values as a proper moral underpinning for debating and creating secular public policies is a fatal flaw of modern bioethics. “Ninety percent of the population identifies with the Judeo-Christian tradition,” writes the Loma Linda University professor of Ethical Studies James W. Walters. As an obvious consequence, “our society’s most fundamental moral views are rooted in religion.”81 If Walters is right, then bioethics isn’t merely reflecting a new ethic to meet changing times—it is imposing it on and applying it to a population that profoundly disagrees with bioethics’ most basic assumptions.
That is not to say that religion in the public square does not have its problems. (Murdering doctors in the name of “life” comes readily to mind.) But it is also true that religion played an indispensable role in creating an ethic of humanity that gentles the savage injustices of life.
Consider the modern hospice movement that owes its origin to the dedication and compassion rooted in the deeply held religious values of its founder, Dame Cicely Saunders. Dame Cicely, as she is known affectionately in England, was a nurse and devout Anglican who was a medical social worker in a London hospital in the years immediately following World War II. She met a Jewish émigré named David Tasma, who had escaped the Warsaw ghetto only to lie dying in a London hospital at the age of forty. Tasma was alone in the world, and Saunders made a special point to visit him every day. Their friendship changed our world.
As Saunders and Tasma spoke of his impending death, she began to comprehend “what he needed—and what all of the other dying patients and their families needed.” Saunders had an epiphany. She told me, “I realized that we needed not only better pain control but better overall care. People needed the space to be themselves. I coined the term ‘total pain’ from my understanding that dying people have physical, spiritual, psychological, and social pain that must be treated. I have been working on that ever since.”82 Tasma left Saunders 500 British pounds to begin her work, telling her, “I will be a window in your home.” Saunders told me, her eyes moistening, “It took me nineteen years to build the home around that window.”83
Saunders epiphany was not “rational” but spiritual, coming from a deep empathy inspired by her religious faith. Her work was a “personal calling, underpinned by a powerful religious commitment,”84 wrote David Clark, an English medical school professor of palliative care and Saunders’s biographer, to whom she has entrusted the organization of her archives. So strong was Saunders’s faith in what she perceived as her divine call that she began volunteering as a nurse at homes for the dying after work.85 Urged on by her deep desire to help dying people, she went to medical school at the age of thirty-three, this at a time when there were few women doctors.
Saunders focused her medical practice on helping dying people and alleviating pain. She obtained a fellowship in palliative research and began work in a hospice run by nuns, where pain control was unevenly applied, a nearly universal problem at the time, causing much unnecessary misery. Saunders conceived of putting patients on a regular pain control schedule, which, in her words, “was like waving a wand over the situation.”86
Saunders’s faith pushed her toward founding a hospice based on her concept of treating the total patient. Believing firmly that “the St. Christopher’s project [was] divinely guided and inspired,”87 she became an activist, energetically raising money for the new project and in the process raising the consciousness of the medical establishment. Based as it was on religious inspiration (“I have thought for a number of years that God was calling me to try to found a home for patients dying of cancer,” she wrote to a correspondent88), Saunders’s initial idea was for St. Christopher’s hospice to be a “sequestered religious community solely concerned with caring for the dying.” But the idea soon expanded from a strictly religious vision into a broader secular application; in Clark’s words, a “full-blown medical project acting in the world.”89
Saunders succeeded beyond even her own wildest hopes. St. Christopher’s opened in a London suburb in 1967 and jump-started the modern hospice movement. “We started in-home care in 1969,” Saunders said. “The majority of our work is out in the community.” Saunders soon exported hospice to North America. In 1971, she sent one of her team doctors to New Haven, Connecticut, to help found the first modern hospice in the United States, from whence it spread nationwide. Hospice has been a certified medical specialty in Britain since 1987.90
There is a direct line of compassion, succor, and love from David Tasma in 1948 to the millions of others who have benefited from hospice care since 1967—including my father, who died under hospice care in 1984, and my aunt in 2013. None of this would have happened without the religious values manifesting in the secular milieu of medicine through Dame Cecily, specifically the belief that no matter what our state of health, no matter our age, no matter how much help we need, no matter how we look or smell, we all have equal moral worth.
To promote such values is not to support theocracy. It does not divide a pluralistic society by imposing religion on an unwilling public. Rather, it is a secular application of the sanctity of life. How sterile and harsh the world would be if the values that inspired Dame Cicely were barred from the public square simply because they were founded in religious faith. How dangerous to exclusively base our approach to issues of public health policy and clinical medical ethics on amoral “moral philosophy.” It is true that religion not tempered by secular restraint and rationalism can lead to the tyranny of theocracy. But secularism not enriched by the values inspired by spirituality and religious faith, as this book demonstrates, will lead to the creation of “hierarchies of human worth,”91 the building blocks for a medical culture of death.
BRAVE NEW BIOETHICS
Having rejected the core values and virtues of Western civilization as bases for determining what is moral and good, bioethics turned to secular moral and analytical philosophy for the answers. This approach accepts no moral standard or ethical rule, no matter how deeply valued, as a self-evident truth. Every moral principle must be reassessed and deemed “rational” if it is to pass bioethical muster. Not surprisingly, the people bioethicists deem best able to perform this task are themselves, especially those trained in the arcane schools of secular philosophy. Needless to say, that stacks the deck in favor of those values and approaches to morality that the most influential bioethicists embrace personally. Unfortunately, some critics (me included) find that important human values such as “decency, kindness, empathy, caring, devotion, service, generosity, altruism, sacrifice, and love” are too often omitted from their equations because they are perceived to have little value in determining “what is ethical or moral.”92
Ironically, mainstream bioethics, which explicitly eschews religious values in public policy and medical ethics discourse as well as proudly proclaims itself the epitome of rationality, has itself become something of a secular faith among its adherents. Renée Fox notes, “Bioethics has always been a societal happening, dealing with issues that have religious import and ramifications. It deals with real dilemmas, issues of how society deals with ultimate beliefs. Bioethics uses medicine as a metaphor for discussing with each other issues of ultimate values and belief, questions that are as religious as they are ethical.”93 Adds Leon Kass: “While bioethics is not formally a religion, it is absolutely faith-based and is as equally indemonstrable. They purport to grapple with First Principles. Yet, they step into the public square with no greater claim to wisdom than does someone who believes in the resurrection or in the revelation of the Law at Sinai.”94
Bioethicist Daniel Callahan clearly perceives bioethics in quasi-metaphysical terms. “Above all,” he wrote in 1994, “bioethics needs to develop the capacity to help individuals make good moral decisions in their own lives and to do so in the context of the most basic moral questions: how ought I to live my life? The health of the soul (as they might have put it in an earlier day) is even more important than the health of the body.”95 In the same article, Callahan advocated a bioethics that helps
