The “good life” represents an important concept for bioethical thinking. In discussions of issues such as prenatal screening, selective reproduction, or the choosing (or not-choosing) of children with diseases,[1] scholars often presuppose that the experience of disability or prolonged suffering hinders well-being and cannot be reconciled with the concept of the “good life.”[2] Such reasoning not only degrades the lives of people with disabilities as unworthy to be lived but also puts women under pressure to undergo screening and possible termination processes in order to prevent the existence of a purportedly not-good life.[3] Moreover, it raises the question of how Christians should understand and delimit this significant concept. In the present paper, I will examine the assumption that the absence of suffering constitutes a “good life” worthy to be lived by biblically and theologically investigating the properties and characteristics of such a life. Specifically, I will study selected Genesis narratives presenting a proto-logical vision of the good human life within a salvation-historical framework of creation and redemption. This will help us to a) resist a mere historical-exegetical approach and to b) add an eschato-logical viewpoint to our analysis. Furthermore, this theologico-ethical matter should not be investigated in theoretical isolation. As noted above, the issue plays an important role in discussions of selective reproduction. Hence, the paper will address different scholarly proposals concerning the relationship between disability, happiness, and abortion. Specifically, it will unfold the hypothesis that a theological reading of selected Genesis narratives enables us to formulate an anthropological account of the good life which resists attempts to diminish the grave nature of illness, on the one hand, and approaches which devalue life with a disability, on the other.
An important initial conversation partner in the present paper is Oxford ethicist Julian Savulescu, who argues that disabilities represent “opportunity altering states” which hinder wellbeing. Since parents should only select a child that is expected to have the best life (i.e., Savulescu’s principle of procreative beneficence), there is good reason to only give birth to children with the least disabilities.[4] Thus, he favors a subjective context-relative definition of the good life consisting in the experience of as much unhindered opportunity as possible in a given time and place.[5]
While a number of ethicists have noted that Savulescu’s proposed correlation between well-being and disability does not do justice to the intricacies of the relationship in question,[6] scholars opposing such a stark dichotomy between the good life and the experience of disability generally belong to one of two argumentative camps: a) those who emphasize that people with disabilities commonly claim to experience well-being despite their impairments; and b) those who question that impairments hinder well-being in the first place.
The former framework is characterized by a desire to accept the truth of well-being testimonies provided by people with disabilities. Hence, scholars employing such an approach attach greater importance to subjective satisfaction than to objective constructions of the good life.[7] Ethicists operating within the latter framework commonly emphasize the need to overcome a medicalized paradigm according to which life with disabilities is understood to be defective. According to these scholars, disablement represents a societal construction based on a supposed deviation from an idealized abled body. Once this conceptual lens is deconstructed, it becomes clear that “people with disabilities are no different from anyone else living a life of circumstantial highs and lows.”[8] It is not impairments which hinder people from well-being but unjust and excluding “physical and attitudinal barriers in society.”[9]
However, both paradigms inadequately oppose the assumption of a close relationship between disabilities and the not-good life, especially in the context of a Christian worldview. While the latter framework is forced to ignore realities such as “pain, loss, disruption, and reduced life expectancy” to treat disabilities as neutral characteristics,[10] the former paradigm errs on the side of hedonism. Approaching the good life primarily as a subjective experience of satisfaction falls prey to Robert Nozick’s famous experience machine objection which convincingly demonstrates that felt pleasure cannot be equated with well-being.[11] Moreover, within a Christian worldview of creation and redemption, disabilities cannot be treated as neutral or mere societal constructs (which would suggest that such a perspective also contributes to our understanding of disabilities) but must be named as post-lapsarian ills in need of redemption. To deny the evil nature of disability, a concept which will be expounded in more detail below, means to deny the possibility of the redemption of the body and the anticipation its perfection.
Nevertheless, Christian ethicists such as Hans Reinders have taken a similar route and argued that life is simply good “because it is what it is.”[12] Reinders refuses to connect the goodness of life to any condition and instead maintains that its goodness is guaranteed by life’s status as a divine gift. Supposedly, what is needed is a change of perspective (perhaps a deconstruction) rather than the redemption of the body.[13] Not only does such a view declare the realities of suffering and pain as unimportant, it also proclaims a somewhat gnostic dualistic framework according to which well-being is a matter of the human thought world.
Is Savulescu then justified in assuming that disabilities hinder the good life by presenting opportunity altering states which should be eliminated by means of selective reproduction? As established in the previous section, Christians cannot ignore and should not belittle the realities of suffering. However, are disabilities truly incompatible with the good life? In order to provide answers to this question, it will be helpful to theologically read Genesis 1–2 as a protological discourse describing how things were intended to be in this world.
Publications investigating the scriptural representation of complex realities of human life such as illness and disability have become numerous in recent years.[14] However rather than employing theological readings, Biblical scholars usually explore disabilities as past social experiences by “examining ancient notions of disability” that are “encoded” in the text.[15] Joel Estes, on the other hand, has offered a theological interpretation of Gen 2 through the lens of disability studies, arguing that the assumption of an original state of perfection presents itself as problematic. According to Estes, Adam’s embodiment implies necessary limitations, such as passibility, pain, and loss, which nevertheless exemplify good aspects of creation because they bring forth human virtuousness.[16] Given the subject matter at hand, his account represents a feasible starting point for the present inquiry. By arguing that able-ness is an illusion in the first place, Estes appears to fall in line with those ethicists who maintain that “people with disabilities are no different from anyone else living a life of circumstantial highs and lows.” However, does his claim do justice to the character of the good life in this passage?
While the recurring and refrain-like appearance of טוֹב “good” in Gen 1–2 presents itself as somewhat unspecific, the divine exclamation that something in paradise was לֹא־טוֹב “not good” (Gen 2:18) promises to deliver interpretative satisfaction. Estes understands this phrase as implying a state of loneliness resulting in subsequent painful feelings (Gen 2:19f).[17] However, his reading goes against the grain of the text which does not expound the first man’s inner thought world but paints a vivid picture of humanity’s assigned place in the cosmos. In Gen 2:18, the order of creation, as it pertains to Adam, hangs in the balance. The לֹא־טוֹב “not good” represents a last hiding place of the state of “formless and void” to be overcome in the process of speaking and ordering creation into existence. God had already formed טוב “good” things in Gen 1 by continuously crafting order out of disorder, light out of darkness, and life from the ground. However, Adam’s lonely state without a “suitable helper” (עֵזֶר כְּנֶגְדּוֹ) exposes a remaining space in which creation has not yet fallen into its place. Nevertheless, more is at stake than mere companionship. The creation of humanity as God’s image included both men and women (Gen 1:26f). Hence, a “suitable helper” (עֵזֶר כְּנֶגְדּוֹ) was needed to ensure that Adam was able to realize his creational mandate. In other words, in order to overcome the לֹא־טוֹב “not good” of disorder and to establish the טוֹב “good” state of order, the אִישׁ (man) had to receive an אִשָּׁה (wo-man).[18]
This brief exegetical excursus demonstrates by way of example that the goodness of creation and, hence, the goodness of life according to creation, must be understood as relative to the divinely intended purpose of the cosmos and its constituent parts. That is “good” which aligns with God’s perspective of what things are made for. Similarly, with regard to רַע “evil” as the antonym of “good” Faro notes that “evil, then, from God’s perspective is presented predominantly as choices that conflict with God.”[19] Given that Genesis 1 and 2 present humans as created for the task of representing God’s rule as his image, the protological good life consists in fulfilling this creational mandate. Within this teleological account, everything supporting the human role in the cosmos should be classified as good and necessary (such as the presence of a “suitable helper”).
While it is not possible to enter a full discussion of the human role as the image of God, McDowell’s convincing explanation of the image as kinship, kingship, and cult will suffice in the present context. Based on exegetical observations in Gen 1:26f and Gen 2:5–3:24, she argues that Adam was created as a statue (צֶלֶם “image”) designed to live in God’s presence in the garden sanctuary. This life is characterized by a father-son relationship with God, the responsibility to rule the earth on behalf of God, and the role of a statue representing God.[20] Within the framework of Gen 1 and 2 as a protological discourse displaying the goodness of creation relative to its telos, the good human life consists in living out one’s role as the image of God. Consequently, dis-ablement must be redefined to include everything that hinders humans from fulfilling their God-given mandate.
To add an additional perspective, we might say that a theological reading of Gen 1 and 2 suggests a close relationship between ethics, anthropology, and, as will be discussed in more detail below, soteriology. In this passage, there is an overlap between the good life and the demand to fulfill the creational mandate. In other words, protologically speaking, one can deduce that happiness coincides with submission to the will of God. This concurrence falls in line with other theological reflections such as the first and second question of the Westminster Shorter Catechism:
Q: What is the chief end of man?
A: Man’s chief end is to glorify God and to enjoy him forever.
Q: What rule hath God given to direct us how we may glorify and enjoy him?
A: The Word of God, which is contained in the Scriptures of the Old and New Testaments, is the only rule to direct us how we may glorify and enjoy him.
On the flipside, the not-good life must be associated with rebellion against God’s will—that is, the negation of acting according to man’s chief end. Within the framework of the theological analysis of Gen 1 presented above, sin and dis-ablement concur. The refusal to glorify God results in an impossibility to enjoy him; to live out the relationship for which humans were created. Hence, sin represents a dis-ablement towards living the good life.
At this point, the categories used in the present paper should not be misunderstood. Dis-ablement according to Gen 1–2 cannot be equated with medical disability, that is, with illness. They are alike each other only insofar as they both hinder humans from fulfilling their God-given mandate. However, they are unlike each other insofar as disability does not necessarily coincide with personal rebellion towards God. Scripture portrays sin as individual choice which has both individual and corporal effects. As Groenhut notes from a Reformed perspective:
So we shouldn’t always react to illness by asking: “Who sinned, this man or his parents?” (John 9:2). Instead, a Reformed view of sin emphasizes that the connections between sin, evil, and illness are pervasive, structural, and entangled in every aspect of human life.[21]
Therefore, by associating the good life with obedience and the not-good life with sin, soteriology becomes a bridge between the two realities. It is redemption which creates a good life out of a not-good life. This framework allows us to overcome approaches which underplay suffering from illness as an evil reality (such as Reinders’ reflection on life as a gift) and, consequently, fall short of the graveness of disability. Life with illness is not good. It is in need of redemption because it hinders people from fulfilling their God-given mandate. Scripture affirms this perspective by relating salvation to healing (Is 53:5).
At this point, I would like to reintroduce Savulescu. His attempt to establish the good life through abortion represents a deviant soteriology as he attempts to produce happiness through selective reproduction. While Savulescu is to be commended for rejecting approaches which declare the realities of suffering and pain as neutral or unimportant, he is unable to provide hope outside the material realm and, thus, makes death a moral imperative for those facing opportunity altering states. One might say, Savulsecu lacks the eschatological vision with which the Genesis stories address the problem of the not-good life.
Genesis 3 narrates the Fall which hinders humans from dwelling in God’s presence and, thus, from living out their God-given mandate. Following the first couple’s disobedience, such dis-ablement is presented as a spatial reality (Adam and Eve have to leave God’s presence), a physical reality (thistles, thorns, and pain), and a spiritual reality (fear before God and estrangement among humans). Therefore, illness and death are associated with a movement away from God (cf. Gen 3:19–23). Much like everything else that is רַע “evil,” they represent both the cause and the result of failing to live as God’s image.
Nevertheless, beyond Genesis 3, dis-ablement does not have the last word. Human failure to live according to the protological standard for the good life is addressed by means of a story expounding eschatological redemption in later chapters of the book. The narrative of Joseph (Gen 37–50) presents a young man from the family of Abraham who is spatially removed from dwelling in God’s presence through a wicked act of his brothers. In the logic of the narrative, the land of Canaan and the family of Abraham had become the place where God began to restore his dwelling with humans (cf. Gen 12:1–3 and Gen 28:10–22). However, the story also provides us with a redemptive-eschatological interpretation of רַע “evil” in relationship to טוֹב “good”, albeit not in a systematic fashion. In Gen 50:20, we read how Joseph addresses his brothers in retrospective:
וְאַתֶּם חֲשַׁבְתֶּם עָלַי רָעָה
אֱלֹהִים חֲשָׁבָהּ לְטֹבָה
לְמַעַן עֲשֹׂה כַּיּוֹם הַזֶּה לְהַחֲיֹת עַם־רָב
For you planned it as evil against me,
but God planned it for good,
in order to keep alive a great nation, as it is today.
The text refuses to call evil good or to bring evil close to God’s planning. However, it acknowledges that God redeems the not-good life by recreating a good-life in the middle of evil. Moreover, it demonstrates that such recreation is tied to an eschatological purpose, namely, the preservation of God’s people which represent his new dwelling place. Ultimately, God’s dwelling with humanity, which is most pronounced in the incarnation, is aimed at restoring the possibility for humans to live as God’s image (cf. Eph 4:22–24; Col 3:9–10). Hence, the Bible presents the good-life as an eschatological reality breaking through into the here-and-now. The full and painful reality of the not-good life does not negate the anticipation of the redemption of the body, the mind, and alienation from God. Here Savulescu’s position and the Christian worldview differ. While both affirm the reality of the not-good life and resist attempts to minimalize its consequences on the human condition, only the latter is able to counter the weight of protological failure with eschatological hope.
It goes without saying that Genesis does not provide us with a systematic theology of disability. Nevertheless, in light of the analysis sketched above, a number of observations may be applied to the present problem. First, medical disabilities are a product of the Fall, hinder humans from living a good life, and must be viewed as “not-good” in a protological perspective. Theologically read, the Genesis narrative prohibits approaches which attempt to neutralize disabilities in a social, experiential, or spiritual fashion.
Second, people with medical disabilities are not essentially different from other post-lapsarian humans. While all suffer from the curse of the not-good life, not all suffer from it equally. It is a matter of degree rather than of essence. This observation also informs debates surrounding the value of human life with disabilities. Since every person suffers from protological dis-ablement (may it be medical or not), the notion that a “difficult” or “suffering” life should not be lived is bereaved of anthropological justification. Proponents of selective reproduction misunderstand the vast dimensions of this human problem. They assume that people without disabilities live a good life because of a lack of ongoing illnesses. However, in a biblical-theological perspective, “opportunity altering states” are rooted in an estrangement from God. Savulescu’s best possible life will always be a dis-abled life.
Third, God can redeem a not-good life. In a Christian perspective, the good life is an eschatological category effectuated through salvation. Following Athanasius’s dictum in On the Incarnation of the Word, there is no inconsistency between creation and salvation, that is, recreation.[22] Hence, redemption happens not only spiritually but also bodily as God saves a not-good life and makes it a good life. Scripture’s close alignment of healing and salvation attests to that. Here, we finally approach the ethical dimension of our anthropological and soteriological discussion. Selective reproduction denies this hope for the redemption of the body and, consequently, God’s work of recreation. It only embraces creation but not recreation, protology but not eschatology. Hence, it condemns a life which God can and might redeem.
To conclude, Christians should both affirm the reality of medical disabilities as effectuating a not-good life and hold fast to the eschatological hope for the redemption of the body. Leaning too far into one of these sides results either in a deviant soteriology, that is, selective reproduction, or a diminishing of the painful reality of disability.
[1] For an introduction to issues and problems related to selective reproduction see Stephen Wilkinson and Eve Garrard, Eugenics and the Ethics of Selective Reproduction (Staffordshire: Keele University, 2013). In general, Wilkinson and Garrard write that “developments in medicine and genetics have made it increasingly possible for prospective parents to choose not to have a child with a disability” (10).
[2] Hans Reinders, “Life’s Goodness: On Disability, Genetics, and ‘Choice,’” in Theology, Disability and the New Genetics: Why Science Needs the Church, ed. John Swinton and Brain Brock (London: T & T Clark, 2007), 163.
[3] See Marsha Saxton, “Why Members of the Disability Community Oppose Prenatal Diagnosis and Selective Abortion,” in Prenatal Testing and Disability Rights, ed. Erik Parens and Adrienne Asch, Hastings Center Studies in Ethics (Washington, D.C.: Georgetown University Press, 2000), 147–164. For further ethical problems created by such reasoning, see Megan Best, “The Dilemma of Prenatal Screening,” Ethics & Medicine: An International Journal of Bioethics 34, no. 2 (2018): 113–124. For a helpful review of theories of well-being in relation to bioethical reasoning, see David Wasserman and Adrienne Asch, “Understanding the Relationship between Disability and Well-Being,” in Disability and the Good Human Life, ed. Jerome E. Birkenbach, Franziska Felder, and Barbara Schmitz (Cambridge: Cambridge University Press, 2014).
[4] Julian Savulescu, “Procreative Beneficence: Reasons Not to Have Disabled Children,” in The Sorting Society: The Ethics of Genetic Screening and Therapy, ed. Loane Skene and Janna Thompson (Cambridge: Cambridge University Press, 2008), 51–68. In full, his principle reads as follows: “couples (or single producers) should select the child, of the possible children they could have, who is expected to have the best life, or at least as good a life as the others, based on the relevant, available information.”
[5] Interestingly, Savulescu tries to argue that the principle of procreative beneficence does not imply that “the lives of those who now live with disability are less deserving of respect and are less valuable,” as selection only reduces disability but “is silent” on the value of persons with disability. Julian Savulescu, “Procreative Beneficence: Why We Should Select the Best Children,” Bioethics 15, no. 5–6 (2001): 413–426. However, Savulescu’s distinction does not reflect an actual categorical difference. Disabilities do not exist apart from persons.
[6] Wasserman and Asch, “Understanding the Relationship between Disability and Well-Being,” 139f.
[7] For instance: Sara Goering, “‘You Say You’re Happy, but . . .’: Contested Quality of Life Judgments in Bioethics and Disability Studies,” Bioethical Inquiry 5 (2008): 125–135.
[8] Jerome E. Birkenbach, “Disability and the Well-Being Agenda,” in Disability and the Good Human Life, ed. Jerome E. Birkenbach, Franziska Felder, and Barbara Schmitz (Cambridge: Cambridge University Press, 2014), 189.
[9] Deborah Beth Creamer, Disability and Christian Theology: Embodied Limits and Constructive Possibilities (Oxford: Oxford University Press, 2009), 25.
[10] Wasserman and Asch, “Understanding the Relationship between Disability and Well-Being,” 163. Wasserman and Ash intend to treat disabilities like race and sex by factoring out such realities. However, they finally note: “It may well be that we have factored out too much” (164).
[11] Philip Davies, “Well-Being in Philosophy, Psychology, and Economics,” in The Good Life in a Technological Age, ed. Philip Brey, Adam Briggle, and Edward Spence (New York: Routledge, 2012), 16.
[12] Reinders, “Life’s Goodness: On Disability, Genetics, and ‘Choice,’” 164.
[13] Ibid., 178.
[14] For instance, see Jeremy Schipper, Disability Studies and the Hebrew Bible: Figuring Mephibosheth in the David Story (London: T & T Clark, 2006); Saul Olyan, Disability in the Hebrew Bible: Interpreting Mental and Physical Differences (Cambridge: Cambridge University Press, 2008); Michael D. Fiorello, The Physically Disabled in Ancient Israel According to the Old Testament and Ancient Near Eastern Sources, Paternoster Biblical Monographs (Crownhill: Paternoster, 2014).
[15] Candida Moss and Jeremy Schipper, “Introduction,” in Disability Studies and Biblical Literature, ed. Candida Moss and Jeremy Schipper (New York: Palgrave Macmillan, 2011), 7.
[16] Joel D. Estes, “Imperfection in Paradise,” Horizons in Biblical Theology 38 (2016): 1–21.
[17] Estes, 12–15.
[18] It should be noted that the narrator uses לא טוב instead of רע in Gen 2:18. Adam’s lonely state did not represent a corrupted or imperfect creation but an incomplete creation.
[19] Ingrid Faro, “The Question of Animal Death Before the Fall,” Trinity Journal 36, no. 2 (2015): 199.
[20] Catherine L. MacDowell, The Image of God in the Garden of Eden: The Creation of Humankind in Genesis 2:5–3:24 in Light of Mīs Pî Pīt Pî and Wpt-r Rituals of Mesopotamia and Ancient Egypt (Winona Lake: Eisenbrauns, 2015).
[21] Ruth Groenhout, “Not Without Hope: A Reformed Analysis of Sickness and Sin,” Christian Bioethics 12 (2006): 138.
[22] Athanasius, On the Incarnation of the Word, 1.
Mario Tafferner, “The Good Life in Genesis and Beyond: A Christian Account of Disability,Selective Reproduction, and the Goodness of Life,” Dignitas 26, no. 1-2 (2019): 3–7.
