Bioethics and the Body: Moral Formation in the Hospital

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2018

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Abstract

This dissertation explores the formational power of healthcare as revealed in the modern hospital, offering a constructive theological and moral response to two interrelated questions. First, how should the work of healthcare be described? Answering this question requires careful attention to distinct formations of patients and practitioners undergirded by tacit theological assumptions. Second, what moral responses are fitting for these descriptions of the work of healthcare? In contrast to the standard prescriptive approach in modern bioethics, the moral concerns and sources present in contexts of action must be articulated in order to enable prudential moral guidance. Through engaging the relationship between moral description and prescription in the modern hospital, this dissertation argues that the practice of healthcare should be ordered within an overarching moral and theological vision of hospitable bodily care.

In dialogue with writings in phenomenology, ethnography, and history, the dissertation excavates the theological, philosophical, and political assumptions that undergird different accounts of the work of healthcare in the hospital. Within this institution, bodily disruption is imagined and engaged in distinct ways, which form how patients and practitioners speak, perceive, and act. This formation is examined in three paradigmatic medical sites within the modern hospital: the surgical ward, the Intensive Care Unit, and the labor and delivery ward. Within them, the patient’s body is imagined and engaged as enemy, object, and friend. These medical imaginaries are made possible by the development within the modern hospital of distinct arrangements of discourses, practices, and practitioners, each undergirded by particular normative schema.

By articulating the moral sources and conflicts within the modern hospital, the project illuminates the moral theories of three prominent Christian bioethicists: James Childress, H. Tristram Engelhardt, Jr., and Stanley Hauerwas. I argue that Childress offers a just-war inspired bioethics fitting for conflictual encounters, and that Engelhardt’s position, as developed by Jeffrey Bishop, ultimately counsels separation in light of the objectification of the body that occurs in the modern hospital. In his writings, Hauerwas offers an account of care befitting the institution’s roots in practices of hospitality. By developing this moral vision through the work of Luke Bretherton, the dissertation articulates a postsecular approach to bioethics, one that seeks to work within and across robust moral communities to foster the conditions and possibilities of hospitable bodily care.

The project argues that the dominant modes of imagining and engaging the patient’s body in the modern hospital—as enemy and object—do not have to be fundamental. Instead, a constructive normative vision of hospitable bodily care can order the practice of healthcare within the modern hospital. The theological underpinnings of this overarching moral framework are provided through understanding the encounter between patient and practitioner as a Christologically charged event, as depicted in Matthew 25 and the work of St. Basil. This is developed further through a pneumatological account of healthcare. The project concludes by arguing for a theological construal of the practice of healthcare as a means of participating in the Spirit’s work of befriending flesh. Through acts of hospitable bodily care, patients and practitioners are formed into the image of Christ through the power of the Spirit.

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Doctor of Theology

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Citation

McCarty, Michael Brett (2018). Bioethics and the Body: Moral Formation in the Hospital. Dissertation, Duke University. Retrieved from https://hdl.handle.net/10161/20191.

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