By Paul J. Hoehner
Throughout the land, arising from the throngs of converts to bioethics awareness, there can be heard a mantra, “…beneficence…autonomy…justice…” It is this ritual incantation in the face of biomedical dilemmas that beckons our inquiry (Clouser & Gert, 1990, p. 219).
Ethics as a theological discipline is the auxiliary science in which an answer is sought in the Word of God to the questions of the goodness of human conduct. As a special elucidation of the doctrine of sanctification it is reflection on how far the Word of God proclaimed and accepted in Christian preaching effects a definite claiming of man. (Barth, 1981, p. 3)
· What are the four elements of a Christian worldview and how do they influence a Christian approach to medicine, healing, and medical ethics?
· What are the four principles of medical ethics and how are they defined? How can a Christian appropriately use these four principles?
· What is meant by specifying, balancing, and weighing the principles? How does a Christian worldview influence how one defines and uses each of these four principles?
· What is the four-boxes approach to organizing an ethical case study? What is the difference and the relationship between the four-boxes approach, and the four principles of medical ethics?
· What are the four ethical topics that compose the four-boxes approach and what questions does each topic entail? How does the four-boxes approach help solve ethical dilemmas in a case study?
Biomedical ethics, or bioethics, is a subfield of ethics concerned with the ethics of medicine and the ethical issues involving the life sciences, particularly those raised by modern technologies, such as stem cell research and cloning. The term medical ethics is closely related to biomedical ethics but is primarily focused on ethical issues raised in the practice of medicine and medical research, such as abortion, euthanasia, and medical treatment decisions (World Medical Association, 2015).
Because the terms biomedical ethics and medical ethics are closely related and involve a great deal of overlapping subject area, they will be used interchangeably to avoid confusion. The study of biomedical ethics and medical ethics presents some of the most complex and controversial challenges in applied ethics. The complexities of dealing with individual patients and the intricacies of modern health care, coupled with the rapid advances being made in medical science, present formidable challenges. For many health care workers, clinical ethical dilemmas will often challenge their own settled positions, especially if they have not taken the opportunity to reflect critically on their own moral presuppositions and how their own intuitive ethical positions may be justified.
When one encounters the many ways the world and even portions of the Christian church respond to ethical issues, it is easy to be tempted to think there are no right or wrong answers. The complexity of these issues and the myriad of answers and justifications given by so many “experts” can drive many students toward some form of ethical relativism.
There are certainly many complexities in health care ethics: competing ethical ideologies, beliefs or virtues, different interpretations of the facts surrounding an issue, and differing approaches on how to address these issues; however, one should not confuse complexity with ethical relativism. These are two very different things. Relativism is the belief that “what is right and wrong, good and bad, true and false varies from time to time, place to place, and person to person. There are no absolute standards of truth or morality” (Cook, 1995, p. 726).
Coupled with the complexity of biomedical ethics is the loss of moral consensus in the medical profession and society as a whole, whereby moral positions once taken for granted cannot be taken for granted any longer. There are plenty of examples in the medical field: abortion, contraception, euthanasia, suicide, and anything that has to do with sexual morality. This lack of moral consensus is primarily a result of the cultural plurality that exists in many Western nations. Cultural plurality is a term that simply refers to the sheer diversity of race, value systems, heritage, language, culture, and religion. It is the simple observation that many cultures contain people with different worldviews, ideologies, and moral frameworks.
One of the consequences of many pluralistic societies is an increased tendency toward secularization. Secularized societies tend to relegate religious perspectives, and moral frameworks based on those perspectives, to the periphery of public discussion or limit them to the private spheres of life. According to most secularist thinkers, religious, spiritual, or faith-based perspectives may play an important role in one’s personal life, but they have no place in the public square of politics, public education, law, or medicine, particularly medical ethics. As Guinness (1983) notes, this results in a faith that is “privately engaging, but socially irrelevant” (p. 79). Limiting one’s faith, spirituality, or religion to merely private matters does not do justice to the role that religious or spiritual worldviews play in deciding how to live and interact within the world and society. Biblical Christianity stresses the role of the Christian in the world in matters of justice as well as civil engagement.
Plurality, the fact that different worldviews exist side-by-side in a culture, needs to be distinguished from pluralism, an instance of relativism. The distinction is important. Pluralism is a philosophical or ideological statement that maintains that no single ideological or religious claim is actually “right;” all truth claims have equal validity (Hoehner, 2006). The practical result of philosophical pluralism is to deny any objective truth claim or deny that any objective truth can ever be obtained. This leads many students to conclude that there can be no common approach to finding right amid the many perplexing and complicated moral issues of the day.
In this postmodern and relativistic world, divine or even natural, given norms of moral behavior are soon replaced by a form of morality based solely on one’s own personal subjective views, conforming the world to one’s own feelings and desires. Instead of orienting one’s behavior to an objective standard beyond oneself (e.g., divine and biblical revelation), many in today’s postmodern society seek to orient norms and standards of morality to their own self-referential existence (e.g., what one feels, intuits, or wills according to one’s own needs, wants, or desires). What is “right” and “true” has no reference outside of one’s own personal experience and feelings. What is right and true for one person may not be right and true for another. This can be profoundly challenging and perplexing for the Christian health care worker attempting to insert a Christian ethic into this social mix. Most people would never apply this way of thinking to empirical scientific matters. There is an inconsistency in much of modern culture that holds simultaneously to both relativism and scientism; however, this way of thinking is itself incoherent and is generally only applied to issues of morality and religion.