Books in Brief
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Embracing a New Ethical Model
African American Christian Ethics.
Samuel K. Roberts.
Cleveland, Ohio: Pilgrim Press, 2001.
$26 (Softcover).
Samuel K. Roberts presents a
thought-provoking, systematic critique
of African-American Christian
ethics. His analysis assumes the reality of
this behavior and discipline, based upon
the experience of African-American
Christians as it is concretized in the spirituals.
This ethic emerged amidst a faith
that enslaved those deemed "other,"
even as they relied on this faith for liberation.
As Roberts notes, this ethic
recognizes that neither the enslaved nor
their oppressors could be free in such a
status quo. Yet Roberts also observes
that, for such an ethic, African-American
exclusivism in response to oppression
cannot be liberating. With poetic signification,
Roberts resolves the paradox by
claiming that God is beyond human limitations
and perspectives. He articulates
his framework by explicating Eurocentric
cultural idolatry and Black theology,
and by suggesting a model of intellectual
integrity and moral consistency that
posits a Tillichian God "as ground of
being rather than a God of personal
being."
Methodologically, Roberts explores
God, Christ as Liberator and Reconciler,
and the Holy Spirit as Counselor and
Inspirer, and the sources that shape this
African-American Christian ethic: Bible,
ecclesial tradition, human nature and
freedom, and knowledge and reason
interfacing with faith and God. Roberts
concludes by investigating contextual
praxis and addressing the foundations
and resources that mold life in the
African-American community—from sexuality
and bioethics to justice at the polls.
Roberts proposes a vision of African-
American Christian ethics as interdisciplinary
scholarship and critiques various
thinkers and schools of thought, challenging
what he calls their flawed
premises and logic.
Building a theological orientation
for a distinctive ethic, Roberts explores
the concept of God, God's relationship to
created order, the question of moral evil,
and theodicy. He highlights African-
American male thinkers while avoiding
cultural exclusivism. From classical
Christology, Roberts explores representations
of Christ in Black culture and
theology, and he offers a Christology of
freedom through reconciliation with God
in Jesus the Christ, and of freedom in
God's kingdom that moves toward community
participation. He deconstructs
the Holy Spirit as God's emanating grace
that intersects worship and work as a
creative force in the believing community,
the church. Given the exegetical
heritage of the spirituals, framed by their
"creative genius with the historical experience
of terror," an African-American
concept of biblical authority must discern
the glimpses of God's will in an
alien world. The complex, diverse
African-American church fosters spiritual
alertness, works in the world,
inspires without couching rhetoric in
ideology, praises God, encourages faithful
living, and nurtures believers. Roberts
uses the spirituals to posit "the freedom
inherent in human nature and human
existence" with, unfortunately, an underdeveloped
argument. The impetus for
knowledge amid faith and reason in the
African-American religious consciousness
is the "interplay between victimization
and vindication," where people
overwhelmingly affirm the sufficiency
of God's grace and the potential for
human beings to make a difference.
Mindful of the sexual commodification
of African Americans and ongoing
stereotypes, an African-American sexual
ethic of commitment and integrity
authenticates sex and love. A healthy
bioethics involves African-American
participation and inclusion within prin-
ciples of Christian faith. Roberts analyzes
justice in the courts, markets, and electoral
precincts, and calls for a full inclusion
of African-American political
interests within the American political
order. He invites a new institutional and
personal piety with an enlivened praxis
of partnership within African-American
life, moving toward an authentic interracial
dialogue of diverse viewpoints and
perspectives, one not steeped in guilt.
Roberts's tome speaks like a
renaissance work, as his analysis juxtaposes
artistic renderings with scientific
investigation and interrogates early
church history and classical philosophy
with the present-day reality of African
Americans. He allows interfaith and
interreligious perspectives by not
assuming that Jesus is the only mark of
salvation. Yet, how do a depersonalized
God and a related ethic have an impact
on people who are extremely Christocentric
and wedded to a personal Jesus
as Lord and Savior?
Roberts's work is such a cut above
that his omissions of womanist scholars,
Jon Michael Spencer's work on theomusicology,
and Robert Lovell Jr.'s magnum
opus on the spirituals are
bewildering and unfortunate. Roberts
uses inclusive language for the divine,
but does not offer a critique of God as
Father. Despite these exceptions,
Roberts's work is a must-read for those
interested in the American Christian
experience, including the African-
American experience. It is highly recommended
for seminary or university
courses that combine theology, ethics,
history, liturgy, and lived experience.
—Cheryl A. Kirk-Duggan
Ethics, Faith, Health, and
Moral Freedom
Moral Freedom: The Search for Virtue in
a World of Choice.
Alan Wolfe.
New York: W.W. Norton, 2001.
224 pp. $24.95 (Hardcover).
"Idon't think you can teach a kid to
follow orders," one of sociologist
Alan Wolfe's interview respondents says.
"You can try to convince the child that
that's right, but if we don't let the child
think for themselves and make their
own decisions, you're leaving them, as
an adult, vulnerable to these ad campaigns
where they're told what to think."
People's concerns about vulnerability go
far beyond advertising, but that statement
is moral freedom in a nutshell:
Think for yourself, and make your own
decisions. This idea, although "casually
taken for granted" in contemporary
America, is also "quite revolutionary."
"Now for the first time in human history,"
Wolfe argues, "significant numbers
of individuals believe that people should
play a role in defining their own morality
as they contemplate their proper
relationship to God, to one another, and
to themselves."
Wolfe emphasizes that people have
neither chosen nor lapsed into moral
freedom; instead they find it forced
upon them. As he puts it with characteristically
gentle wit, "Once upon a
time, Americans raised families without
being able to know whether their children
would turn out to be good or bad.
Now they raise children uncertain about
what good or bad actually are." Moral
freedom is "a sometimes terrifying sense
of insecurity as to what they consider it
means to lead a good and virtuous life."
The significance of Wolfe's argument
for ethics and faith—two of the
three words that subtitle this journal is
evident. I believe the book is equally significant
on the issue of health, but since
Wolfe does not discuss health, illness, or
medicine, that significance requires
some interpolation.
Wolfe reports both survey data and
interviews with randomly selected people
in eight diverse American communities.
The book contains a few
percentages but no graphs or tables.
Instead Wolfe quotes respondents saying
what is representative of how Americans
talk about their values, morals, and
ethics. He recognizes that this approach
is itself a symptom of an age of moral
freedom. The idea of inducing morality
by asking people how they lead their
lives is part of the general belief that
"any form of higher authority has to
tailor its commandments to the needs of
real people." What do these real people
believe, and how are they trying to live?
With respect to faith, Wolfe's
respondents confirm what other commentators
have noted: People consider
themselves religious but are often suspicious
of organized religion. Religion,
as one respondent puts it, "so often
functions as keeping people in check
and keeping them in this little box and
makes life not messy." People recognize
that life is messy. The mess requires
avoiding absolutes, even though finding
a creative response to each situation is
itself messy.
With respect to ethics, moral freedom
is anything but the anarchy feared
by conservative commentators whom
Wolfe engages throughout the book.
Part of what makes Moral Freedom such
a delight to read is Wolfe's ear for people's
sincere attempts to lead good lives,
even as they are unsure what that
means. Wolfe genuinely likes and
admires people perhaps because of, not
in spite of, their contradictions and
dilemmas, which are especially apparent
in ideas about honesty and forgiveness,
two of his central concerns.
What does Wolfe tell us about
health? A recurring theme is that when
people seek explanation for others'
moral behaviors, and when they judge
or refuse to judge others, therapeutic
explanations trump theological and
philosophical ethics, and medical explanations
trump psychological. As people
seek to affirm the disrepute of acts
while providing leeway to actors, they
look to medicine, especially genetics.
If Wolfe had asked about health care, I
suggest his respondents would have said
that people are responsible for their
own health, but individuals can rarely
be blamed for their particular sicknesses.
Americans, Wolfe shows repeatedly,
value personal responsibility, but they
also limit it in their unwillingness to
blame except in extreme circumstances
and, provocatively, sexual choice.
Wolfe's counsel is to be neither
for nor against moral freedom but to
learn to live with its inevitability. He
never underestimates the problems of
moral freedom, but his attitude seems
that of his respondents: for all the
uncertainty they face, "they also have
some reason to hope." This generous,
carefully researched, insightful book
leaves me with no doubt that he is right:
"The twenty-first century will be the
century of moral freedom." In this brave
new world, Wolfe is an exemplary, and
most hopeful, guide.
—Arthur W. Frank
The Respect Due to Persons
Who Count as Persons? Human Identity
and the Ethics of Killing.
John F. Kavanaugh.
Washington, D.C.: Georgetown University
Press, 2001. 248 pp. $45 (Softcover).
Who Count as Persons? is a passionate
defense of the proposition
that the direct killing of human
life is always morally wrong. The author,
John Kavanaugh, S.J., believes this
proposition follows from a proper
understanding of the human person.
Thus his book does more than discuss
the ethics of killing; it sets forth a theory
of personhood.
Kavanaugh locates an essential
aspect of personhood in the capacity
for what he calls "reflexive consciousness."
Reflexive consciousness is the
ability of persons to be conscious of the
fact that they are conscious. This ability,
in turn, is necessary if persons are to
step back from their environment to
engage it, which is a necessary condition
for the formation of the self.
Grounding personhood in reflexive
consciousness appears to imply that
human beings who lack the capacity
for reflexive consciousness are not persons.
Surely the fetus, the anencephalic
baby, and the patient in a persistent
vegetative state do not possess consciousness
of their consciousness.
Kavanaugh insists, however, that such
individuals, indeed all human beings,
belong within the class of persons. The
steps that lead him to this conclusion
are not altogether clear to me, but the
crux of the argument seems to reside in
Kavanaugh's view that human nature
contains potentialities, one of the most
important of which is the potential for
self-reflexive action. All human beings,
from the fetus to the patient in a persistent
vegetative state, possess this
potential and are, therefore, deserving of
the respect due to persons.
The argument from potential is by
no means decisive, but it is stronger in
my judgment than some will be willing
to recognize. My one-week-old daughter
may possess no more rational ability
than a mouse. However, if I were to
treat her like a mouse, subjecting her to
laboratory experiments, I would be
inflicting harm on the person she is to
become. The experiments performed
now would produce their harmful effects
later, and those harms would be qualitatively
different from the harms experienced
by a mouse in full maturity.
Thus, genuine regard for any species of
animal requires consideration for what
that species can be, and insofar as
human beings are capable of becoming
more than other animals, they are
deserving of a different kind of respect.
Next Kavanaugh argues that his
theory of personhood leads to the ethical
maxim: Affirm the intrinsic value of
human beings and do nothing to negate
their personhood. Intentional killing is
the willed negation of personhood, says
Kavanaugh, and those who justify killing
must do so by disregarding human dignity
for the sake of a competing value.
This justification, Kavanaugh says, is
unacceptable.
However, a recognition of the
intrinsic value of the human person
does not necessarily entail an absolute
prohibition on killing. In order to draw
that conclusion one must first consider
a prior question about the relationship
between human dignity and the right to
immunity from lethal harm. If in certain
circumstances persons do not enjoy
moral immunity from lethal harm, then
killing them in those circumstances will
not violate their dignity. The just war tradition,
for example, justifies the intentional
killing of combatants by asserting
that they do not enjoy immunity from
lethal intention. They do not enjoy
immunity, not because their lives lack
dignity, but because life itself is a value
within an order of values that includes
justice, order, and liberty, values which
the just war seeks to protect.
Perhaps if one considers life an
absolute value, one will think that all
justifications for killing are built upon a
suppression of human dignity. However,
to claim life is an absolute value
requires more than a theory of personhood,
it requires a theory of the objective
order of values in which life finds its
place. This is something Kavanaugh
does not provide, nor do I believe he can
provide it to produce the conclusion he
needs. Life has value through its relationship
to higher values such as truth,
justice, and the good; in other words, if
there are no values greater than life,
life itself has no value.
My disagreements with Kavanaugh
notwithstanding, I believe he has written
a thought-provoking book worthy of
critical engagement. His arguments will
enrich ethical discussion both in and
out of the classroom.
—Helmut David Baer
How Sexual Science Operates
Sex, Love, and Health In America:
Private Choices, and Public Policies.
Edward O. Laumann and Robert T.
Michael, eds.
Chicago: University of Chicago Press,
2001. 535 pp. $48 (Hardcover).
In 1994 six prominent sociologists
characterized the sexual practices of
Americans.1 Their National Health and
Social Life Survey employed sophisticated
scientific methods to obtain a representative
sample of adults from
eighteen to fifty-nine years old and to
maximize truthful self-reporting. Their
work represents the best that cross-sectional
study has to offer about sex. It is
so large in scope that their data are
likely to be quoted for decades to come
in professional and lay articles. The
media quickly publicized some of the
findings with headline-grabbing spins
on the revelations about our private
behaviors. Sensationalism aside, many
professionals found it exciting to learn
that Americans have tame sexual lives.
Two of the survey's architects, both
distinguished professors at the University
of Chicago, planned this volume of
thirteen essays based on further analysis
of the original data. With graduate
students and an occasional colleague
coauthor, their essays discuss important
aspects of adolescent sexuality,
adult sexual behaviors, sexually transmitted
disease, and public policy.
Clearly, sex is not simple. Sexuality
does not lend itself to any direct definition.
It is simultaneously private and
public, individual and collective, biological,
social, and psychological, conscious
and unconscious, measurable
and beyond measurement, static and
evolving. Every informed professional,
each relevant discipline, and all interested
institutions should know that it is
impossible to have the last word on the
subject. This is not just because the
United States contains a great diversity
of opinions about everything sexual. It
is also because the clinical and social
sciences have learned that sex is a profoundly
rich topic, and numerous perspectives
are better than one.
The text's nineteen authors delve
deeply into sexuality's complexity. Their
data begins with the influences of age,
gender, marital status, education, race,
ethnicity, and religious affiliation, which
is used to build models for understanding
psychological topics such as abortion,
sexual satisfaction, sexual dysfunction,
and AIDS prevention. The essays—serious,
academic, and carefully edited—
invariably educate the reader. The book
is hard work, particularly for the statistically
unsophisticated reader; there are so
many findings, possibilities, and uncertainties.
The book contains many useful
contributions for those whose profession
it is to grapple with issues involving teen
pregnancy, sexually transmitted diseases,
racial disparities, sex education, pornography,
sex research, and how sexual life
ought to be conducted. These professionals
may include local, state, and federal
government officials, legislators,
academics, religious educators, teachers,
clinicians, and foundation officers.
A theme of the book is the need
for continued scientific study of sex.
This is not because research will show
us what to do with our controversies
involving unwanted pregnancies, sex
crimes, extramarital sex, and homosexuality,
for instance, but because having
an objective starting point makes the
discourse more efficient. These erudite
authors are not attempting to create
new public policies. They are informing
the public about the issues and helping
to keep the rhetoric from becoming too
simplified.
Funded sex research is rarely
directed toward the study of health.
Government agencies and foundations
fund studies in the hope that they will
ultimately assist in the solution of problems.
Of the key words in the title, two
are a bit misleading. Health is a relevant
but largely implied topic in some of the
essays. Love, however, cannot even be
found at the edges or between the seams
of these discussions. This subject is too
private, subjective, and quixotic2 to be
grasped by the data examined here. So
why is "Love" in the title? The book's
focus is on selected socially relevant
sexual problems; it is not about the evolution
of individual sexual health. These
essays induce readers to wonder how we
Americans actually come to acquire our
private ideas and personal rules for sexual
conduct and how we actually make
some of the choices that shape our fates.
These questions, although thoroughly
illuminated, are only partially answered.
—Stephen B. Levine
NOTES
1. R. T. Michael, J. H. Gagnon, E. O. Laumann,
G. Kolata, Sex in America (Boston:
Little Brown, 1994). E. O. Laumann, J. H.
Gagnon, R. T. Michael, S. Michaels, The
Social Organization of Sexuality: Sexual
Practices in the United States (Chicago:
University of Chicago Press, 1994).
2. See my essay, "The Nature of Love," in
Sexuality in Mid-Life (New York, Kluwer
Academic Publishers, 1998).
The Forest for the Trees
Genetic Dilemmas: Reproductive
Technology, Parental Choices, and
Children's Futures.
Dena S. Davis.
New York: Routledge, 2001. 153 pp.
$22.99 (Softcover).
For many women today, having a
baby may require working through
a decision tree, the kind of flow chart
that Dena Davis lays out: Have a child?
If yes, have it with/without assistance by
technology? If assisted, which technology?
Here, especially, the branches of
the decision tree are multiple. If or if not
assisted, should the embryo (or fetal)
cells be tested? If tested, implant/continue
pregnancy based on results? And
so it goes.
Each node or choice on this decision
tree raises difficult ethical questions
not only about what should be done, but
also about who should be deciding and
for whom. It is these "should" issues
that Davis examines using a fresh lens:
Will our choice of reproductive technology
affect the choices available to a
child born using that technology?
As far back as the 1970s, when
amniocentesis came into widespread
use, it was clear that women's limited
reproductive choices were already overwhelmingly
painful, with no option costfree.
Even then, we knew it was one
thing to have some control over the
number of children we would have—and
for many, even this was an unavailable
option—but quite another to have some
say in the kind of children we would
have. The latter seemed to place a particularly
heavy burden on a woman, and
make being either a parent or a child
possibly and troublingly conditional.
In the decades since then, the burden
of decision-making has only gotten
heavier, and our social and ethical analyses
of these issues have failed woefully
to keep pace with the multiplicity
and complexity of the choices offered to
us by researchers and clinicians. Our
daughters and sons have a forest of
options and the compass Davis offers as
an aid through this thicket provides a
refreshing and stimulating, if not always
successful, tool.
Borrowing the concept of an "open
future" from the philosopher Joel Feinberg,
Davis proposes that we evaluate
reproductive and genetic options with
regard to how they will ensure and protect
the fullest autonomy for the childto-
be. In brief, she wants us to assess
our choices about the use of these technologies
in terms of the choices they will
permit our children to make, for example, about their own lives, education,
employment, and procreation. Will using
some technology now in childbearing
expand or limit the choices that will be
available to the children to be born?
A philosophical analysis of this position
is beyond the scope of this brief
review. It is perhaps sufficient to say that
I found Davis's presentation sometimes
persuasive, other times inadequate—if not
inappropriate. Davis herself is aware that
many may reject the open future lens she
prescribes for working through the ethical
thickets of genetic and reproductive
technology, while others may dismiss the
trail she marks out while using it. She graciously
invites such objections. In fact, it
is almost impossible, when reading this
book, not to make frequent marginal
notes expressing agreement and disagreement
with her positions on issues
such as choosing to have a child with a
disability, choosing the sex of a child,
and choosing to learn what genetic disorders
threaten an unborn child. Whatever
a reader concludes, all will benefit
from Davis's shifting our focus from the
decision-maker to the potential child
about whom these prenatal, even preconceptional,
decisions are being made.
Yet, welcome and important as this
shift is, it remains problematic, since
Davis generally ignores how an open
future resides so much more in societal
(i.e., political) than in individual
parental decisions. Will our society allow
entry to children of all kinds? How will
we ensure a full range of choices to all
women now and to all children? The
structures of society we create collectively,
the social and political arrangements
we establish, determine whether
all citizens in all their diversities have a
full menu from which to choose and
whether they are enabled to make the
fullest range of choices.
Thus, although an "open future,"
rather like "unconditional love," is a
powerful construct in thinking about
what parents owe their children, it cannot
be idealized out of context. It must be
examined in terms of what, not just who,
opens or closes a future; what societal
conditions allow, and not just what limits
are set by the choices or behaviors of
parents. Unfortunately, Davis does not
fully grapple with these questions. Nor
does her lens always distinguish what
might be a different—non-White/middle
class—array of choices.
Using protection of the right to an
open future as a lens through which to
assess reproductive options made available
(to some) by the new technologies
does lead to a fresh view of the forest,
but this tool alone cannot get us through
the thicket of options. It appropriately
expands our attention beyond simplistic
arguments about individual autonomy
and the "right" to choose, but it does not
highlight sufficiently the determinants
of the options available and of one's
ability to select among them. And these
contextual limitations on what most of
us are enabled to do and to choose—
what I have elsewhere called our
"response-ability"—necessarily restrict
the possible futures for most.
As I was finishing Genetic Dilemmas,
the New York Times ran an Associated
Press article that announced:
"Starting in August, expectant couples
can walk into an obstetrician's office
and ask to be tested for any of 24 variations
of the gene that causes cystic
fibrosis."1 If nothing else, this news puts
the matter of choice into a reality context.
In the future, even more than at
present, choices will be determined and
futures opened and closed not by
women making decisions about the use
of genetic and reproductive technologies,
but by insurance companies, medical
healthcare providers, biotechnology
and pharmaceutical companies, and
government officials who determine the
options put before us and set limits on
our abilities to respond. Readers who
keep these structural determinants in
mind will have a rich engagement with
Davis's easily read, highly accessible,
and provocative (but not polemic) book.
Others will at least have their conceptions
of autonomy broadened if not
challenged.
—Abby Lippman
NOTE
1. Leslie Gornstein, The Associated Press,
"Panel: Gene Testing Not Ready for Prime
Time," June 27, 2001.
Reformulating Professional
Ethics
Ethics and Excuses: The Crisis in
Professional Responsibility.
Banks McDowell.
Westport, Conn: Quorum Books, 2000.
169 pp. $59.95 (Hardcover).
Some of us may be reluctant to read
a book that asks us to take excuses
seriously. This is not easy, accustomed as
we are to thinking of excuses as ways to
avoid responsibility. We want to promote
a greater commitment to high ethical
standards, and it seems counter
intuitive that taking excuses seriously is
a good way to do that.
Nevertheless, taking ethical excuses
seriously can sometimes help us better
understand the influences at work in
the day-to-day lives of professionals.
Taking excuses seriously is important,
not because most excuses are legitimate
ones, but because the study of
excuses prepares both ethicists and professionals
to address the most important
and difficult issues in professional ethics
today. McDowell leads the reader to
reconsider the ways in which professional
ethics are formulated.
We may suspect that someone who
relies on people's excuses to reformulate
professional ethics may also lower standards
to the level of actual behavior.
But that is not McDowell's agenda. He
advocates reformulating professional
ethics so that its standards and presentation
can more effectively shape behavior
and guide practice. The divergence
between standards and practice is partly
the result, he argues, of the failure by
those teaching ethical duties to address
the realities that professionals often face
at work.
Excuses help to identify the nature
of the gap between "ethical standards
and the needs and the problems of contemporary
professional practice." This
gap is the crisis referred to in the subtitle.
In chapters eight and nine, McDowell
identifies some of the considerations
that should influence the reformulation
of professional ethics. The model or
paradigm that has been used in developing
professional ethics needs to be
changed. The model of a lone professional
who works as a generalist in a
stable community, has long-term relationships
with clients, and functions
largely in one-on-one situations is no
longer adequate. Most professionals
today work in groups, often as specialists
in bureaucratic organizations. The model
of professionals as autonomous experts
is no longer adequate; a better model
recognizes that professionals often work
in an organizational setting that stresses
efficiency.
Professional ethics, McDowell suggests,
must be reformulated with a better
understanding of the context in
which professionals work today. "It may
seem incongruous to talk about the ethical
conduct of a law firm, a hospital, a
business corporation, or a governmental
department, but that may be increasingly
our only alternative." Professional
ethics must recognize that responsibility
has shifted from individuals to institutions
and organizations. This does not
mean that common business perspectives
should determine the standards
of professional ethics. Maintaining professionalism
often requires, in fact, challenging
accepted business and economic
models.
McDowell challenges us with
questions about the compatibility of
common economic ideology with professional
ethics. There is a clash of values
between the dominant economic
theory and professional ethics, but the
clash has not been addressed adequately.
It must be addressed if presentations
of professional ethics are going to
meet the needs of professionals. Moreover,
social ethics, and a social justice
orientation, should play a part in formulating
and instilling business ethics.
McDowell's analysis of ethical
excuses and his suggestions about the
need to reformulate professional ethics
are worth careful consideration. His
emphasis on the importance of the organizational
setting for professional ethics
fits well with the growing recognition of
the importance of organizational ethics
in health care.
—Leonard J. Weber
Learning from Death
Compassion Sabbath: A Resource Kit.
Midwest Bioethics Center and the
Compassion Sabbath Task Force.
Kansas City, Mo.: Midwest Bioethics
Center, 1999. $75.
The resource kit is a result of a pilot
project held in the Kansas City
metropolitan area in 1999, which
sought to prepare faith leaders, their
congregations, and the larger community
to better minister to the spiritual
needs of their seriously ill and dying
members. Using a weekend model and
a community approach, the materials
prepared interested ministers to participate
in the "Compassionate Sabbath"
outreach held in February 2000.
Included in the three-ring, vinyl
binder kit is a video "More Lessons From
the Angel of Death"; a syllabus containing
an introduction, an afterword, and
five resource sections; the special issue of
Bioethics Forum 16, no. 1 "Meditations
by Wm. G. Bartholome"; and the "Caring
Conversations" workbook and study
guide.
The video presents William
Bartholome giving a public lecture
sponsored by the University of Kansas
Medical Center's Department of History
and Philosophy of Medicine.
Bartholome, who died in 1999 of
metastatic adenocarcinoma of the
esophagus, spent the last five years of
his life teaching an autopathographic
lesson on the values of dying and living
while dying. As Bartholome struggles to
speak in the video, the talking-head
camera angle does little to distract you
from a straightforward, lengthy lecture,
and it is only the compelling message
that keeps one attentive.
Worship resources include materials
from Christian, Jewish, Native American,
Islamic, and Hindu traditions and
are intended for Christian corporate worship
and for private devotion. The citations
are rich and varied giving ample
selections for one to review.
The education/training section
includes six sessions on "For Everything
There is a Season—Faith Reflections
on the End of Life" and five
sessions on "Caring Conversations—
More Lessons from the Angel of Death."
Session plans include a reflection piece,
discussion questions, leadership team
preparation materials, and a timeline
with content and suggested teaching
methods. Resource pages complete each
session.
The fifth section of the syllabus
lists Kansas-area and national resources
on grief, children, family, and end-of-life
issues. Educating the reader about the
Last Acts Coalition takes up the sixth
section. The cochairs of the Compassion
Sabbath Task Force write the afterword
in which they restate the desire to
provide "new tools and stratagems for
religious leaders to inspire, educate,
comfort, and console those who rely on
them."
"Caring Conversations: Making
your wishes known for end-of-life care"
combines the spiritual lessons of
Bartholome with workbook questions
designed to engage a social ritual that
helps persons plan for the end of life. The
workbook lists frequently asked questions
about advance directives. Workbook
users are introduced to questions
regarding personal relationships, spiritual/
religious values, healthcare decisions,
career and work decisions, legal
documents, and financial matters. Both
"Advance Directives" and "A Durable
power of Attorney for Healthcare Decisions"
forms are enclosed.
As a resource kit, there are many
materials here to choose from when
designing a program or event of one's
own. However, there is not a clear
instructional design that incorporates the
video, the special edition of the Bioethics
Forum, the "Caring Conversations"
Group Study Guide and Workbook, and
the syllabus material. The parts remain
separate, and the user must build a unified
whole. The developers, however,
have set forth a model of a community
approach to handling this difficult topic,
and this is the greatest contribution of the
resource kit.
—Mary Ann Clemens
Bioethics Past, Present, and
Future
The Nature and Prospect of Bioethics:
Interdisciplinary Perspectives.
Franklin G. Miller, John C. Fletcher, and
James M. Humber, eds.
Totowa, N.J.: Humana Press, 2003.
206 pp. $44.50 (Hardcover).
Retrospective assessments of
bioethics are in vogue. The field is
"old" enough (around 35, say most—not
all—in this book) to offer the 21st-century
surveyor some depth of perspective. This
interdisciplinary collection employs retrospect
in the service of prospect, and
functions as a kind of introduction to
the field. The editors' intended audience
includes students and "even" degreed
academics and practicing professionals in
bioethics' contributing disciplines who
lack an understanding of important
aspects of the field.
The editors believe that many in
these constituencies need a clearer picture
of what bioethics is and what its
practitioners do, how an aspiring bioethicist
would prepare to "practice" in the
field, and–presumably not least—why
bioethics is a worthwhile profession.
They recruited prominent scholars to
trace the relationship between their
respective disciplines and bioethics: John
Arras (philosophy), James Childress
(religion), Howard Brody (medicine),
Eric Meslin (policy), Patricia Benner
(nursing), Kathryn Montgomery (literary
studies), and Tina Stevens (history).
Editors Miller, Fletcher, and Humber
want to achieve four broad goals:
examining the roots of bioethics in
the several disciplines, showing how
bioethics needs these disciplines if it is to
"flourish," demonstrating "the value of
bioethics as a profession," and indicating
likely future directions in bioethics scholarship.
There is some discrepancy
between the needs attributed to the
intended audience and the goals enunciated
for the book itself. Will the reader,
for example, really come away with a
clear sense of what bioethicists—perhaps
especially clinical bioethicists—do?
John Arras' opening chapter begins
to allay such concerns. It provides a
concise sketch of the field's clinical, policy,
and academic emphases and their
varying relationships to philosophy.
Arras also offers constructive proposals
for reframing and reclaiming the usefulness
of philosophy for bioethics. While
Arras speaks for the discipline that has
been most influential in shaping
bioethics, Kathryn Montgomery advocates
for "genuine interdisciplinarity" as
she offers a sustained critique of "medical ethics" in light of literature and literary
theory. If some ethicists believe
that bioethics is now largely a matter of
applying known answers to clinical
FAQs, Montgomery counters that the
persistent reemergence in clinicians'
experience of supposedly answered
questions shows that, in fact, "most
issues are far from settled."
Eric Meslin's illuminating presentation
of the challenges of conducting
policy analysis in governmental bioethics
commissions provides a useful backdrop
for James Childress' consideration of
the role of religion and theology in public
policy. Childress' chapter comes
alive in this discussion, where he presses
the argument that "religious perspectives
and voices" have a legitimate,
indeed important, role in "public reason"
and the process of policy making.
They can expand our moral imagination,
advance moral positions that do
not depend solely on underlying religious
commitments, and articulate
important features of the "background
culture" (John Rawls) that will in any
case influence public opinion on issues.
(Childress adds, with equal conviction,
that religious perspectives should not
control the content of policy decisions or
provide their public rationale.)
Appropriately, most of the
"prospects" the authors propose are not
claims for a likely bioethics future, but
sketches of possible or desired futures
for bioethics and their discipline's relationship
to it. The editors' emphasis on
identifying directions for future scholarship
is mirrored in the tilt of most of
the essays toward the academic world
and its concerns rather than, say, the
world of clinical practice. On the whole,
this rich and wide-ranging collection
deserves to be read by its intended audience
as well as others interested in what
bioethics is, how it got here, and where
it may be headed.
One author's assessment of
bioethics as a social phenomenon
speaks particularly to "the value of
bioethics as a profession." Those who
wonder, and perhaps worry, whether
bioethics has done—or can do—the good
it sets out to do may be unsettled, as I
was, by this observation from Tina
Stevens: "[B]ioethics plays an important
role in buttressing biomedical
authority by midwifing the ultimate
social acceptance of exotic biotechnological
development." Stevens adds that
the field has played an "‘ambiguous
role'" (Charles Rosenberg) because
"bioethics legitimizes authority by questioning
it . . ."
The paradox of legitimizing while
ostensibly criticizing dogs the field at
least in part because bioethicists have
ineluctably become allied with, and
dependent upon, those who invite their
"critical" advice. How to address this
paradox, and the social and institutional
relationships that shape it, is surely a
central challenge for bioethics in this
generation.
—David B. McCurdy
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Second Opinion #11
Publisher: Park Ridge Center, Chicago
Date: April, 2005.
ISSN: 0890-1570
105 pages.
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