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ss nucleus - January 2014,  summer school 2013

summer school 2013

Ella Kim reflects on serving Christ in secular medicine.

Christian medics often face difficult ethical issues, and as society becomes increasingly distant from Christianity, we need to be intentional about honouring God with our work. I don't want to go with the flow and be a people-pleaser with the way I practise medicine; I want to be salt and light, standing up for the truth and doing what is right! (1) I want to glorify Christ! As a minister at my church puts it, we should 'stick out like a healthy thumb in a world full of sore thumbs'. (2) To really stick out as a faithful Christian medic, I needed to find out what God actually has to say about medical ethics and so signed up for summer school.

Students and junior doctors travelled from all over the UK for two days of teaching and discussions on Christian medical ethics organised by the KLICE (3) and held at UCCF's Tyndale House in Cambridge, in early September.

We aimed to think deeply about serving Christ faithfully in the medical profession, and to tackle some of the ethical challenges we face in a secular society. How do we live and speak for Jesus as medics? And what does the Bible have to say about medical ethics?

We began by identifying challenges in contemporary healthcare, thinking about John Stott's concept of 'double listening' - listening to God's Word, and also to today's world. (4) We are to be both faithful to Scripture and sensitive to culture, and modern-day Christians act as bridges between the two.

When we think about ethics, there is no neutral ground to stand on. Our thoughts, beliefs, and actions will inevitably be based on our worldview - the fundamental presuppositions and assumptions we have about reality. And everyone is coming from somewhere! What would others say ultimate reality is? What's a human being? What's the point of existence?

personhood

One topic that particularly interested me was personhood. How do we define personhood? Is every living human being a person, or are there certain quality controls? Can a living body be non-personal?

The modern concept of personhood originates from the Renaissance movement with Descartes' famous maxim, 'I think, therefore I am'. Consciousness and ability for self-reflection subsequently became a foundational element of the Western philosophical view of personhood. Personhood was regarded as a 'totality of impression, thought, and feeling that make up a person's conscious being'. (5) But hang on, does this mean that the unconscious patient in ITU is no longer a person? What about the 97 year-old patient on the ward with dementia, or the child with severe learning difficulties? Intellect, thought, reason, and even mind are capricious, changing from day to day. Surely the criteria for personhood cannot solely be defined by consciousness, attributes and abilities. (6) If some humans are deemed to be non-persons, are they worthy of the same respect and moral considerations? If the unconscious patient is considered a non-person, would it be permissible for a doctor to end their life? What makes life worth living anyway?

The word 'person' comes from the Greek prosopon, which literally means 'the face'. This word refers to the masks that actors wore to represent characters in plays - the face they showed the world; the role they played in society. We've kept this meaning in the word 'persona'. God's ultimate being is in the form of three distinct persons in communion - Father, Son, and Holy Spirit - and the meaning of personhood is derived from that Godhead. To be a person is to be both unique and in communion with other persons.

So to be an autonomous individual, an isolated person, is actually a contradiction in terms! It is in relationship that we find our meaning. In Genesis, when God says 'Let us make man in our image', (7) the 'us' is the Godhead-in-community, and we are made in his image to be persons-incommunity, reflecting his nature, created to give ourselves to God and to others in love.

Instead of 'I think, therefore I am', Prof John Wyatt suggests an alternative Christian version, 'You love me, therefore I am'. (8) My personhood doesn't come from my abilities but from the fact that I am known and loved by God himself, and by other human beings. And even if I'm rejected by other humans, I'm still a person because ultimately my personhood rests on the fact that God called me into existence and that he continues to know and love me. This gives a firmer, more stable basis for affirming the worth of all human beings that underpins the practice of medicine.

Descartes' philosophy suggests that personal worth arises not from human existence but from human attributes, which becomes confusing when these attributes are lost. According to this stance, those without such attributes are non-persons, unworthy of the same moral considerations as other persons. Taking this to the extreme, philosopher Peter Singer argues that a human with Alzheimer's disease is 'worth considerably less than a normal adult pig or cow'. (9)

All human beings are made in God's image. (10) So God loves and cares for us, and gives us responsibilities to subdue the earth.

'What is mankind that you are mindful of them, human beings that you care for them? You have made them a little lower than the angels and crowned them with glory and honour. You made them rulers over the works of your hands; you put everything under their feet.' (Psalm 8:4-6)

Even though we humans made a mess and rejected God, Jesus willingly died for us to reconcile us to God and bring us into relationship with him. (11) Jesus paid the ultimate price; he thinks we're worth it!

implications for us

Since all human beings are made in God's image, this should affect the way we view and treat our patients (and colleagues, and everyone else for that matter!). We should respect all people whatever their mental capacity, severity of disease, or conscious state. And we should have genuine empathy for critically ill and dying patients because they are equally valued and cherished by God.

References
  1. Matthew 5:13-16
  2. St Helen's Bishopsgate sermon series on 1 Peter
  3. The Kirby Laing Institute for Christian Ethics
  4. Quoted at: www.licc.org.uk/about-licc/john-stott
  5. Locke J. An essay concerning human understanding. II.xxvii.183
  6. Miller T. The folly of attributional personhood. Ethics in brief 2012;18(1)
  7. Genesis 1:26
  8. Wyatt J. Matters of life and death: human dilemmas in the light of Christian faith. (2nd edition) London: CMF and Nottingham: IVP, 2009:58
  9. Peter Singer: Some people are more equal than others. Independent, 1 July 2004
  10. Genesis 1:26
  11. John 3:16; Romans 5:8
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