Nonmaleficence and Hope: a Correlation

Abstract

This essay is an application of a method of inquiry described in Nathan Carlin’s 2019 book Pastoral Aesthetics. In Pastoral Aesthetics, Carlin correlates four principles of bioethics with four images of pastoral care to provide new perspectives on these principles by offering inquiry that is theologically informed, psychologically sophisticated, therapeutically oriented, and experientially grounded. In the epilogue of the book, Carlin notes that other correlations are both possible and desirable. In this essay, another correlation is presented. Specifically, the author positions the bioethics principle of nonmaleficence with Donald Capps’s pastoral image of the agent of hope by exploring Jean-Dominique Bauby’s The Diving Bell and the Butterfly (1998), a memoir about locked-in syndrome.

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Notes

  1. 1.

    For a brief description of my method, see my blog in the American Journal of Bioethics, titled “A New Role for Religion in Bioethics?” The link can be found here: http://www.bioethics.net/2019/05/a-new-role-for-religion-in-bioethics/. In justifying my method, I realize that some may feel that I have created a straw man depiction of principlism only to knock it down. However, this would be a misunderstanding of my position in that I am critiquing the critics of principlism as well.

  2. 2.

    Also see Jessica Carle’s (2019) dissertation on pastoral theology and bioethics for a critique of principlism.

  3. 3.

    In Pastoral Aesthetics, I discuss Paul Tillich’s (1947) method of correlation and, in doing so, I mention in the footnotes that others have critiqued and modified Tillich’s method. Because I wrote the book for two audiences—bioethicists and pastoral theologians—I did not want to overly conceptualize the book, turning off either audience with jargon or fine points. But here, because this article is written for pastoral theologians, I would like to mention two influential commentators on Tillich: David Tracy and Rebecca Chopp. Tracy (1987) offered “a revised correlational model” in response to Tillich’s (1947) model to make the point that the correlation of theology and culture needs to go both ways. In other words, just as culture can and should be used to inform theology, theology can and should be used to critique culture. In effect, this puts theology and culture on equal footing. In the 1980s and 1990s, some theologians worried that Tillich’s model gave up too much ground to culture, perhaps relegating theology to be the handmaiden to existentialism or other forms of secular/modern thought (cf. Hunsinger 1995; Powlison 2010). Chopp (1987) critiqued Tracy’s (1987) model on the grounds that, on her reading, his method seems to essentialize “common human experience.” So, she advanced, as an alternative, “a critical praxis correlation.” Commenting on Chopp’s model, Nancy Eiesland (1994) notes that the aim of a critical praxis correlation is to transform “the social-symbolic order,” including “the dominant practices and principles of language, subjectivity, and politics” (p. 22). Of note, Eiesland (1994) uses Chopp’s (1987) model to offer a liberation theology of disability. I will conclude with some of Eiesland’s insights to provide a final illustration of the implications of the correlation in this article. By using Eiesland’s (1994) appropriation of Chopp’s (1987) correlational method, I intimate that I am not committed to any one way of doing correlation. Indeed, I affirm a spirit of pluralism in terms of potential principles and images to be correlated, as well as understandings of correlation, so as to stimulate creativity and promote freedom.

  4. 4.

    However, antibiotics will not undo the damage already done to the body.

  5. 5.

    This is an example of institutional/scientific/medical racism. In other words, racist ideas were built into the assumptions of the research itself, in addition to any personal prejudice a White doctor or researcher may or may not have had. Relatedly, Ryan LaMothe pointed out to me that one could convincingly argue that the healthcare system in the United States is classist because it drives persons and families into bankruptcy due to medical bills. He added that care given to the poor and/or uninsured is often inadequate (e.g., diabetes is not infrequently treated so late in county hospitals that the only remaining option, other than death, is amputation). Like institutional/scientific/medical racism, classism is structural. Thus, the whole healthcare system could be seen to be violating nonmaleficence in a systemic way.

  6. 6.

    A key term on this topic in research ethics is therapeutic misconception. Therapeutic misconception is when research subjects “fail to understand the purpose and aim of research, thereby misconceiving their participation as therapeutic in nature” (Beauchamp and Childress 2013, p. 133). An example is when a clinical researcher (e.g., an oncologist) presents a patient with an opportunity to enroll in a clinical trial that is testing an experimental drug but in doing so does not clearly explain to the patient that he or she is very unlikely to benefit from the drug, that their participation is intended to help future patients. Of note for readers of this journal, using ideas from Living in Limbo (Capps and Carlin 2010), I coauthored a case report that involved therapeutic misconception in dental research ethics (Flaitz and Carlin 2011).

  7. 7.

    Lee Butler and Gregory Ellison II pointed out to me that there are limits to, and important critiques of, Capps’s writing on hope. Specifically, Ellison mentioned the insights of Afro-pessimism. While the term may seem defeatist, it is really about struggle, resistance, and resilience and thus is also related to hope, but in a more social and political way than Capps’s writings. However, it is important to note that Capps understood the goals of pastoral care to be congruent with social justice. In seminary, I took a class with Capps titled “Poetry and Care of the Soul” in which he distributed a handout that quoted a line from William Stafford’s poem “Thinking for Berky”: “justice will take us millions of intricate moves.” Capps writes: “Pastoral care seems to me to be an interim sort of enterprise, one that seeks to enhance our sense of freedom from oppression and external control in the here and now as the quest for universal justice takes its agonizingly slow pace. Thus, pastoral care is an ally of social ethics, as the freedom that it seeks to enhance in the here and now is a foretaste of true justice” (these quotations are from an unpublished class handout). Perhaps Afro-pessimism would critique this as a rationalization for not working more directly for social justice. For more on pastoral care and poetry, see The Poet’s Gift (Capps 1993).

  8. 8.

    In Pastoral Aesthetics (Carlin 2019), I advocate for attention to mundane matters such as these, referring to them, in light of art theory, as “eccentric” considerations. In my usage, “eccentric” does not mean “odd.”

  9. 9.

    Making a distinction between medical humanities and health humanities, Olivia Banner (2019) suggests that health humanities, in contrast to medical humanities, privileges the perspectives of disability studies.

  10. 10.

    Others have made this point about idolatry as well (for a recent example, see Duff 2018, p. 13).

  11. 11.

    Relatedly, I talked with Eugene Boisaubin, an internal medicine physician at McGovern Medical School in Houston, Texas, about what he thinks of the words “hope” and “cure” in a clinical context. Boisaubin, who has written extensively in clinical ethics (and won the lifetime achievement award from Baylor College of Medicine), makes it a point not to hide behind words. He pointed out to me that, in his experience, it would rare for doctors to use the word “cure.” Rather, doctors more often use phrases like “a chance to do better.” He added that in many cases it is not obvious to him what a “cure” would look like in actual practice. Boisaubin also noted that, when he is confident that a patient will do very well after a given intervention—e.g., an intervention to treat a bladder infection, which a patient may have anxiety about if the infection was caused by sexual activity—he will say something like this: “You will get better. This will go away.” Notice that these are very strong and clear words from Boisaubin, intended to inspire hope yet without the language of cure.

  12. 12.

    In contrast, see Christopher Hitchens’s (2012) Mortality (pp. 15–16).

  13. 13.

    In “Voyage around my Cell,” Ahmet Atlan (2019) writes about “forgetting” as a great source of freedom, which is an interesting contrast to fantasy. Atlan says that the process of writing helps him to forget; perhaps writing functioned similarly for Bauby. Atlan was arrested in 2016 for alleged participation in an attempted coup d’état in Turkey. He was released on probation in 2019. I’m grateful to Benjamin Saxton for sending this essay to me.

  14. 14.

    Various happiness studies have found that non-disabled persons consistently undervalue the experiences of persons living with disabilities (cf. Carlin and Capps 2012).

  15. 15.

    There are many theologies of disability. See, for example, the work of Molly Haslam (2012) and Amos Yong (2007) for different theological perspectives. I am grateful to Jaco Hamman for pointing out these sources to me.

  16. 16.

    For a congruent pastoral reading of Jesus as embodied, see Finding Ourselves Lost (Dykstra 2018, pp. 116–124).

References

  1. Atlan, A. (2019). Voyage around my cell. The Paris Review, https://www.theparisreview.org/blog/2019/10/10/voyage-around-my-cell/.

  2. Banner, O. (2019). Introduction: For impossible demands. In O. Banner, N. Carlin, & T. Cole (Eds.), Teaching health humanities (pp. 1–15). New York, NY: Oxford University Press.

    Google Scholar 

  3. Bauby, J.-D. (1998). The diving bell and the butterfly. New York, NY: Vintage.

    Google Scholar 

  4. Beauchamp, T., & Childress, J. (2013). Principles of biomedical ethics (7th ed.). New York, NY: Oxford University Press.

    Google Scholar 

  5. Beauchamp, T., & Childress, J. (2019). Principles of biomedical ethics (8th ed.). New York, NY: Oxford University Press.

    Google Scholar 

  6. Buckman, R. (1992). How to break bad news: A guide for health professionals. Baltimore, MD: The Johns Hopkins University Press.

    Google Scholar 

  7. Callanan, M., & Kelley, P. (2012). Final gifts: Understanding the special awareness, needs, and communications of the dying. New York, NY: Simon and Schuster.

    Google Scholar 

  8. Campbell, C. (2019). Bearing witness: Religious meanings in bioethics. Eugene, OR: Cascade.

    Google Scholar 

  9. Capps, D. (1993). The poet’s gift: Toward the renewal of pastoral care. Louisville, KY: Westminster John Knox Press.

    Google Scholar 

  10. Capps, D. (2001). Agents of hope: A pastoral psychology. Eugene, OR: Wipf and Stock.

    Google Scholar 

  11. Capps, D. (2005). Agents of hope. In R. Dykstra (Ed.), Images of pastoral care: Classic readings (pp. 188–199). St. Louis, MO: Chalice Press.

    Google Scholar 

  12. Capps, D., & Carlin, N. (2010). Living in limbo: Life in the midst of uncertainty. Eugene, OR: Cascade Books.

    Google Scholar 

  13. Carle, J. B. (2019). Beyond autonomy: A theological anthropology for pediatric bioethics (unpublished doctoral dissertation). Nashville, TN: Vanderbilt University.

    Google Scholar 

  14. Carlin, N. (2019). Pastoral aesthetics: A theological perspective on principlist bioethics. New York, NY: Oxford University Press.

    Google Scholar 

  15. Carlin, N., & Capps, D. (2012). 100 years of happiness: Insights and findings from the experts. Santa Barbara, CA: Praeger.

    Google Scholar 

  16. Chambers, T. (2015). The fiction of bioethics: Cases as literary texts. New York, NY: Routledge.

    Google Scholar 

  17. Chopp, R. (1987). Practical theology and liberation. In L. S. Mudge & J. N. Poling (Eds.), Formation and reflection (pp. 120–138). Philadelphia, PA: Fortress Press.

    Google Scholar 

  18. Cole, T., Carlin, N., & Carson, R. (2015). Medical humanities: An introduction. New York, NY: Cambridge University Press.

    Google Scholar 

  19. Couser, G. T. (2009). Signifying bodies: Disability in contemporary life writing. Ann Arbor, MI: University of Michigan Press.

    Google Scholar 

  20. Day, E. (2008). A story told in the blink of an eye. The Guardian, https://www.theguardian.com/film/2008/jan/27/2.

  21. Diedrich, L. (2001). Breaking down: A phenomenology of disability. Literature and Medicine, 20(2), 209–230.

    PubMed  Article  Google Scholar 

  22. Duff, N. (2018). Making faithful decisions at the end of life. Louisville, KY: Westminster John Knox Press.

    Google Scholar 

  23. Dykstra, R. (1990). Intimate strangers: The role of the hospital chaplain in situations of sudden traumatic loss. Journal of Pastoral Care, 44(2), 139–152.

    PubMed  Article  Google Scholar 

  24. Dykstra, R. (Ed.). (2005). Images of pastoral care: Classic readings. St. Louis, MO: Chalice.

    Google Scholar 

  25. Dykstra, R. (2018). Finding ourselves lost: Ministry in an age of overwhelm. Eugene, OR: Cascade Books.

    Google Scholar 

  26. Eiesland, N. (1994). The disabled god: Toward a liberatory theology of disability. Nashville, TN: Abington.

    Google Scholar 

  27. Erikson, E. (1964). Human strength and the cycle of generations. In Insight and responsibility: Lectures on the ethical implications of psychoanalytic insight (pp. 109–157). New York, NY: W. W. Norton.

  28. Flaitz, C., & Carlin, N. (2011). Living in limbo: Ethics and experience in a conversation about persistent oral lesions. Texas Dental Journal, 128(5), 427–437.

    PubMed  Google Scholar 

  29. Furman, B., & Ahola, T. (1992). Solution talk: Hosting therapeutic conversations. New York, NY: W. W. Norton.

    Google Scholar 

  30. Gawande, A. (2014). Being mortal: Medicine and what matters in the end. New York, NY: Metropolitan Books.

    Google Scholar 

  31. Haslam, M. C. (2012). A constructive theology of intellectual disability: Human being as mutuality and response. New York, NY: Fordham University Press.

    Google Scholar 

  32. Hawkins, A. (1999). Pathography: Patient narratives of illness. Western Journal of Medicine, 171, 127–129.

    PubMed  PubMed Central  Google Scholar 

  33. Hitchens, C. (2012). Mortality. New York, NY: Twelve.

    Google Scholar 

  34. Hoberman, J. (2012). Black and blue: The origins and consequences of medical racism. Berkeley: University of California Press.

    Google Scholar 

  35. Hunsinger, D. (1995). Theology and pastoral counseling: A new interdisciplinary approach. Grand Rapids, MI: Wm. B. Eerdmans.

    Google Scholar 

  36. Jones, J. (1993). Bad blood: The Tuskegee syphilis experiment (new and expanded ed.). New York, NY: Free Press.

    Google Scholar 

  37. Kearney, P. J. (2006). Autopathography and humane medicine: The diving bell and the butterfly—An interpretation. Medical Humanities, 32(2), 111–113.

    PubMed  Article  Google Scholar 

  38. Kennedy, K., Kilik, J., & Schnabel, J. (2007). The diving bell and the butterfly [motion picture]. United States: Etienne George/Miramax.

    Google Scholar 

  39. Kleinman, A. (1995). Writing at the margin: Discourse between anthropology and medicine. Berkeley: University of California Press.

    Google Scholar 

  40. Miles, S. (2004). The Hippocratic oath and the ethics of medicine. New York, NY: Oxford University Press.

    Google Scholar 

  41. Powlison, D. (2010). The biblical counseling movement: History and context. Greensboro, NC: New Growth Press.

    Google Scholar 

  42. Rambo, L. (2008). The diving bell and the butterfly: A film review. Pastoral Psychology, 56, 463–465.

    Article  Google Scholar 

  43. Raoul, V., Canam, C., Onyeoziri, G. N., Overboe, J., & Paterson, C. (2001). Narrating the unspeakable: Interdisciplinary readings of Jean-Dominique Bauby’s The diving bell and the butterfly. Literature and Medicine, 20(2), 183–208.

    PubMed  Article  Google Scholar 

  44. Tillich, P. (1947). The problem of theological method: II. Journal of Religion, 27(1), 16–26.

    Article  Google Scholar 

  45. Tracy, D. (1987). Practical theology in the situation of global pluralism. In L. S. Mudge & J. N. Poling (Eds.), Formation and reflection (pp. 139–154). Philadelphia, PA: Fortress Press.

    Google Scholar 

  46. Yong, A. (2007). Theology and down syndrome: Reimagining disability in late modernity. Waco, TX: Baylor University Press.

    Google Scholar 

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Correspondence to Nathan Carlin.

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I receive royalties from four books cited in this article. These are Living in Limbo, 100 Years of Happiness, Medical Humanities, and Pastoral Aesthetics. Please see the reference list for complete bibliographic details.

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Carlin, N. Nonmaleficence and Hope: a Correlation. Pastoral Psychol (2020). https://doi.org/10.1007/s11089-020-00903-8

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Keywords

  • Pastoral aesthetics
  • Bioethics
  • Method of correlation
  • The diving bell and the butterfly
  • Ableism
  • Medical humanities
  • Disability studies
  • Chaplaincy