Adam Omelianchuk

There is an active debate about whether religious, and specifically Christian, clinical ethics consultants should allow their beliefs to influence their assessments and recommendations. Speaking as a Christian consultant, my problem with this debate is that it often treats “Christian belief” narrowly, as a set of rules derived from Christian authorities. I argue that this framing focuses exclusively on the theme of “law” in Christian theology and neglects the central Christian theme of “gospel”: the good news of God’s mercy and compassion extended to “lawbreakers.” Christian conduct is to be shaped not only by “the law” but also by the transformative power of God’s grace. While identifying the rules and principles in a case is important, how ethicists conduct themselves matters just as much. Ethics consultation requires active listening, interpreting others charitably, and building trust. What is missing in current debates is how the virtue of compassion and the work of mercy can guide the consultation process and help manage the burdens of moral responsibility. A Christian approach to ethics consultation not only influences these practices but also supplies a spiritual engine that inspires action.

A crucial test for the dominant Rawlsian ‘consensus’ brand of public reason is whether it is complete – sufficient in content, that is, to yield determinate answers to the political questions put before it. Yet while doubts about the incompleteness of Rawlsian public reason have been often voiced, critics have thus far carried out relatively little of the philosophical spadework needed to substantiate them. This paper contributes to remedying this omission, via a detailed analysis of the implications of Rawlsian public reason for an important bioethical problem arising at the end of human life. This is the problem of how to define and diagnose the death of a person, or determine at what point the clinical and legal practices conventionally associated with death, such as the removal of vital organs, may take place. My thesis is that this is a matter on which Rawlsian public reason does indeed have a grave incompleteness problem: the model produces indeterminacy, I argue, between a broad range of legal definitions of death. I also aim to go beyond existing articulations of the incompleteness objection, moreover, by examining what Rawlsian consensus liberalism implies about how decision-makers ought to respond to indeterminacies in public reason. Insofar as the route to a reasoned choice between competing criteria of death is foreclosed, I contend, the Rawlsian view requires that selection among policy options proceed in an intolerably arbitrary fashion. The latter finding alters the cast of the familiar incompleteness objection, by closing the gap between it and what I have elsewhere called the ethical objection – the objection, that is, that public reason can in some cases generate determinate but morally unacceptable decisions.