Medicine and Medical Technology in Biblical Perspective
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…
