The Foundations of Christian Bioethics
H. Tristram Engelhardt Jr., Swets & Zeitlinger, 2000, 440 pages, $39.95

Many years ago, I had my medical ethics students read Foundations of Bioethics (1986) by H. Tristram Engelhardt Jr., the renowned physician, philosopher, and ethicist. With unusual candor and clarity, Engelhardt explained that once we surrender premises drawn from nature or grace, the only remaining moral authority is procedural that is, an ethic of permission-giving among moral strangers who do not share a common moral vision. This earlier work can still be read as a forceful statement that anything is permissible if it conforms to the ethic of consent.

Since then, however, Engelhardt has converted to Antiochian Orthodox Christianity. As a result, in Foundations of Christian Bioethics he develops a quite different position. As a Christian speaking on moral theology rather than public policy, he now states that "everything is required; anything can be forgiven." From the perspective of "traditional Christianity"—by which he means the Orthodox theology of the first millennium A.D.—bioethics is not chiefly a matter of either medicine or justice. Rather, it is a spiritual ascesis by which agents and !patients prepare themselves for participation in the mystery of grace. Bioethics is a particular application of the universal principles that govern holiness. Such a view, Engelhardt says, "is one that few in the West have ever encountered, much less experienced."

Though the author is perhaps too eager to insist upon the strangeness of Orthodox theology and overly polemical in his estimation of the failure of the West to preserve Christian wisdom, there is much to be learned from this book.

The first three chapters form a picture of how ethics is situated in a post-Christian world. In the wake of popularized extreme Darwinism, bioethicists have had no way to assign compelling moral predicates to the facts of biological science, leaving subjective !consciousness as the only principle of authority. Obviously, this ideology can produce only a limited consensus—namely, a procedural ethic of permission-giving. This was Engelhardt’s own preconversion conclusion, and he still finds it reasonable so long as it is not confused with the cosmopolitan liberal ethic that insists the autonomous self is normative—and so long as it is not confused with Christian ethics.

Once this position is honestly understood, he argues, the public ethic should be libertarian. The libertarian does not attempt to remediate moral diversity by imposing a single ethic, but instead pays attention to the moral standards that groups of individuals have mutually agreed to. Though not itself a Christian ethic, the libertarian framework "makes space for such an ethic." Engelhardt argues that Christians can live with this framework.

The rest of Engelhardt’s book moves beyond public morality to moral theology. His main point is that Christian bioethicists have misunderstood the modern situation. In the past, Catholic theologians were able to presuppose a certain unity of perspective and content among the various sciences. It seemed normal for the theologian to try to harmonize theological findings and methods with those of the other disciplines. In the modern world, however, this unity has been abandoned. Rather than harmonizing faith and reason, moral theologians abandon theology on the altar of consensus.

The Christian thought of the first millennium was not warped by this false and useless ecumenism, because it never had to negotiate a moral consensus among Scholastic, Protestant, and Enlightenment thinkers. Its most distinctive characteristic was the central authority it ascribed to saints and mystics. This tradition, Engelhardt explains, "understands that to know truly is not a matter of discursive or scholastic reasoning, but of changing the knower and of being granted illumination by God." Not reason, not tradition, not Scripture, but direct experience of God is the proper foundation of Christian bioethics.

In the face of problematic issues such as abortion, contraception, in vitro fertilization, genetic engineering, and euthanasia, the Christian should not consult an academic textbook but rather seek spiritual direction from someone like Padre Pio—or, in Engelhardt’s case, St. John the Faster or the Elder Porphyrios. The mystic provides spiritual therapy, teaching us how to overcome temptation and passion in order to prepare for an experience of God. While he makes it clear that some actions are always contrary to the Christian life, he hastens to add that the nor!ms are "embedded in the pursuit of holiness, not constraints set by natural law in a structure of impersonal norms."

Notwithstanding his negative characterization of natural law, there is hardly as much difference as Engelhardt imagines between Catholic and Orthodox bioethics. It seems, rather, that Engelhardt wants all of the traction of divine law without embracing a community that is responsible for its interpretation and application. On most (but not all) controversial issues, Engelhardt’s position coincides with the Roman Catholic Church’s teaching. His exposition of the theology of the body and the mystery of marriage, for example, is in some respects strikingly similar to John Paul II’s early papal Angelus messages on those subjects.

The distinctly Orthodox emphasis that makes his book so interesting is Engelhardt’s articulation of the idea of direct illumination of the soul. He is correct, by and large, when he claims that contemporary Western moral theologians have not shown much interest in this idea. St. Thomas Aquinas’s belief that the intellect knows by virtue of a created rather than an increate (uncreated) light minimized explorations into Christian Platonism in the West. Though the Western tradition never intended to ignore the gift of direct illumination, it has sometimes fallen into a rationalism that is contemptuous of—or at least impatient with—direct experience of God and ascetical training of the intellect. In contrast, Platonists insist that human intellection depends primarily on increate light. The problem of moral knowledge is essentially therapeutic, a removal of impurities that cloud our direct experience of God.

Engelhardt’s work is essentially a return to Christian Platonism, which has an honorable history in both East and West. This tradition is not without blemishes, however. For example, !it has a tendency to conflate science and wisdom and to distinguish inadequately between the gifts of creation and those of grace. And there is no evidence that the Orthodox approach has any cura societatis (care of society) that would allow it to formulate social doctrine. The world outside the Church is left to fend for itself.

Even so, one cannot but admire The Foundations of Christian Bioethics for its brilliant theological insight, and most of all, for raising with a certain urgency issues that have been neglected by contemporary Catholic moral theologians for too long.