Sin, guilt and divine judgment are not popular in polite society; they're not things that people like to talk about. Richard Dawkins thinks Christianity a 'nasty little preoccupation' with 'sin sin sin sin sin sin sin'. (1) If you don't believe in a good and personal God who cares about his creation, then you're unlikely to believe in sin, guilt or judgment either. A nonexistent God can't be offended, can't declare us guilty, can't judge us. Instead, sin becomes just a wrong thing we do to each other, or even just something a bit naughty but fun. Guilt becomes just a subjective feeling, and the only judgments are those we ourselves make of others.

And the idea that everyone is inherently sinful is even less acceptable. Dawkins says it's 'morally obnoxious'. (2) Many people like to think that human beings are essentially good, even if they sometimes do make mistakes.

This statement in CMF's doctrinal basis is radically at odds with the world's understanding of humanity, and profoundly unpopular. So why is it there, and what does it mean?

It's there because this is what the Bible teaches. Quoting Psalms 14 and 53, Paul writes in Romans 3:10-12: 'There is no one righteous, not even one; there is no one who understands; there is no one who seeks God. All have turned away, they have together become worthless; there is no one who does good, not even one.' This sinfulness is universal, and though often expressed in unloving actions to others, it's primarily a rejection of God and his word. It's a failure to love him with all our heart, soul and might (Deuteronomy 6:5), as well as a failure to love our neighbour as ourselves (Leviticus 19:18). After David had committed adultery with Bathsheba and murdered her husband, he realised his sin wasn't just about the devastation he'd wreaked on them, but it was an offence against a holy God: 'Against you, you only, have I sinned and done what is evil in your sight; so you are right in your verdict and justified when you judge. Surely I was sinful at birth, sinful from the time my mother conceived me' (Psalm 51:4-5). David knows his very nature is sinful, and this is true of all people since Adam's fall. 'Sin entered the world through one man, and death through sin, and in this way death came to all people, because all sinned' (Romans 5:12). Paul and David know that a perfect, holy God cannot tolerate sin; he is right to judge sinners, and the penalty is death. So the human race is objectively guilty before God; we're born in sin, our lives are full of sin, we're dead in sin. Like the rest of mankind, 'we were by nature deserving of wrath' (Ephesians 2:3).

doing evil and good?

It is our human nature to sin, to rebel against God, to fail perfectly to love him and others. So by nature God is angry at our sinfulness, we are under sentence of death. This nature, reinforced by the evil of the world around us and the scheming of the devil, works itself out in the multitude of sinful actions we commit day by day, hour by hour. This doesn't mean that human beings aren't capable of wonderful acts of truth, beauty or love; the image of God in us is shockingly damaged, but it isn't lost. We still recognise what is good and what is evil (Romans 2:14-16). But even the best human actions are spoiled by sin; even at our best we are still under God's judgment. His standard is perfection; no-one is holy as God is holy (Leviticus 11:44, 1 Peter 1:16). However good we think our actions are, they're not good enough because they are all tainted by sin.

punishment now and eternally

And the judgment we face is not just the spiritual death of separation from God now, and then eternally in hell. God's judgment on sin began when Adam and Eve were expelled from the garden into a cursed world of pain and suffering (Genesis 3:16-19). This is now a world of broken relationships, of futility, of disease, and ultimately, of physical death. Much of the punishment we face for our sin is seen as God hands us over to the consequences of our own actions; to a shameful and vicious spiral of ever more depraved behaviour, our minds debased and our bodies degraded as we are filled with all kinds of wickedness (Romans 1:18-32).

what has all this to do with medicine?

Firstly, it's why there is medicine! Disease is a result of the fall; it's part of God's curse on our world. Disease is not 'natural', it's not how God designed things and it's not how things will be in his new creation. When Jesus came to defeat sin and death, one of the ways he showed this was by healing the sick. Not just because he's God and he could, but because all sickness will one day be removed. It has no right to be in God's presence. But although disease is part of the punishment people face in this earth, an individual's disease does not necessarily result from their own sinful actions. Some behaviours obviously have medical consequences, but when eighteen people were killed by trauma in Luke 13, Jesus was absolutely clear that they were not worse sinners than anyone else. Instead, such suffering is a reminder that the world is not as it should be, it is damaged by our sin, and we all need to repent.

Secondly, medicine is not the means of salvation. It is good to relieve the suffering of others; God has commanded us to love others, and Jesus demonstrated this compassion in healing the sick. But even the best medicine is spiritually just symptom control. Disease is a symptom of our underlying heart problem of sin (Mark 7:21-23). Medicine cannot remove our sin, its condemnation or its eternal punishment. Our guilt is not a psychological pathology that we need to escape; it's a forensic objective reality that needs to be forgiven. Medical technology cannot perfect humanity despite the best efforts of the trans-humanists. And the tragedy of secular medical ethics is that the world's answer to our ethical dilemmas is so often 'autonomy'. Yet autonomy, self-rule, got us into this mess in the first place! It's the assertion of self over God that lies at the heart of our problem.

Thirdly, we need to be aware of the corrupting power of sin to ruin what is good in our own medicine. It is so easy to become arrogant and elitist. Medical school is highly competitive, society puts doctors on a pedestal, and we can end up believing the lie that we're better than others. We can manipulate or demean colleagues to achieve our ends. We can fall into dehumanising technical medicine that prioritises targets or procedures over people. Patients become nameless cases or bed numbers who exist to further our learning and advance our career. We can be greedy for money or status or publications or diplomas.

But even if we avoid all that (and we won't), we can fall for the more subtle lie that makes medicine our idol. We can do this with any good thing God gives us: marriage, friendships, our ministry to others. We end up worshipping the thing, rather than the God who gives it to us. Our medicine is a gift God has given us for now; we are to use it to his glory. We must not allow it to come before God. One day he might give us another calling; perhaps through our own illness or exam failure or for whatever reason: do not resent the loss of your medical career, do not be angry with God for taking it from you. Perhaps your plans for your medical career don't work out, perhaps you don't get to do the groundbreaking research you thought God had called you to, perhaps you don't get to build the clinic in Africa you thought you would, perhaps you don't end up as a GP partner or consultant. Don't let these destroy you. None of these should be our ultimate goal; our chief end is to glorify God.

So lastly, this doctrine of sin will keep our focus on the good news of Jesus. The more we understand the enormity of our sinfulness, the more we will understand the vastness of God's love and grace to us in the gospel. The more we will glorify God. Awareness of our sin keeps us humble; there is nothing we can do to make ourselves right with God, we were dead in our sin (Ephesians 2:1-10). Doctors need the gospel as much as the drug addict they're treating; grace never allows us to look down on others. And we'll never forget that the most important need people have is not medicine; it's Christ. We will want to practise real whole-person medicine that recognises we are not just body, but body and spirit, and that to care truly for someone's spirit means pointing them to Jesus. And we will always see our medicine in the context of this bigger picture of living and speaking for Jesus Christ, bringing glory only to him.