People of faith are often accused of irrational bias. Some ethicists go further to argue that the morally neutral demands of the secular state should always supersede doctors' personal beliefs. They would even deprive doctors of their current legal right of conscience not to participate in abortions, for instance. Ethicist Julian Savulescu writes:

A doctor's conscience has little place in the delivery of modern medical care. What should be provided to patients is defined by the law...and the patient's informed desires. If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors. (1)

It is important to question this view, which is becoming influential; not just among secular humanists, but also clinicians, lecturers, and your medical school classmates. This article will refute three claims: medicine is a morally neutral science; people of faith are more prejudiced; and a doctor's Christian faith harms patients.

1. clinical medicine is not a morally neutral science

Values are unavoidable in the practice of medicine. All doctors make value judgments daily; indeed it would be wrong not to do so. Good doctors do not simply dispense whatever patients request, as if we were 'medical slot machines'. Value judgments are guided by our individual moral compasses, as we will see in the following examples.

Imagine you are a doctor who diagnosed breast cancer in an elderly lady. The family asks you not to inform her of the diagnosis as it might upset her. No scientific knowledge can equip you to decide what would be best, but moral principles and your conscience (moral sense of right and wrong) can. Here, truth telling is a compelling principle.

A patient once consulted me for fertility treatment, and the very next week returned requesting an abortion. Why the change? It transpired that she was being coerced by her partner, who had decided he did not want children after all. Although science was involved, it was my 'moral indignation' that led me to ask the 'why' questions.

Or suppose that a neurotic patient with low self esteem demands inappropriate plastic surgery. Do you simply acquiesce if they are informed? Or do you try to do what is in the patient's best interest, and consider the best allocation of resources? Morality surely requires the latter. Yet some academics write as if morality and medical science belong to separate worlds. Where did this idea come from?

Enlightenment thinking

Enlightenment thinkers such as David Hume 2 (1711-1776) suggested that the only trustworthy truth claims were those based on the scientific method (based on empirical observation and logical analysis). However, this view fails by its own standards, because the assertion itself is not based on any scientific observation or logical reasoning!

The key word is 'only' - nothing but science has any authority. The absurdity of this claim passes us by because the most efficient route to reliable knowledge about the material world is indeed empirical science. But this pragmatic approach is very different to the dogma that science is the only source of truth, thereby excluding history, personal experience, accumulated wisdom and divine revelation.

The Enlightenment divided the world into two. The physical world of 'fact' explored by science was seen as 'real'. The non-physical realm - of emotions, values and ethics - was seen as subjective and immaterial (non-physical). 'Immaterial' has now come to mean irrelevant. Outside of science, no consensus was possible, so ethics (and the humanities generally) were reduced to personal opinion. Thus materialism, the idea that nothing exists except material things, was born.

How did materialism affect ethics? Prior to the Enlightenment, Aristotle describes four dimensions (termed 'causes') necessary for explaining events in the world: (3)

• material cause (physical substrate and nature) nefficient cause (physical mechanism)
• final cause (purpose)
• formal cause (soul or essence).

Take the example of a sculpture, such as Michelangelo's David. You can describe the stone it is made from (material cause), as well as the sculptor's work (efficient cause). But the complete account of an artist's work should include the purpose and meaning; for instance to celebrate a hero (final and formal causes). The Enlightenment excluded the last two causes as redundant, and even forbidden, leaving the West with an impoverished culture of materialism.

Before the Enlightenment, morality was concerned with how things should be - measured against design and purpose. So another by-product of rejecting an absolute purpose (eg giving glory to God), was moral relativism. Right and wrong were now 'relative to social, cultural, historical or personal circumstances'. (4)

We have now seen how the erroneous idea developed that medicine, being a science, is morally neutral. What about its practitioners; is there such an entity as a 'morally neutral doctor'? Let us consider how everyone, atheists included, has values.

2. everyone has values

John Patrick (former Associate Professor in Clinical Nutrition at the University of Ottawa) was asked to teach his medical students 'from a morally neutral position'. (5) This is such an accepted ideal today that no-one questioned the medical school dictate. But only a little reflection is needed to demonstrate the absurdity of such a request. The question is 'why should I practise morally neutral medicine/education?' And the only appropriate answer would appeal to values such as tolerance (of diverse moral standpoints) and subsequent non-judgmentalism. These may be laudable, but they are moral commandments nonetheless. In practice, we all behave as if moral facts exist that are known to all, even if we cannot agree on the details. (6) (7)

Everyone has a worldview - a set of assumptions, prior truth commitments, by which to interpret the world and live by - on which they base their morals, even if they do not realise it. Worldviews are not scientific conclusions, but that does not make them irrational or biased. They answer questions such as:

• How and what we can know? (epistemology)
• What is the purpose and goal of life? (teleology)
• What does a good life consist of? (ethics)
• What is wrong with man and the world, and how we can address it? (politics and faith)
• Where did man come from and who is he? (anthropology or ontology)
• What happens after death? (eschatology)

The worldview (and subsequent values) we adopt will determine our medical ethics. The table gives an example of how this works, from the perspective of a secular humanist.

Statements at the worldview level are no more rational, scientific or provable than mainstream faith beliefs. Given that everybody has a worldview, what are the values of the secularist worldview?

understanding secular humanism

The Council for Secular Humanism outlines its worldview: (8)

• A conviction that dogmas, ideologies and traditions, whether religious, political or social, must be weighed and tested by each individual and not simply accepted on faith.
• Commitment to the use of critical reason, factual evidence, and scientific methods of inquiry, rather than faith and mysticism, in seeking solutions to human problems and answers to important human questions.
• A primary concern with fulfilment, growth, and creativity for both the individual and humankind in general.
• A constant search for objective truth, with the understanding that new knowledge and experience constantly alter our imperfect perception of it.
• A concern for this life and a commitment to making it meaningful through better understanding of ourselves, our history, our intellectual and artistic achievements, and the outlooks of those who differ from us.
• A search for viable individual, social and political principles of ethical conduct, judging them on their ability to enhance human well-being and individual responsibility.
• A conviction that with reason, an open marketplace of ideas, good will, and tolerance, progress can be made in building a better world for ourselves and our children.

Much of the outline appears acceptable at first glance. But their position is spelt out more fully in a manifesto. (9) (10) It claims that, 'any account of nature should pass the tests of scientific evidence', and any new discoveries can only confirm their materialism. It excludes even the possibility of transcendent values, or any goal beyond the here and now. It rejects any authority higher than man, and embraces subjective ethics. These are hardly neutral, scientific statements, but are unashamedly materialistic. Specific examples of secular humanist beliefs that are value-laden (and non-scientific) include: nAll men should be valued equally, even if evolution has not made us equal

• A baby in the womb can be treated as a disease that marginally increases a mother's mortality
• There is no objective right or wrong, as there is no authority higher than man
• If God exists, he should prove himself to us according to scientific standards

compare the Christian worldview

It is easy to forget how distinctive the Christian worldview is, with its insistence on the sanctity of life. Non-Western cultures (without the Judeo-Christian heritage) are often less prepared for human rights and democracy, because they lack a theistic worldview. The vanguards of modern liberal democracy recognised that rights are absolute (or unalienable) because they are divinely endowed. These include the French Declaration of the Rights of Man, (11) and the American Declaration of Independence: (12)

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

Nevertheless, when secularists appeal to universal human rights, they are plundering the resources of Christianity, while rejecting the authority of the Creator who endowed them. The debt owed by secular humanism to Christianity is clearer to those outside our culture. Lee Kuan Yew, Minister Mentor of Singapore, responded to the Western outcry over a sentence of flogging for vandalism saying: 'To us in Asia, an individual is an ant; to you he is a child of God. It's an amazing concept.' (13) Given the values that secular humanists hold to, we can now look at whether they are able to act ethically without appealing to values outside of science.

a case example

Evan Harris (a prominent secular humanist Member of Parliament) recently campaigned to extend current abortion laws to Northern Ireland. (14) The 1967 Abortion Act has never covered Northern Ireland, and the democratically elected representatives have rejected such a move, encouraged by various polls of public opinion. (15) (16)

So on what basis can democracy be over-ridden? In order to supersede a nation's choice, one must appeal to some transcendent value, higher than public opinion. But secular humanists specifically deny any such higher authority!

In this case, Harris might invoke equality. In that, once a freedom has been granted to one part of the population, it should be granted to everyone within the jurisdiction of the legislature. However, equality can also be cited in favour of the unborn child, so it cannot decide the issue. Certainly there is no human right for abortion, despite attempts by some secular humanists to establish one. Secular humanists, whilst not bowing to the divine lawgiver, appeal to a higher authority to advance their cause. Their claim of moral neutrality is nonsense.

even moral relativists impose their morality

Secular humanists who espouse moral relativism tell us not to impose our morals on others. Yet they commonly exempt themselves from the absolute injunction not to impose one's morals on another (when it comes to their particular interests or cause). They are right in the second instance: either a moral law is binding on everyone or no-one. For example, it is meaningless to say 'racism is completely unacceptable...to me!'

James Porter Moreland (an American philosopher and theologian) tells the story of a conversation he had with a student in his college dormitory. The student objected to Moreland's traditional morality on marriage, and told him not to impose it on him. On the way out, the philosopher agreed, but deftly grabbed the student's stereo and made for the door. 'Hey, where are you taking my stereo? That's theft!' The philosopher replied, 'don't you impose your morality on me!'

This may have been a cheeky prank to make a point, but it is surely the case that all relativists are merely selective relativists. Students who are taught the culture-bound nature of ethical codes in a sociology lecture would be incensed if their lecturer was found awarding the best marks to students who offer monetary bribes or sexual favours!

to impose or not to impose?

So everyone who has a moral opinion will rightly try to persuade others to abide by it. Thankfully, Christians agree with non-believers on most moral issues in medicine. The areas of conflict are mostly around our care of the most vulnerable, the taking of human life, and free speech.

Recently, concern has been raised about Muslim medical students refusing to see patients who have self-inflicted illnesses caused by alcohol or promiscuity. (17) After consultation with the medical profession at large, the General Medical Council (GMC) has issued guidance on 'personal beliefs':

All doctors have personal beliefs which affect their day-to-day practice. Some doctors' personal beliefs may give rise to concerns about carrying out or recommending particular procedures for patients. (18)

It is reassuring that the GMC recognises that every doctor has beliefs which necessarily impact on their practice, whatever their worldview, and therefore rejects the myth of secular neutrality. It also confirms the current legal position that gives doctors the statutory right to exclude themselves from involvement in providing abortions. Doctors are obliged to ensure that patients are informed of how to procure such services which are legally provided, and that they are not discriminated against on the basis of lifestyle and self-inflicted illnesses, such as sexually transmitted infections or alcoholic liver disease.

3. Christian doctors have done good in medicine

CMF has always maintained that a doctor should not discriminate on the basis of patients' moral choices, but should treat patients as Christ would. (19) He treated people as moral beings whose choices matter for their present health and eternal destiny. He was both bold in confronting wrongdoing, while responding compassionately. (20) Perhaps at times we can forget that our moral condemnation should be reserved for disciplining those in the church family. (21)

But how should Christians respond when the secular state threatens the lives of the vulnerable? Proverbs tells us to 'rescue those being led away to death; hold back those staggering towards slaughter'.(22) Civil disobedience is occasionally necessary. (23) Daniel is a role model of someone who continued to do right, even when the society around him became wicked. (24) Likewise, Paul tells us to obey the authorities who have been established by God. (25) But where the government legislates wickedness or compromises the sharing of the gospel (eg by outlawing free speech),'we must obey God rather than men'. (26)

Conscience should not be considered a dirty word in medicine. Thankfully, doctors with (and without) faith have acted on their consciences. They have refused to assist in judicial amputations, female genital mutilation, and torture of political prisoners. Conversely, it is out of religious conscience that pioneering doctors have started: hospice care, adoption of orphans, missionary medicine, leprosy care, as well as care for the homeless, drug addicts and those who are HIV-positive. We need not be ashamed of recommending faith sensitively and with permission, as there is growing evidence for the benefit of faith for health. (27)

conclusion

No-one can avoid making moral judgments, whether they are religious or not. Secular humanists also make them on the basis of their worldview and act as if they are binding on everyone else. Christians are explicit in recognising the authority of divine revelation in ethics, but that does not make faith irrational. Christians have good reason to be proud of the impact of Jesus' ethics on Western medicine, as long as we follow his example of valuing both truth and love.

Alex Bunn is CMF Acting Head of Student Ministries and a GP in London