"The Future of Bioethics and Christianity", Echoes of Peace No.64

Katsuhiro Kohara

The emergence of bioethics as a discrete discipline can be dated to the early 1970s, when the term first came into general usage. In those early years, Christianity made a substantial contribution to the field through the work of such Christian bioethicists as Paul Ramsey and Stanley Hauerwas. Subsequently, however, bioethics parted company with Christianity and developed along secular lines, independent from any particular religious tradition. In this sense, secular bioethics can also be considered post-traditional bioethics. 
 Of course, even the Christian community has begun to acknowledge the fact that Western culture today is post-Christian culture. The traditional values of Christianity can no longer hope to enjoy the sort of monopoly they once did. This being the case, we need to ask ourselves the fundamental question of what sort of active role Christianity can play in the debate and resolution of contemporary bioethical issues.

Christian bioethics in a post-Christian era

It goes without saying that the diversification of values and morals in our society is being accompanied by the rise of secularism and religious pluralism. In the past, it would have been possible to trace a single moral order to the personal God of the Judeo-Christian tradition. However, in today's multireligious society, we can no longer presuppose such a concept of God. In short, in today's society no one religion can expect to win the support of an overwhelming majority for a single clear-cut value system.
 Further complicating the situation is the fact that the same sort of diversification of values has gone on within Christianity. A good illustration of this is the disunity among U.S. Christians on the issue of abortion. The tension between the religious right and others of the pro-life camp, who oppose abortion unconditionally on the grounds that a fetus is a person and the pro-choice camp, which stresses a woman's right to choose, is not simply a matter of varying religious beliefs but a source of serious political conflict.
 As the foregoing suggests, the problem today is not simply one of progressive secularization sweeping society as a whole. To the contrary, one characteristic of the age in which we live is the tendency toward religious resurgence and revival among some segments of society. By the same token, society's views with respect to life and its processes, far from converging around any particular belief system or philosophy, are increasingly diverging and clashing with one another, even within the Christian community. This means that a single, monolithic Christian system capable of providing unified standards in respect to bioethics is out of the question.
 Even so, it is fair to ask how we can define Christian bioethics without denying its internal diversity on the one hand or reducing it to secular bioethics on the other. In what respects can Christianity contribute to the discussion by challenging the assumptions of secular bioethics? In the following, I would like to attempt an answer to this question by examining varying types of responsibility.

Expanding self-determination

The idea of response is implicit in the word responsibility; that is to say, responsibility exists when one is answerable to others. We all generally agree that each person is responsible for the consequences of his or her action or inaction. In other words, individuals can be held responsible for things that are under their control, whereas they normally are not held responsible for events that are not, including past incidents in which they were not involved or accidents that they could not have foreseen. Thus, we can say that the general concept of responsibility is tacitly predicated on a cause-and-effect relationship between an act and an outcome.
 Following this general concept of responsibility, bioethics has generally required bioscience to take responsibility, as clearly as possible, for what it caused. A consequence of this effort has been the expansion of the right of self-determination. Under the principle of self-determination, the consequences of an action are traced, wherever possible, to the conscious choices and decisions of an actor. At the same time, the principle requires that we respect an individual's actions to the greatest extent possible providing that they do no injury to others, even if they cause harm to the actor.
 This is best illustrated with respect to the issues of euthanasia and death with dignity. The principle of self-determination puts an individual's life under his or her own control. In Japan, where the issue of brain death and organ transplants has been the subject of considerable controversy, the question of whether a person can be pronounced dead before the heart stops has been left to the individual. How one defines death is more a cultural than a medical issue, but in Japan organ transplants from brain-dead patients with beating hearts have been sanctioned since 1997 on the premise that an individual should have the right to decide whether he or she will be pronounced dead when the brain ceases to function. We can confidently predict that henceforth the principle of self-determination will play a central role in respect to the whole range of ethical issues occasioned by advanced medical technology.

Contingent responsibility

We can see that the concept of self-determination is very influential in bioscience and bioethics. Does the Christian concept of responsibility differ in some significant way from the concept that bioscience presupposes and asks the rest of society to subscribe to as well? Of course, Christian ethics and general ethics share many of the same themes and methodologies. If we are to show the world that Christian ethics has something to contribute, it will not be by demonstrating its remoteness from general ethics but by carefully explaining where and why Christian ethics, as an inevitable consequence of Christian doctrine, diverges from general ethics. In the process, we may also cast some doubt on today's ethical trends, including the expansion of the principle of self-determination.
 In fact, the Christian faith embraces a brand of responsibility that cannot be understood in terms of the principle of self-determination taken for granted in our society-that in fact could be thought of as standing at the opposite extreme from the principle of self-determination. This is a responsibility that arises by accident or chance. For the purposes of this paper, I would like to call it "contingent responsibility." Whereas the principle of self-determination limits an individual's responsibility to the consequences of his or her own actions, in keeping with the laws of cause and effect and the idea of just retribution, contingent responsibility is not bound by cause and effect. That is because, unlike responsibility rooted in self-determination, contingent responsibility concerns matters about which we have no choice. With the former concept, a main focus of debate has been whether a given outcome of an action was under the actor's control. With the latter, by contrast, the focus is on circumstances beyond the individual's control.
 Contingent responsibility is closely tied to the Christian experience, particularly the experience of being called to the ministry. Paul's experience of being called and his subsequent life as a missionary reveal with striking clarity how his sense of responsibility grew out of his experience of contingency-namely, the "accident" of being chosen, involuntarily, to do that which he could not have chosen to do himself. Indeed, through this contingent experience of God's grace, Paul immediately recognizes his responsibility as an apostle as something originating even before his birth: ". . . God, who had set me apart before I was born, and who called me by his grace, was pleased to reveal his Son to me, in order that I might proclaim him among the Gentiles" (Galatians 1:15-16). 

Beyond determinism

Within the history of Christian thought, the idea of contingent responsibility assumes its most radical form in John Calvin's doctrine of predestination. In the Institutes of the Christian Religion, Calvin wrote, "By predestination we mean the eternal decree of God, by which he determined with himself whatever he wished to happen with regard to every man. All are not created on equal terms, but some are preordained to eternal life, others to eternal damnation" (3.21.5; Henry Beveridge trans.). In short, God has foreordained whether each of us is to be granted eternal life or condemned to eternal damnation, and no one but God knows which lies in store for us. This doctrine of predestination invalidates the principle of self-determination, since it is impossible to improve one's chances of salvation by the conscious decisions one makes. It might be thought that an awareness of this fundamental contingency would render people apathetic and resigned, but paradoxically, it leads them to an awareness of their own responsibility to God. Max Weber attempted to explain this paradox in The Protestant Ethic and the Spirit of Capitalism. As he understood it, uncertainty and anxiety arising from this basic contingency promoted an active and rational asceticism, which led in turn to the development of capitalism.
 Interestingly, Calvin's insistence that "all are not created on equal terms" might strike a chord in the world of bioscience. The doctrine of predestination holds that it is fundamentally impossible for individuals to know what fate awaits them. Because this fundamental contingency is ensured, it gives rise, paradoxically, to an active sense of responsibility. In the not-so-distant future, bioscience, armed with extensive, in-depth knowledge of the human genome and with the ability to control it, might well generate a new kind of determinism, having proven at the level of molecular genetics that all human beings are not, in fact, "created on equal terms," even while robbing human destiny of the element of contingency. And lacking that element of uncertainty, such biological determinism could lead all too easily to apathy and irresponsibility. If the principle of self-determination is hastening the day when scientists, having decoded the entire human genome, can manipulate our genetic makeup at will, then surely there is a need to highlight the inherent limits and dangers of self-determination and to propose an alternative concept of responsibility. Indeed, this is among the most important tasks confronting Christian ethics today.

Katsuhiro Kohara is an associate professor of theology at Doshisha University, specializing in Christian thought and comparative religious ethics. He is also a pastor of the United Church of Christ in Japan. He is the author of Kami no Dramaturgie (Dramaturgy of God) and a coauthor of Kirisutokyo to gendai (Christianity and the Present Day).