My heart became hot within me. As I mused, the fire burned; then I spoke with my tongue: "O Lord, make me know my end and what is the measure of my days; let me know how fleeting I am!"

14 April 2005

Book Review - Medical Ethics

Medical Ethics
John Frame, systematic theology & philosophy prof at RTS/Orlando

I know I won't need them there, but there are some books I'd like to take to heaven. This is not one of them. That's not to say it's a bad book, just that it's designed for life in a fallen world. It's just not fun to think through issues of disease, dying, death, etc. My only consolation in reading this book is that medical ethics, too, can be used for the glory of Christ.

Frame begins with a brief but helpful intro to ethics in general. His method of approach is to look at areas in three perspectives: the normative perspective (Scripture), the situational, and the existential (a focus on the "personal moral agent"). While many Christians often pick and choose simplistic applications from God's Word, Frame notes: "Often, believing in an authoritative, and therefore consistent, bible makes ethical decision making even more difficult." amen. This section also makes helpful distinctions between Scriptural prohibitions, permissions, commands and praises (i.e., David's men getting him that drink of water was praiseworthy, but didn't mean the others had to do the same thing).

After asking, "What difference does it make to trust in a fully authoritative Scripture?", Frame goes on to lay out general principles upon which a good medical ethic should be built: the meaning and value of God's world, the value of human life, the idea of "quality of life" ("The best life is a life lived in fellowship with God"), the precedence of godliness over health, the provision of care - this is the sticky life we all have to face, pastors more than most. Even theologians can't make this stuff dry.

Thankfully, Frame keeps another foot planted in that real life, going on to address specific issues:
What is a person? "...everyone who belongs to the race of Adam bears God's image [and is thus a person]
Are we autonomous? "The word autonomy should be rejected, since it almost invariably connotes lawlessness, which is the opposite of man's responsibility to God."
What constitutes competency? "...competence is conformity to God's will"
What about informed consent? "...[in some cases] Scripture warrants nondisclosure, even deceit, to save life."
What about confidentiality? "...according to Scripture, confidentiality is not an absolute."

Taking another step into real life, Frame continues to address even more specific issues like medical research, criteria of death ("we should not declare someone dead until we can conclude that heart, lungs, and brain have all irreversibly ceased to function."), differences between dead/dying/comatose/terminal/handicapped ("Terms such as 'vegetable' and 'bodies without persons' greatly inhibit clarity"), and the fine, graying line between killing and letting die (letting die is sometimes morally justified).

The two appendices address (1) other authors' criteria of death and (2) abortion.

Should you read this book? idunno. I'm glad I did; I expect it'll come off my shelf several times before I die, due to the nature of ministry in a fallen world. It is a worthy book on a heart-rending topic - but a topic in which our whole country (including the church) seems to be wandering blind. My only suggestion would be for the author to direct God's people in seeing how Biblical decisions really do glorify the Biblical God, thus making even the end of life glorifying to the giver of life.

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