The search for guidance does not take place in a vacuum, but in the context of a perceived erosion of confidence. The costs of health care rise amid serious debates about access to care and the adequacy of health insurance. Litigation increases amid important questions about the relation of causal accountability to moral and legal responsibility. Questions about the rationing of care appear just when physicians are charged with overtrading patients. Though all of medical practice is not disputed, the number of significant problems and the lack of consensus in dealing with them set a context for scrutiny by an increasingly broad public. The interacting roles of patient and physician are reexamined; the numbers of ethics committees and review boards grow; pressure groups and lobbies emerge. Medical practice seems to have become everybody's business. Along with other aspects of life, it becomes increasingly specialized and at the same time seeks legitimation in a democratic forum.

At the heart of these discussions are disagreements about proper modes of treatment. These disagreements are the source of fears that are larger than disputes about individual cases. One fear concerns the possible effects of a lack of uniformity in practices. The desire for uniformity is rooted in part in an understanding of fairness, the principle that similar cases should be treated similarly. When similar cases are not treated similarly, something seems askew morally. Judgments are difficult here, for there is room for diversity. Adult Jehovah's Witnesses, for example, undoubtedly will continue to refuse blood transfusions, a refusal generally accepted as an exception to standard practice. At issue is the amount of diversity a practice will tolerate. The specter which haunts is that the ethos that sustains standard practices will falter. Thus the second fear is that the very practice of medicine will erode, a practice inherited from the past which has served society well. These fears are strong enough to set a context for addressing the issue of the role of religious belief and participation in biomedical decision making. Clearly religion has the potential to erode, sustain, or enrich at least the ethos that nourishes standard medical practice.

FACTORS IN RELIGIOUS BELIEF

The topic this paper addresses is part of the more general problem of the relation of religion to modern society. The pioneering studies of Max Webber and Ernst Troeltsch have been followed by an enormous literature from several fields.1 Though not unmindful of these studies, the primary intention of this paper is to provide a framework for understanding the relation between religion and biomedical decision making, and it undoubtedly reflects the viewpoint of a mainline Protestant ethicist. I first provide a scheme which points to important dimensions of religious belief. Although this scheme oversimplifies in ways that offend even my own schol-



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