THE
DIVINITY SCHOOL REVIEW
A New Face on Things
The disappearance of the University Chapel from the cover of our Review has nothing to do with any recent events on campus. Happily, the Chapel stands. Yet we are in a period when church edifices generally seem inadequate as symbols of a relevant style of Christian life and witness. In this regard the university campus is certainly no exception. (The handsome new cover is by Richard Heitzenrater, Ph.D. Duke, 1969).
No one needs to be told that university, church, and community life is presently marked by turbulence and controversy. This situa- tion is reflected in several of the articles in this issue. Perhaps it is not coincidental that the President of the United States is mentioned or alluded to in three of these articles, and never in an entirely com- plimentary light ! Possibly this implies that the authors are Demo- crats— and some may be — but more likely it simply reflects the way in which church, theology, and politics overlap one another in con- temporary discussions. The world is very much with us, for weal or woe, in every consideration of the mission and life of the church.
D. M. S.
THE DUKE DIVINITY SCHOOL REVIEW
Volume 35 Winter 1970 Number 1
Contents
A New Face on Things Inside Front Cover
Obsolescence and the Wisdom of God 3
by Robert E. Cushman
The Ecology of Theology 10
by Howard C. Wilkinson
Chapel Meditation 15
by Andrew Sagar
The School Of Babylon 19
by Van Bogard Dunn
Dean's Discourse 28
Book Reviews 32
Divinity School Review Committee: D. Moody Smith, Chairman; Frank Baker, Donn Michael Farris, Thor Hall, Creighton Lacy, Gene M. Tucker, and David Rutledge.
Published three times a year (Winter, Spring, Autumn) by The Divinity School of Duke University
Postage paid at Durham, North Carolina (27706)
Obsolescence and the Wisdom of God
Robert E. Cushman Dean, Duke Divinity School
"But where shall wisdom be found, and where is the place of understand- ing?" (Job 28:12)
"But of him are ye, in Christ Jesus, who was made unto us wisdom from God, and righteousness and sanctification, and redemption ..." (I Cor. 1:30)
I
The opening of the school year and the reassembly of the Divinity School family is the recurring occasion of this Convocation. As on previous anniversaries of this day, we pause to get our bearings and chart our course. Once again we celebrate our hopes in the light of God's promise and seek to refine our expectations. We welcome newcomers to our midst as fellow seafarers, both students and faculty. Some portions of the voyage may be stormy, some placid, and others favored with a steady blow to windward that spells progress for sails well trimmed and a proper pointing of the compass or manning of the rudder. Whatever the weather, today we say bon voyage to new- comers and mean it ! We only caution that, in sailing, advance is made by using the wind at oblique angles, not "luffing" the sails, and so arriving at one's destination. It is for this reason that sailing is a better guide to life than automotion, but few there are who now- adays could be expected to know it !
We are a Divinity School, and being what we are — a theological center committed to exaltation as well as preparation of the Christian ministry — our opening Convocation is, first of all and above all, a Te Deum. As such it is our corporate acknowledgement of our rea- son for being ; that is the service of God. And this is our "reasonable service" if we heed who and what we are as a school according to the charter of the University, the expectations of the Church, and the mandate of Christ.
All are welcome here who desire to join in our corporate Te
Opening Convocation Address for the Academic year 1969-70.
Deum and in so far as each is searching to discover for himself the ways in which God is truly to be served in his generation. It is very true that the ways of serving God are not one, but many, and that the changing scenes of life conduce to the obsolescence of some ways and the greater timeliness of others.
This circumstance is a mystery with which the poet Tennyson wrestled much, and Camelot was among us last year to underscore once more the enigma of the obsolescence of the good. Nothing in Anglo-Saxon literature highlights so well the glory and the misery of man as is dramatized in the Arthurian Legend. The glory of the Round Table and the tragedy of its dissolution were among the massive impressions of my childhood. And Tennyson struggled to give it meaning in the dying soliloquy of Arthur :
"Time makes ancient good uncouth; ....
And God fulfils himself in many ways,
Lest one good custom should corrupt the world."
I do not venture to judge whether Tennyson successfully illumi- nates the tragedy of obsolescence. This morning my eye is rather upon the sword Excalibur which Sir Bedevere, faithful to Arthur's last request, flung into the meer and was withdrawn from sight by the same mystical arm that committed it to Arthur in the first place. Excalibur was and remains the symbol of the divine calling. It is a parable offered to us, as to all God-fearers. No one inherits the divine calling; none have it by "divine right." In the Arthurian Legend, it falls to him who is worthy, able, and ready to rise to grasp it as a higher mandate and a life vocation. Excalibur stands for the diviner calling that is not a matter of inheritance nor in the power of men to transmit. Rather it is reserved for higher appoint- ment and bestowal upon him who will and can receive it.
To rise and respond to such appointment and bestowal is that liturgy of life, that leitourgia or service to God, which, according to St. Paul, is our "reasonable service" and proper Te Deum. It is to find those ways in which God seeks to fulfill himself — that is his purpose — in every age and to make common cause therewith. More- over, Excalibur is the reservation of final authority to God. His- torically, it has been a check to the pretensions of absolutism in monarchy and statecraft. Excalibur publishes the truth that power and authority are God's. They are man's only for good usage, never for possession !
And one more observation about Excalibur of the Arthurian
Legend : the bearer of the sword never presumes to know why he has been appointed to this high calling. He is not an enthusiast, verging upon fanaticism, who is over-confident of easy discernment of the purposes of God amidst the tangled web of human life and change. Among the altering and multifarious traditions of men, he struggles to discriminate the ways of God. He seeks the interwoven thread of meaning, the emerging pattern of the slow sure march of Destiny and aims to ally himself with the continuity of history. This is the living tradition. As it issues out of the past, it also holds the promise of the future. To unite with this tidal flow of history calls for maturing discrimination between what is merely in vogue and what is enduring.
There is truly a past, a part of the human past, which is preface ! From another perspective, history is also the graveyard of dis- carded idols, vagrant enthusiasms, and obsolete cause which, in their time, offered themselves as God's ways for men. Perhaps in their time they were "broken lights" of the enduring purpose of God. Tennyson thought so. And such perhaps is human history at large, always and only a refraction of the larger light of God and his more ample purposes for his creation.
It is this latter which I like to call the Tradition as distinguished from the multifarious and transient ways of men. And I say again as I urged a year ago at this time that the business of the theological center is to track the Tradition and, by the art of discrimination, find it out. Indeed, I say again, the heart-aim of theological education is cultivation of the art of discrimination. It is urgent today, for unless you learn to discriminate between current panaceas and God's ways, between apparent solutions and real ones, not only will your present endeavors be "dated," they will have become obsolete by the time you are forty.
II
What I am also asking today, in the face of another academic year and our own particular enterprise of theological education, is the question about obsolescence. Of this reality the Arthurian Legend is the glorious and tragic embodiment. You students are not forty, and I am at least that ! Meanwhile, it is widely rumored that none over thirty are to be trusted ! On this premise most of you have not far to go before your usefulness will be spent and your contribution expendable. On this premise, indeed, you will hardly get started!
What will you do? Will you take a cue from modern industry
and merchandising and resort to a program of "planned obsoles- cence?" What will you do with the old model that is yourself and your life investment? Although they clutter the landscape, old cars may be junked and things discarded, but what will you do with your person at thirty or, possibly, at forty if you make it? The trend to- ward early retirement may assure you of getting out of the way if not out of sight !
Planned obsolescence could also include a studied effort to "change with the times," as it is said. "The old order changeth yielding place to new." Undoubtedly a wise flexibility is a guide to life if critical and discriminating. On the other hand, there are pit- falls; and, among assured ways of becoming obsolete, is uncritical espousal of contemporaneity as one's mode of life. Modish conform- ism is unplanned obsolescence for sure !
But there is a deeper problem that besets our common humanity and from which the devotees of change are not exempted. It is a question as old as Heraclitus and never more insistent than in our own time of unparalleled alteration of the face of human existence : in the deluge of change that is our era, to what passing events or cluster thereof shall we attach such ultimate significance as to hold our devotion and find our reason for being?
Ill
Without such a vision we may already be obsolete ! So, I think we are confronted again with Job's old question : "Where shall wis- dom be found ? And where is the place of understanding ?" We sense, somehow, Job was so far right that, without that wisdom, the welter of events are overwhelming, the ways of the world inscrutable, and manner of our calling unknown. Or, without that wisdom our lives are already obsolete in principle, purposeless, however captivated they may have been by a lifetime of successive engrossments. It is for a similar reason, if in a different idiom, that St. John says : "the world passeth away and the lust thereof, but he that doeth the will of God abideth forever" (I John 2:17).
What is not obsolete, then, is every alliance of man or institution with the long, long thoughts of God. What is not so allied is in process of obsolescence and passing away. So our obsolescence is guaranteed by attachment of life to what is transient or ephemeral. Conversely, the authenticity of our vocation and the efficacy of our days depend upon alliance with what abides just exactly through all the chances and changes of our mortal history. This is alliance with
Destiny, with what I would call the perennial Tradition. It is al- liance with what is "aborning" rather than aborting in the purpose of things. To have such alliance as a personal vocation is the only rele- vance which seems to me to have any promise of preserving us from obsolescence either at thirty or at forty.
In like manner, it is the business of the theological faculty and of theological education to assist men to discriminate between what is "aborning" and what is only aborting in history. Likewise, it is the business of the Church to know the same differences and to challenge and win the adherence of men and women in the world to what is "aborning" in the ways of God with men. We may call this emer- gent reality the thread of history. In the New Testament it is called the Kingdom of God !
IV
"But where shall wisdom be found, and where is the place of understanding?" This past August I sat one morning at breakfast with a local tradesman. I have known him as a hard-working and humble man whose personal life has been touched by a succession of baffling family sorrows. I do not know his church or with what regularity he attends one. I do know that he is a seeker after the wisdom of which Job's search was predecessor.
In some such words as these, with hesitant modesty and even trembling concern, he posed a question and offered his own answer : "Dr. Cushman," said he, "I wonder whether you think I am mis- taken. I believe Mr. Nixon is an intelligent and good man, but how could he say of the 'moon-walk' a few days ago, 'This is the greatest week in the history of the world since the Creation ?' Dr. Cushman, I may be wrong but my Christian faith can't square with that. Don't Christians hold that what Jesus Christ was and did, with Calvary and Easter, are the greatest events since the Creation?"
I remembered St. Paul's words in Romans, 8:22: "For we know that the whole creation groaneth and travaileth in pain together un- til now." What, for the moon-walk? Plainly, the "now" referred to the "new creation" in Christ Jesus ! Elsewhere in First Corin- thians, Paul identifies the "wisdom" which liberates from the bondage of corruption and, thus, also from obsolescence : He speaks of Jesus Christ "who was made unto us wisdom from God." I think the tradesman was right, and President Nixon was wrong!
Earlier in this address I raised a question. It persists, as peren- nial as human life itself. Amidst the welter of events and ceaseless
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change, to what passing event or constellation of events will you attach ultimate significance and so find ends and aims worthy of your final devotion? That is the perennial question of man, and, unless he has answer, his personal and communal history falter and become aimless. Torpor overtakes him ; all becomes vanity and a striving after wind. Where only "Whirl is king," to use Shakespeare's words, meaninglessness overtakes our human lot and we and all our works are destined to early obsolescence!
Without depreciating the technological marvels dazzlingly dis- played by what even Pope Paul is reported to have called the con- quest of the moon by astronauts Armstrong and Aldrin, and, cer- tainly, without any detraction from the extraordinary physical cour- age of the latter, I have to register personal doubt whether this fabulous feat of applied science is more than the latest and, perhaps, the near zenith of man's age-old conquest of space. Solid state phys- ics and the electronic computer made possible this latest and most spectacular advancement of the Baconian program which Bacon called "the extension of the powers and greatness of man," indeed, "the kingdom of man founded in the sciences."
Man may yet have some more millions of miles to range within the perimeter of the solar system, but I cannot wholly credit the Pope's deduction that, thereby, he faces "a new destiny !" To solve his problems man has regularly resorted to relocation in space by migration and exploration, but he has been stymied by two realities, the irreversibility of time and himself. Wherever he goes his nemesis is that he cannot elude himself ! He takes himself with him ! It is the same man who could not make it here that goes there ! For this reason it was wisely said long ago :
"He that is slow to anger is better than the mighty, And he that ruleth his Spirit, than he that taketh a city."
(Prov. 16:32)
But the prevailing story of man is his disposition to take another city rather than rule his spirit. He seeks salvation by expansion in space, but, in every relocation or expanded Lebensraum, he cannot evade himself. That is his fate ! Something better may be his Destiny !
The Christian faith is premised on the finding that the man who ruled his spirit and successfully evaded himself did so, not by relo- cation in space, but by full self-identification with the Author of Being. Self-conquest with him was not by way of space-conquest
but by self-surrender to the Diviner Calling. It is for this reason, too, that St. Paul declares : Jesus Christ . . . "was made unto us wisdom from God." He also saw Christ as the mediator of our righteousness, sanctification and redemption.
This self-evasion through self-identification is hardly spectacular. Its only sign was a cross ! Yet Paul glories in the paradox : God chose the foolish and weak things, even the things that presently are not to revolutionize the things that are. The revolution still goes on in the face of the deceptive promises of space aggrandizement or empire building as the way of human salvation.
Job is our predecessor; he asks "where is wisdom to be found, and where is the place of understanding?" The answer of the whole Bible, and pre-eminently the answer of the New Testament is that wisdom and understanding have no place until they are truly em- bodied in the life of man ! It is this embodiment that bears good fruit in the relations and affairs of men; if not, wisdom is not really embodied : "By their works ye shall know them."
This school, unless I quite misunderstand its charter, is com- mitted to the proposition that the wisdom of which I have spoken is for embodiment; that among its human embodiments — of which there are not a few — the surest moment of truth, the unparalleled embodiment, is the man Jesus, called Christ ; and finally, we are here committed to the proposition that the likeliest way to avoid obsoles- cence is to be united with Christ who is said to be "the same yes- terday, today, and forever."
This is the case just exactly because our Lord made salvation to consist, not in relocation in space but through self-identification with what transcends every place and time, that is, with God the Father. Obsolescence is guaranteed for every time in any place. The way of salvation, in the final analysis, is by transition from quantity to quality, but the way is strait and the gate narrow; and few there be that find it !
Until you are sure that better is he that ruleth his spirit than he that taketh a city, you may be fit for the kingdom of man, but you are a long way from the Kingdom of God. The apparent tragedy of King Arthur is his real victory and deathless glory : He was better at ruling his spirit than taking a city ! The sword Excalibur is still available to those who will receive it as a higher calling. Not unlike the Cross, it stands, I think, for what is "aborning" in con- trast with what is aborting, or obsolete, in human history.
The Ecology of Theology
Howard C. Wilkinson Chaplain, Duke University
Several years ago I listened to Joseph Sittler speak about the ecology of faith. It was clear that he was discussing something im- portant about the life of the Christian enterprise in the world. Among other insights which he brought to focus was the idea that our Christian faith of necessity manifests itself in different forms, de- pending upon the particular environment in which it is being lived out.
He clarified the point that Christian faith might properly seem different to a casual observer who is beholding its shape in two different settings or who is analysing its expression in successive eras. Yet it might be the same Christian faith which is being wit- nessed to in each instance.
While listening to Sittler talk about that, a kindred idea occurred to me, and I have called it "The Ecology of Theology," not because this rhymes better than his "Ecology of Faith," but because that is what this short paper is about. Not the ecology of faith, but the ecology of theology. Forgive me while I make a somewhat simplistic distinction between the two concepts.
We can begin with an analogy. One of the species involved in ecology is the rat. The rat and his ups and downs correspond to the life of faith. The study of the rat and his ups and downs corresponds to theology. The rat's diggings, his gnawing into the corn bin, his encounters with traps, dogs, smoke bombs and other rats, represents the life of faith, and Sittler can properly speak of how one rat's life will be different from another, depending upon whether he finds him- self in an Iowa barn or a Louisiana swamp.
Theology is represented by the attempt to define the essential nature of rat-ness, to describe in intellectual terms what it means to be a rat, as opposed to being a skunk; the search to refine the con- cepts which are involved, so that one can speak precisely and mean- ingfully about the rat, his relationships to the universe and his terrestial peers.
Theology, then, as distinguished from faith, is that intellectual process by which we take the raw materials of the life of faith and
11
seek to establish meaningful categories through which they may be understood in the mind while they are encountered in the heart and applied in the life. A traditional definition of theology is that it is the intellectual expression of religion. Webster's Unabridged Dic- tionary defines it as the ideational element in religion, a methodologi- cal description of what the faith is, or in the light of its experience of religious values, ought to be. A second definition given by Webster is that theology is a system of religious theory.
This then is what we are talking about in this paper. Of course, it is difficult to become involved in the life of faith without doing a modicum of theologizing and, conversely, the person who spends very much time theologizing will likely find himself in personal en- counter with the God about whom he is speculating. But to the ex- tent that the two can be separated and dealt with in different com- partments, it is important to the idea of this paper for me to em- phasize that we are concerned here with theology and not with the life of faith itself.
Before moving on to the business at hand, it is necessary to strop and hone one additional concept, namely, ecology. It is crucial that we have a very clear idea of both theology and ecology if the two practical affirmations toward which this paper moves are to be clari- fied.
So, what of ecology? A twelve-volume work, entitled The Audu- bon Nature Encyclopedia, provides the following statement : "Ecology is the study of animals and plants in relation to each other and to the physical environment of their natural habitat. The word, ecology, first used in 1869 by Ernst Haeckel, the German zoologist, is based on a Greek word, meaning home. To study a plant or animal ecologi- cally is to observe a species in the home where it lives naturally and where it is intricately dependent on all the other plants and animals and physical features — rainfall, altitude, soil, and so on — with which any species coexists."1
Zoologists have discovered that it is one thing to study rats under the carefully controlled conditions of the laboratory, with its bright lights, microscopes, and dissecting apparatus; but another thing to study rats under the musty floors of rotting barns and in the dingy corners of grain elevators. Of prime importance, both to zoology and to its analogy for theology, is the fact that scientists now know that the laboratory study of rat-ness without a thorough study in the
1. Philadelphia : Curtis, 1965, Vol. IV, pp. 594-96.
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filth of the barnyields up an inadequate and distorted picture of the rat-ness of the rat, even for the purpose of the science of zoology.
Moving now from the ecology of the science of biology to the ecology of theology (said to be the "queen of the sciences"), one finds an interesting parallel. The ecological matrix of theology is as relevant to an intellectual understanding of the Author of nature as it is to an understanding of nature.
I wish now to move quickly to a declaration of the two practical affirmations or contentions of the paper, and then to discuss them together briefly. ( 1 ) The first is that it is better to locate a theologi- cal seminary in the complex of a great university which is struggling with the conflicts between activists and the establishment, and in a city where it cannot escape being involved with the struggles of man's day-to-day agonies, than it is to locate a theological seminary in a secluded retreat, aloof from the clash of secular ideas and the smoke and din of vulgar men. To state the same emphasis in dif- ferent words, we might say that the ministerial student who is choosing a seminary will be wiser to choose one of the first type than to choose one of the other kind.
(2) The second practical contention is that the parish minister should not quench the impulse to theologize a bit at the end of an exhausting day of crises and frustrations. Often the busy pastor is so burdened down with counseling demands, unexpected emergencies, bone-crushing tragedies, and organizational dilemmas that he feels he is not qualified to attempt any serious theology; yet it just might be true that he would, in that circumstance, write better theology than his brother who had nothing to do but write theology. There- fore, with an abundance of humility, but with a measure of confidence, let the active, practicing parish pastor yield to his impulse to the- ologize.
Now that the two theses are before us, let me discuss them briefly. The raw materials of our Christian faith more nearly paral- lel the life of the rat in a dirty barn than they do the life of a rat in a sterile laboratory. Therefore, just as the ecologist who is on his knees and elbows under the musty floor of a rotting barn will learn things about the rat-ness of the rat which he would never learn in an antiseptic laboratory, even so the theologian who wears out his shoe leather serving as a mediator in one of today's social confron- tations will ponder dimensions of the doctrines of sin and grace which he would never visualize while merely wearing out the leather in the seat of a comfortable chair in his study.
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The theologian who helps sweep up the remains of a suicide vic- tim who fell from a great height ; the theologian who has been in jail because the world is still out of joint ; the theologian who has shared the agony of a young couple whose beautiful dream was shattered by an unwed pregnancy ; the theologian who has introduced a brilliant professor to Alcoholics Anonymous and has seen him begin to stay sober a day at a time — such theologians are likely equipped to articulate the great classical doctrines of theology with a pungency, a clarity, and a depth of relevant insight which the purely academic theologian likely could never achieve.
Although at a given moment parish theologians may be three weeks away from a personal encounter with Tillich and three years away from Harnack, it is possible that they still may have something worth saying.
This ecological aspect of theology provides for a type of exis- tentialism in our thinking about God's redemptive activity in the world which the traditionalist can at least find understandable if not comfortable. Paradoxically, it also occasionally may be true that the theologian who has less time to theologize will serve up better theology than the one who has never found time to do anything except to theologize in the academy.
As we pause to reflect upon some of the catch-phrases on which theological ink has been spilled in recent years, we wonder about the relevance of these both to the human situation on the one hand, and to God's Incarnation in Jesus Christ, on the other hand. Instead of having theological trends, moods and emphases determined by catch-phrases conceived in the laboratory (e.g. "God is dead"), let serious theological attention be given to the poignant dilemmas of man in his "dirty barn" encounters with himself, other men, and a God who will not be denied. In short, let theory be structured around the empirical confrontations which make up the minister's week-to- week work load.
To change the figure, there is much for the theological Geiger counter to be found in the "fallout" which comes from the fission of the youth's id and super ego — to mention only one heated encounter which the pastor witnesses in a day. There are implications for Christian ecclesiology in a Selma march. The Anniversary of Martin Luther King, Jr.'s death plunges us at once into thoughts of eschat- ology. Who among us has not wrestled with questions about the nature of grace when it became our duty to tell a parent that his son or daughter died as a result of drunken driving?
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One further word about the seminary : However incandescent its faculty may be, a school of theology which labors in excessive de- tachment from the struggle between labor and management, white and black, rich and poor, will be a school whose theology will be harmed rather than helped by that detachment. The effect of de- tachment may be only a matter of attitude or motive, but that will be ample to achieve sufficient alteration in the "end product" so as to render it less than true to the divine mysteries revealed in the shed blood and speared guts of Golgotha.
The area of this paper's interest is the articulation of faith, the province of theoretical theology ; and the conclusion here presented is that the ecology of theology has a profound effect upon the theory, as well as the practice of our doctrines.
In our time we have seen the rise of an entirely new school of psychiatry which was born, not in a laboratory or in a classroom, but in the hell of a death camp where a desperate psychiatrist saw mean- ing and purpose make the difference between sanity and insanity. Out of what he saw and experienced, he perfected a theory of healing called "Logotherapy," and it has been found to work outside the concentration camp as well as inside it. Similarly, some of our best theologizing about redemption might be done on a dark and cold night, after an exhausting day of ministering to people who literally cannot live without the grace of the Lord Jesus Christ.
Chapel Meditation
Andrew Sagar Duke Divinity School, 1970
I am a Divinity School senior, with twenty years of education behind me. I am young, idealistic, theologically aware. I am eager to become a leader in the church militant, a catalyst for the inbreak- ing of God's kingdom. Soon I will take a church. I am the hero.
He is a layman, with the Depression years behind him. He is middle-aged, pietistic in expression, materialistic in motivation. He is Richard Nixon's kind of people, a guardian of middle-class values. He is waiting in the pew. He is the enemy.
The enemy appears in other guises, too :
He's the little old lady who greets me after my most radically devastating sermon: "I enjoyed your message."
He's the district superintendent's wife who told me: "You'll go far in ministry if you just keep that wonderful smile."
He's the conference recruiter who recently gave me some practical advice : "Let's be realistic, Andy. The salary is what you should be con- sidering."
He's all the nice, innocuous little ministers whose image I am inheriting, all the so-called Christians who hold Christ's church hostage to the narrow, complacent, self-serving values of middle America.
You could say to me, "That's a rotten attitude for a prospective minister" — and you might be right. But I think I've made real prog- ress since just last month, when I was still trying to tell myself that I loved all those people.
I don't think Jesus ever said, "Pretend you have no enemies." I could handle a commandment like that — Just flop back to where I was a month ago and repress all those nasty thoughts.
No, you know the one that's giving me trouble : — "Love your enemies."
But I never even had any trouble with that one until I figured out who my enemies really were. I always thought "enemies" re- ferred to the Ruskies or the Viet Cong or somebody like that. — Heck, I'm real good at loving them. They're on the other side of the world.
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But that doesn't get at what Jesus was talking about. Those are just the people my government tells me are my enemies. But they aren't my enemies. My enemies are the people I meet every day, the people who comprise that arthritic old behemoth which is sup- posed to serve as the body of Christ.
These are the people with whom I am at war; these are the people I'm supposed to love.
But how can I love them? They stand in the way of all I hope to accomplish through the church.
For all their sentimental morality, for all their token charity, American churchmen generally devote their God-given talents and energies primarily to looking out for themselves.
And that goes for most of our liberals, too. No matter what they say or who they campaign for, no matter what humanitarian programs they advocate, I get the definite impression that very few liberals would really be willing to give up the security and comfort of the American Way of Life — a way of life which we insist on maintaining at the expense of the poor, both here and around the world.
The human cost of our collective sin is beyond imagination. We pile wealth on top of fabulous wealth, working feverishly to invent enough new junk to waste it all on, while all around us are poverty, disease, hunger and all the other human tragedies which we have managed to reduce to political cliches.
And does the "great silent majority" we've been hearing about give a damn? I mean really.
I'm not talking about misty eyes, and 5% of the church budget for social action and missions. I've heard it said that we're doing all we can. We may be doing as much as we can without pain. But how many of America's Christian majority really, really care enough to push for a genuinely sacrificial mission on the part of America the Rich?
As I get closer to graduation, I become more and more frightened by the prospect of trying to bring my idealized understanding of Christianity alive in a real institution composed of such people — people who are part and parcel of our self-centered culture.
But I would not deceive you, brothers. I do not do all my weep- ing on behalf of Christ. I was forced to recognize that, just this past week, when I finally got around to reading Newsweek' s report on "The Troubled American."
As the article quoted one angry white after another, all I could
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see was a parade of small minds and the overwhelming evil which oozed from their irrational and intransigent attitudes, the same atti- tudes that I continually encounter within the walls of the church.
But this time, reading the article in the privacy of my own home, I allowed myself the emotion I had denied in face-to-face encounters. Inside of me there welled up a great big, blinding ball of hate- unbridled hate for every one of those God-damned, small-minded bigots.
What's the matter with them anyway?
Why are they so stubborn ?
Why won't they listen?
How can I save the world, how can I bring in God's kingdom, if I can't change their attitudes?
And then I knew why I hated them.
I hated them, not because they wouldn't change, but because I couldn't change them. The great unwashed are a mirror for my own inadequacy, for my own sin.
I can't even claim the excuse of a small mind. I have seen what the Gospel demands, I have been shown the better way. And I haven't measured up.
The way of the cross is too much for me. I'm not at all sure how much I'm willing to give up on behalf of others.
I crave security, and I'm much more secure with rhetoric than with action. Just think how great it would be if I could talk people out of their present life-orientations. Then they would change their ways — because of me; and I would be justified, and my inadequacy would be obliterated.
It would be great — but it doesn't work. I've been trying to use these people to pick up some cheap grace, but none has come my way. I'm all tangled up in sin — just like they are.
And that's it ! We're all in this thing together. No more good guys and bad guys ; no more pretense. Every one of us is caught.
This strange-new-wonderful sense of community with the enemy has helped me to know what I've been trying to tell myself for so long. I am not the unique failure. God loves me. He really does love me just like I am. And he loves them, just like they are.
And you know what ? So do I !
End of war ? No more enemies for Sagar ? No, sir !
Even as I bring this sermon to its happy ending, men, women and children are dying at the hands of our personal representatives in Asia, or withering for want of some of the wealth we continue
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to hoard. American policy has not changed in the last ten minutes, and the church is as arthritic as ever. Countless enemies of the kingdom remain on the church rolls, and they must be fought — fought and loved.
Is that possible? I'm here to tell you now, for me, it is.
The School of Babylon
Van Bogard Dunn Dean, The Methodist Theological School in Ohio
My text is written in the refrain of the first stanza of a poem by Thomas Blackburn :
This is the School of Babylon And at its hands we learn To walk into the furnaces And whistle as we burn.1
The imagery, as you all know, is from the story of the fiery fur- nace in Daniel 3. When I read the poem last summer in a critical essay by May Sarton, I knew at once that here was my title and germinal idea for this lecture.2 But what was on my mind then is not at all what I will say here today. The image of "the School of Babylon" has unsettled my mind and forced me to consider more than I had intended to say. For as Miss Sarton has written : "Ten- sion between idea and image has to do with the depth and complexity of the image ; if it is an inspired image, i.e., one that comes from deep below the surface, it may very probably change the original idea, for the image is all the time pointing the way to what we really mean, and not what we thought we meant."3 So today I speak to you about the "the School of Babylon" in the hope that this image will help me say and you hear not what I thought I meant but what I really mean.
I. This is the School of Babylon.
To mention "the School of Babylon" in a gathering of Divinity School Alumni is to take a calculated risk. The image lends itself to easy application to all the negative experiences and unpleasant memories which clergymen often associate with their years of formal
The Alumni Lecture for 1969, delivered at the Fall Convocation, October 28, 1969, in Page Auditorium. Dean Dunn holds the B.D. degree from The Divinity School and the Ph.D. from The Graduate School of Duke University.
1. Thomas Blackburn, "The School of Babylon," quoted by May Sarton, "The School of Babylon" in Don Cameron Allen, ed., A Celebration of Poets (Baltimore: The Johns Hopkins Press, 1967), p. 131.
2. Ibid., pp. 131-151.
3. Ibid., p. 143.
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theological education. If one allows a casual and superficial en- counter with the figure to lead him along the way of old hostilities and half-forgotten frustrations, he will find the subtle pleasure of prejudice confirmed but he will pass by the exhilarating joy of a new perspective unveiled. So I ask you in the beginning to resist the temptation to identify particular professors or administrators as Nebuchadnezzar and to forego the satisfaction of defining certain academic experiences as a fiery furnace.
The power of this poetic image arises in large part from its in- clusiveness. The image appropriates our storied past but is not limited to what happened to us "back then." It focuses our attention on what is happening "right now" as we seek to realize our calling in the immediate present. "This is the School of Babylon." Wher- ever we are and whatever we are doing as men and as ordained ministers, we are enrolled in "the School of Babylon." When we think about our lives under the guidance of an inspired image like this, we may be freed from the illusion that we have to pick and choose from what happens to us in order to make life tolerable. "The School of Babylon" administers a course of study which includes all our ex- periences: the good and the bad, the exciting and the boring, the joyous and the sad. Here we are instructed not by what we accept as desirable or reject as undesirable but by the entire gamut of un- censored and unrestricted events as they occur. The image itself challenges us to affirm the reality of life instead of some fancy about a part of it.
Now I think this is what faith is all about. It is a trusting re- lationship to what really is; an attitude of confidence toward what actually happens. The image, "the School of Babylon," may become the occasion for a decision about the trustworthiness of reality. Yet it does not endorse Pollyanna romanticism any more than it pro- motes the "power of positive thinking." It simply confronts us with the fact that we live in Babylon. What does that mean? Just this: in all that we think and do we overstep our human limits by claiming absolute and unconditioned value for that which is relative and contingent. This idolatrous claim is not restricted to some special sphere of life, nor is it the particular vice of the wicked as distin- guished from the righteous. It breaks out everywhere and in every- body. "This is the School of Babylon" because here on earth we are always making images of gold.
This insight can be applied to any realm of human experience but it is particularly appropriate for those of us who are professionals
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in the religious sphere. No matter how we complain or resist, as clergymen we are supported by organized religion, the institutional church. We are the establishment. This religious organization is Babylon, for it often claims that its relative and contingent forms and doctrines have absolute and unconditioned worth. This holy institu- tion is sometimes no more than an image of gold which we have made. We not only fall down and worship the golden image but we seek to compel others to join us in our idolatry. The words of King Nebuchadnezzar have a familiar ring: "If you are ready ... to fall down and worship the image which I have made, well and good; but if you do not worship, you shall immediately be cast into a burning fiery furnace ; and who is the god that will deliver you out of my hands?" These are familiar words because they have been used to bring us to our knees before the golden image and we have used them in the name of the institution to force others to serve our gods and worship our idol.
So this is Babylon. The only world we know is the realm where we make our idols. Yet Babylon is not a prison but a school. "This is the School of Babylon." Babylon is not simply the place where idols compete for our allegiance ; it is also the setting of our growth and development as persons. It is important that we recognize the complexity of our relationship to Babylon, for if we assume a simple attitude of either whole-hearted friendship or outright enmity we will destroy the creative tension which encourages our highest achievement. There is no escape from Babylon but there is the pos- sibility of going to school in Babylon.
A man, especially a clergyman, is blind if he cannot see the idolatrous reality of contemporary church life. But that observation alone leads a man to frustration, cynicism and withdrawal. Without becoming the least bit sentimental, it is possible to affirm that a man, even a clergyman, may see that institutional religion, although it worships its idols, is one of those Babylonian structures which nur- tures and stimulates his growth as a human being. One might argue that there ought to be some other kind of setting for our schooling in humanity. But to what purpose? Either we get our schooling in Babylon or we don't get it at all.
I didn't really intend to raise this subject. But what I thought I meant has given way to the pressure of what I really mean. I have always had trouble coming to terms with the establishment. My problem is even more acute now that I am the establishment. I don't claim at this stage to have reached a final solution. But the ministry
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of this inspired image, "the School of Babylon," has exposed me to the creative possibilities of growth within the tensions of my relation- ship to the institutional church. Faithfulness, at least for me in my ministry, requires that I walk the straight and narrow path of af- firmation of the reality of the church, neither wandering off into flabby complacency nor withdrawing into unyielding hostility. As I make my precarious way, hardly managing to keep my balance, one of the stabilizing forces is the simple assertion : "This is the School of Babylon."
II. This is the School of Babylon And at its hands we learn.
Paul Lehmann has argued forcefully that the mission of the church is the humanization of man.4 If that is true, and I assume it is, then the competence of those who serve as clergymen in the church can never be reduced to narrow professional skills but must be mea- sured against the standard of true humanity. Competence to minister is basically competence as a human being or, as the author of Ephe- sians puts it, "mature manhood," "the measure of the stature of the fullness of Christ." Lacking this fundamental competence in man- hood, skills in the various clerical functions are the form of ministry without the substance.
Where does one learn what it means to be truly human? As an administrator in a theological school I am haunted by that kind of searching question. I am tempted to overstate the case for theological education as a schoolmaster in humanization, but my experiences as student, teacher and administrator place me under great restraint. I suppose the highest praise I can give this Divinity School is to say that my years here have helped me to affirm the pedagogy of the School of Babylon. About all I can claim for theological education is that it may inspire one to go on learning at the hands of Babylon throughout all his days. And if that claim is realized now and then, it is enough to justify the process.
How does Babylon instruct men in humanity? The answer is not different from what Babylon is. "At its hands we learn" what is ultimately important, for Babylon in all its forms demands that we decide under whose allegiance we will live. And that decision about our heart's devotion is absolutely crucial in defining what kind of men we are. Life's loyalties are decided in the shattering encounters
4. Paul Lehmann, Ethics in a Christian Context (New York: Harper and Row, 1963).
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with the golden images of Babylon whose devotees promise death to all who refuse to serve their gods.
You see, Babylon is the only setting for revelation. "At its hands we learn" to recognize the images of gold and the tyrants who build them. And that is not all we learn. In the classroom of confrontation, where the relativities of history are absolutized, we encounter the Absolute whose being is made known to us in the ambiguities and contingencies of our Babylonian captivity. Here in this struggle to determine what is ultimately important we settle the issue about the measure of mature manhood. If we fall down and worship the image of gold, we say that the measure of a man is determined by his own power. But if we say "no" to the idol, we proclam that the measure of a man is determined by God's purpose. The grandeur of Babylon is not the power to make men kneel before its images of gold but the courage which enables men to stand before tyranny in the name of the Most High God. In defiance of Nebuchadnezzar, Shadrach, Meshach and Abednego said : "Be it known to you, O king, that we will not serve your gods or worship the golden image which you have set up." The true glory of Babylon is not the pomp and power of Nebuchadnezzar but the mature manhood of men of faith.
If we have not learned at the hands of Babylon what it means to be a man, it matters little what else we may have learned about the techniques of ministry. Our ministry is in Babylon and for Babylon. Here we are called to advance the humanization of man. We qualify for that task not just by acquiring certain professional skills but by becoming mature men. Growth in manhood always involves a de- cision about whom we will serve : Nebuchadnezzar's gods or the Most High God, the God of Shadrach, Meshach and Abednego.
Learning at the hands of Babylon is always a rite of passage. Once a man has passed through the ritual nothing is ever the same again. The passage is never automatic or cheap. But always it comes as a possibility which can only be claimed by a tremendous act of will and at an incalculable price. Yet the transformation which one experiences in a decision to serve the Absolute is not self-induced. The Most High God is the author and finisher of our faith. Because the Absolute has claimed us we can faithfully commit ourselves to his service. Hence, to come of age in the School of Babylon, to learn at its hands, is to be saved by grace. The essential competence for ministry, mature manhood, "is not your own doing, it is the gift of God — not because of works, lest any man should boast."
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III. This is the School of Babylon
And at its hands we learn
To walk into the furnaces
And whistle as we burn. It's a dangerous business to undertake the evaluation of one's own ministry or the ministry of another. The only thing I know more hazardous is the decision not to make any evaluation at all. So, fully aware of the pitfalls along the way, I turn now to some judgments about ministry. I hope they will not sound too judgmental. It seems to me that we can hazard certain judgments about our com- petence and effectiveness as ministers by considering how our school- ing at the hands of Babylon has brought forth fruit in our lives. If we have learned mature manhood in our encounter with idols and idol-makers, then that fact will be manifest in our ability:
To walk into the furnaces And whistle as we burn.
"To walk into the furnaces" is to unmask the idols and the idol- makers and denounce them for what they are. I can't think of any ministry that is more desperately needed at this moment in our his- tory or that is in shorter supply. "To walk into the furnaces" de- mands that one forsake the asylum of safe generalities for the ex- posure of specific action in response to concrete issues. Our cities are rotting at the heart ; our rivers and streams are fouled almost beyond redemption ; our atmosphere burns the lungs and blinds the eyes ; our human resources are either neglected or squandered. And yet, in the face of these real and present threats to our existence, we are preoccupied with the deployment of an ABM System, the de- velopment of a Supersonic Transport, and the pursuit of an immoral and insane adventure in Southeast Asia. While we decrease our commitments to those programs designed to humanize our lives, we increase our expenditures for projects which have already made it difficult for millions to live as human beings on this planet.
These are the furnaces of our time. If you have any doubt about their fiery flames, ask those who have walked in them. Ask the men and women who have been harassed and hounded from this country by the very legal structures designed to protect their in- dividual rights and personal dignity. Ask those who have been per- secuted by the federal police power in an abortive attempt to silence their dissent from the government's policies. Ask the conscience- driven critics of our culture who have experienced at first hand the
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burlesque of legal procedures devoted to punishing protest and vin- dicating things as they are.
The furnaces raise the fundamental question about our compe- tence for ministry, for they are the proving grounds of our manhood. The conclusion is unavoidable : if we have not learned "to walk into the furnaces," then we have failed the qualifying examination in the School of Babylon. If we really want to establish the credibility of our ministry and remove the questions about our manhood, the fur- naces of Babylon provide all the opportunities and programs we need. One man, walking in the furnaces, is worth more than a thousand conferences on the renewal of ministry.
I cannot overemphasize the fact that in Babylon the basic issue is not priesthood but manhood. In our town, as in most towns, we have a public school system devoted to "death at an early age" for any signs of intellectual curiosity and enthusiasm for learning. One manifestation of the oppression of the system is the determination of administrators and teachers to maintain conformity among the stu- dents in dress and hair styles. I have a young friend, a junior in high school, who last week found himself threatened by the system. He came to school wearing a medallion on a ribbon around his neck. The assistant principal told him to take it off. He said, "No." He was warned and ordered once more. Again he said, "No." Then he was told that he had five minutes to report to the office. The five minutes passed and still he remained obstinate. He was commanded to go to the office. His answer was the same, "No." At last the principal and assistant principal carried him bodily from the room. I don't know what else he learned that day in school, but I'm fairly sure that he learned what it means "to walk into the furnaces" and be a man.
I think we are entering into a period of severe testing in this country for all who commit themselves to the humanization of man. The testing will come at the point of deciding our priorities. Specifi- cally it has already come and is mounting in intensity as we are forced to decide which is more precious, the order of society or the rights of the individual. What is demanded now is men with insight and courage to say "no" to those powerful forces of government and industry which place a higher value on maintaining the order of social organization than on enhancing the dignity and freedom of persons. When the issue is the inviolability of the individual conscience, there can be no compromise. The law, no matter where it originates or how it is sanctioned, has no right to reach "into the personal domain
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of a man's soul."5 As David King has said in reply to George Ken- nan's criticism of the Student Left, "In the end, every individual is responsible to a higher authority than the government and whether it is religious or personal, it is sacrosanct."6
Will the democratic processes and structures of this country be used to promote social order at the expense of social justice? The prevailing mood of the comfortable majority is becoming alarmingly clear. The "forgotten man" seems to think "order more important than justice."7 His spokesman has raised his voice to shout that he will not be influenced by those who are criticizing our policies in Viet Nam, while at the same time he has lowered his voice to listen to the counsel of those who place profit before people. Government at all levels is obstinately deaf to the cries for social justice but is quick to hear the screams for law and order. To such an abuse of the privileges of power the answer must be "no." If we do not speak out now clearly and courageously, history will record that we chose to kindle the fires, refused "to walk into the furnaces," denied our manhood, and forfeited our ministry.
If we learn in this crisis "to walk into the finances," we will also learn to "whistle as we burn." As I have talked with some of my friends who have chosen to leave the ordained ministry and as I have faced the possibility of that choice for myself, it seems that the one thing that makes that choice attractive is the meaninglessness of much that we do. Now I don't think we can overcome that empty feeling of purposelessness through a frenzied program to glamorize the life of a clergyman. But I do believe that when a man has made a costly commitment to the humanization of life on this planet, his time for burning lights up all that he is and does so that in the face of the absurdities and frustrations of his existence he can affirm ultimate meaning for human history.
What I am talking about is not to be confused with whistling in the dark. Whistling in the dark is the desperate effort of those who walk alone to reassure themselves with they puny sound of their own chirping. But whistling in the fire is the confident assurance of those who burn that they never walk alone. Such men are not sustained by their whistling. On the contrary, they whistle because they are sustained by the Absolute which has claimed them absolutely. For
5. Stephen Spender, The Year oj the Young Rebels (New York: Vintage Books, 1969), p. 120.
6. Ibid., pp. 120-121.
7. Ibid., p. 152.
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such men burning never comes as a surprise. They know that as surely as tyrants make images of gold they also build fiery furnaces for men who refuse to worship and serve their idols. So they do not whistle to escape the fire but they whistle because, even as they burn, they are aware of a power and presence which gives meaning and purpose to the choice they have made. The determination to throw all one's resources into the struggle to humanize life is always highly personal and often lonely but it is the foundation of the only true community available to men on this earth. Men who "walk into the furnaces" find themselves in good company, the goodly fellowship of "those who were truly great,"8
.... Who in their lives fought for life,
Who wore at their hearts the fire's center.
Born of the sun they traveled a short while toward the sun,
And left the vivid air signed with their honour.9
I have told you more than I thought I meant. Perhaps I have even revealed what I really mean. Along the way you may have discovered that we are classmates in the same school where we sing the same song. Therefore . . .
We praise the School of Babylon, For where else could we learn, To walk into the furnaces And whistle as we burn ?10
8. Stephen Spender, "I Think Continually of Those Who Were Truly- Great," in Oscar Williams, ed., A Pocket Book of Modern Verse (New York: Washington Square Press, 1965), p. 505.
9. Ibid., p. 505.
10. Thomas Blackburn, op. cit.
Dean's Discourse
Is the Medium the Message?
The American Association of Theological Schools will hold its biennial meeting in June of 1970. One of the principal reports of a sub-committee which will come up for discussion and possible action is that of a Committee on the Professional Doctorate as a First Theological Degree. The preliminary report was submitted to the member schools in October 1969 and regional hearings have been held in various parts of the country to receive and assess the evalua- tion of member schools. The actual recommendations are as follows reproduced in part :
"Recommendation 1 : We recommend that the term Bachelor of Divinity (may) be phased out. We affirm the tendency in American education and culture by which the bachelor's degree is understood as the basis for graduate studies, academic or professional, and that professional fields with a B.A. prerequisite continue with masters' and doctors' degrees. . . .
"Recommendation 2 : We recommend that a professional doctorate be the standard degree for the practice of ministry. (D.Min. or D.Div.)
"We recognize that, in the continuing process of reexamination and restructing, faculties may well find that an adequate professional doctoral program will require approximately four academic years. This, in fact, already prevails in many B.D. and M.Div. programs. In view of the report, Theological Education in the 197 0's, and new awareness of the variety in and shifting nature of ministry, we find it wise and proper to refrain from specifying requirements beyond those now pertaining to the accreditation of the B.D. -M.Div. We expect the change in nomenclature to be coupled with serious attention to the professional character of this degree. We encourage experimentation by faculty and students and ex- pect a strengthening of both the academic rigor and the integration of field education and/or internships into such a doctoral program, both through professional supervision and by programs placed at significant points in the life of church and society.
"We also recognize the place for a seminary program of shorter duration than that of the professional doctorate. One of the new facts of theologi- cal education in the 1960's has been the growing number of students who find seminary education significant as their preparation for various careers that call for theological perspective and knowledge. Field edu- cation may be either optional or required. We suggest that such a pro- gram be normally of two years' duration, although well-prepared students
29
may qualify for the degree in less time. Such a degree could be called M(aster) of T(heological) S(tudies), and may be analogous to the M.R.E. and M.S.M."
Of interest to our readers may be the response of the faculty of the Divinity School adopted at regular meeting for November 1969:
"While it is acknowledged that we are in a period of experimentation in American education and that in theological education the proposed pro- fessional doctorate could be regarded as a symbol of innovation and up- grading, we do not favor the recommendation contained in the Report of the Committee on the Professional Doctorate as a First Theological Degree, namely, that a 'professional doctorate be the standard degree for the practice of ministry.' Our reasons for a negative response are out- lined below.
1. The question of a professional doctorate as the basic theological de- gree cannot be reduced to a mere consideration of 'nomenclature.' This is perilously near to obscurantism that may be prompted more by con- siderations of a competitive society than by either the norms of the Gospel or integrity of honest educational objectives. In limiting its recommendation to the specific matter of nomenclature the committee has by-passed the more profound question of what is a standard theologi- cal education. What is meant by a professional doctorate? In an effort to achieve 'equality of nomenclature' the committee has reversed the order of priorities. Before a change is made in the name of the standard theological degree, it is essential that changes in the substance and dura- tion of the degree program be delineated. To attempt, by a change of title, to 'equalize' the status of the ministerial profession with that pres- ently associated with such professions as medicine and law would be a response to pressure and circumstance but not necessarily an up-grading of the degree program. Something more is needed in theological educa- tion than the equalization of degree titles with those used in other schools.
2. On the premise of a "professional doctorate" as the standard theologi- cal degree either the generality of existing candidates would not qualify or the degree would be unworthy of the level of attainment claimed for it.
3. The Committee nowhere indicates that it has inquired of the churches whether they regard the doctorate as a needed level of certification of the practicing ministry.
4. To make a professional doctorate retroactive would adulterate and hold the degree up to ridicule ab initio.
5. A doctoral program may not be feasible in all theological institutions in view of differences in size, location, denominational affiliation, and declared intention. It is apparent that if a number of schools adopt the doctorate as the first degree, others will inevitably have to try to follow. This could work to the disadvantage of schools limited in financial and other resources. Few persons will deny that the change as proposed by
30
the committee will be expensive. For the most part the churches pay the bill for theological education. At the present time the financial sup- port from the churches is inadequate to support a three-year program.
6. The Committee's sharp differentiation between a professional and research doctorate does not justify in our view the awarding of the doctorate as the first theological degree.
Our reluctance to approve the professional doctorate as a first degree does not necessarily mean that we oppose such a doctorate as an advanced theological degree."
The Preliminary Report, perhaps in an altered form, will come up for review and action by the Biennial Meeting of the A.A.T.S. in June of this year at Claremont, where, already for some years, a four- year professional doctorate has been the basic degree program. The biennial agenda and the place of meeting have an interesting coinci- dence. At the present writing the Preliminary Report, however, does not recommend a four-year program, but merely a change of "nomen- clature" without specifications.
Implicit in the proposal is an unstated premise to the effect that a fully professionalized ministry is both relevant to the needs of the hour and is an adequate as well as suitable image of the ministry for tomorrow. Unstated also is the presupposition that the ministry, considered with respect to relevant function, takes precedence over a learned ministry, rooted in Biblical sources or historic revelation. The look is to the future ; the professional is to be groomed for it ; indeed, a prevailing ahistorical perspective presides over the pro- posed pedagogy and its product.
Thus, by a succession of stages and steps, the A.A.T.S. — which began as an accrediting agency to enhance the standards of Ameri- can theological education — has become the chief promotional agency — with empowering Foundation support — for the up-dating of the image of the minister in the direction of full professionalization as the norm of excellence. In a true sense it is the benevolence of Foun- dations, not the Churches, which is greatly influential in the shaping of the new ministry under the auspices of the A.A.T.S. So far as I am aware the views of the Churches and practicing churchmen have not been consulted either as to the end-product in view or as to costs in educational outlay. With respect to the former — that is, the prod- uct or the ministry to be nurtured — it is doubtful that there will be sufficient alertness to the issues to expect either cautions or dis- suasives from beleaguered churchmen. So confused is the present
31
climate and so wanting is any articulate consensus among churchmen concerning the desired or desirable shape of the ministry, that, in their perplexity, few churchmen, I think would incline to dampen any, however forlorn, hope that greater professionalization might relieve the doldrums presently afflicting the practicing ministry.
Thus, silence of perplexity on the part of churchmen may contrive to lend just the needed consent of desperation that will put the pro- fessional doctorate on the ways as the basic degree for ministerial education at Claremont in June. If so, one may hope that it will be more than a change of nomenclature, that it will be at least a four- year program "beefed up" to a measure that will preclude its being made simply retroactive as in the case of the Juris Doctor, the new Law degree. Even so, it will be the pedagogy of as radically an ahistorical era as men have known since the Enlightenment. It is, I suppose, a minor concomitant that it will require another decade of vast curricular overhaul and readjustment.
It matters not, especially, if what God requires and Christ's king- dom most needs these days are professionals ! After all, we have been instructed of late that "the medium is the message." On that anti- intellectual and positivistic basis, it is evidently presumed that pro- fessional doctors will provide viable media for becoming the message. This would be, indeed, a radical innovation in the reshaping of the ministry.
— Robert E. Cushman
Book Reviews
The Growth of the Biblical Tradition: The Form-Critical Method. Klaus Koch. Translated by S. M. Cupitt. Scribner's. 1969. 233 -f- xvi pp. pb. $6.95.
This book is presented as "a guide for students, as an introduction to form-critical research. . . ." (p. ix.). The need for such a guide has been felt for some time. Though the form- critical method has been an impor- tant discipline in biblical criticism since the beginning of the century, no adequate systematic presentation of the method itself has appeared. Until recently, the best descriptions of the methodology were to be found in the programmatic articles of Her- mann Gunkel, written more than half a century ago.
Koch attempts to present form criticism as a method for both the Old Testament and the New, but his roots are clearly in the Old Testament side of the discipline. He first de- scribes the various methods of form criticism: 1. the determination of the literary type or genre, 2. the history of literary types, 3. the search for the situation in life, 4. the history of the tradition (essentially at the oral level), and 5. the history of redaction (the literary stage of transmission). In each of these sections he shows how the various questions may be raised and answered by using the Decalogue and the Beatitudes as ex- amples. Secondly, Koch discusses the relationship between form criticism and some other issues and methods in biblical criticism, namely, literary criti- cism, the "oral tradition" school, the problems of Hebrew poetry, and issues concerning the canon. Third, he dem- onstrates the form-critical method by examining selected biblical texts from the narrative books, the songs, and the prophetic writings.
This book can serve as a very use- ful pedagogical tool, but it must not be read uncritically. One of its major problems is that it perpetuates a con- fusion which has run through the history of the form-critical approach to the bible, that is, an ambiguity in the use of the terms "form" and "type." Koch himself asserts that "it is useless to try to differentiate be- tween 'type' (Gattung) and 'form' {Form)." (p. 5, n. 5.) But type (or genre) is one concept and form (or structure) is another. One of the im- portant facets of a given genre (or type) is its form (or structure), but, as Koch himself points out, both form and content determine type (p. S ; and cf. the review of the German edition in Dialog, 5 [1966].).
Though it is a method which must be employed in concert with other approaches to the biblical text, form criticism has a very important role to play in interpretation. "It has arisen out of the recognition that we are faced here with a view of things which can provide us with a deeper understanding of the ancient texts, and which could make contact with them relevant to our own times. In my opinion this is because form criti- cism brings out the link between literature and life, between the bibli- cal text and the history of God's people, in a way hitherto unimagined." (p. xi).
— Gene M. Tucker
/ Saw a Nczv Earth: An Introduction to the Visions of the Apocalypse. Paul S. Minear. Corpus Books, 1968. 385 pp. $10.00.
If there is one area of Biblical study which needs the concerted ef- fort of scholars, it is indeed the area of apocalyptic literature in general and the book of Revelation in particular.
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This new book by one of the more respected New Testament scholars deals with the interpretation of Reve- lation. It is well written and thor- oughly provocative, and it is intended as a "companion" for a study of the Apocalypse for student and minister.
The work itself is divided into three parts : part I gives a translation and exposition of the text; part II con- tains essays on debated issues con- nected with the book and its interpre- tation; and part III is an annotated translation of the text. Part I is especially interesting and beneficial for the student. There are four head- ings which are utilized in the study of the various parts of the text: 1) a translation of the text; 2) a literary analysis of the text ; 3) a section which contains suggestions for reflec- tion and discussion ; and 4) a biblio- graphical section to direct the student in his further study.
It would be indeed difficult, if not impossible, to relate to the reader even a small precis of the wealth of information contained within this very fine work. Perhaps it would be best to indicate one of Minear's chief themes in his attempt to interpret Revelation. Basically he feels that the book is written to the people of the churches to challenge them to loyal endurance and to warn against apos- tasy and false prophets in the midst of the churches. This latter point is especially predominant in this writing to the point of Minear's transferring many references concerning judgment, usually interpreted as being directed at the persecutors of the church, to the apostate Christian : for example he interprets the "Lamb" figure of chap- ter 13, usually thought to be the cult of the Emperor as ". . . the inroads of deceptive prophecy within the Church. . . ." (p. 256) He challenges the usual view that 666=Nero and the view that the "wounded" head refers to Nero. He says, "It [the wounded head] was the plague of death released through the Messiah in his own crucifixion and exaltation." (p. 254)
It would be impossible to enumer- ate all the very significant points set forth in this book or to enter into a discussion of the controversial ones. There are many points with which this reviewer finds himself in agree- ment with Minear (sometimes for different reasons, however), and there are various places where one could quarrel with him. This is especially true with his basic emphasis on the false prophets within the church and his contention that the judgment is primarily upon them rather than on the persecutors. Nevertheless, this is a very good work on the book of Revelation (we need more), but it is not really for beginners. The arrange- ment leaves something to be desired since certain points are made in part I which are discussed in detail in part II. This does not cause great difficulty, only annoyance at points. Some of the translation is excellent, and Minear is to be complimented on this. An excellent bibliography divided into four parts is included which the student will find most help- ful.
New Testament scholarship is again indebted to Professor Minear. Hope- fully, this work will arouse greater interest in this very important aspect of the New Testament and cause further discussion and research into apocalyptic in general and Revelation in particular.
— James M. Efird
Saint Paul: A Study of the Develop- ment of his Thought. Charles Buck and Greer Taylor. Scribner's, 1969. 278 pp. $7.95.
This new work on Paul is quite adequately described by its title even though it contains much more than a discussion of Paul's thought. It is an attempt to determine a chronology of Paul's life and letters on the basis of the letters. It is assumed that there is development in Paul's theological thought especially in three areas : eschatology, Christology, and legal theory. The attempt is to date the
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letters ". . . on the basis of the de- velopment of the thought they reflect" (p. 9). From this investigation the authors have concluded that Paul's thought in each letter is consistent in these three areas just mentioned. In fact they go so far as to argue that : "In the fabric of each letter, the threads always make a complete pat- tern. There are no floating strands, and no loose ends." (p. 16)
The best summary and outline of the work is supplied by the authors : "We have begun, therefore, with the assumption that the lines of develop- ment which are traceable in the three longest letters, I Corinthians, II Co- rinthians 1-9, and Romans probably extend into the others. Since these three letters can be shown to have been written in that order on grounds [i.e. references to the collection for the Jerusalem church] that have noth- ing to do with the development of ideas, they provide an objective deter- mination of the direction in which the development was moving. Once this direction has been determined it is relatively easy to arrange the other letters in the proper order. That done, it is possible to reconstruct the order of the principal events in Paul's mis- sionary career. And finally it is pos- sible ... to discover where the Acts chronology has gone wrong, and to correct the error in a simple but com- pletely satisfactory way." (p. 19)
The first section deals with the let- ters, their dates, and their "thought." Using only the letters to determine the order, the authors reach the con- clusion that Paul's writings should be arranged as follows : II Thessa- lonians, I Thessalonians, I Corinthians, II Corinthians 10-13, Philippians, II Corinthians 1-9, Galatians, Romans, Colossians, Philemon, and Ephesians. The letter to the Ephesians is con- sidered authentic because it is ". . . exactly the sort of letter we should expect Paul to have written at the end of the theological development that the other letters reflect . . ." (p. 139) The date of the earliest
letter is considered to be ca. Septem- ber 44 A.D. And from this chronology Paul is in Rome ca. 55 A.D.
The second section deals with Acts. The authors do not dismiss it as completely unreliable but rather argue that the facts of Paul's life are es- sentially correct as stated therein but are in the wrong order. The account of Acts has one too many visits to Jerusalem and one journey too few! This had occurred because the author of Acts has used three sources (the Hellenist source, the Journey source, and the Log source) in his compo- sition and because of partial ignorance has placed them together in this man- ner. The misinformation is, however, not so much deliberate as it is an honest mistake based as much on faults in the sources as on Luke's ignorance.
In the third section a kind of syn- thesis is outlined. Paul's theology can be summarized by three stages. First, there was the idea that Jesus was soon to return; this came from the experience on the Damascus road. Secondly, there was the idea that Jesus had freed men from slavery to sin, which came from his meditation in an Ephesian cell possibly awaiting death. Finally, there was the idea of Christ's life of love and forgiveness, which stemmed from the Jerusalem Council. This Council, according to the authors, does not glorify Paul as the champion of Christian freedom but depicts him as a bitter man who angrily accuses the apostles of an action of which they are not guilty. "In a word, what Paul experienced at the Council was not merely vindica- tion of the position he had taken during the [Judaizing] controversy but forgiveness from those he had wronged." (p. 256)
The book is fascinating reading. It plows some old ground with a new blade. At times it seems almost bril- liant; at others naive and almost ignorant of Pauline studies. The present reviewer is quite open to the idea of development in Paul's thought,
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to the order of composition which these authors list for the letters, and to the basic idea about Acts as a sec- ondary source, at times confused. But it does seem strange, however, that so little is made of the occasion for Paul's writing and how these factors shaped what he says in the letters. One gathers from reading this work that the occasion for Paul's writing is only the opportunity for him to set down his new thinking which has emerged from his own experiences. Further, there appears to be little understand- ing of Paul's Rabbinic interpretation (cf. p. 63, p. 72, n. 2, and p. 99). In the discussion of eschatology from imminent to present no mention is even made of the problem which arises from Philippians 4 :5 or Romans 13:1 Iff. And, in spite of what the authors say, their argument does suffer from circular reasoning.
Nevertheless, the present reviewer recommends this book for careful study because it definitely stimulates one's thinking about Paul, his life and thought.
— James M. Efird
Christian Community and American Society. Waldo Beach. Westmin- ster, 1969. 190 pp. $6.00.
In this book of nine brief chapters, Waldo Beach has given us a straight- forward, lucid and insightful introduc- tion to the dialogue between theology and social science which is at last getting under way today. He sets out to examine the meaning of com- munity from the point of view of Christian ethics as a normative sci- ence, "setting the terms of the good life as understood in the Hebrew- Christian tradition," and sociology as a descriptive science. His thesis is that the analysis of American society by contemporary sociologists, their description of the loss of community and some elements in prescription for its recovery, accords with the basic insights of Christian theology. He spells out the fundamental theological assumptions underlying the Christian
understanding of community and ex- amines the value assumptions, ex- pressed or covert, operative on all levels of the social scientist's enter- prise. Beyond the mutual put-off of the theologians and social scientists' stereotypes and caricatures of each other lie common concerns that make dialogue imperative and promising.
Beach focuses on the concept of anojnie, or normlessness, which soci- ologists have used to account for the loss of community. The negative as- pects of American society, alienation, anonymity, conformity and status- seeking, are exposed, and both secular sociological and Christian solutions examined. Whereas the sociologists generally prescribe some version of individualism in the face of the threat of the collective, Christian ethics ad- heres to the norm of agape, commun- ity-creating love. The Christian view of community is applied, in the last three chapters of the book, to the problem areas of politics, race and the university. The theological moments of creation, sin and reconciliation and the ethical qualities entailed in Chris- tian community, explicated in the first several chapters, are here adduced as illuminating insights for under- standing the dialectic of love and jus- tice, the nature of political choice and compromise, the sin of racial pride, the movement toward an integrated society and the recovery of community in the university.
The reader of this book will have his own questions and cavils, depend- ing on his point of view. Because of the breadth of territory surveyed, depth of treatment is sacrificed at some critical points. To speak of a dialogue between "theology" and "so- ciology" suggests a homogeneity of each group that is conspicuously lack- ing in the real world. Beach explicit- ly adopts the theological approach of H. Richard Niebuhr, supplemented at points by insights from Reinhold Nie- buhr. While admittedly a major op- tion in American theology, and gen- uinely ecumenical in substance and
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spirit, it does not adequately reflect the movement and tenor of current theological discussion. A wide-ranging selective bibliography at the end of each chapter serves as a guide to the intramural debates in theology and sociology, but this debate is scarcely echoed in tbe treatment of issues in these disciplines. Consequently, the substance and methods of Christian Ethics appear less problematical than they in fact are in our situation today. Beach himself is vulnerable at the points at which the Niebuhr brothers can be criticized. H. Richard Nie- buhr's preoccupation with the Chris- tian tradition and his view of "Christ transforming culture" is somewhat eclipsed currently by the theologians of hope with their concern for es- chatology and its implications for a political theology. Reinhold Niebuhr's reduction of theology to a set of her- meneutical principles for the interpre- tation of history and society tended to ignore the role of the church as Christian community. In seeking to provide a Christian justification for democracy, he came perilously close to identifying the two; in Reinhold Nie- buhr's view, democracy was the only viable political system for the Chris- tian. Beach and Niebuhr's ideological bias (pp. 128, 139, 144) reveals an ethnocentric view of the relation of Christianity and American society. Beach asserts that "Christian com- munity" is the guiding norm for the state, i.e., for the citizens in their political relations. But this is to say both too much and too little. Too much, on the one hand, for some secular thinkers have paralleled Christian insights with principles and norms which serve the same function but without appeal to theological or metaphysical sanctions. Too little, on the other hand, because it treats the Christian faith as a set of insights and interpretative principles which if ab- stracted from a community of faith lose both their compelling sense of validity and their impelling power of motivation. Beach criticizes the view
of those who make the community of faith coterminous with the whole so- ciety in the name of an American national "religion." But he nowhere deals with the question of where the Christian community may in fact be located. It may in theory be the pro- totype of all genuine community, but if it is more than a Platonic ideal — and historically it is certainly other than a Platonic ideal — it must have a social base, a "reference group." This points to a serious lacuna in the book — the failure to provide a sociological analysis of the Christian community in America. The viability of "Chris- tian values, or the norm of Christian community" (p. 123) should be dem- onstrated within the church, if any- where. While the dust jacket of the book carries an abstract design of a church, an examination of the institu- tional church is missing within (and by intent, p. 127), except in the recog- nition that the church too is plagued with anomie (p. 124). The church's contribution is "the word of the Chris- tian theologians to the problem of community" (p. 124). It is under- standable if secular sociologists are unimpressed with "Christian commu- nity" if it remains discarnate, a matter of what Beach himself calls "glittering generalities" (p. 139).
The Christian perspective may en- able one to make evaluations of society from a "perch transcendent of the crowd" (p. Ill) but the urgent prob- lem in ethics — as in sociology — today is "what difference does it make?" While chapters are devoted to race and to the dynamics of American democracy, the failure to stress racism and injustice in the general analysis of American society points up the danger of remaining too long on the "perch transcendent." While appreci- ative of the compactness of this study, I could not but feel disappointed that the really critical issue of our time — the revolutionary demand for freedom now on the part of minority groups in this country and the Third World — is treated only in passing recogni-
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tion that both conservatives and revo- lutionaries have sought legitimation of their political ideology in the Chris- tian faith. The constructive sugges- tions in the book are too brief and sketchy. The high level of abstraction on which the two disciplines are treated contrasts with the level on which the problems of social and eco- nomic inequity, racial conflict and uni- versity turmoil are confronted. This does not vitiate the analysis, but it does necessitate the careful explication of middle axioms, a way of moving from abstraction to action. With all that sociologists might learn from theologians, they can teach a concern for the operational use of concepts. Ethics should be more than "judg- ment" ; it should throw light on what ought to be done in light of what can be done. At this point the dialogue between theology and sociology can be of more than theoretical interest, indicating the possibilities and limits of action in concrete situations.
By limiting himself to analysis at the expense of proffering solutions, Beach has achieved a surprisingly comprehensive study of the problem areas of politics, race and the uni- versity. The ambiguity of universal principles provided by a particularistic faith in a pluralistic society remains to the end and makes this readable book a provocative source of discus- sion for students of contemporary religion and society. May it speedily appear in paperback !
— Thomas E. McCollough
Norm and Context in Christian Ethics. Edited by Gene H. Outka and Paul Ramsey. Scribner's, 1968. 414 pp. $7.95.
Some theories and fashions in the- ology and ethics are ephemeral, some are perennial. God is dead is dead. But the storm raised about "situation ethics" or the "new morality" is of more permanent importance. Despite the claim of Professor James Gustaf- son (who contributes a discerning
piece to the volume) that the debate was "misplaced," it will not fade out soon. This compendium of essays, edited by two Princeton Professors of Christian ethics, is the most thorough- going scholarly analysis of the con- textual ethics school, its forbears, its proponents, and its opponents that we have had thus far, containing over four hundred pages of close reasoning and pungent argument.
It's quite an assemblage of minds. Four of the fourteen scholars are Roman Catholic; several are English dons. Contextual ethics is not an ex- clusively American or Protestant phe- nomenon.
In one sense much of the debate is indeed a semantic one. But even after one has determined the degree of hardness or flexibility of key words like "principles," "rules," "laws," "maxims," etc. (as Gene Outka's es- say sorts them out), there remains a substantial division of the house be- tween the "principled" and the con- textual ethicists. What is surprising to note, however, are the rich historic precedents for the situationist's per- spective. Fathers Curran and Hiring are at pains to exonerate the Catholic "natural law" tradition for the charge of legalism and affirm its dynamic flexibility, while Professors E. L. Long and David Little interpret Lu- ther and Calvin in similar terms.
Properly understood, situation ethics moves between the opposite perils of legalism and lawlessness to a position beyond those centered on agapeic love. As Frederick Carney's opening essay delineates, however, Christian love's distinctive style is faithful love issuing in just action. The relevance of this norm is advanced by James Gustafson's treatment of Christian moral discernment. The problem of application is not much advanced by Paul Ramsey's own piece, where he floats off for sixty-eight pages on a cloud of refined and precious distinc- tions.
Professor Joseph Fletcher, whose Situation Ethics is the most widely-
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known statement of the new morality and who may be regarded as some- thing of the chief hero or villain in this affair, contributes a restatement of Situation Ethics, typically brisk, arresting, beguiling, and a bit slippery. (His essay is then painstakingly if pedantically taken apart by two En- glish Professors of Philosophy.) In the criss-cross of argument, this re- viewer finds Fletcher most convincing in his charges against legalism, but somewhat less persuasive in specifying the character of Christian love as dependent on its theological faith, or what he calls "metaethical considera- tions." His reading of how love is to decide moves too close to the prox- imate factual context of the immediate situation and too far from the ultimate theological context of faith which gives love its distinctive Christian style.
— Waldo Beach
Dialogue in Medicine and Theology. Edited by Dale White. Abingdon, 1968. 176 pp. $1.95.
In the spring of 1967 several hun- dred physicians and clergymen were invited — under the joint auspices of the Mayo Clinic, the Rochester Metho- dist Hospital, and several agencies of The Methodist Church — to Rochester, Minnesota, for a Convocation on Medicine and Theology. The stated purpose of this meeting (too lengthy to reprint here) was generally ac- knowledged, as one participant put it, to be "more and better communication between physicians and clergymen." The volume reviewed here contains the major addresses given at that con- vocation.
As one who listened to these speeches, I have found it interesting now (after three years) to read them and reassess my initial impression of the convocation. I thought then that the range of participants and plenary session topics provided little oppor- tunity for specialized presentations and that too much time and energy was expended on generalities ; this
judgment has been confirmed in re- viewing the contents of this volume. It is doubtless a function of mutual professional ignorance, which men of medicine and theology share, that conversation between us is ordinarily a miscellany, sometimes banal, of vaguely-held but commonly-supposed interests. Particularly the efforts at dialogue, both at the convocation and in this book, indicate that we do not yet find it entirely comfortable or com- pelling to talk in depth to each other about the things that we care about most.
On the other hand, the principal es- says published in this symposium sig- nify that some physicians and clergy- men are willing to learn from each other and incorporate that learning in reflections upon their respective pro- fessional responsibilities. There is not space here to comment on each of these contributions ; but I think it worth noting that all of these authors make some attempt at inter-disciplin- ary conversation. This is an alto- gether hopeful sign and appropriate undertaking; and it deserves every encouragement.
Physicians and clergymen are in- creasingly obliged to talk to each other (and sometimes about each other!) ; and there is no reason cur- rently to suppose that this obligation will not intensify in the years ahead. If we are ever to get beyond the stage of polite euphemism and anec- dote and down to the business at hand, each of us will have to become better informed about and acquainted with the other. This book, like the convo- cation it reports, is a useful beginning.
— Harmon L. Smith
The Multiple Staff Ministry. Marvin T. Judy. Abingdon, 1969. 288 pp. $6.95.
In a most comprehensive approach the author utilizes wide experience, extensive research, keen understanding of the church's nature and mission, and a broad knowledge of human re-
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lations in presenting a timely and distinctive book at a strategic moment in the life of the church. For some time it has been my conviction that if the witness of the church is to be effective and if the administration of its program is to be efficient there must be two dominant characteristics, namely, long-range planning and co- operative effort. Driven by contem- porary change and challenge, the church has no alternative but to plan wisely and to work cooperatively. There is no better way for these char- acteristics to be displayed than in the multiple staff approach. Thus the book undergirds my conviction.
As indicated by the author, three basic types of materials are used : the theoretical, which deals with theology, sociology, psychology, and administra- tion; the analytical, which deals with statistics concerning staff positions, human relations, and staff understand- ing; and the practical, which deals with administrative procedures for good human relations within the staff. Regardless of the type of material being presented, the author returns to his stated definition :
A multiple ministry is composed of persons under the call of God in the universal Christian church who are selected by a congregation or appointed by a denominational offi- cial to be its chosen leaders. It is constituted or ordained and unor- dained persons, both men and wom- en. It has its mission in sharing a responsibility, of mutual concern and support of one another as it assists, directs, and participates in a local congregation of Christian believers as they assemble for wor- ship and nurture and are dispersed for work and service in the world.
Though there must be definite pat- terns of operation and organization, clearcut job analyses, adequate support with proper fringe benefits, satisfac- tory facilities and working tools, and though there must be excellent under- standing and support on the part of
the congregation, the multiple staff will function only if each person clear- ly understands himself as a person who has adopted, along with other staff members, a common goal and objective and is able to work with others to achieve the common purpose. Professional persons, competent in their respective fields, must be able to blend their contributions in order to carry out a unified ministry to the congregation. To this task the author addressed himself as he developed a theological basis, shared the principles of leadership, opened the broad field of personnel management, and dealt specifically with the task of the senior minister, the associate or assistant minster, the church educator, the church musician, the church business administrator, and the church secre- tary.
My prejudiced hope was that the title of the book might have been "The Multiple Staff Ministry in a Multiple Church Parish," for herein lies my area of concern and respon- sibility. Alas, there are too few such ministries ! In the lone chapter de- voted particularly to this theme the author effectively presents the char- acteristics which are more pronounced in multiple church situation : the ne- cessity to maintain a high degree of local autonomy, the diversity of par- ticipating congregations, the demand for highly motivated leaders (clergy and laity), the importance of mutual support through wholesome staff as- sociations and close family relations, the significance of the relationship with boards and agencies that provide financial support and supervision, the necessity to maintain intense relations between the parish on the one hand and the government and social agen- cies on the other. Add to these the basic factors of coordinated efforts, team planning, constant programming, and continuing preparation, and there seems to be no area of ministry that demands more creative imagination and personal dedication than the co- operative or multiple staff ministry in
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the multiple church situation. If a multiple staff in a station church can achieve established goals, why is it not equally true that a multiple staff in a multiple church parish can achieve comparable goals?
Paramount are the dedication and the qualifications of the senior minis- ter, as well as the qualifications and devotion of all the members of the staff and their readiness to serve with- in the framework of their respective fields of responsibility. The needs of the staff members and the needs of the individual members of the congre- gation will best be met as staff mem- bers understand fully all that is in- volved in a staff ministry. Church administrators and members of a mul- tiple staff would do well to use Judy's book as a basic text and guide, uti- lizing selected resources from the ex- tensive bibliography to create an understanding of the necessity and the potential of a cooperative approach through the multiple staff. Judy's book was not intended to be extensive. It does a good job of opening avenues and providing the base for richer and fuller experiences and research. It is an excellent companion to his The Co- operative Parish in Non-Metropolitan Areas.
— M. Wilson Nesbitt
Liturgies in a Time When Cities Burn. Keith Watkins. Abingdon, 1969. 176 pp. $3.75.
The Reverend Sydney Smith, the caustic English clergyman, once re- marked : "I never read a book before reviewing it; it prejudices one so." I had read Watkin's Liturgies twice before I ran across Sydney Smith's insight, so I cannot make use of his counsel. How does one review a book which bores yet interests one from beginning to end? It is studded with professional gobbledegook, such as : "Worship is a symbolic form that combines words and actions in a stylized expression of the experience of ultimate concern" (p. 46), and "The church, too, must find its way, and
for its provisional design I am pro- posing two elements : paradigmatic story as the approach to truth, and imaginative use of the Christian cal- endar as the approach to contemporary life styles" (p. 101) — presumably when cities burn. Yet it abounds in sentences which prime the thought : "At its best free prayer has a beauty, relevance, and power that prescribed prayer rarely attains. But free prayer is rarely at its best" (p. 84), and "Christian domination of the life of man has come to an end, and this vision of life must now make room for others that seek men's loyalties" (p. 139), and "The survival of the church in any form is of secondary importance. The urgent matter is the survival of the nation and of the world . . ." (p. 150).
The author is Professor of Worship at Christian Theological Seminary, Indianapolis, Indiana, who spent a sabbatical leave with a front-line church instead of in a theological Pentagon. This book is a description of what he experienced and how he reacted liturgically, under the written influence of Ernst Cassirer and Su- sanne K. Langer. But the experience should have been recounted first and the liturgical rationale should then have followed — I think. But, is he talking to me — and to you ? He writes : "I speak to three accusers. A black barber in Seattle, ... a white execu- tive in Kansas City, ... a bishop from New York State" (p. 7). Is he speak- ing to us? Maybe you had better read it to find out.
— James T. Cleland
Words, Music and the Church. Erik Routley. Abingdon, 1968. 224 pp. $4.95.
Words, Music and the Church is a true, how-it-really-is, picture of the poor state of the general Protestant worship service. The book is an edi- torial : a critical study, with some answers to the problem ; and what the author has to say has needed say- ing for a long while.
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Although he deals with many as- pects of worship, Dr. Routley's basic theme is that worship is drama. Drama not to amuse or entertain the audience, but drama to be performed by the people set to do it (the clergy and musician), and involving a com- munity, (the congregation).
According to the author, words and music are only important and relevant to this drama in the degree to which they adhere to the script of the drama. The author is very critical of the preacher, who has become sort of a star actor in the drama, but whose script often contributes little.
Music and the musician are not treated any more kindly than are the word and the preacher. Unless the hymn, anthem, and incidental music contribute to the service, says the author, then leave them out of the service. And, he goes on to say, some- one has to be in charge of the produc- tion, namely the minister consulting with the choirmaster on selecting the hymns and the anthem. If music is selected without this consultation, it serves only as a break in the drama for entertainment. Dr. Routley feels this reduces the drama to sort of a revue or vaudeville in which short bursts of drama follow one another without relevance to each other.
The author speaks much of society and the drama of worship. There is a most interesting section on the social implications of music in church.
He points out how our attitude to- ward "good" music is closely associ- ated with a set of social values. It is often difficult for us to accept and value others whose musical values differ from our own. This leads to the reluctance of many to accept the use of popular and folk music in churches. On the other hand, we accept "good" music (because it is associated with "nice" people) even if it has nothing to do with the service at hand. To the statement, "Classical music is good and jazz is bad," the only answer, according to the author is, "Who says so?"
The preceding are but three of the many areas of worship covered in a book that deals with music from the very old to Jazz, Rock, and the Folk Song, and with the drama of worship from the medieval period to the pres- ent.
Originally a set of lectures, the book is loosely joined together ; this makes for questionable continuity and repeti- tion. However, Dr. Routley says in a readable book what always needs to be said, "It is time for those respon- sible for the music and worship ser- vice to get about their work." This book is highly recommended to all in- terested in improving the worship ser- vice and music program and for those who are just not happy with the way things are going on Sunday morning.
— John Kennedy Hanks
THE DUKE DIVINITY SCHOOL REVIEW
Spring 1970
A New Departure
The present issue of the Review represents something of a new departure, at least in recent history. It arose out of a discussion in the Review Committee, in which it was suggested that our readers might be interested in becoming acquainted with some of the new directions being pursued in The Divinity School. Recently, Professor Harmon L. Smith has been investigating certain ethical issues arising from the practice and procedures of modern medicine. In fact, he has con- ducted courses on this subject and now has a book scheduled for publication in the fall of this year. So, this area of research presented itself as a natural possibility.
The proximity of the Duke Medical center has given Harmon Smith and a number of students opportunity to pursue these matters quite extensively and in an informed way. The articles in this issue represent the tentative results and proposals issuing from some of their investigations. They were submitted at the invitation of the Committee and under the direction of Professor Smith. All of the authors are students in Duke Divinity School. Hopefully, we shall again in the future be able to exhibit in this journal representative examples of the relatively new kinds of work going on here.
D. M. S.
THE DUKE DIVINITY SCHOOL REVIEW
Medical-Ethical Issues in a Christian Perspective
Volume 35 Spring 1970 Number 2
Contents
A New Departure Inside Front Cover
Preface
by Harmon L. Smith 45
Human Experimentation
by Donald Dial, Russell Martin, and David Pacholke* 47
Euphenic Engineering for Clinical PKU
by Melvin Dowdy, Richard Richards, and
Linda Van Tassel* 64
Medically Induced Drug Addiction
by George Ennis, Robert McConathy, and
Morgan Peterson* 80
Abortion: Responsibilities and Relationships
by Richard Fisher and Paul Morrison* 96
An Appropriate Time to Die
by Gregory Dell, Powers McLeod, and John Mann* 112
Dean's Discourse 129
^Written in consultation with Prof. Harmon L. Smith and an editorial committee.
Published three times a year (Winter, Spring, Autumn) by The Divinity School of Duke University
Postage paid at Durham, North Carolina (27706)
Preface
No one who reads newspapers, listens to radio, or watches tele- vision (or pays taxes!) has to be convinced of the enormous accom- plishments of modern science and technology. Indeed, most of us benefit from these achievements in ways that make them seem more or less indispensable. If you yourself do not see Cinerama movies, or dress more comfortably, or eat healthier foods, or drive the latest thing in automotive design, or know what it is to recover from an illness that only a few years ago would almost certainly have caused your death, odds are that you know someone for whom these things do apply and that you could compose another list (comparable to this one) from your own experience.
That modern science and technology provide a potential (and, in some ways, already actualized) boon to our common human existence appears self-evident. That this remarkable and relatively new power will in fact be put to uses that are genuinely directed toward humane goods remains, however, to be ascertained. Saying this, I do not mean to imply either a prejudice against or a naive approval for what- ever is done or might be done to advance or retard our science and technology. On the contrary, I would rather we try to assess what words like "advance" and "retard" mean in this context. Or, to put it differently, I believe with Reinhold Niebuhr that our capacity for doing evil is proportional to our capacity for doing good; and this suggests to me that we need therefore to be alert to both the promise and the threat of our science and technology if we are responsibly to exercise control over them for good rather than evil ends. It may be finally an article of faith — at least there is not space here to develop the argument — but I think that we function as men in the measure to which we control our technics and are not controlled by them, and that science and technology function best when they serve human need and purpose rather than vice-versa.
Last fall the chairman of the Review committee indicated to me the committee's interest in developing an issue of this journal which would undertake to address some (but only some!) of the moral questions which are emerging from medicine and bio-medical tech- nology. The rationale for such a venture (if I may quote myself!) is that "Physicians and clergymen are increasingly obliged to talk to
46
each other (and sometimes about each other!) ; and there is no reason currently to suppose that this obligation will not intensify in the years ahead. If we are ever to get beyond the stage of polite euphemism and anecdote and down to the business at hand, each of us will have to become better informed about and acquainted with the other." That, at least in part, is what these papers are about.
Among several alternative approaches and resources considered by us, we elected to publish the following essays which, in their original form, were composed by students enrolled in an advanced course in Christian ethics in the Divinity School. In their present form, how- ever, these papers represent not only the primary research and reflec- tion of original authors but also the additional contributions of class members together with revisions and emendations by an editorial committee.* There is therefore an uncommon kind of corporate authorship and collaborative effort which has produced these articles.
The focus of these essays is on the issues and elements which emerge in decision-making within these several contexts. Because of limited space the papers mainly intend merely to describe some of the ways in which these issues and elements raise theologically and morally significant questions, and then to offer some modest sug- gestions for direction in addressing them. There is, as you will see, no external coherence among the essays except a common sphere of inter- est. Moreover, you may also detect that internally the papers make different emphases and employ different approaches. We think that is as it should be, both as illustrative of the varieties in ethical method as well as affirmative of situational diversity. We submit them with the hope that you will find them informative, suggestive, and perhaps even useful.
Harmon L. Smith
Associate Professor of Moral Theology
♦Members of the editorial committee were Gregory R. Dell, Melvin D. Dowdy, Russell E. Martin, L. Powers McLeod, and Richard P. Richards.
Human Experimentation
Donald Dial, Russell Martin, and David Pacholke
In July, 1963, twenty-two very seriously ill patients at the Jewish Chronic Disease Hospital in Brooklyn, New York, were injected with live cancer cells without their informed consent. The patients had previously been asked only for their verbal permission to be used in tests to determine their resistance or immunity to disease. They were told that a lump would form, but only for a few weeks. They were not told in plain language, however, that this procedure was not^ part of their normal treatment. Neither were they informed that the cells to be used were cancer cells. This case became widely publicized when three physicians, who had resigned in protest of the manner in which the experiment was being conducted took their grievance to a New York lawyer who was also a member of the hospital's Board of Directors. After being refused permission by the hospital to examine the records of the experiment, the lawyer appealed to the Brooklyn Supreme Court for formal permission to see the information. The story was quickly picked up by the news media.1
In subsequent hearings before the Board of Regents of the Uni- versity of the State of New York, two primary arguments were presented on behalf of the two reputable doctors who had directed the experiment. It was argued that there were no clear standards to guide the researchers in such experiments and that the methods employed were not significantly different from those used by other professional researchers. Several notable medical researchers testified on behalf of the defendents. The accused doctors were found guilty of fraud and deceit and unprofessional conduct in the practice of medicine. The real importance of the case, however, came in the realization by physicians and concerned laymen alike that there were no adequate guidelines for medical experimentation on human sub-
1. E. Langer, "Human Experimentation : Cancer Studies at Sloan-Kettering Stir Public Debate on Medical Ethics," Science (1964), 143:551-3; E. Langer, "Human Experimentation : New York Verdict Affirms Patient's Rights," Science (1966), 151:663-6. A good legal review of the case is contained in Robert D. Mulford, "Experimentation on Human Beings," Stanford Law Review (1967), 20:99-117.
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jects when the experiment was not for the direct benefit of the patient. Indeed, this case called to the attention of all concerned persons that the issue of non-therapeutic human experimentation had not been adequately explored as regards either its ethical or its legal implications.2
Although the above case is perhaps the most dramatized instance of non-therapeutic human experimentation in the past decade, it is far from being the most questionable. Dr. Henry K. Beecher has listed twenty-one other examples in which medical investigators ventured to "risk the health and life of . . . patients" in experiments without any direct benefit to them.3 Dr. M. H. Papp worth, in his book Human Guinea Pigs: Experimentation on Man,4 has given ex- tensive case material to indicate the ethical problems present in non- therapeutic human experimentation. These problems are not new, but they have come to the attention of many people lately because of the frequency with which they have occurred in recent years.
The rapid growth and advancement in medical techniques and skills since World War II have kept medicine constantly on the frontier of new discoveries in the diagnosis and treatment of diseases which, before that time, had been beyond its reach. This rapid ad- vance has provided numerous situations in which human trials are necessary. Many new discoveries simply cannot be tested adequately on animals due to basic physiological differences between human beings and other species. Thus, medical research has been increas- ingly obliged to employ human experimentation as a means of testing and confirmation.
Human experimentation is itself a very broad category; for, technically, every medical procedure is an experiment to the unique- ness of each individual and the subsequent uncertainty factor. How- ever, human experimentation is generally separated into two areas : therapeutic and non-therapeutic. The therapeutic experiment is characterized by having as its purpose the welfare of a particular patient. The doctor-patient relationship is typically based on the as-
2. Two excellent contributions bring together much of the literature from various disciplines: I. Ladimer and R. Newman (eds.), Clinical Investigation in Medicine: Legal, Ethical and Moral Aspects (1963), and "Ethical Aspects of Experimentation with Human Subjects," Daedalus (1969), 98.
3. Henry K. Beecher, "Ethics and Clinical Research," Neiv England Journal of Medicine (1966), 274:1354-60.
4. M. H. Pappworth, Human Guinea Pigs: Experimentation on Man (Lon- don: Routledge & Kegan Paul, 1967).
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sumption that the doctor will act only in a manner that is intended to benefit the individual patient. In the non-therapeutic experiment, the primary objective is the discovery of knowledge. The invesigator- siibject relationship does not assume that the patient's benefit is the primary goal. The question of whether new knowledge obtained by the experiment might benefit the subject is of secondary importance. It is therefore the primary intention of the physician-investigator that tends to determine the nature of the experiment.5
Within the category of non-therapeutic experimentation are various sub-categories which are generally determined by what is being tested. One such division is between experiments designed to test new drugs and experiments designed to test new non-drug procedures. The experiment involving the injection of live cancer cells offers an example of non-drug, non-therapeutic human experi- mentation. Another important area of consideration concerns the subject involved in the experiment. Any subculture of society might be potential subjects : children, prisoners, the mentally-ill, hospital patients, healthy persons, etc. This paper will deal only with the ethical issues raised in non-drug, non-therapeutic human experimen- tation on mentally competent, non-imprisoned adults who are being treated in or by a hospital.
II
The ethical questions involved in non-therapeutic human experi- mentation can ultimately be traced to the problem of individual rights versus social responsibility.6 In principle, it may be argued that human beings should not be used as guinea pigs because this action conrtadicts an individual's rights. By appealing to other principles, however, it may be argued that it is the individual's responsibility to become an experimental subject for the good of the society. In any society certain individual freedoms have to be forfeited to the society in order that the society and the individual might exist and grow. Thus, the question concerns the degree to which an individual is to be called upon to forfeit his rights for the good of the social
5. Hermann L. Blumgart, "The Medical Framework for Viewing the Problem of Human Experimentation," Daedalus, op. cit., pp. 248-74.
6. For two excellent treatments of the philosophical problems see Otto E. Guttentag, "Ethical Problems in Human Experimentation," Ethical Issues in Medicine, ed. E. Fuller Torrey (1968), pp. 195-226; and Hans Jonas, "Philoso- phical Reflection on Experimenting with Human Subjects," Daedalus, op. cit., pp. 219-47.
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order. At what point does society have the right to take from its members their individual liberties?
The actual balance between individual rights and social responsi- bility is never static but always responding to the circumstances which affect the society. For example, when a society is threatened by war, it requires its members to forfeit some of their individual rights for the defense of the society. Careful analysis would also show that certain basic attitudes about the individual are the basis upon which the society is built. These attitudes, moreover, are reflected in the laws of the society.
In the laws of a democratic society, high value is placed on the individual and his personal physical integrity. The value of the individual is primary except in issues which threaten the society's existence — as in the case of war. The rights and freedoms of the individual are the very basis upon which a democratic society is founded. Any threat to the primacy of the individual under normal conditions represents a threat to the whole social order. This principle applies to all persons in the society, regardless of their objective merit or station or status of life, or nearness to death. The governing standard is the equal worth of each person as a human being.
Normally in such a society, where the individual is primary, no individual or group of individuals is singled out as a special sacrifice for the good of the society. In fact, "we like to think that nobody is en- tirely and one-sidedly the victim in any of the renunciations exacted under normal circumstances, by society 'in the general interest,' that is, for the benefit of others."7 This type of social order is primarily concerned with men's overt public acts and not with the individual's private life. The primacy of the individual is the foundation of a democratic social order.
Totalitarian or communistic systems, on the other hand, are based on the principle of the primacy of the society. The freedoms of the individuals are always of secondary consideration under the primacy of the state. In such a society the individual is unquestionably used for the benefit of the social order.
Justification for non-therapeutic human experimentation falls some- where between the totalitarian value of community and the demo- cratic value of the individual.8 In human experimentation there is (for the most part) no extreme issue of social survival at stake; the
7. Jonas, op. cit., p. 225.
8. Ibid., p. 226.
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issue is rather societal benefit. The individual who is asked to be a subject is really being asked to forfeit some of his individual rights to the society in order that the society might benefit. Some forfeitures might be one or more of the following :
1. invasion of privacy;
2. donation or sacrifice of personal resources such as time, at- tention, dignity and physical, mental or emotional energy;
3. surrender of autonomy as in studies entailing restriction of movement or action;
4. exposure to procedures entailing mental or physical pain or discomfort, but no risk of injury or lasting harm;
5. exposure to procedures that may entail risk of physical or emotional injury.9
What is being requested goes beyond what is normally asked of a person for the betterment of society in a democratic system. In light of these considerations, two questions need to be raised. What right does the society in general, and the medical profession in particular, have to ask persons to participate in non-therapeutic human experimenta- tion? What reasons justify a person in risking his health and well- being in a non-therapeutic experiment ?
What is at issue is whether individual rights or social health is more important. Probably no one would argue that health is not a desirable good. If we had the opportunity to choose between health and disease, there is little doubt as to which of these two we would elect. Health is a value. Public attitudes reflecting our society's valuation of health over disease may be attested by the widespread public support of medical research by the federal government.10 People generally encourage the conquest of disease through medical research. This societal support for health is an indirect support of life.
People associate health with life and illness with death. But life and health for whom ? For the society, of course ! The health in question is predicated on the whole of society. In reality, however, very rarely is disease of such an epidemic proportion as to threaten the health and, thus, the life of a society. Attributing health to the whole society has the effect of making society's health a higher good
9. Wolf Wolfensberger, "Ethical Issues in Research with Human Subjects," Science (1967), 155:49.
10. Medical research funds in the United States have steadily grown from approximately $45 millions in 1940 to approximately $2.5 billions in 1968; and current trends indicate that they will continue to grow.
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than the individual's health and thereby gives it more social appeal. Thus, in non-therapeutic human experimentation, the conflict is finally between two societal values, namely, health and individual physical integrity. Is an individual's physical integrity to be sacrificed for the benefit of a more healthy society or is the general health of society to be sacrificed to maintain the principle of the individual's physical integrity? Or more specifically does the society in general, and the medical profession in particular, have the right to use a person for non-therapeutic experimentation? Legally these questions are unresolved ; there seems to be great uncertainty about non- therapeutic human experimentation in the laws.11
Ill
Over the last several years the increase in human experimentation in medical research has put pressure on the legal establishment to give guidance to clinical investigators in their research. The develop- ment of legal wisdom to deal with the new techniques and dis- coveries has not kept pace with advancing medical research. This advance is a result of the basic scientific nature of medical research, wherein each breakthrough suggests a possible next step to be taken. Thus, medical research is constantly taking the initiative in new areas while the law must generally await these discoveries in order to respond with appropriate legal considerations. Not only does the law have to wait for medical science to initiate the new situation, but insofar as the law is frequently "no more than the technical and official formulation of the society's moral convictions," the law has difficulty in dealing with questions of a moral nature until the society has come to some conclusions about them.12 Thus, in a sense, the law is caught between medicine's adventuresome research and society's conservative morality.
The law embraces three major areas: the legislative (statutes), the executive-administrative (regulations and adjudication), and the courts (adjudication). Prior to 1960 there were no specific federal or state statutes purporting to regulate investigators or research organi- zations in their methods, their areas of research, or their use of
11. For legal treatment of human experimentation, see Paul A. Freund, "Legal Framework for Human Experimentation," Daedalus, op. cit., pp. 314-24; and Howard N. Morse, "Legal Implications of Clinical Investigation," Vandcr- bilt Law Reviczv (1967), 20:747-76. See also Mulford, op. cit., pp. 99-117.
12. Samuel E. Stumpf, "Some Moral Dimensions of Medicine," Annals of Internal Medicine (1966), 64:462.
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human subjects or patients in research.13 Today legal experts who have examined this area believe that American courts, if confronted with the necessity to determine legal principles which are applicable, would turn to a small number of appelate court decisions in the United States and Great Britain which involve the common law (by which we mean the law devised and administered by the courts) of medical malpractice.14 Thus, it may be expected that the law will develop on a case-by-case basis, in traditional common law fashion, i.e., the courts will look to expert witnesses from the research field to guide judicial understanding of the common, accepted practices in clinical investigations.15
In examining the common law, two principles are applicable to the consideration of non-therapeutic human experimentation : consent and reasonable care. The common law places high value on consent to physical invasions which threaten the health or physical integrity of the individual.16 But consent presupposes some knowledge of the procedure to which consent is being given. The clinical investigator is therefore under a general duty to communicate to the patient such information as is necessary for his free and informed consent. The question of the kind and amount of information necessary for such a consent is a knotty problem. While in theory it is recognized that there is no relationship between consent and risk, it can generally be said that the courts will require understanding proportional to the risks involved.17 It should be noted that the consent requirement allows the subject the final veto regarding participation in the experi- ment, thus affirming the basic democratic principle of individual physical integrity. In principle the consent requirement is the af- firmation of the equal worth of every person insofar as no man is legally justified in violating the physical integrity of another apart from the subject's informed consent.
Legally, persons lacking the capacity to consent should not be used for any clinical investigations merely because they are convenient or available. At present there is no adequate legal defense for such action — neither arguing the benefit available to society nor the
13. William J. Curran, "Government Regulation of the Use of Human Subjects in Medical Research: The Approach of two Federal Agencies," Daedalus, op. cit., pp. 542-3.
14. Ibid.
15. Ibid., p. 545.
16. Morse, op. cit., pp. 748-57; and Mulford, op. cit., pp. 102-5.
17. Morse, op. cit., pp. 751.
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minimizing of risk to the subject. These latter arguments are very unstable legal grounds.
The second major principle of the common law bearing on human experimentation is the investigator's duty to exercise reasonable care. A person is liable when his negligence has caused injury to the person or property of another. This standard is applicable only to situations where improper care by the investigator can be related to injury to the subject. It is likely that the applicable standard in such cases would be determined by the testimony of other investigators regarding common research practices of reasonable care.18
In summary, the present legal requisites for legitimate, liability- free non-therapeutic experimentation can be described in three points :
1. the exercise of due care in administering the procedures;
2. soundness of experimental design, in that it must not be incapable on its face of producing significant results and its known hazards must not be disproportionate to the ends sought;
3. informed, voluntary consent.19
IV
The most hotly debated issue in non-therapeutic human experi- mentation is that of free and informed consent. It is the issue which historically has been most controversial as well as that point at which legal experts and others not involved in medical research most often enter into the debate. This is largely due to the central place of con- sent as the determining factor in adjudicating between individual rights and social rights. Consequently a large number of articles have been written which deal with this subject and in varying degrees of idealism and realism.20 Realistic treatment of the subject has suffered due to the lack of research into the dynamics of the consent situation. Cur- rently, however, work is being done on what actually goes on in the consent situation.21
One point often forgotten has to do with the various levels of consent involved in a human experiment. This matter has been ob- scured by calling the subject's action a "consent" and the doctor's
18. Ibid., p. 760.
19. Freund, op. cit., p. 321.
20. For an excellent review of the consent issue and a good bibliography, see John Fletcher, "Human Experimentation : Ethics in the Consent Situation," Law and Contemporary Problems (1967), 32:620-49.
21. Ibid.; see also Lynn C. Epstein and Louis Lasagna, "Obtaining In- formed Consent," Archives of Interna! Medicine (1969), 123:682-8.
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action a "decision." In essence, of course, both the subject and the investigator consent to the experiment. A medical experiment is con- ceived in the mind of the investigator who pursues his hypothesis as far as possible in ways other than human trials. When he has reached the limit of testing his hypothesis on non-human subjects, he faces the decision of whether to try the experiment on human beings. This involves a moral decision on the physician's part. He must try not to allow his enthusiasm or pride to influence unduly his decision- making process. It is essential, for a relatively free decision on his part, that the investigator understand his motives in making his decision. Thus, introspection and a good understanding of ethical decision-making, as well as a definite set of values consistent with his profession, are essential for good clinical investigation. He should also be fully aware of the implications that his consent might have for the lives and well-being of others, in both a beneficial and a harmful sense. He must carefully weigh the possible benefits, risks, and hazards which he can predict. Primarily because of these considera- tions, the best guarantee for suitable human experimentation is "an intelligent, informed, conscientious, passionate, responsible investiga- tor."22
The "golden rule" has been suggested by some to be a guide for the investigator. Superficially this appears satisfactory, but it breaks down on practical, legal, and ethical grounds. Practically, one criti- cism has been that if an investigator submitted to his own experiment, it would not be a valid test because "those who are conducting the procedure, who will be his colleagues and very likely his subordinates, are likely to exercise particular care (with him). So that the element of risk may appear the same when the identical experiment is per- formed on others, yet it may actually be greater."23 There is also the obvious health difference between a patient who is presumably suffering from a disease that has brought him to the hospital and the doctor who is supposedly in good health. Ethically and legally, an investigator's willingness to experiment on himself is not justification for repeating the experiment on a patient.24 As one forceful critic has put it, "Some people deliberately expose themselves to stupid risks . . . but this does not entitle them to expose others to these risks, or to make others submit to their folly."25 Thus, the golden rule does
22. Beecher, op. cit., p. 1360.
23. Pappworth, op. cit., p. 80.
24. Blumgart, op. cit., p. 260.
25. Pappworth, op. cit., p. 80.
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not provide an absolute answer to the investigator's decision-making process, although it can no doubt provide valuable data for the decision-making process. In this regard, Guttentag suggests that the motivation for self-experimentation is important. If the investigator's motivation is to identify more with the patient and thus help the patient in his decision-making, such self-experimentation would be beneficial. However, if the purpose is to sway the patient unduly, then the investigator is hindering the patient's freedom of choice. Guttentag goes on to point out the difficulty in determining the physician's motivation.26
After the investigator has consented to try his hypothesis on human subjects and has formulated a protocol for the experiment, it becomes the task of a committee of his peers under the National Institute of Health guidelines27 to examine once again the purpose and protocol in order to weigh among themselves the proposed pos- sible benefits against the possible risks involved. Risks to be con- sidered should include not only the foreseeable hazards to a subject who might participate but also risks to the very basis of the social order. As has been pointed out, an experiment is moral or not at its inception and does not become moral post hoc.28 Thus, an experiment whose basic nature is inconsistent with affirmed social values should not be allowed to continue regardless of possible benefit. It is the task of the committee, acting as representatives of the social order, to evaluate this risk. Under this rule, it is possible for a committee to reject an experiment for which persons have already volunteered. The criteria for this committee's consideration should be primarily moral in nature and should not be influenced by the availability of volunteers.
In addition to the institutional committee's consent, there is also the consent of the staff at NIH. The decision of these two groups comprises the second level of consent.
Between the second and final levels of consent is the question of who will be approached as a potential subject. In some instances this group will be extremely limited due to the experimental require- ments. However, the investigator should be aware of the criteria he
26. Guttentag, op. cit., p. 208.
27. The NIH guidelines are reviewed in Curran, op cit., pp. 574-80. However the guidelines were revised 1 May 1969 and therefore Curran is not always accurate. To obtain a copy of the current guidelines write : Director, Division of Research Grants, National Institute of Health, Bethesda, Maryland, 20014.
28. Beecher, op. cit., p. 1360.
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is using in selecting potential subjects because this has a direct bearing on the third level of consent, namely, the freedom with which the subject may decide to participate. Approaches to potential subjects should minimize undue influences and avoid expediency and avail- ability. Jonas suggests in this regard, "The poorer in knowledge, motivation, and freedom of decision (and that, also, means the more readily available in terms of numbers and possible manipulation), the more sparingly and indeed reluctantly should the reservoir be used, and the more compelling must therefore become the countervailing justification."29
The third and most debated level of consent is at the point of obtaining the free and informed consent of a subject. It has been said that this is the most important single aspect of human experimenta- tion inasmuch as it is decisive for the patient's sense of being respected as a person and the point at which the society's welfare and the individual's welfare are balanced and harmonized. There is no disagreement in principle that free and informed consent is necessary for all non-therapeutic human experimentation. In fact, it is basic to any society or system which places value on individual rights. If the person is denied the right to volunteer freely or to abstain from participating, he is denied a basic human freedom. Likewise, if he is denied any information that might affect this decision, he is also denied his humanity and reduced to a mere passive thing.30 Insofar as the investigator withholds such information and thus denies a subject his humanness, in the same act he forfeits his own humanity and contradicts the very principle upon which the integrity of his experiment is based. "To violate a structural value (of the society that has enabled the experiment) is to violate the very structure which makes benefits meaningful."31 Thus stripped of the require- ment of a reasonably free and adequately informed consent, experi- mentation and medicine itself would rapidly become inhumane.
In principle, then, there can be no objection to requiring that the potential subject be allowed optimum freedom and maximum infor- mation regarding the experiment in which he is being asked to participate. The "rub," however, arises when one moves from theory to practice. Investigators, while agreeing with the theory, point out
29. Jonas, op. cit., pp. 236-7.
30. Ibid., p. 235.
31. John Fletcher, "Informed Consent : The Nature of the Art," Unpublished paper, p. 8.
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that each case is different in terms of the makeup of the subject and the design of the particular study. All men are not equal in their ability to comprehend the intricacies of an experiment. Moreover, all the risks and hazards of any particular experiment are not always knowable in advance. It is difficult to determine what information about an experiment is important for informed consent. It is question- able whether a person is ever absolutely free in the sense that no external influences are affecting him. Thus, the whole issue of free and informed consent is highly ambiguous and it is little wonder that in a recent study investigators spoke of it as their chief difficulty.32
We have indicated that a serious problem in obtaining free and informed consent is the question of how much information is needed for the subject to be informed. Ideally, informed consent exists when the subject understands all essential aspects of the experiment — that is, what his consent means in terms of his rights, the types and degrees of risk, the detrimental and beneficial consequences, if any, as well as the procedure and objectives of the experiment. Prior to understanding the aspects of the experiment, however, the subject must understand that the procedure to which he is being asked to consent is not part of his treatment and has no direct relationship to his therapeutic treatment. As has been noted in recent studies of the consent relationship, this has not always been the case. "Patients tend not to distinguish between research and treatment and hence entertain an inner sentiment that the procedure, even when they are told it is non-beneficial, holds out some hope for their improve- ment."33 Thus, in the use of hospital patients as subjects for non- therapeutic experimentation, the responsibility weighs very heavily upon the investigator to impress the non-beneficial nature of his experiment upon the patient. In all non-therapeutic experimental situations the responsibility for informing the subject always rests with the investigator ; he is not to assume that merely answering the subject's questions constitutes informed consent.34 This is only one essential element of an informed consent.
V
Two recent studies in the dynamics of the consent situation might aid the investigator in insuring a more adequately informed consent.
32. Fletcher, "Human Experimentation," p. 627.
33. Ibid., pp. 635-6. See also Pappworth, op. cit., p. 102.
34. Pappworth, op. cit., p. 83
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In a study using three different written explanations of an experi- ment, Drs. Epstein and Lasagna found that "comprehension, maximum retention of information and ability to utilize information intelligently is obtained when the presentation of data is brief and to the point."35 In tests following the informing process, it was dis- covered that the subjects who received the shortest forms in which the pertinent information was included, without detailed elaboration, retained more of the important information than did those who received more detailed forms.
In a study by Professor John Fletcher of several consent situa- tions at the NIH Research Center in Bethesda, Maryland, three interesting conclusions resulted.36 Professor Fletcher found that giving consent is actually a series of decisions rather than one solitary decision. He suggests that such decisions begin for the patient when he enters the hospital. In addition, the informing of the patient actually takes place over the course of several meetings prior to the actual formal consent request. Also the outcome of the formal request is largely due to the previous meetings rather than the formal request meeting. Within the meetings, the relationship between the investigator and the patient is extremely important. Fletcher notes three forces at work in this relationship: the illness of the patient which influences understanding and motivation; the investigator's expectations of himself, of the patient, and of the institution for which he works; and the perception of the doctor by the patient. These forces seem to have the greatest influence on whether the subject and the investigator conclude with informed consent. On inquiring into the patients' reasons for giving consent, three considerations were predominant. First, the patients were satisfied with the investigators' explanation of the risks and the procedure. Second, the patients were affected by the idea that they would be participating in a valuable medical project. Third, the patients trusted the investigator as a person and as a physician. On the basis of these studies, it seems that informed consent does not depend so much on the quantity of informa- tion as on the attitudes of the investigator and his sensitivity toward the subject in their relationship.
The quality of the informed consent not only depends on the quality of the information the investigator imparts but also the manner with which he imparts it. The investigator's ability to explain the
35. Epstein and Lasagna, op. cit., p. 685.
36. Fletcher, "Informed Consent," pp. 18-22.
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technical aspects of the study in lay language is very important. This includes not only the procedure which will directly affect the patient but also the purpose of the study.37 Due to the patient's lack of education and sophistication in scientific matters, and/or his lack of health, it is difficult for the patient to understand the full implications of the procedures and the purpose of the experiment even when these are carefully explained.38 In response to this situation, it has been suggested that a physician who has no direct connection with the experiment counsel with the patient in an attempt to help him under- stand that to which he is being asked to consent.39 The physician would assume the traditional role within the physician-patient rela- tionship and would act as a "physician-friend" in helping the patient to understand and respond to the investigator. This proposal does seem to offer an added measure of assurance that the patient will better understand the experiment and his own feelings toward it. Also, it helps the patient to distinguish between therapeutic and non- therapeutic procedures by personifying them in the physician-friend and the investigator. While there are criticisms of this procedure, we believe a person who is well-informed about the experiment and who acts as a counselor with the potential subject could be a great help in insuring the proper understanding and clear thinking of the patient. Another area of difficulty in fully informing the subject is an area also largely unknown to the investigator. The question of risk involved is often unknown. Investigators are frequently hesitant to inform patients that the consequences of an experiment are ultimately unpredictable.40 If the investigator is working under the NIH guidelines, he may assume that if his procedure has been approved by the committee of his peers and he believes it to be the lowest possible risk or hazard to the subject, the experiment is, in fact, as safe as pos- sible. However, to express this belief as anything more than an im- perfect judgment based on insufficient information is to contradict the requirement of informed consent. The subject should understand that ultimately the result of the experiment is unpredictable even
37. Fletcher, "Human Experimentation," p. 637.
38. Henry K. Beecher, "Experimentation in Man," in Newman and Ladimer, op. cit., p. 8.
39. Otto E. Guttentag, "The Problem of Human Experimentation : The Physician's Point of View," in Ibid., pp. 126-33.
40. Pappworth, op. cit., p. 191. See also Louis G. Welt, "Reflection on the Problems of Human Experimentation," in Newman and Ladimer, op. cit., pp. 126-33.
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though its probable outcome is predictable. The investigator's tenta- tive judgment should never be given as absolute. In this situation also, the "physician-friend" could help the subject to evaluate the evidence. Objection has been raised from some physicians and investigators "whether such a principle is always capable of application or even desirable."41 Often the objection is based on the difference of such a role from the physician's traditional role "which is to provide hope for and comfort to the patient."42 However, in non- therapeutic human experimentation, the traditional role of the physician no longer is applicable to the investigator-subject relation- ship. In non-drug experiments fully informed consent of the subject is always desirable.43 If for any reason the person is incapable of giving a fully informed consent due to unconsciousness, then under normal circumstances any non-therapeutic procedure is impermis- sible.44 It has been suggested that this might also be the case for children and mentally incapable persons.
Regarding the ideal of totally free consent, much the same ambiguity exists. Total freedom in the consent situation is impossible due to the very nature of the human creature. What a man is cannot be separated from the past influences upon him and his dreams of the future. All of these influence him in the decision-making process. Likewise, man does not exist apart from other men ; he is a social being influenced by his many and various social relations. For example, a man whose wife or child had died of cancer would be greatly swayed in his decision if asked to participate in a cancer research project of no benefit to him. The aim of the investigator should be to allow the greatest amount of freedom possible. In response to the enormous difficulty in determining a man's motivation, some persons have suggested that perhaps too much emphasis is being
41. Louis Lasagna, "Can the Public Be Overprotected ?" p. 15. A copy of this article was given the authors, but we are unable to supply full bibliographi- cal data.
42. Comment by Edward Freis in Medical Ethics in Research: A Symposium (Veterans' Administration, Department of Medicine and Surgery, 17th Annual Medical Research Conference), VA monograph 10-2 (Cincinnati, 1966), p. 6.
43. Drug experiments constitute a different problem due to the blind and double-blind experiments and the placebo effect.
44. Jonas, op. cit., p. 240. "Normal," as used here, refers to a time when only an average number of persons is in danger of disease at any given time as opposed to an epidemic situation when large numbers of the population are endangered simultaneously, thus raising the danger to society as a whole.
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placed on freedom due to "an excessive ethical fastidiousness."45 An alternative to the ideal of disinterestedness, the standard of "fairness," is substituted, by which the writer means "what in retrospect will seem fair to him (the subject)."46 The problem here, however, is that at the time the subject has to make the decision he does not have the perspective that is required for retrospection, namely, a view of him- self after the experiment. If "fairness" can only be determined at the end of the experiment, what good does this do for the patient's decision-making ? Also, this proposal is based on the assumption that the ethics of an experiment are determined by its ends — but this is contrary to the view proposed above, namely, that the moral nature of an experiment is determined at its inception. This proposal, therefore, is inconsistent with the goals of society and the research itself.
While it is correct that complete disinterestedness is unattainable, some reasonable criteria needs to be employed to insure the minimiza- tion of coercive and undue pressures on the freedom of the subject to decide upon participation in an experiment. It is this reasoning that makes the issue of free and informed consent central in all major attempts at establishing codes for the ethical conduct of human experi- mentation.47 The writers of these codes, who were in most cases themselves physicians and investigators involved in human experi- mentation, realize the complexity of the issue of informed consent; but they also realize the necessity of some standard by which investiga- tors might be guided with their ethical sensitivities. As one prominent writer in the field said, "a requirement of 'voluntary, informed consent' ... is far from the be-all and end-all of legal and ethical safeguards but it is a valuable check. . . ,"48
The weakness of the codes, as indeed of any legalistic answer to informed consent, has been justly acknowledged by both professional and lay critics.49 In the last analysis there is danger in either too strict or too lax statements about informed consent. Here again the ambiguity involved in the issue of free and informed consent is evi- dent. The functional basis upon which decisions about this issue
45. Louis L. Jaffe, "Law as a System of Control," Daedalus, op. cit., pp. 423-6.
46. Ibid., p. 424.
47. For an analysis of codes and consent, see Fletcher, "Human Experimenta- tion," pp. 629-31. Cf. Mulford, op. cit., pp. 102-5 and Morse, op. cit., pp. 764-70.
48. Freund, op. cit., p. 323.
49. Henry K. Beecher, "Consent in Clinical Experimentation : Myth and Reality," Journal of the American Medical Association (1966), 195:34.
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will be decided is a certain anthropology affirmed by those involved in the various levels of consent mentioned above. Their attitudes about the nature of man, and the ways in which these attitudes are implemented in actual research processes, tends to determine in large measure the moral quality of non-therapeutic human experimentation. It may, therefore, be here, most appropriately, that the Christian theologian makes a significant contribution to the discussion.
Euphenic Engineering for Clinical PKU
Melvin Dowdy, Richard Richards, and Linda Van Tassel
The primeval inorganic slime gave forth the first elementary forms of life nearly 2,000,000,000 years ago. From that time on evolution- ary history was marked by the interaction of DNA and the environ- ment. 3,000,000 years ago the species homo sapiens was born and is today a mere adolescent in evolutionary history. In the near future, however, evolution may no longer follow the whim of the laws of probability, but the direction of man !
In 1831 a young Cambridge theologian, who had a yen for beetle collecting, set out on a five-year voyage aboard the H. M. S. Beagle. The subsequent years found Charles Darwin struggling to integrate his observations of variability with a theory to explain them. In 1859 he published The Origin of Species, which not only summarized his reflections upon the theory of natural selection, but caused an intel- lectual uproar in both science and theology. In 1870 he added further fuel to the debate when he published Descent of Man.
At approximately the same time, an Austrian monk was con- ducting experiments in plant breeding in a small monastery garden. Gregor Mendel, heralded as the father of the science of genetics, published a paper in which he described the basic principles of the science of genetics. He observed that some characteristics remain relatively constant from one generation to another. He determined that genes interact in pairs, having similar functions and positions along the chromosome. He also found that the pair of genes may not be complimentary, i.e., one may dominate the other. Thus he found that the same gene may have a dominant form and a recessive form; and he named these differing forms of the same gene alleles. A reces- sive trait can only express itself when the pair of genes are both recessive. Mendel also discovered that when the genetic material duplicates itself, the alleles, or paired genes, will separate and reunite with other genetic material independently ; this he called independent assortment. His laws were innovative and highly significant as the first descriptive explanation of genetic functions. His discovery
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remained largely unnoticed until William Bateson brought Mendel to the attention of the scientific world around the turn of the twentieth century. It was Bateson who gave the modern science of genetics its name.
An English mathematician, G. H. Hardy, and a German physician, Wilhelm Weinberg, simultaneously came to the same hypothesis about gene frequency and random mating in 1908. The Hardy- Weinberg law states that a balance of distribution or an equilibrium would prevail in a population with respect to the number of persons carrying a genetic trait. If certain factors held constant, they found that it was possible to determine mathematically the number of dominant, recessive, and mixed gene pairs in a population. By using the mathematical formula of Hardy-Weinberg, it is possible for modern geneticists to determine the occurrence of a deleterious gene in a particular gene pool (population) and predict its occurrence in the future.
The study of human genetics began in earnest about 1900 when another Austrian, Karl Landsteiner, discovered the A, B, and O blood groups. The study of human heredity was given its greatest stimulus by medical genetics. This was most noted by the discovery of "in- born errors of metabolism" in 1908 by Sir Archibald Garrod. These were metabolic diseases (inability to digest certain nutrients) which had baffled physicians until Garrod demonstrated their hereditary nature. Interest in genetic influence on and participation in disease processes has gained significantly ever since and has added abundantly to current therapy procedures.
The science of genetics continued to advance in all its subdisci- plines, discoveries in one adding knowledge in others. But it was not until 1953, when J. D. Watson and F. H. C. Crick published their landmark article in Nature, that an adequate model was proposed which would explain the four essential functions and properties of the genetic material : specificity of genes, sufficient coding capacity for multiple genes, self-replication, and mutation. Watson and Crick proposed that the chromosomes are made up of a macromolecule of deoxyribonucleic acid (DNA) in a double helix (spiral chain). DNA is made up of four bases : two single ring bases, thymine and cystosine (pyrimidines), and two double ring bases, adenine and quanine (purines). This discovery made it possible for the genetic code to be broken and for a dictionary to be compiled which lists the messenger RNA codons (specific protein compounds which carry messages from
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a gene to the cell). These two discoveries have brought the science of genetics to a place where, in theory, scientifically knowledgeable men can manipulate the very biochemical structure of life.
Jim Shapiro and others reported on their success of isolating the "lac Operon DNA" gene.1 Because of this discovery, it is now techni- cally possible to isolate a single gene. With this new insight, scientists may well be able in the near future to learn how genes act as adminis- trative watch-dogs, administrating the activity of cells, as well as what substances activate the gene itself. Such a discovery could ultimately be the beginning of learning to correct defective genes and thus cure (rather than just treat) hereditary diseases.
After nearly 3,000,000 years in the evolutionary history of the species homo sapiens, a new day is dawning and once unimagined possibilities in man's control of his genetic destiny are now near realization. As scientists perfect their technology and gain greater control over its effects, they will be able to offer alternative genetic futures to their neighbors. Leaving aside, for a moment, the debate over whether our wisdom will match our technical powers, the moral question is raised in the problematics of a situation in which one has to choose among several alternative futures. Our capacity to challenge and change our hereditary endowment, both now and in the future, raises a decision-making moment with which men have not had to deal previously.
Manipulation of our genetic future falls into three general tech- nological categories : eugenic engineering, or the selection and re- combination of genes already existing in the "gene pool" of the population; genetic engineering, or the change of undesirable genes to more desirable forms by a process of directed mutation ; or euphenic engineering, or the modification and control of the expres- sion of existing genetic information of an organism so as to lead to a desirable physical appearance.
Eugenic engineering involves selection for or against certain genotypes. Herman J. Muller, a noted geneticist of our century, argued that men ought to practice this type of intentional selective breeding to improve the gene pool of the human race. There exist today at least two techniques which could accomplish these ends : artificial insemination by a donor (A.I.D.) and ovum implantation.
1. Jim Shapiro, Lome Machattie, Larry Eron, Garret Ihler, Karin Ippens, and John Beckwith, "Isolation of Pure lac Operon DNA," Nature (1969), 224:768-74.
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On the horizon are improved freezing techniques by which sperm and ova could be collected and preserved until such time as they were desired for conception. All of these techniques have been used suc- cessfully in the breeding of animals. Currently, A.I.D. is used by some physicians in the treatment of human infertility. The most formidable problem facing positive eugenics (selecting for positive or desired traits) is the establishment of criteria upon which "good" sperm and ova could be chosen. The problem arises in delineating the specifics of the word "good." Another problem lies in the fact that even the best genomes may carry between four and ten lethal recessive genes. In addition, because of the nearly infinite variety of gene combinations within any particular gamete (egg or sperm), it would be difficult, if not impossible, to guarantee that any particular sperm or ovum specimen contained the best combination of genes. To top off the problems faced by positive eugenic engineering is the debate over the importance of genes versus the importance of environment in the development of persons.
Eugenic engineering also includes negative eugenics. This is the selection against deleterious genes to lower or eliminate defective genomes from a population's gene pool. Men have at hand various techniques to select against the propogation of these genes. The most effective technique, and perhaps the simplest, is sterilization: tubal ligation in women and vasectomy in men. There are also other less final, but nevertheless effective, methods of contraception which can assure that certain genomes are not passed on to other generations. Selection against deleterious traits is much easier than selection for a positive trait. By the technique of amniocentesis (a surgical proce- dure for observation of the developing fetus) it is possible to identify certain genetically defective fetuses in the womb and either treat them prenatally, abort them, or allow them to be born and attempt to treat them post-natally. Medical genetics coupled with more precise testing equipment and techniques of other sciences is becoming able to diagnose not only the homozygote, a fetus which has a high possibility of being affected by the negative characteristics, but also the heterozy- gote, who is a carrier of the negative characteristic in his genetic makeup while he may or may not be noticeably affected by it. For example, the heterozygote carriers of the deleterious genes which cause phenylketonuria, muscular dystrophy, Down's Syndrome (mongoloid idiocy), or the Cru Di Chat Syndrome are all able to be identified in the heterozygous state. Such carriers, when identified,
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can be given the needed information about the chances of passing the gene on to their progeny, the techniques to prevent this from happening, the treatability of the disease. On the basis of this infor- mation, such persons may be ready to make a decision for negative eugenics.
Another procedure by which we may manipulate genomes in the future involves direct intervention to change the composition of the chromosomes by mutation. This is known as genetic engineering. This science is still in the earliest stages of research with human subjects. Although we have the power to cause mutation we are not, as yet, able to control and direct the process of genetic mutation with sufficient precision. Experience with X-rays, LSD, and Rubella indi- cate at least three ways that mutations can be caused. The biggest problem with genetic engineering at present revolves around the in- ability to make precise point mutations or precise interchanges of healthy genetic material for strands of DNA. At present, geneticists have not mapped human chromosomes completely enough to know where the affected loci are. There are, however, some techniques being used in other facets of genetics which look promising for the future. For instance, significant genetic engineering is adding to our knowledge of deleterious genes, especially as they may relate to cancer and leukemia. Studies with cancer and leukemia are adding to evidence for the use of viruses to re-program affected strands of DNA.
Another way to change a person's genetic complement is the process known as transformation.2 This is the incorporation of a segment of DNA from one cell into the genetic material of another cell, thereby transforming the affected cell into a normally functioning cell. It has also been found that certain micro-organisms and chemical compounds have this mutagenic power.3 This means that they can induce changes in the genetic material which can mutate a gene from one form into another. There is some evidence that this can be done in a non-random fashion and, thus, controlled mutation may be possible some day. Genetic engineering is still very much in the experimental stages of development, but may offer the greatest potential of genetic control and perfectability available to man.
2. Elizabeth H. Szybalska and W. Szybalska, "Genetics of Human Cell Lines: I. V. DNA-Mediated heritable transformation of a biochemical trait," Proceedings of the National Academy of Science (1962), 48:2026-34.
3. Donald Huisingh, "Should Man Control His Genetic Future," unpublished paper.
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Euphenic engineering is perhaps the most common and perfected procedure for genetic manipulation. This refers to the modification of gene expression by manipulation of the genetic environment or the interference in the way a gene would "normally" express itself. For instance, there is evidence that diabetes is a genetically inherited disease and it is treated by injections of lacking insulin. Agammaglo- bulinemia, characterized by the inability of the body to produce gam- maglobulines, is treated by the routine addition of these blood consti- tuents. Among "inborn errors of metabolism" which are treated by euphenic engineering is galactosemia; it is a genetic disease caused by the inability of the affected person to metabolize galactose to glucose because of a lacking enzyme. If the disease is allowed to take its normal course, the affected infants die at an early age from large concentrations of galactose in their blood. This can be avoided by the use of a diet which does not contain the amino acid, enabling the child to mature into an adult, otherwise normal.
Not altogether dissimilar to galactosemia, phenylketonuria (PKU) is a genetic disease caused by the inability of the affected person to oxidize the amino acid phenylalaine into the amino acid tyrosine. Un- like galactosemia, this disease is not easily treated and may result in infant death, mental retardation, or both. Because of the significant number of persons affected by this disease, and the apparent neglect of confronting the problematics of treatment by genetic manipulation, the authors of this paper have chosen to examine the nature of pos- sible treatment of phenylketonuria, including genetic engineering and its correlated ethical considerations. We have selected a representa- tive case to focus upon salient issues and to offer a tentative prospectus for a total medical and ethical treatment. This is an innovative task and one which cannot be conclusive at this time. However, the hope lies in doing an ethical exercise which may prepare us for future dis- cussions.
PKU is a disease inherited as an autosomal (the genes are one of a pair of chromosomes other than the x or y) recessive trait. Since it is a recessive condition, the individual who exhibits the disease is a homozygote ; i.e., he has two recessive, defective genes. The normal or dominant gene produces the enzyme phenylalanine hydroxylase (a catalyst or agent which causes chemical changes to occur). The reces- sive allele, or genes which carry PKU, prevents or fails to produce this enzyme. This failure is its only genetic defect, but it has a variety of effects on the organism.
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Phenylketonuria was first described by Foiling in 1934.4 Since then, the biochemistry of the disease has been conclusively demon- strated to be a disruption in the normal metabolism of phenylalanine. This disruption results in an abnormally increased level of phenyla- lanine and a lower incidence of tyrosine in the blood. As the primary channel of metabolism by which phenylalanine would normally be broken down is blocked, the body finds other pathways to rid itself of the excess phenylalanine. Much of it is transformed into phenyl- pyruvic acid and is excreted in the urine. Because of this, the disease is easily detected by the testing of urine with a solution of ferric chloride. This is a very simple, inexpensive test which is reliable for the detection of the disease, and provides a method for early detection, which is vital for treatment. The abnormal amount of phenylalanine can also be demonstrated by a blood test which is conclusive proof of the presence of the disease. The blood test is required by law in most states and is performed on newborns before they leave the hospital.
Heterozygotes, persons who carry both a dominant and a recessive gene for PKU, can be detected by the phenylalanine tolerance test. Because these people carry the defective gene they are not able to metabolize phenylalanine as well as a normal person, thus the excess can be detected in the blood. It has been found that these people are twice as likely to suffer from mental disorders and mental deficiency as the normal population.5
Phenylketonuria has an incidence of 1/25,000 births and PKU patients make up about 1% of institutionalized mentally defective people. This disease expresses itself phenotypically in severe mental retardation. In the first few weeks after birth it is not unusual for the PKU infant to be very irritable, have epileptic seizures, or vomit severely.6 As far as physical appearance is concerned, some PKU victims may be slightly stunted, have lighter coloration than their siblings, and have abnormally vigorous reflex responses.7
The exact physiological cause of retardation is not known for sure, but there are several theories. One popular theory is that "it
4. W. Eugene Knox, "Phenylketonuria," The Metabolic Basis of Inherited Disease, ed. T. B. Stanbury, J. B. Tyngaarden, and D. S. Fredrickson (New York: McGraw-Hill, 1966), 2nd ed., p. 258.
5. Ibid., pp. 279ff.
6. David Yi-Yung Hsia, Inborn Errors of Metabolism, I (Chicago: Year- book Medical Publishers, 1966), 2nd ed., p. 135.
7. H. Harris, Human Biochemical Genetics (Cambridge: Cambridge Uni- versity Press, 1962), pp. 36ff.
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results from the toxic action of one or another of the various metab- olites which occur in unusual amounts as a consequence of the block- age of phenylalanine hydroxylation."8 Pathologically, autopsies have indicated that the brain weights of PKU victims are two-thirds normal weight. But, more importantly, the most consistent problem was deficient myelin formation in the central nervous system and brain. "Not only may the myelin formation in phenylketonuria be deficient, but also the myelin itself may be defective, so that it ulti- mately breaks down."9
We have already seen that failure to metabolize phenylalanine causes the disease phenylketonuria. It has been stated that the result- ing symptomatology is a severe arrest of intellectual processes which normally develop beyond the basic sensory-motor behavior. We can- not conclusively say that the resulting mental retardation is caused by the deleterious gene for PKU.
There are several factors which contribute to the intelligence of a given person ; i.e., environment as well as innate ability affects the intelligence. Our study leads us to assert that intelligence has a genetically derived basis in the total organization of a person. A person is a highly complex organism with sensory-motor systems, kinesthetic (or moving) systems, central nervous system, and so on. The unity of all these systems and others comprises the biological structure of a person. The biological structure has as its property the capacity to receive from or to extend oneself into the environment ; the dynamic equilibrium between the assimilation of the environment; and the accommodation to it is basic to learning.10 Initially, intel- ligence develops in this person by means of sensory-motor behavior. He learns by doing, before he learns through abstractions. It is the nature of human behavior to seek active interaction with an adaptation to the environment. Adaptation to one's environment is manifested in the ways in which one copes with himself in relation to the world around him; in the degree to which his behavior corresponds to the resources and the limits of his environment, we say that he has begun adaptation. This is an over-simplification; however, the fundamental
8. Ibid., p. 135.
9. Knox, op. cit., pp. 266-7.
10. Many disagreements exist on this issue. R. C. Tyron and others have argued experimentally for a hereditary basis for intelligence; while others have produced contradictory evidence from "free versus deprived" environ- mental experiments. Moreover, experiments with identical twins, who were separated at birth, have not given conclusive evidence in either direction.
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notion is apparent. Intelligence itself is not inherited ; only the biological structure necessary for its development is inherited.11
It is precisely this organization of genetically determined biologi- cal structure which is impaired by the unmetabolized amino acid. Thus, we do not attribute to the untreated PKU patient "bad," "wrong," or "illogical" thinking. Rather, we simply recognized an arrest of development prior to the emergence of integrated rational processes, or at least a dysfunctioning of adaptive behavior, issuing from the disorganization of the basic structure. The untreated PKU patient will not develop at the expected rate, and he may not develop beyond the most infantile behavior. For example, his behavior may remain rigidly imitative, copying the motions of others without any awareness of the purpose or meaning of these movements. He may never develop a concept of number or any notion of the permanence and constancy of objects. He may never develop an ability to discriminate the differential size of objects, or that the size of some objects remains constant.12 Thus, while his cognitive capacity to understand his world is severely impaired, this handicapped person lives within a mysterious world of frightening fluctuation and change.
We must keep in mind that the handicapped PKU patient does not fail to develop cognitively without also failing to develop related socio- emotional abilities. During the years before the age of seven, we may observe the normal child learning to focus upon an object from a perspective different from his own; we call this capacity "decenter- ing." This ability to decenter is in contrast to the perception of the former stage, egocentrism (prior to three years). The surrender of egocentricity is the early manifestation of social consciousness and is a necessary developmental shift if the child is to learn to cope with the social world. Thus, we observe in the untreated PKU patient a lack of true social consciousness, a pervasive egocentricity with manifest infantilism.
There are other behavioral and somatic symptoms which indicate an arrest of development. In the case of one particular patient, she did not sit without support at the expected age of six months ; rather sitting occurred at twelve months. She did not walk at twelve months, but at four years. Her speech remains infantile and meaningless, even
11. John Flavell, Developmental Psychology of Jean Piaget (New York: Van Nostrand, 1963).
12. B. Inhelder and Jean Piaget, "Diagnosis of Mental Operations and Theory of the Intelligence," American Journal of Mental Deficiencies (1947), 51 :401-6.
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at age twenty-eight. She discharges pervasive hand tremors and seizures. She also suffers from skin lesions, a common somatic condi- tion among PKU patients.
The girl, who will never score above the two year level on standard intelligence tests (Stanford Binet, Gessel Block Test, and so on), is a tragic example of the underdeveloped child. What appears more tragic is that the neurological damage could have been pre- vented. In addition to this, she was one of four children, all of whom suffered from a deleterious genotype. Her birth might have been prevented, provided our society had sought early diagnosis of the genotype and legalized limitations to reproduction. No institutional care, regardless of its altruistic intentions, will substitute for the quality of life this child lost. The potential for conquest, achievement, self-awareness, and interpersonal relationships — these qualities com- monly shared and understood to be a meaningful contribution to humanness will never be fully experienced by this patient. In this regard, she has lost distinctly human possibilities.
Since the time of the disease's discovery in 1934, several treat- ments have been tried to alleviate the symptoms without much success. In 1952, Bickel was the first to institute the diet low in phenylalanine. He had good results and this has become the treatment of choice since his discovery.13 The purpose of this diet is to lower the blood level of phenylalanine and at the same time promote growth through good nutrition. It was found that a certain amount of phenylalanine was necessary for proper synthesis and general growth ; thus, the diet is not devoid of the amino acid.14 After a time, the dietary treatment diminishes the excess phenylalanine in the body and the patient estab- lishes a "normal" metabolic pattern.15 Presently, the diet is available in commercial formula.
The administration of the diet should be started as soon as pos- sible, for, the sooner the treatment is begun, the better the chance to prevent any further cerebral damage and deterioration. The diet does not seem to correct any damage already present.16 Centerwall states that if treatment is begun by the age one month, the affected child should develop normally. If treatment is begun by age two months, the person's mentality should be normal, but may be 10-15 I.Q.
13. Clinical Team Looks at Phenylketonuria, U. S. Department of Health, Education and Welfare (Washington: U. S. Children's Bureau, 1964).
14. Harris, op. cit., p. 41.
15. Hsia, op. cit., p. 139.
16. Clinical Team, op. cit., p. 33.
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points behind other persons of that age level. However, if treatment is put off until after the child is six months old, there will be exten- sive retardation. Regardless of when treatment is begun, there always seems to be some behavioral improvement.
How long does one have to continue on the diet? This is a question that is still debated. There is some evidence that indicates that the cerebral damage does not continue too long after three years of age. Others say that the treatment should continue until adoles- cence.17
If a PKU woman becomes pregnant, evidence indicates that she should return to the diet throughout the course of her pregnancy. However, there is conflicting evidence in this situation. Some reports indicate that the mother's high level of phenylalanine may cause fetal damage, regardless of the diet. On the other hand, it has been reported that some PKU mothers have given birth to normal chil- dren.18
Though the medical profession is inclined to end a discussion of treatment with the introduction of a diet, control of seizures, and so on, we must argue that this treatment only relieves the symptoms; i.e., it does not cure the disease. Moreover, treatment implies "total care" and, as such, must extend into non-medical interests. We would like to demonstrate the possible areas involving total care with which the medical profession and others must deal.
Recently, a southeastern institution for the care of mentally retarded faced a difficult decision. During the course of treating hundreds of patients, a clinical case of phenylketonuria was admitted, examined, positively diagnosed, treated for one year, and then dis- charged by the request of the patient's parents. At no time during her custody at the institution, nor after her discharge, were the parents or the patient informed of the nature of the diagnosis. Nearly five years elapsed when, to the panic of the resident physicians, the institution received a formal wedding invitation from their former patient and her family. Evidently, the patient and family knew of no reason why this marriage would be undesirable.
The physicians immediately notified the patient and her family of the nature and consequences of her condition. The response was
17. Willard Centerwall and Seigreid Centerwall, Phenylketonuria, An Inherited Metabolic Disorder Associated zvith Mental Retardation (Washing- ton: U. S. Department of Health, Education, and Welfare, 1965), pp. 16-7.
18. Ibid., p. 17.
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threefold. On the one hand, her parents were outspoken in their op- position to the extent of consulting their clergyman and their at- torney about possible religious and legal prohibitions to the marriage. The parents would have followed through with a formal request to the state Eugenics Board for the mandatory sterilization of their child, but it was felt that this would be undesirable and likely to alienate the child permanently.
The prospective husband was apparently undisturbed by the physician's appeal and generally refused to accept that any genetic deformity existed. (This appears as insensitivity and ignorance on this man's behalf.) In fact, the physicians adjudged him to be less intelligent than the patient. The patient, who has a mid-range I.Q. of 50 and who is in her late teens, did not oppose her prospective spouse. The two of them were married. Under the law of that state, either the institution or a local welfare officer could have formally requested the patient's sterilization prior to their marriage. In that state no statute provides for sterilization once the couple is legally married.
The problem of Pandora (name fictitious) was made evident as a result of the forthcoming marriage. However, the beginning of this problem occurred five years prior to the wedding announcement, when the physicians neglected to inform the family of the nature of the patient's illness. In an attempt to correct this initial mistake, the doctors, at the time they received the wedding announcement, in- formed the family about the nature of phenylketonuria.
This then created a problem for the parents. They were afraid of insisting on sterilization for Pandora for fear of alienating her in light of the forthcoming marriage, a condition which did not exist five years earlier. Thus, the decision about sterilization was passed on to the future spouse. The institution informed him of the situation. His reaction was to deny that any genetic condition existed. The result of this series of discussions is that Pandora is given the full weight of responsibility which incorporates a decision that she is incompetent to make.
The theologian and the humanist will both agree to the intrinsic claim of human life to health. Christian ethics is not needed to justify this claim; it seems to be self-evident. Yet, Pandora is among those persons deprived of this natural claim, and, while no single individual can be held responsible, each decision preceding her present condition and dilemma has had a relative contribution. The relative nature of
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each contribution, however, indicates to us the need for joint decision- making in which each person, professional or friend, is informed by the other. The time when we can remain isolated within a private exercise of our own will has long ago passed away. To encourage this private modality is to encourage apathy, impotence, and enlarged ambiguity. Besides, Pandora's future, together with the future of all other PKU patients, directly and adversely affects the future of yet unborn persons, persons who also have claim to a healthy life. A responsive decision cannot ignore these unborn individuals, nor can it afford to neglect all the resources available through the joint decision- making context.
The Christian ethicist especially will appreciate the call of this situation to the intrinsic claims of the PKU person. In Tillich's ex- plication of Christian love {Love, Power, and Justice), he defined the response to this intrinsic claim as love fashioned after the love of God. Similarly, Tillich asserts that the whole body of persons, the com- munity, also has claim to this love. Thus, we are faced again with an ethics of joint management between individual and society, as well as management by the individual and society. This two-sided tension is the balance of two legitimately based self-interests : 1 ) patient's interest in health, and 2) society's interest in protection from defec- tive genes such as the PKU gene. But as a tension, lest either pole dominate the other, we are faced with a situation of potentially en- larged ambiguity and alienation. In the case of Pandora, neither her legitimate self-interest nor the legitimate self-interest of the com- munity-at-large was adequately managed. The results were painful, especially for Pandora and her family. Her family was left with an ambiguous situation, a situation in which no clear and just alterna- tive was available. And they were faced with a potentially alienating situation, a situation in which they stood to lose the understanding of, rapport with, and respect of their daughter and her prospective spouse. Theologically, we abstract from this concrete situation the existential notion of sin.
Certainly, much of the potential for alienation was implicit in the nature of the disease. Yet, the responsive person must not allow this threat to immobilize his capacity for an ethical management. The responsible person cannot abandon the PKU patient to the natural, deleterious whim of the disease. For, such an abandonment acquiesces to the tragic consequences, to impeded development and its implica- tions for the remainder of the life-history. The full and complete
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joint management of responsibility is what is called "total care," and it is noteworthy that such care extends beyond medical, technological treatment. Explicating "care" as a psychological and theological phenomenon, Rollo May has developed upon the usage of care by Martin Heidegger. In his book, Love and Will (W. W. Norton, New York: 1969), May described care as "moving toward the other," becoming involved, establishing relational qualities in community. As such, care is diametrically opposite to a laissez-faire and apathetic management of decision. Care is total pouring out of oneself in responsive love to the intrinsic claims of individual and community; i.e., the Christian principles of neighbor love.
Returning to our dilemma, we may observe the PKU patient requiring care (neighbor love) that extends from conception to death; i.e., total care in the historical as well as the technological sense. For a complete treatment program, all concerned persons are called to a decision on behalf of the patient (or potential patient) and on behalf of the community-at-large. When these persons are not jointly involved, partial treatment results in enlarged ambiguity and potential alienation. Moreover, the most responsible decision will hold in ten- sion the legitimate self-interest of both patient and society. With these responsibilities in mind, three alternatives are immediately ob- vious :
1) to refrain from the dietary treatment and, thus, condemn the child to retarded growth in the community ;
2) to offer the dietary treatment and place the solution of his social alienation totally upon his shoulders ; or
3) to couple the dietary treatment with a socially responsible solution which limits ambiguity and potential alienation.
Operating from the principle of legitimate self-interest and the principle of total care, the first alternative is eliminated. It is in the legitimate self-interest of society to have individuals function at their fullest capacity. The diet allows for an increased capacity for socializa- tion, personal development, self-care, and overall social functioning. In terms of the obligation to love the neighbor, we hold that the treat- ment enables the affected PKU to enter more fully into a qualitatively fuller, richer, and more personalizing relationship. It is our responsi- bility in care to provide both an environment and a treatment (in this case) in which this person can enter as fully as possible the process of personhood.
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The second alternative provides for the partial fulfillment of society's legitimate self-interest and the total care principle but com- plicates the context. Once we decide to treat the PKU, we provide for his entrance into society's life and future. He is now subject to its laws and to a second facet of its legitimate self-interest. The treated PKU person, who is intellectually developed and sociable, has simultaneously become a potential parent who could pass on his deleterious trait and in that sense, he may propogate an ambiguous and alienating condition. This is embodied in the threat to society's physical well-being, and to his potential offspring, which results in a breakdown in community with the patient. He suffers from alienation perpetrated in the treatment of his disease. Thus, the community participates, through the medical treatment, in the genesis of his and future persons' alienation.
Whatever we mean by responsible decision-making, prerequisite to it are intelligent responsiveness and the ability to relate socially. Al- though the low phenylalanine diet does seem to allow increased devel- opment of all these capacities, just how effective it is remains debated by physicians. The genetic incidence indicates that mental damage probably occurs or begins occurring prenatally. Persons such as Pandora are not recognized as legally competent to make decisions for themselves. Adolescents are also held to be legally incompetent. It is precisely during adolescence that PKU persons reach the age of fertility, and, as we have seen, become a threat to society's future. Normally, society does not hold children responsible for the decisions that they make.
The later stages of the decision-making context are centered on whether or not this person is going to be allowed to procreate, since procreation is the sole vehicle of PKU. We would argue that the ability to procreate is not an unlimited nor an absolute license. It is influenced by contextual and social circumstances and claims. Thus, it is a social function and subject to social responsibility ; i.e., joint- management. We also assume that no individual genetic endowment has an unlimited and absolute right to survival. Consequently, we affirm that there is an appropriate time for certain genotypes to expire. With the limits placed upon these affected persons, consid- ering the age at which such a decision would have to be made, and remembering the social implications of not making a decision about procreation, all these indicate for society to assume the responsibility for joint-management and for the risk involved.
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The discussion has examined the concept of total care as it en- courages us to establish the conditions and community in which persons can reach the fullest potential in their relationships with other persons and with God. Consequently, we would opt for the use of the diet to enable victims of PKU to become as fully human as they pos- sibly can, while recognizing the various responses and successes that that treatment holds for these people.
The paper has also discussed the various facts which have to be recognized and accepted regarding PKU. There is damage prenatally in PKU patients ; the diet is not 100% effective, i.e., the test does not assure treatment. A corollary to these facts is that decision-making requires a certain amount of intelligence. Intelligence is a prerequi- site for knowledge and freedom, which are essential elements in decision-making. Considering the facts and the corollary to them, we have persons whom society cannot trust with whether or not they should procreate. Society must assume that responsibility, if it is to assume the responsibility for treating PKU patients. In other words, total care of PKU persons is required, both as patients with a biological disease and as patients with a disease of radical social consequences, requiring joint-management. It is the conclusion of this paper that for total care the diet be coupled with sterilization. Therefore, we propose that all detected PKU homozygotes be treated with the diet and sterilized. Also, we propose that heterozygotes receive adequate information and counseling about the disease they carry and its effects, and, in the event that they have a child with PKU, they should at that time be sterilized.
As long as treatment for PKU persons is limited to a treatment of the symptomatology and not a treatment of the enzymatic condition, this proposal stands. If an artificial or a synthetic enzyme is produced which allows for normal metabolism of phenylalanine to tyrosine, the proposal would be modified because we would then be treating the disease and not the symptoms. Such a state of affairs could potentially remove the problem of alienation, since the danger from the deleteri- ous gene would be muted !
Medically Induced Drug Addiction
George Ennis, Robert McConathy, and Morgan Peterson
Drugs are tools of the physician for treatment of the sick and protection of the healthy, and the medical doctor participates at every stage in their creation, development, evaluation and use. It is the physician's responsibility to relieve pain by eliminating its cause if possible. In the treatment of patients with chronic or painfully incurable conditions, it is purportedly ethical practice to administer morphine-like drugs over a prolonged period when all reasonable procedures have failed. Generally, this situation is most frequently found in cases of terminal disorders.1 On the other hand, "continued administration of drugs for the maintenance of dependence is not of itself a bona fide attempt at care, nor is it always ethical treatment."2
According to John J. Bonica, M.D., in his book The Management of Pain (p. 578) :
The complications which are inherent to the administration of opiates for the relief of pain make it mandatory that when employing those drugs one should observe and adhere strictly to the fundamental principles of good therapeutics: namely, (1) to give a specific indication, (2) to administer the drug in optimal doses, i.e., the smallest amount which will cause the desired effects, (3) to administer it by the optimal route. These entail individualization of type and amount of drug and the route of the administration for the particular patient and the particular pain. Routine uses of opiates is haphazard therapeutics and should be avoided.3
It is in the process of individualization that problems arise in the evaluation and use of drugs.
Medically speaking, drugs having a stimulating or calming effect on the central nervous system may produce psychic dependence. A number of these drugs lead to a physical dependence that manifests itself by a typical abstinence syndrome when the drug effects are interrupted by its sudden withdrawal. According to one medical
1. Drug Dependence: A Guide for Physicians, American Medical Associa- tion, Committee on Alcoholism and Drug Dependence (Chicago, 1969), p. 83.
2. Ibid., p. 83.
3. John J. Bonica, The Management of Pain (Philadelphia, 1954), p. 578.
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source addiction is a condition that develops after continued adminis- tration of certain drugs.4 It is characterized by altered physiological processes and psychic craving when the drug is withheld. Somehow the drug has become essential to the maintenance of ordinary cellular activities. (Tolerance is also manifest in true addiction.)
In treatment of pain the risk of dependence occurs with potent analgesics of morphine type and with other central nervous system depressants. The mechanism leading to physical dependence on mor- phine and allied substances is set in motion with the first therapeutic dose. Such dependence has been observed to occur less rapidly in the use of barbiturates, sedatives, and tranquilizers.5 Therefore, addiction is problematic prior to the first administered dose.
In order to avoid, or at least delay, the development of dependence, good clinical management will endeavor to keep dosages at the lowest effective level and to change between drugs within the same type or to combine representatives of both types. The alternation between substances of the same type is ineffective, however, because of the rapidly developing cross-tolerance within each of the types in question here.6 While the techniques of management are clear, other prob- lematics make management of drugs an oftentimes ambiguous activity for the medical doctor. Aside from the management of addictive drugs are the problems of the subjective reactions to pain on the part of the house staff. These will be mentioned later.
The legal aspects of this situation of narcotic drug addiction are monumental. At present it is difficult to define where the legal juris- diction of drug addiction ends and the medical jurisdiction begins ; so much so that at present physicians are reluctant to handle such cases. For instance, the doctor may feel that he has a responsibility to cure a medically induced addiction which he has perpetrated, but due to present legal and enforcement standards he may be reluctant to fulfill his responsibility. In such a situation as this, the question of who is responsible for medical drug addiction becomes more complex.
Religious views of medically induced addiction and its participants differ. One may view pain as a means whereby, in God's presence, one can assure growth and maturity of the soul. Pain may also be seen as an interloper in the Divine-human drama. Consequently,
4. B. S. Bergersen and E. E. King (eds.), Pharmacology in Nursing (St. Louis, 1966), p. 107.
5. H. Halback, "Treatment of Pain and Risk of Drug Addiction," Pain, ed. A. Soulairac and J. Charpentier (London, 1968), p. 500,
6. Ibid., p. 500.
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patient and doctor may be said either to be participating in a process that immorally interrupts that which is naturally good or to be facilitating an unnatural state for the sake of another good. Dif- ferences in religious attitudes should not be lightly regarded, since it is at this point that the foundation of morality is established. Medically induced drug dependency prompts queries about the nature of pain, the status of that which is natural, and the moral dilemmas which often occasion a choice between the lesser of two evils.
Fourteen per cent of all narcotic drug addicts in the United States are medical or accidental addicts. Accidental or medical addiction caused through therapeutic means falls under the same laws and legal standards as non-medical addiction. The existing legislation does not deal directly with medical addiction. Nowhere in the world is it a crime to have an incurable or a curable disease either due to mental or physical illness ; yet it is a crime, punishable by some form of incarceration, to be helplessly addicted to a narcotic drug in twenty- eight of the United States. In all fifty states it is a crime to possess any form of narcotic drug without a prescription. Although it is not a crime to be an addict in many of these states, mere possession brings the addict under the condemnation of the law. Whether narcotic drug addiction, medical or non-medical, is a crime or a disease is debateable. Drug addiction is treated as a disease by some experts, a symptom of a mental disease by others, and a crime by many legal standards.
In the United States the physician has generally been deprived of an appropriate and an adequate role in the treatment of drug ad- diction. The doctor may often find that the operation of the law pre- vents him from acting in the interests of the addict patient. Although the Federal Statutes allow for the treatment of addicts by physicians, due to the interpretations of these statutes by the Supreme Court and The Federal Bureau of Narcotics and Dangerous Drugs, doctors have been stifled in their treatment of addicts. Through the interpretation of these laws, doctors have only been allowed to treat addicts with the intention of cure. The policies established by the Federal Bureau of Narcotics and Dangerous Drugs are basically derived from federal statutes and Supreme Court decisions on the "good faith" of a doctor and "bona fide" medical practice as prescribed by the laws. Accord- ing to these policies, no continued dosage is permitted either at a constant or an increased level. The dosage of the narcotic drug must be gradually decreased in order for addiction treatment to be within the bounds of the law.
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It is usually taken for granted that one of the functions of medi- cine is to relieve unnecessary pain and suffering and to keep patients in relative comfort. Yet the medical doctor who seeks to apply these principles to drug users is usually threatened with criminal prosecu- tion. Prevention of withdrawal is often prohibited and withdrawal is often more detrimental to the addict's health than the drug itself. On the other hand, in the hospital setting, there is no legislation to control the dosage of a narcotic analgesic drug that a doctor may give to a patient to relieve pain. In this case, the doctor is permitted to administer drugs as he sees fit, even where drug addiction is virtually certain.
The medical addict, although often able to receive prescriptions for his addiction, is, because of the Supreme Court's interpretation of the law and the enforcement policies of the Federal Bureau of Narcotics, a type of criminal, punishable by harsh laws. The medical addict is invariably treated in the same manner as the non-medical addict and must face the same laws, prosecutions and other consequences, even though these laws are generally inadequate in dealing with drug ad- diction.
Overall, laws have tended to become increasingly stringent and inflexible concerning narcotic addiction, and seem designed in the interest of police expediency rather than the structures of justice. In the entire process, the man feeling the brunt of condemnation has been the addict. His degradation and hopelessness have been increased by denying him the benefits of adequate care from the medical profes- sion and by turning the unsolved medical problem of addiction over to the law enforcement agencies.
According to the law, narcotics can only be dispensed for legiti- mate medical purposes and in the course of a doctor's professional practice. When administering narcotic analgesics to patients in the hospital setting, the doctor must take into account the fact that while attempting to alleviate pain there is also the possibility that the patient may become addicted. According to legal and medical ethics, the hospital physician is permitted to administer narcotic drugs to alleviate pain. The doctor is entitled to employ solutions of narcotic drugs as local anesthetics in the performance of operations and may prescribe preoperative narcotics for a patient on whom he intends to operate. He may use narcotic drugs for the relief of pain in acute conditions such as pneumonia and for the relief of pain due to chronic ailments such as arthritis. A doctor is also considered to be legally justified in
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dispensing narcotic drugs in adequate amounts to keep the victim of an incurable disease from suffering unnecessary pain during the last days of life. He may also administer narcotics to an aged or infirm patient whose collapse and death might result from withdrawal of the drug to which he is accustomed.7
The only regulations for a doctor to prescribe narcotic drugs are that he must have a narcotics license and a license to practice medicine in his particular state. He is also required to register with the Bureau of Internal Revenue which requires a tax on all narcotic drugs dis- pensed. Legislation policies, treatment policies and public attitudes generally reflect a judgment that narcotic addiction is an evil to be stamped out at any cost. The application of increasingly severe penalties in an effort to stamp out the use of narcotics except by patients suffering from serious pain from illness other than that resulting from addiction presents several problems. The narcotics laws present several ambiguities concerning the dispensing of narcotics within the hospital setting and by the doctor in private practice. There seems to be a tight web of enforcement on medical treatment outside of the hospital setting, while a laissez-faire attitude exists toward the dispensing of narcotics by physicians to relieve pain and suffering in the hospital setting.
Early Supreme Court rulings concerning the relationship of doctors to narcotic addicts were based upon cases involving physicians who prescribed large quantities of drugs to many patients in an indis- criminate manner. These early rulings formed the policy for law en- forcement officials and began the process of severing addict-doctor relationships. The Supreme Court rulings seemed to be moving toward the idea that the physician could not legally prescribe drugs to relieve withdrawal distress or to maintain the addict's habit, but could provide drugs only to an addict undergoing institutional withdrawal and then only in diminishing doses.
Several Supreme Court cases are monumental in the formation of Federal Bureau of Narcotics and Dangerous Drugs policy. In 1919, a Dr. Webb was convicted of selling drugs indiscriminately to his patients. In the case of Webb vs. the U.S., the court upheld the doctor's conviction on the grounds of an illegal prescription.8 This
7. B. Shartel and M. L. Plant, The Law and Medical Practice (Springfield, 1959), p. 308.
8. Edwin M. Schur, Crimes Without Victims (Englewood Cliffs, 1965), p. 130.
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particular case was the beginning of a constant action in court decisions to curb the illicit use of drugs by expressing the feeling that the only responsible reply to drug addiction is the cure of the addict. For the court, the cure of the addict meant either gradual or abrupt withdrawal but not sustaining the addict on a constant or an increased level.
Even though a new direction seems to have been taken by the court in the Linder Case,9 Federal Bureau of Narcotics policy re- mained unchanged, and many doctors were convicted for prescribing narcotics to sustain addiction. The Courts constantly ruled on the "good faith" of the doctor and the doctor could only know the legitimacy of his act after the trial. The federal courts have done little to restrict their jurisdiction in narcotic addiction treatment in a manner consistent with their own theory that addiction is a disease. Although the courts seem to be more lenient after the Linder case, the Federal Bureau of Narcotics' policy has remained stringent. In numerous court cases that followed, the good faith of the doctor was constantly left up to the judgment of twelve jurors. In cases such as Hawkins vs. U.S. in 1937 and the U.S. vs. Brandenberg in 1946 the good faith of the doctor was decided by the jury on the basis of the frequency and quantity of the prescription issued.10
Federal Bureau of Narcotics policy presents several issues because it seeks to police the use of narcotics by private practitioners while being relatively lenient in policing the administration of narcotics in the hospital setting. The policing of narcotic drugs outside of the hospital setting is basically done by agencies which have little or no interest in the medical cure or treatment of addicts. Their major interest in treatment occurs only in so far as it deals with the pre- vention of illicit narcotics and the prosecution of violation. It would seem that the medical profession has a responsibility not only to police narcotics use more closely within the hospital setting but to take a greater role in policing narcotic addiction treatment in the private clinic or doctor-patient relationships outside of the hospital setting.
In the hospital setting, the doctor can legally supply a patient with an addicting narcotic analgesic in any amount for severe degrees of pain, with the possibility of making that patient an addict. Outside
9. Drug Addiction: Crime or Disease, Joint Committee of the ABA and AMA on Narcotic Drugs (Bloomington, 1961), p. 70.
10. Ibid., p. 79.
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of the hospital setting the physician is limited in treating addicts, al- though the physician can legally treat an addict but only with the intention of curing him. Because of Federal Bureau of Narcotics policy, a hospital physician may supply a patient in pain with all of the narcotic drugs he may require on the basis that relieving pain is bona fide medical practice, yet the relief of withdrawal distress outside of the hospital setting is not considered to be bona fide medical prac- tice. The basic issue of whether any treatment of addicts, whether medical or non-medical, is bona fide medical practice remains un- settled by the Harrison Act. In essence the policies controlling nar- cotic drug use are less stringent in the hospital than outside of the hospital setting; being too harsh outside of the hospital and too lenient within the hospital.
Applied to the medical or accidental addict, these conditions are multiplied and the magnitude of the addict's dilemma is increased. The medical addict being forced into the drug situation comes under the constant surveillance and jurisdiction of the Federal Bureau of Nar- cotics and Dangerous Drugs. In many states if he attempts to supply the needs of his addiction or his disease, he is incarcerated and labeled a criminal.
In general, the doctor has no criteria or standards to guide him in dealing with drug addicts since each case is different. Doctors may legally treat addicts and prescribe narcotic drugs to an addict under the Harrison Act. Moreover, they must act in good faith and accord- ing to proper medical practice. But the medical profession should not leave the problem of determining proper medical standards and good faith to an ex post facto judgment made by so-called experts in the enforcement agency alone, who have differing views as to the treat- ment of narcotics addiction. The courts have not renounced their right to rule on the good faith of the doctor or to submit this question to a jury. Because no definition of "good faith" has ever been created, the doctor can only discover whether he acted legitimately after the trial itself. Other legislation provides the same problems as the Harrison Act. The Boggs Act of 1951 and the Narcotic Drug Control Act of 1956 only provide for more severe penalties and inflexible penalties for addicts.
Generally, the laws regarding addiction in this country tend to offer a simplistic solution to a problem which is for us both complex and morally ambiguous. It is morally preferable to be free from drug dependency than to be drug addicted. If one is addicted, the treat-
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ment of choice would be that which would free one from drugs. To this point we can share common value with current statutes. Rarely, however, can a complex human problem like drug addiction be resolved on the basis of a single value choice. As we will demonstrate in the following sections, there are situations in which it may be morally preferable to support an addiction. Such an action is not legal, however, at this time. Since this paper deals with the problem of medically induced drug addiction, the apparent double standard between in-hospital and out-of-hospital drug regulations is a cause for moral concern.
Within the hospital setting, several groups of drugs have proven problematic in that they all may lead to addiction. Two of these groups are barbiturates and analgesics. Some physicians have ex- pressed concern over the misuse of barbiturates. These drugs are classified as central nervous system depressants and have many uses, two of which are as hypnotics and as sedatives. The extent of effect varies from mild sedation to deep anesthesia. Some of the side effects and toxic effects include:
( 1 ) addiction if given over a prolonged period ;
(2) marked symptoms of hangover — listlessness, prolonged de- pression, nausea, and emotional disturbances;
(3) skin rash, urticaria, swelling of the face, and asthmatic attack ;
(4) bad dreams, restlessness, and delirium.11
A recent editorial in the Journal of the American Medical As- sociation expressed concern over the negligent use of barbiturates. It read :
When it is remembered that 200 mg of a barbiturate or the equivalent of another hypnotic is what is almost routinely order for sleep in hos- pitals (not so much for the patient's sleep, we suspect, as for the house of- ficer's sleep), these findings deserve serious consideration. It is not common to hear of patients who first received hypnotics in a hospital and then continued to use them after discharge for an indefinite period, often for years. Over a period of years tolerance to quite high dosages can develop.12
The clinical manifestations of barbiturate addiction are similar to those of chronic alcoholism. Because of the poor motor coordination,
11. Bergersen and King, p. 266.
12. "Sleep Now, Pay Later," Journal of the American Medical Association, 208 (May 26, 1969), p. 1485.
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patients may fall and be injured. Often they are unable to work, and they constitute a real hazard if they attempt to drive power machinery, e.g., an automobile. Furthermore, their judgment may be so im- paired that they take additional doses of their drug when they are al- ready seriously intoxicated. Some authorities feel that the addiction resulting from the overuse of barbiturates is, in some respects, more dangerous and undesirable than the addiction resulting from the mis- use of opiates.13
In another recent issue of the Journal of the American Medical Association a physician complains about the therapeutic misuse of the barbiturates. He asserts, "Perhaps I am in error, but it appears so obvious ! Sedatives and hypnotics are given for insomnia. Insomnia is almost invariably due to depression. Barbiturates are central nervous system depressants. When are we going to stop giving de- pressants to treat a symptom which is due to depression."14
The other group of drugs, to which we have already alluded, that induce dependence are among the analgesics. Basically, analgesics are drugs that relieve pain without loss of consciousness. Opium and its derivatives, related synthetic compounds, and aspirin belong to this group.
A drug of the analgesic group which is addicting and often used is meperidine hydrochloride (demerol). Essentially, meperidine is a synthetic substitute for morphine to produce analgesia. When so used it has the advantage of producing much less sedation and constipation. It is suited to the management of intermittent pain such as renal colic. An average dose varies between 50 mg and 100 mg, although 150 mg may be given for relief of severe pain. Most important, it is addicting.
Side effects of meperidine include dizziness, nausea and vomiting, dry mouth, sweating, headache, fainting, and drop in blood pressure. In addition, toxic effects include dilated pupils, mental confusion, tremor, incoordination, convulsions, respiratory depression and death. Toxic effects are said to produce more physical impairment than any of the narcotic drugs.15
As with the barbiturates, the mismanagement of meperidine has resulted in drug dependence for some patients. According to one report, the number of meperidine addicts at the U.S. Public Health
13. Bergersen and King, p. 271.
14. W. C. Ellerbrock, "Barbiturate Addiction," Journal of the American Medical Association, 209 (August 18, 1969), p. 1089.
15. Bergersen and King, p. 246.
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Service Hospital, Lexington, Kentucky, has risen from six per year in 1945 to one hundred and forty-four per year in 1953 and 1959. It is purported that nearly all meperidine addicts begin the use of the drug as a result of therapeutic administration by physicians, and depend on physicians for their supply of drugs.16
Since the analgesics are used for the relief of pain, and, because it is as a consequence of this action that the danger of drug dependence exists, a consideration of the nature of pain and pain relief would be in order.
In determining the amount of analgesic drug which is to be administered, several factors must be considered, including the age, weight, and physical status of the patient, the reflex irritability of his nervous system, the intensity of pain, and the presence of co-existing disease. However, excepting extremes in age, the intensity of pain is the most important factor determining the amount of analgesic medi- cation required for relief. Thus, it is essential that an attempt be made to estimate the degree of pain before giving the initial dose of the drug.17
Though drugs are often prescribed for the alleviation of pain, progress in the field of analgesia has been hampered by lack of knowl- edge of the fundamental physiology of pain and of the mechanism by which drugs can relieve pain. Everybody knows what pain is from personal experience, but none of us can define it. Even so, one of the points which aid in understanding the problem is that pain involves two main processes, the perception of noxious impulses giving rise to the sensation of pain and the reaction in response. The reaction in response to pain is seen, moreover, as a complex physiopsychologic process which involves the highest cognitive functions of the individ- ual. Basically, it represents the emotional and physiological expres- sions resulting from the perception of pain.18 According to H. K. Beecher, the pain for which medication is needed is a combination of a response to a physical stimulus and psychic modification of the sen- sation, which could better be called 'suffering,' in distinction from simple 'pain' as a response to a stimulus."19 In any case, it is a contention of this paper that the presence of pain should instigate
16. John O'Donnell and John C. Ball (eds.), Narcotic Addiction (New York, 1966), pp. 171-172.
17. Bonica, p. 578.
18. Ibid., p. 73.
19. Charles A. Winter, "The Physiology and the Pharmacology of Pain and its Relief," Analgetics, ed. George DeStevens (New York, 1965), p. 12.
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study of its underlying causes, rather than mere relief of the patient's discomfort.
To the Christian ethicist who holds to the belief in a benevolent God, the existence of pain and evil is a problem. While pain is often seen as having a soul-making characteristic, adherent in its nature, such an understanding seems to be an assessment made after the fact. Moreover, while the existence of pain and mutilation which interferes with the humanizing process remains a theological problem, there is the equally difficult question of an appropriate response to that pain.
In his book, Evil and the God of Love, John Hick makes a distinction between pain and suffering. Pain is a biological phenom- enon, while suffering is a spiritual and psychological interpretation of that pain. This distinction has been suggested frequently in medi- cal research. It is for this reason that we hold tenaciously to the crucial importance of the patient in pain to receive not only medical relief from his pain but widespread and comprehensive care in dealing with his suffering that accompanies both the pain and the dependency which relieves the pain.
We are open to the theological interpretations of pain, and sym- pathetic to understanding pain as a "soul-making process." Ultimate- ly, however, we find no necessity so to justify that which is natural in the world, and note that the existence of pain can often interfere with and become a hindrance to one's ability to relate to and respond to other persons. It is just this humanizing process which we value most. We therefore favor elimination of pain, even by the use of addictive drugs, when that pain seriously interferes with one's capacity to relate to the neighbor.
Such value choices are predicated upon theological commitments at several points. (1) We believe that God reveals himself in and acts through history. (2) We believe that God reveals Himself in and acts through nature. He acts through an ever-changing process of actualizing creative possibilities so that the world, history, and human life are ever in the process of becoming. (3) We believe that God has revealed himself uniquely in the person and ministry of Jesus Christ, and that this is a full and sufficient revelation. Christ reveals the nature of God as agape. This love is made incarnate in the person and ministry of Christ in his relation to both man and God.
From such theological affirmations, we can begin to discern certain ethical foundations from which the morality of medically in- duced drug addiction may be analyzed. While the natural world is
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seen as a part of God's creation, it need not be viewed as completed or perfect. The natural world is still becoming, and one of its frontiers is the frontier of human health. The doctor not only has the possibil- ity of interfering with natural illness but the obligation to do so as well. His is not an unprincipled participation, but one which occurs within the framework of what it means to be fully human.
At least part of what it means to be human is the capacity for relating and responding to our neighbors. To be fully human is to have one's life characterized by agape; such is the norm for human existence. The humanizing process is that of growth and maturation in relationship to God and fellow man toward the end goal of perfect love. God's love for man is therefore the basis of Christian virtue and action; it is the ground of our love for the neighbor and the self's aspiration to perfection. Yet an abstract ethic of love is not to be desired over the equally concerted effort to translate tradition into its appropriate counterpart for contemporary man.
For the moralist, the immediate problem is the translation of agape into the realm of contemporary and existential life. We see pain in all its aspects to be the enemy and destroyer of that which is human. There are cases in which the administration of addictive drugs within the hospital setting will produce side effects that are more problematic than the pain they are intended to relieve. It is the physician's responsibility, as earlier stated, to insure that the side effects of addictive drugs will not be disproportionate to the therapeu- tic effects. It is the patient's obligation to discriminate choices in light of that knowledge and to seek out the course of action that allows optimal realization of himself in relationship to the neighbor and to God. This also means that there will be cases in which no simple choice is available and where the options are frankly morally ambigu- ous. Administration of drugs which will eventually lead to and foster dependency may well be the only moral choice open to physician and patient, not only in times of terminal illness but also in extreme cases where pain disrupts that which is distinctively human. The transla- tion of agape at such times will not be encapsuled in uncritically ac- cepted solutions.
When operating out of the Christian tradition, rules and laws for all occasions are not to be found. Jesus was not a lawgiver. "What Jesus was concerned about was not rules but principles, not obedience to commands but purity of heart. It was love to God and man, and a transcendent and holy will that he required of man, and
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these are timeless."20 Again, one is thrown back upon the grace of God in the individual's imperfect translations of that which is perfect.
In a word, to use Bonhoeffer's terminology, the love of God is indicative and not imperative. In faith and hope, men carve out tentative arrangements of perfect love in relation to one another in an imperfect world, arrangements that are always new and changing but ever faithful to the principle of love as set forth in the incarnation, arrangements in constant need of the redeeming grace of God. And that is what it is to be human. That which maximizes man's response to God and his fellow man is morally desirable ; that which diminishes his capacity for love and service is morally undesirable.
It is out of such a beginning that we have made some proposals relating to the person who is dependent upon drugs which we feel maximizes the possibilities for his being fully human. The following case study will help to intensify and exemplify the reasons for such proposals.
Jane Smith (name fictitious) is an attractive, twenty-two year old female who is married and the mother of one boy, aged four years. In 1965, during pregnancy for her only child, she was noted to have enlarged glands in the left supraclavecular node diagnosed as Hodgkins Disease. During five subsequent hospitalizations through 1969, she received radiation treatment. During these hospitalizations, further complaints ensued, the most notable being ulceration of skin nocules on the left shoulder and pectoral regions, cervical vertebrae damage, and subsequent plastic surgery from the left thigh to the pectoral region. Her latest admission was for severe pain in the neck requiring large doses of narcotic analgesics, accompanied by the char- acteristic signs of addiction to Demerol such as constipation, anorexia, and sleeplessness. At this time, she was diagnosed as having stage IV-B Hodgkins Disease and Demerol addiction. The question was whether to continue administration of Demerol or to find alternative methods of treatment which had previously failed, notably radiation therapy. The moral question the staff faced was, "Ought we try to withdraw this young woman or should we continue to administer Demerol ?"
Here is the situation the staff faced. Mrs. Smith works as a clerk in a grocery store in a small, Southern community. Mr. Smith works in a factory in their home town. Mr. and Mrs. Smith live in a trailer
20. George C. Knudson, Principles of Christian Ethics (New York, 1943), p. 299.
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court. They have used their savings for a house to pay for the expenses incurred during her frequent hospitalizations. Social con- tact seems to be minimal. Mrs. Smith's son is a regular attender of Sunday School. She has indicated membership in the Holiness Church on previous admissions, although on this last admission she declared that she had no religious preference.
During hospitalization, many persons remarked how pleasant a person Mrs. Smith was. Most of the ward personnel found them- selves invested emotionally with her. Conflict was in evidence when Mrs. Smith became depressed or would make tearful demands for relief from intense pain. Visitors consisted of the patient's mother, aunt, and husband. The mother was observed to be protective, foster- ing a dependent relationship. Both the aunt and mother entertained considerable religious talk between themselves and Mrs. Smith, centered about the necessity of her repentence in order for God to heal her. Mr. Smith impressed the staff as being the younger of the couple, dependent upon his wife. He communicated infrequently with the staff. During the last hospitalization, the mother and husband were noted to be reversing their patterns of behavior with favorable effect upon the patient.
Mrs. Smith's prognosis is indefinite. In most cases, Hodgkins disease races to a fatal conclusion, but the course is extremely varied and it is impossible to predict what changes will occur and when. While in some cases patients have died within a few weeks after ad- mission into the hospital, others have gone away to live useful lives for the next ten years.21
The attending physician decided upon continuation of Demerol therapy after a careful and sustained study. Although we might up- hold his action as being within the context of the principles outlined in the preceding sections, there are a number of additional ethical questions which arise.
Since it is the patient who is going to suffer the possible side effect of the drug, possible addiction, and possible criminal prosecu- tion for medically induced addiction, should not she have a choice in whether or not addictive drugs are administered to her during the course of her hospitalization ? Our considered opinion is, within the
21. Lloyd Craver, "Treatment of Hodgkins Disease," Treatment of Cancer and Allied Disease, ed. George T. and Irving M. Ariel (New York, 1964), p.
57.
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limitations of a context of severe illness and pain, a patient has the right to know as much as he can understand about the proposed drug therapy and has the right to enter into the decision-making process. Or, to put it differently, the attending physician has an obligation to inform his patient about the nature and consequences of addictive drug therapy prior to the administration of the initial dosage of an ad- dicting drug. We are assuming that the choice for or against the use of addictive drugs should be a shared responsibility. At the same time we would opt for the right of a doctor to act in the best interest of his patient and withhold addictive drugs.
There are a number of other morally significant questions which surround the initial dosage of drugs. Is a physician justified in lend- ing sleep and relief from pain when it is the patient who pays in terms of side effects and/or after effects ? Does a physician have the right to addict a patient as a solution to another problem such as chronic illness or severe pain? On what model and for what reasons are addictive drugs administered ? Should a doctor be allowed to ad- dict a patient in the patient's own best interests? The preceding paragraph hints at our proposal for answering these questions ; how- ever, these queries are in need of much further discussion, investiga- tion and research than can be covered in the space of this paper.
In cases such as Mrs. Smith's, we would opt for the patient's right to enter into the decision-making process. In cases where the patient is addicted as a result of medical treatment, he should be apprised of the various avenues of treatment, withdrawal, continued addiction, increased dosages of drugs, and the rest. The attending physician should still retain the obligation to act in his patient's best interest, if the patient is not capable of doing so. We recommend that this not be a lonely decision, but done rather in the company of disinter- ested persons not associated with the patient's immediate care — such as, perhaps, another physician, a psychiatrist, a clergyman, or a social worker.
Whatever the decision for withdrawal or continuation of drug dependency, comprehensive care for the patient should include more than just the removal or administration of addicting drugs. This could be accomplished by the creation of a narcotic team whose job it would be to review and advise cases of medically induced drug ad- diction. We favor increased research into non-addicting drugs which would have the same pain relieving qualities of morphine type drugs.
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Finally, we think that revision of state statutes, to bring them into more accord with the reality of the situation of drug addiction, is urgently needed. Special attention should be given to specific legal protection of medically or accidentally addicted persons and their treatment under the law.
Abortion: Responsibilities and Relationships
Richard Fisher and Paul Morrison
Induced abortion has been a special problem for all civilizations since the beginning of recorded societal life. The specific methods em- ployed to induce the abortion have varied widely; it has, moreover, been performed under a variety of circumstances. Many societies have readily accepted induced abortion as merely another birth con- trol measure with no major moral complications. However, as the staff of the Kinsey Institute has pointed out : "The attitude toward abortion takes on a particular intensity when abortion becomes a matter of religious rather than purely secular concern."1 Christianity appears to have been greatly influential in raising questions concern- ing the moral implications which induced abortion might have for a society.
Before we proceed further, we need to define our terms in order to avoid any possibility of confusion at a later point in our discussion.
Abortion is the expulsion of a living fetus from the uterus before
viability.
Spontaneous abortion is that which results from accident or disease.
Induced or voluntary abortion is that which results from man's intentional
interference with the normal course of pregnancy.2
According to Dr. Frederick J. Taussig :
. . . for the present, and perhaps for some time to come, the lower limit of viability may be taken to range between the twenty-sixth and the twenty-eighth week of fetal life.3
In this discussion we are concerned with induced abortion, i.e., inten- tional expulsion of a living fetus from the uterus by deliberate inter- ference with the course of pregnancy.
1. Paul H. Gebhard, Wardell B. Pomeroy, Clyde D. Martin and Cornelia V. Christenson, Pregnancy, Birth and Abortion (1st edition; New York: Harper and Brothers Publishers and Paul B. Hoeber, Inc., Medical Books, 1958), p. 190.
2. Charles J. McFadden, Medical Ethics (4th edition ; Philadelphia : F. A. Davis, Co., Publishers, 1956), p. 135.
3. Frederick J. Taussig, Abortion, Spontaneous and Induced: Medical and Social Aspects (St. Louis: The C. V. Mosby Co., 1936), pp. 21-22.
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I
There need be little argument with the statement that induced abortion is a problem in the United States today. An indication of a few of the statistics concerning the social incidence of induced abor- tion may be helpful in discerning just how great a problem such a phenomenon is. Dr. Harmon L. Smith has stated that :
According to reliable estimates, about one million abortions are performed annually in the United States. Of this number, approximately 99 per- cent are estimated to be illegal. About 1,000 deaths annually are at- tributed to illegally performed abortions and, beyond these fatalities, thousands of other women suffer irreparable mutilations.4
Some other estimates are more conservative. In either case we have a picture of the possible extent of the problem. The Kinsey staff has done considerable research on the subject of induced abortion. Un- fortunately their figures are a dozen years old ; but they still offer one of the best breakdowns of the social distribution of induced abortions. In analyzing "270 females who account for 355 pregnancies that ended while the females were unmarried" it was discovered that "the great majority (316) terminated in pre-marital induced abortion."5 This rather alarming statistic may be set within the context of a larger group of women who had married at some point in their lives. A survey of this group revealed that
... in their reproductive lifetimes about three quarters of them experi- enced a live birth, one quarter had a recognizable spontaneous abortion, and one fifth to one quarter had had an induced abortion.6
Speaking of divorced or widowed women the researchers reported :
Of the 157 terminated post-marital conceptions, 4 per cent resulted in live births, 10 per cent in spontaneous abortion, 79 per cent in induced abortion, and 7 per cent were carried into a subsequent marriage.7
The researchers reported that induced abortion is most prevalent among women aged sixteen to twenty years, and that it decreases con- sistently in incidence of occurence after the age of twenty.8 This helps us further to define the limits of the group with which we are con-
4. Harmon L. Smith and Louis W. Hodges, The Christian and His Decisions (Nashville and New York: Abingdon Press, 1969), p. 233.
5. Gebhard et al., op. cit., p. 54.
6. Ibid., pp. 93-94.
7. Ibid., p. 147.
8. Ibid., p. 94.
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cerned, although we are by no means dealing with women within this age group exclusively.
Negative social consequences following an induced abortion ap- pear to be infrequent. As might be expected, the women who receive these unfavorable social reactions are the single females who would likewise have received the harshest societal treatment if they had continued their pregnancies rather than choosing to terminate them.
So far as the medical complications resulting from induced abortion are concerned, it appears that if the abortion is performed under sanitary conditions and with the proper technique and super- vision it carries with it about the same risks as a tonsillectomy. Boeth's comment concerning the technique of dilation and curretage (D&C) (in this case, in illegal abortions) is helpful in understanding the procedure employed in many cases :
The operation itself is quick and simple: the cervix is stretched by a series of increasingly large dilators. Then the abortionist uses a tiny, rake-like instrument called a currette to scrape the embryo from the wall of the womb. If there are no complications, the patient can go home the same day. If there is trouble, any hospital will take her if she has but sense enough to go to one — without recriminations from the law.9
It also appears that, like any other operation, abortion becomes safer the more experience the person performing the operation has. There is a good deal of speculation that many doctors are becoming quite skilled in the performance of such a procedure. Dr. Mary S. Calderone has made the following observation concerning the im- proved quality of abortion techniques :
. . . abortion, whether therapeutic or illegal, is in the main no longer dangerous, because it is being done well by physicians.10
The state of medical science in relation to this operation is rather highly advanced. There are at least five accepted techniques which are successful and indicated at different times, depending upon the duration of the pregnancy. D&C (described above) is indicated in the first twelve weeks of a pregnancy. An alternate D&C procedure involves vacuum aspiration of the uterus, a procedure which employs a suction currette and is relatively safer than D&C, since the suction currette is not as apt to puncture the wall of the uterus as the surgical
9. Richard Boeth, "The Anatomy of Abortion : 1968," The Washington Post, June 16, 1968, p. 2.
10. Mary Steichen Calderone, "Illegal Abortion as a Public Health Problem," American Journal of Public Health (1960), 50:949.
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currette. After 16 weeks an intravenous injection of a concentrated drug brings about premature labor. If the pregnant woman is not to be sterilized and is fairly far advanced in her pregnancy when she comes for the abortion, a hysterotomy may be done. Sometimes a caesarian section of the pre-viable fetus is done, in which case future pregnancy is not foreclosed. If the woman is to be sterilized, a hysterectomy will ordinarily be done, i.e., the removal of the uterus and the tying of the fallopian tubes.11
There is a growing body of opinion that psychological reaction, though generally rare, may be the most serious complication to arise.12 Dr. Harold Marcus, Associate Attending Psychiatrist at the Mount Sinai Hospital in New York City, has addressed himself to this subject :
The question might be asked, does abortion do any harm psychiatrically ? Do these women suffer? Is the abortion harmful to them rather than therapeutic? This, of course, is a very valid question. It is a question that we are in the process of studying right now at Mount Sinai. We are following up all of our women who have therapeutic abortions. We see them before and after the abortion in an attempt to find out just what are the effects of a therapeutic abortion and attempt also to survey the popula- tion that comes from therapeutic abortion. We have not been doing it long enough to come up with any real definitive results although we certainly have not had any adverse effects.13
In one of the most complete studies of the subject, Dr. Martin Ekblad (Stockholm, 1955) checked the psychiatric reactions of 479 women who had been granted induced therapeutic abortions for psychiatric reasons. The results of his study are, in part, as follows :
With reference to the women's statements concerning their attitude to the abortion at the follow-up examination the material has been divided into four groups. 65% had been only satisfied with the abortion and had not felt any self-reproaches, and another 10% had also not felt any self- reproaches, but had thought that the operation itself was unpleasant, 14% had felt mild self-reproaches and 11% had felt serious self-reproaches or regretted the operation.14
11. Alan Guttmacher, "Techniques of Therapeutic Abortion," Clinical Ob- stetrics and Gynecology, Vol. 7 (March, 1964), p. 102; Jaroslav F. Hulka, Therapeutic Abortion: A Chapel Hill Symposium (Chapel Hill: Carolina Population Center, 1968), pp. 75-95.
12. Gebhard et. al., op. cit., pp. 208-9.
13. Symposium on "The Social Problem of Abortion," Bulletin of the Sloane Hospital for Women (Fall, 1965), 11:70.
14. Martin Ekblad, Induced Abortion on Psychiatric Grounds: A Follow-up Study of 479 Women. (Stockholm, 1955), p. 233.
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In speaking of a smaller group of women within the group mentioned above, Ekblad noted :
Detailed case-histories are given for the 54 women (11%) who had felt serious self-reproaches or who had regretted the operation. A closer study of the case-histories of these women with serious self-reproaches shows that even if their subjective sufferings due to the abortion were severe, from a psychiatric point of view their depression must in general be designated as mild. It is only rarely that the women's working capacity has been impaired or that they have needed to consult a doctor on account of their mental troubles.15
Further examination of the statistics in the above citation reveals that only five cases (10%) required consultation with a doctor. Of these five cases, four reactions could probably be linked to desertion by the male partner after the abortion. Thus in only one case (2% of the 54 women who had felt serious self-reproaches) was the re- action inexplicable.
II
The opinions of Jewish, Roman Catholic, and Protestant theologi- cal authorities appear in works on medical ethics with varying degrees of frequency and clarity. It is essential that we understand the opinions of the various faiths in order to formulate our own opinions and determine how they compare with established attitudes.
The orthodox Jewish opinion on induced abortion can be neatly summarized in a quotation from Jakobovits' Jewish Medical Ethics:
The point at which human life commences to be inviolable and of equal value to that of any adult person is . . . distinctly fixed at the moment when the greater part of the body — or, according to some versions, the head — has emerged from the birth canal.16
Such an attitude plainly leaves the option of induced abortion open for the woman and the physician. Since the life of the fetus is considered to be of a lesser value than that of an adult person, the disposition of the fetus can take a position of subordinate importance to the disposi- tion of the life of the adult involved. Jewish ethicists have also held that the fetus can, under certain circumstances which endanger the life of the mother, be considered an aggressor against her and dealt with accordingly.
15. Ibid., p. 234.
16. Immanuel Jakobovits, Jewish Medical Ethics (New York: Bloch, 1962), p. 184.
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Roman Catholic ethicists have taken a very strict position on the inviolability of fetal life. Their concern seems to center on a concern for the innocent soul which is endangered by induced abortion. Charles McFadden has stated the Roman Catholic position on induced abortion in the following manner:
Direct and voluntary abortion is a moral offense of the gravest nature, since it is the deliberate destruction of an innocent life. The very nature of direct abortion is such that it involves the deliberate and direct removal of the inviable fetus from its natural situs, the womb of its mother, to an environment in which it cannot possibly live. Such an action is es- sentially murder.17
Roman Catholic theologians, however, have added the distinction between "direct" and "indirect" induced abortion. A summary of this distinction is indicated in the following quotation from Fr. Mc- Fadden's Medical Ethics:
Induced abortion may be of two types : direct and indirect abortion.
By direct abortion we mean any instance in which means are specifically
employed to procure the expulsion of the fetus.
By indirect abortion we mean any instance in which a treatment or operative procedure is performed for some other purpose but incidentally and secondarily does cause the expulsion of the fetus.18
Applying the rule of double effect to the problem of induced abortion would seem to be arbitrary and perhaps even cruel, placing a tre- mendous burden on the individual physician as to how he will interpret the intended results of a procedure which he may undertake.
Canon P. Tiberghien, observing the way in which this distinction has been handled in practical application, suggests an interesting reservation for the Roman Catholic position :
A distinction must ... be made between 'direct abortion,' which is always forbidden, and 'indirect abortion,' permitted for grave reasons.
Experience shows that this distinction, when left to the doctors, is very often badly handled by them. Abortion is really indirect only if the removal of the foetus is not willed, either as end or means. Now, doctors very often convince themselves that, when they decide to save the life of the mother by an abortion, it is the safety of the mother they aim at and not the removal of the foetus. In certain cases, it is quite true to say that the safety of the mother is willed as the end ; but the removal of the foetus is also willed as the means to save her. This is very clearly so for the moralists, and therefore the operation is forbidden.
17. McFadden, op. cit., p. 138.
18. Ibid., p. 136.
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Let no one plead 'purity of intention.' There is no 'purity of inten- tion' which renders lawful an act contrary to moral principles. 'Purity of intention,' as thus understood, is merely the disguised masquerading of the false principle that the end justifies the means.
We must therefore eliminate the term 'indirect abortion' from our phraseology, and supply a definition which answers only to direct — always unlawful — abortion.
Here then is the proposed definition : 'Abortion is the medical inter- vention, by operation or medical treatment, which has for its object to expel a living, non-viable foetus from the mother.
Abortion is here defined by its object. A clear distinction is also made between the object or the action and the motive which places the action and which can vary. What one wishes is distinguished from why one wishes it.19
Tiberghien's comments are not a part of official Roman Catholic doctrine, but they do offer a good illustration of what would result from an absolute application of the rule of double effect.
Unfortunately Protestant theologians have written comparatively little on the ethical standards involved in induced abortion. In what follows we will include quotations from several Protestant thinkers on various aspects of the question of induced abortion. Thereafter we will attempt to derive some conclusions from these citations.
Paul Ramsey has pointed out :
The legal reason for prohibiting abortion is not because it is believed to be a species of murder; it is the religious tradition, we shall see, and not the law which inculcates the latter view. The law's presumption is only that society has a stake in the pre-human material out of which the unique individual is to be born.
The theologians debate the question, when between conception and birth the unique not-to-be-repeated individual human being has arrived on the scene. Wherever the line is drawn, the direct destruction of a fetus after that point will, by definition, be murder, while before that point its direct destruction would fall under some other species of sin or grave violation.20
Dr. Harmon Smith has spoken of abortion in relation to the subject of personhood:
19. Canon P. Tiberghien, "Principles and Moral Conscience," New Problems in Medical Ethics, edited by Dom Peter Flood and translated by Malachy Gerard Carroll and Norman C. Reeves (Cork, Ireland: The Mercier Press Limited, 1953), pp. 141-142.
20. Life or Death: Ethics and Options, edited by Ed Shills, Norman St-Iohn Stevas, Paul Ramsey, P. B. Medawar, Henry K. Beecher, and Abraham Kaplan (Seattle and London: University of Washington Press, 1968), p. 64-65.
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To be a human person is not a matter of statically being a certain kind of substance, but rather a matter of becoming personal through temporal duration.
... In some important sense being and becoming a human person means entering into both inter- and intra-personal relationships.
In the final analysis 'personhood' or 'being personal' may be an empiri- cal concept, but in the process of becoming-personal-in-time the per- sonalizing relationships of other persons exercise continuing antecedent priority.21
Joseph Fletcher has taken a considerably more radical stand on the issue of induced abortion. Speaking of the fetus in induced abor- tion, he has stated :
... an embryo in therapeutic abortion has no personal value or develop- ment at stake and cannot exercise the moral qualities of freedom and knowledge.22
Thus it appears that Protestant thought on the subject of induced abortion covers a broad range. The more moderate Protestant thinkers seem generally to feel that abortion may be justified under a variety of circumstances but that man, in taking such an action, can never claim moral exemption from the consequences which may sooner or later follow upon his choice. "Caution" seems to be the key word in most Protestant consideration of induced abortion.
Ill
In the United States the designation of abortion as a crime is fairly recent.23 The first U. S. anti-abortion law was passed in Mis- souri in 1835; and it was not until 1943 that the last state (North Dakota) adopted an abortion statute. The state laws remained generally unchanged until 1966; typically, they provided that any abortion save one to preserve the life of the woman is a crime. Four states, in substance, allowed no abortions.24 All states in 1966 defined abortion as a crime; the definition of therapeutic abortion is found in the exceptions.25
The laws remained vague for several reasons; among them that
21. Smith and Hodges, op. cit., pp. 248-9.
22. Joseph Fletcher, Morals and Medicine (Boston: Beacon Press, 1954), p. 205.
23. Louis J. Regan, Doctor, Patient and the Law (St. Louis: 1956), p. 320.
24. Louisiana Revised Statutes, Sec. 27, 1285. Massachusetts General Laws, Ann. Ch. 272, Sec. 19, 1957. New Jersey Revised Statutes, Sec. 2a:87-l. Pennsylvania State Ann. title 18, Sec. 4718 (1963).
25. Regan, op. cit., p. 321.
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in the few cases brought to trial, the defense has usually been to deny the act. Modern abortion law reform is related to a notable English case: Rex vs. Bourne. In this 1939 test case, an English physician was brought to trial, under an 1861 law, for aborting a fifteen year old girl who had become pregnant as a result of rape. In the charge to the jury, the judge instructed them to find the defendant "not guilty" if they were convinced that Bourne had performed the abortion for the purpose of preserving the physical and mental health of the girl. Mr. Bourne was acquitted.
Another cause of vagueness, also adding to the physician's liability, is that the term "abortion" in law does not take into account the medical nuances which distinguish "miscarriage" and "premature birth" from each other and from abortion. Abortion is most common- ly defined as the administration of any drug to a woman or the use of any instrument on her for the purpose of procuring an abortion or miscarriage. Under this definition, the majority of states punish even an attempt to bring about an abortion. In a number of states there is no requirement that the woman be pregnant — the performing of the prohibited acts upon the woman with the intention of producing an abortion constitutes the body of the crime.26 In an Iowa case, the substance used in an attempt to produce an abortion was tobacco. An expert medical witness testified that tobacco would not produce miscarriage, but the court ruled that this fact did not prevent the conviction of the defendant for attempted criminal abortion !27
The medical profession has not reacted to the vagueness of the laws in a uniform manner. Some physicians refuse to perform any abortions; most work under a system of elaborate safeguards and rationalizations. One physician claims that in order to rationalize an abortion on medical grounds the facts are distorted. Abortions are done for hypertensions "because pregnancy in such cases may lead to a heart attack or stroke," whereas the actual risk of these complica- tions in pregnant hypertensives is not significantly higher than the risk in nonpregnant hypertensives.28 To obtain an abortion on psychiatric grounds often means the risk of suicide is exaggerated.29 Whatever the reason, and although the laws are vague, the courts have been at times lenient with the physician acting in "good faith." The New Jersey Supreme Court, for example, in 1967 held that :
26. Ibid.
27. State vs. Fitzgerald, 49 Iowa 260, 31 Am Pep 148 (1878).
28. Robert Hall, Ethical Issues in Medicine (New York: 1968).
29. Ibid.
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. . . when a physician performs an abortion because of a good faith determination in accordance with accepted medical standards that an abortion is medically indicated, the physician has acted with lawful justifi- cation within the meaning of the statute and has not committed a crime.80
It was not until 1959 that the American Law Institute incor- porated in its Model Penal Code the suggestion that an abortion be permitted if :
(1) a licensed physician believes that there is substantial risk that con- tinuance of the pregnancy would gravely impair the physical or mental health of the mother or that the child would be born with grave physical or mental defect, or the pregnancy resulted from rape ... or from incest; and
(2) two physicians, one of whom may be the person performing the abortion, have certified in writing their belief in the justifying cir- cumstances.31
Since 1966 the legislatures of twelve states have enacted laws pat- terned to some extent on this model, and permitting abortions to be done in hospitals by licensed physicians. In 1967 the House of Delegates of the American Medical Association approved the ALI model penal code. This was the first policy change by the A.M.A. in 96 years ! (The North Carolina Abortion Act of 1967 is similar to the revised laws mentioned above.)
The more permissive laws have thus far resulted in no convictions of medical doctors. However, the fact that the freer laws have not made abortions more generally available to other than the middle and upper class has had an effect on certain pressure groups in this country. Instead of trying to get abortion laws changed, a strategy is now evolving which seeks to have the laws declared unconstitu- tional. The New York Times of November 12, 1969, reported that an anonymous donor recently gave the James Madison Law Institute $60,000 to challenge the constitutionality of the State laws. In ad- dition to three suits in New York, this institute is in cooperation with the American Civil Liberties Union in suits being brought in Indiana, New Jersey, South Carolina, South Dakota, Pennsylvania, and California.
Roy Lucas, a lawyer who is contesting the constitutionality of New York's law in a federal suit, claims that 90% of the women who get legal abortions in New York are white, while 90% of the women who die from illegal abortions are black or Puerto Rican.
30. Gleitman vs. Cosgrove, 49 N. J. 221, 1967.
31. Model Penal Code, Section 230.3 (2), (3). Proposed official draft, 1962.
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The issues raised in the New York suit therefore include the follow- ing major points :
1. that the law allegedly discriminates against poor women and denies them the equal protection of the laws by prohibiting them from obtaining medically safe abortions ;
2. that it is so vague that physicians grant legal abortions at their peril, thus denying the doctors and the women due process of law ;
3. that various provisions of the Bill of Rights create a right of marital and sexual privacy — similar to the right that overturned Connecticut's ban on the use of contraceptives — which the state cannot invade by regulating abortions.
In the District of Columbia, U. S. District Judge Gerhard A. Gessell ruled on November 11, 1969, that the District of Columbia's 68 year -old statute which permits abortions only where necessary "for the preservation of the woman's life or health" was unconstitu- tionally vague when applied to physicians and when it placed upon the defendant the responsibility for proving that the abortion was necessary. Therefore, ruled Judge Gessell, any "competent licensed practicioner of medicine" could legally perform an abortion in the District of Columbia for reasons satisfactory to himself and his patient. At the same time the judge invited the U. S. Attorney's Of- fice to appeal to the Supreme Court. The Justice Department has announced that it will appeal the ruling.32
Judge Gessell also upheld a similar indictment against a hospital nurse's aid, on grounds that the Government could properly outlaw illicit medical practice.
The New York Times of December 11, 1969, reported that none of the hospitals in the District of Columbia had announced any changes in their rules or procedures since the court ruling. A com- mittee of twenty doctors and citizens, appointed by the Mayor of Washington, recommended to D. C. General Hospital that the decision "be implemented immediately;" but as of December 11 the hospital had made no statement. Because the decision by Judge Gessell is not binding on any other Federal district judge who might be called to rule in any abortion proceeding,33 the Times reported that doctors in Washington were cautious in proceeding under the ruling. The
32. New York Times, November 16, 1969, p. E9.
33. New York Times, December 11, 1969, p. 40.
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Medical Society of the District of Columbia has formed an ad hoc committee to formulate a policy.
IV
It may be a truism that induced abortion is a complex problem, but there is a danger of oversimplifying the matter if we do not recognize this from the beginning. As with any ethical decision this involves many claims and counter-claims which impinge upon the people participating in it. We would therefore like at this point to set forth the various responsibilities incorporated in the problem of induced abortion. The moral obligations appear to fall mainly upon the prospective parents, society, and the ethicist, as together they consider the problem. These three groups obviously cannot be as neatly discriminated in a real situation as we will do in the analysis below, but perhaps an initial consideration in this manner can elim- inate some of the emotionalism involved in particular concrete situa- tions.
Prospective parents have moral obligations to the fetus, to the society, and to themselves. The prospective parents have an obligation to each other. Coitus implies responsibility. While this responsibility varies with circumstance, it is never appropriately abdicated. The simple fact is that two persons are directly involved in pregnancy. If coercion, insensitivity, or ignorance are present in the inaugural act, responsibility and obligation may be weighted differently than if the act is one of acceptance, love and knowledge. But it nevertheless remains.
The responsibility of the parents in all cases is to weigh and share obligations and benefits of the pregnancy insofar as biological and personal circumstances admit. This sharing represents an affirmation of the value of each party without an abrogation of uniqueness. Thus, a father does not undergo the struggle of physical delivery of a child, but he does have a responsibility to share in the decision-making which accompanies it. Similarly, the prospective mother cannot share her physical responsibilities as a hostess of a foetus, but she has a responsibility to share with the potential father the burden of moral choices.
It is important to emphasize a reservation for the sharing of responsibility. If either party is incapable of participating in the decision-making process by virtue of biological or mental insufficiency, or if either breaks the covenant of partnership in pregnancy, a re-
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assignment of responsibility obviously takes place. Thus a rapist chooses, by virtue of his coercive participation in the inaugural act, to disqualify himself from much of what would normally be shared decision-making. Similarly, the prospective mother's responsibility may be diminished if for any reason she is incapable of making decisions.
The prospective parents' obligation to the fetus includes their responsibility to maintain the expectant mother in such a way during her pregnancy as to insure the child a safe birth. This obligation implies the preliminary obligation to realize such responsibility before they ever participate in an act which may result in the conception of a child. Their obligation to the fetus also implies the obligation care- fully to consider the potential mother's ability and willingness to care for herself in such a way as to insure the child's safety. If, after such consideration, they find that she is either unable or unwilling to care for herself (and indirectly for the child) then — within the framework of Christian love — it would appear to be their moral obligation to do the most loving thing for the fetus and consider abortion as an option to endangering the quality of this potential life.
The potential parents have an obligation to society to present a child that is normal and healthy and to make provision for its care, either through caring for it themselves or by providing for its care by others, e.g., through adoption. However, it is important to remember that this obligation to present a normal and healthy child to society is not a final or absolute obligation inasmuch as it is ultimately condi- tioned by an understanding of the child's and their own relationship to God.
The prospective parents also have an obligation to themselves to maintain and to safeguard their personal and marital integrity. This obligation arises out of their realization that life in an absolute sense is not theirs but the gift and creation of God. Full recognition of the individual's stewardship obligations clearly reveals the necessity of caring for the life given into their care to the best of their ability. Nevertheless, this mandate to care for the individual personal life is conditioned by the impinged relative responsibilities of the framework of Christian love. Therefore the prospective parents are under the obligation to consider the other individuals around them as well as their stewardship responsibilities to God in making their decision concerning induced abortion.
Society has certain obligations to the prospective parents in its
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consideration of the option of induced abortion. From the Christian doctrine of the Incarnation, which implies the primacy of human life fulfilled through the exercise and presence of Christian love, we observe that the society's primary obligation to the prospective parents is to provide them with the opportunities for fulfilling their personal worth. This obligation is closely related to a doctrine of radical freedom with its implicit limitations. The couple's freedom, and their fulfilling of their personal worth, are conditioned by their obligation to act in accordance with the Christian injunction to love their fellow men.
Perhaps an even more important obligation which the society has to the prospective parents is its obligation to provide them with all available information concerning the pregnancy and the options which are available as alternatives to that pregnancy. This is partic- ularly important in instances in which the fetus may stand significant chance of being born deformed in one way or another. It is also im- portant in that the society should provide the prospective parents with information concerning the alternatives to an induced abortion (such as adoption of the child after birth.)
The above-mentioned obligations of society to the prospective parents may be thought to apply mainly to the situation after the woman has become pregnant. Therefore it is essential to note the prior obligation that the society has to the couple before the woman becomes pregnant. It ought to inform them of the obligations which they will have to the fetus, the society, and themselves if the woman should become pregnant. In order for them to be qualified to exercise their own decision-making faculties in a proper manner, they must be informed and aware of the possible implications of their actions. In this manner, it might be possible to avoid many of the tragedies which result from situations in which couples are unaware of all of the impli- cations when they decide to participate in relationships which then produce children who must suffer the consequences.
Society's responsibility to the potential child is equally as complex as its obligation to the prospective parents. The central thrust of its obligation to the child is to provide a favorable environment into which it can be born. This includes an obligation to provide an atmosphere of love and justice for it, and also the attempt to insure its ability to participate meaningfully in the relationships which are a part of such an environment.
Society likewise has a responsibility to itself, i.e., those members
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of the society other than the pregnant woman and prospective father. Its obligation to itself is basically twofold. It has an obligation to protect its members from the growing menace of the social dangers imposed by deformed or incompetent children that might be born, and also to incompetent mothers who might be incapable of making appropriate decisions. Society also has an obligation to itself in that it must protect itself from the social dangers which often result from the presence of unwanted children. Statistics on juvenile delinquency amply substantiate the opinion that unwanted children pose a great danger to the society, especially if the society makes no provision for their care after they are born into an environment which deprives them of the loving family relationship to which they should be entitled.
The ethicist has many responsibilities when he considers the problem of induced abortion. He has obligations to all parties involved. It is his responsibility to delineate the factors involved in the moral judgments of the situation.
The ethicist has a responsibility to the unborn child in that he is in a unique, i.e., relatively detached position, from which to view the situation and protect the rights of the fetus. This is particularly im- portant since the fetus itself is not specifically protected by law. The ethicist can utilize his position of detachment to act as the agent for both the prospective parents and the society by viewing all sides of the question in relation to the rights of the fetus.
From a Christian perspective, it is apparent that the desired quality of human life is one of love and justice. Under this influence it is obvious that the child has a right to be born into an atmosphere of parental and societal love in conjunction with favorable social and economic factors. The child also has a right to be born a whole person, physically and mentally, in order to participate in the rela- tionships which create the environment of love and justice.
The ethicist is under a further obligation to safeguard the rights of the prospective parents. The rights of the prospective parents include the right to exercise their freedom (within the limits explicated above), the right to know all the available pertinent information about the woman's condition and the options open to them, and the right to maintain their personal mental and physical health through their decisions in light of the information which has been provided them. The ethicist must also point up the prospective parents' moral obliga- tions to them in order to aid them in making their decision.
The ethicist's responsibility to society focuses, moreover, on his
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obligation to maintain a fitting societal attitude regarding the char- acter and quality of human life. This is important since, without a proper attitude on this matter, neither the ethicist nor the society as a whole can operate effectively in making decisions regarding any of the related concerns. The ethicist attempts to help the society decide just what its considerations should be, and how to weigh those considerations against its basic system of values. He also has a sub- sidiary responsibility to remind the society of the consequences which may result whatever their decision may be.
V
Induced abortion is at best an unfortunate and inadequate solution to a problem which man brings upon himself. Man's violation of potential relationship between an individual and God is something which we should strive constantly to avoid.
It would be a better situation if adequate programs of birth con- trol, preconception medical investigation, and comprehensive examina- tion of potential parents could be instituted, thereby largely removing the need for extensive use of induced abortion. It should be possible, with the techniques currently at our disposal, effectively to eliminate any large demand for interference with pregnancy once it is begun. There will probably always be need for some induced abortion — perhaps in cases involving a pregnancy which resulted from rape or incest — but medical, legal, and ethical authorities should do all in their power to reduce that need to its absolute minimum through prelim- inary checks on potential pregnancies. Until such programs are devel- oped and implemented, however, discriminating utilization of induced abortion appears to be one way to deal with unwanted or dangerous pregnancies.
An Appropriate Time to Die
Gregory Dell, Powers McLeod, and John Mann
Man dies. That seems to be one of the few certainties about death. The questions of death's how, when, and where are answered mostly by conjecture. So it is largely a mystery. But it does occur. And because it occurs in a world of men living in finite space and time, the question of the appropriate circumstances surrounding death arises.
Already it is clear that some ambiguities surround this question. These ambiguities are reflected in attitudes toward euthanasia. Basi- cally, these attitudes reflect one or more of the particular formulations of the phenomenon, formulations which fall into the following basic categories : involuntary direct, involuntary indirect, voluntary direct, voluntary indirect. Each of these four types of euthanasia may be further defined by subject : first, concerning the euthanasia of adults ; and second, the euthanasia of children.
The defense and prosecution of euthanasia ordinarily focuses on the fourth form, i.e., voluntary indirect. Joseph Fletcher calls this form 'anti-dysthanasia' (against a bad, or inappropriate, death) and says about it :
even though death is brought about quite rationally and deliberately, it is accomplished only indirectly through omission rather than directly by commission. It is, in short, a procedure by which death is not induced but only permitted. In some kinds of Christian ethics and moral theology an action of this kind is called an "indirect voluntary."1
It is the purpose of this paper to explore the problem of euthanasia, suggest working guidelines for its possible implementa- tions, and examine some of the implications of such guidelines.
Euthanasia of one type or another was a common practice in classical Greece and Rome. This practice seemed to stem largely from the intrinsic bond seen between the welfare of the state and the good of the individual. In general the state's welfare ranked quite
1. Joseph Fletcher, "Anti-Dysthanasia — the Problem of Prolonging Death," Journal of Pastoral Care (1964), 18:78. Fletcher sees basically three types of anti-dysthanasia. They are: 1) administration of a death dealing pain killer; 2) stopping treatment (where it has begun) ; 3) withholding treatment not already begun (p. 79).
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high as a priority of concern. The sacrifice of an individual was not regarded as a great loss if done for the good of society.
Theistic conceptual schemes hold a somewhat different position. God is the ultimate value and it is from him that life proceeds. Individual and societal well-being are derivative from that primal and ultimate value. Thus, "society has no natural right to take away what it has not given."2 Correspondingly, individuals do not possess or exercise unconditional control over their private existence.
The statements on euthanasia by the various institutionalized faiths of the Judeo-Christian tradition are permeated by this as- sumption. That they also usually arrive at a negative consensus on euthanasia is the result of this principle's being coupled with and reinforced by a fear of genocide and the introduction of a "wedge principle" into human decision. That is, the reality of Nazi genocide, together with the fear that one permissive action may lead to other more permissive action, bolsters the subordination of society's value to individuals and supports the prohibition against euthanasia.
The precise formulation of the prohibition is complex but we can summarize by saying that euthanasia is identified with murder. And murder violates the commandment, "Thou shall not kill."
It is usually the more conservative, legalistic or fundamentalist branches of Christianity which make this connection most binding. They are, because of this correlation of euthanasia with murder, most likely to be quite vehement against all forms of euthanasia.
Conservative Protestants would tend to' agree with this position. Because they eliminate involuntary euthanasia from consideration, they seem to concentrate more on the problem of the relation of voluntary death to suicide. Suicide, like murder, is believed to be wrong, but the prohibition appears to be aimed at taking one's own life for selfish motives, rather than at self-destruction in principle. Society sanctions heroic self-destruction. The Protestant churches endorse this sanction when such heroism is done for "altruistic" reasons. It is, in fact, altruism to which appeal is made for exceptions to the euthanasia prohibition. The sanctions which result apply to both the patient and the practitioner but they are not very frequent.
Where sanctions for euthanasia do occur in institutional religion, they seem to occur first and with the greatest frequency in this
2. William S. Hockman, "Letters to the Editor," Christian Century (1967), 84:20.
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humanist-Protestant tradition.3 However, the incidence and strength of opposition seems to overshadow the influence of sanctions.
The Roman Catholic view can be summarized by the following points :
1. That mercy killing is murder.
2. That no one except God has the direct right to dispose of human life.
3. That 'self mercy killing, that is, the killing of a person who asks to be killed, is suicide and therefore wrong.
4. That mercy killing solves no problems and benefits no one. In fact it causes greater evils in that it permits anyone and everyone to judge who shall live and who shall die.
5. That to kill off by mercy killing the incurable, the insane, the crippled, the defective is not justified by science, since science's knowledge of the laws of human heredity is sadly lacking in certainty.
6. That no matter how great the suffering or helplessness of a man, he is useful to himself and to society; if he bears his suffering and offers it to God, he can earn for himself and for others an almost infinite amount of grace.
7. That to permit mercy killing would be to retard the advance of medical science, since the practice would make it almost impossible to do research in diseases that are now considered incurable.
8. That in the Bible, God definitely and emphatically condemns as intrinsi- cally evil this most vicious practice of mercy killing, which is nothing less than murder.
9. That if mercy killing is permitted, patients' confidence in their doctors will be completely destroyed.
10. That the practice of mercy killing will ultimately lead us into the abominable practices that characterized Nazi Germany.
11. It is to be accentuated that we are obliged to use ordinary means of prolonging life, but not extraordinary means.4
These reasons should be kept in mind as answers are addressed to the problem of euthanasia.
With the more or less specific (though admittedly ambiguous) responses of Protestants and Roman Catholics presented, it now becomes appropriate to examine some of the basic ethical and theo- logical presuppositions upon which society's current, basically nega- tive, attitudes are based.
Human life has been given to man by God. Because it is a divine gift, it is regarded with a certain sanctity. Its holy nature is such that
3. Joseph Fletcher, Morals and Medicine (Boston: Beacon Press, 1954), p. 179.
4. Bernard J. Ficarra, Newer Ethical Problems in Medicine and Surgery (Westminster, Md. : The Newman Press, 1951), p. 95.
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it deserves care and respect. Therefore, we may not ordinarily tamper with human life without the consent of that life ; nor may we directly terminate life, even with the consent of that life. The only instances in which interference with human life is permitted without consent are those in which organic life would otherwise be lost ; consent is unobtainable; or life has lost its recognized sanctity through a for- feiture of innocence.
Because life was bestowed upon an individual, the individual person is granted priority in making decisions affecting his life. Although there is recognition of the existence of and need for com- munities, the individual typically sees himself as autonomous. Com- munity is therefore supplementary rather than definitive. Man makes contracts with communities when and where he chooses. He does this in the view that community is a potential source of benefit. However, he realizes that a certain serious forfeiture of individual prerogatives is necessary for the community to operate. Community prerogatives thus have a relatively high priority. They tend to be expressed, however, in terms of restrictive guidelines rather than prescriptive formulae (i.e., indicating the points beyond which it is not safe to act, rather than which action is desirable). If there is a very deep conflict between community prerogatives and individual priorities, the individual may exercise his own will, realizing that to do so he must suffer the consequences of a violated or broken com- munity.
One of these consequences may be death. This, however, is a rare consequence; for death, like life, is viewed as an "ultimate." It is a separate ultimate but an ultimate none the less. These two phenomena define man's being. Life is existence ; death is non-existence. Man is alive, so death is seen as the enemy ; it is the unknown other-than-life fighting for the person. When death comes, it means defeat. Yet, it must come ; it does come to all. Death then is omnipotent — it always wins. Because of its power it inspires a certain awe and fear. The fear is predominant. Man does not know what occurs so he will not become involved. Death's mystery inspires fear and causes man to attempt to hide from death.
In his flight man "hangs on," as it were, to the belief that death is only somatic. Death does not really affect the person, only the body. But the sense of loss incurred by death seems sufficient to keep this last assumption more in the realm of hope than of assurance.
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At worst, death is God's punishment; at best, it is His cruel joke — the painful initiation into a new and different existence.
Medical Aspects
In face of the present legal structure, there is no place in medical practice for active euthanasia. There is, indeed, no legal sanction for any action which causes or allows one's patients to die. Action on the part of a doctor with the intent of causing the death of a patient may be seen under law as first or second degree murder.5
However, when we get into the matter of what has been called passive euthanasia, we must make some different statements. We become concerned here with ordinary and extraordinary means of prolonging life. Doctors feel themselves obligated to do whatever is ordinary to prolong a human life. (This has always been their practice.) Doctors do not, however, feel that it is always in the best interest of the patient or the society to perform extraordinary feats in attempting to prolong life.6 One reason for this is that many of the methods which would be termed extraordinary methods are very expensive, very painful, or very inconvenient.7
The terms, ordinary and extraordinary, are ambiguous and rela- tive in the present situation. In present practice there are several factors which may determine what is ordinary and what is extra- ordinary. Medical consensus is one of these factors. Financial con- siderations and the location of the hospital may be others. What might be ordinary for President Nixon at Walter Reed Hospital may be quite extraordinary for a construction worker in a small North Carolina town.
In cases such as these, tacit legal sanction is given to the practice of not performing extraordinary acts to prolong life in every case everywhere. There have, therefore, been some instances in which what is called passive euthanasia has been practiced by physicians.8
5. George Fletcher, "Legal Aspects of The Decision Not To Prolong Life," Journal of the American Medical Association (1968), 203:65-8. Fletcher points out that there has not been a single instance in the annals of Anglo-American judicial proceedings in which: 1) a doctor has been convicted of murder or manslaughter for having killed to end a patient's suffering, 2) a layman or doctor has been convicted for failing to take steps that could have averted death.
6. David Daube, "Sanctity of Life," Proceedings of the Royal Society of Medicine (1967), 60:1238. See also Mary M. Shiedler, "Coup de Grace," Christian Century (1966), 83:1499.
7. Joseph F. Fletcher, "Anti-Dysthanasia— the Problem of Prolonging Death," op. cit., p. 80.
8. Samuel D. Kron, "Euthanasia, a Physician's View," Journal of Religion
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Tacit sanction is also given to the fact that medical consensus as to what is ordinary and what is extraordinary may, and does, differ from case to case and from place to place. In the present situation this tacit sanction adds to the moral, legal, and medical ambiguity which already exists.
At present, one may observe a change in the medical attitudes toward, and the legal understanding of, the Hippocratic Oath. For nearly two thousand years western practice of the healing art has been greatly affected by the presuppositions behind one particular section of that oath :
I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients and will abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel.9
Instances of passive euthanasia (i.e., those instances where no extra- ordinary means are undertaken to prolong life) suggest to us that the Hippocratic Oath is undergoing some informal reinterpretation. Indeed, some doctors have opted for a formal reevaluation of the oath or the formulation of a new oath based, like the Hippocratic Oath, on a deep concern for the welfare and dignity of patients, but also geared to the problems of modern medicine.
What do these present circumstances seem to indicate? They obviously point to some kind of credibility gap between articulated medical values, on the one hand, and certain contemporary medical practices on the other. For while doctors openly affirm a stated inter- pretation of the Hippocratic Oath, and while they view the role of the doctor as being that of preserving and prolonging life (i.e., biologi- cal life), they themselves ineluctably make decisions involving the appropriate time and manner of another person's death.
It often appears that when doctors argue against legalized consid- eration of the possibility for euthanasia in certain cases, they do so
(1968), 7:335. "There is no question that passive euthanasia is widely practiced, even though this fact is not publicized."
9. L. B. Hohman, in "The Right To Live and The Right To Die," ed. by Cleland, Medical Times (1967), 95:1184: "I, personally, would not be critical of a person with incurable cancer who took the suicide route. Again, I would not personally aid such a person to die. That is because something seems to be woven into the mind and feeling of a physician that he must preserve life. / realise this is somewhat irrational." (Italics added) See also Otto Guttentag, "The Meaning of Death in Medical Theory," Stanford Medical Bulletin (1959), 17:169.
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not because they value the Hippocratic Oath so greatly, but because they would rather make such decisions themselves without inter- ference from other disciplines. Viewing the doctor/patient relation- ship as a sort of holy of holies, doctors seem to feel themselves the only professionally qualified persons to deal with the problems sur- rounding death.
We are unwilling to accept the rationale that doctors are the only persons qualified to decide when and if another human being is to be put to death mercifully. While the most obvious aspects of this matter are medical, other vitally important aspects are of social, legal, and theological significance. Doctors should and must have an irreplace- able role to play in the consideration of euthanasia for another human being. But to leave the decision solely to a doctor, or a group of doctors, would be unfair, both to the doctors and to society. No one profession is prepared to deal with the medicine, psychology, sociol- ogy, and theology involved in a decision such as this. To make the doctor solely responsible for the decision is to put an awful and unfair burden upon him. Further, our society with its web of family, eco- nomic, legal, and religious principles, is not such that other than medical interests can easily and fairly be left out of such a considera- tion.
Legal Aspects
The current law regarding euthanasia embodies the popular, and largely unconsidered, theological and medical perspectives elaborated previously in this paper. These premises bind the law to awkward and sometimes inconsistent conclusions in actual cases of euthanasia.
One reason for difficulty in the case of mercy-killing is the in- ability of the law formally to consider the motivation behind criminal activity. Thus, if the facts establish the guilt of the individual, there is no legitimate mechanism through which the motivation may affect the verdict.10
The immense latitude in practical application of the law demon- strates the inadequacy of the present theoretical presuppositions. Currently the legal situation is seriously compromised, with the fol- lowing results. Disrespect for the law is fostered, for example, when a judge instructs the jury in a case of mercy-killing that motivations are not to be considered, and that the facts must be weighed in isola-
10. Luis Kutner, "Due Process of Euthanasia," Indiana Law Journal (1969), 44:540.
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tion to determine the guilt or innocence of the defendant on a charge of murder. The jury may then acquit an obviously guilty party with the result that the entire legal structure loses respect and effect.
The law is compromised also in the measure to which the present structure allows inconsistent sanctions. When doctors are practically immune to punishment for the same activity which nets other citizens years of imprisonment and even death sentences, the justice of law itself is threatened.
Finally, the present system may allow persons who have practiced murder disguised as euthanasia, to go free. Because of lax application of the statutes regarding murder in cases of mercy-killing, some who cause death for less unambiguous and less worthy motives are ac- quitted. Confusion and contradiction in technical law and practical application hinder sound legal practice.
The specific premise in today's law which permits all of these (we think deleterious) effects is the connection of malice and pre- meditation. In the statutes concerning murder, the first degree of homicide is established when "malice aforethought" has been proven. Unfortunately, subsequent interpretation of this phrase has not demanded the presence of both, but rather assumed that "malice" was an adverbial qualifier for "aforethought." The establishment of pre- meditation is automatically supposed to prove malice. This is an especially difficult problem for responsible mercy-killers who act not out of vindictiveness or hostility or frenzied emotion, but painful and responsible decision before-the-fact.
It might also be pointed out that human life is not an ultimate if common practice be any indication. Practices of capital punishment and war make it evident that the debt owed to society or the safety of society are higher goods than a human life. This is to say that a human being may be called on to surrender his biological life for some good seen as higher. Certainly a dying patient could be considered to be in a similar position and voluntarily relinquish his life for what he considers a higher good. Current legal processes make no allowance for this possibility, however.
A Proposal
We argue the justifiability and the advisability of active euthana- sia under certain conditions. These conditions and the implementation of the act of euthanasia are described in the following proposal. How- ever, it should be noted that the proposal is intended to do more than
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activate machinery which would "legalize" euthanasia. Its primary purpose is to propose an economy of structures under which fair consideration of the issue would be most likely to occur. Thus, it does not assume infallibility, but it does intend to mobilize the maxi- mum potential for just decisions in this highly complex matter. All prescriptions presently used in channeling the decision-making process can realistically have only this intent for their goal. Every situation is unique, and cannot therefore be fitted precisely with a preconceived prescription. Uncertainties and ambiguities will always be present. Thus, maximization of guidelines is the most we can hope for. If this proposal satisfies that criterion then it should, like some of its prescriptive counterparts, be made effective through legis- lative action on the state or federal level.
Perhaps the easiest way to present the particulars of the proposal is to view it from the perspective of a possible result of its implementa- tion. We present here in order those conditions and criteria which must be satisfied if active euthanasia be advocated.
Three conditions must be present before euthanasia would become a serious option for any person of legal age judged to be mentally competent. First is the presence of an incurable "mutilation" of the person. Such a mutilation could be in the form of physical disability, disease, or mental disability.
The second is the absence of the patient's opposition to the per- formance of the act. The possibility for altering this second condi- tion (i.e., recognition of a patient's opposition) presupposes the mental awareness of the patient. (If mental awareness were absent, or if the patient's will could not be discovered for any other reason, or if he actively sought the procedure, then this second condition would be established.) It would be the duty of the hospital adminis- tration, through an appointed representative (e.g., a chaplain or other professional equipped to inform, understand, and discern the patient's feelings), to discover the explicit wishes of the patient at the time of the consideration of his case.
Such a consideration would take place in the procedures of the third condition, that is, the agreement of three of five members of a panel appointed to deliberate such cases. Such a panel would be acti- vated only if and when the other two conditions were met and if it were notified of the case by a concerned individual or group.11
11. Such notification would start the procedures outlined for condition num- ber 2.
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Panels would be appointed preferably by city or county govern- ments and in sufficient number to meet the demand on their services. The appointing body would also voir dire prospective panel members in order to establish the absence of an inprincipled objection to the practice of euthanasia. In legal terms voir dire, meaning to speak the truth, is a preliminary examination to determine the competency of a witness or juror. It is within the voir dire that evidence is sought concerning any preconceived ideas or notions concerning a case or practice. It is often felt that such preconceptions might affect one's ability to weigh evidence fairly under the law.
In this case, the panel members must be free to vote for euthanasia should deliberations on the case warrant its exercise. The patient's personal physician and a representative of his religious faith would be the only members exempt from the voir dire. The five members of a deliberating panel would be : ( 1 ) a physician not otherwise con- nected with the case or the family; (2) the attending physician; (3) a professional representative of the patient's religious faith, other than the patient's own clergyman.12 (4) a lawyer or judge not presently involved with the patient; (5) a psychiatrist previously uninvolved with the patient. (The psychiatrist would be the only member of the panel other than the patient's physician who would be able to inter- view the patient if he felt it necessary to do so. )
The decision of the panel would be binding on the hospital in which the patient was being treated. Individual physicians on the hospital staff could only be prevented from performing certain life- saving or death-assuring procedures by the decision of the panel. All actions, however, must be by licensed physicians. Finally, any decisions of the panel would be made immediately void if the first two conditions were altered.
It remains to outline the criteria upon which the panel would make its decision. The panel is not limited in the scope of its consideration except in one respect. (While it may include in its deliberations any factors it sees proper or necessary for a complete consideration of a case, it must include at least the following.) Further, it would be understood that these required criteria would be weighted in descend- ing order as they appear here :
12. In the case where the patient voices no denomination or faith preference, the last theologian to sit would remain. For atheists, no theological consultant would sit on the panel, but three votes would still be required.
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a. The patient's desire for death or the absence of his opposition to death, and his preference for direct or indirect action.
b. The patient's same desires as expressed through a legally recognized "pre-will."
c. The patient's same desire as expressed prior to the present crisis to legally recognized witnesses who thus testify.
d. The nature and status of the illness and the amount of suffering and duress experienced.
e. The ability of the patient to engage in reciprocal human relationships.
f. The presence or absence of the family's opposition to euthanasia for the patient.
g. Financial considerations.
h. The presence or absence of spontaneous respiratory, circulatory, and cerebral functions.
In the case of a patient who is a minor or who is judged mentally incompetent the procedure would be altered in the following way :
Since such a person cannot express a legally binding will, the second condition as stated above would not apply. That is, such a patient could not, on his own, express legally recognized preference for or opposition to euthanasia. At least he could not do so with the authority which such a legal requisite demands.
However, such an expression is a valid consideration for the mix of factors which the panel must review in making its decisions. While the law recognizes diminished responsibility, it seldom would contend that any individual's voice is meaningless. Operating on this as- sumption of worthy, though diminished, expression, the criteria of the panel's deliberation would be changed at four points.
Criterion (f), "The presence or absence of the family's opposition to euthanasia for the patient," would follow criterion (a), "The patient's desire for death or the absence of his opposition to death, and his preference for direct or indirect action," as the second-most important factor.
For reasons stated above, criterion (b), "The patient's same desires as expressed through a legally recognized 'pre-will,' " could not be established unless the patient had at some previous time estab- lished a "pre-will" when he had the authority of a competent person of majority. In such a case it would follow criterion (f) as noted above. Criterion (c), "The patient's same desire as expressed prior to the present crisis to legally recognized witnesses who thus testify," would remain in order.
Following this, an additional, parallel criterion (b) would be
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inserted stating, "The attitude of the family as expressed prior to the recent crisis to legally recognized witnesses who thus testify."
If Criteria (a), (f), (b), (c), and (i) as they are denned here are all in agreement, they would be recognized, under this proposal, as having the authority of condition #2 concerning the absence of the patient's opposition. If they were not in agreement, or if their agree- ment did not result in opposition (i.e., the breaking of condition #2), then the panel would be activated for further deliberation.
Such deliberation would follow the altered order as described en- compassing the additional criterion in its place and including the re- maining criteria as they stand.
The flowsheet for the consideration of criteria would then be as follows :
(a). The patient's desire for death or the absence of his opposition to death, and his preference for direct or indirect action.
(f). The presence or absence of the family's opposition to euthanasia for the patient.
(b). Where possible — the patient's same desires as expressed through a legally recognized "pre-will."
(c). The patient's same desire as expressed prior to the present crisis to legally recognized witnesses who thus testify.
(d). The nature and status of the illness and the amount of suffering and duress experienced.
(e). The ability of the patient to engage in reciprocal human relation- ships.
(g). Financial considerations.
(h). The presence or absence of spontaneous respiratory, circulatory, and cerebral functions.
If, as a result of the panel's action, the three conditions were met and the obligation of the hospital was thus incurred, the question would remain concerning the means and timing of the act of euthanasia.
It is here proposed that the act should take place as soon after the decision as possible. The patient's opposition again should be checked as the minimum preparation. The means employed should be those causing a minimum of duress to the patient and should be checked against his preference for direct or indirect action as it was expressed in establishing criterion (a).
A Theological Basis for the Proposal
The theological and ethical presuppositions and implications of the proposal are central to its understanding. It is of course impossible
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to examine exhaustively these concepts or even to bring all pertinent concepts to light. It is, however, possible to examine some of the con- cepts which have the most immediate and forceful bearing upon the proposal. Death is one of these concepts.
The first thing which might be said about death is that it is uni- versal. It occurs to all men and thus to each man sometime. It is one process in life which is inescapable. It has been said that with man's first breath he begins dying. While this is not strictly true by our definition, it does indicate strongly that death is part of life and that properly it can not be isolated from it.
As has been said, the prevalent attitude about death is to see it as being apart from life. Further, death is seen as the enemy of life. In fact, whether death is seen as a part of life or not, this charge is still levelled against it. It is a correct observation that death has emotional overtones both for the dying and for those around the dying. However, it is arguable whether the emotional impact of death must leave a negative impression. Death is not necessarily an enemy. This can be true for the dying person because death can come to him as one of the processes of life. Indeed it may be a welcomed process, one of relief from suffering and depersonalization. It also may have the positive value of being a deep experience in itself.
Death is not necessarily an enemy to those around the dying person. Being considerate of the patient's state they may find for instance that the void caused by the individual's absence is not as pain- ful as watching the patient suffer. Thus death is not necessarily an enemy and dying not necessarily a horror.
To substantiate this position and to draw out its implications it is necessary to examine the terms life and death, as they operate within our conceptual economy.
Life is created by God. That is, the totality of life as a qualitative distinction is under the influence and jurisdiction of God. Human life is not a birthright. It is a given, a gift from God, who seeks continually to work with it. In every situation, from conception onward, God is seeking to work for the enhancement and preserva- tion of the human dignity and personhood which makes life human. Death is not beyond the scope of this influence ; it is rather an integral part within it.
Life then, in its totality including the death process, is caught up in a relationship with the Divine. It is from this relationship that life
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gains its value.13 Insofar as a person is available to dignity and personhood, his life has value and is to be highly respected. But the referrent for dignity and personhood — for the humanness of life — is not the isolated somatic system which seems to serve as the present criterion. It is rather the community of systems. The wholistic view of man upon which this proposal is based demands the perception of man as an integrated whole. His somatic, psychological and spiritual aspects are completely interwoven. Further, his individual self which is formed by the mix of these aspects does not become a personal self, a human self, until its social and theological relationships are realized.14 The individual is still the referent ; but it is the individual in community.15 As the disintegration of these interrelated systems becomes irreversible and accelerated, the patient begins to die. Death occurs when the disintegration is seen as accomplished. Personal life is over. The humanness of life is gone.
But "human" dignity is not irrelevant until "human" life is judged as terminated. Thus, while an acceptance and recognition of death is called for, such an acceptance and recognition is not unqualified. As a process in life, dying is acceptable only insofar as it does not un- necessarily interfere with the dignity and personhood of the indi- vidual. That is, while the various factors of the integrated self begin to break down and some imbalance will take place, it is not necessary to accept an acute imbalance and disintegration. And it is certainly not necessary to prolong such a misfortune.16
13. B. Baird and J. Fletcher, "The Right To Die," Atlantic Monthly (1968), 221 :64 : "The sanctity is not in life itself, intrinsically ; it is only extrinsic and bonum per accidens ex casu — according to the situation." For the Christian the accidens is the status of the relationship with God.
14. "For a person to live, he must either be realizing his potential or have the capacity to realize his potential ... 1. To have a rational awareness and 2. To interact emotionally with other people." (P. Wesley Aitken, "The Chaplain," included in the article by James T. Cleland, "The Right to Live and The Right to Die," Medical Times (1967), 95:1186.
15. This is excellently summarized by Adrian Verwoedt, Communication with the Fatally III (Springfield, 111.: Charles C. Thomas, 1966), p. 160: "The psychological level . . . cannot exist without the integrated biological function which make possible an intact central nervous system and the resultant mental activity by which man distinguishes himself from lower animals. Even with the psychic apparatus intact, however, man is not complete. He must also func- tion as a social creature. For, just as his intellectual power sets him apart from other animals, his social orientation sets him apart from his fellows and imparts his unique individuality."
16. "The right to life does not necessarily entail the obligation to live, especially when continued existence is so hideous and demoralizing that the
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This conclusion is reached by the following reasoning : If, in fact, the dying process is part of life and if God's will is for personhood and dignity to be enhanced, then it can be assumed that God's will is to enhance personhood and dignity in the dying process. When this is not done, then there is in fact a certain evil present which hinders the will of God. Such an evil, and thus such a death, cannot be ac- ceptable. To look at it another way: it is as if the natural arena of God's activity is insufficient in this case for His will to be done. Some "natural" deaths thus go against God's will, disintegrating rather than terminating human life. In such a situation, God's will may be acted out by instrumentalities other than the natural processes. Man has a part to play in such a situation. His role can be seen by exploring the implications of the assumption that God does work through the instrumentality of man. To most men there does not seem to be a ready-made interpretation of God's will for each situation. Further, because man is free he can realize the possibility of choice. Man chooses and his decision may be, in a given situation, better or worse. But even if he does not select an alternative, he has chosen. His choice is simply whether to participate actively in the decision. Such a choice may be relatively good or bad. Since God works through the instrumentality of man and since part of man's God-given dignity is his freedom to act and choose, it can be said that God does work through the choices of men. This is almost tautological. It would not make sense for God to work for dignity and personhood by a means which denies one of the central components of the goal.
Thus man's decision becomes very important in the working out of his instrumentality. He must decide how he will interpret God's will in a given situation. Understanding the limitations of time and knowl- edge, man is aware that his actions must remain imperfect. But risk of mis judgment does not free man from his responsibility to act in the best way possible to him. Luther's admonition to "sin boldly," and its accompanying concept of munificent grace, seems few places more applicable than here. Where man seeks to do the will of God, and through his finitude fails, forgiveness is available.
Certainly man does not shirk this responsibility in many of the matters of human well being. He freely and properly disseminates services which overcome the minor sicknesses, sufferings, and injuries of life. Further, he is actively engaged in affecting the beginning of
person is blotted out and reduced to coma or ungovernable nerve-reactions." J. Fletcher, Morals and Medicine (Boston: Beacon Press, 1954), p. 188.
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life as he discusses contraception, practices pre-natal care (including surgery and abortion), and aids in the childbirth process. In all of these instances man can be seen trying to affirm the dignity and personhood spoken of above. He is taking seriously natural events as an indication of his sphere of activity. He is then attempting to en- hance the personal-social integrity by the means available to him. The problem arises when man confronts death. As was said, his at- titude is one of fear; his actions normally are attempts to prolong life. This seems to be the result of misplaced priorities. Life becomes the object of our veneration and individual existence the center of all meaning.17
Such an approach not only has touches of blasphemy but per- petrates an inconsistent system of medical ethics. Certain practices used to aid the patient during other phases of his life are withdrawn during terminal phases.18 An artificial limitation is placed on permis- sible practices for the patient's care.
This limitation is more often than not the result of restricted conscious deliberation. Medical ethics tells the doctor to save life. If death's process is not recognized as the end of life, ignored as being what it is, then the doctor may ignore its special implications for the care of his patient and continue fighting a hopeless battle or merely allowing, without influencing, the inevitable.
This seems to shirk the responsibility of decision for the best care to the patient. Such decision by default is acceptable neither within the decision-making economy described above nor in the scope of true humanitarian concern for the patient.19 Responsibility requires
17.". . . if we are dedicated to preserving life under all conditions, at all cost, then we are wrongly worshipping life as a substitute for God." D. P. Sholin, "Death of a Son," Ladies' Home Journal (1968), 85:70.
18. Fletcher points out the irony : ". . . we are, after much struggle, now fairly secure in the righteousness of easing suffering at birth, but we still feel it is wrong to ease suffering at death!" (Morals and Medicine, op. cit., p. 196).
19. The argument may be substantiated in this way: Default activity is the result of a type of rationalization. "We are so afraid that someone will make a wrong decision that we take refuge in the maxim that because we can keep these persons alive, we must — a maxim that has been reached not by intelligent and compassionate study but by default, or at best by transferring a sound principle of medical ethics bodily into social ethics." M. M. Shiedler, op. cit., p. 1500. However such rationalization has its consequences. "Still it may be asked whether greater depths of inhumanity are not reached when we allow people to die in isolation, walled off from effective community with others under the cover of medical necessity." James T. Laney, "Death and Ethical Reflection," Reflection (1969), 66:4.
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that positive decisions be made and implemented.20
In summary what has been attempted by the proposal is the crea- tion of an arena within which God's will for personalization of indi- viduals could be acted upon. It is an attempt to check both natural insufficiency and man's foibles while being aware that it operates within an atmosphere of imperfection and forgiveness.
Fletcher speaks to our position quite well :
The right of spiritual beings to use intelligent control over physical nature rather than submit beastlike to its blind workings is the heart of many crucial questions. Birth control, artificial insemination, sterilization, and abortion are all medically discovered ways of fulfilling and protecting human values and hopes in spite of nature's failures or foolishnesses. Deatb control, like birth control, is a matter of human dignity. Without it persons become puppets.21
20. A course of positive action could be dictated if the assumption is correct that : "When a Christian is dying, a doctor needs to be aware of his patient's sense of values. For such a one a vegetable existence offers no opportunity of living for Christ . . ." Andre Bustanoby, "The Right to Die," Christianity Today (1963), 7:39.
21. Fletcher, "Anti-Dysthanasia — the Problem of Prolonging Death," op. cit., p. 83.
Dean's Discourse
Thoughts on the University*
"Brethren, whatsoever things are true . . . think on these things . . . these things do, and the peace of God will be with you." Phil. 4:8, 9.
The nation is deeply troubled. Some universities are in partial disarray ; many seethe with unrest. Academic life is disturbed, studies are in jeopardy. Students are aroused and profoundly stirred; teachers are disquieted ; administrators alternate between hope and despair. Cambodia touched off the smoldering pile of young adult resentment toward a protracted war that had already amassed an appalling record for debauchery, atrocity, and futility. The pattern of turbulence and closed universities of southern Europe may lie ahead for us. Mass education adds to the problem by geometric progression : not only does it provide arenas for massive ferment, but mass educa- tion is itself potentially a massive reservoir of political power, for good or ill.
In the face of these realities, it is, perhaps, already too late in the day to hope for a constructive answer to the question, what is the role of the university in today's society ? In some ways, the events of the past three years make the answer all too apparent. For the "new left," the decision has already been made : it holds that the university is a chief instrument of social revolution. It is just this that astute conservative reactionaries perceive, and it is this which many teachers and scholars, pursuing their researches with time-honored non- judgmental objectivity have been slow to take in.
All decent people, inside and outside the universities, are aghast over the desperate events at Kent State and, now, at Jackson State. They are also bewildered and shocked by recent calculated student indecencies at Princeton in March. These plainly violated standards of academic process and scholarly restraint. Ordinary people do not comprehend disruption of the university when disruption is planned and then justified as an instrument of social protest. They have not,
* A sermon preached by Dean Robert E. Cushman in Duke Chapel May 17, 1970.
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up till now, understood the university as the chief instrument of societal change.
They are, perhaps, still thinking of the university in the manner of John Henry Newman's idea of it ; namely, as the place of liberal learn- ing where "knowledge," as he said, "is capable of being its own end." In his Idea of a University, Newman spoke of university education as "a comprehensive view of truth in all its branches." This "liberal education," he taught, engenders the "philosophic temper." It instills a "habit of mind," serene and composed, which fosters "throughout life the personal attributes of freedom, equitableness, calmness, moderation and wisdom."
For such conceptions of university education, the platform of the "new left" is, on the face of it, unintelligible. From the Newman 19th century perspective, the eloquent defense of Princeton graduate student, Michael Teitelman, on behalf of his fellows charged with disruption and insubordination must seem incredible and outrageous :
"This is a political trial," Teitelman declared, "and that's what we want everyone to understand. We're not on trial here. What's on trial is the ruling class and its racism and imperialism. We have said that the real explanation of all that we do in this trial is to be found in the unhuman, unfree, repressive social reality all about us. We do not deny we organized a demonstration against Mr. Hickel. We ex- plained why we did so and why we thought it right to do so." (Princeton Alumni Weekly, April 28, 1970, pp. 11, 14).
It is not necessary to enlarge upon the bill of particulars with which Mr. Teitelman indicts the established orders of society, includ- ing those of the university. It suffices to observe two or three things :
The first is that, by asserting the "political" character of the hear- ing for students charged with violating the university code, Mr. Teitelman means to exempt the defendants from the standards pertain- ing to their membership in a university community. He does so on grounds of the Tightness of their political views !
Secondly, and behind this, is the premise that the really sufficient reason for continuing university membership is political "enlighten- ment" issuing in liberating social action.
Thirdly, that disruption of university practice and academic protocol is non-censurable if it is politically justifiable. The end justifies the means! Our ends are right, therefore our behavior, how- ever obnoxious, is justified !
But beyond this is the underlying premise about the nature of
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the university that justifies this logic of expediency with immunity. It is that the university is, at the least, a staging area for, perhaps even an instrument of, social revolution. Certainly, the "new left" is not above using the university as such under the guidance of ends taken to be, as Teitelman says, "right." So "right," indeed, so valid he believes, is the end in view that even means which denature the uni- versity are not deterrents to the apostles of social reform, urged on as they are by revulsion against oppressive established orders — both inside and outside the university.
II
The agony of the present-day university is something like this : it is caught in the pincers of a societal revolution surrounding it, while, at the same time, the university is itself disturbed and disrupted from within by morally defensible outrage against maladies without. It is caught in the middle between societal inaction and leftist reaction. Meanwhile, often, as at Princeton, the leftist reactors within claim all the immunities of the academy while exhibiting the behavior of fanatics.
The resulting internal conflict is insupportable. For, of all civilized institutions, the university — committed as it is to rational inquiry, persuasion, and the honor code of the gentleman — is most vulnerable to disorder. The discipline of the university is still mainly self- discipline. When the university, however, becomes the focus of the infectious ills of the environing society, it is the first casualty of the prevailing cultural disorder. Liberal education is incompatible with the illiberal spirit ; when the latter waxes, the former wanes.
But this special vulnerability is not all that imperils the university. In addition, by its very nature, the university tends to' invite, however unintentionally, the disorders with which it is presently afflicted. For, the university is, as the medieval schoolmen understood, a microcosm of the world. It is microcosm of the surrounding culture. In so far as there is reasonable working harmony between the ends or goals of a society and its institutional support of them, there is stability. In such a case, there is also stability enough for the peculiar role and func- tion of the university. When the contrary prevails, that is, when there is contrariety between new emerging goals and the institutional vehicles for their realization, then the resulting ferment and strife in the surrounding culture first comes to articulate consciousness in the university — as the microcosm of the macrocosm.
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To be more explicit, it is the nature of the academy, from the time of Plato, that it should proceed on the Socratic premise that "the unexamined life is not worth living" and that, therefore, the purpose of the academy is just exactly to examine life as it is being lived to the end of its progressive betterment. In a sense, the academy has always stood in the role of critic of the established or prevailing culture. That is why "the gown" and "the town" have frequently experienced some measure of estrangement and some need of reconciliation. But in times of intense cultural revision, when the nisus of history moves toward the renovation of cultural forms in the interest of squaring the practices of society with a larger human good, this pressure frequently has its initial acknowledgment in the university.
Here, the inequality, or the contrariety, between the things that are and the things that ought to be come first to disquieting aware- ness. And in our time of immense societal distortion — stubbornly resistant, it seems, to humane solutions by way of present modes of political and institutional response — the university tends to become the home of radical solutions to social ills. All this obtains while the ailing society is laggard either frankly to acknowledge its sickness or to resolve it by finding the cure.
So the university spawns social activists — students and faculty with varying degrees of revolutionary commitment. Among these the most zealous, like those at Princeton, are not above turning the academy into an instrument of social change, disrupting the educa- tional process itself in the interest of radical renovation of the political order and its economic base. Unfortunate as it may be, their strength is that they have too good a case ! But, at the same time, they denature the function of the academy by using it as a political tool.
So it has come to pass that the currently ascendant idea of the university is that of the "new left." They hold that the university is properly an agent of societal change. At times they act and speak as if the university should become the Church. It cannot be denied that, in some part, they represent a rebirth of conscience of which the Church should always be the promoter. But prompted by great "righteous indignation," these apostles of social reform have their residence in the Academy. Yet the Academy is not the Church. Un- like the Church, the Academy has not required that its members be regenerate. But apostles of righteousness who are not regenerate may easily become fanatics.
The "new left" does, I think, follow in some part the admonition
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of St. John: It comprehends what the academy has characteristically been slow to acknowledge. This, namely, that the Truth is not some- thing to be known only, or always to be being sought after, but rather something to be done, and now. The "new left" in part seems to hear what churchmen ought always to heed : "If we say that we have fellowship with him and walk in darkness, we lie, and do not the truth." It is the New Testament and the Church which always say that the truth is for doing. The "new left" is urging that there is a no more needed pedagogy, and no Christian can deny it. The fact is that the truth for doing, as St. Paul declared, is just exactly faith, hope and love. And the exasperating thing is that the "new left" concurs with St. James that faith without works is dead.
Nevertheless the academic apostles of social righteousness are mainly blind, or perhaps uninformed, respecting Isaiah's more authen- tic apostolic calling. They are unaware that, just because he was a man of "unclean lips" dwelling among "a people of unclean lips," Isaiah could not be trusted with mission until he had acknowledged his complicity in the sin and guilt of his people. He could not be trusted with mission until he had been cleansed for mission. He was not sent until he had received the grace of a diviner forgiveness which preserves "righteous indignation" from supercilious fanaticism. From the Princeton Weekly nothing is plainer respecting the academic apostles of righteousness than is declared in Proverbs:
"There is a generation that curse their father, And bless not their mother.
This is a generation that are pure in their own eyes, And yet are not washed from their filthiness."
The Biblical view of man does not indulge such an interpretation of "the generation gap" as would distinguish between one generation and its successor by the sinfulness of the former and the righteousness of the latter. Nevertheless, only invincible ignorance would deny that the young adult generation are warranted in some of the grave indict- ments they bring against contemporary American society.
Ill
What happened at Kent State and, perhaps, at Jackson is a frightening disclosure, I fear, of the moral sickness of our culture. Surely it is a time of peril for any nation when agents of government, charged with maintaining the peace, resort to overwhelming force against an indiscriminate body of unarmed citizenry — especially
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youthful ones. Such official excess is probable evidence, as was stated by John W. Gardiner this week in The New York Times, that "we are dealing with disintegrative forces that threaten our survival as a society."
As for the universities — and I speak after nearly thirty years' ex- perience in three such institutions — the universities, as microcosms, cannot sustain much longer the inner turmoil engendered by the un- resolved ills of the larger society. After nearly three years of internal divisiveness the universities are becoming disfunctional. It is true, as Mr. John Gardiner also is reported to have said, that "today's divisive- ness is not confined to one issue. There are multiple points of conflict," he said, "the war, race, the economy, political ideology. There are multiple rifts — between old and young, between regions, between social classes."
This is all true; yet I suspect — so far as the universities are con- cerned— it is much as I wrote for the Divinity School Alumni a year ago, namely : ". . . that until the futility of Viet Nam is retired, with its violation of conscience, the scepticism of youth toward the wisdom of their elders and the propriety of established orders will not recede. Viet Nam is the scandalous symbol of the bankruptcy of capitalistic democracy's way of meeting the future or dealing with human destiny by stereotyped and outworn patterns of response. More than anything it epitomizes . . . the frustration of the young with the sheer inertia of the Establishment." And I would affirm again what I then declared that, "Unless creativity replaces inertia, Viet Nam may turn out to be the fatal nemesis of the American way of life — its dissolution of confidence."
This past week Mr. Gardiner declared that "a crisis of confidence" is indeed upon us : "We must move vigorously," he said, "to solve our most crucial problems" and we must seek "a healing of the spirit of the nation." It was in commentary upon these words that the Times noted that "Almost two years ago, the National Commission on the Causes and Prevention of Violence warned that the greatest threat to American survival was not from without but from within."
The real enemies are those of our own household : it is this un- blinkable fact that simply renders obsolete, I believe, the premises and consequent policies that seemed to justify Viet Nam in the first place. Certainly, they are now discredited for any further extension of the war. And that is the scandal of Cambodia : it not only offends against
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the decent opinion of mankind, but flies in the face of reason itself. To many, it seems an invitation to societal suicide.
But if there is to be, as Mr. Gardiner has urged, a "healing of the spirit of the nation," then, surely, there must be, in addition to acknowledgment of our moral blame as a people, a recovery of moral integrity and vision. If, as Proverbs has it, "without vision the people throw off restraint and perish," will we as a people give heed to our foundations ?
"Brethren, whatsoever things are true, whatsoever things are honorable, whatsoever things are just, whatsoever things are pure, whatsoever things are of good report . . . think on these things." So counsels St. Paul. But, more emphatically he enjoins: "these things do, and the peace of God shall be with you."
Brethren, our jeopardy as a nation, the threat of our dissolution as a people and as a society, is that we cannot continue to exist in defiance of the moral Universe. At last and inescapably, the truth is for doing! But it is the nation, and the individuals who compose it, that must do the truth. The universities cannot, in this, substitute for society. Neither can they safely assume the apostolate of the Church. Only this week student activism has resorted to the legitimate avenues of democratic legislative process. This may be a turn of the tide. I pray God the legislators may hear them.
May 17, 1970 Robert E. Cushman
DUKE DIVINITY SCHOOL REVIEW
Autumn 1970
Prayer
Oh God,
whose glory is in all the earth,
and by whose presence we are preserved from
ourselves
and from all else that would quench
Thy light and warmth of life, We praise Thee.
Forgive our feverish ways, our random ventures,
our bold and thoughtless prods at life,
our fear-filled and our hate-ridden incubations. Grace us with the discipline of trust in Thee,
that we may find footing on the firmament of hope and love, that our vision may pierce the low-hung-cloud-ceilings of self-aggrandizement, self-deception,
and self-indulgence. We thank Thee for this place of service.
Fructify our minds that we may better understand our tasks. Strengthen our hearts that we may be in warm pursuit of our goals. Inspire our wills that we may be steadfast in Thee towards all people.
Oh God,
in the midst of the Darkness of our times grant that we may not succomb
to the strange allures
and gaping easement of
Darkness.
By Thy grace
keep our gaze steadfast on the light that shines forth from Thy Christ,
and from the refracted rays leaping all around us in
Thy fractured image that is Man.
We commit ourselves to
Thy goodness and mercy, Creator, Preserver, Redeemer.
Seal our commitment by Thy gracious Spirit with the assurance that those who labor in Thee and for Thee labor not alone nor in vain.
And to Thee the only true
only wise
only faithful
living and loving God, through Christ our Lord
be all honor and glory now and from the ages unto the ages.
Amen
THE DUKE DIVINITY SCHOOL REVIEW
Volume 35 Autumn 1970 Number 3
Contents
Prayer (at the first meeting of the Faculty) Inside Front Cover
by Franklin W. Young
Worship, Our Ministry 139
by Robert E. Cushman
A Man to Stand in the Gap 146
by Gene M. Tucker
On Styling It 152
by Charles K. Robinson
Focus on Faculty 161
by Paul A. Mickey, Robert L. Wilson, and Robert Terry Young
Looks at Books 167
Editorial Committee : Frank Baker, Donn Michael Farris, Paul Field, Ray C. Petry, Charles K. Robinson, Robert L. Wilson, and McMurry S. Richey, Chairman
Published three times a year (Winter, Spring, Autumn) by The Divinity School of Duke University
Postage paid at Durham, North Carolina (27706)
Worship, Our Ministry
Robert E. Cushman Dean, Duke Divinity School
I.
Today we enter upon the forty-fifth academic year of the Divinity School. As the first established graduate professional school of Duke University, the Divinity School began its distinctive service to Church and University in 1926. Today it is an honor and privilege to greet returning students, in the name of the University and the faculty, and to welcome the new students who come to partake of what we can offer here. We are committed to offer, in word and deed, the substance of Christian faith as a life and a vocation. In the course of your passage, and ours, we hope that your misgivings may recede before enlarged understanding and firm aspiration for ministry in Christ's name. A theological school is not an escalator ; it is more nearly a ladder of discipline which may, if you will, assist you "to make your calling and election sure" (II Pet. 1 :10).
This morning, as in previous years, we reassemble in this opening convocation of praise and thanksgiving. We remember that our Lord, in discharge of his ministry, arose a great while before day and went into the desert to pray. Because we do not suppose that our need of prayer is less than his, we reassemble as a community for worship. We propose to make our beginning in worship as, indeed, the Chris- tian life — if it is to be possible at all — must begin, continue and end in worship. So today we find worship our starting-point and believe that in this context we may rediscover again, also, our reason for being as a school.
For a theological school, worship is native air. This morning I propose to show that it is not only the matrix of our life as a school, but the substance of it. Our presupposition is God and God as Lord. In this convocation we properly begin our year in acknowledgment of Him.
In the final analysis, all worship is man's acknowledgment of God. Its language is the language of response. Accordingly, this convoca-
Divinity School Opening Convocation Address September 22, 1970.
140
tion intends at least two things. First, it convokes the Divinity School community for listening and for self-recognition as a people who are addressed. But, secondly, our convocation intends that our communal self-recognition should take place in the corporate recognition of God. For it is necessary, if we are to know ourselves in our dis- tinctive corporate identity, to recognize ourselves as a community under God. Yet we can do this only as a people at worship. There- fore it is further clear that the prior purpose of this convocation is not, primarily, that we meet here to relate to one another, but that our meeting is open to a wider dimension of Being, which we assemble to acknowledge. Moreover, finding one another in the presence of God may be the only auspices under which we can really meet and get through to one another at all. If there is to be a real community of men with men, perhaps it must begin, continue, and end in worship, that is, under the acknowledged Lordship of God. This at least is the message of the Bible. With it, there is no lasting community of man with man save under the common acknowledgment of God.
II.
No other division of the University avowedly operates on the prior acknowledgment of God either as its presupposition or reason for being. It is not, however, that God as Lord is denied by the other schools ; it is only that their reason for being does not have acknowl- edgment of God as the distinctive objective of their function. Even a department of religion in the University may delineate the phenomena of faith, without either enjoining it or inviting acknowledgment of its presumed divine Co-implicate. If a theological school were simply a "school of religion" as a part of the Graduate School of Arts and Sciences, its faculty would be under no mandate save to exhibit the historic forms of the Christian consciousness in relation to the suc- cession of its institutional expressions, called churches, and possibly to indicate contextually suitable models for today.
But, eo ipso, 2l theological school has God as its presupposition and his acknowledgment as its reason for being. It is the momentous if neglected distinction between knowledge and acknowledgment which signifies the difference between the kind of study that confines itself to the phenomenology of religion, even of the Christian religion, and the kind of endeavor that goes on here or in any school of theology.
To add that we are a professional school helps but does not fully disclose the differentia of a seminary unless "professional" is taken
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in its literal sense — as it may be — meaning "to profess." In that case, what is entailed in our context is a profession of faith. That pro- fession of faith takes the form of ministry, or, better, is embodied in it. And that ministry is a ministry after the fashion of Christ.
Now, none takes upon himself such a ministry unless he professes its significance for him and its mandate upon him. This is when profession of faith issues in practice. When profession issues in practice, there is evidence that knowledge has been transformed into acknowledgment. And acknowledgment of God is worship. Con- versely, when, after the analogy of electrical conduits, acknowledg- ment is transformed downward, "stepped-down" to the voltage level of knowledge, faith gives way to conclusions rated according to more or less probability. Then, worship becomes something else — prob- ably "science" or some form of it. Then profession of faith ceases to be also vocation, that is, a personal commitment, and may become the subject-matter of a learned discourse.
No theologically literate person, responsible for this Divinity School, supposes that it is a school of the science of religion. On the contrary, in a variety of ways — some more informed than others — all recognize that the Divinity School is pledged to education for min- istry. But, if so pledged, then by implication pledged also to ac- knowledgment of God in the form of life commitment. Students do and may come here to find out whether they can make that com- mitment their own, but they cannot rightfully presume or expect that the school, for its part, will share their ambiguity, or that it should intentionally accommodate its purposes to their own ambivalence. The school is prepared to nurture, embrace and assist. It is prepared to illuminate, exalt, and invite participation in the ministry of Christ, but it is not permitted to denature its own distinctive role and purpose as keyed to that ministry.
III.
The subject of this convocation message today is worship. What has so far been said is intended to introduce the subject in relation to our role as a Divinity School. I have suggested that our endeavors after knowledge here have a distinctive difference from those of other schools. It is proposed that all our endeavors after knowledge have their proper issue in acknowledgment, namely, the acknowledgment of God. Acknowledgment entails the involvement of the whole man. On the one hand, it means hearing and being grasped and, on the
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other, it means loyalty. Acknowledgment entails a pledge, a commit- ment; and commitment is a giving up to the other. Generically, I have said acknowledgment of God is the heart-meaning of worship. It is, in fact, self-offering.
So I say also that worship as acknowledgment is the aim and end of this school ; the end is not scientia, science ; the end is consent to the Being of God. As worship is the end, so prayer, as the language of worship, is the medium of its fulfilment. Plainly, then, this school has a distinctive role and purpose just because it has a distinctive presupposition. Every school has its distinctive presuppositions: For Law, it is that, in the strife of counter claims and counter claim- ants, order is better than disorder and equity the surest bar to in- justice. For Medicine, the presupposition is that health is better than disease and that there are ways of avoiding the one and enhancing the other. Neither Law nor Medicine, as such, may wish to probe be- hind these presuppositions for, let us say, their ontological co-impli- cates. For Divinity, however, the presupposition is ontological. It is God as self-disclosed, as mysteriously eruptive in history, in the ministry of Jesus called Christ. Plainly, with this presupposition, the derivative purpose of a Divinity School is the nurture of men and women for acknowledgment of God after the manner of and by par- ticipation in this ministry. But now, as the acknowledgment of God is worship, so the acknowledgment of God by participation in Christ's ministry is, precisely ministry in Christ's name. Therefore, from the Christian standpoint, worship and participation in the ministry of Christ are inseverable and, in most respects, one and the same thing. Hardly, therefore, can this school nurture in ministry apart from worship, nor worship without nurture in ministry. Where these fall asunder, worship and ministry, both are denatured.
IV.
This outcome, then, invites a closer look at the question, what is the worshipful life, or what are the parts of worship? If we would know, at least in Christian perspective what is the nature of worship, then, in fact, these things are best disclosed in a life. The meaning of Christian worship is its manifestation in a worshipful life. For it is my thesis that the ministry of Jesus Christ is the fulfillment of worship. Because I cannot say better or more concisely what I wrote and published some years ago in a volume entitled, Worship
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in Scripture and Tradition (Ed. M. Shepherd, Oxford Press, 1963), I will quote the summation :
"To sum up, in 'the full, perfect, and sufficient sacrifice' of Jesus Christ, the whole meaning of the Law is fulfilled, in unfaltering love of God and unhesitating love of man. This is the enpersonalization of worship; therefore the early Church saw it as God's own deed. God himself set forth this sacrifice to be an 'expiation' for sin available to those who receive it in faith (Rom. 3:25). The true worshipper is, first, Jesus Christ himself, and true worship is attained for those who, 'crucified with Christ,' walk in newness of life. This is life in which God's dominion is regnant. It is life in which autonomy is no longer reserved, and in which the stewardship of all life is acknowl- edged."
The article might have been entitled "the enpersonalization of worship." What is meant is that, in the personal history of Jesus Christ, that is his ministry, is fulfilled all that God requires of man in acknowledgment of Him. Accordingly, I also wrote: "The worship of the New Testament is celebration of the fullness of sacrifice. It is the unreserved acknowledgment of God accomplished in Jesus Christ and, through him, made possible as the vocation of every man. Worship is living sacrifice, a way of life open to the humble and the contrite heart — but a heart moved to contrition by 'the glory of God in the face of Jesus Christ.' " {Ibid., p. 41)
Christian worship is living sacrifice in the likeness of Christ's ministry. It is a way of life open only to the humble and the contrite heart. It is only this openness that has in it any possibility of par- ticipation in the sufferings of Christ or the unreserved acknowledg- ment of God the Father as the mastering motivation of existence. It is only such openness to the Grace of God's forgiveness that will sustain and empower a would-be-follower for the hard, long, fre- quently disappointing and toilsome way of ministry in Christ's name. Without this openness, this self-abasement in the presence of his sacrifice, without a recurring unreserved acknowledgment of "the glory of God in the face of Jesus Christ," I am convinced that nothing that we do here as a faculty and nothing that may happen to you here as students will count for very much for very long toward the enlargement of God's lordship among the children of men.
In this and other eras — now in one way, now in another — aspirants after the manner of Christ's ministry presume to buy it too cheap. Nothing is needed more these days, I think, than to rediscover with
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St. Paul what it means "to die with Christ in the likeness of his death" in order to be able to rise with him to "newness of life" (Rom. 6:4,5). It is this newness that makes ministry possible. Only so is it supportable through all the chances and changes of this mortal life. Only so can Christ's "yoke" be easy and his "burden" light. To resolve that paradox requires more than all things human.
V.
So far, then, we have identified the truly worshipful life. We have found in it the fullness of worship because also the fullness of sacrifice. It is this fullness that, in fact, we call the ministry of Jesus Christ, and in our own worship we find it fitting to celebrate his victory. Our worship is always, and appropriately, thanksgiving as well as confession, and celebration as well as dedication to mission.
But here we may pause to observe that perhaps a perennial weak- ness of Christian worship — that of the churches and that of all of us — has been a greater readiness to celebrate than to participate. It may be a greater readiness to celebrate the victory of Christ by way of the liturgy than to endure his sufferings. It is in this way that we divorce liturgy from life. In this way, we reduce ministry to good works and liturgy to ceremony. So, this divorcement fosters, as it also manifests, two perennially recurrent aberrations of the Christian religion, the enshrinement of worship or prayer without works and, conversely, the desacralization of worship or works without prayer. Liturgy is for life. It pre-figures ministry and may empower it. Yet the current dismissal of liturgy is understandable insofar as it has become celebration divorced from participation. The recovery of liturgy will be the remarriage of celebration with participation.
Finally, then, what is this ministry that comprises the substance of our worship? The answer is openly declared in the New Testa- ment ; and, in the Old, there are foregleams of its manifestation. The ministry of Jesus Christ is just exactly suffering God to be Lord of the whole life. It is embodying in the rugged stuff of daily vocation the words of the Psalmist : "O my soul, thou hast said unto Jahweh, Thou art my Lord. I have no good beyond thee." To mean it, to make "I have no good beyond Thee" the spring of thought and action is suffering God to be God in "the muck and scum of things." It is heeding and enacting the words of the Shema : "Hear, O Israel : The Lord our God, the Lord is One." Worship is fulfilled in the Old and the New Testament when God is the One, that is, when he is
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acknowledged with all the soul, mind, and strength. At that point there is a true worshipper. All idols and lesser gods are dethroned. "I have no good beyond Thee" is the end of both pluralism and am- bivalence.
The suffering of Christ is first of all his suffering God to be Lord. Thus was the fullness of worship and sacrifice. It was the onset of ministry.
That was the first victory and after that the other was conse- quential. The remainder of worship for one who has no good beyond God is the freedom to seek the good that God wills. That good is the inclusion of the neighbor also in the love of God. It is both to care and to labor for the neighbor's good. This is the second part of worship. It, too, is fulfillment of the commandment. For, said Jesus, "and the second is like unto it : Thou shalt love thy neighbor as thyself" (Mk. 12:31). The ministry of Christ, and his victory, is the fulfill- ment of the two-fold commandment. This is true worship. It is the unreserved acknowledgment of God. It is the prototype both of our worship and our ministry.
The question that confronts us all is the question whether ministry can really be enpersonalized in us? Not, I think, in our own strength without the plainest presumption and the assurance of failure : Surely, not until, like Isaiah in the Temple, we behold the Lord, high and lifted up, acknowledge the uncleanness of our lips, and receive the divine cleansing (Isa. 6:1-8). Only thereafter may we be able to receive a mission and discharge a ministry. If this should come to be in some mode and measure then it will be true that mission and ministry have issued from worship. It will be true that worship is the enablement of ministry, and ministry is the fulfillment of worship. They will remain forever inseverable. So be it, Amen.
A Man to Stand in the Gap
Gene M. Tucker
Ezekiel 22:23-31 I Timothy 1:18-20
When the invitation to speak at this service first came to me it was inevitable — most of you will know — that I should first ask myself, "What genre, what Gattung, is most appropriate for this particular Sitz im Lcben ?" Then I thought : You are leaving, and I am leaving ; since many of us are departing from this world, perhaps a last will and testament is called for. But I rejected that idea; the occasion is solemn enough as it is. And, after all, the baccalaureate sermon is a distinctive genre, well-known in our society. It is closely related to the commencement address. It belongs to a distinctive setting, follows within broad limits a certain form, and has a particular in- tention. Perhaps the most common feature of the baccalaureate sermon, whether it is to the local high school or the great university, is its free use of empty cliches, such as "The youth of today is the hope for tomorrow." It speaks about the challenge of the great world "out there" and the open future which lies before the new grads. It is full of admonitions to work hard and to remain faithful to some kind of "ideal." One of the best graduation addresses I know of is one by Art Buchwald, who summed it all up: "All right now kids, we've given you a great world. Now just don't go and foul everything up."
And what divinity school baccalaureate would be complete with- out a text from Timothy ?
It is inevitable that this sermon will follow some of those patterns. If not I would be contradicting everything I have said to you about genres of speech and their settings. And I don't want to do that so late in the day.
But I want above all to speak personally, as we think together of what you have before you in the years ahead ; and I want to be as faithful as possible to our tradition, represented in the text from the
Dr. Tucker, formerly Associate Professor of Old Testament in Duke Divinity School, is now on the faculty of Candler School of Theology, Emory University.
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book of Ezekiel. This is a text which speaks not only to the exiles of Israel in Babylon, but to all of us who perceive our existence in many ways as exile. Further, it has a particularly pointed word for those of us who have responded and do respond to God's call to special duties.
I.
This speech by Ezekiel is presented not as his own thoughts but — as usually is the case in the prophets — as the very word of the Lord. The situation is the exile. The land of Israel — the holy land promised to the fathers and received from God's gracious hand — lies in ruin. The temple — the chosen, holy place — is a pile of stone. All of Israel's old sacred institutions have come to an end. And for the exiles in Babylon as well as the tattered remnant in the land, it is a fate almost as bad as death itself.
Ezekiel is looking back somewhat nostalgically to the days before the fall. What went wrong? How could such a thing happen to God's chosen people? The point of this speech is to answer such questions. And what he says is nothing new. It had already been shouted by the prophets as early as the eighth century: Your cor- ruption and evil and violence — especially in high places — lead to death and destruction. What is different is that now — now that it is too late — the people hear and understand. It is just possible that we who feel our world crumbling around us can hear the warning in these and similar words before it is too late.
The prophet first reviews the failures and crimes of all classes of Israel's leaders. He specifies the sins of each in turn — the princes, the priests, the prophets, and the landed aristocracy — in order to emphasize the radicality of the evil in the land. He is not willing to confine himself to one problem or one group, but tries to say it all.
First, the princes : ". . . they have devoured human lives ; they have taken treasure and precious things; they have made many widows in the midst of [the land]." Can't you hear that same word in the weekly report of casualties from Viet Nam — and now Cambodia? Statesmen and politicians and princes and presidents are making many widows, not only in this land but in many others. And taking treasure and precious things. Is that the prophetic word in the de- fense budget and the reports of the systematic destruction of property and vegetation in Viet Nam?
Next he turns to the priests : They "have done violence to my
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law . . . they have made no distinction between the holy and the common, neither have they taught. . . ." One of the most important duties of ancient Israel's priests was to teach, not only the distinc- tion between clean and unclean, but all the covenant requirements to the community. Such teaching involved handing down the tradition, and also interpreting it in each concrete situation. If people are not taught, how can they act responsibly ? And here is one of those sharp words for us : When and if we fail to teach, or in our teaching dis- tort the nature of Christian responsibility — for example by identifying Christian ethics with the morality of one class or another — we blur the distinction between the holy and the common.
And the prophets : They "have daubed for them with white- wash, seeing false visions and divining lies for them, saying, 'Thus says the Lord God,' when the Lord has not spoken." A lying prophet is a contradiction in terms, for a prophet is simply one who tells the truth. He speaks the word of God. But it is not always easy to tell the truth, and many prefer to follow the teaching of Flip Wilson's prophet Leroy. The prophet Leroy says, "A lie is as good as the truth if you can get somebody to believe it !"
But today we are finding prophets — and prophets of doom — in surprising places : The quiet academician who has spent years in his laboratory examining water samples, the civil servant who spends his days studying specimens of air from above Los Angeles or Dur- ham, and the little slip of a girl who works for Planned Parenthood. These and many like them are telling the truth : Massive action on an international scale is required immediately if our planet is to survive !
Finally Ezekiel turns to the landed aristocracy : They ''have prac- ticed extortion and committed robbery; they have oppressed the poor and needy, and have extorted from the resident alien without redress." The Lord holds the rich and powerful responsible for the plight of the poor and — if we may interpret the text loosely — for the oppression of minorities. Can't we hear that same accusation in the reports of poverty and hunger in rural communities in the South, of unemploy- ment and underemployment of blacks, South and North? Granted, all are not equally responsible simply because they are rich. But if someone is allowed to starve by those who are able to provide food, there is oppression as surely as if bread had been snatched from a man or milk from a baby, oppression by employers who discriminate or government officials who ignore the hard facts about hunger while storing tons of surplus food.
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II.
Thus Ezekiel deals with the crimes of the princes, the priests, the prophets and the landed aristocracy, crimes which led finally to the downfall of the nation. But all of this, his catalogue of sins, is merely background. That was — and to a great extent is — the situation. This just summarizes some of the problems — war, poverty, racism, the ecological crisis — and notes some of the duties of leaders. To put it somewhat grimly as Lucy has been telling Charlie Brown recently, "These things are very high on my list of 'Things You Ought to Know.' " Or only somewhat more optimistically with Pogo : "We are faced with insurmountable opportunities !"
The special word for us — here and now and in the years ahead — is in the sentence which follows the catalogue: "I sought for a man among them who should build up the barricade and stand in the gap before me for the land . . . but I found none." In that situation, once upon a time in Israel, the result of the Lord's failure to find a man was disaster. It can happen again — do you believe it? — if you and I do not take this word more seriously than it was taken in pre-exilic Israel.
The Lord seeks, first of all and quite simply, a man. No special qualifications are given. No experience is necessary. Behind this search lies the assumption that God's will for his people will not be accomplished without men who respond to his call. The biblical tra- dition never lets us forget that men shape history. And now we begin to hear the word of hope in this account of tragedy : The future can be changed, if the Lord can find a responsive man.
It is reassuring that all the Lord seeks is a man, but it is also frustrating. The danger, especially in our time of instant communi- cation and greater awareness of the multiplicity of powerful economic and social and political forces which shape our existence, is that we become convinced that the individual is helpless and ineffectual. The result is paralysis. But more and more men and women, especially in your generation, are realizing that the only way one can maintain his humanity is to act as if his decisions make a difference. And they do. Our awareness of history surely teaches that not only do historical circumstances produce men but men affect history.
Next, the Lord wants his man to stand. I interpret that as both a call to stand up and an admonition to endure. First, to stand up, to speak in accordance with conscience, lest, in the words of the letter to Timothy, one make a "shipwreck of his faith." One could, of
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course, quibble about the ambiguities of conscience. We all know that conscience depends to a great extent upon training and experience. But let us come clean : On the basic issues we know what is right. Our Christian tradition and training and experience have taught us that much. War is hell. Racism is wrong. There is no way to justify poverty in our rich land. And, as far as I know, according to any doctrine of creation in the Christian tradition, the rape of nature stands condemned.
Naturally, we shall continue to disagree concerning the solutions to these complex problems. But neither these disagreements nor one's lack of total knowledge of a given situation qualify as excuses to remain silent. Our main duty is to call attention to the problems and to point directions, as we see them in the light of the Gospel. The role is similar to the one which historian and philosopher R. G. Collingwood perceived for himself. He said, "When Rome was in danger, it was the cackling of the sacred geese that saved the Capitol. I am only a professorial goose, consecrated with a cap and gown and fed at a college table ; but cackling is my job, and cackle I will."
And if we need an example of a contemporary "sacred goose" whose cackling has been heard, look at Ralph Nader. Almost single- handedly he is bringing about reforms in the safety standards of the automobile industry, and now turning to other fields. One young man who had given up a very promising and lucrative career to work with Nader for the protection of the consumer said, "If I don't do it, who is? There is a tremendous amount of satisfaction in know- ing that."
But it may turn out to be even more difficult to endure than to stand up. I am confident that most of us can stand up in the dra- matic moment, and risk everything when the issues are clear. But, God save us, what is required is standing day by day, when the issues seldom are clear, when the routine and boredom of apparently in- significant duties begin to take their toll.
Two things will enable us to endure. First, we have the knowl- edge that we are not alone. You and I need one another and — what is more — we know that we need one another. However much we are separated geographically, we stand together. We shall think of one another often in the years ahead, and take courage. When I am tempted to despair, I think of the Lord's response to Elijah when he whined that he was the only faithful man left in Israel : "Look around, there are at least seven thousand who haven't bowed the knee to Baal !"
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And then we have hope. Pessimism has no survival value at all. But hope and expectation arouse and sustain the determination to act, to do what is possible. The word of judgment, when it is required, is viable because it is predicated upon hope. You know — as did the prophets before you — that beyond and even within the word of judg- ment lies the word of salvation. You are able to point to wrong and call for change within the church and the society not just because you want something better, but because the Gospel demands and promises a future, God's future.
Finally, God calls for his man to stand in the gap. Ezekiel is thinking of the battle, of the city under siege, when the wall has been breached. The Lord needs a man for the most vulnerable place, the front line, where the action is.
Now, as never before in America, the front line is the church at the local level. That's where the action is. William Sloan Coffin said recently, "People say, 'The church is a crutch.' My answer is: 'It certainly is — but what makes you think you don't limp.' " And you are going to be, to a great extent, the church at the local level, whether you are destined for the small parish in rural North Carolina, an assistantship in the suburbs of Chicago, a mission school in Sarawak, or even a private school in New England or a public school in Florida. You will be the church by virtue of your training here and — more importantly — by virtue of your calling, which may be no more than your perception of the human needs around you.
God grant that each of us may be, in the years ahead of us, the Lord's man to stand in the gap.
Amen
On Styling It
Charles K. Robinson Associate Professor of Philosophical Theology
Skillful adaptiveness, we all know, may be an important virtue. After all, that ultimate authority, "SCIENCE," teaches — does it not? — the adaptive "survival of the fittest." Yet we have also learned not to give unqualified respect to skillful adaptiveness in any and every form. Take the middle class, establishment-oriented conformist, for example — and that is the example we usually take : we all know as a current "self-evident truth" that establishment conformism, wher- ever it rears its ugly head, is bad. However, I would derive little satisfaction, and you small benefit, were I merely to belabor today's version of self-evident truth.
Rather I am going to say that conformism is where you find it. Or more accurately, conformism is wherever it functions — whether or not you "find" it, that is recognize it, there. I would even be willing to say that, functionally viewed, some of the prime loci of conformism in our culture are cults of "noncomformity."
Now that we have the material essential to all theology to work with — namely, a "paradox" — let us begin to demythologize it. We can, of course, only do this by means of another myth. So let me sketch out one. Let us pretend that there are imaginary creatures whom, for want of a better name, I will call "cool stylists."
The cool stylists are the children — twenty years later — of the "other-directed" members of David Riesman's The Lonely Crowd (1950, read it!). They are indeed the appropriate offspring of their parents' seed, come to harvest in due season in a space meanwhile grown much closer together and light years more distant apart and in a time now hot as "the lake of fire" and cold as "the outer dark- ness" of Apocalypse.
Style — if you'll pardon something as out-of-style as a little meta- physics— is the analogicality of concrete expressions of sensibility mediated through concrete modes of embodiment. As analogical, style is a concretely perceivable integration of relationality and indi- viduation : of participation and differentiation, of dependence and origination. The stress, however, is on the side of relationality:
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participation and dependence. As an embodying expression of sensi- bility, style is functionally adaptive.
For our imaginary creature, the cool stylist, his life-embodiment is his expressive style ; his life-sensibility is his interiorizing adaptive- ness. Life as he lives it has little by way of larger purpose or end for the sake of which adaptiveness and style might function as means. Life is simply lived as adaptive stylizing.
The embodiment of the cool stylist is the style of his external image as projected by him and received by others — namely, others who count, other cool stylists who are "in." The embodiment of the cool stylist is thus constituted by the principle of Bishop Berkeley : esse est percipi, to be is to be perceived. If the style of his image- projection is perceived favorably,' he is "in" ; he exists. If it is un- favorably perceived, he is "out" ; he exists not ; he is nihilated.
The sensibility of the cool stylist is the adaptiveness of his finely tuned computer adjustment which is constantly calculating the feed- back he is getting on his radar screen. The sensibility of the cool stylist is thus constituted by the principle of B. F. Skinner : to be is to react to determining stimuli. (Though, indeed, Professor Skin- ner might be hard put to account for the tacitness and subtlety of the behavioral clues to which the skilled stylist reacts!)
In the life of this imaginary creature, the cool stylist, the dialectic of the functional relation between inwardness and outwardness is a basically simple one. He indeed interiorizes. He is in a peculiar sense quite introspectively "reflective." He may even be at times painfully "self-conscious." But the controlling mode of his inward- ness is simply the interiorization of externalities. He is, again, indeed "expressive." Style is expressive or it is nothing. But the controlling mode of his outwardness is simply the momentary expression of his immediate impressions.
His immediate impressions, moreover, are immediate impressions of the immediate impressions of other cool stylists. In the game of cool stylism it always takes at least "two to tango." Though indeed "group grope" is better. "Instant intimacy" is best served in mass phenomena. The ideal is total interchangeability. The open secret of every cool stylist is that he does not know who he is. His only really functional identity is a group-identity. Hence he is radically vulnerable to rejection by and isolation from the group.
I spent one summer during college years living alone in the fire lookout tower on top of Bald Mountain in Idaho. I had no radio
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and rarely used the phone except for reporting fire information. I went for weeks at a time without beholding a human face. I had nature and God and silence and no man but myself. That summer was one of the richest experiences of my life. But, for the cool stylist, a summer at hard labor in Siberia would be preferable. There, at least, would be a group !
The circular dynamics of cool stylism as a group phenomenon reminds me of one of my favorite cartoons by one of America's great cartoonists, Thomas Nast. (Actually, I had to wait awhile to enjoy the cartoon. It was published in Harper's Weekly in 1869.) Nast himself, while a master of style, was nobody's cool stylist. He in- dignantly rejected a private offer of half a million dollars to "cool it" and take a European vacation ! In this cartoon Nast pictures the members of a political organization known as Tammany Hall standing around in a circle. The caption reads, "Who stole the people's money?" In the picture each person in the circle is pointing to the person standing next to him. The conclusion is perhaps that every body did it and hence no person did.
The circularity of the game of cool stylism is a trick with mirrors. Every body in the group is reflectively mirroring every body in the group. The mirroring game has no transcendent in-put of content. Some content there must, of course, be — but only as a contingent necessity. The kind of content matters little. The game has no trans- cendent purpose beyond the exhibition of adaptive skill in playing it. "The play's the thing." The circularity is hollow and empty. But boredom and futility are staved off by dynamisms of change and inter- changeability, novelty and feeling.
Intensity of feeling is not incompatible with the "coolness" of cool stylism. Feeling is okay as long as it is not kept private and as long as it serves the superficial group rapport of pseudo-intimacy. Indeed the more intense and sensation-al the generation of immediate feeling the better. For boredom is never more than a step away. But through it all the cool stylist must not "lose his cool." Through it all he must remain peculiarly detached. Yet for the adept adaptor this is scarcely difficult. He does not know or believe in himself enough to be capable of involving and committing himself deeply and enduringly.
Let me indulge in a little more metaphysics. Integration involves the complementary interpenetration of transcendence and immanence. The level of integration is a function of the depth of the transcendence and the comprehensiveness of the immanence involved. Now, the
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experiential togetherness of cool stylism is integrative. Indeed, integration is its only essential positive function (though its negative functions are manifold). But the integration tends to operate down- ward toward the level of the lowest common immediate contextual denominator. The depth of the integration is essentially superficial and the comprehensiveness of the integration is essentially exclusi- vistic.
The cool stylist can find his functional identity only as an "in- group" identity in reaction to others. Similarly, a collectivity of cool stylists can find its functional group identity only as an "in group" in reaction to some other group which functions in negatively identifying contrast as an "out group." YAF needs the SDS as surely as the SDS needs YAF. Thus if any of my imaginary creatures, the cool stylists, actually existed they could as well stylize themselves on the radical right as on the radical left. Attitudes, slogans, and ideology the cool stylist must have. But which is essentially a matter of indifference. (Though if the cool stylist were to recognize this fact he might begin to discover himself as a self.) Cool stylists are not leaders, but they are peculiarly susceptible to manipulation and ex- ploitation by the charismatic leader of the left or right. All they like sheep have gone astray and may be led ... to the slaughter.
Cool stylism is characterized not only by superficial relational immediacy but also by ahistorical absorption in the temporal present. In his rhetoric the cool stylist may appeal to heroes, real or imaginary, in the past and extol the ideological program of the "inevitable" wave of the future. But he is substantially concerned neither with mastery of comprehensive rootage in historical traditions of the past nor with enduring commitment to practical action and long-range planning toward the task of shaping the historical future. He lacks the temporal-historical transcendence to live in the sustained dialectical tension between recollection and hope. He lives only in the present tense where experience is to be experienced. There is neither yester- day nor tomorrow. There is only always now. Satisfaction must be obtained and tensions relieved now. Instant victory, instant euphoria, instant capitulation, instant sex, instant interchangeability. All values of life are ideally concentrated in the instant pay-off: the enduring climax of the "good trip" in which time stands still and euphoria is all there is ... is all there is ... is all there is . . .
Now I have been saying, somewhat with tongue in cheek, that, cool stylists are creatures of my imagination. There is some truth iru
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that. No one can simply be a cool stylist without remainder, anymore than a man can simply be a machine. Yet human beings can asymp- totically approach becoming simply cool stylists. Frankly, I have yet to meet a Duke Divinity student who approximates very far toward cool stylism. And, while my contacts with undergraduates are now rather limited, I would doubt that the majority of college students could be classified as "cool stylists" without many important reserva- tions and qualifications.
But this sketch of cool stylism might be tentatively suggestive in pointing toward one direction in which a considerable part of our cul- ture, especially among teen- and subteen-agers may be moving. I say this with concern and — God knows — with compassion. It is not as though youth were somehow perversely opting against meaning in favor of meaninglessness ! It is rather that they are increasingly unable to find significant meaning.
I have thus far talked, not too happily, about "cool stylism." How- ever if I may paraphrase and reverse Shakespeare — I come not to
bury style, but to praise it.
I have good reason to praise style : like . . . namely ... I could use some. If you've ever happened to notice how I walk down the hall, you'll recognize that I have some stylistic problems that are quite unsolvable — and you won't bother to ask me whether I used to be a basketball star. I have other stylistic problems that may be equally serious. I am, for example, supposed to be a professor of "philosoph- ical theology" and yet I know everybody knows there isn't any such thing. I am, to my shame, as Bultmann would put it, not only "weltanschaulich" but also "metaphysisch." And you just can't be anything more out-of-style than that. I could add that I'm still in the process of "questing for the historical Jesus." (I wouldn't, of course, mention these things, except that they've already leaked out.) The sum and substance of my anachronistic professional plight is that I have somehow or other gotten myself irrevocably committed to the lifetime task of system-building, trying to integrate into one compre- hensive world view all kinds of unlikely partners, such as wave- particles and Jesus. Now, for being out-of-style, man, you just can't beat that !
But I'm really not hostile to such stylistic helps as I can get. For example, I noticed awhile back that men's ties had gotten wider while I wasn't looking. I rushed right down to Sears and bought one. I would have been willing to buy several, but even with my SRC
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I couldn't quite afford that. I would have worn it this morning but it doesn't go with black. And under this robe you can't really tell what I'm wearing, anyway. Also, I noticed last summer that men's hair styles were getting longer. So I've let my hair grow a little longer too. I was glad to make that stylistic adjustment since I've long been in process of losing my hair, anyway.
Also, I pay some slight attention to women's styles. I have, for example, noted the existence of the mini-skirt. I might add, by way of cultural observation, that in the midst of transience, flux and rapid social change, there is a basic human need for some stylistic stability somewhere. Accordingly, it would, I think, be helpful in this transitory life if the mini-skirt, at least, can endure. As for the maxi-coat, neither time nor stylistic proprieties allow me to express myself.
Clearly, and on any accounting, there is a great deal of novelty in the stylistic factors of contemporary life. Yet the degree of novelty is likely not as great as may appear on the surface. A great deal about style is not basically new.
The centrality and essentiality of style in human life and culture is, as such, certainly not new. The achievement of any great human civilisation has always been in considerable measure correlated with the richness and comprehensive integrativeness of its stylistic com- ponents. Style has, in antecedent epochs, served the functions of concretely mediating, expressing and commun-icating the transcen- dent values and depth insights and commitments, as well as the more superficial orientations, of human interpersonal life in more or less comprehensively integrating ways.
Style, we say, can either "turn-on" or "turn-off" receptivity in the processes of would-be communication. But this in itself is not new. Style has always functioned to facilitate communication or dis- functioned to block communication. Style affects, often crucially, interpersonal and intergroup relations. It always has. Stylistic rap- port has always served to mediate community. And major stylistic differences have always operated as both effect and cause of inter- personal and intergroup alienations. None of this is fundamentally new.
What is new — relatively new, since there is no absolutely new thing under the sun — is the contemporary cultural matrix which affects and is affected by style.
New is the interconnected complexification of our global culture. The increasingly intricate network of interconnectedness means that
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escape from interrelation with one another in ever-more-complex ways is impossible or, even if possible, disastrous. This complexifica- tion is a more bewildering challenge to human life-integrative powers than that faced in any previous and relatively more simple epoch. In- sofar as the overwhelming tasks of effective and comprehensive inte- gration are not accomplished, the options are schizophrenic rejections of the integrative tasks or lowest-common-denominator superficial commonalities.
New also is the ever-increasing momentum and acceleration of the global processes of interconnected complexification — yet further complicated by the differential paces of acceleration in different com- ponents and dimensions of global culture, with resultant "cultural lags" and increased tensions.
In tribal communities and even in previous great civilizations, especially among the masses who were not style innovators, contex- tually appropriate style could be adaptively acquired by the young, one might almost say, "by osmosis." Little conscious attention to style and certainly no painful "self-consciousness" about it was required. That day is gone, presumably forever.
Today, and for all our foreseeable tomorrows, inattention to style is a luxury of irresponsible sloth which our humanity can no longer afford. Some basic principles of what is required are simple enough to state: (1) The interconnected complexification of our culture de- mands sensitivity to and some mastery of not one style, but many. (2) The ever-increasing acceleration of cultural change demands constantly alert adaptiveness to changing contexts and stylistic inno- vations. (3) The communicative will to understand will increasingly demand a depth sensitivity toward significant meaning which can penetrate beneath superficial differences of styles to discern the depth of content, meaning and intention which they express — not being easily "turned off" by stylistic differences. (4) On the other hand, the will to communicate will increasingly demand a flexible stylistic adaptiveness so as not unnecessarily to "turn off" those to whom we want to, need to, must communicate.
There are two, opposite, ways of "copping out" on the human stylistic task. The cool stylist cops out by reductionistically equating human life with life-style, reducing himself to mere stylizing for the sake of nothing beyond the empty circular game of reactive adaption, foregoing depth commitment and forfeiting transcendent purpose and meaning. The rigid traditionalist cops out in the other direction :
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unable or unwilling to distinguish between style and meaning or form and content, he clings inflexibly to the relative simplicity of prior weddings of transcendence and immanence, determined stat- ically to hang on, even at the cost of the break-down of the immanence of communication and the break-down of interpersonal life.
The Apostle Paul once wrote: "I have become all things to all men that I might by all means save some." Paul was keenly sensitive to the possibility of and need for a variety of viable weddings of immanent style and transcendent meaning. Paul had some fairly definite notions about the transcendent meaning of the gospel of Christ and the Christian life. But he was too wise to equate these with externalities of stylistic expression. And he was too compas- sionately committed to restrict his communication to those who might respond to a single style. Paul's task is the task of the Church today and tomorrow. Doubtless that task is much more complex than it was in Paul's day. But the same Spirit is with us. And He is able insofar as we are willing.
If style becomes everything; if "the medium" simply "is the message" : the message is nihil ; the message is that there is no message. But, on the other hand, if the message is not relevantly mediated there is no message either: for the message exists only in its being communicated.
Now and again I am haunted by the words of the Simon and Garfunkel song, "The Sounds of Silence." God in heaven knows . . . I want to communicate. I know — I say I "know" it — there is some- thing overwhelmingly, incommensurably important to be communi- cated. For that I live, and insofar as I cannot do that I die. But so do we all — whether or not we know it.
Not everything in life can be measured. Insofar as reality is transcendent it cannot be measured : it is incommensurable. Skillful adaptiveness as a basic life-orientation (whether in unlimitedly flexible cool stylism or in establishment-oriented conformism) undercuts the human capacity to recognize the incommensurability of transcendent reality and thereby undercuts the possibility of genuine faith, love, trust, obedience and worship. The adept adaptor may be, if he so chooses, quite skillful in using language and performing acts which would be relevant and appropriate to love or even to worship. But his language and acts are hollow style without relational depth and meaningful comprehension, though he himself — never having ex-
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perienced, and being securely insulated against, the real thing — may have little awareness of self-deception.
All genuine experience of transcendent reality exhibits a two- sided paradox: on the one hand, a recognition of the incommen- surability, such that no possible expression can be fully or adequately expressive in response to the reality known; yet, on the other hand, an inescapable compulsion to express some relevant, appropriate response.
So it is with the experience of falling in love. The "lover" who thinks he can adequately express his love is — whatever he may be — not in love : he has not experienced an incommensurable relationship. Falling in love cannot be adequately expressed. But, on the other hand, the "lover" who can avoid any expression of love, perhaps because it is not adequately relevant or appropriate, is not genuinely in love either. For falling in love compels expression — no matter how inadequate.
So it is with faith. So it is with worship.
There may be principles of style, but there is no such thing as a "manual of style." Style is communicated and learned tacitly and concretely.
But I will conclude with just two little suggestions for life-style: humor and seriousness. If you cannot "hang loose" to the jolts and surprises of life with a transcendent sense of humor, especially to- ward yourself, God have mercy on your mortal life; you're in for a pretty rough time of it. But if, on the other hand, in and through all the relativities and contingencies and trivia of life, you cannot serve the times with an ultimate seriousness, God have mercy on your soul. This life matters. You had better believe it, baby. You had better live it. The task of Christian life-style is, in ever-changing contexts, to say in ways that may be heard, two words, which are distinguishable but not separable: "God" and "love."
FOCUS ON FACULTY
Paul A. Mickey Assistant Professor of Pastoral Theology
One year ago I had no inkling that I would be in Durham, let alone on the Divinity School faculty this fall. But our whole family is taking it in stride. One thing about being a minister's son, having wrestled in school, being a private pilot as well as an ordained clergy, I've learned to take my opportunities when they come. So it is. The opportunity to come to Duke was surprising and offers unexpected potential to me, my family, and hopefully to the students and fellow faculty members who must bear the brunt of my insights in the field of pastoral theology.
Being here continues to amaze me. Growing up in Ohio one went to college at Ohio State either to study medicine or play football. I enjoyed both football and medicine in high school but never went to Ohio State. In fact I joined the Air Force right after high school in order to avoid going to Ohio State or that now famous university, Kent State, where I attended high school and where, in a revolution- ary fit of insight my senior class nominated and elected me president from the "convention" floor. Kent State or Ohio State would have been all right but long before the days of Joe Kapp or Joe Namath I held out for a grant-in-aid to attend Harvard College. After four years churning through the enlisted ranks of the Air Force, winding up as one of the youngest (if not the youngest looking) peace time Staff Sergeants, I jumped at an early out, took my accrued leave- time pay, bought a diamond (at PX prices), being a firm believer in the "theology of hope" five years early, for someone in the future who I trusted would eventually become known to me !
After getting in shape for freshman football by working on con- struction work during the summer of 1959 I started Harvard four years behind my times. Through sleight of hand or lapse in imagina- tion I was admitted to the first of the Harvard Freshman Seminar programs, not, as I found out later, because of academic qualifications but because I had made enough money sharecropping while in high school to buy a car. The Seminar was the best part of my freshman
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year because seminar was a joint Harvard-Radcliffe group. The professor had statistically proven (at Sarah Lawrence) a positive cor- relation between bust size and intelligence; this astute academic in- sight was further exchanged by the fact that these seminars began in the dark ages of undergraduate education when RadclifTe girls did not try deliberately to look ugly as they seem to today ! That seminar was the saving grace for three years of Harvard. The fourth year and all years since, have been saved by my marriage to the former Jane Becker, of Lancaster, Pennsylvania. With good Dutch "plain folk" blood cheerfully coursing through her presence, Jane, long before the public was aware of the "tell it like it is" campaign, showed the value of calling "a spade a spade" in the Mickey household — and we're all stronger for it.
At Princeton Seminary I spent most of my time scrambling: grubbing for grades, negotiating two new foreign languages (Greek and Hebrew), part-time jobs, time with my family, and a more mature understanding of the church, due largely through a wonderful relationship as student assistant under Ken Wildrick at the Com- munity Congregational Church, Short Hills, New Jersey. I finished out my B.D. work with a senior thesis on "Hartshorne and Freud" under Seward Hiltner, took an inner city assignment in the Ohio East Conference (EUB), and became, almost on schedule a father for the second (and thanks to miracle medicines!) and last time. The inner city work was nip and tuck all along including my promise to Jane that I would paint the driveway and sidewalks at the parsonage green so my children would at least know what color grass (lawn type) looked like.
Through the sudden availability of a Fellowship I began doc- toral studies in September, 1967 under Seward Hiltner in Theology and Personality. By May 1970 my dissertation (which my wife claimed was harder to understand than some of the physics papers she had typed as a secretary) was complete, and immediately follow- ing my oral examination Jane and I drove from Princeton to Durham to house hunt.
My greatest concern before coming to Durham seems unfounded now : my "southern drawl" has not thickened. We are settled com- fortably, enjoying the warmth and privacy of our home in Durham and the openness of airways for private flying. A lingering but daily reminder from my parish in Bay Head, New Jersey, calls me forth
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to my tasks here : the senior highs in that parish gave me a desk pen set as a going away present, inscribed : "Do It To It, Rev."
Robert L. Wilson Research Professor of Church and Society
In an age of mobility one may come from many places. My child- hood and youth were spent in the anthracite coal region just outside Scranton, Pennsylvania. Graduation from high school which came during World War II was followed by three years as a medical corps- man in the Navy. A portion of this time was spent aboard an escort carrier in the Pacific.
With the end of the war, I joined the returning veterans crowding the college campuses. My undergraduate work was taken at Asbury College. This was followed by an M.A. in American History from Lehigh University.
At this point two significant events occurred. First, I was married to Betty Berenthien of Macon, Georgia. Second, we moved to Havana, Cuba where we taught English to Spanish speaking students at Colegio Metodista Central. After two interesting years, punctuated by the revolution which ended Cuba's last elected government, we returned to the United States.
We moved to Chicago where I became pastor of the Wyclif Methodist Church, an inner city congregation located just southwest of the Loop. I also attended seminary at Garrett and became a member of the Northern Illinois Annual Conference.
Upon completing seminary I became a Research and Teaching Fellow at Garrett, a post I held while completing a Ph.D. in Sociology of Religion at Northwestern University. During this period I also taught at the National College of Education.
After graduate school I joined the research staff of the National Division of the Board of Missions which was first located in Phila- delphia and subsequently in New York. I remained with the National Division for twelve years, the last seven as Director of the Department of Research and Survey. This department serves as the research arm of the National Division and conducts a variety of research and planning studies for churches and Methodist denominational orga- nizations throughout the United States.
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Here at Duke I shall be working in two related areas. The first will be teaching in the area of church and community. The second will be as Director of the J. M. Ormond Center for Research Planning and Development, which will involve studies for churches and de- nominational groups. The center will therefore have both an edu- cational and service function.
We moved to Durham from New Jersey in mid summer and are living on Monticello Avenue. We have two children, Keith, fifteen, and Marian, ten.
Robert Terry Young Assistant Dean for Admissions and Student Affairs
There were thirteen children in my large, active, and independent family. We were all born in a small, rural section of Buncombe County in the Western North Carolina mountains. I am the twelfth of these thirteen children and I was born some thirty-five years ago now.
Until I became a student in Scotland, all of my education was gained in North Carolina schools — in the public schools near Ashe- ville, undergraduate studies at the University of North Carolina in Chapel Hill, and seminary work at the Divinity School of Duke Uni- versity. When I finished Duke, my family and I spent the year 1960- 61 at the University of Glasgow in Scotland where I was a special student in Trinity College.
And then, to work in a local parish. There for nine years and now back at Duke — in a new role, of course.
In the process, many things have happened to me and with me.
The most important experience that has happened to me con- tinues— in my relationship with my wife, Jackie. She has worked hard now for fourteen and one-half years trying to keep me honest and real and open. Not an easy task ! Our relationship began at Carolina on February 19, 1956, continued through an election where she ran for secretary of the student body and I for president. We both won and served in 1956-57. She was Miss Alumna and I Mister Alumnus of the U.N.C. Class of '57.
We made "Mr. and Miss" into Mr. and Mrs., and she went to work teaching to put me through Divinity School. We have expanded
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our family and now have four young Youngs — Sherri Leigh, Terri Lynn, Robby, and Andrew — the oldest eleven and the youngest four.
We have served in three parishes — when I was Associate Min- ister in a Church of Scotland church ( 1960-61 ) , Minister at Skyland Methodist Church (1961-67), and at Boone United Methodist Church (1967-70). Hopefully, we have ministered and served in each place. Surely, we have learned in each.
I have always been related to the church — baptized in a little Baptist Church at twelve years of age, joined the Methodist Church at fifteen, and have been there ever since. I was moderately active in the church in high school and college — after all, a young man's interests are wide and varied at these times !
Seminary was a mind-stretching, faith-deepening experience for me. I began to learn that the church, and its people, are to serve and love and care rather than just to be loved and served and cared for. This learning came as I saw some people really concerned about others. Included in my seminary days was a period of cynicism, and I was ready to leave the church. From all I could see, the church was a money-seeking, self-satisfied, and prejudiced institution that promoted those ministers and laymen who "played the game" and rejected or ignored those who did not. And, I did not care to waste my ministry in such an institution.
I then met a friend who helped me to see that a man can be a man and serve God also ; that a man compromises and "sells himself" only if he wants to ; and that a man can have a creative, honest min- istry if he seeks it. With this friend's guidance and support, I headed for the parish ministry.
All along there have been persons who have helped me see what living and ministry are to be — Bernard Boyd and Hugh Lefler and Bill Poteat and Jim Wallace at Carolina; John Carlton and Egil Grislis and Don Williamson and Bob Cushman at Duke; William Barclay and G. H. C. McGregor and Willie Wright in Scotland; Carlyle Marney at Interpreter's House; Ed Harrill and Ruth Ingle and George Kirchoff and Ruth Petrey in the parish.
There are many experiences that have been meaningful to me, but my greatest vocational satisfactions have come from two types of experiences : being a pastor and being a preacher. No greater or deeper joy can a man feel than that he knows when he feels claimed by God to preach a given message or when he feels led by God's Spirit to show compassion for a person in need.
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Life is caring. My purpose in the church, and specifically in being here at this time, is to try to let someone (and hopefully many "some- ones") know that I care. To be human and to allow others to be human, all the time knowing that we are loved by God and are to love one another. It's hard to care. Or, it is, for me. But, this is what life's all about to me — at least for the present time.
at
LOOKS BOOKS
Thomas Coke: Apostle of Methodism. John Vickers. Abingdon. 1969. 394 pp. $14.50.
During his own day Dr. Thomas Coke was misunderstood and vilified by- many who were jealous of his speedy rise to prominence in the Methodist movement, and especially of the great trust reposed in him by the aging John Wesley. Such men too readily jumped to the conclusion that Coke was little more than a vain and ambitious man who in his zeal for pre-eminence inserted his finger in too many Methodist pies. In spite of occasional tributes to Coke's enthusiasm, generosity, and self-sacrifice, he has constantly been pursued by this tradition of being a little man with grandiose ideas about his own impor- tance and destiny. At long last we have a carefully-documented and honest portrait of the man, in the pages of Mr. John Vickers' Thomas Coke: Apostle of Methodism; at last we are able to see him in the round.
The word "round" is deliberately chosen, for what struck most people when first they set eyes on Dr. Coke was his rotund figure, five foot and one inch tall, but compensating with corpulence for what he lacked in height, topped off with what William Wilberforce described as a "smooth apple face, and little round mouth," so that "he looked a mere boy when he was turned fifty." This is revealed by his portraits, though not so fully in the one chosen as the frontispiece for this volume.
Until now, however, it has been much more difficult to visualize Coke in the round spiritually. Earlier writers have not tried, or have found it an almost impossible task, to portray his global enthusiasm from every angle, but have concentrated a malevolent, or a myopic, or even an admiring eye, on one aspect or another only, so that they have drawn little more than a two-di- mensional plan of one part of the man, instead of giving us an experience of the spinning globe of Coke as a restless ecclesiastical conjuror dizzily changing his many hats. Only a multi-volume work could adequately ac- complish this formidable task, but Mr. Vickers has come as near a definitive biography in this handsome volume as we can reasonably expect.
This book began to take shape when the author was invited to deliver the Wesley Historical Society Lecture for 1964 on the subject of Coke, upon whom he had been working for some years. His researches have continued during the following years, greatly enriching the final product. Especially valuable has been Mr. Vickers' search for Coke's letters and other manuscripts, and his researches among many allied documents not touched by Coke's earlier bi- ographers. The mass of materials thus accumulated has been carefully gleaned to provide many hitherto unknown details about Coke's life, as well as il- lustrations serving to bring him to life for the modern reader.
The first few chapters deal chronologically with the early phases of Coke's life — his childhood and youth at Brecon in Wales, his carefree career as a gentleman commoner of Jesus College, Oxford, his ordination and curacy at South Petherton in Somerset, where John Fletcher's writings led to a deepened sense of his spiritual calling, so that he became more and more "Methodist" in discharging his parish responsibilities, even trying to substitute Wesley's hymns for the Psalms in public worship. In 1776 he was dismissed from his
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curacy, and his enemies celebrated the event by pealing the church bells and by broaching several hogsheads of cider in the street.
When they first met that year Wesley was 73, Coke not quite 29. Although Wesley was served by many trusted senior lay itinerant preachers, and even by one or two ordained helpers, Coke quickly gained his confidence, and became his right-hand man, at first travelling with him, and then setting forth as his deputy on various missions, both as evangelist and as trouble-shooter. This culminated in the epochal year of 1784, when Wesley signed the Deed of Declaration which incorporated the annual Conference to take charge of Methodism after his death, prepared a revised Book of Common Prayer for overseas Methodists, and began ordaining preachers for America. In each of these important steps Coke was in close consultation with Wesley, though in each instance Wesley himself was in control, and apparently pushing Coke rather than being pushed, as has frequently been charged.
This year of 1784 witnessed the proliferation of Coke's own activities to the point where his enthusiasms almost ran away with him. He continued to serve as Wesley's chief supervisor over British Methodism, he published his first appeal for overseas missions, and he became the senior bishop and co- founder of the Methodist Episcopal Church of America. Over three-quarters of Mr. Vickers' book is devoted to following these three major themes through the remaining thirty years of Coke's life, in a series of overlapping and inter- meshing chapters, with one chapter devoted to a fourth theme — important, yet subsidiary to the other three — his literary work.
Although Coke had at first been somewhat prejudiced against the Amer- icans, he was sincerely converted to a deep sympathy for their cause, a genuine love of the American landscape and people, and a keen desire to serve American Methodism fully as their senior bishop. In this he was constantly being frustrated by Francis Asbury. Asbury was two years older than Coke, had loyally served American Methodism through its most trying decade, and had insisted that if he were to accept ordination at Wesley's behest and at Coke's hands he would only do so after a vote of confidence from his American brethren. Coke's wanderlust seems to have justified Asbury's reluctance to yield him any real episcopal power. In spite of the Welshman's sincere offer to put America first and to live there permanently if accorded authority and loyalty, after his ninth visit he left in 1804 intending to return but in fact never did, having married a frail English wife — though he continued in readiness for the recall that never came. Nevertheless his ministry in America left lasting marks, not only in conversions and new societies, but in securing the overthrow of Asbury's proposed government of American Methodism by a permanent council, for which Coke won the substitution of the system of annual and general conferences which still prevails.
In his attitude to Negro slavery Coke was well ahead of contemporary American opinion, and this occasionally involved him in serious trouble, as when he urged the Christmas Conference of 1784 to threaten slave-holding Methodists with expulsion. In order that the general work should not suffer unduly, however, he found it expedient to moderate the vehement expression of his views. Although he was similarly deeply concerned about slaves in the West Indies also, he was less militant about slave-owners there, possibly be- cause American opposition had convinced him that it might be wiser to attack some social evils indirectly and gradually, even though this was quite contrary to his temperament.
Coke's standing in British Methodism was prejudiced not only by jealousy over his comparative youth but by his involvements both with America and
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overseas missions. Nevertheless he maintained his position as Wesley's lieutenant. He shared the direction of Irish Methodism to such good effect that even though at the Irish Conference immediately following Wesley's death the preachers elected one of their own members to preside, in most subsequent years this honour and responsibility was accorded Coke, who maintained, "I do love Ireland above all other places" — though it must be acknowledged that he said the same thing about America also. It was Coke who was chiefly re- sponsible for founding in 1799 a successful mission to the native Irish, followed a year later by a similar Welsh-speaking mission in his own native country.
In England also Coke remained a dominant force after Wesley's death, even though in their desire to avoid having "another king in Israel" the preach- ers at the 1791 English Conference similarly passed over Coke to elect the rela- tively obscure William Thompson as their first President. Mr. Vickers points out that this rebuff was graciously taken by Coke, although Alexander Mather, who was also rejected, was "deeply wounded," and circulated an angry handbill. Coke accepted instead the arduous though less prestigious task of serving as secretary to the Conference, a position which he occupied for seventeen of the twenty-three conferences between Wesley's death and his own. When in 1797 Coke intimated that he intended returning to America permanently the British preachers pleaded with him not to do so, and showed their sincerity by belatedly electing him as President, which they did a second time in 1805. He was, indeed, one of their best friends, and it was he more than any other preacher who was responsible for the formation in 1803 of the Committee of Privileges, and for its subsequent success in defending Methodists from dis- criminatory legislation.
Despite his genuine claims to lasting gratitude as a builder of both British and American Methodism, however, Coke is chiefly remembered as the un- doubted father of Methodist missions. In 1784 he published A Plan of the Society for the Establishment of Missions among the Heathens, following this up in 1786 with An Address to the Pious and Benevolent, proposing an annual subscription for the support of the missionaries in the highlands and adjacent islands of Scotland, the Isles of Jersey, Guernsey and Newfoundland, the West Indies, and the Provinces of Nova Scotia and Quebec. Almost unaided he wrestled with Wesley and the British preachers to secure men and money for such ventures. His mission to the Caribs of St. Vincent was unsuccessful, as was one to Sierra Leone in 1796, but other undertakings were eminently successful. This was especially true of his great missionary love, the work in the West Indies, the dearer to him because he regarded the storm which drove him and his Canadian-bound missionaries to Antigua in 1786 as a providential sign. He made only four tours of the islands, occupying about seven months in all, his last ending in 1793, but he continued to supervise the expanding mission there, he fought successfully in 1808 for the right of the Jamaican Methodists to minister among the slaves, and in the midst of all his other labours compiled A History of the West Indies in three volumes (1808-11).
Thomas Coke could not be confined to the West Indies, however, no more than to the varied aspects of home missions in Britain, among the soldiers in Gibraltar, in the Channel Islands, and even in revolutionary France, for which he brushed up his French. He wanted the world for Christianity. In 1798 the Methodist Conference legitimized what it could not ignore by officially desig- nating him for the task that he had long been carrying out, naming him superintendent of overseas missions. His was almost a one-man show. He generated what little missionary enthusiasm there was ; he raised money, often by arduous collecting from house to house, as well as by dipping deeply into
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his own pocket and that of his wife ; he recruited men ; he formulated and directed policy, so that when he was absent in America the committee ap- pointed to assist him was almost helpless.
Frustrated by poorly-chosen leaders and the killing climate from realizing his persistent dream of founding Methodist missions in Africa, increasingly Coke's eyes turned to the east. In 1800 the Conference authorized him to send a missionary to Madras, though the project did not materialize. During the years 1805-6 he sounded out the Directors of the East India Company, and made several abortive attempts to begin an Indian mission. In 1809 his atten- tion turned to the more promising prospect of Ceylon as a springboard for India, and in 1811 he secured Conference authorization for the venture. Dur- ing the years of preparation he lost one wife, married another, and lost her also, yet pressed on through his grief with what was becoming his master project. In 1813 he even secretly offered himself as a candidate should an Anglican bishop be appointed for India, apparently having in mind the needs of India far more than the merits of Thomas Coke, though this indiscretion furnished further evidence to his enemies of his personal ambitions. Rescued from an imprudent third marriage by the skin of his teeth, and plagued by controversy over the expenditure for the mission, on 30 December 1813 Coke set sail with his companions, only to die and be buried at sea. The mission itself continued, however, and became his lasting memorial.
Mr. Vickers has told Coke's complex story with sufficient detail to bring it to life, but not to distort the perspective. The secular background is touched upon only so far as it is essential for grasping the main point of any incident, and further research in those fields is needed for a full understanding of Coke's relationships with the leaders of British politics and the interactions of Methodism with the world of the Napoleonic wars. Coke himself is painted "warts and all." We see his simple piety and his gullibility, the Welsh charisma of his eloquent preaching and his administrative acumen, the charm and courtly manners which readily won friends, and the impetuous lack of tact that lost them. We are not surprised to discover that he needed to be handled with kid gloves, so ready was he to take offence, though swift and generous in for- giveness. We realize that his many projects, his mercurial enthusiasms, were in some part the side-effects of emotional instability, though beneath lay a solid foundation of deep concern for people deprived of the gospel, which sustained him in the courageous facing of monotonous labours, frequent frus- trations, and constant criticism.
Thomas Coke: Apostle of Methodism appears in a handsome format — indeed one wonders whether the margins on the heavy paper are somewhat too ample, especially at the foot. The printing is well executed, with a minimum of the almost inevitable printing errors, though two of these are in prominent places — "Louisberg" instead of "Louisburg'' on Mr. Curwen's attractive front endpaper map, and "Cosummation" as the Contents title for Chapter 23. Some of the errors are probably slips in the typescript, such as William Newcome (correctly) in the text for the Archbishop of Armagh, but "Newcombe" in the index, and the consistent spelling Edward "Smythe," though the evidence of Smythe's many publications shows that he spelt his name without the final "e". The apparatus is of real value, especially the list of 62 publications by Coke, but this reviewer would have valued a chronological summary that enabled the reader to find his way at a glance through the complexities of Coke's life. These, nevertheless, are minor flaws in a work of major importance, which will almost certainly remain the definitive life of Thomas Coke for this generation.
—FRANK BAKER
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The Bible Reader: an interfaith in- terpretation. Prepared by Walter M. Abbott, S.J.; Rabbi Arthur Gil- bert ; Rolfe Lanier Hunt ; and J. Carter Swaim. Bruce (New York) and Geoffrey Chapman (London). 1969. 995 pp. $7.95.
Here is a book of a thousand pages at a modest price (paperback), pre- pared by no less than four editors of three faiths. It consists of many things, all in one. Foremost, it is a shorter Bible (about fifty-fifty) in- cluding something from every book except Second and Third John. Even the Apocrypha is represented, in six of its major books, and is here entitled "deutero-canonical" (reflect- ing Catholic usage, as contrasted with Jewish practice). The Biblical text printed is a mixture of the RSV, the Catholic Confraternity edition, and the Jewish Publication Society ("Old Testament") plus the Tor ah; unfor- tunately, the separate passages are not labeled.
Further, the book has brief and elementary commentary — on the Bible, on each Testament, on each book, and on each passage ; it is again unfor- tunate that the distinctive contribu- tion from each editor and so from each faith is not identified. The Commentary is a pot-pourri of inter- faith ideas, not resolved in harmony or agreement but merely standing in juxtaposition. The editorial philos- ophy holds that "if we know more about each other we can hope to live together in harmony." This is cer- tainly not a truism, and yet it ex- presses the optimistic reason for this mixture of ingredients. Most of the Commentary is commonplace, and some would impress one as indoc- trination.
The intellectual position of this book is a humanistic liberalism such as was common among us a generation ago. We are reminded of our "pluralistic society," of current extra-religious legal opinion, and of objective de- cisions as to scriptural questions. The
editors would "live together" in mat- ters of history, literature, culture, and religious institutions ; implying that this way lies harmony, if not unity. It is considered useful to learn merely "why another believes differently" though we still remain different. Our Bible is optimistically defined as "a book that binds the world together," even though this Bible belongs to a minority of the world's population showing little cohesion in our time.
The Biblical criticism reflected in the editorial Notes is quite conserva- tive. The "Gospel according to Mat- thew" is attributed to Levi the tax- collector disciple. "The Letter of James" is attributed to James the Less, "the brother of the Lord" (said to mean really "cousin"). Other lit- erary problems are alluded to but deli- cately. Of course, "The Bible Reader" here is seen to be an uninstructed layman unaware of the many schol- arly investigations that underly this "interfaith interpretation." One may hope that as he reads, serendipity may reward him.
— Kenneth W. Clark
Amos and Isaiah: Prophets of the Word of God. James M. Ward. Abingdon. 1969. 287 pp. $6.50.
The stated reasons for treating these two prophets together in one book, instead of the more usual combinations of Amos and Hosea or Isaiah and Jeremiah, are that they were the first literary prophets to Israel and Judah, respectively and also that there is considerable literary and theological affinity between the two, in addition to their near con- temporaneity. One may add that the amount of genuine literary material from each of these two prophets is approximately the same : most of the nine chapters of the book of Amos may be considered as coming from the prophet of that name, whereas of the sixty-six chapters in the book of Isaiah, barely ten can be reliably
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attributed to the original prophet. Thus it comes about that this study is divided almost equally between the two protagonists.
Professor Ward believes that the book of Amos is mainly "a collection of oracles composed initially for oral publication," afterwards recorded in haphazard fashion. Thus our author feels no need for minute literary analysis and so uses most of the allotted space for discussion of the prophet's message and of the prophet's theological stance as deduced from his message.
This discussion begins with the confrontation of the prophet by Ama- ziah, priest of Bethel (7:10-17). Here our author scores a good point by returning to the use of the past tense in 7:14bc, as in the King James Version, against the present tense of more recent translations. Since the passage stands in a past context, a past translation of these nominal clauses is grammatically valid. It may indeed be true that Amos zvas not a prophet originally; but he could hard- ly have said "I am no prophet" while in the very act of delivering one of the most significant prophecies in the entire Bible.
In general it can be said that Ward is not trying to be old-fashioned or new-fashioned ; he looks calmly at the whole gamut of critical study and tries to reach sensible and construc- tive conclusions. We have space only to summarize a few more of his conclusions.
The visions of 7:1-9; 8:1-3 are really only one vision, a "visionary drama," and is not necessarily to be connected with the call of the prophet. It is erroneous to assume that all prophets had inaugural visions. In any case, the implied doom is uncon- ditional with regard to the political existence of the Kingdom of Israel ; Amos never changed his mind on this, though he could very well have allowed for the survival of a rem- nant of the faithful.
With regard to the antiforeign oracles, Ward is somewhat conserv- ative in denying the genuineness of only the oracle against Judah. In the presentation of these oracles under the head of "Liturgical Forms," a broad background is sketched, ex- tending all the way from the Egyp- tian execration texts and the curses from the royal archives of Meso- potamian Mari, both of the early second millennium B.C., to Jeremiah 19, Deuteronomy 28, and Leviticus 26, long after the time of Amos. Good background material is also presented for the cosmological doxologies (4:13; 5:8; 9:5-6), leading to the conclusion that they might have been adapted by Amos from his liturgical environment instead of having been added by a post-exilic editor. This is not to say, however, that Amos did not criticize the sacrificial cult in Israel. He criticized it bitterly and probably even rejected it in principle, though without rejecting in principle all pub- lic worship.
Finally, with regard to the "happy ending" (9:8b-15), Ward, rejects it flatly and completely as belonging to Amos : "There is not a single word in these lines about the righteousness that God demands of men." Here our author turns away from some of the newfangled criticism that allows a prophet to say something one day and contradict it the next. Was this prophecy without hope? No Amos's faith in the unwavering righteousness of God "was one of the truly hopeful factors in the religious consciousness of Israel in his time." That is prob- ably why his little book survived.
We must deal more briefly with the second half of the book. Isaiah 6 is treated first, though Ward is not sure that the vision therein is inaug- ural. There is the problem of why the people were to be made too stupid to hear. Ward struggles with this without a very clear result, except that perhaps it was already too late for them to be saved or that they must
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become deaf to the wrong teaching which had misled them so long. Later, Ward says that Isaiah's "dominant tone" was negative and included "harsh criticism."
In Chapter 6, Ward deals with Isaiah 7 and 8, especially the three children and their naming at the time of the Aramaeo-Israelite attack on Judah about 735 B.C. Shear-Yashubh is translated A-Remnant-Shall-Re- turn, but interpreted as "a remnant of them would be left," that is to say, both a warning and a promise. There would be a time of trouble, but not all would be lost if Judah trusted in God rather than in political expedi- ents. Immanuel is taken as another child of the prophet; the name means God-Is-With-Us, which is to say that God will be with us if we trust in him rather than in political ex- pedients— the same message as before. The reviewer has been teaching this interpretation for years and welcomes support for it. The name of the third child, M aher-shalal-hash-bas, is trans- lated as Speedy-Spoil-Quick-Plun- der, and refers to what will happen to Aram and Israel if Judah stands firm. In other words, all three names carry essentially the same message for Judah : practice your religion properly and stay out of international politics. The prophet's warning was not heeded.
Chapter 7 treats of "Zion in the Oracles of Isaiah." Ward's view on Zion's inviolability is best expressed in his own clear words : "Isaiah never proclaimed the military or political inviolability of the city of Jerusalem, either in the present or future." The prophet could never have said, "My country, right or wrong," for righ- teousness was a key word with all the preexilic prophets. Ward feels that Isaiah felt that the sacrificial cult in Jerusalem was so bad that it must be destroyed at any cost. Only a purified city inhabited by a purified remnant could have satisfied the proph- et. Such a concept is expressed in 2:2-4 and 4:2-6, though both of these
passages, and especially the latter, may be later interpretative additions to the original book.
Chapter 8 deals with "The Rem- nant and the Future King." Isaiah has traditionally been credited with the doctrine of the remnant and with much messianism. Ward takes up the latter idea first. The question is whether 9:1-7; 11:1-9; and 32:1-8 are from the prophet or from a later editor. Ward is not sure about this, and so allows the possibility that these passages may be from the prophet, since they avoid the old nationalism and instead "represent a prophetic transformation of the Judean royal ideology." If they are not by Isaiah, they are by someone who was in his tradition in repudiating nationalism and cultism in favor of righteousness. With regard to the remnant idea, it does belong to Isaiah, as seen in the name of his first son, and as developed in 10:20-27, where we see present tragedy leading to a great hope for the future.
This is a worthwhile book, with much of which the reviewer agrees ; but it is not an introductory work, and had best be read by those already somewhat advanced in their study of the Old Testament prophets. On the whole it is well written, well edited, and well printed. Two questionable translations may be noted : p. 234 (Isa. 1:18), "Though your sins are like scarlet, they shall be as white as snow" probably should read "could be white as snow," since the promise was conditional, depending on good conduct; p. 242 (Isa. 4:4), the trans- lation "daughter of Zion" is clearly erroneous, since Zion did not have a daughter — Zion was the daughter; the proper rendering is "daughter Zion" or "maiden Zion."
— W. F. Stinespring
The Tendencies of the Synoptic Tra- dition. E. P. Sanders. Society for New Testament Studies, Mono- graph Series 9. Cambridge. At the
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University Press, 1969. 327 pp. $14.50.
Although form critics and others have for more than a generation spoken of tendencies and laws govern- ing the development of the synoptic tradition, the latter cannot be re- garded as having been clearly estab- lished. Form critics have classified the gospel material according to form and have shown or suggested its re- lationships to situations in the early church. They have not, however, established any "laws" for the trans- mission of tradition on the basis of a systematic study of comparative folk literature or oral tradition. While Gerhardsson has attempted to define these matters precisely on the basis of rabbinic procedures, his effort is less than convincing. For, on the one hand, he takes rabbinic statements concerning the transmission of tra- dition uncritically as indicative of actual rabbinic practice ; while on the other he assumes that the analogy between the Christian church and rabbinic Jewish communities is ap- posite.
Given this state of affairs, Sanders proposes to examine several commonly held principles or assumptions fre- quently employed in gospel criticism as criteria of whether traditional materials are early or late. While the relevance of Jewish and other sources is not denied, Sanders sets about to examine, as of primary importance, the tendencies of the Christian tradi- tion, using the evidence of the textual tradition, the early fathers and the apocryphal gospels. Sanders prin- cipally investigates three widely held principles or tendencies thought to be reliable indicators of change, and therefore lateness, in the tradition : increasing length, increasing detail, and diminishing Semitism. His can- vassing of the manuscript traditions, the fathers and the apocryphal gos- pels is not, of course, comprehensive, but wide enough to be adequately rep- resentative. The balance of the evi-
dence supports neither the view that the later recension of a pericope is the longer nor the principle that Semitisms diminish in the transmission of Christian traditions. Yet on the whole increasing detail does seem to be a rather reliable indicator of lateness.
Sanders' investigation, while neces- sarily not exhaustive, is an exemplary piece of scholarly research both in conception and in execution. The material he has collected will prove valuable for further study and re- flection. Interestingly enough, how- ever, Sanders' results are most closely analyzed with a view to their impli- cations for source criticism rather than form criticism ; and the author concludes that his research lends no unambiguous support either to the Marcan hypothesis or to its alterna- tives. It is nevertheless arguable that the implications of his study for form criticism may be equally, if not more, significant. Sanders' research may not support the Marcan hypothesis any more than it supports Farmer or Griesbach. But the Marcan hypothe- sis is basically a judgment based on the comparison of specific New Test- ament texts, not a theory dependent upon alleged general tendencies of the tradition. The argument from order, recently under such sharp attack, does not, as Farmer has pointed out, prove Marcan priority. It does, however, suggest either that Matthew and Luke used Mark or that Mark conflated Matthew and Luke. If these are the alternatives, most critics will probably go on believing that the more prob- able explanation of the relationship in view of the character of the texts and the state of our knowledge of early Christianity is that Matthew and Luke used Mark.
At the least Sanders' research should put an end to loose generaliza- tions about the development of tradi- tion. Moreover, it shows that the Marcan hypothesis is neither confirmed nor overthrown by the evidence of
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the tendencies which actually emerge in later tradition. Readers of this Revieiv will be interested in the fact that Sanders' work was done orig- inally as a Th.D. dissertation at Union Seminary in New York under the direction of W. D. Davies, now George Washington Ivey Professor in the Divinity School.
— D. Moody Smith, Jr.
Wisdom, Christology, and Law in Matthew's Gospel. M. Jack Suggs. Harvard University Press. 1970. 132 pp. $6.00.
This new book by Professor Jack Suggs (Brite Divinity School at Texas Christian University) revolves basically around the examination of several synoptic pericopes which the author argues have been influenced by ". . . Jewish and early Christian speculation about Sophia [Wisdom]." (p. 1) The thesis is that Wisdom speculation is not a "tangential" but an important and central part of Matthew's Christology.
In Chapter I, "Traces of a Wis- dom Speculation in Q," the author assumes the existence of Q and in- terprets it in the light of a "gnosti- cising Wisdom speculation." Matthew 23:34-36 (and its parallel, Luke 11: ■19-51), the saying about the rejection of the prophets and wise men, is examined. It is concluded that this saying was derived from a lost wis- dom apocalypse originally given as an oracle by personified Wisdom. The use of this saying in Q demon- strates that Q has moved toward a Wisdom Christology, and therefore, does not have (at least in this say- ing) a Christology but rather a "Sophialogy."
Chapters II and III deal with Mat- thew 11:28-30 and Matthew 23:37-39 respectively which, the author argues, are dependent on Jewish Wisdom speculation. As an envoy of Wisdom Jesus (and John as well) is rejected, but in addition Jesus is a sender of
prophets as was Sophia. Thus Mat- thew has moved away from "Sophia- logy" toward the identification of Sophia with Jesus. "Jesus is Sophia incarnate." (p. 58) "I hope that our investigation thus far has served to establish that speculation about Wis- dom emanated from circles which tended to see Jesus' significance large- ly in terms of his function as Sophia's finest and final representative, as the mediator of eschatological and divine revelation. . . . Matthew is at pains to correct the tradition in certain ways. First, he brings the tradition within the framework of the passion- dominated gospel form. Second . . . Matthew proceeds to an identification of Jesus with Sophia." (p. 97)
Chapter IV, "Wisdom and Law in the Gospel of Matthew," contains the argument that for Matthew Jesus is the "Wisdom-Torah," "the embodi- ment of Torah." The Sermon on the Mount is naturally the locus for this investigation.
Dr. Suggs concludes : "My thesis was that Wisdom speculation was a major current in Matthew's Chris- tian environment and that Matthew was a lively participant in the cur- rent." (p. 130)
It is difficult in a work such as this to argue with the author unless one has the space to argue in detail. This is not possible here. The author has made his point in a well-written and logical monograph. The present re- viewer, however, feels that the case has been over-stated, but this criti- cism is not intended to detract from the very fine work and presentation by Professor Suggs. Perhaps it would have been better had the thesis been directed toward a broader interpre- tation of Matthew's gospel. This was, as the author stated, not the purpose of this work, but it would be useful and helpful to see a second volume with the thesis of this book applied systematically to the gospel as a whole. It may prove to be enlighten- ing especially in some passages. And
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further it would test the thesis that "Jesus is Wisdom Incarnate" in the broader context of the Gospel rather than derive this hypothesis from a few selected passages which are al- ready recognized to have wisdom motifs and overtones. This kind of in- vestigation would possibly lend sup- port to the conclusion of the author and also demonstrate where the thesis needs to be modified.
This is a scholarly work not pri- marily suited to the needs of the average pastor, but those who will read it will find some interesting in- sights.
— James M. Efird
Mark the Evangelist: Studies on the Redaction History of the Gospel. Willi Marxsen. Translated by Roy Harrisville et al. Abingdon. 1969. 222 pp. $5.50.
Marxsen's book first appeared four- teen years ago, and the second edition is now over ten years old. It has been extensively reviewed and dis- cussed, so there is scarcely need for another thoroughgoing Auseinander- setzung or summation at this point. (For a full report and critique see J. Rohde, Rediscovering the Teaching of the Evangelists, pp. 113-140.)
The appearance of the English trans- lation does, however, afford an oppor- tunity for calling attention to the importance of the book. After Conzel- mann's The Theology of St. Luke, Marxsen's monograph stands as the second major work in the field of gospel redaction criticism. It takes up and continues the tradition of Wrede, Lightfoot, J. M. Robinson and others who have sought the theolog- ical meaning and purpose of the Second Gospel.
Unlike the form critics (and un- like earlier interpreters), the re- daction critics have concentrated upon the editorial framework of the Gos- pels as the key to the intention of the
Synoptic writers. Given the hypothesis that the framework is editorial, while the stuff of the individual stories and sayings is traditional, this procedure is altogether logical. Redaction critics have by the separation of tradition from redaction and the close analysis of the latter successfully contested the view of the early form-critical works that the Synoptic Evangelists were little more than collectors of traditional materials. They were authors in their own right.
Perhaps Marxsen's chief contribu- tion is rigorously to set forth and advocate the redaction-critical task both by precept and by example. His attempt to see Mark as theologically informed proclamation rather than history is a healthy antidote to his- toricism, if somewhat exaggerated or one-sided. His effort to distinguish the purpose and character of Mark (an evangelion) from Matthew (a biblos) and Luke (a diegesis — the terms are found near the beginning of the respective gospels) may be some- what overdrawn. Nevertheless, it is a needful corrective of the once com- mon opinion that the Synoptics em- body a common point of view. While Marxsen may be correct in seeing eschatological expectation still very much alive in Mark and in taking 16:8 to be the end of the original gospel, his theory that Mark is a Galilean gospel calling Christians to assemble in Galilee for the parousia of the Lord lacks unambiguous sup- port in the text. There is, for ex- ample, considerable evidence that Mark was written for a Gentile au- dience (presumably not in Palestine), as Rohde (p. 138) has pointed out. Moreover, if one were trying to assemble Christians for the imminent parousia, would writing a Gospel in which this purpose is at best subtly expressed to be the most expeditious way to go about it? To ask the question is to imply an answer.
Nevertheless, Marxsen's book is full of valid and stimulating insights
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and worth the expenditure of effort entailed in working through it.
— D. Moody Smith, Jr.
Bonhoeffer's Theology. James W. Woelfel. Abingdon. 1970. 350 pp. $6.95.
As William Kuhns observed in the preface to his study of Bonhoeffer's theology (The Pursuit of Dietrich Bonhoeffer, 1967), Bonhoeffer's emer- gence as a focal theological figure for the thought and efforts of our time — from civil rights to a theology celebrating the "death of God" — has been rapid and unmistakable. Further evidence of the validity of this scarcely debatable assessment of Bonhoeffer is this latest addition, by Woelfel, to the growing, if not burgeoning library of Bonhoeffer interpretation. Hardly without exception the watershed that finally distinguishes the interpreters is, of course, the question of how one reads Bonhoeffer's call from the Te- gel prison for a "religionless Chris- tianity." The conservative approach, represented for instance by Thomas Torrance, reads the letters from prison altogether in terms of Bonhoeffer's previous writings and these, incidently, in terms of Barth. The revolutionary interpreters, such as William Hamil- ton, regard the letters as offering a radically new vision, to be pursued not by reference to Bonhoeffer's past but in the creativity and imagination of his successors who admittedly must go beyond Bonhoeffer himself. The middle road is taken by those who see "religionless Christianity" as the last phase of an organic evolution of Bonhoeffer's polyphonic, highly dialec- tical thought which focuses according to Woelfel (and also John Godsey in The Theology of Dietrich Bonhoeffer, 1960) on Christology. On this as- sumption Woelfel is persuaded that another interpretation of Bonhoeffer is in order, one that would analyze Bonhoeffer's thought systematically, thematically, so as to trace the poly-
phonic interaction and development of these themes in the organic evolution of his thought. Thus he finds at the beginning and traces through to the end, Bonhoeffer's "liberality" and openness to the secular world, as well as his Barthian-based respect for rev- elation as opposed to religion, and the integrity of dogmatic theology vis- a-vis natural theology and apologetics. I came away from Woelfel's study persuaded, both by the theological evidence Woelfel adduces as well as by the image of the man Bonhoeffer that emerges, that Bonhoeffer was simply a classical theologian, as Woel- fel contends, who, like his mentor, Barth, is both markedly consistent and yet just as radically open, for whom the mystery of Christ infinitely and always transcends the knowledge of theology. Woelfel is therefore justified when he eschews the his- torical, chronological approach taken, for instance, by Godsey, Phillips and Kuhns, in favor of his more system- atic study. However, because his argument depends so heavily on cross references between the Letters and Papers from Prison and the earlier writings, having to turn to the back of the book for the footnotes is a serious handicap. As for the substance of the argument, I was a bit put off by his handling of another matter of con- tention among Bonhoeffer students, namely the issue of Bonhoeffer's debt to Karl Barth who, without question, was the most formative of the in- fluences on the young Bonhoeffer. Woelfel convinces me that while Bon- hoeffer was indeed in debt to Barth, he nevertheless was an independent thinker who went beyond Barth, especially in his very concrete Chris- tological focus, at a time (in the early thirties) when Barth had yet to free himself from notions of transcendence that inhibited a fully Christological concentration. It is tribute enough to Bonhoeffer to show that he did antici- pate Barth's later Christocentrism, but the eminence of Bonhoeffer is
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hardly enhanced when Woelfel, rein- forced by the very dubious criticisms of Emil Brunner, takes Bonhoeffer's charge of "revelational positivism" as the definitive word about what finally emerged in the Church Dog- matics, so that we are asked to believe not only that Bonhoeffer moved ahead of Barth, but that when Barth finally caught up he had sold out to a scho- lastic fideism. A much more flattering tribute to Bonhoeffer would be to demonstrate, as could be done, that while Bonhoeffer learned from Barth how theology would be done, Bon- hoeffer showed Barth what it is finally all about — namely, Jesus Christ.
This is a fine book. Read the last chapter, "Paths in Bonhoeffer Inter- pretation," first, then cut out the foot- notes for a ready reference, and finally read Karl Barth to see where the direction Bonhoeffer was taking does indeed lead.
—Robert T. Osborn
Companion to the Hymnal. Fred D. Gealy, Austin C. Lovelace, and Carlton R. Young. Abingdon Press. 1970. 766 pp. $10.00.
The Companion to the Hymnal, a handbook to the 1964 Methodist Hymnal, has been awaited with much interest. The authors and publisher have gone to great effort to make this a complete hymnody, and they have very nearly succeeded.
The work is divided into four main sections. Part I contains three his- torical articles ; two concerning hymns, their texts and music, and a third on the 'American Methodist Hymnal," past and present. Part II is devoted to comments on the texts and tunes in the 1964 hymnal ; Part III is a biographical study of each composer, arranger and author; and Part IV contains the bibliographies and indexes.
Part I begins with a rather com- plete article on "The Psalms and
Hymns of the Church" by Fred D. Gealy. In this study are especially good sections on Greek, Latin and American hymns. However, the sec- ond article, "A Survey of Tunes" by Austin Lovelace seems very brief and too shallow in its coverage. Both the Lovelace and the Gealy articles are hampered by the way they use the hymn examples. Dr. Gealy, in most cases, uses only the number of the hymn in the new hymnal, while Dr. Lovelace uses the tune name and number. It seems to this reviewer, that using the first line and number of the hymns would have been prefer- able in both cases, since most persons who will use this handbook are more familiar with the first line of the hymns. The third article, "American Methodist Hymnbooks" by Carlton Young, is interesting, informative, and contains a useful chronological chart on Methodist hymnals from 1780 to the present.
The real meat of the book is Part II, which deals with the study of the texts and tunes of the hymns, can- ticles, service and communion music in the new hymnal. The hymns are listed alphabetically by first line which makes for easy usage and quick iden- tification. This is an excellent work and covers most of the texts, their authors and sources, in a very thorough manner. Unfortunately, coverage of the music is uneven, often very brief, and in some instances in- complete since it is often the great- ness of the tune that gives a hymn its appeal. However, considering how bad the coverage of music has been in most hymnodies, this is a small complaint indeed.
In Part III, Dr. Young has com- piled concise, to-the-point, biograph- ical sketches. Again, this reviewer would have appreciated more in- formation concerning the composers, their musical style and compositions.
Most readers will find the bibli- ography in Part IV very adequate. It contains a complete list of hand-
books (Hymnal Companions of other denominations), a long listing on hymnology, and a general list of church music.
To sum up : The general articles are for the most part very good, al- though a consistent system of refer- ence to hymns would have been help- ful. The study of the texts and tunes is the best available so far, even though the treatment of the music is still not quite what it could be. The biographies and bibliographies are excellent. The criticisms made by this reviewer are in no way serious enough to impair the real value of this book. For the average minister, choirmaster, organist and layman, it should prove most valuable in aid in the successful use of the 1964 Meth- odist Hymnal.
— John Kennedy Hanks
Companion to the Book of Worship. Edited by William F. Dunkle, Jr. and Joseph D. Quillian, Jr. for the Commission on Worship of the United Methodist Church. Abing- don. 1970. 207 pp. $4.50.
This long-awaited book is addressed to central and urgent needs of our church as we seek to reclaim and effectuate our unique Wesleyan "campmeeting and cathedral" her- itage. Addressed to any and all who use the Book of Worship, and the Hymnal, it is intended to aid us in "creative use of the traditional forms," and "in the creation of new forms, without sacrificing continuity and in- tegrity." I have tested it by use in a Divinity School summer class of stu- dent-pastors, and we have found it a useful book.
We now have a Methodist equiv- alent of Massey Shepherd's Protestant Episcopal Oxford Prayer Book Com- mentary, and so crucial are the issues of Christian life and work it ad- dresses that every serious owner of the Book of Worship and of the Hymnal should own and consult it.
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For it is intended to explicate Chris- tian worship personal and corporate, in study and classroom no less than in the great congregation.
So varied are our interests, so lim- ited my space, I have decided to identify authors, and make a brief and too-general statement about each chapter. It would be helpful were each reader to open his Book of Wor- ship, noting its five divisions, which are treated in ten chapters, by nine writers. Thus you may be "clued" to your concerns.
Chapter I "The Order of Worship : The Ordinary Parts," by James White, teacher and co-author of The Celebration of the Gospel, is the best account I know of the tortuous pro- cess by which our present Morning Service, displacing the Lord's Sup- per, is today "a curious but workable fusion of ancient Christian tradition with Nineteenth Century evangelical Protestantism, tidied up in the Twen- tieth Century." Stronger historically than pastorally, and descriptive rather than prescriptive, here are identified "points of leverage" at which creative pastors are working.
II "The Order of Worship: The Proper Parts" is also by James White. Since most of the proper (or change- able) Aids to Worship and Acts of Praise — as well as hymns — are in- tended to flesh out the Christian year Sunday by Sunday, this expounds its development and values. It will help us to remember Christ in gratitude and participate in his ministry as we offer praise, prayer, and preaching to the Father and are built up to par- ticipate in his work in his world.
III "Baptism : Its Historical, The- ological and Practical Considerations" is by David James Randolph, former teacher of preaching, now Associate Director of the Board of Evangelism, and editor of Ventures in Worship. Released in 1968 by the Commission as an official brochure, the title would imply that it was also written for this book. Pastoral rather than formally
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theological and scholarly, it suffers from lack of footnotes, and does not adequately communicate the present world-wide concern with our theories and practices of baptism, child and adult.
I must report with consternation that there is no chapter on "the Order for Confirmation and Recep- tion into the Church." In the light of Dean Quillian's earlier statements that this service is our most signifi- cant liturgical recovery, and the ap- pointment by General Conference in 1968 of a special three-commission group to study and effectuate this ex- perience in young people's lives, this is amazing.
IV "The Lord's Supper or Holy Communion," is by Dean Joseph D. Quillian, Jr., former chaplain, pastor, teacher, editor, and a Methodist mem- ber of the liturgical commission of C.O.C.U. The three-page history of the Lord's Supper (51-4) is helpful indeed, meanings of the Supper (drawn from The Celebration of the Gospel) less felicitous, with the an- amnesis motif separated from Eu- charistic thanksgiving. "The great offertory" (55-6) is a less successful attempt to explain our participation in Christ's self-offering.
Throughout the careful explication of the shall and may rubrics I detect discreet suggestions for strengthening and contemporizing our weak liturgy, safeguarded by faithful adherance to its basic "shape" and intent. Pre- dictably, these focus at sermon, offer- tory (65), fraction (67), and sharing of bread and cup (69-70). The muted notes of Eucharistic thanksgiving and hope are not sounded, the Wesleyan "evangelistic sacrament" motif is not mentioned, and the lack of specific allusions or footnotes deprives us of Dean Quillian's experiences with sev- eral more contemporary and cele- brative liturgies.
V "The Order for the Service of Marriage," by Professor Paul Hoon, of Union Theological Seminary in
New York, one of the most scholarly and theologically explicit, expounds Biblical data concerning sexuality, covenant and sacrament. As through- out the Book of Worship, the note of Eucharistic thanksgiving and mem- ory is muted, and liturgical participa- tion and response by the congrega- tion is not highlighted.
VI "The Funeral," is by Professor Grady Hardin, Duke alumnus, pastor, teacher of liturgy and preaching. Brief historical preamble leads into explication of the rubrics, by which means helpful pastoral -liturgical prac- tices are suggested. Values and func- tion of the sermon are highlighted. He neglects to mention the emerging values of a brief spoken obituary, and he could well have showed how skillful use of the name of the de- ceased can personalize the service. Again, sources would have aided.
VII "The Ordinal" by Albert C. Outler, Duke alumnus and teacher, and "Mr. Ecumenical Theologian," is a scholarly and detailed exposition of Protestant, Wesleyan and later Methodist doctrines of ministry and ordination services. Made cogent by excellent sources and the Outlerian wit, it ends on an ecumenical note.
VIII "The Lectionary" is by Wil- liam F. Dunkle, Jr., pastor, author and co-editor. After a brief, illuminating exposition of lectionaries (lists of lessons or Bible readings, usually fol- lowing the Christian calendar), he explains the principles shaping our lectionary. Then follow thirty-eight pages charting the lectionaries of all the major denominations. Valuable as this may be for scholars, Dr. Dunkle's own skills in preaching the Gospel following the Gospel Year, are not brought to our aid, as we endeavor to recover Biblical Praise, prayer, and preaching in a Christ- centered context. I regret that he did not write chapter II.
IX "Uses of the Book of Worship in the Home and with Small Groups," by M. Lawrence Snow, United Meth-
odist pastor and author, is so lum- inous, cogent and helpful that one could wish that he had written chap- ter II, or that this chapter had been expanded to include "Morning Wor- ship." Every pastor, church school teacher, and every editorial writer for the Upper Room should study these suggestions for small group devotions, love feasts, and household commu- nions. This pastor brings alive his Methodist "campmeeting and cathe- dral" heritage and the subtitle of the Book of Worship" ; "for church and home."
X "Other Occasional Services" by Professor Roy A. Reed, teacher of worship in one of our United Meth- odist theological schools, highlights theological, liturgical and pastoral elements in the Wesleyan genius for guiding ministers and people into numerous experiences of personal and corporate dedication and consecration, focused by various occasions in our common life. For through such we may recognize and communicate our identity as God's people, grow in Koinonia with Christ and each other, grow in grace by "using the means of grace," and do Christ's work. Here a sacramental theology begins to emerge (195-7), and the term "sacra- mental celebrations" becomes an apro- pos term for all these "life-experience" occasional services. Anyone concerned with realistic and authentic pastoral leadership is wrestling with the prob- lem of wholeness of life and cele- bration : here are suggested funda- mentals— fundamental because they root back into Christ's consecration of himself and our constant renewal in Koinonia and liturgy with him.
Imperfect though it is, this book is useful and we should use it. And we should hope that the Commission will now plan a careful series of "tracts for the times" "bracketing" and sup- plementing this book : several brief background expositions of New Test- ament-Wesleyan Eucharistic theology, explicating the central, unifying and
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vitalizing functions of grateful anam- nesis of Christ and thanksgiving in each of our sadly drab and wordy services. And several "practical" articles, supplementing Ventures in Worship, should make available var- ious creative recoveries of corporate prayer, Concerns, and contemporary idiom by pastors and their people. These should appear in the national Advocate. And let them seek authors outside their own group. Thus they may break out of the in-group ap- proach which so seriously limits their work and this book, and we shall be led into the larger meanings of lit- urgy as Christ's work, done by his people.
—John J. Rudin, II
Crisis in Eden: A Religious Study of Man and Environment. Fred- erick Elder. New York. Abingdon. 1970. 172 pp. $3.95.
Frederick Elder seeks a theological base for both interpreting and hope- fully correcting man's careless ex- ploitation of nature's forces and forms. In light of western man's historic disregard for environmental impacts of his technologies the writer pro- poses an "environmental theology" which leans heavily upon tutelage of the natural sciences. In this context Crisis in Eden provides Elder with an interdisciplinary forum for distin- guishing environmental "doves" from their hawk-like counterparts.
Elder classifies his line of thought on environmental issues with partic- ular reference to man's place in the natural order. Arguing this "inclu- sionist" position, he asserts the neces- sity of regarding "man as an inex- tricable part of nature," differing primarily in intellectual power and technical prowess from less developed biotic forms but sharing with them, nonetheless, an essential unity. Elder indicts a number of well known the- ologians, among them Teillard de Chardin, Herbert Richardson, and
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Harvey Cox, for abstracting homo sapiens from the ecological calculus and making of him merely homo faber. These "exclusionists" assume man potentially controls and will eventually generate his own environment, an en- vironment of simplified, self-contained subsystems for biological and social support quite apart from what one currently knows as nature. For Elder and the representatives of the in- clusionist approach, biological and social interdependence hold infinitely greater survival value and fulfillment potential in man's evolutionary rela- tionship with his environment than either artificial environments or ab- stracted independence from nature. The exclusionist mentality, devoid of awe and reverance (Otto's sense of the numinous) and remiss in wonder before nature's complex webs of life, invites simplified reductions of in- herantly complex processes and unified systems. The viability of these inter- dependent systems, argues Elder, de- pends directly upon highly perfected levels of natural integration and inter- system integrity. Elder's criticism of the exclusionist attention to technol- ogy without regard to ecology raises several questions about Elder's own theological groundings.
Although Elder chides exclusionist thinkers for brands of callous anthro- pocentrism instrumental in buttressing unenlightened views of nature's econ- omy, his own theological perspective reveals admitted anthropological pro- clivities. Early he notes as funda- mental to the environmental crisis "the issue over the correct perspective on man." He attributes increased "desacralization" of Nature and con- comitant exploitation for narrowly conceived gain to a historical destruc- tion of theological unity between na- ture, man, and God. He observes this trend beginning in early neo- orthodox theologies in which man is elevated above nature as God's chosen instrument of creation. Elder will not agree to Richardson's proposal for
a God-concept designed specifically to ". . . undergird the primary relations of the cybernetics world. . . ." He insists that the environmental theo- logian's task is to move from human centered systems of relations to those in which man and nature interface. "The inclusionist could well agree that God is the unity of manifold systems . . . emphasizing that relations, to be truly encompassing, must include those of nature to man as well as man to man." At this point Elder stands open to the tradition of Schleier- macher, though one might question the author's awareness of that tradi- tion. The danger of latent pantheism in this system certainly exists. De- spite this possibility, however, biolog- ical pan-entheism provides an evalu- ation more responsive to Elder's in- tent. This notion, articulated by Ian Barbour, includes a hierarchical sys- tem of reality, in this instance bio- logical interfaces, levels of which share and incarnate the encompassing unity of the Divine. Such a system resurrects possibilities of awe and wonder. Depth and reverance before nature's organic diversity rejuvinate. Throughout his study the author is malcontent to allow discourse about theological implications of environ- mental crises to remain at strictly erudite levels. Elder's commitment to a fundamentally interdisciplinary approach to theology well prepares him to present poignant glimpses of the inclusionist position applied. Close personal relation to Berkeley ecologist Daniel Luter and equally strong af- fection for the work of landscape en- vironmentalist Ian McHarg reinforce the writer's perception that natural consequences of undetermined magni- tude await already deployed tech- nologies. If technology alone is not Elder's bete noir, then man's predelec- tion for insensitive and uninformed application of technology certainly is. His call for broadening interdisciplin- ary interaction on academic and pro- fessional levels in which theology may
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take note of its own historic miscon- ceptions and move to more inclusive orientations bears serious considera- tion by those who fashion models for theological education. Perhaps Elder heralds a theological holism which swings wide for the 70's doors which theological pluralism merely cracked for past decades. In Elder's words :
The human race probably has no more than a generation left in which to decide whether it will live in a diversified, balanced world or one either biologically devasted or imperialistically con- trolled in order to avoid bio- logical devastation. This means that environmental theology, and its concommitant environmental ethics, must emerge .... The time is now; a failure to proceed properly insures a future that is bleak.
— William M. Finnin
Professional Education for Ministry: A History of Clinical Pastoral Edu- cation. Edward E. Thornton. Ab- ingdon. 1970. 301 pp. $7.50.
This is essentially the story, as the subtitle indicates, of the Clinical Pas- toral Education movement treated historically, with the opening chap- ters centering on men, the middle chapters on structures, and the clos- ing chapters on issues and processes.
Articles by Tom Klink whose con- ceptualizations of the supervisory process are unsurpassed and by other recent articles on preparing students for ministry in the 70's such as those appearing in Theological Education, the journal of the American Associa- tion of Theological Schools would be valuable and necessary supplements to Thornton's discussion of issues and processes.
The appeal of this book may be limited to professional educators, whether in academic or clinical set- tings. Nevertheless, it is interesting reading in what is considered as the most significant movement in theo- logical education in our time.
— Richard A. Goodling
A Pastoral Counseling Casebook. Aldrich C. Knight and Carl Nighs- wonder. Westminster. 1968. 224 pp. $5.95.
Would you like to join a group of fellow ministers weekly with a psy- chiatrist and a chaplain supervisor to discuss pastoral counseling cases? A Pastoral Counseling Casebook is the next best thing. Discussions at such weekly case conferences were tran- scribed and edited and published in this informative and very readable book. The consultants were Aldrich, a psy- chiatrist, and Nighswonger, a chap- lain, both at the University of Chi- cago School of Medicine. Cases con- sidered deal with grief, anxiety and depression, suicidal threat, marital conflict, delinquency, adolescence, al- coholism, and one with a couple which called for collaboration with a psy- chiatric consultant. The spontaneous, conversational style of a case con- ference is retained but the material was carefully edited to provide clarity and precision of thought. Good use was made of the "teaching moment" to draw out the pastor's investment in each case, to introduce in a natural and relevant way conceptual material on the life problems being considered, and to enhance professional counsel- ing skills. An introductory chapter on personality development provides an excellent theoretical framework for the behavioral patterns revealed in the case materials.
— Richard A. Goodling
Winter 1971
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