You must check out the blog for the Center for Morality in Public life. Titled Ethika Politika (sounds familiar, doesn’t it?!?), this looks like it going to be a treasure trove for those wishing to applying natural law thinking to contemporary, hot-button issues. CFMPL President Andrew Haines was kind enough to e-mail me last week. I do hope that we’ll have a chance to partner in something big in the near future.

God’s blessings, Andrew and EP!

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.

I believe this is the first paper to consider and critique the concept of the imago Dei as explained by Rev. Dr. Nathan Jastram, who offers “to be like God” as a general definition of the image. I believe Dr. Jastram’s definition is deficient, and ultimately leads to a devaluation of the unique dignity of man, although I am sure he would disagree with that assessment. I grateful to Dr. Jastram for spending about 45 minutes of his time last week explaining his views to me over the phone, and also for reviewing and providing helpful comments to this paper.

It is also the first paper that I’m aware of that briefly explores the differences in biblical interpretation between the orthodox Lutherans and contemporary Lutheran theologians, in this case Johann Gerhard and Dr. Jastram. For more information about that, see the Twentieth-Century Project, also located as a tab at the top the page.

They recently published an article in the Guardian’s “Comment is free” blog, under the headline, “Stand up, stand up, against Jesus”. They reject accommodationist atheism which cozies up to religious people if they are prepared to support evolution. Schuklenk and Blackford, however, call for more robust criticism:

“Religion cannot be eradicated — that is not a realistic goal — but the many problems with religious dogma can and should be highlighted. As atheists, we should state clearly that no religion has any rational warrant, and that many churches and sects promote cruelty, ignorance, and civil rights abuses.”

They also have edited a 360-page book, Voices of Disbelief. This collects essays from 52 atheists and will be published in the second half of next year. According to Blackford, it is “an exciting and extraordinarily diverse group of people”. And perhaps to confirm the worst fears of some Americans, it includes a number of well-known writers on bioethical issues: John Harris, Marc Hauser, Sheila A.M. McLean, Tamas Pataki, Julian Savulescu, Peter Singer, Michael Tooley, and, of course, Schuklenk and Blackford. They discuss the book in Schuklenk’s blog.

How did New England get to be so liberal? As I mentioned here, you can blame it (partly) on those arch-advocates of individualism and intellectualism, the Puritans.

While IVF creates thousands of new families a year, an increasing number of the newborns are twins, and they carry special risks often overlooked in the desire to produce babies. While most twins go home without serious complications, government statistics show that 60 percent of them are born prematurely. That increases their chances of death in the first few days of life, as well as other problems including mental retardation, eye and ear impairments and learning disabilities. And women carrying twins are at greater risk of pregnancy complications.

Yet curiously, The Lutheran Church–Missouri Synod’s Commission on Theology and Church Relations in their 1996 report on procreative issues find it difficult to say either Yea or Nay:

The Commission is troubled about the potential for abuse opened up by this technology. We understand why some Christians urge us simply to reject the entire practice. But we are reluctant to locate the problems that arise simply in the medical technique itself and to suggest that Christians could never faithfully use it.

Our discussion of the previous cases outlined the scriptural basis for taking into account the divinely established one-flesh union of marriage. We agree with the synodical representatives who argued that faithful use of in vitrotechnology will involve sperm and eggs only from within the marriage. This conclusion is consistent with the advice we offered in the cases involving surrogacy and artificial insemination by donor.

Why is it so difficult to see and believe that the divinely instituted means for the procreation of children is through the proper use of our created bodies, that is, the one-flesh union of male and female? It seems that the CTCR’s argument is similar to those who want to offer grape juice and rice cakes for the Sacrament, and then justify such because the Words of Institution were added.

Source: Christians and Procreative Choices: How Do God’s Chosen Choose? September, 1996, p. 37 (accessed October 11, 2009)

Let’s look at (late-) Luther for some hints so as to unravel this mystery. In his Genesis lectures, Luther calls “the heinous conduct of the people of Sodom” (same-sex behavior):

“extraordinary, inasmuch as they [the Sodomites] departed from the natural passion and longing of the male for the female, which is implanted into nature by God, and desired what is altogether contrary to nature. Whence comes this perversity? Undoubtedly from Satan, who after people have once turned away from the fear of God, so powerfully suppresses nature that he blots out the natural desire and stirs up a desire that is contrary to nature.” (Luther’s Works, Vol. 3, p. 255)

Wow. What’s he talking about?

Dr. Baker, could you please elaborate on the “strong divine command theory ethic”? I was recently accused of perpetrating the heresy of “taking the Bible literally”, an error which was portrayed as being a phenomenon which sprang up in the early 1900s in response to scientific advances. I think my accuser was saying I am a Fundamentalist, which I am not.

Here’s my response:

Pastor Keith, at the turn of the last century many Christians were divided over the issue of evolution, the purpose, role, and authority of Scripture, etc.

The world was changing. Because believers also use the language of the world, which brings with it ideas and concepts foreign to the faith, they begin to reflect and write on their faith in a different way. Some believers followed after the Princeton theologians and accepted Fundamentalism. Others, following Kant and Schleiermacher, accepted Liberalism. When you are accused of being a Fundamentalist, or a literalist, or a traditionalist, for example, most likely the person making such an exaggeration is operating from a Liberal set of beliefs, whether or not he or she is aware of it.

In addition to Fundamentalism, another reaction to Liberalism came through the teaching of Swiss Reformed theologian, Karl Barth. Barth denied Natural Law and taught a strong divine command theory ethic, which means that the only commands valid for the Christian are those recorded verbatim in Scripture. If you cannot find a Bible verse specifically condemning any activity, then you are free to do that activity.

I find this line of reasoning being utilized, with no apparent credit to Barth, by Missouri Synod theologians beginning in the 1930′s, about the same time as when Barth was having his famous debate with Emil Brunner.

The strong divine command theory ethic is why, in my opinion, that modern ["conservative"] Lutherans accept contraception (because it is not specifically condemned in Scripture), whereas orthodox Lutherans (Luther, Melanchthon, Chemnitz, Gerhard, et. al.) condemned it as violating the first, fourth, fifth, and six commandments.

This [ethic] is also why “conservative” Lutherans today are unable successfully to address current moral crises. To wit, most current condemnations of the ELCA’s decision to allow same-sex unions and the ordination of gays and lesbians highlight that these are condemned in Scripture.

True, but same-sex attraction and activity also violates the moral law embedded in human nature. [In addition to God's wrath, there are also severe temporal consequences for violating Natural Law. "Conservative" Lutherans don't talk about those, either.] Even without Scripture, these folks should know better. If you don’t believe me, ask St. Paul.

For more about my views, log on to bioethike.com.

Blessings,
Robert C. Baker