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PASTORAL AESTHETICS
It is often said that bioethics emerged from theology in the 1960s, and that since then it has grown into a secular enterprise, yielding to other disciplines and professions such as philosophy and law. During the 1970s and 1980s, a kind of secularism in biomedicine and related areas was encouraged by the need for a neutral language that could provide common ground for guiding clinical practice and research protocols. Tom Beauchamp and James Childress, in their pivotal The Principles of Biomedical Ethics , achieved this neutrality through an approach that came to be known as "principlist bioethics."
In Pastoral Aesthetics , Nathan Carlin critically engages Beauchamp and Childress by revisiting the role of religion in bioethics and argues that pastoral theologians can enrich moral imagination in bioethics by cultivating an aesthetic sensibility that is theologically-informed, psychologically-sophisticated, therapeutically-oriented, and experientially-grounded. To achieve these ends, Carlin employs Paul Tillich's method of correlation by positioning four principles of bioethics with four images of pastoral care, drawing on a range of sources, including painting, fiction, memoir, poetry, journalism, cultural studies, clinical journals, classic cases in bioethics, and original pastoral care conversations. What emerges is a form of interdisciplinary inquiry that will be of special interest to bioethicists, theologians, and chaplains.
In Pastoral Aesthetics , Nathan Carlin critically engages Beauchamp and Childress by revisiting the role of religion in bioethics and argues that pastoral theologians can enrich moral imagination in bioethics by cultivating an aesthetic sensibility that is theologically-informed, psychologically-sophisticated, therapeutically-oriented, and experientially-grounded. To achieve these ends, Carlin employs Paul Tillich's method of correlation by positioning four principles of bioethics with four images of pastoral care, drawing on a range of sources, including painting, fiction, memoir, poetry, journalism, cultural studies, clinical journals, classic cases in bioethics, and original pastoral care conversations. What emerges is a form of interdisciplinary inquiry that will be of special interest to bioethicists, theologians, and chaplains.
216 pages, Hardcover
Published April 4, 2019
4 people want to read
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February 21, 2026
Pastoral Aesthetics (Carlin):
Novel approach. I loved the structure Carlin gives, using Tillich’s correlative methods to connect some of Robert Dykstra’s Images of Pastoral Care to each of the famous four principles of biomedical ethics by Beauchamp and Childress. Highlights for me include exemplar ways of both identifying and answering to the critiques of each principle, and in particular the exposure to Dykstra’s collection. I find the deeper goal of “thickening” moral imagination rather than doing away with principlism powerful. While I found Carlin’s identification of the need for remedying psychological, experiential, contextual, and theological points back into principlism, I did find his approach and literary examples left-field albeit inviting; I personally found the first and last principles' correlations particularly effective. I also wish there was a final review of all the principles together, and a wholistic response of pastoral theology to that, after the detailed correlations he made. I appreciate also coming across responses to his work, including strong agreements that bioethics needs more attention to lived experiences, especially in its teaching and formation of caregivers (i.e. pedagogy of possibilities), and the critique in lack of actionable (prophetic?) items. I particularly love Carlin’s response that his novel approach is a beginning—to which I am sure others will carry forward.
1. Respect for Autonomy: decisions > persons as stable and rational without disorganization or effects of trauma/disruption. Boisen/Gerkin, Living Human Document to be interpreted. (plus Kleinman).
2. Nonmaleficence: assumption that harm can be avoided by control and ordered reasoning. Faber, Circus Clown: entering chaos with solidarity, with example of humor and humility.
3. Beneficence: technical, biomedically reductive, paternalistic interventions. Pruyser, Diagnostician: seeking interpretation, understanding, and meaning in addition to intervention.
4. Justice: abstract distribution of resources, underestimating relational/structural dynamics. Miller-McLemore, Living Human Web: relational, moral, moral responsibilities that analyzes systems, institutions, and communities.
---
“The most striking change over the past two decades or so has been the secularization of bioethics. The field has moved from one dominated by religious and medical traditions to one now increasingly shaped by philosophical and legal concepts. The consequence has been a mode of public discourse that emphasizes secular themes: universal rights, individual self-direction, procedural justice, and a systematic denial of either a common good or a transcendent individual good… In time, theologians left the field. Callahan offers two contributing factors: (i) theologians and religious studies scholars became more interested in discussions of race and class in the 1970s and (ii) as bioethics became established in the public sphere, “there was great pressure (even if more latent than manifest) to frame the issues, and to speak, in a common secular mode…religion was for the most part bypassed altogether.””
“Principlist bioethics has been criticized for privileging the principle of respect for autonomy. Meilaender joins this criticism: “We should not suppose that any individual’s dignity can be satisfactorily described by the language of autonomy alone—as if we were most fully human when we acted on our own, chose the course of our ‘life plan,’ or were capable and powerful enough to burden no one…not believe that Christian bioethics should affirm this assumption.
Other key components of Meilaender’s particular Christian moral vision include the following notions: human beings are both free and finite; human beings are both persons and bodies; suffering, while not good in itself, is not to be avoided at all costs; and health, while a good (health is something to be pursued), is not the supreme good (i.e., health is not something to be pursued at all costs).”
“They add that “it is a mistake in biomedical ethics to assign priority to any basic principle over other basic principles,” and that “the better strategy is to appreciate both the contributions and the limits of various principles, virtues, and rights, which is the strategy we adopt.” It is important to note, too, that others have suggested different or additional principles than those offered by Beauchamp and Childress, such as veracity. Beauchamp and Childress are right that their work has been unfairly criticized with regard to the principle of respect for autonomy. However, there have been a number of other critiques raised about their approach that do have considerable merit. One that is especially important for my argument in this book may be put as follows: principlist bioethics pays insufficient attention to experience and to context. While principlist bioethics does in fact tend to be detached and abstract, pastoral theology can supplement principlist bioethics by paying more attention to experience and to context.”
“Miller notes that bioethics tends to be more philosophical than ethnographic and that sociologists and anthropologists lament that “conventional bioethics fails to explore the social contours and experiential complexities of professional life.” Miller continues: “Excluded from the standard account of bioethics are medical professionals’ moral idioms, personal challenges, logistical obstacles, religious commitments, and interpersonal interactions with patients and families.” He adds: “Instead, medical ethics is often abstract, deductive, and/or highly rationalistic, detached from the anguishing empirical realities and power struggles in which medical professionals find themselves.” In support of this critique, Miller cites the work of Arthur Kleinman, who similarly argues that conventional bioethics “fails to capture the existential challenges of patient suffering.” Kleinman is disappointed that “lay perspectives” and “everyday life experiences” are not central in bioethics.”
“If a major critique of principlist bioethics is its tendency to pay insufficient attention to experience and context, to remedy this deficiency scholars writing from literary and anthropological perspectives have employed methodologies beyond philosophy to do bioethics in a way that pays more attention to “thickness.” But literary and anthropological perspectives do not tend to draw on psychological theories and therapeutic techniques, which is why some bioethicists have called for more psychology in bioethics. Additionally, in recent years there has been a rebirth of religious perspectives in bioethics. Thus, what is being called for now from different places in bioethics is more psychology and more religion. Because the academic field most closely identified with psychology and religion is pastoral theology, pastoral theologians have a special opportunity to contribute bioethics.”
“Dykstra notes that the images offered in his book “function less as technical training guides or ‘how-to’ manuals for basic counseling or crisis intervention skills than…as works of art intent on inspiring ministry in more indirect and subtle ways.” Viewing pastoral images as evocative art, Dykstra notes three ways one may view art: (i) with adoration, as one (such as an Eastern Orthodox Christian) might view religious icons; (ii) with disdain, as one (such as a Protestant Christian) might view graven images/idols; and (iii) with appreciation and critical appraisal, as one (such as an art critic) might view works of art in museums. Dykstra endorses the third approach because it “seems to be the one that both honors the tradition and enables its adherents to adapt to new realities.””
“To put this another way, the key take away for health professionals regarding my psychoanalytic reading of A Monster Calls is for them to assume that patients and their family members often experience ambivalence about their choices. Perhaps this is especially so when the stakes are high, when the decisions are life and death. We all need to be patient with patients as well as with their family members, assuming not rational actors who can make autonomous choices but assuming instead ambivalent individuals who do not know what they want, because they want opposite things at the same time.”
“While I think the primary motivation for viewing patients as living human documents is to provide better care, I hope this call to curiosity also will stimulate the moral imaginations of caregivers, enabling them to reconnect to why their work is so deeply meaningful, if reconnection is needed. If caregivers find themselves losing empathy for patients and if they find themselves experiencing burnout due to a variety of reasons, ultimately becoming disconnected from why they pursued this life as a health professional in the first place, I wonder if viewing patients as living human documents, as having experiential depth, would make a difference? Would this enable encounters to become an opportunity to witness the complexity of what it means to be an individual? Would this yield some healing for healers, who also are living human documents in need of care? I hope so.”
“What does idolatry look like with regard to medicine and science? In biomedical contexts idolatry manifests itself when hopes become distorted such that they exacerbate suffering. Humor is one way, though not the only way, of mitigating harms deriving from this idolatry, and the image of the circus clown can be particularly instructive to health professionals and researchers, helping them to reign in their expectations, as it were, bringing the show of modern medicine back to earth…Also, to understand what we might call “medical idolatry,” some discussion of secularization is helpful. Secularization has many meanings…I simply want to point out similarities between religion and medicine to draw attention to the existential longings of which they both participate, similarities that have been noted by sociologists and theologians for decades.”
“When she first articulated the living human web, Miller-McLemore emphasized feminist theological insights, and, as such, the image fits nicely with feminist perspectives in bioethics. An important, recent essay in this regard is Karen Lebacqz’s “Philosophy, Theology, and the Claims of Justice.” Lebacqz is one of the founders of bioethics who contributed to the Belmont Report, and, in her essay, she makes several arguments that spell out what it means to think theologically about justice in bioethics. Based on her understanding of justice which is derived from the Bible and informed by liberation theology, she argues that a biblically based understanding of justice (i) “implodes” and “explodes” articulations of justice in mainstream bioethics, thereby expanding the scope of justice; (ii) makes central the categories of “oppression” and “liberation” in discussions of justice; and (iii) places the principle of justice “first”—that is to say, questions of justice should have priority over other principles such as respect for autonomy and beneficence. As has been noted earlier, in mainstream bioethics the principle of respect for autonomy often has priority in practice and is sometimes called “the first among equals,” despite the fact that Beauchamp and Childress argue that the four principles are independent and equal. In any case, Lebacqz makes justice primary. The upshot is that the primary difference between Lebacqz’s understanding of justice and articulations of justice in mainstream bioethics is that mainstream bioethics, by and large, focuses on abstract questions of distribution and allocation (e.g., Who should receive a kidney transplant?), whereas her understanding of justice focuses on systems of oppression and structures of power (e.g., In what ways does modern medicine exploit people who are poor and other minorities or oppressed groups?). This is what she means by “exploding” articulations of justice in bioethics. By “imploding” articulations of justice in bioethics, Lebacqz means recovering more traditional understandings of justice by focusing on character formation. These understandings of justice have all by fallen away in mainstream bioethics, although such concerns are making a comeback with various authors writing about professional identity formation.”
“It is my view that insights able to be derived from Principles of Biomedical Ethics have not been completely harvested and that pastoral theology has something to offer in this regard—this is why I wrote this book. Principles of Biomedical Ethics remains worthy of our critical attention.”
“People are attracted to bioethics because it is exciting and interesting, but principlist bioethics, while helpful, tends to take complexity and context out of classroom discussions. When this happens, Beauchamp and Childress would argue (rightly) that their approach is being misunderstood and misapplied. Nevertheless, my reimagining of principlist bioethics is an attempt to bring imagination back to bioethics, not by focusing on media headlines per se, but by looking for and at the richness of everyday experience. I want health care professions to listen to their lives. Outside of the classroom, I would like for there to be more venues for conversation.”
“The central claims of this book are that pastoral theology can contribute to bioethics and that bioethics can contribute to pastoral theology. Pastoral theology and bioethics, when cross-fertilized, can yield new crops. Specifically, pastoral theology can contribute to bioethics by offering new methods of inquiry and bioethics can contribute to pastoral theology by providing new areas of focus. They offer each other an expansion of territory…I want chaplains, theologians, and others to feel a greater ° of freedom as contributors to bioethics because of this book.”
“The theological perspective on principlist bioethics that I have offered in this book may be summed up as follows: 1. A pastoral perspective on respect for autonomy shifts the focus away from a respect of choice to an appreciation of individuals; 2. A pastoral perspective on nonmaleficence considers harm not only in light of physical and psychosocial considerations but also in lights of idolatry; 3. A pastoral perspective on beneficence places an emphasis on existential well-being as influenced by the caregiver; and 4. A pastoral perspective on justice requires attention to be given to the local manifestations of systemic sin by listening to the voices of oppressed individuals.”
Novel approach. I loved the structure Carlin gives, using Tillich’s correlative methods to connect some of Robert Dykstra’s Images of Pastoral Care to each of the famous four principles of biomedical ethics by Beauchamp and Childress. Highlights for me include exemplar ways of both identifying and answering to the critiques of each principle, and in particular the exposure to Dykstra’s collection. I find the deeper goal of “thickening” moral imagination rather than doing away with principlism powerful. While I found Carlin’s identification of the need for remedying psychological, experiential, contextual, and theological points back into principlism, I did find his approach and literary examples left-field albeit inviting; I personally found the first and last principles' correlations particularly effective. I also wish there was a final review of all the principles together, and a wholistic response of pastoral theology to that, after the detailed correlations he made. I appreciate also coming across responses to his work, including strong agreements that bioethics needs more attention to lived experiences, especially in its teaching and formation of caregivers (i.e. pedagogy of possibilities), and the critique in lack of actionable (prophetic?) items. I particularly love Carlin’s response that his novel approach is a beginning—to which I am sure others will carry forward.
1. Respect for Autonomy: decisions > persons as stable and rational without disorganization or effects of trauma/disruption. Boisen/Gerkin, Living Human Document to be interpreted. (plus Kleinman).
2. Nonmaleficence: assumption that harm can be avoided by control and ordered reasoning. Faber, Circus Clown: entering chaos with solidarity, with example of humor and humility.
3. Beneficence: technical, biomedically reductive, paternalistic interventions. Pruyser, Diagnostician: seeking interpretation, understanding, and meaning in addition to intervention.
4. Justice: abstract distribution of resources, underestimating relational/structural dynamics. Miller-McLemore, Living Human Web: relational, moral, moral responsibilities that analyzes systems, institutions, and communities.
---
“The most striking change over the past two decades or so has been the secularization of bioethics. The field has moved from one dominated by religious and medical traditions to one now increasingly shaped by philosophical and legal concepts. The consequence has been a mode of public discourse that emphasizes secular themes: universal rights, individual self-direction, procedural justice, and a systematic denial of either a common good or a transcendent individual good… In time, theologians left the field. Callahan offers two contributing factors: (i) theologians and religious studies scholars became more interested in discussions of race and class in the 1970s and (ii) as bioethics became established in the public sphere, “there was great pressure (even if more latent than manifest) to frame the issues, and to speak, in a common secular mode…religion was for the most part bypassed altogether.””
“Principlist bioethics has been criticized for privileging the principle of respect for autonomy. Meilaender joins this criticism: “We should not suppose that any individual’s dignity can be satisfactorily described by the language of autonomy alone—as if we were most fully human when we acted on our own, chose the course of our ‘life plan,’ or were capable and powerful enough to burden no one…not believe that Christian bioethics should affirm this assumption.
Other key components of Meilaender’s particular Christian moral vision include the following notions: human beings are both free and finite; human beings are both persons and bodies; suffering, while not good in itself, is not to be avoided at all costs; and health, while a good (health is something to be pursued), is not the supreme good (i.e., health is not something to be pursued at all costs).”
“They add that “it is a mistake in biomedical ethics to assign priority to any basic principle over other basic principles,” and that “the better strategy is to appreciate both the contributions and the limits of various principles, virtues, and rights, which is the strategy we adopt.” It is important to note, too, that others have suggested different or additional principles than those offered by Beauchamp and Childress, such as veracity. Beauchamp and Childress are right that their work has been unfairly criticized with regard to the principle of respect for autonomy. However, there have been a number of other critiques raised about their approach that do have considerable merit. One that is especially important for my argument in this book may be put as follows: principlist bioethics pays insufficient attention to experience and to context. While principlist bioethics does in fact tend to be detached and abstract, pastoral theology can supplement principlist bioethics by paying more attention to experience and to context.”
“Miller notes that bioethics tends to be more philosophical than ethnographic and that sociologists and anthropologists lament that “conventional bioethics fails to explore the social contours and experiential complexities of professional life.” Miller continues: “Excluded from the standard account of bioethics are medical professionals’ moral idioms, personal challenges, logistical obstacles, religious commitments, and interpersonal interactions with patients and families.” He adds: “Instead, medical ethics is often abstract, deductive, and/or highly rationalistic, detached from the anguishing empirical realities and power struggles in which medical professionals find themselves.” In support of this critique, Miller cites the work of Arthur Kleinman, who similarly argues that conventional bioethics “fails to capture the existential challenges of patient suffering.” Kleinman is disappointed that “lay perspectives” and “everyday life experiences” are not central in bioethics.”
“If a major critique of principlist bioethics is its tendency to pay insufficient attention to experience and context, to remedy this deficiency scholars writing from literary and anthropological perspectives have employed methodologies beyond philosophy to do bioethics in a way that pays more attention to “thickness.” But literary and anthropological perspectives do not tend to draw on psychological theories and therapeutic techniques, which is why some bioethicists have called for more psychology in bioethics. Additionally, in recent years there has been a rebirth of religious perspectives in bioethics. Thus, what is being called for now from different places in bioethics is more psychology and more religion. Because the academic field most closely identified with psychology and religion is pastoral theology, pastoral theologians have a special opportunity to contribute bioethics.”
“Dykstra notes that the images offered in his book “function less as technical training guides or ‘how-to’ manuals for basic counseling or crisis intervention skills than…as works of art intent on inspiring ministry in more indirect and subtle ways.” Viewing pastoral images as evocative art, Dykstra notes three ways one may view art: (i) with adoration, as one (such as an Eastern Orthodox Christian) might view religious icons; (ii) with disdain, as one (such as a Protestant Christian) might view graven images/idols; and (iii) with appreciation and critical appraisal, as one (such as an art critic) might view works of art in museums. Dykstra endorses the third approach because it “seems to be the one that both honors the tradition and enables its adherents to adapt to new realities.””
“To put this another way, the key take away for health professionals regarding my psychoanalytic reading of A Monster Calls is for them to assume that patients and their family members often experience ambivalence about their choices. Perhaps this is especially so when the stakes are high, when the decisions are life and death. We all need to be patient with patients as well as with their family members, assuming not rational actors who can make autonomous choices but assuming instead ambivalent individuals who do not know what they want, because they want opposite things at the same time.”
“While I think the primary motivation for viewing patients as living human documents is to provide better care, I hope this call to curiosity also will stimulate the moral imaginations of caregivers, enabling them to reconnect to why their work is so deeply meaningful, if reconnection is needed. If caregivers find themselves losing empathy for patients and if they find themselves experiencing burnout due to a variety of reasons, ultimately becoming disconnected from why they pursued this life as a health professional in the first place, I wonder if viewing patients as living human documents, as having experiential depth, would make a difference? Would this enable encounters to become an opportunity to witness the complexity of what it means to be an individual? Would this yield some healing for healers, who also are living human documents in need of care? I hope so.”
“What does idolatry look like with regard to medicine and science? In biomedical contexts idolatry manifests itself when hopes become distorted such that they exacerbate suffering. Humor is one way, though not the only way, of mitigating harms deriving from this idolatry, and the image of the circus clown can be particularly instructive to health professionals and researchers, helping them to reign in their expectations, as it were, bringing the show of modern medicine back to earth…Also, to understand what we might call “medical idolatry,” some discussion of secularization is helpful. Secularization has many meanings…I simply want to point out similarities between religion and medicine to draw attention to the existential longings of which they both participate, similarities that have been noted by sociologists and theologians for decades.”
“When she first articulated the living human web, Miller-McLemore emphasized feminist theological insights, and, as such, the image fits nicely with feminist perspectives in bioethics. An important, recent essay in this regard is Karen Lebacqz’s “Philosophy, Theology, and the Claims of Justice.” Lebacqz is one of the founders of bioethics who contributed to the Belmont Report, and, in her essay, she makes several arguments that spell out what it means to think theologically about justice in bioethics. Based on her understanding of justice which is derived from the Bible and informed by liberation theology, she argues that a biblically based understanding of justice (i) “implodes” and “explodes” articulations of justice in mainstream bioethics, thereby expanding the scope of justice; (ii) makes central the categories of “oppression” and “liberation” in discussions of justice; and (iii) places the principle of justice “first”—that is to say, questions of justice should have priority over other principles such as respect for autonomy and beneficence. As has been noted earlier, in mainstream bioethics the principle of respect for autonomy often has priority in practice and is sometimes called “the first among equals,” despite the fact that Beauchamp and Childress argue that the four principles are independent and equal. In any case, Lebacqz makes justice primary. The upshot is that the primary difference between Lebacqz’s understanding of justice and articulations of justice in mainstream bioethics is that mainstream bioethics, by and large, focuses on abstract questions of distribution and allocation (e.g., Who should receive a kidney transplant?), whereas her understanding of justice focuses on systems of oppression and structures of power (e.g., In what ways does modern medicine exploit people who are poor and other minorities or oppressed groups?). This is what she means by “exploding” articulations of justice in bioethics. By “imploding” articulations of justice in bioethics, Lebacqz means recovering more traditional understandings of justice by focusing on character formation. These understandings of justice have all by fallen away in mainstream bioethics, although such concerns are making a comeback with various authors writing about professional identity formation.”
“It is my view that insights able to be derived from Principles of Biomedical Ethics have not been completely harvested and that pastoral theology has something to offer in this regard—this is why I wrote this book. Principles of Biomedical Ethics remains worthy of our critical attention.”
“People are attracted to bioethics because it is exciting and interesting, but principlist bioethics, while helpful, tends to take complexity and context out of classroom discussions. When this happens, Beauchamp and Childress would argue (rightly) that their approach is being misunderstood and misapplied. Nevertheless, my reimagining of principlist bioethics is an attempt to bring imagination back to bioethics, not by focusing on media headlines per se, but by looking for and at the richness of everyday experience. I want health care professions to listen to their lives. Outside of the classroom, I would like for there to be more venues for conversation.”
“The central claims of this book are that pastoral theology can contribute to bioethics and that bioethics can contribute to pastoral theology. Pastoral theology and bioethics, when cross-fertilized, can yield new crops. Specifically, pastoral theology can contribute to bioethics by offering new methods of inquiry and bioethics can contribute to pastoral theology by providing new areas of focus. They offer each other an expansion of territory…I want chaplains, theologians, and others to feel a greater ° of freedom as contributors to bioethics because of this book.”
“The theological perspective on principlist bioethics that I have offered in this book may be summed up as follows: 1. A pastoral perspective on respect for autonomy shifts the focus away from a respect of choice to an appreciation of individuals; 2. A pastoral perspective on nonmaleficence considers harm not only in light of physical and psychosocial considerations but also in lights of idolatry; 3. A pastoral perspective on beneficence places an emphasis on existential well-being as influenced by the caregiver; and 4. A pastoral perspective on justice requires attention to be given to the local manifestations of systemic sin by listening to the voices of oppressed individuals.”
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