The Church as Care Giver

In this century, the churches and synagogues have yielded their appointed sovereignty over the affairs of birth, health, life, and death to the medical profession and to the “health-care industry.” So argues sociologist Paul Starr in The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (Basic Books).

Such a “twilight of the gods” should not and will not befall us. This demise, like Mark Twain’s, is greatly exaggerated. Were it allowed to occur, it would not only harm the general welfare, but it would impoverish religion and medicine as well.

But perhaps it is not too late for America’s religious community to reclaim some of this sacred territory. Taking cues from Starr’s analysis, we must see first that while an attitudinal shift has indeed occurred, transcendent hope and fear—those impulses linking belief and body—forever remain in place.

Second, we must see that, on the practical level, the church’s historic commitment to hospice and hospital is likely to prevail over the current patterns of secularization.

In the nineteenth century, Starr claims, Americans developed a skeptical, rational, and secular posture toward medical authority.

In a society where an established religion claims to have the final say on all aspects of human experience, the cultural authority of medicine clearly will be restricted. But … [m]any Americans who already had a rationalist, activist orientation to disease refused to accept physicians as authoritative. They believed that common sense and native intelligence could deal as effectively with most problems of health and illness (p. 17).

Medicine’s Religious Roots

According to medical historian Henry Sigerist, Christianity entered the world as a “religion of healing.” Take, for example, the way Christians tried to help afflicted fellow Christians and pagans alike during the mid-third century plague. Dionysius, bishop of Alexandria, described his flock’s activities as “visiting the sick without a thought as to the danger, assiduously ministering to them, tending them in Christ.”

In the fourth century, Christians increasingly venerated martyrs and saints, whose remains, or relics, were thought to have healing powers. The church established martyrs’ shrines, to which people streamed in search of healing. The fourth century also saw the rise of monasticism, which, in its Western forms, emphasized charity and care for the sick and needy. Monastic clergy established hospitals, orphanages, and homes for the poor and the aged.

During the Middle Ages, claims of miraculous healing continued, while clerical and monastic medical practitioners grew in number. Pilgrimages to the shrines of saints were popular during this period, and sometimes clergy administered medical treatment there. This was seen as completely in accord with the New Testament injunction to minister to the sick, especially if clergy tended to the destitute and expected no payment. Monasteries became the refuge of the sick, the poor, and the persecuted.

Enemies or allies?

It used to be argued by some that the church thwarted medical progress during the Middle Ages and opposed the revival of human dissection during the Renaissance on grounds that it was sacrilege to desecrate the dead. Some argued that eighteenth- and early-nineteenth-century clerics tried to suppress the introduction of inoculation and vaccination by linking these measures with “sorcery and atheism.”

Such objections to medicine were far less significant than the criticism from conservatives within the medical community who feared change. It is easier to make a case for Christianity’s having been an ally of medical science than its enemy. It was, for example, a Puritan divine, Cotton Mather, who initiated the first American trials of inoculation.

While Mather once described the combined practice of spiritual and physical healing as the “angelical conjunction,” medicine and religion took increasingly divergent paths in modern times. This drift toward secularization can be seen in the history of the hospital. At first, hospitals were closely identified with the church, which provided personnel for day-to-day operations. In fact, before the rise of professional nurses in the late nineteenth century, few besides members of religious orders were sufficiently motivated to carry out the menial tasks that hospital patients required.

In the eighteenth century, however, physicians began to view hospitals as centers for the study of clinical medicine rather than as mere charitable institutions. Conflict became almost inevitable, as events at the Hötel-Dieu of Paris on the eve of the French Revolution testify. At this gargantuan establishment, Augustinian nurses controlled the most important areas of hospital policy. When the First Surgeon of the hospital in 1787 attempted to transform it from a custodial to a medical institution, the sisters protested that poverty-stricken patients, who were often homeless, might now “be thrown out just as soon as they cease to be afflicted with illness.”

The proliferation of therapeutically active hospitals in the eighteenth and nineteenth centuries created a demand for qualified nurses. Hospitals in Catholic countries could rely on the nursing orders, but Protestants had nothing comparable until the 1830s when a Lutheran pastor and his wife in Kaiserswerth, Germany, founded a nursing school for pious young women interested in a life of service. In 1851 Florence Nightingale visited Kaiserswerth and returned to England to set up a secular version of the deaconesses, as they were called.

In the late nineteenth century, as nursing shifted from a domestic to a medical function in response to diagnostic and therapeutic advances, the profession became more secular. Not only did secular nurses generally receive better medical training, but some physicians found them more flexible. Catholic sisters, for example, disliked catheterizing and bathing patients and in some instances refused to care for persons suffering from venereal diseases. On occasion they were known to place religious duty above medical need, perhaps calling the priest before the physician in cases of emergency.

The church continued to play a role in health care, largely through denominationally affiliated hospitals. This became especially obvious in the 1840s and 1850s when large numbers of Catholic and Lutheran immigrants began arriving. Inspired by their successes, all the major—and some minor—Protestant bodies established hospitals. By the mid-twentieth century, church-related hospitals cared for one-quarter of all hospitalized patients.

In the face of recent ethical dilemmas created by increasing medical technology, many religious organizations and individuals are turning to their religious traditions for moral guidance. What remains to be seen is whether the church will take up the burden of caring for others again in an institutional setting, or relinquish that task due to the high cost and complexities of modern medicine.

Source: Ronald L. Numbers and Ronald C. Sawyer, “Medicine and Christianity in the Modem World” and other essays in Health/Medicine and the Faith Traditions, edited by Martin E. Marty and Kenneth L. Vaux (Fortress).

Had Starr read Luther or Wesley on medicine, he would understand that the root of such a skeptical and secular stance was to be found in religion, at least in its Protestant temperament. Luther, in his Table Talk and elsewhere, and Wesley, in his Primitive Remedies, expressed doubt verging on ridicule toward physicians. Because God is Lord, giver of life, sustainer of health, receiver of death, they wrote, no subordinate or penultimate entity can claim authority over us. Biblical faith, in its prophetic and iconoclastic mood, allows power to no lesser authority. Likewise the church claims all authority, in the words of the Heidelberg Catechism, over “body and soul, in life and death,” for the “faithful Savior, Jesus Christ.”

The Protestant spirit is grounded in a vivid awareness of transcendence. The reality of God conveys to our experience and faith that life and health, suffering and death are divine bequests prompting us to fear, trust, and hope as if our life belonged to God alone. A subliminal form of this religious awareness is manifested in today’s distrust of the sovereign and omniprovident state, seen, for example, in Eastern Europe, and in the widespread demand for justice and kindness toward the oppressed, diseased, disabled, and aged.

Today, church and synagogue are “taking back the street.” Fifty years ago we transferred the “tithe” to the state and asked it to replace the church as provider for security, health, the widowed, orphaned, and homeless. On all counts it failed. Culturally marginalized groups—Latter-day Saints, Seventh-day Adventists, Hutterites, and Christian Scientists—persevered in these responsibilities. But now even our dominant religious culture—Jewish, Roman Catholic, Eastern Orthodox, Islamic, and Protestant—is reclaiming responsibility in the realm of human vitality and mortality.

To exercise cultural authority, religion must receive it from the people and their sense of transcendence and finitude. Such a consensus of the faithful is the only ground for any authority. The practical working out of this faith renaissance can be seen in the religious character of the way we deal with such matters as human sexuality, parenting, suffering, and dying, and the structures and services we call on in such moments.

The history and future of hospitals and hospices are a case in point. I suppose that in my home city, Chicago, two-thirds of the hospitals are founded in and sustained today by patronage originating in the churches and their faithful laity. The names Michael Reese, Lutheran General, Christ, Mercy, Presbyterian—Saint Luke’s, Loyola, Foster McGaw, McCormick, Swedish Covenant, and Norris Nessett among others betray this fact. Starr argues that hospitals, though once “religious and charitable institutions for tending the sick,” are now “medical institutions for their cure” (p. 145). Rather than altruistic ministries in the face of human need, hospitals have become “doctors’ workshops,” “multiunit firms” and “profiteering corporations.”

Indeed, this is so! The budget of just one of the hospitals in our medical center (Presbyterian—St. Luke’s) is four times the annual budget of one entire religious denomination (Presbyterian Church [USA]). But is this expropriation the whole story? Certainly not. The will of devout Jews and Christians in our time still finds moral and pastoral expression in the places where our birthing and dying, our suffering and healing are watched over. Right now this ministry occurs in public and private institutions and agencies ranging from hospitals to hospices to home-care organizations. The significant change in recent years is the reintroduction of charitable care and personal involvement. If we study carefully the agencies that care for the homeless, the elderly, persons with AIDS, and women and children, we realize we are witnessing the ministry of the church. This becomes clearer yet if we observe the individuals who daily offer the helping hand, the cup of cool water, the listening ear, the understanding and consoling presence. Indeed, a significant back swing seems to be occurring as churches become the focal point of holistic health centers, medical clinics, divorce-support groups, havens for the handicapped, sanctuaries for persons with AIDS, and care centers for those growing old, becoming incapacitated, and dying. Right now the church seems too preoccupied with budget raising, building keeping, and fire dousing to be about truly effective ministry, but she will come roaring back. When she gets going strong, she will discover, in T. S. Eliot’s phrase, that she is “back where she had started.”

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