Seeing the Big Picture of Bioethics

I like history, and so I don’t like bioethics. Why? Because I consider it to be a deceptive word used to make people feel good when they should be afraid. And because it took medical ethics out of its privileged position of being solely concerned with the only creature made in the image of God and secularized it.


John Patrick, MD

I like history, and so I don’t like bioethics. Why? Because I consider it to be a deceptive word used to make people feel good when they should be afraid. And because it took medical ethics out of its privileged position of being solely concerned with the only creature made in the image of God and secularized it.

When CMDA asked me to begin writing a regular column on bioethics, which could also involve input my colleagues and friends, I accepted the challenge. This column is therefore designed to lay a foundation for what I hope will ensue-a lot of reading and some worthwhile discussion in the hospital lounge or the office breakroom.

I began medical school in Britain in the late 1950s. At that time, there were no ethics lectures. This, I hasten to add, did not mean there was no unethical behavior; instead, it meant there was simply an expectation that we would become “gentlemen.” British hypocrisy! However, there was also a degree of realism about it. We are all enculturated into medicine; therefore, it changes us, because we cannot avoid being aware of what a great privilege it is to be a healthcare professional and to see both the pathos and the nobility that illness can draw out of ordinary people.

Interestingly enough it was not in medical school or university where I saw the most reliable (ethical) behavior, but it was much earlier in my life. I grew up in a blue-collar industrial community where doors were not locked, women were not afraid to walk down the street alone and divorce was exceedingly rare. It was a community because it had a shared story of how we should behave, which was not thought of as the consequence of history. Indeed, it was not thought about at all. It was simply who we were. Ethics were caught, not taught. The first of Wendell Berry’s Port William novels illustrates my point beautifully. The novel describes the lives of rural America 100 years ago when America was, in the words of Alexis de Tocqueville, “a country with the soul of a church.” The Bible made America.

Bioethics, on the other hand, was created (not maliciously) to push healthcare professionals out of discussions about ethics by professionalizing it, thus providing work and employment for philosophers. Programs were created that made some doctors into amateur ethicists taught by philosophers. Sadly, many of them have largely become the lapdogs of power used to legitimize bad behavior. Pace! I still trust a few of them, but when did you last say that a standard model hospital ethicist had made you wise?

Paul’s ethics, however, are interesting, and they are wise. His letters were largely written to deal with church misbehavior, and he thought the solution was a few pages of theology and a couple of sentences of “ethics,” usually something like “love your spouse and children,” “pay your workers promptly,” etc. It would be hard to put an ethics course together if that were the only content, but Paul was Jewish, so he knew that the Torah makes Jews and disobedience makes tragedy. Only if you are biblically literate and can remind your pupils of the reality of sin, righteousness and judgment with historical illustrations can you have ethics that make existential sense. The secular ethicist, who believes that Darwin got it right and that we are merely highly evolved animals, can’t do that. And the secular ethicist can’t answer the question, “Why should I obey pre-Darwinian norms?” Clearly this deserves an article in its own right. So, one of the future columns will be about why ethics lectures cannot make you ethical and what actually does make you ethical.

Nowadays, most Christians are not terribly good at defending their faith. We are on the defensive. The key to changing this is to learn the art of questioning. When confronted with behaviors the Bible condemns, we don’t need to blurt out, “That’s wrong!” Rather, we need to ask, “What are you presuming to get to that conclusion?” Jesus asked wonderful questions and answered questions with wonderful stories, which put the ball firmly in the opposition’s court. The best modern introduction to this art form I know of is Peter Kreeft’s books of dialogues, especially The Best Things in Life and A Refutation of Moral Relativism. Raising questions and pointing out the best answers will be a motif of this regular column in CMDA Today. I intend to introduce you to many of my friends and colleagues by asking them to contribute columns that include their best questions.

History matters. The history of how science shook off the shackles of Aristotelian science also played a role in how we in the Anglosphere developed a significantly different approach to ethics from that of the Europeans. Thus, one of the columns will be “1277 and all that,” which will lead us to Merton College Oxford and William of Ockham, and thence via Paris and via René Descartes and via Francis Bacon to the scientific explosion of the 17th century, where science took over the word “fact” for what it does and moral facts became personal opinions. These changes are not unrelated to the reformation and the religious thought of Johannes von Helmont and Robert Boyle. Science was not at war with faith, but rather it was dependent on what faith had produced, and in the intoxication of its success, it forgot its parents. Modern science is necessarily reductionistic. I believe that is the right way to do science, but it is not the right way to do life. Once one sees this, it becomes much easier to challenge the modern world.

In the 17th century, most major scientists accepted the Christian position that we were created by God. The humanities, which really took off with the so-called renaissance, were stimulated by the rediscovery of classical art and literature. With the French philosophes of the 18th century, the humanities became dismissive of the faith of ordinary people. What happened? What were the differences between them that led to a hugely successful science and the rest of the university now mired in multiple studies programs which have spawned all the “isms?” There is no agreement among academicians, but some facts are undeniable. For science, systematic experimentation and the consequences of the printing press are certainly major factors. Centuries of trying to work from first premises had not achieved anything like the new obsession with measurement. Quantification replaced the ancient world of qualities, and the scientific world flourished. But “physics-envy” programs in the social sciences lost their roots in the real scholarship of philosophy, theology, languages and history.

Only with a big picture can we see why autonomy, justice, beneficence and non-maleficence must be placed in context and their hierarchy understood. In my view, God’s gift of the Torah is essentially based on a clear account of what God will not tolerate. This can be extended to doing good, which makes justice authoritative, and which makes freedom the power to do what we ought, not the license to do what we want.

About the Author
John Patrick, MD, studied medicine at Kings College, London and St. George’s Hospital, London in the United Kingdom. He has held appointments in Britain, the West Indies and Canada. At the University of Ottawa, Dr. Patrick was Associate Professor in Clinical Nutrition in the Department of Biochemistry and Pediatrics for 20 years. Today he speaks to Christian and secular groups around the world, communicating effectively on medical ethics, culture, public policy and the integration of faith and science.