Life's Living Toward Dying: A Theological and Medical-Ethical Study

Christian Century, Feb 5, 1997 by M. Therese Lysaught

By Vigen Guroian. Eerdmans, 108 pp., $12.00 paperback.

WHEN THEOLOGIANS speak about bioethics they often do so incognito, abandoning theological concepts and language. This pair of volumes both exemplifies and offers a remedy to this problem, and raises the important issue of method in theological bioethics.

Gilbert Meilaender critiques the dominant methodologies of contemporary bioethics, saying it has lost both "the soul and the body." It lost the soul as it became increasingly focused on the task of shaping public policy. Preoccupied with this task, bioethics has devolved into minimalist, procedural ethics, and does not probe "the most fundamental questions about who we are and what we should be" or consider the "alternative imaginations provided by religious vision."

Bioethics also has lost a sense of "the moral significance of our bodies." Meilaender traces this loss to a notion of "personhood" that is defined exclusively by rational autonomy. He explores this development through wide-ranging commentary on such key bioethical issues as living wills, abortion, reproductive technologies, embryo research and the use of fetal tissue.

To correct the situation, Meilaender offers two correlative methodologies. To recover the soul, he calls on bioethicists to retrieve "specification," a method he attributes to Paul Ramsey. "Specification" is a process of "qualitatively tailoring our norms to cases," of "qualifying our commitments in such a way that, if they conflict, at least one of them is made more specific." It is a method whereby particular situations lead us to reflect more deeply on the meanings of our norms.

To recover the body, Meilaender suggests that we need to "recapture the connection between our person and the natural trajectory of bodily life." This trajectory comprises both the "natural history" shared by all bodies--beginning with conception and continuing through decline, disability and death--and each individual's personal journey.

While many of Meilaender's observations are not novel, they are valid, and his rhetoric is often engaging. Three shortcomings, however, ought to be noted. Given his initial claim that he writes "as a theological ethicist, not a bioethicist," one would expect his methodological correctives to be identifiably theological. But the book offers neither theological critique nor theologically informed alternatives. Also, he doesn't develop his constructive alternative or his method of "specification." Finally, his notion of the "natural trajectory of the body" (a position most similar to that of Leon Kass) does not challenge the preoccupation with "personhood" in bioethics, and it is open to the kinds of critiques leveled at other natural-law methodologies.

What is the relationship, for example, between "sin" and this natural trajectory? Is there not, in physical decline and disability--conditions that Meilaender wants to value--also an evil to be fought? Ought not a theological construal of the body contain some referent to or ground in theological concepts--God, the divine image, Christ's crucified and resurrected body, and Christ's Body, the Church?

Although Vigen Guroian does not explicitly attend to methodological issues, his book provides a much more compelling example of how to do bioethics theologically. Continuing his work in liturgy and ethics, Guroian demonstrates how the Christian tradition--richly embodied in liturgical worship--provides a cogent alternative to the contemporary "culture of death" prophetically depicted in Walker Percy's Thanatos Syndrome and exemplified in the words and deeds of Jack Kevorkian.

Through an engaging (although at times too brief) analysis of literature and contemporary culture, Guroian traces the dynamics of our simultaneous aversion to and obsession with death. He then explores the complex interrelationship between love and death. Guroian provides an alternative to contemporary approaches in his accounts of the "Christian Vision of Death" and the "Christian Ethics of Caring for the Dying", which draw on the Byzantine and Armenian Orthodox rites of burial, holy unction, communion of the sick and penance.

In his sustained theological analysis, Guroian traces both the contemporary problems and the effect of the bitter reality of death on fundamental Christian convictions. For example, he sees in Kevorkian's views "the corruption of two [interrelated] truths of biblical faith concerning God and human existence": 1) that death is a great evil because it negates God's gift of life to a creature created in God's image and destined for immortality, and 2) that God gave humanity free will and relative autonomy. These truths have been severed from each other and from their theological and biblical contexts. Each is now elevated "to the status of absolute axiomatic principle": death has become the summum malum and human autonomy has become absolute.

Death is bitter because it is parasitic on love: "Love creates communion and produces joy," and death destroys this communion. But this is so because humans are made in the image of God: "We reflect the triune identity of God and realize the fullness of our own identity only in loving relationships with others. When death destroys those relationships, we are diminished."