• Msgr Antony Perumayan

Introduction

Medicine has made great strides in the prevention and treatment of diseases. There has been a renewed recognition of the Church’s role concerning the social dimension of health care. In “A Framework for Comprehensive Health Care Reform: Protecting Human Life, Promoting Human Dignity, Pursuing the Common Good” (1993), the U.S bishops described how the current health care system was expensive and did not adequately serve all those in need, framing their approach to health care rooted in the Catholic social tradition. In another statement, “Ethical and Religious Directives for Catholic Health Care Services” (1994) the bishops reaffirmed the ethical standards of behaviour that are rooted in the Church’s teaching about human dignity. They tried to provide authoritative moral guidance on contemporary issues facing Catholic health care.

To give wings to our dream of just health care, it is necessary, for the physicians, clergy and other interested persons, to enter into dialogue and explore together their complementary ministries. Taking seriously the relationship, the representatives of both realms (religion and medicine) must search together as allies in the service of the complete person. Anything less would be bad religion and bad medicine.

Here we try to establish the complementarity between religion and medicine (health care) and its implications for the present day health care provision. This can be had from the shared values and concerns. At the outset, we look at the etymological development of the words ‘religion’ and ‘health’. Then we make a perusal through the historical involvement of religious traditions in relieving people from sickness and suffering and then we move towards making a sketch of the religious categories as ethical foundations for health care delivery. This relationship is often misunderstood, either because of the over emphasis given to the ‘medical model’ or the under emphasis given to the wider context of health and health care.

From Confrontation to Co-operation

According to histories of medicine, published over the last 75 years, the story of medicine is, in part, the story of progressive liberation of science from the bondage of religious superstition, tradition and authority. Sometimes superstition and hostility of religious voices has retarded the development of modern science. It should not be forgotten, however, that there has been and still has, a relationship between religion and health care. I use the term health care intentionally, because even today ‘medicine’ does not encompass the whole of our effort to relieve sickness. Many forms of health care transcend the boundaries of the traditional ‘medical model’: care of the poor, the aged, the physically and mentally challenged are but some cases in point.

1. Etymological Development

The very language we use to talk about religion and health indicate subtly at least, the wider relationship between religion and health. The words for health and certain religious realities are almost closely related.

In English language, words like ‘heal’, ‘hale’, ‘holy’ and ‘whole’ derive from the same root ‘hal’ which means ‘complete’ which forms part of the definition for ‘health’, by WHO: ‘health is the complete, physical, mental, social well-being. This will appear plain and simple for those who identify themselves with the holistic health movement. In Latin, ‘salus’ and ‘salvus’ denote health and salvation respectively. For the Roman mind, one was impossible without the other. It sounds more interesting in the Greek language. There, the words ‘soter’ (saviour) and ‘soas’ (health) are derived from the same root ‘sozo’. Sozo also means ‘to make whole’. These etymological developments point to the relationship of religion to wider health concerns.

The above relationship can be approached in two ways: historical involvement of various religious traditions in restoring health and certain religious categories that serve as the ethical foundations of health care.

1. Historical Involvement of Religious Traditions in Health Care

It is opportune to consider the role of the healing god (asklepios) in the ancient Graeco-Roman world. The sick were brought to his temples for restoring health through religious and physical activities. Some of those who were admitted were cured. Even those who were not cured went away consoled and comforted. It was so because of the intentional involvement of the person in the entirety of his being, as body, as mind and spirit. No dimension was left untreated. All activities in the temple were designed to integrate the whole person into a therapeutic community and to reconcile him, with self, with others and with gods. This kind of emphasis on the whole person in community, is characteristic of all religious healing traditions. The same can be seen in the living religious traditions too – Judaism, Christianity, Islam, Buddhism and so on. Their interest is clear from the fact that they founded hospitals and hospices and established the codes of ethics and etiquette for governing the physician-patient relationship.

III.  Religious Categories as the Ethical Foundations for Health Care Delivery

The next approach focuses more on certain religious concepts that serve as the ethical foundations of health care. These foundations give meaning, direction and motive to the health care providers. They have a bearing on issues of sickness and health, with implications for health concerns. We limit our search to nine salient concepts. Of course, this list of ours is not exhaustive. We shall see them in turn.

1. Creation: The Basis for Scientific Development: The first of these concepts is the notion of ‘creation’. Gen 1:1 reads: ‘In the beginning God created the heavens and earth.’ God creates all things and states that they are good. The doctrine of creation is a central factor accounting for the rise of modern science, in the West. We can deduce from the creation account that the world is neither identical with nor opposed to God; neither divine nor demonic. It is simply created and therefore, it may be approached, investigated and even manipulated. Human beings are part of the created order, and so we too may be studied and explored. Here have the foundation of various forms scientific enterprises, even medicine and health care by extension.
2. Sanctity of Life: The Foundation for Physician/Patient Relationship: The second concept is human dignity and the ‘sanctity of life’. Being created in the image and likeness of God, all life merits some consideration from our part: we must respect it from womb to tomb; we shall not destroy it.

According to histories of medicine, published over the last 75 years, the story of medicine is, in part, the story of progressive liberation of science from the bondage of religious superstition, tradition and authority. Sometimes superstition and hostility of religious voices has retarded the development of modern science. It should not be forgotten, however, that there has been and still has, a relationship between religion and health care.

While the eastern religions see in each sentient being an immortal soul, the western tradition bases ‘sanctity of life’ on the doctrine of ‘imago dei’. There are many ways to consider this imago. We can locate it in our capacities: such as reason, creativity, sociality, immortality through which they mirror the divine glory. Accordingly, for the health care providers, the other (the patient) is not an object to be used for his gains, but an ambassador/reflection of God. This awareness will transform the physician/patient relationship.

1. Dominion and Stewardship: Motive for Moving from Manipulation to Moderation: The third concept revolves around the issues of dominion and ‘stewardship’. According to Gen 1:28, man is given dominion over the fish of the sea and over the birds of the air. Man can subdue nature. But this dominion has its limits. We read in Ps 24:1, “the earth is the Lord’s and human beings are but stewards of it.” Adam and Eve were placed in the garden to ‘till and keep it;’ and not to destroy and mindlessly exploit it.

However, the West has forgotten the lessons of stewardship, on both the individual and environmental levels, but the East has showed respect for the theme of stewardship. While the western tendencies are characterised by domination, manipulation and exploitation of man and nature, the eastern thought is characterised by the concepts of harmony and moderation.

From the above, we have come to the realization that our ability to develop a particular procedure or product has to find justification framed by the question of our survival and by the quality of that survival. Its implication to health care is very evident. No one shall squander the scarce medical resources; no physician shall engage in administering ‘aggressive medicine’ (treating for treatment’s sake, with no proportionate results).

1. Love and Compassion: Inspiration for Caring the Down trodden Sick: ‘Love and care’, which occupied a unique place in most of the world religions, is our fourth theme. The demand to love rises out of Judaism and Christianity. The parable of the good Samaritan focuses on the ministry of healing. A good portion of the gospel narrative is concerned with Jesus’ ministry to the sick. In Matt 25:40, Jesus identifies himself with the sick and the poor. Other religious traditions too, witness to the same. The four blessed dispositions of Buddhism are, loving kindness, compassion, sympathetic joy and equanimity. In the writings of Theravada Buddhism, Buddha is pictured as caring for a sick monk and there we read, “whoever would tend me, should tend the sick.” That is, in Buddhism also, those who minister unto the sick minister also to the ultimate reality. This theme should inspire the health care providers to care for the poor and downtrodden sick brethren.
2. Covenant: An Impetus to Go Beyond Contract Models: The fifth is the ‘covenant’ concept. Covenant is a solemn agreement between God and his people. It was modelled upon the formal pacts in the near east. Such treaties respect both the freedom and obligations of each party. What is particularly striking in the covenant is God’s faithfulness and love even in the face of continued unfaithfulness. This model has superiority, as it avoids some of the rigidity characteristic of contract models.

The covenant model has been used to elucidate the physician/patient relationship. It highlights the health care providers’ indebtedness to society and to God, the active view of the patient as a covenant partner, the context of faithfulness and trust necessitated by the patient’s vulnerability etc. Thus, the covenant model fosters the traditional aims of medicine and health care.

1. Freedom and Responsibility: A Call to be the Voice of the Voiceless: The sixth theme is that of ‘freedom and responsibility’. Being free men, we have to take responsibility for our decisions and actions. No religion endorses an absolute and unlimited freedom. We are limited in some way by who we are and by the situations we are in. In this respect, we can see an analogy in medicine and religion. None of us is born with a perfect body or a perfect mind. Still we are free to use our bodies and minds, I mean, we can smoke, drink, engage in stressful occupation, if we wish so. Of course, such choices and behaviours will have their impacts.

We have to remember that some are not as free as others! What then, of freedom and responsibility? Can we encourage a person working in a dangerous situation, to leave his position, if no alternative means of employment are available? Shall we propose a balanced diet to someone who cannot afford it? In this regard religion and medicine are alike: both must seek to increase the options for freedom to give patients and persons the chance to choose freely among real alternatives. This will call for involvement in social and political action. Only then will we be able to avoid immorality in health care.

1. Vocation: A call to go beyond Self-Interest: The seventh religious category is ‘vocation’. Medicine is considered to be a profession. Profession can be seen as a response to a calling from a transcendent power. It has its roots in the medieval Christianity. There it described the vows made by the religious. Later, its use was expanded to practical disciplines like medicine, law and the like. The word ‘profession’ connotes two things: one, the promise to be competent in one’s field, and the other, the intention to place the well being of those served over self-interest.
2. Justice: A Norm for Distribution of Health Care Resources: The demand for ‘justice’ is the eighth concept. This was strongly sounded in the writings of the prophets. According to this prophetic demand God is ethical. He desires that all may be treated justly. We read in Mich 6:8, “But what does the Lord require of you but to do justice and love kindness and walk humbly with your Lord?”

The above teaching involves elements related to health and health care. How shall we distribute the scarce health care resources? Shall we trust the open market place and the ability of the recipient to pay or on the potential of the recipient to make a contribution to society? Can we justify the expenditure of scarce medical resources in the futile prolongation of human life, when by doing so, we deny life – saving services to those who might be saved? Or is there any justification for investing in better diagnostic equipments when large portions lack even basic health care?

Thus the prophetic demand forces us to confront questions that we would otherwise avoid and compels us to consider health care, not only in terms of technical proficiency but also in terms of moral demands.

1. Finitude: An Exhortation to Say ‘Enough’: The final concept in our non-exhaustive list is ‘finitude’. It has a critical importance. We read in Ps 8:5, men are created ‘a little less than God’, which means, we are not God, but limited and finite. We will set ourselves up for disappointment if we were to forget this aspect of our existence. We want to prevent suffering and death, which is not possible always. Accepting this aspect of our existence – finitude – we should be prepared to say ‘enough’ when we realize that the continued treatment will make the condition of the patient worse. However, for the religious persons, suffering and death have their place, as a phenomena which only God can control. For them, God’s final word will be a resounding affirmation of life and of the human effort to preserve it. We shall not expect our efforts at helping the other always to be successful, nor may we expect all suffering and death be abolished. To do so, would be to make of medicine a new religion and the physician a false god. Still, we are not allowed to give up our effort. We can, at least, make an empathetic accompaniment with the person at the end stage.

Conclusion

We have been trying to strike a complementarity between religion and medicine (health care). At the outset, we saw an apparent confrontation between the two. A closer look, basing on the etymological development, historical involvement of religious traditions in health care, and some of the religious categories which act as the ethical foundation for health care, showed us that the relationship is real. These categories will enable us to mete out, a moderate yet just health care with humanness. At a time when medical profession has seemingly become a business profession, this kind of approach to health care, from a religious perspective, will inspire us, to confront questions which we will avoid otherwise and will force us to re-examine our priorities in the health care delivery. If we take the categories of freedom and responsibility seriously, we will be inspired to get involved in social and political actions, thus becoming the voice of the voiceless. It will be to the advantage of our disadvantaged brethren.

To give wings to our dream of just health care, it is necessary, for the physicians, clergy and other interested persons, to enter into dialogue and explore together their complementary ministries. Taking seriously the relationship, the representatives of both realms (religion and medicine) must search together as allies in the service of the complete person. Anything less would be bad religion and bad medicine.