COVENANTS OF LIFE
Philosophy and Medicine VOLUME 77 Founding Co-Editor Stuart F. Spieker Editor H. Tristram Engelhardt, Jr., Department of Philosophy, Rice University, and Baylor College of Medicine, Houston, Texas Associate Editor Kevin Wm. Wildes, S.J., Department of Philosophy and Kennedy Institute of Ethics, Georgetown University, Washington, D.C. Editorial Board George J. Agieh, Department of Bioethics, The Cleveland Clinic Foundation, Cleveland, Ohio Nicholas Capaldi, Department of Philosophy, University of Tulsa, Tulsa, Oklahoma Edmund Erde, University of Medicine and Dentistry of New Jersey, Stratford, New Jersey Eric T. Juengst, Center for Biomedical Ethics, Case Western Reserve University, Cleveland, Ohio Christopher Tollefsen, Department of Philosophy, University of South Carolina, Columbia, South Carolina Becky White, Department of Philosophy, California State University, Chico, California The titles published in this series are listed at the end of this volume
COVENANTS OF LIFE CONTEMPORARY MEDICAL ETHICS IN LIGHT OF THE THOUGHT OF PAUL RAMSEY Edited by KENNETH L. VAUX Professor of Theological Ethics. Garrett-Evangelical Theological Seminary. Evanston. Illinois. U.S.A. SARAVAUX Instructor in Religion. Northwestern University. Evanston. Illinois. U.S.A. and MARK STENBERG Pastor of Theology and Social Critique. House of Mercy in Lowertown. St. Paul. Minnesota. U.S.A. SPRINGER-SCIENCE+BUSINESS MEDIA, B.V.
A C.I.P. Catalogue record for this book is available from the Library of Congress. ISBN 978-90-481-6189-8 ISBN 978-94-015-9898-9 (ebook) DOI 10.1007/978-94-015-9898-9 Printed on acidlree paper AII Rights Reserved 2002 Springer Science+Business Media Dordrecht Origina1ly published by Kluwer Academic Publishers in 2002 Softcover reprint ofthe hardcover lst edition 2002 No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording or otherwise, without written permis sion from the Publisher, with the exception of any material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work.
TABLE OF CONTENTS KENNETH L. V AUX / Preface VII INTRODUCTION: THE THEOLOGICAL, MEDICAL AND PHILOSOPHICAL CONTEXTS OF PAUL RAMSEY'S MEDICAL ETHICS DAVID H. SMITH / Covenant-Centered Ethics: The Theological Context Of Paul Ramsey's Medical Ethics RONALD A. CARSON / Paul Ramsey's Ethic of Covenant Fidelity KENNETH L. V AUX AND MARK STENBERG / Discerning Stewardship: Contemporary Philosophy and the Legacy of Paul Ramsey's Medical Ethics 3 9 19 PART I: FUNDAMENTAL ISSUES OLIVER O'DONOVAN / Keeping Body and Soul Together LEON R. KAss / The Right to Life and Human Dignity PAUL F. CAMENISCH / Applied Ethics and Communities of Value: The Distinctiveness of Medical Ethics PAUL RAMSEY / Response I 35 57 71 85 PART II: THEOLOGICAL ISSUES BYRON L. SHERWIN / In Partnership With God: Health, Healing, and Jewish Tradition 105 ALLEN VERHEY / Technology and Tragedy: An Evangelical Theology ~C~ In PAUL RAMSEy/Response II 147 v
PART ill: MEDICAL ISSUES JAN V AN Eys / The Devil's Being God's Best Inspiration: The Boundary between Research and Care 171 STANLEY SCHADE / Telling and Keeping Still; Reviving and Letting Go: The Ethics of "Do Not Resuscitate" Procedures 183 WILLIAM G. BARTHOLOME / Ramsey as Trellis: Paul Ramsey and the Evolution of Pediatric Medical Ethics 189 PAUL RAMSEY / Response ill 199 APPENDIX PAUL RAMSEY / Should Physicians Hasten the Death Angel when She Paused In Her Flight? Peter T. Bohan Lecture in the Philosophy of Medicine 235 PAUL RAMSEY AND KENNETH L. V AUX / An Interview With Paul Ramsey 245 vi
KENNETH L.V AUX PREFACE The intense fervor of a Mississippi Methodist preacher, the meticulous reasoning of an Oxford logician, the dogged persistence of a head longshoreman, the unflagging humor of a Rabelaisian satirist. To have met Paul Ramsey at a lecture in a medical university; a heady conference at Hastings-on Hudson; a congressional hearing; deliberations at a church assembly; or a bull session in some coffee shop was to be confronted with a gentleman of unforgettable energy, insight, and delight. In many roles--as a young instructor in religious studies at Princeton University, a concerned moral theologian commenting on the ethics of the "sit-ins" and nuclear issues, an observer and dialogue partner with physicians at Georgetown and other medical centers, a faithful editor and analyst of Jonathan Edwards' ethical writings, a trustee of the Hastings center, a voluminous correspondent with others who would join to disciplined pursuit of values--paul Ramsey in all roles was indefatigable in zeal, rigorous in demand and gracious in coadventuring (to use one of his wonderful metaphors). This volume captures a unique exchange between Paul Ramsey and his most prominent colleagues. In one sense it remains a Festschrift in his honor, characterized, at times, by a markedly informal tone. Yet, in the spirit of both the analytical rigor and the self-exposure that marked Ramsey's career, what follows is not simply a tribute to Ramsey's lifework but rather a vehicle for intense conversation and argument about issues of human birth, life, suffering, and death. The editors see it as a state of the art discussion that brings the best insights from Judeo-Christian thought into contact with wider and more public arenas of medical ethics. Of course, such a collection as this grants Ramsey the last word. But this word is entrusted to a mature and remarkably open mind, still sharpening its critical skills and risking exposure to new issues and voices. The volume begins with an introductory attempt to understand the context of, to locate, the thought of Paul Ramsey. This is attempted in three parts. Ronald Carson provides a concise but insightful retrospective of Ramsey's work on specific issues in medical ethics. David H. Smith locates the theological context that shaped these various positions. In the third piece of the introduction the editors engage the philosophical underpinnings of Paul Ramsey's work, attempt to point to some recent shifts on the horizon of public philosophy, and connect these themes with the issues and topics represented in the volume. vii
Part I treats the matter of "Fundamental Issues." Oliver O'Donovan, the Regis Professor of Moral Theology at Oxford University, presents a searching reflection on Ramsey's controversial teaching on the "right to die" debate. This is followed by Leon Kass' essay on "The Right to Life and Human Dignity." Kass is the Henry Luce Professor at the University of Chicago. In his essay, Paul Camenisch, head of the Religious Studies department at DePaul University, considers the influences on medical ethics and the nexus of moral formation in the professional community itself. This section closes with Ramsey's ruminations, carefully developed formal written responses, drawn from the informal verbal exchanges that were offered at the conference. When Paul Ramsey (reluctantly) consented to this unavoidably embarrassing tribute, he insisted that close attention be paid to a variety of theological perspectives. Ramsey has always been a theologian of the Church, one who believed that the interrelated tasks of theology and ethics were always to be considered an expression of a living faith community. Methodologically, Ramsey mixed these notions of community with a rigorous causistry that has deep roots in Judaic and Roman Catholic teaching. Recognizing these deep roots of Ramsey's medical ethics, the second part of this volume is explicitly theological. This section begins with the insight of the late Father John Connery, the insightful Jesuit scholar who taught at Loyola University in Chicago. At the center of the Westem tradition of religious ethics stands the wisdom of Judaism. The profound moral wisdom of the faith is presented by Rabbi Byron Sherwin, the Dean of Spertus College of Judaica in Chicago. Dr. Sherwin is a highly respected biblical scholar, Holocaust historian, and bioethicist. His essay focuses on the grand motifs of Judaic philosophy as they bear on the choices we make in the realm of our biological and mental life and on the covenantal practice of medicine. Allen Verhey, Professor of Philosophy and Theology at Hope College, speaks not only of the mainline reformation traditions of ethics that so deeply shape our moral ethos, he also speaks for the increasingly important "evangelical" perspective. This rapidly growing trend in American Protestantism, expressed in fundamentalist, charismatic, and evangelical branches, contends for extremely important and often controversial bioethical values, including, among others, values on abortion, AIDS, and the delivery system. Clinicians have always had a direct and blunt way of sharpening and even subverting philosophical foundations and theological impulses. The final section holds some of the most intriguing material in the volume by demonstrating the specific cases and concrete practices that have a way of corroborating or, perhaps, confounding foundations and theories. The medical issues in the section are developed by four prominent physician-scientists. Erich Loewy wrestles with human responsibility in the face of a growing shortage of organs for transplantation. Jan van Eys, from the thick contexts of research and clinical practice, raises vital critical questions of the boundary between research and care. Stanley Schade ponders the perplexing problem of viii
resuscitation directives, cessation of treatment decisions, and the more basic question of attending the dying person in good faith. Finally, the late William Bartholome, a prominent physician-ethicist from the University of Kansas, reflects on the agonizing choices in pediatric medical ethics. All of these clinical essays bring the rigor of Ramsey's ethical theory into practical application. The editors wish to acknowledge the generosity of Catherine and Jan van Eys. With their help we hereby present a volume that not only traces Ramsey's pathway through the terrain of medical ethics but also makes a vital contribution to the contemporary scene. Ramsey often noted the wealth of analytical descriptions and the dearth of normative prescriptions. He ventured a position and a persuasion and thus offers refreshing substance for reflection and debate. His aim was not to persuade all opponents but rather to open up the conversation, to expand medical ethical dialogue, to expose dialogue partners to one another. Whatever we might make of Ramsey's positions on particular issues such intuitions must be considered indispensable for a responsible contemporary public ethic. Garrett-Evangelical Theological Seminary Evanston, Illinois United States of America ix