Anti-Religious Bias in Medical Ethics

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English: Medicine

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A few of my medical ethics students (not by any means the majority) object to my including such a large component of religious ethics in my teaching. Such an attitude is not surprising–it is another instance of religion’s increasing exclusion from public life and debate (Fr. Richard John Neuhaus‘ “naked public square,” but it is nevertheless disturbing. The founders of the great Hippocratic tradition of medicine (and ethics) were Pythagoreans, and their thought cannot be understood apart from Pythagorean mysticism. Roman Catholic scholars were producing texts in medical ethics as early as the seventeenth century, and taught medical ethics as a university course long before the contemporary bioethics revolution began in 1966. Roman Catholic concepts such as the principle of double effect and the ordinary-extraordinary care distinction have become a part of the ethical vocabulary in medicine.

In addition, Protestant scholars, such as Paul Ramsey and James Gustafson, have made important contributions to medical ethics. Jewish scholars, such as Hans Jonas and Leon Kass, have also contributed to the field, with Professor Kass serving as the chairman of the President’s Council on Bioethics during the Bush administration. Muslim scholars are beginning to be published in both mainstream medical and in medical ethics journals. At a practical level, understanding diverse religions is important for any health care provider.

The terms of the debates over key bioethical issues such as abortion and euthanasia cannot be adequately understood without understanding the religious arguments involved in these debates. I am not denying the possibility of a consistent secular ethics; I am saying that, as a matter of fact, de-emphasizing the religious aspect of medical ethics is irresponsible, period, and would be more irresponsible for me from a scholarly/teaching point of view.

What is more disturbing than students’ attitudes, which may be as much due to lack of exposure to alternative views (especially for those students who are “rabidly secular”), is the increasing exclusion of religious points of view from medical ethical debates. This exclusion is not absolute; journals such as the Hastings Center Report occasionally publish articles from a religious perspective, as do some other journals in medical ethics, but this is becoming increasingly rare. The false Enlightenment assumption that religion is only a private, subjective matter is part of the problem. Such a view reveals utter ignorance of the function of religion in personal behavior and in society. As one of my teachers at UGA once said, “I would never be such a damned fool as to claim that religion is only a private matter.” He was a liberal Protestant and not a raging Fundamentalist, but he understood the function of religion to be inherently social. He also understood that religions make claims about reality, and such claims can be broadly tested against human experience in general, although there will always be an element of faith and of mystery in religion.

Increasingly, I find a small group of students who could be called “misotheists”–they hate God or at least the notion that any Creator exists. Since these are mostly science students, I would guess they were encouraged to believe such things by some of their science teachers, as well as by the strict methodological atheism of modern and contemporary science. Far too many science teachers make sweeping metaphysical claims regarding religion being a superstition and claim that such a view is “scientific.” Of course this is really the philosophy of “scientism,” the view that science can explain all reality and that any reality claims that go beyond a mythical “scientific method” are, by their very nature, not part of reality. Such a view needs to be justified by argumentation, but neither the scientists who accept scientism nor students are willing to present arguments–their hostility to religion is palpable. Other students (and atheists and agnostics in general) are angry ex-religious people who have rebelled against, perhaps, a harsh religious background (or maybe they just want to get laid and don’t want any religion to get in their way). Since misotheism is, like scientism, an emotionally-based position, there is no rational way to get most people who hold such views to think them through.

I admit I’m frustrated. It is becoming increasingly difficult to be a religious believer who teaches in a college or university. They follow the logic of the eighteenth century Enlightenment, adopting not only its positive side (toleration for different points of view) but also its negative side (the total secularization of the academy). Even in religious schools, the logic of the Enlightenment leads many faculty be be atheists or agnostics and to minimize the role of religion in public life. It is sad that this attitude has spread to future health care providers.

Dr. Richard Nilges: A Tireless Advocate of Truth

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Dr. Richard Nilges, neurologist and long-time critic of brain death criteria for human death, died last month after a long, productive life. I never met him in person, but via e-mail and telephone–the first time was in 1996. I was interested in editing a book of essays opposing brain death criteria. Never having edited a book before, I asked both Dr. Paul Byrne, a neonatologist and the dean of opponents of brain death criteria, and Dr. Nilges to help, and both graciously agreed. Dr. Nilges wrote a chapter for the book, which was published in 2000 as Beyond Brain Death: The Case Against Brain-Based Criteria for Human Death (Kluwer [now distributed by Springer-Verlag]). Dr. Nilges’ chapter, “Organ Transplantation, Brain Death, and the Slippery Slope: A Neurosurgeon’s Perspective,” was the most passionate chapter in the book, reflecting a lifetime of difficult battles against the medical establishment. He retired early after serving as an Attending Staff Member in Neurosurgery at Swedish Covenant Hospital, Chicago. His conscience would no longer allow him to declare patients dead using brain=based criteria. For many years after his retirement, Dr. Nilges, writing with Paul Byrne and others (such as Dr. David W. Evans and David Hill in the U.K.), spoke out against brain death criteria when medical and scholarly opponents of brain-based criteria for death were scarce (the late Professor Hans Jonas of the New School for Social Research was an exception). During the 1970s and 1980s, Dr. Nilges’ position was considered to be a fringe position by the medical and medical ethics establishments. But the work of Dr. Nilges and other pioneering opponents of brain death criteria eventually bore fruit. Professor Stuart Youngner began to hack at the medical arguments in favor of brain death criteria, bringing out arguments concerning continuing brain function in patients declared “bran dead” which Byrne and Nilges had noted years before. The real breakthrough came with Dr. Alan Shewmon, a pediatric neurologist at the UCLA School of Medicine, came out in opposition to brain death criteria. Eventually an entire network of physicians, philosophers, sociologists, and other scholars came to oppose brain death criteria; many questioned the morality of the current system of organ transplantation. If brain death is not death, then removing vital organs from the “brain dead” patient involves killing the patient. Not all opponents of brain death criteria oppose organ transplantation–Dr. Truog does not–but even Dr. Truog believes that people contemplating signing a donor card and families considering donation ought to be told that organ transplantation from a beating heart “brain-dead” donor kills the donor.

Now articles opposing brain death criteria have been published in major medical and bioethics journals. Some younger scholars are writing against brain death criteria, such as Professor Scott Henderson in his Death and Donation (Wipf and Stock, 2011). Thus there is a third generation of scholars willing to oppose the medical establisment’s continued support of brain death criteria. This would not have been possible without the pioneering and courageous work of the first generation opponents, including Dr. Richard Nilges. His legacy and influence will live on in the patients he helped over the years and in the scholars he inspired to have the courage to question what they may have previously taken for granted.

Dr. Nilges was a devout Roman Catholic whose faith was central to his life. Requiescat in pace.