In perhaps the most bizarre and heinous act of Congress in the history of the United States, the Affordable Care Act (ACA) came into being. As Nancy Pelosi said, "We have to pass it to find out what is in it." Well, the American people will find out what is in it, will pay for its virtually unlimited costs, will experience its ineffectiveness, and will suffer all the consequences of a state controlled entity.
But I do not want to talk about Obamacare so much as underlying Biblical principles. Up front I must mention my partner of over thirty years in medicine and medical ethics, Dr. Hilton Terrell, who died three years ago. Without our "iron sharpening iron," I would never have comprehended what follows here, and made grave mistakes. My work is essentially his work-except any errors are my own.
In addition, Rousas John Rushdoony was light-years ahead in prophecy and analysis of the issues, particularly in his twelve Chalcedon Medical Reports from the 1970s and 1980s reprinted in Roots of Reconstruction, one of which appears in this issue of FFAOL.
I have written extensively on medical and medical-ethical issues for thirty-five years and cannot cover everything here. Interested readers can visit my websites and track down the three books I published on these issues through various used book services (see Resources), one of which is available for $10.00 postpaid.1
More Negatives Than Positives
What I want to cover here is a basic understanding of health and medical issues, and surprisingly suggest that the ACA can bring about positive health benefits for the American people in general and for regenerate, Biblically knowledgeable Christians in particular. But let me say clearly that the deadliest effects of the ACA have to do with economic burdens and increasing totalitarianism by the state, not its effect on health and medicine. Rushdoony provides the proper perspective:
There is no reason to suppose that a socialized and federalized medicine will be any more benevolent than the Internal Revenue Service. The IRS, after all, was created with at least equal idealistic motives. Anyone who can think of the IRS as the people's friend will be no better than the IRS and potentially far worse. Any and everything which puts us into contact with a powerful state and its bureaucracy is dangerous, and socialized medicine will place us in a very close relationship to that power-state: at pregnancy and childbirth, in ill health and accidents, for a variety of required medical examinations, and much more. Also, as euthanasia becomes an accepted practice like abortion, the more the state knows about you, the less safe you are.2
I will focus on the negatives of modern medicine because the negatives outnumber the positives. But I do not want to leave the impression that practitioners are intentionally deceptive and evil. They are just blinded by the noetic effects of sin and a functional belief in humanism, as in other professions. For all these limitations and for the most part, physicians do have good, even the best of intentions, for their patients. It is just that good intentions, in the absence of Biblical and rational truth, are often as destructive as evil intent.
Again, Rushdoony puts health and medicine in perspective.
The doctor cannot guarantee health, nor can he guarantee healing. He cannot even guarantee to bring the best available knowledge and skill to bear on a particular illness, because no doctor is omnicompetent, and no patient can legitimately expect his doctor to be the outstanding practitioner with regard to a particular ailment.
Such unreasonable expectations have their origin in resentment against aging and dying, and this resentment manifests itself in hostility against the clergy and against doctors.3
As one grows older, one attends an increasing number of funerals, provoking my wife and me to comment that we do not want more than basic life-sustaining measures in our own dying process. The most common response to this is, "Oh, no, we want the best, most comprehensive treatment, especially for our loved ones." And we have seen this tenacious embrace of earthly life, as persons suffer through intravenous needles, catheters, noisy machines, an increasing array of medications (often to combat the side effects of previous treatments) many of which cloud the mind for final farewells, constant interruption of sleep of patients and families for nursing duties, isolation from families, and a host of other actions for "sound medical practice." For what? Heroic measures that will give only a few more hours or days with no hope of eventual physical recovery and continuing days of prolonged agony?4 Recently, we attended a conference that was definitively Biblical and pro-life where one of the themes was "to avoid starving grandpa" and using all measures available to sustain life for as long as possible. But the Apostle Paul said, "To live is Christ, to die is gain." God has promised a better life ahead!
Now-hear me clearly. Food, water, and air should never be withheld from those who can take them naturally. And all means of comfort should be used in the dying process. Euthanasia should never be perpetrated. But euthanasia is the removal or withholding of food, water, and air with the intent that the person (patient) is to die.5 It is not necessarily the withholding of, or failure to implement, these life-prolonging measures by medical means.6 These latter actions, if implemented in every dying patient, would bankrupt our entire society in less than a year. We cannot violate one commandment (not to steal) in an attempt to honor another (not to kill or preserve life). I cannot go into all the complex details of end of life issues, but have written at other times on this subject.7
Perhaps Biblical economics may be well understood among theonomists. But I have found that medical care often distorts what otherwise are well-known principles. As all theonomists and Biblical ethicists know, "You shall not steal," and by logical extension, "... for any reason!" If your family is starving and you know that your neighbor has food, it is wrong for you to steal to feed your family. With all the wrong notions of modern medicine, how much less should the impulse arise to steal from others to provide medical care?
What if you steal for the "good" of others and discover that you have actually harmed them? You committed a sin that is doubly heinous. If people could grasp the lack of efficacy, and even harm, of medicine in so much of what it does, there would not be the plaintive and heart-driven desire to provide it regardless of cost to taxpayers and society.
Quackery and the Nature of Medicine
I doubt that medicine is any better or worse than any discipline, but it is my field of expertise. We live in a time where logical positivism, as scientific method, reigns supreme in the practical epistemology of the marketplace. Education at the primary and secondary levels has virtually no clue what truth is, much less a "unifying" theory for "uni-versities." I need say nothing about economic theory to FFAOL readers. Likewise, politics, art, management theory, archeology, mathematics, and other disciplines are well-known to you. Rushdoony places medicine in this perspective.
We have quackery all around us, in the church, the school, and in politics. Quackery in the church is not limited to the cults; it is present wherever men offer something short of God's Word as the bread of life. In the state schools, we have educators promising us the best kind of education as their stock in trade, while turning out (millions) of functional illiterates in America. Politics, of course, is our most fertile ground for quackery, because it is for most people the central area of life ... We live in the Golden Age of Quackery, and, instead of merely giving an Oscar to our top quacks, we have been giving them the White House with increasing frequency. Quackery is in great demand.8
On medicine in particular, he says:
The difference between a quack doctor and a good one begins with a sense of limitation. A quack medicine and a quack doctor both promise too much. A sound medicine offers limited help for a limited and specific problem. It offers no miracles and works none. It cannot replace good hygiene, sound nutrition, and healthy habits. The wise doctor makes no large promises; he knows how limited his role is, and yet, within those limits, very important. The more we demand of a doctor or his medicine, the more likely we are to fall prey to quackery.9 (His emphasis)
Few people are more anti-modern medicine than I am, yet I do not embrace much of alternative medicine, either. I fear that Christians have been more than gullible in this area. They make the same mistakes that orthodox practitioners make: they conclude that X medicine or procedure given at a certain point in time caused the healing. That is, they make the fallacy of association with causation. In an orthodox practice, I estimate seventy percent or more of problems are self-limiting. That is, the problem will get better no matter, even in spite of, what the practitioner does. In my retirement, I supervise physician assistants. They are equal to any physicians with whom I have worked, and better than many. However, I estimate that they over-treat at least seventy to eighty percent of the patients that they see.10
The great difference between orthodox and alternative medicine is that the former attempts a scientific approach in spite of its limitations, whereas alternative medicine is mostly based upon individual testimony. There has been a significant attempt, with little impact, towards evidence-based medicine. I say "little impact" because patients want something done, and practitioners are quite willing to satisfy such requests to have a "happy" customer and get paid their fee. We live in a drug-seeking culture, whether legal or illegal.
I believe in the Biblical free market of supply and demand. As long as a person or family has the money to pay for a service, and it does not violate Biblical precepts, then he or they should be free to purchase it-alternative or orthodox. But I caution Christians not to make the same mistakes that modern medicine, as logical positivism, has made. The problem is that any science of medicine generally is extremely difficult, approaching impossibility.
There are some bright hopes in particular areas of orthodox medicine. Technology has greatly advanced in artificial limbs, lab and surgical procedures, monitoring devices, emergency room treatment of severe injuries, antibiotics in certain situations, treatment of burns, and some other areas that do not come readily to mind. But there are the negatives.
With precious few exceptions (leukemia, lymphoma, and especially in children), the "War on Cancer" begun in the 1970s has been lost. Drug treatment of irregular heartbeats (arrhythmias) in the 1980s and 1990s resulted in tens of thousands of deaths.11 The fall in heart disease and deaths from it is not due to modern medicine, but likely to a decrease in smoking and other lifestyle changes. Tens of millions of adults are on mind-altering drugs, and millions of children are on similar drugs, mostly for behaving like children. To make the greatest use of modern medicine would require the application of Biblical principles throughout the practice of medicine. These are just a few examples. Others can be found in the resources that I have provided.
Evangelical Christians could have prevented statist welfare, which inevitably led to Obamacare. Too many Christians who address medical ethics believe that government welfare is consistent with or equivalent to Christian charity. I do not need to develop the Biblical position on welfare with the audience of FFAOL, but readers should note this fact. Perhaps, Obamacare and the totalitarian steamrolling of Christian institutions which apply moral constraints to medical care will open some eyes to the true Biblical position: charity is personal and must be administered personally by individuals, churches, and other social groups. The Gestapo-like mandates to provide contraceptives and other measures for immoral activities is just the tip of the future iceberg.
Biblical truth is not complete without rational thinking about medical science. It is here that many Christians, and some theonomists, may go astray. Biblical thinking requires that one be a logical thinker, not just about the Bible, but in all areas of knowledge. Modern medical care, for all its glitz, glamour, and nearly three-trillion-dollar cost has a net negative benefit for the American people. One could call this recognition the Prophetic Calling of medicine for the thinking Christian.
Medicine as Priestly Calling
Rushdoony repeatedly states that medicine is a "priestly calling," in the same category as being a pastor. I will mention only two reasons why this is so. First, man is a psychosomatic unity-a material (physical) and immaterial (spiritual) component.12 Today, medical students are taught, and physicians practice upon, the metaphysical belief that man is only material-only a chemical structure, a mere confluence of subatomic particles. Thus, their answer for any malady is a chemical. "Mental problems" are seen as chemical problems, so they are treated as such. Interestingly, patients have bought into this metaphysical position-with rare exceptions, they want a chemical "fix," not a spiritual one. Most Christians follow the crowd, seeking sanctification through their local drugstore.
Second, because man is a psychosomatic unity, health is inescapably tied to health of both body and spirit. Many Christians may not know the intimacy of bodily and spiritual health that is represented in Scripture. In Mark 10:52, Jesus said to Blind Bartimaeus, "Go; your faith has made you well." "Well" in the Greek derives from sozo, the word from which soteriology-salvation-is derived. The Apostle Paul speaks of being "saved" (sozo) from shipwreck (Acts 27:31). "Hygiene" (hugaino) is used for spiritual health in the context of Luke 5:31. "Therapy" or "therapeutic" is translated "healed" after Jesus cast out a demon in Matthew 12:22. There are many other words in the Old and New Testament that clearly demonstrate that health and salvation are dependent upon conditions of both body and soul. In the first several chapters of Salvation and Godly Rule, Rushdoony has the fullest development of the totality of Biblical salvation that I have seen anywhere.13 I have a more thorough discussion of such words pertinent to health and salvation.14
Implications for Christians
(1) Neither the health of the body nor that of the soul can be neglected. For a period of time, I was the pastoral counselor for a church. During that time, very few counselees I met with led lives that reflected physical and spiritual health (regular Bible study, strong church attendance and involvement, vigorous personal and corporate prayer, etc.). Most lives were chaotic, lacking family worship, regular meal times (especially with the whole family), regular sleep, and periods of quiet. Schedules were top-heavy with church activity, childrens' (and parents') sports and other "cultural" activities, and television-watching. While Jesus cautioned against linking physical illness with sin (John 9:1-7), He does state that sin must be considered as a cause for illness (James 5:13-16). Unfortunately, most Christians seem to lead "lives of quiet desperation" on a par with their pagan neighbors. Such lives invite illness, even severe illness, which may have these covert origins but is nevertheless sin-engendered.
(2) There are only two reasons for any Christian to pursue the practice of medicine. The first is to practice medicine on the mission field to promote evangelism. The second is to reform, or in Rushdoony's words, reconstruct medicine. I see no reason for a Christian to simply practice medicine in the common way that it is practiced in America today-which actually promotes ill-health on the whole (as argued above).
What does reconstruction entail? There are the obvious moral battles (abortion and euthanasia) but there are others. The National Association of Evangelicals has been embracing birth control for single women and accepting funding from the liberal National Campaign to Prevent Teen and Unplanned Pregnancy.15 Children have been co-opted and will eventually be forced to be vaccinated for sexually transmitted diseases. Many readers may not know that it is legal in all fifty states for their children to be "treated" without parental consent or knowledge (including distribution of birth control, treatment for sexually transmitted diseases, and abortions).
We must also confront the long-neglected empirical nature of medicine mentioned earlier. As Christians we are called to study and proclaim truth. Like evolution, medical science is not truth. In fact, any basic book on logic teaches that empiricism is a fallacy because it extrapolates from an extremely small, well-defined area to the entire universe. One of the most egregious examples in present medical practice are lipid-lowering drugs that affect cholesterol, triglycerides, and other fats in the blood. They are promoted on the basis of a statistical trick. In a study of a hundred patients, one might see a 33% reduction of cardiovascular events (from six heart attacks down to four). This 33% statistic is how the efficacy of these drugs is reported. But note that only two people out of a hundred benefit-one out of fifty! This value is called the "Number Needed to Treat" (NNT). The numbers for these drugs range from one in twenty to more than one in 200. In addition, drugs used in clinical practice are much more loosely controlled than in formal research-the informal fallacy of universalization from a small sample to the entire universe of patients.
Other issues showing poor efficacy are various cancer screens (e.g., breast, prostate, and colon), use of anti-arrhythmic heart drugs, carotid artery surgery for strokes, treatment of common conditions (e.g., colds, sinus infections, sore throat, cough, and fever), and many others. While individuals may benefit from these actions, there is no way to identify who these are without treating the entire group, leaving only a small net benefit.
Ultimately, all healing comes from the body's own extraordinary powers created by God. No medicine can make skin and other tissue grow back together. No medicine can mimic the two dozen or more chemical sequences that cause each heartbeat. No medicine can cause skin, liver, and intestinal tissue to replace itself. Surgery may remove diseased tissue, but the body must repair itself from the surgery. Ultimately, all healing comes from God's reparative mechanisms that are built into the body's systems. Medical practice is merely an aid to that process. Further, all medical practice to a varying degree harms the body, so the body must also thwart and overcome the destructive nature of the treatments themselves, even though there might be positive overall benefits.
The will to understand and expose the fallacious nature of medical "science" is almost non-existent among Christians. I know of no other orthodox practitioner other than myself who has spoken or written on this subject. There are naturopathic, homeopathic, and other alternative medical practitioners who have done some of this reporting, but they have their own agendas with which I do not always agree. But I have reported on numerous non-Christians who have written on this subject and have cited some of their work here.16 There is a science of medicine-an extensive science of medicine-but it must be carefully discerned through Biblical ethics and the best empirical evaluation. For all my criticism of empiricism, it is the only method that we have to discern the practice of medicine, so we have a science of medicine that should be used carefully for God's glory with Biblical understanding.
Thus, Christians should see only Christian physicians who possess such discernment. As Rushdoony has shown, the body cannot be isolated from the soul, and medicine is a priestly calling. Given proper analysis, we might be amazed to find how many of our medical problems are actually spiritual problems. Unfortunately, the needed cadre of physicians does not yet exist.
Obamacare Can Bring Better Health!
I conclude that Obamacare will not significantly change the efficacy of modern medicine which has been thoroughly naturalistic and anti-God for decades. Again, Rushdoony puts medicine in perspective.
Most Americans, where their health is concerned, are guilty of malpractice in taking care of themselves. They are totally tolerant of their life-time health malpractice, and yet highly intolerant of an occasionally real or imagined malpractice by a doctor. They forgive every kind of health malpractice in themselves, and they forgive nothing in doctors.17
I have briefly but strongly argued here that, taken as a whole, American medicine has a negative effect on our health. However, if readers educate themselves and act on that information to better their family's health in the face of Obamacare, then they can improve their chances of not needing medical care, or needing it less, in the future. With the Internet, almost all knowledge available to physicians is available to non-physicians.
Are the readers of FFAOL who are physicians, or their children, willing to develop a truly Biblical model as I've sketched out? Apart from my work with Dr. Terrell, I know of no other efforts that even begin to approach medicine via Biblical law and a discerning empirical basis. The nature of medicine, as Rushdoony argues, calls for Christians to be treated only by Christian physicians, but there are few who can fulfill this role.
It is possible that economic restrictions may actually improve the efficacy of medical care, as more and more provisions have to be curtailed. Already hospitals and nursing homes are dangerous places;18 Christians will have to care more for their own. Across the country, psychiatric institutions are being closed and their patients returned to families and others. Medicaid is already the largest item in many state budgets and cannot continue to be increased.19 Families can learn to eat more nutritiously and exercise more. More importantly, they can "trust and obey, for there is no other way, to be (healthy) in Jesus, but to trust and obey."
It may be possible for physicians to work "outside the system" under Obamacare for a while. Christians and others could provide services for free or even pay-as-you-go, but this activity will likely be criminalized in short order. We ought to consider it for as long as we are free to do so. I currently work in a family practice office which emphasizes "urgent" care. Eighty to ninety percent of the charts I review involve minor, self-limited problems handled by physician assistants and nurse practitioners. Families could be taught how to deal with such matters on an ongoing basis without long lines at government clinics.
Obamacare provides an opportunity to develop what medical care ought to look like in a theonomic society. This issue is the most important one for us here. Christians, even evangelicals and Reconstructionists, continue to neglect applying Scripture to medicine. Rushdoony gave us the foundational tools to do so with his Chalcedon Medical Reports. Dr. Terrell and I worked for more than thirty years through conferences and publications that have been virtually ignored while medical costs skyrocketed and medical ethics imploded. This article is only my third published in the last twelve years, during which I've had only one speaking engagement of any consequence despite the number of worldview conferences sponsored nationwide by serious Christian ministries. Because of this lack of interest, I have mostly moved on from medical ethics, but someone-many someones-must pick up the mantle or we will never build a biblically-consistent medical ethic and practice. Dr. Terrell and I only started the process-others now need to develop it towards a better finish.
I am grateful for this opportunity to speak to Chalcedon's readership. May God use it as He sees fit to advance His Kingdom through Biblical reconstruction.
1. Biblical Healing for Modern Medicine, Covenant Books, P.O. Box 14488, Augusta, GA 30919.
2. Rousas John Rushdoony, Roots of Reconstruction (Vallecito, CA: Ross House Books, 1991), 501-502.
3. Roots, 470-471.
4. While costs should not always be an issue, 18-26 percent of all medical expenditures are in the last year of life.
5. I wrestled for two years for a definition of euthanasia, and I believe that this one covers our responsibilities.
6. A clear distinction should be made between what is "medical" and what is common and natural.
7. See References at the end of this article.
8. Roots, 496.
9. Ibid., 495.
10. I have been able to influence them somewhat, but they are actually practicing the legal standard of medicine that will stand in a courtroom-the legal, not the Biblical or scientific standard of practice.
11. David H. Freedman, Wrong: Why Experts Keep Failing Us..., (New York, NY: Little, Brown, and Company, 2010).
12. The Bible variously calls the immaterial part of man: soul, spirit, mind, heart, and will. The reader will have to pursue his own research to how these are manifested in the person.
13. I have summarized these chapters and added some further details of my own here: http://www.biblicalworldview21...
14. Biblical/Medical Ethics (Milford, MI: Mott Media, 1985), 101-126; Biblical Healing for Modern Medicine, Appendix 1, 195-204.
15. World Magazine, July 12, 2012, 9-11, 88. A later issue reported that NAE is regretting their position and changing their policy.
16. Nortin M. Hadler, Worried Sick: A Prescription for Health in an Overtreated America, (Chapel Hill, NC: The University of North Carolina Press, 2008); Gary Null, Death by Medicine, (Mount Jackson, VA: Prakitos Books, 2010). An immediate online source is: http://webmail.medscape.com/se...
17. Roots, 476.
18. Death by Medicine, cited above.
19. Inability and unwillingness to fund federal medical mandates may be a major stumbling block to the implementation of Obamacare.
www.bmei.org This website contains all issues of The Journal of Biblical Ethics in Medicine, our major journal, and most of the issues of Biblical Reflections of Modern Medicine, my newsletter. Neither is published any longer.
www.biblicalworldview21.org My website that covers a wide range of ethical and worldview issues.
www.biblicalphilosophy.org My current work in philosophy and related issues.
Davis, John Jefferson. Evangelical Ethics, 3rd Edition (Phillipsburg, PA: P&R Publishing Company, 2004).
Report of the Heroic Measures Committee Presbyterian Church in America
Payne, F. E. Biblical/Medical Ethics (Milford, MI: Mott Media, 1985)
Payne, F. E. Making Biblical Decisions (Escondido, CA: Hosanna House Book Publishing Company, 1989). Birth control fertilization issues, genetic engineering, and end of life issues.
Payne, F. E. What Every Christian Should Know About the AIDS Epidemic (Augusta, GA: Covenant Books, 1991)
Rushdoony, Rousas. Roots of Reconstruction (Medical Position Papers) (Vallecito, CA: Ross House Books, 1991), 457-517.
Google or other internet search engine. Virtually everything that I write about, including specific medical issues and economics, can be found on the internet with pertinent key words in the search.
- Ed Payne, M.D.
Franklin E. (Ed) Payne, M.D. served on the faculty for 25 years at the Medical College of Georgia, Augusta, Georgia, where he retired as Associate Professor of Family Medicine in 2000. He then worked for five years in the Emergency Department at Fort Gordon, Georgia, retiring from there in 2006. In 1980, he began writing in medical ethics, co-founding a journal, writing two newsletters, setting up a website ( www.bmei.org), writing six books and numerous articles, and giving various lectures for Christian and secular organizations. He has been married to Jeanne for 44 years with whom he has had four children and thirteen grandchildren.