Robert C. Baker

For partial credit toward MHE 604 Section 01 Social and Cultural Contexts
of Health Care – Summer I 2010

Word Count: 1,935

Abstract: The Commission on Theology and Church Relations (CTCR) of The Lutheran Church–Missouri Synod (LCMS) aids that church body in providing “leadership in dealing with the Synod’s needs and opportunities in the areas of theology and church relations.” For nearly fifty years, the CTCR has issued a number of reports touching upon biomedical and health care ethics issues, including those pertaining to the beginning of human life. Because the CTCR’s reports influence the decisions reached by both LCMS clergy and laity, thus touching upon issues of personal autonomy, this paper examines three of those reports to discern if and how that principle is understood and applied by the CTCR. The paper concludes with a general observation how the reports may be interpreted.

Introduction

The Lutheran Church–Missouri Synod
The Lutheran Church–Missouri Synod (LCMS) is the second-largest Lutheran Church body in the United States. Founded in 1847 by German immigrants seeking religious freedom so that they could practice a traditional form of Lutheranism, by 2008 the Synod had grown to over 2.3 million baptized members residing in every state of the Union.1,2 By and large, the Synod is known outside of its own circles as a conservative, Protestant church body having affinities with conservative Protestantism (a high regard for the Scriptures and traditional moral values), Evangelicalism (a special emphasis the Gospel, or Good News of salvation in Jesus Christ), and Roman Catholicism (traditional liturgy with vestments, candles, crucifixes, and chanting, an ordained all-male clergy, and a deep piety toward the Sacraments, including auricular confession). The LCMS maintains the largest Protestant parochial school system in the United States, which is second only to that of the Roman Catholic Church.3

The Commission on Theology and Church Relations
Since 1962, the LCMS’s Commission on Theology and Church Relations (CTCR) has worked to provide “leadership in dealing with the Synod’s needs and opportunities in the areas of theology and church relations.”4(p.1) Comprised of the Synod’s president and vice president, presidents of the church body’s two seminaries, pastors, teachers, and laypersons, committee members are “carefully chosen so that [the CTCR] is as representative of the Synod as possible.”4(p.1) In addition to providing theological guidance to synodical leaders and organizations, the CTCR also publishes and disseminates theological reports at the request of the Synod. These enable official synodical leaders, organizations, parishes, and ordained clergy and commissioned ministers to carry out their duties in line with the Synod’s teachings. The CTCR also advises and recommends the official recognition of other Lutheran church bodies for “altar and pulpit fellowship,” or full eucharistic communion. The LCMS and its members attach great importance to the work of the CTCR, particularly in the areas of biomedical technology and health care ethics.

A Descriptive Focus
Normative ethics, which appeals to moral rules or principles, can be distinguished from descriptive ethics, which examines moral behavior as it plays out in the world. This distinction is important in that ethics understood by description, rather than mandated by theory or principle, can help justify ethical action.5(p.5) Because religious beliefs directly influence moral decision-making regarding health care and health care choices,6(pp. 164-166) it is important to examine reports by church bodies and their various entities that press upon personal autonomy. To that end, this paper will do the following. Following a brief recital of the principle of respect for autonomy as interpreted by Beauchamp and Childress, three CTCR documents related to the beginning of human life will be examined: Christian Faith and Human Beginnings: Christian Care and Pre-implantation Human Life (2005); What Child Is This? Marriage, Family, and Human Cloning (2002); and Christians and Procreative Choices: How Do God’s Chosen Choose? (1996). Next, a determination will  be made whether these documents uphold the principle of autonomy and, if so on what grounds. Finally, since official religious pronouncements have “significant power to shape and transform the meanings attached” to health care and related issues,7(p.259) this paper will conclude with a general observation about a possible affect these CTCR reports have on personal autonomy and decision-making for both clergy and lay members of the LCMS.

The Principle of Autonomy
Beauchamp and Childress (2009) recognize that while the concept of the rights of persons to make autonomous choices is generally recognized, of what autonomous choice actually consists can receives various treatments.8(p.99) While the principle of respect for personal autonomy is derived from Greek political theory,8(p.99) the personalization of autonomy later received extensive expansion during the Enlightenment. Contributing to that expansion was the philosophical work of Immanuel Kant and John Stuart Mill, which focused on the autonomous, rational moral self. The emphasis on personal autonomy and decision-making have especially influenced and penetrated Western thought,8(p.103) including biomedical and health care ethics. As an example, Beauchamp and Childress place the respect for autonomy as one of four key ethical principles in health care, the others being beneficence, non-maleficence, and justice. Here it is important to note that the principle of respect for persons, supporting the broader concept of personal autonomy, also has been enshrined in federal law through the Belmont Report (1979). The Report recognizes that respect for persons includes an obligation to both (1) treat individuals as autonomous agents; and (2) protect persons with diminished autonomy.9

Three Reports Pertaining to Beginning-of-Life Issues
The first CTCR report to be examined in this paper is titled Christian Faith and Human Beginnings: Christian Care and Pre-implantation Human Life, which was published in September 2005. In its fifty-one-pages devoted to discussing embryonic stem cell research, the report seeks to make “progress toward consensus across the broad range of opinions found in our society and in the LCMS,” with the assumption that not all persons will approach issues related to pre-implantation human life with the same biblical hermeneutic as the Synod.10(p.8) To that end, the report hopes: (1) to offer a “careful articulation of competing viewpoints” about these issues; as well as (2) to aid the synodical members in articulating the Synod’s pro-life position.10(p.9)Along with noting the “competing viewpoints” concerning embryonic stem cell research, the report likewise provides basic scientific information regarding human development while applying pertinent Bible passages speaking to the same. Ultimately, the report concludes that those who would seek to justify using fertilized human oocytes (blastocysts, or embryos) for scientific research have a burden of proof to demonstrate that such research, which inevitably results in the destruction of human life, is morally permissible.10(p.43)

A second and earlier report titled What Child Is This? Marriage, Family, and Human Cloning, was published in April 2002. At twenty-three pages, the report aims “to make a contribution to the ability of Christians to discern when to celebrate emerging gifts and when to witness against looming evils.”11(p.6) The report seeks to apply Scripture passages concerning “marriage, family and procreation. . . in light of God’s redemptive purposes” to the issues of human reproductive cloning.11(p.6) Ultimately, the CTCR suggests that reproductive cloning is unacceptable because (1) it is the procreation of human life outside the context of marriage; (2) since it upsets the balance of contribution of genetic material it likewise violates a purpose of marriage; (3) the cloned individual would be deprived of “normal conditions for establishing its own identity” (presumably by having two, opposite-sex parents).11(p.19) As an alternative, the report suggests that infertile couples be encouraged to consider the adoption of children. The report concludes with an exhortation to caution about the “grave moral dangers in the practice of cloning,” and an emphasis on “assessing contemporary technologies. . . in light of Christ’s promise of new birth” through Holy Baptism.11(p. 21)

A third and still earlier report dated September 1996 is titled Christians and Procreative Choices: How Do God’s Chosen Choose? Capitalizing on the popular secular language of “choice,” this forty-page document is devoted chiefly to helping Christians “practice and reflect on what is involved in biblically disciplined moral reasoning.”12( p.5) The report recognizes that Christians often disagree on difficult moral issues attendant to human reproductive technologies and, as such, the report does not intend “simply to [arrive] at one set of answers. . . [but to] explore how thoughtful Christians can become more practiced and adept at biblically disciplined moral reasoning. . . [so that they can] be able to understand the significance of disagreements. . . and how [they] can continue to reason together concerning God’s guidance.”12(pp.5-6) The report uses concepts such as “disciplined chaos” and “biblically disciplined reasoning” to interpret hypothetical case studies involving gestational surrogacy, artificial insemination by donor, a decision by a couple not to have children, and a case involving in vitro fertilization with a marriage.12(pp.7-39) Taking a utilitarian approach, the document makes a cost/benefit analysis of these issues, but all within the context of the marital union. Thus, for example, the CTCR is “troubled” by the potential of IVF abuse, but is likewise “reluctant” to suggest forbidding the procedure altogether.12(p.37)

Absent Autonomy
Although the Christians and Procreative Choices report mentions the word “autonomy” once,12(p.30) it does not refer to autonomy as understood and promulgated by Beauchamp and Childress or The Belmont Report. Neither do the two other CTCR reports. This is especially curious given that reports seek to develop “consensus” toward embryonic stem cell research (Christian Faith and Human Beginnings), provide a “contribution” toward Christian discernment regarding human cloning (What Child is This?), and offer an aid in developing “biblically disciplined moral discipline” regarding procreative issues (Christians and Procreative Choices). That is not to say that the lack of reference to a secular philosophical principle is not unanticipated given the conservative, Bible-based focus of the church body. One could expect that the CTCR, having been delegated with the responsibility by the Synod in formulating theological documents, would follow suit in speaking only when Scripture speaks. Further, such a focus could be justified on the basis of the scriptural emphasis of the Protestant Reformation: sola scriptura, or “Scripture alone.”

However, in that these reports seek to avoid proscribing certain procreative behaviors (for example, by tacitly permitting in vitro fertilization within the context of marriage but discouraging the practice outside of the marital union), doubt is cast as to whether the guidance these reports offers is actually based on Scripture alone, or whether such guidance is based partly on Scripture and partly on some other source of authority. In this instance, for the conservative Missouri Synod it would seem feasible that the Bible’s clear indication of the inherent value of human life (Genesis 1:26-27), as well as the Bible’s prohibition against murder (Exodus 20:13), would carry weight when applied to a procedure in which unused frozen human embryos, even those created by a married couple, could be destroyed due to surplus or for research.

Conclusion
A medical-anthropological approach to biomedicine and health care ethics recognizes the deep influence of “social, cultural, biological, and liguistic” issues that “influence health and well being (broadly defined).”13 Such deep influence includes official reports and opinions of religious institutions. This paper has offered a small window into the contextual religious issues attending moral discernment regarding beginning-of-life issues within the LCMS. While a longer treatment could provide more detail, the examination provided here of three reports from the LCMS’s CTCR has revealed that the principle of autonomy is absent. However, this paper has also noted the CTCR’s emphasis on marshaling Scripture to aid in consensus-building and decision-making. For clergy and lay members of the LCMS, this emphasis and the apparent ambiguity regarding the tenuous and complicated features of beginning-of-life moral decision-making may be the cause for disappointment or frustration, particularly when clear, moral guidance is preferred. Viewed in this light, it could be interpreted that the CTCR reports examined here ultimately rely on and by default commend the Enlightenment principle of personal moral autonomy when it comes to contemporary biomedical and health care ethics issues that the CTCR has determined are not explicitly addressed by Scripture.

References:

1. The Lutheran Church–Missouri Synod. LCMS at a glance. Available at: http://www.lcms.org/pages/internal.asp?NavID=2436. Accessed June 23, 2010.

2. Loest M. The Lutheran Church–Missouri Synod at one hundred and fifty years, 1847 to 1997. Concordia Historical Institute. Available at: http://chi.lcms.org/lcms/synod150.htm. Accessed June 23, 2010.

3. Nafzger SH. An introduction to The Lutheran Church–Missouri Synod. Concordia Tracts. St. Louis, Missouri: Concordia Publishing House, 2009:1-17. Available at: http://en.wikipedia.org/wiki/Lutheran_Church_Missouri_Synod. Accessed June 23, 2010.

4. Lehenbauer JD. What is the CTCR? February, 2010. Available at: http://www.lcms.org/pages/internal.asp?NavID=10558. Accessed June 23, 2010.

5. Hoffmaster B. Introduction. Bioethics in social context. Hoffmaster B, ed. Philadelphia, Pennsylvania: Temple University Press, 2001:1-11.

6. Beeson D and Doksum T. Family values and resistance to genetic testing. In: Bioethics in social context. Hoffmaster B, ed. Philadelphia, Pennsylvania: Temple University Press, 2001:153-179.

7. Marshall P and Koenig B. Accounting for Culture in Globalized Bioethics. J Law Med Ethics. 2004;32(2):252-266.

8. Beauchamp TL and Childress JF. Moral principles: Respect for Autonomy. Principles of biomedical ethics. 6th ed. New York, New York: Oxford University Press, 2009:99-148.

9. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report. U.S. Department of Health, Education, and Welfare. April 18, 1979. Available at: http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.htm. Accessed June 24, 2010.

10. Commission on Theology and Church Relations. Christian faith and human beginnings: Christian care and pre-implantation human life. September 2005. Available at: http://www.lcms.org/pages/internal.asp?NavID=504. Accessed June 23, 2010.

11. Commission on Theology and Church Relations. What child is this? Marriage, family, and human cloning. April 2002. Available at: http://www.lcms.org/pages/internal.asp?NavID=514. Accessed June 23, 2010.

12. Commission on Theology and Church Relations. Christians and procreative choices: How do God’s chosen choose? September 1996. Available at: http://www.lcms.org/pages/internal.asp?NavID=514. Accessed June 23, 2010.

13. “What Is Medical Anthropology?” Society for Medical Anthropology Web site. Available at: http://www.medanthro.net/definition.html. Accessed June 24, 2010.

The President’s Council on Bioethics is no more. With a one-day notice, the members were told in a letter from the President that their services were no longer required. Pack up, get out. Forget the fact that they had a couple of interesting reports coming out soon, one more meeting, and that the Council’s tenure would expire come this September.

Peter Lawler, member of the now-defunct Council, notes that he is reassured when the letter states that “President Obama recognizes the value of having a commission composed of experts on bioethical issues to provide objective and non-ideological advice to his Administration.” Maybe it’s because the President wants to change to bioethics. Maybe it’s because he’s smarting a bit because, when he issued his new executive order opening the door to more human embryo research and cloning, 10 of the 18 current Council members criticized his new policy. But a more likely reason is that he needs a philosophical, well-stacked bioethics rubber stamp.

The National Institutes of Health, as directed by the President, is crafting new guidelines for federal funding of human embryonic stem cell research. After a short period soliciting comments on their proposed guidelines, they are scheduled to release the final guidelines no later than July 7. It would be embarrassing to have another round of criticism from an existing “President’s Council.” Better to show them the door.

The proposed guidelines on human embryonic stem cell research are more limited than what the President proposed. NIH draws the line at using “excess” embryos from fertility clinics, though they note that the guidelines can be changed whenever they want. But President Obama called for much more, including cloning of embryos for experiments. A number of scientists have chafed and whined at the proposed NIH limits on embryo creation and destruction.

Dr. Alta Charo, an ethicist at the University of Wisconsin and member of the Obama transition team, said that a new commission should focus on helping the government form ethically defensible policy.

Translation: rubber stamp.

While the federal government lurches toward ignoring patients and wasting more taxpayer dollars on unethical, unsuccessful embryonic stem cell research, there are some bright spots in several states where ethics, and real adult stem cell treatments, are being promoted.

LOUISIANA

Prohibiting Human-Animal Hybrids
SB 115 has been sent to Gov. Jindal for his signature (expected); it is a bill that would outlaw attempts to create a human-animal hybrid; transferring a human embryo into a nonhuman womb; or transferring a nonhuman embryo into a human womb.

Prohibiting State Funds for Human Cloning
In June 2008, the state passed a law to prohibit the use of any state money, or federal money channeled through the state, for the practice, known as somatic cell nuclear transfer (cloning).

You can read the rest of the good news here.

“The New York State Stem Cell Board is poised to facilitate the exploitation of low-income women by using taxpayer funds to pay for the retrieval of eggs. This is a grossly unethical, dangerous and exploitative move that treats women’s body parts as commodities. It must be rejected. If the Stem Cell Board itself moves forward with this proposal, then the state Legislature must act to prevent it.

“No other state in the union allows eggs-for-research payments, and for good reason. The Board is considering up to $10,000 per retrieval, which, in the current economic climate, will induce low-income women who are struggling to put food on their table to undergo this painful and dangerous procedure. Such women face serious health risks and loss of fertility. Vulnerable women should not be coerced into risking their health and their lives for speculative science with speculative benefits.

Seems like we’ve heard of taking advantage of the poor for “scientific research” before, eh?

When I decided to sell my eggs, I never thought I’d get cancer. I don’t remember if the clinic told me that the fertility drugs could increase my risk of cancer. They certainly didn’t tell me that the relationship between cancer and fertility treatments for egg donors had never been researched. Now I know more than I ever wanted to know about breast cancer. I know that breast cancers are hormone sensitive and can be affected by hormone treatments. During my cancer treatment, two doctors mentioned that anecdotally they see more cancer in women who have had fertility treatments. I’ll never know for sure if the egg donation caused my breast cancer, but now I know that it is likely to be a contributing factor. I think often about how much I love my husband, and it breaks my heart that my desperation for a couple thousand bucks has caused him such pain. A bad decision made seven years ago may cost me my life.

You can read her entire story at the Center for Bioethics and Culture Network.

Two House members who were the chief backers of legislation to expand embryonic stem cell research are working on a new bill that would codify President Obama’s recent executive order allowing greater federal funding for the research. Their legislation will also contain language allowing the National Institutes of Health to invest in other kinds of research into human cell biology, perhaps including what is known as ‘therapeutic cloning. . .

Rep. Diana DeGette , D-Colo., who is drafting the new stem cell research legislation with Rep. Michael N. Castle , R-Del., said that she does not seek to order the NIH to fund research based on therapeutic cloning. But she hopes to encourage it.

‘I hope the NIH (National Institutes of Health) will allow SCNT (somatic cell nuclear transfer; human cloning) to move forward with federal funding,’ DeGette said. ‘But if they don’t do that right now, what our bill will do is allow them to change that in the future if research shows it is a necessity and can be done ethically.’

HT: Wesley J. Smith at Secondhand Smoke.

Would you let your embryos — left over in a clinic freezer from your efforts to have a child — languish on ice forever, be discarded or be used by medical researchers looking for ways to cure dread diseases?

Why, yes of course, Ms. Grossman, important question. I think they’re stuffed right next to that frozen grouper Uncle Fred caught last year in Tarpon Springs and behind the frozen peas, gosh darn it Helen, where are those embryos?

The callousness by which Ms. Grossman asks the question, as if human embryos were only like so much frozen food that I must, must simply and finally something do good with them (enter happy white-coated lab types) rather than let them languish (Freudian slip?–they’re not human, Ms. Grossman, right?) or be discarded like icky ice-crystal-covered-somethings that I see every day in my freezer at home, is simply appalling.

Thankfully, Ms. Grossman’s blog is “conversational.” Read this cathartic answer by commenter mlfranciskus (6 comments down; edited):

No, I would force millions of them to be implanted thru Obama’s mandatory volunteerism program and in 20 years we would have a whole new tax base.

Delightful!

For immediate release:

Friday, April 17, 2009

For more information:

Federal Legislation Department
(202) 626-8820; legfederal@aol.com
Communications Department
(202) 626-8825; mediarelations@nrlc.org

National Right to Life says the Obama Administration is pushing step-by-step the creation and harvesting of human embryos for research

WASHINGTON – The National Right to Life Committee (NRLC), representing the affiliated right-to-life organizations in all 50 states, issued the following statement regarding guidelines on embryonic stem cell research, published today by the National Institutes of Health (NIH).  The statement may be attributed to NRLC Legislative Director Douglas Johnson.

The Obama Administration today slides further down the slippery slope of exploiting non-consenting members of the human species — human embryos.

Some may characterize the guidelines issued today as narrowly crafted, since NIH will not initially fund research involving human embryos who were created specifically to be used in research.  This seeming restraint is part of an incremental strategy intended to desensitize the public to the concept of killing human embryos for research purposes.  Even today, NIH officials assert that they can go much further when they choose to.  NIH today badly understates the scope of the longstanding law that actually prohibits funding of research that creates or harms human embryos, including all creation of human embryos by cloning.

We believe that today’s action may be part of a “bait-and-switch” strategy, under which Democratic leaders in Congress will suddenly bring up new legislation that they will claim codifies today’s NIH action, but which will in fact authorize further expansions involving the deliberate creation of human embryos for use in research, by human cloning and other methods.  NRLC laid out the evidences that such a “bait and switch” strategy is in the works in a detailed letter sent to members of Congress on March 31, which is posted on our website at: http://www.nrlc.org/Killing_Embryos/NRLCHousecloningwarning.pdf.

It is noteworthy that in its proposed guidelines today, NIH characterizes the Dickey-Wicker Amendment as prohibiting federal funding of the “derivation” of stem cells from human embryos, the term “derivation” being a euphemism for “killing a human embryo by cutting out its stem cells.”  It is true that federal funding of such activity is prohibited by the Dickey-Wicker Amendment, but the prohibition in the Dickey-Wicker Amendment is much broader:  It prohibits federal funding of creating human embryos by any method, explicitly including human cloning, or any “research in which” human embryos are harmed in any way.

The actual language of the Dickey-Wicker law follows:

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SEC. 509. (a) None of the funds made available in this Act may be used for (1) the creation of a human embryo or embryos for research purposes; OR (2) research in which a human embryo or embryos are destroyed, discarded, or knowingly subjected to risk of injury or death greater than that allowed for research on fetuses in utero under 45 CFR 46.204(b) and section 498(b) of the Public Health Service Act (42 U.S.C. 289g(b)).  (b) For purposes of this section, the term “human embryo or embryos” includes any organism, not protected as a human subject under 45 CFR 46 as of the date of the enactment of this Act, that is derived by fertilization, parthenogenesis, cloning, or any other means from one or more human gametes or human diploid cells.

[end of text of the law]

***

The National Right to Life Committee is the nation’s largest pro-life group with affiliates in all 50 states and over 3,000 local chapters nationwide.  National Right to Life works through legislation and education to protect those threatened by abortion, infanticide, euthanasia and assisted suicide.

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