Cahill,-Lisa-sowle.2003.Bioethics Theology and Social Change

BIOETHICS, THEOLOGY, AND SOCIAL
CHANGE
Lisa Sowle Cahill
ABSTRACT
Recent years have witnessed a concern among theological bioethicists that
secular debate has grown increasingly thin, and that thick religious
traditions and their spokespersons have been correspondingly excluded.
This essay disputes that analysis. First, religious and theological voices
compete for public attention and effectiveness with the equally thick cul-
tural traditions of modern science and market capitalism. The distinctive
contribution of religion should be to emphasize social justice in access to
the benefits of health care, challenging the for-profit global marketing of
research and biotechnology to wealthy consumers. Second, religion and
theology have been and are still socially effective in sponsoring activism
for practical change, both locally and globally. This claim will be supported
with specific examples; with familiar concepts like subsidiarity and mid-
dle axioms; and with recent analyses of participatory democracy and of
emerging, decentralized forms of global governance.
KEY WORDS: Genomics, genetics and ethics, bioethics, biotechnology, par-
ticipatory democracy, AIDS drugs, Catholic social teaching, subsidiarity,
middle axioms, theological bioethics
THE CONTEMPORARY DISCIPLINE of bioethics arose as part of efforts in the

1960s and 70s to change social practices in medicine and research. One
key agenda item was experimentation that exploited vulnerable popula-
tions, especially by subjecting them, without their consent, to research
projects that were harmful. The names Tuskeegee and Willowbrook sym-
bolize the failure of U.S. researchers to meet the moral requirements of
the Nuremburg Code.1 Another was the need to find a way to deal with
the use and allocation decisions necessitated by new technologies. The
Seattle dialysis lottery, heart transplants, and the removal of Karen Ann
Quinlan from a respirator made worldwide news and raised public con-
sciousness of the ethical quandaries modern medicine rapidly introduced
(Reich 1996, 88).
1 These are infamous research projects, in which African-American men were left un-
treated for syphilis even after treatments had been shown effective (Tuskeegee Syphillis
Study); and in which mentally retarded children were exposed to hepatitis (Willowbrook
State School). See Kahn, Mastroianni, and Sugarman 1998, 3; and Reich 1996, 8384. The
Nuremburg Code may be found in Beauchamp and Walters 1978, 40405.
JRE 31.3:363398.
C 2003 Journal of Religious Ethics, Inc.
364 Journal of Religious Ethics
Theological luminaries such as Paul Ramsey, Richard McCormick,

and James Gustafson were visible figures in the shaping of the new
bioethics. As a result of their efforts, in cooperation with philosophers,
medical doctors, and researchers, the practice of biomedicine in the
United States shifted directions. It moved decisively toward respect for
patient autonomy and informed consent, and toward the formation of
public policies, laws, and judicial precedents to govern aspects of practice
such as research on human subjects and decisions about life-sustaining
treatment.
In the last ten or fifteen years, however, the complaint has often
been registered that theology has lost influence in public bioethics.
The waning authority of religious voices has been attributed primar-
ily to a growing reluctance of theologians to speak in a clearly reli-
gious voice, as they cede power to a thin and secular discourse that
limits its moral claims to minimal requirements of procedural justice.
Meanwhile, health care dollars are increasingly directed away from
under-served populations; scientists and investors proceed with threats
to human dignity, like stem cell research and human cloning, antic-
ipating profit-making benefits for the wealthy. Theologians and reli-
gious communities are portrayed as guilty bystanders on the cultural
road to perdition, down which biotech corporations and consumers are
traveling at breakneck speed. The challenge to theology, on this anal-
ysis, is to recover its religiously distinctive prophetic voice, enter into
policy debates more energetically, and persuade those with some con-
trol over policy outcomes to adopt a more prudent course and cautious
pace.
After considering this critique, the present essay will argue that the
real conflict is not between thin and thick moral languages and
views of the good, but between competing thick worldviews and vi-
sions of ultimacy, complete with concepts of sin and salvation, good
and evil, saints and sinners, liturgies and moral practices. It will ex-
amine both the appeal and the shortcomings of the worldview gov-
erning biotech innovation today, with special reference to the area of
genetics, then explore some theological alternatives. The thesis of the
essay will be that theological bioethics is not so nerveless and en-
ervated an enterprise as some of its critics make out, nor is it so
marginal to current biomedical practice and policy. However, the im-
pact and potential of theological bioethics can only be seen and appre-
ciated if ones vision is broadened beyond the realms of academia and
high-level government regulation. Although these are the spheres in
which early bioethics made its name, they today do little to deter
the profit-driven race for biotech innovation. The reality of theologi-
cal bioethics certainly includes scholarship and policy, but its roots and
much of its potential influence lie in broader and deeper networks that
Bioethics, Theology, and Social Change 365
can exert pressure on research science, health care policy, and biotech
investment.2
For this reason, theological bioethics can draw on work already done
on local and global social movements favoring peace-making and rec-
onciliation, womens rights, and economic participation. Activism and
analysis surrounding AIDS drugs and genetically modified foods provide
particularly close parallels to the availability of genetic developments in
health care. Indeed, literature describing forms of participatory democ-
racy and of transnational global advocacy and global governance can
be tied to categories more traditionally employed by theologians and
religious communities (solidarity, contributive justice, subsidiarity,
casuistry, and middle axioms, for example). It can support the hope-
ful claims of theologians and religious activists that change toward more
just societies is actually possible.
Theological bioethics as it addresses genetics research is a good lens
through which to examine this possibility. The new genomics (fifty years
after the discovery of DNA) is just emerging, is appearing under the
morally attractive aegis of health benefits for humanity, but is also
growing to maturity in an era in which globalization exacerbates in-
equities in access to resources. The fact that both economic globalization
and genomics are rapidly changing domains, however, offers a window
of opportunity for theologians and religious activists to have an impact
on the ethical global governance of biotechnology and on the future allo-
cation of health care resources.
At the present time, the health benefits of genetics research are
more prospective than real. The directions in which they are develop-
ing are largely determined by perceived need, i.e., market demand.
People who have access to basic nutrition, hygiene, and health care,
and who do not run a high risk of early death from communicable
diseases such as malaria and tuberculosis, are interested in genetic
diagnosis and treatment for cancer, cardiovascular disease, dementia,
and diseases with a clear link to specific genes (such as Huntingtons
Disease and cystic fibrosis). The World Health Organization (WHO)
estimates that pneumonia, diarrhea, tuberculosis and malaria, which
account for over 20% of the worlds disease burden, received less than
1% of the total public and private health research funds. Of the 1233
new drugs marketed between 1975 and 1999, only 13 were approved
specifically for tropical diseases, and six of these were developed under
special grants from the WHO and United Nations Development Program
2 For support in developing this argument, thanks go to Boston College doctoral can-
didates Kristin Heyer, Sarah Moses, and Jerry Beyer, who provided energetic, ingenious,
and internet-adept research assistance. Sarah Moses also read and commented upon a first
draft.
(World Health Organization Advisory Committee on Health Research

2002, 17).
In the case of diseases which strike both rich and poor, and for
which genetic diagnosis or treatments are available, or in the process
of developmentsuch as thalassemia and diabetesaccess to genetic
interventions is dependent upon ability to pay. Thalassemia is under
control in the U.S. and Europe, but in most other countries of the world,
thousands of children a year die of this condition. Diabetes is on the
rise globally, and genomic research is moving toward therapy; but there
is no more reason to expect that the benefits will be any more avail-
able to impoverished families than are tests for thalassemia or AIDS
drugs. Meanwhile, evidence mounts that knowledge of the genomics of
pathogens could lead to much more effective prevention and treatment of
communicable diseases like malaria, tuberculosis, dengue fever, menin-
gitis B, hepatitis B, and even African AIDS (World Health Organization
Advisory Committee on Health Research 2002, 1216). Yet funding for
the necessary research is not plentiful, and access to benefits is very con-
strained for the majority of the worlds population. This will be even more
true of luxury or discretionary genetic services, such as enhancement
of normal traits.
Right now, clean water, food, basic health care, perinatal care, and the
AIDS pandemic are of mightier concern in most cultures than genomics.
Questions of justice in the development of genetic medicine thus arise
in at least the following areas: more equitable health resource allocation
in general, nationally and globally; shaping the future applications of
genetic medicine so that rich and poor are served; and the possible re-
distribution or sharing of profits from genetic biotechnologies so that
advances aimed at a first world market will contribute to a rise in
health in the developing world. It will here be argued that theological
and religious traditions prioritize distributive justice as the moral conse-
quence of religious identity; that religious traditions have in the past and
can presently and in the future mobilize democratic social participation
and change; and that theology and religion have significant roles to play
in public debates and policies on health care in general and genetics in
particular.
1. Is Religion Marginal to Bioethics?

Three or four decades ago, theologians like Paul Ramsey, James
Gustafson, Richard McCormick, and Karen Lebacqz served on national
policy-changing bodies such as The National Commission on the Protec-
tion of Human Subjects of Biomedical and Behavioral Research (1974)
and the Presidents Commission for the Study of Ethical Problems in
Medicine and Biomedical and Behavioral Research (1979). Theologians
were among the highly visible figures who founded and worked in
bioethics institutes such as The Institute of Religion at the Texas Medical
Center in Houston (1954); the Institute of Society, Ethics, and the Life
Sciences, later to become the Hastings Center (1961); and the Kennedy
Institute of Ethics at Georgetown University (1971). Theologians of the
time not only were addressing problems in applied ethics with more fo-
cus and frequency than philosophers; they also came from long-standing
communities of reflection on basic human enigmas like the meanings of
life, death, and suffering.3
These early theological participants in bioethics debates were not hes-
itant to use religious imagery, arguments, and principles. For example,
Gustafson defined the contributions of theology to medical ethics by lift-
ing out three themes: God intends the well-being of the creation; God pre-
serves and orders the creation, as well as creates new possibilities; and
humans are finite and sinful agents who have great power to determine
whether the well-being of the creation is sustained or not (Gustafson
1975, 1922). Yet Gustafson saw theologians as adopting different modes
of discourse at different times, for different purposes. These could include
narrative, prophetic, and ethical forms that were explicitly rooted in theo-
logical premises; they also included types of ethical and policy discourse
that were not. Policy discourse in particular requires persons with in-
stitutional roles to formulate options and recommendations within the
available limits and possibilities, both in terms of the practical adjust-
ments that are feasible and the argumentation that will be persuasive
(Gustafson 1996, 3555).
Paul Ramsey, an ardent champion of a biblical, covenantal ethic, used
creation imagery from the Prologue to Johns Gospel to argue against
reproductive technologies (Ramsey 1970, 88). However, in addressing
the British government with testimony against in vitro fertilization, his
language was not overtly theological. Instead, he appealed to a humane
sense of the dignity and goods of parenthood, and predicted further
assaults upon the natural foundations of the integrity of the marriage
relation, and new ways toward the manufactury of children . . . (Ramsey
1984, 26). Similarly, the Catholic theologian Richard McCormick was at-
tentive to the Christian conviction that the sexual love that generates
ought to become in principle the parental love that nurtures (McCormick
1981, 321). However, he argued against donor insemination on the basis
of what he regarded as a human appreciation of marriage and parent-
hood: it separates procreation from marriage, or the procreative sphere
from the sphere of marital love, in a way that is either violative of the
3 For a more extensive discussion of the roles of Gustafson, Ramsey, and McCormick,
as well as other theologians, in the development of bioethics, see Cahill 2001, 4769. See
also Shannon 1999.
marriage covenant or likely to be destructive of it and the family

(McCormick 1981, 317).
By the end of the 1970s, bioethics enjoyed great cultural credibil-
ity, according to Daniel Callahan, founder, with Willard Gaylin, of The
Hastings Center (Callahan 1993, S8). This came about because most
bioethicists adopted an interesting and helpful approach to biomedi-
cal dilemmas, rather than railing against the establishment, and also
because they were quite willing to talk in a fully secular way. In fact,
bioethics became popular because it was able to push religion aside
(Callahan 1993, S8). This, according to critics, was precisely what led
theologians in bioethics eventually to lose their influence. Theologians
succumbed to the pressure to frame the issues and to speak in a com-
mon secular mode (Callahan 1990, S3). Religion became intimidated
from speaking in its own voice, or came to viewed as able to speak with
integrity only within the confines of particular religious communities
(Callahan 1993, S4).
Among others, John H. Evans, who focuses especially on genetic sci-
ence, laments the ascendancy of an approach to bioethics centered on the
four secular principles of autonomy, beneficence, nonmaleficence, and
justice (Evans 2002, 88).4 Evans employs a distinction between thick
and thin theories of the good that ultimately goes back to John Rawls
(Rawls 1971, 39599; see also Rawls 1993, 17895). Rawls distinguished
between a thin and a fuller theory of the good in order to get people
to come to the table of public decision-making agreed that certain pri-
mary goods should be secured for all in a just society. He maintained
that social inequalities are just only insofar as they work to secure these
primary goods for societys least favored members (Rawls 1971, 396).
Evanss complaint is that the consequent thinning of public debate has
eviscerated the discourse needed to make important decisions about
whether human genetic engineering is compatible with worthy societal
ends, since discussion of those ends is ruled out of bounds in the first
place.
In his view, the policy discourse on genetic engineering in the United
States is both exemplified and shaped by Splicing Life, a report of a
4 These four principles were first given a philosophical explanation and defense in
Beauchamps and Childresss Principles of Biomedical Ethics (1979), which has subse-
quently seen five editions. However, they had been earlier articulated as principles for
public policy at a conference convened in 1974 by the National Commission for the Pro-
tection of Human Subjects of Behavioral and Biomedical Research (created by Congress
in 1973). This conference or retreat issued recommendations in the form of the 1978
Belmont Report, named after the conference center, Belmont House. The report was
submitted to the Department of Health, Education, and Welfare, which adopted it as
public law governing federally funded research. (See Evans 2002, 8389; and Callahan
1990, S3.)
presidential advisory commission on genetic engineering (Presidents

Commission for the Study of Ethical Problems in Medicine and Biomed-
ical and Behavioral Research 1983). The commission entertained the
concerns of theologians and religious leaders about the aims of genetic
engineering and its ultimate effects on human life and on societies. Yet
the final report termed the theological concerns vague, and focused on
more concrete problems (e.g., creating animal-human hybrids) that the
theological objections could not definitively resolve. Thus the concerns
that the creation of new life forms oversteps the boundaries of prudence
and humility, or that the poor are being left behind in the development of
genetic technologies, are left out of account in the final reckoning of the
ethics and legality of genetic engineering (Evans 2002, 12731). Evans
maintains that more recent debates over cloning have served to consoli-
date the formal rationality of bioethics, and to further eliminate thick
traditions and perspectives on the larger ends of biomedicine from pub-
lic debate. Instead, autonomy has become an unexamined end in itself
and few if any limits have been imposed by law or regulation on the
adventures of science (Evans 2002, 15865).
Evanss ideal, for which he believes the prospects to be bleak, is
for citizens to listen to professional debates about genetic engineer-
ing, take their concerns back to their thick communities of belief and
value, and then bring the demands of their group regarding ends to
the publics elected officials (Evans 2002, 197). To reinvigorate pub-
lic debate, he recommends that separate commissions be established to
deal with societal ends, and with means to ends. Professionals might
serve on the latter, but not the former. These commissions might so-
licit public participation through local consultations and surveys, pos-
sibly adapting the model used by the State of Oregon to determine
the medical procedures that would be covered under Medicaid. Evans
cites the burgeoning participatory democracy literature to bolster his
case.5
In my view, Evans is on the right track in suggesting that greater
public participation in bioethical debates would more fully engage the
members of religious traditions and other groups whose perspectives do
not find a comfortable home in the discourse of professional bioethics.
At the same time, it is striking that he and other critics of the seculariza-
tion of bioethics keep their gaze so firmly fixed on governmental bodies
such as public commissions, regulatory agencies, and legislatures. Not
only are the decisions and policies of such bodies the ultimate target of
influence, they are also expected to play a major role in the reinvigo-
ration of the discourses that they are claimed to have suppressed. No
5 He cites the groundbreaking work of Gutman and Thompson 1996.

wonder Evanss expectation of change is modest. And Evans is not alone;

in fact he represents the general assumptions of most of the literature
on theology, bioethics, and policy.6
To a remarkable degree, the critics of the Enlightenment Project7
of secular discourse have bought into the terms of that project when
they agree that influential public discourse not only is secular but is
controlled by intellectual and scientific elites who are privileged ar-
biters of the direction government will take. Michel Foucault used the
term the repressive hypothesis to refer to the way modern discourse
about sex co-opts everyone who discusses sex into the belief that their
sexuality is under illegitimate constraints that must be thrown off. As
a consequence, everyone behaves as if such constraints really existed,
and, perversely obedient to the modern discourse that re-creates sex
as sexuality, obsesses about sex as something that must at all costs
be rediscovered, owned, and liberated. In this way, the discourse
of repression stimulates and proliferates the very reality supposedly
constrained, even while convincing those engaged in it that its exis-
tence is precarious. Moreover, the reality produced (sex) follows norms
of the controlling discourse (a scientific and therapeutic discourse),
delegitimating countervailing experiences, values and norms (Foucault
1978, 349).
One might conclude the same about the supposed marginalization
of theology in bioethics, taking note of the number of papers and articles
that have dealt with the phenomenon in the past fifteen or more years.
The parallel with Foucaults analysis of sexual repression is especially
6 To mention just one recent and generally very worthwhile book, Hanson 2001 is an
edited collection of papers resulting from a Hastings Center project on the engagement of
religious groups and leaders and of theologians with the ethics of patenting human and an-
imal DNA, and of cloning. Hanson concludes in his Introduction that, although religious
leaders and theologians entered policy discussions, policy discourse was impoverished by
an inability to accommodate religious insights in productive ways (x). Campbell rightly
urges religious thinkers and communities to put up meaningful resistance to the domi-
nant focus on autonomy, and encourages them to introduce imagery and themes regarding
the ultimate meaning of life from their formative narratives into the public discussion
(23). However, since he envisions the audience of such appeals as public policy and the
policy process (26), it is not clear what avenues of social change might be amenable to
religious influence, if law and policy are not. Law and government policy are important
concerns, but the identification and development of other avenues of religious and theo-
logical influence on social practices is important. In the same volume, Lustig (3052) and
Chapman (11243) push further in this direction.
7 Marty uses the perhaps over-used derogatory term the Enlightenment Project to
refer to the monopoly or at least the legally privileged hegemony given academic philos-
ophy which brings, or can bring with it, quasi-religious commitments . . . (Marty 1992,
278).
striking, in light of the never-ending advocacy of many churches, reli-

gious groups, and theologians for pro-life causes.8 The prevailing dis-
course has managed virtually to equate religious bioethics with such
advocacy, constructing it as a public danger, even while insisting on its
marginality. An important corollary is that the official discourse also
establishes the bioethics issues that will be central to public policy. For
public debate in law, policy, medicine and research, the focal issue is
undoubtedly the protection of autonomy by procedural guarantees of in-
formed consent. Meanwhile, religion is framed as entirely preoccupied
with status of life issues, especially the fate of embryos and the pro-
cesses of reproduction, and as in the grip of a vaguely articulated and
ultimately baseless fear that interference with natural reproduction
will denigrate human dignity. Leaving aside the possible merit of such
concerns, an equally or more important concern of religion and theology
the economics of biotech development and genomics and their effects on
social solidarity and distributive justiceis quite effectively kept off the
policy table by the dominant discourse, and its construction of main-
stream and marginal voices. Religious thinkers, policymakers, and
the public have, for the most part, conceded that religion and theology
have very little ultimate effect on what really goes on in biomedicine and
research, and that even laws and policy that appear to set limits will
eventually give way in the face of scientific advances and corporate
demands.
The disenfranchisement of theological bioethics is sealed by theolo-
gians concession of their own irrelevance; theologians complaint that
secular thinking has squeezed them out of the public realm in fact
abets the very worldview that displaces theology. The narrative of the
exclusion of religion helps conceal the fact that secular bioethics is
in fact deeply and extensively tradition-based and thick with the im-
agery and language of transcendent meaning. Like other forms of tran-
scendent experience and worship, science and genetics are grounded
in communal practices, imaginatively nourished by mythologies and
saints, justified by ideologies of purpose, warned against outer demons
and inner sinfulness, and urged to keep the faith with promises of
salvation.
8 The United States Catholic Conference and state bishops conferences provide a voice
on such issues. A journal that presents and defends Catholic pro-life views and covers mag-
isterial, judicial and legislative developments is The National Catholic Bioethics Quarterly.
See especially thematic issues Vol. 1/2 (2001), Respect for the Human Embryo; and 2/4
(2002) which includes articles on genetics, cloning and embryos. For an evangelical per-
spective, see Cameron, Daniels, and White, eds. 2000. Volumes that bring pro-life positions
into contact with others are Waters and Cole-Turner, eds. 2003 projected; and Snow, ed.
2003 projected.
2. Thick Traditions: Science, Economics, Liberalism

The quasi-religious overtones of scientific ideals in general and the
quest for genetic knowledge in particular have been identified be-
fore. Carolyn Merchant searches out the religious motivations behind
Francis Bacons drive to restore mans dominion over nature for the
sake of the human race, and so to redeem humanity from the conse-
quences of the fall (Merchant 1980, 16471). She also traces the evolution
of a mechanistic approach to nature in which different parts are rear-
ranged without regard for the ways in which parts take their meaning
from the whole (Merchant 1980, 291). Dorothy Nelkin and Susan Lindee
note that geneticists have described the genome as the Bible, the Book
of Man, and the Holy Grail, viewing it as a sacred text with great ex-
planatory power, and even as the secular equivalent of the human soul
(Nelkin and Lindee 1995, 39, 198). Opponents of genetic engineering are
thus cast as the enemies of human self-transcendence. Yet genetic sci-
ence also views DNA as being the key to manipulating different aspects
of human embodiment, physical function, and psychology in disjunction
from one another, from personal identity, from spiritual significance, and
from communal roles and values. Andrew Lustig notes that in debates
about cloning, ostensibly nonreligious and explicitly religious arguments
for and against cloning can function in analogous ways, placing aesthetic
and moral concerns against a backdrop of ultimate meaning (Lustig 2001,
3336). Lustigs main point is to show that religious objections to cloning
can converge with secular concerns, helping to build consensus. I want
also to stress that secular justifications of cloning and other genetic
techniques can rely on the same kind of framework of transcendence that
backs religious arguments, and that is often considered unacceptable in
public discourse if put forward in explicitly religious or theological terms.
Science is not the only symbol system of ultimacy, morality, and mean-
ing competing to define the cultural role of the new genetics. Ron Cole-
Turner astutely noted a decade ago that genetic engineering involves
nations, corporations, individual researchers, investors, and consumers,
and thus cannot be said to serve the interests of humanity as such, as
is so often claimed (Cole-Turner 1993, 54). Cole-Turners point is that it
would be nave for theologians to accept the eschatology of genetics, in
which the new knowledge serves the future of humanity as a species. But
his observation also exhibits why neither beneficence nor the quest for
scientific knowledge fully accounts for the direction, claims, and power of
the new genomics. New discoveries and patented techniques for cloning,
genetic testing, and pharmacogenomics promise prestige for researchers
and profits for biotech corporations, pharmaceutical companies, and even
research universities. The mystique of science is reinforced and perhaps
even co-opted by the ideology of market capitalism as the driving force
of liberal democracys global expansion.
Biotechnology is big business, and industry advocates present it as

having a moral role in shaping humanitys future. According to the
Biotechnology Industry Organizations website, BIO is the largest trade
organization to serve and represent the emerging biotechnology industry
in the United States and around the globe. As envisioned by this self-
defined leading voice for the biotechnology industry, biotechnologys
future is bright. BIOs website assures visitors that its leadership and
service-oriented guidance have helped advance the industry and bring
the benefits of biotechnology to the people of the world.9 BIOs 2003
projects included an ad campaign to guarantee that pharmaceutical com-
panies would be paid for drugs for the elderly under Medicare, support
President George Bushs assertion that the genetically modified foods
can help end hunger in the Third World (not displace subsistence farm-
ing and create dependency on corporate seed manufacturers, as critics
claim), and celebrate the modern era of molecular biology in which the
discovery of DNA through the initiative and creativity of scientists led
to the industrys profitable yet humanitarian endeavors. In a publicity
statement, BIO President Carl B. Feldbaum celebrates the sacred tradi-
tions, search for ultimate meaning, the salvific potential, the humanistic
ethic, and the saints of genetic science:
No doubt in another 50 years we will look back in wonder at just how much
suffering will have been alleviated through a chain of events that began in
the early 1950s with a couple of scientists looking for the secret of life in
X-ray diffraction photos and ball-and-stick chemical models.10
Unfortunately, according to Dan Eramian, BIOs Vice President for

Communications, some in the religious community, including funda-
mentalists and radical anti-abortionists, are trying to obstruct at-
tempts to further embryo cloning and stem cell research in the United
States. Interference would undermine the lead such research has al-
ready achieved, thanks to a government that pumps millions of dollars
into basic research. That would mean disaster for the countrys biotech-
nology industry, since the largest pharmaceutical companies . . . have
continued to partner with biotechnology companies to develop new
drugs based on this [stem cell] science. Eramian calls for dialogue
with religious representatives as part of a program to manage contro-
versy and permit research, development, marketing, and sales to go
forward.11
9 See the BIO website, www.bio.org.

10 Statement by BIO President Carl B. Feldbaum, Washington, April 14 /PRNewswire/,
accessed at www.bio.org.
11 Dan Eramian, Stem Cell Research: The Dialogue between Biotechnology and Reli-
gion, delivered during Managing Controversy in Science and Health at the Global Public
Affairs Institute, Dublin, Ireland, May 7, 2002, accessed at www.bio.org.
On a functionalist view at least, this is not a competition between re-

ligion and a secular, scientific, or business worldview, but a contest
between missionary agendas. It has been argued that the most powerful
explanation of the world is science; the most attractive value system,
consumerism; the largest religious denomination, our economic sys-
tem; the theology in service of that religion, the discipline of economics;
and the god whom all serve, the Market (Loy 1997, 275). Traditional
religions have been deplorably unable to offer a meaningful challenge
to the aggressive proselytizing of market capitalism, which has already
become the most successful religion of all time, winning more converts
more quickly than any previous belief system or value-system in hu-
man history (Loy 1997, 276). The appeal of this new religion lies in its
promise of salvation from human unhappiness through commodities, a
promise that can never be fulfilled even for the few who enjoy the ability
to purchase almost unlimited quantities.
Theological critics have likewise unveiled the religion of the market
in ways that are instructive for bioethics. The vitality of this religion
depends on several myths, nicely laid out in a critique of globalization
by Cynthia Moe-Lobeda (Moe-Lobeda 2002, 4865). First, growth bene-
fits all. The way to growth is through free trade and investment, which
in turn lead to greater economic well-being for everyone. The fallacies
within the myth are that economic activity translates into social and cul-
tural health; that economic growth brings general welfare, regardless of
income distribution; and that the environment and future generations
can sustain the costs of current growth. Second, freedom means the right
to own and dispose of private property. This notion of freedom disregards
the impact of market freedom on the limits posed to human freedom by
deprivation of basic necessities for those who cannot find a reliable liveli-
hood, compete in the market or accumulate property. It also disregards
the fact that, especially in a globalized economy, most market exchanges
are not voluntary. Most importantly, freedom as market freedom dis-
misses or represses other notions of freedom, including the freedom to
participate in a community that includes the common good of all.
Third, the religion of the market depends on the myth that human
beings are essentially autonomous agents, who find ultimate fulfillment
in acting individually or by contract to maximize self-interest, with self-
interest defined in terms of acquisition and consumption. Like the previ-
ous myth, this one eliminates aspects of life in community and in solidar-
ity with others that most religious and cultural traditions have defined
as fundamental. It dehumanizes the human and subjects the less to
the more competitive and dominating persons, groups, and economies.
Fourth, and most dangerously for the fate of theological bioethics, is
the myth that market expansion and the growth of transnational corpo-
rations (including the major pharmaceutical companies) are inevitable
and evolutionary, a contemporary form of manifest destiny, a step in

modernitys march of progress (Moe-Lobeda 2002, 62). On the contrary,
the market economy can be resisted and changed, both locally and in-
ternationally, as can a rapidly globalizing biotech industry, including
genomics.
Along with the religions of science and market capitalism, the tra-
ditions, symbols, and practices of liberal individualism provide a frame-
work of meaning and transcendence that deserve a challenge from theol-
ogy. Liberal philosophy and politics are even more deeply entrenched in
the U.S. cultural ethos than science and the market, and much more ex-
plicitly linked to claims of ultimacy. Liberalism provides a rationale for
the ways in which the science and economics of health care and research
are institutionalized and discussed. Liberalism, the political theory of
modernity, begins from the proposition that persons have different con-
ceptions of the good life that cannot be reconciled without violence, and
that therefore must be accommodated within a rational legal system
that favors none and allows all to flourish, provided that no one view
of the world and its representatives do violence to any other. Classical
liberalism upholds a political order that aims to ameliorate the human
condition by the peaceful competition of different traditions. According
to defenders of liberalism, the classical liberal advocacy of the free mar-
ket is, in effect, only an application in the sphere of economic life of the
conviction that human society is likely to do best when men are left free
to enact their plans of life unconstrained except by the rule of law (Gray
1986, 9091).
Strangely oblivious, for a theory of political economy, of the effects that
differences in economic and social class will have on basic material and
social goods, and hence on the ability of citizens to enact their life plans,
liberalism as a philosophy and political theory has been attacked from al-
most too many directions to enumerate: Marxist, feminist, liberationist,
and more. Its continuing hold on the North American imagination and
culture is partly explained by our founding myths of independence, and
partly by the strength of the economic interests with which liberalism is
symbiotic. Yet the irreversible reign of liberal autonomy within the mar-
ket, within science, and within health care is another myth that can be
uncovered. The narratives, moralities, liturgies, and institutions created
by the religion of liberal democratic capitalism can be reformed.
3. Theology, Bioethics, and Social Justice

Theological bioethics is, then, not embedded in a free-standing reli-
gious silo from which it must struggle to be heard in a post-Christian,
post-religious, modern and secular policy world, where the natural
sciences and economics have claim to a more objective, inclusive,
persuasive, and publicly appropriate language. Science, economics,

theology, and liberal democratic political norms all depend on anal-
ogous worldviews that define human nature, human meaning, human
goods and goals, and the good society.12 All invoke symbols of ultimacy
that capture the imagination, convert desires, direct practical reason,
and motivate action. That being said, are any of these symbol systems
false religions, or are they simply equal competitors in a postmodern,
relativistic, and ultimately violent world?
This is not the place to mount a full-fledged moral epistemology, much
less a theology of religious pluralism; moreover, the occasion commends
a much narrower focus on bioethics. I can briefly endorse an approach
to theological ethics in which religious traditions, philosophy, history
and other social sciences, the natural sciences, and contemporary ex-
perience and practical social problems create a circle of mutually criti-
cal resources.13 These resources do not produce theory abstracted from
moral and social life; on the contrary they embed theological ethics
deeply within it. Rather than elaborating conceptions of human well-
being and the good life that are merely relative to disparate traditions,
however, human moral practices and social institutions worldwide tend
to reveal certain basic goods sought across cultures as essential to hu-
man welfarefood, clothing, shelter, clean water, remedies for illness,
education, immunity from violence, political stability, personal respect,
and communal participation, including family roles. More in dispute
cross-culturally and within any one culture are the systems of access
that prioritize and allocate material and social goods, utilizing crite-
ria such as gender, race, class, wealth, merit, and need. A distinc-
tive contribution of theology, especially but not exclusively Christian
biblical theology, can be to challenge exclusionary systems of access
under the aegis of love of neighbor, self-sacrifice, or the preferen-
tial option for the poor. Such a theological-ethical perspective seeks
confirmation and consensus from other interpretations of human well-
being and morality, discovered in and through practical commitments
to enhancing the good life, inclusively understood as providing ba-
sic needs and social participation for all. Nontheological value systems
and their social consequences can be evaluated in light of this inclusive
ideal.
12 Stiltner argues that liberalism, feminism, communitarianism, and other philosoph-
ical schools, like religion and theology, make substantive and not merely procedural
arguments, and that these imply comprehensive accounts of human beings and what is
of value to them. Hence, all can and should contribute to policy formation, as part of the
common good (Stiltner 2001, 184). Stiltner is right, but the resemblances among these ap-
proaches go beyond the kinds of contributions they make to philosophical argument, and
the sphere of their influence goes beyond public policy in the narrow sense.
13 See Gustafson 1981, 195225; Hollenbach 2002, 152159; and Cahill 2002, 324344.
To return to the value systems implicated in the situation of contem-

porary bioethics, the scientific worldview positively enhances knowledge
and human health; the worldview of market economics assumes posi-
tively a commitment to enlarge human production of goods, and to give
agents a role in creating the conditions of their own welfare and that
of others; and liberalism positively affirms the goods of individual dig-
nity, rights, and freedom, as well as the rule of law, taking bioethical
shape in the requirement of informed consent. But all systems of ul-
timacy, including Christianity, can and have been manipulated so that
the goods and values they provide are channeled to the privileged few,
with inequities being ascribed a transcendent validation. Prophetic re-
ligion explicitly places this process against the horizon of the absolute,
declares human enterprises to be not only dependent and fallible, but
frequently malicious, and names the domination and deprivation of the
many by the few as sin. In the words of Reinhold Niebuhr, The moral
and social dimension of sin is injustice. The ego which falsely makes itself
the centre of existence in its pride and will-to-power inevitably subordi-
nates other life to its will and thus does injustice to other life (Niebuhr
1964, 88).
Christian theological bioethics is increasingly making distributive jus-
tice in health care resource allocation, especially in the form of affirma-
tive action on behalf of historically excluded populations, its priority.
Even pro-life ethics and activism align with this priority, to the extent
that vulnerable early human life, disabled or seriously ill lives, and lives
at the end of their course are interpreted as belonging to oppressed pop-
ulations that need a public voice.14 My focus, however, will be on the
emerging social justice agenda of theological bioethics, especially as it
pertains to genetic science and its potential for health benefits as well
as for profits. Several years ago, Roger Shinn wrote that the formation
of public policies on genetics necessarily represents an interaction of hu-
man values and faiths, scientific information and concepts, and political
activity. Religious communities are part of the body politic, advocating
their political convictions within the political process. They are especially
committed to exposing ideological biases, and to speak for the oppressed
and those too often despised by elites. The convictions of theologians
seek and often find wide resonance in a pluralistic society, especially
regarding the value of community and of freedom, and the concern for
justice (Shinn 1996, 92).
14 The perceived extremism of religious pro-life bioethics is due in part to the fact
that these legitimate concerns are not always balanced with or even linked to the needs of
other vulnerable populations or persons, nor the potential for conflicts among the needs of
vulnerable lives fully acknowledged.
In 1998, Ted Peters edited Genetics: Issues of Social Justice,15 in which

several authors contemplate the possibility that the new genetics could
lead to an increase in social inequities. Thomas Shannon presents the
Roman Catholic tradition as essentially open to the possibility of genetic
innovations in health care, yet he does trace a concern with equity back
as far as 1975, when Bernhard Haring remarked on sufficient cause to
fear that genetic engineering could fall under the heartless rules of
the market (Shannon 1998, 161, citing Haring 1975, 185). Lutheran
theologian Karen Lebacqz outlines the susceptibility of both research
and development and government policy to market forces (Lebacqz 1998,
82110 and 23954). Audrey Chapman similarly identifies concern with
justice in light of commercial interests as a distinctive contribution of the
religious response to genetics, and urges stronger religious leadership
(Chapman 1998, 126). James Walter projects this task to the macro level
of the global community, asking, Who will have access to these high
tech and very expensive technologies, and at what cost are we willing
as a human community to develop them for the use of a wealthy few?
(Walter 2002, 48). Feminist theology may be the subcategory of bioethics
in which these questions have been most addressed so far.16
Cynthia Crysdale reminds us that the market-place is, of course,
not some evil demon of capitalism per se, but we, the consumers, who
are ourselves eager both to engage in lucrative enterprises and to en-
hance our quality of life through purchasing whatever tests, treatments,
new knowledge, or genetic opportunities may be available (Crysdale
2000, 241). Ultimately, the obstacle to the public effectiveness of theo-
logical bioethics is not that it is a religious discourse in a thin policy
world, but that it is one among other deep-rooted thick discourses that
have a hold on the moral imaginations and self-interest of the public,
including Christians and other religious people. For the theological cri-
tique and agenda to be heard and bring conversion, it may need more
than rhetorical force and moral authority, as Reinhold Niebuhr astutely
warned. Those in power do not relinquish power readily; usually force-
ful intervention is necessary to enable more just and inclusive practices
to dislodge well-entrenched patterns of social inequality. But can such
intervention be accomplished, and, if so, how?
4. Theological Bioethics and Social Transformation

While public theological bioethics has typically focused its energies
on government regulation and legislation as means to control genetic
15 Ted Peters, ed., Genetics: Issues of Social Justice (Cleveland: Pilgrim Press, 1998).
16 For a review, see Cahill 2002b, 5377.
developments, traditions of Christian social activism and new studies

of participatory democracy and participatory, democratic global gover-
nance may in combination suggest new directions for theological anal-
ysis of bioethics and social change. A few theologians note, specifically
in regard to the practice and social institutionalization of genomics, that
the many mediating institutions of public life provide opportunities for
theological impact beyond the more visible debate on legislation, policies
and funding. Everyone in civil society lives in many overlapping asso-
ciations where values are formed that affect the common life (Waters
2003 projected, read in manuscript). Andrew Lustig draws on commu-
nitarian construals of public engagement, in which various forms of
suasion and moral authority are at work in the conversation, in which
extra-legal sanctions for decisions and practices could be developed.
Theological bioethicists themselves work in a variety of more and less
formal professional capacities, including ethics committees, institutional
review boards, advisory commissions, and professional advisors (Lustig
2001, 47; referencing Etzioni 1996).
It is possible to extend and deepen the connection of theological
bioethics to social activism by linking religion and theology to coalitions
working for distributive justice on multiple levels, from community or-
ganizing to national legislation to transnational advocacy networks. Re-
sources include studies of participatory democracy in the U.S., as well as
participatory global governance; many participatory social movements
are sponsored in whole or part by faith traditions or ecumenical organi-
zations. Catholicism stands out as having a more long-standing institu-
tional presence in health care, as well as a substantial teaching tradi-
tion on social justice issues, including health resource allocation, and a
track record of activism to empower disenfranchised groups (Cochrane
and Cochrane 2003, Chapter 3, Rethinking Health Care Policy). These
achievements find parallels in Protestant Christianity and other reli-
gions, including the Social Gospel, temperance, womens suffrage, and
civil rights movements, and more contemporary projects that include
health care and genetics.17
Before introducing these examples, it will be useful to discuss at least
briefly some familiar categories of Christian social ethics that medi-
ated historically between theology and a number of social causes. To-
gether, these provide theoretical illuminations of the connection of argu-
ment to practice in theological bioethics. While even a simple review of
Christian action on health care would significantly expand the param-
eters in which theological bioethics is usually assumed to operate, it is
just as important to place such efforts in a mutually critical relation to
17 See Chapman 1991 for a discussion of Protestant social engagement that is back-
ground to current involvement in bioethics. For the latter, see Chapman 1999.
ethical theory. The ethical constructs to be considered here are casuistry

(a method of argument), subsidiarity (a principle), middle axioms (osten-
sibly a category of principles), and contributive justice (a social-ethical
norm). While casuistry is usually considered to be a method of deductive
argument, applied more to individual than to social behavior, the prin-
ciple of subsidiarity stands at the other end of the theoretical spectrum.
It refers not to moral reasoning, but to political arrangements, speci-
fying that smaller, more local and larger, more comprehensive types of
government should have an interdependent relation to one another. The
meaning of the term middle axioms has long been contested, precisely
because it is unclear whether it refers primarily to principles that further
moral argument, or to a sort of political practice through which values
and norms are joined to positions on current social issues. Contributive
justice refers to the right and duty of all to participate in the common
good by enlarging and enhancing it as well as by benefiting from it.
First, casuistry refers to a tradition of moral argument developed
through the thirteen to the seventeenth centuries, primarily by Catholic
moralists, especially the Jesuits. Stereotypically, it denotes a process of
logical deduction from abstract principles to concrete cases, and was fa-
mously satirized by Blaise Pascal (Provincial Letters, 1656) for being
not only arid and detached from reality, but specious as well. As philoso-
phers and theologians have recently noted, this reputation is ill-deserved
(Jonsen and Toulmin 1988; Keenan and Shannon 1995). Philosophers Al-
bert Jonsen and Stephen Toulmin arrived at a more appreciative view
after working with the National Commission for the Protection of Human
Subjects in the mid-1970s. Both scholars noticed that, despite different
backgrounds and ways of construing the ultimate ground of morality, the
eleven Commissioners were often able to reach agreement on particular
problems. Jonsen and Toulmin interpret this surprising development in
light of Aristotles view that moral reasoning is practical, calling for ex-
perience in relation to particulars and concrete situations, more than
for rigorous logic. Practical reasoning in ethics, guided by the virtue of
prudence, is a matter of exercising good judgment, not of drawing for-
mal deductions from invariable axioms (Jonsen and Toulmin 1988, 19
and 341). Today, a companion concept to casuistry is virtue ethics, an ap-
proach elaborated in relation to theology and genetics by James Keenan
(Keenan 1995, 1999, and 2001; see also Keenan and Shannon 1995, 227
28). To connect virtue to moral argumentation is a way of recognizing that
analysis of cases is guided by practical reason, habituated in individu-
als toward wisdom, by concrete moral struggle, within a community of
discernment that shapes perception and judgment according to shared
values and commitments.
How are concepts of casuistry and virtue related to the relation be-
tween theology and genetics? These concepts clarify why theology can
rarely if ever provide master theories for bioethics policy or definitive

resolutions of dilemmas and value conflicts. Rather, theology and reli-
gion nurture a social and intellectual milieu in which the social priorities
of religious communities can be recognized sympathetically. Social prac-
tices and policy outcomes are more likely to reflect respect for all human
lives and a preferential option for the poor if religious thinkers repre-
sent these values while engaging with others in the practical negotiation
of solutions to shared problems.
The principle of subsidiarity was generated within papal social en-
cyclicals, aimed not at theoretical certainty, but at political flexibility
within a normative framework centered on the common good of society.
Developed first by Pius XI in Quadragesimo Anno (1931),18 subsidiar-
ity refers to a reciprocal relationship between higher and lower organi-
zations and their governments, especially in the context of the nation
state. The obligation of governing authorities to intervene when neces-
sary for the common good is given increasing emphasis by John XXII and
later popes, as inequities in global resources began to occupy the center
of papal attention to social issues. According to John XXIIIs Mater et
Magistra (1961) recent developments of science and technology make
it more crucial than ever that public authorities assume the respon-
sibility to reduce imbalances whether within one nation, or between
different peoples of the world as a whole (no. 54).
The principle of subsidiarity is a means of responding ad hoc to a vari-
ety of challenges of international political life; it evaluates particular po-
litical arrangements and their adequacy for a diverse social contexts. For
example, in the context of human and agricultural genetics, subsidiar-
ity can be used to advance the right of local cultures to control advent
of genetic manipulation and to enjoy whatever benefits it may bring.
Yet it also implies that international governmental and nongovernmen-
tal organizations should limit the power of international researchers
and transnational corporations to remove or patent DNA from local
species, plant or human, or to introduce modified species into the local
environment.
Despite the fact that the concept of middle axioms is even more am-
biguous, it has undergone an intriguing revival. Audrey Chapman, ex-
pressing dissatisfaction with bioethicists vague prophetic stances, calls
for the development of middle axioms that could mediate between gen-
eral convictions and principles, and the policy evaluations and political
strategies that lead to specific genetics policy (Chapman 2001, 124). Yet
the meaning of the category has been contested almost since its invention
by J. H. Oldham in 1937, in a paper prepared for an Oxford ecumenical
18 Papal encyclicals will be cited in the text with reference to numbered paragraphs.
The encyclicals cited may be found in OBrien and Shannon, eds. 1996.
conference on church and state (Oldham 1937, 210, 238). Ronald Pres-
ton leads off his dictionary article on middle axioms with the phrase, A
misleading term . . . (Preston 1986, 382).
While it is generally agreed that middle axioms are supposed to ne-
gotiate the distance between Christian ideals and social realities, some
have understood this to occur by means of deduction from more general
to more concrete judgments (Bennett 1956, 77, 79); others, including
Oldham, seem to see middle axioms as indicating more a process of in-
teraction between Christian values and social problems, with the church
endorsing positions that seem the best available social alternatives at the
time. Middle axioms are definitions of the type of behaviour required
of Christians in their peculiar settings, and are produced not by logical
deduction but by interactive efforts to embody Christian values amid the
perplexities of life (Oldham 1937, 210). They assume the need to make
common cause with others and to compromise. The notion of middle ax-
ioms arose to help Christian ethics contend with an era, between the
World Wars, in which the certainty of Christian social teaching had been
upset, and in which its proponents were acutely aware that the kingdom
of God would be very difficult to find on earth, or even to begin.
In a parallel context of historical angst, the concept has found favor
with liberation theologians, including Charles Villa-Vicencio and Robert
Schreiter. According to Villa-Vicencio, middle axioms call the church to
renew society even if the gospel demands more than society can deliver
(Villa-Vicencio 1992, 9). They are part of a corporate approach to theology,
in which social renewal and mental constructs work together to give
theology not only a praxiological foundation, but a role in democratic
participation (Villa-Vicencio 1992, 283, 276, 279). Robert Schreiter con-
nects middle axioms to interdisciplinary collaboration, and particularly
to the task of building up civil society and its mediating structures and as-
sociations, in both local and global contexts. Religion is a powerful source
of such renewal (Schreiter 1998, 111). At the global level, theological dis-
course can help create community and facilitate shared protests against
certain consequences of globalization. Religions and theologies are con-
crete in their cultural settings and practices, yet they are intelligible
to discourses in other cultural and social settings that are experiencing
the same failure of global systems and who are raising the same kind of
protest. This has already occurred in theologies of liberation, feminism,
ecology and human rights (Schreiter 1998, 16).
In sum, the originally Protestant concept of middle axioms conveys a
self-conscious attempt of Christian ethicists to negotiate among Chris-
tian values, social realities, local contexts, and global interconnections of
societies and faith traditions. In contemporary bioethics, middle axioms
should be interpreted neither as part of a deductive process of reason-
ing, nor as tools solely with which to engage the policies of national or
higher-level governments. The concept can provide a theoretical niche

to the multiple ways in which religious individuals and groups interact
with the changing practices and institutions of medicine and health care,
seeking opportunistically to make Christian social values more effective.
A parallel awareness of the need to broaden the scope of theological
engagement, and especially to respect and empower within civil society
heretofore silenced groups, is conveyed in the development of Catholic
social teaching and its ongoing redefinitions of justice. Rising importance
is given in this evolving tradition to concepts of solidarity, participation,
and preferential option for the poor, all within advocacy for global jus-
tice, termed, since the 1960s, the universal common good (for a general
discussion see Hollenbach 2002). Since the time of Aquinas, justice has
been categorized as either commutative (relations among individuals in
society) or distributive (what society owes to each) (see Porter 2002, 277
79). The neoscholastic tradition introduced the category of legal justice to
specify what each person owes to society (Curran 2002. 189). Since Pius
XIs Quadragesimo anno (1931), the social encyclicals, various bishops
conferences, and other Catholic writings have used the category of so-
cial justice, never defining it precisely. However, it is generally accurate
to say that social justice is an integrative concept, bringing together and
indicating the interdependence of all the just relations and institutions
that make up the common good. Social justice is increasingly defined to
consist in or include contributive justice, what all persons bring to the
common good by their active participation (Curran 2002, 18991).
The contributory dimension of justice is essential to theological
bioethics, indicating both the need for a preferential option favoring the
voice and participation of the poor, and the interdependence of the good
of all participants, on which the well-being of the whole depends. At
an international conference on transforming unjust structures, British
theologian Julie Clague delivered a paper on modifying and implement-
ing patent laws so that biotechnology benefits are available to those
who need them most (Clague 2003).19 In discussion, she suggested that
activism in favor of global public goods could be linked to a theory
of contributory justice recognizing that, with globalization, the motiva-
tions of self-interest and altruism cannot be completely separated. The
point might be extended by saying that the contemporary requirement
of contributive justice integrates the older principle of subsidiarity with
the newer emphases on solidarity and participation, by calling atten-
tion to the fact that all the associations of civil society are in constant
19 The conference, Transforming Unjust Structures: Capabilites and Justice, was
sponsored by the Von Hugel Institute, St. Edmunds College, Cambridge University, June
2627, 2003. The agenda and some papers are available at the Institute website, www.st-
edmunds.cam.ac.uk/vhi.
interaction. Decisions made and goods sought in one sphere inevitably

reverberate throughout the global network, offering theological bioethics
multiple points of entry for wide-ranging transformations.
5. Participatory Democracy: From Local to Global

The public role of theological bioethics, and its potential impact on
the way genetics research is put to practical use, can be understood as
part of a global trend toward activism for participatory democracy. The
phrase was coined in a manifesto for Students for a Democratic Society
(SDS), drafted in1961 by Tom Hayden for a meeting in Port Huron, Michi-
gan (Polletta 2002, 12526). According to sociologist Francesca Polletta,
participatory democracy became one of the eras most powerful ideas.
Egalitarian decision-making did not abolish structures, rules, or formal
procedures, but it combined these with a deliberative style and an experi-
mental character (Polletta 2002, 218219). Referring originally to the in-
ternal organization of leftist social movements, participatory democracy
captured the sort of society student activists aspired to create through
desegregation, civil rights and womens liberation. Aimed in part at the
U.S. government and legislation, action for participatory democracy also
protested state and local policies, and it united groups across racial, class
and religious lines to challenge the status quo. Though the sought-after
reforms were only partially effective, both within 60s organizations and
in the larger culture, they made a lasting impact on the consciousness
of the nation regarding political engagement. Perhaps their most signif-
icant impact was not so much at the structural level, but at the level of
expectation about what commitment and organized action can actually
accomplish. Though Americans today are disaffected from the political
process, the tradition of participatory democracy is a latent catalyst for
change. Theological bioethicists who feel stifled in official policy de-
bates should turn to this tradition for a more optimistic prospect.
Polletta notes that one model and resource for participatory democracy
movements has been religious fellowship, exemplified in Quaker paci-
fism. Religion has also been operative in faith-based organizing, which
is less focused on authority figures and less resistant to forging new bases
of authority (Polletta 2002, 18). Paul Ostermans ten-year study of the
Southwest Industrial Areas Foundation confirms the link between reli-
gious organizing and political participation (Osterman 2003).20 Though
not a faith-based organization as such the IAF gains much of its power
from religious leadership and congregations, and the ecumenical coop-
eration it engenders. Meetings usually begin with prayer, and speeches
20 On the positive connection between religious and political participation, see also
Verba, Schlozman, and Brady 1995.

at conventions and rallies are replete with biblical references. Osterman

opens his book with an account of an IAF convention in Austin, Texas,
that exemplifies many of his main points, including his view that partic-
ipatory democracy can resist politics as increasingly a game played by
the economic and political elites operating out of Washington (Osterman
2003, 17). Successful mobilization against economic inequality, the core
of the progressive agenda (as well as of theological bioethics), should and
does locate alternative ways to exert pressure.
Fifteen hundred people, many of them Spanish-speaking, and most
of them traveling with church groups, convened in a hotel ballroom in
Austin in April 2001 for a rousing send-off of prayer and political exhor-
tation, then wended their way through several sessions of workshops.
Afterwards, they repaired to a downtown church for an accountability
session in which six IAF representatives shared a panel with about a
dozen state representatives and senators. Taking health issues first, in-
cluding Medicaid eligibility and government insurance for children, the
IAF six went down a list of agenda items, demanding of the lawmakers
a yes or no answer to the question of support. Then two thousand people
marched to the state capitol, to locate (and if necessary outwait) mem-
bers of the legislature who had not agreed to attend, to whom they posed
the same questions. Every working day thereafter for several weeks, IAF
delegates returned to work the legislature (Osterman 2003, 206).
Exemplifying the potential of participatory democracy in the local
community, Osterman also tells of two women from Mexican immigrant
families who joined with local city, health, and business leaders to create
the free Milagro health clinic. This required securing state funding, over-
coming opposition from the local health care establishment that wanted
all efforts focused on a research facility, and identifying a nonprofit cor-
poration to manage the clinic (Osterman 2003, 8487). Although the IAF
alone cannot re-energize broad-based political participation in the U.S.,
some of its strengths are its leadership development, methods of commu-
nity organizing, commitment to maintaining a broad base, and flexible
collaboration with other groups and movements (Osterman 2003, 185).
It also demonstrates that seemingly powerless groups can become sites
of resistance and advocacy with real impact on the social order.
Advocacy networks have operated similarly at the transnational
level.21 A striking example from the health care realm is a series of
events that in about a two-year period loosened the grip of major phar-
maceutical companies on patented AIDS drugs, making them available
cheaply or for free in countries with high rates both of poverty and of
AIDS deaths, beginning with South Africa. In this particular example,
21 For examples in womens rights, human rights, and the environment, see Keck and
Sikkink 1998.
religious voices, local activism, NGOs, the U.N., market competition from
generic drug manufacturers, and market pressure from consumers and
stockholders all played some part, resulting in a modification of World
Trade Organization policy on intellectual property, over which the power
of big business had seemed unassailable at the start.22 Again, the les-
son for theological bioethics is that social change is possible even when
the entrenched systems of control over goods are infected with struc-
tural sin. Forceful intervention can be accomplished cooperatively, along
a spectrum of pressure points, even in the absence of commitment from
top-level arbiters of law and policy.
6. Theology, Genomics, and Advocacy

Although genomics is not yet perceived as having enough impact on
basic health needs to mobilize constituencies whose levels of deprivation
across the board is dire, that could change as awareness increases in de-
veloping countries and specific gene-based vaccines and drugs to target
AIDS, malaria, hepatitis, and diabetes grow closer to reality. A model
for activism on human genetics already exists in the form of interna-
tional mobilization against genetically modified foods, in which religious
participation is high. Although promoters of genetically modified crops
maintain that they will help feed the poor, opponents contend that there
is no evidence that such crops are cheaper or more nutritious. Moreover,
European activism against Frankenfoods has raised levels of resistance
in the EU, if not the U.S., and seed manufacturers like Monsanto need
new outlets for an increasingly unpopular product. Under the guise of
humanitarian aid, U.S. corporations and government are trying to force
acceptance in the third world in the form of food donations. However,
the introduction of such crops risks displacing local varieties, creating
dependence on imported products (especially when the imported seeds
are designed to be unable to reproduce), putting subsistence farmers
out of business and raising levels of poverty throughout Asia and Africa.
There is still some argument (especially in Africa) that genetically
modified foods could some day benefit the poor, by enhancing nutrients
or resistance to adverse environmental conditions. Yet, a growing in-
ternational advocacy network, making extensive use of the internet, is
working hard to solidify local opposition and reveal the corporate profits
that an altruistic facade protects. In 2000, an international organization
of fifteen Catholic NGOs published a study calling for affected nations to
resist patent law by making as wide a use as possible of the discretionary
power allowed them under WTO regulations, and to seek the moral high
22 For discussions, see Barnard 2002; Power 2003; and Cahill 2003.
ground with Catholic social teaching, especially the popes declaration

that there is a social mortgage on property requiring the rich to fulfill
obligations to the developing world (CIDSE 2000).
In February 2003, a consultation on Biotechnology and Agriculture
A Faith-Based Perspective was held in Chicago. Many of the sponsor-
ing or cooperating organizations already had strong relationships, and
had participated in a conference in September 2002. They included but
were not limited to Agricultural Missions in New York,23 the National
Council of Churches of Christ in the U.S.A., the National Catholic Rural
Life Conference, the Evangelical Lutheran Church in America, Lutheran
World Relief, the Presbyterian Hunger Program, the Episcopal Church
of the U.S., the South African Catholic Bishops Conference, the Catholic
Bishops Conference of the Philippines, Catholic Relief Services, Bread
for the World, the Maryknoll Office for Global Concerns, and the Adrian
Dominicans (a Catholic womens religious order). In addition, individ-
ual representatives also arrived from El Salvador, Nicaragua, Haiti,
and Ghana. A 2002 report was circulated from the Church and Society
Commission of the Conference of European Churches, Bioethics Working
Group.
The Chicago meeting resulted in a position paper available for indi-
viduals and groups to sign or to publicize, declaring that agricultural
genetic engineering has not been demonstrated to safeguard the com-
mon good, human dignity, the sacredness of life and stewardship. The
paper calls into question the marketing of crops by large private com-
panies for profit, equating private control by patent law under current
global trade policies with a threat to local food systems. The church has
a responsibility to monitor developments and educate its membership
according to principles of accountability and social justice. In order to
further these aims, the conference participants use an email list to cir-
culate information, news, and opportunities for cooperation, mobilization
and protest. One item within the first three months after Chicago was a
report on Principles for Global Corporate Responsibility: Bench Marks
for Measuring Business Performances, the work of a coalition of reli-
gious organizations and advocacy groups from 22 countries (Globalizing
the Principles Network 2003). Another was an invitation to participate
in a four-week United Nations Food and Agriculture Organization inter-
net conference on regulating GMOs in developing and transition coun-
tries.24 Statements were also circulated from the Catholic bishops in
the Philippines and Brazil, and from African organizations; reports and
23 A letter of invitation to me as a panelist came from Winston G. Carroo, of the Agri-
cultural Missions, New York, NY, wcarroo@ncccusa.org. Another key planner was Robert
Gronski, of the National Catholic Rural Life Conference in Des Moines, IA, ncrlcg@aol.com.
24 Conference 9 of the FAO Electronic Forum on Biotechnology. See www.fao.org/biotech.
news items were submitted on regulation or boycotts of GM foods in the

EU, U.S., and Asia.
Similar forms of participatory democracy for genetics and human
health could be extended or developed from existing advocacy networks
for justice in national and worldwide health care. Oddly, complaints
by John Evans and others about the dearth of a theological voice in
thin bioethics do not say much about the long-standing presence of
the churches in the health care setting, especially in Roman Catholi-
cism.25 A recent study shows that, despite the anticipated loss of moral
credibility following on the sex abuse crisis of 200203, the U.S. Catholic
bishops still wield significant clout in local and state politics, directly
influencing measures taken in at least four states (Yamane 2003, 17).
Richard A. McCormick, S. J., a major voice in Catholic bioethics, a fre-
quent sparring partner of Paul Ramsey, and a member of the National
Commission on Human Subjects, does not even appear in Evanss book.26
Yet McCormick made his reputation writing annual reviews of Catholic
bioethics and its relation to developing technologies, law and policy in
the journal Theological Studies, and gained a wide audience. He also fol-
lowed an impressive line of Catholic moral theologians who commented
upon the Ethical and Religious Directives for Catholic Hospitals (and its
successors), helping to determine the ways Catholic moral views would
and would not be implemented at the concrete level. The Directives still
establish practical norms for the significant institutional presence of a
religious tradition that is still a major health care provider in this coun-
try, especially for the poor and underserved.27
The Catholic Health Association, an organization that serves and pro-
vides a mission focus for Catholic health facilities, has published advi-
sory papers on a multitude of issues in which medical care intersects
with ethics and policy. It not only shapes local policy for Catholic hos-
pitals, it holds annual conventions in which social justice concerns are
frequently a focus. A CHA Genetics Vision Work Group produced Har-
nessing the Promise of Genomics: A Christian Vision toward Genomic
Advances in April 2003, under the direction of bioethicist Ron Hamel.
This paper was to be incorporated into a project including publications
for educated lay readers, a Leadership Summit on Genomics, and a ge-
nomics education toolkit to be made available to Catholic health care
25 For some history, see Kelly 1979.

26 See for example McCormick 1981 and 1984.
27 McCormicks most well-known predecessor is Gerald Kelly, S. J. (see Kelly 1958). His
medical ethics book was a commentary on the Directives. McCormick authored a proposal
for a revised Directives (1984). The current Ethical and Religious Directives for Catholic
Health Care Services (United States Conference of Catholic Bishops 2001) is available from
the United States Conference of Catholic Bishops, Washington, D.C. (www.usccb.org).
providers within several months. The theme of the June 2003 annual
convention of the CHA was Advocacy: Uniting Our Voice for Change.
The CHA has initiated a new e-Advocacy network to raise the public
profile of the ethical values it represents.28 Catholics have been inter-
nationally active in health care issues, for example, through the NGOs
Catholic Relief Services, Caritas International and CAFOD. Already ac-
tive on AIDS care and prevention, these and other religiously-sponsored
organizations are poised to turn their attention to human genetics as a
global health resource and justice concern.29
An ecumenical alternative is a joint initiative announced in June 2003
by the Biotechnology Industry Organization and the National Council of
Churches USA. In a Memorandum of Understanding signed by their
presidents, the two organizations pledged to seek engagement between
the religious and scientific communities on matters requiring a national
consensus such as the pursuit of scientific knowledge, equity of access to
biotechnological applications that benefit American society and other na-
tions and an appropriate regulatory system within which biotechnology
will operate (BIO-NCC 2003, 1). The level of agreement to be achieved
by such a collaboration remains an open question, but it certainly pro-
vides an opportunity for religious groups and theologians to call for and
initiate varieties of constructive engagement.
Political scientists and other students of global governance today, and
not only theologians, seem to believe a decentralized approach to social
change has great potential. Richard Falk writes of trends toward global-
ization from below as evidence of a Grotian moment. As in the time of
Hugo Grotius, the seventeenth-century father of international law, ours
may be an era of change that permits a new type of international order
to emerge, one less focused on governance by nation-states complicit in
market norms, and one more open to global public goods (Falk 1998,
331). Falk identifies this prospect as a sort of rooted utopianism, in
which the aspiration for a better future appears currently out of reach,
but is supported by recent development toward more participatory ways
of resolving conflict and distributing goods (Falk 1999, 59). Falks hope is
bolstered by the emergence of an informal global system of governance
that Anne-Marie Slaughter has described. This system is comprised of
networks of regulatory bodies, judiciaries, and even legislators in differ-
ent countries, as well as of cabinet-level ministers, financial officials, and
even chief executives, who cooperate toward mutually beneficial goals
28 The CHA website is www.chausa.org.

29 Consult Keenan 2000, which includes contributors worldwide, and presents a
variety of grassroots efforts to intervene in the many interlocking causes of AIDS,
within Catholic-sponsored schools, clinics, hospitals, support groups, and community
organizations.
(Slaughter 2003). Fostering an ethos of positive comity, these officials

and their non-coercive alliances open new institutional horizons for the
possibility of global justice (Slaughter 2003, 89). In an address to the-
ologians, Falk waxes hopeful about the re-emergence of religion as a
world-political force that is ecumenical and inclusive. Religion in such
a form may help overcome the paralyzing politics of impossibility that
is the condition as well as the outcome of political realism, and that
feeds into theological resignation to being marginal to any vital political
debates, especially about the future shape of globalization (Falk 2003, 2).
If not responding specifically and directly to religious values, some
transnational entities, including corporations, are taking steps toward
incorporating criteria of distributive justice and of democratic par-
ticipation into certain practices concerning research, global health
care responsibilities, and genomics. In April 2001, a World Health
Organization/World Trade Organization Workshop determined that af-
fordable medicines for poor countries is a feasible goal that can be pur-
sued through differential pricing of drugs. In other words, companies
would charge different prices in different markets without giving up
patent rights; this would be achieved through a combination of high-
volume purchasing, reliable and adequate financing, advocacy, corporate
responsibility and market forces.30 The report itself noted that while
low-cost availability is key, actually getting drugs to poor people will
require major financing from wealthy countries and from the interna-
tional community, since the health care delivery systems in the pur-
chasing countries need to be strengthened substantially.31 In May 2003,
the WHO announced a joint initiative of the UNDP, the World Bank,
the WHO and the Bill and Melinda Gates Foundation to develop bet-
ter diagnostic tests for communicable diseases, especially tuberculosis,
that afflict the developing world.32 In June 2003, The Indian Council of
Medical Research, Medecins Sans Frontieres, and four public research
institutes announced a Drugs for Neglected Diseases Initiative, to work
in concert with WHOs Tropical Disease Research program.33
30 World Health Organization Press Release, WHO/WTO Workshop on Pricing and
Financing of Essential Drugs, 11 April 2001, accessed at www.who.int/inf-pr-2001. The

Workshop was also co-sponsored by the Norwegian Health Ministry and the Global Health
Council (U.S.). The modification of patent law is of course another alternative, something
that the WTO may have been trying to avoid by participating in the workshop. An extensive
study recommending differential protection of patent rights according to different global
markets is Lanjouw 2003.
31 WHO and WTO Secretariats, Report of the Workshop on Differential Pricing and
Financing of Essential Drugs, 2. Accessed at www.who.int.

32 See www.who.int/mediacentre/releases.
33 Announced June 25, 2003, on the WHO website, www.who.int/mediacentre/releases,
as New Initiative to Research and Develop Drugs for the Worlds Most Neglected Diseases.
Some corporations are using profits from products in the first world
to subsidize drugs sold more cheaply or developed expressly for third
world populations. Avant Immuno-Therapeutics (Needham, MA) plans
to use sales from vaccines for travelers, food safety, and antibioterror-
ism to support vaccine sales to developing nations.34 Una Ryan, CEO of
Avant, presented at an ecumenical conference bringing together theolog-
ical and philosophical views, bioethicists, researchers, clinicians, indus-
try representatives, and policy-makers to discuss biotechnology, ethics,
and policy,35 and is the chairperson of the Biotechnology Industry Or-
ganizations subcommittee on global health. Perhaps, along with the
NCC, she will be a conduit for interdisciplinary exposure that will re-
orient BIOs perception of religion and raise the profile of justice in ge-
netics, partly to manage controversy, but also in part to meet social
responsibilities.
Conclusion
I began by showing that the idea that theology has disappeared from
public bioethics is a fallacy that distracts attention from the competing
and equally elaborate symbolic narratives of science, the market and lib-
eral individualism. I ended by showing that theological accounts of mean-
ing and transcendence were never really evacuated from the spheres of
human health, and of institutional allocation of the goods necessary to
health and well-being. However, for theological bioethics to reassert and
extend its authority in emerging global practices of research and health
care distribution, especially genomics, it will be necessary to take the
preferential option for the poor beyond rhetorical or abstract conflicts
with countervailing social norms.
Theological bioethics must take shape in broad, inclusive, participa-
tory, and ultimately global networks that bear out the conviction that
more just practices are not only obligatory but a possible impossibil-
ity (to reverse the terms of Karl Barths definition of sin and concur in
Richard Falks hope for the future global role of religion). Religious lib-
eration movements show that theory and practice are interdependent.
History confirms not only the doctrine of sin, but also the amelioration of
the social order through conversion when possible and forceful interven-
tion when necessary, sometimes from below. Let the energy of emerging
global practices of equity in health care verify that theological bioethics
34 Vicki Brower, Finding Biomedicines for Infectious Diseases, Genetic Engineering
News 23/2 (2003), 3. The article gives similar examples involving other companies as well.
35 The conference was sponsored by the Wilstein Institute of Jewish Policy Studies and
the Interreligious Center on Public Life, at Hebrew Union College and Andover Newton
Theological School, Newton Centre, MA.
can prioritize the criterion of justice in the new genomics and make good
on its promise that the criterion can be met.
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BIOETHICS, THEOLOGY, AND SOCIAL

Lisa Sowle Cahill

THE CONTEMPORARY DISCIPLINE of bioethics arose as part of efforts in the

Theological luminaries such as Paul Ramsey, Richard McCormick,

(World Health Organization Advisory Committee on Health Research

1. Is Religion Marginal to Bioethics?

marriage covenant or likely to be destructive of it and the family

presidential advisory commission on genetic engineering (Presidents

5 He cites the groundbreaking work of Gutman and Thompson 1996.

wonder Evanss expectation of change is modest. And Evans is not alone;

striking, in light of the never-ending advocacy of many churches, reli-

2. Thick Traditions: Science, Economics, Liberalism

Biotechnology is big business, and industry advocates present it as

Unfortunately, according to Dan Eramian, BIOs Vice President for

9 See the BIO website, www.bio.org.

On a functionalist view at least, this is not a competition between re-

and evolutionary, a contemporary form of manifest destiny, a step in

3. Theology, Bioethics, and Social Justice

persuasive, and publicly appropriate language. Science, economics,

12 Stiltner argues that liberalism, feminism, communitarianism, and other philosoph-

To return to the value systems implicated in the situation of contem-

In 1998, Ted Peters edited Genetics: Issues of Social Justice,15 in which

4. Theological Bioethics and Social Transformation

developments, traditions of Christian social activism and new studies

ethical theory. The ethical constructs to be considered here are casuistry

rarely if ever provide master theories for bioethics policy or definitive

higher-level governments. The concept can provide a theoretical niche

19 The conference, Transforming Unjust Structures: Capabilites and Justice, was

interaction. Decisions made and goods sought in one sphere inevitably

5. Participatory Democracy: From Local to Global

Verba, Schlozman, and Brady 1995.

at conventions and rallies are replete with biblical references. Osterman

6. Theology, Genomics, and Advocacy

ground with Catholic social teaching, especially the popes declaration

23 A letter of invitation to me as a panelist came from Winston G. Carroo, of the Agri-

news items were submitted on regulation or boycotts of GM foods in the

25 For some history, see Kelly 1979.

28 The CHA website is www.chausa.org.

(Slaughter 2003). Fostering an ethos of positive comity, these officials

30 World Health Organization Press Release, WHO/WTO Workshop on Pricing and

Financing of Essential Drugs, 11 April 2001, accessed at www.who.int/inf-pr-2001. The

Financing of Essential Drugs, 2. Accessed at www.who.int.

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