A Good Class

My students nearly came to blows this week, arguing over the ethical implications of a serious reading of Revelation.

It doesn't get any better than that, does it?

Books in Review

I don't recall whether or not I had a specific textbook on the Historical Jesus Problem in Intro to the New Testament. I remember the professor's lecture on it (very clearly), and I remember some books I read on the topic in subsequent years.

But I can't remember whether we had a book in NT 18 that explained the debate.

If not, that's likely because Mark Allan Powell's Jesus As a Figure in History wasn't published yet.

This is a surprisingly good textbook for introducing seminary students, religion majors, and beginning biblical students to the field of Historical Jesus research. Powell is detailed, clear, thorough, and--what was perhaps the most surprising--unfailingly generous in his descriptions of scholars and their methods. It would be a useful addition to any introductory New Testament syllabus.

Books in Review

Joseph Amato's Victims and Values: A History and a Theory of Suffering has been a frustrating book to read.

It was frustrating primarily because I was desperately interested in an excellent treatment of his thesis: that the modern conception of and pursuit of justice is impoverished by its dependence on an inadequate understanding of the relationship between suffering and justice. Amato's treatment certainly raised issues, but without the sort of care and discretion that one must adopt when preparing to slaughter sacred cows.

Amato rightly (I believe) diagnoses certain problems with socio-political discourse in the US. The public discussion of justice, where it occurs, has become "a game of pick your victim," as Eugene Weber says in the intro to the book. Injustice and suffering--whether historical or actual, present or potential, rightly or wrongly perceived--are understood to create a debt which the public must honor. Indeed, virtually any kind of suffering is at least potentially the business of the state, whether as arbiter of competing claims to remediation (as in tort law), the administrator of whatever recompense is owed (as in welfare or medicaid), or the party ultimately responsible for inflicting suffering (as in our history of racial injustice).

Amato traces, with varying precision and insight, the historical development of this way of approaching the relationship between suffering and justice. At times, the story he is trying to tell gets lost in the details, but his point is primarily genealogical. It is not "natural" or inevitable to respond to reports of suffering the way we tend to do in the US today. We are the heirs of a philosophical sea-change that began, really, with Bacon, but since Amato is not particularly interested in medicine, he names other Enlightenment figures as the primary actors. Bentham is the obvious front-man: his articulation of utilitarian rationalism changed the way even non-utilitarians approach discussions of justice and suffering.

Unfortunately, when Amato moves from the historical to the contemporary, his argumentation fails. Or, rather, he fails to draw on the data in a way that would convince any that don't already agree with him. He relies on generalities and broadsides, abandoning his earlier practice of relying on texts.

(Reading society, as he purports to do in his final chapters, is both easier and more difficult than reading texts. One has fewer restraints on the interpretations one may advance; on the other hand, one's opponents are similarly unconstrained.)

Yet the questions he raises, particularly in chapter 8, are spot on. The relationship between suffering and recompense, dessert and justice, remuneration and retribution, is one that begs to be investigated. Public policy tends to act on too hazy an understanding of how suffering and justice are related generally and in a particular policy or law. How, for example, is Affirmative Action related to Jim Crow or slavery? More generally, what is the relationship between a people's historic suffering and an individual's demand for justice? What is justice, when the injustice has been so vast as to be irremediable and unforgivable?

These questions are urgent and immediate. Unfortunately, I doubt anyone given to rely on the modern understanding of suffering--that it gives me a claim to innocence, a moral vantage from which to demand something, a right to force others to attend to my perceived needs--is going to find Amato's book anything like persuasive.

In the "It's a Nice Gesture, But . . ." Category

Our winner is: Trinket Round-up Day!

A Minnesota hospital system, eager to show how serious it is about containing drug costs and making prescription decisions based on science alone, has conducted a hospital-wide purge of notebooks, pens, post-it notes, and the like with drug ads on them.

This very admirable gesture netted over 18,000 items, all of which are now banned--that is, doctors are banned from accepting such items as gifts from drug company reps.

One hopes that lavish cruises, expensive dinners, and opulent parties are likewise banned, but such was not specified. In fact, one suspects that drug companies will find ways to "work with the system" (read: work around the system) in order to do what they've always done.

Predictably, a pharmaceutical industry spokesperson called the trinket sweep "Draconian."

But personally, I found the last two lines of the article to be the most telling:

Many of [the hospital's] items will be going to the health system of the Evangelical Lutheran Church of Cameroon, which has three hospitals, and several rural health centers.

Irons said there shouldn't be a conflict of interest in Cameroon because the advertised drugs aren't available there.

Books in Review

The Body in Pain: The Making and Unmaking of the World, by Elaine Scarry, begins with an absolutely brilliant account of the interior structure of torture--how it accomplishes what it intends, what it, in fact, intends quite apart from what it purports to intend, how embodiment is configured in the interaction between torturer and victim.

That we are now having something of a national . . . well, debate is too strong a word, isn't it? . . . thought exercise maybe? (of course, it's only a thought exercise for us) on the subject of torture only makes Scarry's chapter seem eerily prescient (the book was published in the mid-nineties).

She then moves to an equally important reading of the structure of war. Following Carl von Clausewitz, she makes the simple (but hardly simplistic) statement that war is an injuring contest whose physical consequences are held to certify the right of the "winner" to author reality for both parties. Each aspect of that statement (injuring, contest, consequences, winning, authoring reality) receives thorough attention, especially to the ways in which the statement's accuracy is masked (whether intentionally or incidentally) in speech about war (histories, media reports, propaganda, personal accounts).

My respect for Scarry's accomplishment in these two chapters is only partially mitigated by the three chapters that follow. The conceptual lenses by which she is able to read war and torture (and later, capitalism) so keenly are themselves less persuasively described.

For Scarry, bodily pain is the ground of creation/civilization and disembodiment is its product. One makes--coats, bread, speech, ideas--in order to alleviate an uncomfortable awareness of one's body (hunger, vulnerability to injury). The made thing, as long as it perdures, gives benefits the force of which is to remake the body of the maker (resistance to cold, increased mobility, ability to communicate with those outside the range of one's physical capacity) in a manner that disguises the limits imposed by human embodiment.

While this analysis has much to recommend it, Scarry's account of pain and creation are too narrow. Pain is not the only experience in which we become attuned to the fact of our having a body; pleasure serves that function, too. (Thomas's account of pain is much more convincing--it is one of the passions, not the paradigmatic fact of human existence.)

And pain is not the only creative prompt. This is, of course, a theological as well as an experiential claim. (Scarry addresses this objection, incidentally, by claiming that apparently gratuitous acts of creativity are only possible in the presence of a cultural abundance itself produced by pain, a claim which has merit but is not sufficient to explain the phenomenon of creativity.) If we are the children of a God who creates out of peace, out of completeness, without external compulsion, then our creativity likewise may not always require the goad of suffering. (I am obviously borrowing from David Hart's book here.)

I must also find fault with her reading of the Old Testament as compared to the New--like all post-Christian liberals, she depends on a trite and anti-Judaic reading of both texts. The "Christianity is an evolutionary improvement on Judaism" motif is too tiresome for words, and the variation played here is neither subtle nor plausible. The Old Testament god functions in the role of torturer; the violence and cruelty of religion is mitigated by the embodiment of god narrated in the stories of Jesus of Nazareth. If god has a body, the concept of god is destabilized in humanity-affirming ways. We make room for peace and democracy and (a Marxist version of) the American way.

I have other, more minor, quibbles with Scarry's work, but these will suffice. In truth, however, none of these quibbles can undermine my respect for what she has accomplished in her first two chapters. Would that I could make these two chapters required reading for participation in civic life!

Science Reporting

I've been interested by a slight change that's been happening recently in science and medicine reporting. I've only noticed it in online AP articles, but perhaps those of you who watch TV or read other news sources can tell me how widespread the phenomenon is.

An example is this article. Like most science reporting I've seen, it mentions the results of the study, where the study was published, and a one-sentence "take-away" message from an "expert" in the field.

Unlike most science reporting I've seen, it mentions the methodology of the study and its source of funding.

I think this is an important step nearer to the sort of transparency that should characterize the communication of science to non-specialists. I have noticed several popular health trends for which the warrant was a single, poorly-designed study (or rather, ones for which the study was not designed in a manner which suggested an appropriate or effective course of action), inadequately or inaccurately reported by popular news sources.

Having the methodology and the potential for bias spelled out so clearly as in this article is a real service to the health consumer, as well as the merely-interested-in-medical-science non-scientist.

I've also noticed that the AP is being more transparent about the relationship between their "expert" sources and those who might have an interest in how a study is reported. Such an example does not appear in the article I linked above, but I've noticed many "expert opinions" tagged with such phrases as "suggests so-and-so, who was not involved in the study" or "commented so-and-so, who had not yet read the report in its entirety."

Again, this seems like a promising and appropriate move toward more transparency. Good thing, that.

Professional Ethics?

I am watching this judicial showdown with great interest.

First of all, by one reading, I, too, belong to a professional organization (i.e., The United Methodist Church) that has its own professional licensing procedures (The Board of Ordained Ministry). Although my organization's professional licensing procedures are not in any sense overseen, supervised by, or practiced at the mandate of any federal or state legislation, there is at least one major circumstance in which my authorization as a pastor is linked to my authorization to provide a legal service: that is, marriage.

What if my professional organization's licensing procedures were in conflict with the state's guidelines concerning the practice of performing marriages? This could potentially come up, given that my professional organization currently forbids its members to officiate at weddings that are considered legal in some states. I am not aware of any cases where my professional organization has exercised its authority in this matter (the UMC is not exactly known for its episcopal backbone), but what if it did? Would the state recognize the right of a professional organization to set its own ethics, even to the inconvenience of the state or its citizens?

This problem is much more acute in the case of medical practitioners whose ethics conflict with the state's interest in carrying out its business. And the scalpel cuts both ways, politically speaking: at present, doctors are permitted to refuse to perform or refer for procedures or treatments to which they have a moral objection, even where state law has recognized access to those procedures and treatments as a civil right. Generally speaking, those who would be in support of the Medical Board's attempt to do an end run around the law with regard to the death penalty tend to be highly critical of practitioners' attempts to do an end run around the law with regard to abortion and certain forms of birth control.

I'm very, very curious to see how it will play out.

Christian Bioethics?

This past week, I began a four-week lecture series in a local church's Sunday School class. The parish, a significant portion of which is comprised of doctors and lawyers, had requested a class in Christian bioethics.

Believing they were expecting a four-week class in "which side to come down on" ethics, and hoping to problematize their approach somewhat, I decided to focus on biblical portrayals of health and sickness for the first three weeks of the class. We won't get to "Issues in contemporary medicine" until the last week.

The first class focused on Old Testament depictions of health. I depended heavily on observations by Norman Wirzba and Ellen Davis on the holistic nature of the Hebrew concept of Shalom--a concept that included human health, of course, but also the health of the land, of the people's relationship to its God, of the politics of the people, and of interpersonal relationships among the people. Not just health, but justice, mercy, forgiveness, love, economic responsibility, and environmental stewardship are encompassed in the biblical concept of health and wholeness.

We looked at texts like Isaiah 65 and Leviticus 26 to ground our understanding of God's desire for all of creation to share in God's Shalom. I'm hoping that they begin to see that "health," as we moderns understand it (i.e., the absence of pathology in an individual body), is a paltry substitute for Shalom.

Better to live on the corner of the roof . . .

Marital Strife Makes You Sick.

Duh.

Conflicting Goods?

I've often been suspicious of the starring role played by the principle of autonomy in most medical ethics treatises.

So it's interesting--to say the least--to hear a presidential candidate propose a solution to our country's health care dilemmas that proposes limiting patient autonomy in a substantial way--or at least penalizing the irresponsible exercise thereof.

John Edwards (Does anybody else keep accidentally calling him Jonathan Edwards?) recently proposed health care policy that would mandate certain preventative measures, including annual checkups and mammogram screens.

Now, this is a very interesting proposal. In many ways, it naturally follows from the combination of the logic of the market and the logic of liberalism, both of which also depend on autonomy as their chief good. Medicine has been almost completely subsumed into both--it has become an enterprise almost completely dominated by its economic side, and government intervention into and regulation of the practice of medicine is taken as normative. (Ask even the most ardent libertarian whether he'd like his son to be operated on by a doctor who was not board-certified.)

So, assuming medicine to be a predominantly economic enterprise, and assuming government responsibility to make this economic enterprise run well, it makes sense for the government to exercise its authority by incentivising and disincentivising behaviors that have economic consequences within the system.

This means you have three disciplines or systems which derive their internal logic from a primary commitment to autonomy, combining in such a way that virtually demands a limitation of individual autonomy. Fascinating.

In all honesty, though, as much as I loathe Edwards' proposal, I think he is the first candidate whose proposals show that he understands the complexities of the health care problem. Few of the other proposals I've seen seem to take seriously the complex interplay of economics, psychology, law, and biology that comprises health care. I'm not sure he adequately addresses the dynamics of the patent system or litigiousness, but he has covered more bases than most people.

The only bit of utter cluelessness came when he said, in response to the question of whether people would find this too invasive, "We mandate public education—public or private—and no one minds that."

Now, I know he's only homeschooling his kids this year so that they can spend time together as a family while he's campaigning. So he's not a hard-core homeschooler. But still, you'd think he'd have heard of a movement of a couple million people who decidedly "mind that." Or maybe have read of the violent resistance that attended the introduction of compulsory schooling?