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Can Bioethics be done without Theology? Guest Post from Charles Camosy

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Guest Post: Charles Camosy, Associate Professor of Christian Ethics at Fordham University, New York City
E-mail: Twitter: @nohiddenmagenta

The discipline of theological bioethics is in trouble.

Especially as theology continues to morph into religious studies in many university departments, “social ethics” now swallows everything in its path—with almost all questions of ethics becoming questions exclusively about history, sociology and/or economics. Furthermore, especially in the Roman Catholic world, academic and ecclesial politics push against academics working on issues like abortion, euthanasia, health care distribution, and artificial reproductive technologies. After all, regardless of the position one takes on these issues, it is bound to run afoul of one of two orthodoxies: that of the Church or that the secular academy. Especially if not yet established in one’s academic career, it can be dangerous to be branded a heretic by one of these power brokers. Unsurprisingly, good universities are struggling even to find marginally viable candidates for excellent bioethics jobs. Most theological ethicists have decided not to write on bioethics.

But there is another reason that theological bioethics is in trouble. Today’s centers of power in academic and clinical bioethics (at least in the developed West) generally don’t take theology seriously. I recently attended the annual meeting of the American Society of Bioethics and Humanities and was dismayed—though, I must say, not surprised—to see that a grand total of zero papers had an explicitly theological argument. Those of us who do theological bioethics know that, in order to get a paper accepted by today’s ASBH, one is forced to hide or translate one’s theological commitments. The reason I was able to present this year was because I was invited by the Christian theology interest group—the one place at ASBH (during the evening, apart from the formal sessions) where theologians can actually present and discuss theology.

Some colleagues have suggested that the response should be to publish good articles on theological bioethics and change the culture. But bioethics articles with theological arguments don’t appear to be read by those who hold power in the field. Journals like Christian Bioethics and National Catholic Bioethics Quarterly don’t even make the top 20. Meanwhile, the second-ranked American Journal of Bioethics gives a huge platform to target articles like ‘In Defense of Religious Bioethics’, a bracingly honest piece which explicitly argues that theology ought to be marginalized from serious bioethical discussions and platforms.

In response to a Twitter exchange about this state of affairs, the co-editor-in-chief of the journal Bioethics suggested that the reason for this:

I responded by pointing out that as bioethical discussions became isolated from theology they gained a reputation among many serious ethicists for being unacceptably thin. I also mentioned that rigorous and careful theologians built the early discipline—to which Prof. Schuklenk responded with “doubt.”

And why shouldn’t he? Few secular bioethicists appear to be aware of this history—or, if they are aware, few are willing to discuss its implications for bioethics today. In a forthcoming article he circulated this week from the January issue of the Journal of Medical Ethics, Art Caplan acknowledges in an offhand comment that, “truth be told”, today’s bioethics arose out of theology. But the abstract of the article oddly insists that bioethics had its “birth” in the 1970s. He isn’t the only prominent bioethicist to proceed as if bioethics was born 40 years ago, but by this time (as Charles Curran points out) bioethics was already a well-developed subdiscipline of moral theology. Indeed, theologians invented bioethics—which makes their current marginalization that much more problematic.

One mitigating factor in all of this is that many bioethicists seem genuinely unaware of this marginalization. Indeed, it is such a blind spot for the field that even important players like Eric Meslin, director of the Indiana University Center for Bioethics, still feel compelled to go out and make public arguments for the idea that “secular bioethics may be more important than ever.” But as far as today’s academic and clinical disciplines are concerned, bioethics simply is secular. There is no more a need to make a case for secular bioethics than there is a need to make a case for secular engineering.

Caplan is correct in his forthcoming JME article when it says that bioethics is now “shaping public health policy, exercising oversight of biomedical research, consulted by powerful organisations for ethical help and setting normative rules for the diagnosis and treatment of patients.” I’ve admired Caplan and others who have been able to bring bioethics out of the ivory tower, and I’ve attempted to do the same in my own career thus far. But I think it is important to acknowledge that bioethics advanced in this way despite being unable to make progress with respect to its foundational arguments. Indeed, these arguments turn on the very kinds of metaphysical questions of ultimate concern that Caplan and other prominent bioethicists are at pains to avoid. They cannot be addressed in 15 minute ASBH papers or in 2500-word pieces in journals of clinical ethics. And they certainly cannot be addressed in CNN sound bites or New York Times Op-Eds.

Philosophers and others rightly complain that contemporary bioethics, insofar as it focuses on practical issues of policy and the clinic to the exclusion of the ivory tower, is far too thin of a discourse. In order to adequately address its own questions, bioethics must do the messy, difficult and often frustrating work of drilling down into the differences between different normative traditions: from Care Feminism, to Hedonistic Utilitarianism, to Roman Catholic Thomism. It must go beyond merely floating above foundational questions and instead dive deeply into metaphysical questions of ultimate concern. Post-MacIntyre, we know that there is no view from nowhere, and that everyone addressing foundational questions in ethics does so from the perspective of a normative tradition constituted by first principles for which they do not have arguments. Such first principles simply grab or claim the thinker by faith, intuition, or some other authority. This is true whether one is a utilitarian, a feminist, or a Roman Catholic.

If those who wield power within the circles of academic and clinical bioethics took this insight seriously, they would not only recognize that excluding explicitly-religious thinkers is a kind of bigotry (there is no defensible reason for, say, concluding that utilitarians and feminists are “in” but Roman Catholics are “out”), but they would welcome theologians as marshalling a discourse hyper-focused on precisely the questions of ultimate concern with which bioethics must re-engage. Indeed, rigorous theologians are often better partners in this regard than are rigorous philosophers—who tend to look down their noses at attempts to take the insights of the ivory tower to CNN and the BBC.

To be fair, there are important exceptions to the general trend I’ve pointed out in this post. I’ve had wonderful public and private exchanges with multiple secular bioethical thinkers: from Peter Singer, to Joe Fins, to Julian Savulescu. But, in general, those who hold power in the world of secular bioethics tend to exclude theological approaches. In the interest of (1) genuine commitment to a pluralism which welcomes a truly diverse set of approaches and (2) the authenticity of a bioethics field constituted by questions of ultimate concern, this simply has to change. Theologians, without being forced to translate their views into the language and methodology of a different normative tradition, ought to take their rightful (and historical) place as full and equal players in academic and clinical bioethics.

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22 Comment on this post

  1. I do not think I disagree with what you have written, Charlie, especially earlier in connection with your observations about the present state of bioethics within Roman Catholic circles. I also agree that it looks like most of bioethics today is secular. I would note that the Christian theology interest group session at ASBH, in which you spoke and four respondents stimulated an interesting Q&A, was very well attended. Last year’s was, too. I would also note that you are not quite correct in saying that “a grand total of zero papers had an explicitly theological argument.” I presented “Bioethics and Just War Will Meet” as part of a panel on “Justice and Peace Have Kissed: The Inclusive Posture of Just War Theory” with two of our PhD students at Saint Louis University’s Gnaegi Center for Health Care Ethics. The title alludes to Psalm 85:10, and my students came up with it. Maybe the title and the abtract, which we had to formulate several months before we knew better what we’d do, weren’t “explicitly theological” enough for you. Nevertheless, each of us focused on recent work in Christian (not secular) just war theory that is indeed much more theological. In my opening paper, I highlighted how both Jim Childress and Paul Ramsey wrote books and articles on both just war and bioethics back in the 60s and 70s. Childress’s approach became more influential in both areas, focusing more on principles that are less or not necessarily “explicitly theological.” Ramsey’s approach on just war is being retrieved more today, because it is more theological (for example, love as its basis rather than only the principle of justice), by a number of theologians (Daniel Bell Jr, Nigel Biggar, some others, and myself). Here are the last sentences of my paper (and both of my students used it as a springboard for their papers on medical issues, such as “moral injury”: We think, though, that Paul Ramsey’s emphasis on love as “the logic, the heart and soul, of” just war, which Bell and others are now retrieving, is needed. Such an approach is focusing not only on justifying war and limiting its conduct, it is also exploring practices that can help mitigate the causes of war, as well as best practices for restoring a just and lasting peace after the smoke clears in the wake of war. As Adrian Pabst has noted, “For the Church Fathers and medieval theologians, ‘just war’ was a matter of practical judgement…[and] reflections on ‘just war’ were part of a larger framework grounded in the specific praxis of Christian beliefs, namely the belief that peace is the highest truth and constitutes the ontological shape of the world.” What would this approach to the ethics of war look like if it were transferred into bioethics?

    This panel somehow got accepted at ASBH. Perhaps it is an exception that proves the rule. Or, perhaps, if not optimism, we should have the theological virtue of hope.

  2. I think we can safely reject theological bio-ethics on the following two grounds:

    1. Burden of Proof. If theologians can’t even prove the existence of anything metaphysical (God(s), soul, afterlife etc.) then why should their bio-ethical concerns even be considered?

    2. First is Worst. I agree with Christopher Hitchens in this respect, because religion was our first attempt at healthcare, morality, philosophy (and bioethics) it is our worst – we have better explanations for everything.

    If your bio-ethical concerns cannot be grounded in secular reasoning then they are ultimately futile as religious ideology is bound to shift and change. Here, the Euthyphro Dilemma points to why bio-ethical reasoning must be grounded in secular reasoning.

  3. Tobias, thanks for this helpful clarification. (For those who aren’t aware, Tobias is the new Hubert Mäder Endowed Chair in theological bioethics at St. Louis University.)

    As we discovered in a Facebook exchange, I was very much aware of your paper at ASBH, and I was under the (mistaken) impression that your proposal wasn’t explicitly theological. I apologize for my faulty memory in this regard. To answer your question: I do think it is the exception which proves the rule.

    As far the number of people who attended the Christian theology interest group session, I think it is fair to say that an overwhelming majority of those who were there share the frustration of this post. At least that was my experience in talking to them–in that venue and in many others.

  4. Dear Airin, thank you for your comment.

    As I suggested in my piece, all normative traditions (catholicism, utilitarianism, feminism, liberalism, humanism, etc.) also struggle to prove (in your sense) their foundational claims. For instance, “one counts as one and none more than one” is a classic dogmatic claim of utilitarianism. No one can prove this (again, in your sense), and it has been denied (both practically and intellectually) throughout most of history.

    As for your view that “first is worst”, I think the weakness of contemporary secular bioethics in relation to the early theological bioethics is just one of innumerable counter-examples to this thesis.

  5. Thank to the author for this post.

    As Airin, I find it very suspicious that you’d want to consider “theological bioethics” and “non-theological bioethics” on a par. Just as with any other subject in philosophy, ethics should try to comply by our best actual epistemic practices.

    Now, our actual best epistemic practices are guided by the methology and basic principles of natural science. Since theological bioethics, or more generally any theological approach to a particular field of research, is not compatible with the methodology and the basic principles of natural sciences, it cannot be guided by it, and thus does not conform with our best epistemic practices.

    Indeed, theological approaches are not so compatible as they make ethical norms or values ultimately depend on God’s existence. Neither God nor the said dependence are supported by any sort of evidence (actually, evidence points to the direction of a dependence of norms and values upon natural properties of humain beings), and the mere stipulation of the existence of God and of the said dependence is completely at odd with the methodology of natural science.

    So it seems to me that theological approaches, whether in ethics or elsewhere, constitute nice items for collectors with a taste for ethnoscience: they belong to books and museums, but have no place in current research.

    1. Andrews, thank you for your comment, but my response is similar to the one I had to Airin. I’d be interested in any response, and I’ll try to restate it here. But first, two important points for context.

      1. At least twice in your comment you imply that something about ethics follows from “the natural sciences.” It does not. The natural sciences can inform a particular normative tradition, but it cannot be the grounding of that tradition. Science, for instance, has absolutely nothing to offer in an investigation about whether one should be, say, a Singerian utilitarian or Rawlsian liberal.

      2. This claim is utterly false, “Since theological bioethics, or more generally any theological approach to a particular field of research, is not compatible with the methodology and the basic principles of natural sciences, it cannot be guided by it, and thus does not conform with our best epistemic practices.” There are innumerable counter-examples, but perhaps the best one the fact that the Big Bang was first proposed by a Catholic priest. (Interestingly, Einstein first doubted his claims…but eventually realized that he was wrong and the priest was right.)

      Those two points being made, here is my basic challenge to both you and Airin. There is no epistemological challenge which is a defeater for theological bioethics that is not also a defeater for the first principles of any other normative tradition. All such principles are appeals to intuition, faith or some other kind of authority. There is no argument to support, for instance, the utilitarian dogma that “one counts as one and none more than one.” As I mention above, it has been denied for most of human history. That doesn’t make it false, of course. It just means that the standard which you set up for theological bioethics simply cannot be met by any normative tradition. Are you prepared to follow this standard in all circumstances? Since you care enough about ethics to post here, I suspect you do not.

      As MacIntyre asks us at the end of *After Virtue*: who is it to be…”Nietzsche or Aristotle?”

      1. Thank you for your reply. Yet you don’t seem to see (or to want to see) the point I’m trying to make. The problem with theological approaches of X, for any X, has nothing do to with the “content” of the theories that such approaches produce. The problem is methological. The best methodology we currently have is that of natural science — irespective of the content fo theories that this methodology produces (it is obviously true that there are conflicts among scientists). That methodology supposes starting with modest assumptions and building up more complex assumptions in light of evidence, meeting rational constraints such as valid reasoning and coherence in the process. Theological approaches in general fail by that criterion, since they write extravagant assumptions right into the theories they produce. This methodological absurdity cannot be salvaged by the existence of disputes among non-theological theories.

        1. Also, I am not making the outlandish suggestion that ethical truths follow truths of natural sciences. The point, as is now clear, is entirely methodological.

  6. Hello, Andrews. We appear to be talking past each other.

    I’ll just say again: your criticism of theological ethics here may or may not be well-founded (I happen to think it is not…and, in fact, is a classic example of the bias against theology), but yours is a criticism that, if well-founded, devastates the methodology of secular normative traditions as well. The assumptions of utilitarianism, for instance, are not “modest.” Indeed, many, many (theological and secular) thinkers find them to be absolutely outrageous.

    All normative traditions begin with authoritative first principle which often seem immodest (and even ridiculous) for those who are not claimed by that that tradition.

    1. Every theory starts with assumptions. Given the methodology practical philosophy shares with natural sciences, what justifies basic assumptions is their explanatory power and their “groundability” in more general theories. Normative theories are no different; they should capture something explanatory about what we ought to do or about what we ought to be given certain metaethical assumptions, and they should be “groundable” in the metaphysical picture that supports them.

      On this regard, however, theological approaches fail miserably. In particular, normative theological theories fail to capture anything interesting about what we ought to do or about what we ought to be given secularmetaethical assumptions. Grounding them in non-secular metaethical assumptions (i.e. “God is the source of all values”) does not help, as the metaethical view from which those assumptions are taken will itself fail miserably at explaining anything about values if they are to be grounded in non-normative secular metaphysical assumptions.

      The only way out of the circle of “either non-explanatory or non-groundable” is to ground all those assumptions (normative, metaethical, non-normative metaphysical) all the way down in a theological ontology. Which extremely questionable. So the only way to holding normative theories hostages of a very possibly flawed picture of the world is to cut off all dependence relations from theology all the way down to ontology. Which is precisely the methological assumption that naturalism does, and which rules out theological approaches.

      1. Hi Andrews. I think we may be nearing the end of the usefulness of this medium of exchange, but let me try to respond.

        Ethics, if it truly is ethics and not something else, has a very different methodology from that of the natural sciences.

        When you refer to things like “explanatory power” or “groundability in more general theories” you are using the language of the natural sciences. But this will not do for ethics. The moral-anthropological doctrine of utilitarians, for instance, that “one counts as one and none more than one” is true or false only on the basis of some kind of authority. It has no “explanatory power” for those outside of the tradition and those claimed by it. In this sense it is unlike, say, quantum mechanics or epigenetics–which can rise or fall on the basis of its ability to predict phenomena within an agreed-upon framework. But what is at stake in the debate between normative traditions is precisely the most general theory possible. There is nothing to which we can appeal (beyond, perhaps, internal consistency) where the parties in the dispute could have common reference points such that it would by meaningful to speak of “explanatory power” for both of them.

        In closing, let me say that I suggest you read some moral theology. The way you’ve described it in the post at least suggests that you haven’t read the best thinkers. I can make some suggestions if you are interested.

        1. Ethical thinking is “grounded” in human biological nature – it’s an inevitable part of the cognitive toolkit of large-brained social organisms. Disciplined approaches such as found in ethical philosophy can help us design ethical positions that are both rationally defensible and intuitively satisfying. Your objections to utilitarianism, for example, are presumably rational and intuitive. Such objections can be rationally debated in a secular academic context. If your objections are based on some conception of “God’s will”, they’re basically meaningless in in a secular academic context.

        2. Listen Charlie, the debate boils down to this. If normative ethical theories depend on metaethical theories, such as the theory of values and norms, and if those metaethical theories are to be consistent with the claim that normative (i.e. axiological plus deontic) facts supervene on natural facts, then normative ethical theories cannot be consistent with the claim that God exists. For this latter claim is not consistent with the supervenience of normative facts on natural facts — indeed, if moral values depend on God as is ordinarily assumed, you *could* have a difference in normative facts (i.e. moral ones) without a difference in natural facts (since no intrinsic fact about God is a natural one).

          Now, the antecedent of the first proposition made here is true, as can been seen from the different versions of consequentialists which differ only with respect to their theory of values — i.e. some accept that well-being is the ultimate value, other deny this, some deny that there is a unique value to which all other values are reducible, etc. Hence the consequent can be detached — normative theories do depend on metaethical theories (of course the details of the dependence will vary from theory to theory).

          If finally one adds the fact that there is no metaethical theory consistent both with the supervenience thesis plus the existence of God, one gets the result that there is no metaethical theory consistent with the supervenience thesis for theological normative theories to depend on.

          Now of course you can deny the supervenience thesis, as I am sure you will want to. But then you might want to read Gilbert Harman and Nicholas Sturgeon on why that is problematic. As far as I am concerned, though, I am afraid I won’t read any moral theology — nor, for that matter, moral astrology, moral scientology, moral raelianism or moral kryonism. For although there are terrific scholars who have made great contributions to both theolgy AND moral philosophy (Aristotle, Augustinus, Aquinas come to mind), moral theology per se (that is, with all philosophical arguments, methodological principles and claims removed) belongs to the museum if you ask me.

  7. “everyone addressing foundational questions in ethics does so from the perspective of a normative tradition constituted by first principles for which they do not have arguments”

    If you don’t have arguments for them, then why should they play any role in ethical argument? If it were really true that all ethicists were arguing from “faith” (which I doubt is the case) then perhaps you ought to just leave ethical decision-making to the rest of us.

  8. It will be helpful to anyone who uses it, including yours truly Your tips might be very useful. Keep up the good work.

  9. Andrews, I think we have reached the limit of what can be achieved on the bottom half of the internet. I do urge you again to read some philosophical and moral theology, however. These are old problems and they have been answered.

    And, with all due respect, one could not come up with a better example of the kind of bigotry of which I am speaking than your comparison of moral theology to moral astrology.

    1. I presented you a very simple argument and you replied with bookshelves and name calling (“bigotry”). If you want to push your point, however, you’d better give some thought to the argument.

    2. By the way, I sincerely don’t see much difference between moral theology and moral astrology or scientology. The most salient difference I can see is that only the former is indebted to philosophers.

  10. Hi Charlie, I’m with Andrews and Nikolas here. While theologians might have a lot to add to ethical discourse, this is true only insofar as their contributions can be defended on secular grounds. Your own example is telling – the priest you mention was able to make a valid contribution to astronomy precisely because his observations could be defended on secular grounds.

    There probably aren’t any gods, so moral discourse which depends on a god in order to be valid should just be ignored. And if it doesn’t depend on gods, i.e. if it can be supported on secular grounds, then there is no problem!

  11. Thank you for this blog post, Charlie. I enjoyed reading it, and the comments that have followed.

    I had one thought while reading through this, and I apologise in advance if this is a stupid / obvious one. This isn’t my area and I don’t know an awful lot about it…. But, having got that disclaimer out of the way, my question was: is it that bioethics needs theology, or that bioethics needs theologians?

    I’m not quite convinced that bioethics needs (i.e. is fundamentally incomplete without) theology, any more than it needs a utilitarian or feminist perspective. It seems to me that bioethics can be done – and indeed, is done – without reference to theology (or feminist theory, or utilitarianism), and it seems perfectly fine when it doesn’t have such a perspective.

    That said, I think there is a pretty good argument for bioethics needing (i.e. being fundamentally incomplete without) theologians. Given that religion is such a prominent part of the world, and shows no signs it will disappear in our lifetimes, it seems that scholars trained in theology approaching bioethics will be very important for the field. First, there is a pragmatic sense in which if bioethics is meant to be practical and guide policy decisions, it will fare much better in certain countries and contexts if it has some reference to theology (e.g. in Saudi Arabia, or Nigeria, or in Texas). Second, it seems that theologians may be able to provide novel and interesting directions for future research, because they come from a different background and way of thinking. In the same way, I think that have scholars trained in feminist theory as bioethicists is necessary because they provide new insights into the topic that might be neglected by people not trained in this. It seems to me – as a non bioethicist – that bioethics has an awful lot to gain from theologians, rather than theology per se.

    1. Thanks for the thoughtful comment, Jim.

      It might have been a bit over-the-top for me to say that bioethics “needs” theology (or theologians). I do think, however, that if it is to be a truly plural and inclusive enterprise open to all normative traditions then bioethics needs to include theology and theologians. Of course, bioethics isn’t (right now) truly a plural and inclusive enterprise open to all normative traditions…and it is still bioethics. But it would be a more authentically academic enterprise if it were authentically plural and inclusive.

      So it isn’t just a practical concern about the fact that most people in the world have (explicitly) religious normative traditions as their irreducible source of ultimate concern, and that if bioethics wants to speak authentically to these people it must make room for their tradition…rather than forcing them to use the categories and norms of very different (“secular”) traditions. Though this is certainly important. My fundamental challenge to bioethics today is to stop privileging secular normative traditions over religious ones…regardless of the number of adherents in the tradition.

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