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Christianity health and genetics.

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American Journal of Medical Genetics Part C (Seminars in Medical Genetics) 151C:77 – 80 (2009)
A R T I C L E
Christianity, Health, and Genetics
DAVID H. SMITH*
Health is an intrinsic value that Christians should respect, but it is not the highest value. Christians should be willing
to jeopardize their own health for the health of others, and should repudiate any idea that genetic problems are
the result of sin. Rather, sin leads us to make genetic problems harder to live with than they should be.
ß 2009 Wiley-Liss, Inc.
KEY WORDS: health; religion; genetics; disability; theology
How to cite this article: Smith DH. 2009. Christianity, health, and genetics.
Am J Med Genet Part C Semin Med Genet 151C:77–80.
Religion may be involved in the study
and clinical use of genetics in several
kinds of ways. It may motivate the work
of counselors, physicians, and researchers. Religious institutions may provide
education, counseling, or institutional
support. And religious practice may be
the basis for a way of looking at the
world. Religions offer perspectives:
ways of explaining the evil in the world,
specifications of what it means to live a
good life, models of and metaphors for
structuring our moral behavior, proposals for how we ought to live together
and what our basic duties to each other
are. I will talk only about the perspectives
aspect of religion, and the perspectives I
talk about will be Christian. I appreciate
that this may somewhat limit my audience, but religions are so diverse—even a
‘‘single’’ tradition like Christianity is so
diverse—that it’s best not to pretend
more scope than one can deliver.
(I believe, however, that most, if not
all, of the claims I make about Christianity have parallels at least within the other
David Smith is Director of the Interdisciplinary Bioethics Center at Yale University. He is
the first author of Early Warning, published
by Indiana University Press.
Grant sponsor: Ethical, Legal, and Social
Implications of the National Human Genome
Research Institute; Grant number: 1 R13
HG004689-01.
*Correspondence to: David H. Smith, PO
Box 208209, New Haven, CT 06520.
E-mail: david.h.smith@yale.edu
DOI 10.1002/ajmg.c.30199
Published online 21 January 2009 in Wiley
InterScience (www.interscience.wiley.com)
ß 2009 Wiley-Liss, Inc.
Abrahamic traditions of Judaism and
Islam.)1
Religion is something that shapes
our identities. I identify myself as
‘‘spiritual’’ or ‘‘Christian’’ or ‘‘nonreligious’’, Catholic, or Jew. To be sure,
there is a very real possibility of selfdeception about one’s religion. I may
like to think my views are Christian in
the ways I am about to describe, but I
may misunderstand myself. The truth
may only come out when I am pressed or
threatened, because it is our real commitments and religions, not those we
may profess, that shape our identities.
There is also a genetic component
to our identities. I can imagine myself
nurtured in a different womb, growing
up in a different place, attending different schools, failing to meet the woman I
love, or less lucky professionally. But I
can’t really imagine myself with a different genotype—with a leaner or more
hunky body, smarter, faster, or able to
carry a tune. I have fantasies about those
gifts, but the object of these fantasies
would not any longer be me, for I am
inescapably tied to this body. I don’t
mean in this to fall back into a genetic
determinism or essentialism. I do not
think our genetics are the only or even
the most important determinants of our
identities. But they are an inescapable
1
Thus I am presuming a substantive rather
than a psychological definition of religion.
Contrast this with U.S. v. Seeger, in which
religion is defined in terms of intensity of
feeling.
component of those identities, which
may be the reason that we have so many
fantasies about what it would mean to
alter or ‘‘improve’’ them, even when
those fantasies are ultimately destructive.
Thus religion and genetics are both
identity-shaping forces. Their competition or cooperation as theories is less
interesting or important than their
relative priorities as ways of understanding ourselves.
My thesis is that Christianity supports a perspective or attitude towards the
world in which vigorous genetic research
and use of genetic knowledge to heal are
essential. I will illustrate that claim with
reference to three different points. First,
Christians should affirm the value of
health for themselves and others. This
My thesis is that Christianity
supports a perspective or
attitude towards the world in
which vigorous genetic research
and use of genetic knowledge
to heal are essential. I will
illustrate that claim with
reference to three different
points. First, Christians should
affirm the value of health for
themselves and others.
78
AMERICAN JOURNAL OF MEDICAL GENETICS PART C (SEMINARS IN MEDICAL GENETICS)
includes both physical and psychological
health, genotype, and phenotype. Second, Christians should not think of health
as the highest value in life. The greatest
compliment to be paid a Christian at the
end of her life is not: ‘‘my goodness she
was healthy!’’ Third, a crisp distinction
Second, Christians should
not think of health as the
highest value in life. The
greatest compliment to be paid a
Christian at the end of her
life is not: ‘‘my goodness
she was healthy!’’
between illness and morality, genetic
problems and sin, must be established.
The category of sin may be relevant to
genetics, but not as an explanation or
justification of genetically based disabilities. Rather it helps us understand the
complexity of the social problems raised
by genetic knowledge. Thus serious
Christian faith requires us to work to
reduce genetic pathologies and to help
everyone live with the genetic limitations that we all have.
Despite some excesses in the ascetical strand of Christianity, the tradition
has consistently affirmed the value and
goodness of health, with ‘‘health’’ taken
to mean having a body that functions
well, and a capability accurately to
understand and effectively to act to
accomplish one’s purposes in the world.
Ill health is a bad reality, as are wounds
and mental disease; these are things to be
opposed. This commitment to good
health would have been hard for Jesus
the Jew to repudiate, and in fact he did
not. It is true that Jesus can scarcely be
seen as a precursor of the late 20th
century health club or YMCA; in fact
we know virtually nothing of Jesus’
physical health before the crucifixion.
What we do know is that stories of his
healing miracles are pervasive in both the
synoptic tradition and in the fourth
gospel. He clearly treated ill health as a
bad thing, not as a discipline to be
endured but as something to be got rid
of. And by his presence, or his words, or
the faith he engenders, he is presented as
a healer.
Nor is the concept of health
‘‘problematized.’’ The blind do see; the
insane are made whole; problems of
menstruation are corrected; even the
dead are raised. Read ‘‘on the flat,’’ as a
former colleague used to say, these
healings are clear affirmations of the
value of a healthy life.
Theologically this conviction can
find additional support in the doctrine of
creation, that extraordinary mythological claim that despite all the injustice,
sickness, pain, and poverty in the world,
the world, and all that is therein are
nevertheless good as God’s products.
The goodness of creation suggests the
goodness of individual created bodies
and therefore the importance of their
health. For centuries it was standard to
express this point in Aristotelian terms:
bodies have a telos toward functioning
well. When human bodies and souls are
not functioning well they are diseased or
disordered.
I believe that this notion of health as
something objective is a legacy that it is
important for Christians to preserve.
Being healthy is not simply a matter of
someone’s own opinion. People can be
ill and not know it, and whole cultures
may gloss over certain requirements of
health. And people may think they are
sick and not be—that is what it means to
be a hypochondriac.
Second, health is not the most
important thing in the Christian life;
the most important thing is one’s
relationship to God. In some Christian
writing that relationship is described
as love for God; in other places it is
described as faith in God. I have been
most impressed by the idea that the ideal
relationship between the self and God is
one of trust and loyalty. The core idea
goes back to Augustine’s analysis of
human nature some 1,500 years ago.
He argued that all people need something to love—or, as I am suggesting,
something to trust, and loyally commit
themselves to. He went on to suggest
that no one’s happiness could be secure
unless she or he had found an adequate
ARTICLE
object for such trust and loyalty and,
finally, that only the God revealed in the
Bible was such an adequate object.
Augustine was an intellectual and,
unsurprisingly, he thought that the next
best thing to God was a wise person. But
such a person might move away or die.
So happiness built on love even of the
best person in the world was precarious.
In other words, insofar as we have to
choose between health and a proper
relationship with God, that choice is
simple for the Christian and God wins.
There are some complications here I
quickly concede. Many Christian theologians insist that if one has a right
relationship with God true health will
follow; they argue that having faith or
loving God will contribute to one’s
health—as we ordinarily understand
health. While I support their basic
insight, I think we have to acknowledge
that there are times when we have to
make the choice between loyalty to God
and health. Martyrdom is a clear case of
people who have chosen faith over life,
but so may be hard work for any worthy
cause. In fact this is not a particularly rare
occurrence. People jeopardize their
health all the time in working for their
families, their church, or their country.
Laying down your life for another is
scarcely good for your health.
Put differently, trust, and loyalty in
God allows us to see preoccupation with
health as idolatry. It is putting health in
the place of God. Mohrmann [1995]
suggests that this idolatry is shown in our
‘‘fickle shifting obsessions with diets and
exercise machines and with jogging
down every primrose path to perfect
health, whether it is the path of vitamin
C or brewer’s yeast or no yeast at all or oat
bran. . .’’ She claims that this preoccupation with health ‘‘represents a failure
of trust’’ and absence of ‘‘a fundamental
attitude of confidence that we have been
created as far less fragile creatures than
we fear we are’’ [Mohrmann, 1995].
Children do not routinely need artificial
vitamins; menopause is not a disorder
that routinely requires therapy; a
cough is ‘‘God’s brilliant mechanism
for clearing the airways’’ and need not
always to be suppressed [Mohrmann,
1995].
ARTICLE
Most dangerously, as Mohrmann
goes on to point out, preoccupation
with health leads us to forget that death is
something to be expected as part of a
healthy life. If one lives to be healthy
then death can only appear as the enemy
to be fought at all cost, but if one lives
with trust and loyalty to God, then death
can be accepted because it is not the
ultimate loss. I don’t mean to be glib
about this; apart from unusual circumstances no one should (or does) want to
die. Nevertheless, one’s attitude toward
life affects one’s sense of the significance
of death. If I live for health, when I die it’s
all over; if I live for a cause—for example
the cause of God—I die with a sense of
meaning. As Mohrmann [1995] writes
‘‘The question is not, ‘What can I do
to live longer?’. . . [but] ‘How shall I live
the life I have?’ Health seeking behavior
is not death prevention; it is life
enhancement.’’
So, for the Christian, health is a
good but it is a secondary good. It is,
So, for the Christian,
health is a good but it is
a secondary good.
as the philosophers might say, an intrinsic
good but not the highest good. But there
is another complication about this point
that I should raise. This complication
arises from the fact of Christianity’s
altruistic preoccupation. We can see
the issue already in the example of Jesus:
in the New Testament he is presented as
concerned with the health of others, but
not with his own. And his ethic has a
decidedly heroic cast, urging lack of
concern for self and greater concern for
the needs of the neighbor. One important Protestant moralist, writing at about
the middle of this last century, suggested
that Christian ethics did not tell us what
human beings need but rather that
whatever it is we think they need—
whether it be money or food or sex or
health—the Christian should be preoccupied with securing that thing for the other, not
for her or himself [Ramsey, 1952].
Whatever the theological formulation, the relevant point is that Christian
AMERICAN JOURNAL OF MEDICAL GENETICS PART C (SEMINARS IN MEDICAL GENETICS)
ethics seems to suggest that my neighbor’s health is more important and
valuable than my own. It provides a
rationale for nurses and physicians working long hours, for clergy and laity tiring
themselves out visiting, and caring for
the sick. The obvious implication for our
purposes would be that the genetic
health of others is something I should
worry about more than I worry about
my own. As Thomas Aquinas wrote
The obvious implication
for our purposes would be that
the genetic health of
others is something I should
worry about more than I worry
about my own.
centuries ago, I rightly have more
concern for my own soul than for that
of another, but I should certainly worry
about his body more than about my own
body.
More recently, Ramsey [1952], the
Methodist moralist to whom I referred
above, argued that one should be concerned for oneself as an instrument or
tool. The physician or nurse who doesn’t
take care of herself won’t be around very
long to take care of the patients whose
health she wants to advance. Mohrmann
[1995] argues that we have a responsibility of stewardship to our own bodies.
They are to be protected and nurtured
for much the same reason we take good
care of pets or livestock or the environment.
My own sense is better reflected by
asserting that we are concerned with our
health because concern with ourselves is
fundamentally legitimate. We turn to
God because of our finitude and insecurities, including anxiety about illness
and death. We seek help, something we
can trust and dedicate ourselves to, and
then we find that this trust and dedication exacts a price. The price may be
bad for our health, but in the process of
living for God and others we find that
our sense of how important it is to be
healthy has been put into perspective.
79
We won’t ever move to a plateau where
we are indifferent to what happens to our
own bodies—to how healthy we are—
but we will see health in a new light and
see ill health in a different perspective.
The self is one of the neighbors worthy
of love for its own sake.
In fact, however, Christians and
others often (perhaps usually) fail to care
for others or ourselves, as we ought to.
This relates to the sad fact that Christian
theology can misuse genetic knowledge
and has sometimes done so, if inadvertently. Our genes come from some
persons and may be handed on to others.
They are a part, but only a part, of the
embodiment that is central to our
identities.
Christian theology has sometimes
suggested a heredity connection
between the bad things we do and harms
our descendents suffer. ‘‘She has fetal
alcohol syndrome; her problems are her
mother’s fault.’’ A moralistic approach to
ill health and disease, and a tendency to
ask ‘‘was he a smoker?’’ or ‘‘did she
drink?’’ when news of someone’s health
related misfortune comes up is as
common among devout Christians as
among any other social group. Part of the
impulse for this is self-protection. ‘‘His
cancer was the result of smoking; I don’t
smoke so I won’t get cancer.’’ Of course
this is magical thinking.
I concede that people have great
responsibilities for their own health, but
given that ill health seems distributed in
ways that are inexplicable, if not exactly
random, the moralistic tendency to
blame the sufferer accomplishes very
little. Perhaps responsibility for disease
lies on a continuum and our moralizing
tendencies tend to think at only one end
of the continuum, as Joe Fanning has
observed. Not only is the moralistic
focus merciless in its moralism, it is pretty
clearly repudiated in the New Testament. In John 9:2 the Christ is asked
whether a man’s illness is the result of his
own or his parents’ sins. Jesus responds
that neither of those things is the reason,
but the man is ill ‘‘so that the works of
God may be manifest in him’’—presumably meaning that he will be the
occasion for a demonstration of God’s
healing power in the Christ. Note that
80
AMERICAN JOURNAL OF MEDICAL GENETICS PART C (SEMINARS IN MEDICAL GENETICS)
Jesus does not repudiate the idea that
illness might have any divine purpose; on
that level the story is enigmatic. But a
theory of the origin of illness in sin was
repudiated.
Nor is this moralism only a characteristic of popular Christianity. In the
Augustinian tradition ill health and death
are explicable as God’s punishment for
human sin; in the Ireneaen strand of
thought they are occasions for moral
discipline that leads to our salvation. In
both cases there is a connection between
health, morality and salvation, but the
Augustinian tradition puts God in the
position of punishing well beyond any
imaginable justification and the Ireneaen
one makes God a somewhat bumbling
moral instructor [Hick, 1966].
Neither of these theories breaks the
connection between the heritability of
sin and genetic disorders; neither captures the insight ascribed to Jesus in the
Gospel of John. If we look to either for
assistance or insight in coping with
genetic disorders we come up empty. A
more robust moral theology should
enter into the realm of discussion of
genetics.
Use of what is arguably the most
influential theory of sin developed in
20th century Christianity may illustrate
a constructive connection between sin
and genetic problems. Niehbur [1996, p.
150–264] argued that human beings are
essentially finite spirits, ‘‘spirits’’ in that
we are aware of ourselves and of the
existence of others, and finite in that we
know that we will die. The result of that
knowledge is anxiety. Thus for all human
beings the ‘‘human condition’’ is to be
aware of ourselves, our mortality, and
each other. Our consciousness is inevitably comparative, and Niehbur argued
that we respond to anxiety by drowning
out awareness in drugs, routine or selfdeception (a phenomenon he called
sensuality), by trying to be superior to
or to dominate others (pride and the
will-to-power), and sometimes miraculously in love, when we put the interests
of others above ourselves. For Niehbur
love was truly miraculous; he claimed
that our lives were more characteristically ruled by pride and sensuality. That
is original sin—sin rooted in our nature
as finite spirits.
If we were to take a Niehburian
approach to sin and genetics, we would
find ourselves focusing on issues of
power imbalance, disrespect for difference, and the importance of provision of
moral and spiritual support for patients,
families, and caregivers. Thus, for example, we might respond to the ‘‘disability
critique’’—the idea that a focus on
genetic health goes hand in hand with
disrespect for and devaluing of persons
with genetic or other birth defects—by
affirming the basic data driving the
critique: that we tend insufficiently to
support persons living with genetic
differences, that our social institutions
make life with genetically rooted differences more difficult than they need to
be, and that the only way to ameliorate
these problems is through the use of
social and political power.
On the other hand, we would not
ignore the tendency of biologically
disadvantaged persons to do what we
all do: engage in special pleading. We
would not suggest that no genetic
differences are objectively disadvantageous, or be reluctant to call congenital
blindness or deafness disabilities. Moralism is replaced by ambiguity, but ambiguity does not mean insensitivity to
injustice, the need for reform, or the
importance of the miracle of love.
ARTICLE
In sum, I have argued that at
a minimum Christianity can provide
rationale for research into and use of
genetic knowledge. Christians are dedicated to genetic health as we ordinarily
use that term, but such health is not the
highest good for which a Christian
should aim. Genetic health should be
seen by Christians in a theological
context, one that avoids moralistic
theodicies, notices what we can do to
hurt or help each other, and stresses a
realistic hope for a life of trust and loyalty.
When we have to choose, we should
choose personal integrity over improvements in our own health and seek care
for those suffering from genetic disorders rather than enhancements of ourselves, or our descendents.
ACKNOWLEDGMENTS
This project was supported by conference grant 1 R13 HG004689-01 from
the Ethical, Legal, and Social Implications of the National Human Genome
Research Institute. The author offers
special thanks to Laurie Hurshman, his
colleague at Yale, for editorial assistance,
and to Joseph Fanning, Ellen WrightClayton, and Larry Churchill of Vanderbilt University for a welcome invitation and a provocative symposium.
REFERENCES
Hick J. 1966. Evil and the God of love. San
Francisco: Harper and Row. 403 p.
Mohrmann ME. 1995. Medicine as ministry.
Cleveland: Pilgrim Press. 128 p.
Niehbur R. 1996. The nature and destiny of man.
Louisville: Westminster John Knox Press.
680 p.
Ramsey P. 1952. Basic Christian ethics. New
York: Charles Scribner’s Sons. 448 p. U.S. v.
Seeger, 380 U.S. 163 (1965).
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