REVIEWED BY FR. THOMAS KNOBLNCH, PhD
Health and Human Flourishing: Religion, Medicine, and Moral Anthropology
By Carol R. Taylor, Ph.D., and Robert Dell'Oro, eds.
Georgetown University Press
Washington, DC, 2006
292 pp., $29.95 (paperback)
The foundational premise of Health and Human Flourishing: Religion, Medicine, and Moral Anthropology is the need for a richer anthropological approach to the questions of contemporary bioethics than can be provided by the partial, incomplete, and impoverished views of the human person that primarily focus on issues of rationality and autonomy. Such a necessary critique of an overly Kantian anthropology is not new, of course, but the essays collected in this volume represent a deliberate attempt to sketch the outlines and aspects of a response. The book is not merely criticism of lacunae in mainstream bioethics; it is, rather, a contribution of some of the elements that would be used in constructing this richer understanding. Many of the essays go a step further, as well, grounding this richer alternative in relation to the human person's creation in the image of God — a theological anthropology that entails moral consequences for human life, medicine, and health care.
Health and Human Flourishing consists of 15 essays, many of them familiar voices in bioethical commentary from the perspective of faith. In addition to the editors, the contributors are Alisa Carse, William Desmond, Br. Daniel Sulmasy, Margaret Mohrmann, Suzanne Holland, S. Kay Toombs, Richard Zaner, M. Therese Lysaught, Christine Gudorf, Lisa Sowle Cahill, Ron Hamel, Kevin FitzGerald, and Edmund Pellegrino.
The book is divided into five sections. Part 1, "Questioning at the Boundary," raises the issues of vulnerability, human flourishing, freedom, truth, and "the patience of being" (Desmond). Part 2, "Dignity and Integrity," explores those frequently cited but elusive concepts, attempting to root them in philosophical categories, such as those intrinsic and inalienable for all human lives (Sulmasy); being true to form and its suggested themes of teleology and the unity of body and soul (Mohrmann); and phenomenological reflection on a personal experience of reconstructive surgery (Holland).
Toombs, Zaner, and Lysaught conduct excellent discussions of "Vulnerability" and its inherent moral dimensions in Part 3. As noted there, the realities of illness, loss, and attendant power imbalances can elicit either exploitation or compassionate responses of care and help. Themes of vulnerability are necessarily at the heart of health care (and other helping professions), as well as the experience of one's own embodiment and, at times, the intransigence of the body. This vulnerability does fit well in the Kantian ideal of self-determination. As Toombs notes, "In a culture that views health and happiness as a personal right, suffering is an affront" (p. 134). In such a culture, caregiving is seen as a kind of necessary evil dominated by themes of the care-receiver's guilt and the caregiver's resentment at having his or her own freedom interrupted, rather than by themes like humble acceptance, gratitude, trust, and compassion.
Part 4 addresses "Relationality." Gudorf adopts feminist critiques of the areas of sexuality and gender, the role of our sexual embodiment in forming fulfilling human relationships, and the conditioning of culture, social norms, and Catholic teaching on this complex human reality. Gudorf's critical and anti-essentialist stance almost ironically contrasts with Cahill's companion essay in this section, as the latter takes a broader look at the essentially relational, responsible, and thus moral constitution of the human person. Cahill intentionally grounds her argument in biblical sources, Catholic social teaching, and the lived experience of the global Catholic health care ministry, which makes actual and invaluable contributions to the common good. The Catholic health ministry is a lived and demonstrated witness to these themes in faith, since, as Cahill says, "it is not enough for theological bioethics to talk about responsible relationality, or to defend it from a theoretical perspective. . . . [Rather, Catholic theological bioethics is] validated in practice" (p. 220).
Part 5 moves into "Theological Anthropology and Practice." Taylor, Hamel, and FitzGerald reflect articulately on how the practice of health care, the formation of internal and external policies governing this practice, and the rapid growth of biotechnology and its possibilities for altering the human person and the human community through manipulations of the body can be enriched and guided by the fuller vision of what it means to be human sketched in these essays.
The reader would do well actually to begin the book with Pellegrino's concluding essay, "Toward a Richer Bioethics: A Conclusion." Pellegrino masterfully lays out what is at stake in contemporary social debates about health and human flourishing. He outlines three anthropologies that sometimes run parallel and sometimes clash as one wrestles with bioethical questions — questions the significance of which the human community has never had to face in all its long history. The spiritual, transcendent view persists in religious traditions, in which human life is created in the image of God, as gift. More modern is the anthropocentric, immanent view, in which persons are self-created and rely solely on their own powers of reason and will. Related to the anthropocentric view is a philosophical view that sees the weaknesses of the immanent view but cannot bring itself to embrace the transcendent view. Disaffection with modernity has focused attention in a third direction, towards the subjective, intuitive and psychodynamic aspects of lived human experience, though this too can be weakened by overemphasis on individual values, emotions, and preferences.
According to Pellegrino, this methodological split thus means that "bioethics in the twenty-first century tends to rely on the relativistic, pragmatic, and utilitarian criteria of moral truth" (p. 258), dominated by liberal individualism and postmodern skepticism about objective truth and moral norms. Pellegrino suggests that productive dialogue among these approaches, though obviously difficult, is not only possible but urgent, given the questions at stake.
We can, Pellegrino argues, acknowledge the aspects of the complex and rich truth about the human person that each of these methodologies brings to the dialogue, including voices of faith, and come to agreement on a set of moral norms that "are universally and self-evidently true" (p. 266). These norms are, admittedly, rooted in a natural-law approach that may be hard for some to accept, although it remains universally valid and accessible through reason that can be further enlightened by faith.
As in any such collection of essays, this volume is somewhat varied in its pace, tone, and engagement for different audiences. The writings of Dell'Oro, Sulmasy, and Mohrmann, for example, require a level of philosophical and theological sophistication and familiarity with the issues. The pieces by Holland, Toombs, and Zaner, while rich in their implications, read more like narrative than like pages from a textbook.
In general, this book will be most helpful for those who already have some awareness of the issues and themes in question; that is why Pellegrino's essay serves as a good introduction for the more casual reader. Those who would use this book as their first introduction to these complex but vital questions may miss much of the richness found here without some guidance or further commentary. Health and Human Flourishing represents one important voice in a current social conversation; to read it without being aware of the other voices would be like listening to only one party to a telephone conversation — the significance of the remarks for the fuller dialogue would be compromised.
Readers ought to also be aware that a variety of methodologies, presumptions, and commitments are employed, usually without explicit identification. Here, too, not only the contents but the approaches taken by different authors can be of pedagogical value, illustrating diverse methods of ethical analysis and argumentation, and the relative strengths and weaknesses of each as handled by a particular author. This reviewer, because of his fondness for Dietrich von Hildebrand, found the phenomenological discussions of Toombs and Zaner to be especially evocative. At the same time, the volume could be strengthened by more attention to the rich philosophical and theological heritage of Christian thought. This heritage has much insight to offer, as well as some correctives to lend to contemporary debate. Moreover, a fuller presentation of the consistency of these themes in moral anthropology across time, place, and culture may help to bolster their credibility in an atmosphere of postmodern pluralism.
Health and Human Flourishing represents a positive contribution towards validating voices of faith expressed through rational argumentation in the sphere of bioethics. It is a beginning, but hardly the last word. One hopes for more contributions along these vitally important lines, because, as Pellegrino trenchantly concludes:
In the twenty-first century, we seem certain to know much more about man as a biological being, but probably not much more about who, what, and why he is. But we cannot any longer, especially in bioethics, abandon the anthropological question as "utterly problematic." For better or worse, we have the power to alter our biological makeup in still unimagined ways. Without a clearer idea of what man is, we will enter and remain in a dark moral forest without a compass (p. 267).
Fr. Thomas Knoblach, Ph.D.
Consultant, Healthcare Ethics
Diocese of St. Cloud, MN