The self-evident superiority of objective moral truth

We live in a culture in which moral relativism, or what some would call moral individualism, seems very inviting to many. This is not a new thing. Twice in the book of Judges the writer says about the people of Israel that “everyone did what was right in his own eyes.” (Judges 17:6 and 21:25) This happened to Israel because they, like us, were fallen human beings more interested in themselves than anyone else and because of their tendency to absorb things from the cultures of the nations around them. However, they had been given something better than this.

Before his death and in preparation for the nation of Israel crossing the Jordan river to take possession of the land that God had promised to them, Moses reminded God’s people that God had given them something even more important than the promised land. He had given them his law. He let them know that when they lived out the commands that God had given them the nations around them would take notice and say about Israel “Surely this great nation is a wise and understanding people.” (Deuteronomy 4:6)

Think a little about what Moses was saying. The nations around Israel were living by the relativistic principle of everyone doing what was right in his own eyes, but they would recognize that living according to God’s objective moral commands made Israel a wise and understanding people. Even though many today live according to moral relativism, those who look at ethics more closely realize that ethics is meaningless without some type of objective standards. Few still follow the course of the skeptics. Even the utilitarians who dominate modern secular ethics hold to objective principles that allow them to say that it is better to do what is best for everyone than to simply do what is best for oneself.

It is also interesting, however, that it was not Israel’s eloquent proclamation and rational defense of God’s commands that would impress the surrounding nations. It was what the nations would see when they observed Israel living in obedience to God’s commands that would convince them of the wisdom of those commands.

We who understand God’s objective moral truth need to be ready to express those truths clearly, but it is living by those truths that will impact the world around us.

Is Medical Artificial Intelligence Ethically Neutral?

Will Knight has written several articles over this past year in MIT’s flagship journal Technology Review that have discussed growing concerns in the field of Artificial Intelligence (AI) that may be of concern for bioethicists. The first concern is in the area of bias. In an article entitled “Forget Killer Robots – Bias is the Real AI Danger”, Knight provides real world examples of this hidden bias affecting people negatively. One example is an AI system called COMPASS, which is used by judges to determine the likelihood of reoffending by inmates who are up for parole. An independent review claims that algorithm may be biased against minorities. In a separate article, Knight identified additional examples in other AI algorithms that introduced gender or minority bias in software used to rank teachers, approve bank loans and interpret natural language processing. None of these examples argued that this bias was introduced intentionally or maliciously (though that certainly could happen).

This is where Knight’s the second concern becomes apparent. The problem may be that the algorithms are too complex for even their programmers to retroactively examine for bias. To understand the complexity issue, one must have an introductory idea of how the current AI programs work. Previously, computer programs had their algorithms “hard-wired” so to speak. The programs were essentially complex “if this, then do this” sequences. A programmer could look at the code and generally understand how the program would react to a given input. Beginning in the 1980’s, programmers started experimenting with code written to behave like a brain neuron might behave. The goal of the program was to model a human neuron, including the ability of the neuron to change its output behavior in real time. A neurobiologist would recognize the programming pattern as modeling the many layers of neurons in the human brain. A biofeedback expert would recognize the programming pattern as including feedback to change the input sensitivities based upon certain output goals – “teaching” the program to recognize a face or image in a larger picture is one such example. If you want to dive deep here, begin with this link.

This type of programming had limited use in the 1980s because the computers were too simple and could only model simple neurons and only a limited number at one time. Fast forward to the 21st century and 30 years of Moore’s Law of exponential growth in computing power and complexity, and suddenly, these neural networks are modeling multiple layers with millions of neurons. The programs are starting to be useful in analyzing complex big data and finding patterns (literally, a needle in a haystack) and this is becoming useful in many fields, including medical diagnosis and patient management. The problem is that even the programmers cannot simply look at these programs and explain how the programs came to their conclusions.

Why is this important to consider from a bioethics standpoint? Historically, arguments in bioethics could generally be categorized as consequentialist, deontological, virtue, hedonistic, divine command, etc… One’s stated position was open to debate and analysis, and the ethical worldview was apparent. A proprietary, cloud-based, black-box, big data neural network system making a medical decision obscures, perhaps unintentionally, the ethics behind the decision. The “WHY” of a medical decision is as important as the “HOW”. What goes in to a medical decision often includes ethical weighting that ought to be as transparent as possible. These issues are presently not easily examined in AI decisions. The bioethics community therefore needs to be vigilant as more medical decisions begin to rely on AI. We should welcome AI as another tool in helping us provide good healthcare. Given the above concerns regarding AI bias and complexity, we should not however simply accept AI decisions as ethically neutral.

The reformation, sexuality, and the body

In honor of the 500th anniversary of the beginning of the reformation I have been reading the new biography of Martin Luther by Eric Metaxas. One of the things that caught my interest was the role the theology of the human body played in the reformation. That is something that significantly impacts Christian bioethics.

The 95 theses that Luther posted for academic debate 500 years ago related to the issue of the church selling indulgences, but there are many deeper underlying issues that Luther and the reformers were addressing. Primary were issues about the authority of scripture and believers receiving salvation directly from God by grace. However, there were also issues about the unity of Christian believers that were very significant. The church of Luther’s day had drifted into many thoughts and practices that conflicted with the clear teachings of scripture. One of those was the establishment of two separate classes of Christian believers. One consisted of priests, monks, and nuns who were considered to be spiritually superior and the common people who were far below them. This was manifested ritually in priests taking both the bread in the wine in the Eucharist, while the people only received the bread. It was also represented by the priests, monks, and nuns being expected to be celibate, while the common people married and had children. There is certainly a scriptural place for singleness and celibacy in serving God, but Luther understood that this elevation of celibacy as being spiritually superior was a result of ideas about the human body and sexuality that had found their way into the church from Greek philosophy rather than biblical teaching.

Greek thought saw the spiritual and immaterial as good and saw the physical as evil. This concept which did not have a biblical foundation led to the church seeing the human body and particularly human sexuality as evil, which made celibacy spiritually superior. As Luther began to recognize that all Christian believers were on equal standing before God because our relationship with him was based on God’s grace alone, he understood that the incarnation of Jesus meant that the physical nature of human believers had been redeemed and restored to its original state at creation which was good. That meant human sexuality, marriage, and bearing children were also good as a part of redeemed creation.

Understanding that God created human beings as an integrated whole composed of both physical and spiritual parts, and that human sexuality, marriage, and childbearing were designed by God as good parts of his creation are very important parts of the Christian world view that impacts how we think about what is right and wrong. We do wrong when we misuse the physical part of ourselves and do things that are outside of how God designed us to live. We do what is right when we follow his plan for marriage and family.

Common ground in ethical debates

On 7/10/17, Janie Valentine posted a review of the new book, Why People Matter, edited by John Kilner. Recently while I was on vacation I had the chance to read it and found the basic concept of the book very interesting. It begins with the idea that people on opposite sides of many of the ethical debates in our society actually have common ground that they agree on which can be used to engage each other in a constructive way. I heartily agree with that idea and would suggest that one area of common ground is that those interested in moral and ethical issues agree that morality is important and that there are ethical standards that should influence how we live. That is good place to start. Dr. Kilner and his co-authors are more specific in suggesting that the concept that people matter, that they have moral significance and should be treated with respect, is an underlying concept that people on both side of many currently debated issues use to support their positions. That is also a very good place to start.

From that starting place the authors look at five common ways of looking at the world and moral issues and show that there are some problems with supporting the common idea that people matter within those ways of seeing the world. They contrast that with the robust support for the significance of people with in a Christian view. I was particularly impressed by the reviews of utilitarianism, individualism, and naturalism by Gilbert Meilaender, Russell DiSilvestro and Scott Rae. Those are the most common views from the surrounding culture that I see influencing the students I interact with. In each case they show why those views actually undermine the common understanding that human beings have significance – that they matter, and how a Christian biblical view provides much better support for the significance of human beings.

I think that their analyses also address the common ground that morality is important. As Dr. Meilaender points out utilitarianism is unworkable unless we are omniscient and omnipotent, which we are not. That leaves us without a way to determine what we should do. As Dr. DiSilvestro shows, individualism makes moral concepts subjective and gives no objective standards by which we can guide our moral choices. It makes ethical discussion meaningless. With Dr. Rae we can see that naturalism provides no foundation for the validity of rational thought that represents the reality of the world, let alone moral concepts to guide us. In contrast, a biblical view gives us a solid foundation for morality and ethics that is grounded in the nature of God who is good and who created a world and human beings who reflect the goodness of his nature.

No matter which of these areas of common ground we choose, we can engage those who see moral issues differently than we do by recognizing the areas on which we agree and then exploring how those areas of commonality fit with how we view the world. If we do this well with a genuine desire to understand how others think we can encourage civil discussion that will help all of us to grow and come closer to what is true.

Charlie Gard, the New England Journal of Medicine, and the Limits of “Conscience”

I would venture that most bioethicists would agree it would be ethically permissible to remove life support and active care from little Charlie Gard, and let him die.   The hospital in Britain where he has been receiving his care wants to do that, and the courts agree.  But why do they insist on this action when his parents want to transfer him for another try at experimental treatment, have raised the money, and reportedly have a center in the US willing to accept him for such an attempt?

I can think of two reasons.  One is a frank utilitarian insistence on limiting costs.  It has been publicly charged that is precisely the motive for this and similar recent cases in the U.S.

Or it could be that those caregivers who argue against the futility of such care do so on conscience grounds.  This is at least a more charitable reading.

But if that is the case, then might we not ask:  on what grounds do such conscience concerns mandate blocking the wishes of the baby’s parents—setting aside just how quickly the futility of further care would be evident?  It is commonly argued that practitioners who wish not to provide abortions or participate in assisted suicide retain a professional obligation to refer to someone who will perform the procedure in question.

So why don’t we demand that the British hospital actively refer Charlie’s parents to another facility?  Just wondering…

Maybe the parents in this case are the ones appealing to conscience, but, in the view of the medicolegal authorities, wrongly so.  In postings dated June 2 and June 6 of this year, this blog carried a 2-part rejoinder to an April 6 article in the New England Journal of Medicine that took the position that conscientious objection by medical practitioners should be considered unethical.

The NEJM has now published correspondence in response to that “Sounding Board” article.  Unlike the initial article, a subscription is not needed to read these letters and the responses of the authors.  Three letters were published.  One argues that the initial article relied on “reflective equilibrium” as the critical process by which medical practice standards are established, but to do so and reject conscientious objectors is wrongly to restrict that process, which in any case does not indubitably lead toward moral truth.  The second wondered aloud about whether construing the doctor-patient relationship as covenantal matters, whether doctors also have some degree of autonomy that commands respect, and whether the consensus of the medical profession is always ethical.  In the third, a clearly irritated correspondent complains that it is rich to offer, as the authors of the initial article stated, that potential practitioners just avoid moral issues by voluntarily excluding themselves from specialties in question; i.e., would-be OB-GYNs who consider it immoral to perform an abortion need not apply.  In response, the authors say that objectors need not be silenced but must comply, and that society expects physicians to act against their personal beliefs if necessary.

Most tellingly, the authors in question, Stahl and Emanuel, claim that the doctor-patient relationship is NOT a covenant precisely because it is not a relationship of equals; doctors hold immense power of different sorts.  Physicians must respect this inequality by avoiding specialties that pose moral conflicts to them.

I thought that the patient’s special need was precisely why a covenantal relationship is the only framework sufficient to guarantee that the patient as person is appropriately cared for.  Stahl and Emanuel are quite explicit; doctors may not stand in the way of societal calculations, on their patients’ behalf.  They have to get out of the way.

Can there be a new society of physicians dedicates to the categorical rejection of this thinking?  Could such a group possibly practice in today’s legal environment, and in the political-economic spirit that has turned medicine into a centrally-managed public utility?

Dr. Cheyn Onarecker, in the two posts in early June, addressed these points, in opposition to Stahl and Emanuel and, in fact, anticipating their responses in the new correspondence.  Read those again.

But we need to go further, and attempt to restore the covenantal view of medicine.  I’d like to hear more from Dr. Onarecker and other real doctors on this blog about that.

The need for Christians to make distinctively biblical moral decisions




Educating the church about how to think about bioethics




Most pressing bioethics issue





In Defense of a Physician’s Right to Conscientious Objection, Part 2

Guest post by Cheyn Onarecker, MD






In Defense of a Physician’s Right of Conscientious Objection

Guest post by Cheyn Onarecker, MD




