Reading Camosy and Hamdy’s pieces together calls to mind Lisa Sowle Cahill’s critique of the prevailing narrative concerning religion and bioethics in the United States. The elements of the story are by now familiar: The progressive marginalization of religious thinkers and religious language, the wane of “medical ethics” and the birth of clinical bioethics, the triumph of principlism, and the elevation of patient autonomy to the near exclusion of all other moral values. The battle is often cast, especially by those for whom religion is the shunned hero, as a conflict between “thick” and “thin” moral geographies: a deep metaphysical account of human flourishing and a teleological view of nature and history versus agnosticism about the Good coupled with a self that is constituted entirely by the exercise of free choice and the maximization of rational self-interest.
For Cahill, however, this way of characterizing the troubled relationship between religion and bioethics in modernity ignores the fact that secular moralities rest just as heavily on assumptions concerning nature and the human as do religious moralities: “Science, economics, theology, and liberal democratic political norms all depend on analogous world views that define human nature, human meaning, human goods and goals, and the good society. All invoke symbols of ultimacy that capture the imagination, covert desires, direct practical reason, and motivate action.” “The real conflict [therefore] is not between ‘thin’ and ‘thick’ moral languages and views of the good, but between competing ‘thick’ worldviews and visions of ultimacy.”
The distinct contribution of religious communities
Religious traditions can and should provide resources for challenging the extremes of liberal individualism and exposing the religions of science and the market at work in constructing and mediating choices—all kinds of choices—about the development, use, and distribution of biotechnologies. As Charles Camosy notes, both Catholicism and Islam hold views of the meaning and significance of human procreation that suggest why treating decisions related to initiating or terminating a pregnancy as “just another consumer choice” is deeply troubling. Even if we acknowledge that views about sexuality, reproduction and the family are contested within those traditions—there is not unanimity, for example, on questions related to gender roles, same-sex relations or the morality of interventions such as contraception and assisted reproduction—the belief that bringing a child into the world, a being with inherent dignity, is a participation in some measure in divine creation stands as a powerful counter to temptations to objectify children or instrumentalize reproduction. Religious voices play an important role in calling out the often-intertwined logics of science and the market and their impact on patterns of access and exclusion.
But I agree with Cahill’s second point: rather than retrenching in the hope of finding some prophetic sweet spot in the bioethics public square, religious communities today should see their distinctive contribution in advocating for the poor, working for just access for the world’s people to the advances of science as well as basic human goods, and providing the means and the motivation to embody a preferential option for the poor in pragmatic solidarity. Both Catholicism and Islam have strong traditions of social ethics, with a core concern for the effects of poverty on human development and human dignity. Social justice commitments have long been enacted by religious communities in spiritual practices like the corporal works of mercy. The Catholic Church is one of the world’s largest providers of services to the poor (everything from medical care to food, education and shelter). But Sherine Hamdy rightly observes that bioethics, including most of what would be called theological bioethics, has paid scant attention to issues of social justice—questions such as unequal access to scientific advances, global marketing of pharmaceuticals and biotechnologies, local and global disparities in vulnerability to disease and untimely death, and the impact of environmental degradation on health and well-being—and even less to the far-reaching impact of economic and political decisions on health outcomes.
Bridging bioethics and social ethics
The interesting question is why bioethics so seldom talks with social ethics. One reason, as Hamdy’s example shows, is that despite a growing global consciousness, bioethics still takes the West and its clinics and bedsides as its point of departure. That locus defines not only what moral principles might come into play and how they might be weighed, but what counts as a moral issue in the first place. Until the range of voices informing debates in bioethics is expanded to include voices from the global South, we are unlikely to see genuine sustained attention to the pressing questions of public health and just access to medical care germane to resource-poor areas.
At least in the United States, Catholic bioethics has tended as well to focus on the same narrow set of “life” issues privileged by the Catholic bishops (abortion, contraception, embryo research and euthanasia). The result is that the Church’s message on social justice is often muted or drowned-out. Current debates over the Affordable Care Act illustrate this well. Because of the energy expended arguing over coverage for contraception, one hardly recalls the Catholic Bishops’ long-standing support for universal access to health care (or for that matter, the lived commitment to the poor represented in the care long provided by Catholic hospitals). There are also political dimensions. Although there is ample evidence of the serious effects of environmental toxins on fetal development and children’s health, toxins to which low-income families are more likely to be exposed, conservative religious leaders have often backed administrations with abysmal environmental records because of common cause on abortion.
We are unlikely to see the long-overdue conversation between bioethics and social ethics until we begin to acknowledge the costs of political choices and until the range of what counts as a “life issue” is expanded to include things like the effect of environmental policies on children’s health, the relationship between for-profit marketing and development of drugs and access to affordable treatment for AIDS, TB and malaria, and the role of poverty, gender-discrimination and violence in undermining the conditions for childbirth and child nurture for many women and children.
Finally, I suspect that bioethics seldom talks with social ethics because the latter requires a commitment to action for social change. If Cahill is right, religious communities are uniquely positioned to take on today’s urgent issues of global health because of their traditions of reflection on the nature of a just society, their symbolic and liturgical resources, and their global networks of hands-on service and advocacy. But genuine, pragmatic solidary requires sacrifice. Most of us will only seldom, if ever, find ourselves facing the moral decisions that are the stuff of quandary ethics. But we make choices everyday about how we will relate to the environment, how we will participate in the global markets, and which of our government’s policies we will endorse.