Mark Cherry

How can we definitively determine which biomedical choices are morally correct and which engage in seriously wrongful acts? Depending on whom one asks, one is informed that choices such as abortion, euthanasia, and significant body modification involve real moral harm (either as forms of murder or as denying the goodness of the body that God has provided), or that disallowing such “medical care” violates the basic rights of persons (where abortion, active euthanasia, and body modification are appreciated as positive expressions of personal autonomy). Secular bioethics appears no longer able to appreciate what could possibly be wrong with such activities, provided that the individuals involved consent in some fashion. Indeed, many actions that were once openly and easily recognized as sinful have become so commonplace, as well as politically desirable, as to appear as if they were obviously good. As the authors in this issue of Christian Bioethics explore, fully to appreciate the serious moral issues raised by modern medicine requires a foundational orientation to the Christian God.

If one is honestly to face the moral challenges of human suffering, one must first come to terms with human finitude, even when confronted with the collapse of human abilities, suffering, and death. An authoritative response to such existential concerns, however, requires a binding moral standpoint from which to know truly the nature of the right, the good, and the virtuous. This chapter argues that secular bioethics possesses no such definitive moral foundation and, as a result, is unable to give an unequivocal response to human suffering. Instead, such matters are left up to individual idiosyncratic choice. Consequently, secular bioethics routinely sanctions unhindered access to nearly any medical means to satisfy individual lifestyle and death-style choices, so that individuals may avoid unwanted emotional, mental, or physical suffering. The chapter concludes that modern medicine and secular bioethics embody the potentially unconstrained human passion to control life and death.

This volume brings together a set of critical essays on the thought of Professor Doctor H. Tristram Engelhardt Jr., Co-Founding Editor of the Philosophy and Medicine book series. Amongst the founders of bioethics, Professor Engelhardt, looms large. Many of his books and articles have appeared in multiple languages, including Italian, Romanian, Portuguese, Spanish, and Chinese. The essays in this book focus critically on a wide swath of his work, in the process elucidating, critiquing, and/or commending the rigor and reach of his thought. This volume compasses analyses of many different aspects of Engelhardt's work, including social and political philosophy, biopolitics, the philosophy of medicine, and bioethics. It brings together internationally known scholars to assess key elements of Engelhardt's work.

This issue of The Journal of Medicine and Philosophy brings together an international group of scholars from Hong Kong, Mainland China, and North America, critically to explore whole-body/head transplantation. The proposed procedure raises significant philosophical, ethical, and social/political questions. For example, assuming transplant is successful, who survives the surgery? Does personal identity necessarily follow the head? The contributors to this special thematic issue explore the nature and ground of personal identity, what it would mean to preserve personal identity, given such a significant set of physical changes, as well as the morality of such a procedure. As the authors make clear, careful conceptual philosophical analysis is essential for understanding whether whole-body/head transplantation is a life-saving/life-enhancing technological innovation, or a bioethical morass that should not be attempted. How we come to terms with such conceptual and moral concerns will have a significant impact on the future of medicine and medical technological innovation.

This volume brings together a set of conceptual, moral, and cultural concerns carefully to assess a significant public policy issue: the development and proliferation of sex robots. Critics argue, for example, that sex robots present a clear risk to real persons as well as a degradation of society. They claim that the prevalence of sex robots will increase sexual violence, immorally objectify women, encourage pedophilia, reinforce negative body image stereotypes, increase forms of sexual dysfunction, and pass on sexually transmitted disease. Proponents judge robotic sexual companionship as just another step in the exploration of human erotic desire. Sex robots, and similar technology, such as virtual reality pornography and other forms of “digi-sexuality,” are appreciated as providing autonomy affirming companionship, sexual release for the lonely, and a relatively harmless outlet for sexual fantasies that avoids the use of human prostitutes and thus reduces sexual victimization. As these chapters explore, to secure normative claims about sexual activity with artificial humanoids, one will need first to understand what the meaning of the morality of sexual activity can be as well as the significance of various practices with robotic partners on such cardinal social institutions as the family and the relationship between the sexes. One will also need to consider in terms of which ranking of human goods, right-making conditions, social outcomes, or personal virtues we ought to evaluate the significance of sexual relations with robots that look like women, men and children. Without such analysis, it will be unclear whether sex robots ought to be appreciated as a social evil that will further degrade moral culture, a positive technological innovation that will help preserve human dignity, or a more or less harmless pastime.

Sex matters. How men and women regard sex and bond sexually powerfully shapes the lifeworld. Sex is one of the major forces that influence a society and its background taken-for-granted norms. This chapter explores the ways in which the now dominant Western secular culture has generally deflated and demoralized the significance of sexual activity. Differences in preferred sexual activities are, according to this secular culture, to be appreciated as morally neutral lifestyle choices provided that they are consensual and affirm the “dignity” of the parties involved. As I argue, the dominant secular culture seeks to place consensual sexual acts, of which the use of sex robots is just one additional example, beyond moral judgment, further isolating individuals from the rich social connections of traditional family life, thereby transforming the family and advancing the secularization of society.

This book provides cross-cultural ethical exploration of sex robots and their social impact. What are the implications of sex robots and related technological innovations for society and culture? How should we evaluate the significance of sexual relations with robots that look like women, men or children? Critics argue that sex robots present a clear risk to real persons and a social degradation that will increase sexual violence, objectify women, encourage pedophilia, reinforce negative body images, increase forms of sexual dysfunction, and pass on sexually transmitted disease. Proponents judge robotic sexual companionship as just another step in the exploration of human desire. They see sex robots, and similar technology, such as virtual reality pornography, as providing autonomy affirming companionship for the lonely and a relatively harmless outlet for sexual fantasies that avoids the use of human prostitutes and thus reduces sexual victimization. Some appreciate sex robots as a social evil, others as a positive good, and still others as a harmless pastime. How we come to terms with such conceptual and moral concerns will have significant implications for society and the future of human relations. This book is of great interest to researchers in bioethics, human sexual behavior, AI ethics, and philosophy of sex.

Secular bioethicists do not speak from a place of distinction, but from within particular culturally, socially, and historically conditioned standpoints. As partisans of moral and ideological agendas, they bring their own biases, prejudices, and worldviews to their roles as ethical consultants, social advocates, and academics, attempting rhetorically to sway others and shift policy to a preferred point of view. Their pronouncements represent just one voice among others, even when delivered with strident rhetoric, in an educated and knowing tone, from within institutional positions of power. This essay argues that, given the hegemony of progressive secular bioethics, traditional Christians routinely face epistemic injustice within medicine. That is, Christian knowledge regarding moral reality is all too often demeaned or dismissed, unless such norms can be translated into and defended within a secular ethos. Given such systemic bias, I argue, Christians also experience significant moral distress: they are fully aware of their moral obligations and what they ought to do, but institutionalized power structures make it nearly impossible to so act. But, Christian physicians are not mere technicians, obliged to provide whatever patients request from the list of legally available treatments. That antireligious critics seek to remove the rights of Christian physicians to limit how they practice medicine, where they do not offer or refer for abortion, euthanasia, physician-assisted suicide, and other inappropriate forms of care, is unjustified and prejudicial, singling out Christians, and other religious groups, for singular treatment. Regardless of what the law requires or institutional policy demands, however, Christians are obliged to submit to God in all things. As a result, they may at times find themselves required to engage in acts of civil disobedience.

The day-to-day work of clinical ethics consultants and healthcare ethics committees can easily become overly routine. Too much routine, however, comes with a risk that morally important practices will be reduced to mere bureaucratic formalities, while practitioners become desensitized to ethically significant distinctions between cases. Clinical ethics consultation and organizational ethics must be set within the broader social and cultural context of the healthcare environment. This practice requires looking beyond mere legal compliance and the routinely false assumption that there are unambiguous ethical norms that easily govern clinical ethics and hospital policy formation. Together the essays in this issue of HEC Forum challenge readers to rethink taken-for-granted assumptions regarding patient care, physician obligation, clinical ethics consultation, and organizational ethics.

Organ procurement policy from the recently deceased recasts families into gatekeepers of a scarce medical resource. To the frustration of organ procurement teams, families do not always authorize organ donation. As a result, efforts to increase the number of organs available for transplantation often seek to limit the authority of families to refuse organ retrieval. For example, in some locales if a deceased family member has satisfied the legal conditions for first-person prior assent, a much looser and easier standard to satisfy than informed consent, organ retrieval may proceed despite the family’s objections. Some countries have replaced voluntary consent to organ donation with forms of organ conscription. Often referred to under the misnomer “presumed consent,” such policies legalize the harvesting of organs at death, unless individuals exercise official options to opt out. As this article explores, however, there are good grounds for affirming the authority of the family to consent to or to deny organ donation on behalf of recently deceased family members, as well as to reject first-person assent and “presumed consent” policies of organ procurement. Insofar as individuals have failed clearly and competently to provide informed consent to organ donation, moral authorization for the use of the person and his body ought to be grounded on the foundational authority of the family, rather than the state’s supposed interests in obtaining organs for transplantation.

This special thematic issue of The Journal of Medicine and Philosophy brings together a cross-cultural set of scholars from Asia, Europe, and North America critically to explore foundational questions of familial authority and the implications of such findings for organ procurement policies designed to increase access to transplantation. The substantial disparity between the available supply of human organs and demand for organ transplantation creates significant pressure to manipulate public policy to increase organ procurement. As the articles in this issue explore, however, even if well intentioned, the desire to maximize organ procurement does not justify undermining foundational elements of human flourishing, such as the family. While defending at times quite different understandings of autonomy, informed consent, and familial authority, each author makes clear that a principled appreciation of the family is necessary. Otherwise, health care practice will treat the family in a cynical and instrumental fashion unlikely to support social or individual good.

Medicine is always set within particular cultural contexts and human interests. Central aspects of medical practice, such as concepts of health and disease, bioethical judgments, as well as the framing of healthcare policy, always intersect with an overlapping set of culturally situated communities (scientific, moral, religious, and political), each striving to understand as well as to manipulate the world in ways that each finds socially desirable, morally appropriate, aesthetically pleasing, politically useful, or otherwise fitting. Such taken-for-granted background conditions, in turn, impact clinical expectations, understandings of scientific findings, and appreciation of bioethical obligations. As background norms shift, so too do diagnostic categories as alternative modes of classification and treatment prove more useful for achieving socially, culturally, or politically desired outcomes. It is on this point that the essays in this number of Christian Bioethics strike an important chord. As the authors demonstrate, the most fundamental disagreements in bioethics turn on those who seek to frame culture and moral choice around the recognition of God’s existence and those committed to recasting all of our social, moral, scientific, and cultural institutions in terms of a foundational atheism. In various ways, each paper illustrates that without canonical grounding in a fully transcendent God, morality—and epistemic claims more generally—are demoralized, deflated, and brought into question. From the religious practices that guide the provision of Catholic health care and the underlying social norms governing psychiatric medical diagnosis, to whether God should be subject to scientific measurement, and the supposed existence of a “common morality,” the essays in this number of Christian Bioethics explore the implications of significant cultural changes that have impacted the taken-for-granted norms that undergird medicine and bioethics.

On Monday, June 25, 2018, H. Tristram Engelhardt, Jr., PhD, MD, co-founder of The Journal of Medicine and Philosophy, was laid to rest in the beautiful Hill Country of Texas near Comal County. Professor Engelhardt co-founded The Journal of Medicine and Philosophy in 1976 with Dr. Edmund Pellegrino. Engelhardt first served as Associate Editor, and then Editor and Senior Editor from 1976 until 2018. The Journal thrived for more than four decades through his energy, vision, and dedication. One of the intellectual founders of the fields that would become known as bioethics and the philosophy of medicine, Engelhardt’s seminal scholarship has framed the philosophical debates surrounding healthcare policy and medical practice throughout the world. The Journal of Medicine and Philosophy mourns his passing.

In After God: Morality & Bioethics in a Secular Age, Professor H. Tristram Engelhardt, Jr. argues that the now dominant intellectual culture of the West actively shuns any transcendent point of orientation, such as an appeal to God or to a God’s eye perspective on reality. Instead, it seeks to frame its understanding of reality and morality, and thus its bioethics, without reference to any foundation outside of particular human concerns. This article explores the implications of living in a secular culture that eschews any appeal to a fully objective perspective on reality. Drawing on Engelhardt’s analysis, it argues that absent access to a binding moral standpoint that is not already conditioned by a particular society, culture, or place in history, all moral and bioethical commitments are merely contingent, subject to particular human interests, aesthetic inclinations, personal intuitions, idiosyncratic choices, and political objectives.

This article explores the limits of secular philosophy and philosophical reason. It argues that once one abandons God, philosophical reason is unable to establish any particular bioethics or understanding of morality as canonical; that is, as definitively true and binding. Philosophy simply cannot secure the truth of any particular account of the right, the good, the just, or the virtuous. Once one abandons God, all is approached as if it were without ultimate meaning. Throughout, the article explores H. Tristram Engelhardt Jr’s arguments in After God: Morality and Bioethics in a Secular Age, which confronts this major intellectual and cultural crisis. As Engelhardt remind us, traditional Christianity is not a life-style choice, much less another meta-narrative that one chooses and writes for oneself. It is an encounter with God, Who changes everything. Christian bioethics must be appreciated in terms of an encounter with and an authentic experience of God, Whose commands will routinely conflict with the moral dictates of secular morality.

This paper defends an in principle understanding of the authority of persons over themselves and, in consequence, argues for significant limits on morally permissible state authority. It also defends an account of the limits of permissible state action that distinguishes between the ability of persons to convey authority to common projects and what may be judged virtuous, good, safe, or proper to do. In terms of organ transplantation policy, it concludes that it is morally acceptable, and should be legally permissible, for individuals to sell one of their kidneys while living, pocketing the cash to use as that person sees fit to advance their own understanding of their own best interests. Morally objectionable policy proposals, I argue, are not those that encourage individuals to sell a redundant kidney while living or families to sell the organs of a recently deceased loved one, but those that seek coercively to confiscate the organs of the recently deceased. Recognizing the authority of persons over themselves, and their ability to convey moral authority to common projects, including the sale of human organs for transplantation, would shed light on the medical marketplace and clarify public policy, while increasing the efficiency and effectiveness of procuring human organs for transplantation.

This study explores the ways in which adolescents, even so-called “mature minors”, lack adequate development of the intellectual, affective, and emotional capacities necessary morally to consent to medical research on their own behalf. The psychological and neurophysiological data regarding brain maturation supports the conclusion that adolescents are qualitatively different types of agents than mature adults. They lack full adult maturity and personal agency. As a result, in addition to the usual requirements for IRB approval, one or both parents, or a legal guardian, should provide informed consent for minor children to participate in medical research.

The essays in this issue of The Journal of Medicine and Philosophy explore an innovative voucher program for encouraging kidney donation. Discussions cluster around a number of central moral and political/theoretical themes: What are the direct and indirect health care costs and benefits of such a voucher system in human organs? Do vouchers lead to more effective and efficient organ procurement and allocation or contribute to greater inequalities and inefficiencies in the transplantation system? Do vouchers contribute to the inappropriate commodification of human body parts? Is there a significant moral difference between such a voucher system and a market in human organs for transplantation? This paper argues that while kidney vouchers constitute a step in the right direction, fuller utilization of market-based incentives, including, but not limited to, barter exchanges, would save more lives and further reduce human suffering.

With rare exception, Roman Catholic moral theologians condemn the sale of human organs for transplantation. Yet, such criticism, while rhetorically powerful, often over-simplifies complex issues. Arguments for the prohibition of a market in human organs may, therefore, depend on a single premise, or a cluster of dubious and allied premises, which when examined cannot hold. In what follows, I will examine the ways in which such arguments are configured. For example, Thomas Aquinas’(1224-1274) understandings of embodiment and moral uses of the body are usually interpreted as, and cited in support of, foreclosing a market in human organs. Aquinas’ principle of totality requires that one preserve the wholeness of the human body. In approaching Aquinas’ texts, I will assume the role of a revisionist who takes seriously his core commitments, while at the same time indicating that one can further develop his understanding of the body in ways which are supportive of the sale of human organs while remaining in conformity with the author's core concerns. Such considerations will provide significant grounds for concluding that a market in human organs for transplantation appreciates the embodied nature of the human person, respects the body and its parts as personal, rather than as mere things, is consistent with acknowledging God’s dominion over our lives and bodies, and constitutes an appropriate utilization of God's gifts to us. Moreover, such a market would likely create significant opportunities charitably to help others, to enhance human dignity and to protect against the serious dehumanization of current national bureaucratic procedures for organ donation.

Adequate response to physician-assisted suicide and euthanasia depends on fundamental philosophical and theological issues, including the character of an appropriate philosophically and theologically anchored anthropology, where the central element of traditional Christian anthropology is that humans are created to worship God. As I will argue, Christian morality and moral epistemology must be nested within and understood through this background Christian anthropology. As a result, I will argue that physician-assisted suicide and euthanasia can only be one-sidedly and inadequately appreciated through rational appeal to central values, such as “human dignity” and “self-determination”, or through “sola scriptura” biblical interpretation, or individual judgments of conscience. Adequately addressing physician-assisted suicide and euthanasia will depend on a more fundamental spiritual-therapeutic approach. This cluster of moral, epistemological, anthropological, and bioethical claims will be explored by drawing on the texts of St. Basil the Great, St. Maximos the Confessor, and St. Isaac the Syrian. Their reflections on medicine, the human good, and its relationship to worship, spiritual therapy, and God will be used as a basis to indicate a broader philosophical perspective, which will be needed to avoid a one-sided, incomplete approach to the challenges of physician-assisted suicide and euthanasia. Medical morality, I argue, is best understood within categories that transcend the right, the good, the just, and the virtuous; namely, the holy.

This paper critically explores key aspects of the gulf between traditional Christian bioethics and the secular moral reflections that dominate contemporary bioethics. For example, in contrast to traditional Christian morality, the established secular bioethics judges extramarital sex acts among consenting persons, whether of the same or different sexes, as at least morally permissible, affirms sexual freedom for children to develop their own sexual identity, and holds the easy availability of abortion and infanticide as central to the liberty interests of women. Secular bioethics seeks to separate children from the authority of their parents, placing children themselves as in authority to make their own judgments about appropriate lifestyle choices, including sexual behaviors. As I argue, however, absent God, there exists no standpoint outside of our own cultural sociohistorically conditioned understanding from which to communicate any deeper perspective of reality or the bioethics that such a perspective would secure. Consequently, rather than discerning moral truth, secular bioethics merely affirms its own particular cultural sociohistorically conditioned ideological perspective. It is a social and political worldview bereft of definitive moral foundation, independent moral authority, or unambiguous content.

Two clusters of essays in this issue of The Journal of Medicine and Philosophy provide a critical gaze through which to explore central moral, phenomenological, ontological, and political concerns regarding human moral agency and personal responsibility. The first cluster challenges common assumptions in bioethics regarding the voluntariness of human actions. The second set turns the debate towards morally responsible choice within the requirements of distributive justice. The force of their collective analysis leaves us with a well-founded basis critically to approach any account of bioethics or health policy that is insufficiently attentive to the central challenges of human freedom and responsible free choice.

The goal of my comments regarding the case study of Eve Hyde — presented in the introduction of this symposium — is not first and foremost to resolve the conflict between individual autonomy and medical paternalism regarding non-consensual psychiatric treatment. Instead, the goal is to step back far enough from what is generally accepted as the morally appropriate basis for non-consensual psychiatric treatment, including involuntary hospitalization and medication, and to ask very basic questions about when patients may permissibly be treated without their consent. My goal, in short, is Socratic — to explore aspects of what we take for granted in order better to determine whether we ought to take them for granted. Commentators routinely urge that it is morally permissible forcibly to treat psychiatric patients, such as Eve Hyde, in order to preserve the patient’s best interests and restore the patient’s autonomy. Such arguments typically specify duties of beneficence toward others, while appreciating personal autonomy as a positive value to be weighed against other factors.

This issue of The Journal of Medicine and Philosophy assesses the deep and abiding tensions that exist among the competing epistemic perspectives that bear on medicine and morality. Concepts of health and disease, as well as the theoretical framing of medical ethics and health care policy, intersect with an overlapping set of culturally situated communities, striving to understand and manipulate the world in ways that each finds explanatory, appropriate, or otherwise befitting. The articles explore the complexities of framing public health care policy to guide bioethical decision making in the face of the plurality of ethical viewpoints and moral rationalities—including health enhancing supplements, continuous sedation until death, medical futility, the protection of vulnerable populations, and competing professional obligations.