Reforming Medicine

This article will demonstrate the necessity of an explicitly Christian view of medicine by examining the field in light of its presuppositions and characteristics as a profession. The creedal, ministerial, and non-neutral aspects of medicine will be briefly examined, followed by suggestions for bringing this field under the authority and dominion of Christ.

Medicine is Creedal
In the fifth century B.C., a physician by the name of Hippocrates formulated the basic tenets of ethical conduct for physicians. The Hippocratic Oath¹ defined the duties and boundaries within the doctor-patient relationship and contained the three basic elements of a covenant: oath, obligation, and a penalty for violating the terms of the covenant.

To be sure, the Hippocratic Oath was pagan and contained references to the Greek gods. Yet, it endured for countless centuries as the noblest statement of what a physician should uphold.

Sadly, instead of updating the anachronistic parts² of the Oath and Christianizing it, there has been a systematic deconstruction of its most profound elements. The result has been many new oaths³ that are so vague that they no longer commit the physician to anything. Conspicuously absent among these modern revisions are the negative sanctions against abortion and euthanasia. Notably present are positive duties of the doctor to society at large. Like our civil government, medicine has abandoned the notion that law is a negative, restraining force in favor of the socialistic, Enlightenment idea of positive law.

The end result is that doctors now feel compelled to weigh treatment decisions against societal "good" instead of doing what is best for the individual patient. A prominent example of this is the economic pressure of prescribing medicine. When faced with a treatment decision between a more effective, but more expensive drug, doctors often feel compelled to prescribe a less expensive, but often inferior alternative. In many cases this has nothing to do with the patient's ability to pay, but cost-containment for the sake of the HMO, insurance company, or governmental agency. Thus, the consideration of what drug to prescribe is often removed from the doctor-patient relationship and replaced with external factors. Hospitals often force these treatment limitations upon physicians by making the more expensive drug non-formulary, thus limiting the inpatient treatment options. Now, none of this is to say that less expensive treatments should be avoided. Clearly, if a cheaper but equally effective method of treatment exists, it should be sought first before more expensive options. The point made here is that the external controls are often based purely on economic factors and that the changes in the new "Hippocratic Oaths" condition physicians to accept these factors.

To Reform medicine, we must Christianize the Hippocratic Oath,⁴ return to it its negative sanctions, remove the positive societal obligations, and hold physicians accountable to the creed of our profession.

Medicine is Ministry
For the Christian physician, medicine should be viewed as a 100% bona-fide ministry of the gospel of Jesus Christ. Instead, medicine is often regarded as a purely scientific endeavor that is objectified. The scientific revolution and Enlightenment caused this paradigm shift, so much so that many medical schools now include mandatory courses on "humanistic medicine." The goal of these classes is to restore compassion and regard for "the patient" (an objectified, scientific term) as a human being with feelings, thoughts, and concerns of his own.

Unfortunately, these classes often end up merely as values-clarification instruction and glorify man as a self-determining, autonomous being (another Enlightenment concept). No absolute values are taught. Right and wrong are up to the patient and doctor to define together.

Christian medical professionals should look at medicine as a way to either introduce or prepare patients for a real encounter with the claims of our Lord and Savior. There is no other profession today that possesses the power and authority over people in such a direct way as medicine. Doctors are the only people who can tell someone to take their clothes off and examine them intimately without going to jail. Doctors are entrusted with the physical care of God's masterpiece of Creation. Patients routinely share their innermost secrets with their doctors, and many of their problems are a direct result of sin. To think that medicine is not ministry for the Christian physician would be to woefully miss our calling.

Medicine is not Neutral
Even Christian physicians often make the argument that medicine should be a value-neutral scientific endeavor. This idea ignores two important truths: (1) the creedal nature of medicine and (2) the myth of neutrality.

Since some sort of oath is administered to graduating physicians, no matter how watered down, there are certain presuppositions to which the physician is committed a priori. The only question that remains is, by which presuppositions should the physician be governed, Christian or humanistic ones?

Like all other fields of endeavor, there can also be no neutrality in medicine. Commitment to neutrality in itself is hostility to God and His law-word. As Christ taught us, "He who is not with Me is against Me."⁵ There is no middle ground. As Dr. Greg L. Bahnsen put it:

Neutralist thinking would erase the Christian's distinctiveness, blur the antithesis between worldly and believing mind-sets, and ignore the gulf between the "old man" and the "new man." The Christian who strives for neutrality unwittingly endorses assumptions which are hostile to his faith.⁶

Instead, Christian physicians should declare the unique claims of the Christian faith and apply them to medicine. Hiding behind a supposed neutrality only results in the erosion of the Christian ethic from the halls of medicine.

Filling in the Gaps
We've come to the place where humanistic and ungodly presuppositions have replaced Christian presuppositions in the field of medicine. Furthermore, the so-called commitment to neutrality undermines our ability to bring medicine under the authority and dominion of Christ. What can we do to reverse this trend?

For starters, we need doctors and nurses who are believers to assume the role of cultural leadership. This would mean, first and foremost, that they live lives that reflect the name "Christian." Second, it means that we need these same people to teach and mentor students in a distinctively Christian approach to medicine. Third, it means that Christians in medicine strive for leadership positions within the medical arts.

Let me give one illustration as to how effective this would be. Doctors comprise hospital credentialing committees, state medical boards, and medical specialty boards. If committed Christians assumed cultural leadership and filled these positions, not a single law would have to be passed to protect the unborn. Physicians who performed abortions could be de-credentialed, lose their license to practice, or their medical specialty certification. All of this would be done within the context of physicians policing their own ranks.

Now, I'm not arguing that we should stop pressing for laws to protect the unborn. Clearly, we need to be active on that front. Nor am I arguing for the validity of state licensing of doctors. I use this example only to show how Christian physicians today could reverse a downward spiral with the power of the Holy Spirit. Medical professionals, like other people, need to stop looking to the state for solutions to their problems and start pressing for the Crown Rights of Jesus Christ in their own sphere of influence. This is grassroots activism at its best.

Conclusion
Bringing medicine under the authority of Christ will involve, in the final analysis, dedicated Christians to assume cultural leadership through example, mentoring, and through obtaining leadership positions. I would challenge Chalcedon's Institute of Cultural Leadership to provide training for today's Christian doctors and medical students through informative seminars and long-distance mentoring. The sooner that we reach out to the next generation of physicians, the better. Our message should be the same as that of our Lord's, "Occupy till I come."⁷

Notes

1. I swear by Apollo the physician, by Aesculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and judgment the following oath:

To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; to look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and to the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone, the precepts and the instruction. I will prescribe regimen for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug, nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my art. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction, and especially from the pleasures of love with women or with men, be they free or slaves. All that may come to my knowledge in the exercise of my profession or outside of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

2. For example, the original Oath does not consider surgeons to be physicians ("I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by specialists in this art."). This is no longer the case and any revision of the Oath should reflect this.

3. The following is "A Modern Hippocratic Oath" by Dr. Lasagna that nicely illustrates the degradation of the original Oath into a humanistic document with positive obligations of the physician to society at large (quote from http://www.aapsonline.org/aaps/ethics/oaths.htm):

I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow;
I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body, as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection hereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

4. For an excellent discussion of the various Christian versions of the Hippocratic Oath, the reader is directed to Feucht and Calhoun, "The Hippocratic and Other Oaths: Past and Present, Proposal for an Oath for Christians," Journal of Biblical Ethics in Medicine, 10, no. 2, 37-47.

5. Matthew 12:30, NKJV.

6. Greg L. Bahnsen, Always Ready, Directions for Defending the Faith (Atlanta: American Vision and Covenant Media Foundation, 1996), 23-24.

7. Luke 19:13, AV.