From the outset of this book, Lisa Sowle Cahill, professor of theology at Boston College, draws a clear distinction between theological and secular bioethics, but without ever clearly defining the distinctive nature of theological bioethics. Since she has a number of goals for theological bioethics, all of which should result in global justice, they may, in her mind, serve as definition enough. Rather than functioning on the margins, theological bioethics, in Cahill’s view, should be a robust participant in the national conversation, advocating certain common moral values in life and health that transcend particular cultures. From this position in the public square, theological bioethics would champion the preferential option for the poor, gender equity and wide-ranging social change. It would require active participation so that those involved could establish social solidarity sufficient to bring about a just balance in economic power.
By any measure, this is an ambitious agenda, which the author proposes across a broad spectrum of human life issues associated with birth and death, the availability of health care, biotechnology and genetics. In general, the same issues are found in secular bioethics. What is not found is the emphasis on political activism to get us from principles to practical policies. Nor do we find in secular bioethics the importance that Cahill’s theological bioethics would give to balancing local interests by means of some central oversight working for the common good. Unlike secular bioethics, which has always had a preference for individual rights and autonomy, theological bioethicsinfluenced by Christian social valueswould, in Cahill’s hands, favor social interdependence and social obligations.
Beyond that, Cahill sees theological bioethics as a means to influence those movements in civil society that might undermine liberal politics, science and capitalism. With a platform in real-world coalitions, theological bioethics would be able, like a prophet, to challenge what Cahill sees as the injustice consistently accompanying these three forces. In this way, it would empower their victims by giving them moral justification to resist.
In essence, this book shows an author impatient with the moral minimalism of secular bioethics co-opted by the status quo, usually reacting and rarely if ever leading. The time has come, according to Cahill, for an alternative ethic that originates in the Hebrew prophets and the New Testament, and that has been refined over the years, particularly in the social justice teaching of the Roman Catholic Church. What she is proposing is not entirely new, as she admits, acknowledging the work of individuals like the late Richard McCormick, S.J., and institutions like the Catholic Health Association.
Unfortunately, like their theological bioethics, Cahill’s has some serious weaknesses. It is presented here in largely descriptive terms. What is missing is a rigorous methodological demonstration of how one does theological bioethics. For example, how would Cahill use theological bioethics to assess the respective merits of medical, scientific, economic or statistical data as they might relate to the preferential option for the poor? When Cahill declares that pharmacogenomics, which studies how our genetic differences can trigger different responses to the same medication, is not needed to address the causes of most diseases among the poor, she provides no justification for discounting it. Of course it is true, as the author observes, that adequate food, clean water and basic health care would reduce maternal and infant mortality rates.
Since these are desirable outcomes, one would expect theological ethics to pursue themunless putting resources into pharmacogenomics means sacrificing efforts to provide basic health care. In that case, one would think her theological bioethics would require an assessment of their respective merits with regard to individual need and the common good. On the basis of that assessment, theological bioethics could then establish priorities and inform the allocation of resources according to the demands of social justice. Curiously, there is no evidence that Cahill has thought of proceeding in this manner.
In principle, I have no objection to the preferential option for the poor. It closely aligns with John Rawls’s theory of justice, which calls for the equal distribution of goods and services except when an unequal allocation would serve the common goodor at least be advantageous to those in greatest need. But Rawls has a principled justification for this unequal distribution. It is hard to find where Cahill presents a serious argument to justify on its internal merits the preferential option for the poor. Instead she seems to rely on her skepticism of clinical science, biotechnology and capital investment as sufficient warrant. Thus she acknowledges that genetic research, by providing a better understanding of the immune system, may address the diseases of the poor. But in her formulation of theological bioethics, there seems to be no way to evaluate the moral merit of genetics research to determine to what extent it ought to be pursued for the sake of the preferential option for the poor. She simply discounts such research.
In the face of the demonstrable limitations of secular bioethics, however, Cahill is to be commended for seeing the critical need for a theologically based bioethics. Her argument, in its substance and its scope, makes eminent sense. But until she takes it beyond the descriptive and anecdotal to formulate an analytic methodology that will enable a theologically based bioethics to engage clinical research, biotechnology and health care economics critically, theological bioethics will, unfortunately, remain marginalized.