Inhabiting a Biblical Framework in Medicine
Dr. Lazarou received his B.A. from Johns Hopkins University and his M.D. from the University of Maryland. He is currently in residency at the Eastern Virginia Graduate School of Medicine in Norfolk, engaged in Plastic and Reconstructive Surgery.
A previously healthy 20 year old woman has been experiencing abdominal discomfort over the past months. Due to a recent worsening of her pain she decided to see a doctor.
The doctor took a history and did a physical exam. He then ordered some tests. Having assured himself of a diagnosis of irritable bowel syndrome he prescribed a stool bulk agent. Knowing that in many such cases the problem is stress, he added a minor tranquilizer to his treatment. Indeed, if he were to perceive the stress to be severe he may even recommend a psychiatrist. He then tells his grateful patient to return soon for follow-up.
On the surface it would seem to most that the physician has adequately fulfilled his obligations to the patient and all is well. Indeed, this is today's acceptable "standard of care." But, "the first to present his case seems right, till another comes forward and questions him." (Prov. 18:17)
The problem with this case, indeed, begins with the "standard of care." By what and whose standard was this patient treated? There is, of course, no neutral ground. I believe a biblical standard would have resulted in an entirely different approach. The physician's approach to the patient was rooted in Humanism, as I will soon show.
A standard is a point of reference against which we evaluate and interpret reality. We all have an ultimate standard that serves as a grid through which we interpret life. It is a product of our worldview. Our worldview is the belief-ordering conceptual framework that we inhabit. It profoundly influences our daily actions. We are not infinite nor do we exist in a vacuum. We have a large number of assumptions or presuppositions about life (that most of us may not even articulate) and these together form our worldview. Our worldview provides answers to questions concerning, for example, our origins, significance and destiny. It establishes values, right and wrong, good and bad. It provides a means for us to integrate or discard ideas and phenomena that don't fit our expectations. It helps us to make "sense" out of life and equips us to investigate the world. Beginning with these presuppositions, we make observations of the world around us which are both directed and limited by our overall framework.
Ultimately, there are two reference points: God and man. For the unbeliever the reference point is man and leads to Humanism; for the regenerate man it is God as he is revealed in the Holy Scriptures. As unbelievers our concepts of what love is, or health, or justice or the roles or medicine and government, etc., are derived from man. That we have these notions at all evidences that we are made in the image of God and that we do have his "law" imprinted in our minds, though we have corrupted both the image and his law. When we become Christians our point of reference has become Christ and his Word. Our worldview changes. As babes in Christ, however, we invariably drag into the church many of our unbiblical presuppositions. Additionally, we have not expunged from our thinking many of the implications even of those unbiblical assumptions that we have rejected. These assumptions take a long time to change, for we first have to establish regular habits of Bible study, prayer and application of that which we do learn. In this way our mind is transformed and God restores what the locusts have taken away. Since God has commanded us to work out our salvation, it is our duty to bring the Scriptures to bear on all that we do.
My purpose, by way of the example at the beginning, is to expose some of the unbiblical assumptions involved in the way this commonplace case was handled, proposing some biblical corrections. We will consider the role of medicine and the physician as well as the basis for such thinking in the light of the Holy Scriptures.
First, a diagnosis of irritable bowel syndrome can be made with great accuracy by history and physical. No ancillary test can significantly improve on it. What purpose do hundreds of dollars worth of tests serve? In part they serve to spread the wealth among physicians. Partly they serve medicolegal purposes. (Actually, these two reasons feed on each other.) Partly, they serve to make the patient feel the doctor is doing something. Partly, the technological gadgetry combined with unintelligible medical language serve to keep the patient awed and marveling by maintaining an aura of mystery.
Second, the patient is stripped of her responsibility for her illness. By implication, her illness is a product of biochemical reactions and/or life circumstances. By implication, she is not in control of or responsible for her circumstances or, at the very least, her response to those circumstances. But, in fact, stress is ultimately a spiritual issue that implies not trusting the Lord in some or all areas of life. Or, it is the end result of deeply ingrained and yet unquestioned unbiblical habits. True medicine would bring this to the attention of the patient while not necessarily denying medicinal treatment for the physical manifestations of the problem.
Third, because of this unbiblical approach the patient is stripped of the hope of a true cure which would involve repentance and obedience to God's law as part of the process of healing.
Fourth, she is made dependant upon the doctor for her health. In such a role the doctor is playing God.
James 5:14-16 is pertinent. First, it is important to point out that sickness entered the world when sin entered the world. But, as the cases of Job and the blind man (Jn. 9:3) point out, an individual's sickness may in no way be related to his own sin. James says "if". However, God does bring judgement to the unbeliever and discipline to his own through sickness and death. (Ex 16:26, 1 Kings 3:14, I Cor. 11:30-32)
Part of the function of the elders has been superseded by the physician. With reference to administering the oil, James does not use the word chrio, which means anoint. Instead he uses aleipho which means "to rub," implying not a ceremonial anointing but a medicinal treatment. However, the remaining obligations of the elders still stand. Indeed, in our present circumstances these obligations necessitate a cooperation between the elders and physician. The function of the elders is vital and commanded. The medicine was to be administered in Christ's name. The elders consecrate the medicine, trusting not in the medicine alone, but in medicine they ask God to bless. By their prayer they show God is active in healing. Humanism trusts in medicine. The elders were to counsel the patient regarding the possiblity of sin and what to do about it. Note that the ultimate cure is provided by God and acknowledged. Also, the church represented by the elders is in authority over the physician. The sick sister is part of the elders' flock and under their authority. Her well-being is their responsibility.
The situation today has changed through the rise of medicine and the physician. But the principles still stand. The physician is called upon by a sick patient. The physician's responsibility is to direct the patient to the Great Physician, Jesus Christ, who is the author of health and disease. (Deut. 32:39) Jesus healed in the context of directing people to the kingdom of God. He needs to direct the patient along the guidelines God has established. If the patient is an unbeliever and has no interest in these matters then, after having fulfilled his obligation before God to direct the patient (God's law applies to all), the physician must individualize his response. Jesus certainly helped many who did not trust in him. We are still to provide for our enemies though our response has to be in the context of biblical wisdom, always thinking in terms of how to best direct the patient to repentance and salvation.
True healing is a wholistic concern. Jesus exemplified this and so does the language of the Scriptures. The Greek word translated "salvation" and that translated "healing" in many of Jesus' miracles is the same word. The truly saved man was saved inside and out. Of the ten lepers that were healed only the one that came back and gave thanks to God is said to be saved or healed. He was made whole. This is James concern in James 1:4.
As Jesus makes clear when he healed the paralytic brought down through the roof, true health is much more than the absence of disease. It begins internally with forgiveness of sins and a restored fellowship with God. It has to begin that way because disease and death entered the world when sin destroyed that fellowship. Although, certainly Jesus distinguished between the spiritual and the physical, he did not separate the two in the context of healing. He heals people and forgives their sins, then says, "Your faith has saved you," which is often translated, "Your faith has healed you." Thus, just as the kingdom of God is not here in its fullness so health is not here in its fullness. Just as the kingdom of God grows with obedience, so health improves. Compare the health of those nations where the gospel has gone, even if presently they live in rebellion, to those where it has never gone.
Jesus' concern was not merely the salvation of men's souls but the establishment of God's kingdom which includes men's souls but is much more comprehensive. His concern includes the totality of existence -- man and his entire habitat or culture.
This fact should not surprise us. After the Fall of Adam, God renewed his covenant in the context of the curse and reiterated it to Noah, commanding him to multiply, fill, occupy and subdue. The original mandate was to be fulfilled even in the context of man's sin. Salvation would occur in the context of God's mandate.
In considering the covenant of creation that God established with Adam we must consider its general aspects (multiply, fill occupy and subdue) as well as its focal aspect (the specific prohibition against eating of the tree of the knowledge of good and evil). It is essential to consider the organic unity between this commandment and the total responsibility of man as created. If we do not observe the unity Christianity is conceived of narrowly in terms of salvation of the soul. We thus fail to consider adequately the effect of redemption on the total life-style of man in the context of an all-embracing covenant. That view results in a by-passing of redeemed man's responsibility to carry forward the implications of his salvation into the world of medicine as well as economics, politics, business and culture at large.
The ultimate goal of redemption will not be realized merely in a return to the pristine beginnings of the garden. A new imagery of paradise arises in Scripture -- the imagery of a city, of a hustling, bustling center of activity for the redeemed echoing the charge to bring the whole earth into subjection to the glory of God. Indeed, what does it mean to glorify God? Paul says that we must do all to the glory of God. In the Hebrew glory means weight. We can't add weight to God since all that exists is his. Rather, it means to bring to bear on all things the full weight of God's relationship to those things. Therefore, if I am to practice medicine to the glory of God I must do more than say that this is the case, for, Christianity is not magic. Something doesn't glorify God because I said it does, regardless of my motivations. Rather, when I practice medicine in such a way that I apply biblical principles, that is, his Word, to fully bear on it, then I glorify God. God is not satisfied when we bring into the church pagan concepts and institutions. We must erect an edifice founded entirely on biblical presuppositions.
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