REVIEWED BY MARK REPENSHEK, PhD
Theological Bioethics: Participation, Justice, and Change
By Lisa Sowle Cahill
Georgetown University Press, Washington, DC, 2005, 310 pp., $26.95 paper, $44.95 cloth
In this book, Lisa Sowle Cahill, PhD, professor of theology at Boston College, offers a work that aims to liberate theological bioethics from the confines imposed on it by public policy discourse. She argues that people in the theological bioethics field must not only reinvigorate their use of justice claims as their point of entry into bioethics discourse; they also "must go beyond decrying injustice" to truly participate, in a critical manner, in bioethics discourse that ultimately works for change.
Her book is significant in that it allows theological bioethics to utilize a rich tradition of casuistry, virtue, and social ethics — circumscribed by Catholic social teaching — to buttress the argument that individual decision making must not be dislodged from the social context in which those decisions are made. If realized, theological bioethics in this context will, for Cahill, "nourish hope that change for the better is possible."
Cahill devotes a substantial portion of her work to constructing a participatory theological bioethics (i.e., a theological framework that creates a link between normative theory and social change) through the lens of distributive justice, social solidarity, and a "preferential option for the poor." By doing so, she aims not to analyze bioethical issues, but, rather, to use this framework to offer a critique of the social construct that allows injustice in these areas to occur in the first place. Cahill challenges a major cause of injustice, namely a hyper-emphasis on autonomy and individual freedom, which she sees as the cornerstone of Western bioethics. Cahill finds inadequate the idea that participation in medicine rests solely on the principle of informed consent. She doesn,t believe that eliciting such consent exhausts medicine,s moral obligations to the individual patient. For Cahill, theological bioethics includes paying attention to the social context in which care is offered — asking, for example: Who has access to such care? Is the community well served by the goods sought in medicine? Are there systemic barriers to the recognition of the basic human dignity of all?
Faithful to her claim that individual bioethical decisions cannot be separated from social ethics, Cahill examines five particular areas:
- Death and decline
- National health care access and reform
- International health care access and reform
- Reproduction and early life
- Biotechnology, genes, and justice
For each topic, Cahill discusses the contributions that participatory theological ethics could make to this discussion.
In her theological bioethical examination of death and decline, Cahill moves the discussion beyond the traditional principles. Instead of asking whether an individual has certain obligations to particular medical technologies, she asks how the universal phenomenon death is experienced in various cultures. She notes that, in certain cultures, the chronically or terminally ill live fulfilling lives fully integrated in their communities, even when in the midst of the dying process. This fact leads Cahill to argue the need for community and social services for the ill and dying equal to the emphasis placed on advancing technology at the end of life.
In examining access to health care (at both the national and international levels) from a theological bioethical perspective, Cahill relies heavily on the principles of solidarity and the preferential option for the poor. Utilizing these principles of Catholic social teaching, she offers a critical overview of the U.S. health care system, highlighting the endemic injustice resulting from a system that rations care by exclusion. On the international plane, Cahill is encouraged by the growing awareness that AIDS is a problem of poverty and sexism. She is also encouraged by the ability of different faith traditions to work together to combat the disease,s effects.
In her chapter on reproduction and early life, Cahill moves beyond an examination of individual procreative liberty to address matters related to the systemic devaluing of human life — that is, societal contexts that lack support for family, birth, life, and women. Cahill is highly critical of the fact that bioethics has essentially neglected the question whether reproductive technology serves the common good or is simply the blind promotion of technological advances to "remedy" infertility. On the matter of reproductive ethics, she offers an approach, grounded in participatory theological bioethics, that calls for a reexamination of the question of regulation of the industry and alternatives to direct abortion.
In her chapter on biotechnology, genes, and justice, Cahill goes beyond a moral evaluation of gene-based interventions in and of themselves by discussing the social context in which the interventions arise. Cahill eloquently demonstrates the strength of participatory theological bioethics, at least insofar as such an ethics challenges a market structure that supports investment in the most profitable applications of genomic invention to the potential exclusion of investment in efforts to insure the uninsured or ameliorate the suffering of those most vulnerable. Furthermore, she argues that a theological bioethics grounded in the principles of solidarity and charity must constantly raise the question of just access to genomic means of treatment or cure.
Finally, Cahill reflects on the "distinctively religious voice" of theological bioethics, encouraging its practitioners to use this voice and perspective when engaged in public bioethics debates. In conclusion, she writes that by harnessing the shared visions of religious traditions, on one hand, and communities of meaning and value, on the other, a participatory theological bioethics can be brought to life, a bioethics truly concerned about health care justice.
Theological Bioethics is, in part, a thorough examination of the implications of a participatory theological perspective in public bioethics debates. However, it is also, in this reviewer,s opinion, a profound reminder of what can be when the rich tradition of Catholic social teaching is brought to bear on some of the issues in bioethics, guided by a masterful and faithful moral theologian.
Mark Repenshek, PhD
Health Care Ethicist
Columbia St. Mary,s Health System
Copyright © 2007 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.