H Tristham Engelhardt Jr. Swets & Zeitlinger, 2000, 95 DF, US$39.95, pp 414. ISBN 902651557Xp

In this book, H Tristram Engelhardt Jr outlines his interpretation of Christian bioethics. His branch of Christianity, termed “traditional Christianity”, is described as “the Christianity of the first millennium”. Authority is derived from the church fathers (whose works are continually cited) and from the church community, in accordance with “the Spirit” (this is contrasted with Western Christianity's use of scriptures and philosophical theology).

In the first half of the book (chapters 1–4) Engelhardt describes the contemporary moral condition, characterised by moral diversity and fragmentedness. He bemoans the eroding effect of pluralism on moral values and the lack of mechanisms to distinguish between opposing value systems. He terms the present state of affairs as “liberal cosmopolitanism” and argues that the only available moral authority derives from the “principle of permission”—that is, moral authority legitimised by the autonomous choices of those who collaborate; it is procedural rather than objective. In the course of these chapters Engelhardt proceeds comprehensively and persuasively to argue that “liberal cosmopolitanism” is not morally neutral but is a powerful moral framework itself—upholding the values of liberty, equality, autonomy, and toleration—and requiring adherence and belief.

Engelhardt's thesis is that “liberal cosmopolitan” ethics, and by extension bioethics, is fundamentally flawed, because the search for universality has sacrificed moral authority and hence moral content. On these grounds he dismisses both secular and “post-traditional” Christian ethics and bioethics. “Traditional Christianity”, in contrast to “liberal cosmopolitanism”, embraces authority (mediated through noetic experience, ie experiential knowing of God) and exclusivity (terms such as “fundamentalist” and “cult” he dismisses as political; intended to malign those who are not of the “liberal cosmopolitan” majority). Consequently, “traditional Christianity” is in conflict with “liberal cosmopolitanism” since it endorses patriarchal and sexist views which are offensive to the liberal majority, and as a result traditional Christians find themselves in a hostile environment.

The second half of the book (chapters 5–8) focuses upon the practical implications of adopting this version of bioethics. There are few surprises here, as the practices which are endorsed and forbidden are broadly similar to other conservative Christian traditions. For example, contraception is forbidden, as is abortion and prenatal testing (there is no ensoulment in “traditional Christianity”, therefore, disposal of zygotes and embryos is “murder”, as is abortion in general). In addition, little assisted reproduction is allowed: artificial insemination by husband is permissible if the wish for a child does not interfere with the couples' spiritual quest and if there is no third-party involvement (sperm must be collected during intercourse or stimulation by the wife and the husband must carry out the insemination procedure). Of particular interest for bioethicists in this section are the differences which Engelhardt highlights between “traditional Christianity” and more familiar Christian approaches. For example, he rejects frequently cited Roman Catholic doctrines, such as the “doctrine of double effect” and arguments which appeal to biological “naturalness”.

This book contains many interesting insights (though perhaps more for theologians and philosophers than for bioethicists), but would be unlikely to satisfy a reader looking for engagement with the practical dilemmas of bioethics. However, since Engelhardt's intention is to return us to a first millennium Christianity, this is not entirely surprising. His focus on the first millennium leads him to leave out some subsequent advances which have a bearing on his argument; for example, the current philosophical revival of moral realism is not mentioned. This said, the book has much to recommend it, such as an insightful analysis of difficulties which attach to moral pluralism and revealing comments about the philosophies of Hegel, Kant and Kierkegaard, as well as an introduction to the ethics of Orthodox Christianity. On balance, however, this book will perhaps seem somewhat irrelevant to contemporary bioethicists, although it may prove of more interest to theologians, especially those of the more conservative persuasion, such as the emerging school of radical orthodoxy. Ultimately, the difficulty with Engelhardt's position is communication. His rejection of “liberal cosmopolitanism” leads to an unwillingness to compromise, which makes it difficult for those from the “liberal cosmopolitan” world-view to hear his points; this is somewhat problematic given that his intended audience is the academic community.