James M. Gustafson

The contributions of theology to medical ethics

The purpose of this article is to develop a position on the contribution that theology can make to medical ethics, attending both to the forms of the contribution and to the substance of it. The order of development of the argument is as follows. First, it is necessary to indicate clearly what I mean when I speak of theology and of the work of a theologian, for different persons have different perceptions and convictions about what theology is. In a similar way, I shall indicate briefly what I think are the relevant dimensions of ethics. Second, theology is a source of many substantive themes which pertain to ethics, and to medical ethics particularly; I have isolated three affirmations to use illustratively in order to develop the more inclusive intention of this lecture. These are delineated and developed with reference to their contributions to a theological moral point of view, to certain relevant moral attitudes toward human life, and to a basic intentionality that informs action. In the course of the article I indicate some of the ways in which the contribution of theology to medical ethics must be supplemented from other resources adequately to address particular clinical moral issues.

Context Versus Principles: A Misplaced Debate in Christian Ethics

The field of Christian ethics has been the location of a debate over the past decades between roughly delineated parties representing an allegiance to the use of formal prescriptive principles on the one hand, and those representing the cause of the more existential response to a particular situation on the other hand. The debate has taken place in Europe and the United States, it has taken place in Catholicism and in Protestantism. In European Protestant literature Karl Barths Church Dogmatics, particularly Volume II/2, Bonhoeffers Ethics, and Niels Soes Kristelig Etik, have represented what has been called a “contextual” approach. More traditional Lutheran theologians who stress the importance of ethics under the law have a larger place for traditional ethical principles. Werner Elert and Walter Kunneth would be representative of this group. In Catholic literature there was a movement in the early years after World War II that came to be called “situational morality.” A critic has typified it in the following terms, “The ultimate differences between this new morality and traditional morality come down then to this: In an objective system of ethics the moral judgment is submitted to an extrinsic norm, an ontological norm founded on the principles of being. In situational ethics the moral judgment is measured only by the subjective, immanent light of the individual in question.” In contrast to the situational emphasis is the whole tradition of natural law ethics and moral theology as this developed in Roman Catholicism. It should be noted that some of the recent Catholic ethics continues to be influenced by a situational approach, though not in the extreme way of earlier materials.

Modern Dilemmas, Traditional Teachings

Book reviewed in this article: Jewish Bioethics. Edited by Fred Rosner and J. David Bleich.

Response to Margaret Farley

Professor Farley has, with great clarity and extensive scholarly support, provided an interesting model of how contemporary scholarship can relate to historical texts. She acknowledges that the theme of her paper is not central, at least in an explicit way, in the writings of Thomas Aquinas. Her concern is dominantly a modern and systematic oncern; indeed, the problematic of interpersonal commitment is one that has arisen with distinctive urgency in our generation. If I may rephrase the three subquestions of her paper, they are these. 1. Can one have an obligation to love? Can love be commanded? Is it

A Theory of Justice, By John Rawls, Cambridge, Massachusetts, Harvard University Press, 1971. 607 pp.

conflicting views within existentialism itself than he can adequately expound, let alone critically resolve. What is to be done? Macquarrie does two things, neither of which in my judgment is sufficient for his central task. He presents several different views side by side (e.g., on the motif of anxiety), or he lets a given thinker represent existentialism (e.g., Berdyaev on freedom, Buber on the positive sense of fellow-humanity, Jaspers on metaphysics) with brief mention that others hold broadly similar views. The former solution strikes me as less satisfactory than a study organized around an exposition of individual thinkers, for it abstracts certain motifs from the total movement of given perspectives. The latter solution results in a rather selective presentation of existentialism. In neither case is it possible to argue the issues through very rigorously. Macquarrie states that he cannot identify himself with anyone form of existentialism. In fact he would want to modify and broaden existentialism at so many points that the result might not any longer be existentialist (p. 226). Yet, ironically, I can make most sense of this study when I view it as an emergent constructive perspective on how one might synthesize existentialist motifs into a fairly coherent philosophy. Macquarries preferences for Jaspers and Heidegger, enriched with selected features of the work of Buber and Berdyaev, reflect what that perspective is, though it is not fully developed nor is it vigorously argued except at highly selected points. There is much to be learned in this book. Macquarrie knows his sources and he writes with simplicity and clarity. Measured in terms of his stated aim, however, the book is only partially successful. Still, I am not sure that the project Macquarrie sets for himself can be accomplished in this size volume. I am sure that it would in any case require more careful philosophical argument than Macquarrie gives us in this study. THOMAS W. OGLETREE Vanderbilt University Nashville, Tennessee

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is factual, although some hypothetical cases are used as illustrative material. In the chapter on consent, cases are used of experimentation on aborted fetal material. Such cases are of extreme importance in the present abortion controversy, which is not treated as such in the book. The most telling case and the one best suited for sharpening the principles and solutions needed is the true case involving the use of institutionalized retarded children in a New England resident-care facility. Again the pros and cons of such a situation are put forward fairly. Clearly and with great precision of thought, R. finally develops his own ethical position and solution. Chapters on determining death, on (only) caring for the dying, on transplant (living and cadaver donors), on kidney and heart, and on triage (delivery of medical services) follow. Besides the chapter on consent, those on care of the dying and on the delivery of sparse medical resources are in my estimation the best; but there are nuggets not to be missed in the other chapters. I am obviously enthusiastic about R.s book and hope that medical men will take the time to ponder the principles presented. It is an absolute necessity for anyone interested in medical ethics, regardless of his position. R.s style is sometimes difficult, and the cases presented, while they add greatly to the interest and basic understanding of the work, will probably date the presentation. No doubt, lesser ethicians will update the cases; hopefully, they will not lose the Ramsey spirit.

3.95 (paperback)

Book reviews do not provide sufficient space for a multifaceted and thorough critique of R.s formal and material moral theology. His essentially polemical approach makes it easier to see what he objects to than to see all the reasons why he objects. His concentration on practical problems and the issues of practical moral reasoning in the recent writings makes more fundamental philosophical and theological issues increasingly opaque. There seem to be appeals to natural law, but there is no account of the epistemological and metaphysical presuppositions of such appeals. There are brief and sometimes cryptic appeals to explicitly Christian theology, but sometimes one gets the impression that these function more as rationalizations for an ethical point of view (both formally and materially) than as sources for ethical understanding. Of course, no writer can cover all the bases equally well. Without R.s work, Christian ethics in America would be considerably poorer both in the quantity and quality of its publication.

Book Review: Fabricated Man: The Ethics of Genetic ControlFabricated Man: The Ethics Of Genetic Control. By RamseyPaul. New Haven: Yale Univ. Press, 1970. Pp. 174.

Man in Rapid Social Change, by Egbert de Vries. 240 pp. Garden City, Doubleday & Company, 1961.

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4.50.

Book Review: Toward a New Catholic MoralityToward A New Catholic Morality. By MilhavenJohn Giles. Garden City: Doubleday, 1970. Pp. 240.

A TECHNOLOGICAL society is a society of disenchantment. We generally assume that disenchantment is a mark of I maturity. A child’s world is an enchanting world. The patterns of ice and frost on the windows on cold February mornings lead to awesome delight, and give credibility to the wonderful story of Jack Frost. They are not problems to be solved scientifically and objects to be removed by better control of temperature and humidity. Expressions of parental fondness in spontaneous marks of affection are delightfully received at their face value, not phenomena to be interpreted by concepts from depth psychology or explained by statistical correlations between such moments of affection and the lack of tension during the course of one’s work in kitchen or in office. The child often delights in the novel, the unexpected, the unanswerable things that take place in the course of his day. He is in a world of enchantment: fear, wonder, awe, delight. Primitive responses are the stuff of his world. Adulthood involves disenchantment of the world. It depreciates the elements of wonder and fear, of delight and awe. Adulthood involves growing rationality. The technological society is hard put to appreciate enchantment. The artist protests the rationalization of the world with his own forms of deeply personal expression. But men geared to the dominant motifs of a technical age have some difficulty in appreciating the childlikeness of the artist. Technical man’s concerns are not directed to simplicity in observation and the profundity of more primitive expressions of delight or fear. The forest is potential lumber, the mystery of matter is potential energy, words and ideas are potential means of human persuasion and manipulation. Persons are functions, potential producers and consumers. A technological society gets on with its business when the elements of mystery can be reduced if not eliminated. It seeks in every possible way to