Bioethics and the Christian Life: A Guide to Making Difficult Decisions, David Vandrunen outlines a basic approach to approaching contemporary bioethical issues that will allow laymen and expert alike to make better-informed ethical decisions. This approach incorporates a rich grounding on theology and the virtues as a way to guide actions that are God honoring.
The book is organized in a very simple fashion (3 parts) that is localized around a central theme: life. Every ethical issue in this book deals with life--whether it's the beginning of life (part 2) or the end of life (part 3). David Vandrunen is clear in his introduction. When approaching ethical issues—ranging from, contraception to abortion or euthanasia—these issues should not be approached as a "stand-alone [dilemma] isolated […] from a person's broader moral life" (14). Vandrunen locates these ethical issues, correctly, in everyday life and in our character as people. "People facing difficult bioethical dilemmas," Vandrunen writes, "face them not as blank slates but as people with certain virtues and vices" (15).
The author's main goal in this book can be summarized as follows: To give Christians a foundation for making sound ethical decisions in the area of biomedical ethics that centers around the idea that we ought to approach dilemmas in the broader context of our moral lives as Christians and by fostering the proper theological outlook and virtues necessary for dealing with the dilemmas that people face in bioethics today.
With this in mind, Vandrunen turns to the first part of his book where he lays out the theological doctrines and virtues necessary to approach bioethical issues. In his first chapter, Vandrunen makes five distinctions or approaches about the way Christians go about doing bioethics.
The first approach is what he calls the secular approach only. This is basically the idea that Christians should do bioethics by avoiding any religious language and doing bioethics simply through "philosophical or pragmatic argumentation" (24). The next approach is on the other extreme and is the Christian bioethics only. All of bioethics, under this approach, is to be derived only from theological premises. So this can be by making arguments straight from scripture or from theological doctrines or concepts. The third approach is what Vandrunen calls "secular and Christian bioethics identical." This approach strikes a better balance between the two previous ones. It brings forth philosophical/theologically inclined premises that are "secular" enough to be made in the public square. Vandrunen gives an example of this with Catholics who argue from a natural law ethics perspective. Vandrunen remarks, "For such writers, Christianity and theological truth contribute little or nothing substantive to bioethics, but serve to reinforce and enrich natural law bioethics in various ways. The fourth approach is "Secular and Christian Bioethics Radically Different." Here the author notes how some writers argue that there cannot be any common ground between Christian bioethics and secular bioethics. The last approach is "Secular Bioethics and Christian Bioethics Distinct but Legitimate." It's this view that the author believes is the appropriate one for Christians to take since it emphasizes the idea that Christians ought to be involved in secular bioethics while also allowing their faith to influence their perspective and philosophy. This one seems to be the most balanced out of all the approaches and it appears to keep Christianity active in the role of influencing bioethical decisions.
Vandrunen makes it clear to his readers that he hails from the reformed tradition of Christianity. Regardless of one's theological commitments, Vandrunen is fair and clear in his presentation of the relevant theological doctrines to bioethics. There are four areas that the author deems crucial to cultivating a Christian perspective on bioethics: God's sovereignty, human nature, death and the resurrection, and suffering.
Why is God's sovereignty crucial to the Christian who wants to approach bioethics? For Vandrunen, in order to face dreadful circumstances such as terminal illness and anything else that could bring fear, hopelessness and anxiety, knowing that God is in control and benevolent is crucial in giving one hope and courage to face such situations.
The fact that we are made in the image of God plays another crucial role in bioethics. Many bioethical issues--stem cell research, abortion, euthanasia, etc.--are fought on this very battleground. Vandrunen puts it simply by noting that "bioethical issues […] are inseparable from our identity as social creatures" (49). Being a social creature, who is made up of body and soul, and who is "destined for life" are all the aspects Vandrunen takes to be a part of the idea that we are made in the image of God.
When facing life or death situations like terminal illness, there is another theological aspect that is just as important to this matter as God's sovereignty is. That issue is the death and resurrection of Christ. Simply put, because Christ has resurrected from the dead, Vandrunen points out that "death no longer confronts us as a sign of our condemnation," but we are given a hope in the fact that we, too, will be resurrected with Christ in the future (61). Death is not the end.
Lastly, the issue of suffering is also a crucial theological concept for Vandrunen because the reality of suffering is something we all must acknowledge when facing issues such as euthanasia. When someone is in excruciating pain, should the doctor try to alleviate the suffering by overdosing the patient on medication? For Vandrunen, suffering is an inevitable reality, but it's something that God gives people grace to endure, while allowing people to put their trust and hope in God's plan.
The discussion on the virtues centers around the theological virtues (faith, hope, and love), and secondary virtues of courage, contentment, and wisdom. Instead of going through each one, I'll briefly summarize the theological virtues. While having the right theological focus in mind, the next crucial puzzle piece to fit into a proper bioethical approach, according to Vandrunen, is the striving of the virtues, which he defines as a "character trait that orients or disposes a person to act in a good way" (69).
Faith is the most important virtue for Vandrunen since it's the source in which "all the other virtues and the actions that flow from them are the fruit of justifying faith" (71). The main aspect of faith is that it is a trust in God. It's trust in the character in God and the fact that God is faithful to keep all of His promises to those who believe. So when God promises that those that suffer will be rewarded, or that there is hope in Him, and that we can trust in eternal life, we can trust in God to bring these promises to pass and we can face bioethical issues from a better standpoint.
Hope is closely tied to faith as being its fruit (75). Through faith we trust God, and because of hope we can look to the future and trust in God's promises. Thus, Vandrunen explains that hope is eschatological in that we are "looking to the things of the world to come rather than to those of the present world" (76).
Lastly, love serves as the fruit of faith and hope, according to Vandrunen. The most crucial aspect of love, Vandrunen maintains, is that it is selfless. This selflessness is the basis of many right actions and is precisely why this virtue is important.
Having discussed the theological concepts and the virtues necessary to approach bioethics, Vandrunen has already accomplished half his goal. He now turns to applying it. Part 2, The Beginning of Life, commences with a discussion on marriage, procreation, and contraception. He introduces four purposes of marriage: the mutual help of husband and wife, procreation, bearing children who contribute, grow, and add to the church, and lastly to prevent uncleanliness in which male and female may express sexuality (98-99). Vandrunen also acknowledges the fact that there are some people who wish to remain unmarried, and he explores the biblical basis behind this idea. When discussing procreation, Vandrunen makes preliminary remarks that focuses on how many children a couple should have. Should they keep procreating endlessly? Is there a limit? Aren't we supposed to view children as a blessing? But aren't we also supposed to be wise stewards with what we have and not make any rash decisions? His simply answer to how many children a Christian couple should have is a simple "the question cannot be answered" since there is not straightforward answer in scripture. He does advise, however, that Christians seek wisdom and God when facing these questions.
A couple factors that he advises couple to take into consideration when answering these questions are financial situation, and the fact that to procreate is much more than a sexual act but is the responsibility to care, maintain, and protect the child as he/she grows. Vandrunen ends the chapter with a section on birth control in which he briefly address the natural law argument against contraception. He argues that there seems to be no "theoretical difference between artificial and natural means of attaining [the end of not having as many children]" (116). Some contraception is permissible as long as the couples have good reason for using it.
On the chapter about assisted reproduction, Vandrunen's primary focus is the way in which Christians respond to the matter of infertility by fostering the virtues of contentment, courage, and stewardship (120). According to Vandrunen, there are only two options for those who are struggling with infertility: adoption or have no children. With the virtue of courage, Vandrunen encourages Christians to not let fear keep them moving forward in life and facing the issue. Christians are also called to be content with circumstances because of the fact that God is sovereign and we need to accept that fact. Lastly, Vandrunen thinks Christians need to be good stewards when deciding to pursue infertility treatments. Some people spend thousands of dollars and go into debt trying to fix the problem. Instead, Christians should be wiser with their finances and pursue infertility treatment after careful planning. The remainder of the chapter is spent examining third party options and husband-wife only options for fertility treatments, and briefly on human cloning.
In chapter six, the Human Embryo, Vandrunen's main claim is to argue that from the moment of conception, human embryos "are image bearers of God whose lives are to be protected and cultivated" (148). Vandrunen cites a few scriptures such as Psalm 51 and 139 to show how God works and prepares the embryo in its early stages of development. With one puzzle piece on the table, namely that early on the embryo bears the image of God the Creator, Vandrunen pulls out another puzzle piece that makes the connection in showing that a human being is formed very early on in the stages of development: modern science. Calling on modern science, Vandrunen argues that the "newly formed zygote is clearly not the same entity as either the sperm or egg prior to fertilization […] When fertilization does occur, however, a new, genetically unique being comes into existence that is indeed designed for independent life" (159). The overall conclusion is that Christians ought to defend the unborn embryo since it is an image bearer of God since the moment of fertilization.
Chapter seven, which marks the beginning of part 3 in which end of life scenarios are examined, is titled "Approaching Death: Dying as a Way of Life." Vandrunen first seeks to define the attitude a Christian ought to have towards death. He says that while "death remains an enemy that produces sorrow and grief among the dying and their loved ones, yet by virtue of Christ's work of redemption death has been defeated" (174). With this theological mindset in place, Vandrunen proceeds to show how faith, hope, and love are the virtues most pertinent to approaching the end of life. We must first simply live everyday as if it were out last. We are to keep our "house in order now, [cultivate] relationships with loved ones now, [reconcile] with those who are estranged now, and [take] account of [our] standing before God now" (176). If we follow this pattern, we will always be prepared to face death. This is one reason why faith is the chief virtue in this scenario. It's our faith that justifies us before God. With hope, one can face death by trusting in the promises of God and by having an "eschatological perspective" of looking forward to eternal life with Christ (178). Lastly, love helps in how we interact with those who are dying. Vandrunen puts it another way by saying that "love is important for helping other people to die well" (183). Vandrunen closes the chapter by exploring some ways in which we can prepare for cases in which we may come to a place where we're unable to take care of ourselves.
Chapter eight’s importance cannot be overlooked since Vandrunen examines the killing and letting die distinction, while applying it to the cases of euthanasia and suicide. He outright rejects the claim that suicide can ever be justified. Suicide, when contrasted with capital punishment, murder, self-defense, and war, only serves to “destroy” life (199). He rightly points out the instances such as a soldier who jumps on a grenade to shield the explosion from his teammates is not an instance of suicide but a heroic act of selflessness in which the end in sight is not suicide but the protection of teammates.
Furthermore, Vandrunen notes that whenever suicide is found in scripture, it is never portrayed in a positive light, but rather it is viewed as a “tragically fitting [end] to self-destructive, downward-spiraling lives” (200). Theologically speaking, suicide should be avoided because as Christians we are called to trust God’s plan and sovereign control over our lives. When suffering, we should trust that God has an end in sight, and even if our suffering somehow ends in death, if one is a Christian, then eternal life awaits. Moreover, because we don’t live isolated lives but lives in communion with others, Vandrunen explains that we have “mutual obligations” and that “what one person does affects many others” (202).
Vandrunen begins his examination of PAS (Patient Assisted Suicide) and defines assisted suicide as one who “aids another person in taking his own life” (205). He argues that “if suicide is morally wrong, then soliciting someone’s help to perform suicide and aiding a person in committing suicide” would be wrong as well (205). The difference, for Vandrunen, between killing and letting someone die is that in the former one is “actively bringing about a person’s death” whereas the latter is simply allowing death take its course (209). Additionally, Vandrunen argues that if this distinction is invalid, then it follows that we would be obligated to maintain the life of the person in question by any means necessary (210). That means using any technology and finances at hand to pursue this end. Thus, Vandrunen’s conclusion is that actively killing the person is wrong, but letting die is morally permissible.
However, simply because letting someone die is permissible, doesn’t mean that that’s the best choice in every situation. In chapter nine, “Accepting and Forgoing Treatment,” Vandrunen looks to explain how one should decide when the circumstances are appropriate to allow one to die. There are a few approaches that ethicists use when solving these situations, but the one that Vandrunen feels is the best one is called the principle of double effect. His summation of the principle is that “it may be permissible to perform an action that produces an evil effect if the primary intent of the action is to bring about a different effect that is good” (215). Intention, as Vandrunen points out, plays a crucial role in determining the rightness or wrongness of an action in these scenarios. It’s the intention that brings the color to an action that would otherwise be gray. A further point about intention is that it is connected to the virtues (218). The person who has the virtue of honesty will be further disposed to do what is honest. When facing difficult circumstances that may tempt him to lie, because he’s in possession of the virtue, he will have the disposition to do what is honest and will thus have that intention.
Vandrunen introduces a few more precautions when dealing with the decision to accept or forgo treatment. These precautions involve our intention to achieve a spiritual good or a human good. Vandrunen’s main point is that “we should aim to live the right kind of life, not necessarily the longest life” (219). The spiritual good of salvation and maintaining a relationship with Christ must be kept in mind when incapacitated, for example. If a treatment keeps one from continuing their religious devotion, Vandrunen argues that “forgoing such treatment may be the righteous decision for the Christian” (220). Human or earthly goods are defined as but not limited to “physical comfort, the fellowship of family and friends, and the ability to work and play” (221). The remainder of the chapter is spent on Vandrunen approaching a number of particular cases in which he applies all of the moral reasoning learned thus far.
Vandrunen’s book is a good resource for Christians new to bioethics. The jargon is kept to a minimum, which allows for laymen to access this book without much difficulty. This reviewer thinks that one of the good aspects of this book was how Vandrunen stressed the importance of being mindful of theological conviction and how these convictions impact the way one does bioethics. Furthermore, the emphasis on fostering the virtues is also another thing that Vandrunen does that this reviewer believes is needed today to counteract much of the other moral philosophy like Kant’s and Mill’s.
Because this book is simply a guide to making tough decisions, inevitably many details will be left out in some chapters, and more rigorous discussions and debate will be left out. For example, on the chapter about marriage where Vandrunen discusses marriage, natural law theorists would have a lot more to say and respond to with regard to his argument for contraception. The chapter in which he discusses the embryo and abortion was good and straightforward, but it didn’t cover many of the common objections one would hear from pro-choicers. With this type of book and the scope it has, it’s inevitable that this will happen. Vandrunen also includes a bibliographic essay at the end that will allow readers to continue their studies if they wish with a ready list of books for them to pursue.
Apologetics 315 Book Reviewer David Rodriguez is a student at San Diego State University and is majoring in philosophy with a minor in biology. His primary philosophical interests include ethics, philosophy of religion, epistemology and medieval philosophy. In addition to philosophy, David has a keen interest in theology and medieval history. He is currently concerned with pursuing a career in bioethics. His webpages are www.walkingchristian.com and Ad Dei Gloriam.