as a gift of God. Writing as a Christian and mainly for the Christians, Meilaender premeditates on the diverse ramifications of modern-day biotechnology. With a firmly founded base on Christian conception of the human being and traditional respect for the body, he offers "reasons of concern" instead of launching an all out attack. He tries to examine the various implications of different technologies and capabilities of the medical profession that raise grave questions for him. For instance, he asserts that the permission of the law does not prevail over Christian teachings, which he sees requiring that abortion be countenanced only to save the life of the mother and in cases of rape and incest, that genetic engineering be tried only on somatic and not on germ cells, that medical treatment be refused only if useless or excessively burdensome, and that death never be induced by painkillers or disconnecting feeding tubes. Generally directed to Christians, his points has validity for a much wider audience. Although he has a healthy esteem for science, he never accepts technology as an end in itself. He calls for a more circumspect examination of current medical procedures that allow us to prolong life, end the life of the unwanted, and devise a panacea to cure the problems of those who are not "normal." Living wills are unacceptable, he asserts, although health care powers of attorney are not, and if the family disapproves of a members desire to donate organs, its wishes must be given due preference. For each of these major conclusions, he intricately works out his reasoning from the superstructure of Christian writings. Some Christians may object, especially to his regard for suffering as part of Gods unquestionable design, but cannot denounce this veritable exposition on the ethics of medical science. In the first chapter, he treats the basic elements in the Christian vision of the world. As the Baptists believe, Christians are components of the body of Christ. They are called to form a bond with one another; they are called into a community. Christians are created in freedom for communion with God, however this freedom has its limits. A prime portion in chapters two through four is devoted to his argument that parenthood does not essentially mean a right to have a child. The child is begotten and not made. At any cost, parents must not seek to have a child, not even in adoption. On abortion, the author argues that the life of the child in the womb is Gods creation and is part of the world God came to redeem. Next, in chapters five and six, he discusses genetic advances and pre-natal screening. He is of the view that gene type therapy makes children that come after us the products that we have molded. Pre-natal screening tends to separate the natural connection between mother, thus, making parental commitment to offspring tentative and conditional. Throughout chapters six, seven, and eight, Meilaender argues that suicide and euthanasia are attempts at being creators rather than creatures. Creatures do not have the power of ultimate judgment about a person. Christians are duty bound to stand with the suffering--to give them care and succor, not minimize suffering. However, he holds the opinion that it is not immoral to refuse a useless and unbearably burdensome treatment. There is a need for the patients to know the truth and to participate in the decision-making process. Living wills and health care power of the attorney are helpful where the patient is incapable of making a decision. In the ninth and tenth chapters, he discusses two gifts of the body--organ donation and human experimentation. Every gift of the body can be well given if a person considers oneself to be a gift of the creator rather than the creator Himself. Hence, people must freely and voluntarily give their consent in order to participate in medical research. In the final chapter, the author delineates on sickness and health. God is present in our illnesses, and Christians must continue to live in this hope. Physicians should never see themselves as saviors rather they should cooperate with powers, which exist beyond them. Meilaender does a profound work in providing intros to the topics of assisted reproduction, abortion, gene therapy, genetic research, prenatal screening, suicide and euthanasia, organ donation, and research sensitive issues to humans. He is sensitive in providing not a minimalist, common denominator, public policy view, but one that is sensitive to the pro-life, Creator God who sustains all and will judge us at the end. The book is quite promising for the church-- both in individual Christians reading it, and also for Bible study groups. Although Meilanaders viewpoint may differ substantially from that of many evangelical Christians or Catholics, his application of Christian principles to bioethical questions is commendable. It is true that many theological ethicists lose theological eloquence as they learn medical-ese. But this is not so with Gilbert Meilaender—from Bioethics it is easily discernible that he never loses fluency in that first language of faith.  It is quite obvious that all Christians will not agree with his conclusions on abortion or stem cell research, but those who differ are sure to find their arguments sharpened by wrestling with a most worthy opponent.  It was than ten years back in 1996 that Meilaender published the first edition of Boiethics – to much critical acclaim, so much so that World magazine ranked it one of the top 100 books in the twentieth century.  This year Eerdmans published the second edition, and the book almost remains the same except for that Meilaender identifies four substantive changes—first, data updates; second, a hardening in the stand against abortion, for both “empirical and ‘metaphysical’” reasons; then, revision of the chapter on organ donation; and finally, attention to the issue of research on embryos, a clear nod to the controversy on stem cell research.  However, given the books perpetual insights these changes are relatively minor.  Issues like beginning and end of life, medical decision-making, organ donation, and human experimentation have continued to vex us.  The medicine may be improvised or changed, but the core moral issues remain the same. Do we need to do everything within our power for a terminally ill patient?   When does medical technology allow us to prolong life – or merely prolong the process of dying?   How much truth does a patient need or want or deserve?  Who decides the medical fate of children, the embryo fertilized for IVF or already implanted in a woman who seeks an abortion, those who are mentally unable to state their wishes?  Finally, how are we as Christians to respond?  While analysis of Meilaender’s responses to these perennial questions, it would be worthwhile to briefly comment on his method, both what he says he is doing – and what he actually does.  Also, it would be wise to reframe an issue, which has been disagreed upon by many quarters—the reproductive health issue, shifting his “focus on the family” from the biological family to the family of the baptized.  Also, two issues in twenty-first century medicine, which are primary concerns for Christians. As regards moral method, bioethics has pursued two distinct paths, both of which Meilaender rightly rejects, one explicitly – the other implicitly.  Meilaender essentially deviates from an approach to bioethics that emphasizes “rights.”  Acknowledging that such language has a central place in emphasizing the just claims of often-ignored others, he nonetheless finds rights-language a “thin” expression of rich Christian convictions. Instead, Meilaender describes the “mutual burdening and unburdening” that marks Christian community. Exploring the principle for advance directives, he considers a commonly cited advantage--advance directives relieve loved ones of the “burden” of decision-making. Meilaender takes an exception--“to burden one another is, in large measure, what it means to belong to a family – and to the new family into which we are brought in baptism” (p 82). The interdependence of those who bear one another’s burdens far exceeds the rigid reciprocity enunciated by a language of rights and responsibilities – and rights-language never spelled out as clearly attendant responsibilities on caregivers and health professionals.  Refusing the well-trodden path of patients-rights, Meilaender directs his readers to a richer and more novel vision of Christian community. Meilaender says that he works within a deontological ethic--an ethic offering rules and principles that limit the goals that might otherwise drive medical research and care. In this Meilaender favors a biomedical approach essentially oriented by principles of respect for autonomy, nonmaleficence, beneficence, and justice.  However, Meilaender is found to be projecting a less organized by rules and principles than character and questions about “what sort of people we wish to be and ought to be” (23).  Accordingly, Meilaender gives emphasis on the qualities or virtues that describe Christian communities: gratitude, truthfulness, humility, hospitality, interdependence, and hope.  He names the corresponding vices-- independence, self-sufficiency, deception, idolatry, possessiveness or greed, etc.  Meilaender paints all of these character portraits against the background of a “Christian vision of life” which believes that death is not the last word. Essentially, character or virtue ethics provides a richer account of the Christian life that Meilaender seeks, for it deals in questions of formation and discernment. Rules and principles generally draw us to what is morally conspicuous in any given situation, but we consider context and we respect persons in applying them.  And Meilaender recognizes this, valuing someone who struggles to be “in the truth,” as he puts it (74) over someone who rigidly resolves to tell the “truth, the whole truth, and nothing but the truth.”  He gives a sublime illustration, borrowed from William F. May --a man who knew he had had terminal cancer wanted his son, an acknowledged expert on death and dying, to “go easy” on him.  He did not want the “whole truth and nothing but the truth” about his condition; he wanted an appropriate truth – and he wanted it delivered with love. It is beyond doubt that Meilaender adds an important complement to a principalism that dominates bioethics at the moment. Most would agree with Meilaender in that Christians should focus on the family – but the question is which family? Many would hold the family of brothers and sisters dearer to the biological one created by marriage and childbearing. Baptism inducts children into this new family, and the name given there overrides ties of blood, paternity, or maternity. “Child of God” signals a new belonging in a new community. Christians are yet to take their child-rearing responsibilities in this arena as seriously as they should – or as seriously as their first and second century predecessors did. Then, becoming a Christian cut people off from their biological families. As they embraced Christianity, people were disowned and disinherited by their families of origin, and so they turned to their new family of brothers and sisters in Christ for spiritual, but also physical support.  In the chapters on medical decision-making and end-of-life issues and in his discussions of “mutual burdening and unburdening,” Meilaender focuses on the family of the baptized as the primary family unit for Christians. But, when he turns to issues of reproductive health, the author accords preference to the biological family, the sacrality of the mother-child bond, and the image of the Trinity reflected in the nuclear family.  Abortion is considered as a violation on all counts in that it rips apart families, destroys the mother-child bond embedded in the foundational family unit.  But, if he were to retain to consider the primacy of the family of the baptized in his chapters of reproductive health, Meilaender might come to a different stand on abortion. Judgment would shift from the women seeking abortion to a society that undervalues and financially burdens its weakest members.  Censure would fall on a church that too often shuns out-of-wedlock mothers, treats shabbily the children in its midst, and fails to offer material support to the family of brothers and sisters in Christ.  It is often argued that the proper Christian “focus on the family” should be on the family of the baptized.  Christians should shun the practice of abortion, adopting all “unwanted” children as their own.  Until churches can practice that kind of hospitality, abortion exists as a judgment upon the people. Until the church can truly be the family of the baptized, welcoming strangers into its midst, abortion should be safe, legal – and rare. This focus on the biological family is carried into his discussion of adoption.  Adoption blurs lines of biological kinship and results in a child “who cannot (biologically) embody the union of his adoptive parents” (16).  Meilaender finally considers adoption “an emergency measure, aimed chiefly at caring for children whose biological parents have not, cannot, or will not care for them” (18).  But someone with a focus on the baptized, rather than the biological family might judge adoption differently.   If the apostle Paul is right that we all “wait for adoption” (Rom. 8:23) as children of God, then Christians should show boundless love especially for children who do not bear the same DNA strands. This love ought to be manifest spiritually, and materially-- opening homes to those in need. The predominance of the biological family over the baptized family leads to a certain ambivalence on the very critical areas of IVF and stem cell research.  Many ethicists focus on the question of whether to use for research purposes fertilized embryos with the potential to develop into human beings. Not much attention has been paid to the procedures that gave these fertilized embryos in the first place. IVF produces more fertilized embryos than needed, creating the “left over” embryos in demand by stem cell researchers. Moreover, IVF implants more of these embryos in the mother’s womb, eliminating those that are not “needed.”  These aspects of IVF never seem to register as such with “pro-life” moralists.  Again, Meilaender places constraints on IVF and assisted reproduction.  But the primacy of the biological family combines with a warning against adoption to create a questionable openness to reproductive technologies that assist parents in having their own genetically marked children. Finally, present-day Christians should be discussing two issues that surface briefly in this book--health care costs and health care access. The kind of moral decision-making, which Meilaender foresees calls for insurance plans and employers who support them, both of which are fast vanishing among today’s workforce.  A lot of people have health care decisions made for them, for the lack of health insurance, or having inadequate coverage from the insurance they do carry.  IVF is a moral dilemma only for those wealthy enough to afford the costly procedures inherent in the process.  And the fruits of stem cell research will be available only to the financially strong.  But whatever the inconsistencies may be, throughout the book, Meilaender is seen making logical and consistent arguments, and supporting his thesis by drawing authoritative facts from social events, medical advance and reputable authors. He adopts diction, which is simple and devoid of superfluous words. However, he fails in giving a more pastoral twist to the book, and the treatment of lifes starting point is vague. Yet, although a primer on bioethics from a conservative Christian perspective, this book is indispensable for anyone who desires knowing more about biomedical ethics and especially for all students of the medical sciences. Read More