GOE 6: Christian Ethics & Moral Theology

This is an applied ethics question. In a three-page essay show how you, as an Episcopalian, apply moral theological reasoning to one of the following two questions.

EITHER:

1. In light of recent natural disasters, attention has been drawn to the practice of “absolute triage” (the decision to treat some injured persons first, based on an assessment of their likelihood of survival, with the knowledge that delaying or denying treatment to others will likely result in their deaths).

A. How might a utilitarian argument justify the practice of absolute triage? For the purposes of this question, utilitarianism may be understood as the view that we ought to do those things that promote human happiness and reduce human suffering for the most people.

B. How might a Christian moral theological argument justify the same practice? In this part of your answer explain the relevant facts of the case, and the principles, criteria, and authorities, including Holy Scripture, that you would bring to bear on the way in which you approach the question. Explain how these authorities relate to each other.

OR:

2. Assume technology affords prospective parents the opportunity to decide the sex of their child.

A. How might a utilitarian argument deal with the moral issues this opportunity raises? For the purposes of this question, utilitarianism may be understood as the view that we ought to do those things that promote human happiness and reduce human suffering for the most people.

B. How might a Christian moral theology deal with the same issues? In this part of your answer explain the relevant facts of the case, and the principles, criteria, and authorities, including Holy Scripture, that you would bring to bear on the way in which you approach the question. Explain how these authorities relate to each other.

The Christian Apprehension of Tragedy

Tragedy is an innate aspect of human existence; to be embodied is to risk the attendant
pain and tragedy. Nothing highlights this reality more acutely than the series of natural disasters
that have struck various parts of the globe over the past few years; from the tsunami to
hurricanes to earth quakes, the fragility of human life and our inability to exert supreme control
over our environment has been dramatically displayed. In the midst of such tragedy we are often
forced to make difficult and painful decisions. These decisions then tell stories about our
character and who we perceive ourselves to be, both in the process by which they are made and
through the way we react to them afterwards.

One of the painful practices often necessitated by disastrous events is the need to engage
in what has been termed “absolute triage,” i.e. the “decision to treat some injured persons first,
based on an assessment of their likelihood of survival, with the knowledge that delaying or
denying treatment to others will likely result in their deaths.” Events have only recently raised
this issue to the fore of societal consciousness, yet it is a decision the reality of which military
doctors and chaplains have been forced to deal with for generations. As is so often the case, the
horrors of war mirror in a heightened and condensed way the common reality of life in a fallen
world.

From a strictly utilitarian (the maximization of happiness and reduction of suffering for
the most people) point of view the choice to engage in absolute triage makes perfect sense.
Whether in a civilian or military setting, the utilitarian recognizes that limited resources and
capabilities necessitate their most effective use. In this case the decision to treat those patients
with a higher likelihood of survival first, means that at least some of the injured will live, while
operating from another framework or from the reverse, i.e. treating the worst patients first
whether they are likely to survive or not, could result in the deaths of many more.

A robust utilitarian viewpoint might necessitate going even further however, beyond the
immediate question of which patients have the highest likelihood of survival to the question of
who or what their patients are. The famous example of this is the question of whether one would
choose to save the President of the United States or a janitor in a given situation. The obvious
answer from the utilitarian viewpoint would be that one would first treat those patients with the
highest likelihood of survival and order their treatment based upon any knowledge one might
have of their possible contributions to the good of society. The danger here of course, is that any
notion of worth is much more subjective than an evaluation of survivability.

In contrast to the utilitarian viewpoint, a Christian understanding would also support the
implementation of absolute triage when necessary, but would do so for different reasons. The
Christian shares with the utilitarian the concern that the best possible use is made of all available
resources. Like the utilitarian, the Christian is initially concerned with saving the most people
possible, and allocating resources accordingly. Yet where the utilitarian view is almost
exclusively anthropocentric, the Christian perspective is shaped by an understanding of who God
is as well as by a distinctively Christian anthropology that informs our understanding of who we
are.

This Christian anthropology is one that is primarily theocentric, being based upon the
premise that humanity is created in the image and likeness of God and therefore derives worth
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from this principle, this unique relationship with God. Because of this affirmation about the
nature of humanity and our God, a Christian is bound to make choices in view of what would
offer the most people the chance of survival. And yet, this affirmative task of saving as many
patients as possible is balanced within the Christian consciousness by the recognition that those
who will die are also images of God. There is no sense in which a Christian would be able to
disown the fact that their decisions may have resulted in deaths, most of which would perhaps
have happened anyway, but which would have been more bearable had action been taken. And
yet, the recognition that there are situations in which everyone cannot be saved is important. In
this sense then, a Christian perspective is able to maintain a sense of the tragic that may be
unavailable within a utilitarian framework.

The decision of the Christian to engage in absolute triage is based upon an affirmation of
common human identity as created in the image of God; this leaves little room for any
distinctions beyond survivability. Again, it is important to note the element of tragedy in this, a
sense of which is an important aspect of any Christian response to disaster. Any disaster that
takes the lives of human beings is tragic on multiple levels: it is tragic because it cuts short the
life of a human being created in the image and likeness of God, it creates pain among those
friends and family members who are left behind and in a broader sense, is tragic because it
stands as a testimony to a fact of our existence that is not part of God’s will for us, death having
entered the world by sin. This understanding is under-girded by the understanding that our world
is imperfect and fallen and that nature too groans for redemption, as Paul says in Romans.

Such recognition of the fallen nature of the world is the only means by which Christians
might be able to move forward through extreme tragedies and hardships. In such a world,
Christians must reject the desire to explain all decisions away as positive and unblemished
goods. There must be recognition of the scriptural mandate we are under to care for the afflicted.
Christ healed the sick, cast out demons and raised the dead. These miracles stand as both
testimony and mandate that we, followers of Christ, do all within our power to give comfort and
aid to the afflicted and to heal the sick. This is part of what it means to be imitators of Christ.
The call to minister to the afflicted is one that the Christian cannot avoid, with all its attendant
risk and pain.

Because of Christ’s ministry here on earth, and the commandments he left with us, we are
called to minister to our brothers and sisters, to convey the love of God. At the same time
Christ’s example, his death on the cross, should illustrate that there are some situations out of
which we cannot expect to come unscathed or unstained. And yet if Christ was willing to bear
the sins of the whole world upon himself, then his followers should be willing to bear the
possibility of guilt in a situation wherein painful decisions are called for. Indeed, there is a
necessary humility to be found in making such difficult decisions. This humility comes from the
recognition that, as Rowan Williams points out in his book Lost Icons, every choice I make will
somehow limit someone else—the idea that I am a free agent and can make choices without
consequence, without necessarily restricting the choices of another, is a myth.

When taken in this context, when we have accepted that our mundane decisions can have
consequences, it becomes somewhat easier to accept our human frailty and our culpability and
recognize that momentous and difficult decisions are not aberrant in their tendency to affect
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others, only dramatic in their consequences. This is an important realization because decisions
are necessary in all aspects of our lives, including these tragic circumstances. We have to be
willing to accept responsibility, to recognize the nature of the world in which we live and step up
to the task of making the painful choices we’re called to. Such is the lesson of Dietrich
Bonhoeffer’s decision to participate in the plot to assassinate Hitler. Bonhoeffer never attempted
to explain away his actions—or the actions of any of his compatriots—as a positive good; rather,
he demonstrated that there are choices that present us with degrees of evil, and sometimes
refusing to recognize the harshness of the truth and choose anyway is the greater evil or sin.

Bonhoeffer’s situation is not all that different from the situation that faces those
Christians who find themselves faced with the hard choices of who to treat or not treat. There is
no denying the fact that such choices are often tantamount to determining who lives and who
dies. In the situations where such decisions are necessary however, it is more likely that such
choices determine who lives, since not choosing would mean that most or all would die. It
would be a grave sin to allow many to die for an inability to muster the moral courage necessary
to make a choice, and live with the consequences. For some, the refusal to make these decisions
could be the result of fear—fear of guilt, fear of reflecting upon whether they chose the right
people for treatment. For others the motivation could be pride, the refusal to let go of the belief
that we can control every aspect of our lives, that somehow we can make a limited supply of
medicine or supplies stretch, or we can keep our patients alive as they wait in line for treatment,
without the need for difficult decisions. In reflecting upon these situations it is important that we
keep our own human frailty in the forefront of our minds, that we never take upon ourselves the
role of savior and in so doing fail miserably. Indeed, our Lord himself did not heal all who were
sick, nor did he raise all who died from the grave like Lazarus. He suffered the death of John the
Baptist and in the end did nothing within his power to stop his own torture and crucifixion. Jesus
came to inaugurate the Kingdom, to announce the reconciliation of God to humanity and to open
the path to everlasting life in the midst of the fallen and cruel world.

And it is in the time between the inauguration of the Kingdom and the final establishment
of God’s rule that we live. In the time between Christ’s first and second advents, we are called to
recognize the still-wounded state of the world and be prepared to make decisions that we would
otherwise reject. Because of this, there are times when we must bear the blows of the world, but
in doing so, we are called to witness to hope—the hope of miracles and forgiveness in our day,
and the hope of everlasting life in the future, where we look forward with anticipation to the
coming of Christ and the restoration of all things.