Scott B Rae and Paul M Cox, Grand Rapids, Michigan and Cambridge, UK, Eerdmans, 1999, x + 326 pages, $24.00/£15.99.

In a morally pluralist, or in Alasdair MacIntyre's terms “morally fragmented”, society it seems almost inevitable that people engaging with issues of bioethics should operate within something like John Rawls's idea of an “overlapping consensus”—the area in which there is broad agreement between people with different comprehensive worldviews, and in which they are able and willing to operate with the shared criteria of what Rawls calls “public reason”. There are, of course, those who are uneasy about this approach, usually because they see moral fragmentation as being more pervasive and consensus more difficult to achieve, than the Rawlsians believe. From opposite wings Alasdair MacIntyre and Tristram Engelhardt join forces to question the viability of the liberal consensus.

There are, of course, problems with an overlapping consensus. People with religious convictions often feel that the part of their comprehensive worldview that is outside the “overlap” includes the most constructive and important contributions that their beliefs have to offer. They are convinced they have distinctive insights and truths that should affect practice in positive ways. They want to contribute these to public debate because they consider them valid and true, but they often feel that this is not allowed. Theologians who operate in terms of natural law or believe in a rational common morality, have little difficulty in operating in bioethics along with others; similarly, a number of theologians, mostly Protestants such as Paul Ramsey, James Gustafson and Stanley Hauerwas, have eschewed natural law, but engaged very constructively in debates on bioethics.

Rae and Cox are Bible-based evangelicals who attempt to move directly from the Bible and biblical narratives to bioethical conclusions in ways that are sometimes rather problematic, even to other theologians. It is not easy, for example, to see how poetic biblical statements about God “knowing” people in the womb, or being involved in conception really lead to the conclusion that “the fetus is a person with full attendant rights (page 176). Is it really true that the Bible attributes personhood to the unborn from the beginning of pregnancy? As far as I can make out, the Bible does not in fact address this question, or make unambiguous and universal assertions one way or another. It is perhaps good to remember with embarrassment that the Genesis 3 account of the Fall as the origin of the pains of childbirth was sometimes used as a justification for denying pain relief to mothers in labour.

In other places Rae and Cox argue more theologically, and assert that fundamental to a Christian approach are general revelation, common grace, and the dominion mandate at creation. This brings them very close to natural law thinking. And this is indeed where they come out, with sensible procedures for handling bioethical quandaries, and some well-argued positions on euthanasia, physician-assisted suicide and abortion. Sadly, their brief treatment of the appalling injustices of the American health care system does not lead to a sustained biblical or theological critique, or any suggestion that things might be different.

Two concluding comments: First, the authors give little if any indication of how their “distinctive biblical insights” might commend themselves to others in a pluralistic situation. This is a pity, because others, like Bill May or Paul Ramsey, have shown interestingly, for example, how biblical concepts such as covenant may helpfully illumine the doctor-patient relationship. In bioethics today there is a widespread openness to well-argued insights from wherever they may come. We all perhaps still need to learn how best to conduct medical ethical debate in the condition of today's pluralism, and here Rae and Cox's careful accounts of views and cases can be valuable. Second, Rae and Cox seem rather reluctant to face head-on the ethical ambiguity sometimes involved in the practice of medicine. In some situations there is no clearly right or good way forward; one has to act without the assurance of the rightness of the action. Perhaps it is precisely at the point of ambiguity that the most important contribution of theology is to be made.