American Medicine and Easter Hope

J. Warren Smith

In his Nicomachean Ethics, Aristotle offers a common-sense critique of Plato’s idea of The Good. The Good, for Plato, is the form that unites all other forms or ideals. Because the philosopher king knows The Good, he or she is able to unite the work of many citizens of the republic into a polis in which members work corporately to attain the common good. The many cannot, Socrates teaches, be united into one, just society unless the ruler knows the telos of the state and how the many threads of the social fabric should be interwoven in order to attain that end. Not surprisingly, therefore, Plato describes The Good as the light of the sun that allows the philosopher king to see each group within the society rightly and know how it contributes the common good, i.e. justice. Aristotle, however, counters that it is knowledge, not of The Good, but of one’s particular skill or art that makes a doctor a good physician or a general a master tactician (N.E.; 1096b30-1097a14). At first glance the argument seems obvious. The criterion I use for choosing the best doctor to operate on my loved ones or myself is not whether she is a virtuous person, but whether she is experienced and skilled at setting a bone or performing by-pass surgery.

Plato, however, would counter that it is not enough for a physician to be skilled; he or she must also be wise. For, only if she possesses the knowledge of The Good and understands how the art of healing serves the common welfare of society can the doctor rightly understand the limits of human life and of medicine. Only by knowing The Good can she rightly judge when to operate and when not to operate. In other words, if we think about the health of the body in isolation from a larger conception of human flourishing (eudaimonia), then we will make the error of thinking about the health of the body as an end in itself. The preservation of the body will become not merely one good among many, but the highest good.

If how a society spends its money is a reflection of the goods it most prizes, then US expenditure on health care reveals much about our values. A 2004 study in the journal Health Service Research (Amber E. Barnato et al., “Trends in Inpatient Treatment Intensity among Medicare Beneficiaries at the End of Life,” Health Service Research 39, no. 2 [2004]: 363-76) concluded that 30% of all annual medical costs in the US are incurred by 5% of beneficiaries who die within a year. One-third of those costs cover treatment in the last thirty days of their life. Similarly, Daniel Callahan, president emeritus of The Hastings Center for bioethics, says that 5% of patients with chronic disease and/or organ failure are responsible for 50% (roughly $600 billion) of total annual medical spending, roughly $1.2-1.7 trillion (New York Times, 13 January 2013). (For a more conservative estimate, see Melissa D. Aldridge and Amy S. Kelley, “The Myth Regarding the High Cost of End-of-Life Care,” American Journal of Public Health 105, no. 12 [2015]: 2411-15.) That figure reflects a doubling of the overall expenditure on health care between 1999 and 2011. According to a federal government assessment by the Center for Medicare and Medicaid Service, America’s annual expenditure on health care in 2015 reached $3.2 trillion or 17.8% of GDP. To put that in perspective, according to the Organization for Economic Co-operation and Development, the US public expenditure on primary and secondary education in 2010 was 7.3% of GDP. What does this reveal about our values? How much will we spend to hold on to the last 30 days of life relative to the first 18 years of life?

Plato, in a provocative passage in Republic, wrote with considerable prescience when Socrates declares that a sure sign a society has become unjust and disordered is when “… many law courts and hospitals are open. [And] skill in pleading and medicine give themselves solemn airs when even many free men pursue them eagerly” (405A). In other words, the field of medicine gains an exalted place in society when people have not lived a healthy, temperate lifestyle, yet are afraid of death and so rely on doctors to save them from the consequences of their excesses. Doctors become our high priests who mediate life enabling us “to reach old age, dying a hard death all the while” (406B). Perhaps it is not so much that we value the health of the body – our excessive consumption and sedentary life style would suggest we don’t – but that we are afraid of dying and so cling tenaciously even to our final days.

This US expenditure on health care, especially end-of-life care, raises serious theological questions. How do we think about death and life in the present age? Where do we place our hope? What is the telos of the Christian life? To put the question another way, as people who confess that Jesus was raised from the dead and that by his death and resurrection he has opened to us the hope of eternal life in his new creation, how does resurrection hope reveal The Good, i.e., our relationship with God, that should determine how we look upon death and how we order our life in the present? How should a robust doctrine of the resurrection influence the way we as Easter people approach the allocation of funds for health care generally and end-of-life care specifically? How might an Easter faith shape the way we imagine the work of nurses, doctors, and medical researchers in sacramental terms?

An essay like this is certainly a better place to raise questions than to offer facile answers. But these are some of the questions I want to explore in upcoming issues of Catalyst. At the core of each is a common theological conviction, namely, if Christians are to make a substantive and distinct contribution to our nation’s discussion about health care and to guide our people in making faithful decisions about end-of-life care, then we must speak from the core of our faith as an Easter people who before the world confess, “The Lord is risen. He is risen indeed.” That good news has changed everything. And it is high time we reason together about the common good of society within our knowledge of the new reality that Christ’s resurrection opened to us.

Posted Apr 17, 2017

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