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.

“This is a real change in the landscape. . . This is the first down payment on what is going to be a much longer list . . . that will empower the scientific community to explore the potential of embryonic stem cell research.”

More like a down payment on a long list that includes guilt, regret and God’s wrath, Dr. Collins.

From the University of Pennsylvania’s Web site:

President Barack Obama announced today the appointment of Penn President Amy Gutmann as Chair of the Presidential Commission for the Study of Bioethical Issues. As Chair of the Commission, Gutmann will advise President Obama on a range of bioethical issues, while continuing to serve as President of the University.

The Commission will work with the goal of identifying and promoting policies and practices that ensure scientific research, health-care delivery and technological innovation are conducted in an ethically responsible manner

As Penn’s President, Gutmann has been a forceful advocate for access to higher education, for dismantling the boundaries among academic disciplines and for increasing student and faculty engagement with communities both domestically and across the globe.

[Senior staff member and sociologist Nikolas] Rose’s team will train graduate students and staff to consider the social and ethical implications of their research. He says the centre will also work with government and industry to develop a suitable framework to regulate the products of synthetic biology, and to make intellectual-property claims.

SynBERC is a similar center based at the University of California, Berkeley. SynBERC’s Web site provides more information about the new and exciting field of synthetic biology.

HT: Bioethics.com.

Mouse Embryonic Stem Cells

According to Michael Hiltzik in this March 30 piece from the Los Angeles Times, the California Institute for Regenerative Medicine isn’t doing too well these days: 

The $6-billion [stem cell] program was enacted by voters in 2004 as Proposition 71 after a campaign of exceptional intellectual dishonesty, featuring vignettes of sufferers from diabetes, Alzheimer’s, Parkinson’s and other heartbreaking diseases for which it seemed to promise imminent cures through research into embryonic stem cells.

Sound familiar? Read on:

Proposition 71 endowed the program with what looked like an embarrassment of riches. The danger is that, without better oversight and broader debate about its policies and goals, it will become simply an embarrassment.

Which goes to prove:

Successful Emotional Appeal to Voters + Gobs of Government Cash + Lack of Rigorous Ethical Guidelines = Disaster.

You can read the entire article here.

HT: Center for Genetics and Society.