I spent the first two articles making some observations about two specific examples of the issues and controversies we are currently facing when talking about UK healthcare, the Junior Doctors Strike and debates around funding and privatisation when it comes to the NHS.
Now, let’s step back a little and think about how we view the situation as Christians. What are the underlying Biblical/Theological principles when it comes to healthcare. Well, much of how we think about the current situation revolves around two important beliefs or values.
The first is that healthcare is a fundamental, basic human right that we are all entitled to. That’s one reason why people argue that healthcare should be available as a public service, through the State, free at the point of use. Indeed, I would argue that this belief has grown over the years, not only do we assume that medical intervention to attempt to treat disease and to save life is a right. In effect, we have come to expect that a certain level of health and well-being (physical and emotional) is a basic human right. Of course, determining what that level is may create its own challenges.
If medical care is a basic right, then not only might we expect it to be provided as a public service but we also expect the health service to be publicly run but we also expect there to in effect be a civic contract between the people, represented by the Government and those who provide healthcare. We expect those who provide healthcare to do so, even if that involves some forms of personal sacrifice, for example, we would expect them not to treat healthcare as a competitive labour market where they can seek out the best jobs even if that means moving abroad, we would also expect them not to take industrial action. In return they should be able to expect to be properly valued and honoured. The civic/social contract means that they don’t strike, they work long hours, they commit to the UK health service and we in return pay them well.
The latter point draws upon the second belief/value, namely that medical care is of ultimate value. This means that those who provide it are worth more in terms of status in society and in terms of pay and benefits than others, that there is a social hierarchy and we place medics at or near the top.
It also means that we expect medical intervention to come at any cost. I would argue that ironically we have seen two extremes at work. First, the willingness to give up quickly on life through euthanasia when it runs into other conflicting values, such as our belief that suffering should be irradicated and secondly through the way that we expect all resources to be thrown at a situation and seek to cling onto life.
Now, as I said at the start, we need to step back and ask what a Christian worldview teaches. I want to suggest that it teaches us the following. First that God created the world and called it good, however, sin means that the world is subject to decay and we to death. Second that he made us in his image. Third that God the Son came and lived among us as a man, fully divine, fully human, suffering death. Fourth that resurrection hope, rooted in the resurrection of Jesus Christ is physical so that we will have new bodies and we will live in a physical new creation.
From this, we can make the following observations.
- That humans made in God’s image have dignity. We should value and care for human life.
- That as fallen, sinful human beings we are not in a place to demand rights, we do not deserve anything. All that we receive is through grace.
- That the physical body matters. We should have a concern for physical health and wellbeing.
- That whilst physical health matters, it is not ultimate. We don’t take this life lightly, this rules out euthanasia but nor do we cling on as though this is all that there is.
Now, those observations will help us to think about what heath care should look like in our context. Now, there are limits to this. There will be some things that we can agree on. We agree that human dignity and therefore life is important. However, as we get further and further into the day to day practicalities, we will arrive at different conclusions.
Let me show you what I mean. Well, first of all, we will value life, we will therefore rule out the taking of life as an option. For Christians, euthanasia is off the table. However, we also know that life here and now is not the sole or ultimate value. So, it’s not about life at any cost. I remember that when my mum was in hospital with pneumonia and sepsis, she was seriously ill. She told me that the doctor had asked her views on DNR as she was over 80 and this conversation was routine for her age. She explained that as a Christian she did not agree with taking life, so there was to be no euthanasia, including by stealth. However, she knew Jesus as saviour and had assurance of eternal life so she also said “no heroics.” But what do we mean by “no heroics.” We will draw the line in different places when it comes to when to persist with treatment and when we move to palliative care.
Secondly, we recognise that medical care has value but again, it is not ultimate value. I want to suggest that Christians will want to be cautious about setting any profession on a pedestal. We will respect doctors and consider them worthy of their wage. However, we will also point out that the diligent engineer is proactively preserving life, the pastor has a concern for spiritual wellbeing and the teacher for a person’s whole life wellbeing. The fireman, soldier and policeman all play their part in preserving life too. We will be cautious of placing a monetary value on a doctor’s value. We will want to insist that they are first and foremost loved and respected for who they are rather than what they do. However, there will remain different views about how we recognise and reward skills and work. Christians may disagree about how much a doctor or teacher should be paid and therefore what pay rise they are entitled to.
Thirdly, Christians will argue that medical care matters, not because we are entitled to it as a right but because we have a responsibility to each other. The creation mandate includes care for all of that creation including each other.
Does this mean that there doctors and nurses shouldn’t strike though? Well, I don’t think that we have enough of a basis here to decide that question. Some Christians will believe that no-one should strike because of Paul’s words about working for a wage, others will see this as a fair and reasonable part of collective negotiation. I don’t think we can say that public service workers must not strike but nor can I see anything wrong in principle with Governments attempting to make it part of their social contract that they are legally bound not to strike. Of course, the deal should include that they will be fully and generously cared for.
Fourthly, we do have a responsibility to care for one another’s medical needs but I don’t think this is on a pedestal over other aspects of physical care. We are as responsible for making sure that our fellow men and women are well clothed, fed and housed. So, I don’t think that the NHS is more Christian, more ethical than the insurance based systems we see in pretty much every other country, including those with more socialistic leanings! However, I believe there is both wisdom and compassion in ensuring that people do not have to be worried or anxious about the cost of medical care when the time comes. For that reason, my personal view is that we need a system that ensures medical care is genuinely free at the point of service for all and I think we’ve slipped a long way from that. I don’t think this means that we have to solely fund such a system through taxation. However, I recognise that for many reasons others will disagree with me on these points. We can agree to differ as Christians providing we agree on the foundational principles above.
One last thing. If we are describing values and principles that arise out of our Christian beliefs, can we impose these on others. If I believe as a Christian that we have a duty to care out of grace and compassion for the medical needs of others and that we should act to preserve life, then is that something only Christians are required to do? I would argue not because whilst the reasoning arises from revelation, that revelation points us to things that are objectively morally true for all regardless of whether or not they believe them. Common Grace means that we want to see the whole of society benefit from the good that God reveals.
I hope that as you’ve read this, you’ve found things we can unite on and agree with. I’m sure that you’ve disagreed with at least some of my opinions on how we apply the foundational principles. In fact, I hope you do because I’m fallible. I look forward to seeing ongoing, lively debate about these things.