I am currently reading Dietrich Bonhoeffer’s book, Discipleship, and thinking about how what he said relates to bioethics. One of the significant concepts in this book is the idea of costly grace. Bonhoeffer wrote “It is costly, because it calls to discipleship; it is grace because it calls us to follow Jesus Christ. It is costly, because it costs people their lives; it is grace, because it thereby makes them live. It is costly, because it condemns sin; it is grace, because it justifies the sinner. Above all, grace is costly, because it was costly to God, because it costs God the life of God’s Son – “you were bought with a price” – and because nothing can be cheap to us which is costly to God. Above all, it is grace because the life of God’s Son was not too costly for God to give in order to make us live.” (45)
One of the difficulties of Christian ethics (including Christian bioethics) is that when we focus on doing what is right it can seem like we are saying that doing what is right is necessary to gain God’s favor and that we are negating the foundational Christian doctrine of salvation by grace. That was a significant issue in Bonhoeffer’s Germany. The established church had taken a position which Bonhoeffer called cheap grace. They were saying that since God’s grace is freely given and we can do nothing to earn it, we should not try to do what is right, but should conform to the standards of society to show that our salvation is entirely free and not related to any effort of our own. That led them to conform to the Nazi regime’s practices that were engulfing their country and not to oppose them.
Bonhoeffer helps us to see that Jesus has paid the price for our salvation and that we can do nothing to earn it, but that God’s grace calls us to be disciples of Jesus. As we seek to follow him by the power of his Spirit and his transforming grace, we will seek to live by his standards. The moral reflection of Christian bioethics helps us to understand how God would have us live in response to his grace in our increasingly complex world.
Bonhoeffer, Dietrich. Discipleship. Minneapolis: Fortress Press, 2003.
Sunday I had a decision to make. It was one of those small decisions that reflect our underlying priorities. Just as it was time to get up to get ready for church I received a call that a patient was being admitted to our local hospital under my care. She was stable and the ER doctor had written her admitting orders, but I did not know her and needed to see her to be sure her planned care was appropriate. I had several options. (1) I could go to see her before church and miss singing with the choir. (2) I could go to church and sing with the choir, but leave before Sunday School to see my new patient so I could be home in time to see the IU basketball game at noon. (You have to know how much I care about IU basketball to understand why this was a real consideration.) (3) I could go to church and Sunday School (which I knew was going to be a time of sharing concerns and praying for each other) and then go to the hospital and likely miss watching at least some of the game live. (4) I could wait until after the game and go to the hospital later in the afternoon.
At this point some may be wondering what this has to do with bioethics. There are no life and death choices here. There are no principles at stake that will change the course of our culture. But ethics is largely about the little decisions we make every day. It is about deciding which of the good things we do have the highest priority.
So what was I to do? I decided that for that morning my first priority should be worship and prayer. There are times that the care of a patient needs to come first, but in this case the patient was stable and her immediate needs had been taken care of, so she could wait until after the opportunity for corporate worship and prayer. My own entertainment could wait, so I set the DVR to record the game to watch later and went to see my patient as soon as we had finished our time of prayer.
I had originally intended to write 3 posts about bioethics and Christmas, but as I listened to our pastor talk about Mary on Christmas morning, I realized there was one more part to write. I have written about what we can learn about the value of human life, the particular value of unborn human lives and the hope we have in Christ, but I left something out, humility.
It is easy for us as we try to find the answers to bioethical dilemmas and struggle to express God-centered values in a world that has lost sight of moral truth to come across as proud and at times condemning. Christian bioethicists have a strong foundation on which to base solid ethical judgments. We have a passion for protecting the weakest of human beings that comes from God’s concern for those who are weak. But sometimes we (I) can come on too strong. Mary reminds us that we need to be humble.
When the angel came to Mary to tell her that God had chosen her to give birth to a boy named Jesus, who would be the son of God, she didn’t understand how that could be. After questioning the angel and being told that she would be overshadowed by the power of God, Mary responded humbly by saying “I am the Lord’s servant. May your word to me be fulfilled.” (Luke 1:38) Later as she sang her praise to God she remembered her own humble state and that God is the one who lifts up the humble.
When I reflected on these thoughts Sunday and planned what I would post on Wednesday I must confess to some pride about my insight into humility. How human I am to be proud of humility. Then with being off work for the holidays I managed to forget that yesterday was Wednesday and forgot to write this post. I am writing it today with a little more humility.
God’s moral truth is powerful, and we need to express it to a world in need of that truth. But we need to remember that we are just servants and approach each issue and each person with humility, realizing we are totally dependent on the grace of God.
Over the last two weeks I have been reflecting on how Christmas relates to bioethics. My thoughts were focused on how Jesus’ incarnation helps us understand the inherent moral value of every human life and particularly the value of unborn human beings. But I think there is another way that Christmas relates to ethics that may be even more significant.
One of the problems with ethics in general and bioethics in particular is that none of us lives up to even our own ethical standards. All of us, whether Christian or not, understand that there are ethical standards that we ought to live up to, but we are not able to do it. Ethics by itself raises the problem of our being unable to live up to ethical standards, but it doesn’t give us a good solution. One way to respond to our inability to live up to ethical standards would be to give up in despair. Jesus’ incarnation gives another alternative, hope.
When the angel announced Jesus’ birth to the shepherds outside of Bethlehem, the message was “I bring you good news that will cause great joy for all the people. Today in the town of David a Savior has been born to you; he is the Messiah, the Lord.” (Luke 2:10-11 NIV) The joy in that message is based on the hope it provides. The angel gave us the answer to the problem raised by ethics. Since we all fall short of both our own standards and God’s, we need help. The angel announced that the help we need is the Messiah who has come to be our savior. Instead of despair at our inability to live up to moral standards there is hope, hope that begins with the arrival of God in the form of a baby born in a stable and lying in a manger.
Glory to God in the highest!
Even those without much Christian background know that Christmas is about the birth of the baby Jesus. Christmas carols, nativity scenes and creches, and even the pictures on Christmas cards depict the miraculous birth. What is interesting for bioethics is that the story starts before the birth.
Luke tells us in the first chapter of his gospel that the story began with an angel telling Mary that she was going to conceive a child through the intervention of the Holy Spirit without the usual sexual process. God didn’t take much time to do that because by the time she could get ready and hurry off to her relative Elizabeth’s house she was already pregnant. When she got there Elizabeth was in the sixth month of her pregnancy with her own angel-announced child. When Mary entered Elizabeth’s house, John (Elizabeth’s baby who later identified Jesus as the lamb of God) leapt in recognition of the presence of Jesus in Mary’s womb.
This detail of the story suggests that the incarnation impacts how we think about unborn human beings. Since Jesus became a human being it means that human beings have a special status as members of the class of beings that God chose to become. His beginning human life as an embryo and fetus that went through the usual nine months of prenatal life implies that the special status of human beings applies to human beings before they are born. The recognition between John and Jesus suggests the continuity of identity of individual human beings from early prenatal life to after birth.
Remembering that Jesus’ incarnation began nine months before his birth reminds us of the moral value of unborn lives. We should be just as amazed by that as those the shepherds told were amazed about his birth.
I just got back from the Taylor Christmas chapel and as my thoughts have been focused on the amazing incarnation of Jesus, I thought I would share some thoughts over the next few weeks on how Jesus’ incarnation impacts bioethics.
One of the most fundamental principles of bioethics is the inherent value and dignity of all human life. Our ideas of equality for human beings and equal human rights, moral status, and justice all depend on our understanding of the value that each of us has as a human being. When Christians think about the value of human beings we usually think about creation and our biblical understanding of human beings from the account of creation in Genesis 1 and the moral laws given to Noah in Genesis 9. Both of these passages refer to human beings being made in the image of God. We find an understanding of our inherent moral worth in how we were made.
Jesus’ incarnation adds richness to our understanding of who we are as human beings. God made us in his image not just so that we could be enough like him that he could communicate with us and have a relationship with us, but so that Jesus could become one of us. He made us able to choose between right and wrong, knowing we would choose the wrong. He planned all along to have Jesus, the Son, leave his glory as eternal God to become one of us, so that he could be the ransom for our sin. Being made in God’s image helps us see why every human being has moral value. Being one of the class of beings that God chose to become, and for whom he chose to die helps us see that value even more.
Glory to God in the highest.
I was recently talking with some students about how to be effective in teaching students how to apply Christian ethics to how they live their lives. They suggested that for a significant number of students it would be most effective if we did not tell them that we were teaching ethics. They thought that there were many students who would think that anything labeled as teaching ethics was something negative or of little interest to them, and they would not choose to be involved. They suggested it would be better to focus on topics of interest to students in their daily lives and incorporate teaching ethics into the discussion of those topics without identifying ethics as the topic. My own label for their idea was “stealth ethics.”
As I thought more about what they had said I began to wonder if it was ethical to teach ethics without openly stating that you were teaching ethics. My wife says I am the only person she knows who thinks about things like that, but I think she just doesn’t know enough ethicists.
My conclusion was that it was possible to do what the students were suggesting in a way that would be ethical and positive. Using the word “ethics” or the word “morality” is not necessary when we teach ethics and morals. Our desire is to get our students to think about why they do the things that they do and to learn to find standards to live by that are based in God’s revealed truth. If they can learn what God has to say about the value of every human life and how to treat every person with love and respect, and place obedience to God and caring for others first before their own desires we will have succeeded in teaching ethics. There will be those students who want to go deeper and understand how to discern Christian ethical values more rigorously and how to express that understanding to those who do not have a Christian foundation. They are a joy to teach. But my desire is that every student would have an understanding of how to live by God’s standards whether they call it ethics or not.
With Thanksgiving being celebrated tomorrow I have been thinking today about things I am thankful for in the context of bioethics. So here is my list of seven things I am thankful for this year.
1. Students who really want to learn how to make ethical decisions.
2. Medical technology that is effective enough that we have to make decisions on when to stop using it (much better than not being able to do anything for those with serious illnesses).
3. Palliative care for those who are suffering, particularly at the end of life.
4. The amazing miracle of the birth of a new life.
5. People who care for unborn human beings and their mothers.
6. The impact of prayer in people’s lives.
7. God, who made us to be enough like him to be able to have a relationship with him and to bring glory to him.
Like Joe, who wrote Friday about visiting his sister in a nursing home, I was in a nursing home with a family member Saturday. I was there with my mother and father visiting my 97-year-old grandmother who was dying of end stage dementia. Grandma had a gradually progressive dementia and had been unable to communicate verbally for the past year or so.
Thursday my mother had called to let me know that Grandma had become unresponsive and unable to eat or drink. The nurses had asked if they should give her fluids and nutrition by feeding tube or IV. My mother wanted my advice as her son and the doctor and ethicist in the family.
This was an easy ethics consult. Grandma had made it clear before her dementia progressed to the point that she could not make her own decisions that she did not want anything like that done. She had let us know that when it came time for her to die she was ready to go. She had put it in writing as well, but most importantly we knew what she wanted. Even so my mother needed me to reassure her that it was OK to say no. I was able to tell her that doing those things would not change the fact that Grandma was going to die and would just cause unneeded discomfort. Her doctor agreed and she was allowed to ease peacefully out of this life.
When I visited Saturday even the limited ability to respond that she had before was gone. I sat with her for a while with my hand on hers remembering all she meant to me and telling her I loved her. Then we moved furniture. My grandmother and my mother shared being very practical women. It seemed appropriate to take care of things like finding a use for the furniture she no longer needed, so I had brought my truck to haul some things home. I understood it was my mother’s way of coping with losing her mother.
Last night my parents called to say Grandma had died quietly. Later this week we will gather to remember her life and all she meant to us. I will express my thankfulness for her and that she was able to ease gently into the arms of her Lord.
Back in June I wrote a post to let people know about the newly published book Why the Church Needs Bioethics edited by John Kilner with contributions from many people connected to Trinity and the Center for Bioethics and Human Dignity. At the time my appreciation for what the book represented was based on the people involved and what they had set out to do. I just finished reading the book and they have accomplished their goal well.
They titled the book Why the Church Needs Bioethics, but it could easily have been titled Why Bioethics Needs the Church, because what comes through is how bioethics and the church need each other. I found the insights of biblical scholars and theologians such as Richard Averbeck, Kevin Vanhoozer and D.A. Carson particularly helpful in dealing with the issues of infertility treatment, enhancement, and the end of life that are the focus of the book. But many others from areas as diverse as business ethics, counseling, law, intercultural ministry, medicine and nursing, pastoral care, preaching and Christian education brought insights from all parts of the church to enlighten how we see the bioethical issues that people deal with in real life and how the church can play a role in helping them through difficult times. John Kilner, William Cheshire and John Dunlop brought each section of the book together to help the reader see how it all fit.
The church needs an understanding of bioethics to be able to help people as they face bioethical issues in their lives. Bioethics needs the church to enrich its understanding of how biblical truth impacts bioethical issues and how the body of Christ can prepare people for and help people through the bioethical challenges they face in their lives. Those of us involved in both bioethics and the church are challenged to bring those two together for the good of all.