A Place Where We Ought to Fear to Tread

The current issue of World magazine includes a brief article about this work going on in the United Kingdom: attempting to circumvent certain inheritable diseases by replacing the mitochondrial DNA in a mother’s oocyte with mitochondria from an oocyte of another woman.  The re-engineered oocyte is then fertilized in vitro, with subsequent implantation of the embryo, etc, etc.  The article’s provocative title was, “Heather has two mommies.”

If one accepts IVF and is inclined to observe the “therapeutic boundary” as placing limits on what genetic manipulations we should be willing to undertake, then this project would seem to qualify as treatment, rather than enhancement, before a new individual person is conceived, and could qualify as an acceptable use of reproductive technology.  And one can argue that the risk/benefit analysis, in a case like this, is clearly positive (perhaps requiring that all embryos so created are implanted with the intent to carry them to term).

But I’m not so sure that a line has not been crossed here.  Still, to object on grounds of “repugnance”—as I would—would seem to succeed only if said repugnance reflects deep, universal moral sentiments and intuitions that are expressions of a natural moral law.  And a lot of people would not find the case here repugnant.  To object—as, again, I would—on the grounds that the undertaking here is part of the transformation of procreation (and receiving of new life as a gift) into manufacturing seems to require that there is an objective, given, human nature and order of human life that must not be tampered with.  If life is God-given and humans are in His image, then it is more natural to make that kind of assertion, but by so doing I think we (I) accept the task of saying what that human nature is.  The image, in that case, needs to be more than just a “status and standard,” or to say that it grounds the human nature we shouldn’t mess with seems tautological.  Alternatively, on more naturalistic grounds, one might argue that evolution “gave” us a core genetic nature (“in its wisdom??”) that “ought not be disposed with,” a tack the German philosopher Jürgen Habermas seems to take in opposing PGD.  Or, we could even invoke a form of the much-maligned “precautionary principle” and claim that, when we start mixing and matching pieces of genomes in newly-conceived people, we don’t know what difficulties we might be wandering into, so we can’t define a risk-benefit ratio in the first place.

Anyway, I think a line something like this—there is, in a meaningful sense, a “core human nature” that must not be altered, and a natural moral law that grounds at least the most basic, primary moral precepts setting that limit—is the line that is necessary if one wants to claim that our biotechnologic grasp must stop somewhere.  And so I want to hold.  None of it suggests that the march of biotech will be slowed—it seems that somebody will try anything that becomes feasible—but it is a basis for asking people to stop and think, and getting perhaps some to turn back.  It is a basis for articulating a “presumption to forbear.”

We Should All Be Cognitivists

I mean that title without irony…

I have repeatedly described myself as a moral realist, and urged that position on readers of this blog.  Again, a “moral realist” thinks that moral statements—statements like, “setting off bombs at the Boston Marathon is wrong”—are intended to report facts (and hence are the sort of utterance that can be true or false), and that, if we have the facts right, at least some of these statements are true.

Not long ago, I wrote on this blog of a naturalist, atheist friend who I thought was nonetheless a moral realist.  Boy, was I all wet.  I hadn’t been listening to him all this time.  He told me that, after some investigation, he could be “taxonomized” (a pejorative term in his view) as a “non-cognitivist, moral irrealist, naturalist.”  That string of terms is internally consistent, anyway.  Non-cognitivism is a form of moral irrealism (while the moral realist must necessarily be a cognitivist).

To approach these matters invokes about a century (plus a shout back to David Hume, at least) of metaethics.  As I have also blogged here, being an amateur philosopher is dangerous business, but I think that some foray into the field is necessary for those of us who style ourselves as thoughtful members of the general public, on bioethical matters.

I am 180-degrees opposite from my friend on all three of his self-characterizations.  For the moment, I want to make a few sketchy comments limited to cognitivism.  Cognitivism holds that moral statements do express beliefs and make assertions that can be true or false.  Non-cognitivists say that moral statements express attitudes such as desires, approval, or disapproval.  A primitive form of non-cognitivism used to be called “yah/boo” theory—as in, “yah” for courage, “boo” for bomb-setting.  But my very limited study indicates that there are now several variants of non-cognitivism, some of which seem hard to distinguish from cognitivist counterparts.  I’m still learning about those.  (Non-cognitivism has come a long way from what I understand to have been the failed initial attempts of the likes of A.J. Ayer to ground the meaning of language in scientific experiment.)

But in a first approximation, I can’t accept a non-cognitivist approach to ethics for several reasons:

1)      Non-cognitivism rests on a prior (and I assert, pretheoretical) commitment to naturalism.  To be sure, it arises in large part in response to the “naturalistic fallacy”—a statement of what ought to be cannot be deduced from a statement of what is without a prior “ought” premise (following Hume).  Or, as G.E. Moore put it, for any natural property it was always an open question whether that property is good.  But I understand the core tenet of naturalism to be that the only facts are those accessible to the various sciences (physical and social), and I reject that tenet.  It seems to me there are mental facts that are not identical to naturalistic events, for example.  Here we get into the complex arguments about supervenience in metaethics and philosophy of mind, and “naturalistic moral realists” make sophisticated arguments along these lines—arguments that I think ultimately fail—but space prohibits writing more about that now.

2)      Intuitively, we act as if moral claims are true or false all the time, and it appears to me that even my friend (for example) appears not to hold just attitudes about what is praiseworthy or deplorable, but real beliefs about justice and injustice.  Or, as Arthur Holmes put it, moral terms we use express evaluative concepts with real cognitive content.

3)      Full-blown moral relativism seems to me an inescapable consequence of non-cognitivism. If there is no moral fact of the case, at any level, in any matter, then to what can one appeal except a test of wills?  Justice becomes “the will of the stronger,” does it not?  Or doesn’t a dispute require, in the end, just a shrug of the shoulders?

4)      “Bomb setting is wrong,” might just be an expression of my attitude, but what about, “I believe that bomb setting is wrong,” or “I wonder whether bomb setting is wrong?”  The latter two examples suggest that cognition is involved in assessing the normative relationship between bomb setting and moral turpitude.  (This is an example of “the embedding problem,” discussed at length in “Moral Cognitivism vs. Non-Cognitivism” in the online Stanford Encyclopedia of Philosophy.  That article seems to me to demonstrate that non-cognitivism is on an inexorably melting ice floe.)

The above are but superficial comments on a beginner’s level, but we have to start somewhere, and I think these matters are terribly important the more I think about them.  “Everyday” bioethicists should be thinking in cognitivist, realist terms, and training our children to do likewise.

A funny thing happened on the way to the ICU . . .

In the latter half of the last century, medical technology made huge leaps in the ability to sustain biological function. Suddenly we could replace lost kidney function and keep lungs breathing and hearts pumping for people who, but a short time before, would inevitably have died from their kidney, lung, or heart failure.

But something funny happened on the way to the ICU. These new technical means of medicine radically changed the calculus of the goals or ends of medicine. Our technical advances far outpaced our ability to think ethically about how to use our newfound abilities.

The new technological means allow us to keep bodily functions going when they would otherwise stop. For many patients, these are lifesaving and appropriate interventions. However, for others, these new treatments become treatments that treat — nothing. To put it another way, when there is some radical insult to a person’s body, the technical means to sustain vital functions such as breathing and circulation are an appropriate intervention that buys time for the body to heal in ways it obviously couldn’t if those vital function weren’t sustained, i.e., a body can’t heal if it’s dead. But there are some patients for whom death is imminent, inevitable, and no degree of healing is possible outside of a miracle. For these people, the technical means become an end in and of themselves. We sustain a person’s bodily functions, not as a means to allow any hoped-for healing to take place, but because we are able to. We may not even ask why we do it; we do it because we can. Sometimes we even think that if we can do it, we must. Thus a technical means becomes an end in and of itself.

This is one of the inevitable tendencies of technique (of which technology is a subset): the tendency to turn means into ends. If we can ethically control the expansion and use of techniques, then they can be our servants: powerful ones that we must keep a close eye upon, yet servants nonetheless. But we humans have a tendency to place faith in technology, to assume its goodness, and so to catalyze its tendency towards self-justifying expansion. To the degree that we allow this to happen, we end up serving our technology, rather than technology serving us. We end up doing things because we can: keeping the ventilator on because — well, because the patient’s on a ventilator; doing the scan or the blood test because, well, we have a patient here, and we have to do something, and we can, even if it doesn’t really serve the end of improving or preserving the health of the patient.

Of course, it is not only in the ICU that this automatic deferral to technology can occur, but in all areas of medical practice. In light of this apparent deficit of ethical reflection on and regulation of our technology, in light of the exchange of our control over technique for technique’s apparently autonomous self-propagation, I wonder whether the practitioners of the medical art are not in danger of transforming from professionals to technicians.

Toward Reasserting the Ends of Medicine: A tentative beginning, with some historical considerations

Recent posts (Here and here) on this blog referred to the “ends” of medicine, and last week Dr. Holmlund challenged us to explore more systematically just what those ends are. As I have considered that challenge, I have been stymied by the herculean magnitude and complexity of the task, especially given my limited knowledge of, and reading in, the relevant philosophical, theological, sociological, and historical disciplines. However, having been a practicing physician for about twenty years, I will tentatively start on the project, based more on my experience than on any great learning or reading; I hope that those who have the advantage of the learning and reading will make up for and (gently) correct my deficiencies.

One of the hurdles to overcome in defining the ends of medicine is that there are many views held by different groups of people, and they have changed over time. So the question becomes more focussed: What are the proper or correct ends of medicine? Is this something we can discover, or must we merely define it? If so, on what basis? Also, what do we mean by medicine? Are we talking just about the actions of physicians? Or does it include the actions of, say, hospital boards? Biomedical researchers? Public health departments? Medicare utilization reviewers?

My impression of the history of this subject is that the ends of medicine were originally narrowly defined in regard to physicians, and their goal was to help the sick. The Oath of Hippocrates, from around the 5th century BC, speaks of dealing with “the sick” and “sufferers.” There seems to be no reference to preventive medicine or promoting health. This view of medicine’s ends was taken up by the Christian medical tradition: “Care of the sick, grounded in the compassionate sharing of the sufferer’s pain and seeking ways of alleviating and perhaps curing it, is a witness to God’s work of redemption in Jesus Christ.”*

As modern science developed, its founding fathers such as Francis Bacon and René Descartes thought that by gaining power over nature, people could go beyond treating disease to preventing disease and preserving health. Measures to prevent disease were of course known from antiquity, as the health regulations in the Pentateuch demonstrate; and magic charms to ward off disease have probably always been widespread. But somewhere along the way, this idea of not just treating disease but preventing it, and in so doing promoting health, was taken from the priest’s job description and inserted into the physician’s. Thus, the physician’s ends expand to become, “Caring for the sick, preventing disease, and promoting health.” A Tall Order indeed. And one that adds umpteen layers of ethical considerations, such as, What does it mean to “Do no harm”? What is “health”? And many others that I can’t begin to mention in a 500-word post. But in future posts I will attempt to chart a course through this maze , and with Jon Holmlund I invite fellow bloggers and commenters to help us along the way.

 

*Robert Song, Human Genetics, 13.

Moral Beauty and Moral Realism

Loose-associating during a terribly busy week…

I have a friend—a self-described atheist—with whom I renew arguments on a regular basis.  We don’t just argue, but we do argue.  He thinks I’m delusional.  I counter that he’s in denial.  (See Romans 1:18.)  He’s very concerned to live a moral life, and believes (as do I) that he does.   He’s does not attempt to suppress or apologize for outrage over moral failings, and he applies his judgments fairly consistently.  He’s a man of the left (he’d vigorously object to that, but it’s true), I’m a conservative (meaning:  a knee-walking, knuckle-dragging troglodyte).  We agree about more than you might think.  But he can’t explain why an apparently open-minded, rational person like me would disagree with him, except to understand me as a misguided medievalist (his terminology, not mine).  Fair to a point—I am sort of a Thomist, interested in a natural law approach to things, after all.

I appeal to worldview, for one—where we start determines whence we can reason—and I suppose I need to walk him through the limits of reason in achieving moral agreement.  (I hear you, Dr. Englehardt.)   I also try to be a good “natural lawyer” and reason with him.  (Forgive me, Dr. Englehardt.)  That gets one only so far, of course.

Something else is going on, though.  I think my friend is an example of what I call a “modern moral realist.”  (He might disagree, but go with it for the sake of argument.)  The modern moral realist, as I understand him, thinks that when we say “x is morally wrong (or right),” we are stating a true fact about the world.  But that is, as it were, an “observed” fact—not a physical property, but one that supervenes on physical states of affairs.  We can differ about how we recognize these moral facts, but we do.  This is preferable to appealing, for example, to moral laws, which tend to entail something religious or like it.

The details vary, but I don’t find the perspective convincing, because to recognize a moral fact requires the existence of some sort of prior moral precept, it seems to me.  (I take this to be entailed in C.S. Lewis’s argument, for example, in The Abolition of Man, or J. Budziesziewski’s concerns about what he calls “the second tablet project.”)

But then there is this:  in preparation for our men’s retreat this weekend, the men of my congregation have been tasked to read and pray through Psalm 119.  A note to that psalm in my ESV Study Bible says, in part, that “[t]he psalm speaks the language of one ravished with moral beauty, to which there is only one fitting response—to try to reproduce this beauty, as much as possible, in one’s daily life.”

“Moral beauty?”  Should we think in terms of an aesthetic of ethics? Although Psalm 119 repeatedly uses words like “precepts” and “rules,” apprehending moral beauty sounds like something not quite the same as reasoning from first precepts.  It’s not exactly “virtue ethics,” and it’s not exactly the same as recognizing the dictates of conscience—deep or otherwise.  It sounds like something that doesn’t exactly fit analytic philosophy.

Maybe these are distinctions without differences.   As I said at the outset, I’m loose-associating today.  But maybe the notion of moral beauty should make me more sympathetic with the modern moral realist.  Then again, it does require that we learn how to see.

Naturalism and resurrection

Naturalism underlies the ethics of much of our culture. For those who believe that what can be empirically observed is all that exists, ethics can only be some sort of social construct that promotes the functioning of a society, but ultimately is not powerful enough to limit personal autonomy. The result is a very self-focused society. Human embryos should be used in research if that may benefit me in the future. Abortion is permissible if I decide that it best serves my needs. Technological medicine should be pursued at any cost if I can benefit from it. Euthanasia is permissible if it allows me to escape from suffering.

A naturalist makes a number of assumptions. Those include assuming that no supernatural being such as God exists, that human beings have no spiritual part to us that goes beyond the natural, and that miracles cannot occur. One consequence of this line of thought that promotes the self-centered tendencies of our society is the idea that the brief physical life that we have on earth is the only life we have. It says there is no life after death. Carl Sagan, one of the most widely read naturalists of recent years, wrote “I would love to believe that when I die I will live again, that some thinking, feeling, remembering part of me will continue. But much as I want to believe that, and despite the ancient and worldwide cultural traditions that assert an afterlife, I know of nothing to suggest that it is more than wishful thinking.”

Sagan was saying that he needed evidence to believe that there is life after death. If there is a God who provided such evidence what might it be? He could simply tell us, possibly through a personal spokesman (prophet) so it could be written down (scripture). Or he could have someone come back from the dead (resurrection) to show us. God has actually done those things and we have good reason to believe in both the truth of scripture and the historical resurrection of Jesus, but Sagan was not convinced. Jesus predicted that. In the parable of the rich man and Lazarus when the rich man asks for Abraham to send Lazarus, the beggar he had neglected, to warn his brothers, Jesus has Abraham say “If they do not hear Moses and the Prophets, neither will they be convinced if someone should rise from the dead.” (Luke 16:31 ESV)

Sagan said he wanted to believe in life after death, but there was something that kept him from looking at the evidence of the resurrection. I did not know him and cannot know what restrained him, but for many I suspect it is pride in our own presumed knowledge and a fear of admitting that there is a God to whom I must submit myself and let go of my self-centered autonomy.

A Pope Steps Away

The surprise resignation of Pope Benedict last week was not only significant for the world’s 1.2 billion Catholics. Evangelical Christians, who often find themselves at odds with some aspects of Catholic theology, find they have a strong kinship with them over issues of human dignity and rights-of-conscience, and certainly find allies in the Catholic Church in the debate over embryonic stem cell research. Much of the excellent bioethics scholarship on “our side” comes from within Catholicism. As the head of the Catholic Church, the pope’s words mean a lot to the foundational teachings about these important issues, and we should take note of some of the more recent things Benedict has put forward. Within the context of his impending retirement, they are doubly intriguing, especially as they relate ethically to technology and autonomy.

In his Christmas message, Benedict asked, “Do we have time and space for him? Do we not actually turn away God himself? We begin to do so when we have no time for him. The faster we can move, the more efficient our time-saving appliances become, the less time we have. And God? The question of God never seems urgent. Our time is already completely full.” Columnist Peggy Noonan recently noted that, about Benedict, “there was a lot of speculation that attempting to run the Vatican in the new age of technology, of leaks and indiscretions and instant responses, would be hard on” a nearly 86-year old man in declining health. He is in a season of his life where technology is a double-edged sword. He knows the old ways, knows that magnificent churches and cathedrals stand nearly vacant in the lands where technology occupies the fascination of their people, and time saved is poured back into the pursuit of further technological marvels. We have created amazing tools to serve us and now spend our biggest commodities (money and time) in bowing down to them. But he surely can see, as his health deteriorates, that technology has made him more comfortable, likely able to live longer and serve better. He may not be enthralled by gossipy e-mails emanating from the Vatican, or internet addictions, but certainly he can appreciate the wonderful gift of medical technology, right?

I don’t want to read something that’s not there, but I wonder if his caution about worship at the temple of technology, and his historic resignation, is distinctly BECAUSE he faces the technology that can allow him to continue going and has said, “Enough.” His predecessor, John Paul II, wanted to die well, and publicly, by continuing his work to the end after a long, long season of poor health. Maybe Benedict is mightily aware of what technology can do to keep popes and presidents and even regular people alive beyond the point that they may have ever wanted it, and that it might eventually be incumbent on him to do so. As many human beings seek immortality, perhaps this very important man has decided that he is not SO important that he cannot step away from this role, release the ties to this world, and prepare himself for the next. There will be no new speaking engagements for the soon-to-be former pope, just the life of a monk within quieter quarters in the Vatican. This is Benedict’s advance directive, in a way. He, too, is dying well, but not publicly. When John Paul II lay on his deathbed, the cardinals surrounding him announced, “All hope is lost.” No, it really wasn’t. Perhaps Benedict will now be free to embrace the hope ahead.

On the second point, Benedict spoke in Spain this past weekend, likely for the last time in public. “The church, which is mother and teacher, calls on all its members to renew their spirit, turn back firmly toward God and ignore pride and egoism to live in love,” he said. This dovetailed with another part of his Christmas message on how “busy-ness” and technology have crowded out God: “There is no room for him. Not even in our feelings and desires is there any room for him. We want ourselves. We want what we can seize hold of, we want happiness that is within our reach, we want our plans and purposes to succeed. We are so ‘full’ of ourselves that there is no room left for God.” In this age where personal autonomy reigns supreme, often to radical levels, we can always use a reminder of its dangers when we use it as a justification to make ourselves gods, when we use technology to embrace the paralyzing pride of the trans-humanists, and when we seek to hide from a death that will bring us face-to-face with our Creator. Technology used as a means to give us the desires of our hearts or to chase immortality, apart from a love for God and others that tames it, is a risky thing. I am not a Catholic, but I will pray that this German priest that steps away from power and prestige to find more room for God indeed receives the desire of his heart.

Deep conscience and accountability to God

In his last post Jon Holmlund referred to the concept of deep conscience as defined by J. Budziszewski. I think it is worthwhile to spend a little time on the implications of deep conscience. When Budziszewski writes about deep conscience he is distinguishing it from surface conscience. Surface conscience consists of our conscious moral beliefs which may vary from person to person and has similarities to the concept of convictions. Surface conscience applies to our day to day decisions and consists of derived beliefs that may have been derived in error. Deep conscience refers to a foundational first knowledge of morality that is what we derive our moral convictions from. As Budziszewski says in his book, What We Can’t Not Know, it consists of concepts such as friendship is good, gratuitous harm is wrong, and we ought to be fair.

Even though it may be called other things, the existence of deep conscience is widely accepted. Moral philosophers call it common sense morality when they use the moral convictions we all share as a test of moral theories. Beauchamp and Childress built their widely used principles of biomedical ethics on common morality, recognizing that people could agree on basic moral principles even though they cannot agree on moral theory. Mary C. Gentile uses common morality as the justification for teaching business managers to give voice to their values without specifying what those values are.

However, the existence of deep conscience or the fundamental principles of common morality presents a problem for those who do not recognize the existence of God as creator. As C. S. Lewis noted in Mere Christianity we not only recognize that there are moral values that all people share across time and across cultures, but we also recognize that we do not live up to those moral standards. If common morality was just the values that were found to be necessary for the existence of human society, then we would expect that those standards would be readily achievable. What we find is that we all know what is right, but we all fail to live up to those standards. That implies that there is a source of those standards beyond us. The existence of deep conscience does not fit with a godless world that has come about through chance and time. It says that there is a moral order to the world that is beyond us as humans. Just as the order and complexity of the physical and biological world leads to the idea that there must be a designer or creator, the existence of deep conscience implies that there is a source for our moral concepts who has made us with a purpose.

As Jon said in his post, deep conscience tells us that we are accountable to God. That is the uncomfortable thing about conscience in our society. We live in a society that worships autonomy. The idea that we are accountable to the one who is the source of conscience leads either to acceptance of that accountability, and can be the first step toward the answer to the problem of our not living up to what we know to be right that we find in Jesus, or leads to the suppression of our knowledge of right and wrong to try to remain autonomous.

Conscience, Data, and the Burden of Proof

Dr. Susan Haack’s recent posts on conscience, and the ongoing struggle over the HHS regulations on mandatory insurance coverage for contraception under the Affordable Care Act, demand more careful further reflections than will fit in a blog post, but I will dare to stick a toe in nonetheless.

In The Line Through the Heart: Natural Law as Fact, Theory, and Sign of Contradiction, J. Budziszewski argues (see pp 8-15, for example) that “deep conscience,” which is “rooted in the constitution” of all humans, is a cardinal indicator of the existence of a natural moral law.  Deep conscience “remembers” general moral norms (including, he argues, the Decalogue).  I’d take this to be Dr. Haack’s “antecedent” function of conscience.  Budziszewski then distinguishes three “modes” of conscience:  cautionary, accusatory, and (for lack of a single term) confession/reconciliation-seeking—the “consequent” functions Dr. Haack mentions.  He would certainly agree with Dr. Haack (as do I) that conscience points to a transcendent authority.

Presumably (me talking now, not Budziszewski), we form correct moral convictions by agreeing with deep conscience about moral truth.  However we arrive at those convictions, we can argue that they too have “antecedent” functions in that they are, if properly understood, sufficient to motivate ethical behavior.  (I just glossed over a major discussion in ethical philosophy that I ask the reader to accept for the sake of argument here.)  Convictions do not, however, produce a sense of guilt, accountability, or of a need for reconciliation.   Conscience does that.   Whether we recognize it or not, conscience is witnessing to our accountability before God.  People who deny God’s existence, however—and who may well also interpret “guilt” to mean a response to bad-faith intimidation by the organized church—can still coherently claim, it seems to me, to act out of conviction with accountability to the community, as long as the standard is some sort of community-recognized norm.  In a pluralistic society, one can appeal to positive law or what we can agree on; or, alternatively, one can appeal to the shared understanding of what it is to be an autonomous moral agent (as I take the German philosopher Jürgen Habermas to do).  Just don’t plead metaphysics.  But the appeal to convictions is not ripped from its community connections—it depends on them, just in a different, but critically different, way.

And that, of course, is the problem.  People like me are making a metaphysical argument (actually, I want to argue for a form of natural law) in a positive law world.  Some of the “positive lawyers” claim that their convictions are objective, not relativistic, because they are available to observation, as in the natural sciences, so we can agree on them, revising our understanding as we get new information.  We are left with a sort of “naturalist’s natural law.” I think that is irredeemably relativistic, in the end—if God is dead, nothing is out of the question.   I understand Budziszewski to agree.  He criticizes the “positive/natural lawyers,” if you will, of pursuing a “second-tablet project”—that is, isolating the “second [stone] tablet” of the Decalogue (Commandments 5-10) from the more explicitly God-directed first 4 commandments of the “first tablet.”

So what?  First, I would submit that the “conscience/convictions” argument doesn’t help all that much in cases like the HHS mandate.  The issue is how much room to give to particular metaphysical stances—the public/private square problem.  Pluralistic norms vs religious freedom is still the battle.  And it will not do to say that profit-seeking makes the moral application of metaphysical commitments illegitimate.  To put the fine point on it, Hobby Lobby’s owners ought to be accorded the same freedom of conscience as are the Catholic Church, or a church-run hospital, or Wheaton College (for example).  I worry, perhaps too much, that bioethicists in particular worship at the altar of non-profit status in ways that risk serious mistakes.

Second (and cf. the recent post by Dr. Joe Gibes), statements like “[The] lack of any substantial evidence for post-fertilization effects [of emergency contraceptives] may significantly weaken conscience claims, and may militate against refusals to dispense or to refer,” [Lewis and Sullivan, Ethics & Medicine 28:113-120, 2012] will not do.  Failure to prove is not disproof.  Absent definitive data, prohibition of emergency contraceptives may be weakened.  But without definitive data—which may not be accessible by ethical experiments—sufficient to free the conscience of concerns, conscience claims of someone with a reasonable doubt about what the data mean ought to be vigorously defended, even against a strong majority consensus.   We should not let a prevailing tide of naturalistic, “data-driven” ethics confuse our use of the data in service of true moral precepts.

The New Realities of the Public Square

Today’s public presidential inauguration festivities were reported with as strenuous a level of polarization as has characterized our politics these past years. Several, representing both the gleeful and despondent that represent our poles, have evaluated the benediction delivered by Luis Levon. Whatever his flaws or merits as a “benediction-giver”, much has been made over the fact that he is not Louis Giglio, the Atlanta pastor of Passion City Church. Most know that Giglio was initially chosen to give the benediction as a result of his substantive work in the name of justice, particularly toward the recognition and elimination of human trafficking, and that he withdrew his name after a sermon from over two decades ago, critical of homosexual activity, became impossible to reconcile with a presidential speech that linked Seneca Falls, Selma, and Stonewall. It is not my interest to elaborate on this issue, though evangelical thinkers are neither monolithic nor graceless on the matter. This is part of a larger wind, one that already sends a January chill through many who think that the Bible is not a quaint historic book filled with a mix of arcane thought and unreal sublimities, but a legitimate directive on how to live a moral life, and who question their place in the public dialogue.

It was on the “Huffington Post” site, of all places, that the headline jumped out: “After Louie Giglio Bows Out, Some Ask If Conservative Evangelicals Are Welcome in The Public Square.” Lured in, I found no lamentation inside the text for the loss of these voices. Especially for the “H.P.” (and the internet in general, where nuance is replaced by red meat) I found this piece curiously dispassionate. It didn’t blast the bigoted and hateful voices of conservative evangelicalism (that was left to the comments section), but it didn’t speak of the diversity of view that will go missing in the public square without them. It closed with a bland request to offer some names that could replace Giglio.

As someone with a bunch of convictions on all kinds of issues, many of which relate to issues of bioethics, I fear this attitude more than open disdain. I see evangelical Christians engage in solid scholarship, made all the more real by its connection to heartfelt spiritual conviction. I can bear seeing their work refuted, for they often serve as modern prophets to academia, and prophets have never been the popular kids in school. What is worse is to see an entire community dismissed as utterly irrelevant and hardly troublesome to the status quo.

A couple of things should be said about this. First, we knew it was coming, but it sure came fast—the biblical worldview espoused by many evangelicals is no longer welcome in the public square. Speech will increasingly be offered by invitation only, and we won’t be invited. I agree with the premise that a liberal democracy will allow all viewpoints to be presented on whatever basis—religious or secular—the presenter chooses, a Nicholas Wolterstorff view. I just can’t see that happening, when the public square for such arguments is limited to the insular world of faith-based websites and still-protected pulpits and not the wider avenues that reach our culture. The invitations will be fewer to public debate, except to serve as caricatures or foils to the flow of popular sentiment. Christian bioethicists that can’t make cogent arguments to secularists will find themselves as intellectual circus curiosities, as anachronistic as the Amish, but without the charm. If someone who gathers 60,000 people at one time to speak boldly against human slavery can be quickly disinvited by the president, should we assume a seat at the table?

Second, what is the role of a blog site like this, or even of Bioethics program like that Trinity offers? Last week, Chris Ralston and, before him, Joe Gibes, more eloquently (and, indeed, more briefly) than me addressed the sweeping secularization of bioethics as an opportunity, not an obstacle. I do not think what we do here to be an inside game, a list of “house rules” that impact nobody outside our circle. The error of an evangelicalism that strays from biblical conviction is that it has no anchor; it can, at best, supplement an existing secular argument, but not serve as a prophetic voice that to some offers conviction and to others, the sweet aroma of life that Christ provides. If we don’t know our stuff, in its fundamental form, then we have nothing to offer for the increasingly rare opportunities we have to address the public square.