As we start our fourth year, we thank God for His Grace, and all our readers for your support.
Without careful and disciplined action, the church’s theology and practice of mission will be impoverished.
Medicine is practiced in many different contexts, with differing access to resources (including physical ‘plant’ and infrastructure, personnel, investigation and treatment options, and so on), and in quite disparate social and economic contexts.
Furthermore, it is a costly enterprise, with even wealthy Western countries struggling to meet escalating costs of healthcare. It is also one that is both morally loaded and morally complex (some of that complexity associated with costs of treatment and the relative importance of medicine in relation to other social and economic needs).
Most important for our purposes, it is also one in which the church has invested heavily as an expression of care for the weak and vulnerable and of God’s mission in the world. It is worth, then, taking a little time to understand the world of medicine and how we should think about and respond to it.
Medicine in the West
‘Western’ medicine is a context of wealth and privilege. It comprises an interlocking network of services and infrastructure that make sophisticated care possible, enmeshed in complex and sophisticated social arrangements without which its practice is unimaginable.
Medicine in such contexts, while highly effective, faces a number of pressures:
- an ageing population and increased healthcare costs;
- emphasis on sophisticated medical technologies at the expense of patient care;
- increasing bureaucratic scrutiny and control over patterns of treatment and prescribing, in part driven by healthcare ‘efficiencies’;
- questions of ‘conscientious objection’ and the role of religious values in the provision of healthcare; and
- end of life care.
These pressures are generated by a strange mixture of cultural and technical forces: reductionist ‘biomedical’ notions (in which health and disease are seen as primarily biological matters, subject to medical control), coupled with belief in the limitless competence of technology (which presumes that there must be a medical answer to every human problem) and an unthinking medical consumerism (which assumes that if I want it and can afford it—or get someone to pay for it—then there is no good reason not to give it to me).
Medicine ceases to be a profession (a morally significant practice engaged in by moral agents for moral ends) and becomes a biomedical consumer product aiming at ‘health’ (cure) and the eclipse of suffering and personal limitation (enhancement). It turns into an idolatrous enterprise, embodying the false values of ‘developed’ nations.
Furthermore, there is no shared moral language with which to engage in meaningful conversation. Public discourse is reduced to ‘thin’ discussions of utility and the maximising of individual choice (with no sense that such choices should be directed to particular ends or limited by objective values). The moral and relational nature of medicine as interpersonal encounter is lost and broader personal and social issues ignored, while healthcare costs and inequalities both increase. As far as I can see, these trends are continuing, even growing in force, as we see more vocal advocacy of euthanasia at the same time that death is becoming more ‘technologised’; more pressure on health professionals’ rights to ‘conscientious objection’ to provision of particular services; and increasing pressure on healthcare budgets.
Furthermore, the church in the West has largely lost its voice. It is seen as an inherently reactionary institution, desperate to cling to its dwindling power through illegitimate interference with people’s sexual and reproductive choices, and their right to determine the manner and timing of their own deaths. This is very unfortunate, as the church has an important contribution to make, challenging the idea that we can (and should) control all the circumstances of human life, calling people to recognise that human beings are limited, finite, vulnerable and mortal, and that our healthcare policies and practices need to recognise this rather than seek to escape the limitations of the human condition. Such a perspective would make for a more humane and sustainable practice of medicine (and healthcare more generally).
Medicine in the Majority World
Things are very different in the Majority World. The resource constraints in such environments are all too familiar, as are the complex social and economic forces that contribute to the global disease burden and complicate the provision of services. The problems that medicine has to address in such contexts are largely socially and economically determined. As a medical student in the 1980s, the only person I saw die from tuberculosis was in a small rural hospital in India—indeed, he was the only patient I ever saw with severe active TB.
The church’s role here is also becoming more complicated. In the past, Christian mission hospitals could expect an effective monopoly in providing healthcare to the poor. This led to some wonderful opportunities to demonstrate the reality of the kingdom of God in care for the poor and vulnerable, as well as occasions for effective proclamation. Of course, there were many abuses and errors in practice, especially when mission was in concert with colonial agendas, leaving an unfortunate legacy with which we must now contend. However, it has also led to some wonderful legacies in which the church is seen as an agent of hope and transformation and the place where the love of God can be found.
There are still many places where people do not have reasonable access to affordable and sustainable healthcare, something the church needs to continue to address as it has done for centuries. The church also needs to continue the fundamental work of aid and development which will foster the development of the infrastructure and social capital that allow for wider and more just provision of meaningful medical care; and, it should deal with the ‘brain drain’—the loss of competent and well-trained healthcare professionals from the Majority World to the West, a phenomenon that tragically mirrors the net flow of money from global south to north, in spite of the flow of aid to the south.
However, the loss of the effective monopoly of health services also needs to be addressed—not to exclude other providers from such contexts but to demonstrate once more the unique contribution the church can make.
There are a number of forms this could take, but let me mention one: palliative care. The need is clear and severe. If palliative care services are patchy and inadequate in the West (and they are), they are nearly non-existent in parts of the Majority World. There are, of course, many great stories of such care (such as the Missionaries of Charity in Kolkata). However, much more needs to be done, and the church is uniquely placed, given the importance of networks of care and social support to good palliative care, much of which needs to be done in community rather than hospital contexts.
Medicine in emerging economies
The mention of India, of course, raises the issue of emerging technological economies. Space limits comments here, other than to note the growing practice of medical tourism, and the burdens and opportunities this generates for healthcare systems. Particularly acute questions arise in relation to experimental or controversial treatments and the problems of oversight, ethics approval, and so on, associated with them. Commercial surrogacy is only one such ‘industry’; others include transplant surgery (and organ harvesting) in China, unproven stem cell therapies, and IVF services in general. It is hard to know just what response the church can make to such developments.
The world of medicine is complex, and there are many and widely varied challenges that the church needs to address.
In the West we need to consider how our commitment to technology and individual choice drives unhealthy consumerist approaches to medicine—and what we, as those called to God’s mission in the world, can do and say to counter that.
In the Majority World we need to consider how our embodiment of God’s passion for justice and concern for the poor can shape healthy communities, what role medical care should play in that, and how to navigate the changing landscape of emerging economies.
All of these challenges require those who think about mission and engage in its practice to reflect carefully and theologically on the nature and goals of medicine, and the varied contexts in which it is practised (see suggestions for further reading below).
It is also important for Christian leaders to meet key figures in their networks who are engaged in healthcare—to support them in their vital mission, identify the particular pressures they face and help them think theologically about their healthcare practice.
Of course, that requires that Christian leaders are able to provide both effective pastoral care for healthcare workers, and a carefully considered theology relevant to this sector. Without such thought, and careful, disciplined action, the church’s theology and practice of mission will be impoverished.
I have attempted to address the theological issues and their implications for the practice of medicine in the West and the Majority World in Andrew Sloane, Vulnerability and Care: Christian Reflections on the Philosophy of Medicine (London: Bloomsbury T&T Clark, 2016).
Neil Messer’s book Flourishing (Grand Rapids: Eerdmans, 2013) is also worth reading, even though I disagree with him on some fundamental issues.
Useful discussions of some important bioethical issues can be found in John Wyatt, Matters of Life & Death (Nottingham: IVP, 2009).
Excellent resources for material on global issues in medicine, with a particular focus on the church and its mission can be found in the free, open access online journal Christian Journal for Global Health: http://journal.cjgh.org/index.php/cjgh.
Andrew Sloane serves as Senior Lecturer in Old Testament and Christian Thought, and as Director of Postgraduate Studies at Morling College in Australia. He trained as a doctor before moving into ministry and then theological education. His most recent book is Vulnerability and Care: Christian Reflections on the Philosophy of Medicine (London: Bloomsbury T&T Clark, 2016).
 Let me note at the outset that I will not argue for the legitimacy of medicine as a calling and practice or that it is an important expression of and contribution to God’s mission in the world. That will be taken as given, but is clearly justified in the literature. See, for instance, Edmund D. Pellegrino and David C. Thomasma, Helping and Healing: Religious Commitment in Health Care (Washington: Georgetown University Press, 1997); The Christian Virtues in Medical Practice (Washington: Georgetown University Press, 1996); John Wyatt, Matters of Life & Death: Human dilemmas in the light of the Christian faith (Nottingham: IVP, 2009); Neil G. Messer, Flourishing: Health, Disease, and Bioethics in Theological Perspective (Grand Rapids: Eerdmans, 2013).
 For more on this, see amongst others, Stanley Hauerwas, Naming the Silences: God, Medicine, and the Problem of Suffering (Grand Rapids: Eerdmans, 1990); Suffering Presence: Theological Reflections on Medicine, the Mentally Handicapped, and the Church (Edinburgh: T&T Clark, 1986); Gerald P. McKenny, To Relieve the Human Condition: Bioethics, Technology, and the Body (Albany: University of New York Press, 1997); Joel Shuman and Brian Volck, Reclaiming the Body: Christians and the Faithful Use of Modern Medicine (Grand Rapids: Brazos, 2006).
 For this, see, Jeffrey P. Bishop, The Anticipatory Corpse: Medicine, Power and the Care of the Dying (Notre Dame, IN: UNDP, 2011); Atul Gawande, Being Mortal: Medicine and What Matters in the End (New York: Metropolitan Books, 2014).
 There is, unfortunately, a measure of truth in such criticisms. True, many vocal conservative critics of ‘the culture of death’ are deeply (and primarily) concerned about the common good and the dignity and worth of all people, including the most vulnerable. Nonetheless, there is also at least an element of lamenting a lost moral hegemony which renders our other concerns moot. We need to learn new ways of conducting these conversations and ensuring that our concerns are—and are seen to be—broader than the usual ones of sex and the beginning and end of life.
 Andrew Sloane, ‘Love in a time of Ebola – reflections on theology of medicine in resource challenged environments’, Christian Journal for Global Health 3, no. 1 (2016).
 Steffen Flessa, ‘Christian milestones in global health: the declarations of Tübingen’, Christian Journal for Global Health 3, no. 1 (2016); ‘Future of Christian health services – an economic perspective’, Christian Journal for Global Health 3, no. 1 (2016). It is worth noting his social and economic arguments for the need for universal healthcare, in addition to the broadly theological and philosophical ones that others and I have developed (for which see Sloane, ‘Love in a time of Ebola’, as above).
 Christoffer H. Grundmann, ‘Sent to heal! About the biblical roots, the history, and the legacy of medical missions’, Christian Journal for Global Health 1, no. 1 (2014). I should note my disagreement with his theology of health/medicine; he nonetheless makes some good historical observations.
 Worldwide Palliative Care Alliance, ‘Global Atlas of Palliative Care at the End of Life’, (London: WHO, 2014).
 Noree, Thinakorn, Johanna Hanefeld, and Richard Smith,’Medical tourism in Thailand: a cross-sectional study’. Bulletin of the World Health Organization 94, no. 1 (2016): 30-36.