William F. May & the Crisis of Bioethics
I have had the good fortune to know a number of fine fiction writers over the years, and to a man (or woman) they always prayed for the crucial literary award that might gain them the readership their talent deserved; one joked ruefully that he would consider sacrificing an arm or a leg if it would get him included in the annual Best American Short Stories collection. No equivalent recognition exists for works on bioethics, but the editors of the Hastings Center Report—the premier journal in the field—once asked a list of prominent thinkers in the discipline to name the most important article published during the first fifteen years of the journal’s existence. Only one author’s name appeared more than once: William F. May. “Bill has added something to bioethics that almost no one else working in the field really possesses,” says his friend Gilbert Meilaender, professor of theology at Valparaiso University. “He embeds his thinking about particular issues in a very rich, imaginative, and often witty sense of what it means to be human.” “He’s something of a genius at what he does,” adds David Smith of Yale University’s Interdisciplinary Center for Bioethics. “And courageous.”
To appreciate May’s influence during the formative years of bioethics, one need only read his 1971 essay “Attitudes to the Newly Dead” in the inaugural issue of the Hastings journal. The topic was the emerging issue of organ-donation policy, and May drew on an impressive array of sources—from Homer and Sophocles to the Brothers Grimm, Jung, and Unamuno—to urge caution about the routine salvaging of human organs. He argued that the attitude to the body embedded in public policy about organ donation holds consequences for all of bioethics, and that a utilitarian focus on practical consequences makes too narrow an approach for addressing issues of profound human significance. “While living,” May wrote, “a person is identified with his body in such a way as to render the dignity of the two inseparable. A man not only has a body, he is his body.” To think clearly about organ donation, we must acknowledge that the “association between self and body does not terminate abruptly with death.” The view of the body articulated by May in this foundational essay went on to inform much subsequent work in bioethics, including work in Catholic sources. It is echoed in bioethics debates whenever anyone insists that the association between the body and the self is not necessarily terminated by persistent vegetative states, gamete donation, or abortion.
Although May is best known for his work in bioethics, he has made significant contributions to a range of disciplines, and has served as president of both the American Academy of Religion (AAR) and the Society of Christian Ethics (SCE). His 2011 volume Testing the National Covenant: Fear and Appetites in American Politics was based on his address to the SCE in January 2003. Coming a mere fifteen months after the attacks of September 11, it was the first occasion for a president of the society to address the ethical issues raised by the U.S. government’s response to terrorism in a post-9/11 world. May spoke of the twin dangers of tyranny and anarchy, and argued that fear of the latter had become the driving force of political discourse in the West—not merely since the attacks, but going back at least to the 1990s. Fear of anarchy—both political and cultural—had been growing for decades, and failure to recognize that fact was sure to distort America’s response to terrorism.
Developing this theme in Testing the National Covenant, May quotes Flannery O’Connor’s remark that “you know a people by the stories they tell,” and goes on to explore how myth and story shape people both cognitively and morally. He is particularly interested in the stories we tell of good and evil. In May’s view, to understand our responses to the threat of anarchy, we need to grasp the attraction of certain mythic stories that have shaped Western thought.
One such story derives from a religious dualism that posits two gods, not one—in effect making Satan coequal with God—and narrates a cosmic struggle between their rival kingdoms. In the Cold War era, this story molded much of the West’s response to tyranny. Subsequently, as we have shifted from fear of tyranny to fear of anarchy, the contest between beneficent order and malevolent order has been recast as one between order and chaos. In turn, May asserts, our response to terrorism is now informed not by a dualism that misappropriates Genesis, but by the Babylonian creation myth in which “Marduk, a kind of sheriff deity and the enforcer of law and order, battles Tiamut, a formless monster issuing from turbulent waters, the symbol of primordial chaos.”
The problem with the Babylonian creation myth as the shaping narrative of the struggle with terrorism, says May, is that Marduk has a taste for violence as well as a commitment to order. The myth thus “reminds us that a society threatened with disruption and chaos may suspend its self-restraints and rally around its police and militia for the sake of law and order.” Opposed to imperial pretensions and an imperial presidency, May has written that in the struggle between the United States and terrorists—between Marduk and Tiamat—“the dragon’s tail may show beneath the sheriff’s uniform.”
Bill May’s lifelong attention to the temptations of Manichean thinking can perhaps be explained by the fact that he spent his formative years in two cities that were deeply divided—his birthplace of Chicago, with its old ethnic tensions, and Houston, where his family moved in 1938 when he was twelve, and where he was quick to perceive the uneasy dualism that marked the color line in a city where whites asserted absolute control.
Though May spent his early years in the Central time zone, his intellectual training and early career were strictly East Coast. He attended Princeton, where he was one of Paul Ramsey’s first students. Ramsey went on to become one of the most important Christian ethicists of his generation, but he was just starting his academic career when May took his class as a sophomore. Yet Ramsey was already a memorable teacher. “Compared with the smooth, polished, seamless delivery of other professors in Ivy League attire,” May would recall years later, “Ramsey came across as a theological calliope—full of snorts and harrumphs, throat clearings and chortles, bolts of laughter, and a constant reliance on a reiterated ‘You see, you see,’ as he gathered intellectual steam.”
Working with Ramsey led May to Yale, where he completed a BD and PhD. During one of his breaks, he did summer theater in New York. It turned out that the most important role he would audition for was that of husband, for it was there that he met his wife, actress Beverly May. (Apparently he was well cast; the two have been married for sixty years.) From Yale, he went to Smith College, staying for fourteen years before being hired away to build the religious-studies department at Indiana University from the ground up. Not everybody was happy when May sought to include theologians within the religion department at a state school, but in response he simply asked, What sense did it make to have courses on Aquinas as an important part of a curriculum at a university where Aquinas himself would be ineligible for a tenure-track position? His characteristically sensible argument carried the day.
As May’s research and writing turned increasingly to bioethics, he sought positions that would support those interests, spending five years at the Kennedy Institute at Georgetown University, then heading to Southern Methodist University as the first holder of the Cary M. Maguire University Professorship of Ethics. Colleagues from SMU recall the enormous impact May had on campus. One episode looms large. It involved a scandal that earned the SMU football program the “death penalty” for infractions of NCAA rules. In the university and the wider Dallas community the scandal was all-consuming. From 1981–84, the SMU Mustangs had the best record in college football. But in 1987, the NCAA cancelled SMU’s football season, stripped it of scholarships, and imposed other devastating sanctions on the program for charges that included paying players and their families. The Mustangs did not have another winning season for more than twenty years.
May had been introduced as the new “University Professor of Ethics” just as the scandal broke, and he went on to play an important role in the university’s effort to learn from the crisis. Asked to address the community in a town-hall meeting, he gave a talk that should be required reading on campuses with big-time athletic programs. Instead of demonizing athletics as some professors do, May sought to articulate a university’s mission in light of the historical ideal of mens sana in corpore sano. “Ideally in the classroom,” he said, “one hopes for active and vigorous minds in active and vigorous bodies producing active and vigorous citizens.”
Student athletes can serve as role models in this regard, May argued, bolstering other students in their commitment to avoid passivity and sloth—and in doing so, can help make the university “resemble republican Rome and Athens more than imperial Rome.” May advocated keeping college athletics, but insisted that athletic programs protect the goods of human play. “Play distinguishes human culture,” he observed. “Play is the handmaiden of creativity and discovery. The good writer has learned to play with words; the painter, with pigment; the musician, with sound; the scientist, with alternative hypotheses.” Similarly, college athletes “offer a poetry in motion that we all can enjoy.” The play of mind and body, both on and off the field, is precisely what a university “must rightly encourage before young people put on the three-piece suit of the merely useful.”
Such a balanced approach to the scandal at SMU resonated widely on campus, which is probably why May was asked to serve on the many search committees needed to replace various administrators who resigned or were fired in the aftermath. His coolness in a crisis suggests one of the more interesting themes in his work, one signaled by the subtitle of his most recent book: “Fears and Appetites in American Politics.” May is extremely attentive to what we desire and fear, and especially those “runaway fears” that result when a “preoccupation with death and destruction” replaces “attentiveness before a good and nurturant God,” as it has for many Americans. The antidote is what May calls “metaphysical nonchalance.” That may sound vaguely stoic, but it isn’t. Biblical tradition, May writes, advocates nonchalance not through detachment but through its opposite, a fundamental attachment to divine love. This primordial attachment to God’s sustaining love enables “a capacity to take in one’s strides life’s gifts and blows.”
It would be hard to overstate the significance to May’s work of the belief that combating a corrosive fear of mortality is central to the moral life. This concern for identifying the dangers of an obsessive quest for security helps explain why Dostoevsky’s Grand Inquisitor figures so prominently in his writings, and especially in his 1983 book The Physician’s Covenant. Introduced in a chapter on casting physicians in the role of a parent, May’s version of the Inquisitor is not the sinister figure with “withered face and sunken eyes” that Dostoevsky described, but rather the arch-humanitarian, the concerned and overprotective parent. He weeps when we weep; he understands the fear of death that bears down on us. Like a parent who abhors seeing his child suffer, the Inquisitor seeks to hide suffering from us, to shield us from its terror. His ruling principle is the “avoidance of suffering and death,” and his effort to avoid these evils “governs every action.”
The parental metaphor for medicine is worth appropriating in some ways, but it is also dangerous, and May’s reading of the Grand Inquisitor helps us see why. In the process it offers insight into some of the central moral issues raised by contemporary medicine, which May has explored in three important volumes in medical ethics, The Physician’s Covenant, The Patient’s Ordeal, and Testing the Medical Covenant. Describing these works as studies in medical ethics may mislead, conjuring images of an ethicist applying principles to medical dilemmas in order to derive particular conclusions. May insists that such a quandary-based approach to medical ethics, while important, is ultimately limited. And it is limited in a way that frustrates any attempt to understand medical issues in theological terms. Too frequently, May writes, those who seek to apply bioethical principles to cases fail to understand that religious narratives open a horizon against which the “believer can see silhouetted the commands, rules, virtues, and principles” that govern his or her life.
Keeping the narratives of the Christian tradition as the background for viewing rules of medical ethics puts bioethical conflicts in a new and illuminating perspective. Take, for example, prolife and prochoice positions. “One group abhors death and holds life sacred,” May writes; “the other abhors suffering and values quality of life over life.” His summary of these positions is succinct: “Both revere a creaturely good, not the Creator.” So too with partisans in end-of-life controversies. In May’s view, one group would have us do more than we should (insist on futile treatment), the other less (give a lethal injection rather than comforting those in pain). Both are missing what he sees as the good news of the gospel—namely, that suffering and death, while genuine evils, are not ultimate. The desperate resistance to suffering and death found in the writings of both prolife and prochoice advocates stems from a failure to understand that God’s solidarity with the suffering and dying is ultimately liberating. It is precisely this solidarity that undergirds the religious optimism of May’s “metaphysical nonchalance.”
While May’s appeal to religious narratives does indeed complement the application of rules and principles in bioethics, some have asked whether such appeals are always appropriate. The influential ethicist James Childress of the University of Virginia has argued that the appeal to archetypal narratives can “obscure individual narratives and thus seriously distort what a particular patient is saying” in requesting or declining treatment. And then there is the fundamental issue of how well May’s broadly humanistic approach meshes with the rigors of bioethics. “As a humanist, Bill does not write and speak primarily for the gatekeepers of the discipline but rather for the intellectually interested general public,” his longtime friend and colleague, the theologian Charles Curran of SMU, comments approvingly. “His essays refer to sociologists and psychologists, to novelists and poets, to artists and politicians. He illuminates a deeper meaning, for example, by appealing to the differences between Athens and Sparta as well as the differences between formal French gardens and English gardens.”
Another SMU colleague and friend, Dick Mason, notes that even students captivated by May’s classes sometimes express puzzlement over why studying bioethics requires them to examine so many literary references. Some colleagues in bioethics have raised the same concern, even colleagues deeply sympathetic to what May is attempting to do. Gil Meilaender, who joined President George W. Bush’s bioethics commission along with May, observes wryly that some might prefer a physician “of relatively impoverished literary or metaphysical insight...[to] someone who had as an undergraduate gone almost without sleep for a week while working through various interpretations of Dostoevsky’s Grand Inquisitor.” The philosopher Joel Feinberg makes a similar point much more emphatically. Writing about May’s essay “Attitudes to the Newly Dead,” Feinberg lumps May together with Paul Ramsey, who also argued against routine harvesting of body organs; both, he says, “approach these urgent questions more in the manner of literary critics debating the appropriateness of symbols than as moralists. One wants to remind them forcibly that while they distinguish among symbols and sentiments, there are people out there suffering and dying.”
It’s worth recalling, along these lines, how President Bush’s Bioethics Council was criticized for construing bioethics too expansively. When the council’s first meeting was devoted to a discussion of Nathaniel Hawthorne’s story “The Birth-Mark,” the chairperson, Leon Kass, was excoriated in some circles. Writing in the New Yorker, Jerome Groopman complained that beginning the council’s work by reading a piece of fictional literature was a way of sneaking theological assumptions into the group’s deliberations. Echoing Feinberg, Groopman tartly expressed his hope that the council would “help shape a medical guideline that is based on fact, not on literature or aesthetics—one that distinguishes real science from science fiction.”
Groopman might have understood the point of beginning the council’s work with Hawthorne had he read the introduction to the session that Kass asked May to prepare. In it May acknowledged that “novelists do not bake bread or write legislation,” but insisted they can help policy-makers and ethicists understand the human dimensions of the issues to which their work attends. Take, for example, the Hawthorne tale, which chronicles a scientist’s obsession with his wife’s single imperfection, a birthmark on her left cheek, and his compulsion to remove it. “Hawthorne tells us that the birthmark is imprinted on her left cheek,” May writes, “the side on which the heart itself resides, the very fount and core of life.” Giving in to his dream of perfection, the scientist removes his wife’s birthmark, with fatal results. “Ultimately, he cannot perfect her,” May observes; “he cannot remove the mark of mortality without removing her from life.” Hawthorne’s narrative offered the council a salutary reminder about the danger of Promethean ambitions—an appropriate caution, May argued, for a council taking up the issue of embryonic-stem-cell research.
I for one was never convinced that the quick dismissal of using literary sources was warranted. Nevertheless, there is a legitimate concern in the sort of impatience expressed by Groopman, one that applies to May’s work generally. John Evans has articulated the concern nicely in his recent book The History and Future of Bioethics. Contrasting public-policy bioethics with cultural bioethics, Evans argues that, if the two are confused, the profession of bioethics will suffer. Indeed, he suggests that those who, like May, engage in cultural work in the field should stop calling themselves bioethicists altogether.
May would probably be happy to call himself a theological ethicist rather than a bioethicist, but he would continue to insist that attention to literature and the arts, informed by a theological vision of human life and history, can assist us in thinking about the difficult issues raised by biotechnology. The problem is that May’s form of cultural bioethics is in fact countercultural in profound ways. Consider, for example, the theme that is arguably at the core of his work—namely, covenant. In book after book, article after article, May turns to the contrast between covenant and contract to delineate his views.
His account of covenant is deeply appealing. Drawing on the biblical narratives of God’s covenant with Israel, May argues that the metaphor of covenant can structure human-to-human interaction in important ways. For example, he views the theme of covenant as central to traditional views of professional life, in which the professional is covenanted with his clients. Covenants are responsive; they emphasize exchange and reciprocity. They are personal in that those who are covenanted do not meet entirely as strangers. And while contracts are minimalist, encouraging a quid pro quo between parties who meet as self-interested strangers, covenants stress mutual giving and receiving, emphasizing relationship, rather than choice, as the basis of exchange.
Given his literary bent, it is not surprising that May illustrates the difference between contract and covenant by reflecting on the differences between Ernest Hemingway’s fiction and that of William Faulkner. According to May, Hemingway “prizes technique as a shield against ties,” and his characters typically remain solitary even in the midst of social gatherings. By contrast, Faulkner’s novels and stories create a tightly bonded world. Even the stylistic differences between Hemingway and Faulkner mirror the differences between contract and covenant. Hemingway’s stripped-down prose and precisely clipped dialogue suggest a legal document; Faulkner’s expansive, sprawling, relationally dense and allusive sentences are thick with meaning and redolent of the sort of unruly family gatherings where responsibilities are real, even if they are not spelled out. Drawing out this distinction between covenant and contract, May seeks to show how the shift from covenant to contract has impoverished our sense of public responsibility. In Beleaguered Rulers (2001), he examines professions including law, medicine, ministry, and education to suggest that when professional responsibility is understood in contractual rather than covenantal terms, a moral minimalism detrimental to the common good sets in.
This is a powerful analysis; yet the very situation May bemoans raises a serious problem for his work. For the fact of the matter is that in almost every area of American life, the contractual model of human affairs dominates. From campus classrooms to corporate boardrooms, whether studying Thomas Hobbes or worshiping Steve Jobs, Americans embody and enact the “possessive individualism” of contract thinkers. Alas, we are a nation of Jake Barneses, and not Isaac McCaslins. May’s advocacy of certain policies, whether in medicine, business, law or government, is formed against a backdrop of assumptions about the best way to organize our communal life; strip away those assumptions, and his policy recommendations may seem less plausible. There is also the question of whether the notion of covenant itself can generate the policy positions May identifies with it. As the late bioethicist K. Danner Clouser wrote about May’s attention to covenantal relationships, “The focus ends up on the inner self—the agent’s philosophy of life—more than on what actions are morally acceptable.”
As a writer May often sounds prophetic; while he is not given to the thundering jeremiad of a Hebrew prophet, there’s no mistaking that his is a corrective vision, put forth by a man used to swimming against the cultural tide. But his work is no mere flailing against the undertow of contemporary society. In The Patient’s Ordeal he notes that moralists often “pay too little attention to the elements of rhythm and tempo in life.” May himself certainly cannot be accused of this neglect. His work hums with the beauty (and darkness) of everyday life, in part because of its often poignant subject matter—an addict’s struggle with addiction, a burn patient’s struggle for rebirth in a body scarred by flames—but also, and importantly, because he writes so beautifully. May’s colleague, Charlie Curran, describes him as “a sculptor of words,” a writer who chisels his manuscripts with painstaking care until the power and beauty of his ideas emerges in elegant prose.
I had the chance to relate this compliment to May, one afternoon on the deck of his summer home looking out over the White Mountains in New Hampshire, and when I did, I saw the self-deprecating humor so many of his colleagues had mentioned. “Yes, I suppose so,” he said of Curran’s remark; “sculptors do work very slowly.” A bit later, when I asked him to confirm that he had received a standing ovation for his SCE presidential address, he observed that “they might have been stretching.” At eighty-five May continues to wield a sharp and quick wit, one often directed at his own foibles.
From his deck one used to hear the keening music of the saw blades at the mill in nearby Berlin, but, like many of the region’s pulp and paper mills, it’s been closed. As the mill jobs have disappeared, the area has fallen on hard times. Still, there is a quiet dignity in these mountains, and the residents who remain trust in the promise of the place. As May might put it, theirs is a covenant, not a contract with the future. I doubt there is a position of poet laureate in Randolph, New Hampshire. If there were, Bill May would be an ideal choice. The unadorned power of his writing aptly reflects the natural beauty of this part of the world. And like spending time in the White Mountains, dwelling for a while in May’s inspired work renews the spirit and fosters hope for what lies ahead.
This article has been funded by a grant from the Henry Luce Foundation.