T J Papadimos
bioethics, medical philosophy, medicine and religion, theology
T J Papadimos. H. Tristram Engelhardt’s After God: Moral Bioethics in a Secular Age; A Commentary and Eulogy . The Internet Journal of Law, Healthcare and Ethics. 2019 Volume 13 Number 1.
H. Tristram Engelhardt Jr., M.D., Ph.D. was a distinguished medical philosopher of the late 20th and early 21st centuries. He was a founder of the field of bioethics, and was a Professor of History and Philosophy of Medicine at Rice University and Professor Emeritus at the Baylor College of Medicine. He was also editor of Philosophy of Medicine and Christian Bioethics. Engelhardt was an opponent of Western secular moral assumptions that supported the current dominant culture, and he believed these underpinnings could not be secured by reason alone. Such underpinnings required a God’s-eye perspective in order to provide a canonical moral approach to bioethics. In his final book After God: Morality and Ethics in a Secular Age he addressed the moral implications of a society after the rejection of God, and how this may impact bioethics and healthcare policy. Much of his work was inspired by his Orthodox Christian faith.
“We are after God. That is, the dominant secular culture is deaf and blind to God’s existence (Engelhardt 2017).”
I first met H. Tristram Engelhardt in 2010, though I recognized his name, I had never read any of his works (but have done so since). He was an outgoing, larger-than-life Texian (he always called himself a Texian, not a Texan) who had incredible charm. When we met I was an anesthesiology critical care physician who was more interested in “why” we did things as opposed to “how” we did things (a very amateur philosopher at best). I was at a conference on the ethics of aging in Germany where I had been invited to speak about end-of-life decisions among the elderly; and he (Engelhardt), well just let’s say, he came to speak about the universe, God, and all things Orthodox Christian.
That evening as I sat down to have a meal at the hotel, Dr. Engelhardt sat down next to me and introduced himself as “Tris the Texian.” He asked if I would like something to drink and I said “sure.” I was so struck by his gregarious nature that I just said, “thank you” for a drink with which I was not really enamored. After some small talk over a couple of drinks, he inquired of me, “Do you know why I wanted to meet you?” “No,” I replied. It definitely was NOT for my acumen in philosophy or religion. He continued, “Because you have a Greek surname. I’ll bet you are Eastern Orthodox.” “Do you know,” he continued, “that you are part of the original Christian church?” Before I could respond he went into a three-hour conversation, actually, more of an education, or matter of instruction, from Engelhardt to me.
At the end of those three hours I was exhausted because I had closely and slavishly followed (successfully) his reasoning in regard to his views of bioethics. I had been expecting a Texian accounting of bioethics through the argument of rational thought, but that is not what happened. I discovered that while he understood libertarianism, he believed that there was a lack of moral authority to interfere in the choices of people who had free will, regardless of how sinful the act. He was adamant in espousing a transcendent framework for bioethics as defined by the practices and traditions of the Eastern Orthodox Christianity (before the fall of Constantinople). Morality, Engelhardt explained, was something acquired by knowing God. This was not an ethics begot by moral, rational thought; it was begot through and/or by God. Rationality, he explained, does not mean that one is moral or is made moral; he indicated that modern morality was just politics. “They may be related,” he said, but “only God knows the future, not you, and not me.” He went on to say that our culture (world-wide) was rejecting God. He asked me, “How can it be that the evil ones are not punished and the good are not compensated? Without this there is no justice.” Then he smiled and said, “Although a Texian philosopher would be closer to the truth than others.” With that he had my full attention.
In his later years this conversation between Engelhardt and myself had been on my mind, especially when I read his book, After God (Engelhardt 2017), which was completed during his illness. I found After God to be persuasive and dark regarding bioethics from the traditional Christian perspective, and this will be the focus of this short academic commentary, eulogy, and most humble tribute to a mentor and colleague.
“Reason has not been able to substitute for God (Engelhardt 2017).” This is the thrust of Engelhardt’s view of bioethics (and ethics). Engelhardt documents the failed aspirations of the Enlightenment regarding a morality based on reason in which governments would be able to establish their authority through moral rationality, and all citizens would be part of a moral community. He termed this, the Western Philosophical Project, which was born of Greece. Engelhardt deemed this project as flawed because there were background assumptions of a pluralistic society that were necessary for what an individual or group seek(s) to prove. He was adamant that there is no bioethics/ethics that can be established as canonical by philosophers. Post-modernism had unleashed pluralism where there can be no actual or hypothetical moral community. With no original moral/canonical position to work from, bioethical and secular pluralism is ultimately intractable, and, therefore, there will never be an impartial rational point of view. This led Engelhardt to ask, “How ought one rank such cardinal human goods as liberty, equality, prosperity, and security, and why (Engelhardt 2017)?”
How such goods are ranked will determine a particular morality, or bioethics. Through this intractable plurality of post-modernism, and the lack of an anchor through God, moral choices are just life-style choices or death-style choices according to Engelhardt (Engelhardt 2017). He goes on to state that after God, “everything, including God is without meaning. At stake is not just God as an object of religious devotion, but God as a point of final and ultimate, epistemic, and axiological reference (Engelhardt 2017).”
Engelhardt highlights the fact that Christendom has broken and is fallen concept. A secular orthodoxy has replaced it, “We have entered an age resolutely set after God (Engelhardt 2017).” In After God the point is made that a God’s-eye perspective among humans has been lost. Sin and any recognition of God has been erased from the space of public appearance, and “without a recognition of sin, repentance is now impossible (Engelhardt 2017).” Engelhardt makes the point that our society has a post-modern character, and that our bioethics/ethics are no longer well-moored. Our bioethics/ethics come from a “perspective of sound rational argument plural nouns (Engelhardt 2017)” with no evidence of the influence or perspective of God, and that our current dominant secular culture provides no firm grounding for bioethics/ethics. Engelhardt does not deny that we have always lived in a world of agnostics and atheists, but he correctly points out that they were not always the dominant culture. Demoralization and deflation weigh hard on the meaning of morality, bioethics, and political legitimacy in a post-modern society (Engelhardt 2017). What implications does the predominance of a secular culture do to our understanding of bioethics? With the advent of post-modernity Western Christendom softened, and God became more of a philosophical idea than the “Person of the Father, Who begets the Son, and from Whom alone the Holy Spirit proceeds (Engelhardt 2017).” In fact, Engelhardt instructs us that,
“God as the most personal of all was obscured through a theology with a robust philosophical overlay that rendered the theological approach to God primarily one of scholarship, not of prayerful ascetical struggle (Engelhardt 2017).”
Engelhardt believed that all this was not supposed to be an academic undertaking, but a process of theology that involves encounters with Him, not just an intellectual exercise. He did not believe for one moment that through philosophical reflection a human being could argue the correct path “to the right norms for life and the true goals of human existence (Engelhardt 2017).”
Engelhardt’s books, The Foundations of Bioethics and The Foundations of Christian Bioethics are discussed in After God (Engelhardt 1996, Engelhardt 2000). These two works represent the two sides of one coin in regard to his works, which some scholars have found confusing or at odds with each other. However, they actually are not:
“The Foundations of Bioethics and The Foundations of Christian Bioethics, are essentially interconnected. The first demonstrates the severe limits and character of secular-philosophical reflection. It explains why the morality of the emerging secular, global culture, despite its aspirations to consensus, is marked by intractable plurality. The second points the way out of the moral and metaphysical disorientation that characterizes this emerging global culture (Iltis and Cherry 2014).”
Engelhardt goes into great detail in After God to explain the secular morality and bioethics of today cannot really be truly adequate because they are not created through a God’s-eye perspective. He leaves us with the question of “whether generally recognizable moral and political authority makes sense after acknowledgment of God’s existence is lost (Engelhardt 2017).” Essentially the dominant secular culture of today has discounted a transcendent God and left us One of immanence; a God we could mix into our everyday lives, a watered-down version of a once transcendent truth. The problem from his view was that this traditional Christendom was born of a “European medieval synthesis (Engelhardt 2017),” not the Christianity of the first 300-400 years after the birth of Jesus Christ. In other words, not the Eastern Orthodox Church, i.e., the original and all-enduring church. His writings indicate that he was sorely affected with the outcome of Vatican II (O'Malley 2010). From his earliest questions about faith in the 1950s to his conversion to Eastern Orthodoxy in 1991 he was left with the conclusion that one cannot accept a plurality of views regarding the divine in which one can pick and choose their particular truth, “One needs a definitive, socially and historically unconditioned moral perspective, not just one among a multiplicity of webs of moral institutions (Engelhardt 2017).” He viewed ethics and bioethics outside of Western moral philosophy. In other words, he questioned the Western moral-philosophical project. He questioned the moral viewpoint espoused by the Roman church (post Vatican II), and was left with the conclusion that he must leave the Roman Catholic church. “I had come to encounter and to concede a highly politically incorrect truth: the one, holy, catholic, and apostolic Church is Orthodox Christianity (Engelhardt 2017).” This is no small point in Engelhardt’s philosophy, he believed that true Christian belief only comes through the Eastern Orthodox Church, or original church. This is the underpinning of his view of bioethics.
This European synthesis, in his view, was the basis for providing a secular state with a secular moral authority guided by reason through philosophical arguments that could be agreed on by all (Engelhardt 2017). Engelhardt rejected this whole-heartedly, and cautioned the readers to be aware of the fact that,
“there still remain powerful, but unfounded philosophical expectations regarding the existence of a generally secularly justifiable morality, bioethics, and political authority that persist as remnants from the via antiqua of the Western Christian Middle Ages…Most significant is the severance of morality, bioethics, and state authority form any hint of ultimate meaning. Because the contemporary dominant secular culture is after God, secular moral reflection must approach everything as if it came from nowhere, were going nowhere, and existed for no ultimate purpose. The point is not simply that in a godless universe there is no necessary retribution for immense, unrepented-for acts of evil. More fundamentally, all in the end is simply ultimately meaningless (Engelhardt 2017).”
He seized on the fact that post-modernity and its pluralism had led to a secular fundamentalist state, a term that may concern readers, because of the term’s attachment to Islamic fundamentalism. However, he makes his argument in regard to its intractability in this fashion,
“Here it is important to recognize that the contemporary secular state has become a secular fundamentalist state in the sense that a particular ideology, along with its secular morality and bioethics, has been established in a fashion similar to the establishment of a religion, along with its morality and bioethics, in a religious fundamentalist state. Because the differences between the moral and bioethical claims of believers and those of the secular state are so different in content and justification, there is no place for compromise (Engelhardt 2017).”
From this point, he argues the secular state has lost political and moral authority thereby becoming only a modus vivendi because the central authority only reflects a particular policy “among a plurality of freestanding accounts” none of which is anchored in a morally rational canonical account (Engelhardt 2017). The experiment of
reason leading to one secular morality justified by rational thought has failed according to Engelhardt. Therefore, there cannot be a sole, unified, canonical bioethics for all to follow. With a multiplicity of views, bioethics in the 21st century will fail (except for the ethics consultants themselves who have, essentially, become legal representatives of the multiple life-style choices or life and death choices) (Engelhardt 2017). Bioethics had been originally put together with a God’s-eye perspective, but now that has vanished. He voiced a considerable concern “how very different reality and morality cum bioethics and health care policy appear without God (Engelhardt 2017).”
The difficulty with the current state of bioethics, according to Engelhardt, was that human dignity was derived from a specific community (multiple communities), and this pluralism was a problem because there is a socio-historically conditioning of secular morals into an intractable moral pluralism (Engelhardt 2017). A particular secular bioethics or morality today can be found for every community. Engelhardt considered this the loss of a transcendent orientation will prove fatal to bioethics as once envisioned and practiced, i.e., the loss of the God’s-eye perspective. As mentioned above, Engelhardt had a concern that bioethicists had become quasi-lawyers (Engelhardt 2017), and “in accord with the articulate the dominant culture of the age, become an immanent surrogate for God (Engelhardt 2017).” This was of paramount importance to Engelhardt because 21st century post-theistic culture had intellectually excommunicated traditional Christian theologians; today’s main-stream bioethicists thought the traditionalists to be politically insensitive. Therefore, traditional Christian views required banishment. Even today’s bioethicists of the Roman Catholic church have taken a weak positions vis a vis theology, and put some distance themselves and Orthodox Christians (Engelhardt 2017).
Engelhardt was disappointed that bioethics was now forced to reside within the narrative of the dominant culture, which was secular, and all questions in regard to morality and rational thought are settled in the intellectual class represented by philosophers of the dominant culture, a globalized elite culture (Engelhardt 2017). This philosophical elite serves as God when a God’s-eye perspective has vanished. These elite present a view of reality that eventually becomes affirmed by most of the public. Engelhardt claims the necessary conversation between opposing views has disappeared. The intellectual elite of the now dominant secular culture regards traditionalists “not just wrong, but crazy (Engelhardt 2017).” In so speaking and writing without a God’s-eye perspective, “there is not structure of reality beyond grammar of our language and thought (Engelhardt 2017).” Without a real philosophical exchange among civilized and civil-tongued individuals, rhetoric poses as moral truth that sustains the established culture, its morality, its view of bioethics, and its account of the state (Engelhardt 2017).”
Here follows a specific practical aspect where Engelhardt’s views of obligation may be of interest. Two recent publications regarding public health emergencies of international concern (PHEIC), and the ethical conduct of the medical profession, governments, and other international and regional institutions during a PHEIC may give cause to think about Engelhardt and his writings (Papadimos et al. 2018a, b), especially as it regards obligations of what is good and right (Engelhardt 2017). In these two positions statements from the Society of Critical Care Medicine (SCCM) an attempt is made to bring a bioethical perspective to serious international outbreaks of disease. Thereby addressing therapies, treatment limitations, an obligations of health professionals to treat patients during a PHEIC, as well as a perspective on family-centered care. Engelhardt’s work weighs heavily in regard to the cultural wars regarding his positions vis a vis abortion on demand, stem cell research, etc. (Engelhardt 2017). However, his view, or influence, of the teleological vs. the deontological aspects of medical professionalism in regard to serious epidemics affecting major populations may be of interest to all. While rational Kantian thought and religion are not explicitly addressed in these SCCM position statements, Engelhardt’s arguments regarding the underpinnings of what the healthcare provider response should be during a PHEIC could be instructive to some physicians. A practical example of a PHEIC, Ebola viral disease, follows. While a disease such as Ebola is not directly addressed by Engelhardt, certain questions regarding obligations to treat patients arise around this disease. The duty to treat was raised in these SCCM position statements. What should be a physician’s obligation to treat such patients? Is the good independently viewed from what is right? Should physicians maximize the good (teleological), i.e., perform in a manner in which produces the most good? In such a case, physicians judge what are good or best actions without judging whether they are right (Engelhardt 2017). In other words, “the righteousness of an action depends on its consequences (Engelhardt 2017).” This contrasts considerably with the deontological view (supported by Engelhardt), in which a physician, “ought not to violate core right-making conditions, no matter the consequences: fiat justitia,
pereat mundus (Engelhardt 2017).” Here, according to Engelhardt (and Kant), morality is concerned with imperatives that are categorical, not hypothetical; what is right precedes the good and is not independent of it. “Moral choices and, therefore, bioethical choices are to be made apart from any of their consequences (Engelhardt 2017).” Engelhardt probably would say, “just do what is morally right, no matter what.” While Engelhardt and the dominant culture disagree with one another on various secular and religious moral aspects of life, there is much that all persons from all corners of the political and religious spectrum could learn from his body of work.
Since the mid 1960’s the question of whether God is dead has been continually discussed (1966). This was followed by claiming Jesus never rose from the dead, and thereafter Christianity underwent a softening. This disturbed Engelhardt. The secular West had successfully recast the character of the public space. God has become private, and transcendence is abhorred in many circles. However, without God, Engelhardt believed there is a propensity toward the pursuit of self-realization and self-absorption without consideration of God or the transcendent. He pointed out that Orthodox Christians, Orthodox Jews, and Muslims understand this. Uncivil rhetoric and uncivil behavior in public spaces, in physical, written, and visual insults to each other has left a gulf between the secularists, the traditionalists, and those who actually see value somewhere in the middle where values may be discussed. Engelhardt may have disagreed with the secular community as to what should be and what should not be in regard to sex, abortion on demand, politics, procreation, end-of-life matters, stem cell research, etc. (Engelhardt 2017), but he would have never shut any side out of a discussion. He loved
debate and he was always well armed, spirited, and extremely persuasive, and was ever “the enfant terrible of bioethics: irrepressible, irreverent, unpredictable, but ever insightful and brilliant (Iltis and Cherry 2014).” His concern about who will be the spokespersons for bioethics at this time in history concerned him greatly. He had feared that the secular community had become, or at least behaved as, a fundamentalist religion in and of itself, and that the secular community would not listen to what the current non-dominant traditionalist voices had to contribute. He feared that a loss of the God’s-eye perspective would indelibly harm the practice of bioethics and formation of healthcare policy. His work After God, has exquisitely brought his concerns to light.
H. Tristram Engelhardt’s life’s work cannot be given due justice here because only his last book is discussed (although this text does embody much of his life’s work). Furthermore, it is addressed by an author, who while holding him in high regard, does not have the required depth on the matters discussed, but will always remember his friendship and tireless, rigorous work challenging and confronting Western secular philosophical assumptions that he (Engelhardt) believed were not adequate to provide a successful canonical foundation for a bioethics and political theory that supports healthcare policy in the West, as influenced by his Orthodox Christian faith. We will miss him.