Reviewers of Meilaender's many publications in the field of ethics generally use phrases like "accessible language," "concise and definite," and the like. I disagree. If Meilaender's goal in the current volume is, as the blurb on the back cover claims, to "cover a wide range of pressing bioethical issues" and to offer "discerning guidance on how Christians ought to think about them," that goal has not been achieved. Far from being "concise and definite" while using "accessible language," Meilander skates on the surface of critical and complex issues, giving precious little medical information and using wildly exaggerated examples to lead people to his way of thinking.
One thing that struck me from the moment I opened the book was the lack of references. As one who teaches classes in and writes about issues in biomedical ethics, I was appalled to discover that, in 124 pages of text, Meilaender includes just 61 footnotes, and 14 of them pertain to his most curious discussion of organ donation. In the chapter on assisted reproduction, surely an extremely complex issue, there are just two footnotes. Yet the modus operandi for ethicians is to cite sources and data, not just write what amounts to an extended op-ed piece.
Throughout this slim volume, Meilaender steps inside the hearts and minds of others, making sweeping judgments about individual motivation in heart-rending medical and moral decision-making. From the outset, Meilaender insists that "an ethic shaped by Christian vision" will, perforce, take a deontological approach (5). Why? Surely, there are sincere Christians who are more naturally inclined toward a teleological approach. And there is no context or explanation of terms provided in a book presumingly intended mostly for audiences without a good background in formal ethics. And his language about the role of doctors, e.g., "They may heal our diseases but increase thereby our sense of invulnerability…." (8) can lead some faithful Christians to mistrust their physicians.
My newest undergraduate students quickly learn the mantra, "language is important; words do count." They come to understand that, in the field of biomedical ethics, one must weigh words carefully, without leaping to unfounded conclusions. Yet this book is filled with such leaps. For example, Meilaender states that parties involved in artificial insemination by donor "often" keep this secret from the child (15). How does he know this? He later says that "Christians have not generally approved deliberately childless marriages" (17). Again, what is his source?
One broad problem with all the chapters dealing with issues of reproduction and related topics is the failure to discuss natural law theory. Since Meilaender appears to be relying on a strict physicalist approach, which sees biology as the fundamental source of our morality, readers need to be let in on the other strain of natural law, the personalist approach, which sees human life more holistically.
Even in an otherwise balanced chapter on abortion, Meilaender makes this unattributed claim: "advancing knowledge of embryological development indicates that the beginnings of the mammalian body plan are laid down from the time of fertilization" (30). This is such a critical factor in the ethics of abortion that it deserves more scholarly treatment.
While I applaud Meilaender's insistence that not everything that can be done in the area of genetic manipulation should be done, I was disheartened to read his rejection of the World Health Organization's concept of "health" (44). Here, again, he seems to feel that we need only focus on the strictly biological part of our wellbeing and not also be concerned about mental and social wellbeing.
The chapter on prenatal screening raises valid concerns, but betrays an assumption that the only purpose of such testing is to find an excuse to abort. This is very troubling, since it allows Christians to judge all parents using such advances as selfish and unloving. Before using sociologist Barbara Katz Rothman's analysis of prenatal screening, Meilaender makes a disclaimer that, in my opinion, characterizes this entire treatise: "Without by any means doing justice to its intricacies,…" (52).
Meilaender also falls into the trap so many do of discussing "euthanasia" as if it were a single act or circumstance. Suicide, physician-assisted suicide, and refusal or discontinuation of treatment are not to be contrasted with euthanasia: they are themselves forms of euthanasia properly understood. Nowhere do we find the distinction between active and passive euthanasia, nor is there any clarity about the distinct moral questions that pertain to each category. And the serious reservations of the author concerning the use of living wills and the durable power of attorney for medical decisions is dangerous in the context of a book intended for biomedical novices. While reading the chapter on who should make end-of-life decisions, I found myself wondering if Meilaender had ever "been there" himself. And the extreme, rather fanciful, situations used to demonstrate the dangers of organ/body donation seem fairly useless for such an audience.
Although I am apparently not one of the "Christians" for whom Meilaender wrote this volume—he refers to the Roman Catholic Church and its moral teaching as if we are outside the Christian communion—I feel moved to object strongly to the use of this type of shallow discourse on such deep and serious topics. This is not, in fact, a primer for a general audience, but a devotional manual for those who are well schooled in the complex issues that make up contemporary biomedical ethics.