A Theology of Technology

with Chris Ralston, PhD

In our last post we noted that Baylor’s Technology and Human Flourishing conference underscored the need for, as we put it, a “robust theology of technology.” We thought we’d follow up with some reflections on what such a theology might look like.

In chapter three of their book entitled Bioethics: A Christian Approach in a Pluralistic Age,[1]Scott B. Rae and Paul M. Cox develop a helpful framework for thinking about “Medical Technology in Theological Perspective.” The following is a very brief synopsis of their discussion.

The golden leaves of the pecan in autumn in central Texas.

The starting point for thinking about medical technology in theological perspective is the creation narrative as recorded in Genesis 1 and 2—specifically, with what has been termed the “dominion mandate” and with the doctrines of general revelation and common grace. At the creation humankind was charged with a mandate to “subdue the earth and be its master” (p. 94). The fulfillment of this task was, however, complicated by the entrance of sin into the world. Consequently, the post-Fall mandate includes “working toward improving the creation, or reversing the effects of the entrance of sin” into the created order, a significant aspect of which is dealing with death and disease (p. 95). Importantly, the dominion mandate is constrained by our role as stewards of rather than masters over creation: “At creation, human beings were charged with both dominion and stewardship. Creation was theirs to use for their benefit, but it ultimately belonged to God and they were responsible to him for its proper care” (p. 95).

According to the doctrine of general revelation, God provides both the “natural resources” and the “human ingenuity and wisdom” requisite for human beings to fulfill the dominion mandate (pp. 95-96). The doctrine of common grace affirms the notion that “God’s grace… is bestowed commonly, or on all humankind, irrespective of one’s membership in the community of God’s people” (p. 97). (Consider, for example, the rain that God sends, which falls on the “just” and the “unjust” alike; cf. Acts 14:17.)

Taken together, God’s general revelation and common grace provide human beings with “the knowledge and skill that are necessary to develop the kinds of technologies that enable humankind to subdue the creation” (p. 97). This is no less true of medical technology than of other forms of technology.

Crucially, however, medical technology can achieve only a “partial and temporary” victory over death and disease—it can never conquer them entirely. Moreover, given the sinful nature of humanity, technology can be put both to good and evil uses, in service of both virtuous and vicious ends (pp. 98-99). Consequently, “[w]e must distinguish between the use of any particular medical technology per se and its intended or actual use in practice. That is, it is possible to see virtually any medical technology as a part of God’s common grace to humankind. But that does not exempt it from moral assessment of its uses” (p. 99).

Engaging in such “moral assessment” of technology—whether medical technology specifically or other forms of technology more generally—was one of the key tasks to which Baylor’s IFL conference was devoted.

In this vein, I (Cody) sensed that most of the attendees were wrestling honestly with how to use technology wisely and still be authentic in their Christian faith.  On several occasions people mentioned the desire to avoid a “Luddite” dismissal of technology altogether, as if separating from electronic gadgets offered a particular kind of spiritual purity.  Most understood that spiritual health is essentially a matter of the heart, and the external aspect of using technology may or may not indicate the status of the soul.  Instead, many Christians opt for a view of technology that stresses the fact that we use technology and technology should not “use” us.  When technology is no longer useful or, even worse, when it begins to sets us back or harm us as Christian people, we lay it aside.  Or as the Reformers might have put it, “Let us do all Soli Deo Gloria, For the Glory of God Alone.”

We’d like to close with a brief note about the notion of “virtual” technology.  A number of the speakers at the IFL conference dealt with this issue, from discussions of how a child’s involvement with outdoors activities or handicrafts can improve ADHD symptoms to the importance of the local gathering of believers as the body of Christ in church worship.  These ideas emphasize the importance of place, “being there” if you will.  As Kay Toombs mentioned in her talk, we can relay information about a spouse’s illness to many people via a Facebook status update, but this is very different from sharing this information in the presence of someone who can hold our hand.  And this is very directly related to our being ensouled beings, not just cerebral beings that communicate data but spiritual people who are there, in a particular place.  It’s nice that we are able to share with you some of this information over the Internet, but it might be even better if you can now go and discuss some of these heart-felt issues with a friend over a cup of coffee.

We invite further reflection on these topics from our readers.

 

 

 


[1] Eerdmans, 1999, pp. 91-127.

Technology and Human Flourishing, Baylor University

with Chris Ralston, PhD

I was honored to have Trinity colleague Chris Ralston come to Texas and join me for Technology and Human Flourishing, a conference of the Institute for Faith and Learning at my alma mater, Baylor University. We thought we’d give a quick run-down of some of the ideas presented.

On October 25-27, 2012, scholars, undergraduate and graduate students, faculty, and other interested individuals from across the globe gathered at Baylor University in Waco, Texas to discuss issues surrounding the relationship between technology and human flourishing. The conference featured a variety of individual paper presentations and plenary speakers, ranging across a broad spectrum of topics, from “Building Emotions into Machines” to “Interstellar Exploration and Human Flourishing.”

Many of the presentations engaged with a number of common themes, including the relationship between science and faith; epistemological questions about the sources of knowledge, in particular the question of whether or not science exhausts the domain of “knowledge”; and questions about the impact, for better or for worse, of technology on human dignity and flourishing. Some of the specific questions raised include the following: How does technology encourage us to think about ourselves? About human nature? As our capacities to manipulate the physical “stuff” of our bodily existence (DNA, genes, etc.) expand, will this encourage us increasingly to think of ourselves strictly in physicalist terms? Should we think of ourselves in such terms? And what would be the implications or consequences of so thinking about ourselves?

In addressing these and other related questions, one recurrent thought that emerged is the notion that technology should be assessed not only in terms of what it can do (what can be done with it), but also in terms of how it affects us as human beings, both individually and collectively. That is, how does technology and its various applications shape us, whether as individuals or as society? In this regard, the conference highlighted the need for a deep, robust theology of technology—one that avoids the twin dangers of Luddite rejection of technology on the one hand, and a naïve acceptance of “all things new” on the other. The challenge is to remain open to the potential blessings of technological development, while at the same time resisting what has been termed the “technological imperative”: the assumption that if it can be done, it should be done.

Ian Hutchison, a nuclear engineer at MIT, provided some excellent comments on scientism, much of it coming from his new book Monopolizing Knowledge. Hutchinson is an ardent proponent of the natural sciences, for they have been quite literally his “bread and butter” for many years. However, he made the argument that we are greatly mistaken if we think that scientific tools give us all there is to know about the universe.

At dinner, we had the honor of sitting at the same table with Dr. Hutchinson and one of my former philosophy professors, Dr. Kay Toombs, whose research and commentary on the experience of illness over the years I highly recommend. Dr. Hutchinson had concluded his lecture with a word about the counter-cultural nature of being a Christian and how simply re-discovering virtues about the wrongness of covetousness would be of great help. I made the comment over our salads that is seems strange that speaking against covetousness is thought of as a new idea, for in fact it used to a part of Preaching 101. He agreed that his ideas weren’t all that revolutionary but that we need to have the faithfulness to pursue them even in the face of opposition.

It seems fitting to have more than one MIT professor at a technology conference, and Rosalind Picard of the MIT Media Lab followed well in the footsteps of Dr. Hutchison. In the first place, her research bringing affective (emotional) components to computing and robotics is just plain fascinating, but its application to helping autistic adolescents is heart-warming as well. One could sense from her talk that she is a kind, Christian woman and that she brings a warmth and a Christian ethic to a field that is oftentimes cold circuitry.

For all you Kierkegaard fans out there, the IFL while be recognizing the bicentennial of his birth next year with a conference that includes Richard Bauckham in the line-up, and the 2014 conference on faith and film also promises to be worth the trip as well.

 

Eugenics and the genetic testing of embryos and fetuses

In a recent article in the Australian media Julian Savulescu, a noted Oxford ethicist who is a visiting professor at Monash University in Melbourne, makes the contention that selecting which babies are born by doing genetic testing on embryos or fetuses and only allowing those that are desired to live to birth in the way that it is allowed in Australia shares the moral problems of past eugenics programs that we have rejected. His point is that the current practice in Australia allows selection of embryos by preimplantation genetic diagnosis and fetal testing with selective abortion only for diseases and not for sex selection or other non-disease characteristics. By allowing selection based only on diseases the society is saying that “lives with disability are less deserving of respect, or have lower moral status.” That is why we rejected the eugenics programs of the past.

Savulescu points out that “If either the embryo or the fetus has a moral status – then it would be wrong to kill either, whether or not a disability is present. If the embryo or fetus does not have a moral status, it should be permissible to destroy an embryo or abort a fetus for any reason. In this way, paradoxically, allowing testing for diseases, but not for other genes, is eugenic in objectionable ways.”

It would be easy to go from there to saying that genetic testing of embryos and fetuses for the purpose of selecting who will be allowed to be born should not be done based on the principle of the value of all human lives underlies our rejection of eugenics, but he does not go that direction. Instead he moves toward the permissibility of all embryonic and fetal testing by saying that lifting the restrictions on personal liberty imposed by limiting genetic testing of embryos and fetuses to testing for disease would resolve the moral objection that the current policy involves morally impermissible eugenics. He gets there by saying that since most people already accept the testing of embryos and fetuses for diseases, we should not say that all such selective testing is wrong based on the moral status of embryos and fetuses and the way to validate people’s acceptance of testing for diseases is to allow testing for non-disease characteristics.

Savulescu’s means of getting to his conclusion is an interesting and commonly used one to justify things that have previously been understood to be wrong. Rather than giving arguments for why we should believe that a human embryo or fetus does or does not have full moral status, he says we have already accepted a limited practice that would otherwise have been considered immoral, so we should accept a broader version of the same sort of practice. This is the process by which immoral behavior takes over a society, and also the process by which an individual falls into immorality. First justify a very limited violation of morality, and then once that is accepted use that to justify further immorality.
That is why we need to stand firm on basic moral values such as the dignity and value of every human life. Defending the moral status of the weakest and most defenseless human beings is essential to avoid the acceptance of things like aborting fetuses because they are female that currently seem obviously wrong, but may become accepted by a gradual breakdown of moral values.

Eugenics in Our Day

Researchers have now developed a technique for doing genetic testing of a fetus by using cells circulating in maternal blood, avoiding the more invasive and dangerous technique of amniocentesis.   These new technical capabilities hail the dawn of a new age of eugenics, or the pursuit of “good (eu) genes.”  With these new technical achievements, physicians can gain knowledge of the child’s genetic makeup as early as 7 weeks after conception.  This can mean a new opportunity for interventions earlier in the pregnancy for the sake of the health of the child or it may provide doctors with more information to inform a decision to abort the child.

Arthur Caplan helped develop guidelines for organ transplants in the 1980s and has for some time pressed for similar oversight of the “wild west” of reproductive medicine, largely because of its eugenics implications.  He is very aware that genetic testing could be used for selecting athletic ability, eye color, or gender.  Sex selection using abortion is already something practiced in countries like India and China, and genetic testing using maternal blood would only make it easier.  However, Caplan is firmly pro-choice, saying that there are good and bad reasons for an abortion.  As Caplan puts it,“Sexism is not a good reason for ending a pregnancy.”

What is missing in this discussion is our response to those with diseases and abnormalities.  To many, a chromosomal defect like Down Syndrome or a physical abnormality like malformed limbs is a good reason for ending a pregnancy.   Too often our attitude to those with abnormalities and diseases is to consider them as unfortunate mistakes rather than opportunities to live in fellowship with another human being.  We think getting rid of the mistake solves the problem, especially when it involves fetal tissue out of our line of sight.  If our drive for perfection bumps into human autonomy, we back off.  If it does not, we proceed in getting rid of the patient if we can’t get rid of the disease.  This is a serious misunderstanding of the ethos of medicine.  An improvement in our ethical strategies will not come from a new set of protocols to use in the clinic.  It will only come about if physicians adopt a new value system concerning the purpose of medicine and develop their character accordingly.

Henri Nouwen, well-known for living in the L’Arche community for adults with disabilities, articulated  a vision of such an ethic when he said, “When we honestly ask ourselves which person in our lives means the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand.”

Click here for a video of Art Caplan discussing gender selection.

The Physician and Chaplain Are Kin

One of our good family friends has been in the hospital the last several weeks, and I’ve gotten to spend a lot of time with her. She is in her eighties and regards me as her “grandson by choice,” and I remember fondly visiting my grandparents in my high school years and listening to her vivid stories and witty humor. She has a firecracker personality and that shines through even though she has a number of medical problems.

One day this week, I went to see her at breakfast-time, and I offered to continue to help feed her eggs and coffee. She declined, saying that she was sleepy. I knew the food would be good for her but felt at that instance I should put down the plate and just sit quietly with her as she drifted off to sleep. The conditioned impulse in me wanted me to jump and run off to “get some work done.” But I knew that what I was doing was a key part of the healing process, an important part of medicine. My presence in the room had an impact on her allowing her to sleep peacefully. And her presence with me allowed me to reflect on things that I’m often too busy to think about it.

Unfortunately, physicians often neglect these very human interactions in their rush to analyze the latest data and strategize about the next procedure. But as leaders of the health care team, I believe it is required for them to be aware of the spiritual health of their patients. Over the course of the morning a half dozen nurses, occupational therapists, and respiratory therapists scurried in and out of the room. All of them were polite and technically adept, but none of them really understood the real situation of an elderly woman over 30 miles away from her home sick in the hospital. Of course, it is the physician who sets the tone for awareness of the patient’s human situation. I was beginning to think that the best thing for this sweet lady was for her to return to the smaller, rural hospital for the sake of her spirit.

Many people write with regret on how the medical profession has become a technical endeavor almost void of spiritual insight. The colleagues of Hippocrates didn’t just draw up some guidelines for medical practice but instead swore an oath before the gods because they knew the gravity of their profession. Likewise, the Christian disposition of medicine in America has historically coupled church charity and chaplaincy with medicine because it takes into account the spiritual well-being of the sick and the injured. I pray the physician and chaplain shake hands and once again embark on this healing endeavor together.

Addendum: Today, I asked for a Gideon Bible to read to my friend. There wasn’t a Bible to be found on the entire floor, even at the other nurse’s station. The nurse said, “This isn’t a hotel.” I replied, “I think you need it more here than at a hotel.” To her credit, she agreed.

Finding the right ethical boundaries

In last week’s blog I mentioned that once an ethical barrier is broken we tend to pursue the breach as far as we can. I was trying to say that our nature as fallen human beings requires ethical boundaries to keep us from doing things we should not. Another example of that comes from Israel where a person is undergoing sex reassignment surgery to be changed from being female to being male. This person has requested the preservation of ovarian tissue for future reproductive use. Since this was denied by the Israeli Ministry of Health it has been appealed to the Israeli Supreme Court.

Ravitsky and Heyd argue in a commentary in Bionews that the reproductive rights of transgender individuals and their reproductive autonomy through the use of available fertility preservation techniques should be acknowledged. They base their argument on this case not being significantly different from things that have already been ethically accepted. They note that the Israeli Ministry of Health already considers sex reassignment surgery to be a legitimate medical procedure and that they allow IVF with donor gametes and surrogate mothers. They argue that having the social father of a child be the genetic mother of the child would not be ethically different than those situations that have already been accepted. They do express concern that there could be some psychological impact on the child, but suggest that having your social father be your genetic mother is no more confusing than having two male or two female parents. The door has been opened, so why not go through as far as possible?

It is interesting to think about what ethical boundaries have been broken to get to this place. One has to do with the acceptance of gender reassignment. If we see ourselves as people who have been created by God who has known us before we were born and loves us just as we are, it is hard to justify surgically altering our sexual identity. If the sexual reassignment is not permissible then the rest of this does not come up. Another has to do with our concept of procreation. If we see children as a gift from God, intended to be given to a husband and wife as a result of the physical expression of their love, rather than the result of a person’s presumed reproductive rights, then the use of third party gametes and surrogate mothers are outside of the permissible ways if creating children and the rest is not an issue as well. If we clearly draw the ethical lines on more basic issues then it is not hard to see that it is wrong to create a child whose father is also the child’s mother.

Life unworthy of living

Sometimes we need to remember the past. Of course that is what historians try to teach us. The recent translation into Italian of the 1920 German book Allowing the Destruction of Life Unworthy of Living by Karl Binding and Alfred Hoche prompted a reminder by Italian historian Lucetta Scaraffia about how the central idea of the book played out over the next few decades in Germany (see Washington Post article).

She suggests that the history of that idea is relevant to current bioethical issues. Some of those have been discussed recently on this blog. A few days ago Joe Gibes wrote about decisions to abort fetuses found to have major abnormalities such as Down syndrome. Back in December Jon Holmlund wrote about the use of PGD to diagnose embryos with major genetic disorders so that parents at risk for having a child with such a disorder could choose to give birth to a child without the disorder and not bring embryos with the disorder to birth.

Both the practice of aborting fetuses with a major disorder and doing PGD to choose which embryos should be brought to birth to avoid giving birth to a child with a genetic disorder involve the concept of a life unworthy of living that Binding and Hoche wrote about. If we make a decision to abort a fetus with Down syndrome or even one with a more serious disorder we are making a decision that the life of the person who that fetus will be is not worth living. If we choose to create multiple embryos and choose to implant those who do not have a serious genetic disorder so that they can live, but choose not to implant those who have the disorder so that they will not live we are saying that the lives that would be lived by those embryos who are discarded are not worth living. Whether one believes that and embryo or a fetus has full moral status or not they are unique individuals who have live that they would live if they are allowed to. Not allowing them to live those lives due to the presence of a disorder is saying that those lives are not worth living.

Remembering what happened in Germany helps us remember what a serious thing it is to say that a person’s life is not worth living. The idea that Binding and Hoche wrote about began as a philosophical concept, but it was embraced by the German government under Hitler as a reason for German physicians to put to death mentally deficient children whose lives were thought to be not worth living. Later that was expanded to large numbers of Jews and others whose lives were not thought to be worth living. The experience in Germany helps us to see that the idea that there are people whose lives are not worth living depends on a negation of the fundamental idea that every human life has inherent value. As Christians we understand that this value is due to our being created in the image of God. Even for those who do not have that understanding the inherent value of every human being underlies the concept of universal human rights that has become the foundation for global justice.

The German experience reminds us that there are some lines that we must not cross. One of those is saying that another human being has a life that is not worth living and using that as the justification for ending the life of an embryo or fetus.

FMRI and Normal

Recently I was researching functional magnetic resonance imaging, both for a post on this blog and an article that I am writing for The Best Schools blog. I wanted to look at where fMRI has been used in the clinical setting, and was looking through Functional MRI: Basic Principles and Clinical Applications (2006), which was a very helpful book on the subject. Chapter eight was on “Applications of fMRI to Psychiatry.” In several places the chapter kept referring to testing a person with a particular mental disorder compared to a “normal” patient, but the chapter provided neither a quantitatively nor qualitatively definition of normal. I am not sure if I am missing a technical definition here, or if the definition is assumed.

Brain scanning technologies, such as fMRI, are qualitative measurements. This means your readings are meaningless unless you compare them to something else, preferably a baseline from the same patient. For example, the chapter on “FMRI and Clinical Pain” mentions that fMRI is a good tool for measuring acute pain, but is not as helpful for measuring chronic pain. With acute pain, one can take a baseline reading of the patient while not feeling pain. Then by inducing pain, usually through touching the site of acute pain and an image of the brain can be taken showing what parts of the brain became more active when the pain occurred. In this way, doctors might be able to classify the pain or develop a treatment to reduce the pain. Chronic pain is different because doctors cannot take an adequate baseline (no pain) to then study the neurological response to inducing the pain.

The chapter on psychiatry, however, compares patients with autism spectrum disorder, or attention deficit disorder, or schizophrenia, or manic depression or obsessive compulsive disorder with brain scans of normal patients. Since this technique relies on a baseline for meaningful information, the lack of clarity on what is meant by “normal” makes it difficult to interpret.

Now, I am not saying that the author of this chapter is a eugenicist, nor am I saying that the field of psychiatry is bunk. Furthermore, I am not saying these issues do not having a neurological component to them.  I, actually, am concerned with scientific method here: Are researchers able to obtain meaningful data from these scans when the baseline is 1) a different person from the patient (similar to chronic pain), and 2) is seemingly subjective?

To the authors’ credit, they do point out that as of now “the clinical utility of fMRI to patients has thus far been limited, as no findings have been shown to be diagnostically specific for any psychiatric illness or treatment. Although many hospitals and research facilities complete MRI on psychiatric patients, this information cannot, as yet, be used reliably to generate a psychiatric diagnosis; however scans often are used to rule out the presence of a neurological illness” (185). They seem to be careful not to overstate their case. This is careful science, which is good, but the issue is what is meant by the comparison to normal.

(By the way, neuroscience is an active field. If new research has come out about diagnosing psychiatric disorders, please let us know in the comments section.)

I do not want to make the mistake of quote hunting especially because the chapter is very thorough, but I did want to give a sampling of what I mean by comparing to a “normal” subject. Some of the findings are reasonable, but with others, it seems like the only conclusion that can be drawn is this person’s brain is responding differently from this other person.

Autism spectrum disorder (ASD):

Functional MRI research on autism, although limited, has illustrated that individuals diagnosed with autistic disorder demonstrate an alternate method of facial processing when compared to normal healthy control subjects… In contrast to control subjects, when autistic individuals were asked to respond with a button press to determine the emotion of a facial photograph, they again showed no activation in the left amygdalahippocampal region and left cerebellum. (186)

The patients were people who were diagnosed with ASD and are compared with “normal healthy control subjects” that I am assuming are normal and healthy because they not diagnosed with ASD or any other disorder that would qualify as a mental disorder. This was not stated, specifically, though.

Schizophrenia

Because of the severity of schizophrenia, much fMRI research has been devoted to it. One study that did seem helpful was looking at a patient with schizophrenia before medication treatments, and then after a course of treatment. In this case, the baseline is the patient, himself, so a comparison can be made. Even so, the drug was assumed to be working because the patient’s fMRI looked more similar to the control subjects.

“Mood Disorders”

Depression and bipolar disorder studies are limited because of difficulties with diagnosis. However, studies that have been done have been conducted compared to “nonpsychiatric populations.” This apparently means people that do not meet the criteria for depression, bipolar disorder, or any other psychological disorder.

Certainly there are people who are affected by any of these psychological disorders, and surely many of these disorders have a neurological component. However, I am uncertain how helpful an analytical technique that relies on comparative studies, particularly comparisons to an accepted, yet undefined “normal,” really is for understanding a disorder.

The Virtue of Human Development

New York University bioethicist S. Matthew Liao has recently proposed giving people drugs to predispose them to make decisions in favor of programs working toward climate change:

Yes. It’s certainly ethically problematic to insert beliefs into people, and so we want to be clear that’s not something we’re proposing. What we have in mind has more to do with weakness of will. For example, I might know that I ought to send a check to Oxfam, but because of a weakness of will I might never write that check. But if we increase my empathetic capacities with drugs, then maybe I might overcome my weakness of will and write that check. (1)

What Liao is talking about is something still closely tied to beliefs: the will.  Jonathan Edwards spent a good bit of his time writing about the close relationship between these two aspects of human character.  If all that was needed was a little perk-me-up to help out a sleepy donor, then we would prescribe a cup of coffee.  However, beliefs and the will are both components of human character and therefore are changed and molded by the process of maturation.  And the maturing of a person takes place in relationship with other persons, in relationship to God and in relationship to other human beings.  This is the heart and soul (literally) of the human experience.  Theologians oftentimes use the term sanctification to describe this change within the person as a result of the action of God.  This process is ultimately directed toward Jesus, the Mediator who opens the door for making the human heart living and the One who is the New Adam—the One who is human in the truest sense.  Pharmacological manipulation of human behavior seeks to short-circuit the process of human development, thereby essentially taking away that which is truly human.  Just think: if the literature describing the story of human struggle and development were eliminated, our libraries would be largely empty.  A person no longer growing in relationship with God and with others would be less human.  The manipulative means would have done great harm in pursuit of the end behavior.

The renewed interest in virtue ethics in recent years may serve to steer us away from further attempts at manipulation in favor of choosing a path of maturity.

I have always marveled at how Meda Pharmeceuticals markets their version of the muscle relaxant carisoprodol as Soma because of the name’s negative connotations.   Maybe it has no negative connotations at all.

By this time the soma had begun to work. Eyes shone, cheeks were flushed, the inner light of universal benevolence broke out on every face in happy, friendly smiles. (2)

1.  Anderson, Ross.  “How Engineering the Human Body Could Combat Climate Change.” The Atlantic,  March 12, 2012.

2.  Huxley, Aldous. Brave New World.  HarperCollins, 1932 (2006).

How nonmoral beliefs impact our moral decisions

When people try to support a belief in cultural relativism they often point to the diversity of moral practices in different cultures. One of the ways to explain how that diversity can exist even if morality is really based on objective moral values that are universal is to show how two cultures with similar basic moral beliefs can have different moral practices due to differing nonmoral beliefs. The treatment of the elderly by Eskimos is a common example. However a recent discussion in my medical ethics class reminded me that differing nonmoral beliefs can lead to differences in the ethical judgments we make as individuals as well.

The class was discussing the case of a patient with ambiguous genitalia who sought care at age nineteen wanting to know why she had never menstruated. The physicians discovered that even though the patient had a generally female body type and had been raised as being female this person had no female genitalia and was genetically male. We were discussing whether it was permissible for the physicians to withhold the information that the patient was genetically male. The class was divided with some saying the whole truth needed to be revealed and others saying that to do what was in the best interest of the patient it was permissible to withhold that information.

As I reflected on how the students had supported their positions it became clear that there was a difference in the nonmoral beliefs between the two groups of students that led to their different moral positions, even though they all had very similar basic moral beliefs. Some of the students believed that gender was determined by genetics and this patient was truly male. They were the ones who said it was not permissible to withhold the information that the patient was genetically male. The other group of students believed that there were other things besides genetics that entered into the determination of gender (such as the influence of hormones on fetal development at certain critical times in development and socialization based on the assumed gender from body type). They were the ones who thought it was permissible to withhold the information.

I had intended for the case discussion to be focused on what it means to tell the truth and whether that always needs to include the whole truth. The students’ responses reminded me how important our nonmoral beliefs are in making moral decisions.