The Potential of Pastoral Theology for Bioethics

By Nathan Carlin

October 14th, 2013

In 2009, I completed my graduate training and accepted an academic post as Assistant Professor in the McGovern Center for Humanities and Ethics, housed in the University of Texas Medical School in Houston, Texas. My graduate work focused on pastoral theology at Princeton Seminary and psychology of religion at Rice University (not bioethics). Over the past few years, I have been making the transition to bioethics, broadly construed, because my post has required me to do so—ethics is, as it were, the bread and butter of humanities folks working in medical contexts. Also, in order for me to be promoted it was necessary for me to write about issues related to medicine, health, illness, disease, suffering, healing, and so forth. So the orientation or emphasis of my work simply had to change. Jobs are hard to come by, and I’m grateful for the one I landed.

In 2013, I was promoted to Associate Professor. And so, perhaps not surprisingly, these days I’ve been thinking more seriously about my identity as a scholar, about what is becoming of me: What unique perspective do I have to offer? In what sense is my previous training in pastoral theology and psychology of religion still relevant to my current teaching and writing? How can I keep my vocational selves together? Who am I?

I have begun to refer to myself as a pastoral theologian working in health-related fields (such as bioethics, clinical ethics, and medical humanities), meaning that I consider myself to be primarily a pastoral theologian. The implications of what it might mean to be a pastoral theologian working in these fields has only become a little clearer to me recently. Let me explain.

After reading in bioethics for several years, it occurred to me that, while the field in some sense was launched by pastors and theologians (and while there is a renewed, contemporary interest in religion/spirituality and bioethics, especially because of the University of Chicago’s Program on Medicine and Religion: https://pmr.uchicago.edu/), there is and always has been a virtual lack of pastoral theological voices—that is, the theological contributions to bioethics have come from theological ethicists and systematic theologians, not pastoral theologians (see, e.g., Sondra Ely Wheeler’s Stewards of Life and Stanley Hauerwas’s God, Medicine, and Suffering). The most notable exception in this regard is Bonnie Miller-McLemore’s 1991 essay in the Journal of Religion and Health, titled “Thinking Theologically about Modern Medicine,” which never gained traction in the field perhaps because the persons most likely to do this intellectual work—chaplains—do not publish much. It also occurred to me that what pastoral theology can offer bioethics is qualitatively different from what theological ethicists and systematic theologians can offer: Pastoral theologians can offer theological inquiry that is psychologically sophisticated and therapeutically sound, and this is important because bioethics, whether written by theologians or philosophers, has not tended to draw from psychological and therapeutic literature—so there is, that is to say, new terrain to be traversed in bioethics. I develop this argument a bit further in my recent essay in Pastoral Psychology, titled “Bioethics and Pastoral Concern.” I hope to write a monograph on this topic in a few years.   

I think I can make this point a bit more concretely by focusing on Daniel Callahan’s recent essay, titled “Obesity: Chasing an Elusive Epidemic,” published in The Hastings Center Report. Callahan, trained as a philosopher, is a well-known and controversial utilitarian bioethicist who privileges the social over the individual. And in his article he offers, as one solution to the obesity epidemic in the United States, some practical advice on how to encourage overweight persons to lose weight: social shaming. His suggestion somewhat irritated me as soon as I had read it. As I reflected on why I was irritated, it occurred to me that Callahan, as a philosopher, was not, in all likelihood, familiar with theological and/or therapeutic literature on shame, such as Donald Capps’s The Depleted Self. What, I wondered, do philosophers know about shame, and why should we turn to philosophers regarding questions of personal change—is not this the realm of therapists? While philosophers are good at conceptual analysis, it is the realm of psychologists, pastors, psychotherapists, and other such folk to help persons change. To me, Callahan’s advice comes across as cool and is, it seems to me, likely to be ineffective. He seems heavy-handed and controversial for the sake of being controversial. In contrast to the detached analysis that is so common in bioethics, pastoral theologians can offer more experience-near accounts of moral questions and more effective strategies for change. Why? This is because pastoral theologians draw on the rich traditions of both psychology and theology to care for the souls, spirits, and selves of persons and groups. It seems reductionist and naïve to suggest social shaming as the solution to a complex problem involving taste and desire; a human anthropology that is psychologically sensitive and theologically informed is needed to do this work. Epidemiological findings and logical arguments are not enough. I think Callahan himself would agree with much of what I am suggesting, given his 1990 essay in The Hastings Center Report, titled “Religion and the Secularization of Bioethics,” where he makes a case for theological voices in bioethics.    

This perspective—a pastoral theological perspective—is more or less absent in bioethics. But I should add that it is not because pastoral theologians have been excluded from the conversation; it is, rather, that they have not joined. They have not attended conferences such as the American Society for Bioethics and Humanities. Nor have they published in journals such as the Cambridge Quarterly of Healthcare Ethics. It is almost by accident that I find myself joining these conversations, attending these conferences, and reading these journals, almost by accident that I find myself, as a pastoral theologian, setting out to traverse this new terrain in bioethics.

The Reverend Nathan Carlin, Ph.D., is Associate Professor at the University of Texas Medical School at Houston and Director of its Medical Humanities and Ethics Certificate Program. His primary academic appointment is in the McGovern Center for Humanities and Ethics. Dr. Carlin also is a Minister of the Word and Sacrament in the Presbyterian Church (U.S.A.). He is a member of the Adjunct Faculty of the Institute of Spirituality and Health.