Christianity for Healthcare Professionals

For God so loved the world that he gave his only son, so that everyone who believes in him may not perish but have eternal life.
Jesus Christ
He said to him, ?you shall love the Lord your God with all your heart, and with all your soul, and with all your mind.? This is the greatest and first commandment. And a second is like it: ?You shall love your neighbor as yourself.? On these two commandments hang all the law and the prophets.
Jesus Christ
Introduction
With more than two billion adherents, Christianity is the largest and most widely dispersed religion in the world today. It is also very diverse, especially in what it says and does about health and healing. On the one hand, as evidenced by the pilgrimages to places like Lourdes in France, where millions of Christians have gone each year for generations in quest of miraculous cures, or as seen more controversially in movies like Elmer Gantry and Leap of Faith, its healing methods can be simple, unsophisticated and sometimes even superstitious. On the other hand, over the centuries and in our own time, virtually everywhere Christians have gone they have established some of the best hospitals and universities in the effort to help humankind deal with illness and disease.
Some may find it difficult to see much similarity between ?faith healing? meetings before huge numbers of awe-struck people gathered in public places like gymnasiums, stadiums and huge tents, and the quiet scientific activity of Christian institutions that treat sick people with resources such as chemotherapy, organ transplantation and proton beam accelerators. These differences are real and significant. But for better or for worse, they are all part of the Christian story.
Demographics
Beginning with Italy and moving north and west, most Christians in Europe adhere to Roman Catholicism, the largest of the three primary branches of Christianity. So do those in Quebec in Canada and many in the southwestern portions of the United States. The whole of South America and virtually all of the Philippines are also Roman Catholic. Protestants in Western Europe are most numerous in portions of Germany, all of Scandinavia and the United Kingdom. They are also the primary Christian populations in North America, Australia, New Zealand and South Africa. Protestants take second place in overall numbers worldwide to Roman Catholics. Both are exploding numerically in Africa south of the Sahara Desert.
Starting with Greece and moving roughly north until reaching Russia and then turning east, and covering the vast expanse from there and all the way to the Pacific Ocean, Christians lean toward Eastern Orthodoxy. It is the smallest of the three primary branches of Christianity in numbers. All told, Christians in the United States comprise about 75 percent of the population. Approximately 24 percent of the total population is Roman Catholic. They are somewhat clustered in the Northeast, Great Lakes, and West Coast regions (US Religious Landscape Survey 2007). Approximately 26 percent of the nation's total population is Evangelical (conservative) Protestant. The largest number of these is Baptist of one sort or another (11 percent). In significantly smaller numbers, there are the non-denominational (3.5 percent), Pentecostals (3.4 percent) and Lutheran Evangelicals (2 percent). The other groups of Evangelical Christians are dispersed among 15 or so smaller groups. The greatest number of Evangelical Protestants live in the South and West (US Religious Landscape Survey 2007).
About 18 percent of the people in the United States are Mainline (liberal) Protestants. The most numerous of these are Methodist (5.4 percent). The next largest are Lutherans (2.8 percent) and non-specific (2.5 percent). After them come the Mainline Baptists (1.9 percent) and Anglican or Episcopalians (1.4 percent). The remaining (4 percent or so) can be found in smaller groups. The Mainline Protestants, though favoring the north a bit, seem most evenly scattered throughout the nation. Almost 7 percent of all Americans belong to Historically Black Protestant Churches. Most of these are Baptists (4.4 percent). The others (about 2.6 percent) are in smaller groups. Like the Evangelical Protestants, they are active mostly in the South and West (US Religious Landscape Survey 2007).
History
Born in Bethlehem and reared in Nazareth, as Christians remember it, Jesus left his carpenter shop as a young man and became a traveling preacher, teacher, and healer. His message was that the kingdom or reign of God was at hand and that in some ways it was already present. Like the Hebrew scriptures he had studied, he taught that true morality can be summarized in love for God and neighbor. Yet he emphasized the need for a way of life that was more inward, thoroughgoing and inclusive. Some political and religious leaders of the time took offense at Jesus' words and deeds, interpreting his emphasis upon God's kingdom or reign as a threat to their own. This is why Pontius Pilate, the primary representative of the Roman Empire which was occupying the land, had him tortured and then killed by crucifixion. Most Christians believe that on the third day after his death he was resurrected. After a brief time he ascended to heaven with a promise someday soon to return in power and glory.
The first 500 years of Christian history were marked by rapid growth and increasing cultural influence. Emperor Constantine made Christianity the official religion of the Roman Empire in 323 ce. The first eight ecumenical councils (large and sometimes lengthy meetings of Christian leaders designed to bring consistency to Christian theology and teachings) took place between the fourth and ninth centuries. The Council of Nicaea formulated a frequently recited Christian creed: I believe in one God, the Father Almighty, Maker of heaven and earth, and of all things visible and invisible. And in one Lord Jesus Christ, the only-begotten Son of God, begotten of the Father before all worlds; God of God, Light of Light, very God of very God; begotten, not made, being of one substance with the Father, by whom all things were made. Who, for us men and for our salvation, came down from heaven, and was incarnate by the Holy Spirit of the virgin Mary, and was made man; and was crucified also for us under Pontius Pilate; He suffered and was buried; and the third day He rose again, according to the Scriptures; and ascended into heaven, and sits on the right hand of the Father; and He shall come again, with glory, to judge the quick and the dead; whose kingdom shall have no end. And I believe in the Holy Ghost, the Lord and Giver of Life; who proceeds from the Father and the Son; who with the Father and the Son together is worshipped and glorified; who spoke by the prophets. And I believe one holy catholic and apostolic Church. I acknowledge one baptism for the remission of sins; and I look for the resurrection of the dead, and the life of the world to come. Amen. (Nicene Creed 325)
Roman Catholicism dominated in Western Europe for centuries, with the theologian Augustine of North Africa in the fifth century and Thomas Aquinas in Italy and France in the thirteenth century as the era's intellectual giants. Orthodoxy was far more influential in the eastern part of the Roman Empire, a split that remains into the twenty-first century.
History began to move away from Rome beginning with the Renaissance in fourteenth-century Italy. Tensions boiled over with the Protestant Reformation in the sixteenth century, preeminently with Martin Luther in Germany and John Calvin in Switzerland. Against what they perceived to be spiritual and administrative abuses of the church, the reformers emphasized the authority of scripture?as interpreted by individual Christians? over against that of the church hierarchy, the centrality of salvation by God's grace (without any human participation), and the ?priesthood? of all believers?that every Christian has received a calling from God for ministry and each calling is equally sacred.
The seventeenth century in Western Europe was beset by religious warfare. This contributed to the flowering of the European Enlightenment, which triggered the switch from pre-modern to modern ways of thinking and acting: one response, deism with its naturalistic view of God and the universe, eliminated much of Christianity in the name of human reason. This was the religion of Thomas Jefferson, Benjamin Franklin and other American leaders. A second response was the Evangelical Revival in England and North America. Its leaders?principally John and Charles Wesley and George Whitefield from England and Jonathan Edwards in America?put more emphasis upon emotion, what Edwards called ?the religious affections? (Edwards 1959).
Many positive things occurred in the nineteenth century, such as the largest missionary endeavors in Christian history, the elimination of slavery even in North America and the United Kingdom and the establishment of many Christian voluntary service societies. But the American Civil War, fought primarily by Christians, cut an ugly wound. Also, with the findings of Charles Darwin, Karl Marx and Sigmund Freud, and many others, Christianity's conceptual foundations began to crack. World War I dashed the hopes for an era of unprecedented peace and prosperity. The modern era had ended and the postmodern one had begun. These challenges flowed into the twentieth century. Some, embracing modernism, sought to integrate newer scientific findings with their Christian beliefs, others who objected, moved in the direction now referred to as fundamentalism. This divide has sliced across Christian denominations in America as well as between them into the twenty-first century.
At the end of the twentieth century, Roman Catholicism, which had assimilated enough to see one of its own, John F. Kennedy, become president of the United States, and Evangelical Protestantism, which had done the same thing at least twice, in Jimmy Carter and George W. Bush, amounted to the most vibrant forms of Christianity in the United States. Throughout its long history, Christianity has made many contributions to theoretical and practical medicine?beginning with Eastern Orthodoxy's introduction of the first hospitals. Yet it is impossible to list all of these because it is difficult to distinguish the history of Western medicine from the history of Western Judaism, Christianity, and Islam. Although these are somewhat different streams, their waters intermingle so often and so deeply that it is not easy to distinguish where one begins and the other ends. What is more, the greatest contributions of these religions to health and healing may have been more philosophical and theological.
Beliefs and Practices
General
Christian beliefs differ greatly in their details; however, if one stands back and considers them from a distance, they appear remarkably similar in their main outlines. Also, Christians share many convictions with Jews and Muslims. All three are ?Abrahamic? religions because they each recount their formative narrative to the person and faith of the biblical personage, Abraham.
Like Jews and Muslims, Christians center their lives on the one true God who brought the universe into being and continues to sustain it. God is both immanent, within the universe, and transcendent, beyond and greater than it. There is no place where God is absent, nothing that can be known that God does not know and nothing that can be done that God cannot do. Everything about God is worthy of admiration and acclaim. This is especially so of God's steadfast love that endures forever.
Most Christians believe that the one genuine God is ?Triune.? As many early Christians put it, ?the one God exists in three Persons and one substance, Father, Son, and Holy Spirit.? The word ?substance? means ?essence.? The word ?person? comes from the different masks or roles of actors in theatrical performances. ?Perichoresis,? or ?dancing in a circle,? instead of vertically or horizontally, is one metaphor Christians have used when thinking about the three members of the Trinity. An implication of this doctrine is that relationships characterize everything, from God to subatomic particles and smaller.
Although they vary in their emphasis, Christians believe that God is revealed in nature, history, experience, reason, scripture, and, most decisively, in Jesus Christ. Like Jews and Muslims, Christians are ?people of the book.? This book, the ?Bible,? is actually a ?library? with material from many different times and places. Taken together, these documents from long ago tell a story. It is a story about God's interaction with people and other things. Christians believe that this story points the direction in which our lives should move today.
The biblical idea of creation distinguishes Christian belief from at least two other alternatives. One of them is the kind of dualism that posits a deep, wide, and unbridgeable divide between the spiritual and physical realms of human life; the second is the kind of monism or pantheism that pictures the universe a single whole, with all particular things and people as its partial expressions. Christians believe that dualism is too negative about the physical features of life and that monism or pantheism undervalues the relative individuality of each thing.
Christians believe that all human beings are created in the ?image of God,? the expression coming from the biblical account of the creation of humankind. This does not mean that they look like God. It means that they share in a limited and imperfect way some of God's most important characteristics: reason, freedom, memory, anticipation, purposefulness, intimacy and perhaps even laughter. Although other animals possess these characteristics in lesser or greater degrees, they characterize human life in a qualitatively superior way.
The basic idea of the Christian concept of sin is that pain, suffering, and evil are not essential elements of existence. ?Intruders? and ?violators,? they are the global consequences of misusing the freedom God has given humankind. ?Original sin? refers to the difficulties and inabilities all people inherit. ?Actual sins? are the thoughts, words and deeds in which they freely indulge even when they know they should not. Christians believe that everyone except Jesus Christ is a sinner.
They believe that human beings cannot extricate themselves from sin and its consequences: discord, guilt, meaninglessness, and death. This is something only God can do. The entire Bible is a story of how God has repeatedly done this for others and the assurance that God can do the same for people today. All religions have a story. For many of them it is explanatory, for Christians it is essential. They believe that the story of salvation is the best of all narratives because it proclaims the good news that God loves unconditionally.
The word ?Jesus? is a name, the word ?Christ? a title. It conveys the meaning of the prior Hebrew words: ?Messiah? or ?Anointed.? For Christians, Jesus Christ is the long awaited Jewish ?Messiah.? He is ?Immanuel,? which is to say, ?God with Us,? when the word ?Us? refers to everybody, all of humankind.
Christians believe that Jesus Christ was the incarnation of God, the embodiment of God in human life. In this sense Jesus was truly human and truly God. When Christians talk of Jesus as the ?Son of God? they do not mean that their relationship was like the biological one between human fathers and sons. They are speaking as the ancients did when describing God's reaction to the coronation of a new King. ?This is my beloved son,? or ?This is my only begotten son,? God said in praise of the new monarch. According to the Biblical story, this is what God said of Jesus. From the very start it has been difficult for Christians to avoid confusion in their two-fold conviction that Jesus was truly God and truly man.
?Docetism? was one of the earliest problems. It denied the true humanity of Jesus, holding that he only appeared to be human. ?Arianism? eventually became a problem as well. It denied the true divinity of Jesus, picturing him as divine but not equal with God. There were many other similar challenges. In 451 ce the Council of Chalcedon declared: We confess that one and the same Christ, Lord, and only-begotten Son, is to be acknowledged in two natures without confusion, change, division, or separation. The distinction between natures was never abolished by their union, but rather the character proper to each of the two natures was preserved as they came together in one person and one hypostasis. (Chalcedon 451) This settled the issue for most Christians, even if some have continued debating it ever since.
In addition to Jesus' preaching, teaching, and healing, most Christians emphasize his death and resurrection and their special importance in freeing humans from sin and its negative consequences. In trying to explain how this happens they have used various analogies, as the Bible itself does, and each reflects the social settings from which it emerges. Maybe the process of atonement is like being found guilty in a court of law and having someone else pay the penalty or take the punishment. Or perhaps it is like being kidnapped and then being set free because someone else paid the ransom. Or could it be that the process is more like a school in which we learn about God's love when we concentrate on the final hours of Jesus' life, seeing how he chose to accept suffering than to inflict it upon others? Christians have used all of these metaphors, and many others, claiming all along that the full process of atonement is beyond the capacity of mere words to describe.
Christians believe that the church is the ?body of Christ,? meaning that today it continues the preaching, teaching, and healing ministry of Jesus. Many apply it to Christians in all denominations; however, others restrict its usage to those they take to be genuine.
Christians differ in how they view the billions of people around the world who are not Christians. Many hold that these persons cannot experience salvation because they have not decided to become followers of Jesus, and this is so even if they have never heard of him. Many others hold that God is equally at work in all the religions of the world and that their genuine adherents are all equally saved. Most Christians take one of many alternatives between these extremes; one of these ?middle? alternatives holds that, even though God is at work in all religions, people who are active in ones other than Christianity can still benefit from hearing its ?good news,? and that Christians can benefit from hearing theirs.
Christian worship and life center upon rituals or practices signifying the presence of God in ordinary life called ?sacraments.? Roman Catholic and Eastern Orthodox Christians hold that there are seven: (a) baptism, the use of water to celebrate the beginning of a new Christian life; (b) confirmation, determining on the basis of further consideration to live as a Christian; (c) matrimony, the lifelong, loving and sexually exclusive union of a man and woman who establish a Christian home; (d) penance, doing sometimes difficult things that provide discipline when it is needed; (e) prayer for the sick, asking God for strength and wisdom in the face of illness and death; (f) holy orders, the decision by some to live their entire lives in service to the church as priests; and (g) communion or the Eucharist, a celebration with bread and wine as emblems of the sacrificial body and blood of Jesus Christ. Most Protestant Christians practice only two of the seven sacraments: baptism and communion.
Just as they believe that Jesus Christ was resurrected from the grave, the majority of Christians hold that they will experience life in the hereafter. But again they differ on the details. Most hold that the body and soul are so different that the soul does not die when the body does, and that instead the soul goes either to heaven, paradise, or to hell, punishment. Some contend that body and soul are inseparable, and that death includes the entire person, body and soul alike. They do not even like to talk about ?body and soul,? as though they are basically different. They much prefer ?embodied soul? or ?in-souled body,? or just plain ?person.? Both groups look forward to the resurrection of the dead at the end of time when, according to one view, body and soul are reunited, or according to the other view, persons are given new life as integrated wholes.
Health and Disease
Christians hold a positive view of the human body and its natural environment. Genuine well-being from this perspective is not about fleeing the material world in favor of the spiritual. Neither is it a matter of escaping individuality in union with the Whole or Absolute. Rather, it is the balanced integration and successful functioning of all aspects of life: physical, mental, social, ethical, and spiritual.
At least three types of disease flow from this understanding of health. The first is the malady of partiality. This occurs when an individual or society wholly disregards some important aspect of life, such as sex or spirituality. A second type of disease is the malady of imbalance and disintegration. Succeeding financially but not in other areas of life is an example. A third type of disease is the malady of unsuccessful functioning. This is what many people think of when they hear the word ?disease.? An eye that does not see, an ear that does not hear, or a brain that does not think are signs of ill health. This is the type of disease that medical professionals can most easily and effectively address.
Christians look at suffering?prolonged or continuing pain of any sort?in three primary ways. Some believe that God determines exactly what happens in every case, right down to the smallest detail. For them all suffering is good because everything fits into God's overall plan. Other Christians recoil at this suggestion. For them suffering is not good even though God can often help those who suffer to transform it into something good. A third stance threads a path between the first two by distinguishing between existential (normal) and pathological (abnormal) types of suffering. The suffering that parents often feel after all their children have moved is an example of existential suffering. Trying to escape this kind of suffering is not wise. Suffering from a malignancy is an example of pathological suffering. According to this Christian stance, the second kind of suffering should be prevented or treated as aggressively as the first should be patiently endured.
Either pain or suffering that is not outweighed by its offsetting benefits is evil. Christians hold that this occurs in at least three ways. The first is moral evil. This is caused by the misuse of human freedom. Murdering a child is an obvious example. The second is natural evil which occurs when something in the world of nature causes uncompensated pain or suffering. Tidal waves, earthquakes and tornados are illustrations. The third, and by far the most difficult for many to contemplate, is ecological evil. This is the predatory nature of the whole of life, something most Christians see as a consequence of sin: nothing in this world lives without killing.
Many Christians acknowledge that the pervasiveness and apparent permanence of evil in its three forms is the single greatest challenge to Christian faith. This because it is very difficult, both theoretically and experientially, to believe that the one true God is (a) wholly loving and (b) supremely powerful in light of (c) all the evil we observe and experience. This issue is often called the problem of ?theodicy,? a Greek word made up of two others that mean ?God? and ?righteousness? or ?justice.? Christians today relate to theodicy, or the problem of evil and suffering in the world as it relates to God, in several ways. Some come close to denying that evil is real. They say that life is like a movie and that once we have come to its end we will see that every scene was necessary. Or they say that life is more like a large painting: its dark portions seem pointless when we stand too close; but when we stand back enough to view it as a whole, we can see the contributions that even its shadows make.
Other Christians qualify the idea that God is completely loving. Some of these hold that even before they are conceived God freely chooses whom he will love and whom he will not. Others take a more measured approach. They contend that in our time the word ?love? has become so sentimental that many take it for granted that it is better to feel good than to be good and to do good. Given this widespread meaning of the word ?love,? they contend that it is better not to apply it to God. Yet other Christians take a hard look at the idea of divine power, recognizing that there are some things God cannot do. God cannot do that which is self-contradictory.
For example, no matter how vigorous the effort, God cannot make 2 + 3 = 7. Also, God cannot do that which is contrary to God's own moral character. An example of this is that God cannot command the torture of innocent children or compel unfaithful spouses to stop cheating. Taken together, these three ?limitations? on divine power makes it less plausible to hold God unilaterally responsible for evil. Yet even if this alternative reduces the perplexity and doubt that evil causes, something that many Christians doubt, it does not eliminate them. To some extent this challenge to Christian faith always remains.
As Christians struggle to understand the meaning of pain and suffering on the macrocosmic level, they are also confronted with many health issues that demand decisions for moral and ethical living. Being in optimum health and making wise ethical decisions that impact one's health are not only a necessity for survival and vibrant living, but also a fulfillment of the divine mandate to be caretakers of the gifts and resources granted by God. Christians take seriously Apostle Paul's words, ?Whether you eat or drink or whatever you do, do it all for the glory of God? (1 Corinthians 10: 31). We will see, however, that on some of the most talked-about and relevant health and bioethical issues of daily living, Christians are once again divided. In the paragraphs that follow, we survey five such issues?diet, procreation, abortion, stem cell research, and homosexuality.
For most Christians, the issue of diet is a very personal one. A great majority of Catholics, Protestants and the Orthodox do not have imposed restrictions on diet?what one can consume and not. For them, the death of Jesus voided the distinction between clean and unclean meat that are found in the Old Testament and opened the avenue for a life of freedom on dietary matters as long as one's health is not injured. A minority of Christians, however, have insisted that faithful stewardship of the divine gift of health entails avoidance of food and substances that are known to have negative health consequences. Taking the original diet found in Genesis 1 literally, such Christians have advocated vegetarianism or even strict veganism as the ideal diet to follow. They have argued that human beings were created to only consume nuts, vegetables, fruits and grain, and consumption of meat and fish should be avoided to lessen pain and suffering of animals and to promote greater care for the environment. Others (especially those whose religious communities were strongly impacted by the health and societal reform movements of nineteenth century America) have argued that alcohol has no place in a Christian's life since it is known to be a harmful substance. Most Christians, however, do not follow such restrictions and argue instead that the freedom that Christians find in the salvation offered by Jesus allows them to make individual decisions on these matters. They would oppose excessive consumption of alcohol and meat, but do not find moral or biblical arguments against moderate consumption of either.
Historically, Christians have had strong views on human sexuality. Virtually all of them agree that this part of life has two purposes: one of these is the unitive purpose (making love) and the other is the procreative purpose (making babies). It is very difficult to find Christians of any sort who object to this. Differences of conviction surface when it is asked whether it can be ethically permissible for Christian husbands and wives intentionally to separate these. At this juncture, Evangelical Protestants and Mainline Protestants tend to see things one way and Roman Catholics another, while Orthodox Christians are divided on the issue. Roman Catholicism teaches that it is not ethically permissible for Christian husbands and wives intentionally to separate the unitive and procreative purposes of human sexual intimacy. This is one reason why it opposes sterilization and contraception. Orthodox Christians have historically agreed with Catholics on this issue, but since the 1970s they have moved toward allowing individual believers to make procreation decisions, except for abortifacient measures which they continue to oppose strongly.
Evangelical and Mainline Protestants have difficulty following Roman Catholicism's line of thought when it teaches that artificial insemination, in vitro fertilization, and surrogate gestation inherently violate the unitive purpose of sexual intimacy. They agree that every new human life should begin in loving actions, but not all of them understand why it is unloving for a Christian husband and wife to become parents by working with fully qualified medical specialists in fertility clinics. When it comes to the issue of abortion, Evangelical Protestants, Catholics, and the Orthodox stand in sharp contrast to Mainline Protestants.
The former group has taken a very restrictive position by maintaining that performing or having an abortion is ethically wrong unless it is the foreseen but not intended outcome of attempting to save the pregnant woman's life. This point needs to be emphasized because some mistakenly say that the most restrictive Christian position on abortion means that, if it is necessary to choose between the lives of the embryo or fetus and the pregnant woman, her life should be sacrificed. This is not so. That it is not so can be established by recalling that in the cases we are usually talking about, ectopic pregnancies and uterine cancers, it is often not possible to save the fetus. On the other hand, Mainline Protestants are willing to view abortion with regret but moral approval in cases like rape, incest, profound fetal malformation and extreme maternal distress.
The considerations that inform the intra-Christian debate on abortion surface again with respect to stem cell research. A key issue, which is also intensely debated when the morality of abortion is being discussed, is the ?when? question. Everyone agrees that somewhere in the process of human gestation a line must be drawn, even if it is not entirely precise, between a new human life that the state must protect and one that it need not. Christians answer this question in two primary ways. Many say that conception is the time and this precludes stem cell research on human embryos, though it certainly can continue elsewhere, as Orthodox Christians, Catholics, and Evangelical Protestants think it should. Others hold that successful implantation, not conception, is the time. This makes it possible to do stem cell research on the thousands of no longer needed embryos in fertility clinics that will otherwise be discarded. Those who draw the line at implantation do not necessarily forbid abortion from there on; however, they hold that this decision is ethically weightier than preventing the implantation of fertilized ova or doing research on them.
Homosexuality is another issue that divides Mainline Protestants, on the one hand, and Evangelical Protestants, Orthodox Christians, and Roman Catholics, on the other. Most in the latter group of Christians view the homosexual identity as an aberration from God's created order and condemn homosexual practice as sinful. They regard the creation of Adam and Eve and their heterosexual identity and relationship as providing a normative view of human sexuality. Their view is further buttressed by such passages as Romans 1 where Apostle Paul makes a strongly worded denunciation of male and female homosexuality as found in the Roman world. Many in the Mainline Protestant churches, however, view homosexuality either as a trait that eventually emerged in the human race as part of God's creative activity or as an aberration from the creation norm of heterosexuality yet one that does not need to be condemned?like, for example, being nearsighted or flat-footed.
Both groups within Mainline Protestantism interpret the specific biblical statements on homosexuality as reflecting the cultural norms and biases of the time, thus not directly applicable in the modern era. For them, it is necessary to take into account recent scientific findings and to listen carefully to homosexuals. At the same time, there are many who belong to Mainline churches who, on this issue, agree more with the Evangelical Protestant?Roman Catholic?Orthodox wing of Christianity. This debate explains the reason why the National Council of Churches (a coalition of Mainline churches) has declined to take a stand on same-sex marriage, for example, whereas the National Association of Evangelicals, the Roman Catholic Church, and the Orthodox Church in America have officially opposed it. Perhaps more clearly than anywhere else, on this issue we see the deep and wide chasm between at least two different ways of reading scripture, viewing reality, and interacting with important ethical issues of our time.
Death and Dying
Virtually all Christians in the United States accept the two standard ways of understanding death: one of these is that death is the total and irreversible loss of circulatory (pulse) and respiratory (breath) functions; the other is that death is the irreversible loss of the functioning of the entire brain, including the stem. Though most Christians agree on the physiological meaning of death, the differences that lie among them on its theological meaning lead to different conclusions on such end-of- life bioethical issues as euthanasia and suicide.
The word ?euthanasia? is an English term derived from the Greek language that literally means ?good death,? not ?mercy killing.? Deciding which kinds of death are genuinely good requires an individual or group to face two distinctions: one of these is the difference between voluntary euthanasia and non-voluntary euthanasia, the first being a death that a mentally competent patient chooses voluntarily and with adequate information.
Virtually all Christians approve of not always doing everything to keep a terminally ill patient alive. They agree with the Bible that there is a time for everything, including a time to die, and that all others should respect this. About such measures?also called passive euthanasia?the consensus is overwhelming.
However, most Christians?again most Roman Catholics, Evangelical Protestants, and Orthodox Christians?oppose active euthanasia, an act of shortening the process of dying by doing something that intentionally ends a patient's life. But it is also the case that they usually look with favor upon giving the dying patient enough medicine to keep him or her comfortable even if doing this unintentionally causes the patient to die more swiftly. This is because Christian thinking has long distinguished between outcomes that are merely foreseen, on the one hand, and those that are also intended, on the other. They hold that it is ethically wrong intentionally to shorten a patient's life, but it is not necessarily ethically wrong unintentionally to shorten his or her life while intending only to relieve suffering.
Some Christians who favor the use of palliative care that might unintentionally hasten the dying process point to three analogous situations that seem to justify their view: one of these is that surgeons foresee that they will leave scars but do not intend to do so. Likewise, oncologists foresee that the chemotherapy they administer will have uncomfortable and unsightly side effects but they do not intend this. Still further, those who apply radiation therapy foresee that they will probably damage some healthy flesh but they do not intend this. However, Mainline Protestants, who are swifter to approve active euthanasia, frequently object that the difference between outcomes that are merely foreseen and those that are also intended is a semantic quibble.
Suicide is seen with disapproval by most Christians, even though the biblical writers sometimes report that someone ended his or her own life without expressing moral approval or disapproval. Some have gone so far as to say that it is an ?unpardonable sin? because it is the only one for which it is impossible to ask forgiveness. In previous generations Christians have dishonored the bodies of those who committed suicide and denied them burial in Christian cemeteries. Few Christian groups approve of such treatment in the twenty-first century, many preferring to view one who has committed suicide as an individual who was overcome by difficulties.
This negative attitude toward suicide is still evident in widespread Christian opposition to laws, like those in the states of Oregon and Washington, that allow doctors to give patients prescriptions for medicine with which they?the patients themselves, not the doctors?can end their own lives. Again, almost all Evangelical Protestants and Roman Catholics oppose it whereas a significant number of Mainline Protestants do not object and those who do are usually not strident.
Christians ritualize death and the grieving process in diverse ways but follow a common theme of hope and comfort. For Roman Catholics, it is important for the dying to receive the sacrament of prayer for the sick conducted by a priest in preparation for death. Once the patient dies, three rituals traditionally take place: (a) the vigil or wake at which family and friends spend prayerful time together with the deceased person; (b) a requiem mass at a church or cathedral which is led by a priest, and (c) the rite of committal where the loved one is laid to rest. Protestants typically have three events that parallel these; however, they can be less formal and traditional. Protestants often speak of separate meetings for (a) the viewing of the deceased (though it is often not held); (b) the funeral or memorial service led by a minister or a spiritual leader and involving family members; and (c) interment at the burial site. Orthodox Christians have a four-part process: (a) the Trisagion service (to ask God to grant rest to the departed soul) which takes place the night before the funeral service at the wake; (b) the funeral service with an open casket at an Orthodox church led by a priest; (c) burial at graveside asking God again to give rest to the soul of the deceased; and (d) Makaria, a ?mercy meal? shared by the mourners to celebrate the life of the deceased, traditionally with fish as a sign of fasting and mourning.
While Catholics, Protestants, and the Orthodox all permit autopsies, particularly when required by law, they are divided on the practice of cremation. Orthodox churches view cremation as desecration of the body, thus funeral services with cremated remains are not allowed in Orthodox churches. Until the 1960s, Roman Catholics were of the same position, but they have since relaxed their stance, allowing for individuals and families to decide and giving permission to priests to hold funeral masses with cremated remains. Evangelical and Mainline Protestants, on the other hand, leave the issue of the disposition of the body to the patients and their families.
Conclusion
Over the last 2,000 years Christianity has taken many twists and turns while never entirely losing its own identity. At this time in the United States Christianity is a conglomerate of diverse theologies and historical expressions with Roman Catholics, Orthodox Christians, Evangelical Protestants, and Mainline Protestants aligning themselves in different ways from one issue to another. For the most part, although there are important exceptions, Catholics, Evangelical Protestants, and the Orthodox tend to represent the ?conservative? wing of Christianity, while Mainline Protestants tend to occupy the ?liberal? wing. This pattern is evident and persistent in the relationships between these Christian groups and health and healing. Despite stark differences on a number of theological and bioethical issues, however, Christians are still able to find connectedness with each other through their common commitment to understanding and applying the Bible, common faith in Jesus, and mutual engagement in the world for positive transformation.
Dos and Don'ts



Dos
1. Remember how large and diverse Christianity is.
2. Keep in mind the general bioethical tendencies of Evangelical Protestants Roman Catholics and Mainline Protestants.
3. Understand the difference between foreseen and intended consequences and why many Christians think it matters.
4. Enlist the help of Christian chaplains ministers and priests.
5. Seek mentally competent informed and voluntary consent.
6. Relieve pain and suffering.
Don'ts
1. Act as though all religious people are ignorant.
2. Think that if you know what one Christian believes you know what they all believe.
3. Tell patients that suffering is part of God's plan.
4. Override the medical choices of mentally competent informed and un-coerced people because of your own religious beliefs.
5. Assume that they will eat anything offered.

David R. Larson
Glossary
Body of Christ Either the Christian church as the continuation of the ministry of Jesus Christ or the substance of the bread after it has been changed into the body of Jesus Christ in the Mass.
Deism Reduction of religion to what reason can establish; belief that God created the world but that now it functions on its own; partly a religious response to the European Enlightenment.
Eastern Orthodoxy One of the three major branches of Christianity first centered in the eastern portion of the Roman Empire but now worldwide; originally Greek in language and culture.
Evangelical Widespread and somewhat emotional revival in Awakening eighteenth-century England and North America of Christianity; partly a religious response to the European Enlightenment.
Fundamentalism Intensely negative reactions among twentieth-century Protestants, primarily in North America, against attempts to modernize Christianity; sought to get ?back to basics.?
Protestantism, More Conservative Christian churches in the United Evangelical States that descend from the sixteenth-century revolts against Roman Catholicism led by Martin Luther and others. Simply ?Protestant? in much of Europe.
Protestant, African American Christian churches in the United Historically Black States that descend theologically from the sixteenth- century revolts against Roman Catholicism led by Martin Luther and others.
Protestantism, More Liberal Christian churches in the United States Mainline that descend from the sixteenth-century revolts against Roman Catholicism led by Martin Luther and others.
Roman Catholicism One of the three major branches of Christianity first centered in the western portion of the Roman Empire but now worldwide; originally Latin in language and culture.
Sacrament Christian ritual or practice that conveys divine grace in human life. A ?visible sign of an invisible reality.? Sin Thought, word or deed contrary to the will of God. ?Original sin? used as a theological term refers to the first sin by the first humans, Adam and Eve. The subsequent negative consequences of this original sin affect the lives of each human person.
Trinity The only true God in whom Christians believe, who exists of one substance in three persons.
Bibliography
Chalcedon Christology Formula (451 ce) Center for Reformed Theology and Apologetics. Online, available at: www.reformed.org/documents/chalcedon.html (accessed December 21, 2008).
Edwards, J. (1959) Religious Affections: The Works of Jonathan Edwards, vol. 2., edited by J. E. Smith, New Haven: Yale University Press. Nicene Creed (325 ce) Center for Reformed Theology and Apologetics. Online, available at: www.reformed.org/documents/nicene.html (accessed December 21, 2008).
US Religious Landscape Survey (2007) ?The Pew Forum on religion and public life.? Online, available at: religions.pewforum.org (accessed December 21, 2008).
Suggested Texts
Eck, D. L. (2002) A New Religious America: How a Christian Country Has Become the Worlds Religiously Diverse Nation. New York: HarperCollins.
Gausted, E. S. and Schmidt, L. (2004) The Religious History of America, revised edition, New York: HarperCollins.
Marty, M. (2008) The Christian World: A Global History. New York: Random House.
Meade, F. S. and Hill, S. S. (2007) Handbook of Denominations, 12th edition, Nashville: Abingdon Press. Numbers, R. L. and Amundsen.
D. W. (eds.) (1986) Caring and Curing: Health and Medicine in the Western Religious Traditions, with a foreword by Martin E. Marty, Baltimore: The Johns Hopkins University Press.
Suggested Websites
Christian Medical and Dental Associations (www.cmda.org)
National Association of Evangelicals (www.nae.net)
National Council of Churches (www.nccusa.org)

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