© 2015. Grand Canyon University. All Rights Reserved. Case Study: End of Life Decisions George is a successful attorney in his mid-fifties. He is also a legal scholar, holding a teaching post at the local university law school in Oregon. George is also actively involved in his teenage son’s basketball league, coaching regularly for their team. Recently, George has experienced muscle weakness and unresponsive muscle coordination. He was forced to seek medical attention after he fell and injured his hip. After an examination at the local hospital following his fall, the attending physician suspected that George may be showing early symptoms for ALS (amyotrophic lateral sclerosis), a degenerative disease affecting the nerve cells in the brain and spinal cord. The week following the initial examination, further testing revealed a positive diagnosis of ALS. ALS is progressive and gradually causes motor neuron deterioration and muscle atrophy to the point of complete muscle control loss. There is currently no cure for ALS, and the median life expectancy is between three and five years, though it is not uncommon for some to live 10 or more years. The progressive muscle atrophy and deterioration of motor neurons leads to the loss of the ability to speak, move, eat, and breathe. However, sight, touch, hearing, taste, and smell are not affected. Patients will be wheelchair bound and eventually need permanent ventilator support to assist with breathing. George and his family are devastated by the diagnosis. George knows that treatment options only attempt to slow down the degeneration, but the symptoms will eventually come. He will eventually be wheelchair bound, and be unable to move, eat, speak, or even breathe on his own. In contemplating his future life with ALS, George begins to dread the prospect of losing his mobility and even speech. He imagines his life in complete dependence upon others for basic everyday functions, and perceives the possibility of eventually degenerating to the point at which he is a prisoner in his own body. Would he be willing to undergo such torture, such loss of his own dignity and power? George thus begins inquiring about the possibility of voluntary euthanasia. Intervention and Ethical Decision MakingThe application of bioethical principles in the context of different worldviews and religions will be the goal of this topic. Different models of ethical decision making suggest different steps and priorities, but the important thing to note is that all models are attempting to organize all of the relevant information in a case so that nothing is left out of consideration. Still, the way in which all of the relevant details in a case are considered will always take place within the context of a worldview. As such, the most important determinant of a bioethical decision is not a methodology but the worldview context in which the the methodology is functioning. Consid.

1. © 2015. Grand Canyon University. All Rights Reserved.
Case Study: End of Life Decisions
George is a successful attorney in his mid-fifties. He is also a
legal scholar, holding a teaching
post at the local university law school in Oregon. George is also
actively involved in his teenage
son’s basketball league, coaching regularly for their team.
Recently, George has experienced
muscle weakness and unresponsive muscle coordination. He was
forced to seek medical
attention after he fell and injured his hip. After an examination
at the local hospital following his
fall, the attending physician suspected that George may be
showing early symptoms for ALS
(amyotrophic lateral sclerosis), a degenerative disease affecting
the nerve cells in the brain and
spinal cord. The week following the initial examination, further
testing revealed a positive
diagnosis of ALS.

2. ALS is progressive and gradually causes motor neuron
deterioration and muscle atrophy to the
point of complete muscle control loss. There is currently no
cure for ALS, and the median life
expectancy is between three and five years, though it is not
uncommon for some to live 10 or
more years. The progressive muscle atrophy and deterioration of
motor neurons leads to the loss
of the ability to speak, move, eat, and breathe. However, sight,
touch, hearing, taste, and smell
are not affected. Patients will be wheelchair bound and
eventually need permanent ventilator
support to assist with breathing.
George and his family are devastated by the diagnosis. George
knows that treatment options only
attempt to slow down the degeneration, but the symptoms will
eventually come. He will
eventually be wheelchair bound, and be unable to move, eat,
speak, or even breathe on his own.
In contemplating his future life with ALS, George begins to
dread the prospect of losing his
mobility and even speech. He imagines his life in complete
dependence upon others for basic

3. everyday functions, and perceives the possibility of eventually
degenerating to the point at which
he is a prisoner in his own body. Would he be willing to
undergo such torture, such loss of his
own dignity and power? George thus begins inquiring about the
possibility of voluntary
euthanasia.
Intervention and Ethical Decision MakingThe application of
bioethical principles in the context of different worldviews and
religions will be the goal of this topic. Different models of
ethical decision making suggest different steps and priorities,
but the important thing to note is that all models are attempting
to organize all of the relevant information in a case so that
nothing is left out of consideration. Still, the way in which all
of the relevant details in a case are considered will always take
place within the context of a worldview. As such, the most
important determinant of a bioethical decision is not a
methodology but the worldview context in which the the
methodology is functioning. Consider then how the Christian
biblical narrative determines the values that are deemed
relevant or important in a case and how different worldviews
would impact the decision making in different cases.Consider
the following analysis from a Christian perspecive of the case
study "End of Life and Sanctity of Life" in the American
Medical Associations Journal of Ethics (Available in Loud
Cloud readings). That case is analyzed from a Jewish and
Buddhist perspective by different commentators. This case will
be analyzed by addressing the four principles in the principalist
approach, and then consider that data in light of the Christian
worldview in order to recommend a course of action in
accordance to Christian values and biblical principles.Recall

4. that the four principles of principalism include (1) autonomy,
(2) beneficence, (3) nonmaleficence, and (4) justice. Depending
on the case, different principles will come to have greater
prominence in deciding an ethical course of action. At times
there may be conflicts among the principles themselves, in
which it will have to be determined which principle will have
the greater priority. For example, a common conflict is that
between a patients autonomy and what a physician considers to
be beneficent, or in the best interests of the patient. A physician
might see that a particular course of treatment will be beneficial
for a patient (beneficence), and yet the patient refuses the
treatment (autonomy). Should the physician simpy allow the
patient to choose for themselves a course of action that will
knowingly bring them harm? Is it right for the physician to
coerce or force a patient to undergo a treatment against his or
her will, and violate their autonomy, even if it will bring about
some medical benefit?How do the four principles apply to the
case of 82 year old Mrs. Jones?Autonomy: In this case, Mrs.
Jones is incapacitated; she has been unconscious for two days
and has no ability to communicate her desires for or against
treatment. This is further complicated by the fact that she left
no advance directive (a legal document that details her wishes
for or against certain kinds of medical treatment should she ever
become incapacitated such as a living will or a healthcare power
of attorney). While Mrs. Jones' family and the physian disagree
about the appropriate treatment for her, it seems that
determining what Mrs. Jones would have wanted is not possible.
Thus, while her autonomy is certainly to be respected, in this
case it is not something that is able to be obtained, given her
condition (she would technically be considered incompetent and
unable to exercise autonomy in her current
condition).Beneficence: Dr. Rosenberg believes that it will be
in Mrs. Jones best interest medically to be put on temporary
dialysis. He believes it to be the beneficent course of action;
that which will bring about her good. Mrs. Jones' family
believes that dialysis will be a cause of undue suffering for her,

5. and thus do not consider it to be the beneficent course of action.
The fundamental disagreement lies here. Two parties, who are
not Mrs. Jones' herself, and who presumably do not have
information about how she would have decided for herself,
disagree about whether or not an action is truly beneficent for
her. The principle of non-maleficence is closely
related.Nonmaleficence: Not only does Dr. Rosenberg have a
moral duty to promote Mrs. Jones' good, but he has a
corresponding negative duty to not inflict evil or harm upon her.
Mrs. Jones' family believes that to place her on dialysis would
inflict harm and suffering on her. Dr. Rosenberg believes it to
be his duty to place her on dialysis, and that to not do so would
be harmful to her. Dr. Rosenberg's dilemma involves the belief
that withholding treatment that has a good chance of restoring
Mrs. Jones back to health with little risk is immoral.Justice:
Questions of justice usually come to the forefront in terms of
the equal and fair distribution/allocation of medical goods and
services (i.e., organ donation, health insurance, etc). In this
case this principles does not play a major role. It might be said
that it is unjust or unfair for Mrs. Jones to not decide for
herself. But in the terms of this class, that concern would more
appropriately be a question of autonomy, beneficence and
nonmaleficence.The above discussion sketches out how each
principle would be relevant to or apply to Mrs. Jones' case. But
notice that you do not automatically have an answer to this
dilemma. What should be done ethically? To answer this
question, it is necessary to consider the four principles in light
of an overarching worldview. Thus, how ought a Christian think
about this dilemma?To begin with, it is important to note that
the Bible holds that all life is sacred (Gen. 2:7, Ps. 139:13-16,
Exod. 20:13). Thus, whether a life is at its begging or end, it is
valuable and sacred.The dilemma in Mrs. Jones' case is directly
related to her perceived quality of life. Her family (presumably
if they are being honest) does not desire that she remain alive
and suffer. They perceive it better for her to stop living, than
for her to continue living in a poor quality of life in which she

6. would suffer. Dr. Rosenberg believes that her life is sacred, and
that her quality of life is not so bad as to warrant ending her life
early, if it can be saved with reasonable effort and low risk. For
the Christian, while quality of life certainly matters, it does not
determine the value of a life, or the worthiness of living for a
person.You might ask why exactly Mrs. Jones' family is so
ready to give up on a treatment modality (temporary dialysis)
that will likely succeed? Meilander notes the importance of
taking care of those in need and accepting their dependence
upon those who love them and vice versa, accepting your own
dependence when you are incapacitated, upon those who love
you (2013, pp. 85-88). The reticence on the part of Mrs. Jones'
family seems to communicate a lack of willingness to deal with
her care. It seems as if they want it to be over with, instead of
fulfilling their duty to care for her and be active partners with
Dr. Rosenberg in decididng what is in her best interest.From the
Christian perspective, it would be true that if Mrs. Jones had a
personal relationship with Christ, her quality of life or existence
would be improved dramatically were she to enter into God's
presence directly by way of her earthly passing. However, it
would be radically mistaken to believe that it is up to some one
other than God when that time would be. Does a refusal of
dialysis constitute a reasonable decision? Or does it constitute a
decision that functionally denies the opportunity for healing and
thus denies God's prerogative? It seems more likely that it is the
latter.In brief, it seems that Dr. Rosenberg is justified in his
refusal to refuse reasonable and low risk treatment for Mrs.
Jones. Ultimately, it seems that Mrs. Jones' family does not
want to take responsibility for her care, and is instead opting to
determine her worth or value based upon a perceived quality of
life.In your own case study, consider how each of the four
principles apply, and analyze those facts in terms of a wider
worldview or religion. All ethical decision making takes palced
within a worldview. The content of a worldview will determine
what is valuable and what is not, as well as how a person would
engage in decision making given those

7. values.ReferenceMeilaender, G. (2013). Bioethics: A primer for
Christians. (3rd ed.). Grand Rapids, MI: Wm. B. Eerdmans
Publishing Company. © 2015. Grand Canyon University. All
Rights Reserved
Biomedical Ethics in The Christian Narrative
Introduction
The reality of religious pluralism (the view that there are many
different religions with different teachings) does not logically
imply any sort of religious relativism (the view that there is no
such thing as truth, or that everything is a matter of opinion).
There are genuine distinctions between religions and
worldviews. Given this fact, it is imperative that one be tolerant
of differences and engage civilly with those of different
religions or worldviews. It might be tempting to think that one
is being tolerant or civil by simply rolling all religions into one
sort of generic "spirituality" and to claim that all religions are
essentially the same. But this is simply false. Once again, there
are genuine and important differences among religions; these
differences are meaningful to the followers of a particular faith.
To simply talk of some sort of a generic "spirituality," while
maybe properly descriptive of some, does not accurately
describe most of the religious people in the world. Furthermore,
this terminology often reduces religion to a mere personal or
cultural preference, and it ignores the distinctions and
particularity of each. The point is that such a reductionism is
not respectful of patients. It should also be noted that atheism
or secularism are not simply default or perfectly objective (or
supposedly scientific) starting positions, while religious
perspectives are somehow hopelessly biased. Every religion or
worldview brings with it a set of assumptions about the nature
of reality; whether or not a particular view should be favored
depends upon whether or not it is considered true and explains
well one's experience of reality.Biomedical EthicsBioethics is a
subfield of ethics that concerns the ethics of medicine and
ethical issues in the life sciences raised by the advance of

8. technology. The issues dealt with tend to be complex and
controversial (i.e., abortion, stem cell research, euthanasia,
etc.). In addition, bieothics usually also involves questions of
public policy and social justice. As such, the complexities of
bioethical discussion in a pluralistic society are compounded.
There have been several different approaches to bioethical
questions put forth that have to do with the theory behind
ethical decision making. Three positions have been prominent in
the discussion principalism (also known as the four principle
approach), virtue ethics, and casuistry. For this lecture, it will
be useful to outline principalism and to describe the general
contours of a Christian approach to bioethical issues.
Principalism is oftern referred to as the "four-principle
approach" because of its view that there are four ethical
principles that are the frame work of bioethics. These four
principles are the following, as spelled out by Tom L.
Beauchamp and David DeGrazia (2004):
1. Respect for autonomy − A principle that requires respect for
the decision making capacities of autonomous persons.
2. Nonmaleficence − A principle requiring that people not cause
harm to others.
3. Beneficence − A group of principles requiring that people
prevent harm, provide benefits, and balance benefits against
risks and costs.
4. Justice − A group of principles requiring fair distribution of
benefits, risks and costs. (p. 57)
For every bioethical question, one must seek to act according to
these principles. For each case there will be details,
circumstances, and factors that must be taken into account. The
process of applying these principles to each unique case is
referred to as specification and balancing. That is, these
principles in and of themselves are abstract with no particular
content or concrete application. One must specify the particular
context and details of a case or dillema in order to concretely
apply these principles and arrive at concrete action guiding
results (i.e., individuals need to know how to apply these

9. principles to specific cases and circumstances). But secondly,
the task of balancinginvolves figuring out how each of the four
principles ought to be weighted in a particular case. One needs
to determine which of the four principles deserves the most
priority in any given case, especially in cases in which there are
conflicts between the principles.Though there is disagreement
and diversity about whether or not principalism is the best
theory and method of addressing bioethical questions, these four
pricniples and this methodology have become foundational for
bioethical reflection. One common misunderstanding about
these principles, and most other bioethical methodologies or
theories, is that they can stand on their own and comprise a
neutral or secular system of solving ethical issues. However,
this is a serious misunderstanding. Though these principles
describe well much of the current cultural consciousness about
right and wrong (and so describe what Beauchamp and
Childress call the "common morality" that all human beings
ought to hold to), they do not have enough moral or concrete
content on their own apart from prior assumptions and
worldview considerations.Thus, one might come at the four
principles from a Buddhist perspective, or an Islamic
perspective, or an atheistic perspective and achieve vastly
different results. The moral content and concrete application of
the four principles would not simply depend on the particular
details of a case, but also on the worldview from which one is
approaching the moral question to begin with. The same is true
of causitry as well. The point is that when one utilizes the
principalist approach to bioethical dilemmas, it will always also
incorporate broader worldview considerations and never be
purely neutral or unbiased.The Christian NarrativeWhile it is
not possible to survey every possible religion, the description
below will at least attempt to do justice to the biblical narrative
and Judeo-Christian tradition.The Bible is a collection of 66
books written over thousands of years in several different
languages and in different genres (e.g., historical narrative,
poetry, letters, prophecy), yet there is an overarching story, or

10. big picture, which is referred to as the Christian biblical
narrative. The Christian biblical narrative is often summarized
as the story of the creation, fall, redemption, and restoration of
human beings (and more accurately this includes the entire
created order). Concepts such as sin, righteousness, and shalom
provide a framework by which the Christian worldview
understands the concepts of health and disease.Briefly, consider
the following summary of each of the four parts of the grand
Christian story:
Creation
According to Christianity, the Christian God is the creator of
everything that exists (Gen 1-2). There is nothing that exists
that does not have God as its creator. In Christianity, there is a
clear distinction between God and the creation. Creation
includes anything that is not God–the universe and everything
in it, including human beings. Thus, the universe itself and all
human beings were created. The act of creating by God was
intentional. In this original act of creation, everything exists on
purpose, not accidentally or purely randomly, and it is good.
When God describes his act or creating, and the creation itself
as good, among other things, it not only means that it is
valuable and that God cares for it, but that everything is the way
it is supposed to be. There is an order to creation, so to speak,
and everything is how it ought to be. This state of order and
peace is described by the term "Shalom." Yale theologian
Nicholas Wolterstorff (1994) describes Shalom as, "the human
being dwelling at peace in all his or her relationships: With
God, with self, with fellows, with nature" (p. 251).
Fall
Sometime after the creation, there occurred an event in human
history in which this created order was broken. In Genesis 3, the
Bible describes this event as a fundamental act of disobedience
to God. The disobedience of Adam and Eve is referred to as the
Fall, because, among other things, it was their rejection of
God's rule over them and it resulted in a break in Shalom.
According to the Bible, the Fall had universal implications. Sin

11. entered into the world through the Fall, and with it, spiritual
and physical death. This break in Shalom has affected the
creation ever since; death, disease, suffering, and, most
fundamentally, estrangement from God, has been characteristic
of human existence.
Redemption
The rest of the story in the Bible after Genesis 3 is a record of
humanity's continual struggle and corruption after the Fall, and
God's plan for its redemption. This plan of redemption spans the
Old and New Testaments in the Bible and culminates in the life,
death, and resurrection of Jesus Christ. The climax of the
Christian biblical narrative is the atoning sacrificial death of
Jesus Christ, by which God makes available forgiveness and
salvation by grace alone, through faith alone. The death of
Christ is the means by which this estrangement caused by sin
and corruption is made right. Thus, two parties, which were
previously estranged, are brought into unity (i.e., "at-one-
ment"). For the Christian, salvation fundamentally means the
restoration of a right and proper relationship with God, which
not only has consequences in the afterlife, but here and now.
Restoration
The final chapter of this narrative is yet to fully be realized.
While God has made available a way to salvation, ultimately the
end goal is the restoration of all creation to a state of Shalom.
The return of Jesus, the final judgment of all people, and the
restoration of all creation will inaugurate final restoration.The
Christian Ethical Approach − An OutlineWhile the principalist
approach may be used by the Christian as a general
methodological tool for bioethical reflection, the general
contours of a Christian approach to ethics (not only bioethics)
may be described as a mix of deontoogy and virtue ethics (Rae,
2009, p. 24). Given the reality that there is a God who exists
and has created the world with a moral structure and and
purpose, what is truly right and good is a reflection of the
character and nature of the God of the Bible. The ethic that
follows from the holy and loving nature of God is deontological

12. because it will include principles and rules regarding right and
wrong.These principles can be known in two main ways: in the
form of divine commands, as recorded in the Bible (take for
example the 10 commandments), and in the structure of the
world, from which a natural law (about right and wrong, not
legal matters) can be detected. The biblical ethic will also
involve elements of virtue ethics. The perfect man and moral
exemplar (though much more than only a man and an exemplar)
in the Christian tradition is Jesus Christ himself. The Christian
is to not only obey God's commands, but to be transformed into
his image. Jesus Christ is the perfect representation of such a
life; Christian's thus ought to embody the virtues and character
of Jesus himself. The attaining of these virtues will not only be
a matter of intellectual knowledge of right and wrong, but an
active surrender and transformation by means of God's own
Holy Spirit. Furthermore, the wisdom to navigate all the
complexities of ethical dillemas and apply biblical and natural
law principles appropriately will be a consequence of a person's
character and the active guidance of the Holy Spirit.
Worldview and the Christian NarrativeThe way in which
Christianity will answer the seven basic worldview questions
will be in the context of the above narrative. In the same vein, a
Christian view of health and health care will stem from the
above narrative and God's purposes. Of course, the pinnacle of
this framework is the person of Jesus Christ. Thus, for
Christianity, medicine is called to serve God's call and
purposes, and everything is done in remembrance of, and in
light of, Jesus' ultimate authority and kingship.
ReferenceBeauchamp, T. L., and DeGrazia, D. (2004).
"Principles and principalism" in Philosophy and medicine vol.
78. Handbook of bioethics: Taking stock of the field from a
philosophical perspective. Dordrecht: Kluwer Academic
Publishers.Rae, Scott B. Moral (2009). Moral choices: An
introduction to ethics. (3rd ed.). Grand Rapids, MI:
Zondervan.Wolterstorff, N. (1994). "For justice in Shalom." In
W. G. Boulton, T. D. Kennedy, & A. Verhey (eds.), From Christ

13. to the world: Introductory readings in Christian ethics. Grand
Rapids, MI: Wm. B. Eerdmans Publishing Company
Death, Dying, and Grief
Introduction
Death and dying are a bitter part of the reality of life in general,
and a particularly common experience for those called to health
care. The nature and meaning of death is not simply biological
or scientific, but rather involves deep philosophical and
religious questions. Once again, medical technology has
changed the scope, quality, and experience of death (or at least
the dying process). It has even prompted a changing of the very
definition of death.Death in the 21st CenturyOne of the
incredible benefits of modern science and its application in
medical technology has been the ability to extend physiological
life. In the 1960s, the development of CPR, ventilators, and the
like allowed never before seen intervention in the process of
dying, such that a "millennia-old general understanding of what
it meant to be dead" (Veatch, Haddad, & English, 2010, pp.
390-391) was transformed. In the field of biomedical ethics, the
very definition of what it means to be dead is a controversial
topic. In continuing with a fundamental theme running
throughout this course, it should be noted that while the
pathophysiological and scientifically detectable signs of death
are crucial in this debate, they should not be taken to be
determinative or comprehensive. This debate still crucially
depends on the philosophical background of one's anthropology
(i.e., view of personhood) and in the resulting interpretation of
these scientific and physiological signs. The medical definition
of death is not a purely or irreducibly scientific question.
Worldview and the Meaning of Death
On a worldview level, the question of the medical definition of
death is just the tip of the iceberg in terms of the broader
significance and ultimate meaning of death. Whether or not
there is any meaning to death and what it might be is a question
of one's worldview. Questions regarding whether or not there

14. will be ultimate moral accountability for the way one lived life
and whether there is an afterlife are key questions in this
regard. The very phenomenon of the loss of (at the very least)
physiological and perhaps conscious integrity and activity is a
fact of life that calls for explanation.Once again, an accurate
understanding of religion and worldview is required.
Furthermore, the distinctions among each religion must be
appreciated and not collapsed into one another. The way in
which both technology and religious background color the
experience and meaning of death (both in dying and grieving)
must also be appreciated. Whatever rituals or practices a
religious or cultural group engages in are informed by a view
regarding the nature and meaning of death that fits within an
overarching worldview narrative.Death in the Christian
WorldviewDeath takes on a particular meaning when seen
within the Christian narrative. It is, in fact, not the greatest evil
that could befall a human being and is furthermore transformed
in the light of the resurrection of Jesus Christ. The Christian
teaching that "God died" essentially transforms the way in
which death is seen and experienced (Sanders, 2007, pp. 6-8).
Death is certainly a tragedy and an evil, but it is now a
conquered enemy. It is a conquered enemy because in the
Christian biblical narrative, death is a perversion of God's
original design plan. And yet, the Christian God constantly
redeems that which is broken.
Loss and Grief
Death is a particularly traumatic and difficult experience for
both family and caregivers. Understanding the process and
stages of grieving is immensely beneficial for caregivers to
assess the well-being of patients and families. There are
numerous resources that can be of tremendous benefit for both
caregivers and family. One of the most influential is the work of
American psychiatrist Elizabeth Kubler-Ross. Perhaps the most
influential insight of her work was to notice certain patterns or
stages in the human experience of grief, especially after the loss
of a loved one in death. She called these the five stages of grief.

15. Briefly, they include the following: (a) denial, (b) anger, (c)
bargaining, (d) depression, and (e) acceptance ("Understanding
Grief," 2015).Expectations regarding an afterlife will in large
part determine the manner in which patients and families
welcome or spurn the prospect of death. Furthermore, the way
in which a person experiences the stages of grief will be in the
context of their worldview. Christian theologian Nicholas
Wolterstorff's (1987) memoir, Lament for a Son, is a personal
reflection of his own personal grief after losing his 25-year-old
son in a mountain climbing accident. As he engages with his
own grief and experience, it becomes clear that everything is
ultimately seen in the light of God's loving control and the
ultimate hope of resurrection.
References
Sanders, F. (2007). "Chalcedonian categories for the gospel
narrative." In F. Sanders & K. Issler (eds.), Jesus in trinitarian
perspective. Nashville, TN: B&H Academic.Understanding grief
and loss: An overview. (2015, October 26). Retrieved from
http:// http://healgrief.org/understanding-grief/Veatch, R. M.,
Haddad, A., & English, D. (2010). Case studies in biomedical
ethics. New York, NY: Oxford University Press.Verhey, A.
(2011). The Christian art of dying: Learning from Jesus. Grand
Rapids, MI: Wm. B. Eerdmans Publishing
Company.Wolterstorff, N. (1987). Lament for a son. Grand
Rapids, MI: Wm. B. Eerdmans Publishing Company.© 2015.
Grand Canyon University. All Rights Reserved
PHI-413V Lecture 1Worldview Foundations of Spirituality and
Ethics
There has been an increase of interest in the role of spirituality
in health care, as well as in the workplace and other fields in
general. This interest has been met with a variety of responses,
including an uneasiness that has historical roots. There is
generally a perceived tension between science and
religion/spirituality. This estrangement between the worlds of
science and religion is in some ways not truly reflective of some

16. inherent incompatibility between science and religion per se,
but rather a reflection of underlying worldview tensions. The
rediscovery of spirituality and its implications for health care
provides recognition that the estrangement between the two
worlds has not served patients' best interests. If this is the case,
then part of the task of serving patients well will require some
basic worldview training in order to not only understand
patients' own backgrounds more clearly, but to also promote the
fruitful interaction of science and religion in the health care
setting more generally.
Spirituality and Worldview The theoretical and practical
foundations of any discipline or field take place within the
wider framework of what is known as a worldview. A
"worldview" is a term that describes a complete way of viewing
the world around you. For example, consider religion and/or
culture. For many people, their religion or culture colors the
way in which they view their entire reality; nothing is
untouched by it and everything is within its scope. Yet one need
not be religious to have a worldview; atheism or agnosticism
are also worldviews. Thus, all of one's fundamental beliefs,
practices, and relationships are seen through the lens of a
worldview. The foundations of medicine and health care in
general bring with it a myriad of assumptions about the very
sorts of questions answered in a person's worldview. Consider
carefully the seven questions in the Called to Care textbook in
order to begin grasping more clearly the concept of a
worldview.
A Challenging Ethos A fundamental thesis of this course is that
two sorts of underlying philosophies or beliefs about the nature
of knowledge, namely, scientism and relativism, are at the heart
of this perceived tension between science and religion.
Moreover, scientism and relativism help explain to some degree
why this tension has not served the best interests of patients,
and is even at odds with the fundamental goals of medicine and
care.
Scientism is the belief that the best or only way to have any

17. knowledge of reality is by means of the sciences (Moreland and
Craig, 2003, pp. 346-350). At first glance this might sound like
a noncontroversial or even commonsensical claim. However,
think about this carefully. One way to state this is to say that if
something is not known scientifically then it is not known at all.
In other words, the only way to hold true beliefs about anything
is to know them scientifically. Relativism on the other hand is
the view that there is no such thing as truth in the
commonsensical sense of that concept. Every claim about the
nature of reality is simply relative to either an individual or a
society/culture. Thus, according to this way of thinking, it
might be true here in the United States that equality is a good
thing, but in some Middle Eastern countries it is simply not a
concern. Yet there is no ultimate truth of the matter, it is simply
a matter of individual or popular opinion. In some way, truth is
just what an individual or a culture decides that it is, and
therefore not truly discovered, but invented. The current context
of health care and medicine in the West is defined by an ethos
(the prevailing attitudes and beliefs of a culture) of scientism
and relativism. This ethos has exacerbated the perceived
philosophical and cultural tension between science and religion.
The result has been a general relativizing and caricaturing of
religion, and the elevation of science as the default
epistemology for all things rational or even true. While
scientism may seem commonsensical or rational at first glance,
a closer examination reveals glaring weaknesses. It should be
noted right from the outset that scientism is not equivalent to
science. This is because scientism is a philosophy about the
nature and limits of science as well as the extent of human
knowledge. Scientism is a philosophical thesis that claims that
science is the only methodology to gain knowledge; every other
claim to knowledge is either mere opinion or false. One of the
most pressing dilemmas for scientism is science's inability to
make moral or ethical judgments. To understand why, consider
the nature of scientific claims and their distinction from moral
or ethical judgments. General scientific claims can be described

18. simply as the attempt to make descriptions of fact. But when
people make moral or ethical judgments, they do not simply
make statements of fact (though that is part of it), but are
evaluating those fact claims. Thus when making a moral
judgment people are evaluating whether some fact is good or
bad. Thus consider the distinction between the following
statements:(1) 90% of Americans believe that racism is
wrong.(2) Racism is wrong.
Statement (1) is a statement of fact in the sense that it is meant
to describe the way things actually are, or what is the case.
Statement (2) however, makes a judgment; it makes a normative
claim in the sense that it is making a claim about what ought to
be the case. Statement (2) is not simply reporting or describing
the facts. It is saying that it is not the way it is supposed to be.
In recognizing these differences, a crucial distinction has
surfaced between (1) scientific claims and (2) moral and ethical
claims. Scientific claims are limited to statements of
description; they are solely claims about what is the case. Moral
and ethical statements are prescriptive and are evaluative claims
about what ought to be the case. This has been described as the
fact-value distinction to designate the difference between facts
and values, values being a prescription of the way things ought
to be, the moral evaluation of facts. This distinction has also
been described as the "is" (fact) versus "ought" (value)
distinction. Thus, because science deals with mere facts, it is
not in a position to say anything about what ought to be the
case. Science is relevant to moral and ethical claims in
interesting ways, but prescriptive statements about what morally
ought to be the case are simply beyond the bounds of science.
To try to derive what ought to be the case only from what is the
case is a logical fallacy. If one were to look at the world and the
way things are, and then claim that it simply follows that it is
the way it ought to be does not match the experience of
morality. There are many events that are the case and describe
what is (genocide, war, hatred, murder), but whether or not they
ought to be that way is a further question that science is not in a

19. position to answer. Thus to try to derive an ought from an is
refers to what is called the fallacy of deriving of ought from an
is. Much more could be said of the inadequacy of scientism, but
it should be noted that moral, ethical, and religious claims all
involve normative claims about the way the world ought to be.
One practical effect within health care has been the subtle but
pervasive view that religion is a harmless tangent to medicine
and health care at best, and a superstitious and destructive
distraction at worst. Recently there has been a resurgence and
appreciation of spirituality within medicine in more holistic
approaches to health care. For example, the Center for
Spirituality, Theology and Health at Duke University was
established in 1998 for the purpose of conducting research,
training others to conduct research, and promoting scholarly
field-building activities related to religion, spirituality, and
health. The Center serves as a clearinghouse for information on
this topic, and seeks to support and encourage dialogue between
researchers, clinicians, theologians, clergy, and others
interested in the intersection. (Center for Spirituality, 2014,
para. 1)While a welcome corrective, it is easy to inadvertently
buy into weaker forms of scientism and fail to appreciate the
particularity of each religion by reducing all religion to a
generic spirituality. For example, Burkhardt (1999) attempts to
defend a generic definition of the term "spirituality" (p. 71), but
Shelly and Miller (2006) point out the inadequacy of such a
strategy. It is not fair or respectful to paint all religions or
worldviews with the same brush under the heading of
spirituality and ignore thedifferences.Thus, in the interest of
philosophical clarity, religious sensitivity, and genuine care,
this section will introduce fundamental concepts and challenge
the contemporary ethos to make room for genuine religious
dialogue.The Foundations of Christian Spirituality in
HealthcareIn stark contrast to this ethos is the Christian
tradition and the resources it provides for a rich conception of
care. Contra scientism and relativism, the foundations of
Christian spirituality in health care, includes two

20. attitudes/theses: (1) an acknowledgement of science as a subset
of knowledge in general, and a deep appreciation for science as
a collective human enterprise that reflects the knowability and
order of creation; and (2) the goodness and worth of this
creation (in so far as it reflects God's creative intention) with
human beings bearing special dignity and intrinsic worth,
reflected in the well-known bioethical principle of "respect for
persons" (National Commission, 1979).The foundations of
Christian spirituality in health care assume genuine knowledge
of God and his purposes. Central to this foundation are the
biblical Christian narrative and the person of Jesus Christ. In
order to appreciate and do justice to this center, the ethos of
scientism and postmodernism must be first challenged and
dispelled.This first topic of this course is devoted to
understanding the concept of worldview in detail and to begin
to challenge the philosophies of relativism and scientism. It will
also begin to lay the foundations of a broadly holistic
understanding of the relationship between spirituality and health
care in general, and a Christian worldview for health care in
general.ReferencesBurkhardt, M. (1989). Spirituality: An
analysis of the concept holistic nursing practice. New York,
NY: Aspen Publishers, Inc.Center for Spirituality, Theology and
Health. (2014). Retrieved from
http://www.spiritualityandhealth.duke.edu/Moreland, J.P., &
Craig, W.L. (2003). Philosophial foundations for a Christian
worldview. Downers Grove, IL: IVP Academic.National
Commission for the Protection of Human Subjects of
Biomedical and Behavioral Research. (1979). The Belmont
report: Ethical principles and guidelines for the protection of
human subjects of research. Retrieved from
http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.html
Shelly, J. A., & Miller, A. B. (2006). Called to care: A
Christian worldview for nursing (2nd ed.). Downers Grove, IL:
IVP Academic. © 2015. Grand Canyon University. All Rights
Reserved.