Review of Bouma’s Christian Faith, Health, and Medical Practice

by John M. Frame

Professor of Apologetics and Systematic Theology

Westminster Theological Seminary in California

 

Christian Faith, Health, and Medical Practice by Hessel Bouma III, Douglas Diekema, Edward Langerak, Theodore Rottman, and Allen Verhey (Grand Rapids: Eerdmans, 1989).

 

This book was written by an “interdisciplinary team of scholars” gathered under the auspices of the Calvin Center for Christian Scholarship. Of the five authors, Bouma works in the field of biology, Diekema in medicine, Langerak in philosophy, Rottman in sociology, and Verhey in religion. In the book, however, they speak as “we” throughout, not distinguishing in any explicit way their individual contributions or viewpoints. We are therefore authorized to hold all members of the group responsible for the content of the book. In what follows I shall refer the book as CFHMP and to the authors generally as “the authors” or “the team.”

Thomas L. Jipping reviewed the book’s position onabortion in the November 28, 1989 issue Christian Renewal. Iagree, on the whole, with Jipping’s analysis and stronglynegative evaluation. In this present article I intend to look atthe book as a whole, focusing on issues other than abortion.First, it is important that we understand the methods and criteria by which the team seeks to reach conclusions on ethical matters. For Protestant Christians, the most serious issue here is the team’s view of Scripture. The book’s only systematic reflection on the nature of Scripture is in a long footnote on p. 19. Here the authors begin by saying that “Scripture is the Word of God and the words of men” (emphasis theirs). They follow this statement by misusing an analogy between Scripture and Christ: “the human words– with all their historical particularity– may be neither identified and confused with the Word of God nor divided from and contrasted with the divine Word.” Evidently, however, the team is not much worried here about people who “divide” or “contrast” the human words from the divine. That issue never gets defined; indeed it never comes up again. They are, rather, concerned with some (“fundamentalists?” “conservatives?”) who in their estimation “identify” or “confuse” the human words with the word of God.

Though they cite the Council of Chalcedon as the source of this parallel, they have quite misunderstood the relationship. The Chalcedon Declaration speaks of the two natures of Christ, the divine and the human. It says of those natures that they may not be confused, changed into one another, divided or separated. Now if we apply this language to Scripture, we would have to say that in the case of Scripture also, its human character may not be confused, changed into, divided or separated from its divine character. But our team of authors adds a new element not found anywhere in the Chalcedon formula. They identify the “human element” with “the human words– with all their historical particularity.” Had Chalcedon included such a thought about Christ, it would have had to say that the human Jesus “with all his historical particularity” was so purely human that he could not be identified or confused with God. Actually, however, Chalcedon said nothing like that about Jesus. The closest Chalcedon came to speaking about Jesus “with all his historical particularity” was to speak of his “person” prosopon. And Chalcedon affirms that the person of Jesus was (and is) both God and man. The implication of this is that while Jesus’ human nature is not to be identified with God, his “historical particularity,” his person, may indeed be identified both with God and with man.1 And if we make the precisely parallel point about Scripture, we must conclude that its words in their “historical particularity” are both divine and human, not merely human. They may indeed, then, be “identified with” the words of God. The word of God in Scripture is not something hidden above, within or below the actual words of the Bible in their historical particularity.2 Rather, those words are the word of God. So says Scripture itself and the confessions (both ancient and reformed) of the church.

Since the CFHMP team refuses to identify the words of the Bible with the word of God, they assume they have freedom to criticize the content of Scripture (in its historical particularity, of course!) If we ask of Scripture certain kinds of questions about nature, we can expect only “quaint and curious replies” (p. 19, n. 5). In the “ancient Mediterranean,” we are told, “the demonological understanding of sickness and psychosis was widespread” (p. 18). The context makes clear that the biblical authors, even Jesus, shared this misunderstanding of illness. While the “demonological” theory does contain the truth that the sick do not have control of themselves (p. 19), in general it cannot be accepted today, according to CFHMP. The Bible, of course, is not really at fault for promoting this misunderstanding, because “the biblical stories are not addressed to twentieth-century scientific or clinical questions and may not be used to prescribe either the way to understand such suffering today or the way to provide therapy” (pp. 18, 19).

In my view, the volume greatly overstates its case by speaking of a “demonological understanding of sickness.” Scripture never suggests that all sickness, or even all psychosis, is the result of demonic activity. Indeed, most New Testament narratives concerning miraculous healing do not mention demons at all. And in some passages, such as Matt. 4:24, a clear distinction is drawn between diseases and demon possession. The fact is that the biblical writers did not hold to any generalized “demonological understanding of sickness.” The difference between them and modern secularists is that they believed that some human infirmities were caused or made worse by demonic influence. So stated, I think the biblical view is not at all unreasonable; certainly it does not deserve to be maligned as “quaint” and “curious.”

Even in matters of theology, the Bible is not wholly reliable, according to CFHMP. Some biblical authors, it says, insisted “that suffering is always in some sense deserved” (p. 10). The team is glad, however, that other sources help us to transcend such a naive view. At this point they cite, not the Book of Job, but an article by D. Smith.

The same is true of ethics. “Within the realm of moral inquiry, furthermore, questions concerning what concrete deed I should do or leave undone in a particular context may receive only a quaint reply from Scripture” (p. 19, n. 5). No examples given here. But I gather the team is opposing at this point a particular way of using Scripture found in some Christian ethical writings (including my own!). In the more conservative treatments of medical ethics, such as those of J. Jefferson Davis, Franklin E. Payne, the nouthetic counseling movement of Jay E. Adams and others, the theonomic movement of R. J. Rushdoony and others, the usual approach to ethical problems is to find in the Bible explicit or implicit divine commands which relate to the problems at issue. The attempt is then made to apply those commands to the issues under discussion. The process of application, of course, requires some extra-biblical knowledge as well, namely knowledge of the situation to which the command is to be applied. In such a way, the commands of God shed light upon the believer’s path (Psm. 119:105).

Nowhere in CFHMP is there any suggestion that the believer is subject to biblical commands (even the commands of Jesus), though the book tries to make much use of Scripture in other ways. My suspicion is that those who try to justify concrete decisions on the basis of biblical commands would be among those who in the eyes of the Calvin team are receiving only “quaint” replies from Scripture.

How, then, does CFHMP suggest that we make our ethical decisions? Despite the authors’ deficient view of scriptural authority, Scripture does play a large role in their ethical method. Not that Scripture provides commands to be applied to life situations; but it does provide other things. Primarily, they view Scripture as “story” or “narrative” (pp. 67, 124ff), following the approach of what today is often called “story theology.” “Story theology” is different things to different theologians. To some, it simply means that when we interpret the Bible we should remember that the Bible is not a mere list of doctrinal truths or moral commands, but that it is in many respects a “story.” “Stories” may teach doctrinal or historical truths, they may also teach moral lessons, but they also influence our lives in many other ways: by motivating us, by providing vivid illustrations and pictures of the truth, by giving us insight into the character of God and of human beings. Sometimes, stories affect us in ways which are difficult to put into words.

To other “story theologians,” the importance of story theology is to undermine the traditional concern with historical, doctrinal and moral accuracy in Scripture. On such views, it is not important whether biblical narratives convey accurate historical information. Rather, we accept the “story,” historical or not, as containing various models for our behavior, suggesting new situations which stimulate our thoughts and our ethical motives, etc. Biblical narrative, in other words, is treated much as the church has customarily treated parable. Similarly, it is not important whether the ethical injunctions and doctrinal teachings of Scripture are “true” in the sense of “correct.” Rather, they too are simply part of the story, to be evaluated according to broader criteria. It seems to me that the “story theology” of CFHMP is of the second variety rather than the first. As we have seen, the book denies the inerrancy of biblical doctrine and the significance of biblical ethical injunctions. They therefore see “story,” not as a supplement to other functions of Scripture, but as a substitute for them.

But how do you get ethics out of the Bible if Scripture gives only “quaint” answers to ethical questions, if scriptural assumptions about disease are incorrect, and if scriptural authority has exclusive reference to a “story” which may be true only as parables are true?

CFHMP does also appeal to certain broad, general teachings of Scripture, especially creation out of nothing (pp. 3ff), the reality of evil (pp. 7ff), providence (p. 8f), suffering (p. 9f), God’s faithfulness and care (pp.11f), human faithfulness and freedom (pp. 13ff), faith in God (pp. 16f), watchfulness and healing (pp. 17ff), our obligation to the poor (pp. 21ff), the “already” vs. the “not yet,” (pp. 23ff), “imaging” God (pp. 27ff).3 Their most central biblical concept is “covenant” (esp. pp. 67ff). They urge as an alternative to secular “deontological” and “teleological” ethics a “covenantal” ethic. The “covenantal” ethic affirms human rights (like the deontologist) and considers consequences (like the teleologist), but it sees our primary relationships to one another more in terms of love and family responsibility than of autonomous individuals considering “rights” and “consequences.”

We might say, therefore, that the method of CFHMP is “narrative” or “story” theology plus appeal to some very general scriptural concepts. Sometimes, as with the concept of “covenant,” their accounts of these concepts are illuminating; but often their formulations are questionable at least. Take “human freedom” for example. To their credit, the CFHMP team maintains an essentially Augustinian (as opposed to Pelagian or Arminian) understanding of human freedom, thus resisting some bad tendencies within current theology. Human freedom presupposes an established self, which chooses consistently and predictably by virtue of its own character. Hence divine providence is no threat to human freedom (pp. 12ff). But then the authors try to turn the fact of freedom into a norm, so as to imply that we should never give medical treatment without a person’s “informed consent” (p. 14).4 Now I agree that Scripture requires informed consent, but my argument is very different. It is that God has not given authority to medical people analogous to the authority he gives to parents or civil government. Scripture contains no divine warrant allowing physicians to force care upon a person. That fact, however, is not based on the patient’s metaphysical freedom. On the contrary, there are other human authorities (such as civil government and parental authorities mentioned about) who do have the right in some situations to make decisions for a person against that person’s will. The biblical point is not (as CFHMP suggests) that a person’s will may never be overruled, but rather that God has not authorized the medical community to overrule it. CFHMP’s methods, however, would never have led them to the proper argument. To find that argument we need to have, not a vague focus on “story” and broad “biblical concepts,” but a detailed analysis of biblical precepts to see what God has or has not required. CFHMP’s team could not engage in such analysis, because they believe that biblical moral precepts give us only “quaint” answers to ethical problems.

One mistake leads to another. Their argument against cloning, for example, is that it “establishes an identity for the child that is not freely owned by the child and that does not invite anyone to nurture and engage the child’s capacities for agency” (p. 184). How many of us have identities that are “freely owned” by ourselves? I, for one, had no role in choosing my genetic makeup. Yet I certainly do not consider that an imposition on my freedom. If my genetic make up and environmental training push me in a certain career direction and rule out others, even that, certainly, cannot be meaningfully said to violate my freedom. And is it really true that no one will ever nurture the capacities for free choice in a cloned child? CFHMP assumes that if a child is cloned from a great pianist, society will give him no choice but himself to become a pianist (pp. 184f). But that is simplistic. For one thing, we may well doubt whether anyone can become a pianist (or anything else) unless at some point he affirms that vocation freely from within. If society wants the child in question to become a great pianist, it must nurture his/her capacity for choice, even at the risk that the child will respond by choosing some other vocation. For another thing, the motive of cloning a child from the cells of a great pianist might not be specifically to create another great pianist; the motive might rather be to create a person who, regardless of his vocation, exhibits the creativity and discipline of his clone-predecessor.

CFHMP tries, in other words, to make the concept of “freedom” carry much too much moral weight. In doing so, they miss out on some of the complications of the issues they deal with. (I do feel that one of the strengths of CFHMP is that on the whole they are very much aware of complication, of nuance. But their method, at times, restricts the scope of their moral vision.) Were they able theologically to make more use of Scripture’s “quaint” answers to specific problems, they might have observed that God in Scripture does not consider human freedom in every case inviolable (consider the “rod” in Proverbs), and they might have seen too that there are principles in Scripture relevant to cloning other than “freedom.”

The story-concept approach of CFHMP reminds me of the theological situation back in the 1940s and ’50s. Then the liberal and neo-orthodox theologians were insisting obsessively that God never reveals himself by giving us “information.” If, then, Scripture contains no information about God, how can a theology be based on Scripture? The liberal theologians answered with a kind of narrative theology known as “Heilsgeschichte” or “acts of God theology,” plus an intensive investigation into broad, general biblical “concepts.” God does not give us theological information directly, they thought, but we can develop theologies based on the narratives (regardless of their historical value) and on broad scriptural concepts.

It was James Barr, himself very much a liberal, who called an end to it all. He pointed out, in his Semantics of Biblical Language,5 that communication by language is primarily by sentences (or longer units) rather than individual words. Therefore, he argued, if we are unable to trust the sentences of Scripture (i.e., the “information”), we should not claim to derive our theologies from scriptural words (“concepts”). Words mean nothing except in the context of sentences, and concepts have meaning only in the context of information. Further, he pointed out, from a theological point of view, “revelation” in the Bible does include revelation of information; to exclude information from revelation may meet the desires of modern thinkers, but it cannot be justified on the basis of Scripture itself.

Similar principles apply to CFHMP’s “story-concept” approach. In attempting to escape the “quaintness” of Scripture’s actual moral teachings and ethical injunctions, CFHMP seeks to develop a Christian ethic out of biblical “stories” and broad “concepts.” But the concepts and stories have ethical meaning only as aspects of biblical moral teaching. The bare fact that man is free has, in itself, no moral implications. It gains moral implications when we see that in Scripture not only is man free, but also that God requires us to nurture and respect that freedom in certain ways. But then to find the moral implications of human freedom, we must go to the biblical moral injunctions. CFHMP cannot do this, I gather, because they suppose that these injunctions are merely “quaint.” But without the injunctions, the “stories” and the “concepts” yield no moral conclusions.

This is why the arguments of CFHMP are often weak even when they are presented in defense of sound conclusions. Examples: (1) Over and over, CFHMP invokes the concept of “watchfulness” to enforce a particular conclusion (pp. 17ff, passim): “A watchful medicine will” do this or that. I am not clear as to what they mean by “watchful;” in most contexts it seems to mean something like “reasonable” or “thoughtful.” I confess, however, that I am rarely persuaded by this sort of argument. Often they seem to be telling me that if I am thoughtful, I will do this or that, without leading me through the relevant “thoughtful” reasoning process.

(2) While they have a rather “middle of the road” view of abortion,6 and though they do not exclude the killing of embryos in the course of in vitro fertilization, nevertheless they absolutely exclude “the use of embryos procreated in vitro for experimental purposes” (p. 204). The reason, “it is wrong to begin human life with the intention of discarding it once we have used it.” But elsewhere they are unwilling to say that the embryo is human life. So the basis of this dogmatic exclusion is obscure.

(3) They also absolutely exclude “commercial contracts for surrogacy,” though against surrogacy itself they only raise “caution” (p. 204). The argument against the contracts (p. 203) is not that surrogacy involves parenting without commitment to raise the child; it is rather that commercial contracts for surrogacy will drive a greater wedge between the rich and the poor. Concern for the poor is a major theme in CFHMP, as well it should be (cf. pp. 156-170. But CFHMP does not ever present a careful biblical analysis of what the relations of rich and poor should be. Rather, they operate on rather vague intuitions of a generally egalitarian (though not specifically Marxist) sort, various sorts of prejudices against the commercialization of medicine. It is that vague intuition that seems to underlie their aversion to surrogacy contracts, but it does not, certainly, make their case very plausible.

(4) Following on the last point: Much is said in the book about the “rights” of the poor to various sorts of things and the “requirements of justice” (pp. 82, 162ff). Even a woman’s “right” to abortion is defended on the ground that women should not be asked to make “unequal” sacrifices, pp. 214-216. This talk about rights and equality is mostly unargued; the team evidently thinks that their readers will find it obvious. I do not, though I certainly do believe that we should help the poor to receive health care. The biblical basis for helping the poor is not abstract rhetoric about rights or equality, but the demands of Christian love and the biblical injunctions commanding us to care for the poor. But perhaps that point is too “quaint” for CFHMP.

(5) They use “slippery slope” arguments at a number of points: these are arguments to the effect that society should forbid A because it could lead to B. So, “benevolent killing of those who are dying can too easily justify the benevolent killing of other mortals, even those who are not yet dying” (p. 299). But they are unwilling absolutely to prohibit abortion even though the slippery slope argument from abortion to euthanasia is more plausible than the slopes that they themselves invoke.

(6) Their view of “tragedy” is unbiblical in my view. I grant that we often have to choose between incompatible goods or between “evils:” sometimes any decision will bring harm to someone. Such “tragedies” occur in decisions about the allocation of medical care. This does not mean, however, that in such situations it is impossible for us to do our duty, impossible to do what is right before God. Although at times we must choose between evils, we are never in such a position that we must choose between two wrongs. This, at any rate, is Scripture’s teaching. If by living in a fallen world, human beings are forced by circumstances to make sinful choices, then Jesus must also have been a sinner. But Scripture proclaims his sinlessness, and it promises us also that “God will make a way of escape” from temptation (I Cor. 10:13). But CFHMP ignores this quaint reply to their dilemma and waxes eloquent about the “gathering of evils” and the “colliding of goods” (pp. 132ff). By this they do not mean simply that we must sometimes choose between evils; it means that in some situations we cannot do our duty before God (p. 196).

(7) The last chapter of the book (308ff) is a discussion of AIDS, but it carries out its analysis with no reference to the moral right or wrong of homosexuality! A footnote explains that this chapter was written after the team had ceased to meet together, therefore they could not be expected to deal with this issue, though they were able to discuss AIDS purely as a disease. I confess bafflement. If anything, the reverse ought to be true. What Scripture says about homosexuality is plain as a pikestaff, as Cornelius Van Til used to say. It is the complicated nature of the disease itself which should have required further meetings and team interaction. The chapter isn’t entirely bad, certainly. It does make the point several times that sexual faithfulness in monogamous relationships will prevent one from the sexual transmission of AIDS (pp. 308, 322), and that certainly needs to be said. But in dealing with the homosexual factor, the chapter generally emphasizes the evils of what has been called (though not in CFHMP) “homophobia” rather than the evils of homosexuality itself. (How did they decide, I wonder, without further team meetings, that homophobia was bad?) They are opposed to any kind of quarantine, any movement to “control” people with AIDS, any “arbitrary diminishing of their freedom,” any refusal to treat, any “shunning” or “stigma”. In general I agree with these positions;7 but I think it must also be said, e.g., that people who knowingly infect others with the disease should be punished severely and isolated from the public. The book advocates that gay lovers of AIDS patients be used as proxies to give informed consent to treatment when the patient is unable to do it himself (p. 339), and it suggests that genuine faithfulness can be present in homosexual relationships (p. 333). All of this, without any balancing critique, presents homosexuality in a very flattering light. In my view, this is unworthy of a Christian publication.

Therefore, the method of the book, in my opinion, often leads to confusion and unpersuasive arguments. I would not say that on this account the book is valueless. On the contrary, it contains a great deal of interesting information and ethical wisdom. It is well informed. But it clearly is not adequate as a Reformed ethic, for it is not adequately biblical. The CFHMP team surely cannot say with the Belgic Confession that “we believe without a doubt all things contained in (the Scriptures)…”

And because the book does not forthrightly embrace the Christian church’s authoritative standard, its ethical work is disappointing. Apart from the specific criticisms already noted, I am disappointed in that this book almost never reaches distinctively Christian conclusions. In view of what Scripture says about the antithesis between the wisdom of God and the wisdom of the world, we would certainly expect that a book of Christian ethics would differ sharply, in both its method and its conclusions, from secular ethical thinking. But since CFHMP compromises on the presuppositions of Christian ethics, its conclusions also most often find agreement with the secular traditions. The sad thing is that it is difficult (if it is even possible) to find even one topic on which CFHMP recommends a different conclusion from the consensus of secular ethicists. It differs from them only in its reasoning, which is, as I have indicated, its least valuable feature.

There are basically two kinds of ethics books which claim to be Christian. One kind, such as those of Franklin E. Payne, and others, which I mentioned earlier8 seeks to apply the commands of Scripture to ethical problems, assuming that Scripture is nothing less than God’s word to us. The other kind is what I sometimes call (with an intentional tone of slight deprecation) “love and justice books.” These books derive certain values from the Bible, such as love and justice; but they do not accept the whole Bible as God’s word and thus they feel free to accommodate its ethical teachings to current fashion.

CFHMP is most clearly a “love and justice” book, although to be sure it makes use of more biblical “concepts” than merely those of love and justice. The team in effect disparages the conclusions of the first group of authors as “quaint.” Indeed, CFHMP’s very elaborate bibliography (pp. 376-400: 24 pages!) contains no references at all to ethical works of the first type I have mentioned, except for Clifford Bajema’s Abortion and the Meaning of Personhood.9 (Evidently they felt a need to refer to at least one strongly pro-life author.)

The first group of authors, which one might call the “biblical ethics” group, does read the love and justice books. But as with CFHMP, the love and justice people almost never read the works of the biblical ethicists. The problem, then, is not just that the CFHMP authors are on the wrong track; rather, they are not even teachable. They are not even listening to those who argue another view. Ironically (and this has often been true in other contexts) here it is the “liberals” who are illiberal, closed minded, while the “conservatives” are the ones seeking to learn what they can from those in other camps.

Any member of the Christian Reformed Church must ask seriously why such a book would be produced under the auspices of the Calvin Center– a book that decisively rejects, even ridicules, in effect, the Church’s creedal position on Scripture, and which is not even in dialogue with those whose thinking is self-consciously biblical and Reformed. Discipline, according to Calvin, is a mark of the true church. A church that cannot enforce its own doctrinal standards is surely in deep trouble.

 

 


1 Interestingly, in another context, CFHMP does accept this view, and even presses it to somewhat controversial lengths when it speaks of “God, suffering” on the cross, p. 10.

2 Where is the word of God, according to CFHMP? I gather that it is in the words of Scripture, but not “in their historical particularity.” But where is that? I hate to carp, but all the words of my Bible are historically particular. I cannot even imagine a word that is other than historically particular, unless it is “timeless and general,” and I doubt if CFHMP intends to identify the word of God with timeless generalities… Or am I wrong?  Or is “historical particularity” here just an intentionally vague and pretentious expression intended to throw critics off the scent of what is happening here?

3 See Jipping’s excellent critique of their concept of “imaging” in the CR article mentioned earlier.

4 I will not here go into the philosophical problems raised by CFHMP’s attempt to derive norms from facts, though readers trained in philosophy can profitably meditate on that issue also. While I don’t quite agree with Hume and Moore about the so-called “naturalistic fallacy,” I do think that ethical writers have an obligation to show the basis of their “oughts.” CFHMP is far too often negligent in supplying such bases.

5 Oxford: Oxford Univ. Press, 1961.

6 Again, see Jipping’s article.

7 I do think that those who get the disease by voluntary homosexual activity rightly deserve a “stigma” in some sense. But even that stigma should belong only to the unrepentent.

8 My own Medical Ethics (Phillipsburg, N. J.: Presbyterian and Reformed, 1988) attempts to follow in this tradition.

9 It is, of course, possible that I have missed something among these many titles.