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Abortion and Organ Donation: Christian Reflections on Bodily Life Support Author(s): Patricia Beattie Jung Source: The

Journal of Religious Ethics, Vol. 16, No. 2 (Fall, 1988), pp. 273-305 Published by: Blackwell Publishing Stable URL: Accessed: 31/08/2009 07:15
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In this essay I arguethat childbearing variouskinds of organdonaand tion are morally analogous activities. I argue, further,that the ethos of giftgivingought to informour analyses of both of these forms of bodily life of support.This reframing the abortionand organdonationdebates yields new insightsinto two relativelyneglectedsubtopics. First,thoughfrequentlyasserted,few have demonstrated why bodily life support especially in the form of childbearing cannot be morally required.This comparisonyields insightsinto the reasonsfor such an axiom. Second, while the giving of bodily life supportis sometimes exhortedand and political meanalmost always respected and admired,its intelligibility ingfulnessas a moralchoice is rarelyexplored.Thisanalogicalwagerreveals the why one oughtto give anotherbodily life support.In summary, analogy yields insights crucial to the developmentof cogent argumentsregarding both the grounds for and limits of the responsibilityto give bodily life support. Further,the analogy displays the disparitybetween what has been demanded traditionallyof those who are pregnantand of those men (and women)who by virtueof tissue or blood type can offerotherformsof bodily life support.The analogy enables reflectionon abortion(and organ donation) to developin a contextfree of sexist biases. Finally,effortsare madeto of assess this giftgivingethos in light of the feminist "hermeneutics suspiwhich haveand can sacralizevictimization. cion" regarding arguments

INTRODUCTION In this essay I intend to explore two interrelatedtopics: first, I will to delimitthe responsibility give bodily life support;second, I will analyze Christianjustifications for both the giving and refusing of bodily life support.Both of these topics havebeen neglectedin muchof the literature dealingwith bodily life support.Many,includingmost recently the Iowa State Supreme Court, have asserted that such a gift cannot be legally requiredand therefore its giving ought not be coerced.1 But few have


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defended that assertion, beyond claiming as the courts have that comright to privacy. pulsory bodily life supportwould violate an individual's one may ask: why is this particular invasionof privacyintoleraHowever, ble, whereas others are legally sanctioned,if not enjoined?2 In her book Abortionand the Roman CatholicChurch,(1978)SusanT. Nicholson argues that the teachings of the Roman Catholic church on bodily life supportare inconsistent.Abortionfollowingrape is forbidden, while the responsibilityto offer other forms of bodily life support, she thinks, is quite limited. She quotes Gerald F. Kelly in this regard:"One must help a needy neighboronly when it can be done withoutproportionate inconvenience and with a reasonable assurance of success" (Kelly, 1951:553-554)(emphasis hers). Obviously, Nicholson believes that the towardthe fetus, and is rape victim has no special parentalresponsibilities only a neighborto it. She concludes, with only passing attentionto what she calls the "special nature of bodily life support," that the Roman Catholicproscriptionof abortionfollowingrape is wrong. There are several difficultieswith her argument.First, it is not at all clear that rape victims have no parentalresponsibilities(this is discussed in more detail in endnote #7). However,the charge in inconsistency still stands, of course, because the RomanCatholicchurch(andcommonlaw) has never demandedof parentsthat they offer other forms of bodily life support to their children except under the circumstances detailed by Kelly.The law has never mandatedorgandonationby parentsto children even when Kelly'sconditionsare fulfilled. Second, it is not clear that Kelly's statementof the principleof beneficence is all that limited. It is not evident that in all imaginablecases of of problempregnanciesthat the "inconvenience" the pregnancywouldbe out of proportion with the good that could predictably ensue from a decision to sustain the life support.Indeed, one could imaginea Utopian situation of optimal medical, financial and emotional support where it would be clearly disproportional abort on the basis of a cost-benefit to Harrisonin her book, Our Right to Choose, analysis. Beverly Wildung recognizes this as a logical (thoughnot at present a historical)possibility. Insucha Utopian where women's werereally lives valued world, let world, (a us insist,quiteunlikethe one we know!), probably it wouldbe possibleto adhere an ethicwhichaffirmed abortions to that should resorted only be to in extremis, savea mother's (Harrison, to life. 1983:18) The same argumentcould be developedin regardto other forms of bodily life support, including bone marrowand organ donations, etc. In this essay, however,I will argue that bodily life support can not be morally requiredof persons.It is my contentionthat no person can demandaccess to anotherperson'sbody- to theirblood, for example and that abortion,

ChristianReflectionson Bodily Life Support


along with other refusals to give bodily life support,ought not be forbidden. Second, let us assume for the sake of argumentthat traditionalRoman Catholicteachingsas epitomizedin Kelly'smaximare indeed quitelimited and hence contradictthe RomanCatholic prohibitionof abortionfollowing rape. Why conclude that the injunctionagainst abortion should be dropped?Indeed,perhapsthe moralerrorin the traditionlies on the other side of the polarity,in its minimalism.Why not argue that persons are absolutely requiredto give assistance to others, including all forms of bodily life support?Nicholson did not demonstrate,but instead merely is asserted, that the gift ethos which currentlyinforms transplantations I ethicallyfittingor appropriate. intendto demonstratethat there are good reasons for interpretingboth organ donation and childbearingas gift relations. In this essay, I also intend to articulate some of the reasons why a Christianought to initiateand/orsustain the giving of bodily life support, as well as examinethe feministsuspicionof the gift ethos. Whilethe giving of bodily life support has traditionallybeen exhorted and almost always and for respected and admired,its intelligibility meaningfulness Christian feminists is problematic. In light of their deconstruction of traditional rationalesfor such sacrificialgiving, I will describe in the final section of this essay what the gift of bodily life supportand its refusal might mean. and This will be discussed in terms of both childbearing organdonation. A REFRAMINGTHEACTIVITY: DEFENSE OF THEANALOGY To accomplishthese goals, it is necessary to definebodily life support. By this term, I mean to designate any form of assistance that entails the invasion of the giver's body and which consequently serves to sustain another'slife. This activity arises with particularfrequency in two biomedical contexts: obstetrics and transplantation. Indeed, it is my contenand tion that childbearing variouskinds of live organdonationare morally analogousactivities.3 Donations from living persons, whether of (1) renewableparts of the body, such as skin, blood, and bone marrow,(2) paired organs, such as eyes and kidneys, or (3) (for the sake of argument)unpairedvital organs, such as the heart or liver, are forms of bodily life support. Similarly, pregnancyis a formof bodily life support.An optimalpregnancyinvolves the massive (though temporary) physical modification and the minor of bodily transformation the mother,all for the sake of and in (permanent) of fetal life. At worst it may involve mutilation(caesareansection support or hysterectomy)done solely for the benefitof the fetus, thoughat present


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most frequently such procedures benefit both mother and child. Pregnancy, like organ donation, is a form of bodily life support that can gravely threaten the life of the donor. When women's experience of pregnancy is taken seriously, the invasive element in the experience is quite prominent in the reframing of the activity. In an essay aptly entitled "The Moral Implications of Regarding Women as People: New Perspectives of Pregnancy and Personhood," Caroline Whitbeck makes the following claim. Possession and inspirationprovide the closest analogy to the ultimately unique experience of pregnancy.The difference in the experience of a wantedpregnancyand that of an unwantedpregnancyis as differentas the two experiencesof inspirationand possession. (Perhapsall or most experiences of inspirationhave some element of possession in them and vice versa, and similarlywith wanted and unwantedpregnancies.)(Whitbeck, 1983:264) One obvious strength of my proposed analogy is that it takes seriously not only women's life supporting role in pregnancy, but also their experience of it.

Analogies in moral argumentare usually not proposed without a purpose. My intent in highlightingthe similaritiesbetween these various activities is to allow the moral traditionbehind organ donationto inform the argumentsabout abortionand vice versa.The ethos that pervadesthe medicalliteraturedealingwith organand tissue transplantations that of is Indeed the gift metaphor so pervades the discussion of ingift-giving.4 formed consent in such mattersthat motives of duty or guilt are judged of suspect, because it is arguedthey reflectthe donor'smisunderstanding the discretionarynatureof the act or a less thanvoluntary"consent"to it. The ethos that pervades the medical and traditionalChristianliterature dealing with abortion is that of the duty of nonmaleficence,and the legitimateviolations thereof. By drawingan analogy between these forms of bodily life support,5I of hope to increase our understanding both the limits of and the reasons for the responsibilityone person may have to give bodily life supportto another.If a moralanalogybetween childbearing organdonationcan and be established, then perhapsit will yield clues as to why abortionought not be prohibited.Perhapsit will also yield clues as to why the giving of bodily life supportthrougheither organdonationor childbearing ought to be encouraged.It should,in addition,be noted thatthe analogywill enable this argumentto be developed in a context free of sexist biases. As a to of feminist,I believe it is altogetherappropriate apply a "hermeneutics the suspicion"to the moraltraditionsurrounding currentabortiondebate. Upon comparison, it is hard to miss the disparitybetween what "conservatives"have demandedof women who are pregnantand what those

ChristianReflectionson Bodily Life Support


same persons view as obligatoryin regardsto other forms of bodily life support,which not incidentallycan be offeredby men.6 It is also the case that most moralanalogiesare not self-evident.Given the controversialimplicationsof this analogy,a defense of it is clearly in order. One may object to the claim that these activities are morally analogouson at least the followingfive grounds.Withthe exception of the second and finalobjections, each criticismof the proposedanalogycan be interpretedas an argumentfor the claim that there is a stricter responsibilityto bear childrenthanto donateorgans,and that while the formeris a duty,the latteris supererogatory. (1) First,it can be arguedthat it is not possible to compareorgandonation because by definitionpregnancyentails special (parental) with pregnancy, The analogy (so not necessarily entailedin organtransplants. obligations the objection goes) obscures a distinctivefeature of pregnancywhich is morallysignificant,if not decisive, in that this special obligationcreates a stricterobligationto sustain a pregnancythan to donate organs, etc. One could argue,as Nicholson has, that since a rape victim does not participate voluntarilyin the sexual act that producedthe fetal life, she has no parental obligationto the fetus and conclude that "the moralproblemof as abortionfollowingrape"ought to be "conceptualized that of the bodily life supportone human being owes another" (1978:80)(emphasismine). This rebuttal,however,does not withstandcarefulscrutiny.7 contractualresponsibilities In cases of both transplantsand pregnancy, can come into play and donors may have variousdegrees of parentaland other special obligations.The point is, however,that critics of this analogy assume that parentalduties requireone to give bodily life support.Yet, what strikes them as obvious in regardto pregnancyand motherhoodis somehow obscured when they consider what ought to be required of histocompatibledonor fathers (and mothers). Consistency requires that childbearingand paternal (parental)organ donation both be viewed as either obligatoryor discretionary.

It may also be objected that fetal life is not morally convertiblewith other forms of human life.8 This is indeed a hotly debated equation. However,it is not my intentionto defendthis key assumption,but to adopt it for the sake of the argument that follows. Therefore,this essay is


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addressedto three differentaudiences:(1) those who hold this assumption about fetal life to be true; (2) those who wish to examine this issue exclusively as it relatesto organdonations(andhence will ignoreportions of this argument);and (3) those who wish to explore the moral ramifications of this reconceptualization pregnancy, even thoughthey don'thold of this presumptionabout fetal life. I hope to make it evident that while the status of fetal life is clearly an importantquestion, even from within the most conservativeframeworkit is not the decisive issue in the abortion debate. Much can be gained by exploring other frequently overlooked issues which profoundlyaffect bodily life support.

A third objection to this analogy can be made on the basis of the socalled "passive-active"distinction.In the case of transplants,bodily life to supportinvolves the questionof our responsibility give and our rightto withholdsupport.However,in the case of pregnancy, bodily life supportis a "given"(except perhapsin cases involvingsurrogate motherhoodor the use of the "morningafter"pill) and the centralissue is the questionof the withdrawalof bodily life support.Refusalin the formercase is a passive instance of "allowingto die," whereasin the latterit is an active instance of "killing." Withinthe framework this objection,the duty not to kill is viewed as of stricter than the responsibilityto supply organs. In respondingto this objection, I must begin by explainingthat throughoutthis essay I will assume that abortionimpliesprimarily severingof the host or donative the relation. It does not necessarily imply either the death or killing of the fetus.9 It is of course true that at present the withdrawalof maternal supportearly (before the 20 week mark)in the gestation process invariably results in fetal death. It is also true that some abortiontechniques and (the D and C/aspiration the saline injectionmethods,for example)kill the fetus, though sometimes "only"allowingit to die. instances Proponentsof this objectionrecognizethat not all imaginable of "allowingto die" are justifiable.Likewise, they recognize that not all imaginableinstances of "killing"are unjustifiable. They claim, however, that all other morally relevantfactors being equal, one must have more reason to kill than not to save primarilybecause it is arguedthat such a practice would erode the trust essential to the health care partnership. in (Interestingly, other contexts of death and dying, the duty not to withhold life supportis generallyviewed as stricterthan the obligationnot to withdraw life support because of the time requiredfor diagnostic and prognosticjudgments.)At any rate,the validityof this premiseis the topic

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of much debate among many ethicists both within and without the biomedical context. Once again for the sake of argument,let us takeup the most conservativeperspectiveand assume that this premiseis true. What would its implicationsbe for the topics underconsideration? It would follow that allowing a person to die of, say, renal failure by refusingto donatea kidneytakes less justificationthankillingthe potential it recipient,all other morallyrelevantfactorsbeing equal. Similarly, would follow that abortiontechniqueswhich merely terminatethe host relation, even though they might invariablyresult in fetal death, would be preferable to those methods that entail the killingof the fetus, all other morally relevantfactorsbeing equal. On the basis of these implicationsproponents of this objectionconcludethat since abortionfrequentlyimplieskillingthe fetus, it requires more justification than the refusal to donate organs. Indeed,they frequently jump to the furtherconclusionthat pregnancycan thereforebe required,but organdonationis discretionary. My response is twofold. First, as I understandcurrentabortionpractices, the methods employedto terminatepregnancyvary,because, as a factorsare not equal specifically, matterof fact, all othermorallyrelevant are employed which best ensure maternalwell-being, those techniques which can vary considerablywith differentmethods at differentstages in the gestation process. Second, it does not necessarily follow that pregnancy can be mandated.It may simplybe the case that organdonationis more discretionarythan childbearing. (4) Fourth,this analogy may be objected to on the groundsthat the physical relationship of pregnancy is natural and normal, whereas the nurturanceand dependency associated with organ donationis pathological or biologically nonnormative.Both are instances of "giving life" which is good. However, Lisa Sowle Cahill (1981:14)suggests that "all other things being equal," pregnancyconstitutes an intrinsicgood to be preserved,whereas the donative relationis to be avoidedwhen possible. is Childbearing a premoralgood towardwhich human communities are naturallyinclined. Thus she concludes a more serious or weightierset of reasons is necessary "to justify the destructionof such a 'positive' relation of dependency (physical or otherwise)" than of an intrinsically "negative"one. This is a formidableobjection to the proposed analogy, particularly since Cahill is careful not to interpretthis argumentas supportiveof an for absoluteprescription procreation. Indeed, she suggeststhat contempoin its efforts to avoid the dangers of physrary moral theology is right


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is icalism. However,totally ignoringthe moralsignificanceof corporeality for her. Hence, the analogy I propose obscures acequally problematic characterof the bodily life support cordingto Cahillthe nonpathological constitutiveof pregnancy. It is certainlytrue that the gestationprocess is normal,in the sense that the fetal need for dependency is neither caused by a disease like renal failurenor does it originatefrom some sort of trauma.10 one Furthermore, would be foolish to arguewith Cahillwhen she suggests that the donative unlikepregnancy, relationship, oughtto be avoidedwhen possible through the preventionand/orcuringof variousdiseases and injuries.IndeedI will even grant that pregnancyconstitutes an intrinsicgood to be preserved. Consequently,because there is some kind of responsibilityto maintainall intrinsicallygood states of affairs,there is some kind of responsibilityto continue pregnancyin every case and this is not true in regardto organ donation. However, Cahill jumps from these premises to the conclusion that childbearingis (unlike organ donation) a primafacie duty or obligation mandated by the natural requirementsof justice. Though defended at length in the midsection of this essay, I reject her conclusion for the nor (unlikechildrearing) followingtwo reasons.First,neitherchildbearing donation are responsibilitieswhich can be equitably distributed organ Second, they areboth bodily amongall membersof the humancommunity. forms of life support. Thereforethey are highly discretionarygifts, and ought only be encouraged. In summary, Cahill'sargumentrevealsa significant point of disanalogy. of However,this differenceis only relevantto an evaluation these activities insofaras they ought to be enjoined.One cannot conclude,as does Cahill, that this differencerendersone activity (pregnancy)obligatory,while the other is merely supererogatory. The reframingI propose reveals that neitherform of bodily life supportcan be legitimatelyrequired. (5) Finally, some feminists might object to the proposed analogy on the groundsthat childbearing(unlike organdonation)is an activity that only women can do. Furthermore, they argue,it is a responsibilityshouldered at present in a worldwhich is largelyhostile to both women and children. Thus, they argue,the responsibilityto donate organs is stricterthan that which can be ascribedto childbearing, other factorsbeing equal. all the for Clearly,because of its requirements histocompatibility, responsibility for most types of organ donation cannot be equally allocated. Nevertheless, this natural lottery is not influenced by gender factors,

ChristianReflectionson BodilyLife Support


which are of particular significancegiven the realityof most women'slives within patriarchy. Here again we are confrontedwith a formidableobjection. This is clearly a morally significantpoint of disanalogy.However,I believe it is relevantonly to a comparisonof pregnancyand organ donation as acts of supererogation. Because both forms of life supportare (1) bodily and (2) incapable of equal allocation, neither can be viewed as a duty or obligation.It is this insightwhich I believe the proposedanalogy makes clear, and which I will defend at length in the mid-sectionof this essay. In summary, despite notabledifferences,these activities organdona- are morallyanalogousin significant tion and pregnancy ways.I intendto wager that the moral traditions behind these instances of bodily life supportwill fruitfullyillumineone another.Indeedit is my contentionthat this mutual reframingof the activities will yield insights crucial to the development of cogent argumentsregardingboth the grounds for and limitsof our responsibility give bodilylife support.Beforeproceedingto to these tasks, it is necessary to clarifywhat it meansto say an activityought to be done, if it is not thereby,morallyrequired. REFRAMINGTHE NOTION OF OUGHT In his pamphlet, "Supererogation: Analysis and a Bibliography," An WillardSchumakersuggests that there is more to moralitythan what is minimallyrequiredof us. is because whilewe always havea right ourfair to Supererogationpossible share benefits canalways and of be to of rightly forced acceptourfairshare it for burdens, is sometimes morally preferable us to takeless thanourfair shareof the benefits ourcommon or to voluntarily of life acceptmorethan ourfairshareof burdens; whenever do so foraltruistic and we we reasons, areacting (Schumaker, 1977:33) supererogatorily. For example,simply because it is morallypermissablein some situations not to forgive does not mean that one ought not forgive or that such praiseworthy forgivenessis of only marginalsignificanceto morallife. As Schumakerpoints out (1977:42),Kant is correctin his claim that if persons werejust, then there would be no dire need for charity.However, it is equally true and significantthat as a matterof fact persons are not as alwaysjust. Indeed, Kant'sprogrameven when interpreted entailinga form of moral community establishes only those principles and rules necessary for a barely human,social existence. Thereis no need, I would argue, for either philosophical or theological ethicists to restrict themselves to such a truncatedconception of their reflectivetasks. There is a


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need, even if not a Hobbesianone, to establishthe necessaryconditionsof and morality.It is an appropriate importanttask. However,the content of the morallife is not exhaustedby such work. Since it is my aim in this essay to explore some of the reasons why Christiansought and ought not to offer the gift of bodily life support,I must sketch something of the frameworkthroughwhich I interpretand evaluatethis activity.Thus, this essay will be explicitly both theological and political.It will criticizea modernliberaltheoryof communityin light thereare at least two broad of an explicitlyChristianvision.11In summary, levels of responsibility. First,there are those "oughts"which are requisite for a barelyhuman,social existence. These minimalobligationsare duties, the fulfillmentof which is appropriately requiredby all moral communities. Second, there are those "oughts"which stem from other visions of communallife which exceed or go beyond that of a barely human existence. The "oughts"are best thoughtof as self-imposedby the self's desire to be in its fullness a certainkind of person and to create a certainkind of community. It is my intentionin this essay to examinethe limits of and groundsfor the responsibilityto give bodily life support.In the next section of this essay, I will analyze what it is about this kind of gift- this gift of one's bodily self, as distinguishedfrom a gift of one's property that makes it a choice to be encouragedand commended,etc., but not requiredeitherby Churchdiscipline or civil law. In the finalpart of the essay, I will explore why in light of the Christianvision of life a believer "ought"or "ought not" to give bodily life support. BODILYLIFE SUPPORTSHOULD NOT BE REQUIREDBY CANON OR CIVILLAW All human beings have an obligation or duty to give some minimal situations.Conversely,by degree of assistance to others in life threatening virtue of a person'shumanity, or she may lay claim to or have a moral he his rightto minimalassistancefromothers in perpetuating or her own life. This thesis is put forwardin orderto distinguishmy position from others. It is at least intelligible(thoughI believe erroneous)to delimitthe responsibilityto give bodily life supportby attemptingto demonstratethat there is no general positive duty to give assistance to others and hence no I specific duty to offer bodily life support.12 intendto clarify the "special nature" of bodily life support by explainingits immunityfrom what I regardas the legitimate general requirementsof both social justice and beneficence.

ChristianReflectionson Bodily Life Support


MinimalAssistance Ought to Be RequiredBy Law The obligationto assist othershas roots in bothjustice and beneficence. The obligationto give assistance to anothercan be derivedfrom two very differentconceptions of justice. On the one hand, it can spring from a reciprocaltheory of justice. Minimalassistance is requiredbecause all persons have received and continue to expect to receive such "mutual aid"fromothers.On the other hand,it can be arguedthat thereare certain health maintenanceand procreaprimarygoods- like self-preservation, tion- towardwhich humancommunitiesare naturallyinclined,and thereforejustice requiredprimafacie that all persons pursue these communal goods. Each theory,albeit in very differentmanners,helps illuminethe moral intuition that a starving "thief" can have a right to or can legitimately claimthe "stolen"bread.To the degreethat an agent is responsiblefor his or her neighbor's"need" that is, has profitedin some fashion from the exploitationwhich producedand sustains it- to that same degree, he or she is requiredby justice to go beyondthis minimallevel of assistance. In some cases then, the starving"thief" may be said to have a right to this bread. "donor's" However,no single "donor"can be justly requiredto carrya genuinely communalburden.It is not alwaysthe case that the starving"thief" has a right to this "donor's"bread. For these reasons the traditionhas rooted the generalobligationto give assistance in beneficence as well as justice. Charityis possible for three reasons: (i) not all persons carry their fair share of social burdens; (ii) some communalresponsibilitiescannot be fairly distributed,but ratherfall by virtue of the naturaland/orhistorical lottery on the shouldersof single individualsor institutions;(iii) persons can voluntarilygive up theirfair shareof social benefits. What has all this to do with bodily life support,especially with childbearing and organ donation? First, it establishes that (nonbodily) life supportcan be requiredby the demandsof justice of both individualsand communities.However,it also establishesthat such life supportcan sometimes be at least in part a matterof charity.Why?Because for a varietyof reasons, single individualsare asked to shoulder a burden, the responthat both to sibilityfor which is not theirsalone. It is important understand are organdonationand childbearing alwaysin part (if not largely)acts of charity. This has been clearly recognized in regardto organ donation and is expressedwell in the gift ethos which illuminesthat activity.Even though in theory the responsibilityfor some types of organ donation (eg. blood) could be fairly distributed,in fact many people cannot (say, for health reasons) or do not carry their fair share of this communalburden.Thus


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most blood donors give morethan mightbe theoreticallyrequiredof them by justice. Indeed many give who will never use their fair share of the communal blood supply. The beneficent characterof organ donation is become for vividly dramatizedwhen the requirements histocompatibility more complex, as in bone marrowtransplants.In such a case a donor is asked to carry alone a burden, for which their responsibility(as say a distantcousin) may be miniscule. is Likewise,childbearing alwaysin part (if not largely)an act of charity. This, however,has not been widely understoodnor is it reflectedin the traditionalethos surrounding abortion.The life support of childrenis a joint parentalresponsibilityas well as a communalone. Yet duringthe gestation period this burden can not be equitably distributedeven in theory.Mothersalone carrychildrento term. The fact that everypregnant woman carriesfar more than her fair shareof this responsibilityis simply vividly dramatizedwhen pregnancy results from rape or the failure of contraceptivemeasures, when it threatensthe mother'slife, or when it is accompaniedby total paternalor social abandonment. are However,simplybecause both organdonationandchildbearing acts least in part)of charitydoes not automatically mean they ought not be (at required.Becausejustice cannot alwaysenjointhis "donor"to give his or her loaf of breadto the starving"thief" does not mean that such a gift is As purely discretionary. David Little points out in "MoralDiscretionand the UniversalizabilityThesis," beneficence can give rise to obligations. The robustpasserbycan be blamedif he or she fails to save the drowning child by rollinghim/herout of the puddle. The donor can be blamedfor failingto feed the starving"thief,"even if the "thief" has no rightto this donor'sbread. Thus I must show what it is about the gift of a womb or other bodily organ that makes it discretionary.Why should bodily life supportnot be required? Bodily Life Supportis a Gift In strugglingto identify the logic of beneficent acts, Little identifies some of the criteria for determiningthe extent to which assistance is of discretionary.In my opinion one factor influencingthe determination the discretionaryquality of a beneficent act is the extent to which the "gift"in question is truly a gift. Some gifts are more genuinelygifts than others. Comparea gift of money to the gift of a friendship.The latter is moretruly a gift, and thus morediscretionary (otherrelevantfactorsbeing because friendshipbelongs more to and is more expressive of the equal), giver than is money. The giving of breadto the starvingthief is only minimallydiscretionary because the breadbelongs to the donoronly in a minimalway.Even if one

ChristianReflectionson Bodily Life Support


assumes on a penultimate level, as did ThomasAquinas,that the notion of best serves communalneeds and responsibilities,vis-aprivateproperty vis the goods of the earth, it does not follow that one can ultimately etc. One is finallyonly a stewardover possess or own wealth or property, such goods. The saving of the drowningchild is more discretionarythan the giving of the bread because an agent's actions, labor, skills, etc., belong more to him or her- are more personal than property.Hence, they are more of a gift. (In the particularcase cited by Little, the rescue is still requiredbecause the costs and risks of the saving activity are so minimal.Even though the "gift"is more purely a gift, its giving remains obligatory.) What is the extent of the discretionarynature of bodily life support? Canit ever be said that a needy "thief"has a rightto this "donor's" blood, bone marrow,or womb, etc.? What kind of gift is this? Is the giving of such assistance throughorgan donationor pregnancyever obligatory?If persons havea generalobligationto assist othersbased on the demandsof both justice and beneficence, may this not include bodily forms of life support?If not, why not? Persons do not have a duty to give bodily life supportto others. Nobody, simply as a humanbeing in need, has a claim to the use of another'sbody. Charles Fried in his discussion of "bodily as integrity" a negativerightin his book, Right and Wrong,(1978)offers a fruitfulexplanationof the "specialnature"of bodily life support.Whilehe admitsthat agents have a generalobligationto assist minimallypersons in does not include bodily life support. urgentneed, this moral requirement So, for example,blood donationsare in his judgementpurely "discretionary" options. This is so because when the demands of justice or beneficence conflict with those of autonomy,the latter generally take precedence over the former.(Thereare, of course, exceptions for Fried. Some demands of justice- e.g., the duty to contributea fair share override some conceivable preferences.) However, bodily integrity for Fried is essential to "the sense of possession of oneself," and hence an agent cannot use anotherperson'sbody againsthis or her will without violating the more primaryobligation to respect that person as a person (Fried, 1978:154). This is quitecorrect.In accordwith JamesM. Gustafson,I would argue that "man's 'sovereigntyover himself to use Kierkegaard'sphrase, is fundamentalto any serious moral view of life" (Gustafson, 1968:112). Bodily integrity is viewed descriptively as a foundation of agency or conditionnecessary for humanaction. In the work of Alan Donagan,The Theory of Morality (1979), such a condition becomes the basis for a normative judgment.In orderfor a person to act morally,his or her bodily must be respected by others. (Indeed, we do not hold persons integrity


TheJournalof Religious Ethics

accountablefor choices made underundueduress or coercion.)Therefore the agent must respect these same featuresof agency in others.13 But why drawthe line at bodilylife support?Why not view an agent's body regardlessof gender as one of life's goods (like food, property,etc.) which can like other objects be possessed, exchanged,confiscatedand/or rightlyclaimedby another?Why is bodily integritya conditionnecessary for agency? Bodily life supportcannot be requiredprecisely because the human body is not like the other goods of creation which an agent can objectify without distortion.The body is not like other possessions. One does not have a body- one is embodied. Granted,there are many lived experiences of the body which tempt persons to objectify the body and stoically treat it like a stranger.For example,agents are often affectivelybeseiged by theirphysical needs and must occasionallyfightthem off, as if they were foreigninvaders.Or again, several medical techniques have at their foundationan analogy between the body and a machine in need of upkeep or repair.Accordingto Paul Ricoeur (1966:87),"here lies the temptationof naturalism,the invitation to deprivethe experienceof the body of its personaltraitsand to treatit as any other object." If so much of our experience of the body tempts us to treat it like an object, then why not accept the invitation?Whyview such an invitationas treasonous?Primarilyit is because such objectificationsbreak down according to Ricoeur. Upon close inspection they do not fit our personal experience of the body, le corps propre. "I do not know need from the outside, as a naturalevent, but fromwithinas a lived need ..." (Ricoeur, 1966:87).In Freedom and Nature, Ricoeur adopts GabrielMarcel'sbasic intuition about the ultimate unity of the subject and object. This is for Ricoeurthe real meaningand mysteryof incarnation. This primordial link, "this inherenceof a personal body in the Cognito"(Ricoeur,1966:88),is most evident when the experience of embodiment is analyzed on the prereflectivelevel. In his philosophy of the will, Ricoeur uses the phenomenologicalmethodto unravelMarcel'senigmaticinsightand to elaborate systematicallythe meaningof incarnateagency. In his analysis this elusive unifyinglink between consciousness and body which is incarnation is disclosed to be "alreadyfunctioning" priorto reflectionat the core of the decision-making process. For example,Ricoeur analyzes musculareffort,a typicalexperienceof the body as object. By attendingto the prereflectivelevel of this experience, he is able to demonstratethat the body can be experiencednot only as recalcitrantly alien but also, and primarily, an availableservantto the as will. The prereflectiveexperience of bodily docility is difficultto capture because it shrinks away from attention. However, as Ricoeur notes,

ChristianReflectionson Bodily Life Support


(1966:310) "only willingwhich is alreadyeffectivelydeployedcan encounter limitations.Externalresistancepresupposesthe docility of the body." Persons do not have a right to or claim upon parts or the use of another'sbody,because living bodies are primordially personal.All objectifications of the body are abstractionsfrom this lived unity. Therefore, while the needy "thief" may have a just right to another'spropertyor wealth, such claims may not be extendedto another'sbody withoutdirect violation of the obligation to respect persons as persons. While beneficence may impose upon all agents a requirement give certainkinds of to "gifts" gifts which are only marginallygifts- it can never require of agents so pure and personala gift as the gift of one's body.This is a claim for the most part accepted but inconsistentlyapplied by traditionalbioethicists. For example, in their now famous debates about experimentson children both Paul Ramsey and Richard A. McCormick(albeit to a lesser extent) recognize the moral significance of this axiom. For Ramsey, it grounds his absolute prohibitionof any nontherapeuticexperimentson it children.For McCormick, groundshis prohibition any nontherapeutic of experimentson childrenwhich (1) are morethan minimallyinvasiveor (2) carry any significantrisk. Even for McCormick,only routine weighings and blood work-upscan be tolerated.Both men (althoughagainto varying degrees)recognizethe moralsignificanceof bodily integritywhen analyzing the ethics of organ donation. However,neither Ramsey nor McCormick (like many moral theologians)recognize as significantthe claim to bodily integritymadeby womenin regardto theirreproductive capacityin and both tend to deny its significancein the abortiondebate. general, In a recent essay entitled "Abortion the SexualAgenda:A Case for and Pro-LifeFeminism,"SidneyCallahanreinforcesthis position.Thereinshe notes that no one ought to "be forced to donate an organ or submit to other invasive physical proceduresfor howevergood a cause" (Callahan, But 1986:232). this rightto bodily integritydoes not apply to childbearing according to Callahan(1986a:234),because when pregnant "one's own body no longer exists as a single unit but is engenderinganother organism's life." I would concur with Callahanwhen she claims that a woman's choices about rightto control her own body does apply to self-regarding mastectomies, contraceptionand sterilization,and I have taken as axiomatic her premise that the fetus is not like a cancerous tumor or subhumanparasite.Further,I agree that childbearing clearly an otheris regardingactivity and that this other can be intelligibly regardedas a person, whose very life is dependent upon maternalbodily support.Yet that isn't such also the natureof organ-donation: is, isn'tthe "good cause" the preservationof anotherperson'slife? It strikes me as blatantlyincon-


TheJournalof Religious Ethics

sistent to grant potential donors the right to refuse to participate in as transplantprocedures,yet view childbearing required. The analogy I have proposed illumines the fact that a woman denied access to either birth control or abortionis forced into childbearing a invasive experience with significant risks- against her will. highly Ramsey, McCormickand Callahanwould never tolerate such abuse of either children or reluctant organ donors.14Were they consistent, they would not be able to toleratethis abuse of pregnantwomen. As it stands, they contributeto and endorse that long traditionwhich regardswomen's bodies as objects to be controlled by others, if not by their fathers or husbands, then by the state. Like McCormick,I believe agents ought to give minimalbodily assistance even to strangers.Indeed,in the concludingportionof this essay I will outline some of the distinctivelyChristian reasonsfor such gift-giving. However,McCormickerrs when he argues that this can be requiredof agents by the demands of justice. He moves in this directionin order to emphasize (in contrast to Ramsey and others) the essentially communal natureof justice. Corporateobligationsare constitutiveof the morallife. He is correct when he argues that persons are not properlyconstruedas It autonomous,if that translatesinto an atomisticformof individualism. is counter-intuitive deny that there are certaincommunalgoods- includto ing health maintenanceand disease control towardwhich humancommunitiesare inclined and that agents are requiredto pursuethese goals. While I am most sympathetic with McCormick'semphasis on the communalcharacterof persons and with his warinessof the currentsurge of liberalinterestin "autonomy," believe he is mistakenin his attemptto I link the responsibilityto give bodilylife supportwith the requirements of justice. The communal character of human agency can be accurately portrayedonly when it is recognized that persons are not parts of, but rather"wholes within a whole" (Ramsey,1970). One final comment about bodily integrity seems in order. Many, especially RomanCatholic, pro-lifersview anti-abortion legislationas analogous to anti-slaveryand feminist "equalrights"legislation.Fromwithin this perspective the anti-abortionist, abolitionist, and feminist all are viewed as seekinglegal recognitionof andprotectionfor groupswhose full humanityhas not been generally respected. Sidney Callahanin a joint interviewwith her husbandon their book, Abortion: Understanding Differences, representsthis perspectivewell. too too Justas womenandblackswereconsidered different, undeveloped, as so to too biological havesoulsor rights persons, thefetusis nowseenas 1986b: life. merebiological (Callahan, 4)

ChristianReflectionson Bodily Life Support


Women who "want"abortions, like slaveownersand slave dealers, are viewed as coerced into forfeitingtheir "rights" pro-lifelegislation. by But are these really analogoustypes of legislation?The alleged conflict of rights in the national debate over slavery appears in retrospectto be obviously bogus, once slaves are recognized as persons and not merely At property. most, there was conflictbetween humanrightsand individual (as well as regional)financialinterests.However,as my argument displays, even when fetuses are recognized as persons, an authentic conflict of rightscan remain.The rightjeopardizedby anti-abortion legislationis not the rightto dispose of fetal "property" one sees fit, but ratherthe right as to havecontroloverone's own body.Thisbasic rightto bodily integritycan and sometimes does stand in direct conflictwith the other'sbasic rightto life.15 None of the ethicists who, like McCormick,would argue that some measureof bodily life supportvia participationin routine studies can be requiredof persons contend on the grounds of justice that organ transplants can be requiredor that abortionfollowingrape can be prohibited. This would demandthat a single individualcarry an unjust share of the social burden.Whileas a memberof society,the rape victim sharespartial responsibilityfor this fetal life, (in addition to her portion of parental it responsibility), is blatantlyunfairto ask her to carry the full burdenof life support.I would only reiteratehere that this is true (thoughto a lesser degree)of everypregnantwoman. In summary,one may wish to argue that beneficence may legitimately of requireof all persons the giving of certainkinds of "gifts," particularly objectifiablepossessions. Nevertheless, the more personal the gift, the it more "gifty"and discretionary becomes. I can thinkof no morepersonal and intimatetype of gift than the gift of one's bodily self- whether given sexually, in pregnancy,through various forms of organ donation, or as sacrificedfor another.The more a gift belongs to, indeed is, another,the more truly it is a gift. In his discussion of Sacraments as God's Self Giving,JamesF. Whitemeditateson the natureof gift-giving.
Whenwe give a gift we do not ordinarily "Thisis my body,"or "Thisis say, me," but this is what we mean. And the receiverunderstandsthe gift this way,and not merelyas an anonymousobject. (White,1983:20)

One can only give in the purest sense of gift-givingwhat one is. Thus, communalresponsibilityought not be conceptualizedin such a way as to distortthe bodily integrityof persons. Likewise,it shouldnot place unfair not burdenson individuals.Furthermore, even minorforms of bodily life supportwhich theoreticallycould be fairly distributed(like blood dona-


TheJournalof Religious Ethics

tions) can be requiredof persons because of the special natureof embodiment.16 The ethos of gift-givingthat currentlypervades the practice of organ is to transplantation the only ethos appropriate the "specialnature"of all forms of bodily life support.This ethos should be extended to our moral of understanding both pregnancyand abortion.Health care professionals describedby Fox (and I would add moral theologians)are appropriately and Swazey (1978) as "keepers of the gates," that is, as agents who facilitate gift-givingand who guard against the theft or confiscation of what by its very naturecan only be freely given. In her discussion of the wider moral frameworkof abortion. Beverly WildungHarrison in Our Right to Choose makes the followingassertion: Weneedalso to acknowledge bodilyintegrity any moral the of agentas a foundational conditionof humanwell-being dignity. and Freedom from issue morally; it rather, is bodilyinvasion... is no minoror marginal central ourconception the dignity theperson. to of of (Harrison 1985:196) My purposein this section has been to explainandjustify the axiom. The conclusion that neither pregnancy nor organ donation should be mandatory does not imply that all or even most refusals to offer bodily life support (throughorgan donations or childbearing)can be morallyjustified. Bodily integrityis a necessary but not self-evidentlysufficientcondition of morality.

BODILYLIFE SUPPORT:A CHRISTIANFEMINISTASSESSMENT OF ITS MEANINGS The overarching purposeof this section of my essay is to assess the gift ethos in light of the feministsuspicionof any moralframework that might call for the self-sacrificeof women.ThoughI have explainedwhy I believe bodily life support should not be mandatedof any person, I have yet to examine what it might mean for a Christianto give or refuse to give such gifts either throughorgan donationor childbearing.17 Clearly "ought"in this instance does not mean required.Furthermore, the proposedanalas ogy reveals, the decision to bear a child, like that to donate organs, is a complex decision through which the gift-giver attempts to serve and balance a numberof competingvalues. Thoughthey may be obvious, a brief rehearsalof some of these competing responsibilitiesis in orderinsofaras it will establishthe context for and my analysis of self-sacrifice its refusal.Let us begin by listing some of the factors that might enter into a decision for or against donating an

ChristianReflectionson Bodily Life Support


organ. The donor's general physical and emotional health and life-situation, the value of and likely impact of donationupon his or her life-plan (includingpresent as well as future career considerationsand family and social life ramifications),the extent to which the community (family, church, and townspeople)will support(both financiallyand emotionally) life the donorand his or her dependents,the valueof the recipient's as well best interests(whichare not in all cases obviouslyserved as the recipient's by extending that person's life), and any special responsibilities of a contractual origin that the donor may have to either the recipient or others all of these factorsare normallyconsideredrelevantto a decision regardingorgan donation.18Obviously, there is considerable room for conflictamongthese goods, and it is not alwayspossible to balancethem. In some circumstances, they may be mutuallyexclusive, that is, sometimes morallylegitimateconcerns must be sacrificedfor the sake of other concerns. are Decisions regarding childbearing analogous.All of the factorsidenare likewise morallyrelevantto a woman'sdecision to abortor tifiedabove bear a child. In her essay "FamilyPerspective on Abortion,"Theodora Ooms notes that when one listens carefullyto women who speak about their childbearingand abortiondecisions, the languageof "care,responsibilities and relationships"is emphasized (Ooms, 1986:98).Abortion is nevera "simple"choice based on a single factor,such as the value of fetal life or maternalhealth. Pregnanciesbecome problematicwhen no way of balancing the various responsibilities outlined above can be found. or Whetherterminated not, these pregnanciesneverhavemorally"happy" At best in such tragiccircumstances,one aims to follow the least endings. evil course of action. As Whitbeck demonstrates, women do not ever "want"abortions.Medea is a false image of women; it is the productof misogyny. Those who take women's experiences seriously could never describe an abortion, whether spontaneous or induced, as "a matter of little consequence." Further,women ought not be deceived about or veiled from the developmentalreality of abortedfetal lives. Paternalism, howeverbeneficentin origin,robs women of the opportunityto face their situation and their decision truthfully,with integrity,courage, and selfrespect. Within this wider understandingof the problem, let us first unravel and then critically assess the traditionalclaim that Christians ought to give bodily life support,even when this entails self-sacrifice. Fromthe Kantian"moralpoint of view" others are properlyperceived as strangersand decisions about bodily life supportare "purelypersonal" and "private."In contrast,within the Christianstory a (non-patriarchal) family model is the lens throughwhich persons are perceived as morally linked to one another by obligations of mutual respect, service, and support.These are not merely "special relations"constitutedby optional


TheJournalof Religious Ethics

social contracts.These rightsand obligationsin regardto one anotherare not relatedmerelyto the performance or failureto performcertainacts. of are not subject only to voluntarycontrol.They are also "thruston" They agents who find themselves "stuck with" needy others. According to Hauerwas, life is out of human control, and this is not for problematic him. Nor does it troublehimthat these relationsmaybring neitherhappinessnor self-fulfillment a penultimate level to agents.That on is not what the morallife is chiefly all about given this vision. The moral life is more contingent than social contract theorists would have us believe. It is the Christian of belief,nurtured the command Jesus,thatwe must by learnto loveone another, we becomemorenearly that whatwe weremeant to be through recognition loveof thosewe didnot"choose" love. the and to (Hauerwas, 1981:227) Therefore,simply because there is no voluntaryor contractualrelationto the needy recipientdoes not meanthereis no responsibility offerbodily to life support. (This does not, however,mean one cannot distinguishbetween varyingdegrees of responsibilityinherentin varyingforms of relationships.) Persons find themselves linked by virtue of blood or tissue type, of of their sexual or social nature to other persons in need of bodily rape, life support.These needy others are experiencedas unalterable"givens" in an agent'slife. Theirburdensomeand difficultpresence is experienced as totally beyondvoluntarycontrol.It is not now,even if it mightbe in the future,humanlypossible to reversein all cases the process of renalfailure or prevent in all cases the rape-inducedor otherwise unwelcome conception (unless it is verifiedthat this is in fact what the "morning-after" pill does). These are part of the radically involuntarynecessities which groundand limithumanfreedom.Thoughsuch givens are unalterable they need not crush humanfreedombecause like other brutefacts of life, they are not only unalterable also received.Agents havea choice abouthow but they are going to respond to such burdens and difficulties.This choice informsand is informedby the dispositionalstance the agenthas assumed in relationto the finitudeand frailtyof humanexistence in general. Such a faith stance is not mere intellectualascent to dogmas, etc., but entails a commitmentto see and relateto "reality"througha certainlens or canonicalset of presumptions. can only knowwhat it meansto give We bodily life supportto those whose need crashes into our lives within the context of a particular and faithframework. example,one can interpret For evaluatethe decision of a rape victim to bearthe fetus to termonly in light of a particularvision of reality.

ChristianReflectionson BodilyLife Support


ChristianFaithPresumptions Traditional As Hauerwas notes, "the Christian respect for life is first of all a statement,not about life, but about God" (1981:226).Indeed, in the first instance it is a statementabout God'sultimatesovereigntyover all of life. A voluntaristcommitmentto or love of the potentialrecipientis not the necessary moralpreconditionfor the giving of bodily life support.On the contrary,such bearingof the other is the conditionfor the understanding of what love is in a world where God, not humankind,is in ultimate control. Before God humansstand in radicalpoverty,their life and value hang, as it were, by a providentialthread. From this perspective,human existence and worth come as a gift from God. Apartfromthis presumptionof nakedness, any human activity includingthe giving of bodily life sup- will become a formof idolatrous,self-aggrandizement. Thus, for the port to Christian offerbodily life supportis to convict oneself to a life of radical povertyin a world where God is sovereign. Implicitin such an adoptionof the otheris a latentvaluation.It is a sign of of the ultimatetrustworthiness life. It is also a symbol of hope, for the world provideslittle objective evidence that such confidence is justified. Presumingthat life is a gracious gift from God does not entail being deceived about the frailty and faultednessof human existence. Like the presumptionof a person'sinnocence, this belief is indefeasible.While it (like guiltypersons),they readilyadmitsthe existence of counterexamples do not underminethe presumptionitself. It is for Christiansa faith claim made fromunderthe shadowof the Cross. For example,it is not to assert that objectively renal failure or fetal deformations are gracious gifts. Rather it is to assert that the lives of those who suffer from such evils, despitetheircostly andburdensomefeatures,remaingraciousgifts.It is to consent to one's own frail and faultedlife as graciousgift. It is not to seek to or to yield passively to suffering,but ratherwhen unavoidable, adoptit. View TheMoralImplicationsof the Traditional the faithful agent is one whose particularresponses to Furthermore, others and whose life as a whole is characterized these presumptions. by The Christiannot only comes to perceivelife as graciousgift but becomes a gift-giver,extends favors, mercy, etc., to others. To see faithfullyone's life as graced is, in a word, to live graciously.In his Biblical theology, Sharing Possessions, Luke T. Johnson (1981:108)concludes that "the mandateof faith in God is clear: we must, in some fashion, share that which has been given to us by God as a gift." To grasp,hoard,or hold on As to the world'sgoods, includingourselves, is not a properthanksgiving. notes in his exegesis of Sirach,"it is not enoughto keep Johnson(1981:99)


TheJournalof Religious Ethics

from oppression and injustice; covenant with God demands that we deliver the oppressed." Or again, as Hauerwaspoints out, to believe in the parenthoodof God is to learn to see others, includingstrangersand even enemies, as siblings. "We must be a people who stand ready to receive and care for any child, notjust as if it were one of our own but because, in fact, each is one of ours"(Hauerwas,1981 :229).19 Thus sharingthe gift of life seems to be a consequence of acceptingthe cosmology of Christianfaith. MonikaK. Hellwig writes of this dominical calling,
In a wide sense we are all called to be parentsto one another,to bestow on othersthe life andblessingwith whichwe havebeen blessed, thatis, to bless others with the substanceof our own lives. (Hellwig, 1976:44)

This leads to at least one otherkindof reasonChristians mayofferfor such self-giving.This latterreason focuses not so much on what Christiansare called to do, but ratheron who they are called to be. Christiansare called to be images of God in the world. The paradigmatic exampleof such an image is the Kenotic Christ(Phil.2:5-8), whose outpouringis celebrated in the Eucharist. For Christiansthe death of Jesus is not adequatelyportrayedas the surrogatesacrificeof the perfect scapegoat, the merits from which they passively profit.Insteadthe death of Jesus is seen as foundational a covenantcommunityin which Christo tians are active participants. Thatis why, accordingto Hellwig,the central action of the Eucharistis not the passive, individualreceptionor eatingof food, but the communalsharingof it. Christiansare to be living incarnate signs to the world of that divine self-giving.This explains why the primitive Churchtold the tale of her early martyrsin Eucharisticterms.Those early Christianswho witnessed the sacrificeof the martyrswere clearly conscious of the prototypicalcharacterof their gift. From this point of view, it seems very fittingthat organdonationbe describedin Eucharistic language that is, as the sheddingof blood and the breakingof the body given as testimony to one's experienceof God.20 the Traditionally, Church has recognized at least one woman'spregnancy as having this same prototypicalcharacter.In their perceptionof and devotion to Mary,the Motherof God, Christianshave borne witness to certainbeliefs about the purpose of humanexistence. In his book, The Life of the World, the Russian Orthodox theologian Alexander Schmemanndiscerns in the celebrationof the Theotokosthe exclamation that "fromall eternityall creationwas meantand createdto be the temple of the Holy Spirit, the humanityof God" (Schmemann,1963:61).In her very bearing of the Christ, Mary imaged God's self-gift.Her traditional status as the paradigmatic disciple of Christis rootedin her willingnessto give of her own flesh so that the worldmightsee the face of God.

ChristianReflectionson Bodily Life Support


In her reflections on the meaning of the Eucharistic claim that one person can be the breadof another,Hellwig writes: this trueof the mother the unborn of or and Literally physically is always that unweaned child,andit is not accidental the Bibleuses the imageof . or motherto describeGod'snurturing.. . Nor is it accidental unduly havespoken Jesusandhisrelationship theChurch of to that fanciful mystics in termsof motherhood. 1976:27) (Hellwig, My purpose here has been three-fold.First,I wished to give some indication of how central self-giving,indeed sacrifice,is to Christianfaithand to the sacramental expressions which constitute the Church. Second, I sought to highlight the explicit connection that has been made in the and God'sown self-giving.Farfrom being traditionbetween childbearing viewed as a owed anyone or a right, childbearingis most appropriately not unlike God's own gratuitousPresence. Third, I have gracious gift, suggestedthat organdonationcan be renderedintelligibleand meaningful withinthis same vision of life. FeministReformationsof the Tradition At this point it is importantto delineate and respond to the feminist critiqueof this view of the Christianfaith experience.It mightbe outlined as follows. People, women especially, need to take charge of and responsibility for their lives. They need "to own," not relinquish,control over theirlives. Second, for manypeople, women especially,sin is experienced or as primarily self-negation neglect, not as hubrisor self-aggrandizement. The call to graciousliving appearsat best to romanticizeservitudeand at worst to sacralize victimization. Feminists have documented the sadomasochistic expressions such theology has given rise to in the church'shistory. They have further documented that in fact Christianityhas operated and women are called to self-renunciation submiswith a double standard: whereas men are empoweredand given leadershippositions. Harsion, rison is well worth quotingat lengthon this point. Themorally behavior fromwomenin relanormative, sacrificial expected and tionto childbearing childrearing appliesto the publicactionsof never men.Men's areto be governed strict lives to construed by conformity "duty" as established conventional behavior. Women, connarrowly observing by are a to women trast, expected achieve "supererogatory" morality. Although in have moralobligations relationto procreation, sort of theology this us. double-binds Weareadmonished be obedient passive simultato and but than neouslyare told thatwe werebornto be moreresponsible menfor human and an We nurturing well-being embodying ethicof sacrifice. livein a


TheJournalof Religious Ethics

world where many,perhaps most, of the voluntarysacrificeson behalf of human well-being are made by women, but the assumptionof a special obligationto self-givingor sacrificeby virtue of being born female,replete with procreativepoweris male-generated ideology.(Harrison,1985:62)

In light of such discrepanciesas these, it strikes me as wise to be susof picious of attemptsto sanctify the "crucifixion" women facingburdento some and unwantedpregnancies.It is equally appropriate be wary of that mightforce "martyrdom" potentialorgandonors. on arguments Clearly feminists are correct in assertingthat God is neither a divine child abuser nor a sadist. God's self-givingin the Incarnationled to the slaughterof Calvary not by divine design but by reason of sin, as exwith its drivefor powerand self-negation, pressed in both the Promethean However, correspondingabrogationof personal and social responsibility. Christianfeminists would be wise to be suspicious of other additional cultural assumptions produced by patriarchy,including the prevailing desire to avoid sufferingat all costs. It is appropriate be waryof all that to of results, to use Dorothee Soelle's term, in the "narcotizing life." It is the experience of pain, she argues in The Strengthof the Weak,that enables us to empathizeon a personallevel and eventuallyconnect on a political level with others. Sidney Callahan(1986b: speaks to this point directly 4) when she notes that "thefetus is to a womanas a womanhas so oftenbeen to the dominantmale in a position of weakness and vulnerability." In my own attempt to weave together these feminist and traditional Christian insights, I have reached the following tentative conclusions. First, it is importantto distinguishservitude from servanthood.Though sufferingaccompanies both, servitude is an involuntaryoppression that objectifies, subordinates,and violates persons, whereas servanthoodis a voluntaryvocation that seeks to breakthe cycle of powerlessness,domination, and violence in which we are all trapped.21 Thoughwithin both frameworksa service may be offered unilaterally,within a system of servitude this is normative.In contrast mutualityand solidaritycharacterize servanthood.The differenceis not found in the distinctionbetween a sadistic master(servitude)and a masochistslave (servanthood), some as wouldargue.On the contrary,servanthoodas I defineit breaksaltogether with the master/slaveparadigm,by seeking to empowerand liberateall. Power in this new context stems not from dominion over and isolation from others, but is rathera strengthrooted in connection and solidarity with others, especially the weak. Second, the willingness to carry an unwantedchild to term can be meaningfullyunderstoodas a sign of solidaritywith the weak among us. a And, correspondingly, decision to abortin this context can be seen as an analgesicchoice, a headlongflightfrom suffering.Communitiesthat offer

ChristianReflectionson Bodily Life Support


no web of supportfor personsfacingsuch choices, which do not recognize as heroic the choice to so serve, must be held responsible for their systemic supportof slavery.To offerthose who sufferonly opiatesis in the long run to supportoppression. Many on both sides of the abortion debate continue to romanticize pregnancyand motherhood.This romanticmyth blinds many to the real problems and devastatingconflicts pregnantwomen frequently face. It blinds others to the work, delayed gratification,suffering,and sacrifice constitutive of even planned, ordinarypregnancies.Romanticismabout motherhoodreflects a failure of persons on both sides of the abortion debate to take the experienceof women seriously. Third,the refusal to carry a burdensomechild to term can be meanfor ingfully understoodas an importantsymbol of self-affirmation some women. By this I do not mean raw egoism or selfishness (though such remainsa possibility).InsteadI referto that measureof self-loveand selfbut for respectwhich is not only the prerequisite and enablerof other-love, a also its fittingcorrelate.Correspondingly, decision to continue a pregfor as nancy could be interpreted a blind slaveryto a life the responsibility has forfeited. Communities,ecclesial or civil, which seek to which one mandate childbearing only reinforce the powerlessness and violation manywomen have systematicallyexperiencedwithinthose same communities. In makingthis assertionI wish to distinguishmy own position regarding sufferingand self-sacrificefrom that expressed by Lisa Sowle Cahill. In her essay, "Abortion,Autonomy and Community,"she argues that feminists who affirmthe moral maturityand adulthoodof women must encouragethem to "recognizethat some humansituationshave unavoidably tragic elements and that to be human is to bear these burdens" WhileI concurwith Cahill'srejectionof the avoid(Cahill,1986:271-272). ance of the tragic via both romanticismand masochism, I wish to assert humancan be expressedboth in the that elements of what is authentically decision to abort and in the decision to bear the burdensomechild. Selflove and other-love are both normatively human forms of love. What makes the choice tragic is precisely the fact that neither availableoption can express humanlove in its fullness. of Such a "double-reading" the choices women make about childbearing offers small comfort to those who sought in this part of my essay a "solution"to the abortionproblem.It does howeverclarifyfor Christian feministswhat it mightmean to make such choices in a worldthat is truly an originalblessing howevermarredby originalsin. Finally,somewhatparalleljudgments can be reached in regardto the practiceof organ donation.As the first noted by Parsons, Fox, and Lidz (1972),Christianitycan frame the giving of bodily life supportin such a


TheJournalof Religious Ethics

way as to make it both intelligibleand commendable.Throughthe donation of varioustypes of organs, persons may enflesh certain truthsabout the purposeand characterof all creation.Thus, the inabilityon the partof some (e.g., Fellner, 1971) to understandor encourage live donation between unrelated persons may reflect not limits intrinsic to bodily life support, but rather the convictions constitutive of the modern liberal vision of life. In the future as the risks of graft vs. host disease are minimized,unrelatedlive donationsat least of bone marrowwill become increasinglysignificantfrom a medical standpoint.It would seem to be a tragic form of myopia if the medical communitycontinues to judge unreif lated live donationsas inappropriate, not automatically suspect.22Unrelated live donationis not only intelligiblebut may be a sacramental for act some. Clearly, however, health care professionals need to remain wary of those "volunteers"manifestingmasochistic tendencies. As "keepers of the gate" they ought to be especially cautiousof compensationstructures that might ensnare those who are economicallyoppressed into a personally treasonousforfeiture into the objectificationand sale of their body. This is already a reality in many inner city blood banks. The power of biomedicalcommerce to erode the gift ethos which surrounds most other forms of organdonationshould not be underestimated. NOTES
1. In this case WilliamHead, a lukemiavictim, wished to participatein an experimentalprocedure involving bone-marrowtransplantsfrom a non-related donor. Because computer records indicated that Mrs. X might be a possible matching donor for Mr. Head, she was invited to participatein the research program.She refused,indicatingshe was unwillingto be a donor"unlessit was for a relative."After being informedof her decision, Mr. Head sought a court order which would compel the researchersto reinvite Mrs. X., informingher that a aboutthis specific patientmightbe helped by her donation.For more information case and JudgeJ. McCormick's 1983ruling,see Levine and Veatch, 1984:83-85. For additionallegal precedentsagainstcompulsoryorgandonation,see McFallv. Shimp, No. 78-17711In Equity (C.P. Allegheny County,PA, July 26, 1978). 2. Here I havein mindsuch thingsas requestsfor information one's regarding sexual partnersfor the sake of either (1) encouraging paternaleconomic support for an unwedmotherand child or (2) containingthe spreadof venerealdisease. Or, perhapsmorerelevant,if the police havereasonto suspect that someone'slife is in danger, they may invade one's home without a search warrantor the owner's permission. 3. This analogy has its deepest roots in the fictionalcase createdby Judith Jarvis Thompson in her article, "A Defense of Abortion"(1971). It is further developed by Mattingly(1984).

ChristianReflectionson Bodily Life Support


wouldinclude such books as these: Ray YorkeCalne,M.D., 4. This literature A Gift of Life (New York:Basic Books, 1970);Renee C. Fox andJudithP. Swazey, The Courageto Fail (Chicago:Universityof ChicagoPress, 1974);J. Hamburger in and J. Crosnier,"Moral and Ethical Problems in Transplantation," Human edited by Felix T. Rapaportand Jean Dausset (New York:Grune Transplantation and Stratton, 1968);RobertaG. Simmons, et al, Gift of Life (New York:John Wiley, 1977);RichardM. Titmuss, The Gift Relationship(New York:Pantheon Books, 1971);and such essays as: W. J. Curran,"A Problemin Consent:Kidney in Transplantation Minors," New YorkUniversityLaw Review 34 (May, 1959): A Jr., 891-98; J. Dukeminier, and D. Sanders, "OrganTransplantation: Proposal for RoutineSalvagingof CadaverOrgans,"New EnglandJournalof Medicine279 (August 1968):413-19; A. M. Sadler, Jr., and B. L. Sadler, "A Communityof Givers, Not Takers," TheHastings CenterReport1415(October1984):6-9; and F. William May, "Religious Justifications DonatingBody Parts/' TheHastings for CenterReport 15/1 (February1985):38-42. 5. It is mistaken to think of metaphoricalcomparisons as establishing a relationshipbetween terms. Rather,the analogicalwager sets up substitutionary an interaction(not interchange)between the terms, the fruit of which is new insight into that which is compared.Thoughthe argumentwhich constitutes the body of this essay is not developed analogically(in the substitutionarysense rejected above), it does rest upon the insights yielded by such reframingof the activities. In his book, Womenand Equality: Changing Patterns in American Culture(1977),WilliamH. Chafearguesthat the popularanalogybetween women of and blacks has permittedus new understandings "social control."At this level it of generalization is very useful.It is less (or altogethernot) useful, Chafeargues, in exhibitingthe materialconditions which accompany either sexual or racial oppression.The analogydevelopedin my essay will permitus new understanding of the reasons for and limits of the obligationto give bodily life-support.For a more detailed discussion of the natureand role of metaphorical thinking,see the now classic essay by Max Black entitled "Metaphor." 6. This same "hermeneuticsof suspicion"should be appliedto the growing considerationof prophylactic(for the fetus) cesarean sections at term. For more aboutthe currentshapeof this discussion,readthe briefnote detailedinformation submittedby GeorgeB. Feldmanand JennieA. Freimanon that topic to TheNew EnglandJournalof Medicine (Feldmanand Freiman,1985).Consideras well the growing discussion among both jurists and biomedical ethicists about forcing pregnantwomen to undergofetal therapies.See Engelhardt,1985. in 7. In this essay the questionof whethervoluntaryparticipation sexual acts measures establishes alone- or morepointedly,with the failureof contraceptive a parentalrelationcan not be addressedin detail.However,I wish to suggest that even if contractualconsiderationshave a legitimaterole to play in the determination of the extent of special parentalobligations, they do not settle the matter. in Family obligationsare at least in part non-contractual origin. Clearly a rape victim does not have as much of a parental obligationto her child as one who "planned"her pregnancy;nevertheless, she still has some parentalobligation. Childrendo not choose their parents;persons do not volunteerto be part of a family.Instead we find ourselves inescapablyand inextricably"stuck with" our


TheJournalof Religious Ethics

family and obligatedto them, whetheror not these parents, siblings, or children benefit us. My point is that contract theory alone cannot explain the moral significanceof a person's willingness to have and care for children,particularly those who are unexpected, burdensome,or otherwise unwelcome, since these children highlight the non-voluntary, uncontrollableand risky nature of even "planned"parenthood. It is simply erroneous to assume, in Lisa Sowle Cahill'swords, that "only freedom creates moral obligation"(1981:15).In contrast to this liberal fallacy, Cahillaccuratelysuggests that persons are social not only by contractbut also by nature.Agents are naturallyinterdependent bound by the obligationsof this and and Thus pregnancyand gestationcan be viewed as primordial interdependence. of this naturalsocial interdependence. prototypicalexamples 8. Even though this essay is deeply indebted to the work of Thompson to (referred in Endnote#3), I agreewith Witbeckwhen she arguesthat it is almost absurdto envision the fetus as a dependentadult-stranger. Such an analogy is visualized in photographicand cinemagraphic essays when fetuses are portrayed as mini-astronauts floatingabout in "inner"space connected by an umbilicallife line to their "mothership." Some weaknessesin this analogyare obvious:fetuses are neither adult nor strangers;mothers are not objectifiablethings like spaceships. A strengthof the analogyis equallyobvious:the fetus is usuallydependent upon the motherfor survival,though some in the thirdtrimestermay be viable. is Accordingto Whitbeck,"a claim moreworthyof examination the claimthat human fetuses are relevantly like newborn human beings." (1985:254) Some strengthsof this analogy are obvious: fetuses are immatureand blood relations; mothersare persons, not objects controlledby others;like neonates,fetuses have voraciousappetitiesand place nearlyconstant,at times quite taxing,demandson their caretakers.Furthermore, newborns,fetuses are speechless: they cannot like articulatetheir needs or defendthemselves.Theyare extremelyvulnerable: is this a form of dependance quite unlike that of the astronaut.A weakness of this analogyis also obvious:thoughboth the newbornandthe fetus are dependent,the neonate'ssurvivalis not tied exclusively to the care of one particular individual. and Thoughneitheranalogyis perfect,the second one is moreilluminative less problematic.Yet, it has not informedmuchof the abortiondebate.Why?Women's experienceshave been excludedfrom the pool of wisdom upon which our collective moral imaginationfeeds. Astronautsare apparentlymore familiarto those who have controlledthe terms of the abortiondebate than neonates. 9. Beyond the 20-week mark,the fetal survivalrate can increaseif the abortion is done by hysterotomy (a technique resembling a C-section) or by the injection of prostaglandins (which simulatea normaldelivery).When combined with the increasedavailability neonatalintensive care nursuries,these factors of generate two new moral questions. First, how should postabortionneonates be treated?Second, given a reasonablechance of fetal viability,shouldcertainmethods of abortionbe legally mandated? In his commentary on a 1976 Californiabill which attempted to establish guidelines on this matter, Leroy Walters reached the following commendable conclusions. (1) All newbornsshouldbe treatedequally.As "wardsof the state,"

ChristianReflectionson BodilyLife Support


postabortionneonates should be given neithercompensatorynor punitivetreatment. (2) Womenshould not be requiredto assume higherrisks for the sake of a viable fetus, "just as the law should not requireparentsto rescue their children from burningbuildings."If, however,amongabortionmethods there emerges an which lowersthe risksfor both the pregnant womanandfetus, then the alternative state can (andI wouldadd oughtto) mandatethe safermethod,for the rightnot to is offerbodily life support(to terminatepregnancy) not identicalwith the rightto from within this fetal death (Levine and Veatch, Eds., 1984:5-6).Furthermore, perspectivea woman'srightto terminatepregnancyis not identicalwith the right No to fetal experimentation. one has ever arguedthat a histocompatible parent's fromrenalfailurecan be interpreted refusalto donatea kidneyto a child suffering researchon the "dying"recepient.The case, as proxy consent to nontherapeutic on should there be one, for experimenting abortuses rests elsewhere. 10. In one sense pregnancymaybe said to resultfromtrauma,as in the case of rape, or result from a psychological disease such as immaturityamong the retarded. Notice, however,that in both instances it is the "donor"who is either or traumatized diseased. The (fetal)"recipient's" dependencyremainsnon-pathological in origin. 11. This critiquewill be developedalongthe lines proposedby StanleyHauerwas (1981).He seeks to developan ethical theory of the classical type which can account for the moral life's dependence upon a certain vision of community. Thereinhe engages in a polemic against modernpolitical liberalism.As Ronald liberalismis not a single politicaltheory."Thereare, Dworkinindicates(1983:32), in fact, two basic forms of liberalismand the distinctionbetween them is of great Whileboth versions seek to encourageequalityand legal neutrality importance." and/orsupererogatory vis-a-visself-regarding actions,these conclusionsarebased on quite distinctrationales.In one formof liberalism,equalityis the fundamental servedonly to is valueandthe concernfor publicneutrality a derivative injunction In to the extentmadenecessaryby the priorcommitment egalitarianism. the other is formof liberalism,neutrality the decisive value.It is this latterformof liberalism which Hauerwasattacks, citing as defects its basis in moral skepticism and its essentiallynegativepoliticalvision. Its emphasisupon individualfreedomand its of of discrediting dependenceon andties to othersare viewedas symptomatic this ethos for the uncommitted. 12. Withinthe Anglo-Saxonlegal tradition,strangersare usually not required crime to aid or rescue one another.Indeed,when it reviewedthe old common-law of "misprisionof a felony,"the U.S. SupremeCourtof 1822ruled that strangers Lest this portion were not requiredeven to reportcrimesto legitimateauthorities. I of my argumentbe misinterpreted, believe a sound, moral case can be made againstthis aspect of our legal heritageand that we oughtto be expected in some minimalwayto be our "sibling's keeper."Thus, I wouldarguethatboth moraland shouldbe broughtto bearon those who can assist victims of crime, legal pressure such as the witnesses of Kitty Genovese'smurderin New Yorkand the spectators of the gang rape of the woman in Big Dan's Bar in New Bedford,Mass. 13. This essay divergesfromthe theory of Donaganin that it seeks to do more a than delineate what must be protectedby articulating vision of what must be


TheJournalof Religious Ethics

encouraged.In this sense, it has a much less restrictednotion of what is properly construed as moral argument. 14. Ramsey,it should be noted, even argues againstthe "routinesalvagingof cadaverorgans"when consent cannotbe presumedon the groundsthat "a society will be a better humancommunityin which giving and receivingis the rule, not takingfor the sake of good to come." This is so even when the good at stake is life itself. "The moral sequels that mightflow from educationand action in line with the proposed Gift Acts may be of far more importancethan prolonginglives routinely."Even corpses ought not to become involuntary"donors"(Ramsey, 1970:210).The communal revulsion to the unauthorizedharvestingof cadaver purposes in the mid-1960swas a contributing pituitaryglands for humanitarian factorto the developmentof the UniformAnatomicalGiftAct of 1968.Pro-choice groups express an analogous kind of shock in response to forced pregnancy. 15. In his essay, "Abortion:A ChangingMoralityand Policy?" McCormick which seems compatiblewith the positionI am articulatesa theoreticalframework developing,yet he fails to delineate explicitly its implications. For an act ... to be the lesser evil (all thingsconsidered),there must be at stake humanlife or its moralequivalent,a good or value comparableto life itself. This is not what the traditional formulations but it is wherethe say, corpusof teachingson life takingleads. (McCormick,1979:39) For example, human freedom as expressed in political sovereigntyhas long been accepted as such a value withinthe just wartradition.I havebeen arguingin regardto abortionand organ donationthat humanfreedom expressed in bodily integrityis also such a value. to 16. There is a counter-example this argumentwhich must be considered. been required soldiersduringwar.Further, of Bodily life supporthas traditionally one mightimaginecompulsorypregnancyand/ormandatoryorgandonationreasonableshouldthe survivalof the nationand/orspecies evercome to dependupon it. In addition,though we have awardeddecorationsof honor,such as the Purple Heart, to those honorablywoundedin action againstthe enemy,strictly speaking we have not interpreted such sacrificesas above and beyondthe call of civic duty. when a soldiertakes up morethanhis (or her)fairshareof the risk wouldwe Only and judge the sacrificeto be supererogotory confer a meritoriousaward(such as the Bronze Star.)Althoughthere is considerabledebate about the extent of one's civic responsibilitiesin peace time, there is a wide consensus that military(or alternativethough still potentially life threatening)service can legitimatelybe mandatedduringa nationalemergency.This practicewould appearat firstglance to underminemy claim that bodily life supportought not be required.However,I reject that conclusion for three interrelatedreasons. the First,thoughthis has variedthroughout historyof the draft,many kinds of defermentsand exemptionshave been granted.Thoughnot necessarily all legitimate, the factors considered relevanthave been gender, age, health, education, career,fortune(ala the lottery),religious,moral,andfamily(especiallydependent) related.Therefore, society has clearlyrecognizedthe illegitimacyof makingsuch a requirementexceptionless. Second, while the rationalefor each classificationvaries, severalof the deferments are rooted at least in part in the conviction that this potential conscript

ChristianReflectionson Bodily Life Support


would be asked to shoulder more than his fair share of the burden.Only if the situationworsens or as a last resort would it be appropriate drafthim, if ever. to While some are comfortablewith compulsorymilitaryservice duringpeacetime, most would arguethat hazardousduty should remainvoluntary. Bodily life is a sacrificethat can be mandatedonly in a nationalemergency.Thus it support would seem that the military"counter-example" underconsiderationis in fact an exception which proves the rule. As a society we have not requiredbodily life supportfor the sake of single individualsbut insteadmandatesuch sacrificeonly in extremis. 17. My attentionto the distinctivelyChristianrationalesbehindthe gift ethos as shouldnot be interpreted a claim that only Christianscan intelligiblyengage in life support.There are lots of non-Christian frameworks which can render bodily gift-givingmeaningful. 18. This is clearly not meant to be a comprehensivelist. It is, however,a representativesample of the varietyof factors relevantto such decision-making. 19. DorotheeSoelle (1984)tells a Jewishstory that makes a similarpoint. "An old rabbionce asked his students how one could recognize the time when night ends and day begins. 'Is it when, from a great distance,you can tell a dog from a sheep?' one studentasked. 'No,' said the rabbi. 'Is it when, from a greatdistance, you can tell a date palm from a fig tree?' another student asked. 'No,' said the rabbi. 'Thenwhen is it?' the studentsasked. 'It is when you look into the face of any humancreatureand see your brotheror your sister there. Until then, night is still with us." to 20. It is important note here that such languageandimagesare not uniqueto In Christianity. her recently publisheddiaries, Etty Hillesium, a Dutch woman murderedat Auschwitz, wrote of her efforts to comfort and aid fellow Jews as follows (Hillesium, 1985:195):"I have broken my body like bread and shared it out. ..." The unleavenedbreadof Passoverwas alwaysunderstoodto be not only a sign of freedom but the bread of afflictionas well. It might also be noted that WilliamF. May (1985:42)speaks of organdonationas a "fittingand directsign"of the Christian'sEucharisticparticipation. 21. At first glance, my emphasis on the voluntarycharacterof servanthood may appear to contradictmy earlier rejection of liberalism.By voluntaryI am not referring only to those burdensthat may accompanycontractualagreements but also to those unexpectedburdensthe bearingof which we may choose either to refuse or consent to. 22. At some medical schools, renal specialists automaticallyview unrelated donors as "crazy" and declare them to be "obviously"incompetent.

Black, Max 1954- "Metaphor." Proceedings of the AristotelianSociety, 55: 273-94. 1955


TheJournalof Religious Ethics

Cahill, Lisa Sowle 1981 "Abortion Argumentby Analogy,"paperpresentedAAR Meeting, and San Francisco. 1984 "Abortion, Abortion:Understanding DifAutonomyand Community," Edited by Sidney and Daniel Callahan.New York:Plenum ferences, Press, 261-276. Callahan,Sidney 1986 "Abortionand the Sexual Agenda: A Case for Pro-Life Feminism," Commonweal,CXIII/8(25 April): 232-238. 1986 "Abortion:UnderstandingOur Differences," with Daniel Callahan. Update, 2/2 (March):3-6. Chafe, WilliamA. 1977 Womenand Equality: ChangingPatterns in American Culture.New York:Oxford University Press. Dworkin, Ronald 1983 "Why Liberals Should Believe in Equality,"The New York Review of Books, 30 (February3):32-34. Engelhardt,H. Tristram,Jr. 1985 "CurrentControversies Obstetrics:Wrongful in Life and Forced Fetal AmericanJournalof Obstetricsand Gynecology SurgicalProcedures." 151 (February1):313-18. Feldman,George G., and Freiman,Jennie A. 1985 Note on prophylacticcaesareansections. TheNew EnglandJournalof Medicine (9 May):1264-67. Fellner, Carl H. 1971 "Altruismin Disrepute:Medical Versus Public Attitudes Towardthe Living OrganDonor,"New EnglandJournalof Medicine 284 (March 18): 582-85. Charles Fried, 1978 Right and Wrong. HarvardUniversityPress. Cambridge: Gudorf,ChristineE. 1984- "To Make a Seamless Garment,Use a Single Piece of Cloth" Cross 1985 Currents.34/4 (Winter): 473^90. James M. Gustafson, 1968 Christ and the Moral Life. New York: Harper and Row, Publishers. Harrison,Beverly Wildung 1983 OurRight to Choose: Toward New Ethic of Abortion.Boston:Beacon a Press. Hauerwas, Stanley 1981 A Communityof Character.Notre Dame, IN: University of Notre Dame. Monika K. Hellwig, 1976 TheEucharistand the Hunger of the World.New York:PaulistPress.

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Hillesium, Etty 1985 An InterruptedLife: The Diaries of Etty Hillesium. New York:Pantheon Books. Johnson,Luke T. FortressPress, 1981. 1981 Sharing Possessions. Philadelphia: Kelly, Gerald F. 1951 "Notes: the Duty to Preserve Life." Theological Studies, 12 (De550-6. cember): Levine, Carol and RobertM. Veatch, Eds. New York:The HastingsCen1984 Cases in Bioethics.Hastings-on-Hudson, ter. Little, David "Moral Discretion and the UniversalizabilityThesis." Unpublished Essay. McCormick,RichardA. A 1979 "Abortion: Changing Moralityand Policy?"HospitalProgress, February: 36-44. Nicholson, Susan T. 1978 Abortionand the Roman CatholicChurch.Knoxville: Studies in Religious Ethics. Ooms, Theodora 1984 "A Family Perspective on Abortion,"Abortion: UnderstandingDifferences, Op. Cit.: 81-108. Parsons, Talcott;Fox, Renee C; and Lidz, Victor M. Social Research39 (Autumn): 1972 "TheGiftof Life and Its Reciprocation," 367-415. Ramsey,Paul 1970 The Patient as Person. New Haven: Yale University Press. Ricoeur,Paul 1966 Freedom and Nature. Evanston:NorthwesternUniversityPress. Schumaker,Willard An 1977 "Supererogation: Analysis and a Bibliography." Edmonton, Alberta: St. Stephen'sCollege. Soelle, Dorothee Press. The Westminister 1984 The Strengthof the Weak.Philadelphia, Whitbeck,Caroline Womenas Poeple:New Perspecof 1983 "TheMoralImplications Regarding tives on Pregnancyand Personhood,"Abortionand the Status of the Holland:D. ReB. Fetus, editedby William Bondesonet al. Dordrecht, idel PublishingCompany,247-272. White, James F. 1983 Sacraments as God's Self Giving.Nashville: AbingdonPress.