Knowing One's Medical Fate in Advance

Challenges for Diagnosis and Treatment, Philosophy, Ethics and Religion

G. Pfleiderer, M. Battegay, K. Lindpaintner, G., Pfleiderer, M., Battegay, K., Lindpaintner, G. Pfleiderer, M. Battegay, K. Lindpaintner

• Publisher: S. Karger
• Year: 2012
• Print ISBN:
  9783805596497
• eBook ISBN:
  9783805596503
• Topic: Medicine
• Subtopic: Family Medicine & General Practice

Modern medicine is now in a position to make advanced prognoses that chart the entire course of illness and recovery. Paradoxically, this is coupled with a new dimension of uncertainty for the patient, i.e. coming to terms with discovering they have an increased risk of a particular disease and deciding what appropriate steps to take. In this publication, renowned experts in their fields discuss these issues. The certainty and uncertainty of one's fate are discussed from both methodological and epidemiological perspectives, using examples of diseases for which treatment and prognosis have dramatically changed. Despite profound insights into the human genome, personalized genetically tailored medicine still lies in the future. Religious, spiritual and philosophical dimensions are discussed, as are the ways in which they may help people cope with these new insights into their future, e.g. the promise of an afterlife. This publication aims to bridge the different fields dealing with this area by addressing the challenges faced and encouraging dialogue. It will be of interest to all readers who deal with ethical problems of prognosis, particularly in medicine, as well as to theologians and sociologists.

Religious Perspectives

Pfleiderer G, Battegay M, Lindpaintner K (eds): Knowing One’s Medical Fate in Advance. Challenges for Diagnosis and Treatment, Philosophy, Ethics and Religion. Basel, Karger, 2012, pp 87–105

______________________

Modern Medicine and My Future Life: A Christian-Theological Perspective

Georg Pfleiderer

Theology Faculty, University of Basel, Basel, Switzerland

Introduction:The Importance of Being Religious

In Western societies, religious belief belongs primarily to the sphere of privacy; it is connected with the idea of individual decisions and convictions which cannot be prescribed to all members of a pluralistic society. Nevertheless, ethical discourses, e.g. on predictive medicine, on questions of the anticipation of individual future can hardly be held without referring to conceptions of good life, of a good future—in the perspective of the respective individual. Such conceptions are always connected with worldviews (Weltanschauungen) and their very often religious backgrounds. This is illustrated e.g. in a recent empirical study done in Basel [1] (see also Gabriela Brahier’s essay in this volume). Differentiated interviews with pregnant women, having to decide whether to undergo a prenatal genetic test or not, show that in such decisions religious ideas on human life and its meaning are much more involved than it is reflected in most academic debates on such bioethical problems.

There is some discrepancy between the amount of theoretical and practical efforts to improve the communication of medical knowledge and awareness of rather formal questions of ethical autonomy, on the one hand, and the usually reduced intellectual interest on the question: how can a person be helped in his or her attempt to get more clarity on the field of his or basic philosophical and religious convictions? Such partial ignorance of many ‘secular’ bioethicists regarding this part of ethical decision-making might support consequences that they actually should not, such as irrationalism and the tendencies to obey authoritarian religious authorities.

The following considerations should shed some light on such religious backgrounds. The discussion starts from the standpoint of a modern Christian (namely Protestant) understanding of individual life-conduct, which is based on an general attitude of trust, hope, and responsibility. This Western, modern type of Christian ethics is not categorically hesitant of using instruments of advanced medical techniques.

It argues, however, that the help ethical deliberation and consultancy can give to concerned persons might be limited, as long as they exclude theological reflections on religious horizons and backgrounds in principle.

In order to illustrate some basic ideas of Christian concepts of life, particularly life’s end, meaning and afterlife (so-called eschatology), it might be helpful to begin with a sketch of antique belief in fate as a foil of contrast.

Individual Life and Its Future in a Christian Theological Perspective

Anonymous Fate or Destiny by Divine Providence?

The Moirai

In Roman and Greek mythology, there were three goddesses of fate: the so-called Moirai (Latin, parcae) or Fates. The first one, Clotho (Nona), spins the fibre of individual destiny, while Lachesis (Decima) interweaves it, and Atropos (Morta) finally cuts it down.

There were different ideas concerning the question whether these deities, and fate in general, were dependent upon the highest God (Zeus, Jupiter), or even the Gods were dependent upon fate. Probably the more archaic Greek idea (Herodot, Homer) was that even the Gods were dependent upon fate, while the later Roman mythology conceived the Parcae as dependent upon Jupiter’s will. While this younger concept may reflect influences from monotheistic religions, the older and more archaic Greek imagination, as particularly Homer in the Iliad conveys it, even speaks of one goddess, called moira. Therefore, one may say that despite their relative plurality and individuality, moira basically and originally is an impersonal, anonymous power of fate. Originally, not even the Gods have an influence on fate. Fate is, so-to-speak, ‘fatalistic’. Fate is either luck, fortune, fortune or misfortune, bad luck or it is a mixture. Our individual destiny is fate, unchangeably fixed at the moment of our birth.

The Solon Paradox

Ancient Greek philosophy in general is at least latently fatalistic. This is the reason for Solon’s famous hesitation to call the most wealthy man on earth, Kroisos, a lucky man. The so-called Solon paradox articulates the dilemma that before the end of our days, we are not able to estimate the quality of our life, but at that end, we do not know it either, because then we are dead. Nevertheless, for Solon himself, the paradox that carries his name, was in fact no paradox: instead of Kroisos, who asked him this question, he named Tellos the most lucky man on earth. Tellos was a more or less ordinary Athenian, who has lived in a flourishing community, has had brave sons, sane grandsons, a good fortune and died an honourable death as a soldier. For Solon, one of the seven wise men of ancient Greece, objective luck and subjective happiness were more or less the same. For modern people, they are different. Luck and fortune are mostly interesting in the first-person perspective: luck is no luck without happiness. Thus, the ‘Solon paradox’ is a retrospective invention of modernity.

Since the times of Renaissance and Humanism, European intellectuals have sympathized with that ancient concept of anonymous fate. Nevertheless, most of the modern intellectuals did not turn back to the sober fatalism of ancient Greek philosophy which speculated on the question: which was better, to live a more or less happy and lucky life or not having being born at all? Therefore, the burden on subjective fulfilment of life, also the burden which is laid upon us by the uncertainties of our prospective future life, have grown immensely. On this background, the famous end of Albert Camus’ existentialist novel [2] is most understood, where Sisyphos should be considered as a happy man.

“Wer immer strebend sich bemüht, den können wir erlösen [3].” Labour and endeavour are the modern solutions of the Solon paradox. The risks and uncertainties of our future life can be overcome by pragmatism. “Hilf Dir selbst, dann hilft Dir Gott” (Help yourself, then God will help you) is the pious version (going even back to the Middle Age), while “Jeder ist seines Glückes Schmied” (Every man is the architect of his own future), is the secular version of such pragmatism, including legitimization and absolution, by procedure.

Providence

It is well known that in Biblical and Christian theology, things are different. Individual fate and individual future life are believed to lie in the hand of God. God, in his divine foreknowledge, knows and foresees our destiny, our deeds and our future; moreover, God is also the latent power behind all earthly action and events. With his almighty providence, he guides and navigates the ships of our lives through the ocean of time— the technical term is gubernatio (originally, steering [of a ship]) in classic dogmatics. Nevertheless, such divine providence must not be understood as an absolute determination of life, as it does not prevent the idea of human freedom; on the contrary, it wants to name its transcendental condition, i.e. the absolute subjectivity of God is the raison d’être of any finite subjectivity.

Such finite freedom is however limited, not as a consequence of divine determination or anonymous fate, but as a consequence of the wrongful use of freedom, of sin. For every individual this ‘fatal’ involvement into sin is a fact, it has always already happened. To put in traditional theological ideas: no human being is free like Adam and Eve before the fall. We are, so to speak, all children of Adam and Eve after the fall. Nevertheless, Christians also believe that the consequences of the fall are overcome by the liberation of Jesus Christ. By believing in him, freedom is possible.

Therefore, in Christianity the three Moirai are replaced by the triune God. One might say it is God, the creator, who spins our fibre of life, it is Christ, the son, who interweaves our present life with those of others, and it finally is the Holy Spirit in which the future of our life (and within this future, sooner or later, its end) is merged.

Thus, in a Christian understanding of destiny, all fatal associations must be understood as negated and overcome. ‘Destiny’ is related to ‘destination’: each individual has a certain aim and perspective in life. He or she is called to find and follow it.

Individual Destiny

Although it was not until the rise of modernity in the 18th century that Christian theologians emphasized the importance of individuality in anthropology, there is a certain inclination towards individualism and appreciation of individual biographical life already at the biblical cradle of Christianity, in the New Testament. A religion whose central theological task is it to relate a certain finite biography of a particular individual (Jesus of Nazareth) to the essence and the being of the absolute, infinite, universal deity is actually compelled to reflect on the meaning of individuality.

The most visible effect of this reflection is the Christian concept of faith—faith is an individual act; in faith, no one is exchangeable by another person, not the wife by the husband, not the children by the parents. In a strict sense of the word, belief is not a social but an individual practice. There are of course groups of believers, there is a church, a community, and there is a common or a shared belief, nevertheless, the act of belief is essentially individual. The objects of vocation in the New Testament, the first disciples, are depicted as particular individuals. Even baptism is individual: “I’ve called you upon your name, you are mine”.

To be sure, belief means the incorporation into a new social body, into the church as the community of believers, which is believed to be the body of Christ. “In Christ, you all are one” (Gal 3,28) —but they do not lose their individuality, they rather gain it—it is the individual charismata which make the church live. Indifference and uniformity are not indices of Christian life and freedom but of sin.

Christian Understanding of Personal Future, Death and Afterlife

Two Formative Tensions

The relationship of the individual to his or her future life is, in Christianity, at least in traditional Western Christianity, determined by strong tensions. They are two-fold and precisely these:

1 The tension between redemption which has already happened (in Jesus Christ) and future redemption (in the ‘day of Judgment’).

2 The tension between finite, carnal and infinite, transcendent, spiritual life.

These strong and two-fold tensions are formative for Christianity. The events and deeds of my finite future life, how I behave, what I will experience, are equally appreciated and filled with enormous meaning, but also, they are very much relative and relieved of heavy impositions.

During the 2,000 years of Christian history, as well as regarding the variety of respective different groups and churches, this two-fold tension is interpreted in an extreme variety of forms. Let us just pick two important particular movements: The Reformation and Enlightenment.

Reformation Theology: The Prerogative of Justification (Grace)

(1) Reformation theology, in the shape of Martin Luther or John Calvin, very much concentrated on the first part of the first tension, i.e. the work of redemption. Exactly spoken, the work of justification or atonement, is done once, forever and sufficiently in the events of the life, death and resurrection of Jesus Christ. No person on earth is able (nor forced) to add in his or her life something substantial to the meaning and the value of this world-changing chain of events. The future, every future of everyone who believes in Jesus Christ, is bright and open, however dark, sorrowful and viewless his or her empiric life and future actually are.

Like Paul, Luther and even more Calvin hurried to emphasize that this fundamentally good message for the perspective of individual future life must not be taken as a permission to live without ethical efforts and social responsibility; on the contrary, the knowledge of this passed justification is entailed with intrinsic necessity the attendance to live one’s life in service for the interests of one’s neighbour, that is, to live a life in so-called ‘sanctification’.

(2) In addition, both Luther and Calvin also agreed in Paul’s claim that by far much better than any future in this finite life would and will be the future life which we may expect after death. The intensity and realism of this belief in the transcendent life (after life) for the Reformed (and not only Reformed) Christianity, until at least early 18th century, is hardly to be overestimated. It was, as it is still well known, much more than a theological doctrine, it was the widely shared assumption and the core of Christianity for more or less all Christians. The music of Johann Sebastian Bach or the hymns of Paul Gerhardt give testimony of this religious reality.

Enlightenment: Spiritualisation of Afterlife Conceptions

It was the movement of Enlightenment which changed this scene more or less radically. However, although under the influence of Enlightenment since late 18^th century, the average European Christian lost the ‘self-evident’ concept of a ‘realistic’ understanding of afterlife. Actually, he or she did not lose any kind of such belief; instead, a great spiritualisation and ‘ethicalization’ of the concepts of transcendent life took place.

This spiritualisation happened surprisingly enough without a major crisis in the Christian religion. The realistic and colourful images of transcendent life were not replaced in a coup de force by usually abstract ideas, but rather slowly and from generation to generation with more emphasis; it was replaced by a more spiritual and— particularly in the heyday of Enlightenment—a more ethical understanding of its meaning.

Nevertheless, and despite its so-to-speak formal character, this transformation of fundamental religious assumptions did go along with some remarkable changes in their material content. Although the enlightened understanding of transcendence stressed the ethical effects of its meaning, and, in turn, the idea of social justice and of a God who repays and rewards our good deeds, enlightenment-theology particularly and even more philosophy went to great trouble to illustrate the other side of this concept: the rigorous and strict side of God and of ultimate Judgement. The concept of hell and eternal punishment had lost its plausibility and, during the 19th century, all the efforts of conservative pastors to keep it present in the minds of their flock became more and more fruitless. Punishment was also spiritualized and internalized; it was transformed in the concept of a mostly bad—at least in the 19th century, notoriously bad—Christian consciousness.

Thus, within about two centuries the modern individual, the modern Christian individual, was born. What made this birth possible on Christian religious grounds was the fact that it actually was not an entirely new birth but rather a rebirth of an older theological concept. In a way, the realistic, physical, supranatural understanding of an afterlife that dominated the phenomenology of Christian imagery and thinking before modernity, had in fact always been rather a kind of external skin of the core of the religious convictions. Under the surface of its epistemological realism, e.g. Reformation theology, in fact, it had a ‘spiritual’ understanding of afterlife and transcendence. Likewise, in the New Testament itself, the images of transcendent life, i.e. the concepts of a bodily resurrection, never were communicated with the claim of a literal, ‘physical’ reality. Otherwise, the fact that the event of the returning of Jesus Christ did actually not happen within one or two generations as the early Christians, even Paul, had expected, would have caused a much deeper crisis in Christianity than it actually had. Therefore, for some 2,000 years, Christian eschatology could mix and combine elements from a mostly Platonic dualism of eternal soul and finite material, flesh on the one side and a rather Bib...

Table of contents

• Cover Page
• Front Matter
• Introduction
• Evolving Therapy and Prognosis in HIV – How Knowing One’s Medical Fate in Advance Can Change Dramatically
• Related to Human Cognition:Is Personalization Feasible and Desirable?
• Ethical Decision-Making on Genetic Diagnosis Facing the Challenges of Knowing One’s Medical Fate in Advance
• Mastering Familial Genetic Knowledge: Shared or Secret? Issues of Decision-Making in Predictive Genetic Testing
• Predictive Medicine – Changes in Our View of Ourselves and Others
• Current Challenges for the Law: Disclosure Dilemmas in Predictive Medicine
• Fate and Judaism – Philosophical and Clinical Aspects
• Modern Medicine and My Future Life: A Christian-Theological Perspective
• Karma, Contingency, and the ‘Point of No Return’: Predictive Medicine and Buddhist Perspectives
• Author Index
• Subject Index