Abstract
Spokespersons for religious denominations have historically been engaged in a process of deliberation about first principles, both institutional (the role of the church) and theological (the role of humanity with respect to the Divine). Since the 1980s religions have not only been challenged to apply their tenets to the dilemmas that new biotechnologies and genetic interventions pose, but to do so in a way that is societally acceptable. This essay explores how deliberative processes have been used to come to agreement, or at the very least mutual respect, in the types of decisions that religion brings to bear in the genetics era. A contrast is made between interpersonal and multi-party deliberative engagement. The measure of success lies in the material change that deliberation can bring about, from raised awareness to new policies to mutual collective action. Deliberation thrusts religion and spirituality into the 21st century and the broader range of dilemmas, from healthcare disparities to global warming, that people of diverse faiths encounter.
Keywords: Religion, Genetics, Ethics, Deliberation
Introduction: Religion and Spirituality as Group Activities
In the aftermath of World War II, many people who had formerly turned to God for inspiration went underground with their faith, or buried it altogether in the rising secularism. The scientific era of the 50s and 60s accelerated the prevailing criticism of the need for more than a material ideology as the challenges posed by burgeoning scientific technologies – atomic, anatomic, and genetic – called into question the ability of religion to supply personal and societal answers about their application. Another two or three decades would be required to show that group deliberation (including people’s faith beliefs and religious values on the implications of the science) is needed where the experts can only supply part of the answers.
In my own field of public health, the salutary effects of religion and spirituality have also become manifest. Harold Koenig’s review of 16 studies revealed that 14 of them found lower blood pressure among the religiously active (Koenig 2001, 323-4). Mindfulness-based stress reduction, which can be conducted both privately and in a group setting, has been found to influence stress hormonal patterns and increase quality of life measures in cancer patients (Modell 2015, 190-1; Carlson 2004, 460-4). The common denominator in health practice and decision-making is that religion and spirituality are a collective enterprise. Like a fine piece of art or type of food, they are most enriching when shared.
The Axis of Deliberation
Minds need to interconnect to reach an appropriate level of agreement before a new scientific or medical technique can be deployed for even a small number of individuals. Deliberation therefore, occur before group or community exposure to a new intervention takes place. The Latin word deliberare has two meanings: to A. “weigh,” or B. “consider well.” Weighing shows intent to act, though the intent may still be in process, not yet occurring. When consideration of action takes place, often the more time that is devoted to the process, the more successful the result will be. Deliberate action begins with measured deliberation.
Deliberation has a history in the religious domain, starting with a 2-person relationship, and culminating in an interchange between religious institutions. While the Hassidic mystical thinker Martin Buber in I and Thou (Buber 1958, 22-3) stressed that the encounter between two beings is concrete, authentic, free of pretence, and independent of explicit communication, Protestant Lutheran theologian Dietrich Bonhoeffer highlighted both the theological and social nature of the self (Ellison 2016, 78). According to Elliston, “Bonhoeffer’s self exists with a multiplicity of ‘other’ selves. The social in this context means more than a dyadic encounter between a self and an other. It is responsible (for) relating to a community” (81).
The notion of “community” is fairly nebulous. In public health circles, it can have a demographic character, such as one’s gender or racial-ethnic affiliation, can be related to work or outside affiliations, or refer to one’s neighbourhood or a larger network. In the religious context, community often implies the church community. Thus, one often comes across religious dialogical interplays as academic discussions of one theologian, representing a particular set of religious principles, is set against another, espousing a contrasting set of principles (Taylor 2016). More abstractly, it is simply a theoretically occurring discussion with a leader of a particular faith. The dialogue serves a purpose, though, in that it drives the quest for greater understanding in terms of self, world, and faith, and how one should relate to the material world while respecting one’s faith. In a broader sense still, e.g., as expressed in the work of Christian existentialist theologian Paul Tillich, dialogue represents an encounter between different religions – it is unshackled from a 1-on-1 encounter between single individuals. Tillich was stymied by his firm conviction in his own Christian faith, yet simultaneously possessing an appreciation that he could not flatly assert its truth over another religious faith. John Foerster indicates, “Tillich has less to say about the question as to ‘What is Buddhism?’ than about the one as to ‘How can Buddhism be brought to bear on the age-old inner-Christian theological debate?’” (Foerster 1990, 2). Tillich’s solution was to allow for a recognition of the theological significance of a system of “alien concepts” within one’s own tradition, which compels an inter-religious dialogue through time, i.e., deliberation with another party, even if at first the reference is only from within one’s own faith.
Deliberation in the Lifeworld
By “lifeworld” I mean an active, mutual and dynamic co-experience between different parties. Communication, ideally a moving towards mutual understanding, is a necessity. This interaction crosses purely academic boundaries – the dialogue is no longer just in book form, or in the context of an interview. When transcendence above the purely academic occurs, the variety of faiths being invoked become broader than just one category of faith, such as religious faith.
Scientific knowledge can also come under the scope of these broadened dimensions of religion.Some time later when scientists discovered genetic engineering using recombinant DNA technology, huge debates broke out in the media and streets on whether it is moral and ethical to alter the genetic code for utilitarian purposes. Jeremy Rifkin, founder of the Foundation on Economic Trends, led a 100-person strong coalition of religious leaders down Wall Street in New York and up the path to the Chicago Board of Trade to protest the hubris of permanently altering and then patenting the DNA instruction booklet within life forms. I was surprised and delighted to read in one of the Journals of Bioethics accessible at my home institution, the University of Michigan, the suggestion that the companies involved in genetic engineering should have meetings with groups of community members. The goal would be to achieve a form of understanding and possibly work at each other’s way of approaching this new technology along the edges, moving closer together on what might be viewed as acceptable. These developments called for people holding a faith in science to meet and reason with people holding to their religious or other moral principles. One can see how valuable deliberation can be, given that genetically modified food now occupies our farms and is shipped internationally, to the praise of some countries and disdain of others.
A personally meaningful encounter between science and religion took place during an Evolution Revolution (“Evo Revo”) night in Flint, Michigan held in March 2010. The event was part of a larger Communities of Colour and Genetics Policy project in which I was involved (Bonham et al. 2009). The evening’s activities involved a talk by the project investigator and also student demonstrations (experiments, not marches!), a panel discussion by five community-based organisation leaders, and audience feedback. All this activity revolved around the topic of human similarity and difference by using the science of skin colour as a bridge to explain evolution. On the post-event questionnaire participants indicated a greater understanding of how evolution was related to their health at the evening’s end. Still more significant were people’s personal responses to what had been discussed in-group about evolution. The number of people who felt “my religious beliefs are compatible with evolution” shifted positively from 14 somewhat / 17 strongly agreeing and 6 somewhat / 7 strongly disagreeing before the event, to 19 somewhat / 24 strongly agreeing and 4 somewhat / 1 strongly disagreeing thereafter. Seventy-seven percent of the participants indicated they would like to see evolution taught this way (using discussion and personally relevant examples, not just by lectures) in the schools. The value of the evening is indicated in the findings of Jon Miller at Michigan State University and his colleagues whose 2005 study showed that 62% of American adults believe God created humans as whole persons without any evolutionary development (Miller et al. 2006, 766). Whether or not, a person is educated in the meaning of evolution can make all the difference in the world. For many medical activities, a huge rift exists between taking restorative action and leaving the outcome to fate, which has a bearing on the maintenance of health.
Extended Deliberation at the Crossroads of Science and Religion
Social justice philosophers advocate a process of “rational democratic deliberation” in decisions about healthcare (Fleck 2006; Gutmann and Thompson 1997). Such deliberation calls for open discussion between stakeholders in which decisions are transparent rather than private. The deliberation can lead to collective action, thus there is the need for participants to state their reasons for holding and espousing a particular belief or personally held value. The full process takes time and can involve multiple gatherings.
To gain a representative sense of what people hold dear, diverse parties should be involved, and the deliberations should occur over time. A prime example of this kind of deliberation would be the “Genetic Frontiers: Challenges for Humanity and Our Religious Traditions” series hosted by the Michigan region National Conference for Community and Justice (NCCJ) at Marygrove College, Detroit between 2002 and 2004 (Modell 2007). Each of the three all-day conferences started with a keynote presentation by a noted theologian. This lead was followed by professional responses from a religious leader and an ethically or religiously attuned M.D. or Ph.D. A panel of four “public respondents,” intimately connected with the healthcare system, then spoke. A number of genetic engineering subjects namely genetically modified organisms (GMOs), human embryonic stem cells, human genetic enhancement, and genetic testing – were covered. The findings, as one might expect, were quite profound; relating to human stewardship of the earth and co-creativity with the Divine, and the need for an ethic of unanticipated consequences, and for a fair assessment of results, which people concluded should be judged by impact on the weakest members of society. The day finished with hour-long breakouts, which involved largely congregational attendees and members of the NCCJ, and small group reporting. It is conceivable that a switch in the protocol, giving the lion’s share of time to the audience, would have generated a completely different set of points, such as people’s personal perception of risk if they or a family member were to experience genetic technology or its impact, and people’s feelings about whether a given technology could alter the meaning of what it means to be human. At its outer most reaches, science impinges upon deep existential questions of universal human importance.
A more recent, exciting development is the “Genomics and Faith” dialogue series hosted by the Center for Public Health and Community Genomics at the University of Michigan School of Public Health. In its first year (2016-17), the monthly series hosted discussion leaders from across campus on topics such as “The Three-Parent Embryo,” “The Role of Religion / Religious Communities in the Promotion of Medical and Genomic Research,” and “The Impact of Gene Editing.” The first twenty minutes of each session consisted of a synopsis of the issues; the remaining hour and a half was straight give-and-take voicing of hopes and concerns by the attendees. Half the participants were from the medical and scientific community; the other half consisted of local religious leaders representing diverse faiths, from Buddhism and Hinduism to Catholicism and Judaism. Many of the speakers permanently joined the group; plans for the second year are to start each session with guidance from a scientist / religious leader pairing. An event open to the general public is scheduled for September 11, 2017 at the Ann Arbor Public Library. This midpoint sharing is critically important. In past gatherings that we have had at the Library and nearby churches, members of the public have been quite vociferous, voicing concerns about whether genetic technology could be used by majoritarian portions of society to dominate marginalised groups, or to increase the number of abortions being performed. The new precision technologies offer at least as many if not more conflicting issues than previously existed.
The dialogues also included two topics that touch on behavioural issues – one dealing with the role of genetics in determining criminal guilt; the other with epigenetics (extrachromosomal influences) and faith. Scientists have shown that an interaction between the low activity monoamine oxidase (MAO-A) genotype and childhood maltreatment results in outcomes such as criminal conviction and aggressive behaviour (Caspi et al. 2002). The scientific finding that reveals genetic causes of aggressive behaviour, calls into question whether criminals showing aggressive criminal behaviour should be judged in terms of God’s mercifulness or God’s sense of justice and righteousness (Gold and Applebaum 2014). The epigenetics discussion revolved around issues of societal responsibility. If a child is born into a home where the parents smoke or the household has higher than normal lead levels, does a societal obligation exist to epigenetically test the child and possibly remove the child if he or she is found to be at elevated level of disease risk?
The September Year 1 culminating event is intended to pull themes together and gather wider input from the general public as a prerequisite to consensus building. It is also surprising to see how a given set of issues can pop up elsewhere on campus. At the August 18, 2017 University of Michigan monthly Medical Genetics Conference, a sickle cell disease researcher described the action of an enzyme, demethylase LSD1, which epigenetically (not changing the person’s genes; just their activity level) represses a gene involved with the production of fetal hemoglobin. His lab has found that the application of an LSD1 inhibitor, tranylcypromine, removes the suppression and allows for the production of fetal hemoglobin levels high enough to be considered therapeutic in sickle cell mice. LSD1 turns out to be a monoamine oxidase inhibitor. He mentioned that LSD1 “knockout mice” who have lost the function of the enzyme show “scruffy, aggressive behavior that requires careful handling.” Imagine the effect on a sickle cell patient receiving an inhibitor of the enzyme for what the investigator suggested would be their entire life! This kind of “epigenetic therapy” deserves to be folded into ongoing discussion about the implications of the new precision genetic technologies.
Educational Implications
Deliberative processes take on increasing meaning as the subject matter comes to be viewed from different angles, bringing different people’s values to the fore and allowing them to reach mutual understanding. This is not to say that a 2-person dialogue cannot have an impact, but the question arises as to whether the effect will fuel further individual “mental” processing, or bring about change at the collective level.
The iterative process of approaching issues at the intersection of science and religion can be awareness raising for those participating. Products of deliberative engagement, whether they exist in the form of summary, descriptive report, or actual recommendations, attain “internal” educational value when they are returned to the participants involved, and “external” educational value when disseminated to professional or policymaking groups that can make a difference in the area under discussion.
Conclusion: The General Value of Group Deliberation
Deliberative processes may not be appropriate for all situations where mutual understanding is needed. Sometimes people, such as those on opposite ends of the religious conservative-liberal spectrum, are simply trying to encounter one another without flying apart. In other circumstances groups of people are attempting to reconcile different intellectual perspectives, which can occur when disparate scientific hypotheses or religious tenets are being compared.
Nonetheless, pure science and pure religion have a tendency to “spill over” into the applied arena. Though this essay has focused on religious views towards burgeoning genetic technology, the year-long “Genetics and Faith” dialogue project has shown that nondenominational spiritual perspectives offer just as much to say about moral guidance in this area as the insights of traditional religions. Values and beliefs within this shared space can be harnessed in deliberations about a wide variety of global concerns – healthcare for all; the threat of war; civil unrest and injustice, and global warming to name a few (Gutmann and Thompson 2014). It would not make sense to hold discussion in these areas to just a single sitting. So much can be unearthed in a more engaging deliberative process evoking people’s inner beliefs. What emerges can have wide educational and material results for those willing to share their faith with each other.
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