Medical Service

In the 1970s I was asked to give an address at a conference on euthanasia and abortion at the RVI. One other of the six speakers was as young as I was. In fact we had been fellow students in the same university Christian Union. At the time he was the Research-Fellow with Cicely Saunders at St Christopher’s hospice in London in its early days. So he was helping develop what is now called “palliative medicine” and “pallative care” and since 1989 has been recognized in the UK as a full speciality.

I can remember two things from his afternoon session. One, that he talked faster than I can. Two, that his session blew the minds of many doctors from the North and Scotland who were listening. It was a slide show on how to use drugs like morphine or diamorphine in the control of pain in extreme cases. You did not have to use them to kill patients as the only release from extreme pain. Death was not the only option.

People at that time had little idea that such treatment was possible. But now students all over the world are taught about palliative medicine and care as a result of the work of Dame (as she became) Cicely Saunders and Robert Twycross - the (then) young doctor.

So … the first lesson for this morning. Because of their fundamental Christian beliefs Cicely Saunders and Bob Twycross believed that life was a gift from God. He alone gave it and he alone could take it away. They knew, too, that men and women are made in God’s image and, therefore, their life is to be respected and protected. So they held to the old summary of the Christian and basic medical, ethic: “Thou shalt not kill, nor strive officiously to keep alive.”

But because of those restraints they invented - yes, for the world - the hospice movement and all that went with it and that others have since developed. So that needs to be remembered in the debate over embryonic stem cell research and other controversial medical interventions.

The stem cell debate, of course, is not over adult stem cell research which is bearing fruit and over which there is no ethical complaint. The issue is over research on, and so the destruction of, human embryos. The development of the hospice movement shows that the prohibition of any intentional destruction of a human existence never means prohibiting science solving problems in other ways.

Millions, literally, around the world, now thank God for Cicely Saunders’ belief. She believed that, however quietly and compassionately, extinguishing the life of the elderly (or younger) people in her care was prohibited by divine law whatever others said.

However, because she was desperate to help people in her care really to die well (the meaning of the Greek based word “eu [well] thanasia [dying]“), she used all the science she legitimately could. And the result is all the 1000s of hospices with their palliative care and medicine that are in many countries of the world.

And thank God that Bob Twycross as a young doctor in spite of the Voluntary Euthanasia Society (now called Dignity in Dying for better PR) did what he believed was right. As a result people have learnt from his studies and experience; and he is an example for young doctors today.

Well so much by way of introduction. I now want to look more closely at the issues of death and life. To help with our thinking I want to look at 1 Corinthians 15 and verses 50-58. My headings this morning are first, TODAY’S PROBLEMS, secondly, A GOOD DEATH, and, thirdly, A GOOD LIFE.


First, TODAY’S PROBLEMS,

In that conference at the RVI 30 years ago, there were, on the one hand, the presenting problems that we were asked to address. These were the suffering of the living (young unmarried pregnant girls with all the problems they feared they would face) and the suffering of the dying (the pain for some and the fear for many). But, on the other hand, there were deeper problems and there still are. These relate to fundamental beliefs.

Peter Singer teaches ethics in the United States. In 2005 he said, in an interview for a UK magazine, that if he had to choose between saving from a raging fire either a mentally disabled child (an orphan child nobody wanted) or normal animals, he would save the animals. If the child had a mother who would be devastated by the child’s death, he would save the child, but unwanted orphans he would not. Nor is this a “one off” statement. In 1984 he was arguing that we must (I quote) “abandon the idea that all human life is of equal worth.”

This view that human life has no innate dignity and that “we are only meat walking” was held by many when Paul was writing 1 Corinthians. We have a letter from an educated businessman away in Alexandria in Egypt about the time of Jesus’ birth. In writing home to his pregnant wife, he refers to the child she is carrying and says: “If you are delivered of a child [before I come home], if it is a boy keep it, if a girl discard it.”

But that all changed as Christianity spread. There was a new respect for life. So 200 years later Dionysius, the bishop of Alexandria, at the height of a great epidemic wrote of the heroic nursing efforts of local Christians. Many of these lost their lives while caring for others. However, “the heathen [he wrote] behaved in the very opposite way … At the first onset of the disease, they pushed the sufferers away and fled from their dearest, throwing them into the roads.”

And this respect and care for human life came from the belief, as expressed in Genesis 1.27, that human beings are supreme in the created order because created in the image of God. So you read in Genesis 9.6 these words:

Whoever sheds the blood of man, by man shall his blood be shed; for in the image of God has God made man.

You, therefore, don’t kill the vulnerable young or vulnerable old but care for them. Their significance and their claim to protection derives not from their "quality of life" or gifts and abilities, but on their status as being made in God's image. And the New Testament makes it clear that we all have the worth God put on us when he

so loved the world, that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life" (John 3.16).

But someone is saying, “this is all fine. Yet how do you choose between these two positions – this secular nihilistic view or the positive Christian view?”

Well, Paul had precisely that problem in Corinth. The church there was so like the church today. It was divided. There was sexual immorality in the church. There was confusion over marriage and marriage breakdowns. There were multi-faith issues. There were disagreements over the role of women; over holy communion and over worship in the church – should it be an informal free-for all, or more sober and structured? And many of these problems were being caused by the beliefs and attitudes of the pagan world outside the church, with the city of Corinth being very wealthy and morally very decadent. It had its temple to Aphrodite with, it was reported, 1000 cult prostitutes of both sexes.

So what does Paul do to help people get their thinking right as he draws his first letter to the Corinthians to a close? First, he reminds his readers of the basics of the Christian faith. Look back to verses 15.1-2:

1Now, brothers, I want to remind you of the gospel I preached to you, which you received and on which you have taken your stand. 2By this gospel you are saved, if you hold firmly to the word I preached to you. Otherwise, you have believed in vain.

But what is the gospel that saves? He tells us in verses 3-8:

3For what I received I passed on to you as of first importance: that Christ died for our sins according to the Scriptures, 4that he was buried, that he was raised on the third day according to the Scriptures, 5and that he appeared to Peter, and then to the Twelve. 6After that, he appeared to more than five hundred of the brothers at the same time, most of whom are still living, though some have fallen asleep. 7Then he appeared to James, then to all the apostles, 8and last of all he appeared to me also, as to one abnormally born.

Earlier Paul had taught the Corinthians that there is only one true God and he is a holy God. He loves humankind - and that means you and me. But he hates all the violence, cruelty, selfishness, lust and evil and sin of every other kind that in varying measure is bound up in every human heart. So the gospel, or good news, is that “Christ died for our sins according to the Scriptures” and therefore according to God’s plan for our salvation. And that was such good news to many of the people in Corinth. Paul says they had been mixed up especially sexually. But they now knew that they were forgiven at the Cross of Christ.

Who needs to hear that message this morning? The sexual chaos in the world of young people at the moment, certainly means some students need to hear it. And the chaos in medical ethics will mean some doctors and nurses need to hear it. But some will say, “how can we know all this is true – this view of a human existence with its glory form the image of God and its shame from sin and evil?”

Well, the answer is there in what Paul says next. He reminds the Corinthians that Christ is risen. There was a real resurrection. That is the evidence and this is the answer. The tomb was empty. Christ’s body was transformed. Yes, that is a mystery. But sane scholarship cannot get away from the facts:

The historian must explain why Christianity got going in the first place, why it hailed Jesus as Messiah despite his crucifixion (he hadn’t defeated the pagans, or rebuilt the Temple, or brought justice and peace to the world, all of which a Messiah should have done), and why the early Christian movement took the shape that it did. The only explanation that will fit the evidence is the one the early Christians insisted upon – he really had been raised from the dead. His body was not just reanimated. It was transformed, so that it was no longer subject to sickness and death.

So wrote Tom Wright, Bishop of Durham and a New Testament scholar, in The Times last Easter. Well, that brings us to our …


…second heading, A GOOD DEATH

The fact of the resurrection of Jesus brought amazing hope to the world. Greek and Roman writers had various views. Some held that death was the absolute end. Many believed in a shadowy future in Hades. A few hoped that the soul would exist bodiless like a happy ghost. But none believed in a resurrection. As for the Jews, as yet they were not clear always about life after death. The Psalmist writes, “It is not the dead who praise the Lord, those who go down to silence” (Ps 115.17). But here and there is the beginning of a belief in a resurrection. Most clearly you have it in Daniel 12.2:

Multitudes who sleep in the dust of the earth will awake: some to everlasting life, others to shame and everlasting contempt..

And by the time of Jesus, while some of the Jews like the Sadducees did not believe in a resurrection, the Pharisees did. The amazing thing about the Christian’s good news is that they not only believed in a resurrection at the end of time. They said one had already happened in the middle of time. For Jesus had actually risen from the dead. And because he has risen, one day all those who trust in him will rise like he did having conquered death and sin. And those that are still alive will be transformed without having to die. So Paul says in verses 51-57:

51Listen, I tell you a mystery: We will not all sleep, but we will all be changed - 52in a flash, in the twinkling of an eye, at the last trumpet. For the trumpet will sound, the dead will be raised imperishable, and we will be changed. 53For the perishable must clothe itself with the imperishable, and the mortal with immortality. 54When the perishable has been clothed with the imperishable, and the mortal with immortality, then the saying that is written will come true: ‘Death has been swallowed up in victory.’ 55 ‘Where, O death, is your victory? Where, O death, is your sting?’ 56The sting of death is sin, and the power of sin is the law. 57But thanks be to God! He gives us the victory through our Lord Jesus Christ.

Of course there is symbolism here. A trumpet was used at festivals and triumphs in the ancient world. What precisely it will be like, we will only know when it happens. Then we will see how right the Bible is to talk the way it does. But – and it is an important “but” - there will then follow the judgment. Paul writes in 2 Corinthians 5.10-11:

10For we must all appear before the judgment seat of Christ, that each one may receive what is due him for the things done while in the body, whether good or bad. 11Since, then, we know what it is to fear the Lord, we try to persuade men…20…be reconciled to God.

If there is a heaven and a hell, how vital we help the dying get right with God in preparation for that last judgment. For there is the possibility for some of what the Bible calls, “the second death”.

The old Book of Common Prayer like the Thirty-nine Articles is still the doctrinal standard for the Church of England. In the litany in the Book of Common Prayer is a prayer, to be prayed regularly, in which we ask to be preserved from “sudden death”. The ideal is not suddenly to die after a healthy life from a heart attack in which you go out like a light without being right with God. No!

The ideal is that you face death carefully, thoughtfully and having made your peace with God. In the Book of Common Prayer there is also a prayer to pray with someone on the point of death. And those Thirty-nine Articles endorse the Book of Homilies in which there is one Homily “against the fear of death”. There was a time when doctors and nurses would happily pray these prayers with patients.

As over 70 percent of the population claim to be Christian, Christian medical staff should still feel free to pray modern versions of those prayers with dying patients who would like it, as of right. And they can remind patients, as the Bible teaches, that for believers “to depart and be with Christ … is better by far” for Romans 8:11 says:

if the Spirit of him who raised Jesus from the dead is living in [them], he who raised Christ from the dead will also give life to [their] mortal bodies through his Spirit, who lives in [them].

And so (verses 38-39):

38…neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, 39neither height nor depth, nor anything else in all creation, will be able to separate [them] from the love of God that is in Christ Jesus our Lord.

Thirdly, A GOOD LIFE.

Christ is risen and reigning. Death is not the end. And one day each one of us will have to give an account of how we have lived. So it is important that we live a good life now. But what is the good life? You have it there in verse 58 of 1 Cor 15:

Therefore, my dear brothers, stand firm. Let nothing move you. Always give yourselves fully to the work of the Lord, because you know that your labour in the Lord is not in vain.

The Corinthians were not stable. They were blown around by every view. They easily followed false teachers and popular opinion. They would have been taken in by the propaganda of an ancient euthanasia group. Paul says, in effect, to them and us, “You should not be.” He says, “Stand firm. Let nothing move you.” And you stand firm first by trusting in Christ as your eternal Saviour and Lord. “If you confess with your mouth, ‘Jesus is Lord’ and believe in your heart that God raised him from the dead, you will be saved” (Romans 10.9). Then you must not drift. But Paul is also positive. He says:

Always give yourselves fully to the work of the Lord.

So be enthusiastic in the work the Lord has called to you in the NHS or wherever you work in the world. And also be positive and enthusiastic in your work for the Church. Why? Because, says Paul, “your labour in the Lord is not in vain.” It is not in vain now. Social studies are proving that a Christian framework of beliefs and behaviours produces, on average, better outcomes than the alternatives. And it will not be in vain one day when, on the day of judgment, Jesus will say, Matthew 25:34:

Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world.

I must conclude with a question.

Because sins can be forgiven, because Christ is really risen, because death is defeated and we have “victory through our Lord Jesus Christ”, if you are a medical professional, will you “stand firm and let nothing move you” this coming year?

Yes, health care is one of those areas where you have to “contend for the truth” over ethical issues. But at the same time be positive and…

always give yourself to the work of the Lord [the work he is calling you to], because you know that your labour in the Lord is not in vain.