Biblical Model for Medical Ethics

 

Christians believe in the divine inspiration, integrity, and final authority of the Bible as the Word of God. This is our starting point for Christian medical and dental ethics. In affirming the authority of Scripture, we follow the command and example of the Lord Jesus Christ, in whom all authority in heaven and earth is vested.

 

We believe that in His Word, God has graciously provided us with the principles necessary to make difficult ethical decisions. Ethical concepts which are not specifically taught in Scripture can be derived from principles which are found there.

 

In addition, our ethical perspectives are guided by the Holy Spirit and enriched by the teachings of Christian tradition, moral reasoning, and clinical experience. The circumstances of each case must be considered to discover the moral issues raised, but we do not accept such philosophies as ethical relativism, situational ethics, or utilitarianism.

 

Neither do we follow mindless legalism. Our Lord stated that the weightier matters of the law are justice, mercy, and faith in God.

 

Biblical ethics is concerned with motives as well as actions, with process as well as outcome. The integrity of moral decisions rests on the prudent use of biblical principles. We acknowledge, however, that sincere Christians may differ in their interpretation and application of these principles.

 

Patients or their advocates, families, and clinicians are morally responsible for their own actions. We, as physicians and dentists, are ultimately responsible to God as we care for the health of our fellow human beings.

 

Approved by the CMDA House of Delegates
Passed with a vote of 63 for, 3 opposed, 1 abstention
May 3, 1991. Chicago, Illinois.

 

Explanation

 

The discipline of medical ethics is quite new considering the age of the profession. It was not much before the 1960's that theologians began to ask physicians the should we...? questions. In the ensuing years, several schools or methods of medical ethics have evolved, including Principlism, Casuistry, Virtue Ethics, Narrative Ethics, and others. Although theological voices were instrumental in the inception of the field, they have been largely supplanted by secular voices from the disciplines of philosophy, law, and medicine. Verhey and Lammers lament the loss of this theological perspective, and they invite us toward a future in which religious traditions and theological voices will be restored to a prominent role in medical ethics(1).

 

Although proposed and adopted before that invitation, it was in this spirit that the Ethics Commission wrote the statement on a Biblical Model for Medical Ethics. It posits that the Bible is the proper starting point for discussions of ethical issues in medicine and dentistry. In addition to the stated and derived principles which can be found in scripture, the statement encourages reliance on the Holy Spirit, with help from Christian tradition, moral reasoning, and clinical experience. The CMDS statement recognizes human fallibility and some areas of ethical uncertainty in our limited human perspective.

 

Footnote:
   1. Verhey A, Lammers SE., eds. Theological Voices in Medical Ethics. Grand Rapids: Eerdmans, 1993 p5

Abstracts


 

Christian Ethics from Universal Principles?

Ed Payne. CMDS Journal Summer 1985; XVI(3):27-30

 

The author draws a clear distinction between how the Christian and the non-Christian should determine what is right. He questions the approach presented in the October 1983 Bioethics Newsletter of the Christian Medical Society to search for universal principles. He uses the watershed of biblical inspiration and authority to give four reasons why Christians should not use a method which derives ethical principles from universal sources: (1) its unbiblical starting point, (2) its failure as an authority to be obeyed, (3) its failure to solve the problem of an objective and absolute standard, and (4) its definition of morality that differs from the biblical concept. He uses the issues of euthanasia, abortion, and truth telling as examples of situations where biblical teaching gives clear answers while universal principles do not.

 

He concludes Together with the evangelical Christian community in general, CMS is experiencing growth and expansion, for which we can praise God. If we are to have any full and lasting impact as Christians on our culture we must be able clearly to discern truth within the pluralism of that culture. Failure to discern may arise from a lack of biblical knowledge, biblical interpretation, or practical application. Christians in general, and we as Christian physicians, would do well to be consciously aware that there are only two human moral states, namely darkness and light. We may speak and act as though there were more, but the Bible recognizes and describes only two, as we have seen. We cannot take this conflict any less lightly than does God Himself. Thus, we have to answer this question: Is a search for universal principles of medical ethics consistently and fully in accord with God s word? I believe that universal principles fail to be biblical and also fail in practice. For evangelical Christians, and the statement of Belief of CMS makes us evangelical, anything that is not biblical is not Christian.

 

Such a conclusion is not to say universal principles of medical ethics are worthless. Every such principle must be measured against and derive its authority from Scripture. A universal principle, therefore, can be said to be universal only in so far as Scripture applies to all men everywhere. CMS desires to become increasingly biblical in every way, including in our ethics. We must be careful that--in Dr. Schaeffer s analogy--we do not flow in a direction that will take us far from biblical truth that is both clear and authoritative in its ethical principles.

 

A Reply [to Payne, above]
Lewis Penhall Bird. CMDS Journal Summer 1985; XVI(3):31

 

...While Holy Scripture provides final authority, it is not the only authoritative voice to heed. The author points out that Paul cited secular authorities in his argumentation at the Court of Areopagus. Both the residual remnants of Imago Dei along with the benefits of common grace provide numerous non-Christian minds with insight, perspective, and quotable quotes which we neglect to our peril. He goes on to point out the difference between universal principles, which are derived from God s general revelation, and absolute principles which proceed from His special revelation

 

Compassion and Cynicism in the Hospital
David L. Schiedermayer. CMDS Journal Winter 1986; XVII(1):29-31

 

The author states that cynicism is the tendency to doubt the value of high ideals. He cites another author who posits that cynicism is a way to get needed distance from troubling situations in medical school and in the hospital. But Schiedermayer believes the problem is more basic, that health care professionals become cynical to deny wounds and withdraw from decay. He suggests that we confront the reality of wounds and decay and respond with compassion as Jesus did by binding wounds and preparing the dying for burial.

 

Honor Thy Patient
David L. Schiedermayer. CMDS Journal Spring 1987; XVIII(2):22-28

 

The author begins by telling how his grandfather s fatal diagnosis was withheld from him in the 1960's. He gives a brief history of the legal doctrine of informed consent and describes its elements. He quotes from Katz s book, The Silent World of Doctor and Patient, as evidence that physicians resist the concept, and expands on why this is so. Using the biblical teaching of free will regarding our souls, he justifies the importance of informed consent regarding our bodies. He then describes Siegler s concept of the doctor-patient accommodation as shared information and mutual consent and gives examples of how applying this concept allows us to respectfully treat patients as human beings.

 

Biblical Revelation and Medical Decisions,
by Richard J. Mouw. In On Moral Medicine: Theological Perspectives in Medical Ethics. Lammers SE, Verhey A. Grand Rapids, Mich.: Eerdmans, 1987.

 

In this discussion of the interface between medical decision-making and biblical revelation, the author first considers how God s revelation in general is to be interpreted and then focuses his attention on how principles for decision-making in medicine are to be garnered from Scripture. He contends that ... divine commands have a crucial bearing on the whole duty of man and that they therefore must certainly be considered when addressing issues in medical decision-making. The author asserts that the Bible is the standard of God s revelation against which all other directives believed to be from God must be checked. In addition, he maintains that the Bible in its totality must be considered when extrapolating guidelines for what constitutes a moral medicine. That is, prayers, historical narratives, and parables, etc., in addition to explicit commands, must be evaluated in determining the biblical dictates for medicine. The author concludes with a discussion of basic assumptions about the nature of medicine.

 

Informed Consent & Prayer: Medical Ethics Need Not Be Separated From Faith
David L.Schiedermayer. CMDS Journal Winter 1989; XIX(4):21-24

 

The author begins by telling of two cases which are clinically similar, but where there is a difference between first-world ethics where the focus is on pre-operative informed consent and third-world faith where the focus is on pre-operative prayer. Both are important items of communication, but prayer differs from informed consent in its object and its expectations. In the informed consent process, the patient is putting herself in the hands of the doctor, while in the prayer process, she is putting herself in the hands of God. Both reassure the patient that she is being respected as a person because she is being involved. He concludes that Medical ethics need not be separated from faith, whether we live in the first or the third world.

 

Salladay SA, Shelly JA. Spirituality in nursing theory and practice: The dilemmas for Christian bioethics. Christian Bioethics 1997;3(1):20-38

 

Moral strangerhood is due in part to competing worldviews. The profession of nursing is experiencing a paradigm shift which creates ethical dilemmas for both Christian nurses and Christian patients. Nursing's new focus on spirituality and spiritual care presents itself as broadly defining a desired state or patient outcome -- spiritual integrity -- supposed to be applicable to all patients of all faiths. Analysis of nursing's definition of spirituality reveals assumptions and values consistent with an Easter/New Age worldview which may cause hostility towards Christian patients stereotyped as dogmatic or noncompliant.

 

 

Bibliography


 

Articles

 

Gourley N. Christian bioethics and moral philosophy. Journal of the CMF January 1993:19-22

 

In response to the ignoring of the Christian viewpoint by sceular philosophers, the author describes Christian ethics in philosophical terminology as a deontological system which can stand against many of the arguments currently used to decry it in philosophical texts.

 

Horner JS. Christian ethics - an irrelevance or the salvation of medicine? Journal of Medical Ethics 1994;20:133-4

 

This guest editorial criticizes the major intrusion of utilitarian thinking into modern medicine. He concludes that the Christian church has adopted and treasured many of the essential Hippocratic standards, and they should not be vilified for doing so.

 

Winslow GR. Christians and bioethics: Can the Bible help? Dialogue 1994;7(1):5-8

 

The author presents a Christian framework for bioethical decisions.

 

 

Journals

 

 

Today's Christian Doctor (formerly Christian Medical and Dental Society Journal), David Biebel, editor. This journal of the CMDS is published six times a year. It frequently includes articles written by members and non-members which address issues of concern from a bioethics standpoint. While it is the official organ of the CMDS, all text represents the opinion of the author and does not necessarily reflect the official position of the CMDS.

 

Ethics and Medicine, C. Benjamin Mitchell, editor. Jointly sponsored by the Center for Bioethics and Human Dignity, Bannockburn IL (USA) and the Centre for Bioethics and Public Policy, London (UK). U.S. editorial address is Trinity Evangelical Divinity School, 2065 Half Day Road, Deerfield, IL 60015. Its editorial policy is that it seeks to develop a Christian mind on the complex and fundamental challenges posed to society by the break-up of the Hippocratic consensus and technological advances in medical science.

 

Journal of Biblical Ethics in Medicine, Hilton P. Terrell, editor. Published four times a year by Biblical Medical Ethics, Inc., P.O. Box 13231, Florence, SC 29501. It s stated purposes are: to recognize the authority of the inerrant, infallible Word of God over the practice of medicine; to uncover and advocate the Biblical principles upon which medicine must rest; to encourage physicians and patients to undertake the prevention and treatment of illness in accordance with Scripture; to challenge existing ideologies which teach the autonomy of man or the sufficiency of reason; to disestablish the mechanical view of man or any other view of man that fails to acknowledge accountability to God; and, to affirm God s provision of mercy through Biblical medicine as a secondary agency.

 

Christian Bioethics: Non-Ecumenical Studies in Medical Morality, H. Tristam Engelhardt, editor. This journal is published three times a year by Swets & Zeitlinger, P.O. Box 825, 2160SZ Lisse, The Netherlands. Aims and Scope: ...a non-ecumenical, interdenominational journal, exploring the content-full commitments of the Christian faiths with regard to the meaning of human life, sexuality, suffering, illness, and death within the context of medicine and health care. The Journal seeks to be fresh, novel, and controversial by taking the content of Christianity seriously, while critically assessing how different Christian faiths and different policies authentically realize that content with respect to bioethical issues. This non-ecumenical approach to Christian bioethics, guided by the usual secular scholarly standards, offers a forum for the extended and vigorous exploration of issues at the interface of theology, moral theory, and health care.

 

 

Books

 

 

Payne FE. Biblical Medical Ethics: The Christian and the Practice of Medicine. Milford, MI: Mott Media, 1985; 267 pages

 

One of the first published by a conservative Christian physician (and former member of the CMDS Ethics Commission), this book contains 13 chapters, including such topics as theism or naturalism, the credibility of science, empirical uncertainties, the theology of medicine, the role of the church in health care, as well as chapters devoted to such clinical topics as abortion, psychotherapy, euthanasia, and others. It includes a large number of references, both scriptural and others.

 

Lammers SE, Verhey A. On Moral Medicine: Theological Perspectives in Medical Ethics. Grand Rapids: Eerdmans, 1987; 657 pages

 

This anthology contains the work of over 50 authors from diverse theological (Christian and Jewish) traditions. Each of the 19 chapters has a short introduction by the editors, followed by several readings from different authors. It has become a classic reference work.

 

Frame JM. Medical Ethics: Principles, Persons and Problems. Phillipsburg, NJ: Presbyterian and Reformed Publishing Co., 1988; 132 pages

 

This shorter work (72 pages of text plus appendices and references) written by a theologian looks at three perspectives (normative, existential, and spiritual) of issues in and approaches to medical ethics.

 

Payne FE. Making Biblical Decisions. Escondido, CA: Hosanna House, 1989; 178 pages

 

This second book by Dr. Payne includes chapters on population control, birth control, artificial insemination, in vitro fertilization, genetic engineering, and the ethics of life and death.

 

Orr RD, Schiedermayer DL, Biebel DB. Life & Death Decisions. Colorado Springs: NavPress, 1990, 208 pp. Reissued in two volumes, Grand Rapids, MI: Baker, 1996

 

This book by two physicians and a pastor (all past members of the CMDS Ethics Commission) includes an introduction, 8 chapters on specific clinical topics (reproductive technology, abortion, handicapped newborns, consent, AIDS, long-term care, artificially administered fluids and nutrition, euthanasia, terminal care), and a concluding chapter which encourages support from churches and pastors as Christians confront difficult medical decisions. It includes references for further reading and questions for group discussion at the end of each chapter.

 

Beckwith FJ, Geisler NL. Matters of Life and Death. Grand Rapids, MI: Baker, 1991; 391 pages

 

This book by two Christian philosophers gives calm answers to tough questions on abortion (Part One - 125 pp) and euthanasia (Part Two - 75 pp) and includes 190 pages of appendices and references.

 

Kilner JF. Life on the Line: Ethics, Aging, Ending Patients Lives, and Allocating Vital Resources. Grand Rapids, MI: Eerdmans, 1992; 349 pages

 

This book by a theologian (and Director of the Center for Bioethics and Human Dignity) proposes a God-centered, reality bounded, love-impelled ethic to approach these difficult issues. It is a scholarly work (over 600 references) which is divided into three parts titled Living Ethically, Ending Patients Lives, and Allocating Vital Resources.

 

Feinberg JS, Feinberg PD. Ethics for a Brave New World. Wheaton, IL: Crossway Books, 1993; 479 pages

 

Two evangelical theologians address several of the typical issues in medical ethics (abortion, euthanasia, birth control, genetic engineering) plus some issues of social ethics (homosexuality, sexual morality, divorce, war, capital punishment). It includes 60 pages of notes and references plus detailed topical and scriptural indices.

 

Pope John Paul II. The Gospel of Life: Evangelium Vitae. New York: Random House, 1995; 189 pages

 

This encyclical letter on abortion, euthanasia, and the death penalty clearly articulates the consistent position of the Roman Catholic Church on these issues beginning with a statement on the incomparable worth of the human person.

 

Hollman J, ed. New Issues in Medical Ethics. Bristol, TN: CMDS, 1995; 198 pages

 

Fourteen CMDS members have each done a video and contributed a chapter to this book which is divided into three sections (Ethical Issues at the Beginning of Life, Ethical Issues During Life, and Ethical Issues at the End of Life).

 

Kilner JF, Cameron NmdeS, Schiedermayer DL, eds. Bioethics and the Future of Medicine: A Christian Appraisal. Grand Rapids, MI: Eerdmans, 1995; 313 pages

 

This multi-authored book contains 23 chapters in four sections on The Practice of Medicine, The Ethical Underpinnings of Medicine, the Evolving Abortion Crisis, and The Expanding Bioethics Agenda.

 

Rae SB, Cox PM. Bioethics: A Christian Approach in a Pluralistic Age. Grand Rapids, MI: Eerdmans, 1999. 318 pp

 

This scholarly work gives an in-depth review of contemporary secular approached to bioethics and compares and contrasts them to a biblical approach. Though academically sound, it is both readable and understandable by those interested in solidifying the Christian underpinnings of their thoughts on and approach to the important issues in bioethics today.