Bioethics as a phenomenon of secular culture
With the onset of post-non-classical science, humankind has reached a horizon of new problems and challenges—threats to the existence of the individual and life on earth. According to the apt comment of the philosopher John Dewey (1859-1952), technogenic civilization has realized the importance of humanitarian values in the face of global danger (Дж. Дьюи, Реконструкция в философии. Проблемы человека, Москва: Республика, 2003: 111-112). Never before had the question of self-harm threatened by an individual’s own achievements arisen so acutely. The dominance of industrialization has caused the pollution of the ecosystem and global warming. Robotization and the development of artificial intelligence has led to the reduction of the value of human labor. The discovery of the possibility of birth control, family planning, and sex-change has led to a devaluation of the family institution. To this issue also belong questions of passive and active euthanasia, eugenics, abortion, artificial insemination, organ transplants, and so on. Bioethics—an interdisciplinary field of knowledge about the way to reduce threats to the existence of life and the disappearance of man as man—has emerged on the basis of such collisions between values.
Bioethics includes a wide range of approaches to resolving its problems that have developed throughout its history. The source of bioethical thought is considered to be the humanistic motives of the American biochemist, Van Rensselaer Potter (1911-2001). With the decline of the era of rationalism prevailing, he attempted to create a “science of survival” for the human species of the future. The main goal of Potter’s project was to create a superethical criterion: “How to use knowledge for the common good” (V. Potter, Global Bioethics. Building on the Leopold Legacy, Michigan State University Press, 1988: 3). In order to put the “new wisdom” into practice, proposals were considered to incorporate technical means into the human body and to modify the environment for optimal life activity.
These and other innovations of Potter’s allow us to speak of the active specificity of his ethics (Ibid., 5): to protect life by artificial means with the help of necessary interpretation and the available tools of science. For this reason, Potter defines his main work on bioethics as a “bridge to the future” (cf. his Bioethics: Bridge to the Future, Prentice-Hall, 1971). In this context, ethics undergoes a change from its original meaning: from the science of the foundations of human cohabitation it is transformed into rules for the arrangement of human existence for maximum protection of health and life. A natural continuation of this trend was the formulation of a fundamental model to determine the conditions under which a human life is valuable. Such an approach has found a successful application in clinical practice to settle biomedical collisions with which physicians are faced (Potter, Global Bioethics, 71).
Later, secular bioethics focused on resolving the moral dilemma in and of itself, rather than on the survival of life. The Jewish bioethicist, Benjamin Freedman (author of Duty and Healing: Foundations of a Jewish Bioethic; d. 1997), emphasized that the principled approach of Americans Thomas Beauchamp (b. 1939) and James Childress (b. 1940) successfully establishes who should make bioethical decisions, but not what those decisions should be (Goldsand, Rosenberg-Yunger, and Gordon, “Jewish Bioethics,” The Cambridge Textbook of Bioethics, Cambridge University Press, 2008: 425).
Thus, bioethics originated as a phenomenon of secular culture alone. The path of its development now brings us to the problem of providing a rationale for morality. The solution to this age-old question has several main vectors that will determine the destiny of bioethics.
The question of providing a rationale for morality in bioethics
Determining a rationale for morality raises the question of authority or foundation, which would ensure the immutability of morality. If the sphere of the transcendental or divine is excluded from resolving this question, the human mind has recourse to various philosophical and epistemological tools, such as sensualism, phenomenology, and intuitivism in the 19th and 20th centuries.
The search for a fundamental moral norm has an analytical character. With the use of his reason the thinker seeks a universal formula for human coexistence which would be equally convincing for everyone as obligatory. An example of this is Kant’s theory of a categorical imperative: act only in accordance with the maxim which you can envision becoming a universal law (И. Кант, Основы метафизики нравственности, Москва: Мысль, 1965: 283). The necessity of observing this maxim must be self-evident for the sane person. In other words, in order to obtain the desired result—one’s own welfare—the individual must realize it himself by observing the imperative.
Such a feature of Kant’s theoretical construct, which can also be designated as “immanent,” shows its inconsistency in practice. One way or another, it raises the question of motivating an individual to observe a categorical imperative, when Ratio is confronted with the dilemma of a reasonable and sincere deed.
This problem is addressed in Kant’s treatise, “On a Supposed Right to Lie Because of Philanthropic Concerns.” He describes a hypothetical situation where one must choose between lying for a good cause (saving a friend by deceiving his pursuers) and truth (giving the friend away). For lack of another rational alternative that would allow one to follow the imperative unconditionally, Kant holds the opinion that here, there, and everywhere one should tell the truth (“О мнимом праве лгать из человеколюбия“).
Another version of the search for values leads to phenomenology. This philosophical approach suggests the formation of an axiological paradigm based on sensibilities. “The idea of building ethics (and the whole axiology) on an emotive basis within the frame of the phenomenological tradition appears already by F. Brentano. It will be also developed by A. Mainong, E. Husserl and N. Hartmann. At the same time, it will be worked out most completely by M. Scheler” (М. Шелер, Оrdo amoris / Избранные произведения, Москва: Издательство «Гнозис», 1994: x). Phenomenologists believe that a person perceives objects in the integrity of their meanings. This is comparable to musical practice, where the melody is perceived not as a set of sounds, but as a system of intervals between notes. Like entire intervals, the phenomena of the world are filled with certain meanings, which is why they form a specific intentionality—the person’s attention to himself. In turn, the individual’s pursuit of beauty, good, or the sacred does not determine the reason, but the sensibilities, or—speaking figuratively—the heart. Such a concept was reflected in Scheler’s philosophy of ordo amoris—the “order of love” (Ibid., 341). The order of the heart has its own laws and logic, which cannot be reduced to mechanical perception alone. It is concentrated in a mysterious, personalistic field which, like intuition, does not lend itself to crude empirical research.
Both Kant’s and Scheler’s concepts find their equivalents in the domain of bioethics. Kant’s approach, with the specific concept of “oughtness,” corresponds most closely to medical deontology, while Scheler’s phenomenology is close to the ethics of care and virtue.
Deontology implies the unconditional observance of certain principles that protect health and life from the harmful encroachments of medicine and human intervention. Such obligatory principles are today mostly limited to the sanctity of life and individual freedom (J.F. Childress, “Methods in Bioethics,” The Oxford Handbook of Bioethics, New York: Oxford University Press Inc., 2007: 21). However, as follows from the above about the problem of substantiating morality, without explaining the meaning or eliminating the ambiguity of principles, their postulation turns into moralizing. The same remark concerns the ethics of care and virtue, where the main concepts do not have an unambiguous definition (Ibid., 38).
In other words, care—no matter how sincere it may be—and virtue can be interpreted in completely different ways and implemented to the detriment of life and health. This problem is widespread in the clinical practice of cancer treatment, when sympathy for the patient’s unbearable pain moves the doctors to the introduction of a lethal injection.
Qualitatively another approach of rationalism in the matter of morality is the appeal to natural human needs. Profit, benefit, happiness, pleasure, and freedom appear in this sense to provide a perfect leash, capable of subordinating the human will to certain norms.
Utilitarian, pragmatic, and liberal principles in bioethics reflect the advantages and disadvantages of the corresponding philosophical concepts. The utilitarian-pragmatic model is convenient in assessing the choice of treatment. Its standard of value is not an abstract good, but a concrete calculation of the cost-benefit, which is why the protection of life and health can be more effective and cost-efficient. However, in the case of a comparison in the scale of material means and life itself, the utilitarian-pragmatic model often turns out to be an executioner, since a rationalistic view does not imply the absolute value of life at its various stages. On the contrary, inexhaustible life support can make a terminally ill individual a hostage of permanent treatment.
In the liberal-radical model of bioethics, the criterion of freedom means the equivalence of all moral concepts (libertarianism), the decisive rejection of all but the one that denies the dominance of moral authority. The radicalism of this model reduces ethics to the situational level, where moral standards are regulated by their own executor. According to Polish sociologist and philosopher Zygmunt Bauman (1925-2017), “In the world of individuals there are only other people” (З. Бауман, Текучая современность, Санкт-Петербург: Питер, 2008: 37-38), who can serve as an example of how one can act in any given situation. For bioethics, this is fraught with a devaluation of life at the wish of the subject and the replacement of the value of life with a set of qualities or attributes that are of material significance alone.
At the same time, within the framework of secular society, the radical-liberal model allows one to create conditions for the effective functioning of the principles of justice, autonomy, and beneficence. However, this approach, fraught with the problem of the hierarchy of principles, shows either their free interpretation or the one-sidedness of the solution of bioethical discourse (medical paternalism) (Э. Сгречча и В. Тамбоне, Биоэтика. Учебник, Москва: ББИ св. ап. Андрея, 2002: 57).
Religion as a way to solve bioethical problems
Philosophical worldviews as a source of bioethics are not without alternative. Religion, although it does not stand at the origins of bioethics as a project of late modernity, nevertheless contains within itself all the necessary components which satisfy the formation of a science for the protection and survival of life.
A radical difference of the religious worldview is its functional practicality. In the ethical plane this fact gives religion an advantage over the cognitive and analytical approaches of natural philosophy.
The revealed perception of the world, as a characteristic feature of a religious worldview, establishes for an individual a perspective of eternity reflected in all aspects of life. Religion marks the teleological character of human life in view of its appearance as eternity in temporality: true being within this perishable life.
For bioethics, a religious worldview means the ordering and unification of reality according to religious meaning—the evangelism of true life. This entails providing religious bioethics with such moral substance that is protected from contradictions and returns to ontology, motivating the behavior of the believer.
The connection of the individual with the Absolute signals another important, distinctive aspect of a religious worldview: awareness of one’s faith and religious feeling. Thanks to divine revelation and one’s interrelationship with God, an individual gains the ability to think creatively about his religion and not to act in a stereotyped way. For bioethics, this aspect of religious feeling imparts an a priori ability to resolve any bioethical conflict. A complete inheritance of the spirit of religious tradition allows us to embody the religious worldview as the core principle of life, harmoniously incorporating this worldview into our view of life itself.
The connection with the Absolute is manifested in religion and in the inverse effect of supernatural forces on an individual. The act of God is carried out in the world in a certain form. This produces two moments of religious culture: the tabooing of certain objects and sin. The first of these imposes on the individual an ethical framework aimed at limiting his selfishness and arbitrariness. In bioethics this means keeping a person from assuming for himself the role of creator and the overdevelopment of a scientific and technological revolution. The second one provides a permanent tension of conscience which constantly assesses one’s behavior.
A Christian model as an example of the effectiveness of religion in bioethics
As an application of the religious model of bioethics, it seems possible to name Engelhardt’s Orthodox model, which was substantively supplemented by Protopresbyter John Breck. In contrast to liberal models of bioethics, Engelhardt formulated the fundamental provisions of a Christian bioethics (H. Engelhardt, The Foundations of Christian Bioethics, Amsterdam: Swets & Zeitlinger Publishers, 2000).
Tо begin with, the source of and channel for the development of the Christian model of bioethics is Holy Tradition, expressed in Scripture, the patristic tradition, and the decrees of the Ecumenical Councils. According to Engelhardt, when resolving moral conflicts one must think like the Holy Fathers.
Secondly, the Christian model does not imply the possibility of abstract reflection in bioethical issues. The Christian approach is to receive moral and metaphysical knowledge through noetic reasoning, the right spiritual order, and holiness. In other words, bioethics is not a set of rules and principles, but a way of life, where priority is not given to achieving social justice, but on the Kingdom of Heaven (Ibid., 162 and Мt 6:33).
The third principle defines the spiritually therapeutic nature of Christian bioethics. Its goal is to heal the soul of sin and reunite it to God. For Engelhardt this points to the moderate use of life-sustaining technology and the primary need for confession and the sacrament of holy anointing.
The fourth important feature of Christian bioethics is the personal connection between an individual and God. This indicates the importance and particularity of each individual person who can become God by grace. For this reason, no impersonal principle or law can underlie Christian bioethics (Ibid., 210). Its perspective is in fact on eternity, not temporariness. Therefore, the attitude towards an individual in Christian bioethics is not an attempt to reduce all people to a lowest common denominator.
Some of the theological teachings of Protopresbyter John Breck allow us to continue the above set of provisions of the Christian model of bioethics.
- Human life is given by God, therefore absolute power over it—from impregnation to death and birth into eternal life—belongs to Him (Dt 30:19).
- The measure of one’s attitude towards one’s neighbor is the Holy Trinity and unfailing love. Through this Christian feeling, the problem of the formalism of the principled approach is solved. Instead of a mechanical compliance with the rights of a bioethical agent comes the Christian perception of the patient as an icon of God, which is damaged by physical mutilation and sin.
- The ethical dilemmas that arise before an individual are the result of sin. They arise in the discontinuity between the will of God and the will of a Christian, who is taken away from obedience to the Creator by the “mad autocratic will” (Протопресвитер И. Брек, Священный дар жизни, Москва: Паломник, 2004: 32). For this reason, the Christian approach to resolving biomedical collisions is to recognize the will of God and to return to it on the basis of the “ethos” of a Christian community living according to Holy Scripture. Orthodox ethics is not a precedent law, but “life in the freedom of the Spirit” (Ibid., 37).
Summarizing the aforesaid, it is necessary to emphasize the effectiveness of a religious worldview in resolving bioethical problems. The significant potential of religion as an integral worldview structure is fulfilled in bioethics as a central nerve, connecting axiology and worldview within a complete concept. The original completeness of religion with an established paradigm of values is able to eliminate the contradictions of biomedical collisions a priori. The outline of this integral function is shown in the successful resolving of the question regarding the substantiation of morality, which in its entirety is beyond the power of philosophy.
In view of this, bioethics at the present stage represents not only a global turn of mankind to the idea of the importance of humanitarian values, as Dewey wrote, but can also be considered a signal for rethinking the significance of religion in the history and life of humankind.
Photo: Hieromonk Silouan (Pasenko)
Father Silouan (Pasenko) is a hieromonk of the Ukrainian Orthodox Church (UOC-MP) and rector of St. Nicholas Naval Cathedral (Свято-Николаевский Морской Собор) in Kherson. His educational history reflects his wide range of intellectual interests: a specialized high school diploma with honours in the natural-mathematical cycle and English; a BA in Theology from Kiev Theological Seminary; an MA in Theology from Kiev Theological Academy; and currently pursuing both post-graduate studies at Kiev Theological Academy and a second BA (in Philosophy) at Taras Shevchenko National University of Kyiv. He was ordained to the priesthood on the Feast of St. Nicholas 2016 at the age of 24.
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