Christian Bioethics, 23(3), 219–233 2017

doi:10.1093/cb/cbx009

Created in the Image of God: Bioethical

Implications of the Imago Dei

MARK J. CHERRY*
St. Edward’s University, Austin, Texas, USA

*Address correspondence to: Mark J. Cherry, PhD, St. Edward’s University, 3001
South Congress Avenue, Austin, TX 78704, USA. E-mail: markc@stedwards.edu.

Reference to the Imago Dei expresses a foundational relationship between

God and man, with implications for properly appreciating basic human
goods and human flourishing, which in turn have repercussions for
appropriate medical decision-making. Although this theological theme is
often invoked as if its meaning and implications are evident and clear,
they are not. What does it mean to be created in the image of God? And,
what are the implications of that meaning for central questions in bio-
ethics? The authors in this issue of Christian Bioethics consider the ways
in which foundational, and at times very different, understandings of
being created in the image of God lead to particular understandings
of appropriate biomedical moral choice. This essay draws on the theo-
logical reflections of Saint Basil and Saint Maximos, among others, to
set our reflections regarding the Imago Dei within the recognition that
Christian bioethics must be grounded in the Church’s mystical experi-
ence of God and work to orient us towards Him. Approached correctly,
medicine can play an important role in one’s life, but secular goals
should not undermine Christian moral truths, and medical care must
not replace Christian spiritual therapy for the soul.
Keywords:  abortion, Christian bioethics, gender reassignment surgery,
Image of God, Likeness of God, Imago Dei

I. INTRODUCTION

How can one appreciate the cardinal elements of human flourishing that
ought to shape medicine and provide content to Christian bioethics? How
should one demonstrate the proper role of medicine in a Christian life, or
make appropriate medical judgments in hard cases at the edges of life and

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 220 Mark J. Cherry

death? Answers to these fundamental and pressing questions depend in large

measure on the relationship between human goods and God’s commands.
The authors in this issue of Christian Bioethics explore these foundational
concerns through the lens of Genesis 1:27: “So God created man in His own
image, in the image of God He created him; male and female He created
them.” The Imago Dei expresses a foundational relationship between God
and man, with implications for properly appreciating basic human goods
and human flourishing, which in turn have repercussions for medical deci-
sion-making. However, although this theological theme is often invoked as if
its meaning and implications are evident and clear, they are not. What does
it mean to be created in the image of God? And, what are the implications of
that meaning for central questions in bioethics?
Some commentators argue that being created in the “image of God” is best
understood in terms of constitutive “natural” human capacities (e.g., rational-
ity, compassion, relationality); others urge that this Biblical statement is bet-
ter appreciated in terms of appropriate spiritual orientation (e.g., the basic
human freedom to respond to God’s love); still others have construed this
theme primarily in terms of specific human responsibilities to exercise appro-
priate “dominion” as stewards of God’s creation.1 Vladimir Lossky’s overview
of the Imago Dei in the Church Fathers, for example, reveals a tapestry of
applications, each of which provides insight into basic characteristics of our
shared humanity. Sometimes the image of God is understood through man’s
dominion over the natural world: it “. . . is sought in the sovereign dignity
of man, in his lordship over the terrestrial world” (Lossky, 1957, 115). Other
times it is seen in particular aspects of our being: “in his spiritual nature, in
the soul, or in the principle, ruling . . . part of his being, in the mind . . . in
the higher faculties such as the intellect, the reason . . . or in the freedom
proper to man, the faculty of inner determination . . . by virtue of which man
is the true author of his actions” (Lossky, 1957, 115). The focus sometimes
regards specific qualities of the soul: “. . . its simplicity or its immortality, or
else it is described as the ability of knowing God, of living in communion
with Him, with the possibility of sharing the divine being or with the indwell-
ing of the Holy Spirit in the soul” (Lossky, 1957, 115). Other times, as with St.
Macarius of Egypt, Lossky notes that the Imago Dei is identified with the for-
mal condition of free will and human liberty, embodied in the faculty of free
choice (Lossky, 1957, 115), or “that communion with God, whereby before
the fall man was clothed with the Word and the Holy Spirit” (Lossky, 1957,
116). According to Lossky, Saints Irenaeus, Gregory of Nyssa, and Gregory
Palamas identify the image of God as a characteristic of both body and the
soul: “. . . not only the soul, but also the body of man shares in the charac-
ter of the image, being created in the image of God. ‘The word Man,’ says
St. Gregory Palamas, ‘is not applied to either soul or body separately, but to
both together, since together they have been created in the image of God’”

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 Bioethical Implications of the Imago Dei 221

(Lossky, 1957, 116). In each case, these Saints and Fathers of the Church are
grappling with the inadequacy of human language to convey central ele-
ments of our created human nature and our relationship with God.
The authors in this issue of Christian Bioethics consider the ways in which
foundational, and at times very different, understandings of being created
in the image of God lead to particular understandings of appropriate bio-
medical moral choice, resulting in divergent substantive and methodological
emphases. John Kilner and Brad Mellon, for example, approach such con-
cern through a Protestant biblical account, arguing that Christ must be under-
stood as the ideal of God’s image and as the moral and spiritual standard to
which persons ought to conform. With that shared Christological emphasis,
they reject efforts to equate the image of God in individuals with the current
presence or absence of particular traits or capacities, arguing instead that all
humans enjoy equal status before God. Mary Jo Iozzio draws our attention
to the Roman Catholic tradition of liberation theology and its reflections
regarding the preferential option for the poor to offer insight into how the
Imago Dei should illuminate and transform medical treatment of persons
with disabilities. Bryan Pilkington works to lay out the bioethical implica-
tions of the Imago Dei for appreciating what is often termed “human dignity.”
B.  Andrew Lustig analyzes the links often drawn between image/likeness
language and appeals to “human dignity,” a term widely invoked in both reli-
gious and secular debates. In addressing that linkage, he questions whether
faith-based claims about human dignity based on image/likeness language
function independently of other principles and norms, and whether such
claims require greater specification to be practicable. Nonetheless, Lustig
concludes his contribution with this observation: “appeals to human dignity,
following directly from the affirmation of being made in the ‘image of God,’
may contribute to a deeper respect for what is at stake in the profound mat-
ters at issue in bioethical debates” (Lustig, 2017, 331). Together, these authors
lay out a theological geography of the meanings and uses of being made in
the image and likeness of God and their implications for Christian bioethics.

II. CHRISTIAN MEDICINE AND THE IMAGO DEI

Vladimir Lossky appreciated that “The perfection of man does not consist
in that which assimilates him to the whole of creation, but in that which
distinguishes him from the created order and assimilates him to his Creator”
(Lossky, 1957, 114). Humans are created to worship God and to come to
know Him. This central reality of Christian moral anthropology frames all of
Christian life. Applied to medicine, for example, it calls Christians to recog-
nize that medical interventions cannot be sufficiently evaluated if one only
regards bodily functions, pain, and suffering within an immanent horizon of
human needs and interests; a transcendent focus is also essential. “For what
shall it profit a man, if he shall gain the whole world, and lose his soul”

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 222 Mark J. Cherry

(Mark 8:36). Christians have long appreciated that medicine is permissible,

and its use is generally to be encouraged, so long as it does not involve sinful
choices or actions, or otherwise impede one’s relationship with God.
St. Basil the Great (AD 329–379), for example, reminds Christians that
medicine is a gift from God:
Each of the arts is God’s gift to us, remedying the deficiencies of nature . . . And,
when we were commanded to return to the earth whence we had been taken and
were united with the pain-ridden flesh doomed to destruction because of sin and,
for the same reason, also subject to disease, the medical art was given to us to relieve
the sick, in some degree at least. (St. Basil, 1962, 330–1)
Although suffering can, appropriately understood, help us learn to control
our passions, to repent, to love others unselfishly, and to love God, St. Basil
concludes that even the control of pain and distress can be important goods.
He notes approvingly that “. . . with mandrake doctors give us sleep; with
opium they lull violent pain” (St. Basil, 1994, 78). Yet, he still warns that “To
place the hope of one’s health in the hands of the doctor is the act of an irra-
tional animal” (St. Basil, 1962, 331). Medicine is an important human good,
but neither it nor the pursuit of any other earthly goods should replace faith
in God and obedience to His commands.
Moreover, as St. Maximos reminds us, it is often the distortion of human
goods, rather than the goods themselves, which is sinful. “It is not food that
is evil but gluttony, not the begetting of children but unchastity, not material
things but avarice, not esteem but self-esteem. This being so, it is only the
misuse of things that is evil” (St. Maximos, 1981, 83). This is why St. Basil for-
bids “whatever requires an undue amount of thought or trouble or involves
a large expenditure of effort and causes our whole life to revolve, as it were,
around solicitude for the flesh . . .” (St. Basil, 1962, 331). Medicine should not
become an all-encompassing endeavor. For example, working to save life at
all costs, obsessive plastic surgery in search of the “perfect figure,” as well as
excessive or inappropriate usage of reproductive medicine, all risk turning
the desires of this life and the ministrations of medicine into idols. Nota bene:
It can indeed be appropriate to save life, to obtain corrective plastic surgery,
or to seek medical assistance with reproduction; again, it is the distortions of
such goods, not the goods themselves, which can become sinful.
The same is true if excessive emphasis is placed on the achievement of
political goals through medicine. St. Maximos notes:
There are many people in the world who are poor in spirit, but not in the way
that they should be; there are many who mourn . . . many are gentle, but towards
unclean passions; many hunger and thirst, but only to seize what does not belong
to them and to profit from injustice; many are merciful, but towards their bodies
and the things that serve the body; many are pure in heart, but for the sake of self-
esteem; many are peace-makers, but by making the soul submit to the flesh; many
are persecuted, but as wrongdoers; many are reviled, but for shameful sins. Only

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 Bioethical Implications of the Imago Dei 223

those are blessed who do or suffer these things for the sake of Christ and after His
example. (St. Maximos, 1981, 90)

The political aim to create equality in this life or social justice for all can eas-
ily lead one astray, especially if one loses one’s primary focus on God.
For example, as Genesis 1:27 makes clear, being made male and female is
central to God’s creation of humanity: “male and female He created them.”
Consequently, traditional Christianity recognizes the deep sinfulness of reject-
ing one’s sex in favor of gender reassignment surgery. Sex differences are
deeply rooted in our biology; they are real and consequential aspects of our
creation. Men and women have importantly different biological natures, giv-
ing rise to natural distinctions in underlying psychologies, interests, talents
and family roles. Although there will always exist variations along a normal
distribution of sex characteristics, the most fundamental human passions
(such as sex, nurturing, and aggression) manifest themselves differently in
men and women (see Cherry, 2016).
As early as AD 325 at the First Council of Nicaea, the Church promul-
gated canons prohibiting the practice of voluntary, non-medically indicated
castration:
If anyone has been operated upon by surgeons for a disease, or has been excised
by barbarians, let him remain in the clergy. But if anyone has excised himself when
well, he must be dismissed even if he is examined after being in the clergy. And
henceforth no such person must be promoted to holy orders. But as is self-evident,
though such is the case as regards those who affect the matter and dare to excise
themselves, if any persons have been eunuchized by barbarians or their lords, but
are otherwise found to be worthy, the Canon admits such persons to the clergy. (Sts.
Nicodemus and Agapius, 1957, 163)

Persons are to master their passions rather than mutilate their bodies as a
physical shortcut. Castration could be licitly performed only if it were neces-
sary to save the life and health of the individual:
For precisely as the first Canon of the Council held in Nicaea does not punish those
who have been operated upon for a disease, for having the disease, so neither do
we condemn priests who order diseased men to be castrated, nor do we blame lay-
men either, when they perform the operation with their own hands. For we consider
this to be a treatment of the disease, but not a malicious design against the creature
or an insult to creation (canon 8, First and Second Regional Synod). (Sts Nicodemus
and Agapius, 1957, 465)

Castration that results from rejection of one’s creation as male (or the anal-
ogous surgical alterations to accommodate rejection of one’s creation as
female) is mutilation that inappropriately rejects the fundamental sexual
nature of God’s creation. As with all human goods, medicine must be placed
within the Christian life and understood in terms of the struggle towards
salvation.

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 224 Mark J. Cherry

III. REPRODUCTIVE MEDICINE, ABORTION, AND EUGENIC IMPULSES

Consider, for example, the way in which reproductive medicine has taken on
a central social role, with a strong political valence. On the one hand, access
to assisted reproductive services, often at tax-payer expense, have come to
be judged as central to civil rights and moral equality.2 Many perceive the
failure to provide such services to homosexual couples and single women
as unjust discrimination.3 Civil rights law and court decisions have been
specifically crafted to forbid Christians from refusing to assist homosexual
couples and single women with fertility treatments on religious grounds.4 On
the other hand, other elements of reproductive medicine seem to embrace
as their primary function the avoidance of the birth of any child that is less
than fully desirable. Prenatal testing and abortion, for example, have become
central to the achievement of political goals to remove particular forms of
disease and disability from the population.
There is real social pressure to ensure that children are free from any
significant mental or physical disabilities. A  disabled child consumes pub-
lic and private resources, impacts on career and financial goals, while also
being at odds with a secular moral ethos that accents control over one’s
lifestyle. Consequently, as Christian Bioethics has documented in the past,
secular bioethics encourages a reproductive ethos of “responsible parent-
ing”, which holds that responsible parents ought to choose carefully when
to become parents and of which children (Lastochkina, 2013; Cherry, 2015).
This reproductive ethos normalizes not only contraception to control when
to have children and medical selection of embryos for desirable traits through
assisted reproductive technology, but also prenatal diagnosis and selective
killing in utero of children with a likelihood of disabilities or undesirable
genetic characteristics.5
As Mary Jo Iozzio argues in this issue, such initiatives continue to kill large
numbers of children:
While eugenics may not be institutionalized with anything like an official position, it
holds normative ideological power and is practiced widely in reproductive medicine
and the selective abortion of fetuses; it has become commonplace under the cloak of
routine prenatal genetic testing – from the 10th to 20th week of pregnancy, chorionic
villus sampling, amniocentesis, and/or maternal serum screening to detect chromo-
somal and/or genetic variance (in the US, pregnancy termination rates following a
diagnosis of Down Syndrome range from 67-92 percent). (Iozzio, 2017, 242; see also
Mansfield et al., 1999; Natoli et al., 2012)

When states encourage abortion, or otherwise discourage the births of spe-

cific groups of individuals, such actions strongly suggest a eugenic motive.
Consider Denmark, for example, which instituted routine prenatal screen-
ing for Down’s syndrome in 2006 as a so-called “public health initiative”;
other European countries, including France and Switzerland, followed suit.

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 Bioethical Implications of the Imago Dei 225

Denmark’s stated goal was to remove Down’s syndrome from its population.
The data demonstrate that putting this policy into practice has reduced the
number of children born with Down’s Syndrome (Ekelund et al., 2008).6 One
should note, however, that there is no medical cure for Down’s syndrome;
eliminating it from the population requires aborting all children who test
positive for Down’s (Lindeman, 2015). Policy proponents depict such dis-
abilities as a tragic state that justifies termination of the pregnancy, even in
cases where the couple would like to keep the child ( Jesudason and Epstein,
2011, 541).
Other aspects of reproductive medicine look strikingly eugenic as well.7
Sonia Suter, for example, notes that while today’s policies and practices are
“. . . not identical to the eugenics of yesteryear, many of the same impulses
and drives exist today; most notably, the desire to improve the human spe-
cies and our children though reproductive choices” (Suter, 2007, 969). Here
one might consider, for example, selective breeding practices, such as those
encouraged through gamete donation. Maxwell Mehlman documents that the
Genetics & IVF Institute collects the following personal information about
egg donors for potential purchasers:
. . . adult photos, childhood photos, audio interviews, blood type, ethnic back-
ground of donor’s mother and father, height, weight, whether pregnancies have
been achieved, body build, eye color, hair color and texture, years of education and
major areas of study, occupation, Scholastic Aptitude Test (SAT) scores and grade
point averages, special interests, family medical history, essays by donors, and per-
sonality typing based on the Keirsey test, which uses a Jungian approach to classify
temperaments . . . (Mehlman, 2011, 222–3)

He notes, similarly, that California Cryobank, Inc. provides sperm purchas-

ers with a 26 page profile on each donor (Mehlman, 2011, 223). As already
noted, other examples of selective breeding practices include prenatal test-
ing for undesirable DNA profiles, such as Down’s syndrome, or various ill-
nesses, including infection with the Zika virus (Ali et al., 2017), followed by
abortion for those children who test positive. Similar concerns can be raised
regarding in vitro fertilization services with preimplantation genetic diagno-
sis of fertilized embryos and the destruction of those embryos not chosen
for gestation.
Sexual activity and reproductive preferences have been demoralized into
private lifestyle choices.8 No longer does the dominant culture of the West
recognize the unbroken understanding of traditional Christianity to place all
carnal sexual activity within the relationship of husband and wife.9 Because
of God’s blessing of the marriage of man and woman, heterosexual marriage
provides the remedy for sexual passions and desires that would otherwise be
misdirected.10 Steeped in the permissive contemporary culture, it is difficult
to appreciate that the union of husband and wife is the uniquely appropri-
ate locus for reproduction or that utilizing donor gametes inappropriately

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 226 Mark J. Cherry

involves a third-party in the reproductive relationship of husband and wife

(see Engelhardt, 2000, chapter 5).11 Indeed, men and women have generally
lost sight of the importance of having and raising godly children. As St. John
Chrysostom summarized, “Hear this, ye fathers bring up your children with
great care ‘in the nurture and admonition of the Lord.’ (Eph. Vi) . . . Let us
bestow great care upon them, and do everything that the Evil One may not
rob us of them” (Chrysostom, 2004b, 436–7).12
There appears to have been a large scale abandonment of the religious
view that parents are called to reproduce and trust in God for the protection
of their families.13 Where Christian families appreciate that children are not
just another accoutrement of one’s particular lifestyle preferences, the back-
ground secular culture has lost any appreciation of abortion as the murder of
a child in the womb much less, as Iozzio rightly notes, recognition that each
child is created in the image and likeness of God.

IV. HUMAN DIGNITY, PROTECTION OF THE WEAK AND DISABLED,

AND OBEDIENCE TO CHRIST

The next brace of articles turns the reader’s attention to the ways in which the
Imago Dei shapes Christian perspectives on bioethics and medical decision
making. John Kilner argues that recognition that humans have been made
in the image of God radically transforms how Christians ought to address
and resolve bioethical challenges, the bioethical positions Christians ought
to hold, and the degree to which we ought to engage in such challenges.
Brad Mellon exhorts medical decision makers to see, even in the profoundly
mentally disabled, persons who are deserving of care, love, and dignity.
Bryan Pilkington’s explicit connection between being made in the image of
God and concerns for human dignity leads him to conclude that simply sup-
porting patient autonomy is insufficient. Physicians and others must guide
patients towards appropriate medical choices that honor the image of God.
Kilner argues, for example, that Christians should approach the world
neither as utilitarians nor as isolated individualists; instead, they are called to
emulate Christ in obedience to God:
Utilitarianism’s weakness is not its concern for utility (benefit). Rather, its flaw is to
reduce everything to benefit, thereby leaving out of account such bioethically impor-
tant considerations as people’s creation in God’s image. Similarly, individualism’s
weakness is not its concern for personal fulfillment. Rather, its flaw is in failing also
to require loving one’s neighbor as oneself and, especially, loving God – following
the standards Jesus set for all bioethical thinking (Matt. 22: 37–40), a standard that
puts God’s intentions for humanity front and center. (Kilner, 2017, 277)

As Kilner notes, Christianity has long settled judgments on a wide variety

of medical issues, including abortion, infanticide, and euthanasia: “All living
human embryos, fetuses, and born human beings, regardless of disabilities

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 Bioethical Implications of the Imago Dei 227

fatal or otherwise, then, are created in God’s image” (Kilner, 2017, 277).
This means that human embryos cannot be produced and destroyed for the
sake of research, nor tested and discarded in the name of assisted reproduc-
tion; that we should not limit access to lifesaving treatment simply because
individuals are older or disabled; and that individuals may not be killed
whether through assisted suicide or euthanasia. At the same time, he argues,
Christians should recognize their obligations to put forth positive compas-
sionate messages: not merely to be against abortion, but to support children
and to promote adoption; not simply to oppose human embryo experimen-
tation, but to advocate other forms of medical research that are appropriate
to help treat suffering people, and so forth.
Brad Mellon’s response to Kilner works readers carefully through a detailed
analysis of several clinical ethics case studies that involve medical decision-
making for disabled individuals. Drawing carefully on biblical analysis,
Mellon argues that one ought to appreciate that the image of God in human
beings is distinct from any particular human characteristics, such as suffi-
cient intelligence, reason or rationality. All humans, he concludes, “including
those with disabilities, enjoy an equal status before God and the church”
(Mellon, 2017, 295). It is not possible to damage or destroy the Imago Dei
in human beings. This means that “involuntary eugenic sterilization, denial
of life prolonging treatment (especially for newborns), and euthanasia” are
deeply sinful practices that straightforwardly deny the importance and worth
of such individuals (Mellon, 2017, 285). “Individuals with disabilities are to
be included and cared for as full human persons because they are fully in the
undamaged image of God” (Mellon, 2017, 295). Mellon recognizes, however,
that while we are commanded not to kill, we are not always obliged to save.
So, while Christians should neither engage in nor promote assisted suicide or
euthanasia, when patients are terminal and in the immanence of death it may
be appropriate to permit a natural death “once superordinate medical treat-
ments become futile” (Mellon, 2017, 295). Even the goals of saving human
life and reducing suffering must be placed within a proper Christian orienta-
tion towards God. All must face human finitude; all must eventually stand
before the dread judgment seat of Christ.14 But, killing the weak, the dying,
or disabled (even at their own request) utterly fails to recognize the image
of God within them, and similarly fails to respect their basic human dignity.
Drawing on the rich Roman Catholic tradition, Pilkington (2017) works
carefully through three central theological concerns—conformation, trinity
and vocation—to add depth to our understanding of human dignity and its
bioethical implications. Conformation is an aspirational concept: having been
conformed to the image of God, we must strive to orient our lives towards
Christ and to be like Him. We are similarly called, he argues, to share in the
Trinitarian love of God. This teleological orientation calls us to “collaborate
in God’s creative work,” to develop our relationships with others and with
God. We should not encourage others or support them in evil choices, even

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 228 Mark J. Cherry

if such decisions are autonomously made. The source of human dignity is

precisely that we are created in the Imago Dei; all of humanity is united in
Christ, and thus should not be degraded or humiliated. As Christians, love of
God and love of others ought clearly to inform and shape our treatment of
ourselves and others, especially, he argues, protection of the weakest against
routine attacks on human life.
Finally, B. Andrew Lustig, in a broad overview of Roman Catholic, Protestant,
and Orthodox Christian perspectives, considers how “image” and “likeness”
language functions within the central sequence of salvation history: Creation,
Fall, and Redemption. Given different perspectives on the nature of the Fall
and its effects, various interpretations of image and likeness assess the effects
of redemptive grace through the saving acts of Christ in somewhat (or mark-
edly) different terms, depending on their accounts of which attributes of
God are “imaged” in humanity, the scope of “human nature” and its “natural”
capacities, and the possibilities of restoring or renewing the image/likeness
in the wake of Original Sin. Lustig then rehearses the possible implications
of different understandings of image/likeness themes for Christian living and
normative practice. In that discussion, he explores how various construals of
human image or likeness to God offer useful examples of the ways that fun-
damental theological themes play out in the moral life, both methodologi-
cally and substantively. For example, image/likeness language might clarify
what is at stake in matters of moral discernment and ethical judgment and
function primarily at the level of character and virtue. Alternatively, that
language may undergird deontological judgments, either proscriptive or pre-
scriptive, about particular choices and actions. Lustig analyzes the links often
drawn between image/likeness language and appeals to “human dignity,”
and considers whether faith-based claims concerning humans being made in
the image and likeness of God in Christian ethics in fact function indepen-
dently; that is, without further specification in terms of other, perhaps more
determinative, principles and norms.

V. CONCLUSION

As the essays in this issue of Christian Bioethics illustrate, because medi-

cine promises to ameliorate the challenges of sexuality, reproduction, suf-
fering and death, it has become a commanding good, usually articulated
solely in terms of the immanent concerns of this world. As a result, the
contemporary culture has come to affirm basic rights to autonomy driven
health care, including extensive access to assisted reproductive technol-
ogy, prenatal testing, as well as abortion on demand and is now moving
toward affirming basic rights to physician-assisted suicide and voluntary
active euthanasia. The secular culture accepts such practices because it
has demoralized all such choices to issues of lifestyle and death-style
decision-making (Cherry, 2016; Engelhardt, 2017). Patients are appreciated

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 Bioethical Implications of the Imago Dei 229

as in authority to define the right, the good, and the virtuous for them-
selves. Indeed, at times, physicians appear as little more than technicians
whose social role requires assisting patients in developing and supporting
their own self-pleasing lifestyle choices.15 Reference to any underlying or
foundational moral law, much less obedience to God or recognition of the
Imago Dei, has been swept away. Such secular bioethical impulses, how-
ever, must be resisted.
Christianity is not a set of philosophical principles, an interpretation of
historical texts, or a particular set of values, much less is it a progressive
political agenda. Instead, Christianity is an encounter with God Himself. As a
result, Christian bioethics must be grounded in the Church’s mystical experi-
ence of God and work to reorient us towards Him. Although we must use
philosophical and theological language to shape persuasive arguments to
explain and defend Christian morality, to carve out social space for Christian
life and medicine, as well as to draw people into conversion, we must always
recognize that rendering Christianity, and by implication Christian bioethics,
into an academic research program ultimately misses the mark. As Patriarch
Bartholomew stresses:
Therefore we do not engage in idle talk and discuss intellectual concepts which do
not influence our lives. We discuss the essence of the Being Who truly is, to Whom
we seek to become assimilated by the grace of God, and because of the inadequacy
of human terms, we call this the image of the glory of the Lord. Based on this image,
and in the likeness of this image, we become “partakers of the divine nature” (2 Pet
1:4). We are truly changed . . . (Bartholomew, 1997)

Christianity is not a set of conceptual and theoretical conversations. As

Engelhardt puts it: “Grace is the uncreated energies of God Himself”
(Engelhardt, 2000, 199). We must first come to know God, so as to know the
content and meaning of His commands. As St. Symeon the New Theologian
noted: “The Holy Ghost is spoken of as a key because through Him and
in Him we are first enlightened in mind. We are purified and illuminated
with the light of knowledge; we are baptized from on high and born anew
(cf. Jn 3:3, 5) and made into children of God” (St. Symeon, 1980, 343–4).
Our moral arguments and bioethical analyses will always be insufficient
fully to capture the essential reality of Christianity’s encounter with the one
true God. Yet, as Saint Basil reminds us, Christian medicine and Christian
bioethics ought to be shaped with full recognition of God’s commands and
the rightly oriented Christian life. Approached correctly, medicine can play
an important role in one’s life, but secular goals should not undermine
Christian moral truths, and medical care must not replace Christian spiritual
therapy for the soul.16

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 230 Mark J. Cherry

NOTES

1. Thomas Aquinas, for example, associates being created in the image and likeness of God with
human rationality or intelligence: “The first stage is man’s natural aptitude for understanding and loving
God, an aptitude which consists in the very nature of the mind, which is common to all men. The next
stage is where a man is actually or dispositively knowing and loving God, but still imperfectly; and here
we have the image by conformity of grace. The third stage is where a man is actually knowing and loving
God perfectly; and this is the image by likeness of glory” (Aquinas, 1948, I.93.4).
2. The Ethics Committee of the American Society for Reproductive Medicine concluded, for exam-
ple, that fertility programs have an ethical duty to provide equal access to treatment for same-sex couples:
“As a matter of ethics, this Committee believes that the ethical duty to treat persons with equal respect
requires that fertility programs treat single persons and gay and lesbian couples equally to heterosexual
married couples in determining which services to provide” (Ethics Committee of the American Society for
Reproductive Medicine, 2013, 1526).
3. The American College of Obstetricians and Gynecologists asserted, for example: “Allowing
physicians to discriminate on the basis of sexual orientation would constitute a deeper insult, namely
reinforcing the scientifically unfounded idea that fitness to parent is based on sexual orientation, and,
thus, reinforcing the oppressed status of same-sex couples” (American College of Obstetricians and
Gynecologists, 2007; reaffirmed 2013).
4. In 2008, the California Supreme Court ruled in North Coast Women’s Care Group v. Benitez, 44
Cal. 4th 1145 (2008), that refusing to provide assisted reproductive medicine to a lesbian couple based on
the physician’s religious views violated state law.
5. “Prenatal screening using non-invasive methods (e.g., ultrasound scanning, maternal serum
screening) and genetic testing following invasive methods for obtaining fetal material (amniocentesis,
chorionic villus sampling or fetal biopsy) to detect genetic conditions or fetal anomalies have become
routine elements of reproductive medical care. They are framed as normative reproductive health prac-
tices allowing parents to avoid the birth of an affected child through ‘therapeutic abortion,’ or to prepare
for the child’s birth” (Kelly, 2009, 81; see also Jacobs et al., 2016).
6. Ekelund et al. document that their testing policy resulted in approximately half of the usual num-
ber of babies born with Down Syndrome: “Even before full implementation of the policy for combined
risk assessment during the first trimester in Denmark, the number of infants born with Down’s syndrome
decreased by about 50% and the number of cases diagnosed prenatally increased by about 30%” (Ekelund
et al., 2008, a2550).
7. Francis Galton defined the term “eugenics” as “the science of improving stock, which is by no
means confined to questions of judicious mating, but which, especially in the case of man, takes cogni-
zance of all influences that tend in however remote a degree to give to the more suitable races or strains
of blood a better chance of prevailing speedily over the less suitable than they otherwise would have had”
(Galton, 1883, 24).
8. Here one might consider the recent issue of Teen Vogue that provided detailed instructions on
how to engage in anal sex. See Engle (2017).
9. As Father John Breck notes, sexual activity involves human passions that have ontological and
spiritual significance.

If we have insisted so adamantly on this point, it is because of its implications for the realm of sexual behavior. Most
basically, if gender and its sexual expression have neither ontological nor spiritual significance, then sexual behavior is
limited to earthly life, with no eternal consequences. In such a case, sexual morality would be a psychological or socio-
logical issue, not a theological one. On the other hand, if the sexes are ontologically equal and complementary, sharing
a common nature yet reflecting in ways appropriate to their specific gender the beauty and perfection of the divine
nature, then sexual conduct impacts directly on the person’s growth toward the likeness of God. Orthodox Tradition
unquestionably holds the latter to be the case. (Breck, 1998, 87)

All sexual activity outside of the union of husband and wife is misdirected and falls short of the mark. It
is sinful in turning towards and affirming one’s passions rather than orienting one towards the pursuit of
God and holiness.

10. As St. John Chrysostom argues in his commentary on Colossians, sexual pleasure in marriage is
an appropriate direction of one’s passions. “And how become they one flesh? As if thou shouldest take
away the purest part of gold, and mingle it with other gold; so in truth here also the woman as it were
receiving the richest part fused by pleasure, nourisheth it and cherisheth it, and withal contributing her

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 Bioethical Implications of the Imago Dei 231

own share, restoreth it back a Man. And the child is a sort of bridge, so that the three become one flesh,
the child connecting, on either side, each to other” (Chrysostom, 2004b, 319).
11. As H. Tristram Engelhardt Jr. notes, for example, “Misdirected sexual activity does spiritual harm,
even if in some sense involuntary, because passion has a compelling force . . . Traditional Christianity
recognizes sins that are ‘involuntary’ and ‘of ignorance’. Even if there were illicit sexual behaviors that are
‘genetically determined’ so that those who engage in them ‘do not choose their lifestyle’ (e.g., lifestyles
shaped from a compulsion to commit adultery or engage in homosexual acts), still those behaviors and
lifestyles remain sinful: they disorient from the pursuit of holiness. They would be sins, albeit involuntary”
(Engelhardt, 2000, 249).
12. Consider also Deuteronomy 6: 3–7, “Hear, O Israel, the Lord your God is one Lord; and you shall
love the Lord your God with all your heart and with all your soul, and with all your might. And these
words which I command you this day shall be upon your heart; and you shall teach them diligently to
your children, and shall talk of them when you sit in your house, and when you walk by the way, and
when you lie down, and when you rise.”
13. Unless couples are strongly and traditionally religious, they are statistically willing to have at
most one or two children. There is a significant connection between being traditionally religious and the
willingness to reproduce and raise numbers of children beyond the mere replacement rate (Longman,
2004a, 2004b).
14. Consider St. John Chrysostom, who reminds us not to place too much emphasis on the health
of the body while forsaking the soul. Some ailments physicians cannot cure, “but in the case of souls . . .
there is no incurable malady” if one would only properly treat the illness:

For not only the bodily wounds work death, if they are neglected, but also those of the soul; and yet we have arrived
at such a pitch of folly as to take the greatest care of the former, and to overlook the latter; and although in the case of
the body it naturally often happens that many wounds are incurable, yet we do not abandon hope, but even when we
hear the physicians constantly declaring, that it is not possible to get rid of this suffering by medicines, we still persist in
exhorting them to devise at least some slight alleviation; but in the case of souls, where there is no incurable malady; for
it is not subject to the necessity of nature; here, as if the infirmities were strange we are negligent and despairing; and
where the nature of the disorder might naturally plunge us into despair, we take as much pains as if there were great
hope of restoration to health; but where there is no occasion to renounce hope, we desist from efforts, and become as
heedless as if matters were desperate; so much more account do we take of the body than of the soul. And this is the
reason why we are not able to save even the body. For he who neglects the leading element, and manifests all his zeal
about inferior matters destroys and loses both; whereas he who observes the right order, and preserves and cherishes the
more commanding element, even if he neglects the secondary element yet preserves it by means of saving the primary
one. Which also Christ signified to us when He said, “Fear not them which kill the body, but are not able to kill the soul;
but rather fear Him who is able to destroy both soul and body in Hell.” (Chrysostom, 2014a, 105)

15. See, for example, Ronit Stahl and Ezekiel Emanuel (2017) who argue that conscientious objection
for physicians and other health care workers not to participate in procedures that they find religiously
objectionable ought to be starkly curtailed. They conclude that physicians should either participate
directly or indirectly in abortion or leave the profession.
16. Truly to know the good, adequately to comprehend human flourishing, or to discern appro-
priate Christian medical choice, one must be oriented correctly towards God and united with Him. As
Engelhardt observes, there is “. . . a synergy of the Creator with the creature, through which God reaches
out to those who reach to Him as they turn to Him . . .” (Engelhardt, 2000, 183). As St. Maximos the
Confessor puts it, “The soul would never be able to reach out toward the knowledge of God if God did
not allow Himself to be touched by it through condescension and by raising it up to Him. Indeed, the
human mind as such would not have the strength to raise itself to apprehend any divine illumination did
not God Himself draw it up, as far as is possible for the human mind to be drawn, and illumine it with
divine rightness” (St. Maximos, 1985, 134).

REFERENCES

Ali, M., K. Miller, R. Folz, B. R. Johnson, Jr., and J. Kiarie. 2017. Study protocol on establish-
ment of sentinel sites network for contraceptive and abortion trends, needs and utiliza-
tion of services in Zika virus affected countries. Reproductive Health 14:19.

Downloaded from https://academic.oup.com/cb/article-abstract/23/3/219/4565806

by University of Leicester user
on 22 January 2018
 232 Mark J. Cherry

American College of Obstetricians and Gynecologists. 2007. Committee Opinion No. 385.
The limits of conscientious refusal in reproductive medicine. Obstetrics and Gynecology
[On-line]. Available: www.acog.org/Resources-And-Publications/Committee-Opinions/
Committee-on-Ethics/The-Limits-of-Conscientious-Refusal-in-Reproductive-Medicine
(accessed August 3, 2017).
Aquinas, T. 1948. Summa Theologica. Trans. Fathers of the English Dominican Province.
Westminster, MD: Christian Classics.
Bartholomew, P. 1997. Address of His All Holiness Ecumenical Patriarch Bartholomew
Phos Hilaron “Joyful Light.” Washington, DC: Georgetown University. Available:
https://www.patriarchate.org/homily/-/asset_publisher/NrbYUGIG0n1r/content/
address-of-his-all-holiness-ecumenical-patriarch-b-a-r-t-h-o-l-o-m-e-w-phos-hilaron-
joyful-light-georgetown-university-washington-dc-october-21–1997/pop_up?_101_
INSTANCE_NrbYUGIG0n1r_viewMode=print&_101_INSTANCE_NrbYUGIG0n1r_
languageId=ro_RO (accessed August 8, 2017).
Basil, St. 1962. Ascetical works: The long rules. In The Fathers of the Church, vol. 9, ed.
R. J. Deferrari et al., trans. Sister M.  M. Wagner, C.S.C. Washington, DC: The Catholic
University of America Press.
———. 1994. The hexaemeron. In Nicene and post-Nicene Fathers: Second Series, vol. 8, eds.
P. Schaff and H. Wace, 52–107. Peabody, MA: Hendrickson Publishers.
Breck, J. 1998. The Sacred Gift of Life. Crestwood, NY: St. Vladimir’s Seminary Press.
Cherry, M. J. 2015. The consumerist moral babel of the post-modern family. Christian Bioethics
21:144–65.
———. 2016. Sex, Family, and the Culture Wars. New Brunswick, NJ: Transaction Publishers.
Chrysostom, St. J. 2004a. An exhortation to Theodore after his fall, Letter I. In Chrysostom: On
the Priesthood, Ascetic Treatises, Select Homilies and Letters, Homilies on the Statues. Nicene
and Post-Nicene Fathers, vol. 9, ed. P. Schaff, 91–111. Peabody, MA: Hendrickson Publishers.
———. 2004b. Homily XII on Colossians iv. 12, 13. In Chrysostom: Homilies on Galatians,
Ephesians, Philippians, Colossians, Thessalonians, Timothy, Titus, and Philemon. Nicene
and Post-Nicene Fathers, vol. 13, ed. P. Schaff, 314–21. Peabody, MA: Hendrickson
Publishers.
Ekelund, C. K., F. S. Jørgensen, O. B. Petersen, K. Sundberg, A. Tabor and the Danish Fetal
Medicine Research Group. 2008. Impact of a new national screening policy for Down’s
syndrome in Denmark: Population based cohort study. BMJ 337:a2547–54.
Engelhardt, H. T., Jr. 2000. The Foundations of Christian Bioethics. Lisse, the Netherlands:
Swets & Zeitlinger.
———. 2017. After God: Morality and Bioethics in a Secular Age. Yonkers, NY: St. Vladimir’s
Seminary Press.
Engle, G. 2017. Anal sex: What you need to know. Teen Vogue [On-line]. Available: http://
www.teenvogue.com/story/anal-sex-what-you-need-to-know (accessed August 8, 2017).
Ethics Committee of the American Society for Reproductive Medicine. 2013. Access to fertility
treatment by gays, lesbians, and unmarried persons: A committee opinion. Fertility and
Sterility 100:1524–7.
Galton, F. 1883. Inquiries into the Human Faculty and Its Development. London, United
Kingdom: Macmillan.
Iozzio, M. J. 2017. Radical dependence and the Imago Dei: Bioethical implications of access
to healthcare for people with disabilities. Christian Bioethics 23:234–60.
Jacobs, M., S. A. Cooper, R. McGowan, S. M. Nelson, and J. P. Pell. 2016. Pregnancy outcome
following prenatal diagnosis of chromosomal anomaly: A record linkage study of 26,261
pregnancies. PloS One 11:e0166909.

Downloaded from https://academic.oup.com/cb/article-abstract/23/3/219/4565806

by University of Leicester user
on 22 January 2018
 Bioethical Implications of the Imago Dei 233

Jesudason, S., and J. Epstein. 2011. The paradox of disability in abortion debates: Bringing the
pro-choice and disability rights communities together. Contraception 84:541–3.
Kelly, S. E. 2009. Choosing not to choose: Reproductive responses of parents of children with
genetic conditions or impairments. Sociology of Health & Illness 31:81–97.
Kilner, J. 2017. The image of God, the need for God, and bioethics. Christian Bioethics
23:261–82.
Lastochkina, M. 2013. Remedying sexual asymmetry with Christian feminism: Some Orthodox
Christian reflections in response to Erika Bachiochi, ‘Women, sexual asymmetry &
Catholic teaching.’ Christian Bioethics 19:172–84.
Lindeman, R. 2015, Jun. 16. Down syndrome screening isn’t about public health. It’s about
eliminating a group of people. The Washington Post [On-line] Available: www.wash-
ingtonpost.com/posteverything/wp/2015/06/16/down-syndrome-screening-isnt-about-
public-health-its-about-eliminating-a-group-of-people/ (accessed August 3, 2017).
Longman, P. 2004a. The Empty Cradle: How Falling Birthrates Threaten World Prosperity. New
York: Basic Books.
———. 2004b. The global baby bust. Foreign Affairs 83:67–79.
Lossky, V. 1957. The Mystical Theology of the Eastern Church. Cambridge, United Kingdom:
James Clarke & Co Ltd.
Lustig, B. A. 2017. The image of God and human dignity: A complex conversation. Christian
Bioethics 23:317–34.
Mansfield, C., Hopfer, S., and T. M. Marteau. 1999. Termination rates after prenatal diagnosis
of Down syndrome, spina bifida, anencephaly, and Turner and Klinefelter syndromes:
A  systematic literature review. European Concerted Action: DADA (Decision-making
after diagnosis of a fetal abnormality). Prenatal Diagnosis 19:808–12.
Maximos, St. 1981. Four hundred texts on love. In The Philokalia, vol. 2, comp. St. Nikodimos
and St. Makarios, trans. G.  E. H.  Palmer, P.  Sherrard, and K.  Ware, 52–113. London,
United Kingdom: Faber and Faber.
———. 1985. Chapters on knowledge. In Selected Writings, trans. G. C. Berhold, 127–80. New
York: Paulist Press.
Mehlman, M. J. 2011. Modern eugenics and the law. In Century of Eugenics in America:
From the Indiana Experiment to the Human Genome Era, ed. P.A. Lombardo, 219–37.
Bloomington: Indiana University Press.
Mellon, B. 2017. John Kilner’s understanding of the Imago Dei and the ethical treatment of
persons with disabilities. Christian Bioethics 23:283–98.
Natoli, J. L., D. L.  Ackerman, S.  McDermott, and J. G.  Edwards. 2012. Prenatal diagnosis
of Down syndrome: A  systematic review of termination rates (1995–2011). Prenatal
Diagnosis 32:142–53.
Nicodemus, St. and St. Agapius. 1957. The Rudder. Chicago: Orthodox Christian Educational
Society.
Pilkington, B. 2017. Putting image into practice: Imago Dei, dignity, and their bioethical
import. Christian Bioethics 23:299–316.
Stahl, R. and E. Emanuel. 2017. Physicians – not conscripts. Conscientious objection in health
care. New England Journal of Medicine 376:1380–5.
Suter, S. 2007. A brave new world in designer babies? Berkeley Technology Law Journal
22:968–9.
Symeon, St. 1980. Symeon the New Theologian: The Discourses. Trans. C. J. de Catanzaro. New
York: Paulist Press.

Downloaded from https://academic.oup.com/cb/article-abstract/23/3/219/4565806

by University of Leicester user
on 22 January 2018