Love it or hate it, an understanding of ethics is essential to practising effective and consistent medicine. Wherever you turn, there are decisions to be made. How should you respond to this patient's request for contraception, or an abortion? How do you respond to a son's request to withhold information from his father who has cancer? And that's just medical ethics. What about other decisions you make? Do you give money to the person begging on the street? Who do you decide to vote for in an election?
How are we to approach these decisions? In a world that often insists there are no absolute rights or wrongs, how are we supposed to act? As Christians we want to do what God says is right. But how do we know what that is?
Over the years many great thinkers, including Christians, have devised ethical principles. But there are so many differing opinions that it almost makes things worse! Where are we to go?
why biblical?
Living in 2010, why would we want to look at a book written thousands of years ago? There's no mention of antibiotics or anaesthetics there, let alone physician assisted suicide. So why make so much of it?
Ultimately it's because in the Bible God reveals himself to us. If you want to know what God is like, and what he thinks about the world, start here. Paul famously writes: 'All Scripture is God-breathed and is useful for teaching, rebuking, correcting and training in righteousness'. (1)
The Bible is a divine book, but this doesn't mean that the words were simply dictated by God. As well as being divine, it's also a human book. God used different people at different times, in different ways to write it. For example, occasionally parts are dictated (the letters in Revelation) (2) or directly given by God ('This is what the Lord says' (3) in the Old Testament prophecies), but other parts are carefully collected by historians and written down. (4)
Even though written long ago, the Bible remains authoritative. The writer of Hebrews illustrates this in his use of Psalm 95, written long before Hebrews. 'So, as the Holy Spirit says: “Today, if you hear his voice, do not harden your hearts as you did in the rebellion”' (5) (author's italics). The Holy Spirit initially said the words through David hundreds of years before; but the writer is clear that he still says them at the time of writing, and implies that they are still relevant even after so long.
Hence understanding the Bible correctly takes work. Because it's a human book, each part was written at a certain time to specific people, but because it's also a divine book, the meaning remains vital for us today. We can't just make the jump from original writer to us. To ascertain its meaning we need to do the hard work of understanding what was being said then, before we can see how the principles apply now.
the authority of the Bible
If the Bible is 'the word of God' then its authority is greater than all other authorities - church teachings, experience or our ability to reason.
Many approaches to biblical ethics forget this. People sometimes use experience or feelings to guide them, saying 'this is what feels like the right thing to do' and then find some part of the Bible to back them up. Or they might take principles based on human reasoning, such as Aristotle's virtues, and then go from there to the Bible, saying 'look, the Bible teaches virtue ethics here, so that's the right set of principles'.
creation: god makes
God makes an intensely varied and complex universe. From galaxies and stars to cells and DNA, he makes it with order. The patterns we call the 'laws of nature' are created and continually sustained by him 8 and he also sets the pattern for how things work morally. At the pinnacle he creates humanity, giving us an amazing gift: 'In the image of God he created him; male and female he created them' 9 and a command: 'You must not eat from the tree of good and evil'. 10
There is much to be said about the principles that come from creation and how they shape ethics, but the first question must be: 'what does this teach me about God?' The Bible is not, first and foremost about us!
From the outset we see the work of God in trinity. The 'Spirit of God' is present and active in creation, 11 and God the Son is 'the word' through whom 'all things were made'. 12 God is relational, and 'continually pours himself out between the persons of the Godhead, in unceasing communication, love, friendship, and joy'. 13
In creating humanity in his image, God creates beings who 'continually pour themselves out' in all of life. 14 At creation Adam and Eve do this perfectly as they fully depend on God and follow his commands. This is the response God deserves, because he is worthy. It is the essence of worship.
Much ink has been spilt trying to define 'the image of God', but that almost misses the point. Ultimately, the image of God gives humans tremendous value, demanding deep respect, and shows that God makes us like him, for his glory. The ethic is set: We are made to be centered on God in all-of-life worship as we image him.
If we do that, we're imposing ourselves onto the Bible, allowing feelings or reason to have the final say. Instead we need to do our best to allow the Bible to speak first, and let it shape our thinking and decisions.
God hasn't given us an ethical handbook. Nor is the Bible a list of commands (although it does contain some) or even a 'manual for our lives' because the Bible isn't primarily about us (though in our pride we often think it is). It's about God, and his dealings with his creation. So the first step to understanding and applying the Bible in any arena, let alone ethics, is to ask: What do I learn about God here? This means that we need a good understanding of the full 'storyline' of God's work in human history. (6) This is divided into four episodes: creation, fall, redemption and restoration. Through these, God progressively reveals himself like a master painter adding layer upon layer until the full picture appears. This is important because, as John Wyatt points out, we will 'obtain distorted and partial ideas of Christian truth if we fail to use this four-fold perspective'. (7)
At each stage we see that God's revelation demands a response. He is not a passive God who reveals himself and then leaves it at that; the only right response to him is worship. Our approach to ethics as Christians must begin and end with worship of God.
fall: god judges
In Genesis 3, Adam and Eve 'strike a blow for moral autonomy independent of God'. (15) They ignore God's command and decide right and wrong for themselves. Now God reveals his justice, and even this demands worship. He pronounces judgment on Adam and Eve: the promised consequence of their dethronement of him in their lives.
After the fall, creation becomes fractured. Has it ever occurred to you that before this the study of ethics didn't exist? Prior to the fall we enjoyed perfect relationship with God; worshipping him alone in obedience to his will. But since we 'exchanged the truth of God for a lie, and worshipped and served created things rather than the Creator', (16) our relationship with God, one another, and creation is damaged.
In Romans 1 Paul makes it clear that God 'gives us over' to this 'creation-worship'. We become unable to see God's will, let alone follow it. Sin leads to blindness leading to sin, and so on. (17) It's no wonder that we sometimes struggle to know what's right or wrong! We need God's revelation to cure our blindness.
Is the worshipping image of God in us destroyed? No! We are still worshippers, but our worship is misdirected. The image isn't destroyed, but marred. Individual humans remain incredibly valuable, and deserving of deep respect, which is seen even more clearly as God unfolds his restoration project.
from here to there: worship-ethics
That was hard work wasn't it?! But it still feels like we're a long way from real-world ethics doesn't it? We've seen that the creation ethic was: 'we are made to centre our lives on God in all-of-life worship as we image him'. That continues through the Bible as God reveals himself in grace that demands response, and is what God is working towards in us today.
That has massive implications for ethics. Various suggestions are put forward today as a basis for making ethical decisions, such as relief of suffering, doing our duty, or bringing the greatest good to the greatest number. In contrast, the primary motivation in biblical ethics is always worship. The central question, 'what is right?', is re-defined to be: 'How can I image God by honouring him most? How can I be most like Jesus?'
As the Bible applies 'worshipethics', it's amazing to see how many secular ethical theories hold much partial truth. In his goodness God allows us to get some of the way even without him! But, unless we look to his revelation, we always fall short of his truth.
redemption: god pursues
Throughout the Bible, God reveals himself by calling people. He gives promises of grace, which always demand a response. Just as the creation pattern set out, that response is complete devotion and all-of-life worship.
It starts with Noah. God reveals himself as he warns Noah about the flood, gives instructions to build the ark, and promises: 'I will establish my covenant with you and you will enter the ark - you and your sons and your wife and your sons' wives with you'. (18) Noah's response is complete devotion in all-of-life worship. He sacrifices reputation and friendship by building the ark in trust and obedience to God.
Then comes Abraham. God calls Abraham and gives him a mindblowing promise: 'I will make you a great nation, and I will bless you; I will make your name great, and you will be a blessing ... all peoples on earth will be blessed through you'. (19) Abraham's response is complete devotion in all-of-life worship. He sacrifices everything, leaving home and family. He is even willing to sacrifice his promised son, Isaac, when God asks.
God is faithful. Abraham's descendants do become a 'great nation' and then, under Moses, God reveals himself further as he saves Israel from slavery and brings them to Mount Sinai.
God does this even while Israel consistently ignores him. Even at Mount Sinai, as God reveals himself in such power that no one can even touch the mountain, the people repeat the pattern of the fall by ignoring the creator and worshipping a statue of a calf. (20)
Meanwhile God graciously gives these people 'the law' through Moses. So what is the law? What's it for?
The most famous part is the ten commandments, which act like a summary of the whole law and are rightly some of the most famous verses of the Bible. But what is often missed is God's explanation for them: 'I am the Lord your God who brought you out of Egypt, out of the land of slavery'. (21) The entire basis for God's law is what he has already done by saving his people.
God revealed himself in similar ways to Noah and Abraham, giving them a promise that demanded the response of all-of-life worship. So what is the promise to Israel? It becomes clearer when we see the repeated reason given in the Old Testament for God's work to save his people, despite their resistance to him: 'I will take you as my own people, and I will be your God'. (22)
Read on to the first commandment and we see the full picture: 'I am the Lord your God ... you shall have no other gods before me'. (23) In other words, 'I am God who has shown myself by saving you to be my people, so don't worship anyone or anything else'. The promise is 'being God's people', the response is complete devotion. As the rest of the law is unfolded the basis is still the same. It's not, 'you need to keep this law to stay in my good books', but 'you will be my people - this is how my people live'. In other words the law is God's description of all-of-life worship.But Israel continued as they did atSinai, by rejecting God and worshipping other things. Despite this, prophets like Jeremiah look forward to God acting in even more outrageous grace. The promises remain, and the law still plays a central role: 'I will put my law in their minds and write it on their hearts. I will be their God and they will be my people ... for I will forgive their wickedness and remember their sins no more' (24) (author's emphasis).
Later, God's reveals himself fully in Jesus, the 'image of the invisible God'. (25) This means, not only that Jesus is the perfect revelation of God, but also that he is the perfect example of humanity. He shows us what it looks like to image God, and is said to 'fulfill the law' as he perfectly keeps God's description of all-of-life worship.
But he is far more than an example. As he worships God perfectly, he obeys him to the cross and death in our place. There God reveals himself most completely in both judgment against our sinful creation-worship and in grace towards us. As ever, this revelation demands a response. Jesus dies to break the power of the fall and call people to him. (26) Those who respond are enabled, by his Spirit, to 'worship in spirit and truth' (27) and the words of Jeremiah are fulfilled as 'the righteous requirement of the law is fully met in us who live, not according to the sinful nature but according to the Spirit'. (28)
the duties of worshippers
One common theme in ethical theory is the 'deontological' view that stresses our duties. The best recognised is probably that of the philosopher Immanuel Kant. For him, there was no possible answer to 'why should I do my duty?' other than 'because it is your duty.'
God created us to image him in all-of-life worship. There is an appeal to duty here but this duty is not a reason to do something in itself. It is because we are God's creatures, made by him, dependent on him, and designed to image him in all-of-life worship, that we have a duty to obey him. It is what God deserves.
the virtues of worshippers
However, the history of Israel shows that mere duty isn't enough to bend our stubborn hearts to God's will. The law wasn't enough to break the power of the fall (31) because we simply don't want to be devoted to God. So, God promises 'new hearts' with the law 'written on them'. 32 As God works in our new hearts we have new character traits, or 'virtues' that gradually change our desires, and what we do.
Virtue ethics places high regard on the character of a person as they make decisions. For Aristotle, virtues cause us to respond to our feelings correctly, for example what we do when we are angry or unhappy. The person who develops them is a 'good' man, and is happy. (33)
The Bible teaches that we cannot become 'virtuous' ourselves. It's only through Jesus that we can develop character that causes us to want to do what is right. Those who follow the desires of their new hearts, are joyful as they image God in all-of-life worship as they were designed to. (34)
The ultimate list of virtues is the 'fruit of the Spirit'. (35) They are the product of the Spirit's work in us as we seek to serve Jesus in all-of-life worship. In God's mysterious power, he restores his image in us as we respond to him. (36)
This doesn't deny the duty we have to follow God's revealed will in the law, although it changes our motivations for doing so. In many places the New Testament teaches that development of godly character fulfills the law. One example is Romans 13, where Paul encourages us towards that greatest of godly virtues: love, 'the fulfillment of the law'. (37) Love does not allow us to justify anything as long as it was a 'loving act', rather, the law helps define what 'love' means. Paul gives the command 'do not murder' as an example. It's possible to keep this command in itself while holding all the negativity of vengeance, bitterness and hate - everything up to, but not including the actual act of murder. However love fulfills this command more completely because these negatives are ruled out and replaced. (38)
This means that 'the law' of the Old Testament is still vital now. The power of the fall is still present because we're living this side of God's final restoration. There are times when what we want to do is not right according to God's revealed will. It's at those times that we need the law to prompt us to do what's right. It's then that we find our desires changing because doing what God declares to be right in allof- life-worship brings us joy.
Under the worship-ethic we are driven towards godly character as we seek to follow God's will in dedication to him.
restoration: god renews
At the end of history God is fully revealed in Jesus, and our response is perfected: 'we shall be like him, for we shall see him as he is'. (29) Jesus sits on his throne at the centre of all things, and his image in us is restored. We will be part of 'a great multitude that no-one could count from every nation, tribe, people and language standing before the throne and in front of the Lamb' 30 pouring ourselves out in worship to him.
the aim of worship
Many ethical theories put consequences first. It doesn't matter what you do or even how you do it, as long you were aiming for 'good'.
The Bible places a lot of focus on the what and how of our decisions, but where the aims are concerned, worship of God is central. As the Westminster Catechism puts it 'the chief end of man is to glorify God and enjoy him forever'. (39) The 'good' consequence the Bible emphasises is always God's glory.
In Romans 14, Paul talks about situations where people find God's will hard to discern. Sometimes Christians disagree. This may mean that we need to work harder to understand his revelation, but it may mean that it truly isn't clear.
In Romans 14 Paul addresses the issues of eating meat and observing certain religious days, saying that 'he who regards one day as special, does so to the Lord. He who eats meat, eats to the Lord, for he gives thanks to God; and he who abstains, does so to the Lord and gives thanks to God' (40) (author's italics). In other words, these matters are to be handled with the recognition that what motivates all Christians is, and should always be, God's glory.
Under the worship-ethic we aim to bring God glory in everything.
the finality of worship
From creation to the end of history God is restoring his image in us. We are his masterpiece, flawed by our sin now, one day to be restored even beyond the perfection we had at creation.
Biblical ethics teaches that our view of humanity should take account of his purposes in both original design and restoration. As John Wyatt helpfully expounds, our responsibilities in medicine towards people 'are to act as art preservers and restorers... [restoring] them in line with the artist's original intentions'. (41)
The worship-ethic encourages us to act in the light of God's revealed eternal purposes.
It is liberating to know as we grapple with ethics that one day there will an end to sin and its consequences. We struggle now because we only 'see in part' but then we will 'see fully' (42) and worship in response!
