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Encyclopedia of Bioethics
By Lisa Sowle Cahill

THE Encyclopedia of Bioethics is an astoundingly comprehensive, intricate, and well - designed map to more ground than most will likely ever want to cover in the field of the ethics of health care and the "life sciences." The preparation of the first comprehensive reference work in a young but burgeoning field was a mammoth undertaking. The Encyclopedia was funded primarily by the National Endowment for the Humanities and was edited by Warren T. Reich (Senior Research Scholar at the Center for Bioethics of the Kennedy Institute of Ethics, and Associate Professor of Bioethics at the Georgetown University School of Medicine), with the cooperation of eight associate editors, a sixty - member editorial advisory board, and a sizable supporting staff. Its four volumes (2000 pages) were authored by 285 contributors chosen on the basis of expertise in assigned specialties, ability to communicate theoretical or technical material concisely and lucidly, and distribution within an "interdisciplinary, intercultural, and international context" (p. xi).

In scope, the Encyclopedia comprehends concrete ethical and legal problems (e.g., sterilization, health policy); basic ethical and biomedical concepts (moral norms, health and disease), and ethical principles ( justice, double effect); ethical theories (utilitarianism, theological ethics); religious traditions (Roman Catholicism, Buddhism); historical perspectives (a history of medical ethics; historical articles on eugenics, human experimentation); and disciplines relevant to medical ethics (philosophy of biology, sociology of science). In order to avoid immediate obsolescence, articles dealing with medical science and with law emphasize salient options or views and criteria of analysis.

Both Reich, in his introduction, and K. Danner Clouser, in "Bioethics," propose what all authors seem to assume, i.e., that the task of the bioethicist is not to create new tools ex nihilo, but to refine and apply traditional ethical equipment to special (and rapidly changing) realms of practice. Hence the immense importance of Clouser's discussion of "Bioethics"; of the several articles under "Ethics," intended to serve as "a virtual primer in ethical theory" (xviii); and of the entries on the distinctive ethical viewpoints of religious traditions. These system -

Lisa Sowle Cahill is Assistant Professor of Theology at Boston College. She holds degrees from the University of Santa Clara and the University of Chicago and has published several articles on bioethics and theological ethics in the Journal of Religion, Linacre Quarterly, Religious Studies Review, Journal of Medicine and Philosophy, and other journals. She is reviewing here the new four - volume Encyclopedia of Bioethics, edited by Warren T. Reich (New York, Macmillan, 1978), $200/set.

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atically provide groundwork for discussions of practice, e.g., of population ethics or sexual ethics.

I

Bioethics is by definition an interdisciplinary enterprise. Although the representatives of contributing disciplines (philosophy, theology, medicine, law, social science, government, etc.) do not always agree on the appropriate methods for pursuit of the ethical ramifications of common subject matter, most major points of view are articulated and organized within the Encyclopedia into a relatively well - balanced whole. Although implicit (and sometimes explicit) value - judgments are perhaps unavoidable in a collection on ethics, most pieces are characterized by general objectivity and neutrality. Thus, the "raw material" of normative judgments is made available for the academic and counselor alike. Theologians and pastors should be satisfied both with the intelligent and intelligible clinical and technical presentations, and with evaluative entries by recognized theological scholars, including, but certainly not limited to, John R. Connery, Charles E. Curran, Arthur J. Dyck, Margaret A. Farley, Bernard Häring, Stanley Hauerwas, Immanuel Jakobovits, James T. Johnson, Richard A. McCormick, William E. May, James B. Nelson, John T. Noonan, Ralph B. Potter, and Helmut Thielicke.

The infrastructure of these volumes has been meticulously joined. Most "entries" contain several "articles" covering the subjects' preeminent aspects, e.g., scientific, historical, legal, and ethical. At the end of each entry, other entries and articles are cross - referenced in descending order of importance. All articles are classified systematically at the Encyclopedia's conclusion. Other valuable reference features are the bibliography with which each article ends, and the exhaustive index in the final volume, which is indispensable in locating discussions of a given topic dispersed through several articles, or in discovering the title by which some subject has been "filed" in the Encyclopedia.

Since the mind boggles at the prospect of consuming and reviewing the Encyclopedia's entire menu, I will limit myself to a selective sampling of the fare Reich et al. set forth.

II

The twelve articles on theoretical aspects of "Ethics" are authored by notables including Joseph Fletcher, R.M. Hare, Frederick S. Carney, and Philippa Foot. One central theme is basic models of ethics. Kurt Baier provides important discussions of "Teleological Theories" and "Deontological Theories," sorting out types within each category, and avoiding tendentious definitions of either. Hare's article on "Utilitarianism," which he defines carefully as a form of "consequentialism" in the broad sense, fits with Baier's, though Hare himself seems disposed to make a case for utilitarianism (a subcategory of teleology) as the most comprehensive and adequate ethical approach. Fletcher's "Situation

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Ethics" is more circumspect than other of his writings, but still quite definitely the sort of advocacy platform which both friends and detractors of the author might be disappointed not to find. Carney helpfully suggests that the three types of normative judgments basic to "Theological Ethics" are those about obligation, virtue, and value. However, the article would be better integrated into the total entry, "Ethics," if, as is frequently done in contemporary ethics, it related these three terms to the deontological and teleological options.

Moving from theory to practice, one might expect normative evaluation by authors to be often in evidence. However, in the entry on "Abortion," possibly the most volatile issue in the four volumes, the predispositions of the contributors are just barely perceptible. The reader suspects that appeals to the conclusions of groups with which the authors bear affinity are transparent to views of their own. André Hellegers ("Medical Aspects") concludes his ethical considerations by citing a 1976 policy statement of the American College of Obstetrics and Gynecology which "implies" that abortion methods should be selected to "maximize survival chances of the fetus." David M. Feldman ("Jewish Perspectives") ends a history of Jewish law permitting abortion up until birth for a variety of maternal considerations, including "mental anguish," by remarking, to the opposite effect, that rabbis in "the Jewish community today" tend to allow abortion "only for the gravest of reasons." John R. Connery ("Roman Catholic Perspectives") attends scrupulously to the gradual development of the church's present stand on abortion, which, while always protective of unborn life, remained in flux until 1869. In conclusion, he summarizes the present magisterium's very restrictive position on resolution of conflict cases as maintaining "strict continuity with" traditional teaching. In Roman Catholic parlance, consistency with tradition indicates legitimacy and is even a ground of infallibility.

James Nelson ("Protestant Perspectives") notes that the Reformers attributed full humanity to the fetus, but moves away from them by claiming that they also provide resources for seeing abortion as a "situation of ambiguity." Contemporary Protestant views range along a spectrum, with the "large number of ethicists and Protestant groups" said to envision abortions as "justifiable - but - tragic." Charles Curran ("Contemporary Debate in Philosophical and Religious Ethics") is more forthrightly evaluative as he indicates more and less adequate answers to the key question of fetal status. Opting for the direct approach, he identifies his own answer (implantation is a significant "line") in distinction to others, thereby informing readers of the perspective from which the analysis is written. J. M. Finnis ("Legal Aspects") reviews three basic models for regulation of abortion, but he seems to give the 1975 French law (permissive regarding at least early abortions) favored status by claiming that it "is representative of much international opinion."

Although these ostensibly descriptive accounts do contain value

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judgments, they are competently authored, rich in information, and comprehensive of divergent interpretative viewpoints. All authors discuss with admirable fairness the merits of positions in evident disagreement with their own. Indeed, it might be wondered whether thoroughly "neutral" reporting of such urgent moral dilemmas would be desirable even if possible.

III

An even more ancient challenge to the most fundamental principle of bioethics, respect for life, and to the derivative duty of its protection and preservation, is posed by the web of moral issues surrounding the event of human death. The entry, "Death," includes anthropological, sociological, philosophical, and religious perspectives. Two further entries, "Death and Dying: Euthanasia and Sustaining Life" and "Death, Definition and Determination of," address related medical and ethical questions. The first includes historical, moral, and public policy considerations. The latter is of interest because it focuses on an area in which ethical reflection proceeds under the considerable impact of twentiethcentury technology. Gaetano F. Molinari covers "Criteria for Death" in a style which is quite technical but commensurately informative. He discusses not only the influential 1968 report of the Harvard Committee on Irreversible Coma, but also international studies through 1975. Though some of this information will no doubt become dated, companion pieces address philosophical issues at stake in the medical and legal redefinition of criteria for determining that death has occurred (Alexander Morgan Capron, "Legal Aspects of Pronouncing Death"; Dallas M.High, "Philosophical and Theological Foundations").

Despite the Encyclopedia's inclusiveness, one omission seems regrettable, and that is the absence of an article on recombinant DNA research. Although the subject is mentioned in passing six times, it nowhere receives sustained attention. One wonders why the sort of schematic survey of the "state of the art," of avenues of progress, and of moral and legal implications, provided in relation to definitions of "brain death" and in vitro fertilization, could not have been achieved even in this swiftly moving research specialty.

Any evaluation of so massive a work as this must necessarily remain incomplete. I hope that the scope and high level of achievement represented by the Encyclopedia of Bioethics will lead to a very wide appreciation of its value as a resource, whether in researching, teaching, counseling, or choosing.