Ed: Can you think of any distinctives of the Reformed faith/doctrine that would apply to medical practice or medical ethics, contrasted with generic Biblical practices and ethics?  I have some ideas but wanted to see what you might come up with.  (You should save this sentence that ends, not with just one preposition, but two!)

Hilton: Well, let’s see.  The distinctives would have to be quantitative in emphasis, not qualitative.  The one that comes readily to mind is the old Cartesian issue.  We are a body/spirit unity.  Medicine uniquely lives near that interface much of the time.  I read repeatedly that the Hebrew mindset did not see the mind and spirit as distinct from the body.  The N.T. provides some instances, however, in which there is a pertinent distinction.  We have, for example, “As the spirit without the body is dead, so is faith without works,” and Paul’s out-of-body experience, and the admonition that we should fear Him who can condemn both body and spirit to Hell, rather than Satan who can only kill the body.  I have tended toward dualism, but in recent years have had to conclude that any neat dividers satisfying to my Pharisaical/Teutonic mind cannot be pursued too far.  The mind is to the body perhaps something like the way white is to rice.

Psychology erred at its outset by pretending to apply a scientific model to the non-material entity which is the mind.  Neurology, on the other hand, wants to absorb all of mental/spiritual activity into itself, the most egregious example of which was stated by Nortin Hadler in his execrable “solution” to the problems he so ably outlined in his book, Worried Sick.  He imagines that PET scanners capture the mind.  On the other hand, you can get some traction from neurology when you study Gilles de la Tourette’s syndrome which prominently includes coprolalia.  The first person I ever remember with this syndrome was Melvin, whom I met at a Boy Scout camp in the late 1950’s.  I still remember Melvin’s choice words, which accompanied his tics: “Hell, shit, piss-ass.”  Today, that can be made to disappear entirely in most cases, if one is willing to risk taking haloperidol or the like.  I don’t see Haldol as a spiritual remedy.  Tourette’s seems like a peculiar subset of a seizure disorder, temporarily resistible, like a cough, but pressing through volitional (spiritual) restraints to expression eventually.  Foul speech is proscribed in Scripture, yet Tourette’s seems to test the boundaries of volition.  “Brain pacemakers” already exist for this and some other rare neurological disorders.  Can such a device be a mercy or pressing toward Holier Living Through Electricity?

The dualism problem is most pungently captured in our medical duty of pronouncing death, the departure of the spirit from the body.  This whole issue may relate to the monistic bent of naturalism and materialism, as distinct from the solution to the philosophical problem of the one and the many in the Trinity.  Perhaps there is some distinct Reformed thinking on the one and the many issue, which I am unaware of.  (See?  I can end a sentence with at least one preposition.)

Another area of quantitative distinctiveness for medicine is connected with biblical admonitions to charity.  Biblical charity is laden with responsibilities for both giver and receiver (contrary to Duncan Rankin).  In medicine we have to deal with deciding the degree of incapacity for the insane, the demented, the retarded, and most problematically the fatigued.  Is the patient holding up his end of the charitable treatment bargain?  It is not so important in surgery, in which the patient merely has to hold still for a while until he is asleep, but in continuing care of chronic illnesses, it is supreme.  Not only medical charity hinges on these decisions, but also other provision for those with diminished capacity.  We are to feed those who can’t work.  Physicians are supposed to be the experts on who can’t work, as distinct from those who won’t work.  (Again, apparently Rev. Rankin would just have us all be taxed to feed them all, no questions asked!)  I suspect that Calvin and other leaders had to deal with this very practically in Geneva, so there is likely something there to pull from.

It would be a challenge to find something relating to the very definition of an individual person in our Reformed doctrines.  You have been mining the catechism at the Ten Commandments, and something may be there, or in the Canons of Dordt, or the Heidelberg.  In medicine we are edging toward confusion in distinctive personhood.  An insertion of genes from other species, even from plants, into the human germ cell line hasn’t been done to my knowledge, but is done already in other creatures.  Will such be meddling with the establishment of the “kinds” of Genesis?  Organ transplantation is commonplace, but we are perhaps going to see transplants of brain tissue.  If such were done, would the issue arise as to who is really in there?  (Many decades ago, some underemployed psychologist trained planaria [flat worms] to make a right or left turn in a T-maze.  After training them to near 100% success, he ground them up and fed them to worms naive to the maze.  He found that the cannibalistic worms learned the maze significantly faster.  The point would be that transplantation of an intact cerebrum, thalamus, or cerebellum — impossible it seems — might not be required for something being transferred that was individual and acquired in a personality.)  Already we have definitions of a human being challenged in practice, with abortions being done because of in utero deformities said to be incompatible with sentient existence.  Peter Singer at Princeton wants human babies to have to pass a test before being issues a birth certificate.  I myself would not view the products of a molar pregnancy as a human being, reasoning that it is essentially a deformed placenta and a placenta is not a human being.  The Scripture in many places compares humans to animals, usually in a pejorative, though we also can mount up with wings as the eagle.  While there are thus certain animal-like comparisons to be made, we are always held to be above the animal s in the created order, and a little lower than the angels.  It follows that for a medicine to admit nothing more than the animal-like aspects of our nature (evolution) is wrong.  Not sure if reformed theology has something special to say here, but I bet it does.

The so-called Hippocratic ethic majors in the orientation of the physician to the patient, as opposed to the state or his own interests.  I don’t think, however, that ancient Greek philosophy can consistently bear this weight.  The oath begins with its allegiance to false gods, holds out against abortion even if asked, and implicitly resists the state’s inquisitions in its maintenance of confidentiality.  The Oath holds for a kind of professional nepotism in medical education, confusing the teacher-pupil relationship with the parent-child one.  Only a Reformed theology can properly sort these out, under the banner of a stewardship informed by Scripture.  There was nothing consistent or even admirable in the Greek pantheon.  A biblical stewardship does not make confidentiality ultimate.  It concurs on abortion and not debauching servants (common grace was granted to the Greeks).  It recognizes the teacher-pupil relationship, as derivative from, but not equivalent to the parent-child relationship.  Very likely there is something on stewardship from the Catechism which can form the basis for this issue.  Even working together, Hygeia, Panacea, Apollo, Electra, Diana, Hermes, Jupiter, etc., cannot manage to be the foundation for “Hippocratic” medicine.

Most basically, only a Reformed worldview can support science.  I won’t elaborate because you already have this in spades.  Only a consistent, providential God can be the basis for using observations to make useful predictions.  The materialists want to have randomness AND order, meaninglessness AND teleology.  Can’t be.  Inasmuch as medicine purports to have a scientific aspect and the purpose of healing it can only rest upon the one true God of order and divine purpose.  The Confession’s paragraphs on Providence likely will ground this (relative) distinctive.

While it would be illustrative at best, and not a proof, it might be interesting to investigate how many renowned physicians and medical researchers were reformed.  I mean really reformed, not the anemic lists you sometimes find claiming this or that famous fellow was a Christian, including some very questionable characters into the list.

I will cease, here, with the sense that I went off completely on a tangent with respect to your target.  You can see how I have worked at your issue backwards.  I have outlined some medical issues wishing to find an address of them in Reformed theology.  I’ll end prepositionally.  I’m not someone you can count on.

Extra Value Added

Who is responsible to provide medical care? That is, where does the authority lie and the obligations? Our Democratic presidential nominee this week proclaimed that medical care is a [political] right. Hence, it is Ceasar’s obligation and he will take what resources he deems necessary to provide it as he sees fit, empowering (and forbidding) those whom he favors.

* The effectiveness of medical care almost certainly will not be mentioned by anyone, so powerful is the assumption today that our methods work. Actually, of course, we have made a near idolatry of our scientific technology. Our use of medicine is inordinate — that is, not wrong in itself but wrong in the degree which we pursue it and what we trample on in our pursuit.