The pace of change in health and medicine is simply staggering. But, of course, that change will present all sorts of new ethical challenges. As we know more, so we will be presented with all sorts of dilemmas in clinical practice to which the answer will not be immediately obvious, and in which it is likely that wildly different answers will emerge within the health community.
Take the use of medical data. As machine learning develops, old notions of privacy will be tested beyond their limits, and our current regimes of protection are likely to be severely challenged. As that happens so, inevitably, there will be new and intensified disagreements about fundamental questions regarding the relationship of the individual to society, and of the health professional’s duty to their patient and to the cohort of which they are a part. These will be essentially ethical and not clinical debates, and they will be debates in which it is vital that Christian practitioners take a leadership role. The discomfort for many of finding themselves at odds with their professional colleagues on issues such as the recent abortion debate is only likely to grow as we face increasingly complex questions in the ethics of clinical practice and the changing shape of the health system. In that context, it is incredibly important that we know how to disagree, and to disagree well.
In writing our University’s Strategy for 2016-2020, one question in particular attracted considerable attention. That was the question of how to live out the value of respect in the context of intense, even passionate, disagreement. We all know how to hold in respect those whose opinions we admire, or whose worldviews we share. But what does it mean to respect those with whom we are in profound dispute, those whose values and choices are antithetical to our own? In short, what does it mean to ‘disagree well’?
Disagreeing is, of course, key to the academic enterprise. Academics are professionally disagreeable, and teach their students to be as well. Much academic writing runs something along the lines of: “You have heard that x and y and z are true, but verily I say to you that x and y and z are all rubbish and that my idea is much better, and probably worthy of a Nobel Prize, or at least a place in the best journal, and many citations, and a promotion to a professorship.” This practice of disagreement tends to run to the collective life of the institution as well. At any given point, the place is alive with ideas passionately advanced about how it might be better run, very few of them compatible with each other. Academics know how to disagree.
But disagreeing well, rather than just disagreeing, was thought to be something regarding which the University community had some room for improvement. And we are not alone. The current culture wars seem to evince a decided dearth of the capacity to disagree well. The Facebook algorithm can’t quite work me out. My first wife’s father has remarried into a family in which Trump is taken very seriously and it is believed that the right to bear arms is fundamental, while to many of my European university friends Trump is the devil incarnate and the American legal position on gun control incomprehensible. And so my Facebook feed delivers material from the American right and the European left. What is distressing, is that the difference between their accounts of the world does not simply involve differences of interpretation as regards agreed facts. It involves fundamentally, radically, almost unrecognisably-different accounts of the facts themselves. And this in a world in which, increasingly, facts don’t seem to matter. The Post-Truth Initiative at the University of Sydney, which looks at ways in which we might deal with this new online reality, points out that the principal problem now is not simply that a claim might involve a lie or a misunderstanding, but that the question of whether it is true or not has become (in some circles) independent of its value to political and social debate. As the US commentator, Salena Zito, put it pithily in 2016, “The press takes [Trump] literally, but not seriously; his supporters take him seriously, but not literally.” The old rules even for disagreement itself, far less for disagreeing well, seem to be under threat.
As I suggested at the outset, I have to say that I think this issue of disagreeing well is a particular issue for Christians. Christians will almost inevitably be in a cognitive minority, at odds with the dominant culture, whatever veneer of Christian values that culture may wear. The gospel challenges the very best in our fallen human cultures and the prophetic voice of the church must never be lost. So, for Christian health professionals, dealing with issues in practice that sometimes go to the very heart of how we value human life and perceive of human flourishing, to navigate the complexity of disagreeing well is a particularly vital skill. If you doubt the complexity of that task, spend some time in the book of Daniel and watch how skilfully the central character in that book is seen as weaving a path between merely accommodating the culture in which he finds himself, and altogether withdrawing from engagement with it.
Right from chapter one, when Daniel is deeply immersed in the culture of the Babylonians and yet chooses to make food (for no reason that the commentators can easily discern) a point of distinctiveness, the question as how to live well in, and how to disagree well with, the norms of the dominant culture is everywhere to be found.
“Christians find it hard enough to live at peace with one another, to disagree well in the church. The history of the church is one of division over disagreement.”
To disagree well, it is a sine qua non we must be equipped with, and constantly refresh, a robust epistemic toolkit: the ability to formulate questions, to look for evidence, to weigh arguments, to critically analyse claims of various kinds, to listen well, to formulate hypotheses and to express findings and opinions well, both orally and in writing. But we also need a strong sense of the epistemic virtues, and it is those that are in increasingly short supply. We will only disagree well if we take these into private, public and online debate and into decision-making in our own lives.
For Christian educators, I think that there are enormous resources for thinking through what disagreeing well might look like in the second half of the twelfth chapter of St Paul’s Letter to the Romans. He speaks into this issue with profound and challenging clarity, “If it is possible, as far as it depends on you, live at peace with everyone.” The assumption here seems to be that conflict, disagreement, will come, but the Christian is ‘if it is possible… to live at peace with everyone.’ Living at peace does not mean that the Christian will simply agree with the values and standards and goals of the world around them. On the contrary, the opening verses of chapter twelve underscore a distinction between the mind that is in conformity with the world and the mind that is being transformed by the Holy Spirit. It is not merely that the Christian will sometimes disagree with the world; the Christian’s whole cast of mind will be in radical contradiction, transformed to be different, to that of the world around them. But they are to ‘live at peace with everyone’.
It is important to recognise the scope of this command – Christians find it hard enough to live at peace with one another, to disagree well in the church. The history of the church is one of division over disagreement. The Centre for the Study of Global Christianity at GordonConwell Theological Seminary suggests that there are currently 41,000 Christian denominations – not bad for a faith whose scriptures are full of commands to unity and whose Lord prayed that, ‘they may be all one’. But this command to live peaceably in Romans is perhaps more challenging still. Paul calls the Romans to live at peace with everyone, not just other members of the church, and to do so even in the context of radical disagreement flowing from a fundamentally different cast of mind. If the church could really model that behaviour – ‘if it is possible, as far as it depends on you, live at peace with everyone’ – how challenging a witness to the power of the gospel in our lives that would be! How powerful a witness it would be in a community that does not disagree well, that knows consensus and division, but finds respectful difference very difficult to achieve!
I had the great privilege of thinking through what disagreeing well might look like in writing the discussion paper that we took to staff consultation as a part of the development of our culture strategy. In that paper, I suggest six characteristics demanded of those who would disagree well. The list is not terribly creative but it covers the usual attributes. I wrote:
“In contexts of disagreement [the] value of respect needs to involve at least:
• An empathetic willingness to listen carefully and be open to the opinions of others
• A recognition of the particular expertise and experience of individual participants to a dispute
• A recognition of the particular responsibilities within the organisation of any individual participant in the conversation
• A choice of language commensurate with the goal of increasing levels of communication and understanding
• An orientation towards finding common ground with the other
• A desire to identify with some precision those points on which difference exists, rather than to create an ‘enemy’ of the other. “
That’s a good start, and we would do well to remember those epistemic virtues. Virtues such as these are increasingly the focus of attention of theorists of democracy, as democracy itself begins to unravel under the pressure of social change. As I pointed out in the consultation paper:
“Interestingly, as David Schlosberg, Professor of Environmental Politics at the University has pointed out, even those theorists most committed to notions of agnostic pluralism highlight ‘the need for an agnostic respect across difference’.
Belgian political theorist, Chantal Mouffe, for example, describes an ideal in which, “The ‘other’ is no longer seen as an enemy to be destroyed, but as an ‘adversary’, i.e. somebody with whose ideas we are going to struggle, but whose right to defend those ideas we will not put into question.””
Moreover, the spirit of those virtues is reflected throughout the commands of Romans 12. The people to whom Paul writes are ‘not to think of [themselves] more highly than [they] ought’, to ‘honour one another above [themselves]’, to ‘not to be proud or conceited’. These sound like the attributes of people who would disagree well.
Up until this point it all seems rather neat. I can turn this disagreeing well thing into a worthy, if slightly dull, charge to Christian medical professionals, and particularly to the recent graduates. In this opening address I would encourage you in a changing landscape of practice to use the intellectual skills that you have acquired, skills in critical thinking, in weighing evidence, in mounting an argument, in testing hypotheses, in effective oral and written communication, and to go out into the world to model the epistemic virtues that I outlined – to listen to the commands of Romans 12, and to take leadership roles in your professional communities, in the church and in society, in which you show what it means to live peaceably and to disagree well. And all that is important. I genuinely do think that the church, and the world, could be changed if we knew better how to ‘live at peace with everyone’. It is an important message.
The only problem was that just as I began to write that worthy address, I remembered that this same Paul who wrote the letter to the Romans was the author of the letter to the Philippians in which he calls his interlocutors ‘dogs’. And, of course, Jesus calls the Pharisees ‘whited sepulchres’; and he drove the merchants and the money-changers from the temple and overturned their tables. That doesn’t sound like disagreeing well. If a complaint were brought against St Paul and Jesus under the University Code of Conduct, I am not sure that they would escape criticism. The problem is that living at peace with everyone sounds suspiciously like being nice, and I doubt that anyone who saw Jesus cleansing the temple would have reached for that adjective. Moreover, right in the middle of Romans 12 Paul says ‘Never be lacking in zeal, but keep your spiritual fervour, serving the Lord.’ ‘Zealous’ and ‘nice’ are rarely words that go together.
So how do we really make sense of living peaceably, and what does it tell us about disagreeing? I think the answer to that question comes in the powerful parallel between verse 9 and verse 21: ‘Love must be sincere. Hate what is evil; cling to what is good …. Do not be overcome by evil, but overcome evil with good.’ I am to live at peace with everyone; but my highest commitment must be to their good. My commitment to their good is precisely why I am to seek to live at peace with them, but sometimes seeking their highest good may mean that peace is simply unachievable. The Christian must humbly display the epistemic values, but the Christian must also be willing to speak out, sometimes stridently, against evil, and to seek the good of the city in which they find themselves. That will sometimes demand that the Christian takes a clear and unequivocal stand, even when doing so may cause offence, and even when it may make living at peace with our community more difficult.
“Only the transformed mind … will know when love demands that we prioritise living at peace with everyone, and when love demands that we risk that peace for the sake of taking a stand against evil.”
Of course, the key to this is love. The epistemic virtues are in fact love and respect for the other in disagreement. But ‘love must be sincere’, and love will also not let me stand by when what is demanded is the prophetic word or action. Only the transformed mind, the fruit of the body that has been offered to God, will know when love demands that we prioritise living at peace with everyone, and when love demands that we risk that peace for the sake of taking a stand against evil.
This, I think, will be the dilemma of the church as our society grows further away from its Christian roots and as there are more and more issues over which the values of the church and the values of our society are at odds. We are to disagree well, we are to live in peace with all; but we are not to lack zeal and we are to hate what is evil. The church, and our professions, need leaders equally marked by zeal and a peaceable spirit. The task that you have as a community of Christian health professionals is together to work through when to listen and when to take an uncompromising stand – how both (patiently) to argue and to hate what is evil. If the world can see us do that – disagree well, but stand for truth; live at peace, but hate evil – then the church will stand in good stead and the world will see the power of the body offered to God and the transformed mind – the power of the gospel in our lives. If our health system includes practitioners who can operate in that way, it will be much better prepared to navigated the potentially dehumanising possibilities of some of the new technologies.
This is not an easy task, and it is not one that can be taught simply through instruction. It must be modelled by professional leaders who are themselves grappling with difficult issues, doing so within a Christian framework, and inviting others into that conversation. Those conversations must be open, so that everyone knows that grappling with those questions is part of a real and committed pursuit of the true, the good and the beautiful, and not merely an exercise in which the ‘right’ answer is known from the start. The art of disagreeing well – and disagreeing well in a way that is honest and faithful to the radical and prophetic spirit of the gospel – is something not only to practice, but vital for a community of Christian professionals to learn to live together. Each should know, in that context, that truth matters and that they have a personal responsibility to seek the truth, a moral duty that cannot be delegated. They should feel that responsibility by participating in meaningful interactions in which their opinions are taken seriously and respected (but also challenged), their unexamined assumptions uncovered and their minds stretched. That is why organisations such as these, in which Christian professionals can do that together, are so very important indeed. If your association ever becomes merely a social network, it will be of some, but of little use. At its best, you should be equipping one another to grapple with the challenges of a changing health landscape, practising together the art of disagreeing well, so that you may be very much needed salt and light in the health system of which you are a part.