Wonderfully Made, Terribly Fallen: A Framework for Bioethics
The contemporary world of medicine and biotechnology has brought incredible gains to the human race. Through these advances, people who a century ago would have died are today alive. An infertile couple can share in the biblical mandate to "be fruitful and increase in number" (Gen. 1:28). A dying patient can experience less pain and suffering. In a tragic accident, organs can be transplanted to a person in need. A person with neurological and nerve impairment can have functions restored. Thus, we can view medicine and biotechnology as a gift of God's common grace for which we give thanks.
At the very same time, these gifts raise some of the most difficult ethical questions humanity faces in the 21st century. Medical/technological breakthroughs mean that we have unprecedented potential control over life and death. Humans in the modern (and postmodern) world have fixated on control over the forces of nature, including one's personal life, destiny and offspring.
Leon Kass, a former chair of the President's Commission on Bioethics, notes that the new technologies tend to blind us to the negative side of their utopian dreams. "Nearly all are wedded to the modern technological project; all march eagerly to the drums of progress and fly proudly the banner of modern science; all sing loudly the Baconian anthem, 'Conquer nature, relieve man's estate.'"
As a result, we now have the capacity to terminate a life when pain becomes burdensome or one's life is no longer deemed "worth living." We can control life at its beginning, determining whether an embryo will live when it seems inconvenient or unplanned. We can control, to some degree, the outcome of our offspring by selecting embryos that fit with a preconceived desire or predetermined medical need. We can transplant an organ from a dying patient to a needy patient, but can, in the absence of guidelines, also hasten death to procure the organ. And invariably, we face the challenge of who gets the organs when there are not nearly enough available. We are on the verge of being able to transplant a chip into the human brain that will allow a quadriplegic some movement and bodily control. But with the technology, we face the prospect of actually changing human nature as we now know it.
With unprecedented control over life and death, we need an ethical framework to guide us and bring wisdom to these complex issues. That is a great challenge in a secular, pluralistic culture where there are few agreements on moral frameworks and assumptions. But as Christians, we bring some significant paradigms, principles and virtues to the bioethics discussion. Above all, we bring a broad basic framework from the biblical story, namely, that we are wonderfully made, but terribly fallen. This is not the whole of a Christian contribution to bioethical discussions, but it is an essential paradigm that contributes much. Moreover, it is framework that can, in part, be understood by even a secularist.
In the biblical story, humans are made as a special creation, set apart from the rest of the created world. The Genesis account of creation provides two fundamental understandings that are essential to bioethics: the goodness of creation, and humans formed in the image of God. The physical and biological world is a good creation of our Maker. After each day of creation in the Genesis narrative, God proclaims the material creation to be good. After creating humans in his image, there is the grand summary, "God saw everything that he had made, and indeed, it was very good" (Gen. 1:31). Though the world is now fallen in every facet, there is still an essential goodness to the world that God has made and continues to sustain.
The goodness of the physical/biological world means that Christians can work with this world to meet human need. The cultural mandate to have dominion over the world (Gen.1:28) and "take care of it" (Gen. 2:15) is a mandate to work with God's creation as trustees or stewards. Thus, Christians need not hesitate to enter the world of medicine and biotechnology in which we develop mechanisms of care and healing from God's created world. Understanding and caring for God's world can, of course, be misused, especially when we venture from stewardship to self-centered control over his creation. But the goodness of creation and the related cultural mandate are invitations to work with the biological world for the glory of God and the good of humanity. As the Psalmist put it, "What are mere mortals that you are mindful of them, human beings that you care for them? You have made them a little lower than the heavenly beings and crowned them with glory and honor. You have made them rulers over the works of your hands, and put everything under their feet" (8:4-6).
A second essential understanding from creation is that humans are made in the image of God. Biblical scholars and theologians have long debated the meaning of the imago dei, but clearly, in part, it means that humans are set apart in a special way from the rest of creation, and thus are endowed with dignity and intrinsic worth. While Christ is the ultimate image of God (Col. 1:15; 2 Cor. 4:4), and believers are made anew in the likeness of Christ, there is a creational image that extends to all humanity. Thus, James could appeal to the imago dei and its implied dignity in discussing the misuse of the tongue to slander a person: "With it we bless the Lord and Father, with it we curse those who are made in the likeness of God" (3:9).
We understand that "human dignity... is not tied to a claim that human beings are divine or inherently worthy apart from God, nor is it a function of human autonomy independent of God whereby people assume the authority to declare their own worth. Instead, human dignity is grounded in humanity's unique connection with God, by God's own creative initiative."
The intrinsic dignity of human beings is a major principle for bioethics. From conception to the grave, a human being should be treated with a value that is not dependent on physical or cognitive capacity. Today, there is a tendency in our culture to replace intrinsic dignity with functional dignity, meaning that a person's worth depends on the degree of functionality with which he or she can perform, or a value that is determined by others. This easily leads to treating persons as things rather than as precious beings made in God's image. Thus, the call for physician assisted suicide (i.e. a form of euthanasia) is typically rooted in a functional dignity determined by a person's own sense of worth, or the value others place upon her. The drive to clone a human being overlooks the inherent dignity of the human person in its attempt to duplicate a living being for the value it might bring to science. The same can be said for cloning to produce embryonic stem cells, or cloning to bring a child into the world totally outside of the loving intimacy of husband and wife.
While the new reproductive technologies have the potential to address the anguishing infertility of a couple, some of these technologies have the capacity to turn reproduction into manufacturing. Christians can judiciously utilize many of these technologies, but great care should be given to preserve the dignity of our offspring in the way they are utilized. Similarly, the gift of cadaver organs for transplants is a marvelous way to extend the life of another, even in the midst of tragic loss. But in deciding who gets the organs amid excessive shortages, we must ensure fairness and justice, protecting the dignity of every human being. Thus, organs should never be distributed on the basis of social status.
Humans are wonderfully made. Their dignity and worth should be preserved in every facet of medicine and biotechnology.
The Christian worldview not only posits a good creation with humans made in the image of God. It also portrays another side of human nature: We are terribly fallen. Though God gave humans the ability and task of caring for the world, we have frequently turned that stewardship into a pillaging of the earth, acts of injustice for our own self-centered gain, and, at times, even moral malice while seeking to do good. Thus, in bioethics we must constantly be aware of the human proclivity to distort God's designs and misuse his good natural resources and the artifacts and technologies made from them.
In Genesis 3, the story of the Fall depicts distortions in the multiple spheres of life: with God, self, others and nature. Thus, like Adam and Eve, we attempt to take life into our own hands on our own terms, and we deceive ourselves in the midst of our dominion and care for God's creation. Self- deception is one of the major marks of fallen humanity, and it can play a significant role in distortions in the moral life, including bioethics.
Several years ago while teaching in Kiev, Ukraine, I visited the Great War Museum. In one section of the museum depicting the atrocities of the Nazi regime throughout Europe, I noticed a glass case containing a rather strange-looking white glove. I asked the interpreter accompanying me to read the statement beside the case. He soberly read, "This glove was made from human flesh." Part of what makes this so heinous was the involvement and even leadership of leading scientists and doctors of that time. Men and women trained in the top medical and science schools of Europe acquiesced to unspeakable evil under the guise of science and medicine.
Being terribly fallen, we must be cautious even in the most laudable efforts to apply medicine and biotechnologies to the human race. As good gifts of God, they are a wonderful resource for therapy, healing and human good. But simultaneously, because the gifts and their "masters" are fallen, they can be used to defy God's designs for life, and deface the most precious of God's creation: Humans made in the image of God.
Wonderfully made, but terribly fallen. This paradigm does not solve all the ethical quandaries we face in the world of medicine and biotechnology. But it is a basic framework in which to carry out the related vocations, and through which we all will make some of the hardest decisions in life. No other worldview paints the human self in quite the same way as God's Word. Nevertheless, it is a paradigm that resonates with the way human beings universally experience life and the world. And it is a paradigm that can guide believers into the exciting new world of medicine and biotechnology with both hope and realism.
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