Healthcare and the Common Good

One of the hot topics in the presidential election campaign is healthcare and healthcare reform, but is there a Christian perspective on healthcare? If so, what is it? I had the privilege of attending the annual bioethics conference hosted by the Center for Bioethics and Human Dignity and Trinity International University this past July. Guided by this year’s theme, “Healthcare and the Common Good,” some of the health profession’s leading practitioners discussed issues of healthcare and the health profession from a Christian perspective.

What Is “The Common Good”?

Dr. Edmund Pellegrino, chairman of the President’s Council on Bioethics, began the conference by distinguishing between first-order healthcare questions and second-order healthcare questions. First-order questions in this case involve the moral or ethical implications of healthcare. These questions include: What do we do with the poor and ill? What are our moral obligations to them? By what criteria do we judge healthcare programs? And, is the healthcare system providing for basic human needs? Second-order questions, often covered by the media, include economic issues, systems, and politics. Usually, this level of inquiry seeks to answer questions like “How is healthcare to be structured?”

Dr. Pellegrino used Aristotelian philosophy to discuss the idea of common good. He describes common good as everyone being enabled to fully achieve their own perfection as men. Essentially, everyone is valuable because he is a human being, and part of giving them value is to provide for them relief from suffering and the opportunity to flourish, whether they merit it or not. Dr. Pellegrino asserts that this is similar to the biblical idea of being not only your brother’s keeper, and your enemy’s keeper, but also ministering physically to those who are irresponsible. As Christians we have an obligation to care for the weak and the infirmed, and we, furthermore, cannot make value judgments on the worth of someone’s life because of their personal behavior.

Human Dignity

Underlying any area of bioethics based on a Christian worldview is the concept of man as a special part of creation made in God’s image.{1} This means that our views on healthcare should reflect the inherent dignity of the individual. Dr. Pellegrino discussed this essential element that part of common good is valuing man because he is man, and I would add that it is expressly because he is made in the image of God.

Many of the sessions at the conference, whether they were on doctor/patient relationships or public policy, centered on this point that man is made in the image of God and that individuals should be valued as unique and important. This presupposes a theistic worldview.

During my paper session at this conference, I emphasized the importance of a worldview approach for laying the foundation of how to evaluate specific bioethical issues. This is also essential in evaluating healthcare policies and our moral obligation to the weak and infirmed. How does one’s worldview affect their various views on healthcare?

As Nancy Pearcey points out in Total Truth,{2} every worldview answers three basic questions: Where did we come from? What happened to us (why is there evil)? And, how can things be made right? As Christian theists we would answer these questions with “Creation-Fall-Redemption.” Naturalists, on the other hand, would answer with the triad “Darwinism–Evil is an illusion–Survival of the fittest.” A naturalist’s creation story is that of Darwinism.{3} Therefore, man is nothing more than a product of natural selection. He does not hold a unique position above other animals, and he was not specifically created with a purpose.

One’s view on origins is fundamental to how man is regarded, and it determines which ethical system is used to determine right and wrong views on healthcare. The tension is between the theistic view that man has inherent dignity and worth, despite his capabilities or lack thereof, and the naturalistic view that man’s worth is based on whether or not he is a burden on society as a whole.

One view places an absolute value on a person while the other places a relative value. This, in turn, determines whether or not we share a moral obligation to help the weak and infirmed.

But We Vote on Second-order Questions!

While the ethical implications on healthcare are of primary importance, usually we are asked to evaluate healthcare based on second-order questions: How much does healthcare cost? Who should get subsidized? How are they subsidized? Should healthcare and health insurance be privatized? Which candidate’s plan do I agree with?

Several of the speakers at this bioethics conference addressed specific plans by candidates and their opinions about them (For more information on second-order analyses, see the Women of Faith Blog post which summarizes Dean Clancy’s discussion on McCain/Obama Healthcare plans. See also James Capretta’s discussion on policy analysis, PowerPoint® presentation from the conference and a related article.) But the emphasis at the conference was not in endorsing one candidate over another as much as evaluating healthcare from the perspective of a Christian worldview. In other words, we first must answer the primary questions and then use that analysis to guide our views on the secondary questions in healthcare.

I came away from the conference with an understanding that there are several problems with the current healthcare system, from overuse of technology to doctor/patient relationships to how the government subsidy system works. However, these problems are really the fruits of a deeper problem having to do the worldview approach that medical health professionals, politicians, and we, as a culture, take on the issue of health and healthcare. Healthcare is becoming more and more a consumer business or a commodity, and less and less a moral obligation to help those that are weak and infirmed (or a moral obligation to help prevent people from becoming weak and infirmed).

There is no one solution; thus, no one candidate has the solution to all of our healthcare problems. And deciding between expanding government subsidies and privatization is not the root of the problem, so it is not the ultimate solution. As Dean Clancy, former member of the President’s Council on Bioethics, pointed out in his session on “Solutions,” society can achieve four levels of “happiness”: 1) the ultimate good, 2) good beyond oneself, 3) personal achievement, and 4) immediate gratification.

As a culture we are stuck at levels 3 and 4 (personal achievement and gratification), and this means our priorities and decisions are stuck there. This is directly tied to our worldview. From a naturalistic vantage point, it would be logically inconsistent to move beyond levels 3 and 4. However, on a theistic worldview, 1 and 2 follow from the biblical perspective on priorities such as, “You shall love the Lord your God with all your heart and with all your soul and with all your mind…You shall love your neighbor as yourself.”{4} God is the ultimate good, and then we are to love others by doing good beyond what benefits ourselves.

What Can I Do?

We can serve a witness to our culture by modeling the biblical perspective on healthcare and human dignity. Maybe not necessarily on the voting ballot, but oftentimes this mindset is modeled on a very personal level by providing for the weak and infirmed in our churches and communities. Or by treating individuals with value, even if they are irresponsible with their health. Or through the way doctors and nurses treat their patients. These are all very tangible ways that people can see the love of Christ and may very well be one way to change some of the problems in our healthcare system from the grassroots level.

Notes

1. “So God created man in his own image, in the image of God he created him; male and female he created them” Genesis 1:27 (ESV).
2. Pearcey, Nancy, Total Truth: Liberating Christianity from Its Cultural Captivity, Crossway Books, 2004, pgs. 45-46.
3. This is referring to Darwinism as a philosophy: The presupposition that there is no God, only nature.
4. Matt 22:37, 39 (ESV).

© 2008 Probe Ministries


The Moral Fallout of the ’98 Elections

Now that the November elections have passed, it is time to apply a little 20/20 hindsight to the results. An initial observation is that even the experts were surprised by the outcome, as Democrats gained five seats against the Republican majority in the House, while drawing even in the Senate. Less than a month before the elections, the political director of the Democratic National Committee stated that losing less than twenty-six House seats and less than six Senate seats would be a victory for Democrats. Even moderate political analysts believed that Republicans would secure net gains of eight House seats, three Senate seats, and three governorships. Yet, this election was the first one since the presidency of FDR in which the party of the president did not lose seats in a congressional election. It would seem that these elections deserve special consideration.

The reason why so many had expected poor election results for the Democrats was obviously the scandal that has enveloped the Clinton presidency in the last year. Many Republican leaders seemed to regard the election as a referendum on the President, discounting polls which suggested otherwise. The question is, How could so many “experts” have so misread this election?

Perhaps one of the most significant aspects of this year’s results has to do with the vote of religious conservatives. By comparing this year’s vote with the elections of 1994, when Republicans regained control of the House after years of a Democratic majority, we notice a major shift in the voting activity of the so-called “religious right.” In 1994, 67 percent of self-described religious conservatives voted Republican for Congress, while only 20 percent voted for Democrats. In the 1998 elections, however, 54 percent of religious conservatives voted Republican, and 31 percent voted for Democrats, a significant 24 percent swing.

This, in itself, helps explain the strong showing of Democrats, but prompts the question, Why did religious conservatives have such a dramatic shift in voting patterns? Several attempts will be made here to answer this question.

Earlier this year, James Dobson of Focus on the Family issued a kind of ultimatum to the Republican Party leadership. Expressing frustration at the failure of Republicans to pass significant legislation in areas such as abortion, he threatened to take as many of his radio listeners as he could away from the Republican Party if they did not make more of an effort to focus on social issues important to evangelicals. Immediately after that threat, there was a sudden emphasis by Republican leaders on abortion and homosexuality, and once again the ban on partial-birth abortions was brought to a vote. However, it was again vetoed by President Clinton. Even though, in that respect, Republicans have made an effort to reflect the social concerns of evangelical Christians, their failure to make any progress even with a majority may have left many supporters alienated.

Another factor may have been the failure of Republicans to stand up to President Clinton in the last-minute budget negotiations in October. Instead of pressing for their own agenda months earlier, when Mr. Clinton was at his weakest, Republicans were pressed into a corner by the threat of another government shutdown. Their failure to acknowledge that their constituents were concerned with more than just President Clinton’s behavior ultimately seems to have backfired. The main message this year was that conservatives themselves sent a message to Republicans that they can no longer be counted on to simply vote anti-Democrat. As Steve Forbes has said, “A party that loses sight of its values and principles loses its base.”

Presidential Scandal and the ’98 Elections

Republicans and Democrats alike had anticipated major gains for the Republicans in the House, mainly because of the scandal involving President Clinton. House Speaker Newt Gingrich had predicted a gain of as many as thirty seats. Yet when the votes were tallied, Democrats had actually gained five seats, and Newt Gingrich has now resigned his position as Speaker of the House. Does this mean that voters rejected an agenda favorable to religious conservatives?

Many Christians have been dismayed by the apparent lack of voters who were willing to punish Mr. Clinton for his actions. Of course, Mr. Clinton himself was not running for office, but it was thought that, by voting against Democrats, voters would signal their disapproval of President Clinton’s behavior. Instead, it appears that voters voted for candidates on their own merits; it would seem that voters were in most respects voting for candidates and issues, not just against Mr. Clinton.

Some, associating the Democratic Party with the Lewinski scandal, have suggested that the positive gains of Democrats indicates that Americans are less and less concerned about the morality of their political leaders. Several factors have to be considered before making that judgment. In the first place, no single party has a monopoly on morality. This became especially evident when it was revealed in recent months that several prominent Republicans had been involved in sexual affairs in the past. And even though the current legal issue against Mr. Clinton is all about perjury under oath and suborning of perjury, as well as possible obstruction of justice, it is impossible to separate these issues from President Clinton’s involvement with Ms. Lewinski. Consequently, the emphasis in the press on the sexual nature of the scandal has led many to conclude that Mr. Clinton’s behavior is not unique.

Another key factor in how the American people have reacted to the Lewinski scandal is a simple psychological response to the long period between President Clinton’s denial of an affair and his eventual admission of an “inappropriate relationship.” In the eight months between those two speeches, most Americans had gradually become convinced that the President lied in his initial denial. Consequently, when President Clinton admitted he had misled the public, the shock factor was absent–many people had already concluded that he wasn’t telling the truth. And the constant emphasis in the news about the story eventually led many to conclude that our elected officials were obsessed with the scandal. Though it has been suggested that the reluctance to condemn Mr. Clinton’s actions is indicative of a nation that has lost its moral compass, it could be that it also points to a sense of morality that is repulsed by publicly discussing private matters.

Exit polls indicate that over half of all voters did not consider President Clinton an issue in the election. Some candidates and issues which he supported won, and some lost. It seems what was most significant was that Republicans in this session of Congress failed to establish an agenda of their own that emphasized traditional conservatism. As we will see in the next section, it is evident that voters did not reject the social and moral concerns of Christians, but rather the failure of some Republicans to make a principled stand on the issues.

Major Victories for Christian Conservatives

The mainstream press has attempted to portray the lack-luster performance of Republicans at the national level as a major blow to the religious right, yet exit polls indicate that the major difference this year was that it was the religious right itself that shifted its allegiance away from the Republican Party. The clear message is that Republicans cannot expect religious conservatives to slavishly vote Republican every time. Voters seem much more willing to look at each individual candidate on his or her own merit, rather than simply following a party line. It would appear that some of its strongest supporters are attempting to send Republican Party leaders a message.

Christians and other religious conservatives who are concerned that the elections indicate a major shift away from traditional morality may be focusing too strongly on their reaction to the Clinton scandal. Whereas 20 percent of voters went to the voting booth with the clear intent of voting against Mr. Clinton, another 20 percent voted with support of the President in mind. Those two groups thus canceled each other out. The other 60 percent of voters maintained that they voted with no thought of President Clinton. And since many Democrats attempted to distance themselves from President Clinton during their campaigns, it would be a stretch to suggest that those who voted Democrat were voting for the President. And when we consider the issues which were voted on this past November, we can’t help but notice that major victories were won in areas important to Christians.

Perhaps one of the most defining moments of these elections was the banning of same-sex marriage in both Hawaii and Alaska. Of course, the silence from the major media has been deafening, especially when it had been suggested just two years ago by gay activists that Hawaii would open the floodgates for same-sex marriage. Even though homosexual activists poured considerable amounts of money and energy into their campaigns, nearly 70 percent of both Alaskan and Hawaiian voters affirmed marriage as being between one man and one woman. In a related issue, Republicans had high hopes that Matt Fong would defeat liberal Senator Barbara Boxer in California, but Fong shocked many conservative supporters late in the campaign by making concessions to the gay and lesbian community. Needless to say, Fong lost, mainly due to his failure to take a principled stand.

Also, another major issue for Christians has been the emphasis on the sanctity of life. In the home state of Jack Kevorkian, Michigan voters defeated doctor-assisted suicide by a wide margin. Colorado voters also placed a limitation on abortion by requiring parental consent for teenagers seeking abortion. Unfortunately, Colorado and Washington both refused to outlaw partial-birth abortions, although the votes were very close.

In sum, while conservatives seem to be laying all their bets on the Republican Party, and because Republicans didn’t do as well as expected, there has been a tendency to say conservatism, and especially religious conservatism, was a big loser on election day. But when we look at the results of particular races, we see that only a handful of true conservatives lost at the national level, and many referendums were won. Any attempt to view the elections as an outright rejection of a conservative religious worldview cannot be supported by the facts.

Moral Judgment and the Sexual Revolution

As we have examined the November elections, we have concluded that the attitude of most Americans toward President Clinton was left out of the ballot box. President Clinton was not running for office, and the major shift in voting patterns was demonstrated by religious conservatives, who appear to have punished Republicans for failing to act like the majority in Congress. Probably the best way to gauge how Americans view the President is to recall the polls that have been taken since the Lewinski matter erupted in January of 1998.

Certainly one of the most curious aspects of this political year has been the consistently high job approval ratings the President has enjoyed, while at the same time he is considered a poor role model by a majority. The very fact that people have made a moral judgment of the President is once again a positive indication that American society is not simply concerned with pragmatism. But on the other hand, the majority of Americans seem to be willing to forgive Mr. Clinton and simply want the issue to go away. In this respect, Americans seem perfectly content to ignore the scandal as long as there is peace abroad and economic prosperity at home. Besides, it is the opinion of many that the scandal is “just about sex.” If anything, it is that small phrase which should be of concern for society, since it seems to imply that sexuality is of little importance. A biblical worldview is entirely opposed to such a notion.

According to Genesis 2, God’s desire is that one man and one women should become “one flesh” in the act of marriage–a euphemism for sexual union. But since the beginning of time, humanity has rejected God’s plan, and the consequences have been devastating. In the United States, there has been a concerted effort since the 1960’s to overcome any social restrictions against sex outside of marriage, all in the name of personal freedom. But in fact, many of the social pathologies in this country can be traced to a distorted view of sexuality. When men and women reject the sacredness of sexuality and view sex as simply recreational, the natural results are obvious: unwanted pregnancies, abortion, sexually transmitted diseases, AIDS, divorce, single-motherhood, and poverty. Not so obvious is another related issue. When young men grow up without fathers, they typically learn conceptions of manhood from other youth, rather than learning from their fathers. Violent gangs are often the only families that some young men ever identify with. Thus, to speak of sexuality as though it is of little import is a tragic mistake.

Of course, because the sexual revolution has had such a powerful grip on society, it is easy to see why so many are able to separate President Clinton’s personal life from his public duties. When any society loosens its attitude toward a particular activity, the members of that society will feel less ashamed for engaging in that activity. As a consequence, those who engage in that activity will be much less likely to condemn anyone who does the same thing, since to do so would necessarily be a condemnation of themselves. More than likely, the willingness for many to simply ignore the Lewinski matter is a residue of a casual view of sexuality. However, the American people must remember that the issue before them is not only a sexual scandal, but a question of the rule of law. That issue has broader implications for us all.

The Case for the Common Good

As we have been considering the recent national elections and the suprising results, we have considered the possible connection between the results and the public’s reaction to President Clinton and the Lewinski scandal. We have noted that exit polls indicate that candidates were typically judged on their own merits. Thus, overall results cannot be said to reflect favorably or negatively on Mr. Clinton. We also noted that the sexual revolution has lessened the tendency of Americans to judge anyone for sexual indiscretions. But, what must now be emphasized is that the President’s impeachment hearings are based on allegations of perjury and obstruction of justice. That many Americans are willing to dismiss such an offense should be of concern to all of us.

Perhaps the first thing that should be acknowledged by all is that President Clinton is well-liked by many Americans. Consequently, this case is similar to the O.J. Simpson trial, where a well-known and well-liked celebrity won a trial of public opinion. In this situation, millions of Americans are sympathetic toward the President. Unfortunately, many Americans have construed their affection for the President as being admissible as evidence in a court of law. In reality, juries are not simply allowed to determine a person’s fate by majority rule. And contrary to what has been stated recently by media friends of President Clinton such as Geraldo Rivera, perjury is a criminal offense. To simply ignore its possibility in this case would be devastating for our legal system.

When we consider that this country’s government is founded on an intricate system of checks and balances, we must ultimately recognize that the rule of law is essential to a just society. When people are discriminated against, or granted special favors in the legal system, the result is injustice. President Clinton himself recognizes this, as he is the top law enforcement officer in the land. In addition, the following statement is found in the Justice Department’s manual for federal prosecutors: “Because false declarations affect the integrity of the judicial fact-finding process, all offenders should be vigorously prosecuted.”

Unfortunately, contemporary society tends to denigrate public service, and place a premium on the comforts of private and family life. Consequently, many people are willing to ignore the legal case against President Clinton since they assume it does not directly concern them. But, as Alexis de Tocqueville reminded us over 150 years ago in his great work Democracy in America, one of the dangers of democracy is that it can flatten people’s personalities, making them “creatures of mass opinion and enslaving them to the drive for material security, comfort and equality.” But if the American people are willing to forfeit the integrity of the law out of a desire for convenience or prosperity, it demonstrates not so much the lack of a moral compass as it indicates that many Americans no longer recognize the concept of the common good.

When a government becomes too powerful, de Toqueville warns, its citizens are willing to sacrifice freedom for comfort. Should contemporary society assume that President Clinton should not have to be held accountable for perjury, it would establish a legal precedent that would call into question the rule of law in our society. To that extent our elected congressional leaders must remember that their first responsibility is to the laws which they as a body have sworn to defend. While the spectacle of impeachment hearings is a sad prospect, even more tragic would be the cynicism that would be the result of ignoring this case for reasons of political expediency.

©1999 Probe Ministries