Book Reviewed
by Sherman Hope, MD
Health-Care Ethics: A Comprehensive Christian Resource
James R. Thobaben, InterVarsity Press, 2009.
Dr. Thobaben sets the tone of his book in the introduction: “The first task of Christian bioethics is not to enter into extensive ethical discussions with those of the world, but to determine from within the Christian community what relationships define, which virtues inform, and what principles guide any moral analysis” (18). He seems to contend that only the evangelical interpretation of the Bible can serve as a basis of ethics, even in health care.
The author contends that most evangelicals learn their ideas by the analogical method. This means that they read a Bible passage and apply it to contemporary situations. Thus he claims that “Christians acknowledge the final inadequacy of moral constructs based on anything but Jesus Christ” (21).
Chapters 1-3 are devoted to a theological, philosophical, and historical explanation of the assertions stated in the introduction. The tone of the book is carried forward with statements such as, “Learning from and cooperation with those of the world is limited by the foundational claims of the gospel” (29).
Section 2 is composed of 14 chapters, each dealing with a specific topic in bioethics. Each chapter begins with a scripture reading, followed by a discussion of what the author thinks that scripture means. This is followed by a discussion of how this scripture should apply in bioethics and finally how it should apply in the world in general.
Chapter 4 discusses suffering (including diseases) and states: “[S] uffering, including that which is primarily physical, in one way or another is an expression of the fallen-ness of humanity. . . .”(91).
Chapters 5 and 6 emphasize recognizing all beings as individuals, not as groups such as embryos, disabled, terminally ill, etc. Chapter 7 stresses the role of the patient to the caregiver, and Chapter 8 expands this to the family and even society while, Chapter 9 and 10 delineate the ideals of a “Christian” caregiver.
This is expanded to the institutions of health care providers in Chapter 11—“Christians should recognize the need to develop and maintain health-care institutions” (237). Chapter 12 discusses the political question of health care being a right. The author states: “There is no clear biblical requirement to support a positive right to health care. There is, likewise, no clear biblical argument against such an entitlement” (251). Chapter 13 discusses public health issues such as smoking, obesity, AIDS, birth control, and public education on health issues.
This same chapter gets to some of the more day-by-day problems in today’s practice of medicine. Dr. Thobaben states, “The choice to kill oneself or to facilitate such remains immoral today, though immoral in varying degrees” (296). He discusses medical documents (the Living Will, etc.) that the medical profession uses to render medical care in serious and often terminal diseases, but then goes on to state, “The right to die— an absurd concept as no one needs such a right nor can it be denied as death comes to all—is equated with liberty by those who mistakenly promote the Western notion of hyperindividualism” (310). This leads to his assertion that there is never a justifiable suicide (or its cousin, euthanasia), and rarely a justifiable decision to terminate life support, or even the option not to do everything to keep a body alive regardless of the condition, cost, or desires of the person or family.
Reproduction and Sexuality (Chapter 14) has the author expressing abhorrence to abortion but admits “arguments against abortion are not based on specific exegetical work on biblical passages about abortion because there really are not any” (328). He adds, “evangelicals should oppose all abortions except those that are necessary to save the life of the mother” (334). Chapter 15 discusses genetic modification in plants, animals, an humans, and the author warns of the dangers in each field. “Altering nature is acceptable to Christians, but only within constraints of reasonable environmental evaluation. Altering human nature is not acceptable, but genetic change for disease control is” (373). Even a rough definition of what is disease and what is human nature is not given.
Organs and blood donation for research or treatment is discussed in Chapter 16, and Dr. Thobaben states that such donations of these are “near sacramental” (381).
The final chapter (17) discusses death in a theological manner emphasizing an eternal life for the worthy, i.e. the followers of Christ.
Conclusion: This book is a good resource to reinforce philosophical arguments for the ethics which are promoted by a select group of Christians, which he identifies with and refers to as “Evangelicals.” The author seems to consider all other ethical thought and action as inferior, and only something to be tolerated. This book touches on many, but not nearly all of the medical ethical issues faced by the current practice of medicine in today’s real world. To serve as a practical resource for physician, medical institutions, the legal system, and the public, this reviewer believes that the book is too steeped in taking just one viewpoint on ethics, and it is too theoretical and vague about many specific medical ethical problems.
