Van Huyssteen J.W. (editor) Encyclopedia of Science and Religion

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MATHEMATICS

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Hanson, Norwood Russell. “The Dematerilization of Mat-

ter.” In The Concept of Matter, ed. Ernan McMullin.

Nortre Dame, Ind.: University of Notre Dame Press,

1969.

Jammer, Max. Concepts of Mass in Classical and Modern

Physics. Cambridge, Mass.: Harvard University Press,

1961; reprint New York: Dover, 1997.

Jammer, Max. Concepts of Mass in Contemporary Physics

and Philosophy. Princeton, N.J.: Princeton University

Press, 2000.

Lange, Frederick A. The History of Materialism, trans.

Ernest Chester Thomas. New York: Humanities Press,

1950.

Mark, Siegfried. “Dialectical Materialism.” In A History of

Philosophical Systems, ed. Vergilius Ferm. New York:

Philosophical Library, 1950.

O’Connor, John, ed. Modern Materialism. New York:

Harcourt: 1969.

Parker, DeWitt H. Experience and Substance. Ann Arbor:

University of Michigan Press, 1941.

Robinson, Harold. Matter and Sense. Cambridge, UK:

Cambridge University Press, 1982.

Rosenthal, David M. Materialism and the Mind-Body

Problem. Englewood Cliffs, N.J.: Prentice Hall, 1969.

Schofield, Robert E. Mechanism and Materialism. Prince-

ton, N.J.: Princeton University Press, 1969.

Schwarz, Harmann. Der moderne Materialismus. Leipzig,

Germany: T. Weicher, 1904.

Sellars, Roy Wood. Philosophy for the Future: The Quest of

Modern Materialism. New York: Macmillan, 1949.

Wetter, Gustav A. Dialectical Materialism. New York:

Praeger, 1959.

MAX JAMMER

ATHEMATICS

The ancient Greeks, building upon earlier work

by the Egyptians and Babylonians, transformed

mathematics into an integral part of liberal educa-

tion during the fourth century

B.C.E. The academic

disciplines (mathemata) of arithmetic and geome-

try were then sharply distinguished from the me-

nial rules of practical calculation (logistica) neces-

sary for the everyday work of artisans, tradesmen,

and money changers. Arithmetic studies the prop-

erties of whole numbers such as divisibility and

factorization by primes, while geometry studies

properties of magnitudes such as congruence, sim-

ilarity, and proportion. Both are concerned with

aspects of measurement, understood in a broad

sense, but arithmetic deals with discrete quantities

(multitudes of a unit) while geometry considers

continuous magnitudes (line segments, planar

areas, and solids).

The notion of a ratio (logos)—the size of one

thing relative to another—plays a major unifying

role, yet many advances in both classical and mod-

ern mathematics have sprung from the inherent

tension between the continuous and the discrete.

The tension we may sense today between our

flowing, or continuous, temporal existence and the

discrete digital world of the modern computer re-

veals the distinction between these cooperating

opposites and suggests the possibility of a power-

ful interaction.

Pythagorean and Platonic connections

Measurement is made by expressing a ratio of the

thing to be measured to a second thing, usually to

a standard unit that is more familiar—nowadays

taken to be a meter, second, liter, or the like. In the

fifth century

B.C.E. the Pythagoreans made much of

the fact, said to have been well known already in

China, that ratios of small whole numbers in arith-

metic are related to harmonious musical intervals.

Thus, to speak in modern terms, the easily recog-

nizable octave is produced by two pitches in the

ratio 2:1, while the ratio 3:2 yields a musical fifth,

and 5:4 determines a third. Our ability to sense the

ratios between pitches in music and their identifi-

cation with ratios between numbers may have

helped inspire the Pythagorean dictum, “All is

number.” By this is meant, presumably, that inte-

gers and their ratios (logoi) have the power to ex-

press underlying harmonies in nature that will be

hidden from those ignorant of mathematics. Per-

haps the most familiar modern (nineteenth-

century) example of this power is the order in-

duced in the periodic table by the assignment of

an appropriate atomic number—an integer—to

each basic chemical element.

Pythagoras (c. 560–c. 495

B.C.E.) is traditionally

credited with putting together two Greek words to

coin the word philosophy (“love of wisdom”) and

with objectifying the notion of order by taking the

Greek word for it, cosmos, and giving this name to

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the universe. Despite his mystical leanings,

Pythagoras is sometimes seen as the founder of

Western science because his followers continually

promoted mathematics as a means of finding

order and harmony in the natural world. The

Pythagoreans used the connection between arith-

metic and the science of music to develop a musi-

cal scale based upon just intonation (and they ap-

preciated the difficulties that were finally

ameliorated in the eighteenth century by well-

tempering). They also noted the more obvious

connection between geometry and astronomy.

Stars are like points and the constellations are

formed by line segments joining pairs of stars—so

that problems in navigation may become prob-

lems in geometry.

Aspects of astronomy are thus naturally mod-

eled by geometry, just as some properties of music

are modeled by arithmetic. But these sciences deal

with things in motion—the rotating celestial

sphere, the vibrating strings of a lyre—whereas the

mathematics of arithmetic and geometry deal with

idealized static objects such as whole numbers and

stationary line segments. A striking analogy is due

to Archytas (fifth century

B.C.E.), a latter-day

Pythagorean: Arithmetic is to Music as Geometry is

to Astronomy. Almost a thousand years later these

four mathemata became collectively known as the

quadrivium, a name given them by the Roman

philosopher Boethius (c. 480–c. 524), although his

practical countrymen prized logistica more highly.

Eventually, the quadrivium became an integral part

of the classical liberal arts in medieval European

universities.

The word ratio has long been associated with

measured study and hence with reason itself, while

logos, the Greek word for ratio, has taken on a

wide-ranging religious significance as well. The

unit generates all numbers, whose logoi, according

to the Pythagorean faith, have the power to meas-

ure (know) everything in the cosmos. Thus, for the

Pythagoreans, the logos is a mathematical means

of expressing cosmic harmony. The variety of basic

roles that the logos plays in mathematics, science,

philosophy, liberal education, and religion is sug-

gested by the wide usage of such cognate terms as

logic and analogy, and the host of academic words

with the suffix -logy. Pythagoras seems to have

been drawn toward a holistic view encompassing

all these spheres, but their explosive growth would

make this view ever more difficult to sustain.

Plato (c. 427–347

B.C.E.) became familiar with

Pythagorean doctrines through Archytas and en-

dorsed their emphasis upon mathematics and their

insistence upon the same basic education for men

and women. Plato thought that our power of direct

apprehension of idealized mathematical forms like

the circle might be refined to help us apprehend

such things as truth, beauty, and goodness—Pla-

tonic forms whose properties, moreover, might

also be studied by deductive reason. If, as Plato in-

sisted, mathematics helps train the mind to rise

from the apparent and ephemeral to the true and

permanent, then its study should promote both

science and religion. Indeed, when Jewish and

early Christian thinkers began to view Platonic

forms as ideas in the mind of God, an important

link was established between Platonism and

Judeo-Christian thought.

Plato even suggested that the immortality of the

soul is intimated by geometry, especially when

learned by the Socratic method, where it may ap-

pear that we are remembering—rather than learn-

ing anew—connections between geometric forms

that we had somehow forgotten. To Plato this im-

plies the existence of some earlier state of fuller

communion with the forms. We must therefore

(re)search in order to remember where we came

from. In the midst of this perhaps fanciful argu-

ment, however, is Plato’s admonition with which all

modern scientists would agree, that in research we

must look beyond mere sensory impressions. The

laws governing the stars are fairer than the stars.

Plato comes close to espousing a religious mo-

tivation for scientific inquiry by taking the position,

ardently embraced much later by Johannes Kepler

(1571–1630), that the universe is, in some sense, an

expression of the nature of its creator. Many re-

searchers in mathematics and science, including

some to whom Plato’s views might appear naïve,

have occasionally expressed a belief that they are,

so to speak, reading the mind of God. “We cannot

read [the great book of Nature],” wrote Galileo

Galilei (1564–1642), “unless we have first learned

the language and the characters in which it is writ-

ten .… It is written in mathematical language.”

Mathematics as a human endeavor

A quick excursion sketching the rise of seven-

teenth-century calculus may help to put a human

face upon the making of mathematics. In the early

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Middle Ages a slowly growing quantitative sense

began to evolve, later bolstered by the conven-

ience of working with numerals developed in India

that would eventually be used in Indo-Arabic dec-

imal fractions. The preservation, refinement, and

advancement of Greek and Indian ideas during the

rising tide of the Islamic movement led to the de-

velopment of algebra—the very word for which

comes from Arabic (al-jabr) and has somewhat the

sense of “rearrangement.” Mohammed ibn Musa

al-Khwarizmi (c. 780–c. 850

C.E.) began his influ-

ential algebra book of the ninth century by prais-

ing God for bestowing upon man the power to

discover the significance of numbers. The word al-

gorism (later, and more commonly, algorithm) de-

rives from the author’s patronymic.

Calculus may be seen as a post-Renaissance

blending of these developments with a new

propensity to think in terms of the intuitive notions

of variable, function, and limit, coupled with the

development of analytic geometry, which unites

large parts of algebra and geometry through the

use of Cartesian coordinates. The joining together

of such diverse ideas gave mathematics (and phys-

ical science) an astounding vitality in the seven-

teenth century. Isaac Newton (1642–1727) and

Gottfried Wilhelm Leibniz (1646–1716) were the

first to see the calculus as a unified whole that stud-

ies the interplay between functions and derivatives.

This interplay casts light upon previously perplex-

ing philosophical and scientific problems concern-

ing the notions of instantaneous velocity and ac-

celeration, gives new and efficient ways to find

optimal solutions to many types of problems, and

provides natural and effective methods for solving

equations and for finding lengths of curves and

sizes of areas and volumes. Newton used the cal-

culus, together with his physical laws (axioms) of

motion, to show how Kepler’s observations about

planetary motion follow from the law of gravity.

The scientific successes of “reason” inspired at-

tempts to extend its methods beyond science. The

philosophy of René Descartes (1596–1650), who

developed analytic geometry, drew a clear distinc-

tion between reason and ecclesiastical authority.

Descartes—and, later, both Newton and Leibniz—

made serious, rational contributions to theology.

The early reaction to such efforts by Blaise Pas-

cal (1623–1662), who had helped develop several

nascent branches of mathematics (probability, pro-

jective geometry, and calculus), would be telling.

Repelled by the idea of a god “of philosophers and

scholars,” Pascal abandoned everything for theol-

ogy, returning to mathematics only once, in 1658,

when he published some pretty results about the

cycloid that calculus students still study. Pascal’s

writings exalting heart over mind (“Humble thyself,

impotent reason!”) would be seen to help inspire

romanticism during a much later period, which left

in its wake a great gap between the sciences and

the humanities. Mathematics would find itself

stretched ever more tenuously across this gap.

Ironically, the great mathematical advances of

the so-called Age of Reason owe more to the imag-

ination and intuition of mathematicians than to

their logic and reason. The development of calcu-

lus was facilitated, as its developers were well

aware, by a relaxation of the strictures of rigorous

geometrical methods that proceed from precise

definitions and clear first principles. Instead, math-

ematicians embraced loose numerical methods al-

lowing unending decimal expansions and other

infinite sums—thus going far beyond the finite

arithmetic of the Greeks. This attitude led both to

unprecedented progress in research and to occa-

sional confusion and contradiction. The logical dif-

ficulties encountered were principally due to the

suggestive, but slippery, notion of an infinitesi-

mal, which was supposed to be a discrete entity

that retained qualities of the continuous. Not until

the precise formulation of the notion of a limit by

Augustin-Louis Cauchy (1789–1857) and others

were these difficulties decisively overcome.

In the meantime the shaky foundations of the

calculus were exposed by the philosopher George

Berkeley (1685–1753), an Anglican bishop, who

published in 1734 a witty and acerbic essay called

The Analyst, where he famously (and justly)

ridiculed infinitesimals as “ghosts of departed quan-

tities.” His subtitle—To an Infidel Mathematician—

reflects his purpose, to rebuke mathematicians of

his day by showing that their discipline contains

mysteries no less subtle than those of theology. Per-

haps the best eighteenth-century advice to those

who would learn the calculus was given by the

French mathematician Jean le Rond d’Alembert

(1717–1783): “Go forward, and faith will follow.”

The search for coherence: Euclid’s legacy

The axiomatic method consists in somehow intuit-

ing basic accepted facts (axioms) about a discipline

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and logically deducing all else. Axiomatization of

the real number system in order to derive rigor-

ously the results of calculus—and thereby answer

criticisms of Berkeley and others—did not occur

until the late nineteenth century, when finally ra-

tional sense was made out of the huge mass of cal-

culus-inspired research largely due to, but overly

dependent upon, an unbridled trust in mathemati-

cal intuition. Pressure to provide such coherence to

a discipline usually comes only when its elements

have been basically established and it is time to

synthesize a great web of connections into a con-

sistent body of work.

The most celebrated example of such a syn-

thesis is Euclid’s Elements, which appeared in

Alexandria around 300

B.C.E. Here, the towering

edifice of geometry appears to be solidly built up

by logic, unerringly applied to a small number of

“self-evident” facts that we are willing to accept at

the outset. The Elements is doubly valuable, how-

ever, because its study—with the help of a skilled

tutor—will also impart the dual thinking tech-

niques of analysis and synthesis that are indispen-

sable in achieving rational coherence in any disci-

pline. Analysis, as Plato used the term, refers to the

testing of the truth of a proposition by deducing

implications from it. If one of these implications is

false, then the proposition must of course be false

(reductio ad absurdum); otherwise, one hopes to

deduce a consequence that is self-evidently true,

and a synthetic proof is said to be obtained if the

steps in this deduction can be reversed so as to ob-

tain the given proposition as a logical consequence

of self-evident truths.

The power of such analysis had been strikingly

felt when the central tenet of the Pythagorean

faith—the proposition that every ratio can be ex-

pressed as a ratio of whole numbers—was tested

and proved false by reductio ad absurdum: If the

proposition were true, then the ratio of the diago-

nal of a square to its side would be expressible as

a ratio of integers. But this implies (to use modern

terminology) that the square root of two is rational,

which leads to contradiction, as first noted by the

Pythagoreans about 430

B.C.E. Perhaps partly as a

consequence of the limitations of arithmetic re-

vealed by this shock, the Greeks came to look

more favorably upon geometry, which Euclid at-

tempted to put on a firm, rational foundation. It

was not, however, until the nineteenth century that

the foundations of mathematics were seen to re-

quire substantially more careful attention than Eu-

clid had provided.

Archimedes (287–212

B.C.E.) effectively in-

vented mathematical physics by giving an ax-

iomatic development to hydrostatics, beginning by

deriving from simple axioms the fundamental law

of the lever. He then went on to discuss rigorously

how to find centers of gravity of complicated

solids, solving problems that are routinely handled

today, but only by using calculus in a fairly so-

phisticated way. Mathematical physics came of age

with Newton in the seventeenth century, and

physicists today who seek an axiomatic basis for

quantum mechanics follow in this tradition.

Western civilization has absorbed over a thou-

sand editions of the Elements, whose influence is

sometimes subtly felt. As noted by Bertrand Russell

in Wisdom of the West (1959), a revealing moment

in the Enlightenment occurred in 1776 when Ben-

jamin Franklin spotted the phrase “sacred and un-

deniable” in the penultimate draft of the American

Declaration of Independence and suggested that

“self-evident” be substituted. A revolutionary list of

moral and political rights of individuals was thus

introduced to the world not with a religious invo-

cation, but with an implicit salute to Euclid: “We

hold these truths to be self-evident.”

In contrast to Euclid, who presumably thought

that his basic axioms about geometry were obvi-

ously true, both Nicolaus Copernicus (1473–1543)

and Kepler on occasion spoke of an “axiom” of as-

tronomy as a provisional truth that one might

someday hope to establish. Axioms of empirical

disciplines may alternatively be viewed simply as

facts to be tested by analyzing their implications to

see how well they model reality. The scope of ax-

iomatics was decisively extended beyond the sci-

ences when Baruch Spinoza (1632–1677) set down

philosophical axioms and deduced the conse-

quences in his Ethics. Systematic theology em-

braces a similar method of exposition when it ex-

hibits the collective implications of basic religious

tenets as a rationally coherent system.

In light of these modern points of view, the ex-

istence of non-Euclidean geometry—a startling de-

velopment when Euclid was thought to represent

“absolute truth”—is now seen as unsurprising. If

“light rays” of physics are to be modeled by “lines”

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from geometry, why should the lines satisfy Eu-

clid’s axioms, now that we know of consistent

mathematical structures developed by N.I.

Lobachevsky (1792–1856) and G.F.B. Riemann

(1826–1866) in which “points” and “lines” can be

defined in such a way that Euclid’s parallel postu-

late fails while the other axioms hold? Modern

physicists routinely use non-Euclidean geometry to

model the cosmos.

Faith in Euclid’s absolute truth is thus clearly

unfounded. In fact, modern mathematicians, when

presented with axioms defining a vector space or

some other mathematical structure, typically do not

ask whether the axioms are “true,” but instead set

about deducing theorems that must hold for every

structure satisfying the given axioms. The existence

of foundational mathematical structures such as the

real number system, out of which vastly compli-

cated, useful, and interesting structures can be

constructed, is generally regarded as unproblem-

atic by working mathematicians. Mathematical lo-

gicians, on the other hand, study foundational

questions intensely, usually basing their work

upon the theory of sets. The surprising “incom-

pleteness” theorem proved in 1931 by Kurt Gödel

(1906–1978) demonstrated unforeseen limitations

in the power of the axiomatic method and has

sparked further study.

Conclusion

Modern mathematics has expanded far beyond the

study of calculus and differential equations that has

helped scientists to cope with continuous

processes and, as well, beyond the developments

in probability and statistics that have advanced the

mathematical treatment of discrete processes. Carl

Friedrich Gauss (1777–1855), perhaps the greatest

modern mathematician, made deep contributions

to almost all areas of the subject. By the early

twentieth century, however, the scope of mathe-

matics had grown so large that no single mathe-

matician could claim to have mastered more than

a small portion of the field.

The attraction of mathematics as a worthy

human interest lies in discovering and establishing

surprising and interesting connections between

apparently disparate mathematical ideas that have

not yet been fully comprehended. Mathematicians

pursue useful goals, but while attaining them they

often meet new ideas without immediate practical

value that are appealing in their own right. Some-

times, intriguingly, these ideas prove to be surpris-

ingly useful, whereas their initial appeal is only

aesthetic in the sense that they seem to call for an

imaginative synthesis expressed with clarity and

style. “The love of a subject in itself and for itself,

where it is not the sleepy pleasure of pacing a

mental quarter-deck, is the love of style as mani-

fested in that study,” said the mathematician and

philosopher Alfred North Whitehead (1861-1947).

Whitehead contended that pure mathematics,

in its modern developments, may claim to be the

most original creation of the human spirit. A simi-

lar claim might be made in connection with an

often overlooked feature of its ancient develop-

ment. Howard deLong perceptively observes in A

Profile of Mathematical Logic (1970) that early

Greek interest in abstract thought owes much to

the expansion, from the physical to the mental

arena, of the familiar spirit of competition and

play. The sportive aspect of the play of the mind,

which animates mathematics in its purest form, is

bound up with this remarkable growth of the

human spirit so long ago.

In A Mathematician’s Apology (1940), G. H.

Hardy (1877-1947) bases his defense upon aes-

thetic grounds and confesses a genuine passion for

his calling. Something akin to Hardy’s passion is

known to all who have experienced the revelation

that follows a spell of total concentration and have

found themselves echoing in their own tongue

Archimedes’s famous cry of eureka (“I have found

it”). Mathematicians count heavily upon the spirit

that compels such engagements and articulates

such an involuntary cry of delight. What transpires

under its spell may even seem like something done

to—rather than by—a mathematician. No one

seems ever to have argued, however, that a calling

to an Archimedean engagement implies the exis-

tence of a “caller.” Attitudes of mathematicians to-

ward religion range from Whitehead’s well-known

sympathy for the religious experience to Hardy’s

strongly opposing view.

See also ALGORITHM; GALILEO GALILEI; PLATO

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York: McGraw-Hill, 1945.

Berggren, J. L. Episodes in the Mathematics of Medieval

Islam. New York: Springer-Verlag, 1986.

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Burkert, Walter. Lore and Science in Ancient Pythagore-

anism, trans. Edwin L. Minar Jr. Cambridge, Mass.:

Harvard University Press, 1972.

Burtt, Edwin Arthur. The Metaphysical Foundations of

Modern Physical Science, Rev. edition. New York:

Harcourt, 1932.

Courant, Richard, and Robbins, Herbert. What is Mathe-

matics? An Elementary Approach to Ideas and Meth-

ods. Ed. Ian Stewart. New York: Oxford University

Press, 1996.

Crosby, Alfred W. The Measure of Reality: Quantification

and Western Society, 1250–1600. Cambridge, UK:

Cambridge University Press, 1997.

Davis, Philip J., and Hersh, Reuben. The Mathematical Ex-

perience. Boston: Birkhäuser, 1981.

DeLong, Howard. A Profile of Mathematical Logic. Read-

ing, Mass.: Addison-Wesley, 1970.

Field, J. V. Kepler’s Geometrical Cosmology. Chicago: Uni-

versity of Chicago Press, 1988.

Grant, Hardy. “Mathematics and the Liberal Arts.” College

Mathematics Journal 30 (1999): 96–105, 197–203.

Grattan-Guinness, Ivor. The Fontana History of the Mathe-

matical Sciences. London: Fontana Press, 1997.

Hardy, G. H. A Mathematician’s Apology. Cambridge, UK:

Cambridge University Press, 1940.

Hersh, Reuben. What is Mathematics, Really? New York:

Oxford University Press, 1997.

Kline, Morris. Mathematics in Western Culture. Oxford:

Oxford University Press, 1953.

Lloyd, G.E.R. “Science and Mathematics.” In The Legacy

of Greece, ed. Moses I. Finley. Oxford: Clarendon

Press, 1981.

Marrou, Henri Irénée. A History of Education in Antiq-

uity, trans. George Lamb. New York: Sheed and

Ward, 1956.

Priestley, William M. Calculus: A Liberal Art. New York:

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ting. Garden City, N.Y.: Doubleday, 1959.

Stein, Sherman. Archimedes: What Did He Do Besides Cry

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Westfall, Richard S. Never at Rest: A Biography of Isaac

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W. M. PRIESTLEY

MEDICAL ETHICS

Moral concerns have always been implicit in med-

icine. Indeed, the division between science and

values—the objectivity sought in the study of na-

ture and the values governing human behavior—

disappears at the bedside. The medical choices

made by physicians and their patients must, by

their very nature, reflect a complex array of values

that determine how the findings of clinical science

and the applications of their associated technolo-

gies are to be deployed in the care of the ill. Thus

medicine necessarily obscures the line separating

science and human values because of the intimate

connection between clinical science and its object

of study and intervention: the person—the nexus

of politico-judicial action, moral agency, scientific

scrutiny, and religious sanctification.

The origins of contemporary medical ethics

may be traced to the Enlightenment, when the sci-

ence of morals and the morals of science became

the subject of intense deliberation, and from which

medical ethics arose as a system of mutually re-

lated contracts between doctor and patient

(Haakonssen 1997). But an even older religious

tradition—Catholic (Kelly 1979), Protestant

(Fletcher 1954), and Jewish ( Jakobovits 1959)—

has debated the moral implications of modern

medicine generally, and in particular, since the

mid-twentieth century, those matters arising in

consequence of clinical interventions that chal-

lenged dogma about life and death, including

abortion, terminal care, genetic counseling, and

the like. But medical ethics in its present form—

philosophical, secular, legalistic, and professional-

ized—has had a brief history.

During the late 1960s, medical ethics burst forth

into the political arena. Rapid technological ad-

vances brought new challenges to the very defini-

tion of life and death. This in itself would have ini-

tiated speculations over how such new-found

scientific power should be utilized. In addition, a

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massive social realignment was underway under

the auspices of a renewed commitment to civil and

human rights. Focused upon various forms of pa-

ternalism, particularly heated debates about in-

formed consent for therapy, protection of subjects

enrolled in human research, and recourse to med-

ical malpractice, stimulated both a reexamination of

the ethics underlying these issues as well as a more

general discussion of medicine’s moral philosophy

and legal standing (Rothman 1991; Jonsen 1995).

Soon, medical ethics became a formal discipline,

replete with institutes, journals, books, conferences,

and professionals devoted to what had heretofore

been a subject reserved for religious contemplation.

Definitions and distinctions

Medical ethics may be defined as the discourse that

seeks to define moral guidelines for the care of pa-

tients. Within this discipline, a distinction must be

drawn between judicial medical ethics and philo-

sophical medical ethics. In the former, medical

ethics comprises rules or procedures established

by governing agencies and the courts meant to

guide decision-making in difficult areas like abor-

tion, for example, or the involuntary commitment

of a psychotic patient. In this context, medical

ethics implicitly informs the legal directives, and

“risk management,” the distillation of this dis-

course, defines the procedures hospitals and

health care professionals follow to minimize their

legal liability. On the other hand, philosophical

medical ethics has no proscribed rules, only a tra-

dition of offering philosophical or theological per-

spectives to ethical dilemmas and proposing possi-

ble answers. Thus, diverse matters ranging from

informed consent to end of life issues to new tech-

nological opportunities (e.g., artificial insemina-

tion) may be addressed at these two levels, the ju-

dicial and the philosophical: What, on the basis of

the law, is the correct procedure for dealing with a

clinical predicament? or, alternatively, What are the

secular ethical or religious principles that offer

ways of thinking about a morally ambiguous prob-

lem? Judicial medical ethics—practical instructions,

rules, regulations, contracts, and ultimately the

law—may be distilled from such philosophical de-

liberations, and these, together with judicial prece-

dent and political considerations ultimately result

in accepted practice. In short, although the law is

the final arbiter of practice, philosophical ideas im-

pact on the shape of social policy.

This entry will consider “medical ethics” solely

in its philosophical mode. It is around this topic

that one can most clearly discern how theologians,

poised and ready to participate in a discourse they

had already developed for their own purposes,

offer insights (and ideologies) from their rich intel-

lectual and religious heritage in order to influence

the development of contemporary judicial and

philosophical medical ethics (Lammers and Verhay

1987; Verhay and Lammers 1993; Camenisch 1994).

The competition of moral principles

Medicine reflects broad social values, and Ameri-

can multiculturalism has demanded a mixture of

ethical precepts from diverse sources. In the end,

citizens live together under a common law, one

that seeks to satisfy the pluralistic demands of

contemporary life and still remain faithful to

the older core of foundational principles. Since

at least World War II, America has developed a

rights-based culture that endeavors to respect

the autonomy of its citizens and thereby to en-

hance their ability to enjoy life’s pursuits offered by

the opportunities afforded by civil equality and

respect for differences in religion, race, sexual ori-

entation, and a whole host of differentiating char-

acteristics (Sandel 1995). American medicine has

been caught in this vast social experiment stimu-

lated by cultural diversity and unified by constitu-

tional law.

So when medical ethicists ponder, “Under what

circumstances are particular ethical responses

evoked?” or “What are the ethical implications of

those ethical choices?” their answers draw upon

a complex array of moral principles forged together

from various religious traditions and secular moral

philosophies. Given the current dominant legal and

political culture based upon the protection of indi-

vidual rights, autonomy as a governing philosophi-

cal principle has been prioritized in medical ethics.

For, as noted above, in the process of deliberating

medical ethics, philosophers consider the practical

application of their studies, and these are, in a

sense, over-determined by legal interpretation, one

focused on rights. Thus, in the judicial context,

medical ethics is like a lopsided table with five legs:

Although autonomy, beneficence, justice, utilitari-

anism, and non-malfeasance each claim considera-

tion, autonomy usually trumps other contenders

(Beauchamp and Childress 2001). This dominance

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has been widely regarded as both a judicial and

philosophical problem.

Autonomy draws on two understandings of

freedom (Berlin 1969): One is negative, the free-

dom from oppression or interference by another,

and the second is positive, the freedom to partici-

pate in the process by which one’s life is con-

trolled. In the research setting, autonomy in the

form of informed consent is the governing princi-

ple that protects human research subjects from hid-

den manipulation (Belmont Report 1979). And

while in the clinic and the hospital, similar rules of

informed consent operate, a rights-based morality

makes little attempt to articulate the ethics of other

dimensions of the doctor-patient relationship. And

here we discover an ambiguous moral construction

lying at the foundation of medical care.

Indisputably, autonomy serves a vital judicial-

legal function in our system of medical law, and

this may well account for its continued importance,

but it is more likely that the moral depth of our no-

tions of respect for persons reflects a still deeper

commitment to Western religious roots (Downie

and Telfer 1969; Thomasma 1984; Engelhardt

1996). Our care of the ill is based on a deep meta-

physical sense of response to the other, a reaction

that generates response-ibility (Tauber 1999). This

ethical metaphysics is essentially a theological

assertion, not a philosophical one. This position

was first espoused by the early founders of

American medical ethics, Joseph Fletcher (1954)

and Paul Ramsey (1970). They championed

autonomy, because this principle reflected their

basic humanitarianism as theologians ( Jonsen

1998). But autonomy had little philosophical

support in their writings, where it served as a

placeholder for a humane medicine, one that held

the sanctity of life paramount. Indeed, by not de-

lineating how autonomy was in competition with

other moral tenets, these early discussions inad-

vertently obfuscated the complexity of medicine’s

moral universe.

Physicians and nurses assume responsibility

for the care of their patients, and the “moral space”

in which patients reside is not necessarily coinci-

dent with that of autonomous citizens. Autonomy

is inadequate, by itself, to account for medi-

cine’s moral calling because of two failings. First,

from the patient’s perspective, the notion of au-

tonomy is frequently distorted in the clinical setting

(Schneider 1998; Tauber 2001). Patients necessarily

relinquish their full autonomy to experts, and in

this regard, they cannot make truly autonomous,

self-reliant, fully informed decisions, and must in-

stead ultimately rely on the competence and good

will of their health-care providers to represent their

best interests. Second, autonomy as a construct

cannot account for the ethical responsibilities of

the caregiver (Tauber 1999). The sense of respon-

sibility exhibited by physicians and nurses arises

from their sense of care for others, not primarily

from a set of rules designed to protect patient au-

tonomy. Respect for the person in this setting is

implicit to their professional role, a role character-

ized by a profound sense of commitment to their

charge. This ethic of compassion regards auton-

omy as only one of a number of moral principles

governing the caring relationship, among which it

finds in beneficence a more resonant expression of

medicine’s fundamental ethos. This is the moral

principle that perhaps most obviously captures the

Judeo-Christian religious ethos, the appreciation

that God’s work on Earth is articulated through the

caring relationship between people and their re-

spective responsibility for each other (Pelligrino

and Thomasma 1988; Kultgen 1995). The founda-

tions of social justice and much of the implicit un-

derstanding of our social mores are based on this

deep moral maxim.

Thus “patients” and “citizens” are revealed as

not necessarily occupying the same ethical do-

main. While their respective moral identities over-

lap, they nonetheless are distinct. The patient, at

least in the autonomy model, receives medical at-

tention only to the extent that his or her rights as

an autonomous citizen are respected. This is es-

sentially a defensive posture, one at potential odds

with those moral (ultimately religious) concerns

most prominent for the doctor or nurse, whose pri-

mary ethical affiliation is to beneficence (Pelligrino

and Thomasma 1988) or, in another format, re-

sponsibility (Tauber 1999).

Seeking a synthesis

Much of philosophical medical ethics has been

devoted to balancing the politico-legal view of

individual autonomy with other moral principles

that make strong claims in the medical culture.

Although (secular) autonomy and (religious)

beneficence has each followed a historical and

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philosophical trajectory of its own, they may be re-

duced to a more basic formulation, a moral foun-

dation, which, for the sake of simplicity is, “Re-

spect for the person” (Ramsey 1970). This idea of

the inalienable sanctity and dignity of every human

being derives most directly from ancient themes in

the Western religious culture rather than from phi-

losophy as such, and may account for the hold of

“autonomy” on Western moral sensibilities. For

theologians as well as nonbelievers, the sanctity of

life—essentially a religious principle—remains

paramount even as it was secularized into the po-

litical principle of autonomy (Callahan 1969; Jon-

sen 1998).

Autonomy, a relatively new moral tenet, claims

a dual heritage: The first source derives from no-

tions of Puritan personal religious responsibility

and conscience, balanced against the obligations

of persons to a community designed to serve God

(Shain 1995); the second source, again religious in

origin, arises from natural law’s endowment of per-

sons with natural rights, self-governance, and the

freedom to pursue their own dictates (Schneewind

1998). This latter tributary, one we might call indi-

vidualistic, grew at the expense of communal

values in the development of American demo-

cracy, while European views of autonomy have

more evenly balanced community interests and

responsibilities (as evidenced by universal social-

ized health care) against autonomy-based rights

in health care delivery. Consequently, in the

United States, individual rights increasingly have

been regarded as sacrosanct, and correspondingly

the respect for persons has shifted from one cen-

tered on communal responsibility—both the citi-

zen’s identification with the state and the state’s re-

sponsibility for the citizen—to one focused on

autonomy in its more atomistic interpretation

(Sandel 1996). And here we see how an ethos of

responsibility for others (“caring”) may be subordi-

nated to a preoccupation with protecting the rights

of the individual.

The seam that ties religious and secular

philosophies together is not always evident, which

is strong testament to the success of liberal society,

but as this discussion has emphasized, conflicting

moral orientations may still show signs of differing

ethical perspectives straining against one another.

While autonomy carries the ancient banner of life’s

sanctity, its contemporary secularized meaning and

applications have shorn off its religious heritage,

leaving its more immediate allegiances plainly in

view. So when this political and judicial principle is

extended to medical ethics, the law accompanies

the ill to the clinic and hospital to protect citizens.

Due to this legal extrapolation, the more ancient

basis of the doctor-patient relationship must ac-

commodate a superimposed orientation different

in kind and purpose to an older ethic of caring.

And perhaps of more concern, telling lapses in

judiciary medical ethics appear as the discourse

stutters when addressing the legal basis of benefi-

cent concerns: Physician fiduciary responsibility,

those duties dictated by law that translate bene-

ficence into standards of care, are restricted only to

maintaining patient confidentiality, disclosing

financial conflicts of interest, and prohibiting the

abandonment of patients (Rodwin 1995); Good

Samaritan laws protect doctors from suits arising

from non-consented care only in the most dire

of circumstances; empathy has no legal basis

whatsoever.

In summary, the complexity of medical ethics

begs for a full hearing, to reflect both the claims of

individual rights as well as the demands of a

morality that fosters responsibility. In that discus-

sion, a combination of various moral principles al-

lows for a philosophical discourse that attempts to

represent fairly diverse interests and relationships,

including the challenge of accommodating differ-

ent belief systems. The product of that delibera-

tion, which must draw upon the entire Western tra-

dition of philosophy and its handmaiden, theology,

frames a perspective on, and the terms of, the

never-ending debate over the most crucial nexus

of human endeavor, the life and death decisions so

manifest within modern medicine’s power to influ-

ence, if not control.

See also ABORTION; BIOTECHNOLOGY; MEDICINE;

EPRODUCTIVE TECHNOLOGY

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ALFRED I. TAUBER

MEDICINE

Religion and medicine are twin traditions of heal-

ing. Although they have overlapped for most of

their history, in the past three hundred years the

two traditions have become separate and have

often been in competition with one another. At the

close of the twentieth century, serious considera-

tion began to be given to reintegrating religion and

medicine. In this discussion, a review of the his-

torical connection between these two traditions

will be offered. Research that has led to a possible

rapprochement will be examined as will the impli-

cations for practicing clinicians.

Historical background

There is a long historical tradition that connects re-

ligion and medicine. The first hospitals in western

civilization for care of the sick in the general pop-

ulation, particularly for those unable to pay for

their own care, were built by religious groups. In

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