Based on “Case Study: Fetal Abnormality” and the required topic study materials, write a 750-1,000-word reflection that answers the following questions: What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity? Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected? How does the theory determine or influence each of their recommendations for action? What theory do you agree with? Why? How would that theory determine or influence the recommendation for action? Remember to support your responses with the topic study materials. While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. This youtube video might be helpful in answering the question https://youtu.be/smuhAjyRbw0 Use the file that I uploaded to answer the question. This reading material might be helpful in answering the question as it is part of the instructions to utilize the study materials. 19 The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities D evan S tahl Michigan State University J ohn F. K ilner Trinity International University Abstract All people are created in the image of God, which gives every human being a dignity that can never be lost or diminished. This article develops a biblically sound understanding of what it means to be in God’s image. Next, it explores how important such an understanding is for people with disabilities. Finally, it traces out a number of implications of that understanding for people with profound intellectual disability. Keywords: agency, destiny, dignity, image of God, intellectual disability, justice, relationality Devan Stahl, Ph.D. (St. Louis University), M.Div. (Vanderbilt Divinity School) is Assistant Professor of Clinical Ethics at the Center for Ethics and Humanities in the Life Sciences, Michigan State University. She chairs the Bioethics and Christian Theology Affinity Group of the American Society for Bioethics and Humanities and has published on genetics and disability. stahldev@msu.edu John F. Kilner, Ph.D. and A.M . (Harvard University), M.Div. (Gordon-Conwell Theological Semi – nary) is the Forman Chair of Theology and Ethics, Professor of Bioethics & Contemporary Culture, and Director of Bioethics Programs at Trinity International University. His 20+ books include the recent award-winning Dignity and Destiny: Humanity in the Image of God (Eerdmans, 2015). 19 © 2017 Joni and Friends, Agoura Hills, CA. Used with permission. All rights reserved. Additional reproduction is prohibited. 20 © 2017 Joni and Friends, Agoura Hills, CA. Used with permission. All rights reserved. Additional reproduction is prohibited. The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017 The biblical affirmation that all people are created in God’s image has long been a liberating force in the world, as documented in Dignity and Destiny and Why People Matter (Kilner 2015, 2017). 1 It has inspired people to respect and protect the dignity of every human being. The creation of humanity in God’s image, rightly understood, makes a huge difference for people with profound intellectual disabilities (PID) 2 in particular. It endows them with a dignity that demands humanity’s attention and best efforts in support. It re- quires of others—who are also created in God’s image—that they reflect such divine attributes as love and justice in their individual and societal response to the needs of those with such disabilities. If this is the case regarding the most readily-disparaged people with profound disabilities, then people with disabilities of all sorts stand to benefit as well. The problem is that misun- derstandings related to the image of God have too frequently neutralized its liberating power and even fostered oppression. Identifying and guarding against such misunderstandings must first take place if humanity’s creation in God’s image is to foster humanity’s flourishing, to God’s glory. The common, basic misconception here is that being in God’s image is about how people are (actually) “like God” and “unlike animals.” This view understands being in God’s image in terms of attributes that people have now, most commonly people’s ability to reason, rule over (manage) creation, be righteous, or be in relationship. In this view, sin can damage such attributes and thus damage God’s image. Accordingly, people vary in the extent to which they have these attributes—and are in God’s image. For many, that means how much people warrant respect and protection as those in God’s image varies from person to person. The door to devastation is open as soon as people begin to define being in God’s image in terms of currently having God’s attributes. People who are lowest on the reason, righteousness, 1. The present essay draws upon some of the material presented in Kilner 2017, which is a chap – ter-length summary of parts of the fuller account in Kilner 2015—the fuller account providing substantially more documentation and illustration than space here permits. Material from Kilner 2017 used by permission of Baker Academic, a division of Baker Publishing Group. 2. The Diagnostic and Statistical Manual on Mental Disorders (DSM-5) and the American Associa- tion on Intellectual and Developmental Disabilities (AAIDD) agree that “[i]ntellectual disability is a disability characterized by significant limitations both in intellectual functioning (reasoning, learning, problem solving) and in adaptive behavior , which covers a range of everyday social and practical skills” (AAIDD 2017). DSM-5 classifies the severity levels of intellectual disability, also known as intellectual developmental disorder, as mild, moderate, severe and profound, based on adaptive functioning conceptual, social and practical domains (APA 2013, 318.2 F73). Generally, persons with profound intellectual disabilities have an IQ score of 20 or below as well as poor adaptive functioning, such as extreme difficulty with language development, social skills and performing daily tasks. 21 © 2017 Joni and Friends, Agoura Hills, CA. Used with permission. All rights reserved. Additional reproduction is prohibited. The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017 rulership, relationship, or similar scale are deemed least like God and least worthy of respect and protection. This way of thinking has put people with disabilities in great jeopardy, particularly people with PID. The problem here is not that a biblical idea has proven to be destructive, but that an unbiblical idea masquerading as a biblical idea has proven to be destructive. This unbiblical idea is at odds with what the Bible’s authors mean by being created in God’s image and how they employ this concept in life situations. Accordingly, this article will first develop a biblically sound understanding of what it means to be in God’s image. Next, it will explore how important such an understanding is for people with PID. Finally, it will trace out a number of implications of that understanding for people with such disabilities. What It Means to Be in God’s Image When the Bible talks about something being an “image,” that means it has a connection with something else in a way that may also involve a reflection of it. Being the image “of God,” in particular, means having a special con- nection with God as well as being a substantial reflection of God. Having a special connection is significant, because mistreating the image means one is mistreating the original. Being a substantial reflection is significant, since that means the image displays attributes (capacities, traits, abilities, etc.) of the original to the extent that it is able. The idea that being an image sig- nifies having a special connection is evident, for example, in Daniel 3:1-7, which reports the Babylonian King Nebuchadnezzar erecting a large image in the province of Babylonia. Kings in the ancient Near East would periodi- cally erect an image to establish their presence as rulers where they were not physically present (Clines 1968; Middleton 2005, 104-7). The other element often present in an image is the way that it provides a reflection of certain attributes of the original. In Old Testament times, images often displayed something about a king. In Daniel 3, the great height and gold surface of the image reflected the king’s grandeur and wealth. When the New Testament refers to Christ as God’s image, both connection and reflection are in view. In Colossians 1:15, for instance, Paul straightforwardly affirms that Christ “is the image of the invisible God.” 3 Christ’s special con- nection with God is so close here as to constitute oneness. Moreover, Jesus is a substantial reflection of God—someone who can be seen, in contrast with 3. Unless indicated otherwise, all quotations of the Bible are from the New Revised Standard Version. 22 © 2017 Joni and Friends, Agoura Hills, CA. Used with permission. All rights reserved. Additional reproduction is prohibited. The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017 the “invisible God” (Kelsey 2009, 966). The text surrounding 2 Corinthians 4:4 similarly communicates that Christ’s image-of-God status involves con- nection with, and reflection of, God. Being vs. Being in God’s Image Whereas Christ “is” God’s image, the Bible states people are “in” or “accord- ing to” God’s image. The insertion of a preposition indicates people stand in some relationship with God’s image. The image-related passages in Genesis (1:26; 1:27; 5:1; 9:6) consistently insert a preposition between people and the image. Image-related passages in the New Testament directly or indirectly referring to Genesis (e.g., James 3:9; Col. 3:10) also insert a preposition. It’s not plausible that in each of these passages the author is simply saying that people are God’s image, as if there were no prepositions there, and no need to add them. 4 In fact, prepositions such as “in” or “according to” make quite a difference. Saying that someone is in the water is quite dif- ferent from saying that someone is the water. Saying that a violin is according to a paper blueprint is quite different from saying that the violin is a paper blueprint. The Bible’s authors use prepositions to distinguish the rest of humanity from Christ. With Christ not overtly in view as a reference point in the Old Testament, the recognition there would simply have been that people are not yet God’s image but are created “according to” 5 the standard of who God is (in order to reflect God’s attributes to God’s glory). 6 In the New Testament it becomes clearer that Christ as God’s image is the standard to which people need to conform. James 3:9 is particularly significant on this point since it conveys a New Testament author’s summary of how the Genesis idea should be understood. 7 The Impact of Sin Failing to take seriously the distinction between Christ being God’s image and humanity being in God’s image has contributed to overlooking a second important distinction—that sin has damaged people, not damaged God’s image. If people were God’s image, then by damaging people, sin would 4. For further explanation, see Hughes (1989, 21). 5. The standard Hebrew and Aramaic Lexicon of the Old Testament by Ludwig Koehler and Walter Baumgartner (2001, 104) specifies that “according to” is the best rendering of both prepositions, be and ke , in image-of-God passages in Genesis 1 and 5. 6. On the importance of this distinction see McDonough (2009, 91). 7. On the harmony of 1 Cor. 11:7 with this understanding, see Kilner (2015, ch. 3) and Hughes (1989, 22). 23 © 2017 Joni and Friends, Agoura Hills, CA. Used with permission. All rights reserved. Additional reproduction is prohibited. The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017 plausibly damage God’s image. However, if people are created in (i.e., accord- ing to the standard of) God’s image, there is no damage done to the standard just because people are later damaged. There is ample discussion and documentation in the Bible regarding the destructive impact of sin on people. Yet, at the same time, there is every indication people remain “in God’s image”—that no harm has been done to this status or to the image on which it is based (see Gen. 5:1; 9:6). People retain a special connection with God (though their relationship with God is badly damaged), and God still intends for people to reflect likenesses to God (though in actuality they largely fail to do so). The image of God is the standard of who people are created to be—embodied in the person of Christ— and that standard is not diminished in any way because of sin. Similarly, in sanctification it is people who are being renewed. God’s unchanging image is the standard for that renewal (see Rom. 8:29; 2 Cor. 3:18: Col. 3:10). What Exactly Is in God’s Image? People, then, are created in (according to) God’s image, in a way unaffected by their fallenness. “People” (the “ adam ” of Genesis 1:27) refers not only to a single man named Adam but also to humanity as a whole. Contemporary readers can easily miss this point if they are located in societies like the United States that emphasize individuals, personal freedom, and autonomy. Connecting God’s image both to humankind as a whole and to each of the humans who constitute that “kind” of creation guards against a destructive over-emphasis on individuals or collectives. Equally important, being in God’s image has to do with people as entire beings (whether humanity as a whole or its component members are in view). There is no suggestion that being in God’s image is constituted by particular “attributes” people have or once had (i.e., abilities, traits, capacities, or other things that people are, do, etc.). Select attributes (even if God-like) are not what are in God’s image—persons as a whole are. As we will see in the following sections, people with disabilities are espe- cially at risk of being demeaned and oppressed when particular attributes rather than persons are considered to be in God’s image. The (generally unspoken) logic is that since attributes like reason, sensory abilities, and strength are what make people in the likeness of God and worthy of protec- tion, those deficient in such attributes are not as valuable as others. A similar logic is at work concerning one’s degree of wealth, skin color, etc. 8 Biblical 8. Regarding this logic, see Cortez (2010, 282-83). 24 © 2017 Joni and Friends, Agoura Hills, CA. Used with permission. All rights reserved. Additional reproduction is prohibited. The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017 affirmations that all people are created in the image of God provide a ringing denunciation of basing people’s significance on their particular attributes. As Martin Luther King, Jr. (2000, 88) has observed, “there are no gradations in the image of God.” Image and Likeness Being “in God’s image” is actually an abbreviated way of referring to the biblical idea of being “in God’s image and likeness.” Because two terms are involved here, some people have mistakenly thought they refer to two differ – ent ideas. However, there is ample biblical and external evidence to confirm there is a single idea here that falls within the range of meaning of each term. Either term alone is sufficient to refer to this idea. 9 Nevertheless, that idea does have two aspects, related to connection and reflection. First, some sort of special connection between God and people is in view here, as previously explained. However, an image may or may not have any- thing to do with being like (i.e., sharing the traits or other attributes of) the original. Including “likeness” with “image” communicates the kind of im- age in view here somehow has to do with likeness to the original. It ensures reflection as well as connection are a part of the concept. The reflection cannot be referring to people’s actual reflection of God’s attributes today, however, because that is damaged by sin and varies in degree from person to person. Rather, the focus here is on God’s intention —who God wanted people to be at creation and still wants them to be today. Being created in the image and likeness of God—or in the image of God, for short—is thus about special connection and intended reflection . People have a special connection with God and God intends them to reflect God’s own attributes to the extent that they are able. The tremendous significance of human beings is completely secure, rooted in God’s unwavering intentions rather than in variable current human capacities. Being in God’s image is not unrelated to the actual capacities, relation- ships, and functions that people have—but having those things is what nor – mally flows from being in God’s image, it is not what defines it. People who lack those things are not any less “in God’s image” than anyone else, because of what it means to be “in” (i.e., “according to”) God’s image. It means that God’s image (revealed to be Christ in the New Testament) provides the stan- dard for their existence and their growth. To whatever extent they fall short 9. See Kilner (2015, 124-28). 25 © 2017 Joni and Friends, Agoura Hills, CA. Used with permission. All rights reserved. Additional reproduction is prohibited. The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017 of fulfilling that standard, God intends more for them and offers them the means now and eternally to become more. Why Being in God’s Image Matters The implications this understanding of God’s image has for how best to view and treat people are extensive. Every person matters precisely because each has a special significance that comes from being in God’s image. This is not the dignity that varies according to circumstances, but the dignity that necessarily accompanies being human. Since God’s image has a cor – porate dimension to it and is not just something true of particular people by themselves, humanity’s existence in God’s image entails that everyone has this special significance. There is a basic equality among members of the human community. This does not mean that people should consider everyone to be equal or identical in every respect; rather, it suggests “that they deal with each person as uniquely sacred and ignore all claims to special sanctity” (Niebuhr 1996, 155). As ethicist Hans Reinders observes, human- ity’s creation in God’s image signifies “in the loving eyes of God… there are no marginal cases of being ‘human’” (Reinders 2006, 124). People who are socially marginalized need not define themselves by their circumstances or the demeaning viewpoint of those who would oppress them. Such dignity is the foundation for the often-misunderstood concept of human rights. Tying rights closely to a clear sense of the dignity of all people is important. Otherwise, rights claims can degenerate into mere as- sertion of self with no regard for others. Human rights are really God’s rights over humanity more than one person’s rights over another. God is every person’s creator, so God is the one to direct how people treat one another. People have rights; but contrary to much secular thinking, they do not have a right to those rights. Those rights flow from the God-given dignity rooted in creation in God’s image. Moreover, just as humanity is not merely a collection of separate people but is also an interrelated whole, so humanity’s status as created in God’s image has implications for the whole of humanity. God intends justice to be a hallmark of human society, as it is of God’s own character. How the weakest people in a community are treated is an indicator of the extent to which a community is living out its status as created in God’s image. People never warrant less than what justice requires, but they frequently warrant more—they warrant love. Love is essential to who God is, and is God’s ultimate intention for relationships of people with one another and 26 © 2017 Joni and Friends, Agoura Hills, CA. Used with permission. All rights reserved. Additional reproduction is prohibited. The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017 with the natural world as well. Love involves giving more than the minimum required and requires more than utilitarian maximizing of social benefit. It generates true solidarity and communion. Such social blessings are as much human rights as are personal protections and provisions. Not only do all warrant receiving love because they are in God’s image—they also must love others for the same reason. People can empower others to love themselves— and their neighbors as themselves—by helping them to recognize everyone as created in God’s image. Implications for Persons with PID Persons with PID are among those created in God’s image and, as a result, warrant special care and welcome. They have an image-based dignity that does not waver, regardless of their ability or potential ability (Yong 2007, 173; Rodriguez 2008, 50). Persons with disabilities have a special connection with God, and God intends them to become a reflection of God as well. For per – sons with disabilities, as for others, God’s intention must await resurrection after death before it can be completely fulfilled. Humanity’s creation in the image of God can make one of its most powerful differences in this world long before then, however, as people live out their image-related status by caring for those with PID. Apart from the biblical affirmation that all are created in God’s image, the rights of all individuals are not secured and our duties toward other persons remain unclear. If people do not believe human worth is externally conferred, then they must look to internal characteristics to establish what about human beings makes them unique and, therefore, worthy of respect. For centuries, philosophers and theologians have tried to discover which human characteristics set “persons” apart from “non-persons” and give the former a unique dignity. Unfortunately, regardless of the characteristics se- lected, some humans are necessarily left out of the “personhood” category as a result. They are thereby considered devoid of human dignity and so not due the respect and protections that such dignity requires. Past Mistreatment Where people have understood being in God’s image (and thus human worth) in terms of the rational capacities that humans possess, persons with PID are often deemed less worthy of respect and protection (Hall 1986, 108-9; Brink 2001, 93). Some Christian leaders in the history of the church, such as Thom- as Aquinas, have considered the image of God in mentally-compromised 27 © 2017 Joni and Friends, Agoura Hills, CA. Used with permission. All rights reserved. Additional reproduction is prohibited. The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017 people to be “practically nonexistent” (1947, I.93.8). 10 The result has been a degrading of all people with intellectual disabilities—a denial of their dignity (Primavesi 2003, 187; Hilkert 2002, 78). This has led to their exclusion from activities and communities in which they ought to be able to participate (Moore 2003, 106). They have been viewed at best as “marred images,” re- sulting in “perilous” outcomes (Reynolds 2008, 177). Given this background, it is not surprising that when disabled people gathered at a symposium in Sheffield, England to compare their experienc- es, they repeatedly reported not being viewed or treated as “made in God’s image” the way that other people are. 11 As one participant painfully tried to understand the source of the discrimination that she regularly experi- ences: “I became disabled—so was I once in God’s image, but am no lon- ger?” (Davies-John 2003, 124). Her experience participates in a long history in which some Christian leaders such as Emil Brunner have denied that normal protections apply to people with profound disabilities (e.g., those who are “grossly retarded”) because of the compromise to God’s image that they consider to have occurred. 12 Apparently Martin Luther even advocated drowning a “feebleminded” 12-year-old child because his severely limited mental capacities appeared to evidence corruption of his reason and soul. 13 Such treatment of people with disabilities was characteristic of the culture in which the early church developed, 14 and has offered an influential pattern for the church’s treatment of people with disabilities whenever Christians have reduced being in God’s image to particular attributes. The Nazi holocaust is another powerful historical illustration of how the idea of humanity in God’s image invites destructive misuse when people understand it to be referring to current human attributes. Adolf Hitler, as part of developing his approach to the weaker members of society in his 1927 book Mein Kampf , identifies the stronger members of society as “images of the Lord.” In contrast, the weaker members for Hitler are mere “deformities” 10. See discussion in Hoekema (1994, 37). 11. This symposium, a fruit of a World Council of Churches initiative, is discussed in Mayland (2003, 211). 12. For Brunner (1952, 57), the protection of being in the image of God “ceases where true hu- man living ceases—on the borderline of imbecility or madness.” Wennberg (1985, 131), reflecting on whether all people are fully in God’s image and so have full moral standing, concludes: “the grossly retarded… need not be assumed to possess a moral standing as full as that of a normal human adult.” 13. Luther (1952, 387) reports this in a write-up of one of his famous “Table Talks.” See discussions in Kanner (1964, 7); Towns & Groff (1972, 38-39). 14. As Seneca (1995, 32) affirmed in the first century: “We destroy abnormal offspring at birth; chil- dren, too, if they are born weak or deformed, we drown.” Cf. discussion in Ferngren (2009, 101). 28 © 2017 Joni and Friends, Agoura Hills, CA. Used with permission. All rights reserved. Additional reproduction is prohibited. The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017 of that image to be “cleansed” from society (Hitler 1939, 606). What resulted in Nazi Germany were categories of people who were untermenschen (subhu- man), those in whom the attributes that constituted God’s image were most deformed, marred, distorted, etc. They became the targets of Nazi efforts to eliminate people with disabilities or other frailties through neglect, forced sterilization, or killing. 15 Dietrich von Hildebrand was one of a relative few in Germany at the time who recognized that it was precisely the biblical teaching that all of humani- ty continues in the undeformed image of God that offered the greatest defense against Hitler’s destructive initiatives. As he wrote, soon after being forced to flee Nazi Germany in 1933: “All of Western Christian civilization stands and falls with the words of Genesis, ‘God made man in His image.’” 16 Hildebrand was exceptional among Christians in his recognition of the importance of understanding God’s image in a way that excluded the possibility of it being diminished. Sad, laments ethicist Lisa Cahill (2006, 58), has been “the dev- astating refusal by Christian theology to attribute the fullness of the imago Dei” to groups such as the millions exterminated in Nazi Germany. The Current Challenge Today, Christians must be cautious in assuming biology alone informs the abilities, capacities, and potentialities of groups of people. What is deemed “natural,” “normal,” and deserving of moral attention may be dictated by persons in power whose interests are self-serving. The dignity of persons with PID remains precarious. Within the arena of bioethics, which is a field that helps to shape medical responses to persons with disabilities, debates con- tinue over the need for prenatal screenings to detect and potentially abort fetuses with genetic disabilities (Buchanan et al. 2000). Similar debates ad- dress the ethical rights of parents to euthanize newborns with disabilities that are expected to be profound (Giubilini and Minerva 2013). Naturally, secular bioethicists do not appeal to the image of God when determining whether disabled newborns lack personhood, but the logic is analogous. Much like those who claim the image of God is damaged in some persons, 15. Many influences helped to shape Hitler’s thinking, including the government-run program of forced sterilizations of intellectually disabled people in the United States. During the Nurem- burg Trials, that program was a primary precedent to which those defending the actions of Hitler and his followers appealed. See http:/buckvbell.com and Lombardo (2008). Others have noted the very same idea so captivating to Hitler—that God’s image can be damaged—has continued to be influential up to the present, to the detriment of the weakest people in society (Yong 2007, 173) 16. As translated in Crosby (2006, 9). Please use all material uploaded and whatever I was able to copy for material to be used in the paper. And whatever references you can find on your own, noting that it has to be no more than 6 years old. Thanks attachment PHI-413V-RS-T2CaseStudyFetalAbnormality.docx

Based on “Case Study: Fetal Abnormality” and the required topic study materials, write a 750-1,000-word reflection that answers the following questions:

  1. What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?
  2. Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected?
  3. How does the theory determine or influence each of their recommendations for action?
  4. What theory do you agree with? Why? How would that theory determine or influence the recommendation for action?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

This youtube video might be helpful in answering the question

https://youtu.be/smuhAjyRbw0

Use the file that I uploaded to answer the question.

This reading material might be helpful in answering the question as it is part of the instructions to utilize the study materials.

19
The Image of God, Bioethics,
and Persons with Profound
Intellectual Disabilities
D
evan
S
tahl
Michigan State University
J
ohn
F. K
ilner
Trinity International University
Abstract
All people are created in the image of God, which gives every human being a
dignity that can never be lost or diminished. This article develops a biblically
sound understanding of what it means to be in God’s image. Next, it explores
how important such an understanding is for people with disabilities. Finally,
it traces out a number of implications of that understanding for people with
profound intellectual disability.
Keywords:
agency, destiny, dignity, image of God, intellectual disability,
justice, relationality
Devan Stahl, Ph.D.
(St. Louis University),
M.Div.
(Vanderbilt Divinity School) is Assistant Professor of
Clinical Ethics at the Center for Ethics and Humanities in the Life Sciences, Michigan State University.
She chairs the Bioethics and Christian Theology Affinity Group of the American Society for Bioethics
and Humanities and has published on genetics and disability. stahldev@msu.edu
John  F.  Kilner,  Ph.D.
and
A.M
.  (Harvard  University),
M.Div.
(Gordon-Conwell  Theological  Semi

nary) is the Forman Chair of Theology and Ethics, Professor of Bioethics & Contemporary Culture, and
Director of Bioethics Programs at Trinity International University. His 20+ books include the recent
award-winning
Dignity and Destiny: Humanity in the Image of God
(Eerdmans, 2015).
19
© 2017 Joni and Friends, Agoura Hills, CA. Used with permission.
All rights reserved. Additional reproduction is prohibited.

20
© 2017 Joni and Friends, Agoura Hills, CA. Used with permission.
All rights reserved. Additional reproduction is prohibited.
The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities
From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017
The biblical affirmation that all people are created in God’s image has long
been  a  liberating  force  in  the  world,  as  documented  in
Dignity  and  Destiny
and
Why People Matter
(Kilner 2015, 2017).
1
It has inspired people to respect
and protect the dignity of every human being. The creation of humanity in
God’s image, rightly understood, makes a huge difference for people with
profound intellectual disabilities (PID)
2
in particular. It endows them with a
dignity that demands humanity’s attention and best efforts in support. It re-
quires of others—who are also created in God’s image—that they reflect such
divine attributes as love and justice in their individual and societal response
to the needs of those with such disabilities. If this is the case regarding the
most readily-disparaged people with profound disabilities, then people with
disabilities of all sorts stand to benefit as well. The problem is that misun-
derstandings  related  to  the  image  of  God  have  too  frequently  neutralized
its liberating power and even fostered oppression. Identifying and guarding
against such misunderstandings must first take place if humanity’s creation
in God’s image is to foster humanity’s flourishing, to God’s glory.
The  common,  basic  misconception  here  is  that  being  in  God’s  image
is  about  how  people  are  (actually)  “like  God”  and  “unlike  animals.”  This
view understands being in God’s image in terms of attributes that people
have  now,  most  commonly  people’s  ability  to  reason,  rule  over  (manage)
creation,  be  righteous,  or  be  in  relationship.  In  this  view,  sin  can  damage
such attributes and thus damage God’s image. Accordingly, people vary in
the extent to which they have these attributes—and are in God’s image. For
many, that means how much people warrant respect and protection as those
in God’s image varies from person to person. The door to devastation is open
as soon as people begin to define being in God’s image in terms of currently
having God’s attributes. People who are lowest on the reason, righteousness,
1.
The present essay draws upon some of the material presented in Kilner 2017, which is a chap

ter-length summary of parts of the fuller account in Kilner 2015—the fuller account providing
substantially more documentation and illustration than space here permits. Material from Kilner
2017 used by permission of Baker Academic, a division of Baker Publishing Group.
2.
The Diagnostic and Statistical Manual on Mental Disorders (DSM-5) and the American Associa-
tion on Intellectual and Developmental Disabilities (AAIDD) agree that “[i]ntellectual disability is
a disability characterized by significant limitations both in
intellectual functioning
(reasoning,
learning, problem solving) and in
adaptive behavior
, which covers a range of everyday social and
practical skills” (AAIDD 2017). DSM-5 classifies the severity levels of intellectual disability, also
known as intellectual developmental disorder, as mild, moderate, severe and profound, based on
adaptive functioning conceptual, social and practical domains (APA 2013, 318.2 F73). Generally,
persons with profound intellectual disabilities have an IQ score of 20 or below as well as poor
adaptive functioning, such as extreme difficulty with language development, social skills and
performing daily tasks.

21
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The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities
From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017
rulership, relationship, or similar scale are deemed least like God and least
worthy of respect and protection. This way of thinking has put people with
disabilities in great jeopardy, particularly people with PID.
The problem here is not that a biblical idea has proven to be destructive,
but  that  an  unbiblical  idea  masquerading  as  a  biblical  idea  has  proven  to
be destructive. This unbiblical idea is at odds with what the Bible’s authors
mean by being created in God’s image and how they employ this concept in
life situations. Accordingly, this article will first develop a biblically sound
understanding of what it means to be in God’s image. Next, it will explore
how important such an understanding is for people with PID. Finally, it will
trace out a number of implications of that understanding for people with
such disabilities.
What It Means to Be in God’s Image
When the Bible talks about something being an “image,” that means it has a
connection
with something else in a way that may also involve a
reflection
of it. Being the image “of God,” in particular, means having a special con-
nection with God as well as being a substantial reflection of God. Having a
special connection is significant, because mistreating the image means one
is mistreating the original. Being a substantial reflection is significant, since
that means the image displays attributes (capacities, traits, abilities, etc.) of
the original to the extent that it is able. The idea that being an image sig-
nifies having a special
connection
is evident, for example, in Daniel 3:1-7,
which reports the Babylonian King Nebuchadnezzar erecting a large image
in the province of Babylonia. Kings in the ancient Near East would periodi-
cally erect an image to establish their presence as rulers where they were not
physically present (Clines 1968; Middleton 2005, 104-7).
The other element often present in an image is the way that it provides
a
reflection
of certain attributes of the original. In Old Testament times,
images often displayed something about a king. In Daniel 3, the great height
and gold surface of the image reflected the king’s grandeur and wealth. When
the  New  Testament  refers  to  Christ  as  God’s  image,  both  connection  and
reflection are in view. In Colossians 1:15, for instance, Paul straightforwardly
affirms that Christ “is the image of the invisible God.”
3
Christ’s special con-
nection with God is so close here as to constitute oneness. Moreover, Jesus is
a substantial reflection of God—someone who can be seen, in contrast with
3.
Unless indicated otherwise, all quotations of the Bible are from the New Revised Standard Version.

22
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The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities
From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017
the “invisible God” (Kelsey 2009, 966). The text surrounding 2 Corinthians
4:4 similarly communicates that Christ’s image-of-God status involves con-
nection with, and reflection of, God.
Being vs. Being in God’s Image
Whereas Christ “is” God’s image, the Bible states people are “in” or “accord-
ing to” God’s image. The insertion of a preposition indicates people stand in
some relationship with God’s image. The image-related passages in Genesis
(1:26; 1:27; 5:1; 9:6) consistently insert a preposition between people and the
image. Image-related passages in the New Testament directly or indirectly
referring to Genesis (e.g., James 3:9; Col. 3:10) also insert a preposition.
It’s  not  plausible  that  in  each  of  these  passages  the  author  is  simply
saying that people
are
God’s image, as if there were no prepositions there,
and no need to add them.
4
In fact, prepositions such as “in” or “according
to” make quite a difference. Saying that someone
is in
the water is quite dif-
ferent from saying that someone
is
the water. Saying that a violin
is according
to
a paper blueprint is quite different from saying that the violin
is
a paper
blueprint.
The Bible’s authors use prepositions to distinguish the rest of humanity
from Christ. With Christ not overtly in view as a reference point in the Old
Testament, the recognition there would simply have been that people are not
yet God’s image but are created “according to”
5
the standard of who God is
(in order to reflect God’s attributes to God’s glory).
6
In the New Testament
it becomes clearer that Christ as God’s image is the standard to which people
need to conform. James 3:9 is particularly significant on this point since it
conveys a New Testament author’s summary of how the Genesis idea should
be understood.
7
The Impact of Sin
Failing to take seriously the distinction between Christ being God’s image
and humanity being
in
God’s image has contributed to overlooking a second
important  distinction—that  sin  has  damaged  people,  not  damaged  God’s
image.  If  people  were  God’s  image,  then  by  damaging  people,  sin  would
4.
For further explanation, see Hughes (1989, 21).
5.
The standard
Hebrew and Aramaic Lexicon of the Old Testament
by Ludwig Koehler and Walter
Baumgartner (2001, 104) specifies that “according to” is the best rendering of both prepositions,
be
and
ke
, in image-of-God passages in Genesis 1 and 5.
6.
On the importance of this distinction see McDonough (2009, 91).
7.
On the harmony of 1 Cor. 11:7 with this understanding, see Kilner (2015, ch. 3) and Hughes (1989, 22).

23
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The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities
From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017
plausibly damage God’s image. However, if people are created in (i.e., accord-
ing to the standard of) God’s image, there is no damage done to the standard
just because people are later damaged.
There  is  ample  discussion  and  documentation  in  the  Bible  regarding
the destructive impact of sin on people. Yet, at the same time, there is every
indication  people  remain  “in  God’s  image”—that  no  harm  has  been  done
to this status or to the image on which it is based (see Gen. 5:1; 9:6). People
retain a special connection with God (though their relationship with God
is badly damaged), and God still intends for people to reflect likenesses to
God (though in actuality they largely fail to do so). The image of God is the
standard of who people are created to be—embodied in the person of Christ—
and that standard is not diminished in any way because of sin. Similarly, in
sanctification it is people who are being renewed. God’s unchanging image
is the standard for that renewal (see Rom. 8:29; 2 Cor. 3:18: Col. 3:10).
What Exactly Is in God’s Image?
People, then, are created in (according to) God’s image, in a way unaffected
by their fallenness. “People” (the “
adam
” of Genesis 1:27) refers not only to
a single man named Adam but also to humanity as a whole. Contemporary
readers  can  easily  miss  this  point  if  they  are  located  in  societies  like  the
United States that emphasize individuals, personal freedom, and autonomy.
Connecting God’s image both to humankind as a whole and to each of the
humans who constitute that “kind” of creation guards against a destructive
over-emphasis on individuals
or
collectives.
Equally important, being in God’s image has to do with people as entire
beings (whether humanity as a whole or its component members are in view).
There is no suggestion that being in God’s image is constituted by particular
“attributes” people have or once had (i.e., abilities, traits, capacities, or other
things that people are, do, etc.). Select attributes (even if God-like) are not
what are in God’s image—persons as a whole are.
As we will see in the following sections, people with disabilities are espe-
cially at risk of being demeaned and oppressed when particular attributes
rather  than  persons  are  considered  to  be  in  God’s  image.  The  (generally
unspoken)  logic  is  that  since  attributes  like  reason,  sensory  abilities,  and
strength are what make people in the likeness of God and worthy of protec-
tion, those deficient in such attributes are not as valuable as others. A similar
logic is at work concerning one’s degree of wealth, skin color, etc.
8
Biblical
8.
Regarding this logic, see Cortez (2010, 282-83).

24
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The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities
From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017
affirmations that all people are created in the image of God provide a ringing
denunciation of basing people’s significance on their particular attributes.
As Martin Luther King, Jr. (2000, 88) has observed, “there are no gradations
in the image of God.”
Image and Likeness
Being  “in  God’s  image”  is  actually  an  abbreviated  way  of  referring  to  the
biblical idea of being “in God’s image and likeness.” Because two terms are
involved here, some people have mistakenly thought they refer to two differ

ent ideas. However, there is ample biblical and external evidence to confirm
there is a single idea here that falls within the range of meaning of each term.
Either term alone is sufficient to refer to this idea.
9
Nevertheless, that idea
does have two aspects, related to connection and reflection.
First, some sort of special
connection
between God and people is in view
here, as previously explained. However, an image may or may not have any-
thing to do with being like (i.e., sharing the traits or other attributes of) the
original. Including “likeness” with “image” communicates the kind of im-
age in view here somehow has to do with likeness to the original. It ensures
reflection
as  well  as  connection  are  a  part  of  the  concept.  The  reflection
cannot be referring to people’s actual reflection of God’s attributes today,
however, because that is damaged by sin and varies in degree from person to
person. Rather, the focus here is on God’s
intention
—who God wanted people
to be at creation and still wants them to be today. Being created in the image
and likeness of God—or in the image of God, for short—is thus about
special
connection
and
intended reflection
. People have a special connection with
God and God intends them to reflect God’s own attributes to the extent that
they are able. The tremendous significance of human beings is completely
secure, rooted in God’s unwavering intentions rather than in variable current
human capacities.
Being in God’s image is not unrelated to the actual capacities, relation-
ships, and functions that people have—but having those things is what nor

mally flows from being in God’s image, it is not what defines it. People who
lack those things are not any less “in God’s image” than anyone else, because
of what it means to be “in” (i.e., “according to”) God’s image. It means that
God’s image (revealed to be Christ in the New Testament) provides the stan-
dard for their existence and their growth. To whatever extent they fall short
9.
See Kilner (2015, 124-28).

25
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The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities
From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017
of fulfilling that standard, God intends more for them and offers them the
means now and eternally to become more.
Why Being in God’s Image Matters
The  implications  this  understanding  of  God’s  image  has  for  how  best  to
view and treat people are extensive. Every person matters precisely because
each has a special significance that comes from being in God’s image. This
is  not  the  dignity  that  varies  according  to  circumstances,  but  the  dignity
that  necessarily  accompanies  being  human.  Since  God’s  image  has  a  cor

porate dimension to it and is not just something true of particular people
by  themselves,  humanity’s  existence  in  God’s  image  entails  that  everyone
has  this  special  significance.  There  is  a  basic  equality  among  members  of
the  human  community.  This  does  not  mean  that  people  should  consider
everyone to be equal or identical in every respect; rather, it suggests “that
they deal with each person as uniquely sacred and ignore all claims to special
sanctity” (Niebuhr 1996, 155). As ethicist Hans Reinders observes, human-
ity’s creation in God’s image signifies “in the loving eyes of God… there are
no marginal cases of being ‘human’” (Reinders 2006, 124). People who are
socially marginalized need not define themselves by their circumstances or
the demeaning viewpoint of those who would oppress them.
Such  dignity  is  the  foundation  for  the  often-misunderstood  concept
of human rights. Tying rights closely to a clear sense of the dignity of all
people is important. Otherwise, rights claims can degenerate into mere as-
sertion  of  self  with  no  regard  for  others.  Human  rights  are  really  God’s
rights over humanity more than one person’s rights over another. God is
every  person’s  creator,  so  God  is  the  one  to  direct  how  people  treat  one
another.  People  have  rights;  but  contrary  to  much  secular  thinking,  they
do not have a right to those rights. Those rights flow from the God-given
dignity rooted in creation in God’s image. Moreover, just as humanity is not
merely a collection of separate people but is also an interrelated whole, so
humanity’s status as created in God’s image has implications for the whole
of humanity. God intends justice to be a hallmark of human society, as it is
of God’s own character. How the weakest people in a community are treated
is an indicator of the extent to which a community is living out its status
as created in God’s image.
People never warrant less than what justice requires, but they frequently
warrant  more—they  warrant  love.  Love  is  essential  to  who  God  is,  and  is
God’s ultimate intention for relationships of people with one another and

26
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The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities
From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017
with the natural world as well. Love involves giving more than the minimum
required and requires more than utilitarian maximizing of social benefit. It
generates true solidarity and communion. Such social blessings are as much
human  rights  as  are  personal  protections  and  provisions.  Not  only  do  all
warrant receiving love because they are in God’s image—they also must love
others for the same reason. People can empower others to love themselves—
and their neighbors as themselves—by helping them to recognize everyone
as created in God’s image.
Implications for Persons with PID
Persons with PID are among those created in God’s image and, as a result,
warrant  special  care  and  welcome.  They  have  an  image-based  dignity  that
does not waver, regardless of their ability or potential ability (Yong 2007, 173;
Rodriguez 2008, 50). Persons with disabilities have a special connection with
God, and God intends them to become a reflection of God as well. For per

sons with disabilities, as for others, God’s intention must await resurrection
after death before it can be completely fulfilled. Humanity’s creation in the
image of God can make one of its most powerful differences in this world
long before then, however, as people live out their image-related status by
caring for those with PID.
Apart from the biblical affirmation that all are created in God’s image,
the  rights  of  all  individuals  are  not  secured  and  our  duties  toward  other
persons remain unclear. If people do not believe human worth is externally
conferred, then they must look to internal characteristics to establish what
about human beings makes them unique and, therefore, worthy of respect.
For  centuries,  philosophers  and  theologians  have  tried  to  discover  which
human characteristics set “persons” apart from “non-persons” and give the
former a unique dignity. Unfortunately, regardless of the characteristics se-
lected, some humans are necessarily left out of the “personhood” category
as a result. They are thereby considered devoid of human dignity and so not
due the respect and protections that such dignity requires.
Past Mistreatment
Where people have understood being in God’s image (and thus human worth)
in terms of the rational capacities that humans possess, persons with PID are
often deemed less worthy of respect and protection (Hall 1986, 108-9; Brink
2001, 93). Some Christian leaders in the history of the church, such as Thom-
as  Aquinas,  have  considered  the  image  of  God  in  mentally-compromised

27
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The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities
From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017
people to be “practically nonexistent” (1947, I.93.8).
10
The result has been a
degrading of all people with intellectual disabilities—a denial of their dignity
(Primavesi 2003, 187; Hilkert 2002, 78). This has led to their exclusion from
activities  and  communities  in  which  they  ought  to  be  able  to  participate
(Moore 2003, 106). They have been viewed at best as “marred images,” re-
sulting in “perilous” outcomes (Reynolds 2008, 177).
Given this background, it is not surprising that when disabled people
gathered at a symposium in Sheffield, England to compare their experienc-
es, they repeatedly reported not being viewed or treated as “made in God’s
image”  the  way  that  other  people  are.
11
As  one  participant  painfully  tried
to  understand  the  source  of  the  discrimination  that  she  regularly  experi-
ences:  “I  became  disabled—so  was  I  once  in  God’s  image,  but  am  no  lon-
ger?” (Davies-John 2003, 124). Her experience participates in a long history
in  which  some  Christian  leaders  such  as  Emil  Brunner  have  denied  that
normal  protections  apply  to  people  with  profound  disabilities  (e.g.,  those
who are “grossly retarded”) because of the compromise to God’s image that
they consider to have occurred.
12
Apparently Martin Luther even advocated
drowning  a  “feebleminded”  12-year-old  child  because  his  severely  limited
mental capacities appeared to evidence corruption of his reason and soul.
13
Such treatment of people with disabilities was characteristic of the culture
in which the early church developed,
14
and has offered an influential pattern
for the church’s treatment of people with disabilities whenever Christians
have reduced being in God’s image to particular attributes.
The  Nazi  holocaust  is  another  powerful  historical  illustration  of  how
the idea of humanity in God’s image invites destructive misuse when people
understand it to be referring to current human attributes. Adolf Hitler, as
part of developing his approach to the weaker members of society in his 1927
book
Mein Kampf
, identifies the stronger members of society as “images of
the Lord.” In contrast, the weaker members for Hitler are mere “deformities”
10.
See discussion in Hoekema (1994, 37).
11.
This symposium, a fruit of a World Council of Churches initiative, is discussed in Mayland (2003, 211).
12.
For Brunner (1952, 57), the protection of being in the image of God “ceases where true hu-
man living ceases—on the borderline of imbecility or madness.” Wennberg (1985, 131), reflecting
on whether all people are fully in God’s image and so have full moral standing, concludes: “the
grossly retarded… need not be assumed to possess a moral standing as full as that of a normal
human adult.”
13.
Luther (1952, 387) reports this in a write-up of one of his famous “Table Talks.” See discussions in
Kanner (1964, 7); Towns & Groff (1972, 38-39).
14.
As Seneca (1995, 32) affirmed in the first century: “We destroy abnormal offspring at birth; chil-
dren, too, if they are born weak or deformed, we drown.” Cf. discussion in Ferngren (2009, 101).

28
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The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities
From The Journal of the Christian Institute on Disability (JCID) Vol. 6.1-6.2 – Spring/Summer & Fall/Winter 2017
of that image to be “cleansed” from society (Hitler 1939, 606). What resulted
in Nazi Germany were categories of people who were
untermenschen
(subhu-
man), those in whom the attributes that constituted God’s image were most
deformed, marred, distorted, etc. They became the targets of Nazi efforts to
eliminate people with disabilities or other frailties through neglect, forced
sterilization, or killing.
15
Dietrich von Hildebrand was one of a relative few in Germany at the time
who recognized that it was precisely the biblical teaching that all of humani-
ty continues in the
undeformed
image of God that offered the greatest defense
against Hitler’s destructive initiatives. As he wrote, soon after being forced to
flee Nazi Germany in 1933: “All of Western Christian civilization stands and
falls with the words of Genesis, ‘God made man in His image.’”
16
Hildebrand
was exceptional among Christians in his recognition of the importance of
understanding God’s image in a way that excluded the possibility of it being
diminished. Sad, laments ethicist Lisa Cahill (2006, 58), has been “the dev-
astating refusal by Christian theology to attribute the fullness of the imago
Dei” to groups such as the millions exterminated in Nazi Germany.
The Current Challenge
Today, Christians must be cautious in assuming biology alone informs the
abilities, capacities, and potentialities of groups of people. What is deemed
“natural,” “normal,” and deserving of moral attention may be dictated by
persons in power whose interests are self-serving. The dignity of persons with
PID remains precarious. Within the arena of bioethics, which is a field that
helps to shape medical responses to persons with disabilities, debates con-
tinue over the need for prenatal screenings to detect and potentially abort
fetuses with genetic disabilities (Buchanan et al. 2000). Similar debates ad-
dress the ethical rights of parents to euthanize newborns with disabilities
that are expected to be profound (Giubilini and Minerva 2013). Naturally,
secular bioethicists do not appeal to the image of God when determining
whether  disabled  newborns  lack  personhood,  but  the  logic  is  analogous.
Much like those who claim the image of God is damaged in some persons,
15.
Many influences helped to shape Hitler’s thinking, including the government-run program
of forced sterilizations of intellectually disabled people in the United States. During the Nurem-
burg Trials, that program was a primary precedent to which those defending the actions of Hitler
and his followers appealed. See http:/buckvbell.com and Lombardo (2008). Others have noted the
very same idea so captivating to Hitler—that God’s image can be damaged—has continued to be
influential up to the present, to the detriment of the weakest people in society (Yong 2007, 173)
16.
As translated in Crosby (2006, 9).

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