A Theological Challenge: Coordinating Biological, Social, and Religious Visions of Humanity

This paper attempts two tasks. First, it sketches how the natural sciences (including especially the biological sciences), the social sciences, and the scientific study of religion can be understood to furnish complementary, consonant perspectives on human beings and human groups. This suggests that it is possible to speak of a modern secular interpretation of humanity (MSIH) to which these perspectives contribute (though not without tensions). MSIH is not a comprehensive interpretation of human beings, if only because it adopts a posture of neutrality with regard to the reality of religious objects and the truth of theological claims about them. MSIH is certainly an impressively forceful interpretation, however, and it needs to be reckoned with by any perspective on human life that seeks to insert its truth claims into the arena of public debate. Second, the paper considers two challenges that MSIH poses to specifically theological interpretations of human beings. On the one hand, in spite of its posture of religious neutrality, MSIH is a key element in a class of wider, seemingly antireligious interpretations of humanity, including especially projectionist and illusionist critiques of religion. It is consonance with MSIH that makes these critiques such formidable competitors for traditional theological interpretations of human beings. On the other hand, and taking the religiously neutral posture of MSIH at face value, theological accounts of humanity that seek to coordinate the insights of MSIH with positive religious visions of human life must find ways to overcome or manage such dissonance as arises. The goal of synthesis is defended as important, and strategies for managing these challenges, especially in light of the pluralism of extant philosophical and theological interpretations of human beings, are advocated.

Rationing Antiretroviral Therapy for HIV/AIDS in Africa: Efficiency, Equity, and Reality

Background: Rationing of access to antiretroviral therapy already exists in sub-Saharan Africa and will intensify as national treatment programs develop. The number of people who are medically eligible for therapy will far exceed the human, infrastructural, and financial resources available, making rationing of public treatment services inevitable. Methods: We identified 15 criteria by which antiretroviral therapy could be rationed in African countries and analyzed the resulting rationing systems across 5 domains: clinical effectiveness, implementation feasibility, cost, economic efficiency, and social equity. Findings: Rationing can be explicit or implicit. Access to treatment can be explicitly targeted to priority subpopulations such as mothers of newborns, skilled workers, students, or poor people. Explicit conditions can also be set that cause differential access, such as residence in a designated geographic area, co-payment, access to testing, or a demonstrated commitment to adhere to therapy. Implicit rationing on the basis of first-come, first-served or queuing will arise when no explicit system is enforced; implicit systems almost always allow a high degree of queue-jumping by the elite. There is a direct tradeoff between economic efficiency and social equity. Interpretation: Rationing is inevitable in most countries for some period of time. Without deliberate social policy decisions, implicit rationing systems that are neither efficient nor equitable will prevail. Governments that make deliberate choices, and then explain and defend those choices to their constituencies, are more likely to achieve a socially desirable outcome from the large investments now being made than are those that allow queuing and queue-jumping to dominate.