Christian Bioethics, 15(1), 17–30, 2009 Advance Access publication on March 23, 2009

doi:10.1093/cb/cbp003

Christian Bioethics in Europe: In Defense

against Reductionist Influences from the
United States

PAUL T. SCHOTSMANS
Katholieke Universiteit Leuven, Leuven, Belgium

Christian ideas have continued to inspire European bioethics until now.

The central thesis of this essay is that the open-mindedness of Roman
Catholic and other Christian denominations in Europe is crucial
for understanding why Christian ethics is so well integrated in the
European culture. The essay describes first the institutional frameworks
in which these Christian mainly Roman Catholic ideas are developed.
It analyzes further the difference between the secular Anglo-American
and European bioethics as it has been influenced by these Christian
ideas. It finally summarizes the challenges to which Europe’s Christian
bioethical identity is presently exposed to. The essay states that the
Christian inspiration of European bioethics is mainly connected with
the ideologically moderate, tolerant, and dialogical participation of
Christian bioethicists in the bioethical debate in Europe.
Keywords: Christianity, human dignity, personhood, Roman
Catholicism, solidarity

I. INTRODUCTION

Bioethics as a field of research widens the horizon of traditional physicians’

ethos and medical ethics. It integrates reflection on new developments in
bio-technology, which go beyond narrowly curative concerns. It also reflects
on medicine’s social, political, and economic framework conditions. This
field of applied ethical research started in the United States in the 1970s; it
reached Europe only in the middle of the eighties. Its character was pre-
dominantly secular and even secularizing.1

Address correspondence to: Paul T. Schotsmans, Professor of Medical Ethics, Centre for
Biomedical Ethics and Law, Faculteit Geneeskunde, Kapucijnenvoer 35/3-bus 7001, BE-3000
Leuven, Belgium. E-mail: Paul.Schotsmans@med.kuleuven.be

© The Author 2009. Published by Oxford University Press, on behalf of The Journal of Christian Bioethics, Inc.
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 18 Paul T. Schotsmans

This American influence on the development of bioethics in Europe can-

not be ignored, when one describes Europe’s own position in bioethics.
Since the early eighties and up to today, several European philosophers vis-
ited North American centers.2 The success of all these courses has been most
visible in the United Kingdom3 and the Netherlands.4 The former country
accepted secular bioethics with so much enthusiasm that continental Euro-
peans today speak of an Anglo-American influence rather than a merely
American one.
In spite of this powerful import, so this essay argues, Christian ideas have
continued to inspire European bioethics until now. I shall therefore first (1)
describe the institutional frameworks in which these Christian mainly Roman
Catholic ideas are developed and publicized, second (2) analyze the difference
between the secular Anglo-American and Europe’s bioethics as it has been
influenced by those Christian ideas, and finally (3) summarize the challenges
to which Europe’s Christian bioethical identity is presently exposed to.

II. THE DEVELOPMENT OF CHRISTIAN BIOETHICS IN EUROPE

The creation of the Institut Borja de Bioètica by the Catalan Jesuit Francesc
Abel in Barcelona in 1985 is certainly one of the earliest “achievements” of
continental European Bioethics. As a Jesuit Father, medical doctor (gyne-
cologist), and manager of a large hospital in Barcelona, Abel became inter-
ested in the ethical aspects of new developments in gynecology. He followed
an intensive training in the Kennedy Institute of Ethics at Georgetown Uni-
versity (Washington, DC, USA), where he found excellent academic compan-
ions in the Roman Catholic medical doctors John Collins Harvey and Edmund
Pellegrino. His interest in bioethics—as this may be the case for many of his
Roman Catholic colleagues—is also linked with debates within the Roman
Catholic Church on how to ethically evaluate new medical developments
around the beginning and end of human life. Highly sensitive issues like
contraception (since the Encyclical Humanae Vitae in 1968 by Paul VI),
abortion, artificial insemination, in vitro fertilization (linked to the Instruction
Donum Vitae in 1987 by the Congregation for the Doctrine of Faith) and end
of life decision making (see for e.g., the Declaration on Euthanasia in 1980),
etc., are still being discussed by Roman Catholic bioethicists. The need to
create centers of bioethics for thorough reflection and clarification was there-
fore urgent. The Catalan Center played a pioneering role for several similar
centers in Italy (Rome, Milano, Palermo, etc.), Portugal (Lissabon, Coimbra),
France (like the Centre Sèvres in Paris, where Jesuit Father Patrick Verspieren
was and still is extremely influential), and the Centre d’Ethique Médicale at
the Catholic University of Lille (with the priests Charles Lefèvre and Bruno
Cadoré, as well as the nun Marie-Louise Lamau). In Holland, the Catholic
University of Nijmegen and in Belgium two Catholic Universities (of Leuven

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 Christian Bioethics in Europe 19

and Louvain-la-Neuve) followed suit. Also the Linacre Center in London

may be seen as inspired by the same tendencies, namely, to create a reflec-
tive network for bioethics inside the local Roman Catholic churches. Another
Jesuit Father, an emeritus professor of Paleontology, Edouard Boné of
Louvain-la-Neuve, was eminently active in connecting all these centers with
the goal of establishing an internal Roman Catholic dialogue.5 He regularly
brought together (mainly) Roman Catholic ethicists from inside and outside
of Europe to reflect on the challenges of modern technologies. This network
functioned however exclusively inside the Roman Catholic communities. It
was generously sponsored by Catholic benefactors who insisted that this dia-
logue with the Magisterium on delicate issues like prenatal diagnosis and
abortion, reproductive technologies, and end of life decision making should
go on.6
At the same time, these influential leaders of Roman Catholic bioethical
debate were aware of the need of opening their discussions for other opin-
ions and disciplines. Therefore, they started the formal creation of a pluralist
European Association of Centers of Medical Ethics. F. Abel and E. Boné—
again those two—played an eminent role in the foundation of this Associa-
tion. They invited the late Nicole Léry, a professor of forensic medicine in
Lyon, to take up the role as first president. She had played a very active role
in the defense of human rights against torturing practices in South American
totalitarian regimes. She was chosen because of her open view on the ethical
debate in modern societies: her main objective was to stimulate the debate
among as many denominations and disciplines as possible. In cooperation
with centers in Louvain-la-Neuve (J. F. Malherbe, the new director of this
Center, and E. Boné), London (R. Nicholson), and Maastricht (M. de Wachter,
the second president), the Association developed an international research
and communication network. “European” here was envisaged in the broad
sense of the term, that is as extending from the Atlantic to the Urals, a vision
that was realized only recently by the integration of several centers from
Eastern European Countries into the Association’s network. The goal was
and still is to promote public critical debate regarding the ethical issues in-
volved in the development of biomedical sciences in our communities.
As a result of this integrative approach, this European Association is char-
acterized by world view diversity, as it reflects different cultures. Catholics,
Protestants, Orthodox, “libre pensée,” and “neutral” centers entered into the
Association. The presence however of the Catholic and Christian Centers
remained strong, for some observers even too strong. Typical for the annual
(sometimes even two in a calendar year) meetings of the Association was
however their openness to a critical debate between all normative perspec-
tives. The first presidents (Léry from Lyon and de Wachter from Maastricht)
were committed to that goal and their successors (Schotsmans from Leuven
and Widdershoven from Maastricht) tried to strengthen this strategy even
more. At this moment, more than sixty centers from all over Europe take part

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 20 Paul T. Schotsmans

in the Association. Its multicultural orientation guarantees that the Anglo-

American approach does not dominate the development of European bio-
ethics. The Germanic, Romanic, and Eastern European cultures can thus
develop a “medical ethics” that is rather different from the Anglo-American
mainstream, even if this approach also has its place within the Association.
In particular, Principlism’s restriction to medical decision making is avoided,
and the societal and relational integration of medicine is secured. In addi-
tion, foundational philosophical approaches to bioethics were considered as
an important correction of the narrow application orientation within the
Anglo-American mainstream (as reflected in bioethics journals, conferences,
publications, etc.). All of this may justify my conclusion that if European
bioethics developed an open atmosphere of critical debate, this is mainly
due to the open mindedness of Roman Catholic scholars, like Boné, Abel,
and Verspieren. It illustrates my thesis that Christian ideas still inspire Euro-
pean bioethics today, understanding however that these pioneers are sym-
bolic for a moderate and dialogical presence of their basic Christian inspiration
in modern pluralist societies.

III. COMPARISON OF THE CHRISTIAN AND PRINCIPLIST

APPROACHES TO BIOETHICS

In order to clarify the characteristics of the Christian influence on European

Bioethics, a comparison with Principlist bioethics may be helpful.

Bioethics in the Anglo-American Tradition

The most popular and influential bioethical position in the United States
comes under the heading of “Principlism.” This position was developed by
Beauchamp and Childress in their Principles of Biomedical Ethics (see for
e.g., supra). They present four clusters of principles: (1) respect for autonomy
(a norm of respecting the decision-making capacities of autonomous per-
sons), (2) nonmaleficence (a norm of avoiding the causation of harm),
(3) beneficence (a group of norms for providing benefits and balancing benefits
against risks and costs), and (4) justice (a group of norms for distributing
benefits, risks, and costs fairly). The influence of this approach in Anglo-
American bioethics is closely linked with the leading role of the Kennedy
Institute of Ethics Center and its Bioethics Intensive Course, organized since
1974 every year in June. Many European scholars followed this course, which
may be considered an excellent introduction into Principlism. The book of
Beauchamp and Childress still functions as the textbook for this teaching
week. Where in the beginning Principlism was taken without many criti-
cisms, rather quickly this approach to making moral judgments came in for
some serious criticism, also in the Anglo-American context. Thus, according
to Clouser and Gert (1990), this “way of thinking about morality is wrong

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 Christian Bioethics in Europe 21

headed.” But Principlism is still not without its defenders: B. Andrew Lustig,
David DeGrazia, and Beauchamp and Childress themselves have all responded
to these criticisms, rejecting its supporting argumentation. In an overview of
this debate by Davis (1995), he concludes by observing that neither side in the
debate over Principlism has succeeded in carrying its case. The debate centers
clearly on the notion of a moral theory and whether Principlism is an adequate
substitute for moral theory in resolving biomedical conflicts. Although the de-
bate on Principlism is still going on, the impact of this approach remains im-
portant. In my view, it strengthens the secularization of the medical profession.
By secularization, I refer to the divorce of the profession from those values that
make health care a fully human service: medicine is more and more restricted
to a purely technical profession and does no longer invest in real encounters
with patients. An approach like Principlism flourishes therefore mainly in a
market-driven health care system, like the one in the United States.
The dominant position of the principle of autonomy is another factor that
helps to explain the success of Principlism, even in what traditionally was sub-
sumed under “medical ethics.” The principle of respect for the autonomy of
the patient indeed reflects the high priority accorded to individual autonomy
in Anglo-American casuistry; it transforms the bioethical discourse into a
discourse about “bio-law,” rather than about bioethics. It is easy to see why the
secularization of medicine feeds off of an absolute notion of patient autonomy.
When autonomy is radicalized, very little thought is given to the values that
ought to inform and guide the use of autonomy. Given such a vacuum, the
sheer fact that the choice is the patient’s tends to be viewed as the sole right-
making condition of this choice. Correctly, in my view, McCormick (1994) is
of the opinion that this trivializes human choice. Indeed, Anglo-American Prin-
ciplism has favored a development that reduces the physician to a technologi-
cal tool for the patient, conscripted to do the patient’s bidding for a price.

Christian Influences on European Bioethics

The impact of a Christianized Hippocratic tradition is still much more
significant in Europe. The concept of philia was transformed in the New
Testament concept of agapè or caritas. The Lord as healer of the sick
became the icon for all healing professions: “Come to me, all of you who
labor and are overburdened, and I will give you rest … (Mt. 11:25–30)”
The Christian tradition recognizes the physician-patient relationship as
foundational for every bioethical discourse (Godderis, 2005, 786–802; see
also Pellegrino & Thomasma, 1996).
This approach is splendidly represented in a recent report of a research
project under the Biomed II Program of the European Commission
(Rendtorff and Kemp, 1995–1998). F. Abel and his collaborator N. Ter-
ribas from the Institut Borja de Bioètica have written the introductory
presentation. The objective of this European Program was to establish

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 22 Paul T. Schotsmans

a consensus on the formulation of basic ethical principles in bioethics

and bio-law. This excellent report may help us to clarify the main ideas
in the European bioethics tradition and to illustrate how the Christian
influence cannot be ignored. 7

The concept of personhood

The first essential difference between American and European Bioethics
concerns the concept of personhood. The European vision of personhood
goes further than a minimalistic concept of the person. It not only focuses
on autonomy but also looks at the concepts of integrity, dignity, and vulner-
ability. Of special interest is the extent to which the basic ethical principles
relate to the limits of human existence and lead to a vision of the develop-
ment of civilized society and the realization of human beings in solidarity
and responsibility: “We can further argue that human beings at the edges of
life should be respected in their ‘proximity to persons’. Our treatment of
them is dependent on cultural understandings of the potential for gaining or
regaining self-awareness; the potentialities of becoming a personal being
and bonding to significant others or to society at large. The anthropological
underpinning of this conception of human being is that respect for the basic
ethical principles is used to protect the development of the human character.
Thus integrity and dignity are terms which, though not identical, are closely
linked” (I, 23).
The Christian self-understanding of theological (bio)ethics after the Sec-
ond Vatican Council (1962–5) never has claimed to be “specific” on the con-
tent of moral life. Christians refer to the dramatic experiences of all those
parents who decide about abortion and find in this a justification that abor-
tion should always be considered as an act that creates a disvalue. The same
can be said about childless parents who have to use technological innova-
tions like in vitro fertilization to realize their child wish. Even more, this is
the case for patients who request euthanasia: nonbelievers and believers are
convinced that everything should be done to avoid the request. Specifically,
Christian is essentially the motivation of the current moral directives out of
Christ and their orientation toward Christ (De Clercq, 1988, 275). Therefore,
Christian bioethicists always have fully integrated the most important philo-
sophical mainstreams. The difference with other philosophical worldviews is
the “Gesamtgestalt” of Christianity; Christians are devoted to the realization
of what they understand to be the full humanum. This commitment is their
foundational motivation and orients them to develop their value system. This
leads to a more radical and sometimes even paradoxical interpretation of the
meaning of human life. Integration of moral life and thought into personal
and social existence “in Christ” is meant to achieve a radicalization of moral-
ity (“completed justice”: Jesus’ message and promise) and may be called the
only basis of a specifically Christian “ethical competence” (De Clercq, 1988,
275–6).

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 Christian Bioethics in Europe 23

It is important to notice that the protection of the free development of the

human person is central to this Christian self-understanding. This finds its
inspiration in twentieth-century philosophical ideas: existentialist and phe-
nomenological philosophies, as developed in Germany and France, offer
anthropological premises that underlie the way in which European thought
about ethics is linked with the human person. This anthropological founda-
tion rests on a variety of philosophical inspirations: E. Husserl inaugurated
the phenomenological project; M. Heidegger, M. Scheler, H. Bergson, J. P. Sartre,
M. Merleau-Ponty, A. Camus, and many others developed existentialism;
M. Buber and E. Levinas construed a relational philosophy; and the Frankfurter
Schule contributed with an integration of the societal concerns (e.g., communi-
cative ethics). Personalist theories, linked to Christianity, intend to apply these
perspectives in a dynamic understanding of the human person (Schotsmans,
1999). This approach can be perfectly integrated in the basic Christian inspira-
tion, and it permeates therefore many Catholic movements and universities in
Western and Southern Europe today. This all makes understandable why this
kind of Christian bioethics is integrated so easily into the pluralist climate of
modern European societies: all “people of good will” worked together for a
better society in general and a more humane medicine in particular.

The physician-patient relationship

A typically European concern is also the physician-patient relationship, un-
derstood as a structural and foundational basis for bioethics and medical
ethics. This is probably linked to still vibrant traditions of professional ethos
in countries like France, Spain, Germany, and Belgium. It is also linked to
the basic mainstreams of the Judeo-Christian tradition. The healing relation-
ship is seen as an incarnation of the healing presence of Christ in our every-
day reality: “That evening, after sunset, they brought to him all who were
sick … and he cured many who were suffering from diseases of one kind or
another” (Mark 1: 29–39). It explains also why Care Ethics at the moment
plays such an important role in European bioethics: much more attention is
given to the care of chronically ill patients than to the so-called dramatic
cases of modern technological medicine (Gastmans, 2006).
European philosophers as Buber (1923) and Levinas (1974)8 (both Jewish,
but with a large influence on contemporary Christian ethics)—and also the
Protestant philosopher Ricoeur (1975)—have contributed to a deeper under-
standing of this relational structure of medicine: the medical (and nursing)
profession should be seen as a commitment and full devotion to the patient.
Even in a document that, like the Biomed Report, seeks to capture the full
range of Christian and non-Christian ethical positions in Europe, this rela-
tional commitment is clearly recognized. “In recent years there has been a
shift from medical paternalism toward respect for the will and wishes of the
patient as an independent moral agent. In understanding the relationship
between health personnel and patients, it is important to distinguish between

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 24 Paul T. Schotsmans

bioethics and bio-law. This means that a ‘friendship model’ based on close
encounters and prudential relationships between health care personnel and
patients precedes the ‘contractual rights model’ of bio-law” (I, 70). For Chris-
tian bioethics, this implies that many professionals react extremely critically
on the radicalization of autonomy: a fully ethical understanding of the medi-
cal relationship as a covenant is for them the leading orientation for develop-
ing a well-balanced ethical approach to medicine.

Solidarity as the founding value of European health care systems

By stressing the value of solidarity, European bioethics has always favored
socialized health care systems. The very idea of European civilization is founded
on the ideal of social justice, where everyone is respected in his or her human-
ity. There is no more Christian notion than this “incarnational” translation of
the prophecy of the Kingdom of God. It is a vision of a collective history to-
ward solidarity and fraternity in the creation of a civilized society. This vision
inspires them and makes Christians full members of modern societies.
Speaking from a social-ethical point of view, Christians achieve no more
than nonbelievers the majority of the time. Yet, whatever Christians do, they
do on the basis of a specific conviction and expectation, out of a yearning
for God’s reign that is already realizing itself in this world and a desire for
the ultimate coming of the Kingdom of God. The ethical realm and the ethi-
cal reality of experience thus receive an eschatological dimension that makes
it impossible for them to be understood as a form of autarchic self-realization
(De Tavernier, 1988, 298). A useful way to make this clear once again (see
our notion of the “Gesamtgestalt” earlier) is the distinction between criteria
and motives of moral action. A criterion points to what I have to do: to the
content of action; whereas a motive expresses why I am doing something.
Criteria are based on arguments, expressing a certain rationality; motives
have the character of an appeal and they address the will (De Clercq, 1988,
273).
A remarkable statement on this subject can be found once again in the
Biomed Report: “We can even say that the welfare state has changed the
contractual liberalist understanding of law, based on the social contract. Civil
law has changed into social law, leading to a broader conception of state
responsibility toward members of society. The sharp distinction between law
and morals in traditional civil law has been changed by the development of
the welfare state. The ideas of universality, liberty and fraternity are essential
principles that govern legal structures in the modern state. Thus, the liberal
credo of personal liberty and responsibility related to the specific actions of
a free individual has been replaced by state responsibility for the destiny of
a citizen” (vol. 1, 60).
The Christian ideas about justice and equal access to health care are at the
basis of a solidarity-based health care system in Europe, mostly constructed
on the idea of collective responsibility. The social network is developed in

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 Christian Bioethics in Europe 25

such a way that not only the rich and privileged but also the poor and the
unemployed may enter the health care institutions with an equal access to
standard medical treatment. This kind of solidarity, based on the dignity of
the human person, protects those human persons whose existence is threat-
ened by circumstances beyond their own control, particularly natural fate or
unfair social structures. Care services for persons who are unable to care for
themselves because of psychological handicaps, for example, or Alzheimer
disease, psychiatric disorders, or mental retardation, should have priority.
Christian social and bioethics has collaborated intensively with socialist
movements to realize this kind of humane society.
The justice of social institutions is reflected in the attempts to counter the
lack of opportunity caused by unpredictable bad luck and misfortune over
which the person has no meaningful control. To the extent that disease, dis-
ability, or injury cause considerable and significant disadvantages and restrict
a person’s capacity to fulfill or pursue his or her individual life projects, jus-
tice demands the use of public health care resources to counter these morally
arbitrary disadvantages and to restore to persons a fair chance to pursue their
life plans, given his or her talents and skills (Denier and Meulenbergs 2002).
This solidarity-based approach is incomprehensible for an ethics based on
individualism, and as I observe regularly, almost incomprehensible for Anglo-
American observers of European health care. European bioethics applies this
approach, in particular, as a kind of prevention against a too strongly market-
driven approach in health care. But of course, the enormous costs of the
welfare state also create their typical problems. Still, the issue of the alloca-
tion of scarce resources takes a radically different form, if one approaches it
from the side of solidarity, rather than from an endorsement of the market.

The concept of human dignity

Probably the most important European Christian concept is that of human
dignity (the human person as created by God in His own image). The an-
thropological mainstream, shaped by strong Germanic and Romanic influ-
ences, has preserved the Christian concept of “human dignity” as a core
concern in European bioethics and bio-law: “… the issue of dignity is fun-
damentally one of recognizing the ‘abstract nudity of humanity’ in every
human being. Even bodily decay cannot abolish the appeal to treat every-
body as ends-in-themselves with equal dignity. It is this conception of
human dignity that has become the foundation of human rights as the le-
gal instruments to protect the human person … This also includes the
extension of human rights in bio-rights for all ways and kinds of human
life. In bioethics the very essence of mankind is at stake. The need to pro-
tect human dignity is in particular present at the limits of human life,
where the human person can no longer be said to have autonomy. This
pertains to the dignity of the embryo, the dead body, handicapped new-
borns etc.” (I, 37).

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 26 Paul T. Schotsmans

To be sure, the question of what is ethically implied in the endorsement

of human dignity is also intensively debated in European bioethics. It is
therefore interesting to see how the Biomed Report tried to make a synthe-
sis. Although they admit that there are great disagreements concerning the
adequate understanding of human dignity, a substantial content of the con-
cept has been presented by this research group. They stress that human
dignity emerges as a virtue of recognition of the other in an intersubjective
relationship. Dignity is universal and indicates the intrinsic value and moral
responsibility of every human being. The person must, as a result of the in-
tersubjective understanding of dignity, be considered as being without a
price. In the light of this interpretation, the dignity of the human being as
such is not a value that can be lost. Therefore, human beings cannot be ob-
jects for trade or commercial transaction (I, 35). This synthesis coincides
perfectly with foundational Christian ideas about human dignity.
The explicit recognition of human dignity—in a Christian sense—explains
also why the European Convention on Human Rights and Biomedicine
(Council of Europe, Oviedo, 1997) radically prohibits deriving financial gain
from the human body and its parts (article 21). This concept of human dig-
nity indeed clearly shaped the Convention on Human Rights and Biomedi-
cine of the Council of Europe: its main purpose is the protection of human
dignity among present as well as future generations. It is typical for the
European approach, and in my view also for the Christian presence, that
some observers are convinced that this concept is still not clearly enough
related to the phenomenological or personalistic foundation of law: “Instead of
focusing on self-determination the Convention on Human Rights and Bio-
medicine should accept the full consequences of its anthropological presup-
positions, and found respect for the body of the human being in the notions
of integrity and dignity in order to make a clear formulation of a philosophy
of the human body and the whole living world” (I, 301).9

Summary of the Comparison

Principlism favors a procedural approach to bioethics. It accounts for the fact
of pluralism in society by leaving individuals to their own value intuitions.
European bioethics, by contrast, has accounted for such pluralism by seek-
ing to secure some at least minimal value consensus. This consensus is
strongly influenced by basic Christian anthropology, which stands for the
recognition of every human person as a multidimensional human being;
free to realize his own projects, relational in his encounters with other
human beings and fully societal in his integration in modern civilizations.
The concept of personhood here provides a basic clarification of what is
humanly desirable (“le meilleur humain désirable”, see for e.g., Ricoeur, 1975;
Opdebeeck, 2000): the striving to realize all the dimensions and relationships
has thus been recognized as the dynamic factor of all human activity.

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 Christian Bioethics in Europe 27

IV. CONCLUSION: CHRISTIANITY’S CONTRIBUTION TO

BIOETHICS AND ITS DIFFICULTIES

Presenting the main tendencies in continental European bioethics implies at

the same time a radical critique of the Principlist approach: the “Georgetown
mantra” lacks a sound ethical basis that could allow it to function adequately
so as to secure consistent ethical decision making. This is not something
new: from the early beginnings of the breakthrough of bioethics, European
medical ethicists (especially those who belonged to the Christian atmo-
sphere) remained very reluctant to integrate Principlism into their ethical
reflection. For the majority of continental European Christian bioethics, Eu-
ropean philosophy and anthropology suggested a more foundational ap-
proach: phenomenology and existentialism as historical background are
engaged for adequately addressing the ethical relevance of vulnerable pa-
tients and of the medical profession, relational philosophy for the physician-
patient relationship, and the commitment to solidarity and social justice for
the welfare state.
These inspirational traditions maintain their persuasive force and make
bioethics much more than a method for medical decision making. They help
to realize an ethical culture in medicine by situating bioethics where it really
belongs: in the heart and the middle of the relationship between the physi-
cian and the vulnerable patient. Still, observing the European scene as it
presents itself today, three main characteristics come into view that also il-
lustrate the current difficulties of Christian bioethics in Europe.
• Christian Centers of Bioethics diverge strongly in their application of moral
methodologies. A strictly normative approach is very typical for several
protestant centers (like the Lindeboom Institute in Holland), as also for the
“strict” Roman Catholic centers like the Linacre Centre in London and all
the Catholic centers following carefully the teaching of the Roman Catho-
lic Magisterium. These centers criticize strongly new reproductive tech-
nologies and euthanasia practices. Other protestant and Roman Catholic
centers follow a more dynamic approach. What realizes more values and
avoids disvalues will be classified as morally right. In that sense, they ac-
cept, for example, in vitro fertilization for the reason that it makes the child
wish of infertile couples realizable. They also support legal liberalization
of euthanasia (like in Holland and Belgium) because they accept that in
some circumstances the application of euthanasia may be the lesser evil.
The “reconciliation” of these two methodologies is almost impossible.
• This profound disagreement may eventually lead to the exclusion of
open-minded centers, so that the “really Christian” approach is narrowed
down to a purely normative approach. As can be observed, the internal
bioethical debate inside the Roman Catholic Church on the integration of
new reproductive technologies has recently become highly intense. This is

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 28 Paul T. Schotsmans

essentially due to the inquiries by Roman authorities of clinical practices

in university hospitals, linked to Catholic universities. Pertinent examples
are Leuven and Louvain-la-Neuve, where the instructions of the Magiste-
rium on in vitro fertilization are not followed. The debate is now going on
if these universities may keep their label of “Catholic” universities, while
practicing in vitro fertilization, prenatal diagnosis, etc. In June 2007, the
leaders of these universities were invited to Rome and asked to explain
why they did not obey Roman instructions. At this specific moment (Sep-
tember 2008), everyone is waiting for the official report of these investiga-
tions by the Roman authorities. It cannot be stressed strongly enough that
the result of these discussions will function as an essential factor deciding
about the future presence of more “open-minded” Catholic universities in
the academic world.
• Market mechanisms are slowly invading the European health care system.
This is also a consequence of the growing success of Anglo-American in-
fluences, which mainly stresses a utilitarian approach to health care ethics
and a radicalized interpretation of the principle of respect for autonomy.
As mentioned above, the translation of this principle of autonomy into
a right to self-disposal (see for e.g., the publications of H. Leenen in
Holland) lies at the basis of very liberal legislations on abortion, artificial
reproduction technologies, euthanasia, etc. This is certainly true for the
Low Countries, where the “right to self-disposal of life and body” has been
the starting point of the legislation on euthanasia.10
These evolutions will certainly become stronger. The Christian character of
several European countries (certainly in the North) diminishes. The main Chris-
tian players in the European network are getting older (like Abel), some of
them (like Boné in 2006) died. They incarnated a strong Christian influence on
the bioethical debate in Europe. At the same time fortunately enough, one can
observe that several young and new players in the field took care of a kind of
revival of the Christian influence, like in Care Ethics (Van Laere and Gastmans,
2007). But still, the challenge of a secular society and of the integration of Christi-
anity in pluralism is very high and may become the real landmark of the future.

NOTES

1. To be sure, in the United States, eminent Christian scholars like Richard McCormick, James
Gustafson, or Charles Curran have enriched bioethics by their fundamental moral philosophical and
theological backgrounds. They had a great influence on bioethical debates in the Christian communities
all over the world. But America’s main bioethical influence in Europe was a secularizing one, as linked
to the work of Beauchamp and Childress (1st ed., 1974, 6th ed., 2009).
2. Zbigniew Szawarski from the Institute of Philosophy at the Warsaw University in Poland de-
scribes his experience in the Hastings Center as follows: “I think that the Hastings Center is the best place
in the world to learn this bioethical culture. It seems to me that the most valuable thing that foreign visi-
tors with other social and political traditions may learn here is the art of creative cooperation among

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 Christian Bioethics in Europe 29

people with different moral, religious, political and professional backgrounds. And this is great.” (Hast-
ings Center Report 1988: 18, Number 3: cover page). The Institute for Health Ethics of Maastricht in the
Netherlands (with Maurice de Wachter as Director) published in the eighties several bioethical contribu-
tions in line with the ideas of Beauchamp and Childress: see for example de Wert and de Wachter (1980),
Magi k uw genenpaspoort? (May I Have Your Gene Passport?).
3. The Journal of Medical Ethics started in 1975 and followed closely the developments in the United
States. In his editorial on twenty years Journal of Medical Ethics, the editor in chief Raanan Gillon describes
how the journal should remain free from religious influences: this entails “a transdisciplinary embrace of
any reasoned viewpoint, regardless of its provenance” (Journal of Medical Ethics 1995; 21: 3–4, 3).
4. Several bioethics centers in Holland (like the ones at the Universities of Rotterdam and Amster-
dam) also imported Principlism into the European scene (see for e.g., Heleen Dupuis, the first academic
professor in bioethics of Holland, and the health care law expert H. Leenen who translated the respect
for the principle of autonomy of the patient not only as self-determination but also as a “right to self-
disposal”). They thus laid the groundwork for legislation on abortion and euthanasia in the Low Countries
(see Leenen, 1988, Handboek Gezondheidsrecht).
5. Edouard Boné was the secretary of the Catholic Schools of Medicine Network inside the Inter-
national Federation of Catholic Universities. He prophetically observed that bioethics was one of the main
concerns for that intercontinental network, as it pursued the dialogue with the Roman Magisterium.
6. In 1985, I was for the first time invited to assist such a meeting in Milano (with John Mahoney,
John Collins Harvey, Richard McCormick, Francesc Abel, and Cardinal Martini) to discuss the ethical im-
plications of the abortion of anencephalic babies.
7. We will therefore refer to this publication by simply mentioning the volume and the pages.
8. As no one else, Levinas was capable of philosophically clarifying the healing relationship. In his
second major work, Autrement qu’être (1974), Levinas affirms … that the “one is keeper of his brother”
… When Cain asks after the murder of his brother “Am I my brother’s keeper? (Gen. 4, 9),” we must
understand this literally: we are already (by God) thus linked with each other that we owe it to each other
to link ourselves—actively and creatively—to the other (Burggraeve, 2008, 1–22, 4).
9. The editors of this volume refer to their personal critical remarks on the Convention.
10. The Belgian Advisory Committee on Bioethics developed four options in their first opinion on
Euthanasia Legislation (1997): the first and the second one were purely based on the principle of “self-
disposal.” The majority in the Belgian Parliament has followed these options in the final redaction of
the Law. See the Web site of the Belgian Advisory Committee on Bioethics (www.health.fgov.be/bio-
eth). See also the publication of Schotsmans and Meulenbergs (2005) on Euthanasia and Palliative Care
in the Low Countries, essentially the chapter on the comparison of the Dutch and the Belgian Eutha-
nasia Act (Adams & Nys) and the one on “The Sanctity of Autonomy?” by Meulenbergs and
Schotsmans.

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