«Date:_ Approved: _ Stanley Hauerwas, Supervisor _ Richard B. Hays _ Allen Verhey _ Gerald McKenny Dissertation submitted in partial fulfillment of ...»
Mapping Suffering: Pain, Illness, and Happiness in the Christian Tradition
Sarah Conrad Sours
Program in Religion
Stanley Hauerwas, Supervisor
Richard B. Hays
Dissertation submitted in partial fulfillment of
the requirements for the degree of Doctor of Philosophy in the Program in Religion in the Graduate School of Duke University i v ABSTRACT Mapping Suffering: Pain, Illness, and Happiness in the Christian Tradition by Sarah Conrad Sours Program in Religion Duke University Date:_______________________
Stanley Hauerwas, Supervisor ___________________________
Richard Hays ___________________________
Allen Verhey ___________________________
Gerald McKenny An
of a dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Program in Religion in the Graduate School of Duke University i v Copyright by Sarah Conrad Sours Abstract Respect for autonomy is the foundation of modern bioethics, even (or especially) where bioethics is attentive to the problem of suffering caused by the practice of medicine itself. It provides guidance in the midst of therapeutic and moral uncertainty, justification for morally problematic enterprises, and the promise of protection against self-serving or predatory medical personnel. Yet bioethical arguments that appeal to the injustice or the horror of suffering depend on an instinctual and uncomplicated association of suffering, especially imposed suffering, with evil. This uncomplicated association, thisflattening of the complexities of the moral landscape, must lead to a diminished capacity to navigate the very difficulties that define the field of bioethics.
This dissertation explores the relationship, particularly, of autonomy, suffering, and happiness in modern bioethics, as represented by three key theorists (James Childress, Tom Beauchamp, and H. Tristram Engelhardt). It then contrasts these findings with resources from the Christian tradition: Luke-Acts, the letters of Paul, and the theologians Thomas Aquinas, Catherine of Genoa, and Margaret Ebner. Their accounts of the meaning and experience of suffering within well-lived lives makes for a more robust account of the moral life, one in which suffering plays a formative part.
v Contents Abstract
Chapter 1: Autonomy, Suffering, and Bioethics
Bioethics Approaches: Beauchamp and Childress
Bioethics Approaches: Engelhardt
The Solution’s Problem
Chapter 2: Suffering in Luke and Paul
Luke-Acts and the Healing of All Harms
Paul: Productive Suffering
Chapter 3: Thomas Aquinas and Suffering the Passions
The Passions Properly So Called
Suffering pain and sorrow
Chapter 4: Suffering Lives of Beatitude
Catherine: Suffering as Purgation
Margaret: Suffering Openness to God
Lives of Beatitude and Suffering
Merriman, wrote a lovely piece for the Chronicle of Higher Education, in which he emphasized the essentially philanthropic nature of education. Were he familiar with Thomas Aquinas, he might rather have said the charitable nature of it; the work of education is nothing short of a labor of love, generosity, and friendship. I am exceedingly grateful to those whose time, wisdom, work, and gracious kindness have been so readily shared, whether as instructors, mentors, committee members, or kindhearted bystanders. I have been especially fortunate in my supervisor, Stanley Hauerwas. His keen eyes have saved this work from its most egregious faults, though his kindness has, no doubt, led him to pass over many of its flaws in silence. Amy Laura Hall read chapters three and four and was an enthusiastic advocate for me at every stage. I would not have considered working with Catherine or Margaret but for Susan Keefe; indeed, the central question of this dissertation largely arose from a class I took with her. Randy Maddox had no professional responsibility for me whatsoever (is there such a thing as a fifth-reader-in-law?) and yet gave unstintingly of his time and wisdom.
I am grateful for the Richard and Julia Wilke Institute for Discipleship, which granted me a teaching and dissertation fellowship at Southwestern College; two generations of Wilkes and numerous other colleagues at Southwestern supported and encouraged me while I was there. An AFTE Fellowship provided financial support during the early years of my doctoral work; more importantly, it provided me with a group of friends and colleagues, the John Wesley Fellows, who have often given me encouragement—intellectual, spiritual, and personal—throughout this process.
remember the happy and all-too-few years of his life when his mother was not a graduate student. Isaac, thank you for going easy on us all these years, and for being willing to talk theology with us more often than any child should have to. Theo, thank you for making an early riser of me, and for giving us something to laugh about more days than not. Amos, thank you for smiling so readily, and for learning to say “Mama” earlier than either of your brothers.
No three boys ever had more loving and dedicated grandparents. I am deeply indebted to both my parents and my parents-in-law for restful vacations and an eager “Yes!” to every request for babysitting. My parents have, moreover, been my most enthusiastic cheerleaders throughout my education—never once asking whether I was done with school yet, or why I was going back to school again, or why I didn’t pick a more useful field of study. I am grateful for their encouragement, their example, and their love.
To give my husband all the praise and thanks he deserves is impossible; to attempt to condense it to the few sentences convention allots to an acknowledgments page, laughable. Studying with him has made me a better theologian, working with him has made me a better teacher, and living with him has made me a better person than I could have been otherwise. Paltry compensation though it may be, I offer him my wholehearted thanks, and the dedication of this volume.
The experience and meaning of pain and suffering are at the heart of legal, philosophical, and theological bioethics. Personal medical decisions, medical malpractice case law, public health policy, ethical position papers, sermons on medicalpolitical issues, bioethics curricula for medical personnel—all depend in some way on an understanding of how suffering and illness, versus well-being and health, relate to a well-lived life. Yet while appeals to the fact of physical or psycho-social suffering may be explicit in any of these settings, the meaning of that suffering and its relationship to human wholeness is too often facile and unreflective (if it is articulated at all).
Take, for example, Judith Jarvis Thompson’s infamous parable in support of abortion rights, in which an involuntary pregnancy is likened to being kidnapped and forced temporarily to provide one’s own body as a life support system for a worldfamous violinist.1 That the woman so conscripted suffers in myriad ways provides the rhetorical force of the argument. She suffers a removal from her life projects, the physical pain inflicted by the medical apparatus, and the violation of her bodily integrity and self-determination. Yet it is the interpretation of the meaning of that suffering in the life of the woman and her society that is the point of the parable. All these inconveniences and pains would be acceptable if chosen, Thompson intends us to understand; it is the involuntariness of her suffering that makes it unjust, and the injustice that makes it incompatible with the well-being of the afflicted woman.2 Thomson’s readers are meant to recoil in horror at the thought of being so afflicted.
Judith Jarvis Thomson, "A Defense of Abortion," Philosophy and Public Affairs 1, no. 1 (1971).
Indeed, for Thomson, the person who chooses to participate in the project of saving the violinist, even after having been so immorally conscripted thereto, is a Good Samaritan, perhaps a Splendid Samaritan— By contrast, the relationship between injustice and well-being is exactly reversed in certain strands of the Christian tradition. In 1 Peter 4:12-19, for example, the author intimates that a life marked by that suffering which meets the criteria of retributive justice—punishment for the violation of societal expectations or laws—is incompatible with the life of Christian discipleship precisely because of the element of choice involved.3 The individual can choose not to violate societal norms (particularly where those norms are compatible with Christian discipleship); where he receives the punishment of society justly, therefore, he has chosen that which thwarts his own wellbeing. Where punishment or suffering is unjustly inflicted on him (that is, because of his alliance with Christ), on the other hand, both the injustice and the involuntariness are understood to transform the quality of that suffering such that it is ordered to his good.
The reader is instructed not to recoil in horror, but to “give glory to God” in the face of such suffering.
The relationship between choice and suffering is more complicated, of course, than either of these brief sketches suggests. In the 1 Peter passage, for example, the righteous sufferer is instructed to “give glory to God” on account of the sufferings associated with following Christ. The sufferer thus assents to the persecution in a way that seems, at least superficially, similar to the way Thomson’s Splendid Samaritan assents to being used as a life support system. Thomson’s argument does not trace the function of consent with respect to the other ills suffered by her hypothetical victim: is it the cardinal ill, is it one among many ills, is it an intensification of those other ills, or someone whose morality is so exceptional that it cannot be considered normative for those of us who are content to remain Minimally Decent Samaritans.
As this text does not address a particular issue of medical decision-making, it would not normally be considered a bioethical argument. Yet it intends to place the experience of physical and socio-political suffering in a particular theological context; as such it aims toward the same meaning-making that medical decisions propose or enact.
does it transform the character of the other ills suffered in some unidentified way? The difference between the two authors’ conception of the well-lived life does not hinge simply on a differing conception of the moral weight of consent, as the relationship between consent and suffering is not a simple one.
In the face of those complexities, and thanks in part to the more spectacular examples of biomedical atrocities the past century and a half have offered us, bioethics turns inevitably to individual choice as its guiding star. Respect for autonomy is the foundation of modern bioethics, even (or especially) where bioethics is attentive to the problem of suffering caused by the practice of medicine itself. It provides guidance in the midst of therapeutic and moral uncertainty, justification for morally problematic enterprises, and the promise of protection against self-serving or predatory medical personnel. Yet bioethical arguments that appeal to the injustice or the horror of suffering depend on an instinctual and uncomplicated association of suffering, especially imposed suffering, with evil. This uncomplicated association, this flattening of the complexities of the moral landscape, must lead to a diminished capacity to navigate the very difficulties that define the field of bioethics. Such an approach to bioethics can only view suffering, especially avoidable suffering, as gratuitous, and its imposition as cruel.
In chapter one, I show how secular bioethics depends on autonomy for its navigation of the moral dilemmas arising from the practice of medicine. Where questions of suffering—particularly imposed suffering, or suffering that arises ineluctably from the practice of medicine—arise, autonomy is the key principle guiding the discussion. I focus on three important theorists: Tom Beauchamp and James Childress, who together wrote the influential Principles of Biomedical Ethics, now in its seventh edition, and H. Tristram Engelhardt, whose second edition of The Foundations of Bioethics is a thoroughgoing articulation of the limits of secular bioethics in a pluralistic state. Both works treat autonomy as the foundational principle of secular bioethics, though each in their different way. Engelhardt insists openly on the primacy of autonomy as an ethical commitment in conditions of pluralism; the intensely personal nature of medicine only intensifies the need for the protection of explicit permission.
Beauchamp and Childress are unwilling to call autonomy their foundational principle;
nonetheless, the chapter shows how their ethical principles and prescriptions are consistently offered in terms of a commitment to autonomy.