Biblical Reflections on Modern Medicine
Vol. 6, No. 4 (34)
or . . .
Gregory W. Rutecki, M.D.
(Ed's note: The following is a letter sent to me challenging the attack by Dr. Hilton Terrell and myself on the efforts by some Christians to resurrect the Hippocratic Oath as a moral standard for physicians in modern times. I have chosen to publish it as an article and to respond to it as the major portion of this newsletter.)
Permit me to paraphrase the inspired Word (Mark 9:24): "I do agree but allow me to respectfully articulate the areas in which I disagree." I am writing in response to the May 1995 issue of Reflections on . . . engaging the criticism of the Hippocratic Oath contra an integrated Biblical worldview. I know both of you well enough by now -- I trust that you know my heart just as well -- to dialogue responsibly as brothers in Christ.
Let me begin in an arena where we have essential agreement. To quote your words (actually those of Jay Adams), "We have no Biblical warrant to produce oaths that are not squarely based on Scripture" is certainly truth. Absolutely no question should remain -- in fact, a definite litmus test -- Scripture is the sole normative authority for the Christian. Furthermore, it is correct that "we disarm ourselves when we are asked to drop our 'sword of the Spirit which is the Word of God.'" (Ephesians 6:17) When we are armed appropriately, the result is a Biblical theory which ensures our inhabitation as believers within a holistic, consistent Biblical worldview. Within the pro-life movement per se, your observations are indeed trenchant in that anything short of this theology is compromising God's truth.
Christians disarmed of God's Word have unfortunately become the rule rather than the exception. David Wells in No Place For Truth Or Whatever Happened To Evangelical Theology states presciently, "We now have less Biblical fidelity, less interest in truth, less seriousness, less depth and less capacity to speak the word of God to our own generation in a way that offers an alternative to what it already believes." In substituting man-made oaths for the Word of God, the pro-life community has accommodated itself to the relativism of post-modern culture in a most unconscionable manner.
Your publication also provided a further example of the Hippocratic Oath's inadequate statement of truth as reflected in its incomplete development of the concept of confidentiality. I have carefully studied God's word previously in an attempt to define Scriptural boundaries to the confidentiality debate relying on God's wisdom as opposed to man's foolishness (Journal of Biblical Ethics in Medicine, Fall 1991, pp. 73-78).
Since it should be abundantly clear that normative authority for the Christian is not to be found in the Hippocratic Oath, does the oath itself have any value -- or better yet an appropriate context in contemporary Christian dialogue? Or should the oath, as well as its 20th century update, as Hilton disparagingly suggests, be relegated to the category of error, trivia, or banality? I come to a different conclusion than you.
To say that the Hippocratic Oath had no impact outside the pagan west is patently untrue. A number of medical oaths, ancient as well as modern, contain substantive restatements as well as adumbrations of essential aspects of the Hippocratic Oath (W. T. Reich, Ed., Encyclopedia of Bioethics, New York: Simon and Schuster, 1995). Some examples include: the oath of Caraka Samkita (Hindu, 1st century B.C.); the oath of Asaph (Hebrew, Syria or Mesopotamia pre-7th century A.D.?); advice to Holy Abbas (Persian, 10th century A.D.); rules of Enjuin (Japanese, 16th century A.D.); and the Chinese five commandments and ten requirements of medicine (1617).
The modern Russian medical oath (1992) deliberately returned to a Hippocratic tradition as American physicians were simultaneously abandoning that tradition. In fact, I find an important apologetic parallel between the Hippocratic Oath and C.S. Lewis' illustrations of the Tao in The Abolition of Man. Lewis' illumination of the Law of general beneficence, present in a number of otherwise disparate cultures, resembles the oath's message -- a natural revelation of God's law for medicine.
When you incorrectly suggest that the Hippocratic Oath was limited to pagan Greeks or select Westerners, you have unwittingly restated the specious appraisal of the oath by the United States Supreme Court in the notorious Roe v. Wade decision. The justices thereby invalidated the binding authority of the Hippocratic Oath previously resulting in a proscription of abortion. The justices' rationale was that the influence of the oath was ostensibly limited to Pythagorean philosophers and was invalid for a generation of American physicians.
What is it about the Hippocratic Oath which explains its consistency, tenacity as well as its ability to cross over ethnic and religious lines in medicine? Margaret Mead, the anthropologist, summarized it thus, "with the Greeks the distinction was made clear. One profession ... were to be dedicated completely to life under all circumstances, regardless of rank, age or interest -- the life of a slave, the life of the emperor, the life of a foreign man, the life of a defective child ... but society is always attempting to make the physician into a killer -- to kill the defective child at birth, to leave sleeping pills beside the bed of the cancer patient."
The Hippocratic Oath was the first medical oath to separate the black and white sides of medicine and as a result, physicians were dedicated to life through an oath containing an explicit prohibition against abortion and euthanasia. Furthermore, unlike tepid contemporary oaths such as the Geneva Convention Oath, the Hippocratic Oath is grounded in both vertical (the physician's relationship and responsibility to God) and horizontal dimensions (physician's relationship to teachers and patients).
Ed surmises quite appropriately, "It seems that Christians who are pro-life are obsessed with the resurrection of the Hippocratic Oath as if it had some magical powers to right all the wrongs of modern medicine ... in my mind, it is a false hope that somehow a pagan consciousness will be awakened by a modern version of that oath!" Yet, the medical ethos has mirrored the oath so accurately that when the Hippocratic Oath is absent from culture, medicine strays to the black side. This was evident in German medical practice before and during World War II and in more contemporary circumstances in the Netherlands. The Oath does not have the power to regenerate depraved consciousness: only Jesus Christ does!
Nonetheless, I think that the Oath still has an appropriate context in Christian dialogue, and this may be summarized in Nigel Cameron's words. "The purpose (of the Hippocratic Oath) is to offer a sufficiently careful ethical definition of medicine to ensure its distinctive continuance in a context of pluralism, in which there is a fundamental disagreement about right and wrong in medicine as in every other aspect of social life."
In Postmodern Times: A Christian Guide to Contemporary Thought and Culture, Gene Veith explains the difficult task of the Christian messenger in contemporary society. "The difficulty (in presenting the Gospel) was in finding a common frame of reference ... experience is a sobering illustration of how resistant the modern mind has become to the Christian message." We presently live in a post-modern culture characterized by a relativity in which there are a number of fundamental disagreements about right and wrong in medicine. The majority of this culture also actively denies the ultimate Truth provided by the metanarrative in Scripture.
So where may we begin with unbelievers? To quote Carlos F. Gomez who studied euthanasia in The Netherlands, "Some opponents of physician-assisted suicide note that the prohibition against killing is embedded within the Hippocratic Oath and is part of the ethos intrinsic to the proper practice of medicine. Thus, a change that would allow physicians to kill their patients -- even within the most tightly controlled circumstances -- would not be a mere addition to the physicians' techniques and drugs, rather it would fundamentally alter that established 'frame of reference.'" Establishing a frame of reference for secular physicians through the long-lived tradition of the Hippocratic Oath -- doctors may never kill -- may serve as an initial apologetic tool, never as a substitute for Scripture and kerygma (proclamation of the Gospel).
Though I agree unequivocally that the explicit statement of Christian truth must emanate solely from Scripture, to remove the historical and traditional impact of the Hippocratic Oath from a pluralistic society that has banned Scripture from the marketplace is literally throwing the baby away with the bath water. All truth is God's truth, and if the Oath is relegated to its appropriate context (i.e., as being the traditional Oath which proscribes any killing by physicians from any of a myriad of background cultures), it is still useful for our engagement of an unbelieving, Biblically illiterate post-modern culture. I sincerely believe that preserving the oath in this context in no way minimizes our belief in Scriptural integrity.
Admittedly, Dr. Rutecki has raised a good argument in favor of the promotion of the Hippocratic Oath as moral standard for medicine. However, while I am not closed on this debate, his argument has weaknesses and there are other strong arguments for my contentions against its promotion by Bible-believing Christians.
First, occurrence in history and influence in history are two different issues. I seem to recall in my liberal Old Testament class in college that other cultures were found to have laws that were similar to those of the first five books of the Old Testament. From that identification, it was concluded that Moses' writings were not all that unique, certainly not inspired by God.
However, any Bible-believer knows that regardless of common agreement with other cultures/nations, the Old Testament laws were uniquely the Word of God. Thus, similar content of one culture's oath with that of Hippocrates does not automatically establish a direct link to it. As Rutecki states, there is a great deal of common moral principle found from culture to culture without any necessary direct link to moral standards in other cultures.
Second, even where such linkage can be traced, there is certainly not an automatic binding of the consciences and actions of any culture. I contend that the influence of the Hippocratic Oath in past times has been mostly read backwards into history by modern writers. My argument is based upon history in the United States and Christianity in the West.
A common citation for pro-life authors is that of the Transactions of the American Medical Association of 1859. In those recordings, a strong defense of the unborn and against abortion is found. However, no mention is made of the Hippocratic Oath as having any influence on their position.
Further, little, if any, evidence exists in American history for the Hippocratic Oath as having any influence against abortion. Marvin Olasky's book, Abortion Rites, is a carefully documented history of abortion practices within the changing culture of the United States from Colonial days to the present. In his index, Olasky has no reference for the "Hippocratic Oath."
Now, some indexes are not comprehensive, so I called Dr. Olasky. He could recall no appeals to the Hippocratic Oath by either the medical profession, ethicists, or others as a standard to be held against the all-too-common abortion practices of those days.
Now, American history is that of only one nation. However, the United States is a direct descendant of the Western world which is supposed to have been so influenced by the Hippocratic Oath. The paucity of appeal to the Oath as a standard in raging abortion debates for 200 years is a large hole in the modern assumption of its power to influence the consciences of men and women.
Another large hole is made by the conclusions of two modern ethicists. Dr. Robert M. Veatch and Carol G. Mason sought evidence for the contention that the dominance of Christianity in the West gave life and impact to the Oath. However, the historical records show otherwise.
It seems that any influence that the Oath has on Christians was indirectly through a Christian revision of it (Ibid.). Thus, the Hippocratic Oath survived by an interest in "medical scholarship and classical Greek antiquity rather than ... any real convergence with Christian thought" (Robert M. Veatch, A Theory of Medical Ethics, New York: Basic Books, 1981, p. 24.)
Thus, survival of the Hippocratic Oath in the West and sporadically in other cultures does not equate with ethical impact. Advocates of the Oath assume the reverse. That is, impact is assumed because of survival which is supported by the following.
Third, the Hippocratic Oath has no more power of moral persuasion today than a castle in the air. I offer three evidences. A) I said the Oath at my medical graduation and I might better have been whistling "Dixie" (a Southern colloquialism for wasting one's time). While I was not a converted Christian at the time, I never reflected on its meaning or binding of conscience for me.
B) Rutecki also has stated how easily the Supreme Court threw out the Oath as any ethical standard in the Roe v. Wade decision that opened the floodgates to abortion in the United States. There was no binding of consciences there.
C) There is no binding of conscience by the Oath today. The anti-abortion and anti-euthanasia clauses have been facilely cast aside as needed. I see repeated references to the Oath by medical-ethical writers and speakers today, but they choose one portion to support while holding to a strong pro-abortion stand that is opposed by another portion. That is, they pick and choose from the Oath rather than support it as a standard. This fact may derive from severe weaknesses in the Oath itself which we will now examine.
Fourth, too much has been read into the pro-life statements of the Oath. "I will not give to a woman a pessary to produce abortion" only proscribes one method of abortion. It says nothing about medications or surgical methods to produce abortion. Such a narrow stance more likely reflects a bias towards a particular medical treatment within the Hippocratic cult than a general statement against all abortions.
Similarly, "I will give no deadly medicine to anyone if asked, nor suggest any such counsel" may prohibit the physician only from conspiring with a patient's enemies to poison him. "It does not pledge the physician to prolonging life or even to having any ethical duty to care for the dying" (Veatch, "Hippocratic...," p. 93). Again, this narrowly limited phrase is hardly a solid basis for a pro-life position.
I admit my own gullibility here. Until I began to read further in my concern over this debate about the Oath, I had not considered the narrowness, nay the falsity, of the Oath as a pro-life defense. These limited statements of the Oath argue strongly against it as any standard to bind consciences in medical-ethical issues.
Fifth, God has provided a conscience within the unbeliever.
The previous four arguments pale beside this one. Christian proponents of the Hippocratic Oath would rather appeal to the weak, inconsistent, ethereal tradition of that Oath rather than to the God-implanted conscience of unbelievers!
I will go further. Might we not have here two separate traditions? One is Biblical orthodoxy. The other is Enlightenment thought that has consciously and forcefully tried to eliminate God and His ethics from any influence or presence in modern man and his society. Cannot an argument be made that proponents of the Hippocratic Oath contend for Enlightenment thought that has been built upon Greek and Latin philosophies?
Dr. Veatch's research has concluded that at the moment of "convergence" of the Hippocratic and Christian traditions, a Christian version of the oath appears. It seems that these earlier Christians were concerned not to incorporate the Hippocratic Oath into their culture.
This push for a pagan oath seems stranger still in the United States...
Sixth, Christianity is the (possible) fertile soil for a Biblical standard. One recent Gallup poll has shown that 83% of Americans are Protestant or Catholic. Some 95 percent of Americans believe in "God." Eighty-one percent believe that the Bible is the "inspired Word of God," although 60 percent of these believe that it should not be interpreted literally (40 percent believe that it should be interpreted literally).
I am not naive about these statistics. In fact, I lament in this newsletter often about the dreadful Biblical ignorance of American Christians. However, most Americans identify themselves with the Bible and with Christianity. The more clear truth that they are confronted with, the more likely they are to be active, growing Christians or they will no longer identify themselves as Christians because they do not believe the truth.
Relative to this situation, I refer back to Rutecki's mention of "All truth is God's truth." I grate every time I hear that phrase. Yes, it's true, but it is not helpful and it mis-directs discussion. The determination of truth is a deep philosophical issue that belies the simple statement "All truth is God's truth."
It is purposeful that God chose to call His Word a "Sword" (Ephesians 6:17). Its first cut is a separation of all mankind into two groups: believers and unbelievers. Do you get the import of that statement? All mankind is divided into two groups simply on the basis of their belief from the Bible as the Word of God that Jesus Christ is Savior. Once the Bible is believed, then one can begin to mine its truth (a hermeneutical pursuit that is not necessary for our discussion here).
Truth outside the Bible, however, is impossible to prove. For example, a debate rages between classical physics and Einstein's theories. Today's medical treatments are tomorrow's jokes. The understanding of radioisotope decay and a young earth are difficult to integrate.
Unfortunately, we cannot do more than present the problem of the determination of truth here. Suffice it that the shibboleth "All truth is God's truth" is not helpful and obscures the difficult (and often impossible) task of determining truth.
Dr. Stanley Hauerwas writes:
In the Old Testament, prophets began "Thus saith the Lord." I wonder if we err today in not following their example to both Christians and non-Christians. The Bible is easily arguable as the most potent language in existence. With its promises and threats (infallibly applied by an omnipotent God), what else can compare in motivation? Yet, we shy away from God's truth with watered-down, cryptic messages designed not to offend.
After years of writing, I am drawn more and more to the use of the specific language of Scripture. I recently wrote Dr. John C. Gienapp, the central figure in the recent mandates for abortion education in Ob-Gyn education programs. While I primarily argued for him to rescind the requirement, I also warned him of God's judgment on him and his family. Perhaps that was an error. I won't "win friends and influence people," but does he not need to be warned of God's wrath for his determined killing of unborn babies?
Frankly, I don't do that often. But, I debate in my mind whether I should do it more. I debate whether pro-lifers ought to do it more. I debate whether all Christians ought to do it more. The promises (and threats) are from God's words, not ours!
The battle of light and darkness in this nation will be decided in public debate or actual armed conflict at several levels. The key to winning the public debate (if it is winnable and I am not sure that it is) is to force all debate onto religious grounds. Every idea of what one ought to do, that is, moral instruction, is religious. Religion must be defined in that way for Christians to have any chance in public debate, else we are simply brushed aside as irrelevant.
Education of children is a religious issue. All laws of government are religious. The concept of the family is religious. The practice of medicine is religious, and an Oath to that practice is religious. Every facet of discussion that tells me or you or another what to do or not to do is reli gious. The question is not whether religion ought to determine culture and law, but which religion will determine culture and law. Currently, the Religious Left is in power (in spite of recent conservative victories at the polls).
Christians have lost the battle before it is engaged if they do not understand
this defining principle. We may win some minor battles, but right principles
will not be implemented by Biblically ignorant legislators. Worse, as Hauerwas
said, "we abandon society to its own limits" (that is, an ethics of
literal death and destruction).
The invocation of some who advocate a non-Christian approach to abortion and the Hippocratic Oath is Francis Schaeffer's "cobelligerency." His only mention (that I know of) is:
I leave it to readers with this actual context of Schaeffer's words to judge whether the pro-life movement has kept to Schaeffer's distinctions. For sure, it has largely "aligned" itself with the a-religious camp when it chooses to leave God and His Word out of the debate. I also leave it to Schaeffer's students to prove "cobelligerency" from Scripture. I think that they will find it difficult.
Suppose the efforts to revive the Hippocratic Oath are directed toward defining all debates about "ought" as religious. Suppose we force the abortion debate as a religious issue. Suppose we taught our legislators to think religiously. Perhaps to hope for these events is to hope for Christ's reign in the Millennium.
My mind is not closed on the place of the Hippocratic Oath. Two great men whom I esteem and who are my mentors advocate its importance. However, at this stage of my thinking, I am not even close to being convinced. I stand primarily on the fifth and sixth arguments above, but other arguments have gaping holes as I have discussed.
In the beginning was the Word and the Word, and the Word was with God, and the Word was God. He was in the beginning with God.... In Him was life; and the life was the light of men. And the light shines in the darkness; and the darkness did not comprehend it. John 1:1-2, 4-5
While the red ribbon symbol of compassion for AIDS patients remains prominent, it seems that the "No. 1 hip cause on the planet" is "animal rights." AIDS patients are irate! One agenda of the animal rights advocates is the elimination of animals from medical research, including AIDS research! (Chicago Tribune, May 26, 1995, Section 1, p. 25)
Commentary: Your worldview is only as good as it is consistent... and is centered on truth. Liberals have been caught on the horns of their worldview. They cannot defend animal research and AIDS patients at the same time. They got themselves into this dilemma when they failed to call for sexual morality to prevent the spread of AIDS.
There are only two sets of ethics: those that are pro-life and those that are pro-death. When Moses set before his people the choice of life or death (Deuteronomy 30) and Jesus said, "I am the way, the truth, and the life..." John 14:6), they were speaking literally on both physical and spiritual levels.
Teleological ethics is concerned with ends. From a Biblical perspective, the telos of one's ethics can only be one of two: health and life or disease and death. See -- ethics is not all that complicated!
Recently, the American Medical Association gave its "Report Card on Violence in America." Its grade was "D," but it ought to have been "H" for itself for hypocrisy. The AMA went after gun control, blamed crime on socioeconomic status, and called for increased scrutiny by physicians for "domestic violence." (Chicago Tribune, June 14, 1995, Section 1, p. 1, 6)
The AMA's next president, Dr. Lonnie Bristow, is black. He believes that the AMA should "close down the tobacco industry, sponsor health clubs for children and older Americans, and push for legislation to end 'managed profiteering' by corporation-run health maintenance organizations." (Chicago Tribune, June 21, 1995, Section 1, p. 4)
Commentary: The AMA is no paragon of virtue to say anything moral. In the 1970s, it was caught holding tobacco stocks in its portfolio. Only in 1968 did the AMA adopt bylaws banning racial discrimination in its membership and other medical organizations. It has recently advocated the harvesting of organs from living anencephalic babies.
It is interesting that the AMA decries those "big bad HMOs" who are greedy. Well, the AMA welcomed Medicare in 1965 and its members gouged the government for every nickel they possibly could. Result: runaway medical inflation. Next result: HMOs designed to curb those costs.
So, the AMA condemns a solution to what it helped cause. It condemns activities which it previously advocated. Some critics of the AMA say that its chief goal is to protect physicians' incomes. That contention is not hard to prove: just read any issue of the AMA News. Its most prominent articles concern physicians' incomes (directly or indirectly).
Commentary: The headline here was the headline in a recent article in the Chicago Tribune (June 14, 1995, Section 2, pp. 1, 4). If I as a "conservative medical ethicist were to use "aggressive" or "ghoulish," little notice might be given. However, when a secular newspaper uses those words, a loud alarm has been sounded.
With 50,000 people a year registering for organ transplants, only 18,000 organs are available. Transplant specialists are pushing for "aggressive" methods to ensure more organs. Such actions might include state or federal laws that assume anyone's organs may be donated unless they carry a card or have otherwise clearly stated that they do not want their organs donated.
A "ghoulish" recommendation is to "redefine death" to include anencephalic babies and adults in persistent vegetative states. The AMA has officially endorsed anencephalics as organ donors, as they flirt with giving consent to euthanasia, so that domino has already fallen.
Keep alert! Watch for state and federal laws on this subject and the AMA to continue to lead us down their ethical road of death. Remember that a potential donor is alive when they take his major organs (heart, lungs, and liver). It is the taking of the organs that kills the "donor," not the condition which caused his severe medical state.
There may seem to be a fine line between causing death by the taking of organs and allowing the "donor" to die of his medical condition, but these "aggressive" and "ghoulish" designs clearly show the power of that distinction. If implemented, such actions would severely compromise individual and family freedoms and remove one more obstacle on the dangerous "slippery slope."
Unbeknownst to me, an article on near-death experiences (NDE) appeared in Christianity Today (April 3, 1995, pp. 39-42), as I was writing the May Reflections in which I briefly discussed such events. That article in CT is quite good. The author, Douglas Groothuis, has also published a book, Deceived by the Light (Harvest House).
Then, as I was finishing this edition of "Briefs," Physician (Focus on the Family) for July/August 1995 arrived. Its cover article concerned NDE. However, they vacillate to include all sides of the issue (as they usually do), rather than focus on a Biblical understanding, as Groothuis does.
It seems that NDE is gaining popularity again!
Several years ago, the AMA stated that physicians' participation in capital punishment was unethical. Recently, they extended that prohibition to include "the medical treatment of mentally incompetent death-row inmates that renders them competent to face a death sentence." (American Medical News, July 3/10, 1995, pp. 3, 30)
Commentary: The incongruity of the AMA staggers an ethical mind. It condones, nay vehemently defends, 4,000+ abortions every day, while it coddles convicted murderers. While these "Briefs" were not intended to be a repetitive attack on the AMA, they seem to have become that. But, then, the AMA has become the opposite of what it is supposed to be: a protector and healer of life. It needs to be exposed for what it has become.
Most Americans could probably care less about the lawsuits and controversy over silicon breast implants. However, we are all being affected. God designed our bodies with powerful defenses to reject foreign substances. Silicon is one of the few substances that does not trigger a major rejection by the body. Thus, it has been used for breast implants.
However, silicon is used in many other medical devices: catheters, heart valves, prosthetic devices, pacemakers, etc. The liability that silicon has caused from breast implants is causing all medical products with any quantity of silicon to be withdrawn from the market. Perhaps, a substitute for silicon can be found, but it is likely that much suffering and possibly death will occur from this withdrawal.
Society is indeed a whole. What one part does will affect the whole. Who would have thought the worship of women's breasts would cause a major medical threat? But, then, God did warn us that He is a jealous God and will not tolerate the worship of other gods.
Copyright © 2003 BMEI, Inc.