Respect for Autonomy and the Living Human Document

The focus of this chapter is on respect for autonomy. Part one begins by providing an overview of the principle and then reviews a classic case in bioethics (the case of Karen Ann Quinlan). Part two moves to a discussion of Anton Boisen’s pastoral image of the living human document. The essential feature of this image is that it provides a theological rationale for studying human experience. In part three, respect for autonomy is correlated with the living human document by focusing on the novel A Monster Calls, using Sigmund Freud’s theory of dreams to interpret a key scene from the story. The central claim of this chapter is that a pastoral perspective on respect for autonomy can shift the focus away from respecting choices to appreciating individuals and that this shift facilitates the potential to improve caregiving.

Justice and the Living Human Web

This chapter focuses on justice. Part one begins with a discussion of how justice is articulated in Principles of Biomedical Ethics. This is followed by two classic cases concerning justice: the Seattle Dialysis Committee and the Tuskegee Syphilis Study. The former deals primarily with clinical ethics, and the latter with research ethics. Together they illustrate how justice is often understood in bioethics. Part two focuses on Bonnie Miller-McLemore’s pastoral image of the living human web. The essential features of this image include the following claims: (i) human suffering needs to be understood in context; (ii) psychology, while valuable and necessary, cannot by itself make sense of the whole of individual human experience; and (iii) other perspectives and disciplines, therefore, are needed, such as sociology, anthropology, philosophy, economics, and more. Part three correlates justice and the living human web.

Introduction: Bioethics and Theology

This chapter reviews the role of religion in bioethics and proposes a new way forward, which, in terms of methodology, will be outlined in chapter 1. What this books adds—how it is different from most accounts of theological bioethics—is that this is a work of what the author calls pastoral aesthetics. Specifically, the distinguishing feature of this book is its employment of pastoral theology (via a distinct interdisciplinary method of correlation) in bioethics. The chapter begins with a review of how bioethics has been defined and then makes an argument for the reintroduction of religion to the field. The author uses Gilbert Meilaender’s Bioethics: A Primer for Christians as an example of religion’s role in bioethics and juxtaposes Meilaender’s view with those of feminist theological ethicists Beverly Harrison and Shirley Cloyes. Finally, the author outlines the structure of the book, which aligns with the four principles in Tom Beauchamp and James Childress’s Principles of Biomedical Ethics.

Beneficence and the Diagnostician

The focus of this chapter is on beneficence. Part one begins by providing an overview of the principle and then offer two classic cases in bioethics that illustrate how it is often understood. One deals with the first heart transplant, and the other deals with smoking cessation. Part two moves to a discussion of Paul Pruyser’s pastoral image of the diagnostician to open up another way of looking at beneficence. In part three, the author correlates beneficence with the diagnostician. The previous chapter engaged pathographies as a means of offering experiential inquiry. This chapter does so by focusing on a pastoral conversation with a medical resident in the author’s care. The chapter concludes, as previous chapters, by emphasizing how pastoral aesthetics raises different moral concerns not usually considered by principlism. The argument is that a pastoral perspective on beneficence emphasizes existential well-being.

Epilogue

This chapter offers a reflection on Van Gogh’s Ward in the Hospital in Arles, painted in 1889, noting that religion in the painting is significant but subtle. Likewise, the chapter argues, as in Ward in the Hospital in Arles, religion should play a significant but subtle role in bioethics. The author uses the painting to advocate for a particular method rather than specific content. That is, the book’s conclusions are less important than the process itself. Also, it emphasizes perspectives more than principles, aesthetics more than ethics. The chapter summarizes the author’s particular approach as well as the book’s central claims, with a nod to the role of pluralism and spirituality in modern-day bioethics.

Nonmaleficence and the Circus Clown

The focus of this chapter is on nonmaleficence. Part one begins by providing an overview of the principle and then reviews a classic case in bioethics on abortion to illustrate how the principle is often understood. The discussion also draws on poetry to intimate that moral issues beyond decision-making are relevant to abortion. Part two offers a discussion of Heije Faber’s pastoral image of the circus clown to set the stage for opening up another way of looking at nonmaleficence. The essential feature of Faber’s image for the purposes of this chapter is that it provides a theological rationale for appreciating humor in the hospital. In part three, the author correlates nonmaleficence and the circus clown by using an essay by Sigmund Freud on humor to interpret select passages from scenes from two pathographies. The chapter argues that a pastoral perspective on nonmaleficence can help to mitigate harm stemming from idolatry.

Principlist Bioethics and Pastoral Theology

This chapter begins with a discussion of principlism, focusing on its limits, thereby providing an opening for pastoral theology to contribute to bioethics. It then discusses several definitions of pastoral theology, giving special attention to various ways theology and psychology may be related in pastoral theology. A specific vision of pastoral theology is offered (Robert Dykstra’s view of pastoral theology as aesthetic imagination) as well as a means of positioning bioethics and pastoral theology (Paul Tillich’s method of correlation, informed by art theory). The discussion focuses on the theories of pastoral theologian Donald Capps and art theorist Rudolf Arnheim. The chapter closes with a discussion of images and ethics.