Huston Smith, the scholar of world religions, observed that "symbolism is the language of religion generally; it is to religion what numbers are to science."¹ If a religious tradition is deprived of its symbols, its "grammar," it will find itself at a distinct disadvantage in trying to communicate its teaching and meaning to others. Indeed, in an important respect, so symbolically laden are religious traditions that efforts at communication without symbols may be considered, both by members of the community and by outsiders, as nonsense—analogous to a grammatical or linguistic rule violation.

I begin with these simple observations because I think that affirming the role of symbols and symbolism as a vital part of religious experience can enable us to ascertain questionable features of the current contested terrain between religious moral teaching, the field of professional bioethics, and their interaction in the realm of public policy. Using several examples from classical debates in bioethics literature, I contend that the dominant discourse of professional bioethics systematically finds the substantive and symbolic grammar of religious moral teaching deficient, and routinely discounts it as a source of moral wisdom for public policymaking. The bioethics discourse is largely informed by a narrowly and myopically construed rationality. Exposing this bias should make professional bioethics discourse more inclusive, welcoming, and open to moral contributions from religious moral traditions.

It needs to be acknowledged at the outset that professional bioethics is by no means the only area in which religious, ethical, and policy domains overlap. Indeed, in certain respects, I believe that what is played out at the professional and political level is often illustrated in the microcosm of the academic bioethics classroom.² But beyond the classroom context, religion and bioethics may be interrelated in several different community contexts, including within an ecclesiastical body, a clinical setting, a healthcare institution, civic forums, legal cases, and the formation of public policy.

Thus, the "problem" with the interrelationships of religious moral teaching, the discourse of professional bioethics, and public policy may be rather abstract, removed from practical contexts where something actually depends upon the resolution of a question. In other circumstances, however, the interactions at this abstract level may well illuminate the contexts and issues confronted in practical settings. At least, that is the presumption of this essay.

INSTRUMENTAL AND SYMBOLIC RATIONALITY
The concept of symbol is itself a subject of dispute. I will not seek to resolve that dispute here, but simply indicate in what sense I use the terms "symbol" and "symbolic rationality." Human beings are symbol-making beings, as the philosopher Ernst Cassirer observed.³ It is part of our nature to construct and make symbols; the letters typed in this sentence are themselves symbols. Insofar as any discourse seeks to differentiate and exclude symbols from consideration, it is presupposing a philosophical anthropology that is somewhat alienated from the people we know ourselves to be.

We not only construct symbols but encounter and respond to them every day. One common symbol in American public life is the flag of the United States. Like all symbols, the flag makes concrete something that is abstract. The flag represents certain ideals of unity and democracy, and equality and liberty, and the sacrifices that were made to approximate those ideals. We use or respond to symbols because they convey meaning, and they convey meaning more effectively because they are concrete presentations or representations of the abstract.

Symbols are effective insofar as they communicate meaning not only by stimulating cognitive awareness or understanding, but also by shaping and eliciting affections and emotions. That is, effective symbols involve the whole person and induce a response. Those responses may differ: the flag may invoke feelings of reverence, allegiance, or disgust—the latter partly because of the chasm between the ideals and meanings conveyed by the flag and actual political practices—but almost never indifference.

Symbols are also situated within social and historical contexts. Thus the meanings they bear and the responses they elicit can differ according to the embedded sociohistory of a group or culture. A flag can elicit pride and a sense of historical continuity for one group, and represent hate and oppression to another; such has been the furor over the public display in some southern states of the Confederate battle flag. The meanings of symbols are thus not univocal, an important point for bioethics.

Religious communities are, as Smith observed, well versed in symbols and even systems of symbols. Bread and wine, set within a Christian context, become the focus of liturgical worship. Similar symbols can be identified within all religious traditions and faith communities. Religious symbols are significant, if not distinctive, in that they not only convey meaning but point to matters of ultimacy in human life, questions of the highest concern and relationships of the most significant nature.

It is in this sense that I use the terminology of symbols and symbolic rationality in this essay. Symbols convey meanings and evoke responses that involve the entire embodied self; symbols from within religious traditions convey meanings of ultimacy, evoke distinctive responses such as awe, and enable self-discoveries that express spiritual dimensions. Such symbols may be artistically represented or they may be embodied and discursively described, for example, an understanding of a child as a gift or of a person as created in the divine image. Both symbols point to matters of ultimacy and identity, elicit attitudes and actions of awe, compassion, and respect, and forge relational connections that are deeper and more meaningful than connections with moral strangers.

In thinking about how symbols may be integrated within the discursive patterns of professional bioethics, it is vital to draw upon a distinction first articulated by the founder of the modern study of sociology, Max Weber. Weber distinguished between two types of rationality that characterized patterns of thinking in the political, scientific, and economic realms.⁴

The first of these, Zweckrationalitat, is a common form of reasoning in which the goal is to determine the most efficient and effective means to achieve a specified end. The ends themselves are beyond political and perhaps even moral scrutiny; the central issue revolves around examining alternative means with respect to their efficiency and effectiveness.

The pattern of Zweckrationalitat is thus instrumentalist and utilitarian. Means are instruments to achieve certain ends. This form of "instrumental rationality" is compelling in a public policy setting where certain ends or goods are taken as necessary for a flourishing society, such as civil and national defense, education, and transportation. It is also this kind of reasoning that dominates professional bioethics discourse when it undertakes matters of public policy. Bioethicists devote their attention to such matters as how society can implement procedures to increase the supply of transplantable organs or tissues, expedite the development and application of knowledge generated by scientific research studies, or refine informed consent processes to ensure that persons are provided a diverse array of choices to enact their life plans as part of their general pursuit of happiness. There are very few issues in bioethics with direct public policy implications in which the discourse is not dominated by the pattern of instrumentalist rationality delineated by Weber.

In Weber's view, instrumental reasoning is part of the general process of secularization in western culture expressed through his language of "rationalization." The rationalized world becomes explicable and demystified through scientific thought. Instrumentalist patterns of reasoning do not generally accommodate points of view that examine intrinsic or inherent value; the means themselves are not intrinsically meritorious, but rather derive their value from the efficient and effective accomplishment of the desired ends generated by human will and interest.

In characterizing the rationalization of the modern world, Weber implicitly rejects another pattern of reasoning, one that is compatible with religious tradition rather than secularization, with intrinsic rather than extrinsic worth of acts, and with focused moral communities rather than with public policy for moral strangers. Weber designates this pattern of reasoning Wertrationalitat. Ends are not unimportant in this second pattern of reasoning, but the means to the ends cannot be reduced to mere technical strategies. Instead, in "value-rational" patterns of reasoning, focus is placed on moral conduct and the values, attitudes, and virtues expressed in the conduct, apart from its resulting in the desired goals.

James F. Childress articulated the difference between the two modes of reasoning delineated by Weber: "Conduct that is value-rational involves matters of value, virtue, character, and identity that are not easily reduced to ends, effects or even rules of right conduct. There is thus an important distinction between realizing a goal [instrumental rationality] and expressing a value, attitude, or virtue [symbolic rationality]."⁵ It is in this effort to convey values through conduct or policy that symbols and symbolic rationality are so important. And, contrary to the view of some bioethicists, symbolic rationality is itself a form of rational discourse. Symbols, metaphors, and analogies—all part of symbolic rationality—presume a world view within which the symbols are coherent moral expressions. If the symbol or metaphor is excised from its formative moral context or worldview—take for example, the symbol of a child as gift—and inserted into a different moral context, such as public policy, the symbol may indeed make little sense. Instrumentalist rationality, by contrast, seeks a kind of divorce between its ends, its means, and any background worldviews.

A recent example may illustrate more vividly the contrast and interaction between instrumentalist and symbolic rationality.⁶ In 1987, John Kitzhaber, president of the Oregon state legislature, proposed an unprecedented transfer of healthcare funds. Kitzhaber observed that the state would receive some $3.3 million in federal Medicaid funds that traditionally had been allocated to subsidize solid organ transplantation. These funds provided support annually for approximately thirty-four transplant recipients. Kitzhaber contended that the same funding could instead be used for preventive health care rather than rescue medicine. In so doing the state could bring the benefits of vaccinations, immunizations, and more frequent medical exams to approximately 1,500 pregnant women and children from low-income families who would otherwise fall into the abyss of the medically indigent.

Kitzhaber's proposal was a model of instrumentalist reasoning. The social good of providing quality health care is arguably better met by providing 1,500 people access to basic medical care than providing transplantation to some thirty-four persons, even if the latter receive a benefit that is lifesaving. The Oregon legislature agreed with Kitzhaber and passed his proposal, initiating the beginnings of the state's experiment with rationing health care and providing the political basis for what became the Oregon Health Plan of the early 1990s, in which criteria of efficient and effective use of scarce resources for health care were paramount.

However, despite some successes in extending healthcare services to persons who would otherwise be uninsured, the Oregon Health Plan has not experienced the broad-ranging adoption anticipated at its inception. It is inadequate medically because not all diseases can be tracked and prevented; some arise from unknown causes or are multifactorial in origin. It may not be morally adequate either, insofar as the preventive benefits anticipated from participation in the plan must be weighed against the harms and deprivations of the loss of autonomous choices. Finally, certain earlier provisions, particularly those concerning transplants, have been reinstated, because the state has thus far been unwilling to reduce decisions about whether or not to allocate resources that could have a direct impact on saving human life to a matter of cost-effectiveness. Thus, in the Oregon rationing context, instrumental rationality is limited and constrained by value or symbolic rationality.

The question in bioethics public policy is often how to strike the appropriate kind of balance between instrumental forms of rationality and more symbolic forms, including those that derive from religious traditions. However, the bioethics literature reveals a rather pronounced effort to establish the moral primacy of instrumental rationality, and to diminish the impact of symbolic appeals. In the hopes of illuminating how—if the grammar of religion is philosophically suspect—the arguments of religious traditions are ignored in bioethics discourse, I will examine three examples of this tendency.

THE CADAVER: SYMBOLIC RATIONALITY AS CALLOUS AND ABSTRACT
A first example of the instrumental rationalist critique of symbolic rationality is presented by Joel Feinberg, a legal philosopher, in a dispute with William F. May, a Christian ethicist, about acceptable methods of organ procurement. In general, May supports donation and argues how it can be acceptable within both religious and nonreligious traditions. Feinberg, however, maintains that donations will prove insufficient to meet the demand for transplantable organs and that the social goal of increasing organ supply can be met better through a policy of presumed consent or even routine salvage. Feinberg presents a straightforward example of instrumentalist rationality to achieve the goal of enhancing procurement, whereas May contends it is morally better for procurement policies to express a value, such as donation or gift, even if the goal is not achieved.

The dispute is not simply over the mode of transfer of organs, but fundamentally about the kind of respect owed to the body and to the human cadaver. May contends that the cadaver does have a moral claim upon us: "Even in death, it commands respect. No longer a human presence, it yet reminds us of that presence which once permeated it."⁷ Thus, May believes, it is vital to avoid treating the human cadaver cavalierly and disrespectfully, as nondonative models of organ retrieval imply. This leads Feinberg to ask: In what sense can a cadaver be "mistreated"?⁸

Feinberg's answer to this question acknowledges the importance of symbols for personal life and for social stability. We cannot have a cohesive individual or collective life without availing ourselves of symbols and symbolic modes of reasoning. May's concern for respect for the human cadaver, however, reflects not appropriate reliance on symbols but rather the "moral trap of sentimentality and squeamishness." This moral trap consists of respecting symbols at the expense of the values they symbolize. In the case of the cadaver, May's admonition to respect the cadaver as a symbol of the person neglects the fact that the lives of several people could be saved through a more effective mode of organ procurement than that of donation.

The problem of moral sentimentalism, as Feinberg portrays it in the context of organ procurement, is that a vital interest in life and prolonging life is subordinated to symbolism or sentiment, particularly the desire of donors to understand the transfer of body parts in a particular symbolic fashion, that of a gift. Thus, the second symbol in question in this dispute concerns the characterization of body organs and tissues retrieved from the cadaver. Feinberg is not necessarily opposed to gifts or sentiments, as that would reflect a form of dehumanization; however, he pointedly observes that gift-oriented moralists such as May and others, especially within religious traditions, need a "forcible reminder" that "while they distinguish among symbols and sentiments, there are people out there suffering and dying." Feinberg alleges, in short, that May is involved in an abstract veneration of respect for the body that betrays a fundamental callousness toward human life.

Thus, sentimentality involves acting against or contrary to real interests on the basis of an excessive sentimental/emotional response to "mere symbols." This is a problem in two respects: First, the sentimentalist response is rationally contradictory because it violates the interests embedded in the symbol. The point of a gift or donation of a body tissue or organ is to preserve life and relieve suffering. A fastidious attachment to the symbol of gift or of the body as the image of God, as reflected in opposition to presumed donation, violates the interests in sanctity of life and relief of suffering that the symbol should advance. Organ transplantation cannot, Feinberg maintains, mistreat a cadaver and cause it suffering, but transplant policies restricted to donation models perpetuate the suffering of numerous individuals. Secondly, by their nature, symbols are abstracted from the practical world, the world of real decisions, where people live and die. No matter how similar in form, or how deserving of our moral respect, paying last respects to a cadaver should not take moral primacy over the life-extending needs of a transplant patient.

Feinberg's "rational superintendency" of the sentiments entails a dominance of instrumentalized rationality over symbolic rationality. Symbols are intentionally and unavoidably evocative; the human cadaver can elicit sentiments of both awe and revulsion, but seldom indifference.⁹ But these sentiments are not sufficient guides for ethical decision making or public policy. There is in fact a significant difference between (a) acknowledging a symbol as symbol—for example, a cadaver as a symbol of the person, not merely as surplus organ and tissue, or tissue as gift rather than resource—(b) experiencing an emotional stirring or sentiment in response to the symbol—awe and charity in the gift process, rather than a routine commercial service—and (c) basing policy on symbolic preference.

Feinberg's arguments notwithstanding, it is significant, after all, that U.S. policy on organ procurement, as well as the views of the majority of its citizens, is much more closely aligned with the gift position advocated by May. Unbridled instrumental rationality seems too cold-blooded in its proposed use of the human body. Feinberg may well claim that the sentiments are misguided, and that people should be educated out of their mistaken beliefs about the cadaver and realize the greater social purposes it can facilitate.

Still, it is no doubt odd to rest transplantation policy solely on a symbolic concern about respect for the cadaver when so many people live at the edge of death waiting for a transplant. Other values converge to bolster the case for donation, including compassion for the family, and relational community and solidarity. A humanitarian appeal to saving lives can display its own form of inhumanity: it would require a dispassionate callousness to inform a grieving and vulnerable family that for reasons of social utility they have no say over the disposition of the body of their relative. Or, as May observed in one of his earliest writings, there is "a tinge of inhuman in the humanitarianism of those who believe that the perception of social need easily overrides all other considerations."¹⁰ As illustrated by the next example of the debate between instrumental and symbolic rationality, retaining basic sentiments and symbols is taken by some to be vital to retaining our humanity, even if larger social ends are thereby impeded.

FEEDING TUBES: NOURISHING PEOPLE OR SYMBOLS
The ethics of withdrawing medically provided nutrition and hydration from the persistently or terminally ill provides a second illustration of the conflicts between instrumental and symbolic rationality. While both the law and bioethics in general have resolved this question in the last decade on the side of a patient's right to forgo this treatment, it remains a difficult decision for families and some caregivers because of the symbolism laden in stopping feeding. As this dispute unfolded within the bioethics literature, the arguments concerned not only conflicting opinions, such as whether there was a moral claim to have medically administered nutrition and hydration refused, but also a conflict over the moral significance of basic symbols, such as care, feeding, and starvation, and ultimately about the validity of symbolic rationality itself.

The dispute in bioethics was joined initially by a very tightly reasoned essay by Joanne Lynn, a physician, and James F. Childress, an ethicist, that argued for the moral legitimacy, in rare circumstances, of withholding or withdrawing medically provided nutrition and hydration.¹¹ Lynn and Childress based their argument on principles of autonomy and beneficence, and the conceptual continuity between forms of treatment refusal already accepted by society and the forgoing of nutrition and hydration. For the authors, the medical or technological means by which treatment was provided was of much greater significance than the actual treatment itself in terms of the moral legitimacy of refusals. In short, their analysis considers treatment refusal an efficient and effective means to achieve a desired end: not protracting the dying process of patients who have negligible or minimal hope of recovery.

Philosopher Daniel Callahan wrote a rejoinder to the Lynn-Childress argument that invoked symbolic rationality.¹² Callahan found himself reluctantly conceding the compelling moral logic in the position advanced by Lynn and Childress. Nonetheless, Callahan expressed concern that the principles of autonomy and beneficence, fully extended, would encompass much more than the rare circumstances of treatment refusal envisioned by Lynn and Childress. In particular, Callahan maintained that this newly justified moral right to refuse treatment would evolve into a duty to withhold. Such a descent down the slippery slope was possible because the logic of instrumental rationality eroded the symbolic rationality that had upheld the practice of feeding vulnerable patients in the first place.

Indeed, the instrumentalist rationality underpinning the Lynn-Childress position could, Callahan argued, instigate a dramatic shift in medical practice and societal ethos because it aimed at a central moral emotion and necessary social instinct, to feed the hungry. "The feeding of the hungry . . . is the most fundamental of all human relationships. It is the perfect symbol of the fact that human life is inescapably social and communal." Rather than being reeducated by instrumentalist moral philosophy into accommodating a duty or social mandate to die, he insisted that a "cluster of sentiments and emotions that is repelled by the idea of someone starving to death" was the only impediment to a medically and morally rationalized practice of bringing about nonvoluntary deaths by nonfeeding. Callahan recognized that such a practice could be supported by "hard rationality" and logic, but portended dire social results.

Soon after Callahan voiced his concerns about eroding a basic moral symbol through such nontreatment decisions, Childress subjected Callahan's position to a very thorough critique in which the validity of symbolic rationality was challenged. Indeed, Childress bitingly suggests that Callahan's support of feeding the dying risks "nourishing a symbol" rather than providing beneficial nourishment to patients.¹³ Indeed, in certain circumstances, to continue feeding may run contrary to the interests of actual patients.

In general, Childress at least acknowledges that an appeal to symbols in moral debate is a form of rational argumentation. However, Childress reconstructs Callahan's resistance to withdrawing nutrition and hydration, as buttressed by various moral emotions and sentiments, as a form of "symbol" utilitarianism. That is, it manifests the very kind of instrumentalist rationality that Callahan claims to be arguing against. Symbol utilitarianism functions, Childress claims, in a manner analogous to rule utilitarianism: even if certain acts of not feeding the seriously ill may be permissible, a point Callahan concedes, the act should nonetheless not be performed because through repetition over time the action will become a customary practice, thus eroding the symbol of societal care for the hungry that is expressed through feeding. Symbol utilitarianism affirms, by contrast, that adhering to the symbols of care and feeding best maximize social welfare, because they express emotions and sentiments that are, in Callahan's view, necessary social instincts.

Like Feinberg, however, Childress constructs the question in terms of opposition between symbolic morality and interest-based morality. Actual patients whose interests or preferences, including an interest in a shortened dying process and a humane death, will be violated or overridden by symbol utilitarianism and by the symbol of feeding. Nourishing the symbol trades off the interests of present patients in the hope of preventing speculative harms to future generations of patients.

Likewise, Childress believes that Callahan has failed to make a compelling case for "the transfer of coarsening effects" from primary to secondary objects, a point Childress derives from Feinberg's critique of May. May wants to uphold the symbol of the body lest we become callous to the treatment of the living, and Callahan wants to uphold the symbol of feeding lest we lack compassion for the hungry. Both arguments assume, however, that the emotions and sentiments embedded in the symbol are undifferentiated, that is, that we can't adequately differentiate respectful treatment of the cadaver from disrespectful treatment of the person, or nonfeeding of the seriously ill from feeding the starving in general.

Childress contends that we can and do compartmentalize our sentiments and emotions, and engage in much more selective expression. Hence, what we experience in the primary case—acceptance of withdrawal of a feeding tube for the seriously ill—will not be transferred to and diminish or coarsen our legitimate revulsion about the plight of the poor and starving in society. Childress wants to affirm the moral continuity of withdrawal of feeding tubes with other acts of refusal of medical treatment, but this does not, he believes, carry over into callousness in the context of providing assistance in nonmedical situations, such as the need of the hungry for subsistence.

This is of course not so much a moral argument as an empirical one: Will there be any moral reverberation when a certain social barrier is lifted, such as presuming consent to body or organ donation, not feeding the seriously ill, or assisting the suicide of the terminally ill? It is obviously difficult to determine the practical outcomes, and assess whether they would be more compatible with those scenarios proposed by Callahan or those of Childress, without actually proceeding to remove the barrier in a kind of trial-and-error study. However, errors on this issue can well be irreversible and irrevocable, suggesting the need for a kind of precautionary principle within medical ethics. That is, when an argument to remove a barrier is proposed, the burden of proof should be on those in favor of lifting the burden.

In retrospect, Callahan's Cassandra-like warning of social disaster should medicine go down the route of routinized withdrawal of feeding tubes was perhaps exaggerated. To be sure, there is little moral controversy if a patient is seriously or terminally ill and has requested, or requested through an advance directive, the withdrawal of tube feeding if their condition declines to one of irreversibly dying. Indeed, the U.S. Supreme Court endorsed the rights of competent patients or their proxies to stop tube feedings in the groundbreaking case of Nancy Cruzan. Medicine, medical ethics, and public policy have gradually evolved in the direction of a standard practice of withdrawal of tube feedings as directed by the patient or their proxy.

Still, withdrawal of tube feedings does not ever seem to be a routine decision. It is a decision that, in most circumstances, has to be explicitly stated in an advance directive, rather than tacitly presumed with all other treatment-refusal decisions. It is a decision that, in my experience, both professional caregivers and family speak about with much anguish and even regret. Such anguish is appropriate if we are to recognize the claim of the symbols embedded in such decisions, and the significance of symbolic rationality in bioethical decision making.

As the foregoing should make clear, the articulation of an argument rooted in symbolic rationality need not be religious; Callahan, after all, argues entirely on philosophical grounds. However, as suggested by Huston Smith, the use of symbols and symbolic rationality is more conceptually at home in a religious context. Nor does instrumentalizing rationality always carry the day without any attention to symbolic themes. Sometimes the larger society agrees with symbolic understanding, and, as in the case of organ donation, continues to opt for positions that are more reflective of certain symbols even when they are at odds with instrumental efficiency. Even if a policy, such as withholding tube feeding, is directed by an instrumentalist approach, a residue of moral symbolism is retained by certain requirements: specific consent is needed, and routinization of morally difficult choices is thereby avoided.

Finally, discourse about symbols in bioethics commonly concerns issues and interests of marginalized, vulnerable patients, who frequently are unable to articulate their preferences. This framing of ethical boundaries at the edges of life and the moral community may explain the intensity of such debates. At least this is the claim offered by legal scholar John Robertson in his critique of symbolic issues at life's beginnings, including reproductive technologies and research on human embryos.

HUMAN BEGINNINGS: LIFE SOURCE OR RESEARCH RESOURCE
John Robertson analyzes and critiques symbolic morality in many contexts, including embryo research, human cloning, organ transplants, and fetal tissue transplants. Like the other scholars, Robertson often engages in moral reductionism: a complex moral conflict or choice is reduced to a simplified moral dichotomy of either rights and interests or symbols. Given Robertson's strong affirmation of individual autonomy in almost every moral context, and the policy presumption that affords self-determination strong legal protections, almost invariably Robertson finds the stronger case on the side of protecting and advancing personal choice. Bioethics policy for Robertson serves the instrumental purpose of extending the scope of self-determination.

Given these basic philosophical presumptions, it is worth noting the one situation in which Robertson's analysis comes down in favor of symbolic concerns. Interestingly, the issue returns us to the controversy that engaged May and Feinberg: how society can effectively and efficiently secure more organs for transplant without violating important social values. In this context, Robertson turns his attention to the recent question of whether the "dead donor rule" should be relaxed so that more organs can be made available. After reviewing some of the common arguments, Robertson finally concludes: "The symbolic importance of the dead donor rule is so great that even the slightest explicit deviation from it confronts a very high presumption of unacceptability."¹⁴

The claim that the law is not simply a means to achieve social goals, but that it also instantiates symbols and teaches values embedded in those symbols is a view very compatible with patterns of thinking in some religious traditions. For example, John Calvin and his followers in the Reformed tradition of Protestant Christianity have commonly appealed to a third use of law; law restrains sin, provides political order, but it is also a moral teacher. Law, these Christians believe, has a pedagogical function in moral development—a point of view that seems to have been entirely neglected in contemporary bioethics. This is not surprising, of course, insofar as contemporary bioethics works with an instrumentalist pattern of ethical reasoning and public policy.

What may seem surprising is that such a view of law should also show up in a secular libertarian like Robertson. At first glance, the presumption in favor of retaining the dead donor rule because of its symbolic value may appear to make Robertson's critique of moral symbolism in other contexts rather arbitrary.

While he contends that the dead donor rule should not be rescinded in order to retrieve more organs from anencephalics or from cadavers, he is a strong advocate of retrieving tissue from aborted fetuses for purposes of research and fetal tissue transplants. Indeed, so pronounced is his commitment in this regard that he is quite willing to erase certain symbols—such as noncommodification of the body—that most bioethicists believe are morally responsible and politically prudent. However, the question is ultimately very simple once Robertson's moral reductionism is employed; the "harm of abortion is a symbolic loss of respect for human life, and not a substantive violation of fetal rights."¹⁵ If the substantive interests of living people can be advanced through transplanted fetal tissue, then there is a moral and political obligation to pursue such means. If those interests can be facilitated through the financial lubrication of a marketplace transaction, such as compensation to pregnant women for relinquishing dispositional authority over the aborted fetus, there is no necessary moral or legal problem with such compensation, since the harm that occurs is symbolic, not substantive.

Thus, what looks like an aberration for Robertson, the support of symbolic claims in the case of the dead donor rule, turns out to be consistent with a more general proposition about standing in the moral community. Robertson understands the fetus as a symbol of human life, but not itself human life; the fetus is therefore distinguishable from potential sources of human organs, such as anencephalic infants or PVS patients, who might be declared dead to accomplish the social end of increasing organ supplies. A potential organ source, meanwhile, has full moral status, which is not diminished until death, when organs can be retrieved.

Similarly, Robertson does not believe the human embryo is human life but instead describes it as "a potent symbol of human life." Embryos symbolize important values, such as respect for life, and the well-being of resulting offspring, but this symbolic moral value must give way to the interests that can be advanced through the promotion of scientific research on the embryo. This applies not only to excess embryos created through in vitro fertilization, but also to embryos created expressly for research purposes. Robertson believes that prohibiting funding for research on the latter, which has been supported by many federal advisory bodies, is a good illustration of "a symbolic line." However, the "symbolic benefit of protecting embryos from being created solely for research purposes does not justify the loss of scientific knowledge."¹⁶

Robertson provides his fullest exposition of the subsidiary moral stature of symbolic concerns in discussing the question of embryo research:

• symbols are open to subjective interpretation, that is, their meaning is personal and variable;
• symbols reflect a connection to matters of ultimate meaning and moral identity; thus their use in public discourse will most commonly arouse intense views that are not susceptible to rational resolution; and
• as illustrated with respect to the scientific benefits that could be gained by research on embryos, including embryonic stem cell research, no moral violation occurs when the symbol is subordinated to actual persons' interests.

Some additional features of Robertson's understanding of symbolic concerns are developed when his attention turns from research issues to expanding self-determination through the diverse modes of reproductive technology. Robertson claims that there is a fundamental right to procreative autonomy, a right broad enough to extend to technological assistance in reproduction of various forms, whether donor insemination or, if technically feasible, human cloning. These rights carry more moral and legal weight than what he describes as "paternalistic and symbolic attitudes" regarding procreation.

It is not a surprise that Robertson would connect symbolic rationality and paternalism. Objections to reproductive technology may invoke several kinds of symbols, such as the idea of children as gifts, the intrinsic connection between sexuality and procreation, or the ideal of nurturing children in heterosexual families. The policy implications of all of these objections would include restrictions on liberty of choice regarding access to reproductive technologies. Insofar as these restrictions infringe upon the autonomous choices of capable decision makers, they are "paternalistic." Whether they are unjustifiably paternalistic would ultimately depend on whom is burdened or harmed as a consequence. Robertson labels these "speculative" harms, that is, conjectures about foreseeable bad outcomes whose probability or magnitude are not known, and considers them the moral equivalent of symbolic attitudes about reproduction. The moral weight of these attitudes is diffused further by the fact that reasonable people may differ about the symbols and the scope of the harms.¹⁷

In presenting his opposition to a ban on federal funding for human cloning, Robertson distinguishes "tangible" harms from "speculative" harms. In the case of tangible harms, fundamental rights or interests of people—such as procreative choices—are violated. Speculative harms are constituted by symbolic concerns unrelated to actual harms; the harm is to the symbol, rather than to people. In the case of cloning, Robertson believes, most objections invoke speculative harms, such as arguments that creating children through cloning will undermine the symbol of a child as a gift. He acknowledges the need for further animal and human embryo research on cloning to promote safety and diminish the risk of physical, tangible harm to a clone. Yet even the occurrence of tangible harm may not be sufficient to override the violation of fundamental rights to procreative freedom. After all, Robertson claims, we must assume that existence is ontologically preferable to nonbeing, and but for the cloning procedure, the child, whether born with an anomaly or not, would not exist.¹⁸

The prospect of a legal ban on human cloning enables Robertson to reiterate his concern that letting symbolic rationality influence ethics and public policy will open the door to subjective interpretation and relativism. An argument that objects to cloning on the basis that such a practice would lead to objectification and an instrumental view of children presupposes, in Robertson's view, a subjective view of harm. That is, the argument is not adequately grounded in widespread acceptance of a normative account of parental relations to offspring. This morally subjective understanding of parent-child relations, and the meaning of a child, simply does not have a sufficient basis for overriding the interests and rights embedded in a principle that Robertson believes commands widespread acceptance: the principle of procreative freedom.

However, Robertson is open to the criticism here of imposing an unreasonable and unfair standard of moral consideration upon symbolic—read "religious"—concerns. First, it is an empirical matter as to whether there is wide agreement on the question of a connection between cloning and the objectification of children. Moreover, Robertson does not indicate what view of our relation to children would satisfy his criteria of being more than subjective and symbolic. It is arguable that there is no such common view, which would seem to leave the question in a kind of moral anarchy. However, moral anarchy is a short step from Robertson's general affirmation of unfettered libertarianism on issues of life beginnings and life endings.

CONCLUSION: TAKING SYMBOLIC RATIONALITY SERIOUSLY
I have illustrated how the dominant discursive paradigm of bioethics finds little room for symbols and symbolic rationality. This paradigm of instrumental rationality, as unfolded in the writings of Feinberg, Childress, and Robertson, illustrates the necessity of what Feinberg calls the "superintendency" of reason. Symbolic rationality, by contrast, is rooted in sentiments and emotions, important aspects of personal moral character, but not the needed resource for public discourse and public policy. Symbolic rationality may be deemed by its critics as callous and abstract because it seems to place moral primacy on sentiments rather than on the rights or interests of actual persons. Indeed, symbolic rationality may be criticized for "nourishing symbols" rather than persons. Finally, symbolic rationality is especially inappropriate for public policy because, by their nature, symbols reflect personal and variable views of meaning and are thereby open to subjective interpretations. They do not seem amenable to the need for public accessibility and accountability, a condition for policy discourse in bioethics.

This exclusionary perspective on symbols and symbolic rationality in bioethics poses restrictive limits on religious understandings, insofar as Smith is correct in observing that symbolism is the essential language of religious tradition. Religious scholars who participate in general bioethics discussions will face the daunting task either of speaking in the language of their tradition and risk being dismissed as paternalistic and/or irrelevant, or of trying to translate their symbolic concerns into the bioethics policy vernacular of autonomy and utility, or of experiencing frustration over their exclusion.

However, this understanding of the limited moral significance of symbols also reveals, I suggest, a moral superficiality at the core of bioethics. What moral world is bioethics addressing? It is a world of moral strangers, individuals who have fairly minimal interactions with each other, and virtually no moral responsibilities for others except those of avoiding harm and respecting freedom of choice. It is a rationalized world, in Weber's term, in which reason exerts a moral hegemony over emotion and sentiment, something that would be appealing to strict rationalists, but not to the philosophical predecessors deemed to have provided the philosophical foundations for bioethics, such as Aristotle, Hume, Mill, and even Kant or Weber. It is a moral world in which "rights" and "interests" language reigns morally supreme; yet the language of rights presupposes not only a world of moral strangers but of moral adversaries in which inequalities in power are pervasive. It is a great oversight of contemporary bioethics not to have appropriated the concepts of power, empowerment, and disempowerment, both personally and institutionally, into its moral analyses other than through the language of rights. Finally, it is a moral world focused on procedural ethics—the bottom-line question is: Who decides?—and for that reason agnostic about matters of substance and meaning. In short, contemporary bioethics addresses itself to a world that few people actually live in.

The moral deficiencies revealed in a bioethics of instrumental rationality provides some guidelines for how a case for including symbolic rationality can be articulated. Symbols draw on, and contribute to, world construction. It is not only superficial but also artificial to proceed with bioethics analysis on a post-modernist assumption that all we are left with in the twenty-first century is making our way morally amidst the fragments of the past. Stephen Toulmin discovered this intellectual mistake in bioethics a quarter century ago, when he found himself puzzled as to why the National Commission for the Protection of Research Subjects of Biomedical and Behavioral Research could come to consensus on particular conclusions while invoking quite different principled reasons for those conclusions. Toulmin observed: "Such principles serve less as foundations, adding intellectual strength or force to particular moral opinions, than they do as corridors or curtain walls linking the moral perceptions of all reflective human beings with other, more general positions—theological, philosophical, ideological or Weltanschaulich [according to one's worldview]."¹⁹ Symbolic rationality is more authentic to this connection to background world views than an instrumentalist rationality shorn off from its perspectival roots.

A bioethics of instrumental rationality must be supplemented by matters of ultimate meaning and identity conveyed through symbolic discourse. A focus merely on the procedural means that are most effective and efficient runs precisely the same risk Kant identified regarding treating persons merely as means: it is disrespectful and distorts identity. The ends count as well, and must be opened more to moral scrutiny. We have, for example, sought for over three decades to fine-tune the instruments of healthcare reform; these cosmetic changes have avoided the questions of the ends of health and the ends of a healthcare system. The results of instrumental rationality are widely known: advances in technology at the expense of cost-controls and equitable distribution of the benefits and burdens of healthcare delivery. Emphasizing efficiency over justice, we have wound up with a system that is both inefficient and unjust.

Finally, the critics of symbolic rationality are correct in their observations that symbols express sentiments and values that are basic to persons and moral life in a community. This should, however, be celebrated, not disparaged. Such symbols and sentiments can enliven what is often an arid discussion; they remind us that bioethics must be attentive to the character of the whole person, not a disembodied will. Perhaps most important, symbols and symbolic rationality liberate passion so that the intellectual talk can be translated into action.

NOTES
1. Huston Smith, The World's Religions (San Francisco: Harper, 1991), 262.