Despite the concerns I expressed earlier that religious participation in health care ethics is too often limited to philosophical considerations to the exclusion of the theological, I recognise that all modes of enquiry rely on an implicit philosophy. This is true of both health care and theology. For theology, the relationship with philosophy is well established, as “faith seeking
understanding” through a variety of philosophical resources. In the case of health care, the connection is less clear-cut.
Let me offer an example from the area of medical practice. Michelle Clifton- Soderstrom has pointed out that as medicine becomes increasingly scientific in orientation, methodology, and discourse, the distance between practitioners and patients is also increasing. Associated with this increasingly scientific orientation of medicine is the view that the uniquely female aspects of health care need to be controlled. Child-bearing, which in most pre- medicalised cultures is viewed as a natural process, is viewed in contemporary Western medicine in “quasi-pathological” terms.42 The
physician is the agent on whom all activity is focused; the woman is passive and needs to have her condition managed and controlled.43 This tendency to
view health care professionals as the agents, and patients as merely passive in the process of health care, implies a distinct philosophical stance, however unavowed. Dominant models of health care, especially when they are basically utilitarian, and their associated ethics, filter all health decisions through a lens focused on autonomy, beneficence, non-maleficence and
42 I recognise that this is a provocative claim, even with supporting research; however, the kinds of language which are associated with pregnancy and birth do lead to such conclusions. For example, one cause of the inability to carry an embryo to term is described as an "incompetent cervix." More overtly is that the procedures for birth described in standard nursing and medical texts simply assume that this is first and foremost a medical procedure. 43 M. Clifton-Soderstrom, "Levinas and the Patient as Other: The Ethical Foundation of Medicine," Journal of Medicine and Philosophy 28, no. 4 (2003).
justice. They are subject to the calculus of the greatest well-being for the greatest number, so that the emphasis is overwhelmingly on the activities and responsibilities of professionals according to particular professional codes of conduct. As a result, little credence is given to the response of the patient or recognition of his/her significance in the process—they are the subject of the activity, not a participant in the activity.
In the elaboration of a more relational and interactive model, this investigation relies on the work of two philosophers. Scottish philosopher John Macmurray (1891–1976) and Emmanuel Levinas (1906–1995), the Lithuanian/French philosopher, propose that relationships are fundamental to any understanding of persons and are vital to the development of any authentic ethic. Macmurray argues that all human relationships are linked to an archetypal relationship, that of mother and child.44 Levinas highlights
another aspect by presenting a more obviously asymmetrical view of person relations compared to Macmurray. The person we meet or care for breaks into our lives as the essential other who pleads not to be rejected and, ultimately, not to be killed.45 While neither of these philosophers applied
their thinking to health care, their emphasis on the relationships between
44 John Macmurray, Persons in Relation, The Form of the Personal Volume 2 (London: Faber and Faber, 1961).
persons and the priority of the other would have a dramatic impact on the theory and practice of health care and the ethics governing it.
Further, the methodology of the thesis draws on the work of Alistair McFadyen (1961- ), an English theologian who likewise has developed a philosophy of personhood focusing on the process of person formation.46 He
argues that through their relational interactions, including commitments, persons are bound to others, both as individuals and communities. These interactions take the form of communication. Information is offered, received by the other and reflected back. Through such communicative encounters persons are linked to their communities in a practical manner. As the communication in question is not simply a matter of information, but is self- revelation that invites a response of self-revelation, from this commitment to the other occurs. The process of person formation points to a “sedimentation of relations”47 in the constitution of the person. McFadyen, in his
philosophical-theological account appeals also to a trinitarian perspective, arguing that the intrinsic sociality of human persons reflects the inter- personal relations of the Trinity.
46 His two principal works are, A.I. McFadyen, The Call to Personhood: A Christian Theory of the
Individual in Social Relationships (Cambridge: Cambridge University Press, 1990). and, Alistair I. McFadyen, Bound to Sin: Abuse, Holocaust and the Christian Doctrine of Sin, Cambridge Studies in Christian Doctrine 6 (Cambridge, U.K.: Cambridge University Press, 2000).
These philosophical approaches provide valuable lines of reasoning for the theological investigation pursued in this thesis. Indeed, theologians have not been slow to exploit these philosophical accounts in a variety of theological doctrinal and ethical contexts—for example, the Australian theologians, Glen Morrison48 and Damien Casey,49 and the British theologians John Swinton and
Esther McIntosh.50 Even the Orthodox theologian and Metropolitan of
Pergamon, John Zizioulas acknowledges his admiration for Macmurray51 and
has recently been criticised for his reliance on the philosophy of Macmurray in his reading of the Cappadocians and construction of his theological anthropology.52 At this stage and for the purpose of the thesis, it is sufficient
to note that both Macmurray and Levinas, along with McFadyen, have an obvious relevance to the relational understandings of personhood and their pertinence to health care.
48 Glen J. Morrison, "Emmanuel Levinas and Christian Theology," Irish Theological Quarterly 68 (2003).
49 Damien Casey, "Levinas and Buber: Transcendence and Society," Sophia 38, no. 2 (1999). 50 John Swinton and Elizabeth McIntosh, "Persons in Relation: The Care of Persons with Learning Disabilities," Theology Today 57, no. 2 (2000). John Swinton, "Constructing Persons: John Macmurray and the Social Construction of Disability," in John Macmurray: Critical Perspectives, ed. David Fergusson and Nigel Dower, (New York: Peter Lang, 2002)
51 John Zizioulas, "Human Capacity and Human Incapacity: A Theological Exploration of Personhood," Scottish Journal of Theology 28, no. 5 (1975).
52 Lucian Turcescu, "'Person' Versus 'Individual', and Other Modern Misreadings of Gregory of Nyssa," Modern Theology 18, no. 4 (2002).
After making these references to three main philosophical sources in the orientation of the thesis, we can now move to the theological approaches that have structured its methodology.
The philosophical perspectives provided by Levinas, Macmurray and McFadyen are given a theological specification by referring particularly to the relational theology of the now Greek Orthodox Bishop and scholar John Zizioulas. For him, relationship is an ontological category, pertaining to the structure and dynamics of reality itself.53 Within a strongly trinitarian
perspective, Zizioulas argues that all personhood is communal, for it derives from the trinitarian mystery of persons-in-communion. As a result, relationality is intrinsic to all realisations of personhood. This objective, realist account of relational personhood will be taken as a solid basis in the consideration of health care and its ethics in this thesis. The main value of Zizioulas’s approach for this thesis consists in his emphasis on the ontological reality of persons, their essential co-existence in communion, and the trinitarian foundations for this ontology.
53 J. Zizioulas, "On Being a Person: Towards an Ontology of Personhood," in Persons, Divine
and Human: King's College Essays in Theological Anthropology, ed. C. Schwöbel and C.E. Gunton, (Edinburgh: T&T Clark, 1991) and, John Zizioulas, Being as Communion (Crestwood, NY: St Vladimir's Seminary Press, 1993).
The health care implications of each of these philosophical and theological approaches is, at one level, obvious. Yet only with McFadyen are such implications made explicit and then only briefly. Hence, to make these philosophical and theological implications explicit is the major purpose of this thesis, by calling on these different thinkers working in the field of interpersonal relationality, and by focusing the resources they provide on the field of health care. A key value is the ontologically transcendent character of the human person. By recognising that, and by developing it in the contexts to be elaborated in the course of the thesis, counters the tendency to eliminate certain groups or categories of humans from the moral status of persons.
After outlining the philosophical and theological perspectives of our methodology, it now remains to move on to indicate the outline of the thesis and the chapters it contains.