Book Review: Gilbert Meilaender, “Bioethics: A Primer for Christians, 4th edition”

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Bioethics: A Primer for Christians, 4th edition

Gilbert Meilaender, Eerdmans, 2020.
ISBN 978-0-8028-7816-8, 156 pages, Paperback, $20.99.

Gilbert Meilaender, I believe, is among us for such a time as this.

I first met Dr. Meilaender in the late 1970s as a pre-med student enrolled in his course on C.S. Lewis. It was a wonderfully demanding course, and Dr. Meilaender, formerly a Lutheran pastor, challenged us to “go deeper” in all we thought and wrote.

A year or two later, I stopped by his office to pay my respects as each of us was preparing to leave the University of Virginia, he to teach at Oberlin and I to study medicine in Washington. Many years later, he and I have never entirely left behind that meeting space and that attitude, and his thought continues to encourage and inform this thirty-year veteran of critical care medicine.

Bioethics: A Primer for Christians, now in its fourth edition, first appeared in 1996—an era vastly different from our own, yet one in which the challenging bioethical thickets of today were taking root. In the current text, Meilaender preserves his twelve-chapter format and subject headings, updating his book to keep pace with contemporary science and thought. Bioethics is in harmony with other works of the same genre published contemporaneously, but is unique in style: it is predominantly reflective rather than prescriptive. Unlike other excellent Christian treatments of bioethical issues wherein scriptural proof texts abound and are collated in a separate index, Meilaender acknowledges and embraces the silence of Scripture on many contemporary issues. He approaches the sacred text to mine it for wisdom, using profound prose that is accessible and beautifully written.

Meilaender presupposes biblical and Nicene Credal truth and assumes that his readers desire to lead lives and make decisions pleasing to God. But he also assumes that his readers are immersed in and influenced by secular culture, one more hostile to Christian thought than a quarter-century ago. Accordingly, he walks pastorally with his readers, shepherding their reflections toward and into a proper biblical/theological orientation.

Twelve chapters take the reader across the span of life and the ethical considerations encountered along the way. His first chapter, “Christian Vision,” frames and orients all subsequent chapters, providing the reader with a Christian anthropology as a necessary corrective to the “expressive individualism”[1] of our society’s mindset and understanding of ‘personhood.’ Meilaender contends that individuals are “free but finite,” possessed of a body/spirit duality (but not dualistic). And we are situated in a community, and through baptism, in the Christian community. Upon these two understandings—free but finite and living in community—hang all bioethical considerations.

Topics include infertility options such as in vitro fertilization and surrogacy, abortion, prenatal screening, physician-assisted suicide, end-of-life decision-making, organ donation, embryo research, and human experimentation. In all these, radical individualism and self-interest—decontextualized from the community, moral law, and life lived in God’s presence—are the common conduit to a slippery slope of ever more problematic choices. Outside the moral constraints of the biological bond in marriage and procreation, embryos risk being discarded. To deny the full humanity of the zygote is to make the embryo at any stage dispensable through abortion. Genetic manipulation that presumes us to be self-creators places our children at unknowable risk. Prenatal screening leading to abortion as a “treatment,” as though the fetus were a malignant tumor, reduces the child to a dispensable entity. The expressive individualism that demands the autonomous and intentional right to die at the hands of physicians requires the (religious) heresy of a hierarchical dualism of mind over body and denies outright “each person’s life as a divine gift and trust” (p. 77).

In my domain of clinical practice in the intensive care unit, the demands of patients, families, and surrogates for invasive and patently futile treatments require physicians to become what Curlin and Tollefsen call “providers of services”[2] rather than moral agents who seek the right and good healing action of their patients.[3] “[D]octors,” says Meilaender, “need not practice bad medicine simply because patients want it” (p. 94). He rightly rejects the contention of secular ethicists that the well-being of a patient can be determined only by the patient (p. 96).

Bioethics does seem incomplete in a few areas. In dealing with abortion, the author declares the procedure permissible where the mother’s life would be threatened by carrying a pregnancy to term. He also states that abortion should be allowed for pregnancies resulting from sexual assault. In this latter circumstance, he cites the psychological trauma of the memory of the rape that such a pregnancy and childbearing would propagate. While Meilaender’s pastoral experience is evident here, the discussion omits any consideration of the full image-bearing humanity of the child. “The case,” says Meilaender, “bears important analogies to that where lives conflict . . . [the fetus] may constitute for her the embodiment of the original attack upon her person” (p. 42). Though I cannot disagree with his conclusion, the discussion seems incomplete, and the analogies merit unpacking. The same chapter also appears to omit the ethical and pastoral duty to the ‘second victims’ of abortion, namely those women (and many men) burdened with the choice they once made and now inexpressibly regret. How are we in the Christian community to come alongside these sorrowful ones?

Finally, this edition of Bioethics has a conspicuous omission. He has failed to engage the transgender issue, from its cultural motivations to its theological failures. Beleaguered Christian families across our land need his compassionate shepherding through these dark valleys.

I conclude this review with the author’s reflection on Psalm 139 in his consideration of abortion. The passage is paradigmatic for the entire book:

What the psalm does quite effectively . . . is depict a God who does not value achievement more than potential, who cares even for the weakest and least developed among us. More important still, at least for Christians, has been the Christological teaching that in Jesus of Nazareth, God has lived and redeemed the entirety of life, from its very beginnings to the death toward which we all go. He has been with us in the darkness of the womb as he will be with us in the darkness of the tomb (p. 35).

In America today, we are, ethically speaking, in both Wilderness and Babylon. Meilaender’s revised text is a foundational resource for those vexed by volatile ethical questions or personal crises, who cannot locate clear answers and pathways in a vain search for biblical proof texts. Bioethics: A Primer for Christians is manna for the people of God in the wilderness and serves the welfare of the secular city (Jer 29:7). Ethics, in this book, becomes doxology.

References

[1] Robert Bellah, Richard Madsen, William Sullivan, Ann Swidler et al., Habits of the Heart: Individualism and Commitment in American Life, (Berkeley: University of California Press, 1985), 27; referenced in and examined in the domain of contemporary bioethics in O. Carter Snead, What It Means to Be Human: The Case for the Body in Public Bioethics (Cambridge, MA; Harvard University Press, 2020), Chapter 3, “An Anthropological Solution.”

[2] See Farr Curlin and Christoper Tollefsen, The Way of Medicine: Ethics and the Healing Profession (Notre Dame, IN: University of Notre Dame Press, 2021).

[3] Edmund Pellegrino, The Philosophy of Medicine Reborn: A Pellegrino Reader (Notre Dame, IN: Notre Dame University Press, 2008), 38.

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