Public. The term shows up with health, faith, and ethics with such a frequency that we can only hope it is not wearying. This issue of Second Opinion, in at least three of its articles, demonstrates how the Park Ridge Center and its—yes, I can't avoid the word—publics continuously wrestle with the concept.
A public is heterogeneous, made up of clumps and clusters of people, interests, and groups that may share many commitments and contentions, just as more intimate and homogeneous communities do. But there is a "y'all come" aspect to publics that makes the search for consensus more daring and frustrating, and the claims for consensus more tenuous than one finds where "sameness" prevails. As if publics were not sufficiently divided on regional, partisan, class, racial, ethnic, gender, and interest grounds, their internal differences are more acute when one tosses in the realities that go with religions.
Finding consensus on profound moral and ethical issues posed by medical controversies may be just a dream. When most philosophers deal with pluralism, they do not picture that the essential condition of humanity is marked by a consensus from which we have "fallen." Observers of the human scene are more ready to say that dissensus is the human condition, out of which publics come to tentative agreements now and then. "We hold these truths" and "We the people" introduce magnificent topics—for debate. You cannot keep profoundly religious people from using their convictions when they engage in the debate.
Stephen E. Lammers reappraises the most influential text in medical ethics, the famed "Beauchamp and Childress." Having said the appropriately positive things about it, he asks whether its authors sufficiently question the kind of moral framework they construct for conversation and argument about desperately urgent decisions, life-and-death questions. The work is "classic," Lammers agrees. But classics set terms for discussion more than they end them. Lammers reopens debate about the religious element and what it might or might not have contributed to this text and those who teach it.
Curtis W. Hart examines the role pastoral care plays in the bioethical debates and among practitioners. It has long been the habit of bioethicists, who are well-schooled in philosophy and who are thoroughly at home in an academy whose members often disdain religion, to regard the pluralist scene as one in which faith communities and religious individuals should not get a hearing. What sense does that exclusion make, one asks after reading Hart, if among those faith communities are individuals who are closest to the patients, individuals who are then excluded from ethics committees?
Most credentialed pastoral care people know the niceties and nuances of life in a pluralist society. They have been taught to mind their manners; too much so, say critics and prophets who want people of faith to resist conventionally approved ways of thinking. But if they know too well how to muffle their or their patients' abrasive voices and how to mumble their affirmations, they still provide creative irritants and, one expects, angles of vision that might well be overlooked if they are not represented.
Yet if they are on that scene, especially in public institutions, how does one square their presence with American traditions that would make or keep religion "a private affair," that would see these religious voices as potential violations of putatively settled church-state boundaries?
David E. Guinn, who as a staffer contributed much to the Park Ridge Center's research and reflection on these issues, has produced a virtual condensed textbook on the whole range of themes that must be addressed. He does not raise his voice, perhaps because his intention seems to be of the calming sort, but the calm he seeks does not call for superficial agreement or shallow consensus. Instead, he removes some shibboleths—that, for example, the American founders silenced religion, or that whenever the religious voice does get heard, the argument either gets so loud that many retreat or so general that it cannot adequately represent the depth of religious conviction across a free republic.
Where do these articles leave us? None of the three authors allows for the religious to hide, as if private life were all of life. Nor do the authors assure that the intensely religious will be heard because they are intense. And without a hearing, they cannot make a contribution. By reporting on and giving a face not only to reason, faith, tradition, and community, but also to memory and affection, religious communities can help the otherwise unheard be heard.
Many theologians and philosophers of religion will not let anyone get away with the claim that faith communities cannot be participants in the conversation because, by resort to revelation, they "pull rank." Pulling rank would mean excluding those who are unresponsive to the revelation, scriptures, and traditions of "the other," those who share citizenship but not creed. Yet living with revelation and scriptures and traditions does not, or need not, lead the faithful to be mum because they do not employ only reason when in the public arena. Some of the ways they grapple with issues may be compelling for people who do not share the particuar creed.
It is beyond the sphere of mere reason, however, that those in pastoral care or religious ethics can make distinctive contributions, and have done so. They can bid those who make decisions along with them to be ever more responsive to patients and publics who are on diverse paths in search of meaning and company. Those who so respond will find elements in religious traditions that have a bearing on healing and on how one decides ethical questions. They might well find that religious communities encourage their members to introduce responsibility in terms of response to God and public alike.
Everyone who is a member of a religious community is a citizen who cannot always have her way. But more and more citizens are finding the reward of learning about how and why others follow the practices that they do.
