Beginnings: Interrogating Hauerwas (9): Medical Ethics, Disability and the Cross

I’m deliberately posting this on Easter Sunday – the content is profoundly appropriate.

This is a series of short excerpts from each chapter of Beginnings: Interrogating Hauerwas edited by Leixlip lad Kevin Hargaden.

The outline of the book is in this post. This is an excerpt from Chapter Seven, Medical Ethics, Disability and the Cross.

How do we think of modern medicine? What questions do we need to be asking as Christians when facing life and death decisions? In whom or what do we trust and how is this revealed in what we expect or hope medicine to do for us? What should we be saying NO and YES to?

This is a long conversation ranging over a number of topics. The thread tying them together is Hauerwas’ work in critiquing liberal modernist assumptions within the practice of medicine and how ‘the disabled’ are treated.

As Brian Brock puts it at one point .. “the technical apparatus of caregiving, organized by liberal society, gets to define the field” (201). This is the tyranny of the expert; how power is ceded to the medical professionals : how we put our trust in medicine to such a point that –  as Hauerwas likes to say – we begin to believe that it will enable us to get out of life alive.

Books discussed are Suffering Presence and Naming the Silences. This post only touches on one aspect of the discussion – Brian & Stephanie Brock’s encounter of the health care system through the experience of their disabled son Adam, who also has leukemia and a degenerative eye condition. It’s a very honest and moving account.

Naming the Silences (1990) talks about the need to hear and listen to those actually suffering before talking about suffering. It also hones in on the issue of facing childhood leukemia. Brock, the interviewer, is coming at this discussion from first hand experience of both. He comments that

I feel in an especial position to revisit it and probe the whole theology of modern medicine and the role of church and family in offering a better way. (214)

These are my words and they may or may not be accurate to the discussion: the issue here is how the juggernaut of medical professionalism and high-tech treatments swamps our humanity. We treat because we can, but all sorts of ethical and moral questions do not get asked.

For example, in the children’s leukemia ward, progress of how to treat childhood leukemia is mostly made by what is, in effect, experimentation on children. There will be little benefit for the child being experimented on, but over time advances are made … and so goes the process. But this is a process that is largely hidden from parents and children. (215-16)

Brian Brock tells of he and wife fighting to have their son treated free from involvement in medical experimentation – and how incredibly difficult it was. Hauerwas adds:

SH: I was talking to one oncologist who said, “You know, we’re pretty good now at curing hard tumors.” And I said, “How did you get there?” And he said, “Oh we just used the drugs we had. We’ve had them on hand but we just got better at doing it.” I said, “How’d you do that?” And he said, “We experimented on kids.” And I said, “Did they die?” And he said, “Yes.” And I said, “Did you tell the parents it was experimentation?” He said, “No, we told them it was therapy.”

Even if they had told them it was experimentation, many parents of course are so desperate to have their children live they’ll say, “Oh yes, do whatever you think is necessary.” I do think that what’s crucial here is a truthful medicine, in which the parents have some sense that if they want to use these experimental techniques on their kids, that their children may well suffer pain they wouldn’t otherwise have suffered and will also die. (216)

Which leads a bit further on to this exchange ..

BB: We are in an odd kind of Mobius-strip world in which medicine can then only be funded because it is experimental and going to produce more high-tech medicine.

SH: I keep saying that Americans are committed to the idea that if we just get smart enough then with our medical technologies we will be able to get out of life alive! It’s not going to happen.

BB: Taking it back down to the concrete level: even with all the improvements in success rates, leukemia is still a terrible disease to treat because what you are treating is the bone marrow. You can’t get to it without a needle or a drill. And you treat it by injecting poison that is so toxic to the body that you have to put it in an arterial vein. If you put it into a peripheral vein it will burn right through the blood vessels and into the surrounding tissue. This means that when the disease is discovered you need both to get the chemo going and to surgically implant a port, so you don’t burn up too many of the peripheral veins with the chemo. But the kid at the point of diagnosis is pretty sick, so their immune system is not working very well.

I say all that because I vividly remember sitting on the edge of the hospital bed with Adam on my lap and holding the wound on his chest from where they’d put the port in. My despair was complete as I saw the incision slowly splitting open because his skin and his blood were unable to muster the strength to bind the wound. I tell this story because leukemia is a disease that leaves no marks at all, but the treatment leaves incredible wounds. I know people would find your comment about the barbarism of those treatments offensive, and yet any truthful account would say that it’s the treatment that is so scarring. You cut and stick and poison the kid because the only alternative is their dying. (218-9)

And Brock adds this from the perspective of a parent of son who is mentally delayed and largely non-verbal.

Adam hurts but he can’t verbalize where it hurts. He thus seems incapable of being incorporated within this medical narrative. In this, he seems to be more than a canary in a coalmine— another way that you often talk about disabled people— because he reveals modern medicine for what it is. Because he is impermeable to the mutual pretenses that govern our lives, for him there seems to be no other reality than trust and communion, or its lack. Without a horizon of future or past, he demands presence. (219)

And it is this demand for presence that meant that the Brocks decided that they would not subject him to the cruelty of a bone marrow transplant and 6 weeks in a bubble to avoid infection. To be separated from physical presence would be beyond bearing.

It did not come to this –  but these are the sorts of questions that Hauerwas and Brock are probing and encouraging Christians to think hard about rather than unthinkingly go with the modernist flow of whatever the medical experts say.

It would be wrong to end here without some more theological comment. At the end of the chapter Brock raises the idea that disability is a hermeneutical key to reading Hauerwas. By this he means that as Christians we are to live by and under the cross.

The Christian faith is not a success story. It is God’s glory revealed and victory won at the cross. The church and all theology can never move past the cross. We live in a world that Hauerwas has spent his life trying to engage Christianly – a world of war, pain, mental illness, physical illness and death, slavery, patriarchy and so on. (237)

He is, I think, an ‘anti-success theologian’. He takes seriously that the foolishness of God is wiser than the bankrupt wells of human wisdom.  And that is profoundly counterintuitive in a North American culture dedicated to success, happiness and positive thinking.

Comments, as ever, welcome.

 

 

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An Easter Reflection: 1 John 4, love, life, wrath and the cross

In 1 John 4: 7-10, the apostle writes this:

7 Dear friends, let us love one another, for love comes from God. Everyone who loves has been born of God and knows God. 8 Whoever does not love does not know God, because God is love. 9. This is how God showed his love among us: he sent his one and only Son into the world that we might live through him. 10 This is love: not that we loved God, but that he loved us and sent his Son as an atoning sacrifice for our sins.

That is 9 occurences of the noun or verb for love of [agapē (love) and agapaō (to love)] in 4 verses. I John is easily the most ‘love saturated’ book in the Bible and these verses represent the most ‘love saturated’ section of the epistle.

Famously – and uniquely in Scripture – John states that ‘God is love’. Love ‘comes from God’ because God, in himself, in his essential being, is love. This means everything that he does is loving – whether creating, sustaining, redeeming or judging.

For John, love is never abstract; it is always concrete and practical. God’s love takes the visible and tangible form of sending his one and only Son into the world – in John a realm of sin, death, rebellion and hate. If love is the motive, the result is that we might have life through him.

John thinks in big picture theology rather than systematic details. The ‘sending’ of the Son is shorthand for the whole story of Jesus – his incarnation, life, ministry, death and resurrection. His focus here is on the cross as verse 10 makes clear.

The Son is sent in love to give us life. But how does this work?

1. Somehow the death of the beloved Son is an ‘atoning sacrifice’ (hilasmos) for our sins – yours and mine. Despite some attempts to evade this, hilasmos has the sense of propitiation – turning away divine wrath against sin and sinners via an acceptable sacrifice. The love of God sits right alongside his anger and judgement against sin. It is at the cross that the love and judgement of God meet. To see Easter and the cross only as a supreme example of divine love and to airbrush atonement for sin out of the picture is to depart from the apostolic gospel.

2. In atoning for our sins, the death of the Son gives believers life. This implies a doctrine of regeneration. To be in the world is to be in a realm of death. Through God’s loving initiative, we are given the gift of eternal life. We no longer are to belong to the realm of the world.

3. Easter is solely dependent on God’s love and is God’s initiative alone – we are utterly unable to deal with our sin or be reborn into new life. It is only God who can  atone for sin and give us life. He does so at supreme cost to himself.

4. If the whole point of Easter is to give us life – what does this life look like? Quite simply it is a life of love. John’s focus is our love for each other. If we do not love, it reveals that we do not actually know the God who is love. Love is the ‘proof’ that we have received new life and our sins have been atoned for in the death of the Son. As we enter this Easter weekend, let’s first and foremost remember that both the motive and the ultimate purpose of the cross is love.

Easter is therefore a good time to reflect on our ‘love lives’ – how well are we loving?

Easter is an appropriate time to pray, repent and ask God to help us love – to be the people that the atoning death of Christ is designed to make us be. Perhaps there is someone we need to act to be reconciled with this Easter.

Easter is most of all a time to rejoice and worship the God who is love and who acts in love so that we might have the privilege and joy to know him.

Comments, as ever, welcome.

The kindness of God (2) Mission, violence and suffering

Kindness of GodWhat can we make of the fact that Christian history is soaked in blood?

Christianity is a cross-shaped faith. Christians follow a Messiah who freely gives up his life on the cross for us. The death of Jesus, God’s son, is the critical event of the NT and forms the core of the missionary proclamation. The message of the gospel is one of reconciliation and peace with God and with one another.

Yet in events like the Crusades, the cross of Christ was paraded as a symbol of God’s blessing on military carnage. Where soldiers were promised forgiveness and absolution for participating in God’s work on the battlefield (a sort of Christian jihad when you think about it).

What do we make of the fact that spiritual giants like Bernard of Clairvaux could write hundreds of deeply devotional hymns and yet be a passionate supporter of the wars against Muslims?

These are some of the questions considered in chapter 3 of David Smith’s The Kindness of God, called ‘Mission, Violence and Suffering’.

David points to different voices and approaches to Islam such as Francis of Assisi, who ‘waged peace’ on Islam in Egypt (interesting story this). Smith gives other examples; his point is how to engage ‘on the frontier’ with other cultures, particularly Islam, is a critical challenge in global mission.

Conversion is at the heart of mission. But there is a difference between proselytism and conversion. The former seeks to make the other exactly like me.  Conversion sees the other come to Christ but does not necessitate the other losing his/her cultural identity. You see this cultural pluralism in Acts 15 and the inclusion of Gentiles into the budding church.

Smith offers three guidelines or principles for doing mission in our troubled and deeply divided world.

1. ‘Other worlds’ across cultural boundaries are going to be places of surprise.  Mission is ultimately God’s initiative and we are given the privilege of joining in what he is already doing. This means for example, suggests Smith, that God may already be at work within Islam, preparing the way  and he quotes an Islamic prayer as an example.

What do you think of this notion of (some) divine revelation within other religions? Smith points to how God was ahead of Peter, working in a pagan Gentile’s life (Cornelius).

I recently met an ex-student who comes from Iran. It was not only wonderful to see him again, but encouraging to hear of many stories of what God is doing among Iranians in Iran – very often through dreams and visions. God is present and active well beyond the ‘reach’ of formal mission contact.

2. The need for an informed and sensitive understanding of the social, political and religious factors that may have caused a negative reaction to evangelism. Smith mentions Muslim and non-Western reactions to Western imperialism. (Ireland is a good example here too with its long legacy of politicised Protestantism suppressing the Catholic threat to English rule.)

3.The task of disentangling the gospel from the cultural wrapping in which it has been contained. Along with an understanding, in our post-Christendom west, of the factors why Christianity has, and is, being rejected. Only then can the church begin to re-translate the gospel afresh to the world.

Comments, as ever, welcome

Falling over themselves to explain Easter

Sacrifice, justification, redemption, penal substitution, ransom, healing, victory, example, reconciliation …..

The writers of the New Testament are falling over themselves to explain the saving work of God on the cross. All of these pictures or metaphors are ways to explain what happened at the cross.

And all of them would be meaningless if it were not for the resurrection (1 Cor 15). The resurrection is the seal, the vindication, the visible triumph of God in Christ through the Spirit over sin and death and evil. We celebrate today Resurrection Day.

They are not, however, random pictures. They are creatively and imaginatively chosen in the midst of ‘flesh and blood’ letters and gospels  consistently to interpret the cross of Jesus through the lens of the biblical story. In a very real sense, the entire New Testament is a theological reflection on the life, death and resurrection of Jesus Christ in terms of fulfilment of God’s promises to Israel. And these fulfilled promises now extend wider than Israel. The astonishing good news of Easter and Pentecost to come, is that this is a victory won by no localised Jewish Messiah, but a saviour for the world.

We can’t understand the depth and wonder of the cross without that OT framework. And even then, we will only scratch the surface. Such is the magnificence of saving work of God, there is no one picture that can possibly capture its scale and beauty.

To change the metaphor to a golfing one (from Scot McKnight in A Community Called Atonement – an excellent book ) we need to play with all the clubs in the bag if we are to play well. Each club is designed to do a particular job. If we play with one club all the time, our game will become one-dimensional and much less effective. And there are a lot of clubs in the Bible’s bag …

All of these pictures of the atonement are different ways of explaining HOW the gospel of Jesus the Messiah is good news (forgiveness, peace with God, right relationship with God, adopted as children into the promise, victory over sin and death etc).

God’s work of salvation is comprehensive and complete; it cannot be bettered.

They point to the COST of salvation. Jesus died for a purpose. The cross is necessary.

They show us WHY we need salvation. Enslaved, under judgement, captives who need releasing, facing death …

They point to the immeasurable LOVE of the triune God; Father, Son and Holy Spirit  (1 John 4:9-10)

This is how God showed his love among us: He sent his one and only Son into the world that we might live through him.10 This is love: not that we loved God, but that he loved us and sent his Son as an atoning sacrifice for our sins.

With best wishes to you for a joyful Resurrection Day

The call of the cross

A Good Friday Reflection

Without the croMonasterboice High Crossss, Christians have nothing whatsoever distinctive to say.

The cross is at the heart of all truly Christian theology. The Christian life is a life lived under the shadow of the cross.

The gospels can be described as passion narratives with extended introductions. While you might be uneasy with this (does it not relegate Jesus’ birth, life and preaching of the kingdom to secondary importance?) the fact is that the birth, life and teaching of Jesus are all cross-directed. They lose all sense and coherence without the cross.

Matthew captures the developing conflict with the authorities which leads to his climatic abandonment and death. All happening to fulfil the words of the prophets.

Mark consistently talks of discipleship in terms of suffering and the way of the cross  (8:34-8). Jesus’ own clear self-understanding of his mission is famously summed up in 10:45 where he comes not to be served but to give his life a ‘ransom for many’ – a reference to the servant of Isaiah in 52:13-53:12.

Matthew also links to Isaiah 53, a profoundly important framework for the mission of the Messiah (Matt. 8:17; 12:17-21).

Luke describes Jesus setting his face to Jerusalem, the place of his death and the focus of mission (9:51).

John opens with Jesus ‘the lamb of God who takes away the sin of the world’ (1:29). His whole gospel is focused on the death (and glorification) of the Christ. His link to Passover is echoed by Paul who calls Jesus ‘our Passover lamb’ (1 Cor 5:7). Here is the cross as sacrifice for sin, a theme expanded on at length in the book of Hebrews.

Paul wants to know nothing but know nothing but “Jesus Christ and him crucified” (1 Cor 1:1-2). He talks of Christ crucified being the power and wisdom of God. While Jews look for miraculous signs and Greeks look for wisdom, ‘we preach Christ crucified’ (1 Cor 1:18-25).

The foundational act of fellowship within the early Christian communities is a meal to remember and proclaim Christ’s death (1 Cor 11:26). In terms of the gospel, it is of first importance that Christ ‘died for our sins’ (1 Cor. 15:1-5). To be a Christian at all means to be ‘baptised into his death’ (Roms. 6:3). If Paul is to boast in anything, he will only boast in the cross of Christ (Gal. 6:14).

Take Colossians 2: 13-15. It is at the cross that sin is atoned for and forgiveness achieved. It is at the cross that condemnation and judgement are dealt with through Christ our substitute taking the penalty for sin. It is at the cross that a decisive victory is won over the powers and authorities opposed to the reconciling work of God.

“When you were dead in your sins and in the uncircumcision of your flesh, God made you alive with Christ. He forgave us all our sins, having canceled the charge of our legal indebtedness, which stood against us and condemned us; he has taken it away, nailing it to the cross. And having disarmed the powers and authorities, he made a public spectacle of them, triumphing over them by the cross.”

Or back to Corinthians: It is at the cross that the rulers of this age are ‘outsmarted’ – they did not comprehend the wisdom of God seen in the mystery of the cross, “the hidden wisdom which God predestined before the ages to our glory; the wisdom which none of the rulers of this age has understood; for if they had understood it they would not have crucified the Lord of glory” (1 Cor 2:7-8?)

Take Romans 5:1-11: It is the cross which supremely reveals the depth of the love of God “But God demonstrates his own love for us in this: While we were still sinners, Christ died for us.” It is the cross which speaks of the immeasurable grace of God since we are powerless to save ourselves. It is the cross which leads to justification (being declared righteous) and reconciliation (peace with God). It is the death of Christ which saves us from God’s wrath.

Yes, yes, the cross must never be separated from the resurrection – otherwise it remains a brutal form of execution; a place of death and despair. Yes, the cross lead to Pentecost where the victory won at Golgotha leads to the outpouring of the promised Spirit.

But the Scriptures are insistent that something unique happened at the cross. The texts are packed full of images and stories and metaphors of what went on there – and quite rightly we should unpack and explore each one. But the very diversity of images should tell us something. No-one image or picture or theme can neatly capture the cross. We need so many of them because what happened at the cross is something that is profoundly mysterious and beyond easy explanation.

So let’s never get so wrapped up in debates about how the cross works, or what it achieves, that we miss what the cross of Christ calls us to.

It calls us to worship, to adoration, to thanksgiving, to humility, to self-giving lives lived to honour God. It calls us to die to ourselves and live for him. It calls us to be willing to suffer for our faith. It calls us to give up power and control and manipulation as routes to ‘success in ministry’. It certainly calls us to reject violence as followers of a crucified Messiah. It calls us to daily repentance and fresh seeking of the generous grace of God. It calls to wholehearted love of the one who first loved us.

Tenebrae, lament and tears

tenebraeThis evening our wee church will be having what has become an annual Tenebrae Service (‘Service of Shadows’)

I’ve found it a very moving and powerful way of reflecting on the passion of Christ and am grateful to those who got us started some years ago. It’s structured around a liturgy of music, Scripture, silence and a gradual extinguishing of lighted candles after each reading. It ends in darkness when the lit Christ candle is carried out of the room and people leave in silence.

The scripture readings focus on the betrayal, arrest, suffering and death of Jesus, and on the cross as the climatic fulfilment of God’s redemptive purposes.

There are few places within low-church Protestant and evangelical spirituality for silent reflection together on the suffering love of the Messiah. Perhaps this is one reason why Tenebrae makes such an impact each year.

There are perhaps even fewer places for lament, and perhaps even tears, in the songs we sing, in the busy Sunday services we have, and in the activist lives we lead.

What place does lament, and perhaps tears, have for you at Easter?

Tears perhaps of gratitude & wonder at the self-giving character of God?

Or perhaps tears of repentance?

Or perhaps tears for the sacrificial suffering of the innocent One?  “For you know the grace of our Lord Jesus Christ, that though he was rich, yet for your sake he became poor, so that you through his poverty might become rich.” (2 Cor 8:9)

Or perhaps tears at the brutal apparent finality of the enemy that is death?

Or tears at the brokenness, violence and systemic injustice of the world we live in?

But when that Christ candle leaves the room in darkness, it is not extinguished ….