The Body of Compassion: Ethics, Medicine, and the Church

Christian Century, Nov 3, 1999 by Courtney S. Campbell

The Body of Compassion: Ethics, Medicine, and the Church. By Joel James Shuman. Westview, 216pp., $25.00.

JOEL JAMES SHUMAN'S boyhood hero was his grandfather, a hardworking farmer and woodsman from West Virginia who was 1 to his family, the land, his traditions and his church. Even leukemia did not change his work habits and life patterns. But a surgical intervention meant to arrest the cancer went poorly, and the grandfather died from subsequent complications, "alone in a hospital, hours from home, denied an active role in the last days of his life by a world that was almost completely foreign to him ..."

Shuman, an instructor in theological ethics at Duke University Divinity School, uses this narrative to unfold the major themes of The Body of Compassion. The isolation, passivity and alienation of his grandfather's experience of dying points to a moral crisis in contemporary biomedicine: its knowledge about the body has come at the expense of knowing and caring for patients as embodied persons. The modern discipline of bioethics, Schuman observes, would have offered little to address his grandfather's need for compassionate care. He criticizes bioethics as a pretentious academic specialization that rests on a mistaken view of ethics.

In his concluding chapters, in which Shuman moves from cultural critic to constructive theologian, he comments that "there was something missing" in the way survivors responded to his grandfather's death. This "something" has much to do with a Christian account of the body that has been buried by biomedicine and bioethics. What Shuman sees as the "tragic" elements of this death lead him to explore ways of being ill and caring for the ill that reflect and witness to the Christian story.

Shuman describes the church as a countercultural community and believes that not only modern culture but its expression in bioethics must be resisted and transformed by Christian practice. Unfortunately, his interpretation of bioethics is badly off the mark. He portrays bioethics' "dominant working assumption" as "helping professional caregivers make morally difficult decisions on behalf of their patients." Yet the history of bioethics is largely rooted in a rejection of paternalistic professional authority and in an attempt to empower the patient as a moral authority in the caregiving encounter.

Shuman's critique makes power the central category of bioethics. Bioethics takes the power to make decisions away from patients and their families and gives it to experts; indeed, "ethicists vie with physicians" for that power. Rather than seeing ethics in Aristotelian terms as discourse among friends about the good life, bioethicists, says Shuman, construct the moral world of medicine as a conflict of wills between strangers, focused on the opposition between expert control and self-determination. Despite bioethicists' pretensions to moral insight, their "`ethics' becomes simply another way of masking coercive power under the guise of knowledge." Yet Shuman never presents any convincing evidence to support his argument.

While it is fair to say that bioethics as a professional discipline does not embody the characteristics and traditions of the Christian community, it is certainly not the slave to modern scientific, political and economic thought that Shuman proposes. Insofar as he has made bioethics a pivotal term in his book and a pivotal culture for Christians to counter, his misdirected critique undermines the bioethical relevance of his theological understandings of modernity, the body and Christian life.

Shuman seeks to illustrate his self-described "polemic" against bioethics through short assessments of the scholarly work of influential ethicists. All of bioethics' expositors fail, in his view, because they uncritically accept the scientific, political and economic assumptions of the modern world. He seeks prophets to witness against modernity and instead finds in bioethicists opportunistic priests with hidden pretensions to kingship. An example of how Shuman's polemic has clouded his analysis is his repeated affirmation that contemporary ethicists not only aspire to replace physicians and patients as the key decision-makers but also hope to present their own decisions with the precision and objectivity that mark modern science.

Yet not one of his three short assessments supports such a conclusion; in fact, all of his exemplars acknowledge an Aristotelian and Thomistic modesty about ethics. Shuman particularly chastises two leading bioethicists, Tom Beauchamp and James Childress, for presuming that "there is nothing wrong with contemporary medical practice that rigorous ethical analysis cannot fix." He misreads the central thrust of the Beauchamp-Childress approach: that bioethics is more about trouble-making (for those in power) than trouble-shooting, more about problem-seeing than problem-solving.

According to Shuman, bioethics is a reflection of modernity, and modernity's essence is the "antagonistic juxtaposition of wills to power." Because modern science has rejected a teleological account of nature and of human life, it makes itself the ultimate savior, with medicine as the mediator. God, meanwhile, is increasingly irrelevant, relegated to those shrinking realms that have yet to become scientifically explicable. In the absence of a human telos, the individual claims moral sovereignty regarding his or her particular good.