Christianity and Modern Medicine: Foundations for Bioethics, by Mark Wesley Foreman and Lindsay C. Leonard. Grand Rapids: Kregel Academic, 2022. 384 pp. $29.99.
This volume is co-authored by the father-daughter duo of a bioethicist professor and a practicing attorney, allowing their respective proficiencies to inform the conversations. Mark Wesley Foreman taught bioethics at Liberty University for three decades. He passed away on June 17, 2022 (a month after publication), leaving this volume as a parting gift to the church and academy. Lindsay C. Leonard is an Assistant Attorney General for the Commonwealth of Virginia. The volume is an amended treatment of Christianity and Bioethics: Confronting Clinical Issues (published in 1999), which was authored by Foreman alone. The revised volume is designed as an introduction, and thus “requires no prior knowledge on the part of the reader” (10).
The preliminary chapters address the intersection of medicine and ethics, ethical theories, principles of bioethics, moral reasoning, and legal procedures. The authors lament the “moral fog” that has descended upon contemporary culture (15). After summarizing consequentialism, deontology, and virtue ethics, they propose a framework comprised of “a pluralism of theories” (36), in which a virtue ethic is “the primary ethic” and a “deontological ethic” ranks “second in priority” (37). Although consequentialism is “the weakest of all views,” it still plays a role in moral reasoning (37).
Borrowing from the 1979 groundbreaking work of Tom Beauchamp and James Childress (under whom Foreman studied at the University of Virginia), Christianity and Bioethics describes the rudiments of bioethics as respect for autonomy, non-maleficence, beneficence, and justice. These four basic principles require “specification and balancing” in real-world application (70–72). The core commitments of a specifically Christian bioethical perspective involve the character of God as Creator and Redeemer, the dignity of humanity, and the sanctity of human life, the balancing of individual liberty with communal responsibilities, the recognition of both freedom and finitude, the ability of God to bring good even out of suffering, and the limited yet positive nature of medicine (72–74).
Subsequent chapters cover the specific topics of abortion, infanticide, euthanasia, physician-assisted suicide, procreational ethics, genetic ethics, clinical ethics, and medical research ethics. Each chapter begins with an engaging opening illustration drawn from real-life events. Regarding abortion (the first topic), the “question of personhood is the single most important question” (96). This “core issue” and “strongest pro-life argument” overrides a right to privacy and the quality-of-life argument (87, 97). A person is “a simple undivided being,” and therefore there is no such thing as a “potential person,” only “the potential to function as a person” (114–15). In one of its few clusters of biblical texts, the volume gleans scriptural evidence for the personhood of the unborn and the ontological continuity between conception and birth (115–18). The authors espouse a “soft” prolife activism that works within the laws while seeking respectfully to change the laws (119). The multi-faceted support (financial, relational, emotional) of women facing difficult mothering situations would have been a welcome addition.
With the establishment of “the right to life itself” as “the most basic right of every human being,” an opposition to infanticide is a foregone conclusion (chap. 4). As with abortion, one must distinguish between “functioning as a person and being a person” (133). Even in the case of anencephalic infants, the preemptory harvesting of organs involves the unethical use of persons as a means to an end (146–50). The fifth chapter, covering euthanasia, differentiates between active/passive procedures, withholding/withdrawing treatment, voluntary/involuntary procedures, and ordinary/extraordinary means (158–60). The sixth chapter tackles physician-assisted suicide. Foreman and Leonard define suicide as the “intentional taking or forfeiting [of] one’s life primarily for self-serving motives” (185). Of course, some who attempt suicide are under the (mistaken) impression that others will be “better off” without them, and they might quibble with the primarily “self-serving motives” attributed to them.
Chapter 7 (procreational ethics) warns against discarding embryos in IVF procedures and the use of third parties in artificial insemination and gestational surrogacy. Chapter 8 (genetic ethics) draws the customary distinctions between recessive and dominant disorders, therapy and enhancement, and somatic cell therapy and gene line therapy (255, 271). Foreman and Leonard insist that “every effort should be made to avoid any kind of enhancement intervention” (278), as such procedures smack of “eugenics” (276). They also warn of the commodification of babies and the commercialization of baby-making, and they decry the “technological imperative” of thinking something should be done simply because it can be done (273).
The next discussion (chap. 9) addresses clinical ethics. The analysis focuses upon informed consent, confidentiality, and whistleblowing. The examination of “paternalism” favors rational persuasion over legal force or physical force, although coercion “is always preferable to manipulation” (304). In limited instances, nondisclosure by medical personnel is ethically justified (such as the use of placebos in clinical trials). A “duty to warn,” or a moral obligation to infringe upon confidentiality, arises when a third party or the general public are endangered by the withholding of relevant information (326–27). Regarding informed and voluntary consent, “Understanding does not need to be complete but should be substantial, detailed, and accurate” (291). “Fully voluntary” remains the ideal, even though patients are inevitably affected by outside influences (292). A logical corollary of informed consent is the persistent possibility of the informed refusal of treatment (294).
The theme of voluntary consent continues into chapter 10, which covers research ethics and human experimentation. A large percentage of the material consists of a sweeping overview of the history of research ethics and human experimentation (338–51). Foreman and Leonard warn of the dangers of conducting experimental research upon vulnerable groups (such as children, prisoners, the poor, and the terminally ill). The chapter closes by building a firm case against embryonic stem cell research.
Foreman and Leonard believe that natural law theory holds more “explanatory power” than divine command theory and Kantian deontology. Perhaps not surprisingly, therefore, biblical citations rarely appear, even when most naturally expected (cf. 164–66, 324, etc.). They affirm that their book addresses bioethical questions “from a distinctly orthodox Christian perspective that takes Scripture and the historic position of the church seriously” (10). They also acknowledge that “The Scriptures are the inspired revelation of God and are authoritative on matters of faith and moral practice” (15). Nevertheless, one is struck by the relative paucity of specific Scripture texts within the volume, as contrasted with logical argumentation founded upon general bioethical principles.
The volume’s alternative tactic is to paint in broad strokes by using the catchphrase “as Christians,” without dipping the brush into the specific hues of particular biblical passages: “As Christians, we recognize that God has given mankind the basic capacity to freely chose what to believe and act on those beliefs” (46). “As Christians, we also recognize that we are both finite and yet transcendent” (73). “As Christians, we recognize that medicine, medical practice, and medical research are a good and should be praised and pursued” (74). “As Christians, we recognize that it simply isn’t your life to do with as you please” (186). “As Christians, one needs to recognize that God’s plan is for man and wife to participate in an act of procreation as a means of conceiving children” (240). “As Christians, we need to remember that God respects our free will to form worldviews and live in accordance with those worldviews, even if they go against what we believe to be God’s commands and will” (286). “As Christians, the sanctity of life principle is perhaps one of the most foundational principles in moral thinking and therefore it will generally trump when there is conflict” (287), etc. The grounding of this moral reasoning “as Christians” remains generally indeterminate (though see the use of two biblical references to ground reasoning “as Christians” on 69).
Four new chapters were added for this edition, and all other chapters were thoroughly updated. Foreman and Leonard acknowledge, “There are many other topics we could have included and perhaps will in a revised edition” (10). The work does not address current ethical tensions within organ transplantation, the allocation of limited resources (such as medical lotteries), or animal testing in medical research. The authors recognize that the burgeoning field of bioethics encompasses social health care policy as well (16). But the incorporated chapters do not cover the ethics of such topics as health inequities, access to care, mandated quarantines, and mandated vaccinations. The final composition was completed as the world faced the COVID-19 outbreak, but one would not catch this historical context by reading the book’s content. Similarly, the most recent statistics regarding abortion were culled from 2020 (84), prior to the Supreme Court’s 2022 ruling in Dobbs v. Jackson Women’s Health Organization.
A subject index would have supplemented the volume’s functionality as a reference tool, allowing readers to look up topics and trace thematic strands throughout the volume. A few grammatical errors are scattered in the book (i.e., 42, 185, 195, 257, 342). Nevertheless, the overall style of the work is precisely reasoned and clearly articulated. The father-daughter duo of Foreman and Leonard has unraveled knotty topics for the average reader without over-simplifying complex issues. The historical and legal discussions are particularly strong. The volume would serve as a worthy supplemental textbook for Christian ethics courses filled with students possessing limited medical backgrounds.
