About Bioethics

Bioethics is the discipline or set of disciplines that considers the ethics of medical interventions and the ethical implications of the human biological sciences. It is therefore essentially about human beings considered as vulnerable, material, dependent, mortal, more or less sick, more or less confused, and more or less desperate. It considers human beings in relation to others as parents or children (born and unborn), as spouses or lovers, as carers and/or as professionals.

It is curious, then, that many who write on bioethics write as though they had no bodies, sickness, or vulnerabilities, no relationships on which they depended. Much bioethics is conducted as though those engaged in it were pursing activities of pure reason, a kind of moral mathematics or ethical Sudoku, requiring no experience or maturity but only a limited set of logical rules. Modern practitioners of bioethics have boiled down Kant, Bentham, and Mill leaving a residue of two thin and ostensibly self-evident principles - autonomy and utility. These can then be applied by a kind of bloodless accountancy of which it would seem, at least in principle, a computer would be perfectly capable. If anyone thinks this charge exaggerated I would invite him or her to survey a couple of issues of the more prominent bioethics journals (such as Bioethics or the Journal of Medical Ethics).

Against this background the present volume comes as a breath of fresh air. It is not written by automaton but by an author who introduces himself, and his story, as a way to explain his perspective. It was precisely as someone afflicted by severe illness (and given but a short time to live) that Nicholas Tonti-Filippini gained an interest in philosophy in general and in bioethics in particular. Later in the book Tonti-Filippini attributes to Charles Taylor the argument that, "reasoning in morality is reasoning with someone else" (p. 117), and it is very clear from the outset of the book that his reasoning has occurred within a particular tradition and been inspired by particular thinkers (living and dead). This is of course true of all philosophers, but not all philosophers are so aware of it or so candid about it.

The context in which Tonti-Filippini works is Australia, and this undoubtedly helps his perspective on both British and American public policy, of both of which he is knowledgeable and critical. He is also Catholic, and much of this book is an exploration of what it means to be a Catholic philosopher engaging in public policy in a Westernized secular state at the turn of the third millennium. As a Catholic philosopher he is sympathetic to the natural law tradition which he characterizes as seeking "to engage the secular world in argument based on pure reason and without assistance from revelation" (p. 66), but he is unconvinced that this can be effective in practise. On pp. 48-49 he does not mince his words:

"The UK probably provides the clearest example of a concerted effort by Catholic intellectuals to take that approach, and the UK probably leads the way in the Western world in terms of adopting evil public policies that are aggressively bigoted in the active exclusive of religious views and of natural law concepts, particularly the rejection of the Pauline principle [not to do evil that good may come (Romans 3:8)] and moral absolutes that are at the core of natural law explanations. UK public policy also rejects any notion of sexual ethics other than that there be consent."

In defence of Blighty I should point out that, while Tonti-Filippini's accusation is undoubtedly accurate in relation to sexual health and ethics at the beginning of life (abortion and experimentation on human embryos), in relation to disability and to end of life care the picture is much more mixed, with many positive aspects to British culture.

Furthermore, while I agree with Tonti-Filippini that Christians bioethicists should not confine themselves to pure reason and the natural law, I think that his criticisms of the natural law tradition (and especially the new natural law theory (NNLT) of John Finnis, Germain Grisez, and Joseph Boyle) is not always accurate. For example, while I agree that the NNLT theory of action is problematic in relation to craniotomy, I do not think that John Paul II inVeritatis Splendor (who undoubtedly was aware of the NNLT) either intended to exclude this as a Catholic school of thought or actually did so (as is claimed on p. 96). I think that the Pope wisely did not wish to settle disputes among schools that accepted the central moral conclusions of the Catholic tradition, but rather wished to exclude only those schools (such as proportionalism, consequentialism and the fundamental option) that were being used to deny traditional Catholic moral teaching.

I also think it misleading to call MacIntyre "a contemporary defender of new natural law approaches" (p. 104). This conflates very different forms of natural law theory. Finally, in relation to accuracy I cannot leave unchallenged the interpretation of Thomas' dictum that the theological virtues are "from without" as meaning "that the theological virtues are revealed by God rather than the product of our own reasoning" (p. 62). To be a virtue (i.e. a principle of action) rather than a set of commands, the theological virtues must have an internal principle in the heart, not only an external one in revelation. Thomas states that the theological virtues come from without not because they are a kind of learned external law but because that internal new law, which is the life of grace, itself comes from without - as a gift from God (see Summa Theologiae 1a2ae 91.4 and 1a2ae 106-108). Thomas here, as elsewhere, is much closer to Augustine than he is to Aristotle.

If Tonti-Filippini despairs of convincing people by appeal to pure reason alone within a culture in which religion is increasingly marginalised from public life, what is his alternative?

In the first place he makes a good case for exposing the pretentions of aggressive secularists. The secular was once simply a term for the sphere of the worldly as opposed to the ecclesiastical, an area of activity rather than a philosophy. A tolerant secularism was one that allowed the public practise and expression of different faiths and denominations. However, in recent years this positive pluralism has given way to a form of secularism that suppresses religion and imposes a kind of state atheism, less Bohemian tolerance more Albanian tyranny. Tonti-Filippini expresses it thus, "a bigoted form of secularism has emerged as a form of belief that is intolerant of religious viewpoints and seeks to exclude them from the formation of policy" (p. 135). It is a theme he reiterates throughout the book. Anti-religious bigotry should be exposed and opposed.

The second, more positive, strand of Tonti-Filippini's approach is to be honest about one's background and presuppositions and to engage constructively with people of different backgrounds and viewpoints. This makes a virtue out of diversity, not hiding it but exploring it. "My own experience in working within a pluralistic environment towards an agreed policy on matters of public ethics is that each of us does bring our own culture and tradition and that is likely to include theological traditions. What is spoken about, however, is not theology as such, but rather the search for a set of agreed and basic values upon which a coherent policy can be formulated" (p. 148). He suggests that bioethicists who are Catholics "should participate in public debate openly as Christians rather than trying to engage in pure reason. I would suggest that we should be open about our faith because subterfuge is beneath our dignity and in any case, would only breed suspicion" (p. 61).

The relationship of faith and reason is a ground that many have traversed before (from Karl Barth to Benedict XVI) but what is original here is the advocacy and exemplification of a constructive dialogue between traditions. Drawing on Alasdair MacIntyre, among others, Tonti-Filippini attempts to negotiate a middle way between Enlightenment rationalism and Postmodern relativism. His plea for education in construction of public policy on bioethics, as opposed to education that explores and reinforces divergence and encourages a tendency to "slash and burn alternative views" (p. 169), is as much a challenge for the Church as for the secular bioethical world. And it is this that makes this book truly prophetic, though in a paradoxical way, for, as the prophetic voice is conventionally portrayed - an uncompromising voice in the desert, bioethics "demands a voice other than the prophetic" (p. 145).