Joseph Fletcher

Indicators of Humanhood: A Tentative Profile of Man

with an actual inventory or profile, no matter how tentatively offered. Yet this is what must be done, or at least attempted. Synthetic concepts such as human and man and person require operational terms, spelling out the which and what and when. Only in that way can we get down to cases-to normative decisions. There are always some people who prefer to be visceral and affective in their moral choices, with no desire to have any rationale for what they do. But ethics is precisely the business of rational, critical reflection (encephalic and not merely visceral) about the problems of the moral

Medical Resistance to the Right To Die

0 f what I have read lately, nothing has excited me as much as Dr. Stollerman’s editorial on ”Lovable Decisions.”’ In the editorial, he calls for primary physicians to regain their classic role as “stewards” of the patient’s dying, when the battle for life has been fought and either lost or conceded. Paramedics, medical specialties, hospital systems, intensive care technologies, monitoring committees, law and lawyers, third party payors, ombudsmen, and whistle-blowing aides and nurses-to say nothing of the generally litigious and adversarial attitude rampant today-combine to weaken the physicianpatient bond. We hear on all sides that one-on-one medicine is as dead as Queen Anne, but a lot of people believe, as does Dr. Stollerman, that despite these destructive forces, we still can and should nurture what he calls the “comprehensive and continuous” role of the primary physician. Many of us reject the growing mercantile spirit that speaks of patients as ”consumers” rather than employers. The rich metaphor of physicians as stewards most surely puts these healers in tension with the marketplace concept of medicine, so popular lately with hospital managers, insurance agents, profitseekers, and budget balancers. To challenge these limited views it is important to turn to two notions that are deeply rooted in both Christian and Jewish thinking: stewardship and loving concern as the motive of decision-making. Dr. Stollerman spoke of a “lovable” decision. Of the two concepts, loving concern is not only more subtle, but carries greater moral and legal freight. The term “love” has always had different connotations, but it is far too rich to be dropped from use because of its semantic pitfalls. In Roget’s Thesaurus, loving is synonymous with good will, benevolence, charity, benignity, mercy, be-

SEMINAR 1 Human Experiments—Some Questions of Ethics

When, how and on whom should physicians experiment? How much risk justifies an experiment? Should doctors tell patients the effects and the dangers of all drugs? Who judges what experiments cause the least harm and yield the most information? How is the truth communicated to patients? These are some of the questions this distinguished panel tackles.

The Hartford Declaration

IN the April issue of Theology Today (pp. 94–97), we printed the full text of “An Appeal for Theological Affirmation,” popularly known as the Hartford Declaration. The Declaration, consisting of thirteen themes of contemporary thought considered dangerous to the churchs message, was signed by eighteen people from various Christian churches. Several other people were involved in preliminary consideration of the ideas expressed in the document. A meeting at the Hartford Seminary Foundation in January, 1975, was in large measure organized by Peter Berger, Professor of Sociology at Rutgers University, and Richard John Neuhaus, pastor of the Church of Saint John the Evangelist in Brooklyn, and out of that meeting emerged the text of the “Appeal for Theological Affirmation.” Theology Today erred in giving the impression that the text had been formulated in consultations prior to the January meeting. We have asked four people to respond to the Hartford Declaration, and their reactions, plus a response from Dr. Berger, are printed below. Ernest Campbell is minister of the Riverside Church, New York City, and author of the recent Locked in a Room With Open Doors (1974). Joseph Fletcher has been a regular contributor to Theology Today and is the author of Situation Ethics: The New Morality (1966). Formerly Professor of Pastoral Theology and Christian Ethics at the Episcopal Theological School in Cambridge, he is now Professor of Medical Ethics, University of Virginia Hospital, Charlottesville, Va. Letty M. Russell is Assistant Professor of Theology at Yale Divinity School and author of Human Liberation in a Feminist Perspective—A Theology (1974). Earlier she served as a pastor of the East Harlem Protestant Parish in New York. Richard Shaull, Professor of Ecumenics at Princeton Theological Seminary, has also been a frequent contributor to Theology Today. Formerly a missionary in Brazil, Dr. Shaull is the author of Encounter with Revolution (1955) and, with Carl Oglesby, Containment and Change (1967). Dr. Berger is a member of Theology Todays Editorial Council and his most recent book is Pyramids of Sacrifice: Political Ethics and Social Change (1974), which is reviewed in this issue of Theology Today.

Situation Ethics and Watergate

For some strange reason, evangelicals find curious delight in linking the “mistake” of Watergate with what they take to be situational ethics. In the June 10, 1974, issue of Time, Billy Graham (“both a stern moralist and a firm friend of Richard Nixons”) is reported to have said: “A nation confused for years by the teaching of situational ethics now finds itself dismayed by those in Government who apparently practiced it” (p. 18). In the Sept. 13, 1974, issue of Christianity Today, Erwin W. Lutzer, a Baptist pastor and part-time professor at Moody Bible Institute, accuses Joseph Fletcher, one of the early spokesmen of contextualism, of advocating that “when love (i.e. the best for the greatest number) conflicts with the law, we ought to ‘sin bravely’ and do what is best for the majority.” So it follows that “the Watergate conspirators followed just that principle,” (p. 27). In the Sept. 18, 1974, issue of The Christian Century, Martin E. Marty struggles to contain his editorial composure over this correlation, using a naughty word to describe the Graham-Lutzerline. We asked Joseph Fletcher to comment on the implied connection, and what follows is his response.

Medicine, morals, and religion.

The search for “‘a moral calculus’ is the most crucial problem we have in medical ethics and medical care…. No longer can we turn to the teachings of Jesus or Moses for direct moral guidance. Things are not that simple any more. Medical ethics therefore has to become truly a social ethics, not a simple interpersonal morality. The world is so tied together now that even the words ‘neighbor’ and ‘stranger’ have become archaic. We even need a new ethical language.”

SEMINAR 2 PART 1: When Should Patients Be Allowed to Die?—Some Questions of Ethics

The physician should both prolong life and relieve suffering, but sometimes these duties conflict. Is he obliged to sustain life under all circumstances? Or should he be permitted in certain situations to practice euthanasia or to omit measures that keep the dying patient alive?