Knowledge of God, Knowledge of Ethics.
A key component of the foundations of Christian spirituality and ethics as described above is the view that people can have genuine knowledge of God and knowledge of right and wrong. A few observations about the word knowledge need to be considered. First, by knowledge we mean the opposite of mere opinion. Knowledge is more than just an educated guess; it is being in touch with the real world as it really is. Thus, knowledge in this sense is not merely subjective, but is rather an objective description of reality. For example, the proposition “the earth is round” is an objectively true description of reality, even if some people happen to subjectively deny that the earth is round. Subjective beliefs may be true or false. What would make subjective beliefs true would be if they matched the real objective world. Fundamentally, knowledge is the possession and awareness of truth.
There are two philosophies, however, that stand in contrast to the Christian belief that one can have knowledge of God and knowledge of right and wrong, namely scientism and postmodernism. These two philosophies are very influential in today’s society, although they are not compatible with the Christian worldview. It is important to understand these philosophies because not only are they not compatible with the Christian worldview, they arguably have negative effects on the practice of medicine and health care.
Scientism
Although the term scientism has the word science in it, it is crucial to recognize that (1) scientism is not the same thing as (2) science. In the Christian worldview, science is a great and good thing. In fact, the Christian worldview has always encouraged careful investigation of the natural world. In the Christian worldview, medical technology is considered a good gift from God insofar as God has created the kind of world that has a structure that can be discovered and manipulated to bring about the good of human beings (Rae & Cox, 1999). Scientism, however, is not compatible with the Christian worldview. Scientism is the belief that the best or only way to have any knowledge of reality is by means of the sciences (Moreland & Craig, 2003, pp. 346-350). In other words, if something is not known scientifically then it is not known at all, and the only way to hold true beliefs about anything is to know them scientifically.
That may sound reasonable and even commonsense, but there are two problems with scientism: (1) scientism is a self-refuting philosophy, and (2) science has clear limits. First, if the only way to have true beliefs is through science, then the thesis of scientism itself (“the only way to have any knowledge of the world”) could not be true because it cannot be proven scientifically. Thus, the thesis of scientism fails its own truth test. Scientism’s thesis is, in fact, a philosophical statement. Philosophers call such propositions self-refuting because they invalidate themselves by definition, similarly to someone claiming, “I cannot speak a word of English.”
Second, while science is a powerful way of gaining knowledge of the natural world, science is limited and is not the only way of gaining knowledge. Consider the following two limitations of science (though there are many others); science cannot tell us anything about (1) ethics or (2) how one ought to use the results of science (University of California Museum of Paleontology, n.d.). Science is wonderful and describes the way things are, but it has no authority to tell us what we ought to do morally. Science cannot tell me whether or not I ought to love my spouse, keep my promises, or give to the poor. Even when it comes to ethical issues that involve science, science cannot determine what the right thing to do would be. For example, science might be able to describe the nasty effects of a terminal disease on a person or explain the state of a person’s brain if that person is in a vegetative state. However, science cannot determine whether euthanasia or physician-assisted suicide is good, bad, right, or wrong. Science also cannot determine how scientific data and results ought to be used. Science might enable the discovery of chemical processes or structures, but should the results be used for creating biotechnology to engineer human DNA? Should the results of scientific research be used to create bioweapons for military purposes? Such questions are beyond the bounds of what science can answer. Remember scientism is NOT science; it is a philosophical thesis that claims that science is the only methodology to gain knowledge and that every other claim to knowledge is either mere opinion or false. However, as Nicholas Rescher remarks, “to take this stance [of scientism] is not to celebrate science but to distort it” (as cited in Moreland & Craig, 2003).
Postmodern Relativism
Postmodernism is a broad philosophical position that claims that there is no such thing as truth or an objective reality that can be known. A common way in which postmodernism is expressed is through a view called relativism. Relativism is the view that there is no such thing as truth in the common sense of that concept. Every claim about the nature of reality is simply relative to either an individual or a society/culture. Another way to put this is to say that truth is invented by people (whether it is individuals or entire societies) instead of being discovered. According to this way of thinking, there is not genuine truth to be had or known, only subjective opinions or beliefs. While certain questions are no doubt matters of subjective opinion, such as “what is the best flavor of ice cream?” or “what is the proper way to shake hands?” not all questions are. This is most clearly seen when we consider moral or ethical propositions about right or wrong. It would be a serious mistake to claim that the propositions “murder is wrong” or “racism is evil” are mere subjective matters of opinion. However, that is what relativism implies. If all truth including morality is simply a human invention, then there is no standard for genuine truth, and it follows that there is no genuine right or wrong. However, this is certainly false. Whether or not the Nazi party, made up of thousands of individuals, believed that killing 6 million Jews was a good thing, we have to say without any hesitation that they were genuinely wrong. But it is not possible to be wrong unless there is genuine objective truth to be known.
Both scientism and postmodern relativism are incompatible with the foundations of Christian spirituality and ethics. The Christian worldview holds science in high regard and accepts it as one of the most powerful communal ways of obtaining knowledge about the world. However, contrary to scientism,the Christian worldview does not accept science as the only way of knowing things about the world. Secondly, contrary to postmodern relativism, the Christian worldview holds that genuine objective knowledge of God and of right and wrong is possible. It follows then that who God is and what is right and wrong are not merely matters of subjective opinion, but genuine truths to be discovered.
Conclusion
The foundations discussed above provide the framework for Christian ways of ethical and spiritual decision-making in health care. It is important to understand therefore that the Christian way of ethical and spiritual decision-making is distinct from other worldviews and is not the same as Buddhist, Muslim, or even atheist ways of ethical and spiritual decision-making. It is not fair or respectful to paint all religions or worldviews with the same brush under the heading of “spirituality” and ignore the differences.
Topic 2 will discuss a foundational principle to the practice of medicine and health care, as well as bioethics namely, the principle of respect for persons. The Christian worldview goes even further and states all human beings are made in the image of God and therefore have intrinsic value and are worthy of dignity and respect.
Topic 3 will discuss the field of bioethics and introduce some of the main methodologies of ethical decision-making in health care. The focus in this section will be on the methodology called principlism which stresses the application of four moral principles to all ethical decisions in health care. Prinipalism will be used and interpreted in light of the Christian worldview and the overarching narrative presented in the Bible.
Topic 4 will briefly introduce issues of death, dying, and grief. The focus will be on ethical issues at the end of life and the Christian worldview regarding death in light of the biblical narrative and the hope of resurrection inaugurated by the person and work of Jesus Christ.
Topic 5 will conclude with discussion about the facilitating of ethical and spiritual decision-making for patients, and the practical application of the principles and tools introduced in this course.