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Medicine and Medical Technology in Biblical Perspective
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As discussed in Chapter 1, in the Christian worldview, the ultimate foundation for determining the right, the good, and the just is the triune God. The triune God is the ultimate foundation of reality, including ethics. Moral goodness and justice are derived from the very character of God. God is holy and set apart (Leviticus 20:26, English Standard Version), so people are to live lives of holiness and goodness. God is love (1 John 4:10–11), and so love is a virtue and an essential principle for life and relationships. Because God is just toward people (Deuteronomy 15:15), they are to act justly towards the poor, the sick, and the disenfranchised. People are to live in covenant faithfulness to their spouses and to honor covenantal relationships in their professions (e.g., the doctor-patient and nurse-patient relationship) because God is a covenant God, faithful to his people, even when they were unfaithful (Hosea 1–3; Malachi 2:10,14).
As discussed previously, all ethics flow from one’s worldview and its basic assumptions about ultimate reality. One’s view of human nature, the fundamental problem of humanity, the solution to that problem, and the ultimate direction and goal of history will determine personal ethics. Every worldview embodies these elements in some sense, and the substance of these elemental conceptions influences everyone’s moral vision. These assumptions deeply influence what one believes to be the right, the good, and the just, and they will direct, whether consciously or subconsciously, one’s individual daily choices and actions.
The Christian worldview, which is the focus of this text, is founded on the biblical narrative or story. This narrative is often summarized as the story of the creation, fall, redemption, and restoration of human beings, along with the entire created order (see Figure 3.1). This section will examine how key concepts within this narrative, such as sin, righteousness, and Shalom, provide a framework by which the Christian worldview understands the concepts of health and disease and life and death, as well as provides guiding norms for how one should approach healing and care-giving, the ethical use of medicine and new medical technologies, and justice in health care.
Figure 3.1
Biblical Narrative and Christian Worldview
Creation
The Christian narrative of creation is essential for both Christian theology and for Christian ethics. At the foundation of the biblical narrative is the Christian God who is the creator of everything that exists (Genesis 1–2). The most important aspects of the biblical view of creation are the following:
1. Nothing exists that does not have God as its creator (Colossians 1:16; Revelation 4:11).
2. There is a clear distinction between God and his creation (God transcends creation). At the same time God continues to be involved in every aspect of creation, providentially directing and guiding all things that come to pass for his purpose and design (God is immanent within his creation).
3. God is neither dependent on creation nor is creation necessary to God.
4. God’s act of creation was intentional; everything exists for a purpose, not accidentally or randomly.
Implications of the Biblical Narrative of Creation for Health Care Ethics
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Several aspects of the biblical view of creation give substance and direction to ethical issues. First, the biblical narrative of creation is the account of a good God who creates a good world (Genesis 1:21) with human beings at the apex of his creation. When God described both his act of creating and the creation itself as good, it meant that it was valuable, and everything in its original state was the way it was supposed to be. The goodness that remains in the world even after the fall reminds one that God has called humans to live in his world, not to abandon or reject it. There is a harmony and orderliness to creation and the physical world, the human body, and the institutions of culture and society, and these are good gifts of the creator God.
Second, man and woman are created in the image of God, a concept that was discussed in Chapter 2. As stated in that chapter, various ideas for what the image of God in humans actually is have been proposed by theologians and philosophers throughout history. Nonetheless, there are clear relational and dynamic aspects entailed in the image of God that give rise to implications that are generally affirmed across Bible-believing churches and organizations. These implications are important for a Christian view of ethics.
Being created in the image of God implies that humans are set apart from the rest of the created order and provides a foundation for the intrinsic dignity and value of all human beings. All human beings, without exception, have an intrinsic dignity and value that is to be protected in every stage of life. Whether in health or sickness, with mental or physical disability, from its formation in the womb through the sometimes-debilitating effects of old age, humans have intrinsic value. The Benedictine monk Illtyd Trethowan (1970) expresses this beautifully:
To love people because they are creatures of God, “reflections” of God, is the only way to love them as they really are. To say that they are God’s creatures is not just to mention an interesting fact about them. It is the essential truth about them. They have value indeed in themselves, but only because God gave it to them. Unless we see God in them as the source of value, we should not really see that they had it. (p. 84)
It is also the foundation for distinguishing human beings from other species or kinds. Only human beings are created in God’s image That the dignity is intrinsic means that moral dignity is not dependent on any capacity or specific characteristic or attribute that a human being possesses—there is no distinction, for instance, between being a human being and being a person. To be sure, human beings can be distinguished from other animals based on certain capacities, characteristics, or attributes, but this is not the foundation for their being in God’s image. This means that all human beings have equal moral worth. Dignity and moral worth are conferred on all human beings by God who has created them to be in relationship with him, to reflect him, and to represent himself in the care of his creation. This applies from a person’s physical beginning, to their physical death, and beyond.
To say that all human beings have intrinsic moral worth and dignity is to say that it is morally wrong to use one person for the mere benefit of another. One cannot say that one kind of human being, or a certain human being that lacks certain attributes or capacities, is of less moral worth than another. It is morally wrong to use another human being (or a class of human beings) as an end to someone else’s purpose. That is why Christian ethics views certain biomedical and medical practices, such as embryonic stem cell research, as immoral because it is using another human being (even a human being that is still an embryo) as a means to another end, even if that end is providing medical advances that may help many others—emphasis on may.
To justify any act merely because it results in overall good on balance is a theory that is foreign to Christian ethics (i.e., utilitarianism). To accept this way of moral reasoning, one would have to say that things like experimenting on people without their consent is morally acceptable because those experiments will bring greater good to more people. This thinking has been used to justify many of the atrocities committed in this and the past century in the name of producing “good” things for many people (e.g., the Tuskegee syphilis study).
Third, the biblical narrative of creation provides a foundation for the care of God’s creation. Just as God in his providence cares for all creation, so humankind is given a cultural mandate to represent him in the care of his creation. As created image bearers of their Creator, humankind is to reflect God’s character, do his will, and rule on earth on his behalf as stewards and vice-regents. The discovery of God’s creation through the use of God-given intellect and curiosity is part of that cultural mandate. Medical science is part of the discovery of that created order. Human rule over God’s creation, however, is never absolute, but moderated service. It is always subsumed under the higher rule of God and for his glory alone. Humankind’s relationship to creation is one of covenant-stewardship, not co-creator. It is a stewardship that must be used for God’s purpose, not humankind. Part of that cultural mandate is reflected in the proper use of medical science.
Finally, the biblical narrative of creation affirms that there is an order to creation, that everything was how it was supposed to be and how everything ought to be. This state of order and peace can be described by the term Shalom. Yale theologian Nicholas Wolterstorff (1994) describes Shalom as “the human being dwelling at peace in all his or her relationships: With God, with self, with fellows, with nature” (p. 251). Cornelius Plantinga (1995) describes Shalom as,
universal flourishing, wholeness, and delight—a rich state of affairs in which natural needs are satisfied and natural gifts fruitfully employed, a state of affairs that inspires joyful wonder as its Creator and Savior opens doors and welcomes the creatures in whom he delights. (p. 10)
Moreover, there is a creative normative design that provides a Christian vision of health and flourishing. The concept of Shalom offers a glimpse into the multidimensional view of biblical understanding of health and how healthy persons should function. Health is not merely about physical or biological functioning, but also encompasses the spiritual and communal dimensions of what it means to be a human being created in the image of God. Walter Brueggemann (2001) highlights this multidimensional view of health as Shalom:
Health refers to stability enough to share in the costs and joys, the blessings and burdens of the community. To be healthy means to be functioning full in terms of the norms, values, and expectations of the community. Healing refers to the restoration and rehabilitation of persons to their full power and vitality in the life of the community. Sickness, then, does not refer primarily to physical pain as much as to the inability to be fully, honorably, and seriously engaged in the community in all its decisions and celebrations. (p. 199)
Communal and relational aspects of health are just as important as the physical and psychological.
The spiritual dimension of all human beings cannot be disassociated from the physical dimension, as if it were a separate part of the person. Human beings are not only a physical body (i.e., atoms in motion, a concept referred to as monism or physical reductionism), instead they are multidimensional beings that are a unity of a body and soul. The biblical account of creation describes Adam—and all subsequent human beings—with the Hebrew term nephesh, which means either “ensouled bodies” or “embodied souls.” This has important ramifications for health and healing according to the biblical narrative of creation. Health and disease involve all dimensions of the person at once, the body and the soul. Furthermore, the biblical narrative describes human beings as relational, embodied spiritual beings.
As will be discussed in the next section, sin and the fall affect all aspects of a human being: the body, soul, and its relationship to others and the world. This is the biblical foundation for the biopsychosocial-spiritual model of health and healing, whereby wellness is concerned with and defined by not only the physical, but also the emotional, spiritual, and social wellness of human beings (Sulmasy, 2002).
The Fall
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According to the Bible, the fall has universal and cosmic implications. Just as illness in the body can be viewed as a break in the homeostasis of the body’s physiology, the fall and subsequent separation from God broke the homeostasis of creation itself, bringing disease, sickness, suffering, and death. These are all effects of the fall and not part of God’s original design. This deviation from the normative design of the original creation affects the mind, body and spirit of each human being. The death that sin brings to the world is not merely physical death, but spiritual death, which is eternal separation from God.
Humanity’s predicament, a predicament of humankind’s own making, is not merely physical, but spiritual as well, and both are intertwined and enmeshed because of humankind’s deliberate, spiritual rebellion and estrangement from God. Restoration and healing cannot be perceived as merely the return to physical health or psychological well-being, but requires spiritual and communal restoration. Ultimately, it requires a renewed relationship with God—a renewal that can only come by God’s own initiative.
Implications of the Biblical Narrative of the Fall for Health Care Ethics
The biblical narrative of the fall has several implications for a Christian view of medical ethics. First, though God’s good creation still exists, humans can distort these good gifts and use them in ways the Creator never intended. Science and technology are not unmitigated blessings. The uses of science and technology are always impacted by the fall and, like all of life, need redemption. This does not mean that Christians are anti-science or anti-technology, but that they should be discerning about the application of certain technologies that may seek to usurp God’s wisdom for his creation. Understanding the current technological culture from a biblical perspective helps to determine how one should react to many of the recent developments in bioscience.
To be “as God,” as the serpent put it to tempt Eve in the Genesis narrative, is to embrace the false expectation that something else is required other than God’s image for human fulfillment, and that something else is fully achievable by man apart from God. For many, modern biotechnology has become a false hope that will one day lead to that fulfillment and the ideal human condition. Christians are not called away from modern biotechnology, especially that which holds out promises to relieve the suffering and pain of fellow human beings in this fallen world. But its use must always be constrained by God’s wisdom and direction, a gift of his good creation, and the realization that physical illness and disease is only one dimension of humankind’s total predicament, which is fundamentally a spiritual rebellion and separation from God (Hoehner, 2008).
The fall is also a warning about utopian perceptions of the world and humankind’s efforts to change the way things are. Self-deception and sin occur side-by-side in the story of the fall (Genesis 3:12–13). In the same way, utopian attempts to achieve justice, goodness, and perfect health—even beyond perfect in terms of enhancement of the perfect—have resulted in tragic injustices and evil precisely because of self-deception and sin resulting from the fall. A Christian ethic grounded in the biblical narrative will always hold together these two dimensions of human nature:
1. Wonderfully made in God’s image with the potential for great works of mercy and kindness toward one another, and
2. Terribly fallen in rebellion against the wisdom and design of their Creator with the capacity for the greatest of evils.
Redemption
Because the fall not only has personal consequences, but universal and cosmic consequences, redemption has universal and cosmic consequences as well. The brokenness and estrangement that resulted from the fall is being restored. The restoration of Shalom, or peace, is a central theme in the New Testament explanation of the ramifications of redemption. It is precisely through justification, being made right again with God and his holiness through Christ, that Shalom is reestablished between believers and God. The Shalom between believers and God is the foundation for restoring Shalom in creation. The New Testament affirms that “all things, whether on earth or in heaven” are brought back into Shalom through Christ’s atoning death on the cross (Colossians 1:20), and “that the creation itself will be set free from its bondage to corruption and obtain the freedom of the glory of the children of God” (Romans 8:21).
Just as the concept of Shalom in the Old Testament has implications for salvation (Isaiah 43:7; Jeremiah 29:11), for bodily health (Isaiah 57:18; Psalm 38:3), and for communal well-being and blessing (Numbers 6:24ff), and the New Testament “gospel of peace” (Ephesians 6:25) also brings renewal to the whole of human and creational relationships. It is the beginning of the restoration of all that was lost in the fall. According to J. I. Durham (as cited in Beck and Brown, 1976), the peace spoken of in the New Testament is “a comprehensive fulfillment or completion, a perfection of life and spirit which transcends any success which man alone, even under the best of circumstances, is able to attain” (p. 778).
Implications of the Biblical Narrative of Redemption for Health Care Ethics
The restoration of Shalom that is the consequence of Jesus’s life, death, and resurrection has several implications for Christian ethics and the Christian view of disease, healing, and death. First, it provides the motive for Christian ethics. Christian ethics is primarily an ethics of love. It is one of gratitude and response to what God has already done. And while Jesus’ work of salvation does not depend on man’s efforts or goodness, it does not leave a Christian’s life unaffected. God also works to renew an individual’s heart, mind, and actions; therefore, Christians should be more just, loving, merciful, and faithful because of the work of God within them. Christian ethics is not merely individualistic, instead it spills over into social realities as well. Christians should be empowered to work for justice and peace in all aspects of the world and society, including issues of poverty, social injustices, racial reconciliation, and environmental concerns.
In addition to its spiritual aspects, redemption also has physical dimensions. Jesus came to redeem the whole person as a complete biopsychosocial-spiritual being; therefore, there is a strong relationship between health and salvation in the New Testament. Jesus, as the ultimate healer, is called soter, a Greek term that can mean both “savior” and “healer.” When Jesus heals a paralyzed man, those watching were surprised to hear Jesus first say, “your sins are forgiven” (Mark 2:5). There is both a spiritual healing and a physical healing. Most of Jesus’ miracles during his life had to do with physical healing. In his healing miracles, Jesus’ life witnessed to a beginning of the reversal of the effects of the fall.
Two caveats are in order when evaluating the healing miracles in the New Testament. First, one must understand the purpose of Jesus’s miracles. The miracles of Jesus and the Apostles in the New Testament serve two primary purposes. On the one hand, they are powerful testimonies to the truth of Jesus’ message of the gospel. They were signs of not only his divine nature, but also of his divine authority. On the other hand, they were foretastes of the ultimate physical salvation that would come to all believers, but only at the final resurrection. One could say it was a breaking in and demonstration of the final restoration that will come after death. At that time the bodies of Christian believers will be resurrected and renewed in eternal and perfect health and in eternal fellowship with God.
Christians affirm that God has power over illness and death and can, as he chooses, provide miraculous healing and recovery. But these miracles, which God uses for his own purposes, are not something that can be expected as a test of faith or as a direct result of prayer, as if God can be manipulated. Prayer can never be used like a secret incantation or spiritual therapeutic regimen. Faith and the gifts of God in creation, including medicine, biotechnologies, and the skill and judgment of physicians and nurses, are not opposed or set against one another. Faith is not opposed to reason. Nothing in the traditional, historic Christian worldview gives such priority to faith healing to the extent that it ignores good medical care. This form of faith healing is not part of the traditional Christian worldview, although it appears in many sects of Christianity.
A second caveat is to recognize the relationship between sin, illness, and healing. According to the biblical narrative, there is a connection between sin and the physical brokenness in this world, a brokenness that includes disease and suffering. All illness and suffering are a consequence of the fall in a general sense. This does not mean one can reason from specific sins to specific illnesses or diseases; however, there are the exceptions of physical sins that lead to their consequences, such as substance and physical abuse. When a man born blind was brought to Jesus, religious leaders asked Jesus whose sin was responsible for the man’s blindness. Was it his own or his parents? Jesus, before going on to heal the man’s blindness, gave a surprising answer. “It was not that this man sinned, or his parents, but that the works of God might be displayed in him” (John 9:3). There are two lessons in this story. First, one cannot directly link specific spiritual sins to specific physical illnesses. While in general, all spiritual brokenness results in physical brokenness, one should not equate the guilt of any sin with illness as a specific punishment. Second, Jesus shows that God does use even the brokenness of a fallen world for his own good purposes. Through Jesus’s own suffering, suffering is given a higher meaning and purpose that witnesses to the spiritual redemption that Jesus brings. God can transform suffering, illness, and even death for much grander purposes in this world. Christian believers have an assured hope of a full and complete healing in all their biopsychosocial-spiritual dimensions when Christ returns.
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As followers of their savior, Christian health care professionals are to be imitators of Jesus in his compassion and healing ministry. In gratitude and loving response to what the great physician and healer has done for the world, they are to reflect his love toward others as well. Christian health care workers recognize and use the gifts God has given in this world to mitigate the effects of the fall with loving compassion and mercy as they seek to relieve the pain and suffering of their fellow human beings. As God showed his love and mercy to the whole world through Jesus, so too should Christian health care workers bring that same love and mercy to all persons.
As discussed previously, all human beings are made in the image of God and have intrinsic worth and value deserving of care and compassion. Loving and caring for others shows God’s love, an unearned love that God has already shown the world. One’s love for God is also demonstrated in the love one has for one’s neighbor. Just as God’s love is free and gracious, so should a Christian’s love reflect this in selfless service to their neighbor. It is especially to the poor, the vulnerable, the sick, and the “least of these” (Matthew 25:40) that the Christian’s love should be directed.
Health care professionals are frequently called on to take care of very sick, broken, and sometimes undesirable patients. Some patients will not be kind and will be very difficult to care for. But Jesus calls his redeemed to care for and love all “the least of these” (Matthew 25:40) as if they were caring for and loving him because they are. Often this will not be the least bit rewarding from a personal perspective, but Jesus tells his followers that a greater reward awaits them in heaven.
Restoration
While sin, death, and suffering have all been completely and forever conquered by the life, death, and resurrection of Jesus, the full effect of that redemption awaits a fuller completion in the eschaton, Jesus’s second coming at the end of the age. The goal of the biblical narrative is a new creation—a renewed world that far exceeds the limitations and finitude of the original creation. Revelation, the final book of the Bible, speaks of the “new Jerusalem” and the “new earth” (Revelation 3:12; 21:1) that is being prepared for all of God’s redeemed people who will be resurrected to a new and more glorious life of eternal and perfect Shalom.
Implications of the Biblical Narrative of Restoration for Health Care Ethics
It is all too evident that this present age continues to suffer the effects of the fall. Suffering, pain, death, and injustices are ever present realities in the world. There is an already and not yet aspect to redemption. In one sense, it is complete (i.e., already) in that believers are fully forgiven, redeemed, and possess eternal life. In another sense, believers await a final perfection (i.e., not yet). All believers suffer the continuing effects of the fall, such as further temptation and sin, disease, and even physical death. It is like a sick patient who has been fully treated for a disease, assured of a complete cure, but must still convalesce from the lingering effects of the illness, awaiting a fuller return to health and wholeness. There is both joy and assurance, but there are continued struggles as well. The world itself is redeemed, but it still struggles with the lingering results of the fall, awaiting the new creation. Understanding this Christian telos, or where history is ultimately headed, has a powerful impact on ethics and a Christian view of health, illness, healing, and death.
For the health care worker, this already and not yet aspect of redemption gives an eternal as well as present perspective to the relief of suffering and illness to which they have been called. For instance, death is no longer the ultimate enemy, having been conquered through Jesus’s own death and resurrection. Believers await the resurrection of their bodies and a glorious eternity of embodied life and fellowship with God. But in the meantime, physical death and suffering remain a reality. A biblical narrative of restoration informs the Christian health care professional that while medical science is a great good, it is limited and imperfect. The way medical science pushes back against the reality of aging and death must at some point accept its reality and the finitude of all human beings.
The biblical narrative is very realistic about the sufferings and tragedies in the world. Death is something to grieve. It is not the way it is supposed to be. It is no small test of faith to hold a dying infant or to watch loved ones suffer at the end of their lives. The shortest verse of the Bible, “Jesus wept” (John 11:35), says that even though he knew he would bring him back to life, Jesus grieved over Lazarus’s death because of his great love for him. One can almost hear Jesus crying out of his love and sorrow, “This is not how it was supposed to be!” The biblical narrative affirms that there is something greater that awaits the believer that provides hope and comfort amidst the very real and tragic suffering and pain of this world. The Apostle Paul, who suffered more during his lifetime than many ever will, was still compelled to say, “For I consider that the sufferings of this present time are not worth comparing with the glory that is to be revealed to us” (Romans 8:18).
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Christian health care providers are called in this present time to do all they can to mitigate and push back against the effects of the fall, bringing relief from pain and suffering, loving all persons as image bearers of God and beings of intrinsic eternal worth and value. Sin, suffering, and illness are part of the brokenness of the world that was caused by humankind’s sin. The consequences of sin are not only personal, but also universal and cosmic. Even Christians suffer in this lifetime because of the effects of the fall and sin. While their eternal salvation is already secure and brings a spiritual peace with God, they still must await the final resurrection to bring full physical peace as well. Christian health care professionals, informed by and living in this biblical narrative and worldview, can show the mercy and peace of God to their patients as a foretaste of that future restoration here and now, even while awaiting and anticipating its ultimate fulfillment at Jesus’s return.
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