Can we talk?

In recent months (perhaps years, now), it seems the religious and irreligious are divided more severely than ever. In response to demands that intelligent design be taught in schools or that evolution not be taught, writers such as Sam Harris, Daniel Dennett, and Richard Dawkins have taken religious thinkers and writers to task, attacking religious thought with unbridled enthusiasm. Their writings serve more as a rallying cry than as discourse and, as such, probably exaggerate the true gap between believers and non-believers in our society. Some of the religious seem equally enamored of raising arms against the other side. The Terri Schaivo “debate” quickly devolved into nothing more than grandstanding, posturing, and provocation for combat. With no background knowledge of our society, one would think pluralism had only happened moments ago and that any kind of discourse between the two sides (indeed, there are far more than two sides, but such nuance is invisible at the moment) is impossible. A little reflection, however, will remind us that the United States, while not quite the rich and diverse mosaic some dream it has been, is a country that has managed discussion between divergent groups in the past. The founders of our country were both religious and secular. Although a fair amount of strife resulted, discussion and compromise were always seen as real possibilities. It is possible that a way forward still exists.

When asked who would be an authority on matters of morality, most members of the public, in the United States at least, would first mention members of the clergy. More sophisticated individuals might know to mention theologians specifically. Few people would think to mention philosophers, especially not secular or, worse, atheistic philosophers. In The Elements of Moral Philosophy, James Rachels says:
“It is not unusual for priests and ministers to be treated as moral experts. Most hospitals, for example, have ethics committees, and these committees usually include three types of members: healthcare professionals to advise about technical matters, lawyers to handle legal issues, and religious representatives to address moral questions.”
So, most people in the U.S. believe morality and religion are inseparable. Rachels refers to Plato’s Euthyphro to question whether God’s morality is arbitrary or rational. If actions or values are good only because God commanded them, then morality is arbitrary, or so the argument goes. If God commanded actions and values because they are good, then God’s morality is rational. Rachels quotes Gottfried Leibniz saying that the latter must be true. He says, “For why praise him for what he has done if he would be equally praiseworthy in doing exactly the contrary.” If God’s actions are rational and not arbitrary, then any rational person should have an equal ability to examine moral questions on the basis of reasoned argument. Rachels’ argument is that atheists and secularists should be included in moral discourse.
It is surprising, then, to find that the theologians Rachels felt have an undeserved place of privilege in moral discourse should complain that they have been left out of moral discussions, particularly with regard to bioethics. Courtney Campbell writes, “One unfortunate aspect of civic bioethics . . . is its incivility, including incivility toward religiously grounded opinions.” He also warns that religious bioethicists cannot retreat to the academy as, “the academy exhibits its own forms of intolerance toward religious expression.” Rachels and Campbell appear to be living in two different worlds, one hostile toward the secular and one hostile toward the religious. Authors on both sides declare that they must fight to be included in the discussion and be heard over the tyrannical forces of the opposing side.
Certainly, each side is correct in at least a surface view of discourse in the United States. Most people in the United States are religious, and their religious values are reflected in the public sphere. Some religious groups have shown clear forms of intolerance for opposing views. On the other hand, many professional philosophers are secular or atheistic, and a condescending attitude toward religion is perceptible to even beginning students in philosophy. Philosophers are a small minority, indeed, but their voices are disproportionately loud in the debates over bioethics, at least in part because they have made some provocative claims. How is a religious person to speak to a philosopher who claims it is permissible to kill babies and disabled adults but not animals? The fact that such a question is even asked must be enough to make some religious writers feel dialogue is hopeless.
James Gustafson describes three styles of religious discussion in medical ethics. The first is based on autonomy of religious views; most people would generally associate this view with an assertion of religious authority. When asserting authority, one is likely only to sway those of the same faith who feel compelled to follow the authority of its leaders. This is, of course, an important part of the moral work of many theologians, but it does not engage the wider community. The second style stresses continuity with the wider community. This style seeks to make religious positions intelligible both to those within and beyond a specific religious community. For example, a Catholic theologian may publish and article or give a speech intending to make the Catholic position on social welfare or just war comprehensible to non-Catholics. In doing so, some non-Catholics may come to agree and join with Catholics in support of or opposition to public policies. The final style is interaction, which is the only style in which the religious interlocutor is open to revising his or her original position. The interactive style is not for every writer or every occasion, but Gustafson notes that it is possible and can provide a space where the religious and the secular can converse about matters of medical morality.
J. Bryan Hehir discusses the role of the “public church.” In examining the proper role of Catholic bioethics, he notes that the Catholic Church “defines civil society as both an audience for its teaching and an object of its pastoral care.” From this prospective, theologians and others are obligated to engage the wider, pluralistic public on important matters of morality. He says that religious writers must be prepared to contend with a pluralistic society, a secular state, and a liberal philosophy of law. He notes the success of Martin Luther King in addressing the public on moral matters using rational argument that was not free from religious significance. However, biomedical issues seem especially intractable, particularly with regard to issues related to sanctity of life (e.g., abortion, suicide, euthanasia).
Given the steadfast opinions of individuals on both sides of the abortion debate, many have advised Catholic writers to focus attention on the ecclesial community. Hehir finds this dissatisfying as he advocates a public church, not a church that restricts its reach to its own enclave. He says, with some apparent pride, “The strategy may ultimately fail, but the failure will be that of a public church, rather than a decision by a once-public church to retreat within a purely ecclesial definition of its role.” The question is not whether the church succeeds or fails but whether it fulfills its duty to society as an object of pastoral care.
Hehir moves to another issue that may seem to be less of a problem for discussion between the church and the secular public: public access to health care. While religious language may be used to discuss health care, the general public can certainly understand the positions of the church, and the issues are not nearly so intractable as discussions of abortion, for example. On the surface, it seems that the church would be obligated to support efforts at providing heath care to all, but Hehir sees a problem. Many proposals for public access to health care include provisions for publicly funded abortions. He suggests that multiple strategies could be adopted but not in his short essay. Fortunately, Andrew Lustig expands on the discussion of health care rationing and reform, but the problem remains frustrating. Lustig recalls Christian teaching that demands universalizing love and care for one another, which would seem to require support for public access to health care, perhaps even globally. Nonetheless, he notes that U.S. bishops oppose any health care package that includes abortion. He calls for religious writers and others to invite their religious values to drive arguments expressed in non-parochial, or public, terms. He sees a possibility that religious values will “work their leaven upon the world” indirectly. How is a secularist to respond?
Two secular philosophers, Peter Singer and Peter Unger, have devoted much of their attention to the ethical use of the world’s resources. Both are motivated by a value shared by all Christian writer’s I am aware of: a value of preserving the lives of those who wish to live. Admittedly, some Christian writers would want to preserve lives in cases where someone might want to die, but it is possible to bracket that concern while discussing our individual obligation to others who do want to live. Singer and Unger both argue that taking care of the world’s most vulnerable people is an individual responsibility for everyone. While they both eschew religious language, others have pointed out that only Jesus seemed to have an ethic as demanding as Utilitarianism, requiring all in affluence to give to any who need assistance. Singer and Unger are both Utilitarians (a frequent straw man for non-Utilitarian ethicists) and argue that the interests of all must be considered equally (for Singer, the interest of animals must also be part of the calculus).
On the point of health care in particular, Singer questions the claim of Christians to value all lives equally. He challenges the notion, saying that to value all lives equally would mean spending as much money to save the lives of the world’s desperately poor as we spend saving premature infants and those in the last stages of life. Many of Singer’s positions are anathema to Christian thought and tradition, but on this point common ground seems possible. While not responding specifically to Singer and Unger, Edward Langerak gives an example of a kind of language that is distinctively religious yet still capable of engaging secular philosophers. He notes that religious covenant requires individuals to love their neighbors. He acknowledges that “the problem has usually been that people’s sense of obligation is too minimal for covenantal flourishing.” He quickly adds, “But some special covenants seem especially prone to encourage a ‘savior’ mentality in which persons lose themselves in a bottomless pit of others’ needs.” His language is decidedly religious, but it echoes secular arguments against the Utilitarian calculus. Both the Utilitarian and covenantal ethicist can “bury the self in the bottomless needs of others.”
James B. Tubbs grapples with the question of obligation to strangers. Tubbs exclaims, “Yet Jesus goes beyond the claim that needy strangers should be regarded in the manner in which God regards them. He suggests, in fact, that the needy stranger be regarded as the Son of Man himself!” Tubbs emphasizes this point further by admonishing that the encounter with the stranger should be seen as an encounter with the divine. He then moves to an examination of what it means to be a neighbor. He declares that our moral life is dependent on relationships with others, but he leaves off the discussion of what this relationship demands of us. It would not be difficult for the Utilitarian to agree that strangers shape our moral lives, but it seems more difficult for Utilitarians to turn away from what our relationships demand of us. In any case, it is not religious language or hostility to religious thought that prevents Utilitarians and religious writers from becoming interlocutors. One has no difficulty imagining a discourse on our obligations to strangers between the secular and the sectarian. A certain degree of consistency is of value in any moral tradition.
I have focused so far on obligations to strangers as it seems to me to be the most pressing medical issue for everyone. More than four million people die each year from starvation. Millions more die from treatable or preventable diseases. While academic bioethicists grapple with deep quandaries regarding patients and the role of the doctor at the bedside, most of the world would be improved greatly by having the luxury of becoming a patient rather than another statistic. War and its always-attendant famine kills far more people than withdrawal of treatment from impaired newborns or cessation of treatment for the cognitively impaired. This is not to dismiss the importance of discussions over transplantation and other hard questions, but the easy questions may be a good place for secular and sectarian interlocutors to begin a discussion. An infinitesimally small number of people discussing bioethics and medical humanities would claim that the loss of life is insignificant. Whether the author values life because it is a gift from God or because it is something individuals have developed an interest in maintaining, life is something to be preserved, at least in the cases where the living person values his or her life. Given the almost universal agreement with this statement, it seems that philosophers, theologians, and bioethicists of every stripe could work together not on whether life should be preserved but on how public policy can be shaped to help those who need medical care and cannot procure it. It has perhaps been avoided too often because the task is more daunting than deciding at what moment a dying person becomes a corpse with organs suitable for donation. Nonetheless, if we are to encounter strangers as our neighbors, we must gird ourselves for the struggle and prepare for a significant shift in how we view our fellow sufferers in the world.
If a discussion of helping the world’s neediest individuals seems possible among people of many faiths and philosophical dispositions, Leigh Turner’s example of blood transfusions will have us despair that no discussion is possible in other areas. To be sure, people from many backgrounds would agree that blood transfusions are often required to prolong lives. Many would see providing transfusions to be an obligation of the highest order. Turner points out that none of this rhetoric or consensus of most bioethicists will be of interest to Jehovah’s Witnesses. Turner warns, “Principlist and case-based approaches to moral deliberation typically exaggerate notions of common morality.” The point deserves consideration. It is naïve for any bioethicist to assume that any argument, no matter how well reasoned, will be accepted by all. Turner accuses bioethicists of ignoring the elephant in the room, but this conclusion may be rash. It could be that bioethicists, aware of the elephant in the room, persevere in the hope of lighting one candle rather than cursing the darkness.
It is no question that philosophers and theologians often talk past one another. Many religious concepts cannot be put into a language common enough for the secular and the sectarian. This should not mean, however, that the conversation should not begin. The “public church” should make its beliefs as clear as possible to even an unreceptive audience. The public intellectual should do the same. Resistance should come from all who have the strength of their convictions regardless of whether those convictions come from religious moral traditions or reasoned argument and reflection. Speaking one’s conviction publicly and arguing for it is itself a moral act. Tolerance and respect for diversity do not require us to stifle our voices. They require us to accept that other individuals have the same right and obligation we have to express their deeply held convictions and beliefs.
Public policy, on the other hand, must reflect the greatest respect for individual beliefs and convictions that cause no harm to others. To be sure, it is not easy to decide what beliefs cause harm to others. The case of blood transfusions from the Jehovah’s Witnesses’ point of view is a reminder that sometimes harm seems quite different when seen from different vantages. I personally am concerned about harm done to animals. I realize that most do not consider harm to animals to be harm at all. I join the relatively small group of individuals, mostly but not exclusively secular philosophers, in explaining why much of the harm to animals seems not only cruel but unnecessary. I have learned that the stronger claim that animals should not be harmed or used in research is almost universally rejected, but many people of various faiths and backgrounds accept that cruelty is an evil. Deontologists and virtue ethicists both reject cruelty to animals as a bad habit that could lead to cruelty to humans. Thus, Kant and Aquinas both reject direct obligations to animals but see humane treatment of animals as an indirect obligation to humans. Those with sufficient openness have been able to discuss this subject with respect and results. Globally, a shift toward more humane farming is underway even as factory farming continues to be the most profitable means of producing food.
We can and must engage one another in discourse with respect, tolerance, and courage. The debate will not always produce an answer that is accepted by all, but the lack of debate will always produce frustration and power struggles. Bioethicists are in a position to model such discourse for the larger society. This will require leaving the enclaves of institutions and entering the public sphere in a more visible manner. We must take care to live by the principles we espouse. Peter Singer has been criticized for donating only 20 percent of his salary. He admits he could do more but also points out that it would not be necessary if everyone living in affluence would give only one percent of her or his income. We have achieved nothing near this level of giving, but aid organizations did see a spike in donations after Singer’s essay on world poverty appeared in the New York Times. It is certain that atheist Singer managed to engage the religious with his argument. Discourse can have positive results.
Ronald Carson writes, “In covenant, one receives others as one receives a gift—in trust—and one passes the gift on in response to need, with due regard for the recipient, and without calculation.” Our fellow ethicists are in need of respectful interlocutors just as our fellow humans are in need of medical assistance. As bioethicists, medical humanists, and responsible human beings, we can help provide insight, assistance, and advocacy. We can join and be fully engaged in a moral community. This is the task at hand.

About ethicsbeyondcompliance

I hold a PhD in medical humanities with an major emphasis in ethics. I began teaching college-level ethics in 2000.
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