Mormonism, Medicine, and Bioethics

courtney s. campbell'sMormonism, Medicine, and Bioethics makes significant contributions to the Church of Jesus Christ of Latter-day Saints, Mormon studies, and bioethics. He identifies key Latter-day Saint premoral convictions and ethical principles and shows how they inform medical decision-making on a variety of topics including reproductive medicine and embryonic stem cell research, and preventative medicine and vaccines, among others discussed below. His descriptions include important critical and constructive components including a defense of universal access to basic health care services. The book would, however, have been strengthened by being more analytical; examining why, for example, the Latter-day Saint tradition lacks a bioethics and relies on a moral culture, and when deference to members’ moral agency is appropriate.Campbell has three potentially overlapping audiences: members of the LDS Church (including scholars and health care providers), Mormon studies scholars, and bioethicists (including health professionals). His goal is to develop a more robust Latter-day Saint ethics and bioethics (ix–x), and he characterizes Latter-day Saint morality as restored, re-storied, and prophetic (13, 24). It is restored in the sense that culture has experienced a moral decline and Latter-day Saint morality is recovered or retrieved from preceding religions and moral cultures. It is re-storied in that its principles and values are situated within Latter-day Saint narratives and scripture. These principles and values permit exposure and prophetic critique of contemporary society's moral decline and failures.Campbell focuses on the broad premoral convictions (views about human nature, salvation, knowledge, health, embodiment, and family) and the normative ethical principles, values, and virtues that inform Latter-day Saint morality. He mentions the importance of practical reason (5) and provides examples of narrative ethics (157–59) but does not develop a specific theory of practical reason. The premoral convictions include that persons exist as unembodied spirit beings in a premortal life; become embodied in a tabernacle, acquire knowledge, experience, and wisdom, and make choices; and finally, continue in eternal progress after death. The family is essential to this process because it creates the condition for mortal existence, is the fundamental unit of society, and persists in the afterlife (6–13).There are five key Latter-day Saint ethical principles according to Campbell: love, hospitality to strangers, covenant, justice, and moral agency (13–24). Individual principles are associated with virtues and values. For example, Campbell states, “An ethic of neighbor-love is informed by the moral virtues of charity, mercy, and compassion and is the organizing value of personal integrity” (15). Campbell argues that this framework differs from the secular, libertarian ethos that emphasizes autonomy, nonmaleficence, and individual self-interest (5): love of neighbor exceeds refraining from inflicting harm on others by requiring the promotion of others’ basic welfare and flourishing, and some degree of self-sacrifice. These principles also, Campbell contends, enable prophetic moral critique. Campbell is not, however, always consistent in his use of these principles: he at times identifies additional or alternative ones (compare 215–20).Campbell address several ethical issues: reproductive medicine and embryonic stem cell research, preventive medicine and vaccines, genetics and biomedical enhancement, organ and tissue donation, neonatal care, and end-of-life care and medical aid in dying or euthanasia. He concludes by addressing public policy issues including abortion, medical aid in dying, medical marijuana, and healthcare reform (26–28). Campbell's presentation of specific ethical issues is generally descriptive and at times critical or constructive. He begins many of the chapters on issues with vignettes.The chapter on neonatal care (143–62), for example, begins with the story of Malia and Landon who faced pre- and post-natal medical decisions regarding their son Benjamin, who had intrauterine growth restriction, prematurity, pulmonary hypertension, and a patent ductus arteriosus (the abnormal persistence of a fetal circulatory structure). One of the premortal convictions relevant to Malia and Landon's decision to continue her pregnancy until she developed severe preeclampsia at thirty-one weeks is that family membership in the LDS Church requires birth and conferral of a name and a blessing (although the church does not preclude the possibility that stillborn infants are members of eternal families). The teaching that children who die before the age of accountability or without the capacity for accountability are nonetheless saved subsequently permitted Landon and Malia to discontinue medical interventions when it became apparent that they would be futile. In this chapter, as with many others, Campbell emphasizes moral agency—the decision makers’ obligation to apply the general principles articulated by the church, in consultation with their health care providers. He also mentions the principle of justice—justice would be violated if the government or the medical profession imposed a decision on parents.An example of Campbell's criticism is his analysis of the church's public engagement. He identifies three criteria for ecclesiastical public engagement: separation, core moral values, and civic engagement. While the church supports the separation of church and state, it engages in public policy questions that may compromise its core moral values. Individual members are then supported in civic engagement and responsibility, particularly with respect to specific policy solutions or alternatives (189–91). Campbell is critical of the church opposing a Utah ballot initiative on medical marijuana and negotiating a compromise legislative bill following its passage because the church initially did not clearly articulate the relevant core moral value(s) and eventually usurped members’ role in civic engagement (202–7). In terms of constructive arguments, Campbell articulates a Latter-day Saint justification for universal access to basic health care services. He argues that universal health care access is consistent with the church's statement regarding health care reform in Utah and its health priorities in its international humanitarian assistance (214–22).Mormonism, Medicine, and Bioethics will be very helpful to Campbell's intended audiences. There are, however, several small ways in which it could be more accessible to health care providers and bioethicists. At times, the medical descriptions are not fluent. For example, Campbell reports that Benjamin, who weighed 417 grams, was too small to intubate (145). Infants weighing less than 400 grams can, however, be successfully intubated1; indeed, one infant, who weighed only 245 grams, was intubated successfully.2 There are also aspects of the Latter-day Saint tradition that could be more fully explained to those who are less familiar with it. For example, while Campbell includes a note on sources that describes Latter-day Saint scripture and how it is referenced (xiii), Campbell does not describe other important sources, such as the General Handbook: Serving in the Church of Jesus Christ of Latter-day Saints, Ensign, and New Era (see the references on 245–50).I might also quibble about some of Campbell's selection of topics. His brief discussion of ethical constraints in the COVID-19 pandemic (222–27) is not well integrated with the rest of the text. I would have been interested in a discussion of the neurological criteria of death and donation after circulatory death in the chapter on organ donation (127–42), or at least a statement that the Latter-day Saint tradition does not have anything unique to contribute to the analysis of these topics, and a longer discussion of gender-affirming medical care (68–69).In addition to these minor comments, my major comment is that the text would have benefited from more analysis. For example, Campbell notes, but does not explain, the underdevelopment of the bioethics within the LDS Church and Mormon studies (3). It would be helpful to better understand the theological and ecclesiastical reasons for this, the associated benefits and detriments, and the opportunities for growth. In the absence of robust ethics and bioethics, Campbell references the church's “ethical commitments and moral culture” (ix). Moral culture is not a concept commonly used in bioethics, and Campbell does not provide a source or definition for it apart from referencing Dallin H. Oaks’ use of the term “gospel culture” (6).Campbell's analysis of the church's international humanitarian assistance programs and their precepts is an example of discerning ethical principles from Latter-day Saint practices (217–20). A clearer understanding of this culture and how it informs decision making would also strengthen the book. For example, it is not clear how this culture is propagated outside of the Intermountain West or the United States. Potential resources for such an analysis include work on liturgy and ethics.3A related issue is the discussion of moral agency. Campbell states, “Moral agency comprises our capacities for discernment and deliberation and our existential personal liberty to make responsible choices, a capacity so expansive that it is inviolable even by God” (22). The general principles governing appeals to moral agency remain unclear to me. Many of the church's pronouncements regarding bioethical issues take the form of “this is a personal matter that ultimately must be left to the judgment of the patient or the husband and wife,” sometimes adding “after receiving wise and competent medical advice” and/or “seeking divine guidance or confirmation through fasting and prayer” (see 231–45). This seems in tension with Campbell's description of the Word of Wisdom in his discussion of preventative medicine (79–85). Joseph Smith delivered the Word of Wisdom after Emma Smith raised the issue of tobacco use with him. It prohibits the use of tobacco as well as strong and hot drinks, but permits meat consumption in the winter and at times of cold, famine, and excess hunger. Campbell traces how adherence to these prohibitions eventually became a criterion of worthiness for participating in temple services and holding ecclesiastical office. It is not, however, clear to me in what ways seeking guidance from the current president and prophet still occurs and how his responses are shared with other members of the church; why the Word of Wisdom did not evolve over time as medicine changed, as did other teachings, such as those regarding organ donation (127–42); or why greater agency is not permitted in adhering to the Word of Wisdom. A comparison with the Roman Catholic concept of conscience and its formation might be informative.4Campbell's book is a welcome publication. It has been thirty years since the publication of Lester E. Bush Jr.’s Health and Medicine among the Latter-day Saints.5 It is therefore helpful to have updated material and to have an ethically, rather than a historically, focused approach. Hopefully the book will be successful in its goal to engender further scholarship in Latter-day Saint bioethics given the guidance needed by both patients and providers. Further analysis of the Latter-day Saint tradition and comparative religious ethics will be valuable

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