Should Bioethics Become Less Religious?

The following post comes from a paper I wrote for a Spring Bioethics class. I figured the material in it would be interesting and relevant enough to be featured here. Enjoy!    -Taylor

Introduction

In Genesis 2:7, Adam is given life when God breathes into his nostrils. Taking inspiration from this and other passages, some interpreters of Jewish law hold that death occurs only at the moment when breathing stops. Consequently, organ donation can be a touchy subject among certain Jewish communities in cases where breathing continues with the aid of a ventilator even after brain function has ceased. Israel currently has one of the lowest rates of organ donation among developed nations, with a waiting list for kidney transplants that has increased by 40% over the last ten years since laws were enacted limiting the circumstances for donation.[1] Religious belief is in conflict with what medical science has to say about death, as well as with the ethics of refusing organ transplants to those who might die without them.

The focus of bioethics is on how ethical theory ought to inform decisions in medicine.[2] Of significant concern to bioethicists like Gregory Pence is a question such as, “What makes an act right?” Numerous avenues for consideration are available to those who might ask about the rightness of denying organ transplants on religious grounds, or of letting any religious belief inform any medical decision. Beneficence may motivate us to emphasize the medical well-being of a patient, yet respect for autonomy may involve concession to other aspects of a patient's well-being, including their religious views. This picture becomes all the more complicated when religiously-oriented cultural values are permitted to affect the health and well-being of those who may not share such values.

A line must be drawn somewhere, it seems, and recently one bioethicist has suggested that line be drawn at religion itself. It's one thing to show respect for people of different beliefs, but quite another thing to give preferential treatment to their beliefs in medicine. Religion must be 'exorcised' from bioethics, according to this argument, where it currently holds a privileged status it ought not hold, and with it gone the field will be better able to take an unbiased look at health and human welfare. It is my contention, however, that the case for this irreligious bioethics rests on problematic assumptions about religion, ethics, and science. I begin with a discussion of the argument, followed by some considerations in support of it, and end with objections.

Irreligious Bioethics

In his paper, “In Defense of Irreligious Bioethics,” Timothy Murphy argues that the discipline of bioethics should strive to separate itself from, and even offer critiques of, religious views.[3] The article is largely a reaction to arguments like those advanced by Renee Fox and Judith Swazey, who contend that the modern bioethical paradigm, structured as it is on predominantly Western notions of individualism and individual rights, is incompatible with the religiously-grounded traditions and worldviews of many non-Western cultures.[4] In seeming agreement, Murphy proposes that religion be jettisoned from bioethical theory and practice. Though respect is to be shown to those of different beliefs, and understanding the influence of religion upon one's culture is to be regarded as important, all religions, Murphy recommends, must be treated “with a hermeneutic of suspicion.” Such an approach will allegedly offer benefits not afforded by a secular or religious bioethics, including primarily a greater promise of objectivity.

Following on from Fox and Swazey, Murphy defines religion as a focus on “basic and transcendental aspects of the human condition, and enduring problems of meaning, to questions about human origins, identity; the 'whys' of pain and suffering, injustice and evil; the mysteries of life and death; and the wonders and enigmas of hope and endurance, compassion and caring, forgiveness and love.” Against this broad definition, he defines irreligion as “a lack of religious belief or being at variance with religious principles.” The crucial distinction here seems to be that bioethics ought to consider cultural backgrounds, even be able to learn from religion, but what it adopts cannot be adopted on theological grounds, it can only be adopted based on separate moral or logical reasoning. The advantage conferred in doing this, Murphy claims, is that it offers bioethics “a detached vantage point” from which to observe and judge religion in concert with concerns about welfare or medical technologies, for example. One is free to ask a question like 'Does belief in God undermine efforts to protect people from harm?' in a way that religious bioethics presumably cannot ask without falling into bias.

As an illustration of irreligious bioethics in practice, Murphy discusses intercessory prayer. Why don't those praying for others prioritize their prayers according to things like contributory negligence? Why not pray for everyone everywhere, instead of praying as if only certain conditions or certain individual people can be effectively helped by prayer? Why even think God responds to prayer as though the ones not prayed for will be neglected? Murphy cites studies by Herbert Benson and Leanne Roberts casting doubt on the effectiveness of intercessory prayer, leading up to his conclusion that bioethics has no good reason to affirm the value of prayer, and so must proceed irreligiously, framing its concepts and designs without reference to it.

Where religion seems to most conflict with bioethics is, in Murphy's view, that it relies on assumptions that are “unfalsifiable, infinitely mutable in the face of objections, rooted in personal experiences that defy independent analysis, or rooted in the murk of human history.” Just as metallurgy is able to do its work without invoking divinities, deities, revelation, miracles, or theological accounts of human lives, bioethics should be able to proceed without capitulating to religious views, perhaps even be better off. By seeing the immanent world as the only world, Murphy thinks irreligious bioethics can better concentrate on the work to be done here and now.

Imagine No Religion

Something can be said for the incompatibility of the modern bioethical paradigm with religious traditions. Howard Brody and Arlene Macdonald note that contemporary bioethics operates under a rational secular mode of thought, which they connect with John Rawls and liberal philosophical tradition. “To produce an ideally fair outcome,” they explain, “Rawls envisioned a group of choosers who were rational, mutually disinterested, and concerned to advance the interests of themselves and those they cared about most.”[5] On this approach, the public sphere came to embody things like government and public institutions, while religion, family, and voluntary associations were relegated to the private sphere. In the interest of creating a just and orderly society with the greatest amount of assent, comprehensive doctrines are excluded from the public square. Yet these doctrines contain fundamental teachings about virtues and principles that do not always coincide with the kind of individualistic, rational, or secularist values at the forefront of the paradigm on which modern bioethics is based. As Brody and Macdonald note, this favored approach has come under “increasing criticism” in recent years, not just from religious believers, but from feminist circles as well.

Is this really reason to jettison religion from the fold, though? In fact, there is some research to suggest that religious skeptics perform better on analytical tasks than religious believers. Pennycook et al. assigned syllogisms to a group of 91 psychology undergrad students and measured for their ability to determine the validity of a syllogism, as well as their own assessment of the believability of the concluding statements.[6] Even after controlling for variables like sex, socioeconomic status, age, education, and so on, the study found a negative relation between analytic thinking and religious belief. This seems to be part of what Murphy has in mind when he recommends irreligious bioethics as a means of “getting past biases implicit in religious views.” An ability to recognize and correctly evaluate the logic of religious assumptions is indeed important for ethics and for medicine, arguably for religion itself, and this ability being associated more strongly with religious skepticism is a point in favor of a skeptical approach to religion in bioethics.

What about moral reasoning? One's ability with logical syllogisms could have nothing to do with their abilities in forming moral judgments. However, two studies published by Jennifer Wright and Ryan Nichols show that religiosity does influence moral judgments, particularly when it comes to appraising the motivations and moral character of non-believers. Between the two studies, over 500 participants were presented with cases varying in terms of religiosity, action valence (moral/immoral), and action duration. Participants evaluated scenarios where the same action was performed, albeit with variation in whether the agent involved was described as Christian or atheist. Wright and Nichols conclude their paper with a summary of the general opinion found among the religious believers in their studies: “atheists are not only people who feel less bad about their immoral actions, but they are also people from whom immoral behaviors should be expected, given their beliefs and their shared community values.”[7] If we are concerning ourselves with questions about religion's potential interference with ethical choices and medical decisions – the questions Dr. Murphy wants us to ask – studies like these seem to call for more than a cursory glance at the arguments for irreligious bioethics.

Objections

It's one thing to note the flaws in human judgment or the biases behind certain ways of thought, and it's quite another thing to propose that these are best resolved by weeding out the influence of religion, as if treating a disease. Exactly how Murphy's bold new vision for bioethics should be applied is a question left largely unanswered, but it raises important concerns, such as how far is too far. How sure can Murphy be that his own solution is not just exchanging one set of doctrines for another? In response, Jennifer Miller observes that we often tend to be overconfident in assessing our own objectivity and abilities, a point amusingly illustrated by reference to polls revealing that 93% of American drivers and 69% of Swedish drivers consider themselves better at driving than the average motorist, despite this being statistically impossible.[8] Indeed, whatever studies may say about the rationality or morality of non-believers, confirmation bias and cognitive dissonance are known to affect us all, regardless of where we align ourselves socially.

In his paper, Murphy concedes, “we all belong somewhere on the continuum of ideology, but,” he continues, “some people are more prone to ideological excess than others, and religious believers can be vulnerable in this regard.” Evidence of this special vulnerability is not provided, yet one still wonders why bioethics specifically should be tasked with the responsibility of stamping out religious explanations. If it's a case against faith Murphy is seeking, analytic philosophy in general has a long and rich history of challenging the claims of religion. William Stempsey, Professor of Philosophy at the College of the Holy Cross, goes so far as to argue that, “bioethics too often takes philosophy so superficially as to fall into outright error, as when autonomy, understood as the freedom to follow one's own desires, is attributed to Immanuel Kant.”[9] If the worry is that bioethics is especially susceptible to poorly reasoned views when under the influence of religion, one can respond, as Miller does, that the interdisciplinary nature of the field – drawing on law, history, psychology, economics, utilitarianism, deontology, and a range of other methodologies – serves as an effective safeguard against any sort of widespread 'corruption.' In fact, a compelling argument can be made that it is this very openness of the discipline that gives it the strength and relevance it has.

There is no “view from nowhere,” as Thomas Nagel once explained. In ethics, as in most of philosophy, one often comes to accept different starting points, priors, or principles that involve as much debate and defense as any application of any one of them may involve. Irreligious bioethics seems to have in mind a way that bioethics should do its normative work, and though the ideas are not made explicit, they are nevertheless open to dispute. Bioethics is not like metallurgy like Murphy supposes; it can be and ought to be informed by science where appropriate, but the ethics component of it distinguishes it in a vital sense. We don't distinguish metallurgy from 'irreligious metallurgy,' because the concepts of metallurgy come from a naturalistic methodology available to the religious and non-religious alike. If there is a distinction between forms of bioethics, it serves to distinguish the field from sciences like metallurgy, and in some important ways.[10] Murphy's example of intercessory prayer is instructive here, for not only do the arguments against its efficacy stem largely from that naturalistic methodology, which has long been part of the sciences, but anything that might be further drawn out of such studies, like whether it's permissible for a nurse to pray for their patient, would simply be outside the realm of empirical science. Normative judgments are not discernible through the scientific method alone.

What is so problematic for bioethics if room is left for theologians to offer their own views on certain bioethical matters? In fact, a number of theologians have critiqued prayer studies like those mentioned by Murphy for failing to understand the purpose of prayer, a point that can just as effectively be used to discourage prayer from being implemented as any sort of clinical medical treatment in place of other, far more effectual treatments.[11] In an ironic twist, then, religion can be useful in countering certain strains of religious reasoning that threaten to encroach upon the territory of bioethics. Why not make use of arguments and ideas from wherever we can? Bioethics itself has religious roots in many of its foundational figures, including Beauchamp and Childress, who articulated the four principles of autonomy, justice, beneficence, and non-maleficence. Religious traditions can and do offer ethical ideas that can be accepted on secular grounds, such as Catholicism and natural law, Judaism and Noahide law, or even the Golden Rule, found among innumerable religious and philosophical teachings. Of course, Murphy says he is not opposed to allowing bioethics to “cannibalize” ideas from pretty much anywhere it can, so long as they can be accepted on non-theological grounds, but this already seems to be how the discipline operates. Irreligious bioethics would seem to prematurely shut the door on anything that even resembles religious thought, when some of their views and arguments could prove quite helpful in doing some of the work that Murphy wants to see done in bioethics, like overcoming archaic notions of health and healing, and moving towards a more robust understanding of medicine. Excluding religion from the playing field will only create division where it need not exist, and may actually evoke a kind of change that not even Murphy wants to see.

Conclusion

Would the situation for organ donations be better in Israel if physicians and bioethicists across the country decided to abandon religious considerations in one fell swoop? It's difficult to imagine how this could be. Even if all medical practitioners complied, a lot of religious patients would suddenly find themselves with fewer options, some probably, to their minds, with no options at all. Although lives would likely be saved, they could well come at a cost. When stark lines are drawn and people feel they are no longer being listened to on matters that concern their well-being and their very deepest convictions, they are often influenced into taking highly polarized sides, and the outcome can indeed be toxic, as may be best illustrated in the controversies and crimes that have occurred over the issue of abortion.

That religion creates problems is something that few religious believers would deny, but to ignore the resolutions it can also inspire is to be guilty of the same biased thinking that irreligious bioethics is supposed to reduce. While organ donation is low in Israel, and the kidney waiting list is long, the circumstances have motivated many in the Jewish community in Israel to step up and promote transplants from living donors, leading to a two-thirds increase in donor registrations, a record number of kidney transplants in 2013, and a large drop in the number of patients going abroad for donations. Perhaps just as importantly, the debate over this issue has presented the opportunity for many Israelis to reassess their own beliefs and reconsider what their religion teaches about life, death, and our ethical obligations to one another. Changes like these seem unlikely to develop on a view like Murphy's, where religion is actively expelled from the public square.

Exactly where the boundaries should be between religion and bioethics is a matter of no small contention. Yet just as we can talk about harms without having an absolute and agreed upon definition of concepts like health and well-being, it seems to me we can discuss and evaluate approaches to doing bioethics without having an absolute and agreed upon notion of the purpose of bioethics, or an all-encompassing idea of the proper roles for certain phenomena within bioethics. As a paradigm, irreligious bioethics would filter out a great deal of things from which the field could stand to gain. Many ethical systems are premised on metaphysical claims at the higher, ontological levels, and Murphy's anti-transcendentalist approach would seem to undermine these. In addition, the paradigm holds itself to a standard that even it arguably cannot meet, claiming to offer criticism of religious views when analytic philosophy is better equipped, and claiming to 'protect' bioethics when the discipline of ethics seems entirely capable of thorough self-examination. Indeed, it appears that quite a leap of faith is required to believe that irreligious bioethics could do anything besides further exacerbate the tensions and problems already present in bioethics.

Citations

1. Kevin Sack, “A Clash of Religion and Bioethics Complicates Organ Donation in Israel,” The New York Times (Aug 17, 2014). Available at: http://www.nytimes.com/2014/08/17/world/middleeast/a-clash-of-religion-and-bioethics-complicates-organ-donation-in-israel.html

2. Gregory Pence, Medical Ethics: Accounts of Groundbreaking Cases, 6^th ed. (2011), p. 339.

3. Timothy Murphy, “In Defense of Irreligious Bioethics,” The American Journal of Bioethics, vol. 12, no. 12 (December 2012): 3-10.

4. Renee Fox and Judith Swazey, “Ignoring the Social and Cultural Context of Bioethics is Unacceptable,” Cambridge Quarterly of Healthcare Ethics, vol. 19, no. 3 (2010): 278-282.

5. Howard Brody and Arlene Macdonald, “Religion and bioethics: toward an expanded understanding,” Theoretical Medicine and Bioethics, vol. 34, no. 2 (2013): 133-145.

6. Gordon Pennycook, James Allan Cheyne, Derek J. Koehler and Jonathan A. Fuggelsang, “Belief bias during reasoning among religious believers and skeptics,” Psychonomic Bulletin & Review, vol. 20, no. 4 (2013): 806-811.

7. Jennifer Wright and Ryan Nichols, “The Social Cost of Atheism: How Perceived Religiosity Influences Moral Appraisal,” Journal of Cognition and Culture, 14 (2014): 93-115.

8. Jennifer Miller, “Irreligious Bioethics, Nonsense on Stilts?” The American Journal of Bioethics, vol. 12, no. 12 (December 2012): 15-17.

9. William E. Stempsey, “Bioethics Needs Religion,” The American Journal of Bioethics, vol. 12, no. 12 (December 2012): 17-18.

10. D. Gareth Jones and Maja Whitaker, “Reorienting Bioethics by Releasing It From Any Religious Moorings,” The American Journal of Bioethics, vol. 12, no. 12 (December 2012): 24-26.

11. Audrey Chapman, “In Defense of the Role of a Religiously Informed Bioethics,” The American Journal of Bioethics, vol. 12, no. 12 (December 2012): 26-28.