EMBODIMENT, MORALITY. AND MEDICINE

Theology and Medicine

VOLUME 6

Managing Editor

Earl E. Shelp, The Foundationfor lnterfaith Research & Ministry, Houston, Texas

Editorial Board

James F. Childress, Department ofReligious Studies, University ofYirginia , Charlottesville,Virginia

MargaretA. Farley, The Divinity School, Yale University, New Haven, Connecticut

RonaldM. Green,Department ofReligion, Dartmouth College, Hanover, New Hampshire

StanleyHauerwas, The Divinity School, Duke University, Durham, North Carolina

RichardA. McConnick,SJ., Department ofTheology, University ofNotre Dame,Notre Dame, lndiana

WayneProudfoot, Department ofReligion, Columbia Universlty, New York

The titles published in this series are listed at the end ofthis volume.

EMBODIMENT, MORALITY,AND MEDICINE

Edited by

USA SOWLE CAHILL

Boston College, Chestnut Hili, Massachusetts, U.S.A.

and

MARGARET A. FARLEY

Yale University, New Haven , Connecticu t, U.S.A.

Springer-Science+Business Media, B.V.

Library of Congress Cataloging-in-Publication Data

Embodlment, moral1ty , and medlclne I edited by Llsa Sowle Cahl 11 &Margaret A. Farley.

p. cm. -- (Theology and mediclne : v. 6)Includes blbllographlcal references and index.

1. Medlcal ethlcs . 2. Body, Human--Religlous aspects.I . Cahill, Llsa Sowle . II. Farley, Margaret A. III. Series.R724.E515 1995174' .2--dc20 94-46674

ISBN 978-90-481-4519-5 ISBN 978-94-015-8424-1 (eBook)DOI 10.1007/978-94-015-8424-1

Printed on acid-free paper

All Rights Reserved© 1995 Springer Science+Business Media Dordrecht

Originally published by Kluwer Academie Publishers in 1995.Softcover reprint ofthe hardcover lst edition 1995

No part of the material protected by this copyright notice may be reproduced orutilized in any form or by any means, electronic or mechanical,

including photocopying , recording or by any information storage andretrieval system, without written permission from

the copyright owner.

TABLE OF CONTENTS

MARGARET A. FARLEY / Preface

PART I: PERSPECTIVES ON EMBODIMENT

vii

ALLEN VERHEY / The Body and the Bible: Life in the Flesh Accordingto the Spirit 3

JUDITH PLASKOW / Embodiment and Ambivalence: A Jewish FeministPerspective 23

VALERIE J. HOFFMAN / Islamic Perspectives on the Human Body: Legal,Social and Spiritual Considerations 37

PART11: PRACTICAL APPLICATIONS

JAMES F. KEENAN, S. J. / Genetic Research and the E1usive Body 59CAROL A. TAUER / Abortion: Embodiment and Prenatal Development 75JUNE O'CONNOR / Ritua1 Recognition of Abortion: Japanese Buddhist

Practices and U.S. Jewish and Christian Proposals 93PAUL LAURITZEN / Whose Bodies? Which Selves? Appeals to Embodi-

ment in Assessments of Reproductive Technology 113PATRICK McCORMICK / Embodiment and Organ Transplants: On Giving

and Taking Our Bodies More Seriously 127CHERYL J. SANDERS / African Americans and Organ Donation: Reflec-

tions on Religion, Ethics and Embodiment 141KAREN LEBACQZ / The "Fridge": Health Care and the Disembodiment

ofWomen 155COURTNEY S. CAMPBELL / Marks of the Body: Embodiment and

Diminishment 169JOHN TULL Y CARMODY and DENISE LARDNER CARMODY / The Body

Suffering: Illness and Disability 185USA SOWLE CAHILL / "Embodiment" and Moral Critique: A Christian

Social Perspective 199

NOTES ON CONTRIBUTORS 217

INDEX 219

v

MARGARET A. FARLEY

PREFACE

Every major religious tradition has offered some interpretation of the moralstatus of the human body. Whether explicitly articulated or only implied,these interpretations have been profoundly influential in the shaping of under­standings of human existence and its possibilities. It would be surprising ifsuch understandings did not also influence the attitudes, behavior, and struc­tures of the practice of modern medicine. Hence, it is fitting that a series onTheology and Medicine should include a volume whose aim is to explorereligious and moral interpretations of the human body specifically as theyare relevant to health policies and medical practice .

Systematic explorations of the meaning of "embodiment" can be foundnot only in philosophical and theological anthropologies of the past but in twen­tieth century writings, particularly by Continental philosophers. Both criticaland constructive studies of human embodiment have also been undertakenin recent years by feminist theorists in a variety of disciplines. Still , therehas been relatively little work published that connects theological under­standings of embodiment with the theory and practice of medicine. The essaysin this volume represent an effort to fill that gap.

Theories of the body are not only varied but sometimes in direct conflictwith one another. The major philosophical and theological traditions of westernculture have tended to explain the human body by distinguishing it from ,and often opposing it to, the soul (or spirit or mind). From this perspectivethe boundary between body and mind prevents full union between humanpersons, and it also constitutes a fissure in the individual self. For sometheorists body and soul are completely separate entities (as in the famousmetaphor of container and contained), so that the truly "human" is identifiedwith either mind or body. Others consider mind and body to be separate butas parts of one whole human being, held together in fragile unity or essen­tially related to one another so that each is in some way not only dependenton the other but mutually determined in some way. For still others, body andmind are reducible to one another, either the body reducible to mind or (themore frequent preferenee in modern and postmodern versions) the mindreducible to the body.

Contemporary developments in theories of human embodiment are morelikely to struggle with ways of explaining it neither as disjoined from mindnor indistinguishable from it, but as the locus of unity - the mind embodiedand the body ensouled. Moreover, the body is addressed less as an essentialcomponent of human nature than as acultural text. lts meaning is socially con­structed; society is in it before it is in society. Yet the body is open to new

vii

L. Sowle Cahill and MA . Farley (eds.), Embodiment, Morality, and Medicine, vii-xiii , 1995.

viii MARGARET A. FARLEY

meanings forged in an ongoing social praxis. As such, the body serves as amediator of culture and an object of social control. It follows that, for example,to recognize the body's importance to the polities of gender is to encounterthe task of unmasking its constructed meanings and shaping them throughcritique and reconstruction. This task has been expanded to include more issuesthan gender, and the analysis it requires suggests its extension to many ofthe contexts of human life.

The context of medicine offers a prime site for exploring meanings of thebody and for constructing them. The essays in this volume trace and inter­pret many meanings of the human body, and they attempt to identify andevaluate the sourees and determinants of these meanings. The writers' taskis a shared one by reason of common aims and a shared focus on ideas aboutthe body in the theory and practiee of medicine. Though some of the essaysare more explicitly theologieal than others, and some are more directly thanothers engaged with clinical contexts, they are all part of an exploration ofthe religious meanings of human embodiment in medical research and care.Together they constitute an effort to clarify how understandings of embodi­ment influence moral relationships in health care settings .

Part I of the volume probes notions of embodiment from within three ofthe world's major religious traditions - Christianity, Judaism, and Islam. Theessays included here do not claim to exhaust the perspectives that can be foundinternal to these traditions, nor do the three traditions represent the onlysignificant religious and theological views of the human body that are to befound in the history of the world. World religions are never as monolithie asoutside observers sometimes think, and the writers of these partieular essaysoffer nuanced views that point to the complexities of each religion's beliefsand attitudes regarding the human body. In doing so, they also suggest direc­tions for additional interpretive work in the traditions they are examining. Andwhile Christianity, Judaism, and Islam are not the only religious traditionsimportant to the task set by this volume, it is arguable that they have morefrequently interacted with modern technologieal medicine than have otherworld religions thus faro Still, one of the fruits of this collection of essays isto show the importance of further analogous studies of beliefs about the bodyin, for example , Hinduism, Buddhism, the various religions of antiquity, andthe many religious traditions embedded in the diverse cultures of the world.Some clues to the significanee of such studies emerge in those essays in Part11 that address specific issues (abortion and organ transplantation) as theyare relevant to Buddhism and to Afriean religious traditions.

Allen Verhey, Judith Plaskow, and Valerie Hoffman search respectively inChristian, Jewish, and Islamie sourees for perspectives on the body. While theirfindings are fascinating in their differences, they are also illuminating in theirsimilarities. Each tradition has been marked with great ambivalences towardthe human body; each has struggled to understand the body as both benefitand burden; each has dealt (in at least some of its strands) with questions ofspiritual transcendence of the body, ways of sacralizing the body, puzzles of

PREFACE ix

embodiment in relation to death. All three traditions have also genderized theirassessments of the body, judging women's bodies to be more problematicthan men's - more to be feared, kept hidden, neutralized through institu­tional control .

Verhey approaches Christian understandings of the body by contrastingthe notions of "persen" in the writings of two Protestant theological ethi­cists, Joseph Fletcher and Paul Ramsey. Since both Fletcher and Ramsey claimto offer a Christian account of what it means to be a person, Verhey teststheir claims against his own readings of the Bible and the Christian creed. Whathe is interested in is the status of the body in relation to freedom and ratio­nality. In the end, he prefers Ramsey's view over Fletcher's on the groundsthat Ramsey articulates better a Christian commitment to the person as an'integral whoie. Yet the tensions in Christian theology remain - tensionsbetween materiality and agency, individuality and community - and Verheypoints to their consequences in the context of medicine.

Judith Plaskow begins with the inadequacies that feminists have found inwestern valuations of the body, inadequacies which they have traeed to thedualism of mind and body deeply ingrained in a Christian culture. Her question,then, is whether Judaism offers alternative understandings of embodimentthat can be helpful to feminists. Though Judaism, like Christianity, has beenambivalent about the human body, Plaskow argues that its approach has beendifferent. The body is neutral, neither essentially sacred nor essentially evil;but it can and ought to be sanctified. Judaism finds the way of bodily sanc­tification not through transcendence of the body but in and through the detailsof ordinary life. The aspects of daily life that Plaskow then explores fromthe standpoint of the Jewish tradition are eating, sex, and death. From therich-details of the biblical sourees come insights about such matters as theimportance of nourishment, divine concern for the human body, hospitality andembodiment, anxieties about the sexual body, gendered alienation from thebody, the resolution of opposites in experiences of mourning. Problems forfeminists abound, but so do potentially helpful ways beyond them. There isno charted path from dualism to integrated embodiment, from contradictionto paradox, but Plaskow finds pointers that feminists may trust. These pointershave implications, she says, even for the clinical practice of medicine.

When Valerie Hoffman addresses Islamic perspectives on the human body,she moves to a variety of teachings and practices that reveal belief ina profound connectedness between body and spirit. The ambivalences ofChristianity and Judaism in regard to the body are not absent in Muslimtraditions, yet both positive and negative attitudes are expressed in waysdistinctive of Islam. Hoffman examines key texts in the Qur'an and in thewritings of Muslim theologians through the centuries. Pertinent subjectsinclude fetal development, treatment of the body after death, ritual purifica­tion practices, and attitudes toward nakedness, sex, and women. Overall,according to Hoffman, Islam reveres the human body as nobie, less a burdenthan a possibility. Only Sufism and Shi 'ism favor asceticism to any degree;

x MARGARET A. FARLEY

indeed, Muslim writers tend to emphasize an anti-ascetic tradition based onthe Qur'an 's appeal to moderation. The practice of medicine has long beenan important interest to the Islamic tradition, representing the belief thatwhile sickness can be a gift from God, it is also part of the divine will thatsickness be treated. While sexuality is celebrated as healthy and natural forboth men and women, Islam problematizes the female body as a souree oftemptation for men. The medical as well as social consequences of beliefsabout bodies as gendered are serious and frequently contested .

Against the background of these three religious traditions, Part 11 of thevolume addresses specific understandings of the body in clinical practicesand in experiences of embodiment such as illness and aging. The majorityof the essays here engage Christian theological perspectives when they relateto aspecific tradition, though there are notabie exceptions. This should notprevent reflection on these experiences and practices in relation to Judaismand Islam; rather, it should make it more possible and at the same time showthe urgency of detailed theological engagement with these and other reli­gious traditions precisely in regard to specific medical practices and concretehuman experience.

The particular issues in medical practice that the writers address in thissection of the volume include genetics research, reproductive technologies,organ transplantation, abortion, discrimination in health care delivery systems,and the diminishment that characterizes sickness, disability, and the threat ofdying. In all of these issues, the meaning of embodiment is profoundly influ­ential in moral discemment - discemment not just of what ought to be donebut of how human persons ought to relate to one another and to themselves.The themes that emerged in Part I out of an examination of theologicaltraditions appear again and again as the authors address the particular issuesof Part 11. How is the unity of the person to be understood in the face ofcontinuous tensions in our understanding of tbe relationship of body and mind?How broadly or narrowly is the meaning of body to be construed, as a singlebiological entity or as a cultural body, a social body, whose boundaries arewell beyond an individual's skin? Does embodiment make community possibleor finally only limit it? Why is the genderization of body so vulnerable tocategories of inequality and to policies of discrimination? Does the inevitabilityof death shatter our evaluations of embodiment or help to clarify them?

James Keenan makes the provocative argument that genetics research isactually construed in a way that has little to do with the human body as such.Though genotype and person have long been connected, research on thegenomic map of the human individu al threatens to objectify and finally de­center not only the self but the body. From such a perspective the body appearsto be more and more like a machine that medicine must manipulate and attemptto fix. But this need not follow, for Keenan offers the proposal that geneticstructures are themselves relational; the gene is already in some sense a subject;hence, the body as genetically constituted is a prototype of the embodiedself that is fully human.

PREFACE xi

Carol Tauer and June O'Connor press further the issue of biological con­stitution as determinative of embodiment and ultimately determinative of thehuman. Both take on the issue of abortion, but from very different vantagepoints. Tauer's project is to distinguish objective and subjective appraisalsof human embodiment, particularly as they determine perceptions of thebeginning presence of a human being. The identification of, for example,fertilization, individuation, or brain birth as sufficient as weU as necessarycriteria for human existence, is placed over against subjective experience asthe basis of recognition of human presence. It is difficult to overestimate theimportance of such approaches for the developing of moral guidelines forthe treatment of human bodies in their earliest stages.

O'Connor, on the other hand, is preoccupied with the body as a socialphenomenon. The context of her reflections on embodiment and abortion isthe Japanese practice of ritual recognition of the death of an aborted fetus .She explores this practice in the heart of Japanese culture, influenced byBuddhist traditions, but her argumest is that it has cross-cultural implica­tions for understanding embodiment, abortion, and death. The sensibilitiesof the Japanese in the face of a termination of pregnancy are not unique tothem, and their rituals may weIl speak to western bodily experience of inter­dependence, community, and hope. The body as cultural and social body isparticular to a time and place; yet it has universal aspects as well.

Paul Lauritzen moves from considerations of early stages of human embodi­ment to the experience of human individuals who yeam for children in the faceof particular obstacles to fertility. His treatment of reproductive technologieslocates itself within current debates about the separation of bodily actionsand processes (as in sexual intercourse) from reproduction. Notions of embodi­ment are at the heart of concerns over this separation - whether becausereproductive technology disjoins what nature intends to be joined, or becauseits consequences include the reduction of women to machines and the poten­tial commodification of entities that contribute to and are the result ofreproduction . Lauritzen also expands the internal problem of physicality andfreedom to identify problems of extemal coercion of bodies (specificallycoercion of women regarding their bodies) .

Patriek McCormick and Cheryl Sanders address a quite different question,that of organ donation and transplantion. Here the issues of bodily identity,freedom and integrity, are writ large. As McCormick indicates, the possi ­bility of transplanting human organs from one person to another induces a kindof ethical crisis . The alienation of bodily organs is juxtaposed with claimsof moral responsibility based on human solidarity. Here again issues of thecommodification of body parts, combined with issues of exploitation of theeconomically deprived, raise serious moral questions about the whole enter­prise of organ donation and transplantation. Can the human body be assessedas the property of the one who is embodied? Can it be transferred as propertyto others who act for the embodied one, or to others who are in need of suchproperty for their own bodily survival? McCormick outlines what he calls

xii MARGARET A. FARLEY

moral limits for organ donation - for the procurement of organs and theirjust distribution among those who await them. Drawing on feminist inter­pretations of embodiment, he argues that the body can be understood asintegral to the human person, as revelatory of its own sacred meaning, its limitsand its obligations, and as providing the basis of equality among humanpersons.

Cheryl Sanders pursues questions of the meaning and value of organdonation to African Americans. Surveying the special needs in the AfricanAmerican community for the availability of organs, as well as the reasonsthat African Americans have for not donating organs, Sanders offers an analysisof her own of the moral imperatives involved . Deep in the combined Christianand African religious traditions that are important to many African Americanslie motivations for refusing donation of organs. Yet these same traditions canprovide a theological rationale for donating organs. Everything hinges on inter­pretations of the meaning of the human body. Intrinsic to beliefs of utterimportance to African Americans - beliefs about the body in this world andthe body in a world hereafter - are reasons for both caution and generosityin choices to donote organs for transplant.

All of the ambivalences regarding the human body as gendered are reflectedin the narrative that begins the essay by Karen Lebacqz. Here is a story thatdepiets the ironie disembodying of women as recipients of medical care.Here also is a story that gives dramatic content to the social, economie, andpolitical dimensions of human embodiment. Lebacqz is acutely aware of thecultural components of our understandings of human embodiment, and sheprovides astark analysis of the effects of these understandings on the struc­tures of medical care. Arguing that women's embodiment as women determinestheir health status in many ways, Lebacqz points to the interlocking factorsof not only gender but race, class, age, nationality, and other aspects of thecomplex physical and symbolic structure of the body. The challenge sheoffers to a system of medical care is the (again, ironie) challenge to know indi­viduals as they are embodied .

The essays by Courtney Campbell and by John Carmody and Denise LardnerCarmody address the influence of experiences of diminishment and pain onour understandings of the body. For Campbell this entails pressing the questionof alienation of the body from the self. The tendency of modem medicine tothink of and relate to the body as "ether" is reinforeed by experiences of illnessand aging. Personal awareness of embodiment is heightened when the bodyis in pain; it is an awareness that distances the sufferer from her or his bodyand from the rest of the world. Yet this is not inevitable, according to Campbell.There are ways of understanding the body that can shape experience andchallenge the attitudes of medicine . Campbell finds some of these ways inChristian beliefs about the body, beliefs that stress incarnation, corporateidentity, the essential unity and sacredness of the embodied self. Diminishmentneed not be stigmatized, and the experience of medical care may be trans­formed, for both givers and receivers of care.

PREFACE xiii

For John Carmody and Denise Lardner Carmody, specific cases providethe beginning of reflections on the body suffering. Out of the powerful self­descriptions of those who have experienced serious illness come insightsregarding suffering as both pain and frustration. Illness , disability, andmalfunction provide a lens for understanding embodiment. Out of these under­standings of embodiment come guidelines for the practice of medicine. Whatthe Carmodys call for is a new sense of mortality on the part of medicalproviders and a new mode of interaction in the clinical setting. Weavingtogether experience and belief, life and theology, this essay identifies thepractice of medicine as a primary and privileged locus of humanity, a placefor moral wisdom and for the mediation of grace.

Finally, Lisa Sowle Cahill's essay provides an anchor for the volume as awhoie. Incorporating the questions and insights of the previous essays, Cahilltakes on the challenge to formulate a theory of the human body that inte­grates body and mind, self and society. Drawing on primarily western historicaland contemporary interpretations of embodiment, she offers a theologicaland philosophical critique and construction that attempts to transeend therelevant dualisms. Her proposal holds together compassion for the needs ofembodied selves and freedom of bodily self-determination in relation to thevalues of an existing social order. For the practice of medicine, this meansthat the ethical requirements of both beneficenee and autonomy are maintained,but new forms of relationship are also to be imagined and tried.

Lisa Sowle Cahill and I want to express our gratitude and appreciation toeach of the authors who have contributed to this volume. New efforts at"writing the body" require unusual care and creativity; we have found bothof these in the individual essays and in the community of discourse that theessays have made possible. We are also grateful for the ongoing assistance andencouragement given us by Earl Shelp as the editor of the series on Theologyand Medicine. We also want to acknowledge Antony Dugdale, who carefullyprepared the book's index.

Insofar as the body is a "text," this volume has aimed to exegete, inter­pret, and perhaps translate it. In the process, there have emerged what mayat least be clues for the decisions human persons must make about embodiedlife.

Yale UniversityNew Haven, Connecticut, U.S.A.