Mark Cherry

Generative artificial intelligence (AI) has the potential to transform many aspects of scholarly publishing. Authors, peer reviewers, and editors might use AI in a variety of ways, and those uses might augment their existing work or might instead be intended to replace it. We are editors of bioethics and humanities journals who have been contemplating the implications of this ongoing transformation. We believe that generative AI may pose a threat to the goals that animate our work but could also be valuable for achieving those goals. In the interests of fostering a wider conversation about how generative AI may be used, we have developed a preliminary set of recommendations for its use in scholarly publishing. We hope that the recommendations and rationales set out here will help the scholarly community navigate toward a deeper understanding of the strengths, limits, and challenges of AI for responsible scholarly work.

Despite the well-documented social, economic, and adaptive advantages for young children, adolescents, and adults, the traditional family in the West is in decline. A growing percentage of men and women choose not to be bound by the traditional moral and social expectations of marriage and family life. Adults are much more likely than in the past to live as sexually active singles, with a concomitant increase in forms of social isolation as well as in the number of children born outside of marriage. These social shifts are also connected to public policies that provide incentives for individuals to exit the family, leaving behind its social, capital, and economic resources. The individualistic character of the social-democratic egalitarian ideology that underlies the current dominant approaches to health care financing in Western Europe and much of North America, for example, is associated with a decline in family stability. Welfare entitlements, including state-based health care, have made it easier to exit the family, undermining the centrality of the family’s core human relationships. This essay argues for the importance of recognizing the cardinal role and reality of the family and for the importance of family-based health care savings accounts for preserving family integrity, while also providing for sustainable long-term health care reform.

Brain transplants have long been no more than the subject of science fiction and engaging thought experiments. That is no longer true. Neuroscientists have announced their intention to transplant the head of a volunteer onto a donated body. Response has been decidedly mixed. How should we think about the moral permissibility of head transplants? Is it a life-saving/life-enhancing opportunity that appropriately expands the boundaries of medical practice? Or, is it a bioethical morass that ought not to be attempted? For the purposes of this paper, I set aside questions regarding the surgical operation’s technological plausibility so as to focus on very basic questions regarding personal identity and the morality of head transplantation. The analysis begins with an exploration of the embodiment of persons. It considers whether persons can be conceptually distinguished from all parts of their body, even if they cannot be physically separated from some parts without loss of personhood. It argues that in most cases replacing body parts with reasonably similar parts will not destroy the conditions for sustaining personhood. However, as I explore, the phenomenology of personhood is such that some physical changes may prove to be too significant to maintain personal identity successfully over time. Given such complexity and the significance of the costs involved, the moral permissibility of head transplantation likely depends on recognizing that persons may give permission to collaborate in common activities, including projects with which others deeply disagree, provided that they only utilize the services and resources of free and consenting others.

This issue of Christian Bioethics explores foundational debates regarding the orientation and application of Christian bioethics. Should Christian bioethics be approached as essentially a human activity, grounded in scholarly study of theological arguments and religious virtues, oriented toward practical social ends, or should Christian bioethics be recognized as the result of properly oriented prayer, fasting, and asceticism leading to an encounter with God? The gulf between these two general perspectives—the creation of immanent human goods versus submission to a fully transcendent God—is significant and, as ongoing debate in Christian Bioethics: Non-Ecumenical Studies in Medical Morality over the past nearly three decades has made clear, the implications are both intellectually engaging and spiritually profound.

In lieu of an abstract, here is a brief excerpt of the content:Organizational Ethics and Health Care: Expanding Bioethics to the Institutional Arena **Laura Jane Bishop (bio), M. Nichelle Cherry (bio), and Martina Darragh* (bio)In 1995, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) expanded its patient rights standards to include requirements for assuring that hospital business practices would be ethical. Renamed “Patient Rights and Organization Ethics,” these standards are based on the realization that a hospital’s obligation to its patients is derived from two relationships: the patient-provider relationship governed by “clinical ethics,” and the customer-supplier relationship governed by “business ethics.” “[This] boundary between ‘clinical’ ethics and ‘business’ ethics is not clear and in many cases is nonexistent. While marketing and admission practices are seen as issues related to ‘business’ ethics, they can lead to unneeded admissions or demand for unneeded services, both of which can unnecessarily expose the patient to the risk of side effects or complications. Likewise, underutilization of needed services is likely to lead to less than optimal health outcomes” (I. Schyve 1996, p. 17). “These new standards arose out of well-publicized concerns about abuses in which patients were admitted to hospitals unnecessarily and were discharged or transferred only after their insurance expired” (I. Schyve 1996, pp. 15–16).These abuses also sparked eloquent protests against threats to patient well-being and to the nature of the patient-provider relationship in the bioethics literature. The fiduciary responsibility of the provider to inform and to protect the patient was fragmented by insurer business practices such as gag clauses and economic credentialing of providers (VII. Scope Note 31, 1996). The background role that the institution plays, though poorly articulated historically, has been brought sharply into focus by the explosive growth of the managed practice of medicine. The context of medical ethics is no longer limited to the resolution of individual cases, but instead encompasses the adoption of institutional structures to protect and promote patient welfare (IV. Emanuel 1995, p. 335). In this new configuration, the institution and the providers are co-fiduciaries for populations [End Page 189] of patients, and the medicine that is practiced is “appropriately economically disciplined.” The expression “My patient always comes first” is no longer “... intellectually serious or morally responsible.” But, “... to be sure, both conceptually and in practice, being an economically disciplined fiduciary professional or institution is ethically unstable.... The task is to identify the boundaries outside of which institutional policy and behavior will not count as an ethically defensible form of being... [a] fiduciary.” (IV. McCullough 1997, pp. 143–44). This process of delimiting and enforcing boundaries requires the development of “... a language for talking about the ethical values of the organization. If such a language does not exist, discussions about ethics become cumbersome and unlikely to occur” (IV. Cleveland Clinic Foundation 1998, p. 2).As with bioethics generally, the literature addressing organizational ethics is multidisciplinary. JCAHO’s compliance guide for its revised standards, Ethical Issues and Patient Rights, draws on a wealth of ideas from both clinical ethics and business ethics. This is often an awkward alliance. “Because the study of organizational ethics is in its infancy compared to other areas of healthcare ethics, discussions about it often seem like hot air with no palpable payoff” (I. Boyle 1998, p. 2). The fact that “... there is an ancient history that reflects widespread doubt about the moral probity of business” (II. Frederick 1995, p. 209) does not help. To begin, “Aristotle had rude things to say about business” (II. Jackson 1998, p. 401). A brief review of introductions to several of the business ethics textbooks cited in this bibliography reveals that a rebuttal of “business ethics as an oxymoron” is the standard opening paragraph. This stigma is unfounded, and “increased stability” has characterized the state of business ethics literature during the 1990s (II. Beauchamp and Bowie 1997, p. ix). Significant attention has been given to elaborating two often overlapping theories—stakeholder and social contractarian.Originating in the 1960s as a pun on “stockholder,” proponents of stakeholder theory claim that a corporation’s fiduciary responsibility extends beyond increasing its profitability to protecting the rights of individuals or groups affected by its actions. Popular as a strategic planning tool in the...

Secular bioethics fails to grasp the central moral and spiritual realities of medicine. As the authors in this issue of Christian Bioethics argue, contemporary healthcare practice is often based on the false premise that medical science can secure the safety of human life. Yet, the standard “biopsychosocial model” of medicine fails to grasp the theological dimensions of healthcare often harming patients and their families in the process. Indeed, as the articles explore, all too often secular bioethics manipulates medicine to achieve immoral purposes, such as active euthanasia of the sick or elderly. Such spiritual decay is acutely manifested in the pressure put on patients to accept an economically efficient and medically expedient assisted death as well as in how society often treats the human body as mere res—a thing unimportant in itself apart from animation as a living person. Together the articles illustrate that without careful religiously grounded advice modern medicine is often spiritually disorienting for both patients and practitioners.

Generative artificial intelligence (AI) has the potential to transform many aspects of scholarly publishing. Authors, peer reviewers, and editors might use AI in a variety of ways, and those uses might augment their existing work or might instead be intended to replace it. We are editors of bioethics and humanities journals who have been contemplating the implications of this ongoing transformation. We believe that generative AI may pose a threat to the goals that animate our work but could also be valuable for achieving those goals. In the interests of fostering a wider conversation about how generative AI may be used, we have developed a preliminary set of recommendations for its use in scholarly publishing. We hope that the recommendations and rationales set out here will help the scholarly community navigate toward a deeper understanding of the strengths, limits, and challenges of AI for responsible scholarly work.

Bioethicists often remind health care professionals to pay close attention to issues of diversity and inclusion. Approaches to ethics consultation, where the perspective of the bioethicist is taken to be more morally correct or necessarily authoritative, have been critiqued as inappropriately authoritarian. Despite such apparent recognition of the importance of respecting moral diversity and the inclusion of different viewpoints, authoritarianism is all too often the approach adopted, especially as bioethics has shifted evermore into concerns for public policy. Yet, secular values and philosophical principles are not morally neutral; nor are the private moral convictions of bioethicists. Such analysis is always grounded in particular understandings of the right and the good, the virtuous and the just. Critical examination of common treatments and new alternatives is essential for the careful scientific practice of medicine. The same is true with regard to bioethics. Stagnating in customary or accepted claims of a common secular morality or a standard set of bioethical principles out of an unwillingness to explore the real diversity of moral thought, including traditional religious and cultural worldviews, fails to tap the human capacity to find innovative solutions to the complex challenges facing medicine.

Human enhancement raises a host of important conceptual and moral questions drawn from ethics and metaphysics, social/political theory, and philosophy of medicine. What does it mean to be human? Is it permissible fundamentally to alter our basic humanity? What would that mean? Critics argue, for example, that it is morally permissible to engage in medical therapy to address disease and disability, but not biotechnology to enhance human capacities. Other detractors raise concerns that genetic enhancement would dehumanize persons, involve morally impermissible research, or serve objectionable social/political goals, violating basic human rights or human dignity. Supporters, however, have been known to contend that enhancement may be morally required to level the playing field, given an unequal natural distribution of genetic advantages, physical talents, and cognitive abilities. Others seek to rewire human freedom, biotechnologically engineering “morally improved” human choices or, perhaps, implanting computer chips in the brain, to avoid criminal behavior or international catastrophe. On whose account of morality would enhancements be objectionable or permissible? More generally, which bioethical norms should guide public law on such matters? This number of the Journal of Medicine and Philosophy brings together an international group of scholars from Hong Kong, Macao, Mainland China, the United States, and Texas, to explore critically such concerns regarding forms of human biotechnology, reasons for and objections to pursing various forms of enhancement, and the centrality of such philosophical questions to bioethics and public policy. Together, these authors present a conceptual geography of the possible meanings, creative realities, and likely limits of human bioenhancement.

The “neuromoral” medical explanatory model of antisocial or inadequately prosocial behavior posits a biological cause for what advocates judge to be immoral activity. Proponents of this model hold that immoral behavior is the result of a dysfunction in a network of neural circuits primarily located in the frontal lobes, believed to be the “neurobiological seat” of ethical choice. Advocates encourage medical treatments, such as transcranial direct current stimulation of the prefrontal cortex, to correct brain functional impairments that presumably cause aggressive, risk-affirming, antisocial, or non-empathetic behavior. Assuming therapy successfully modifies patient behavior toward higher levels of empathy and prosocial activity, while reducing risky or aggressive behavior, such an outcome, given these background assumptions, would constitute medical treatment for immoral behavior—plausibly, a form of “moral enhancement.” As I argue, however, neurobiological claims to have found the source of moral decision-making are ambiguous and unjustified or, at least, overstated. Consequently, assertions regarding neurological treatment as moral enhancement should be approached with skepticism.

Given the real-world challenges of caring for the sick and infirm, the unrepresented and elderly, the uninsured and under-insured, it can be tempting to turn aside from Christian charity and its primary focus on love for others through love of Christ Jesus to engage the powers of political activism and government welfare in support of the vulnerable. For many Christians who engage with health care as a modern social institution, the economies of scale and the hope to coordinate social activity to benefit the vulnerable often make such a conclusion seem inevitable. Yet there is no evidence that Jesus Christ came into the world preaching human rights and egalitarian social justice. The Christian duty to care for the vulnerable is radical and personal. It should not be equated with immanent concerns for social equality, institutional honors, or success in this life. Addressing the vulnerable is done out of a duty of hospitality and love for others out of love for God. Regardless of what one thinks about government health care policy, it is far too easy to declare that someone ought to do something to help the “least among us” and then turn to the bureaucratic and redistributive powers of the state to force your own concern on others. Coercive taxation to support welfare entitlements fails to meet any sort of Christian duty to care for others out of love for Christ. Instead, donate time, medical expertise, and treasure to coordinate health care for the poor. As this article explores, Christians are called to overcome our pride, humble ourselves, and through caring for others learning to turn ourselves fully to God.

Careful critical analysis is central to reigning in untutored desires to claim the current canons of political correctness, social assumptions, or personal intuitions as moral truth or as necessarily reliable indicators of appropriate choice. This outlook is particularly essential in medicine since its conceptual and moral convictions are not merely theoretical but are applied directly (often irretrievably) to persons. The growing cleft between traditional Christianity and the methodological atheism of contemporary bioethics colors the very contours of how one appreciates public deliberation regarding morality and medicine. It shapes what is judged acceptable social debate and appropriate moral discussion, proper institutional goals and objectives of public policy. As the authors in this issue of Christian Bioethics reflect, while there exist family resemblances among various accounts of medical professionalism, claims that medicine is governed by uniquely true and universal secular moral obligations is implausible, especially given how far contemporary medical practice has drifted from traditional Christian understandings. Christian witness and traditionally Christian bioethics are central elements of a distinctly Christian practice of medicine.

As the authors in this number of Christian Bioethics recognize, language choice and emphasis shape moral judgments and medical expectations. The first two articles, for example, engage with the diagnosis of death and support for dying patients. Adam Omelianchuk explores challenges for equating brain death with the death of the patient, while Mariele Courtois integrates insights from the medieval Christian ars moriendi tradition into perinatal hospice better to support families of dying infants. The second brace of articles critique post-modern language games and the limits of secular bioethics. This dialogue begins with Dominic Robin, Kyle Karches and Tyler Tate critically engaging with Matthew Vest’s recent book: Ethics Lost in Modernity: Reflections on Wittgenstein and Bioethics. Robin argues for an expanded moral vision that appreciates bioethics as a practice focused less on principles (e.g., autonomy, beneficence, nonmaleficence, and justice) and more on what he terms the “rhetorical spaces” shaping perceptions of medical ethical application. Karches and Tate, in turn, argue that Christians ought to see through the limits of secular bioethics, while patiently reorienting medical practice toward Christ. Here, Vest is provided with the opportunity to have the final word, engaging with these two thoughtful critiques and drawing out ways that secular bioethics hides unjustified moral content in its rhetorical phrasing of moral principles, social duties, and patient responsibilities.

The papers in this number of Christian Bioethics: Non-Ecumenical Studies in Medical Morality explore the complex set of bioethical concerns related to sex. That the secular world appreciates human sexuality and sexual ethics rather differently than Christianity is obvious. For secular sexual ethics, autonomous individual consent usually draws the only morally relevant distinction between permissible and impermissible choice. As a result, secular bioethics typically advocates nontraditional understandings of sex, gender, and marriage, rejecting biological, psychological, or spiritual differences between men and women. For Christianity, sex, as in being male or female as well as in appropriate expressions of sexuality and sexual intimacy, is appreciated as foundational to who persons are and how they maintain proper orientation toward God. Moreover, a sexual ethics is embraced that understands that all sexual intimacy is to be placed within the marriage of one man and one woman, through which husband and wife are to be transfigured in the Mystery of marriage by Christian love. Representing a wide range of Christian perspectives, the authors in this issue draw on the phenomenological reflections of Pope John Paul II, the Roman Catholic Natural Law tradition, contemporary Orthodox Christianity, and the ancient Church Fathers to explore the nature of the self, sexuality, sex, and gender.

This chapter explores the experiential reality of the family and its role in securing human well-being. I argue that the family is an epistemic category as well as an ontological category: it reveals the being of the phenomenological life-world in ways that are necessary for adequately appreciating the embodiment of human health and well-being. Without the family, there are significant areas of human flourishing about which one can neither know nor experience. The family uncovers categories of moral duties and virtues central to the creation and maintenance of core areas of human well-being. Familial interactions, for example, routinely demonstrate significant forms of altruistic behavior and other-directed personal costs at levels that are atypical of nonfamilial relationships. Moreover, significant cross-cultural sociobiological data support the conclusion that family life provides social, emotional, adaptive, and financial advantages, as well as the development of affective autonomy, increased longevity, improved physical and psychological health. Conversely, traumatic changes to family life, such as the death of a spouse, are well-documented as negatively impacting personal stability, life-expectancy, and overall well-being. In short, to focus unduly on the individual in isolation from the family is to diminish this rich and significant category of human good and well-being.

Bioethics functions within a world of deep moral pluralism; a universe of discourse debating ethical analysis, public policy, and clinical practice in which a common, generally accepted morality does not exist. While religious thinkers are often approached within a hermeneutic of suspicion for assuming moral standards that cannot be justified in rational terms, secular bioethicists routinely find themselves in exactly the same intellectual predicament. That ethical theory, proposed values, or normative content is secular, that it does not invoke God or any particular religious perspective, does not mean that it is rationally grounded, necessarily true, or universally binding. As the authors in this issue of The Journal of Medicine and Philosophy make clear, this normative reality directly impacts debates regarding concepts of health, illness, and disease, accounts of socially acceptable health-risky behaviors, and the political frameworks that shape public policy. As a result, honest discussion of diverse moral, religious, and political perspectives remains essential in clarifying the intellectual challenges, ethical intuitions, and ideological judgments that shape clinical practice and healthcare policy. Depending on which moral, political, or scientific concepts are guiding bioethical analysis, careful scrutiny will tend to support rather different policies and practices, each of which is likely to be worth careful consideration.