Life and death are central to the study and practice of medicine. At the beginning of our studies we are taught the life sciences of embryology, physiology and biochemistry; to consider the workings of the cell and the beginning of human life. As we see patients, we learn how to bring a life into this world and to care for the sick and the dying. Much of our professional lives are dedicated to the preservation of life, the promotion of good and healthy living and postponing death. We deal with life and death on a regular basis. But is our thinking shaped more by our scientific and medical training than through reflection on the Bible?

The God of life

When Paul addressed the men of Athens at the Areopagus he noted that: 'The God who made the world and everything in it is the Lord of heaven and earth and does not live in temples built by human hands. And he is not served by human hands, as if he needed anything. Rather, he himself gives everyone life and breath and everything else. From one man he made all the nations, that they should inhabit the whole earth; and he marked out their appointed times in history and the boundaries of their lands. God did this so that they would seek him and perhaps reach out for him and find him, though he is not far from any one of us. "For in him we live and move and have our being." As some of your own poets have said, "We are his offspring."' (Acts 17:24-28)

Paul understood that God is the one who created the world. God initiates and sustains life. Without God there simply would be no life. (1) Throughout the Old Testament, Yahweh is described as the living God, the God who speaks and acts. To Moses at the burning bush He declares 'I AM WHO I AM' (Exodus 3:14). He is the God who simply is; unchanging, eternal and living.

Speaking of Jesus, Paul writes 'The Son is the image of the invisible God, the firstborn over all creation. For in him all things were created: things in heaven and on earth, visible and invisible, whether thrones or powers or rulers or authorities; all things have been created through him and for him. He is before all things, and in him all things hold together.' (Colossians 1:15-17)

All of us are wholly reliant on Jesus as creator and sustainer. This causes me to consider whether I acknowledge and approach each life with which I connect as being created and daily sustained by God himself? As healthcare professionals, so aware of the biology and mechanics of life, have we lost sight of God's vital involvement in life itself? Are we thankful for the daily miracle of life - our own and others? As we view life from the perspective of being created and sustained by God, perhaps we must question our actions and assumptions in the way we handle life.

Death the imposter

The Bible has much more to say about life than death; death is an imposter. Death enters our world because of the choice that the first human beings made to disobey God's instructions. (2) In the shadow of death, life becomes momentary and fleeting. This is expressed by the writers of the Psalms and Ecclesiastes.

'Show me, Lord, my life's end and the number of my days; let me know how fleeting my life is. You have made my days a mere handbreadth; the span of my years is as nothing before you. Everyone is but a breath, even those who seem secure.' (Psalm 39:4-5)

'Since no one knows the future, who can tell someone else what is to come? As no one has power over the wind to contain it, so no one has power over the time of their death.' (Ecclesiastes 8:7-8a)

Life is fragile and precarious. Acknowledging this gives us a choice as to how we live. We can choose to make the most of the limited time we have, or we can live in denial and defiance, accepting the pretence that we and not God are in control of our lives. We can come to the conclusion that life is futile and pointless:

'Life's but a walking shadow, a poor player,

That struts and frets his hour upon the stage,

And then is heard no more: it is a tale,

Told by an idiot, full of sound and fury,

Signifying nothing.' (3)

Although written centuries ago, these words still express what many of our colleagues, patients and even we ourselves can feel, especially when faced by untimely death.

Our response to the reality of death affects how we live and treat life. In the words of the preacher: 'Death is the destiny of every man; the living should take this to heart'. (Ecclesiastes 7:2b)

Bringing spiritual life

When death entered our world, it did so not just in a bodily form but also spiritually and eternally. We yearn for life and see death as the intruder. The prophet Isaiah could therefore look forward to a day where God would defeat death. 'On this mountain he will destroy the shroud that enfolds all peoples, the sheet that covers all nations; he will swallow up death for ever. The Sovereign Lord will wipe away the tears from all faces; he will remove his people's disgrace from all the earth. The Lord has spoken.' (Isaiah 25:7-8)

This hope finds fulfilment in Christ: 'Very truly I tell you, whoever hears my word and believes him who sent me has eternal life and will not be judged but has crossed over from death to life'. (John 5:24) As Paul puts it, 'For if, by the trespass of the one man [Adam], death reigned through that one man, how much more will those who receive God's abundant provision of grace and of the gift of righteousness reign in life through the one man, Jesus Christ!' (Romans 5:17) We are transferred from the state of death to the state of life the moment we come and accept Christ as our Lord and Saviour. Even when we die bodily, we remain alive in Christ. For this reason, the New Testament refers to the death of the believer as sleep. (4)

'Where, O death, is your victory? Where, O death, is your sting?' (1 Corinthians 15:55)

Much of modern medicine is dedicated to fighting bodily death, both that which is untimely and avoidable and that which comes from the process of decline and age. If we consider many of our colleagues' and patients' attitudes to death, we see a strong thread. Medicine seeks to conquer and delay death - to live as long and as well as we can. It seeks to exert control over death. Thus, through medicine we come to believe that we decide the timing and means of our death. Such thinking underlies calls for the legalisation of assisted suicide and euthanasia.

As those who professionally fight against the effects of decay and death, we should do so expressing care and respect for God's creation. While bodily death must be recognised and even welcomed and certainly not forever put off, it should also not be hastened.

That many of our patients are in a state of spiritual death should cause us to desire their transition to the state of spiritual life. As we practice whole person care and medicine, communicating with permission, gentleness and respect, are we willing to consider and address patients spiritual care needs utilising the wider healthcare team?

That our days are limited can be viewed as a severe mercy, for the reality of bodily death alerts us to the state of spiritual death. It is my observation that the 'wrongness' of death as experienced by patients, their families and carers can be an indicator that they are made for life.

Conclusion

Jesus not only redeemed us but in so doing he took on our humanity - fully God, fully human - paying the ultimate price by laying down his life for us. Our very make up and creation is not rejected by God, but sees its ultimate fulfilment in him.

Life is God's initiative, both in the physical creation of life and the way that he has opened to eternal-life through Jesus. Each human life is of immense value to God. Humanity was created for life - not death. This finds its consummation in Christ's return, when '"He will wipe every tear from their eyes. There will be no more death" or mourning or crying or pain, for the old order of things has passed away.' (Revelation 21:4)

It is my prayer that as Christians in healthcare, mindful of the predominant thinking of medicine and society, that we study and practice our craft in the light of what God says about life and death.

Life and death are truly in the hands of God.

James Tomlinson is a practising GP in the West Midlands

This article is based on a talk given at the KLF (CMF Denmark) National Conference in 2009