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.

Moral Subject: “I”Moral Subject: “I”Moral Subject: “I”

human elements expressing imago Dei

corporeal

psychofactual

spiritual

Pre-Conscious

• Naïve state prior to stimulus challenge

Pre-conscious Innate DispositionPrePre--conscious Innate Dispositionconscious Innate Disposition

pre-consciousness

Sub-conscious

• Sense or unarticulable feeling

Sub-conscious emergent feelingSubSub--conscious conscious

emergent feelingemergent feeling

sub-consciousness

pre-consciousness

Image of God- Conscious

• Conscious state

Consciousemergent reflection

ConsciousConsciousemergent reflectionemergent reflection

sub-consciousness

pre-consciousness

consciousness

Image of God-Relational & Functional- Gen. 1:28-31

Moral living: “To be”Moral living: “To be”Moral living: “To be”

I Thouhuman

act

God

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."

(Father/Logos/Spirit)(Father/Logos/Spirit)YHWHYHWH

other

(Essence, Noumena, Thing-in-(Essence, Noumena, Thing-in-Itself)Itself)

Kingdom of the Knowledge of Good and Evil

Object/Phenomena/Appearance (Structure of Sin)

Kingdom of Life

Horizon of YHWH

Truth & Illusion

Heilsgeschichte

Aeveternity

Fact & Symbol

Age of ages

Spiritual Illumination

SpiritualEx-ist-ance

Futurity-Temporal

Communal Spiritual Narrative

Futurity-Eternal

∞

∞

∞

∞

I in Incarnational Community of Contrast

Kairos

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 Medico-ethics 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 tofocus 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 DecisionMaking 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?