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Course 22 · Lesson 6.1

Life, dignity and the aims of medicine

12 minute read

Lessons in this course

Course 22 outline

Module 1: Foundations: Moral Theories and Moral Reality

  1. What ethics is: the good, the right and the virtuous
  2. Natural law: Aquinas and the tradition, with Protestant and Orthodox responses
  3. Virtue ethics: Aristotle, Aquinas and the revival of the virtues
  4. Divine command theory and the Euthyphro question
  5. Moral realism and its rivals: can moral claims be true?

Module 2: The Moral Teaching of Scripture

  1. Law in the Bible: moral, civil and ceremonial categories and their critics
  2. The Ten Commandments: text, numbering and interpretation in the traditions
  3. The Sermon on the Mount: the main readings from Augustine to the present
  4. Using Scripture in ethical argument without misusing it

Module 3: Human Dignity, Sexuality, Marriage and Family

  1. The image of God and the basis of human dignity
  2. Sexual ethics in Scripture and the traditions: Catholic, Orthodox and Protestant positions
  3. Marriage as covenant and sacrament, and the teaching on divorce and remarriage
  4. Family, children and obligation
  5. Serious disagreement among Christians and how to state it fairly

Module 4: War, Violence and Peace

  1. The early church and military service
  2. The just war tradition: Augustine, Aquinas and modern developments
  3. Christian pacifism and nonviolence: Anabaptists, the peace churches and Catholic and Orthodox variants
  4. Evaluating the two traditions: the strongest arguments on each side

Module 5: Wealth, Poverty and Stewardship

  1. Scripture on wealth, poverty, justice and generosity
  2. The Fathers on wealth: Basil, Chrysostom and Ambrose
  3. Property, work and vocation: Aquinas, the Reformers and modern social teaching
  4. Stewardship of creation and of possessions

Module 6: Bioethics

  1. Life, dignity and the aims of medicine
  2. The beginning of life: abortion, embryo research and reproductive technology
  3. Suffering and the end of life: palliative care, withdrawing treatment and euthanasia
  4. Reasoning in hard cases: principles, intentions and consequences

Module 7: Technology, Artificial Intelligence and Social Responsibility

  1. Technology and the human person: a Christian framework
  2. Artificial intelligence: work, truth, privacy, personhood and responsibility
  3. Christians in public life: models of church and society
  4. Moral formation: virtue, conscience and the limits of argument

All courses

Program / Course 22: Christian Ethics / Lesson 6.1

What you will learn

  • Describe the Christian tradition of care for the sick and the sacredness of human life.
  • Explain the principles of secular biomedical ethics: autonomy, beneficence, nonmaleficence and justice.
  • Compare how Catholic, Orthodox and Protestant ethics relate to these principles.
  • Identify the aims of medicine and the limits that Christian teaching places on them.

The big idea

Christians have cared for the sick since the beginning, and they hold that human life is a gift of God with a dignity that does not depend on health, ability or usefulness. Modern medical ethics often uses four principles: respect for autonomy, doing good, avoiding harm and justice. Christian traditions can affirm these, but they place them within a larger account of the person, suffering, death and the purpose of medicine. They differ on how far the preservation of life limits other goods and on the weight of autonomy.

Key terms

Bioethics
The study of moral questions raised by medicine and the life sciences.
Autonomy
Respect for a person’s right to make informed decisions about his or her own care.
Beneficence
The duty to do good for the patient and promote the patient’s well-being.
Nonmaleficence
The duty not to cause harm. Often linked to the old medical maxim, first do no harm.
Justice (in medicine)
Fair distribution of health resources and fair treatment of patients.
Sanctity of life
The teaching that human life is holy and inviolable because it comes from God.
Quality of life
A way of evaluating decisions by the patient’s condition and prospects. The term is debated when used to judge whether a life is worth living.

Background

Christian care for the sick is old. Jesus healed, and told his followers to heal (Luke 10:9). The parable of the Good Samaritan (Luke 10:25-37) became a model of care. In the first centuries, Christians cared for plague victims at risk to themselves, as Dionysius of Alexandria recorded, and in the fourth century, Basil built a hospital complex in Cappadocia. Monasteries cared for the sick through the Middle Ages, and many modern hospitals began as religious foundations.

Modern bioethics arose in the twentieth century after the Nazi doctors’ crimes at Nuremberg, abuses in research such as the Tuskegee study and advances in technology, such as dialysis, ventilators and transplantation, which raised new questions. In 1979, Tom Beauchamp and James Childress published Principles of Biomedical Ethics, setting out four principles, which have shaped teaching in medical schools. Religious thinkers took part from the start, among them Paul Ramsey, a Protestant, and Catholic moral theologians such as Richard McCormick. Later lessons apply these frameworks to the beginning and end of life.

Step-by-step explanation

Step 1: The Christian basis

The Christian view begins with the claims studied earlier: every human being is made in God’s image, and has worth as a person, not because of what he or she can do. The Bible forbids the killing of the innocent (Exodus 20:13; 23:7) and calls for care of the weak. Christians therefore hold that human life should be protected and that the sick and disabled are not less valuable than others. Many Christian writers also hold that life is a gift but not an absolute good: it is not the highest good, and the martyrs show that there are things worth dying for.

These two points together, the inviolability of life and its place under God, shape Christian reasoning at its edges. Catholic teaching sums it up as a duty to preserve life by ordinary means and permission to refuse treatments that are burdensome or futile. The Orthodox tradition, with its sense of the sacredness of the body and the hope of resurrection, holds similarly. Protestant approaches stress the sanctity of life and the freedom of conscience, with varied emphasis.

Step 2: The four principles

Autonomy means that a competent patient has the right to accept or refuse treatment after being informed, which is the basis of informed consent. Beneficence means working for the patient’s good. Nonmaleficence means avoiding harm. Justice concerns fair access to care and fair burdens and benefits. In practice the principles can conflict, as when a patient refuses a treatment that doctors think would help, or when scarce resources must be allocated.

Christian ethicists affirm the importance of these principles but note their limits. Critics such as Stanley Hauerwas argue that the principles are thin because they do not say what health, suffering and death mean, and that they take for granted an individualistic picture of the person. Catholic moralists say that autonomy is real but bounded by moral law and the dignity of the person, and not a right to do whatever one wishes. Defenders of the four principles reply that they are intended as a practical framework on which people of many convictions can agree, and can be filled out by deeper commitments.

Step 3: The aims and limits of medicine

Medicine aims to heal, relieve suffering and care for the dying. Christians hold that medicine is a good use of human skill, as in Sirach 38, which says that the Lord created the physician (a book included in Catholic and Orthodox Bibles and read by many Protestants as wisdom literature). Luther and Calvin supported the use of physicians. The tradition also warns against idolizing health or fearing death so much that it governs all choices.

Issues at the edges of medicine raise sharp questions. Is it right to use any means to extend life? To use medicine to enhance abilities beyond the ordinary? To allocate resources by age or ability? Christian thinkers have long distinguished between ordinary and extraordinary means of preserving life, and between treating a patient and exploiting a person. The following lessons take up the beginning of life, the end of life and the reasoning used in hard cases.

Step 4: Care and suffering

Christian teaching treats suffering as an evil to be relieved and also as something that can be borne with meaning in union with Christ. This should not be used to justify neglecting pain, since the tradition values pain relief and the care of the dying. Catholic teaching in Salvifici Doloris, a letter of Pope John Paul II (1984), speaks of the Christian meaning of suffering, and Orthodox writers speak of its transformation by love. Protestant thinkers like C. S. Lewis, in The Problem of Pain, reflect on pain as a call to turn to God, though they also grieve over it.

These reflections do not remove the duty to alleviate suffering. They shape how Christians accompany patients and families: by presence, prayer, sacraments and practical help. Chaplains, hospices and parish nurses, many of them from Christian traditions, put this care into practice.

  1. Which principle is at stake in this decision: autonomy, doing good, avoiding harm or justice?
  2. What does the view say about the value of a life that is weak, disabled or dependent?
  3. Does the view treat life as the highest good, a basic good or a gift?
  4. Who has the right to decide, and what limits apply to the decider?
  5. What difference does belief in resurrection or in the soul make to the question?
  6. What would a patient of another faith or none say about this reasoning?

Examples

A refusal of treatment

A competent patient with advanced kidney disease decides to stop dialysis. Her doctor wonders whether to persuade her otherwise. The principle of autonomy supports her right to refuse, beneficence urges care for her, and the Christian traditions generally hold that refusing a burdensome treatment is not the same as suicide, if the intention is to accept death as inevitable rather than to cause it. (A constructed example.)

Triage in an emergency

During a disaster, a hospital has too few ventilators. A committee must choose a rule: first come, first served; most likely to survive; or youngest. Christian ethicists urge that no one be judged to be of less worth, that rules be fair and open, and that the decision be made with compassion. Different traditions weigh the criteria differently. (A constructed example.)

The Good Samaritan

The Samaritan binds the traveler’s wounds, takes him to an inn and pays for his care, going beyond a minimum. Christian writers cite the story to show that care for the sick is a mark of love of neighbor, and that it involves time and money, not only feeling.

Different perspectives

Catholic

The Catholic tradition holds that human life is sacred from conception to natural death, that medicine serves the whole person and that the principle of double effect and the distinction between ordinary and extraordinary means help to resolve cases. The Ethical and Religious Directives for Catholic Health Care Services guide Catholic hospitals in the United States. The church affirms autonomy within moral law.

Orthodox

Orthodox teaching holds that life is a gift, the body is holy and the physician is a servant of God. Orthodox bioethics, as in the writings of H. Tristram Engelhardt Jr. and in church statements, stresses the spiritual dimension of illness and death, the role of the spiritual father and the sacrament of anointing, and the dangers of technology without wisdom.

Protestant

Protestants affirm the sanctity of life, the calling of healers and the importance of conscience. Paul Ramsey, a Methodist, argued in The Patient as Person (1970) that the patient must be treated as a person, and emphasized covenant fidelity between doctor and patient. Evangelical statements stress the image of God, while mainline bodies often stress compassion and justice. Views on some specific issues vary widely.

Secular and scholarly

Secular bioethics is dominated by principles, rights and consequentialist reasoning, with debates about autonomy and quality of life. Some secular thinkers, such as Peter Singer, hold that the moral status of a being depends on capacities such as sentience and self-awareness. Others, including many in disability studies, argue that such views devalue people with disabilities. These debates affect Christians and non-Christians alike.

Why it matters

Everyone encounters medicine, as patient, relative or caregiver, and many face decisions of great weight. A student who knows the framework used in hospitals and the Christian convictions that inform responses to it can take part in these decisions with more clarity. The study also prepares for the harder questions of the next lessons.

Common misunderstandings

Misunderstanding: Christian ethics requires doing everything possible to prolong life.

Correction: The traditions hold that there is no duty to use burdensome or futile treatments. Catholic teaching distinguishes ordinary and extraordinary means, and other traditions agree in substance.

Misunderstanding: Christians oppose medicine or rely only on prayer.

Correction: The major traditions affirm medicine as a gift and a calling and urge prayer along with treatment. A few small groups reject medical care, and the mainstream churches do not.

Misunderstanding: Autonomy is the only principle that matters.

Correction: Secular ethics also uses beneficence, nonmaleficence and justice, and Christian traditions add the dignity of persons and moral limits on what may be chosen.

Misunderstanding: Christian bioethics gives the same answers in every tradition.

Correction: The traditions share the basic commitment to the sanctity of life and care of the vulnerable, and differ on matters such as reproductive technology, contraception and the details of end-of-life decisions.

Knowledge check

Name and define the four principles of biomedical ethics.

Autonomy is respect for the informed choices of the patient. Beneficence is acting for the patient’s good. Nonmaleficence is avoiding harm. Justice is fair distribution of resources and treatment. They were set out by Beauchamp and Childress and are widely taught in medical ethics.

How do Christians view life as a gift but not an absolute good?

Life is given by God and should be protected, but it is not the highest good. The martyrs and Christian teaching on resurrection show that there are things worth more than prolonging life at any cost, so there is no duty to use every possible treatment.

What is one criticism Christians make of the four principles?

Critics such as Hauerwas say that the principles are thin because they do not say what health, suffering and death mean, and that they assume an individualistic view of the person. Catholic writers add that autonomy is bounded by moral law. Defenders say the principles are a practical common ground.

What historical events shaped modern bioethics?

Crimes by doctors in Nazi Germany and the Nuremberg trials, research abuses such as the Tuskegee study, and the arrival of technologies like dialysis and ventilators raised questions about consent, justice and the limits of medicine. The field developed in the 1960s and 1970s with the participation of religious thinkers.

Think it through

  1. What is medicine for? What should it never do?
  2. How do you judge whether a life has dignity when a person is very ill or dependent?
  3. Which of the four principles seems to you most often neglected?
  4. How can Christians and nonbelievers cooperate in hospitals and ethics committees?

Independent assignment

Applying the principles

In your notebook, write 400 to 600 words. Choose a case from the news or from a book on medical ethics in which a patient or family made a hard decision. Describe it, apply the four principles, and add how a Christian source might add to or correct the analysis. State where the principles conflict. Do not name private individuals, and do not send this to anyone or post it anywhere.

Further study