The Pastor and Difficult Bioethical Decision Making

Some days, pastoring is more difficult than others. Imagine you’re in your office and a couple from your church asks you what they should do about another couple in the church who have asked them to preemptively adopt any extra embryos that will soon be made through a round of in vitro fertilization. Or imagine there’s a pregnant mom who’s weeping in your office, wondering if she should undergo chemotherapy to remove the tumor in her brain—which will result in the death of her unborn baby—or if she should allow the baby to come to term—which will result in herself being taken by cancer, leaving her husband alone with four young children. Or imagine it’s Sunday after church, and the nice woman in the back who has been visiting for a few weeks comes up you in tears, telling you she has confessed Christ for the first time—and that she used to be called Steve, having recently transitioned to being a woman. Now she wants to know what following Jesus looks like.

In these moments, what is the pastor to do?

These are but a tiny sampling of the bioethical issues pastors face. What is “bioethics”? It’s best understood if we break down the word. Ethics is the practical discipline of decision-making, informed by philosophy and theology. Bio- is a prefix we attach to words that are associated with life. So bioethics is the study of the ways in which we should make decisions about what do in regard to issues of life and death.

My goal in this article is to help pastors who must shepherd and live alongside those who face bioethical dilemmas. This is an important topic for at least two reasons. First, understanding these situations well will be of great pastoral and evangelistic benefit. Second, I’m a pastor who has a degree in bioethics, and through the years I’ve realized that Christians rarely think any better than non-Christians about these topics.

We need to do better. We need to become wiser—to serve both our churches and our neighbors. To that end, here are eight maxims pastors ought to remember as they shepherd people through difficult bioethical decisions.

1. The Bible doesn’t have all the answers.

Moses knew nothing of cloning. David wrote no Psalms about cognitive enhancement. Paul didn’t take up any space in his letters dealing with the Christian position on the use of artificial wombs.

Does this mean the Bible is of no bioethical use? Of course not. It simply means that it isn’t meant to be a simplistic answer key to every bioethical dilemma.

So, what is the Bible good for when it comes bioethics? It tells us about who God is, how we should view the world he created, and who we are as human persons. With this information at our disposal, we can begin to understand how we ought to live in the world. While the Bible is seldom directly applicable to specific bioethical situations, we must glean from it principles for action and behavior.

2. Complicated bioethical questions demand careful answers.

Most people hesitate when it comes to issues of life and death, sickness and health. Decisions are legion, urgency is high, and wise counsel is often lacking. Whether we like it or not, those under our care will listen carefully to what we have to say. What’s more, they sometimes even take our advice, regardless of how uninformed it happens to be. This requires us to do all that we can to study, pray and seek counsel ourselves as we seek to lead and love those under our care. Primers on bioethics, such as David VanDrunen’s Bioethics and the Christian Life, should be on every pastor’s reading list. The fact that all people face tough bioethical questions in life should motivate you as a pastor to learn and think well about these issues. After all, being informed about complex life and death issues offers a way to love our neighbors and perhaps even to share the gospel with them.

Bioethical dilemmas also offer us an opportunity to heed James’ advice: be quick to listen and slow to speak (James 1:19). There are rarely easy answers. Rarely is there one right and one wrong answer. Most of the time, we’re facing options that are better or worse, depending on various circumstances, which leads me to my next point.

3. You are a pastor, not a physician.

Yes, it’s funny to tell medical doctors that we too are physicians . . . of the soul. This may be true, but as with John the Baptist, we ought to know our role. Those in the medical profession are gifts from God.

Physicians wield enormous power and influence that can either go very well or disastrously wrong. So, unless you yourself are a trained medical professional, don’t act like one. Not because people won’t take your advice but because they will. Thus, we should seek out the advice of medical professionals when we run into difficult situations.

Never forget that your people need a physician of their bodies as well as their souls. So be content to be their pastor.

4. Who we are matters just as much as the decisions we make.

God doesn’t care merely about the things we do, but also why we do them. Consider King Saul in 1 Samuel 15 as an example. He directly disobeys God in order to do what he thinks is best in regards to worshipping God. In so doing, Saul loses both the throne and God’s favor (1 Sam. 16:7).

Two people in exactly the same situation, facing the same dilemma, can make the same decision for exactly the opposite reasons. One can act from the vice of fear, while the other might be acting from the virtue of courage. As pastors, we aim to teach the whole counsel of God in order to see people transformed into the image of Christ. We want our people to become virtuous, who by God’s grace and the Holy Spirit’s power do the right things for the right reasons. Who we become matters—and so do the reasons behind our decisions. After all, the decisions we make shape who we become.

5. Elders should strive toward unity and understanding.

Pastors are a gift from Christ to his church (Eph 4:11). And yet, as we all know, each pastor is limited to two hands and 24 hours in a day. As in all other areas of church life, personal limitations offer an opportunity for multiplication and innovation. Here are a few ideas for elders as a whole to grow in their understanding of these issues, despite their inherent limitations:

• Ask one elder, perhaps the guy who is the most interested or educated, to read a book or two and give a report to the whole board at an elders meeting.
• Invite a medical professional to an elders meeting to consult on a situation.
• Have all the elders write memos about hard issues and present them at your elders meeting so that you can reason together well.

What if you don’t have elders? Get together with pastors from other churches. You’d be amazed at how many fellow pastors have gone through similar situations. You can swap advice about what to do—and what to avoid!

6. Advancement doesn’t necessarily equal progress.

We live in an age of unprecedented technological and scientific advance. And so we must admit how tempting it can be to grasp at the promises these advances offer us, especially in situations that involve those we love who are suffering. We ought to thank God for the resources available to us while also recognizing that every advance makes living wisely in the world even the more difficult. In other words, just because an option is available doesn’t mean we should necessarily consider it.

How should we deal with these advances? I’ll address this question in my final two points.

7. We are all going to die.

Benjamin Franklin got it right: “In this world nothing can be said to be certain, except death and taxes.” Nowadays, however, we’re ordinarily removed from the grisly reality of death. And so we simply do not know how to die. In the late Middle Ages, however, death was an ever-present reality, and so Christians developed the ars moriendi (the art of dying), a series of works developed to help Christians die well. Jeremy Taylor’s Holy Living and Holy Dying is considered by many as the preeminent work in the field—and I commend it to you.

We need to be discipled in how to die from the moment we believe—not just before death stands at our doorstep. This shouldn’t surprise us, for Jesus himself calls all who would follow him to pick up their cross and to follow him (Mark 8:34).

Pastor, teach your people to die well. Pastor, die well yourself. We’re never more at risk of denying the gospel than in the face of death. For a new book on this, consider Matt McCullough’s Remember Death (Crossway, 2018).

8. Salvation comes through a mediator, not through medicine.

Stanley Hauerwas accurately captures the spirit of our age when he writes that “in America hospitals have become our cathedrals and physicians are our priests. Accordingly, medical schools are much more serious about the moral formation of their students than divinity schools. They are so because Americans do not believe that an inadequately trained priest may damage their salvation, but they do believe an inadequately trained doctor can hurt them.”[1]

Medicine is a wonderful gift, but because it takes away our pain, makes us feel better, and can even bring us back from the brink of death, we are all tempted to worship it.

But Jesus is the only Savior of the world, and people—both our members and our neighbors—need to be reminded of this fact, especially when they face suffering. As pastors, we’ve been given an incredible calling to teach God’s Word to God’s people for God’s glory. Eternal life and eternal death hang in the balance every time we speak from the Bible. May God give us the wisdom and ability to shepherd our people well, pointing them to the Savior who gives life, even as our mortal bodies are wasting away.