Latter-day Saint Bioethics (feat. Courtney Campbell)

Courtney Campbell, Hundere Professor in Religion and Culture at Oregon State University joins me in this episode to discuss his recent book Moral Realities: Medicine, Bioethics, & Mormonism (2021, Oxford University Press). We discuss Professor Campbell's three-part normative framework for a Latter-day Saint bioethics which centers on a "restored, re-storied, and prophetic morality." 

Transcript

Latter-day Saint Bioethics

Stephen Betts: Welcome back to Scholars and Saints. I'm your host, Stephen Betts. I'm joined today by UVA Religious Studies alumnus, Courtney Campbell. Hundere Professor of Religion and Culture and director of the program in Medical Humanities in the School of History, Philosophy and Religion at Oregon State University. He's the author and co-author of several books, including What Price Parenthood: Ethics and Assisted Reproduction and Duties to Others. We're talking today about his most recent book, Moral Realities: Medicine, Bioethics and Mormonismfrom Oxford University Press. Thanks for being here today, Courtney.

Courtney Campbell: Thank you for the invitation. I look forward to chatting with you. 

Stephen Betts: So Courtney, I guess as a way of getting started, can you lay the groundwork for us? Help us to understand what is religious bioethics and how is it related to things like theology, things like religious studies, and then why did you choose to write about Latter-day Saint bioethics in particular? 

Courtney Campbell: Yeah, those are really excellent questions. Bioethics is a field of academic study developed in the 1960s and 1970s — UVA had kind of a formative role to play in the development of bioethics — and it really refers to the study and practice or guidelines for practice regarding ethical issues that occur in medicine and the healthcare professions in biomedical research, in public policy say, pertain to issues of biotechnology. So that's the broad frame of bioethics. And then religious bioethics looks at the ways in which religious beliefs about, for example, human nature, whether we're fallen beings or whether we're created in the image of God. It's the nature of our relationship with the divine.

How those various kinds of assumptions bear on the questions that healthcare professionals, that families have to deal with on a fairly regular basis. Probably the most common example that people address are issues about death and dying, stopping medical treatment, for example. And obviously that particular question is often influenced by personal, familial, communal beliefs about the nature of suffering, the experience of pain. Does it have any redemptive value? What would ultimately comprise a good death within a religious tradition? So those are ways in which there becomes a religious valence or a religious connection to bioethics and theology clearly has a significant interest in bioethics because, at least theology strictly stated, you're engaged in a study, an analysis of the doctrine of God, and that oftentimes (for some) leads to certain views about what should be done in the context of human reproduction, for example, or certain issues that should be done about healthcare issues that concern care for people that don't have insurance because we're told at least in the Christian scriptures and the LDS scriptures [that] to treat the vulnerable is as if we were to treat God. So again, the nature and the concept of God has an impact on how some of these particular issues get not so much resolved, but at least provide a context for trying to address them. 

Stephen Betts: So what's the attraction for you? You've written a lot over the years about Latter-day Saint bioethics, in a variety of, you know, journal contexts and things like this.

This is, it seems like, the culmination of many years of thinking about these issues. What about Latter-day Saint bioethics drew you to write about [it]? 

Courtney Campbell: I'd say that there was a couple of aspects. I'd say there was a personal pull. Not only, you know, my own sort of religious faith commitments (or lack thereof in some instances), but the personal pull of going through some experiences with family members, particularly the dying of my mother — what I've written about in another book as really a poor death rather than a good [death].

So there was that kind of personal pull. I think also there was an academic development which is the sort of development of Mormon studies as a player in the world of academia and within LDS culture generally. And then there has been a move or a shift within bioethics, you know, at least as it's developed in policy forms and in philosophical discussion to really start to discount or move away from religious voices and religious values. And some of that's understandable, but what I was trying to do in the book, why I was attracted to developing a project like this is to bring together these kind of personal, academic, and sort of cultural strands and see if I could begin a conversation, you know, that had many different dimensions. I guess there's one other point I should mention, I mean, which was really a professional strand. Not my own profession, but my interactions with LDS professionals, whether they be physicians, whether they be nurses, some of whom are not in the healthcare setting at all, but have their own kind of inclinations about ethical integrity but didn't really know what that meant, or sometimes had a hard time translating their faith convictions into their personal vocations and so forth, and providing, at least in the healthcare setting some kind of introduction into that thinking about the medical profession as a kind of vocation, indeed, a kind of religious calling in certain respects, a calling to feel others, which is a call ultimately of, of the Savior. So, there's kind of, if you will, four kind of strands the personal, the academic, the cultural, and then the professional piece.

Stephen Betts: Something I found compelling about the book was the way that you're able to tie together these various strands. People might think that ethicists are these philosophers that sit in the ivory tower and make up rules about how people should act. And in some cases that is true, right? There are philosophers and ethicists and scholars who do that. But what I like about this book is that these are compelling problems that all of us have to deal with, right? Religious or not, philosophical or not, we all have to deal with these pressing, bodily social, cultural, spiritual issues, and those demands aren't going to go away, right? And so, this isn't, you know, an abstraction. This is really applied stuff, and you're able to bring together these various strands in a way that. allows us to see, I think, and you talk about “moral reality”— we'll talk about moral reality [and] what that means— but you're able to kind of paint a picture of what does it look like for a Latter-day Saint trying to navigate a worldview in ways that aren't necessarily philosophically coherent or a list of demands that you say “you have to do these things.” They have these certain commitments to how they see the world, how they interact with the world, and. Those are going to influence directly the kinds of decisions they make about things like end-of-life care, or having children, or whatever the case may be.

Courtney Campbell: Right. 

Stephen Betts: So what are some of the kinds of situations, you talk about a variety of situations in this book. What are some of the situations in which Latter-day Saints or medical professionals, policy makers who interact with Latter-day Saints might encounter bioethical questions or dilemmas? 

Courtney Campbell: So you're right that the scope of bioethical questions really pertains to the everyday and not the sort of crisis. Historically, the field sort of grew up around crisis-oriented responses, but I do think, and I tried to by introducing several narratives from persons that I interviewed and persons that I know from various kinds of social settings introduce their narratives to try and get at what the kind of situations that they were experiencing and how those looked from their perspective inside out rather than, as you put it before, sort of outside in from the ivory tower observer. So, questions that really pertain right to the beginning of life. Questions about contraception, issues of reproductive choices, which are certainly very much in the current public discussion.

And surprisingly enough, the LDS church now has its official position on abortion. A more liberal, if you will, stance on abortion than many state laws have in which LDS residents, LDS members reside. It's very kind of interesting questions that, you know, I was very deeply moved by so many stories of individuals that I talked to and interviewed about their experience of caring for children that have various kinds of medical, physiological, sometimes mental anomalies that were going to lead to a shorter lifespan of a year or less. My daughter attended UVA to receive her bachelor's of nursing, went into neonatal intensive care. And again, the stories that she’s told me are just about the anguish that the parents experienced. Now, again, not every parent experiences that. I was fortunate to not have to experience that people do and their religious values are put to a test that's pretty difficult. Pretty difficult. A lot of questions pertaining to the beginnings of life as we move through adolescence. I mean, obviously questions about vaccination of children and more broadly vaccination against COVID have become everyday realities for all of us in one form or another where whether one approves or disagrees with COVID vaccinations.

I mean, vaccination is an important part of the bioethical landscape. There are questions because I think the LDS interests, the unique kind of LDS interest in tracing family history and genealogy. That intersects in interesting ways with the bioethics concerns about genetics, genetic based [diseases]. Can that be identified in certain lines or certain lineages? The LDS community, the genealogical records [that have] been paired up with the Cancer Institute at the University of Utah have been instrumental in identifying genetic based diseases, and then trying to develop some remedies, perhaps even gene editing questions. I think although the, you know, and in the one chapter, I'm fairly critical of the general Church approach on this. I think issues about access to healthcare are the overriding bioethical problem in the United States. That's not true in other countries in which Latter-day Saints [have at least] some presence within. It's in the society, but it is true in the United States, oddly enough. And I think there is a kind of responsibility that people discuss and talk about that we may need to, I think, address more fully as a religious community.

That particular question. Various questions. Again, to some extent I have personal experience with this, at least within family. But questions about organ donation and organ transplantation, which has undergone a really significant evolution in LDS teaching over the last 50 years as organ transplantation has [become] more safe and effective. And then finally, as we mentioned at the outset, again, questions of death and dying and the meaning of death and what would constitute a good death. Now, it's not the case that, you know, a person's gonna run into those questions every day. I haven't really touched on what persons engage in on a fairly regular basis, which is disclosing confidential information to professionals about their health status or the health status of a family member or the child and so forth. So those are part of the [“warp and woof”] of common experience. Hopefully, I think our religious understandings can shape at least some of those interactions. And perhaps provide a kind of witness, a kind of exemplification of how a religious community works at these problems, rather than those that tend to just be dismissive of religious views and say, you know, “they're just anti-scientific,” or something like that.

“It's fine for them to practice their religion within the context of their own community. It's another thing when they go into a professional setting or into a policy setting.” And trying to make a case at several points that those Latter-day Saints [who] encounter these bioethical questions, that they can also be a witness, if you will, bear witness to the importance of their convictions and their values, which may suggest may have some implications and some meaning. [There are] others that, again, in a secular culture tend to be dismissive of those values. 

Stephen Betts: In some ways as I'm reading this, I'm thinking about this listening to you, I'm thinking about this book number of years ago by Anne Fadiman: The Spirit Catches You and You Fall Down. This book about Hmong immigrants and Laotian immigrants in Southern California and their interactions with the medical community and hospitals and doctors and things like that. And one of the biggest problems they ran into was not just language barriers and cultural barriers, but worldview barriers where without understanding not just set of propositions or a set of beliefs but the way that people actually experience life, without understanding that it's really difficult to be able to kind of translate between the needs of doctors and professionals and policy makers and the people that they serve in these kinds of situations.

Courtney Campbell: Right. That's a really wonderful backdrop, really classic book by Anne Fadiman. And it's interesting, in the Hmong community, you had your ethics sort of carried out through stories and narratives and various kinds of traditions that were, I mean, seen as sort of imaginary, magical, superstitious, and so forth within by the medical community in Merced California. But I think what I've tried to retrieve a little bit, not that I was doing an Anne Fadiman ethnography by any means, but the emphasis on narratives and narrative tradition in the LDS context is so pervasive and so powerful.

Again, for me, the Restoration is really, we're telling a different story about the nature of God and God's interactions with humanity and so forth. But it's, I mean, it's more than just that, but at least the Restoration is a re-storying of people's understanding of what people took to be their understanding of God's relationships with humanity and human nature. And so story and narrative that, again, Anne Fadiman picks up and that I think that I agree exactly with your point that, you know, ethics isn't a matter of didactic propositions or biomedical ethics anyway. It's a matter of listening to and interpreting people's stories because those give us insight into their, their background worldviews and convictions.

Stephen Betts: I think is a good place to introduce some [of the] more technical terms that you use, technical phrases. In the book, you talk about something called “moral culture” and this relates to what we were just talking about, moral culture, moral reality. Can you unpack those for us a little bit? Help us to understand what you mean by that. 

Courtney Campbell: Yeah. By “moral culture,” I am suggesting that there's a set of expectations, beliefs, and practices that are bound up with the religious community. And so that's motivated for at least part of that culture. We designate it by different terms. We designate it as “ministering,” for example, but ministering involves a moral commitment to first respect others and their values, but also to try and engage with them. Encounter them with care, compassion, and service. There are empirical studies that indicate that Latter-day Saints devote, you know, roughly 36 times the amount of communal charity work [as others around them]. Again, our altruistic work [is] largely within the context of the LDS community, not necessarily their own, you know, civic communities. Again, it's that sense of a culture that is built around certain kinds of expectations [that are not] enforceable.

You know, the moral culture is backgrounded by the principle of agency to be sure. But it's a culture that says in contrast to, I mean, the contrast might be with the secular culture, the ethics of, of secular culture, which really fits off of one, one, or two basic principles, which is I have liberty to do what I wish so long as I don't harm others. Well, the moral culture of as, as I, uh, try to give an exposition of it, you know, just isn't satisfied with not harming others. There is a positive commitment to benefit others, to treat others. Not only is one would like to be treated, but as they themselves want to be treated and to “mourn with those that mourn,” [to] “comfort those that stand in need of comfort” and so forth.[1]

To me, those covenantal commitments that are made [are] what I'm really referencing as a moral culture that looks to provide benefits to others and not simply benefiting myself so long as it doesn't harm others. And that's the kind of shift that I'm trying to signal with the idea of the moral culture. And I mean, it gets played out in blood donation drives in LDS wards and so forth and other kinds of positive communal actions. 

Stephen Betts: Yeah. So if moral culture then is the kinds of maybe unconscious (a lot of times) expectations about how people are going to behave, moral reality similarly seems to be the kind of, and correct me here, but seems to be the kinds of, yeah. The reality that we produce through social action in a certain kind of way through moral culture. And one of the ways this plays out really interestingly for Latter-day Saints in your book is at one point you talk about, how, because Latter-day Saints are so oriented towards others among their co-religionists in a kind of kinship-style network, in professional contexts, like in a hospital, they will kind of assume professionals into a sort of kinship relation, extended kinship relation

Courtney Campbell: That's right. 

Stephen Betts: which could be really problematic for making professional decisions for the relationship between patient and doctor. But also you have another aspect of Latter-day Saint ministering or Latter-day Saint orientation towards the Other is a notion of vicariousness, like a notion of identity with absence, which I don't know if I can fully unpack that right now, but the thought just occurs to me that when we're talking about care, when we're talking about the Other, that has to play in there as well.

Courtney Campbell: Yeah, I love that kind of phrase of “vicarious identity” and absence. ‘Cause what that does is provide a set of motivations. First the motivation of gratitude because you are the beneficiary or I am the beneficiary of actions of others that I may not know who they are. Certainly have no obvious kind of personalized connection. I may inherit their genes, but I have no I who they are. So, there's a kind of built in, I think, ethic of gratitude. And in frankly in the other book I recently a published called Bearing Witness Religious Meanings in Bioethics, I go into this ethic of gift and gratitude and responsibility much more deeply than I do in yeah, Moral Reality. But yeah, there's a [sense] in which the Other may not necessarily be a living presence. I'm not gonna say imaginary presence, but we're in a different kind of more relationship with that. And then kind of work off of Kierkegaard at the highest, highest form of love for Kierkegaard is remembering the deceased because the deceased can't for Kierkegaard guard reciprocate. So, it can't be a preferential kind of form of love. But I think there's some, we might disagree with that theologically, but I think there's some real powerful insights about trying to care, connect us, and enables, I think, the cultivation of empathy, of sympathy and compassion for those that we do encounter on an everyday basis.

Stephen Betts: Yeah. So talk about your framework. You lay out a normative framework that you call the “restoredm re-storied, and prophetic morality.” So each one of those words has a lot going on there, but unpack that for us. Tell us more about the kinds of principles you distill out of the analysis of these various narratives in ethnographic fieldwork that you've done.

Courtney Campbell: Sure. So just as background, I mean here, here, part of that project or part of that language is trying to address, trying to start the conversation between Mormon studies and LDS professionals and the bioethics community, which has oriented itself around really four major principles: what are called respect for persons, not harming others, which we've had a little bit of discussion, beneficence or benefiting others. and then issues of justice. And so, my focusing on the language of principles is to try and build that kind of bridgework, that moral infrastructure so that conversations could happen back and forth.

But I think, again, given the distinctive content of the LDS story, the principles are gonna be a little bit different. And so rather than beneficence, my principles have to do [with] love and hospitality, which I think are certainly embedded in the scriptures, but also, again, they're part of the moral culture. They're presuppositions of the moral culture. When you're asked to invite missionaries over for dinner, Well, you're enacting this norm or this principle of hospitality to the stranger. I then develop what, to me is really one of the distinctive elements of an LDS ethic, which is a covenantal principle and all that goes into that issue of promising issuing of witness, the background stories of deliverance.

My criticism here is frankly with Church leaders that tend to refer to covenant as a contract between two parties, and maybe what happens in a business contract. Well, that's not the religious meaning of a covenant. A religious covenant is always a gift given by one party to another with certain kind of assumptions of responsibility built in. Of course, a person has the agency to refuse the gift and so forth. Covenant is a gift-based ethic rather than a sort of contract-based ethic that I think has unfortunately come to define much of a bioethical discourse, as well as some ecclesiastical discourse as well. 

I then tried to develop a principle of justice that again has some overlaps with sort of broader principles of justice in society.

And then all of these presuppose the principle of moral agency, which is I think the LDS term that sort of comes closest to the concept of respect for autonomy in bioethics generally. So, I'm trying to develop a moral map there that, again, [would] be useful, would be recognizable for LDS professionals, LDS believers, but also that the bioethics community say, “oh, okay, yeah, we've got some ground for conversation.” 

And then that leads me to this designation, which is really dense, an ethic that's really “restored, re-storied and prophetic.” And part of what I'm trying to get at that, the LDS message is restoring of the Hebrew message and the Christian message. And the morality I do not see as distinctive or unique, but it's placed within a different story about God's revelation, God's love for humanity, God's final call to humanity and the gathering of Israel and so forth, which is a gathering of all people. So, it's a morality that's restored. It's [also] a morality that's re-storied. It's a morality that's re-storied because the morality is given a different narrative context. And then I want to say it's a “prophetic” morality because it bears witness against not only cultural forms of immorality and idolatry, particularly manifested in neglect of the poor, the vulnerable, and those that are on the margins of society. But it's also a prophetic morality in that it provides a constructive alternative, which ultimately, I think for Latter-day Saints is represented in the symbol or the model of the community of Zion. So, you're right, there's a lot packed into those three words. But anyway, that's a short, thumbnail sketch of what's going on.

Stephen Betts: So, you have prophetic critique. I wonder if we can spend a few more minutes on that. You know, Latter-day Saints think about the term “prophet” in a very unique and particular way where, you know, the president of the Church, the person who's in charge, is considered to be a prophet in the same mode as somebody from, you know, the Hebrew Bible, the Old Testament, or the apostles from the New Testament.

And so they seem to have this continuity. That's the “restoration” part. The prophetic part is again, like you said, this sort of critique. And I mean, one interesting thing here is that I think a lot of people in the United States in particular would look at, you know, presidents of The Church of Jesus Christ of Latter-day Saints and say, “well this is very conservative social critique that's keyed to concerns that are common to other conservative, religious groups.” But I think the interesting thing that you kind of are drawing out here is if you look at foundational Latter-day Saint Scripture, for example, the Book of Mormon, laying aside, you know, specific political concerns in contemporary life, these fundamental concerns of Latter-day Saint scripture center on things like taking care of the poor. Seeing yourself as nothing before God, because that's what allows you to have this kind of relationship of gratitude for the gift and that that relationship of gratitude for the gift, this covenantal relationship with God is what then motivates the building of covenant community that takes care of the marginalized and the poor. And just about at every point in the Book of Mormon where you have marginalization going on, those are inflection points in the narrative where it's like, “this is not what's supposed to be happening.” And so I like that sense of prophetic critique. That might be a slight shift from the way that Latter-day Saints in particular might normally think of that phrase.

Courtney Campbell: Yeah. [those are] really excellent comments. In this context, I'm really trying to reformulate or reinterpret of what I would call the moral meaning of prophecy within the Latter-day Saint community. I want to see “the prophet” or the prophetic critique. I'm not necessarily talking about the office per se, or at least the ecclesiastical office. That has to do with administrative matters and so forth. I'm trying to locate a prophetic tradition, and I do consider the Latter-day saint tradition to be a prophetic [tradition] within the tradition of Jesus and the biblical prophets and so forth, as well as the prophets that bear their social witness against wicked and betrayed societies that lead to two genocides in the Book of Mormon. What [does] that prophetic critique [involve]? [It] seems to me that there's three major kind of components to that. It involves what I call “retrieving the moral memory of the community,” that there is a residue of moral teaching and moral instruction, yes, to be sure attached to some religious convictions and so forth. Not diminishing that, but there is a moral residue that the community has neglected or forgotten or just simply said, that's not for us, and we're going to ignore it all together.

And so, the prophet. Whether it be someone like Jeremiah, someone like Jesus, or someone like Abinadi in the Book of Mormon, comes to the community and says, “this is your moral memory.” Okay? These are the values and norms that defines this community that set you apart as a distinctive moral community, not a political community. Not an economic community, but as a moral community. These are the core values. And so, the prophet retrieves that. The prophet recovers the morality. And sometimes, and I talk about this with respect [to] Jesus quite a bit, restores the morality, tells a different story, tells a parable of the Good Samaritan to say, “yeah, you think your core values are love of God and love of neighbor. Yes, you're exactly right. But if you ask me, who's your neighbor? It's the Samaritan and it's the wounded traveler and the people that you're discriminating against.” And it's as Moroni states in his sort of what he thought would be his final testimony. It's the widow and the orphan that the churches are spending all this money to adorn yourself with fine clothing, and beautiful buildings and you don't even notice the neighbor. So, the first element of the prophetic critique is to retrieve the moral memory for the community. Then it’s to expose the moral hypocrisy of the community. Okay. And particularly the ruling elites of the community because they have agentive power. Many people in the society do not have power to make changes, but those that are in the ruling elites wherever they [may] be. Professional elites, political elites, economic elites, even religious elites, they have a power and influence, and yet they're the ones that are, you know, frankly, exposed for their moral hypocrisy.

So, the prophetic witness needs to do that. It needs to cultivate an alternative community that can then carry forward these values and carry forward the moral memory of the community into the future. If it doesn't do that, then the moral community will cease to be a moral community. It will be a community, but a community without a story.

That's the direction I'm taking this, and I think it has some powerful, very powerful self-reflexive or community-reflexive implications for understanding what our religious community is. But also how we engage in with other communities and with the secular society as a whole. And that's, you know, part why [in] the other book I referred to entitled Bearing Witness, I think that ultimately the prophetic function is to bear witness in those kind of three ways of retrieving the moral memory, exposing moral hypocrisy, and then providing a kind of moral hope for the future. 

Stephen Betts: So you also talk about how the Latter-day saint notion of “calling,” which is not the quite the same as you know, say a Puritan notion of calling or something like that, but the Latter-day saint notion of calling, how does this potentially contribute for you to a Latter-day Saint bioethics?

Courtney Campbell: Yeah, I kind of wish we'd revive some of the Puritan or Protestant understanding of calling because calling was part of the way that one glorified God in the world through one's worldly vocation. I'm starting to be involved with actually a UVA medical student who's interested in interviewing his cohort at UVA medical School about their sense [of] moral formation as professionals — I should say his LDS cohort, not his medical student cohort—do they understand their commitment to medicine as a pursuit? Do they consider that to be part and parcel of a religious commitment, or is it kind of just something separate? You know, and that's fine, but at least [let’s] just kind of explore that in my sense is that if we had a more robust notion of calling as something that is directed inwards towards, you know, teaching on Sunday or ministering or what have you, and was expanded a little bit more outwards as a way for God's glory to be manifest in the world in the way that, again, it's worked out in, you know, the concept of calling in Max Weber's The Protestant Ethic and the Spirit of Capitalism, I think that that would help infuse healthcare professions that are really becoming, I think, poisoned with an ethic of provider consumerism relationships. They're moving inevitably into the realm of marketplace ethics where there's an absence of trust, it's buyer beware. And access to healthcare is based on your ability to pay, not on your need for it. So, there is no, at least in that account, there's no sense of calling to a profession are calling to heal. And I tried to develop in the book a sense of the LDS discourse about medicine. Again, not all pulled together. Some of it based in obviously herbal medicines of the 19th century and then in the 20th century I have a shift towards a greater acceptance of modern medical methods and so forth. That's focus is really about healing and we're not necessarily talking about healing in the sort of religious sense of restoring a sinful soul back to a state of grace or something like that. That may be part of it, can be part of it. But I think if we were to develop a, a robust sense of calling, particularly a calling to heal others and heal broken relationships that then medical professionals or mental health professionals—which I have to say is an omission in the book that I really regret—they can then take into their professional practice and say, “this is my professional identity, this is my moral formation as a practitioner.” And I think that, again, can be a very important, if you will, prophetic witness about what a healthcare professional can be to a profession or set of professions that seem to be now sort of bent towards consumerism, provider-consumer relationships, and have lost the art of medicine and lost the art of healing. 

Stephen Betts: Yeah. The Church of Jesus Christ of Latter-day Saints has an interesting relationship to medicine. You just alluded to kind of early interest in Thomsonian medicine, herbal remedies in the 19th century. There were some significant efforts to send women and men to the East Coast [of the United States] to become nurses and doctors pretty early on. And then, you know, somewhat surprising maybe to some listeners today, the [current] president of the Church is a former heart surgeon, right? Very well-known heart surgeon, and another leading member of the Quorum of the Twelve Apostles, Dale Renlund, also another cardiologist, right? Another former professor of medicine. 

So, because there's no seminary training for leaders of the church, their sense of calling is sort of interesting. They leave their vocation for this permanent church service. And so, you do get these kinds of inflections of trust in medicine and certain attitudes towards medicine that maybe other conservative, you know, especially Christian faiths in the United States may not all have, may not all share. Certainly during [the height of] COVID, the Church had a pretty straightforward recommendation to follow current medical advice, and that was not something that, that all other denominations in the US were doing. Right, 

Courtney Campbell: Right. Yeah. Well, and I think to me that speaks so profoundly of what I call ecclesiastical humility. I'm not by any means saying one ought to blindly trust medicine. I mean, ethics is sort of against that proposition from the get go. You know, there comes a point in which these issues become very complex. Whether you're dealing with a mRNA vaccine or you're dealing with some other form of genetic treatment, it becomes very complex, and so there's a limit to the ecclesiastical moral knowledge or moral repository, and I think a kind of legitimate epistemic humility towards medicine and public health officials and, and so forth. What I often become concerned about is that, again, granted the importance of humility and some deference that often the medical issues get worked through, or the scientific issues get worked through, and there isn't any input from the ecclesiastical perspective whatsoever.

I think that, you know, the kind of debate that Utah has gone through three, four years ago with respect to medical marijuana is kind of a case in point. Don't need to recapitulate that here, but you don't want to be so deferential that at the end of the day, all the major scientific questions or medical questions about a new technology or the new use of something like medical marijuana or in Oregon, we're debating now psilocybin—"the magic mushrooms.” You don't want that religious witness to come right at the very end when everything else has been decided, then you've only got two options. You've got an option of, “well, we'll sign on to the status quo because we respect the authority of professionals.” Or, “no, we're going to oppose this. We're going to oppose Death with Dignity or physician-assisted suicide in Oregon or Washington or Colorado or California.” So, you know, this is a good question. Who contains that moral voice for the LDS community? It's not as clear as it might be in other kinds of traditions, but you wanna at least have that moral voice and that moral presence involved and integrated at the start because you don't want to have all the questions defined by science, by medical safety, and medical benefit. You need to look at the broader picture of the ethical values that, again, religions give voice to and hopefully embody. 

Stephen Betts: So before we close, Courtney, thanks so much for this conversation today. I wonder if you could walk us through briefly what does it look like to apply these principles? You've laid out this moral framework, to you know, questions about dying well, questions about end of life decisions. 

Courtney Campbell: Well, as Aristotle taught us long ago, it's always gonna be messy if one's propensity, that's reinforced by the Church culture, is for definitive right wrongs, black and whites. That's not necessarily gonna happen. But if I was trying to look at a question of what would constitute a good dying process, first you have to engage in what I call sort of being at the bedside or ground truth, and you have to examine the situation that a person might, you know, that is near death, but there might be some additional options that that could be provided. There's a kind of investigatory process. What's the situation before us that we're asked to make a moral decision? A religious, a family decision, even in some context of, you know, an institutional ethics committee or a hospice decision. What does that situation look like? Once we can get the parameters worked out, then I think that there are various principles that start to come into play.

We certainly wanna [respect] a person's agency if they've expressed wishes about their dying course and who they wish to be with and so who they wish to be there and accompany them. I need to respect those if they have certain wishes regarding treatment or the stoppage of treatment. Those need to be respected where and this is a different kind of argument. Obviously, the Church draws the line ecclesiastically against physician-hastened death, or euthanasia. Those bring on not only moral sanctions, but also ecclesiastical judgments as well. And I think that's an issue at some point, you know, that the policy's gonna have to be looked at or developed again. I just think, you know, there's so many states, let alone countries that have such policies of physician hastened death. But again, the presumption is you respect an individual's choices, you certainly want to ensure that those choices are, as with any choice, based on agency, they're informed, they reflect the person's wishes and values over time. And then you'd have to I think, examine the justice context. Okay. Which is, are there some reasons that the person may be requesting stopping treatment or requesting, continuation of treatment?

Reflect sort of background, social concerns, do they feel or familial concerns? Do they feel that if they continue to live, that they're gonna be a burden to their family or that they're, they'll spend down their family savings and so forth. Do they not have sufficient funds, sufficient financial resources to get access to good medical care that might have prevented the occasion for dying in the first place?

Do they have sufficient access to hospice care? So, I think you want to, you take the person's choices and preferences with respect to their dying seriously as a matter of commitment to their agency. But then you need to place those choices in a broader sort of justice and communal context. And then, then I'd say that you bring in the covenantal principle again, provided you got, got some kind of resolution on the first two and that's not always easy. Then you bring in the covenantal principle as, again, what is the covenantal principle? As you're bearing witness to an individual's life, you're bearing witness to their values. You, the caregivers, are bearing witness to an individual's life, their values, their wishes, and preferences. You're standing as a witness to this child of God as they sojourn out of moral life. Those who me are kind of the three, you know, sort of principles that I think are central to that sort of discussion [that you] really need to think through [an] actual circumstance to really say, “I think this would be a wrong choice, or, I think this would be an ethically right choice.”

I would just say that one of, again, one of the motivations for this kind of brings us full circle, I guess, you know, was as I indicated, I felt that none of those principles were reflected or manifested in the dying of my mother, who died alone in a Salt Lake City hospital because her physicians had told the rest of the family that she wasn't anywhere close to dying.

So it seemed to me that there wasn't respect for agency, there wasn't a communal justice consideration, and there wasn't, there wasn't a covenantal consideration, and that to me would be, as I say, that's an example of a poor dying. I hate to say that about the dying of my mother, but a good dying would, again, have the relationships involved, respect to individuals choices, and provide witness in the presence of a caring covenantal community at the end of life. That to me, would be sort of the, the components of a good dying. 

Stephen Betts: That's Courtney Campbell talking about his book, Moral Realities Medicine, Bioethics, and Mormonism, recently published by Oxford University Press. Thanks for joining me today, Courtney. 

Courtney Campbell: Thank you, Stephen. Thank you very much for your questions. 

Stephen Betts: Thanks for listening to Scholars and Saints.

This podcast is made possible by the Mormon Studies Program at the University of Virginia. To learn more, visit mormonstudies.as.virginia.edu. Music for this episode is used by permission of the artist Ben Howington. The track name is “Wayfaring Stranger.” To hear more, visit mormonguitar.com.

[1] Book of Mormon, Mosiah 18:9.