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

11 Bioethics, Relationships, and Participation in the Common Good

c h a p t e r c h a p t e r 11 Bioethics, Relationships, and Participation in the Common Good Lisa Sowle Cahill Relationality is so integral a dimension of being human that it would be impossible to define morality without it. It is thus essential to any view of the human that could successfully ground a theologically informed bioethics . In fact, a recent publication of the Catholic Health Association (CHA) begins a discussion of relationality with this statement: “Human beings are made in the image of a triune God whose very nature is to be in relationship . As such, we are relational or social by nature. We are meant to exist in relationships—with ourselves, with others, with the rest of creation, and with God. Our flourishing as human beings only occurs in the context of relationships. And our fulfillment, our destiny, consists in relationship— communion with God.”1 I doubt that anyone would disagree with this statement, and that is perhaps the only difficulty in taking relationality as a foundation of a theological 208 lisa sowle cahill anthropology for bioethics. It would be easy to keep our discussion at the level of platitudes. There are, however, hard questions that follow from the fact of human relationality. It is human to be in relationships—but what kind of relationships are we in? What is their moral quality? Is relationship essentially benign and cooperative, or is it inherently competitive and conflictual? Even if it is cooperative, is it possible to meet all the requirements and obligations of relationality successfully, at all times and in relation to all persons? Isn’t the reality of conflicting values, relationships, and roles of the essence of morality too? And who defines proper relationship, or the best way to set priorities and resolve conflicts? Does a theological anthropology provide insights that a philosophical or political perspective cannot? Is theological bioethics based on a special view of the human, and an understanding of relationality that will put us at odds with broader views of virtue, justice, social ethics, public policy, and the good society? Are we theological bioethicists ultimately talking to ourselves? And even if we can come to agreement with others on the basic meaning of the human as relational, and the basic shape of a good society, what makes us think that that vision can be achieved in practice? Is a Christian anthropology, especially in its Catholic “common good” versions, hopelessly naïve about the social and political realities that, for example, are causing 45 million people to be without health insurance in this country, or 44 million worldwide to be victims of AIDS? My purpose here is to make the case that a Christian view of human relationality converges with a very basic human experience—interdependence with others in community. There is in fact some common ground in talking about the good society, and about what justice means in bioethics. While acknowledging the reality of competition and conflict, I propose that there is an equal, if not greater, human drive toward cooperation. Religious narratives and symbols can be powerful agents in evoking inclusion and cooperation as moral values and aims. Finally, I argue that the Catholic common good tradition must verify its claims by doing more than talking about ideals; it must combat pessimism and “moral realism” by showing how those ideals can be, and are being, put into practice. As examples, I will use, first, the actual practice of Catholic health services as an institutional response to the need for justice in health care access in this country, and second, the response of transnational Catholic organizations and networks to the AIDS crisis. It is not easy Bioethics, Relationships, and Participation in the Common Good 209 to make a credible and nonnative case for a positive, confident, activist, and social transformationist approach to relationality as a basis for theological bioethics. As Reinhold Niebuhr famously remarked, original sin is the only Christian doctrine for which there is empirical verification. But I propose to show that Christian (Catholic) bioethics can reform relationships of health care, and offer at least some empirical verification of the doctrine of redemption, by advancing the potential for human relationships to be healed. My argument consists of four parts: (1) relationality and responsibility, to use the moral language of H. Richard Niebuhr; (2) biblical resources, especially the “image of God” and “the preferential option for the...