Book Review — Bioethics from a Faith Perspective: Ethics in Health Care for the Twenty-First Century

July-August 2004

REVIEWED BY FR. JOSÉ I. LAVASTIDA STD

Jack Hanford
Haworth Pastoral Press, Binghamton, NY, 2002, 150 pp., $49.95

Some of today's most controversial topics — topics deeply affecting people's lives — are found in the field of bioethics. People constantly deal with life issues relating to the medical field and to very personal decisions they must make. This personal dimension guarantees that those involved will bring important faith perspectives to bioethical decision making. Jack Hanford's Bioethics from a Faith Perspective highlights the importance of this faith dimension vis-à-vis the consideration of crucial questions about bioethics and important human needs related to the medical field.

His book is organized into 12 chapters and a conclusion. Some chapters have conclusions of their own, whereas others address certain issues by raising questions and providing some of the answers. The whole first part of the book (the initial five chapters) is mainly a discussion of moral reasoning and how it is accomplished. Hanford discusses the different stages of moral development as outlined by such writers as Jean Piaget, Lawrence Kohlberg, and, mainly, James Fowler, with whom the author seems to agree the most. The thrust of Hanford's argument has to do with showing how faith, and specifically Christian faith, can have an impact on people's bioethical questions. The author believes that public religion should not just have a voice in bioethical issues; because public religion is well-equipped to offer solutions, it should, Hanford writes, have an expanded role in some of the medical problems facing humanity today. One such problem, highlighted in this book, is organ transplantation.

Chapters six through 10 offer some faith perspectives related to specific topics in bioethics, including transplants, mental health, managed care and justice issues, medical technology, and elderly care. The book's final two chapters offer a faith perspective for the work and ministry of pastors and nurses and how it contributes to effective practices in the medical field.

Hanford's book is intended mainly for people who are familiar with bioethical topics, especially people in the medical, educational, and pastoral fields. There is much to commend here. Hanford makes a very nice transition from his explanations related to faith development to the way that faith can influence bioethical decision making. He also makes a strong case for bringing religion and faith elements back into the "public square." Doing so, he writes, would be to the benefit of society in general and the medical field in particular.

Hanford does a good job in tapping into the most difficult subjects in today's bioethical landscape — for example, the Human Genome Project, genetics, health care reform, mental health issues, and end-of-life issues. He also includes a very interesting section on the elderly and aging, a subject not usually found in bioethical literature. In addressing these issues, Hanford writes in a way that constantly emphasizes the importance of the faith-filled perspective and how the influence of faith plays a role in the decisions we make.

One of the book's weaknesses is that its chapters tend to have different formats, which makes for labored reading. For instance, some chapters include a conclusion at the end, while others do not. The author also claims (on p. 119) that some chapters should be considered both summaries of the book and introductions to new material (p. 119), a sometimes confusing procedure.

There are also weaknesses related to Hanford's point-of-view. The whole first part of the book has to do with developing an argument concerning the importance of the faith perspective in bioethics. However, many of the chapters that follow say little about this faith perspective; at times it is touched on only in very brief questions. This tendency can be seen in chapter nine's conclusion, about technology (p. 83).

Sometimes Hanford addresses the issues from a perspective that seems more in tune with today's popular culture than with more developed and nuanced ethical thinking. An example of this is found in chapter four (p. 42), where he discusses an elderly man afflicted with Lou Gehrig's disease who, having decided to forgo technological means of dealing with his illness, is then injured in a car accident. Physicians diligently restore this person to health, employing aggressive medical means to do so. Hanford seems to say that, given the underlying disease, these means should not have been used. However, the accident changed the situation. The physicians addressed not the Lou Gehrig's disease but the consequences of the accident. Also confusing is Hanford's description (on p. 43) of medical ethics as "therapeutic" when, in fact, it is medical means that are therapeutic. The role of medical ethics is to discern which means are therapeutic and proportionate and which are not.

At other times, Hanford tends to take a rather minimalist approach to principles by highlighting just a few basic ones. This prevents him from acknowledging that certain issues he raises are principles themselves. For example, he describes "informed consent" as justified by the principle of "respect for persons," failing to see informed consent as a bioethical principle in and of itself.

The author's conclusion as to how faith contributes to effective practice in medical care (p. 125) is short and could have been more emphatic. His general conclusion is more of a summary of the book than a summary of why a faith perspective can add to bioethical decision making.

Overall, Hanford's work is very helpful in raising the important questions related to faith perspective decision making in regard to medical issues. The book also helps stimulate the reader's curiosity concerning this topic. It calls for a continued exploration of ways the faith perspective might be brought back into society's consciousness, not just for better decision making but in the interest of achieving a better society.

Fr. José I. Lavastida, STD
Notre Dame Seminary and Graduate School
New Orleans

 

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