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Thanks to Dominic Wilkinson, a formidable clinician-philosopher, for his considered response, and especially for highlighting my work's translatability outside of an (explicitly) theological context. In part, because bioethics’ pioneers were theologians, the discipline misses something important when theology is not an integral part of the conversation. I do not have the space to do an in-depth response,i so the best I can do is use some assertions to gesture at a few key points.
Relational anthropology and the best interests of the patient
Wilkinson spends significant time critiquing my claim that the Social Quality of Life Model (sQOL) is consistent with a healthcare provider acting in the best interest of her patient. And though he notes that my general argument goes through without this claim, the idea that clinicians should always act in the (individualistically considered) best interests of their patients is so commonly held that this topic deserves sustained attention. Wilkinson highlights my relational anthropology as the foundation of my claims about the sQOL, but this anthropology is not founded, as he suggests, on a crude naturalism. Ultimately, it is founded on the first principle that human beings are made in the image of a Triune God who is intrinsically relational. Many different kinds of thinkers (like secular feminists or others with an ethic of care1) have a similar anthropology. We may see the interconnectedness and social nature of human beings as empirical evidence which supports our position, but it is not sufficient to produce the anthropology itself without the naturalistic fallacy Wilkinson rightly mentions.
Much of Wilkinson's disagreement comes down to anthropological first principles. He appears to have an enlightenment view which begins with the person, an individual subject of benefits and burdens. Someone with …
↵i Frustratingly, I must even leave certain important criticisms—like those which focus on which newborns cannot benefit from treatment—without a response at beyond what I did in the book. (On this topic, for instance, I do spend significant time considering the ambiguity of determining which newborns could never benefit from treatment.)
↵ii As I discuss in the book, many newborns ‘declare themselves’ in the first 2–3 days in ways which make further decisions far easier.
↵iii In his defense, he merely gives us a sketch and would presumably have answers to my challenges if he had the space for an extended defense of his proposals.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.