In 1994, CBHD hosted its first conference, The Christian Stake in Bioethics. As we looked back over thirty years’ worth of conferences and Christian engagement, we at CBHD wanted to know what has changed. What topics have emerged since that first conference? What issues are we continuing to engage? Thus, for our 30th anniversary, we chose to revisit many of the themes of that first conference with our 2023 conference, titled The Christian Stake in Bioethics Revisited: Crucial Issues of Yesterday, Today, and Tomorrow.
Bryan Just kicked off the conference by looking back on the history of the Center and its place in the field of bioethics.[1] While there was scattered evangelical engagement on bioethics issues prior to the 1990s, most notably on abortion, evangelicals working in the field largely did so alone among more secular colleagues. Sensing that the time was ripe for evangelicals to organize their engagement, theologians including Nigel Cameron, C. Ben Mitchel, and Harold O. J. Brown arranged a gathering at Trinity Evangelical Divinity School. On July 2, 1993, this group met to discuss the state of evangelical engagement with bioethics. They determined that the best way forward would be to establish an academic center that could be a leader in evangelical bioethics and serve as a network for those Christians working in isolation. This was the beginning of The Center for Bioethics & Human Dignity.
John Kilner became the first director of the Center, and over his decade of leadership it grew and thrived. When he transitioned out of the Center to take over Trinity’s newly formed bioethics degree program, a series of interim and short-term directors led to Paige Cunningham becoming director in 2009. Under her leadership, and with the help of managing director Michael Sleasman, the Center heightened its academic focus and launched a number of ongoing initiatives. When they both stepped away in 2019, Matthew Eppinette took over, and he remains the director currently. Though there have been many ups and downs over the Center’s now 30-year history, it has been blessed by God and remains unique in the evangelical world.
The highlight of Thursday evening was CBHD’s inaugural Virtue Ethics Lecture. Established this year by Dr. Richard and Mrs. Elizabeth Zimmerman in memory of their parents, Dr. Willis and Mrs. Janys Zimmerman and Mr. Henry and Mrs. Anna Wellhausen, because of their display of the virtues of generosity, kindness, and faithfulness, The Virtue Ethics Lecture Series Endowed Fund will allow this lecture to take place at each annual conference.
The inaugural lecture was given by Ambassador Morse Tan, and was entitled “Faith-Nourished, Humble Courage.”[2] He opened with some reflections on Tolstoy’s The Death of Ivan Ilyich and the lack of care and virtue showed by the doctors who treated him, noting that there was a time when the core of a profession was being virtuous as well as skillful. Today, the virtues are often seen as antiquated, but that does not mean they can be dispensed with.
Ambassador Tan focused on the virtues of courage, humility, and faith. He argued that each of these must be grounded in the character of God, who not only possesses but defines what a virtue is. For Christians, we must exhibit all three of these virtues together, and after considering the relations and interactions between these virtues, Tan turned to several examples of the virtues in action, such as Shadrach, Meshach, and Abednego and the fiery furnace, the martyrdom of Polycarp, and Elijah’s duel with the prophets of Baal.
Tan concluded with a personal account of how these virtues have affected his own life and career as a U.S. Ambassador and the need for them in the medical profession. From attempts to hasten deaths in order to harvest organs to physician-assisted suicide and euthanasia to sex change operations and hormones being given to minors to abortion measures being pushed throughout the country, faith-nourished humble courage is needed in our response.
Friday morning opened with an energizing lecture from Christina Bieber-Lake entitled “Transformation over Information: Bioethics meets Broadway,” in which she argued for the power of fiction to change people’s minds and expand their moral imaginations.[3] For her, the Christian stake in bioethics is that every person possesses an inherent dignity by nature of being human, from conception until death. New technologies may make us question the nature of personhood, but a Christian view reminds us that we are created, finite beings, not self-creators.
For the first part of her talk, Bieber-Lake spoke about the necessity of using fiction, not just arguments, in trying to change people’s minds. Stories have the power to stretch our moral imaginations in unique ways. She gave the biblical example of the prophet Nathan confronting king David about his adultery with Bathsheba. Nathan’s story helped to “defamiliarize” the situation and engage David’s moral imagination. Once David passed judgement on the fictional situation, Nathan was able to show David how the story was analogous to his own.
Bieber-Lake pointed out that Nathan’s simple story worked because David understood what was right and wrong in the situation; he just had not applied it to himself. In our contemporary culture, with its moral confusion and blindness, more powerful stories are needed, ones that ignite cognitive dissonance in the reader. She argued that live theater is one such medium for doing this. Unlike a book, a painting, or a movie, live theater is more experiential. It cannot be put down or easily walked away from, and it demands a response.
In the second part of her talk, Bieber Lake used examples from two plays to show how they can “challenge our deeply held cultural illusions relating to bioethics and human dignity,” and in so doing serve as a prophetic voice to our American sensibilities. The first play she considered was Cost of Living, which challenges our illusions of individual autonomy by putting the disabled body “front and center.” As the play progresses, it shows that none of us have complete autonomy: “the biggest problem all the characters have is a lack of meaningful connection with others.” The play reminds us that none of us is truly able bodied, autonomous, and independent—we require and depend on other people. A second play she considers is Wit, which destroys the gnostic illusion that minds are more important than bodies, and our misperception that we have control over our bodies.
As Bieber-Lake closed, she challenged us to learn from plays, books, and poetry and to share them with others as we teach. She warned us not to try to convince others with arguments alone, but to entice their imaginations. Finally, we were challenged to examine ourselves for the times we have changed our own minds—if we cannot model change, how can we expect others to do so?
Saturday afternoon we had a presentation from Adam Omelianchuk on “How Shall We Respond to the ‘Brain Dead’ Body?”[4] In this talk, he interpreted the criteria used to define death since the 1960s in light of Jesus’ final moments on the cross and the resurrection of the Shunammite’s son in 2 Kings 4. When Jesus died, he let out a cry and gave up his spirit. God recognized this as the moment of Christ’s death and performed a miracle—the curtain of the temple was torn in two. Omelianchuk found this suggestive: as Christ’s body is fully human, just as our own, should we link death to the loss of consciousness and the ability to breathe?
Omelianchuk went on to consider the story of Elisha raising the son of the Shunammite woman and offered four theses drawn from this account. His first was that “death is neither permanent nor irreversible.” This account, and the Bible in general, teaches that there is a “finality” to death, but also that it is not truly the end. Omelianchuk’s second thesis was that “the ‘brain dead’ state is a confounding state that requires one to ‘pace and pray’ or let go.” When Elisha is confronted with the dead boy, he paces in front of him and prays. The brain-dead person leaves us in bewilderment and raises questions we cannot always answer. And whether you believe that brain death is truly “death” or not, it does represent the end of what medicine can do. All that is left is prayer and trust in God.
This led to his third thesis, “the case for DNC [death by neurologic criteria] depends on the ‘working togetherness’ of the body’s parts for the sake of impacting its environment.” When Elisha goes to the dead child, the text calls attention to three body parts: the mouth, the eyes, and the hands, which can be associated with breath, alertness and awareness, and purposeful movement, respectively. In treating these together, the text tells us something about how the systems of the body work together. Omelianchuk believes that when the body loses this ability to act in togetherness, as in the case of brain death, the person can be considered dead. He therefore holds to neurorespiratory criteria for determining death—the loss of capacity for consciousness, breathing, and brain stem reflexes (although he acknowledged not all will agree on this).
His final thesis was that “the practice of DNC is a response to the problem of disaggregation of the human form into its organ systems that modern critical care medicine makes possible.” Modern medicine tends to “disaggregate” the body into its constituent parts, treating its organs as individual things rather than treating the body as a unified whole. Drawing on the work of Paul Ramsey, Omelianchuk argued against this understanding. Our life is more than just the sum of its parts. We must hold to a view of life and death that is consistent with the resurrection, and any definition of death must wrestle with both our embodiment and our interaction with our environment.
To celebrate the Center’s 30th anniversary, the final presentation on Friday was a video compilation entitled “Voices from the Past” that highlighted some of CBHD’s past conference speakers who have sadly passed away.[5] Participants heard from Allen Verhey on the topic of autonomy, Christine Pohl on abortion, Robert Orr on clinical ethics, Chuck Colson on a Christian worldview, Francis Cardinal George on moral decision-making, and Edmund Pellegrino on physician-assisted suicide (those interested may view this presentation on CBHD’s YouTube channel).
On Saturday morning, Peter Jaggard revisited a topic he had spoken on at the very first CBHD conference in 1994, advanced directives.[6] He began his discussion with five foundational truths: (1) human life is sacred; (2) human life is brief and contingent; (3) the purpose of human life is to glorify God; (4) humans’ only hope against the fear of death is Christ’s resurrection; (5) all of this means that humans have a responsibility to prepare for their death in a way that glorifies God. How can we glorify God in our preparation for death? Drawing from Scripture, Jaggard presented numerous biblical principles for preparing for the end of our earthly lives.
From here Jaggard moved on to advanced directives and advanced care planning. He covered some of the different stages in the development of advanced directives and the struggle of balancing a technical approach that pleases doctors and a personal approach that takes seriously the values of the patient. For example, in the first generation of documents, living wills contained very personal language and instructions and could be tailored to each individual. In contrast, Do Not Resuscitate orders (DNRs) are much narrower (applying only to CPR), but please physicians because it tells them exactly what they should or should not do. Subsequent generations of documents continue to exhibit these tensions.
All advanced directives have some limitations—those that focus on personal values are often too general, while the more technical ones are either limited in scope or try to get too specific. Another major problem all face is patients do not always understand the medical terminology or what they are actually agreeing to when they fill out an advanced directive. Thus, it is not uncommon that the documents, especially those filled out without the input of a physician, do not truly reflect patient preferences and desires.
In contrast to advanced directives, Jaggard advocated for advanced care planning (ACP). Advanced directives, whether personal or technical, are ultimately just documents. In contrast, ACP is a “process of conversation” with the patient that attempts to educate them about their own conditions, helps them articulate their own goals of medical care, and helps them and/or their proxies make specific care decisions consistent with those goals. The keys to good ACP are education and dialogue. Advanced directives may be a part of this, but ACP is a process, not a one-time event.
Jaggard ended his presentation by considering a number of different questions about ACP, including: What goes into an advanced care conversation? What kind of questions should a physician ask of patients? What are the barriers to advanced care planning? How do we respond to criticisms that ACP doesn’t really work and can’t account for everything? Are there situations where we should change or overrule someone’s advanced directive? As he concluded, he challenged us to live as “witnesses to the resurrection,” helping people who are struggling with these issues and opposing those acts, such as euthanasia and physician-assisted suicide, that run counter to a biblical worldview.
The penultimate session on Saturday was given by Scott Rae, who shared “Advice for Young Bioethicists.”[7] His first piece of advice was to “be prepared for your field to follow you home.” In God’s providence, those within bioethics often find themselves dealing with bioethics issues themselves or with their friends and families. Bioethics is not a purely theoretical field. We can address its philosophical and ethical parts, but we must not neglect its pastoral and human dimensions. His second piece of advice was that bioethicists should be conversant with five fields/groups—theology/biblical studies, philosophy, academic medicine, medical practitioners, and the law/legal literature. In addition to these, bioethicists need to be up to date on the news and current events. It is not easy to stay abreast of all of this material, and no one person can be an expert in everything, but this breadth of coverage is a large part of where the rigor of bioethics comes from.
Rae’s third point was that all bioethicists should “have a cursory understanding of metaphysics.” This does not necessitate becoming an expert. But, since metaphysics is the field that undergirds our understanding of who and what a human person is, we should at least be conversant with it. Fourth, those considering bioethics should “aim to gain as much bedside experience” as possible, whether through shadowing a chaplain or a physician or serving on a hospital ethics committee.
Fifth, Rae recommended that we “read widely among scholars who see bioethics differently than we do.” Those we disagree with may be wrong about many things, but they are not wrong about everything—there are things we can learn from anyone. We must interact with the voices and ideas that are shaping bioethics, even if we do not like them. Six, we should “be able to speak to morality and public policy in bioethics.” Yes, Christians need to be careful not to try to impose our morality on a culture that does not accept it. But, at the same time, we do not need to keep silent on public policy matters just because we approach them with theological convictions. There is a time and place for translating our convictions into publicly accessible language, but the more hostile your audience, the more freedom you have to be unabashedly Christian.
Rae’s final piece of advice was to “make part of your mission in bioethics to help educate the church.” There are numerous areas where the church is drastically under-educated regarding bioethical issues. Everyone faces some bioethics issues during their lifetime. The church needs to be prepared to deal with these issues; we cannot afford for people to think that because we fail to address them, the church has nothing to say. Though this list may seem daunting, Rae reminded us that we do not have to try to do everything ourselves; our call is to do our work faithfully, and to leave questions of success to God.
CBHD’s Executive Director, Matthew Eppinette, closed the conference by reflecting on “Bioethics Yesterday, Today, and Tomorrow.”[8] Those who spoke and presented at CBHD’s early conferences were attempting to define the Christian stake in bioethics. Their work is well summed up by a quote from Nigel Cameron given at the very first plenary of the first conference: “The issues of bioethics all address the question of how we treat human beings in the specific context of the frailties of human life in the aftermath of the fall.” Answering these questions has been the task of CBHD for the past 30 years. In the bioethics of yesterday, Eppinette identified the primary topics as the lack of explicitly Christian engagement with bioethics, end-of-life issues, issues of genetics, managed care, reproductive technologies, and strategies for influencing public opinion and public policy.
Where does bioethics stand today? Eppinette shared a myriad of issues that the Center currently addresses, such as potential changes to the 14-day rule, artificial wombs, 3-parent embryos, the spread of assisted suicide and euthanasia, and the ethics of brain-computer interfaces. Other contentious topics include healthcare inequities, the rising costs of healthcare and healthcare debt, the spread of assisted suicide and euthanasia, direct-to-consumer advertising of pharmaceuticals, CRISPR, issues of sex and gender, the COVID-19 pandemic, AI, the environmental impact of healthcare, developments around the human embryo, and challenges of conscience and religious freedom.
Eppinette then took a speculative tour of the bioethical challenges we might be facing in the near future, including rapidly developing medical technology and AI, the shift from healthcare “professionals” to mere “providers,” the development of the category of “non-human persons,” and conversations about autonomy and responsibility as it relates to AI and robots. He believes the most significant issues of the next 10–30 years will be “the continued spread of assisted suicide and [an] increasing push towards euthanasia, gene editing, issues arising out of artificial intelligence, [and] issues of conscience that arise in the above.” There is much here, but even this is not an exhaustive list; new developments will assuredly occur that take us at least somewhat by surprise.
With all of the bioethical issues that we will face both now and in the future, one of the major challenges for Christians is developing a robust biblical anthropology of the human person. This has been a challenge of Christians in bioethics for the past 30 years and will remain a major task going forward. To begin this task, Eppinette closed with an introductory theological anthropology. He reminded us that humans are created, male and female, in the image of God. We are embodied creatures who God has placed in community with one another. As we seek to address the bioethical challenges of yesterday, today, and tomorrow, “we must both communicate and rely on a robust, biblically based, theologically precise concept of the human person that clarifies and affirms the givenness, the vulnerabilities, and the interdependence of embodied human life.”
We at CBHD are extremely grateful for all those who attended this conference! A special thank you goes to our interns, Jenna Chen and Tanner Whetzel, for all their help throughout the event. Planning has already begun for our 31st conference, The Future of Health: Faith, Ethics, & Our MedTech World! Confirmed speakers include Matthew Lee Anderson, DPhil; Kristin Collier, MD; Mihretu Guta, PhD; Keith Plummer, PhD; Michael Sleasman, PhD; Jason Thacker, PhD (cand.); and CBHD’s own Anna Vollema, MA. We look forward to seeing you in Deerfield, June 27–29, 2024!
[1] Bryan Just, “A History of CBHD” (plenary address, The Center for Bioethics & Human Dignity’s 30th Annual Conference, The Christian Stake in Bioethics Revisited: Crucial Issues of Yesterday, Today, and Tomorrow, Deerfield, IL, June 22, 2023).
[2] Morse Tan, “Faith-Nourished, Humble Courage” (plenary address, The Christian Stake in Bioethics Revisited, June 22, 2023).
[3] Christina Bieber Lake, “Transformation over Information: Bioethics meets Broadway” (plenary address, The Christian Stake in Bioethics Revisited, June 23, 2023).
[4] Adam Omelianchuk, “How Shall We Respond to the ‘Brain Dead’ Body? Some Christian Reflections” (plenary address, The Christian Stake in Bioethics Revisited, June 23, 2023).
[5] “Voices from the Past” (plenary address, The Christian Stake in Bioethics Revisited, June 23, 2023).
[6] Peter Jaggard, “Advance Directives Revisited” (plenary address, The Christian Stake in Bioethics Revisited, June 24, 2023).
[7] Scott Rae, “Advice for Young Bioethicists” (plenary address, The Christian Stake in Bioethics Revisited, June 24, 2023).
[8] Matthew Eppinette, “Bioethics Yesterday, Today, and Tomorrow” (plenary address, The Christian Stake in Bioethics Revisited, June 24, 2023).
Bryan A. Just, “The Christian Stake in Bioethics Revisited: 2023 Conference Recap,” Dignitas 30, no. 2 (2023): 21–24, www.cbhd.org/dignitas-articles/the-christian-stake-in-bioethics-revisited-2023-conference-recap.
