Always Clarify
Session Two-Part Two
– 3 Readings
– 3.1 Two contrasting world views
– 3.1.1 Christian approaches
– 3.2 Robert Orr’s method
– 3.3 Common secular approaches
– 3.4 Bioethics: a tragic view
3.1 Two contrasting worldviews
– Judeo-Christianity
– Darwinian Naturalism
Image of God
• Genesis 1:27 27 God created man in His
own image, in the image of God He created
him; male and female He created them.
• 2 Peter 1:4 For by these He has granted to
us His precious and magnificent promises, so
that by them you may become partakers of the
divine nature,
Image of God-Substantive
Genesis 2:7 And the LORD
God formed man of the dust
of the ground, and breathed
into his nostrils the breath of
life; and man became living
soul.
Pre-Conscious
• Naïve state prior to
stimulus challenge
Sub-conscious
• Sense or unarticulable feeling
Image of God- Conscious
• Conscious state
Image of God-Relational &
Functional- Gen. 1:28-31
Moral living: “To be”
God
I
Thou
human
act
Sanctity and Quality of Life
•
Absolute Sanctity of Life
•
Qualified Sanctity of Life
•
Transcendental Sanctity of Life
•
Pure Quality of Life
“Saying the Unsaid: Voicing Quality of Life Criteria in a Sanctity of Life Position," in The Journal of the Evangelical
Theological Society. (March 1996) v. 39/1, pp. 103-122
tSOL/QoL Criteria
• Imminent Death
• Irreparable Condition
• Irreversible Condition
tSOL& a Theology of
Martyrdom
• Philippians 1:21 For to me, to live is Christ and to
die is gain.
• Philippians 1:23-24 But I am hard-pressed from
both directions, having the desire to depart and be
with Christ, for that is very much better; yet to
remain on in the flesh is more necessary for your
sake.
• Romans 14:8 for if we live, we live for the Lord, or
if we die, we die for the Lord; therefore whether we
live or die, we are the Lord's.
The Fall
• Genesis 2:9 Out of the ground the LORD God
caused to grow every tree that is pleasing to the
sight and good for food; the tree of life also in the
midst of the garden, and the tree of the knowledge of
good and evil.
• Genesis 3:5 "For God knows that in the day
you eat from it your eyes will be opened, and
you will be like God, knowing good and evil."
∞
∞
Horizon of YHWH
Truth & Illusion
I in Incarnational
Community of Contrast
Kingdom of the Knowledge of
Good and Evil
Fact & Symbol
Object/Phenomena/Appearance
(Structure of Sin)
other
Communal Spiritual
Narrative
Kairos
Heilsgeschichte
Spiritual
Illumination
Aeveternity
Futurity- Futurity-Eternal
Temporal
Kingdom of Life
Age of ages
Spiritual
Ex-ist-ance
(Essence, Noumena, Thing-in-Itself)
∞
(Father/Logos/Spirit)
YHWH
∞
The Good God Question
• Job 38:1-2 Then the LORD answered Job out of the
whirlwind and said, 2 "Who is this that darkens
counsel By words without knowledge?
• Job 42:3 'Who is this that hides counsel without
knowledge?' "Therefore I have declared that which I
did not understand, Things too wonderful for me,
which I did not know."
3.1.1 Christian Approaches
– Roman Catholic based principlism1
– Judeo-Christian Hippocratic ethics
– Christian Virtue Ethics
1Ethical
and Religious Directives for Catholic Health Care Services Fifth Edition. United States Conference of Catholic
Bishops, Issued by USCCB, November 17, 2009
3.2 Robert Orr’s Method
• Framing the medico-ethics question
• Four elements for medical clarification
• Clarifying decision making agency
• Clarifying institutional level issues
• Operative norms and values
• Discussion
• Recommendations
• Follow-up
• Comments
3.2.1 Framing the Medicoethics Question
3.2.2 Four elements for
medical clarification
• Patient History
• Diagnosis
• Prognosis
• Treatment plan
3.2.3 Clarifying decision
making agency
• Patient capacity
• Legal competency
• Surrogate agency
3.2.4 Clarifying institutional
level issues
• Distinctives in policy and procedure
• Legal implications
3.2.5 Operative norms and
values
• Primary agents
• Mitigating agents
3.2.6 Discussion
3.2.7 Recommendations
3.2.8 Follow-up and
Comments
3.3 Darwinian Naturalism
• Principlism
• Social Contract
Variation on Principlism
• Medical indication (medical norms)
• Patient Preference (autonomy)
• Quality of life (Beneficence/non
maleficence)
• Contextual features (includes justice)
Albert Jonson: Clinical Ethics
Social Contract
• Contracts made with voluntarily consent to
receive or give up benefits and burdens to its
members, health care institutions and health
care distributions must conform to the dictates
of agree upon principles
• Equitable distribution of health care should be
conceived in terms of justice
• Done under the ‘veil of ignorance’
• Mini/max principle
The proper way to think abut health-care spending is to
focus on the NET SOCIAL VALUE ADDED by health care,
defined as:
Net social
Added by
=
Health System
Gross Value
Added by
Health Care to
Patients
The
Opportunity
Costs of that
Care for Society
Among these opportunity costs are:
• education of our young
• basic science R&D
• nation’s public infra-structure
• national security and defense
David B. Reuben: Portland Providence Medical Center Grand Rounds Providence Nov. 16, 2011
A Matrix for Ethical Decision
Making in a Pandemic
Dr. John Tuohey
An Example of Applied
Synthesis of Principlism
and Social Contract
Ethics Exercise
• Interactive Exercise
• Orr’s Method
Clinical Ethicist Interview
• How did you prepare to be a clinical ethicist?
• What is the policy and procedure for a clinical
ethics consult?
• How do you approach conflict?
• Is there ever a place is their for a local spiritual
counselor in a clinical ethics consult?
• How would you counsel me to respond if I were
called to be involved in a case?