Laurence Crutchlow on respectful interaction with colleagues and authorities.

To deal honestly with our professional and administrative colleagues and to respect the governing authorities.

Our recent discussion of honesty in our dealings with patients (1) set out principles that should extend to others with whom we deal professionally. CMF's ninth value (2) addresses integrity in professional relationships with not only those we work and study with, but also with the wider authorities who govern what we do.

Students work not only with the Professor of Anatomy or Consultant Cardiologist, but with junior doctors, nursing staff, and administrators both on the wards and on campus. Most of these will be authority figures, although the level of authority varies; the Dean has more influence over our future than the clerk on Ward B2, though the clerk may have far more personal contact with us.

Are we more likely to tell the truth to someone more senior? Do we (even subconsciously) differentiate between the faculty administrator, and the security man opening a teaching room? Surely all of them deserve that we deal honestly with them. We can make a great difference simply by being courteous, friendly, and truthful. Of course being truthful may include being firm and standing our ground; it isn't unreasonable to ensure we get teaching that is scheduled, for example. It is quite OK (graciously) to point out administrative problems.

Student integrity challenges include the question of being signed in for sessions not actually attended, or the veracity of reasons given for requesting extensions on assignments. For junior doctors, telling the truth when referring patients or on request forms often present greater challenges.

Governing authorities

'Let everyone be subject to the governing authorities, for there is no authority except that which God has established' (Romans 13:1). Though governing authorities aren't defined explicitly, the tone and context of this chapter (punishment for wrongdoing, payment of taxes) suggests the main thrust is about the government of the day.

The original recipients of this letter lived in Rome in the mid-50s AD. We don't know for certain whether the readers were subjects of emperors Claudius or Nero at the time, but neither were model democratic leaders. Claudius expelled the Jews from Rome, following problems with a figure that historian Suetonius called 'Chrestus' (whether this means Jesus or someone else we don't know for certain). Nero reigned from AD54 after Claudius died (having possibly been poisoned by his wife), and is famous for persecuting Christians. Although Rome did have a 'parliament' (the Senate), participation was based on a property qualification rather than an election as we know it, and the Emperor remained dominant.

So Paul commanded respect for a hostile government over which his readers had little or no influence. He went on to say: 'The authorities that exist have been established by God. Consequently, whoever rebels against the authority is rebelling against what God has instituted, and those doing so will bring judgment on themselves.' (Romans 13:1b-2). God had clearly established even the anti-Christian Emperors.

More than the government?

How far Romans 13 can be applied to structures that are clearly not the government, but nonetheless are in authority? As the principles of submission seem to be more wide-ranging, (3) it is not unreasonable to assume that we should usually submit to legitimately constituted authority over us, such as the medical school, or a hospital hierarchy.

Some read Romans 13 as meaning that we must not only obey the government without question, but should also not challenge it at all. It seems very unlikely in the context of the rest of Scripture that this is what Paul meant. Peter and the other apostles clearly declared that 'We must obey God rather than men!' in Acts 5:29 when in dispute with the religious authorities. In Acts 16 after Paul and Silas are released from prison, they are certainly not submissive in the way the treat the authorities, nor do they hide the injustice they had suffered (Acts 16:37). Daniel clearly disobeyed Darius' (admittedly corrupt) decree in Daniel 6, and had refused the King's food in Daniel 1.

How we are to engage with the government, or other governing authorities? Readers in the UK (although not in every country where Nucleus is read) are not dealing with the effective dictatorship of the Roman Empire. We are dealing with an elected government, for which anyone who has a vote bears some responsibility. Abraham Lincoln cited 'government of the people, by the people, for the people' at Gettysburg. (4) Although we may not think our democracy reaches Lincoln's ideal, his words encapsulate the responsibility that voters have when government is 'by the people'. In the UK the government can be engaged with most obviously through elections to parliament or referenda, but also in public consultations, or through the courts. Using these things is not a failure to submit to authority, but legitimate engagement, even a form of 'respect'.

What about the junior doctors' strike?

Are these verses relevant to the current dispute between government and junior doctors? Exactly what Christians should do has been controversial and raises many issues, and has already been covered in CMF publications. (5) Narrowly here, is a strike is compatible with respecting the governing authorities?

Technically the dispute is between an NHS Trust as employer, and a doctor as employee, rather than with the government. But as Trusts appear bound to implement government policy, it is reasonable to see the dispute as a direct challenge to the government. A strike is a particularly forceful way to challenge government authority; yet many junior doctors clearly feel that other less drastic means have already been tried and failed. Although a strong challenge, a strike is currently one that the law allows. There is a right to strike under current UK Law, and therefore I don't see that exercising that right fails to show respect for the governing authorities.

This would not be the case if the strike moves beyond the parameters of the law. The question is then whether we are in a situation of obeying God rather than men.

Such a challenge does arise if the governing authorities say we should do something that is against our conscience. Statue law in the UK still at least partially reflects the standards of scripture, and in some cases has specific conscience clauses where it does not. However, an increasing number of court judgments have not followed this, and there is constant pressure to change the law.

For British doctors, professional regulations or local guidelines may cause more difficulties than the law.

How should we deal with conflict?

We first need to be clear that the issue really is one of conscience. Is our stand really rooted in God's word, or in prejudices or culture? Are our facts right?

If we're sure of these things, we need to make sure that we've used the avenues we have to challenge where appropriate. Have we responded to GMC consultations? Have we discussed a local guideline with our consultant? Have they taken it further on our behalf?

Sometimes the answer is clear. We may well be very unimpressed with a new discharge summary template and rightly make our feelings known, but there comes a point when this is clearly not an issue of 'God versus Men', and we need to graciously stop fighting and get on with our work. There may even be ethical issues where a Christian response isn't absolutely clear cut, and not all Christians will conclude the same under Scripture. We need to be sure of our ground if we fight.

But sometimes there will still be conflict .Then the overriding principle is to obey God rather than men. The right approach may be a compromise or a 'third-way', but occasionally conflict becomes inevitable. Such clashes may leave us isolated, and we may risk our jobs or even registration. That should not mean that such battles are not fought, but it is important that we consider them prayerfully, and with wise counsel.

The future

Governing authorities change. I've already lived under six British Prime Ministers. It may get harder to submit to the governing authorities in the future. Discerning the exact boundary where submission to the authorities turns into obeying men over God is not easy. Fortunately in the previous chapter of Romans, Paul has already given excellent advice with which we will end.

'Therefore, I urge you, brothers and sisters, in view of God's mercy, to offer your bodies as a living sacrifice, holy and pleasing to God—this is your true and proper worship. Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God's will is—his good, pleasing and perfect will.' (Romans 12:1-2)