“Bioethics” is a word that can feel esoteric and futuristic. The term conjures all sorts of medical mental imagery: swirling DNA helixes, genetic modification, scientists in a lab with syringes and microscopes in hand.
Though it may sound like science fiction, the term “bioethics” describes issues and decisions that we encounter in real life. A newly minted teenage driver is asked if they want to be an organ donor. A young expecting couple at their first ultrasound is asked if they would like to genetically screen their unborn child. A physician asks their aging patient if they have considered preparing an advance healthcare directive. The age of bioethics is already upon us; the future of scientific medicine is now here. How will Christians navigate this world?
In Bioethics: A Primer for Christians, Gilbert Meilaender seeks to educate and equip Christians as they live in this rapidly changing world. It is a guide written by a Christian for Christians who wish to think deeply about the complicated issues surrounding medical science.
Meilaender’s book is organized into twelve chapters, each focusing on a specific theme or topic within bioethics. The book generally progresses from beginning-of-life issues (reproduction, abortion, genetic advancement, prenatal screening) to treatment and end-of-life issues (euthanasia, refusing treatment, medical authority) and concludes with a dive into the ethics of medical research (organ donation, human experimentation, embryos).
Some chapters worth highlighting:
In chapter two (procreation vs. reproduction), Meilaender speaks about the subtle shifts in language surrounding pregnancy and childbearing. Whereas ancient people spoke of the transmission of life from father to son (begetting) or genesis, coming into being, modern Americans employ the mechanical metaphor of the factory, “reproduction.” This shift in language reflects a more profound cultural change—one that views children and the process of bringing them into the world as something to be controlled and mastered. In the modern world of artificial insemination, in-vitro fertilization (IVF), and even surrogates, “reproduction” is a fitting word. However, what effects do such methods have on the bond between child and parent(s)? What do such methods say about our bodies or the embryos we create? Are they simply tools free to be used in pursuit of our goals (i.e., children)? Pursuing such goals with these methods will leave Christians with difficult questions.
In chapter three on abortion, Meilaender does not use proof passages as evidence that life begins at conception. Instead, he points out that Scripture ascribes value to fetal life and that Christians have a God “who does not value achievement more than potential, who cares even for the weakest and least developed among us.” (35). Even more important, Christians can look to the incarnation to find in Christ a God who has lived and redeemed the entirety of human life from beginning to end. “He has been with us in the darkness of the womb as he will be in the darkness of the tomb.” (35).
With this understanding of human life, Christians will reject the “personhood” arguments for abortion (to be protected, living beings should meet specific criteria: consciousness, self-awareness, and ability to feel pain). Instead, Christians understand that the only qualification for membership in the human community is to be begotten of human parents. Thus, even a fetus, the weakest and least among us, is one of us.
Meilaender also pokes holes in the “privacy” arguments for abortion (a woman can do with her body as she wishes and, therefore, can get an abortion if she wishes). Meilaender invites readers to consider the implications of such arguments. Can the bond between mother and child be reduced to social contract theory? Do we only “have obligations to others if we consent to them?” (41) Once again, if we believe that a fetus is one of us, the worth of that child is not dependent on whether we want that child.
Curiously, while Meilaender advocates against abortion on these grounds, he leaves the door open in exceptional cases such as rape and incest: “Even though the fetus is, of course, formally innocent, its continued existence within the woman may constitute for her an embodiment of the original attack upon her person” (42). Meilaender does not explain his stance beyond this.
In his chapters on end-of-life issues, Meilaender points out that the modern world heavily emphasizes independence and autonomy. However, our desire to live as autonomous, self-creators is starkly opposed by the limits imposed on us by death and suffering. Thus, the greatest fear for many is the idea of suffering or dying “without dignity,” incontinent or confused, and in the care of others.
While Christians may also fear suffering or dying in “undignified” ways, Meilander reminds Christians that God has defeated sickness and death. Strangely, God chooses to defeat suffering through suffering: “God defeats and destroys the negative powers of sickness and death, but he does it by claiming even that realms his own—by entering it and bearing it to its own logical end. The perfection and power of God are displayed in the acceptance of neediness, dependence, and even suffering” (152). Suffering is not a problem God takes away or “solves.” Instead, God himself lives that problem for us and bears it with us. Jesus becomes both our model and our hope: “Jesus in Gethsemane—who shrinks from the suffering to come but accepts it as part of his calling and obedience—should be our model here. The suffering that comes is an evil, but the God who in Jesus has not abandoned us in that suffering can bring good from it for us as for Jesus.” (78).
This understanding of suffering and death gives Christians a different perspective of life than the world around them. Medicine is not how we achieve ultimate health; it is a tool to help soothe sufferers. Sickness, suffering, and death will be evils that plague our lives, but they are not the greatest evil. “That would be to lose God, to have reason to doubt his faithfulness to us” (152).
Such a view will also affect how we plan for the end of life. In his chapter on advance directives, Meilaender advises us to avoid holding on to our independence. Rather than using a living will to try and control our futures, extending “our autonomy in a future time when we will no longer be autonomous” (101), Meliander suggests we affirm our dependence by appointing a power of attorney. While we may feel like this approach would burden our loved ones, Meilaender reminds us that this is, after all, what family is for. “To burden one another is, in large measure, what it means to belong to a family—and to the new family into which we are brought in baptism. Families would not have the significance they do for us if they did not, in fact, give us claim upon each other” (103, 104).
Finally, perhaps the most unnerving chapter of the book is Meilaender’s dive into organ donation in chapter nine. Organ donation seems to be a universal good: using one’s death to prolong another’s life. However, Meilaender urges readers to consider what this process says about our bodies. Harvesting often requires organ procurement representatives to be present during the dying process and to access the body shortly after death. What does harvesting say about the relationship between who we are and our bodies? Are these organs (even our own) ours to give? Do the organ needs of others overrule a family’s need to mourn? Meilaender warns, “What we are in danger of losing here is a humane death” (108).
Bioethics: A Primer is impressive because of its brevity and depth. Meilaender writes clearly, and the chapters are easy to digest. As complicated as many topics are, this book will be accessible to many readers, even those without scientific or medical backgrounds. All this Meilaender does while maintaining a distinctly Christian message. Compared to the sterile and utilitarian world of scientific medicine, Meilaender repeatedly points readers to the hope and wholeness that Jesus offers, things that only God and not science can provide.
For these reasons, many readers will be able to benefit from Meilaender’s work: Pastors will find it helpful as a resource for personal study or to recommend to members. Interested lay people and students (medical, seminary, and undergraduate) will find the book an engaging and accessible introduction to the subject.
However, because Bioethics: A Primer is only 150 pages, the book does have limitations. The book is not a survey that explains and evaluates every perspective a Christian might have on a subject. Some Scripture knowledge and a general Christian ethic are assumed. Some might find the bibliography bare; others may wish there were more Scripture references and proof passages.
But for all that Meilaender’s book is not, it is important to remember what it is: “A Primer”; and for that purpose, it will serve its readers wonderfully well. For those looking to dip their toes into the deep waters of bioethics, Meilaender’s book will serve as a trustworthy guide.