God, Humanity, and Human Dignity By Nathan H. White

God, Humanity, and Human Dignity By Nathan H. White

“Great are you, O Lord, and exceedingly worthy of praise; your power is immense, and your wisdom beyond reckoning. And so we humans, who are a due part of your creation, long to praise you—we who carry our mortality about with us, carry the evidence of our sin and with it the proof that you thwart the proud. Yet these humans, due part of your creation as they are, still do long to praise you. You stir us so that praising you may bring us joy, because you have made us and drawn us to yourself, and our heart is unquiet until it rests in you.” (St. Augustine, trans. 2001)

Essential Questions

What does it mean to be a human being?

Why does a human being have value?

What is meant by the concept of personhood?

What are the practical implications for the value of human beings within a health care context?

Introduction

Humankind’s restless heart is an invitation to be involved with the human endeavor and particularly with those who are sick and dying. In caring for other human beings while loving God, human hearts may feel flooded with the fulfilling praises of God. Those called as nurses can praise God through their hands, bodies, minds, hearts, and spirit, and will make decisions that may decide life and death. They may even help others find salvation. St. Augustine writes, “My heart is listening, Lord; open the ears of my heart and say to my soul, I am your salvation” (St. Augustine, trans 2001). This chapter will address why nurses carry this care to others based upon the Christian belief that every human being is made in the image of God.

One of the main hallmarks of the medical profession is its interpersonal nature. Medicine is, if nothing else, a very human profession. A nurse gives medicine, offers comfort to a dying patient, educates patients about their diseases, and walks with patients through their medical treatment. Interpersonal caring defines the experience of the profession. Throughout history, health care professionals have acknowledged and celebrated the compassionate nature of nursing as its motivation and foundation.

Although the vocation of nursing centers around caring for other human beings, medical professionals often do not stop to ask why they are doing what they are doing or what it is about another human being that warrants the kind of involved, and often difficult, care that nurses provide day in and day out. In seeking answers to these questions, the inherent value of human beings becomes apparent. Nurses frequently empathize with others and want to do the best for them, and this is to be applauded. Yet primarily, the Christian belief that human beings are created in the image of God, or imago Dei, undergirds the value and dignity of every human being simply because of his or her existence. This belief suggests certain practical implications in a range of contemporary health care issues, such as abortion, in vitro fertilization, the definition of death, and euthanasia. This chapter will begin to address many of these topics by looking at ways that science, philosophy, and theology have attempted to answer them.

What Does It Mean to Be a Person?

While the question “What does it mean to be a person?” may at first seem to be a straightforward question, scientists, philosophers, and theologians still debate the answer. Some perceive a person to be only a physical body with a brain dependent on the body. This is called physicalism. Others suggest that each person has a body and a soul. This is termed dualism. Some have more complicated understandings of the human person that identify the significance of characteristics, such as reason and the search for meaning, that separate human persons from other living organisms. Each of these descriptions of a person understands a human being in a different way. In the field of health care, how health care professionals approach what it means to be a person uniquely informs treatment options.

For example, if a physician perceives a human as having an eternal soul, practitioners will craft treatment that involves this spiritual reality. If a person is understood as having only a physical body, treatment will focus entirely on these options. Every nurse already approaches a patient with an idea of what a person is, and the goal of this chapter is to raise awareness of the reality of the personhood that lies within every patient.

At its most basic level, being a person means that an individual has inherent worth. The person possesses moral, ethical, and legal rights that a nonperson does not have. Generally, in the Christian tradition, personhood has been understood as a substantive nature that all human beings possess. A person may also possess certain traits, such as faith, reason, moral capacity, and consciousness, that enable deep mutual relationality with other persons, including God. In the Christian understanding, personhood is inherent to human beings and is not merely based upon recognition of certain capacities, such as reason, moral capacity, and consciousness.

Worldview and the Question of Personhood

Worldview significantly impacts the understanding of what it is to be human and to be an individual person. Some believe that God or a transcendent source gives human beings value. Alternatively, another may understand humankind as simply being at the top of the food chain, within the closed system of natural selection. Yet an individual who believes in the existence of God would find God’s nature to be of primary importance for understanding what it means to be human. On the other hand, an individual who subscribes to the worldview described as scientism would assume that science can completely answer the question of what it means to be human. In each of these cases, the question of personhood is not primarily a scientific one, but rather a philosophical one.

Additionally, an individual’s worldview about personhood directly influences decisions regarding the care and treatment of patients. Nurses and other health care professionals may think that beliefs and actions separate easily into different boxes without mutual interaction. In reality, beliefs and assumptions about the world significantly shape interactions with the world. This is easily seen in health care situations. If belief in God shapes understanding of personhood, a nurse may display his or her faith determining the care that is needed based on personal and professional perception as well as listening attentively to the patient. If a practitioner perceives a person as being only a physical body, personal interaction with patients and health care considerations may remain at the level of basic physical care.

For example, in the context of palliative care, what constitutes a human person may help decide when to withhold or withdraw treatment from a patient. If quality of life is assumed to be the only consideration for care, treatment could be withdrawn too early before other methods of comfort care are considered. Alternatively, the Christian worldview makes it clear that every human being is approached as being made in the image of God and worthy not only of quality care for physical ailments, but also of complete care for both body and soul.

The Metaphysical Question: What Kind of Thing Is a Human Person?

The Bible describes the need to reverently consider the mystery of the human person. Some 3,000 years ago, the writer of the Psalms, prayerfully reflecting on the finitude of humanity and the mystery of God’s relation to human beings, wrote, “what is man that you are mindful of him, and the son of man that you care for him?” (Psalm 8:4 English Standard Version). Yet the psalmist does not specifically relate what is so special about human beings or what about human nature separates them from other creatures.

In the postmodern health care situation, nurses will find many understandings of the human person suggested by other professionals and patients. For example, some philosophers, such as Hume, have hypothesized that human beings are only a collection of perceptions. Some, such as Searle, say humans are the creators of their own reality, while others, such as Wittgenstein, say that human beings might not exist at all. All these viewpoints may exist in the health care setting. Yet within the Christian religious tradition, human beings themselves are inherently deserving of dignity and respect.

Because, in creation, God made human beings in his image, personhood has a transcendent origin; therefore, human dignity should be recognized and valued in all human beings. Practically, the truth of human dignity calls forth respectful treatment from others. For instance, people who consider themselves as having dignity would not let others treat them in a demeaning or degrading manner, but rather would consider themselves as being worth more than such treatment would suggest. Thus, individuals would look at themselves as being inherently valuable and deserving of proper treatment.

Dignity logically relates to the concept of human rights. People rightly view abuses against human rights, such as genocide, as being among the worst kind of offenses. But the exact nature of these human rights is not clear. The U.S. Declaration of Independence suggests that human rights refer to the right to “Life, Liberty, and the pursuit of Happiness,” but others may consider human rights as being more or less than this. For instance, some consider the right to life as the most primary of human rights, while others recently have included access to high-speed Internet as a human right (Human Rights Council, 2016). The range of viewpoints is quite staggering. Unless practitioners can determine the source of these rights, whether from God or elsewhere, then there is little reason to ascribe rights to human beings any more than to any other entity.

A medical professional’s beliefs about what constitutes a human being significantly impact actions when caring for a sick or dying patient. The person of Christian faith sees the human being as a creation of God. In the Bible, the psalmist wrote as a prayer to God, “I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows it very well” (Psalm 139:14a). Clearly, in the psalmist’s view, human beings have a special relationship to their Creator who made them in such an extraordinary way. The relationship of human beings to God and to other creatures is, then, of utmost importance.

Scientific Classification: Human Persons in Relation to Other Species

The scientific classification system, based on the ancient Greek philosopher Aristotle’s thought, divides up entities into various categories based upon observed traits. The basic differentiation is between the nonliving or the living, with further differentiation into categories such as animal or plant, vertebrate or invertebrate. In regard to human beings, the species labelled Homo sapiens, such classification labels describe shared characteristics between human beings and other animals. This is helpful to describe what a human being is like, but this does not, in the end, provide an answer regarding what kind of thing a human being is. For instance, it cannot not explain why human beings have particular characteristics, such as reason, emotion, or spirituality.

In his The Origin of Species, Charles Darwin, the originator of the naturalistic theory of evolution, attempted to explain human existence without reference to a divine being. Naturalistic evolution has roots in this system of taxonomy and views the law of survival as the driving force behind the onward movement of life itself. Naturalistic evolution, though, fails to answer some questions fully, such as why human beings exist or how nonphysical phenomena, such as consciousness, arose from purely physical origins.

Darwin’s Thesis

Published in 1859, the full title of Darwin’s book is quite telling as to its thesis: On the Origin of Species by Means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life.

Human beings, in this understanding, are the most advanced form of life on earth, but are not the ultimate end to evolutionary progress. One implication of this viewpoint is that continued human enhancement is not only acceptable but is almost mandated in the onward march of progress. Another implication follows from this: Human beings are merely one stop in nature’s continuing development in the evolution of living things. Yet if human beings are not different kinds of things than a beetle, then there is little ethical reason that they should not both be treated in a similar manner. If it is ethically justified to kill a beetle, naturalistic evolution provides little justification for not treating other organisms, including human beings, likewise. In their assessment of justified ethical treatment for animals, some secular ethicists, such as Peter Singer (1975), argue animals should receive just as much consideration as humans.

Theistic Evolution

Some individuals ascribe to belief in theistic evolution, wherein God is understood to have created all that exists but chose to use the process of evolution to develop the world to what it is today. This approach resolves some fundamental difficulties with a naturalistic account of evolution, but it also may raise other difficulties.

In naturalistic evolution, the existence of phenomena such as the soul, ideas, conscience, and love are either created by physical factors, such as brain chemistry, that assist to aid survival or do not exist at all. For example, philosopher Richard Rorty (1982) wrote, “There is nothing deep down inside us except what we have put there ourselves, no criterion that we have not created in the course of creating a practice, no standard of rationality that is not an appeal to such a criterion, no rigorous argumentation that is not obedience to our own conventions” (p. xlii). Thinking, emotions, faith, and self-awareness, then, come merely as a means of aiding physical survival.

This is a form of reductionism called physicalism in which human persons are treated as nothing but physical material. This reductionism is an implication of scientism, and it has negative effects in health care because it reduces human beings to merely a system of physical phenomena rather than multifaceted beings who should be cared for holistically. In contrast to reductionism, dualism is a viewpoint that sees human beings as complex entities consisting of multiple levels; therefore, dualism offers a foundation for understanding human thinking, emotional awareness, and spiritual reality.

Dualism

The characteristics that differentiate human beings from other living species are nonphysical realities, such as mind, soul, or spirit. Dualism views the human person as being made of both the physical body and nonphysical realities, such as the soul. The soul is intricately connected with the body but is not identical to the body and continues after the physical death of the body. In the history of Christian thought, some thinkers also regard the human person as being comprised of body, soul, and spirit. Theologians and philosophers debate exactly what constitutes the nonphysical reality of human beings, with much debate even about the existence of the human mind. The contents of belief regarding nonphysical phenomena may differ, but that such a reality exists is affirmed by many.

In recent years, empirical research has supported the reality of human transcendent phenomena. Modern research has shown the efficacy of nonphysical, even spiritual, elements in creating beneficial medical outcomes (Koenig, King, & Carson, 2012). Many medical studies have demonstrated that spiritual and religious activities, such as prayer, religious service attendance, and meditation, have positive health outcomes. Alternatively, spiritual maladies, such as unforgiveness and anger, have corresponding negative physical health outcomes. Additionally, other nonphysical phenomena that are not specifically related to spirituality, such as expectation, reappraisal, and worldview, have been shown to have significant effects upon physical outcomes, including the experience of pain (Tracey, 2010; Wiech, Farias, Kahane, Shackel, Tiede, & Tracey, 2008).

Many Christians and other religions believe that a spiritual reality exists beyond the physical; this spiritual reality interfaces with the physical realm, but it is also separate from it. In this understanding, the human being is more than a body, and some part of the human being can survive physical death. As an example, in this view, the human mind is separate from the human brain, though the mind interfaces with and is in some way dependent on the brain; therefore, damage to the human brain can influence expression of the human mind, but it does not eradicate or permanently damage the mind, the soul, or the human being.

The Question of Value?

Many medical professionals perceive human beings as being inherently valuable and see belief in God as being foundational to their work. They want to ensure the care of other human beings because each person would want to receive such care. This attitude has been summed up in the Golden Rule: “The second is this: ‘You shall love your neighbor as yourself.’ There is no other commandment greater than these” (Mark 12:31).

Human beings seem to implicitly recognize some aspects of right and wrong, including the inherent value and worth of human beings. For instance, C. S. Lewis in The Abolition of Man (Lewis, 1944/2001) identifies the reality of consistent moral standards across diverse cultures around the world. Murder, rape, and kidnapping are almost universally regarded as wrong.

Mauthausen survivors cheer the soldiers of the 11th Armored Division of the U.S. Army one day after their actual liberation. The banner reads: “The Spanish Anti-Fascists Salute the Liberating Forces.” Photo courtesy of National Archives and Records Administration, College Park.

Value and ethical judgments such as these seem to indicate that human beings have a different status from other creatures. This suggests that human beings should not be treated in degrading ways. A significant 20th-century example lies in the war crimes the Nazis perpetrated against millions of Jews, Gypsies, and others they deemed undesirable. In the Nuremberg Doctor’s Trial following World War II, Nazi doctors were charged with crimes against humanity for the genocide and medical experiments they conducted on innocent victims. Significantly, the Nuremberg Code that came out of this tribunal set the basic standards for ethical treatment of human beings in medical and research practice. Standard medical concepts, such as informed consent, have their origin in this document. Additionally, in the aftermath of World War II, the United Nations (1948) made a landmark declaration in the history of humanity regarding “recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family” (para. 1).

Holocaust

Viktor Frankl (1973), a Jewish psychiatrist who survived the Holocaust, later wrote:

The gas chambers of Auschwitz were the ultimate consequence of the theory that man is nothing but the product of heredity and environment—or, as the Nazis liked to say, “of blood and soil.” I am absolutely convinced that the gas chambers of Auschwitz, Treblinka, and Maidanek were ultimately prepared not in some ministry or other in Berlin, but rather at the desks and in lecture halls of nihilistic scientists and philosophers. (p. xii)

If human beings are worthy of any dignity and respect, then reasons for arriving at this conclusion must exist. In general, there are two ways of reasoning why human beings have value: a functional view of value and an essentialist view of value.

Functional View of Value

According to the functional view of human value, a person’s abilities determine the value of that person. For example, a person who has highly developed rational thinking abilities may be seen as valuable and important to society. Or a nurse’s ability to educate patients about diabetes or to comfort dying patients will be understood rightly as making a beneficial contribution.

The problem with functionalism lies in the very logic it uses. By making human worth contingent upon function, it becomes arbitrary. A person with deficits in rational thinking abilities may be thought of as less valuable than the person with these abilities; a person without emotional and social awareness may be perceived as less than other people. Philosophers call this understanding of a person an extrinsic or instrumental perspective because it relies on external criteria for determining a person’s worth. For instance, society could decide the value of a person depending on his or her actions, abilities, and contributions, though the assessment of these valuations may change. Alternatively, an intrinsic view of value views human beings as inherently having worth regardless of abilities.

In Nazi Germany, for instance, a functional view of the value of persons led to the extermination of the disabled and handicapped. Yet even insulting and degrading those with whom one disagrees can also be a subtle form of dehumanization. Others may be seen as impersonal adversaries rather than human beings with feelings, families, and inherent worth. Even considering a patient as a number or a symptom rather than holistically as a human being is itself a type of dehumanization.

Sadly, this extrinsic perspective can be applied to patients without their awareness of this judgment. For example, if a patient goes through an unsuccessful medical procedure that leads to extensive brain damage, his or her family must decide about whether to continue treatment or let their loved one die without intervention. According to the functional understanding, because the patient’s brain functioning is now diminished, it would follow that the patient’s value is also diminished.

In another example, when a fetus appears to have few functional abilities, the value of this fetus may be diminished in the view of the family. This process of perceiving people at any stage of life as valuable based on their level of functionality can lead to dehumanization, in which others see the nonfunctioning person as a thing to be manipulated and even destroyed.

Essentialist View of Value

An essentialist view of human value regards humans as themselves being intrinsically worthy of value. In contrast to an extrinsic view, an intrinsic viewpoint regards human beings as having inherent value apart from any external benefits or valuations.

The essentialist viewpoint is compatible with Christian belief and undergirds most approaches to Christian ethics. This is why many Christians believe that abortion, euthanasia, and genocide are morally wrong because they all are instances of killing a human being who has inherent value simply by virtue of being human. The kind of care consistent with the essentialist view of persons is seen in medical professionals providing hospice care for the dying. In this view, patients’ dignity and worth are recognized throughout as they near the end of their earthly lives.

Another example of the practical implications of an essentialist view of human value is the care given to individuals with mental handicaps. Christians believe that people with severe mental deficits still deserve moral and ethical treatment as fellow human beings. Yet in a functionalist view of human value, the affording of equal value to disabled persons makes little sense because these individuals do not have the same level of functioning as other human beings. The essentialist view of human value, by regarding human beings as of worth beyond simply the functions that they are able to perform, has significant practical implications in medical practice.

Respect for Persons

This brief survey of thought about human beings has argued that persons have special worth that is bestowed by God. This value is part of the substance of what it means to be a human being. This is how, in essence, a person is very different from a thing. A thing can be used and manipulated; however, personhood suggests that people ought to relate mutually with one another in an ethical, moral, and respectful manner. To be a person, then, in part, is to have the ability to be in relationship with God and others. Human beings have the grace-filled gift of relating to God and to others, which is a part of personhood.

Those who are deemed to be a person are afforded certain rights and privileges in accordance with this status. Significantly, many of the standards of care within modern nursing came about because of human rights abuses in the past. For example, the actions of Nazi doctors in unethical research led to the drafting of the Nuremberg Code in which current ideas about autonomy and informed consent were formed. Later the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978) wrote the Belmont Report that adopted principles of respect for persons, beneficence, and justice. This report was, in part, a response to another human rights violation in the Tuskegee syphilis study, during which the test subjects were not informed of the negative impact participation in the study would have upon their health. In each case, external oversight boards felt it necessary to define and delimit the proper treatment of human subjects within the realm of medicine.

The effects of these guidelines are still evident today when institutional review boards apply these criteria for the proper treatment of human beings as subjects of research and medical care. In each case, respect for persons is at the heart of these considerations. This means, at a minimum, that practitioners must respect the autonomy of patients, provide them with informed consent, be truthful, and afford them courtesy and respect.

Practitioners should see these actions as being fundamental to medical care, not just because these documents say so, but because it is an inherent duty given the nature of human beings as persons. In other words, these documents identify what is already objectively true of human persons—that they have inherent worth and ought to be treated in an ethical manner. If persons ought to be respected, then practitioners must have a way to determine who qualifies as the proper recipient of such respect. Ethicists have utilized the term moral status to identify those to whom respect and ethical treatment is due. The next section, then, will deal with various ways that practitioners may make determinations regarding moral status.

Moral Status

Within the medical community, moral status commonly refers to a judgment given about an individual’s value and rights to be treated according to moral and ethical standards. For some ethicists, moral status may apply to human beings as well as to animals and objects in the natural world. If practitioners deem an individual to have moral status, then there is a moral imperative to treat that person in accordance with ethical standards. But the most important consideration is how to determine whether an individual has moral status. This has very practical implications in health care settings. For instance, when a nurse gives quality and attentive care to a patient, the nurse is implicitly bestowing moral status upon that patient by recognizing something in her deserving of such treatment.

The distinction between functional and essentialist views of human value is a helpful starting point for determining moral status, but further clarity is needed. Particular theories of moral status more specifically identify the reasoning behind why a practitioner believes an individual has moral status. Each of these theories is a different way of reasoning that an individual possesses moral status and, therefore, deserves moral and ethical treatment. There are five primary theories of moral status: the theory based on human properties, the theory based on cognitive properties, the theory based on moral agency, the theory based on sentience, and the theory based on relationships.

In the field of nursing, the care that patients receive may change with the moral status theory subscribed to by the health care professional. For instance, a nurse may consider whether a brain-damaged patient has the same moral status as a patient who is not brain damaged. In this case, the medical care that a severely brain-damaged patient receives could be dependent on how and why the health care professionals caring for him or her determine whether he or she has moral status.

The Theory Based on Human Properties

The moral status theory based on human properties has many similarities to an essentialist view of human value. Both consider human beings as having value because of fundamental realities that pertain only to human beings. Using the theory based on human properties, a practitioner would deem an individual as having moral status simply if that individual is human. In this way of reasoning, a practitioner would consider unborn children, the elderly, and all human beings as having moral status because each is human; therefore, a practitioner who uses this theory would oppose abortion, euthanasia, and destructive medical testing, for instance.

The Theory Based on Cognitive Properties

Alternatively, the theory based on cognitive properties views an individual as possessing moral status if he or she has certain basic cognitive functions that are foundational to high-level functioning. An individual may regard the ability to reason and to communicate as basic cognitive functions that are necessary prerequisites for moral status. Thus, a person using this theory of moral status may suggest that a tree does not have moral status because it does not have any cognitive properties, but neither would a fetus or a brain-dead human being because cognitive functionality is severely impaired or nonexistent.

The Theory Based on Moral Agency

An individual who subscribes to a moral status theory based on moral agency would suggest that an individual has moral status only if she is a moral agent. That is to say, the individual must have the ability to make morally significant decisions and be held accountable to a moral standard. If the individual does not have the capacity to discern relevant moral information, his or her moral agency is impaired. In one sense, courtroom discussions regarding an insanity defense are truly about whether a person who committed a crime can be held responsible as a moral agent.

The Theory Based on Sentience

Further, other individuals ascribe moral status to an individual based upon whether that individual is regarded as possessing sentience. A sentient being may also be described as a being who possesses consciousness in terms of the ability to feel pain and pleasure and to react appropriately to these stimuli. From this perspective, the experience of pain is considered evil, while the experience of pleasure is considered good (Beauchamp & Childress, 2013). Thus, in this viewpoint, a practitioner may consider a viable fetus, as well as many animals, as having moral status because of the ability to feel pain.

The Theory Based on Relationships

Finally, some would consider an individual as having moral status based primarily on relationships. This viewpoint suggests that relationality is the fundamental consideration regarding any individual. This may be understood either in terms of being the object of relationship or as being the subject of relationship. If an individual is the object of relationship, this means that other persons relate to this individual as a fellow bearer of moral status. Alternatively, if an individual is observed as the subject of relationship, then some would suggest that this individual is deserving of moral status.

Each of the theories above have the following logical structure: X has full moral status if and only if it exhibits Y. X is the human being in question (i.e., embryo, fetus, 12-month baby), and Y is the property that confers moral status upon that entity (i.e., human properties, cognitive properties, moral agency, sentience, or a relationship in which someone else values X). Different worldviews would apply these theories differently depending on how they think about the nature of human persons. It may be that thinking about the value of human beings according to such theories is not compatible with a particular worldview.

Notice carefully that every theory of moral status presented, with perhaps the exception of the theory based upon human properties, is a functional means of assessing the value of human persons. Because of this, they stand in contrast to the Christian view of human beings— an essentialist view of human value—that regards each human person as having inherent value because humans were made in the image of God. This judgment is based upon the inherent worth of a human being rather than on any property that a human being is observed to have.

The Bible on the Nature of Humanity: Divine Image Bearers

For Christians, the foundation of personhood comes from the view that persons are created in the image of God. This doctrine of the imago Dei means that God created human beings to have a likeness to his character, not a likeness to his literal physical appearance. This belief provides the basis for human dignity and worth.

The Image of God

In the account of the creation of the world found in the biblical book of Genesis, the culmination of the world’s creation is the creation of human beings:

Then God said, “Let us make man [humankind] in our image, after our likeness. And let them have dominion over the fish of the sea and over the birds of the heavens and over the livestock and over all the earth and over every creeping thing that creeps on the earth. So God created man [humankind] in his own image, in the image of God he created him; male and female he created them. (Genesis 1:26–27)

“The Creation of Adam” by Michelangelo, located on the ceiling of the Sistine Chapel in Vatican City.

The Genesis creation account views human beings as God’s crowning achievement in all of creation and as those possessing a special relationship to God. Fundamental to both Jewish and Christian belief, human beings are described as being made in God’s image. Theologians and philosophers throughout the ages have proposed various ideas for what the image of God in humankind is, ranging from the capacity to reason and think to the ability to act as moral agents, being in possession of a spiritual nature, and more. One thing is clear: the image of God does not refer primarily to the physical characteristics of human beings resembling the physical characteristics of God. Theologians have always upheld the view that God is a spiritual being and cannot be described in terms of physical characteristics.

Secondly, the image of God has some relation to the task that God gave to humankind: to care for the rest of creation. Because all people are made in the image of God, human beings have been given the authority and ability to do good. Notice how, as God’s final creation, it is designated for persons to care for and seek the flourishing of the rest of creation. There is something innate within human nature, then, that includes a capacity to do good and to help others. Because all persons are made in the imago Dei, they have personal autonomy and moral agency.

This text from Genesis also provides a relational mandate. God created the world and then gave humankind the opportunity to partner with God in maintaining and caring for creation; therefore, the imago Dei also enables a relationship with God who relates to human beings as fellow persons and, in this capacity, partners with them in a common task of seeking the flourishing of the world. Thus, being made in the image of God also means that personhood is derived from God, who first identified human beings as persons capable of relationship, primarily with God, and secondarily, with one another. In a very real sense, then, human beings are relational persons because they are made in God’s image, who is also an inherently relational being. Relationality is reflective of divine image in human beings and, in a large sense, to be human is to be a social creature.

The imago Dei also displays that the foundation of human worth is the grace of God. In this view, human beings are creatures created by God, not existing of their own accord or because of random acts of chance. God created human beings because of God’s grace. Existence, then, is a gift, and even the continuing of human life is because of God’s sustaining grace. Human hearts continue to beat, and lungs continue to breathe, even during sleep, because of God’s gracious creation and continued power to sustain human beings in existence. Each human person has a significant part in cooperatively using the gift of life but possessing this gift in the first place is not the result of human effort.

As human beings created in the image of God, human persons are to be treated with respect and dignity. Sin has marred, but not destroyed the image of God in humanity. Because each patient a nurse encounters is created in the image of God, all patients are to be treated with respect and dignity. Patients are more than their diseases or ailments; the patients that nurses care for each day have inherent dignity because they were created in the image of God. Within the context of medical practice, nurses should see the imago Dei as being of vital importance because of the intrinsic value and equal worth that are a result of this view of human beings. For nurses, discussion about patients should involve words and ideas that maintain the dignity of the patient. Even in private discussions and meetings among the health care team, all language should reflect this same respect and dignity.

Body and Soul

A clear implication of the imago Dei is that human beings are more than simply physical bodies. Because “God is spirit” (John 4:24), being made in the image of God implies that human beings also possess a nonphysical reality, sometimes described as a spirit or soul. The Christian understanding of human beings is not an either/or situation, but rather that human beings are both physical and spiritual.

Against this understanding, various movements throughout history have tended to err toward one extreme or the other. Those who emphasize that human beings are only physical beings, a viewpoint often termed physicalism, deny any nonphysical or spiritual reality in human persons. Alternatively, others have denied the physical reality of human beings. These individuals, often called gnostics, dismiss the physical world as being inherently and completely evil.

A dualist view of human persons, however, enables an understanding of the continuity of personal identity. Here, personal identity does not refer to one’s deepest desires (i.e., to be a mother) or career (i.e., to be a doctor), but rather, it philosophically refers to what makes an individual the exact person he or she is and not someone or something else. Consider that various things about a person can change, such as location, job, health, and desires; however, even through such changes, people retain their personal identity such that they continue to exist as themselves because those attributes about them that changed were not essential to them.

Even some very important attributes about a person might not be essential. Imagine patients who suffer the loss of limbs because of amputation. Such a loss would be tragic and painful; nevertheless, these patients do not cease to exist as themselves after this loss, rather, they are still themselves. From a reductionist naturalist viewpoint, the continuity of personal identity can be difficult to maintain because personal identity is equated, in some sense, with bodily continuity.

If this is true, then any change to one’s body could mean that one ceases to exist, which seems incredibly strange. But if human beings are more than a body, just as the body grows and changes, so the immaterial aspects of the human person grow and change throughout one’s lifetime. Nevertheless, throughout all this change, a human being is the same person. Though a person may gain new experiences and knowledge, or even gain or lose important body parts through transplantation or amputation, that person’s essence remains the same. In the Christian view of the human being, even after death and the loss of one’s physical body, one’s identity remains because of the continuance of the soul.

Because human beings have bodies and souls, care of humans must be holistic. In fact, human well-being has both physical and spiritual facets; therefore, care for the entire well-being of human beings will involve physical and spiritual components. The fact of the imago Dei means that, in the Christian vision of humanity, each human being has intrinsic worth and is to be valued because each one is human without consideration for level of functionality or benefit provided to others.

Intrinsic Value

The starting point of Christian understanding of human beings is God and what God says about humanity, not what human beings perceive in themselves or other members of the human race. According to the Christian worldview, human perception of the world is tainted and imperfect because of the effects of sin and a limited finite viewpoint: Human beliefs regarding the value of a particular individual are not the last word. For Christians, God as the Creator has the last word regarding the worth of each human being, and God has already spoken regarding each one, making clear that each has intrinsic worth because each is created by God and bears God’s image. As caretakers of the world, they all share in God’s creative vision of the world. Thus, human beings are to honor and respect all aspects of creation.

Equal Worth

Because all human beings are made in the image of God, all human beings have equal worth, regardless of physical or mental ability, status of development, race, sex, educational level, or any other differentiation. In the Christian vision of the world, the image of God is the basis for equal worth of human beings as well as for human rights. Though common in Western society today, the idea of inherent human rights that assumes equal worth and inherent dignity has not been the norm throughout history. One only has to look at the way many Romans treated women and slaves in the first century or any number of caste systems throughout history to realize that human beings are more prone to exclude and divide rather than unite.

This was a significant part of the appeal and growth of the Christian faith in the early centuries. If all human beings have inherent worth and are of equal value, then they should all be treated the same—with dignity and respect. This is why, in contrast to the norms of Roman society, early Christians took in and adopted babies who were left to die exposed on the rocks. It is why women and slaves were given equal status within the early church. It is why early Christians were at the forefront of medical care as those who created hospitals and pioneered medical care for those without money or means of payment. In this, they were imitating Jesus’s parable of the Good Samaritan (Luke 15). If the equal worth of human beings extends to all members of the human race, how much more should equal worth be given to all who have been unified by faith in Christ? The Apostle Paul put it this way: “There is neither Jew nor Greek, there is neither slave nor free, there is no male and female, for you are all one in Christ Jesus” (Galatians 3:28).

Moral Status According to The Bible

According to a Christian view of human beings, moral status is afforded to all human beings, regardless of any other criteria. This dignity is reminiscent of the psalmist’s declaration, “I praise you, for I am fearfully and wonderfully made” (Psalm 139:14a). The Christian viewpoint is most in accordance with the moral status theory based on human properties, which likewise recognizes inherent worth in every member of the human race. Similarly, in a Christian understanding, moral status is a gracious gift extended to every member of the human family because of his or her existence as a unique creation of God.

Jesus Christ and Human Worth

For Christians, an additional consideration beyond the imago Dei leads them to consider human beings as being worthy of value: the incarnation of Jesus Christ. Christians believe that God became human in Jesus Christ, who is both fully divine and fully human. Theologians have termed this mystery the hypostatic union. By becoming human and dying for the sins of fallen humanity, Jesus demonstrated that humankind is of supreme value—valuable enough for God to become human and die for their sake.

Because of the fall of humanity, the image of God within humankind had been marred and damaged. Jesus Christ came to save and heal humanity from their sin and restore what had been broken. Jesus is the “new Adam” (Romans 5:17–18) who was faithful, whereas the first Adam—from the biblical account in the book of Genesis—had failed. Now, as Paul says, a Christian is God’s adopted child as he or she “becomes one spirit with him” (1 Corinthians 6:17), transformed into his image. According to Paul, “For all who are led by the Spirit of God are sons [this infers daughters as well] of God” (Romans 8:14). The Spirit himself bears witness with Christians’ spirits that they are children of God (Romans 8:16). For Christians, Jesus Christ is the ultimate and essential definition of personhood, or as theologian Dietrich Bonhoeffer (2005) put it, “To be conformed to the one who has become human, that is what being human really means” (p. 94).

This also has implications for nursing care. Many nurses enter this profession knowing that their labors influence not only the patient they are caring for, but in serving, they also minister to the Son of Man, Jesus Christ. Jesus taught that, in a mysterious way, by caring for those who are most in need, his followers are caring for Jesus:

Then the King will say to those on his right, “Come, you who are blessed by my Father, inherit the kingdom prepared for you from the foundation of the world. For I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me, I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me.” Then the righteous will answer him, saying, “Lord, when did we see you hungry and feed you, or thirsty and give you drink? And when did we see you a stranger and welcome you, or naked and clothe you? And when did we see you sick or in prison and visit you?”  And the King will answer them, “Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.” (Matthew 25:34–40)

Many nurses are enacting this Scripture in the most literal and caring way, “I was sick and you visited me” (Matthew 25:34). When they minister to the least of these, they minister to Jesus Christ.

Christian Reflections

The Christian vision of humanity has very significant implications for how human beings are to be treated, including within the realm of medicine. These implications are wide ranging, extending from how health professionals ought to approach the task of medicine itself, including approaches to patient care that see the patient as a person possessing inherent worth and value rather than simply a number or a body, to suggesting ways to view important, current-day medical issues.

Disability

Contemporary society seems to prize individuals based upon their abilities. Those who are stronger, faster, smarter, or better at accomplishing certain tasks, such as shooting a ball through a hoop or singing, are assumed to have more worth than others. In recent years, some opposition to these assessments has begun, with many prizing the underdog, the powerless, and those with less ability. This has at times included championing those with physical, psychological, and emotional disabilities; however, a potential problem arises in both of these approaches because they both use the same logic for determining the worth of a human being: Both rely on extrinsic means of valuation.

The point is that, for both approaches, the value of persons remains dependent upon ability, whether desirable or not. Any view that assigns human values based on functional ability rejects a genuine equality of worth among persons; there will always be someone faster, stronger, smarter, or richer. For example, take the implicit reasoning behind fetal testing for birth defects, as well as the movement toward so-called designer babies. This testing is not necessarily in itself a problem, but the implicit values behind it can be. If the reasoning for doing this testing is that a child with what some may perceive as defects is neither worthy of celebration nor perhaps even life, then from a Christian worldview this is not to be accepted (Rae, 2018, p. 205).

In opposition to the tendency to judge the worth of human beings by their level of ability, whether considered positively or negatively, Christianity affirms the value and dignity of all human beings, regardless of perceived ability or defect. This is why Christians ought to be at the forefront of celebrating and caring for all people, and especially for those who are disabled. Indeed, this has been the case throughout history.

Care for the Disabled

In the modern era, care for significantly disabled individuals has moved out of the context of the family to institutional care, and a number of individuals began to see the need for specialized care that embraced those with disabilities as valuable members of the human race. One such individual was Henri Nouwen, who left a position teaching theology at Harvard Divinity School to live in a community where he cared for significantly disabled persons (O’Laughlin, 2005).

Another example is Jean Vanier, who founded the community of L’Arche to embrace and honor the dignity of those with disabilities (Vanier, 1995). Each saw something inherently valuable in persons with disabilities—a value that was not being recognized in modern Western culture, but from which they learned much about what it means to be human. These considerations are especially important because a growing concern for many is caring for individuals with neurodegenerative diseases such as dementia.

John Swinton is a psychiatric nurse and theologian who has reflected extensively on the need to see the image of God in these individuals who suffer from such terrible diseases. He contends that we can learn much about what it means to be human and about how to relate to God as human beings from individuals with disabilities (Swinton, 2012; Swinton, 2016).

Abortion

The Christian Scriptures provide a consistent account of the worth of human beings from conception onward (Rae, 2018). From the very beginning of Christianity, Christians have opposed infanticide and the killing of unwanted children. In Roman society, it was common to expose unwanted children to the elements, leaving them in the open countryside to die. Many of these children were female and undesired because of their gender. Early Christians would often search for these children, adopt, and raise them as their own (Rae, 2018). The beliefs of the Christians regarding the sanctity of human life led to practical and costly actions.

Similarly, in the modern era, Christians have often been those individuals most opposed to abortion, which they view as the killing of unborn children. This is based upon the core Christian belief that all human beings have innate worth because each is made in the image of God. Thus, all human beings, no matter the stage of development—be they young or old—are to be treated with respect and their lives valued rather than discarded.

Abortion is a divisive and complex issue. There are many issues at stake, including the autonomy of the mother and the father—whose rights are often not considered—medical outcomes pertaining to the mother’s health, and more. When framing the discussion regarding abortion in view of the fetus being a human being with inherent worth and rights, additional considerations come to light that are often not addressed in similar discussions.

First, by nearly any standard of judgment a practitioner decides to use, the fetus should be recognized as a unique human entity, not merely as a part of the mother’s body. A standard means of determining what is or is not a part of someone’s body is the possession of the same DNA and being derivative of the same source. In both cases, the fetus is clearly a separate entity, possessing different DNA and deriving from an altogether different source than the rest of the woman’s body.

The Christian worldview consistently emphasizes respect for the powerless and mistreated. This is true in the case of the disabled, for the unborn, minorities—whether racial, ethnic, gender, or religious—who have been unjustly treated, as well as for the poor. Certainly, Christians, being imperfect people, have not always lived up to this standard, but the consistent witness of Christians throughout history has been one of loving the least of these and caring for those that others would exploit.

Mother Teresa

Mother Teresa. Photo by Manfredo Ferrari.

The woman known as Mother Teresa is an example of how powerful an idea the imago Dei is when its implications are lived fully. Born in 1910 in modern day Macedonia, Mother Theresa devoted her life to service to God as a nun. She saw the incredible needs of those around her in the Indian city of Calcutta, especially those living in abject poverty. Recognizing the image of God in those destitute and dying, she began to care for them, providing medical and palliative care to those on the streets of Calcutta. She viewed herself as serving Jesus himself in each patient. After dying in 1997, she was canonized by the Roman Catholic Church, and her legacy lives on in the order of nuns she founded who continue to do the work of caring for the least of these.

Embryos

The creation of human embryos outside of the confines of the human reproductive system is controversial. This technological development has been possible only in recent years, and researchers have only begun to consider the ethical implications of this advance. Questions regarding whether an embryo is a human person have now taken on added significance given technological advances; however, this is primarily a philosophical question rather than a scientific one (Rae, 2018).

Given the increasing use of assisted reproductive technologies that create embryos outside of the womb, many are asking whether these embryos are to be considered human persons. Some would suggest that embryos may gain moral status at some point within gestation in the womb, such as at implantation. But there is no clear point at which to make this determination.

Others would point to fetal viability as the point at which a fetus gains moral status, but advances in neonatal technology mean that fetal viability is moving earlier and earlier in gestation. In fact, it would seem that, starting from conception, embryonic life needs only shelter and sustenance to continue to grow and develop (Rae, 2018). This alone is a strong argument, from an essentialist view of human value, for embryos to be considered human persons.

One major area in which the use of human embryos is involved is in relation to stem cells. The use of stem cells to treat various diseases, and even to grow human tissue, is one of the fastest expanding and most promising areas of medical research. Yet it is also an area that is fraught with potential ethical problems. Adult stem cells may be derived from mature cells via bone marrow, but embryonic stem cells are derived from human embryos and most often destroy the embryo in the process, creating the potential problem of assessing whether human life had to be destroyed in order to provide for or sustain another’s viability.

For some who do not recognize the human nature of embryos created uniquely in the imago Dei, such ethical considerations are not challenging. But for those who acknowledge embryos as having innate worth, this approach to medical research can be problematic. Now that stem cells may be derived from sources other than human embryos, the ethical problems as well as possibilities of stem cell research are greatly changing (Regalado, 2019). The use of human embryonic stem cells to assist in reproductive technologies is a growing dilemma within the field of health care and will only become more difficult as various worldviews clash in making these decisions.

Assisted Reproductive Technologies

An issue closely connected with the use of human embryos is the question of technological assistance for those unable to conceive naturally. Infertility has always been a significant challenge for many wishing to produce their own child. At times, such as in antiquity, infertility was the central issue for those who could not bear children and produce a secure heir. Consider, for instance, the biblical stories of Abraham, an important leader who had no heir, and Hannah, a woman who was barren; both were individuals of great faith who were unable to have children, and they wrestled with God regarding this issue for many years.

For those who struggle with infertility, these issues are as important as they were for these biblical ancestors. This means that the advent of assisted reproductive technologies is both increasingly welcome and needed; however, the ethics of the use of these technologies is debated today. Some faith groups do not allow the use of assisted reproductive technologies at all, others may find only some procedures acceptable, and still others may not be opposed to any.

At the heart of many of these concerns is a consideration of the difference between procreation and reproduction (Rae, 2018). Traditionally, procreation was seen as a human task that was ultimately directed by God. Reproduction, on the other hand, is increasingly seen as a specifically human task, achieving humanly desired results. These distinct viewpoints on the nature of human reproduction is at the basis of differing attitudes toward assisted reproductive technologies.

Some assisted reproductive technologies concern aiding the physical functionalities of sexual reproduction. This is the case with treatments that alter the biological workings of the human reproductive system as well as with procedures such as intrauterine insemination, in which human reproductive organs are aided in their functionalities to ensure greater likelihood of fertilization.

Other assisted reproductive technologies take a more invasive approach to addressing more significant reproductive issues by directing and overseeing the reproductive process itself. This is the case with in vitro fertilization (IVF) in which eggs are stimulated and harvested, fertilized in a laboratory setting, and transplanted into a maternal uterus. This infertility treatment, and others such as zygote intrafallopian transfer (ZIFT), gamete intrafallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI), involve significant medical intervention to aid human reproduction.

With the exception of GIFT, these procedures include the fertilization of an egg and creation of an embryo outside of the human reproductive system. One potentially problematic issue concerns what is done with the other embryos created as a part of this process but, ultimately, were not implanted. Some of these embryos are destroyed, others are kept in seemingly permanent storage, while others are donated to science for use in research in which they will effectively be destroyed.

Indeed, the use of stem cells in assisted reproductive technologies has been in process for some time, but has only become viable quite recently (Foht, 2019). Some researchers see the creation of embryonic stem cells as merely a step on the trajectory toward producing designer babies (Regalado, 2019; Rae, 2018). If so, a future that includes this prospect may not be as far away as some might think. This technology could give rise to the possibility of eugenics—the coordinated effort to purify the genetic makeup of a population, such as the Nazis undertook—in levels of specificity scarcely dreamed of before. With these technological developments, practitioners and ethicists must judge these advances and their consequences.

Case Study: Maternal and Fetal Viability

A young married couple, Tina and Jeff, recently moved into their first house. Starting his career in the financial services industry, Jeff has been doing well in this job. Tina enjoys her job at a Christian school as an elementary school teacher. In her 20th week of pregnancy, Tina now prepares for a leave of absence.

On Tina’s drive home from school one day, she pulls out of the school parking lot when another driver, distracted by his phone, collides with her car. Despite nearly being in a head-on collision, both Tina and the fetus are alive. Tina has sustained severe head trauma and is unconscious when paramedics arrive at the scene.

Jeff rushes to the hospital, and doctors tell him that his wife has sustained significant injuries to her brain and may never fully recover. Medical personnel intubate and closely monitor Tina. The fetus appears to have been spared major injuries, but doctors cannot assess the full extent of injuries at this time. Physicians are concerned the fetus may have sustained internal injuries that could cause significant disabilities or other health issues. Further, they are concerned for Tina’s health and recovery, which is complicated by her pregnancy.

Reflective Questions

Should Tina’s pregnancy continue, or should Jeff consider abortion as an option, both for the sake of Tina’s health and out of concern for the viability of the fetus?

Does the fetus have moral status and deserve continued medical treatment, or is the viability of the fetus questionable enough to merit Jeff focusing primarily upon restoring the health of Tina?

What is the Christian view of the worth of human persons?

How might different moral status theories lead Jeff to make different decisions?

Conclusion

In modern Western society, the worth of human persons is often taken for granted, especially by those in helping professions such as nursing. Yet the presumption of human worth is not something that practitioners or ethicists should take for granted. In this age of relativism, medical practitioners cannot assume that all people grant others moral status based on intrinsic human properties or the image of God in humanity. Many medical professionals make moral decisions based on consequentialism’s idea of quality of life in which ethical decisions are made by evaluating the perceived consequences upon human well-being. Understanding the reasons for these developments, as well as the reasoning that undergirds them, can enable health practitioners to be more aware of their own thoughts regarding human worth and can strengthen their resolve to continue to care well for their patients because of their innate worth.

Florence Nightingale. Photo courtesy of the U.S. National Library of Medicine.

If modern history teaches anything about human tendencies, it is that human beings can easily push aside considerations of human worth in favor of expediency or the pursuit of personal goals. The Holocaust, the Tuskegee experiment, and, arguably, the prevalence of legalized abortion displays the human capacity for evil and the dehumanization of other persons. Yet, in the face of these evils, Christians have often stood up for the value of human life, even sacrificing their own time, energy, and selves in support of others’ lives. This witness is far from perfect, but its presence, today as well as in history, displays a counternarrative to dehumanization.

In the medical field, this witness is prominent through individuals such as Florence Nightingale, the mother of modern nursing, whose faith was the impetus for and the sustainer of her care for the sick. The question to medical practitioners in the future will be whether the value of human life will remain a preeminent value in society, supporting the central purpose of medicine in life saving and healing. Other considerations may significantly crowd out this fundamental concern, but the decisions made by medical practitioners and researchers today will have drastic effects upon generations to come for both those who receive health care and for those who provide it. What will be the legacy that they leave behind?

Additional Resources

Banner, M. (2014). The ethics of everyday life: Moral theology, social anthropology, and the imagination of the human. Oxford, England: Oxford University Press.

Beckwith, F. J. (2007). Defending life: A moral and legal case against abortion choice. New York, NY: Cambridge University Press.

Best, M. (2012). Fearfully and wonderfully made: Ethics and the beginning of life. Sydney, Australia: Matthias Media.

Cherry, M. J. (2017). Created in the image of God: Bioethical implications of the imago Dei. Christian Bioethics: Non-Ecumenical Studies in Medical Morality, 23(3), 219–233. doi: 10.1093/cb/cbx009

Colson, C. (2009, July 27). Quality control: Imago Dei and health care costs [Web log post]. Retrieved from https://www.christianheadlines.com/news/quality-control-imago-dei-and-health-care-costs-11606587.html

Cortez, M. (2010). Theological anthropology: A guide for the perplexed. London, England: T&T Clark.

Frankl, V. E. (1984). Man’s search for meaning. New York, NY: Washington Square Books (Original work published 1959).

Hollinger, D. P. (2009). The meaning of sex: Christian ethics and the moral life. Grand Rapids, MI: Baker Academic.

Kaczor, C. (2015). The ethics of abortion: Women’s rights, human life, and the question of justice (2nd ed.). New York, NY: Routledge.

Kilner, J. F. (2015). Dignity and destiny: Humanity in the image of God. Grand Rapids, MI: Eerdmans.

Kilner, J. F. (Ed.). (2017). Why people matter: A Christian engagement with rival views of human significance. Grand Rapids, MI: Baker Academic.

Lee, P., & George, R. P. (2009). Body-self dualism in contemporary ethics and politics. Cambridge, England: Cambridge University Press.

Meilaender, G. (2013). Bioethics: A primer for Christians (3rd ed.). Grand Rapids, MI: Eerdmans.

Pellegrino, E. D., Schulman, A., & Merrill, T. W. (2009). Notre Dame studies in medical ethics: Human dignity and bioethics. Notre Dame, IN: University of Notre Dame Press.

President’s Council on Bioethics. (2008). Human dignity and bioethics: Essays commissioned by the President’s Council on Bioethics. Washington, DC. Retrieved from https://repository.library.georgetown.edu/bitstream/handle/10822/559351/human_dignity_and_bioethics.pdf

Shelly, J. A., & Miller, A. B. (2006). Called to care: A Christian worldview for nursing (2nd ed.). Downers Grove, IL: InterVarsity Press.

Stahl, D., & Kilner, J. F. (2017). The image of God, bioethics, and persons with profound intellectual disabilities. The Journal of the Christian Institute on Disability, 6(1-2), 19-40. Retrieved from https://store.joniandfriends.org/product/image-god/

Swinton, J. (2012). Dementia: Living in the memories of God. Grand Rapids, MI: Eerdmans.

Swinton, J. (2016). Studies in religion, theology, and disability series: Becoming friends of time: Disability, timefullness, and gentle discipleship. Waco, TX: Baylor University Press.

van Inwagen, P., & Zimmerman, D. (2007). Persons: Human and divine. Oxford, England: Oxford University Press.

Wolterstorff, N. (2010). Justice: Rights and wrongs. Princeton, NJ: Princeton University Press.

Key Terms

Abortion: In this context, understood as the elective act of killing a human fetus while still in its mother’s womb. Technically illegal for most of U.S. history, abortion was legalized within the United States in the monumental Roe v. Wade Supreme Court verdict in 1973. Abortion may take place surgically or chemically, such as through the use of RU-486.

Assisted Reproductive Technologies: Aids to human reproduction created by scientific advances. These may range from chemical interventions within the human body to producing human reproductive functions completely apart from the human reproductive system. Some faith traditions do not believe that the use of such technologies is ethical, while others consider many of these technologies to be allowable.

Belmont Report: A document written by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in 1978. It provides an overview of fundamental ethical principles for conducting research involving human subjects and suggests that the three essential principles in this work are the following: respect for persons, beneficence, and justice. This document remains foundational for the United States Department of Health and Human Services as well as for institutional review boards.

Continuity of Personal Identity: The unity of a person’s individual identity across his or her lifespan and even beyond death. This means that, although persons grow and change throughout their life, they also remain the same. The continuity of personal identity is crucial for the concept of personhood and is intricately tied to an immaterial soul.

Disability: A deficiency in full human functioning. This may be a physical deficiency, such as an inability to walk, or a cognitive-behavioral deficiency, such as dementia. For adherents of a functional view of human value, a disability would result in lessened human worth. But for those who subscribe to an essentialist view of human value, a disability does not decrease human value.

Dualism: A metaphysical point of view concerning human beings that understands humans to be made of nonphysical attributes, such as a soul, in addition to physical attributes. In opposition to the viewpoint of physicalism, dualism sees nonphysical human attributes as being just as integral to human beings as physical attributes.

Embryo: An early stage of development of an unborn offspring. An embryo develops from a zygote (i.e., fertilized egg). In an essentialist view of human value, an embryo is considered a human person because it possesses all the potential to become a mature human being. Recent developments in assisted reproductive technology have enabled the creation of embryos outside of the human reproductive system. Embryonic stem cells may also be derived from embryos, but the embryo is destroyed in this process.

Essentialist View of Human Value: A view that understands human beings as being inherently valuable because of their status as human beings. Such a view, similar to an intrinsic valuation of human worth, finds value in the essential nature of human beings rather than in the functions that humans may provide. Thus, a human being’s essence is something deeper than his or her functions or abilities. From a Christian point of view, the imago Dei present in all human beings is the basis for an essentialist view of human value that recognizes humans as being unique in this valuation among all creatures.

Extrinsic Value: Also instrumental value. The use of external criteria for determining the worth of an entity. If an entity has extrinsic value, it is valuable only to the extent that it provides some benefit or may be used to accomplish a desired end. Extrinsic valuation fundamentally differs from intrinsic valuation.

Fertilization: The process of a human sperm entering a human egg and the creation of a zygote. Many believe this to be the beginning of a new human life. Fertilization may occur as a result of natural human reproduction, but more recently, technological advances have enabled fertilization to occur outside of the human reproductive system in laboratory conditions, enabling a range of assisted reproductive procedures.

Functional View of Human Value: A view that appraises the worth of human beings based primarily upon the function that an individual may provide. Akin to an extrinsic (instrumental) valuation of human beings, such a view sees uniquely human functions such as the ability to reason, make independent decisions, act as a moral agent, and be creative as being the aspects of human beings that make them valuable. In this view, the loss of these functions, as in the case of an individual with severe disability, consequently reduces the value of that human being.

Gamete Intrafallopian Transfer (GIFT): An assisted reproductive procedure in which sperm and eggs (i.e., gametes) are surgically transferred to the fallopian tube.

Gestation: The time that an implanted embryo grows and develops within the womb. Gestation can also be understood as the time between conception and birth.

Gnosticism: An early pseudo-Christian sect that denied the Incarnation and essential physical nature of Jesus Christ, instead prizing the spiritual over the physical, which they believed to be wholly evil; therefore, those who were enlightened sought to divest themselves of their physical human trappings, by either fully embracing or alternatively denying their carnal passions because they deemed only the spiritual to be of value. Many derivative philosophies exist and are often termed pseudo-Gnosticism or nontraditional Gnosticism.

Human Dignity: The belief that human beings are the proper objects of respectful treatment. Dignity is especially important for medical professionals because it is the motivation for proper care. Dignity itself refers to rendering due esteem proper to the status of an entity. Beyond innate worth, the concept of dignity suggests an attitude of respectful reverence that is based upon an acknowledgement of the mysterious nature of human existence. Rather than being automatically given, dignity is based upon the inherent worth of human beings, but requires a choice on the part of others to recognize. Dignity is closely related to a mandate to care.

Human Nature: The conglomeration of characteristics that together form what it means to be a human being. The term may be used to identify innate tendencies, abilities, or faculties common to all human beings, but should not be confused with the theological term sin nature that identifies humans as having an inherent bent toward sin.

Human Rights: Those freedoms understood to be inherently deserved by all human beings. Theologians often identify these rights as being bestowed by God. Identification of the existence of human rights largely took place in the modern West, particularly because of its Judeo-Christian heritage, and was further cemented through events such as the Nuremberg Trials following Nazi persecution of Jews in World War II. Although the existence of human rights is now often taken for granted, the particular identity of these rights is not agreed upon.

Image of God: (Latin, imago Dei) The Christian doctrine that understands all human beings, regardless of age, race, gender, religion, or any other qualifier as being created in God’s image and, therefore, possessing inherent worth. This understanding is grounded in the biblical creation account in the book of Genesis that describes Adam and Eve, the first human beings, as created “in the image of God” (Genesis 1:27). Theologians have understood the imago Dei to be related to a variety of human attributes including rationality, sociality, moral agency, and spirituality, but the significance of the imago Dei lies not in these properties, but in the inherent value of human beings.

Implantation: The conjoining of an embryo into the uterine wall of a female human being.

In Vitro Fertilization (IVF): An assisted reproductive procedure in which an egg is stimulated, retrieved, fertilized with sperm outside of human reproductive systems, and transferred to a maternal uterus. The first successful IVF procedure occurred in the late 1970s.

Intracytoplasmic Sperm Injection (ICSI): A treatment for male infertility in which a single sperm is injected into the cytoplasm of an egg. After fertilization, embryos may be transferred to a maternal uterus. ICSI differs from in vitro fertilization (IVF) in that sperm naturally penetrate the egg in IVF treatment.

Intrauterine Insemination: An assisted reproductive procedure in which sperm are placed in a woman’s uterus to aid fertilization by decreasing the sperm’s travel time to the egg and increasing the number of sperm that reach the fallopian tubes.

Intrinsic Value: A means of assessing the worth of an entity based solely upon the inherent worth of the entity and valued independently from any benefit or detriment that the entity may provide. Intrinsic value is contrasted with extrinsic, or instrumental, value. If an entity has intrinsic value, it has worth inherently and for its own sake.

Moral Agency: The ability to make morally significant decisions. This includes, but is not equated to, autonomy because, in addition to being able to make a decision, the agent must also be able to weigh the moral ramifications of decisions.

Moral Status Theory Based on Cognitive Properties: A manner of reasoning that utilizes the presence or absence of cognitive abilities as the basis for determination regarding moral status. From this viewpoint, if an entity possesses key cognitive properties, such as consciousness and the ability to reason or to communicate, a practitioner may reasonably determine that the entity has moral status.

Moral Status Theory Based on Human Properties: A method of determining whether an entity has moral status based upon whether that entity possesses human properties. These properties may be physical in nature, such as DNA, relational in nature, in regard to the parentage of the entity, or nonphysical, such as the possession of reason, consciousness, or moral agency. This moral status theory is generally considered to be the most compatible with Christian belief.

Moral Status Theory Based on Moral Agency: A means of identifying moral status that recognizes the ability of an entity to act as a moral agent as the key determining factor in assigning moral status.

Moral Status Theory Based on Relationships: A theory that perceives the fact of and/or the ability to be in relationship with others as the most important factor in determining moral status. In this way of thinking, the relationship that one has with an entity gives significance and worth, understood in terms of moral status, to that entity. In turn, the reciprocal relationship of that entity to other beings who possess moral status is an exceedingly important consideration.

Moral Status Theory Based on Sentience: The sentience of a being as the most significant factor for determining whether an entity has moral status. Some ethicists view human beings as the only entities capable of sentience, while others also identify some animals as sentient beings.

Moral Status: A determination regarding an entity that certain ethical obligations are due to it because of its status as a moral being. Some philosophers argue that moral status may apply to animals and other members of the natural world in addition to human beings. Practitioners may use various methods of reasoning to arrive at a conclusion about whether an entity does or does not have moral status.

Naturalism/Physicalism: A metaphysical viewpoint that understands the world, including human beings, as consisting of only physical matter. This view excludes the possibility of nonphysical elements such as soul, God, or a spiritual realm. Any seeming occurrence of nonphysical phenomena would be considered merely an illusion rather than a substantive reality. In this view, the physical world is the only source of reliable knowledge or truth.

Person: A designation that recognizes an individual as being intrinsically worthy of dignity and respect. Historically, philosophers have used Boethius’s (trans. 2000) definition of a person as “an individual substance of a rational creature” (p. 26) as a starting point for defining personhood. This suggests that person is a designation that is inherent and is not merely based upon recognition of certain capacities, such as reason, moral capacity, and consciousness; however, personhood is a prerequisite for an awareness of others as the potential recipients of mutual relational interchange. The term may be applied to human beings or to other sentient beings, such as God, and carries with it certain religious or spiritual, moral, ethical, and legal responsibilities.

Personal Identity: The substance of an individual as being distinct from any other person. Such identity is both static—meaning that person at age 2 is also the same person at age 64—and dynamic—meaning that a person at age 64 has changed drastically from the person he or she was at age 2. For the Christian, personal identity is understood to be maintained even beyond death because of the continuance of the soul. It also can have a spiritual origin because personal identity can be given by God (see Revelation 2:17).

Respect for Persons: An integral part of proper understanding of personhood. Identification of an entity as a person necessarily also requires treatment of this person with dignity and respect. In part, this is because of the relational nature of personhood in which identification of an entity as a person is also identification of that person as the proper object of relationship. In part, respect for persons means that practitioners ought to honor their patients’ autonomy, provide them with informed consent, be truthful, and afford them courtesy.

Secular: A term often used as the opposite of sacred to mean something that is not based upon religious beliefs or tenets. A secular understanding of the world, for instance, would view the world without regard to God, religious considerations, or the obligations that these beliefs would entail. The secular and sacred are not necessarily at odds with one another and can denote general areas of responsibility.

Sentience: The ability to perceive pain and pleasure, and to react appropriately to these stimuli. From this perspective, the experience of pain is evil, while the experience of pleasure is good. Thus, in this viewpoint, a viable fetus as well as many animals may be understood to have moral status because of their ability to feel pain.

Soul: A term that theologians use to describe the seat of emotion, intellect, and reason in the human being. The soul is understood to be nonphysical, yet as continuing on after physical death.

Species: The most basic category within a taxonomy of living organisms. At its most fundamental level, it is a grouping of organisms within which two individuals are able to reproduce.

Spirit: The designation given to the aspect of a human being that communes with God and enables deep relationality. It is understood not to be a physical reality but is sometimes considered as the aspect of the human being that enables life. Thus, some view death as the departing of the human spirit. In the Judeo-Christian tradition, the spirit is understood as life or breath, and the Hebrew word for spirit (ruach) can also mean breath.

Stem Cells: Undifferentiated cells that may develop into a variety of different types of cells or tissues and be utilized for a variety of beneficial medical purposes. Adult stem cells may be derived from sources such as bone marrow and are relatively uncontroversial. Stem cells may also be derived from human embryos, which is more controversial because, in most cases, the embryo is destroyed; however, recent technological advances allow stem cells to be harvested from laboratory-made gametes.

Zygote Intrafallopian Transfer (ZIFT): An assisted reproductive procedure that relies on in vitro fertilization (IVF), but the fertilized egg (i.e., zygote) is surgically placed in the fallopian tube. ZIFT differs from Gamete Intrafallopian Transfer (GIFT) largely in that ZIFT involves the placement of a zygote in the fallopian tube, whereas GIFT involves the placement of sperm and eggs.

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