Brandon Lustig

This essay analyzes Roman Catholic social teaching on the right to health care and the legitimacy of healthcare rationing. It considers that discussion at two levels: (1) the specific warrants that undergird key terms; and (2) the accessibility and applicability of those warrants to policy choices in a secular society. The essay concludes with a number of broader reflections meant to reserve an appropriate place for religious voices in the process of policy-making, as distinguished from its justification.

Despite a variety of “non-ecumenical” features in Christian arguments about suicide, assisted suicide, and euthanasia, there are obvious “ecumenical” aspects to be found in the general Christian prohibition of these practices. A fair reading of the Christian tradition requires that we acknowledge both the differences that distinguish particular perspectives and the fundamental themes that allow an identifiably Christian position to emerge in stark contrast to the secular discussion of these issues. Central to Christian interpretations of dying and death are an acknowledgment of God's sovereignty over human life, an understanding of suffering that stresses identification with Christ as the source of Christian hope, and the recognition that God's creative and redemptive purposes are generally (or always) at odds with the deliberate choice of assisted suicide or euthanasia

In response to my earlier critique of recent attempts to rebut principlism as an ethical approach, Green, Gert, and Clouser (GG&C) have in turn offered their own critique of my appraisal. This essay identifies eight major criticisms GG&C raise in their response and offers a rejoinder to each. Among them, three are especially important: (1) that the label of ‘deductivism’ fails to capture GG&C's ethical method and should be replaced by ‘descriptivism’; (2) that pluralistic accounts, including principlism, fail to offer any systematic way to resolve moral conflicts; and (3) that appeals to broader ‘moral’ principles beyond the moral rules are deceiving, since apparent differences in ‘moral’ judgment invariably involve disagreement about empirical facts rather than further moral considerations. In response to (1), I defend my earlier label by emphasizing the stipulated and invariant status of the moral rules GG&C invoke, even as I question the adequacy of their putative ‘descriptivism’. In response to (2), I suggest the plausibility of pluralist approaches and reiterate the modified just-war criteria that Beauchamp and Childress invoke in situations when principles conflict. In response to (3), I suggest that a ‘descriptivism’ worthy of the name must systematically accommodate the appeal to moral principles that remains central to metaethical and normative discussions. Keywords: deductivism, descriptivism, inruitionism, pluralism, principlism, publicity, specification of norms CiteULike Connotea Del.icio.us What's this?

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.

Several scholars have recently criticized the dominant emphasis upon mid-level principles in bioethics best exemplified by Beauchamp and Childress's Principles of Biomedical Ethics . In Part I of this essay, I assess the fairness and cogency of three broad criticisms raised against ‘principlism’ as an approach: (1) that principlism, as an exercise in applied ethics, is insufficiently attentive to the dialectical relations between ethical theory and moral practice; (2) that principlism fails to offer a systematic account of the principles of nonmaleficence, beneficence, respect for autonomy, and justice; and (3) that principlism, as a version of moral pluralism, is fatally flawed by its theoretical agnosticism. While acknowledging that Beauchamp and Childress's reliance upon Ross's version of intuitionism is problematic, I conclude that the critics of principlism have failed to make a compelling case against its theoretical or practical adequacy as an ethical approach. In Part II, I assess the moral theory developed by Bernard Gert in Morality: A New Justification of the Moral Rules , because Gert has recommended his approach as a systematic alternative to principlism. I judge Gert's theory to be seriously incomplete and, in contrast to principlism, unable to generate coherent conclusions about cases of active euthanasia and paternalism. Keywords: active euthanasia, applied ethics, Beauchamp and Childress, intuitionism, paternalism, principlism, W.D. Ross CiteULike Connotea Del.icio.us What's this?

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.

Despite reservoirs of moral discourse about duties in religious communities, professional caregiving traditions, and philosophical perspectives, the dominant moral language in contemporary biomedical ethics is that of `rights'. Duties to Others begins to correct this imbalance in our ethical language through theoretical expositions of the ideas of duty and of the `other', and by applied exemplifications of particular duties to identified others that arise in the context of health care. A pronounced multidisciplinary orientation informs this analysis of our moral call to respond to the needs of others. The essays in this volume offer a stimulating intellectual freshness through a continual engagement of theological, professional, and philosophical understandings of the duties that arise in our relationships with others in medicine, nursing, and social contexts. Duties to Others provides provocative challenges about the terrain of our moral world for both students and professionals in biomedical ethics, medicine, philosophy, and theology.

There are numerous challenges posed to Roman Catholic health care institutions by recent developments in health care delivery. Some are practical, involving the acceptable limits of accommodation to and collaboration with secular networks of health care delivery. Others, quite often implicated in the first set, are explicitly theological. What does it mean to be a distinctively Roman Catholic health care institution? What are the nature and the scope of Roman Catholic institutional identity? More broadly, what is the moral relevance of themes in Roman Catholic social teaching to the provision of health care? This issue of Christian Bioethics addresses these questions with a spirited exchange among its authors. They offer noticeably different perspectives on the general cogency of Roman Catholic social teaching and different strategic recommendations for Roman Catholic institutions to maintain, or recover, their distinctive presence in health care delivery.

Abortion is an especially salient issue for considering the general problematic of religiously based conversation in the public square. It remains deeply divisive, fully thirty-four years after Roe v. Wade. Such divisiveness cannot be interpreted as merely an expression of profound differences between “secular” and “religious” voices, because differences also emerge among Christian denominations, reflecting different sources of moral authority, different accounts of moral discernment, and different judgments about the appropriate relations between law and morality in the context of pluralism. As this paper explores, however, despite those differences, a generally identifiable “Christian” position concerning the moral status of abortion can be distinguished from secular philosophical judgments on the issue, which is important for Christian engagement with public policy debate

Different judgments by Christian communities on issues in sexual ethics involve different weightings of various sources of moral authority, different understandings of the normativity of the natural, and different assessments of the scope of freedom to be exercised in relation to the goods of marriage. These fundamental differences of interpretation can be exemplified by the ongoing Roman Catholic discussion of the legitimacy of voluntary sterilization in certain “hard cases.” The contributors to this issue of Christian Bioethics, in their spirited exchange on that issue, exemplify the need for careful attention to the ways that differences of theological emphasis and moral method lead to different judgments in particular cases, both within and between particular Christian communities.

H. Tristram Engelhardt has made profound contributions to both philosophical and religious bioethics, and his philosophical and religious works may be read in mutually illuminating ways. As a philosopher, Engelhardt has mustered a powerful critique of secular efforts to develop a shared substantive morality. As a religious scholar, Engelhardt has affirmed a Christian bioethics that does not emanate from human rationality but from the experience of God found in Orthodox Christianity. In this collection of essays, both defenders and critics of Engelhardt's religious bioethics have their say, and the spirited nature of their discussion attests, in its own right, to Engelhardt's enduring influence