The Gift of Finitude

I’ve been thinking a lot lately about finitude. About limits. Incompleteness. Even failure.

Like the friend of a friend who is dying and has just been admitted to hospice, whose young teenaged daughter is facing the prospect of a life without her mother.

Like the colleague who is grieving the loss of both a spouse and a parent within a month of each other.

Like my power wheelchair that keeps breaking down, making everyday activities significantly more challenging.

Like the never-ending “to-do” list that seems to be anything but finite, and never quite seems to get any shorter.

Life is, in a word, full of limits. Boundaries. Unavoidable stopping points.

Or is it?

What if we could transcend our limits, as recent developments in genetic and related technologies (e.g., CRISPR) seem to promise? What if, through genetic manipulations of various sorts, we could significantly reduce our limitations—eliminate specific diseases and disabling conditions, improve cognitive function, “select” for desired physical traits, and so on?

If we could do these things, should we do them?

Of course, as anyone who has followed the field of bioethics for even a short period of time knows, these questions are neither new nor hypothetical. In many ways, the “future” is already here: we “enhance” ourselves, “transcend” limits and boundaries, and otherwise seek to “overcome” finitude in a myriad number of ways, on a daily basis. And much of this is salutary.

Still, it’s always worth pausing to consider: supposing finitude could be eliminated entirely from our lives (which seems extraordinarily doubtful), is it the sort of thing we ought to try to eliminate? Put differently: is there anything good about finitude, such that we ought to embrace it (even if in a qualified way)?

Gilbert Meilaender, a bioethicist and Distinguished Fellow of The Center for Bioethics and Human Dignity, suggests that there is something good about finitude. In a reflection on the “created duality” of our human nature—we are simultaneously both “free” and “finite”—Meilaender observes that this “two-sidedness” to our nature both opens up possibilities and imposes certain limits upon us. We are, he observes,

created from dust of the ground—finite beings who are limited by biological necessities and historical location. We are also free spirits, moved by the life-giving Spirit of God, created ultimately for communion with God—and therefore soaring beyond any limited understanding of our person in terms of presently “given” conditions of life…. Made for communion with God, we transcend nature and history—not in order that we may become self-creators, but in order that, acknowledging our Creator, we may recognize the true limit to human freedom. Understanding our nature in this way, we learn something about how we should evaluate medical “progress.” It cannot be acceptable simply to oppose the forward thrust of scientific medicine. That zealous desire to know, to probe the secrets of nature, to combat disease—all that is an expression of our created freedom from the limits of the “given,” the freedom by which we step forth as God’s representatives in the world. But a moral vision shaped by this Christian understanding of the person will also be prepared to say no to some exercises of human freedom. The never-ending project of human self-creation runs up against the limit that is God. It will always be hard to state in advance the precise boundaries that ought to limit our freedom, but we must be prepared to look for them.[1]

I am inclined to agree with Meilaender. Moreover, as I have shared in an autobiographical essay published recently,[2] my own experiences as a person with a physical disability have taught me valuable life lessons that, arguably, might not have been learned otherwise—lessons such as the value of patience and endurance, accepting my limits (an ongoing struggle, I must admit!), and even the importance of having a sense of humor at the (sometimes ridiculous) circumstances in which one finds oneself. Our limits shape our character, our career, and our life choices as much as do our “freedoms”—often in surprising and unexpected ways, and frequently for the better.

None of these reflections, of course, even begin to scratch the surface of the “what?”, “where?”, “when?”, “how?”, or “why?” questions related to the ethical permissibility (or lack thereof) of pursuing various genetic, reproductive, or other technologies. Nor do they, by themselves, tell us whether (and when) we ought or ought not to avail ourselves of abortion, physician-assisted suicide, euthanasia and the like.

They do, however, remind us of one very simple, yet all-too-often overlooked fact: finitude is, in many ways, a gift. Let us not neglect it.

 

[1] Gilbert Meilander, Bioethics: A Primer for Christians, 3rd ed. (Grand Rapids, MI: Eerdmans, 2013), 3-5.

[2] See “Why am I Disabled? Reflections on Life’s Questions and God’s Answers,” in the Beyond Suffering Bible (Tyndale, 2016), available at beyondsufferingbible.com and http://www.joniandfriends.org/bible/.

Human nature, health, and human flourishing

The past few days, I have been attending the Center for Bioethics and Human Dignity’s 20th annual conference, entitled “Health and Human Flourishing,” and the following ramblings are a result of some good speakers and good conversations with fellow attendees.

Two essential truths: First, there is a “given” or normative human nature, and Jesus Christ is the normative human; second, he is the paradigm for human flourishing. By following him (including into suffering), becoming like him, and taking on the fruits of the Spirit, we become more truly human and discover true satisfaction and human flourishing.

Denying these two essential truths leads directly away from human flourishing. The first truth is that Jesus provides the norm for human nature. But the human enhancement project does not acknowledge a normative human nature, instead seeing it as malleable, thus open to tinkering in attempts to improve it (“take control of our evolution”). This naturally leads to dissatisfaction with our current state because we seek endlessly for the next better thing — a dissatisfaction that is the opposite of flourishing.

The second truth is that Jesus is the paradigm for human flourishing. But in a culture with a materialist world view (i.e., matter is all that is and all that matters), it is natural that “human flourishing” will be identified with “physical health.” Add to this the WHO definition of health as “a complete state of physical, mental, and social well-being, and not merely the absence of disease or infirmity,” and the inevitable result of the pursuit of happiness and human flourishing will be the increasing medicalization of all spheres of life. But while health is an important contributor to human flourishing, it is not the same thing as human flourishing, and flourishing can even exist in its absence. In our culture’s rush to turn every event in life into a medical incident we keep pressing the health button in the hope that human flourishing will come out; but the only thing that comes out is more illness, more technology, more dissatisfaction — and less flourishing.

 

Health and Human Flourishing

I am out of town this week, so I will bring in “A word from our sponsor”: The Center for Bioethics and Human Dignity’s 20th annual summer conference is coming up July 18th-20th. This year’s theme is “Health and Human Flourishing.” I have gone to as many of these conferences as I have been able to over the last ten years or so, and they are always thought-provoking, inspiring, ecumenical, and a good time for connecting with others who are serious about bioethical issues and what it means to think about them Christianly. I will be there, and hope you will be too. You can link to online registration here.

In Memory of Edmund D. Pellegrino

I cannot claim to have had anything more than a casual and intermittent personal acquaintance with Professor Pellegrino, whose passing this last week is a great loss for bioethics, medicine, academia, and the church alike. I did, however, have the privilege of meeting him on several occasions (always at CBHD summer bioethics conferences!), as well as, more recently, the honor of serving as a co-editor of an edited book volume to which he contributed a chapter.[1] In all my interactions with him, he was always the epitome of graciousness and generosity of spirit.

As several other bloggers have noted on this site, one of Pellegrino’s chief contributions was to draw our attention, repeatedly and consistently, to persistent and fundamental questions and concerns that are all-too-often neglected in this age in which the “technological imperative” so frequently carries the day. Questions such as: what exactly are the “ends” of medicine? And how do our present medical practices square with those ends? Concerns such as: what does it mean to be a physician? To be a patient? To encounter one another, as physician and patient, respectively, in the clinical context?

Chief among these concerns was an increasingly countercultural commitment to the notion that medicine, as both an art and a profession, really does possess an “internal” morality—that is, a coherent set of moral principles and ethical guidelines arising out of the nature of the medical practice itself, and embodied in a shared set of assumptions (moral and otherwise) and values to which members of the medical profession are (or ought to be) committed. This contention of Pellegrino’s, central as it was to so much of his work, naturally attracted much criticism—and, to be sure, one cannot help but suspect that, for all practical purposes, medicine as an institution today increasingly looks more and more like a “vending machine” responsive primarily to the vagaries of consumer demand and sociopolitical agendas, rather than the robust, ethically-constrained profession to which Pellegrino continued to call its practitioners throughout his career. To his credit, however, he stayed true to his convictions on this matter, even in the face of opposition—a strength of conviction that is worth emulating in its own right.

Importantly, as a Catholic believer, Pellegrino was both courageous and consistent in his insistence that a proper understanding of medicine as a practice can be attained only in the context of a theologically-informed understanding of reality. For Pellegrino, this meant a continual return not only to the philosophical underpinnings of medical practice, but ultimately, the theological foundations upon which all of human experience—including the clinical encounter—is grounded.

For his rigorous, consistent, and persistent insistence that bioethics be approached from within a philosophical-theological framework that attends to the deep, fundamental “first things,” Pellegrino is to be admired and emulated. For his unfailing personal graciousness, he will be missed. And for his contributions to bioethics, medicine, academia, and the church, he will be cherished.

Rest in Peace, Edmund Pellegrino.


[1] See The Development of Bioethics in the United States (Springer, 2013). Pellegrino’s essay, entitled “Medical Ethics and Moral Philosophy in an Era of Bioethics,” addresses four issues in particular:

First, it examines the sociocultural context that gave birth to bioethics, which is characterized by the rejection of traditional moral authority and the rapid development of biomedical sciences and biotechnology. According to Pellegrino, this particular milieu recast traditional medical ethics outside its philosophical foundation and paved the way for the emergence of bioethics. The second issue relates to the decline of medical ethics as the source for the professional ethics of physicians. Bioethics reconfigured medical ethics within the particular socio-cultural and scientific context of the 1960s. Pellegrino deplores this shift because it redefines the patient-physician relationship in term of social mores instead of the traditional foundations of medical ethics. Third, Pellegrino looks at the meaning of the word “ethics” in the terms “medical ethics,” and “bioethics,” each presupposing different moral visions. Medical ethics, he contends, presupposes rigorous classical philosophical ethics whereas bioethics, in its latest iteration (i.e., “progressivist bioethics”), combines the values of liberalism and pragmatism to advance its socio-political agenda. Pellegrino sees the latter development of bioethics as problematic because it conflates social mores and political ideology with ethics. In his view “ethical discourse must go beyond activism or political ideology,” whether in its progressivist or conservative conceptualization. The fourth and final issue Pellegrino addresses is the plea for a “more rigorous adherence to classical philosophical ethics” to ground ethical reflections in concepts such as the good, the right, and the just, rather than in particular ideologies. To this end, he makes a call for a reconsideration of the potential role of moral philosophy in bioethical and medical ethics debates.

Jeremy R. Garrett, Fabrice Jotterand, and D. Christopher  Ralston, “The Development of Bioethics in the United States: An Introduction,” in J. R. Garrett, F. Jotterand, & D. C. Ralston, eds., The Development of Bioethics in the United States (Springer, 2013), p. 12.

Faithful presence

The CBHD conference last week was one of the best since I began attending in 2007.  One of the things that has stuck with me and that I am continuing to think about is Dennis Hollinger’s thoughts about living in the world in faithful presence, an idea he attributed to James Davison Hunter and his recent book, To Change the World. Hollinger said that the foundation of Christian bioethics is our Christian worldview which many in our society do not share and will not accept.  When we look at how we can try to translate the bioethical good that we are able to understand from our Christian worldview into a world that does not accept that starting point he suggested living in the world in faithful presence.

He indicated that there would be several characteristics of that approach.  We would focus on honoring God and loving our neighbor.  We would have modest expectations of our impact on our culture consistent with the Biblical metaphors of salt, light and leaven.  We would need to be bilingual, speaking in a thick fuller language to those who will accept God’s truth and a thin less complete language to those who will not.

I have been thinking about what it means to live in faithful presence in relation to bioethics in our society.  For me it includes caring for my patients compassionately and trying to be better at preparing them for the difficult places in life.  It includes helping my online bioethics students understand what a Christian worldview is and how it applies to the issues they will face in life.  It includes helping students on the Taylor campus see how their faith and how they live fit together.

What does it mean for you?

Contemplating “The Scandal”

CBHD Scandal of Bioethics Conference Graphic

CBHD Scandal of Bioethics Conference Graphic

This coming July, the Center for Bioethics & Human Dignity will host its 18th annual conference. This year’s theme is “The Scandal of Bioethics: Reclaiming Christian Influence in Technology, Science & Medicine.” The conference theme poses a number of interesting questions that, I believe, would be worth considering in advance of the meeting.

First, do you believe Christian moral reflection has been marginalized in bioethical discourse and public policy decision-making, and if so, in what ways?

Second, what may we cite as the evidence of a contemporary bioethics bereft of Christian influence? How might the bioethical terrain differ from its present state if the Christian voice had enjoyed a more sustained presence in public policy discourse?

Third, to what may one attribute this marginalization of Christian moral reflection in bioethics? Is the problem external to the Christian community, or do we share in the blame? If the latter, in what way?

We’ll save the question of a way forward for another post, but perhaps you have other questions pertaining to the diagnosis of a diminished Christian influence in contemporary bioethics and its underlying cause(s).

Your comments?