The Foundations of Christian Bioethics

In 1986 H. Tristram Engelhardt published his widely read book, The Foundations of Bioethics . A second edition followed in 1996. Both editions carried the stamp of Engelhardt’s proudly displayed “Texian” (as in the “Republic of Texas”) commitment to liberty and his contention that in a society such as ours citizens meet as “moral strangers” sharing no common moral vision. Acknowledging the reality of pluralism, they must therefore accept the fact that their shared public morality must be minimal and largely procedural.

Between those two editions, however, came Engelhardt’s conversion and baptism into Orthodox Christianity”or, as he puts it, that faith “which unites in true worship and belief the Patriarch of Antioch, the Archbishop of Athens and of all Greece, the Patriarch of Moscow, the Catholicos of Georgia, the Pope of Alexandria and all Africa, and the Metropolitan of Washington.” For shorthand, we may follow him in calling this simply the Christianity of the first millennium, or traditional Christianity. Engelhardt notes that even in the second edition of The Foundations of Bioethics , having developed “the sparse fabric of the secular morality available to bind moral strangers,” he had written: “If one wants more than secular reason can disclose”and one should want more”then one should join a religion and be careful to choose the right one.”

That he believes himself now to have done and, hence, finds himself in this new book able to offer “the thick morality of moral friends,” though without supposing that this distinctively Christian morality could be adopted by the larger society. The book is, I think, too long and too repetitive. It devotes a surprisingly large percentage of its pages to disputes about method, when one would have thought Engelhardt’s task now was to unfold in its fulness the Christian vision of bioethics. The book’s combination of Texian commitment to freedom with Christian commitment to the Niceno“Constantinopolitan faith may puzzle readers and may not always seem to work. Its decidedly (and, I have to say, enjoyably) non “ecumenical approach to other strands of Christian thought sometimes threatens to lose shared vision in order to emphasize divergences. Nonetheless, none of these problematic features can detract from the fact that readers will meet here a powerful mind”deeply grounded in the literature of bioethics, in modern philosophy, and in many Christian thinkers of that first millennium”along with a passionate and argumentative spirit.

A brief summary cannot do justice to the book’s richness, but the basic structure of argument is approximately as follows: roughly a millennium of a largely undivided Christendom was fractured by a split between East and West and, then, by the Reformation. Pluralism resulted, and Enlightenment thinkers sought to provide a new ethic that, while secular, would still be universal in scope. Now, though, the advent of “postmodernism” has made clear that (as Alasdair MacIntyre put it) the “Enlightenment project” has failed to provide any agreed“upon, content“full morality. Proponents of a universal (but secular) ethic often tell a story in which it was the fracturing of Christendom and the resulting religious warfare that forced nations to accept pluralism and to seek a secular ethic that could transcend the bloodshed caused by warring Christian factions. But, as Engelhardt is quick to point out, that is hardly the end of the story. Enlightenment ethics turned out to bring its own bloodshed (through the French and the Soviet revolutions), and “secular moralities were involved in more carnage in absolute terms than had ever been experienced in religious Western Europe.”

Hence the irony: just when bioethics appears to have gained great success, becoming an accepted discipline, we begin to see clearly its inadequacies. It cannot really ground a “content“full,” a more than procedural, shared public ethic. Our purportedly cosmopolitan world endorses what it calls diversity; yet it finds any real differences of belief to be threatening. Anyone who offers an approach to bioethics that is peculiarly Christian will be thought to be divisive and disqualified from participation in the search for a shared public consensus. In response, much that passes for Christian bioethics tries to rid itself of particularity, of the sharp edges given by traditional belief. In thus attempting to gain admittance to public discussion it becomes harmless and irrelevant”scarcely different from secular bioethics save for its “spiritual” atmosphere.

How traditional Christians thinking about bioethics ought to respond to this situation is not clear, however. There are moments when Engelhardt recognizes a kind of common Christian witness that might be shared by many believers of different denominational affiliations. He notes, for example, the fracturing of (especially) Protestant church bodies, with the result that “Christians at the traditional or liberal poles of the spectrum, respectively, frequently find that they share more with others at the same pole than they do with their coreligionists.” This might suggest possibilities for a more robustly Christian bioethics that would be grounded in shared Christian belief. Engelhardt’s more common move, however, is non“ecumenical. A useful bioethics that can provide real guidance must be developed from within”and that means not simply from within the boundaries of Christian faith generally, but within the more sectarian terms of particular Christian communions. For that reason a good bit of his polemic is directed not against secularists but against other Christians”in particular, against Rome.

In his view, “traditional Christians” (i.e., those who adhere to the Christianity of the first millennium, which Engelhardt identifies with present“day Orthodoxy) “will recognize other Christian groups as struggling to be fully Christian,” but will see these other groups as “one“sided and distorted.” Because the Church is one, other Christian views are bound to fall short unless they are restored to the fulness of Orthodox vision. “The Church may once have had two lungs, but one developed cancer.” As opposed, for instance, to Roman Catholic attempts to instruct and transform the culture by means of argument grounded in shared rational capacities and discursive reasoning, traditional Christians should recognize our society as neo“pagan”a society in which “traditional Christians will survive as Orthodox Jews and Orthodox Christians have known to survive over the ages.”

Methodologically, this approach turns out to cohere very nicely”perhaps a little too neatly”with Engelhardt’s Texian passion for political liberty. With appeals to revelation impossible because of the fracturing of Christendom and appeals to reason impossible because of the failure of the Enlightenment project, any shared public morality cannot be substantive or “content“full.” It will be merely procedural. The only source of shared authority remaining is agreement or consent. Free fellow citizens can be mutually bound only insofar as they can reach agreement, and their public life will perforce have to accommodate, as much as possible, differing visions of the good. Thus, “by default,” a secular bioethics will be a libertarian bio­ ethics, grounded in nothing other than the authority of consenting individuals. Thankfully, however, when taken seriously, such a libertarian bioethics, though not itself Christian, “makes space for such an ethic” (as well as for other moralities grounded in other particular ways of life). It is not always taken seriously, however, and Engelhardt has several pages of devastatingly incisive criticism of the way in which the views of John Rawls, for example, are heavily value“laden and “neutral” only in “the very special sense of not deviating from the background moral commitments of the dominant culture.”

Engelhardt labels Rawls’ approach “liberal cosmpolitanism,” which is to be contrasted with Engelhardt’s own “libertarian cosmopolitanism.” The latter is cosmopolitan in the sense that it provides a way for all citizens to live together without force. It accomplishes this precisely by having no universally established and shared vision of the morally good life. Its authority is drawn solely from the permission of those who live together. Engelhardt explicitly recognizes that this alone is not enough to make life full”or, perhaps, even endurable. Hence, within that larger society libertarian cosmopolitans will need and will form smaller, thicker communities in which they encounter others not just as strangers but as moral friends.

But there is also a “liberal cosmopolitanism” that grows out of our need for deeper communal ties than the old Republic of Texas could provide. Those who lack any transcendent good to give value to their lives may come to value simply their lives! They give moral primacy to the good of self“expression. Hence, Engelhardt argues, a liberal cosmopolitan does, in fact, provide a substantive ranking of moral goods and a content“full vision of the morally good life. That vision gives pride of place to autonomous choice and supposes that all people should do so. It is, therefore, implicitly imperialistic in a way that libertarian cosmopolitanism is not. “Liberal cosmopolitanism is not cosmopolitan in being open to all as they reach out in their own terms to collaborate with moral strangers . . . . It is rather cosmopolitan in the robust sense of aspiring to be the global morality that should bind persons as they shed their particular bonds.”

This is a powerful argument, and the distinction between the two forms of cosmopolitanism is illuminating. One may suspect, however, that no community can hold together without a deeper, shared sense of the morally good life than Engelhardt’s position seems to allow. That is, the split between politics and ethics in his system may finally go deeper than is possible. It is, for example, a little hard to see how Engelhardt’s traditional Christians could share willingly in a polity that allows countless of their fellow citizens to be aborted. Nevertheless, he needs to be taken seriously here both by Christians who want to shape a shared, public consensus and by secularists who are, in fact, far more imperialistic than they suppose themselves to be.

A puzzling feature of this book is that Engelhardt devotes far more space to method, to the argument for the possibility of a Christian bioethic, than to its substantive development. Still, chapters five and six do discuss at considerable length questions that arise at the beginning of life (contraception, reproductive technologies, sterilization, cloning, and abortion) and at the end of life (suicide, euthanasia, and organ transplantation). Anyone can learn a great deal from reading and reflecting upon these chapters, and I do not wish to detract in any way from their value if I note here a few elements of the author’s argument that seem problematic.

Engelhardt emphasizes repeatedly that the substantive Christian bioethic he is developing is “therapeutic” rather than “juridical.” This is, one gathers, supposed to distinguish an Orthodox Catholic ethic from a Roman Catholic ethic. That there is something to such a distinction I would scarcely deny; nonetheless, it needs far more clarifying than Engelhardt provides. It often seems that ethics is being reduced to pastoral care, and Engelhardt can end up sounding surprisingly like contemporary Protestants of a Niebuhrian stripe, who bewail the human condition, wring their hands, and then do the terrible deed. Thus, for example, Engelhardt writes that “if, when faced with a choice between the life of the mother versus the life of the child in utero , one chooses to abort the child, then one must sincerely mourn this circumstance and truly repent. One must also seek spiritual guidance and attempt to involve no one who would be excommunicated through participation (i.e., any Orthodox).”

This is less than satisfying in a number of ways. Engelhardt rejects any attempt to distinguish cases (as Roman Catholic moral theology has done) through categories such as “direct” or “indirect” abortion. To do that would, presumably, be to lapse into a juridical ethic. Yet, if it is true, as he writes, that “often no matter what we do, we will be involved in sin,” he needs to help us see why this abortion can be tolerated (though only with tears) but other abortions may not be tolerated at all. He needs to help us see why other Orthodox believers involved in the act could not also participate with tears and sincere mourning. There is a genuine distinction between the kind of guidance provided by the Church’s ethical teaching and the kind of counsel provided by the Church’s pastoral care. By failing to make such a distinction, Engelhardt’s “therapeutic” bioethics threatens to make place for what we may, paraphrasing Paul Ramsey, term “ample abortions, always with tears.”

Engelhardt is also a little too ready simply to report what the early Fathers taught without exploring the inner rationale of their teaching. I do not mean to underestimate the importance of confronting contemporary Christians with the authority of the Church’s teaching, nor do the faithful always need to understand in order to accept. Still, faith can”with patience and humility”seek understanding. Thus, for example, in a generally very useful discussion of suicide, Engelhardt notes that several of the Fathers held that taking one’s life in order to avoid a violation of one’s chastity was permissible. I rather think, though, that they were mistaken in this”and that we need not follow them in this mistake. Similarly, we need not adopt the strict Augustinian rejection of any lying in order to think that Engelhardt (in a discussion of therapeutic deception by physicians) is too ready to allow (on the authority of St. John Cassian and Abba Dorotheos of Gaza) that lying may often be permitted, even obligatory, though “this must be mournfully followed by repentance.” His discussion here regularly blurs the distinction between intention and motive, and the argument that deception is allowable when “lodged within a moral framework directed to the ultimate cure: salvation” needs precisely more argument if it is to be persuasive.

There is far more here than I have been able to touch upon, and other readers will find other grounds for agreement and disagreement. Engelhardt is likely to welcome especially the latter, and I should note, in closing, that this is a book which”though deliberately dogmatic in ways designed to offend a society in which all opinions are permitted but no opinion can be judged wrong”is written with a kind of zest and good humor that deserves to be enjoyed.

Gilbert Meilaender holds the Phyllis and Richard Duesenberg Chair in Christian Ethics at Valparaiso University.