Christian ethics in the context of modern medicine

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from Luke’s Journal 2018 | Hot Topics #1 | Vol. 23 No. 3

The medical practitioners today finds him or herself immersed in a context saturated with “ethics” in forms such as codes of conduct, policies and procedures, and mandatory professional development activities. He or she operates within a context in which all sorts of ethical assumptions and principles are taken for granted. This is unavoidable.

The practices that medicine engages in are by definition morally fraught, involving, as they do, the health and wellbeing of human persons. Moreover, in our context these practices have been harnessed to modern technology, which has a restless momentum of its own, continually throwing up new challenges as it seeks new opportunities.

What difference can and should Christian faith make to such a person in such a context?

There are two ways of approaching this question. The first is to look straightaway at specific problems and challenges, and try to come to judgments about them in all their complexity. What difference, say, should Christian faith make to our thinking about prenatal testing, or the complexities of end-of-life care? This is an important and legitimate way of proceeding, which can throw up valuable insights and clarifications.

Yet it will also throw up questions about the journey of thought that has been taken, whether explicitly or implicitly, to reach the conclusions that appear to be the right ones. That is why a second way of approaching the question is also important, namely, the task of beginning from the basic structures and assumptions of Christian ethics.

“Christian ethics must be an ethics that corresponds to Jesus Christ.”

Going this way, though, requires patience. The danger here is that the magnetic pull of practical problems will draw us in without our ever quite attending to the basic questions sufficiently. The need to know what to do about this or that question and the ambiguous usefulness of discussing big ideas like nature or the kingdom of God make us hungry for what appear to be more straightforwardly practical ethical ideas (like, perhaps, the well-known principles of autonomy, beneficence, non-maleficence, and justice).

Yet such precipitousness involves risks—most of all the risk of failing to do justice to the grandeur of the work of God in Christ by leaving too much untouched, too many assumptions unexamined. Failing to ask fundamental questions about what our practical context means in the first place, and how a Christian might inhabit it differently, we short-change the possibilities of Christian witness.

With a call, then, for patience, this essay undertakes the apparently impractical task of beginning at the beginning and asks, what is Christian ethics?

The time is fulfilled

Most basically, Christian ethics must be an ethics that corresponds to Jesus Christ. This self-evident point is easily overlooked; but it is critical. Christian ethics must take its bearings from Jesus, otherwise it should not call itself Christian.

What does this mean? First and foremost, it means Christian ethics is driven by an awareness that something of supreme importance has taken place in and with the person of Jesus Christ. Something has come about that makes a difference to everything. “The time is fulfilled,” proclaimed Jesus. “The kingdom of God has come near.” At the heart of the mission of Jesus, and the proclamation of the apostles, was this conviction that his coming was a decisive act of God – not, that is, merely a revelation of what was always the case after all; but an action that changed things. “In Christ, God was reconciling the world to himself,” wrote the apostle (2 Corinthians 5:19). That is to say, Christian ethics is shaped in the first place by an awareness that we are at a particular moment in an unfolding story. “You know what time it is,” writes the apostle Paul, at the conclusion of a section of the letter to the Romans that lays out the shape of Christian discipleship: “it is now the moment for you to wake from sleep” (Romans 13:11). Christian ethics is an ethics of the kingdom of God that has come through Jesus Christ.

Nevertheless, although this kingdom is something profoundly new, it is not simply new, in the sense of being wholly unrelated to what has come before. Jesus is the Christ, the Messiah of Israel, and he came in fulfilment of the expectations of Israel. “Do not think,” said Jesus, “that I have come to abolish the law and the prophets; I have not come to abolish, but to fulfil” (Matthew 5:17).

“At the heart of the mission of Jesus, and the proclamation of the apostles, was this conviction that his coming was a decisive act of God – not, that is, merely a revelation of what was always the case after all; but an action that changed things.”

The kingdom of God can only be understood in relation to Israel’s story and hopes. It is the culmination of that story, the realisation of those hopes. Those who were “looking forward to the consolation of Israel” (Luke 2:25) were not disappointed by Jesus! Although the shape of that consolation was unexpected, and for some too difficult to accept, Jesus did not in fact come to set aside Israel’s life in favour of something entirely different; rather he came to fulfil.

For this reason, Christian ethics, while it begins from a consciousness that a new day has dawned with Christ, can never ignore the moral life and commitments of Israel. Indeed, it can only understand the new day with reference to Israel. This is why even though the apostles insisted that gentile Christians were not and could not be “under law” (Romans 6:15), that is, they were not bound by the Old Testament law in the way that Israel under the old covenant was, they also refused to leave the law behind.

“Do we then overthrow the law by this faith?” asked Paul. “By no means! On the contrary, we uphold the law” (Romans 3:31).

This point has far-reaching significance, because it ties Christian moral thought into an engagement, not only with the Old Testament law, but with the wider account of creation and human life within which that law fits.

Israel’s law was never an isolated, arbitrary set of moral demands, detached from the realities of human existence. On the contrary, from the beginning, Israel’s law was closely woven with assumptions about the nature of the world and our life within it.

Perhaps nowhere is this better seen than with the fifth commandment.
“Honour your father and your mother, so that your days may be long in the land that the LORD your God is giving you” (Exodus 20:12).

The commandments are linked to the natural structures of human life and flourishing. The law is good, not only because God says so, but because it is good for people. This is also why, within the Old Testament, the law is frequently connected with wisdom. “The law of the Lord is perfect, reviving the soul; the decrees of the Lord are sure, making wise the simple… More to be desired are they than gold” (Psalm 19:7; see also, for example, Deuteronomy 4:6 and Proverbs 29:18; 31:26).

Wisdom, in the Old Testament, has to do with the nature of the world we live in, and the ways of life that make sense within it – the ways of life to which the creation is naturally hospitable. God, we are told, “made the world by wisdom,” such that there are good paths on which to walk, good ways of life to follow (see Proverbs 3:13–26). To see Christ as fulfilling the law is also, therefore, to see him as fulfilling the created order, the wisdom that is sown into the nature of the world God has made.

An ethics of the meantime

What follows from all of this for Christian ethics? It means that Christian ethics must have a complex attitude towards what we may call ‘nature.’

On the one hand, Christian ethics must pay attention to the natural realities of human life, because it knows that this is the world that God made by wisdom, and that has a moral order which is reflected in Israel’s law. Christian ethics must pay attention to what the Bible teaches about creation and its moral order, and consider how this makes contact with the claims about what is “natural,” which, in one way or another, has been a constant concern of moral and political philosophy.

“Christian ethics must pay attention to the natural realities of human life, because it knows that this is the world that God made by wisdom, and that has a moral order which is reflected in Israel’s law.”

On the other hand, however, Christian ethics can never be simply or even primarily an ethics of nature and created order. For Christian ethics is beholden, first and foremost, to Jesus Christ, to his life and example, his teaching, and the significance of his death and resurrection – to the kingdom of God. Creation’s order cannot bind the Christian with the authority it otherwise might, for the same reason that the Christian is no longer “under the law” (Romans 6:15). Something has happened in Christ that means a new time has arrived, bringing with it a new freedom. But does that mean we ignore creation, and nature? By no means! We uphold them! (Compare Romans 3:31.)

But why, we might ask at this point, shouldn’t things be simpler than this? Because if Jesus came to fulfil the law and the prophets won’t there be, rather than tension between the kingdom and creation’s order, instead harmony? This is a very important question. The answer is that, although we are certainly right to expect there to be harmony between the kingdom of God and the created order, we cannot expect that just yet. The time will come when the whole of creation will find its fulfilment in Christ’s triumph, when the lion will lie down with the lamb and a little child lead them (see Isaiah 11:6). Yet this is something we may hope for, not something we can already enjoy. For the creation has not yet been made new, but waits for its redemption, just as we must wait with patience for the redemption of our bodies (see Romans 8:19–25). The Christian is located ‘in the meantime,’ and that location shapes Christian ethics.

What this then means is that in the present we find ourselves bound to the task of discerning what obedience to Christ and his kingdom requires of us in relation to our natural responsibilities. Our first obligation is to seek God’s kingdom and its righteousness, yet we may do so only as human beings, within the networks of relationships and obligations in which we find ourselves – only as men or women, children, parents; only as beings with bodies, who need to sleep and eat, and who get sick; only as members of some or other, or multiple, communities and polities, which make their own demands upon us.

“The Christian’s ethical task, therefore, involves discernment of what, here and now, Christ and his kingdom mean for our natural responsibilities.”

The Christian’s task is to “discern what is the will of God” (Romans 12:2). Yet to ask this is to ask a question on which more than one factor bears. It involves considering our situation as created beings; and it involves considering how Christ and his kingdom impacts upon this. The relationship between these two factors is sometimes straightforward, and sometimes not.

Consider again the command to honour one’s parents. That children should honour their parents is not an arbitrary imposition upon humanity; rather, it reflects the wisdom of God, the way creation is hospitable to human life. For this reason, this command is richly reaffirmed within the New Testament as having an important place in the Christian life and the life of Christian communities (see for example Ephesians 6:1–3; Romans 1:30; 1 Timothy 5:8).

In the teaching of Jesus, its basic validity and importance is deployed in order to criticise the Pharisees (see Mark 7:9–13). Yet, we also find moments at which its importance is abruptly thrust aside. “First let me go and bury my father,” says a son; and Jesus replies, “Let the dead bury their own dead” (Luke 9:60). This is illuminating, for it highlights the fact that in the present time a harmony between the ordered call of creation and the command of Christ’s kingdom cannot be assumed. For as the apostle Paul puts it, “the days are evil” (Ephesians 5:15).

The Christian’s ethical task, therefore, involves discernment of what, here and now, Christ and his kingdom mean for our natural responsibilities.

As we forgive

What does this amount to, in practice? Can we say anything more precise than that there is a need for discernment? Space prohibits extended discussion, but we can point out some significant things that unfold from all this.

First, this way of picturing the task of Christian ethics explains why Christians may and do share common ethical concerns and commitments with non-believers, but also why these commonalities are frequently vexed and precarious. Points of shared moral concern and moral agreement will arise because we live in a common world that is morally ordered, a world in which divine wisdom calls, pointing us to paths of goodness and life.

Describing this in terms of ‘natural law’ is not ideal, because the term law puts the idea of obligation front and centre in a way that is problematic. It is better, in my view, to think in terms of a natural order of wisdom, the way the world rewards certain forms of action, and not others. But the fundamental point is that there is a moral reality that bears on us simply by virtue of our life within the world God has made.

“Points of shared moral concern and moral agreement will arise because we live in a common world that is morally ordered, a world in which divine wisdom calls, pointing us to paths of goodness and life.”

And this is why we will frequently find points of moral agreement with those among whom we live, just as Israel discovered wisdom on the lips of foreigners.¹ It is also why Christians should expect to be able to learn from those outside the faith about many things, including things that relate to moral questions.

However, Christians must also expect this learning, and these shared moral commitments, to have limits, and frequently to be tense or collapse. The reason is that although we live in a world in which wisdom calls, the Bible tells us that we are, on the whole, very bad at heeding this call. Wisdom’s first speech in the book of Proverbs is one of deep frustration that people “refuse to listen when I call” (Proverbs 1:24).

Even those committed to the importance of natural law have often seen this point very clearly. Thomas Aquinas, for instance, while taking the idea of natural law very seriously, also recognised that “the uncertainty of human judgment” constantly thwarts our ability to come to practical conclusions about what is right and wrong.² Christian ethics must always reckon with the reality of sin, through which the created order and our knowledge of it have been corrupted.

(The story here has, in part, to do with language. Moral deliberation and practical reasoning are fundamentally shaped by language; because we can only think about what actions mean in so far as we are able to name them.

We work out whether something is good or evil largely by working out what it should be called: is this an act of honesty, or is it harshness? Is this courage, or is it rashness? Is this murder, or is it kindness? As Stanley Hauerwas nicely puts it, “You can only act in the world you can see, and you can only come to see what you can say.”³

This is why many contemporary moral debates have to do with how things should be named and what things should be called, and why campaigns to change laws often involve proposals to rename certain kinds of action. These disputes over names should never be regarded as trivial. Naming, in fact, is the central question for moral reasoning. The problem, however, is that names are fragile. The knowledge of the names of moral actions is a precious thing, safeguarded by traditions of moral teaching. But such traditions are always threatened. They are threatened by new situations that obscure the wisdom they contain and make it seem outdated or unhelpful. They are threatened by forgetfulness of how the tradition worked and fit together, so that it begins to look disjointed or lopsided. And they are threatened by the hypocrisy of the tradition’s guardians, so that the credibility of the tradition is compromised. All of these things have undermined the tradition of Christian ethics in our day, with the result that we have lost the ability to recognise certain kinds of action for what they are.)

Yet above and beyond all this, Christian ethics will have another reason for recognising the limits of moral agreement with those around us, which is its primary concern with the new thing God has done through Jesus Christ.

Christ and the claim of his kingdom introduce a new priority and focus into Christian ethics, which will make other accounts of ethics seem incomplete – preoccupied with non-critical things and out of proportion to reality. By the same token, from another perspective Christian ethics will appear inadequately concerned about certain things and irresponsibly unrealistic.

The distinctiveness of Christian ethics centres on the priority given to grace. One of the striking features of the moral exhortations in the New Testament is their emphasis on graciousness. There are constant calls to bear with one another, to be patient with and generous to one another, to extend grace and gentleness to outsiders, and to forgive.

Indeed, nowhere is the distinctive character of Christian ethics clearer than with the call to forgive. This is an obligation that is, in a real way, unnatural. It is a striking fact that there is no command to forgive in the Old Testament. It is almost always God who is the agent of forgiveness. But with Jesus something new happens, such that now the command to forgive is placed front and centre: it is the only moral obligation that finds a place in the Lord’s Prayer. It is not too much to say that Christian ethics begins from the words “As we forgive those who sin against us.” This is not an ethics that comes naturally to us, and Christian ethics must resist the temptation to minimise this distinctiveness.

Conclusion

Where, then, does this leave contemporary Christian medical professionals, bombarded with ethical guidelines, principles, and assumptions?

Perhaps the best way to sum it up is to say that it leaves such persons free. They are free because they are able both to recognise the value and legitimacy of the ethical regimes in which they operate, and also to recognise their limits and stand apart from them. The way they are positioned is essentially the same as the apostle Peter had in view, when he called for Christians to:

“For the Lord’s sake accept the authority of every human institution, whether of the emperor as supreme, or of governors, as sent by him to punish those who do wrong and to praise those who do right. For it is God’s will that by doing right you should silence the ignorance of the foolish. As servants of God, live as free people, yet do not use your freedom as a pretext for evil. Honour everyone. Love the family of believers. Fear God. Honour the emperor”.
(1 Peter 2:13–17)

What stands out in this instruction is the way Peter sees the space for a genuinely Christian, willing recognition of the legitimacy and validity of ‘human institutions,’ precisely as an expression of, rather than a compromise of, freedom. The basis for this space lies in the terms ‘wrong’ and ‘right.’ There is a recognition here of the shared moral commitments we spoke of earlier. In various ways, Peter implies, Christians will find themselves able to agree with the moral judgments of the world around them, and its institutions. Yet, there are also clearly implied limits to this submission to authority. It is done only “for the Lord’s sake,” and in service to God, which means, as Peter himself made clear at another moment, there are times when it ceases to hold (see Acts 5:29).

In the context of contemporary medicine, such freedom might involve the effort to recognise ethical value and insight where it can be found, whether in codes of conduct, principles of ethics, or practical, contextualised judgments. There will be insights into what is right and wrong here that can be welcomed with gladness. Yet this freedom will also involve a constant recollection of the provisional, limited, and imperfect nature of these human institutions, which may deserve “honour,” but do not deserve either “love” or “fear.”

The authority of regimes of medical ethics can be accepted only “for the Lord’s sake,” and that means there will come moments where they can no longer be accepted at all. This is the freedom which Christian ethics seeks to defend and assist, by explaining how it flows out of the work of God in Christ, to reconcile to himself the world that He made by His wisdom.

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References

1. We have several hints in this direction within the Book of Proverbs. Wisdom literature existed not only in Israel, but throughout the ancient world. This wider wisdom teaching was known in Israel – a fact that should not surprise us, given the stories that depict king Solomon sharing his wisdom with “the whole world” (1 Kings 10:24) – and there are indications that it was taken seriously. Foreigners speak in Proverbs (see Proverbs 30:1; 31:1). More strikingly, in chapters twenty-two and twenty-three of the book, there is a passage that almost all scholars agree depends on a wisdom tradition from Egypt called The Instruction of Amenemope (see, e.g. Roland E. Murphy, Proverbs (Nashville: Thomas Nelson, 1998), pp. 290–294). “By me kings reign, and rulers decree what is just” says Wisdom in Proverbs 8:15. The clear implication is that this is true of all rulers, not only those of Israel. As David VanDrunen concludes, in a discussion of how Proverbs contributes to a biblical theology of natural law, “Proverbs recognises that genuine wisdom exists outside the bounds of Israel and indicates that God’s people should learn from the wisdom of others” (Divine Covenants and Moral Order: A Biblical Theology of Natural Law [Grand Rapids: Eerdmans, 2014], p. 397).
2. Thomas Aquinas, Summa Theologiae, 1a2ae, q.91, a.4.
3. Stanley Hauerwas, “How to write a theological sentence,” ABC Religion and Ethics: http://www.abc.net.au/religion/articles/2013/09/26/3856546.htm