What We Believe
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Bioethics: A Primer for Christians, by Gilbert Meilaender. Grand Rapids, MI: Eerdmans, 2020, 176 pages, $18.92.

Bioethics is concerned with at least three different kinds of questions. All three kinds of questions have become more difficult to answer with rapid advances in medical technology over the last six decades. To see the differences between these kinds of questions, consider a married couple who is struggling to get pregnant. Sixty years ago, In Vitro Fertilization was not an option. It was not possible to test embryos for genetic abnormalities. No one was growing “eternal” stem cell lines from aborted fetuses to enhance medical research. One kind of bioethical question would focus on the choices available to the couple seeking to conceive and carry a child to term. For Christians, these questions would revolve around identifying the biblically permissible ways to pursue having children and acknowledging their biblical obligations to protect every life that resulted from their efforts. Another kind of question raised by this couple’s situation would focus on the public policies that best protect the interests of the couple and others involved with infertility: parents, babies, health care providers, and researchers. A third kind of question would ask what kind of people the parents should have become in order to handle the crisis of infertility when it arose. This kind of question properly goes beyond the couple to their parents (eager to have a grandchild) and their church community (in all the ways they support and set expectations on the couple). These questions are clearly different. Someone helping an infertile couple make choices about reproductive technology options should not insist that the couple spend years growing in patience, self-control, and dependence before helping them. The questions about public policy do not matter to the couple in the midst of their crisis. Public policy impacts the kind of people we become, but it is only one influence among many.

Gilbert Meilaender’s Bioethics: A Primer for Christians is an outstanding guide to the third kind of question: what kind of people should we become in order to deal faithfully with the possibilities offered by advancing medical technology? The positions Meilaender takes on public policy questions are sound, but the book does not provide detailed reasons for these positions that would help a Christian in a debate with someone who disagreed (nor does Meilaender intend to provide debating points). For questions about how to help people in the midst of a medical crisis—the first kind of question—the book will be frustrating. Because Meilaender is most concerned to help Christians guard their hearts against idolatry, the fourth edition does not take account of some important changes in the practice of medicine between the first edition in 1996 and 2020. As a result, the book’s implicit advice for people in the midst of medical crises may end up wounding the people who need guidance. With this caution in mind, however, the book is an exceptionally important resource for people not in the midst of a crisis. Careful attention to Meilaender’s work here and his other publications will prepare Christians (and others whom Meilaender invites to “listen in”) to have hearts that handle medical crises faithfully when they come.

The central concern of Meilaender’s Primer is the need for Christians to recognize that the rapid advance of medical technology has the power to tempt us into idolatry. Meilaender’s chapter topics are chosen to highlight medical advances that encourage us to alter where we are placing our trust and thus what we are willing to allow. The threats to our hearts posed by expanding medical options for fulfilling the mandate to “be fruitful and multiply” take up chapters two through five (“Procreation versus Reproduction,” “Abortion,” “Genetic Advance,” and “Prenatal Screening”). For Christians not in the midst of the crisis of infertility, Meilaender’s recommendations are sobering and wise. Legal and efficient “assisted reproduction” options are often reckless with the lives of the unborn. Meilaender rightly insists that Christians cannot set aside protecting every child in pursuit of having a child “of their own.” Making an idol of childbearing is wrong, and these technological advances intensify temptation to idolatry. The church needs to be talking about these idols and taking seriously Meilaender’s warning that “technology has a momentum all its own” (13).

Chapters six through eleven (“Suicide and Euthanasia,” “Refusing Treatment,” “Who Decides?,” and “Gifts of the Body: Organ Donation,” “Gifts of the Body: Human Experimentation,” and “Embryos: The Smallest Research Subject”) consider the temptations to idolatry near the end of life. Aside from a curiously out-of-date argument against the use of “advance directives” for end-of-life decision-making, the guidance that Meilaender gives in this section is biblically sound and insightful. (The chapter “Who Decides?” is largely unchanged from the first edition in 1996. A lot has changed in the way families are asked to make decisions for loved ones in the hospital since 1996. Although Meilaender correctly supports the use of “Durable Powers of Attorney for Health Care” in all editions of the book, this chapter deserved to be updated lest it cause confusion.) Meilaender’s warnings about creeping idolatry in these chapters lead him consistently to ask how the new medical realities threaten our relationships and corrupt our understanding of what it means to be human. For example, the rapid rise of efficient organ transplantation and the push for donor organs threatens to alter our relationship to our own bodies. These developments encourage us to allow organ-seekers to pressure families to “bring some good” out of the death of their loved one, suggesting that their embodied life and death would have no meaning otherwise. Although I believe it is biblically appropriate to be a volunteer organ donor (and am one myself), Meilaender’s warnings about this feature of current medical practice are sound.

The final chapter, “Sickness and Health,” goes to the heart of the idolatry and how-we-understand-ourselves problem. Modern medicine is prone to see all health challenges as pointless. Drawing on Jesus’s answer to his disciples’ question about the man born blind (John 9), Meilaender points out that the issue was not who was to blame, but rather how God would use the blindness for his glory. Health is not our chief end. Sickness and suffering are not pointless. Jesus Christ himself took on flesh like ours—limited, dependent, frail, and ultimately suffering—not only to accomplish our redemption, but also to draw intimately near to us in our sickness and suffering. A crucial part of resisting making an idol of medical advances is rejecting the lie that sickness and suffering are pointless. The goal is to “become people who give thanks for medical progress without worshiping it or placing their trust in it” (123).

Meilaender’s analysis is spiritually rich, making reassuring use of allusions to Scripture. Even so, readers unfamiliar with Lutheran theological ethics may find two aspects of Meilaender’s book puzzling. First, Meilaender uses Scripture to draw attention to the works of God, and in particular the incarnate Christ in his life and death on the cross. When Meilaender refers explicitly to Scripture, it is not with a list of passages that support his recommendations. While I prefer seeing many explicit references to Scripture, Meilaender’s approach gives human embodiment attention it deserves. The Lutheran imagination is drawn to Jesus hanging on the cross. From there, it easily sees that Jesus suffered in his body and so he knows what it feels like to be limited and sick. Not only did Jesus suffer for us, Jesus suffers with us.

The second feature of Meilaender’s book that may puzzle non-Lutheran readers is his pushing back against seeing medical advances as “redemptive.” Giving medicine that kind of credit, according to Meilaender, increases the chances that we will make medical advances an end in themselves, and thus objects of worship. Many Calvinists are comfortable with seeing everything that pushes back against the effects of the fall as part of Christ’s cosmic work of redemption, and thus as foretastes of Christ’s consummate kingdom. Although I am comfortable thinking of medicine as “redemptive,” Meilaender’s warning is worthy of careful consideration. Triumphalism in the guise of “redemptive activity pushing back against the fall” may owe more to Enlightenment confidence than it does to Scripture.

The fourth edition of Meilaender’s Bioethics: A Primer is most valuable for its persistent attention to the impact that our frequent encounters with medicine can have on our hearts. Meilaender is a clear and compelling writer, making profound spiritual questions easy to understand. Ministers of the Word and everyone involved in church education should give this book sustained, careful attention. A year of COVID-19 has made the role of medicine in our lives unavoidable. Thoughtful efforts to preach and to teach in ways that nurture biblical attitudes about health, sickness, parenting, suffering, and death will bless the church in ways that will pay dividends for years. Meilaender’s book is a good first place to look for help with that task.

William C. Davis is a professor of philosophy at Covenant College in Lookout Mountain, Georgia and a member of Lookout Mountain Presbyterian Church (PCA). Ordained Servant Online, June 2021.

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Ordained Servant: June 2021

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