Health and Human Flourishing: Religion, Medicine, and Moral Anthropology

6 The Integrity Conundrum

c h a p t e r c h a p t e r 6 The Integrity Conundrum Suzanne Holland In bioethics the conversation on integrity most commonly takes place in research ethics. We are all loath to repeat the horrors of Tuskegee, and so we design research studies with what we hope is integrity—that is to say, we aim first of all to protect the dignity and vulnerability of the persons in our studies. This we do through informed consent and through the principle of autonomy. But little of this, while laudable, is helpful in the many cases that come to us outside of the research arena. By focusing on a particular case, I aim to excavate what integrity means in its theological context, as a way of thinking through issues in bioethics that seem to be connected by an invisible thread from our heads to our hearts. I begin by exploring the roots of integrity itself. What are its origins? What kind of theological sense does it include? In other words, does integrity tell us anything critical about what it means to be a human being trying 104 suza nne holl a nd to sort out the conundrums life throws at us? Indeed, does it tell us anything at all about being a human person before God, and if it does, is this clarifying, or does it obfuscate even further? Is it a helpful concept as we sort through the practical muddles of bioethics? After examining the origins and context of integrity I consider the case of elective cosmetic surgery, specifically breast augmentation. I offer a framework for corporeal integrity that I hope goes some way toward helping sort out the ethics of elective surgical makeovers. In doing so, I attempt to integrate a theological ethics into a realm that has largely been the province of philosophical bioethics.1 Integrity in Historical and Etymological Context The Oxford English Dictionary (OED) notes that integrity derives from the Latin adverb integritas, meaning “wholeness, entireness, completeness, chastity, purity, f. integer, integr- whole, INTEGER.” Its earliest recorded usage seems to have been around 1420, and its evolution moved from a sense of material wholeness—the condition of having nothing taken away—to something undivided (1620), to “the condition of not being marred or violated . . . original perfect state” (1561, 1650), and then to the moral sense of the word, “unimpaired moral state; freedom from moral corruption; innocence, sinlessness,” which the OED lists as obsolete. The moral sense appears in Calvin’s Institutes (1561), for example, I.54: “In this integritie, man had freewil, whereby if he would he might haue attened eternall life.” Undoubtedly, Calvin would have been influenced by Aquinas, and perhaps Augustine on this point. The OED gives the common usage of integrity as “soundness of moral principle; the character of uncorrupted virtue, esp. in relation to truth and fair dealing; uprightness, honesty, sincerity.” In the eighteenth and nineteenth centuries its usage is applied to “integrity of heart” (1795, Gentl. Mag. 543/1), and the notion that one tends to “trust in a person known to be of thorough integrity, that he will always be upright” (McCosh 1874). Although it lists the usage of innocence and sinlessness as being obsolete, the OED’s inclusion of “the character of uncorrupted virtue” in common usage does appear rather closely related to the former, obsolete sense of integrity. Whether the ancients thought of integrity as a virtue in itself, it is difficult to tell. Plato wrote about integrity in The Republic as the quality of the philosopher; however, when Aristotle wrote Nichomachean Ethics, he did not discuss integrity as among the virtues, unless it may have been one of the virtues for which he could not find a name, such as in his discussion The Integrity Conundrum 105 of truthfulness, “the mean—also nameless—of which boastfulness is an extreme” (1127a/14). Aristotle’s discussion of moral strength and moral weakness in Book VII in some ways resembles what we think of as integrity , and yet not. Integrity was probably a second-order virtue for Aristotle. Augustine, too, can be read as alluding to integrity when he reveals his struggles with his own concupiscence in his Confessions. Saint Thomas Aquinas equated virginity with moral integrity (Summa Theologiae 2-2, 152, 1-2). Thus we have the origins of the debate over flesh and reason that has troubled dogmatic theology from Augustine...