Bioethics and the Christian Life: A Guide to Making Difficult Decisions, by David VanDrunen. Wheaton: Crossway, 2009, 256 pages, bibliography, general index, Scripture index, $19.99, paper.
There is an abundance of literature published on bioethics. A respectable amount of it is written from a Christian point of view. Most often, though, we are made to choose between solid science and sound theology. Books that are good scientifically are often written by people who are in the field and confront the hard data every day. Their empirical observations have great merit. But they are usually weak or superficial in matters of theology. Often complex issues are funneled into a few simple ethical principles, and there is little real biblical exegesis. Conversely, we find good biblical studies but with insufficient knowledge of the field of biology.
What a pleasant surprise to discover this book which is competent in both areas, biblical hermeneutics and scientific data. More than competent, it is authoritative. On top of that, it is elegantly written. David VanDrunen, who teaches Christian Ethics at Westminster Seminary in California, carries the credentials to accomplish this rare feat. As someone who teaches ethics and also works on a couple of committees in our local hospital where I have to face tough medical conundrums in the trenches, I can say, after a long wait, this is the book to read!
In the opening chapter VanDrunen compares several possible Christian attitudes toward participation in public healthcare. He concludes that, although the world's agendas are often different, even at loggerheads with the biblical approach, Christians need to be active in healthcare, if only because we are called to defend God's justice in a hostile environment. More positively, as VanDrunen articulately demonstrates, cultural activities are still enjoined, alongside the duty to proclaim the gospel.
Chapters 2 and 3 compellingly set forth the principal doctrines and virtues that Christians can bring to the table. Among the most important are the goodness of God, the dignity of human life, and the need for hope and courage as we stand for these values in the fallen world. His discussion of wisdom is particularly strong and appropriate, since we must make decisions based on wise applications of God's law, particularly as there are no Bible verses on such things as the status of the embryo, or stem cell research. VanDrunen's exegetical skills become especially valuable when handling difficult passages such as Exodus 21:22-25 in relation to the status of an embryo (see 155 ff.).
VanDrunen affirms the Reformed view that there was an eschatology to the creation, and that the probation, had our first parents succeeded in obeying, would have been a passage for the entire human race to a higher, consummate life beyond the Garden. Though in the event this did not happen, the covenant promises of God culminating in Christ are not entirely outside that same eschatology. This underscores the great intentions of the Creator, now the Redeemer, who desires not the death of a sinner, but that he should turn from his sin and receive life, life eternal. The life that Adam failed to obtain is now given to God's people as a free gift, through justification. The importance of the doctrine of life becomes clear in the following chapters which investigate bioethical questions in depth. Along the way, too, VanDrunen reminds us of the inevitability of human suffering. Thus, there can be not utopian dreams for the present dispensation, even as we must strive to improve healthcare.
Space prohibits fully exploring the rich materials in chapters 4-9. They are divided simply into "The Beginning of Life" and "The End of Life." The contents are rich, wise, informative, and, I hope this comes across sounding right, non-alarmist. One reads so many works on bioethics which are so emotionally charged that there is more heat than light. VanDrunen is not lacking in conviction, to be sure. He is passionate about the sanctity of human life, the rights of the dying patient, etc., but he is marvelously sane in his arguments.
Take, for example, his discussion of marriage and contraception. He is a strong defender of the creation ordinance of marriage and procreation, yet he recognizes the value of celibacy and of stewardship in having children. He helps the reader decide which kinds of contraception devices are permissible, and which are not. He steers a nice balance between the legitimate desire for children and the danger of idolizing the family. Or, take the chapter on assisted reproduction. VanDrunen is aware of the emotional ironies involved: "What many can attain to they do not want, and what many want they cannot attain" (119). But he is also aware of the technological opportunities along with their advantages and pitfalls. He has great compassion for the plight of couples who are infertile. And while not forbidding the use of certain assisted procreation techniques, he, first, warns against using them as a panacea, and, second, issues strong reservations about such methods as AID (artificial insemination by donor), because it introduces a third party into the mix. In the discussion of adoption, which he highly favors, he raises the question of adoption by single parents. There, he subtly, and in my judgment rightly, distinguishes between "creating" a child by assisted procreation for the purpose of having one's own biological progeny, and adopting an already born child. The former is unacceptable. The latter is better than leaving a child defenseless. Similarly with freezing an embryo. While not morally out of bounds, it presents such a host of difficulties that the couple considering this procedure must exercise great caution.
VanDrunen is at his best, which is saying a lot, when treating end-of-life issues. He shows both exegetical skills and pastoral sensitivity toward those facing such difficulties as whether to withhold or even withdraw treatment of a dying patient. Never maudlin, nor rosy ("it was such a blessing!"), he presents death as the result of the fall. Death is an event that is horrendously telling of a world cursed by God. And yet there is for the believer a way to handle death, indeed, something to understand about it, that makes it the passageway to eternal bliss promised to all those who love Christ's appearing. As he does throughout, VanDrunen reminds us that participating in the life of the church can be the best preparation for the reality of death. At the least, the sacraments are a regular microcosm of death, followed by life. Perhaps his most eloquent pages, though, are centered on love. The love of God and neighbor is the ultimate self-sacrificing virtue. Though never easy to depend upon others, yet, "By learning to live in community with love for our neighbor we prepare ourselves for dying. The person who has cultivated the virtue of love for a long time and thus has learned to give and to receive is much better prepared to face difficult periods of dependence upon others." (182) Someone who is dying is indeed going to have to receive the care and nurture of others; not enjoyable for a would-be autonomous person.
Putting these grand principles into practice in the tough occasions where there are advanced directives, ventilators, feeding tubes, financial issues, and much more, is marvelously effected by our author. I commend this treasure of a book to pastors, believers in the pew, and both believers and unbelievers in healthcare. I do not believe there is anything quite like it, nor is there likely to be for a good while.
Professor of Apologetics and Ethics
Westminster Theological Seminary
Ordained Servant Online, March 2010