Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
doi:10.1093/cb/cbu024
In the early 1970s, Ihad my tonsils removed at the age of six in a small rural
Catholic hospital; it was a town where everyone knew everyone and where
everyone knew not only who went to church and to what church he or she
went, but who did not go to any church. I remember vividly the habited
nuns sweeping in and out of my room, tinkering with various tubes that
connected to my body. Nuns were a novelty to me, a Protestant. Iremember
that every time Iswallowed there was such pain, like someone was running
a wire brush down the back of my throat. Ican feel it to this day. Iremember
one nun in particular; she brought in the ice cream, which Ieyed with great
delight, but at the same time with such fear for the pain it would inflict on
my throat. Ican remember Sister insisting with great verve that Ishould eat it
and that Ishould enjoy it, which at the time seemed impossible. Iate it; Idid
not enjoy it until the last bite. Iremember Fr. Mike, the wheelchair-bound
Catholic priest who suffered from post-polio syndrome, wheeling in to see
me. He was both a kindly pastoral presence and a bit scary for a child, seeing
his limbs withered away from polio. Ieven remember walking by the room
with the iron lung that Fr. Mike used at night to assist his breathing. Iremember my doctor, a Lutheran, coming to see me and working seamlessly with
the sisters and with Fr. Mike. That era of a Christian medicine is gone.1
The point of this reminiscence is not to romanticize a bygone era, but to
show that, in the not-so-distant past, there was no rift between religion and
medicine, or more specifically between Christianity and medicine. My training (as a medical student and then as a resident) occurred in large, urban,
state of the art medical centers, where any religious ideas were tolerated at
best and ridiculed at worst. The regnant myth2 seemed to be that medicine
once lived in the darkness of religious ignorance, and that today medicine
is conceived in science and born of technology. It has left behind our premodern, religious myths. Yet, there is one other point I want to make as
The Author 2014. Published by Oxford University Press, on behalf of The Journal of Christian Bioethics, Inc.
All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
320
Jeffrey P.Bishop
Post-Christian Medicine
321
Not only did the McConnells have to make prenatal decisions, Bethany
Joy had ups and downs over the ensuing thirteen months of her life, requiring them to make hard decisions along the way. The McConnells had to
decide how aggressive to be with the medical therapies that would assist
Bethany Joy in living, from feeding tubes to ICU care to ventilator support.
At her last hospitalization, Bethany Joy developed septicemia, and again
the McConnells were left with another choice to make: either aggressively
treat the infection or to let it go untreated, which would result in Bethany
Joys death. The McConnells asked the doctors a question: was Bethany Joy
struggling to live or was she struggling to die? Doctors are notoriously bad
at predicting when a patient will die, though most physicians can recognize
when a person is actively dying (Kaufman, 2005, 20735). The doctors caring
for Bethany Joy did not seem to want to offer substantive guidance. It was
as if they did not want to take responsibility for the decision or engage with
our ethical decision-making or faith perspective. Once again we were left on
our own, isolated and disoriented. This was a parental decision, not one for
medical staff (T. M.McConnell and R.A. McConnell, 2014, 383-4).
The disorientation that the McConnells felt with the lack of information
about Bethany Joys exceedingly rare chromosomal abnormality was compounded by the secular pluralism that reigned in the Canadian system.
Certainly, on the one hand, the pluralism of the Canadian healthcare system
gave a wide berth to the McConnells moral values, allowing their own personal values to inform the care provided to Bethany Joy. In fact, the doctors
acted in exemplary fashion in that they did not impose their own moral
standards on the McConnells. On the other hand, the McConnells experienced a good amount of disorientation in the lack of substantive guidance,
and it is difficult to separate out the substantive medical guidance from
substantive moral guidance. In other words, despite the benefits of pluralism, the McConnells still felt as if they were lost in a foreign land, unable
to make decisions because there was so little substantive guidance from the
healthcareteam.
To remedy the situation, the McConnells offer a dialogical model, drawing
on the work of Russian philosopher Mikhail Bakhtin. The dialogical model
seeks to find ways for attenuating seemingly insoluble and incommensurable positions by encountering the moral other as a person. The McConnells
claim that a dialogical model would allow doctors to become better informed
on the metaphysical moral substance held by patients and families, creating
a bond between families, patients, and the healthcare team. Perhaps the dialogical model could prevent the kind of disorientation they felt in the largely
pluralistic setting of the Canadian system.
However, such a solution leaves many questions open. The healthcare
system claims a kind of pluralism where everyone feels at home. It claims
a kind of neutrality where all metaphysical moral views can inform decisions about seemingly neutral medical facts. Yet, the question remains: can
322
Jeffrey P.Bishop
metaphysical moral values be merely attached to supposedly nonmetaphysical and nonmoral science and technologies? While the McConnells themselves did not have the question posed to them, virtually every woman in
technologically advanced cultures is presented with the option for screening
for chromosomal abnormalities and other congenital conditions, precisely
because the system holds that these children are expendable. These tests are
not developed to help prepare a family psychologically for what is coming,
but open a set of possibilities that within a Christian life-world would never
have been conceived. Ihave elsewhere argued, with a colleague, that we see
the way that a secular metaphysical moral life-world animated the search for
screening tools for neural tube defects in the 1970s. The test itself was not
just a triumph of amoral scientific knowledge but was created because forces
in the NIH wanted to reduce costly medical and social services in Britain for
the families of children with neural tube defects (Gagen and Bishop, 2007).
The knowledge, however, cannot so easily be disconnected from the values that animate its creation without a lot of conceptual work, prayer, and
thoughtfulness.
These tests are designed precisely because the system thinks it is legitimate to terminate these pregnancies in order to prevent a child, like Bethany
Joy, from being born. That the system permits a family to choose whether
or not to test does not mean that the knowledge and the technology that
creates the conditions for the possibility of this knowledge is simply neutral.
While it is true that a dialogical model, where family and physician engage
each others life-world in a mutually respectful dialogue, could allow a familys moral commitments to be better understood by the practitioners in a
healthcare system, a dialogical model could also open the possibility that the
family could become convinced that terminating a pregnancy or stopping
aggressive medical therapies too soon is not only medically advisable, but
also morally legitimate. In other words, the logic that creates these technologies becomes even more explicit in dialogue, such that the seductive logic
of termination becomes a reality where it had not been before. Of course,
Iam not saying that Christians cannot or do not resist this logic, but that in
a time of trial, the dialogical model opens up a possibility that may become
hard to resist.
The second essay by Philip C.Burcham addresses the way in which an
entire system can shift in what it emphasizes morally. Burcham and many
of his family members carry a variant form of a gene that results in brittle
bones. While Burchams exact genetic variation is not known, the disorder
is characterized generally as a form of Osteogenesis Imperfecta (OI), in
which its carriers are prone to more bone fractures. Burcham describes an
experience with his newborn daughter. His daughter did well and showed
no signs of OI until she was ten months old, when she sustained her first
fracture. At that time, they were referred to a specialist, who they thought
specialized in bone diseasessomeone who might be able to prevent future
Post-Christian Medicine
323
fractures. However, the doctor to whom they were referred was in fact a
geneticist. Burcham and his wife asked why they were seeing him; the geneticist responded: We want to make sure you dont have another one of
those! pointing to their daughter (Burcham, 2014,364).
The point of Burchams essay is that genetic medicine could be seen as
part of the scientific endeavor to search for ways of alleviating fractures, in
his particular case, or to improve the lives of people with genetic disorders,
generally. Burcham, a practicing pharmacologist, states that understanding
the genetics could serve as a springboard for the creation of new therapies to
alleviate the effects of the disorder. Instead, with the rise of utilitarianism in
Australia and financial pressures pushing cost savings for the social welfare
system, genetics research seeks the easiest and cheapest solution for genetically inherited disorders and diseases, prevention of the disease by preventing the birth of those with the disease. AChristian concern to care for the
frailties of the body opens different research agendas, whereas a utilitarian
concern for cost savings creates a different research agenda altogether. This
idea also leaves open the possibility that Judaism, or Islam, or any other religious life-world could give rise to different research agendas. While Burcham
does not say it, he implies that knowledge is not neutral.
Burcham also describes the theological foundations for pharmacological
research. In scripture, we find the use of herbs to remedy sickness. Burcham
describes several theologians throughout different eras of Christian history,
in which use of medicines is celebrated as a use of God-gracious gifts. While
Burcham does not make this claim explicit, it is clear that to the Christian,
the natural world is conceived as gift, and that means that not only does
Christianity seek to know the world for its uses, but it understands it as
gift. This understanding might also shape how nature can be used by the
Christian. In other words, to the Christian creation is a gift and not a resource.
A Christian life-world creates a kind of medical knowledge different from
that created by the hegemony of utilitarianism. Burcham goes on to claim that
once the flower of pharmacology has been cut from its roots in Christianity,
the various pharmaceutical development programs begin to grow in very
different directions. Secularizing forces have driven pharmaceutical development into lucrative areas, leading to the neglect of developing drugs for
orphan diseases. Utilitarian forces strive to keep costs down by eliminating costly patients from coming into existence. Put differently, secularism
and utilitarianism have not only moral commitments, but also metaphysical
commitments with their own understanding of nature as mere resourceas
opposed to giftand with its immanent own immanent tel. In other words,
rather than genetic testing leading to novelty in drug development aimed at
alleviating the suffering of those with genetic ailments, the whole secular
utilitarian society sees people with genetic anomalies as costs and therefore
as consuming too many resources. Thus, they are dispensable, driving pharmaceutical innovators into other domains.
324
Jeffrey P.Bishop
The question before us is whether Christian witness can reclaim the upper
hand from secular and utilitarian society, the prerogative both in the creation of new knowledge, and in the use of that knowledge. Whereas the
McConnells seem optimistic that medicinenow informed by consumerist and utilitarian principlescan be sewn back together with Christianitys
moral commitments through a more dialogical model of encounter, Burcham
seems rather more pessimistic. Is it possible to mend the relationship between
secularized medicine and Christian moral commitments? Or must we choose
between two stark alternatives? On the one hand, we have a secularized
medicine, which hides its own metaphysical moral commitments with its different understanding of nature as resource ordered to usefulness in political
society; on the other hand, we have a Christian medicine, where the research
agendas and routine medical care originate from the gratuity of God in creation, ordered to the compassionate care of frail bodies.
In the third essay in this issue, Paul Tyson describes his radical disorientation with the birth of his first child. Tyson explores the extent to which
the medical system severely circumscribes Christian belief and practice. He
recounts the death of two of his children from a rare genetic disorder, Type
ISpinal Muscular Atrophy (SMA), in which the spinal nerves begin to degenerate after birth, including the nerves that govern respiration. These children are particularly prone to lung infections. While these infections can be
treated, SMA cannot be treated, and in time the acute and chronic changes
in lung function will result in the death of the child. Tyson seamlessly moves
back and forth between narrative description and theological reflection,
claiming that he suffered two wounds.
The first woundthe wound of faithcame from his Evangelical and
Reformed Church community, after the birth of Daniel, his first born. Tyson
and his wife faithfully approached the elders of their Protestant church community, seeking anointing for Daniel and prayers for healing as prescribed
in the Epistle of James, the brother of the Lord. That community too quickly
abandoned all hope for miracle in deference to a medical culture that foreclosed on that as a possibility. Tyson notes that his local parish and the
Western Church generally suffer from a willed deafness to the dissonance
which arises when the church largely accepts the functional and methodological atheism of modern medical care whilst still seeking to claim fealty to
the inherently miraculous dynamis of the church (Tyson, 2014, 331). Tyson
and his wife gave birth to three healthy and unaffected daughters. After the
birth of their fourth daughter, Lucy, the wound inflicted by their Church community deepened. Lucy was also born with SMA. Again, approaching their
parish elders, they were once again rebuffed and demeaned for not accepting the reality proclaimed by their doctor that there was no hope for Lucy.
But what is a miracle if not Gods radical intervention into lives? Why not
pray for a miracle? Why did their elders not pray for a miracle? Tysons local
church community had uncritically accepted the medical worlds conception
Post-Christian Medicine
325
326
Jeffrey P.Bishop
The modern instrumental knowledge, bent on efficient and effective control of the material of the body, too quickly forecloses on the reality that
Christians know exists beyond that rationality. That efficient and instrumental
rationality is so seductive that even Christians want to let it govern. It seems
that we in the West have let medicine become ouridol.
The paradoxes of Christian faitha God Who became fully human without diminishment of His Divinity; a triune God Who is one in being, but
three Persons, all equally and fully Goddoes not submit Himself to the
intellectual simple-mindedness of Western instrumental knowledge. In short,
the power of efficient and instrumental reason at the heart of modern medicine, while it can mediate Gods grace, can too easily become an idol to
which the living God must submit Himself or be thrown out of modern
Western medicine, and worse by the Western churches that have succumbed
to its seduction. Tysons prayerful stance in his conclusion offers us a different kind ofhope.
In his study of the relationship between medicine, miracle, and magic
in New Testament times, Howard Clarke Kee notes that each of these was
utilized to achieve and sustain human welfare. Tracing the relationships of
Christian practice in the context of a Jewish and Roman culture, Kee points
out that what distinguished these modes of healing were the assumptions
upon which each operated. In magic, the basic assumption is that there is
Post-Christian Medicine
327
an inexorable network of forces which the initiated can exploit for personal
benefit, or block for personal protection (Kee, 1988, 127). There was no
need to study the specifics of the powers, but the goal was merely to control them pragmatically. To the Christian mind, not knowing the source of
the powers was highly problematic. There seemed to be no limit on magic.
Pagan medicine, however, originated in the study of the natural and cosmic
order and seemed ready to acknowledge its limits in the face human finitude
(Kee, 1988, 126). Miracle originated in another order, the Divine order of
God (Kee, 1988, 127). There was for the Christian no sense that this power
could be harnessed according to the patients will, but the patient was to
enter into supplication, acknowledging that Gods power is governed only
by His Divine will. The Christian could never use magic, because the source
of the power is suspect. The Christian could however use medicine and hope
for miracle, because in early Christianity, the demarcation between the realm
of nature and the realm of grace had not developed in the way that it had in
the West. Creation is already graced, and as such the line between medicine
and miracle, under the sovereignty of God, is blurred.
It is perhaps for this reason that Christians have always held medicine in
high esteem. The natural order is already graced by God. If medicine was
utilized prayerfully and with an understanding of the gratuity of the created
order, and in devotion and obedience to God, it was thought to be legitimate. If, however, medicine was used simply to control the material of the
body, it was thought to be merely the manipulation of mechanism ordered
by my own will. In this sense, even medicine operating according to the
natural order could be for the Christian more akin to magic than to legitimate
Christian care. It seems that this understanding of medicine is what animated
St. Basils Long Rule No. 55, where medicine is brought under Christian rule
(St. Basil the Great, 1962). The use of medicine must always be ordered
according to Gods will for salvation.
There are several questions that emerge from these insights. Has Western
medicine become more akin to magic in that it employs all the powers,
whatever their sources, in order to control the world according to ones
own will? There is yet another question that haunts the heirs of Western
Christianity: can we (or should we) distinguish the created realm from the
realm of grace? Has the instrumental reason of the West once again become
pagan in that its appeal to natural forces seems to be separated from any
relationship to the Divineorder?
Moreover, modern medicine and medical science operate on a set of originary values: simplicity, elegance, and the drive to control. Simplicity and elegance derive from Ockhams razor, and assume, without much confirmatory
evidence, that the natural order of the body is simple and elegant rather than
complex and chaotic. What we claim to be true about the body, the knowledge gained with these two premises, might shape not only what we claim
as true, but the kinds of things we can do with that knowledge. In addition,
328
Jeffrey P.Bishop
Post-Christian Medicine
329
Notes
1. It should be noted that this hospital was an example of ecumenism, within a more Roman
Catholic context. It is also true that such ecumenism led to the wider cultural concern for diversity. While
certainly diversity can give birth to broader horizons, it can also lead to the loss of ones identity. After all,
if you keep opening the banks of a river more and more widely, you eventually end up with a swamp.
2. Using the word myth here only demeans the word myth.
3. Intrauterine Growth Retardation is a descriptive term of a syndrome. The fetus grows to a level
but fails to progress. There can be any number of causes and it is suggestive of some underlying pathology that has disrupted the normal growth pattern of the fetus.
4. The Epistle of James 5: 1316 encourages Christians to seek from their Presbyters prayer and
anointing with oil. The Presbyters prayers offered in faith have the power to make whole. The passage
also makes it clear that it is the Lord that raises the person up and not the Presbyters themselves.
References
Burcham, P. C. 2014. Science in two minds: Reflections on the missional disunity within contemporary medicine. Christian Bioethics 20:35975.
Ferngren, G. B. 2009. Medicine and Health Care in Early Christianity. Baltimore, MD: Johns
Hopkins University Press.
Gagen, W. J. and J. P.Bishop. 2007. Ethics, justification and the prevention of spina bifida.
Journal of Medical Ethics 33:5017.
Kaufman, S. R. 2005. And a Time to Die: How American Hospitals Shape the End of Life.
Chicago, IL: University of Chicago Press.
Kee, H. C. 1988. Medicine, Miracle and Magic in New Testament Times. Cambridge: Cambridge
University Press.
Mathewes-Green, F. 1992. Abortion: Womens rights and wrongs. Frederica [On-line]. http://
frederica.com/writings/abortion-womens-rights-and-wrongs.html (accessed October 3,
2014).
McConnell, T. M. and R. A.McConnell. 2014. The need for dialogical encounter: An account
of Christian parents making decisions on behalf of their severely handicapped child.
Christian Bioethics 20:37689.
McKenny, G. P. 1997. To Relieve the Human Condition: Bioethics, Technology, and the Body.
Albany, NY: State University of New York Press.
St. Basil the Great. 1962. Question 55. In The Long Rules, ed. M. M. Wagner, 3307. Washington,
DC: Catholic University of America Press.
Tyson, P. 2014. The wounds of faith and medicine, and the balm of paradox. Christian
Bioethics 20:33058.