Bioethics: A Primer for Christians, by Gilbert Meilaender. 4th edition. Grand Rapids: Eerdmans, 2020. 172 pp. $20.99.
Bioethics is a burgeoning field of applied ethics. Gilbert Meilaender (Senior Research Professor at Valparaiso University) dates the genesis of the discipline to half a century ago (xiv), and this is the fourth edition of his Bioethics: A Primer for Christians. The fact that the work is in its fourth iteration attests to its readability and usability, and the fact that a new edition is necessary attests to the field’s ever-changing nature. This revision includes not only new analyses of recent advances in genetics but also an extended discussion of protecting Christian conscience in the practice of medicine. Moreover, new case studies and new data pepper the volume.
Meilaender considers the “general form” of his ethical approach to be deontological (5). He also refers to “the deeper issue” of “what sort of people we wish to be and ought to be,” a seeming nod to virtue ethics (28). Interestingly, even as a deontologist, Meilaender does not cite specific biblical commandments or prohibitions by reference. Instead, he designed his investigation to be “shaped by the structure of Christian belief” (ix), allowing “the basic elements in a Christian vision” both to frame and to inform his discussions (xv). Meilaender does not discount general bioethical principles, such as respect for autonomy, beneficence, and justice (1). Yet he emphasizes that humans are “free spirits” (who transcend the material world) as well as “finite beings” (subject to natural necessity) (4). Readers may be surprised that the volume never refers to the imago Dei. As a Lutheran theologian, Meilaender focuses rather upon the underpinning of the gratia universalis of Christ’s redemption (44, 68).
Chapter 2 transitions to specific topics, beginning with reproductive medicine. Contemporary society has shifted from procreation to reproduction, in which babies are “a product of our will” rather than “the offspring of our passion” (19). However, if a child is a “product,” then “we determine its meaning and use” (22). If money is exchanged (as in the case of surrogacy), then the child becomes a “commodity” (27). Therefore, Meilaender argues that surrogacy is a violation of the human dignity of the child, as well as the human dignity of the gestating mother and rearing mother. In his view, adoption should focus primarily upon the needs of children and only secondarily upon the parental desire to have children.
Roe v. Wade (1973) cemented elective abortion within American culture, allowing legalized abortions for a range of reasons, including economic and lifestyle rationales (33). Meilaender finds the argument from “privacy” to be “unpersuasive” (43), and he is unwilling to extend abortion “beyond the exceptional cases” of rape, incest, and the life of the mother. One senses some tensions within strands of this argumentation. In a commendable trajectory (and in contrast to his first edition), Meilaender acknowledges that fertilization rather than the possibility of twinning is the more likely juncture for the advent of a new human individual (37). He draws from the well of Christian theology (the doctrine of the incarnation in particular) to address the issue. One might add that human cloning could further complicate (or inform) his previously held perspective.
Meilaender discusses the requisite distinction between somatic cell and germ cell therapy. Somatic cell therapy focuses upon the needs of particular patients, does not result in inheritable traits, and is less controversial. Even with somatic cell research, however, the danger always lurks (and must be consistently resisted) of expanding the definition of “health” to include preferential enhancements (55). A discussion of CRISPR/Cas9 (a technique which can be used to “edit” the human genome) enhances this fourth edition (51).
Meilaender opposes mandatory genetic screening. “Christians ought to set themselves against prenatal screening, at least as it is currently practiced in this country in an increasingly routinized way” (61). Using routine genetic screening to decide whether to keep a “tentative” pregnancy leads to “conditional commitment” and an inverted orientation that frames pregnancy as “moving from separation to attachment” rather than vice versa (65, 67).
Regarding suicide and euthanasia, Bioethics pushes back against an assumed “right to die with dignity.” The governing Christian principle is not “minimize suffering” but “maximize care” (78, 80). We are called to live out our personal stories—including providential plotlines of suffering—as faithfully as we can, remembering that such suffering is real but is not ultimate (78–79). When euthanasia wins social approval, the pressure builds to expand the classes of acceptable candidates (76); and with physician-assisted suicide euthanasia moves from an extension of personal autonomy to a communal act (77). By applying the distinction between intention and result, Meilaender maintains that treatment may be refused when it is useless or excessively burdensome (88).
Decision-making in healthcare should respect the human dignity of the persons involved and their relational interactions. “A patient is something different from a client or a consumer, and a physician is not an automobile mechanic” (94). Meilaender opposes legal mandates that require physicians to refer patients to willing providers of “services” they themselves find morally objectionable (95). Moreover, he prefers a healthcare power of attorney to a living will (104). In either case, he argues, one must eschew the “metaphysical self-deception” engendered by the “illusory quality” of our quest for self-determination (101).
The casual observer of bioethics may assume that organ donation (with its altruistic inclination) would be morally uncontroversial. Nevertheless, the complexities of the issue require circumspection and caution (108–9). If we are motivated only by a “god-like responsibility of bringing good out of every human tragedy” we may be tempted to view anencephalic neonates simply as organ sources (121). In fact, everyone is in danger of becoming “a useful precadaver” whose existence finds meaning in down-line donation to others (123). Emerging ethical minefields include children being conceived as bone marrow donors for family members (123).
Bioethics insists that patients are not merely experimental subjects to be used by researchers (127). The exploitation of the weak and vulnerable includes any reckless enrollment of children who cannot speak for themselves (126) and the paying of homeless persons as research subjects (133). One could add the remuneration of poor women for ova contributions. Embryonic stem cell research is intertwined with the destruction of embryos and the push for asexual (such as cloned) reproduction of further embryonic subjects. On the other hand, induced pluripotent adult stem cells are almost identical in potential to embryonic stem cells.
One theme of this volume concerns the inherent limitations of medicine (131). “Doctors are not saviors” (9), and “we should not suppose that medical caregivers can finally provide the wholeness that we need” (10). We tend to grant a redemptive status to the march of progress and to worship medical advancement (128). “In short, we fashion the golden calf of research medicine” (130). Like all false gods, the idol of medical progress ultimately disappoints and mars our human integrity. At times, Meilaender sounds more like a biblical counselor than a conventional bioethicist (148), especially with his assessments of the fallen person (“we are at heart idolaters,” 134).
A related theme centers upon “our nearly idolatrous attachment to the language of autonomy” (100). Meilaender emphasizes that “freedom is not always as liberating as we anticipate” (64), because the freedom to choose between options inherently leads to a burden of responsibility (65). A related danger is the “tyranny of the possible” (112) inherent within the so-called technological imperative. Christian ethicists must always approach the field with “the virtue of humility,” prudentially eschewing “dreams of mastery” (56-57).
A third thematic takeaway is that Christian bioethics requires not only a theology of God-given life but also a robust theology of suffering and death. “How then should we live?” is inescapably related to “How then should we die?” In life and death, we are the Lord’s. Indeed, “we are regarded as stewards rather than owners of our bodily life” (111).
In conclusion, Meilaender’s slender volume is a pithy yet powerful primer—a bantam weight contender that packs a punch. This fourth edition could have tackled a few other topics, including transhuman enhancement, mandated vaccinations, and gender confirmation and reassignment surgeries. Nevertheless, Meilaender’s adept study consistently insists that ethical behavior should be prioritized above medical accomplishment. Medical advance cannot overcome the sting of death, but an empty tomb attests to the ultimate antidote.
