Theologians at the Bedside: On the Role of Theology in Contemporary Bioethical Discourse

The article discusses the role and mission of theologians in contemporary bioethical discourse. Christian bioethicists turn out to be the odd ones out in any academic discourse from a methodological perspective, however, this peripheral position can also be viewed as a privileged situation. They can act with exceptional freedom in domains which require cooperation between diff erent disciplines, such as bioethics. Moral theologians can contribute most if they make use of this role of being the odd-one-out, with the attitude of having nothing to lose, and by placing relationships, the vulnerable, faith, everyday life experience, and the uncommon at the centre of the discourse. They can go beyond the limits of bioethical conversations centred on legal and medical questions bringing in viewpoints inspired by the long tradition of the praxis of the Church.


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theological credibility can be quite benefi cial for the writing of theology today. Th eologians now have nothing to lose, so we can do our work with the freedom that comes to those who have nothing to lose. We can write without apology. At the very least, that means we do not have to try to make what we believe acceptable to those who have decided that what we believe cannot be true. 1 Th eologians act also with exceptional freedom in domains which require cooperation between diff erent disciplines, such as bioethics. When it comes to questions of life or the human environment, physicians, economists, and lawyers are bound by questions which result from that particular viewpoint of their discipline. A lawyer needs to ask whether the proposed changes in regulation can be kept, or whether they can be enforced. Th eologians do not need to worry much about that since, when they speak about questions of human life, they can appeal to the most important and most precious things in life. Th ese are, as we all intuitively know, unenforceable, and can hardly be inserted into the frames of legal regulation. Th eologians may make use of concepts, such as parental love, which go far beyond what can be formulated in legal terms. Th is article focuses on the two abovementioned statements when it asks 'what can theologians say at the bedside?' 2 Do theologians have something relevant to say, even if the partners in the discussion are reluctant to share the starting point of theological thinking? Are theologians able to say something relevant about bioethical questions, which can be seen as a specifi c contribution to the academic discourse?

Beyond Entrenched Positions
First of all, it is important to take a closer look at this exceptional freedom of theologians at the bedside. However, the hazards that Catholic theologians have to overcome must be considered also before starting to think and to speak about early life questions. Th e fi rst and main hazard in this fi eld is the static warfare which pro-life and pro-choice groups have been fi ghting from entrenched positions for a long time now. Th is war is fought over questions like When does life begin? When is a new life to be treated as a person or an individual? From which moment does new life have a right to absolute protection? Do women have the right to make decisions about their own body? Th ese questions and the answers given to them are of great importance beyond doubt. It is necessary to consider what biology says about embryogenesis as equally as the arguments concerning the protection of the embryo's life, be it absolute or gradual. Th ey are important from the aspect of legal regulation and may determine the scope of our choices in a given situation. Th ey oft en fail to help us to fi nd proper solutions since everyone seems to know on which entrenched position one may fi nd the Catholic moralist. Th e biggest problem is, however, that the answers given to these questions are at a reasonable distance from the factual Lebenswelt. People, who are not part of the ongoing debate, may say even aft er the most sophisticated argumentation: 'Well, it sounds logical. But what does the species, the continuity, the identity, or the potentiality argument say about who we are, and how we can lead a good life?' Th e latter are questions which should be at the focus of every ethical theory.
It is possible, however, to place this concrete Lebenswelt at the centre, and to ask these questions from a diff erent angle. An excellent example for this alternative approach is the following sentence proposed by Gyula Gaizler: 'Th e question of when human life begins ceases to be a problem when the child is welcomed by the parents. ' 3 Th is proposition eradicates the debate between pro-life and pro-choice groups since it focuses rather on the experience of parents than on theoretical issues. Th e hair-splitting arguments of philosophy and theology become simply irrelevant at this point. Th e narrow view focusing on the defi nition of when human life begins gives way to a much broader horizon. Questions and topics come into prominence, which could only exist on the periphery of bioethical discussions.

Placing Relationships at the Centre
Th e fi rst such topic a theologian may put at the centre is relationship. Th e central statement of the Judaeo-Christian tradition is that the true fundament of our world is not a cold and distant entity, indiff erent towards the fate of mankind, but a person -or as Christians claim, a community of persons -who is not indiff erent but is in love with mankind, who comes close to human beings and wants their salvation. Martin Buber's well-known phrase, 'in the beginning is relation' , is one of the most important messages of the Jewish and the Christian faiths. 4 If this is true then the most essential feature of reality is personal relatedness. Th is is also the central feature of human existence: being related to others. But in the bioethical discourse about early life decisions this being related to others is oft en neglected. 5 We tend to speak rather about maternal foetal confl ict, the right to life, or the right to self-determination. Th e most important element of early life questions remains vague beyond these questions, namely the birth and evolution of a new relationship. Th ere is a need to shift the focus from viewing the foetus and the mother as two confl icting individuals to the relationship(s) that evolve due to pregnancy. It is obvious that relationships can also be turned down, but even a 'no' signifi es a certain kind of relatedness. Th e question of the beginning of human life or personal being hardly ever emerges in our Lebenswelt. It is highly improbable that a woman, when she becomes aware of being pregnant, might start thinking about whether the baby was already a person or just on the way to personhood. Couples with fertility problems would also be unlikely to put these questions in the fi rst place. From this angle it is clear that questions like Can we consider the foetus as an individual prior to the time when twin formation is not possible anymore? are of marginal relevance in human Lebenswelt. What matters is the affi rmation of relationship and the presence of the preconditions of this affi rmation. Making a further step, it becomes clear that parental relationships have a logic signifi cantly different from the logic of the public sphere, which is based on contract. Th ere is an element of the unconditional in parent-child relationships since, as Hans Jonas puts it, the parent-child relationship is 'independent of prior assent or choice, irrevocable, and not given to alteration of its terms by the participants; and, in that prime example, it encompasses its object totally' . 6 Th e call and the longing to take responsibility and to look aft er another person emerges at this point radically, together with the experience that life was essentially not autarchic but being de-8 2018 pendent on and completed by the other. Legal regulations fail to embrace the inner essence of parent-child relationships. 7 Th ey may establish certain frameworks, defi ning the social standards of parenting, but these cannot reach the central element of these relationships, namely love. Children are essentially dependent on their parents, and love, the essential element of their primary relationship, proves to be unenforceable. Th e drama of early life decisions -be it a maternal-foetal confl ict, the failure of an IVF procedure, a positive prenatal diagnostic test result, or a normal pregnancy with its natural hopes and worries -can only be understood thoughtfully if we perceive them in the context of relationships, and less as individual problems to be solved by legal regulations.

Placing the Child at the Centre
At this point there emerges another central element of Christian theology. To which criteria should parent-child relationships conform? It might sound odd, but in Christian theology faith in God makes the responsibility of parents towards their children relative. It questions the authority of parents over their children. An example for this pattern is when Zechariah, the father of John the Baptist loses his power to speak until he names his son John, as the angel ordered. 8 Giving the new-born this name was odd and unexpected for the family and the community since no one in their lineage had been given that name before. Th is story clearly shows the biblical pattern for parent-child relationships, making the authority of parents over their children relative. Th e act of giving someone a name was a symbolic act of authority in antiquity, including Judaism. 9 Zechariah cannot give his son any name since he belongs fundamentally to God, and not even his parents have authority over him. Th ese ideas might sound strange in our western culture -where only those children are born who are planned and wanted, and where parents want the 'best possible' for their children and feel an obligation to get the most out of their off spring: that the child belongs fundamentally to God. Th is implies that there was something in parent-child relationships which happens to be beyond parental control. Th is is stressed by Jürgen Habermas as he speaks of the moral symmetrical relationships between parents and children, which manifests itself in the fact that no generation has had the power so far to determine the physical characteristics of their off spring. 10 Similarly, Giovanni Maio prompts us to give up the myth of 'the absolute control and producibility of life' , and to resist the inclination to solve existential problems by 'desperately holding on to technical solutions' . 11 Instead we should regain the 'stance of humility' , which is nothing else but an open confrontation with our human nature, with our defencelessness, and with the uncontrollable in us. Th e myth of 'the absolute control and producibility of life' , and the temptation to solve our existential problems with the help of technical solutions does not only put pressure on parents and later on the children, but also on medical staff , since they are expected to perform beyond their limits: to guarantee certain outcomes and to assure the satisfaction of their clients. Let's take an example. How does prenatal diagnosis manifest itself in the Lebenswelt of parents? What avalanche might be induced in parents by a positive test result, for example, when they learn that their child might be born with Down Syndrome? Even if doctors speak only about probabilities and cannot predict the gravity of future symptoms. Th is situation might precipitously narrow the horizon of the parents and, as a result, also the chances of the relationship. Th e medical staff has practically no real tools to change this.

Placing Faith at the Centre
Such situations show clearly how medicine -by becoming a distinctive segment of society, a network of institutions with its own logic -has built up high walls around its territory. Although members of medical staff give testimony about the value of life and its meaning every day, the role of the making and creating sense is one that modern health care institutions, functioning according to the logic of modernity, are unable to fulfi l. It is beyond their scope to answer the question of health, and moreover that of what good life is. In situations like those mentioned above healthcare institutions fail to help parents in their search for meaning within crisis, to gain strength, and to open up or to reshape their horizon once more. At this point religion must be moved from the periphery to the centre since religion fulfi ls the role of creating meaning even in modern societies. One of the commonly shared bases in debates about post-secular societies is the future viability of religious communities and their traditions, aff ecting social life with its goal to fi nd and create meaning. 12 But what does the creating sense mean in the framework of healthcare institutions? One clear example comes from Daniel Sulmasy, a Franciscan friar, doctor, and bioethicist. In an interview he was asked about the possibility to connect medical care, medical ethics, and pastoral care. 13 In his answer he shows the organic link between these three fi elds through an example about a comatose patient and his wife, who was reluctant to agree to the cessation of her husband's treatment. It resulted in a dilemma for the medical staff , since they knew that they could not improve the condition of the patient by continuing treatment. Sulmasy, who was the ethical consultant in the case, discovered in the course of the conversation that the wife was a faithful Baptist, an active member of her congregation. He suggested that she invite her pastor to take part in the ethical consultation, which she accepted. Th is resulted in an important turn in the story. While ethical committees usually ask family members at a certain point to leave the room and discuss the case on their own, it was the pastor who asked everyone except for the wife to leave. Th ose two stayed in the room and prayed. When they came out the wife simply said: 'I think God is calling my husband home. It's OK for you to stop all these treatments. ' 14 In this case religion fulfi lled the role which seems to remain unfulfi lled in most modern medical systems: to provide help in the search for and creation of meaning in an extremely diffi cult existential situation. First, it is not the patient but his wife who is primarily aff ected by the decision which needs to be made. Second, she has to deal with a question that cannot be answered within the framework of the medical system: whether she can let her husband go.

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side of things and can work with the chaplains in the hospital or the patient's own clergy is going to do a much better, more holistic job than if one thinks of these as separate worlds' . 15 Also in the case of early life decisions, for example, in the case of a positive test for Down Syndrome, religion may take the role of creating meaning and broadening horizons.

Placing Everyday Life at the Centre
Since theologians usually work with arguments taken from philosophy, and are thus using the language of philosophy as they take part in the bioethical discourse, there is a need to pose a question about the religious resources of Christian bioethicists. Th e opinion according to which moral principles can simply be derived from divine revelation, which is only accessible to believers, has mostly been rejected within moral theology -at least within the Catholic tradition. Moral questions concern believers and non-believers equally. Both groups may participate in the moral discourse with equal rights on the grounds of reason, intellect, or moral sense. But what is the distinctive element of Christian ethics? What makes the diff erence between Christian and secular moral criticism? Where does the distinctive character of theological works come from? It is the same source as in the case of the example above, when the pastor was able to help the comatose patient's wife broaden her horizon by praying together with her. Due to the work of Alfons Auer, moral theologians have oft en discussed the question of whether faith does not provide precise instructions concerning individual moral questions, but rather a horizon of meaning and motivation, which helps theologians put moral questions in a diff erent light. 16 As everyone's horizon is defi ned by the community to which one belongs, the horizon of theologians is defi ned by the everyday life of the Church. Th e way one views the world and gains motivation for action is defi ned by the practice of everyday life. For theologians this everyday practice is framed not just by tradition, but also by the everyday practice of the Church.

Placing the Uncommon at the Centre
Th e everyday life of the Church includes events and practices, which are unusual and go beyond the frameworks of everyday practice. Th e criterion of the practice of the Church must always be the praxis of Christ. Th is is beautifully shown by the illustration of Mt 8:1-3 in the Codex Echternach, originating from the 11 th century. 17 Th e picture is part of a commentary series to the Gospel of Matthew, showing Jesus coming down from the hill aft er the holding the Sermon on the Mount. A leper steps up to him, who is then healed by Jesus. For theologians in the bioethical discourse the scene has several implications. On the one hand, both Jesus and the leper overcome the common framework of social norms. Th e leper -who was classifi ed in rabbinic theology as dead, together with the blind and the childless -was not supposed to step up to Jesus, not just for ritual but also for easily understandable hygienic reasons. However, according to the gospel, 'Jesus stretched out his hand and touched him' . Th rough this act 'his skin-disease was cleansed at once' . According to biblical scholars, this story is a resurrection narrative. Th e leper, who was classifi ed as dead, has risen from social death. Jesus then sends him in accordance with Leviticus to 'go and show' himself 'to the priest and make the off ering prescribed by Moses' , to enable him to fulfi l social and religious expectations and to return to his earlier life. By healing the leper, Jesus does not simply cure him, but gives him his life back. What is central to the story is not simply the act of healing. Th ere were numerous other successful healers in the time of Jesus. What is important is that Jesus crosses the threshold drawn between him and the leper by Jewish law. He steps up to him and heals him by his touch. He gives the leper what he needs the most, and puts him at the centre, instead of the ritual prescriptions. A closer look at the picture shows that the pictorial interpretation of the biblical passage does not stop at the meeting of Jesus and the leper. Th ere are other fi gures behind Jesus. Th e fi rst two are Peter and John, embodying law and love in the Church. Th ey watch with one eye the action of Jesus and their own hands with the other, checking whether they are acting the same way as their Master. Behind the apostles are contemporaries from the 11 th century, looking at the hands and actions of the apostles. Th e picture illustrates the meaning of tradition for the Church, which is more than the passing on of certain theoretical knowledge, but also a certain way of acting modelled aft er the works of Jesus. Here it becomes clear that the Church is a community of memory, and also that the institutional practice of the Church has always been a tool against forgetting that Jesus always put the concrete person with his 'joys and the hopes, the griefs and the anxieties' at the centre. 18 Th ere are many examples for placing the uncommon at the centre in contemporary praxis. Jean Vanier, a professor of theology at the University of Toronto, left his professorship and invited two men, Raphael Simi and Philippe Seux, with developmental disabilities to reside at his home. He was not mainly moved to provide help for them, but to share their lives, to a common life together sharing and accepting their diff erences and to deepen their faith. Th is momentum resulted later in the development of a movement and several initiatives with the goal to share life with people living with disabilities and to enrich their lives mutually. Th is line is in sharp contrast with the way disabilities are viewed today, being identifi ed with the narrowing of the horizon, the drastic setback of life chances, and the loss of social status. Jean Vanier, the off spring of a wealthy family, found the chance for perfection in sharing his life with disabled people. How does this interpretation of disability change the contemporary context of prenatal diagnostics? Does pregnancy consulting reach beyond the narrow limits of informed consent concerning the range of medical options, and help the people concerned in their search for meaning? Does the treatment of infertility include the option for couples to think about the meaning of having children concerning their relationship, their biography, and their own life goals, and to get help and guidance in that process? For theologians in the bioethical discourse the praxis of the Church preserved by its tradition is of great help, since it directs at viewpoints, existential momentum, and signs of life, which might remain obscure from the horizon of today's Lebenswelt. Th ere is a great need for this wisdom in a society where the people with disabilities, with infertility, or with any condition which hinders them in taking part in social processes as expected are excluded and belong to the dead, just like the leper in the time of Jesus.

Closing Th oughts
What can theologians say at the bedside? How can they contribute to today's bioethical discourse 18 Gaudium et spes 1.