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Adventist Healthcare Ethics – Myths and Dilemmas

We welcome new Spectrum columnist Mark F. Carr. Mark will be writing 6 columns per year, on the third Thursday of the month, alternating with Loren Seibold, who is reducing his workload to provide the other 6 columns during the calendar year – Spectrum Columns Editor

Greetings. I am Mark Carr, a fifty-five year old convert to Adventism with an Army brat background. A privileged white male whose father fought for the United States in three wars while Mom took care of us kids. In my conversion, God did an Ezekiel, dry bones sort of thing – he gave me a heart of flesh, changing me from the inside out. I really wanted to be like Christ. After I fell in love with academic life at Walla Walla College and Andrews Seminary I became a pastor in the Alaska Conference. Although I was ordained, I later left congregational ministry (but not my calling) and returned to school. I joyfully labored through a PhD in religious ethics at the University of Virginia.

After completing that program, many of my friends and family wondered why I would be so excited to find work as a professor at Loma Linda University. It was, they opined, a place where good Adventists lose their faith to liberal, secular, anti-biblical forces of evil. Seriously, people said that to me. On the contrary, words cannot properly express my appreciation for seventeen years of the richest theological, cultural, and congregational life I found within Adventism there in the Loma Linda environs.

But life kept happening and it moved me like everyone else so, after a short time at Kettering College in Ohio, I landed an excellent job back home in Anchorage, Alaska for Providence Health & Services. Providence is a large healthcare corporation built by the Sisters of Providence, an order of Roman Catholic Nuns dedicated to caring for the “poor and vulnerable” among us. They came to Alaska in 1902 and I find their commitment to this mission authentic and thoroughgoing. I am the Alaska Region Director of Ethics, which means I care for clinical consultation, ethics education, and ethics oriented policy management in Anchorage, Kodiak, Seward, and Valdez. 

I hope, with this column, to focus on issues surrounding Adventist ethics and healthcare, though I take a broad approach which will wander at times. Feel free, via your comments and/or email, to help me tell that story in an uplifting manner. Help me be as historically accurate as possible but also as open to God's leading in order to allow our past to inform our future. I'll dig into some thorny issues because that's what theological ethicists do. And I'll encourage us not to fight about the issues in an "us" versus "them" demeanor. We live in a world that does plenty of that anyway, we don't need to bring it through the doors of the Church. We have a Christ who calls us to be persons of virtue, who invites us to let him mold our inner life and character. Let's do our best to follow his lead.

Now to begin. Consider 5 myths (so I claim) about Adventism, ethics and healthcare:

1)       That there actually is a Seventh-day Adventist ethic, although I hope to encourage one and I certainly am a Seventh-day Adventist ethicist.

2)      That there is no need for ethics, per se, in a Christian’s life, since offering ourselves to Christ removes all moral quandaries.

3)      That healthcare is the “entering wedge” of the Church.

4)      That the Church offers Seventh-day Adventist healthcare to our society.

5)      (expanding on the fourth) that Adventist healthcare corporations have lost their way and given themselves over to the world.

Let’s next unpack them. I’ll begin from the end and work backward. Frankly, I am inspired by the commitment I see among leadership in Providence Health & Services to connect with their story. Of course, Catholic social teachings and ethics are essential to that effort, but the specific mission of the Sisters is recounted in lessons for every one of their ~ 75,000 employees. Millions of dollars are spent every year making sure the core values and mission of Catholic healthcare is upheld. Every Providence employee learns the reason we are in the service of caring for others. Chosen leadership undergoes further education in the hope that consistent decisions are made across clinical and business offices throughout the corporation and clinical sites. As a non-profit healthcare corporation they offered $848 million to benefit local communities in 2014.[i] And Providence is only one of a handful of large Catholic healthcare corporations in the United States. They encourage my optimism for Adventist healthcare. We have such a rich and vibrant story within our Church of an authentic desire to care for others out of the love of Christ and for his honor. I hope to encourage us to continue telling our story – starting in Battle Creek with visionary leaders bent on taking the three angels message and the love of Christ to their communities. There is plenty of money in healthcare and the Church to make it happen, but we need consistent and supportive encouragement from every level of the Church. From within two of our Church's healthcare systems (Loma Linda and Kettering) I have witnessed an authentic and thoroughgoing commitment to such mission.

Through the years I have heard so many derisive comments about how lost those “liberal” people at LLU are. While we speak in public of the magnificent healthcare institutions we've built, privately I've heard so many deride those “crazy California” liberals whose Adventism has vanished. I reject such cynical and pessimistic perspectives. In fact, dedicated people from both healthcare and church leadership are doing their best to cast a vision for continuing a path of a cooperative commitment. One that respects our primary emphasis and blended history. Of necessity healthcare must be non-sectarian and purposefully prioritize the health of its local community. Similarly, of necessity, Church leadership must be sectarian with primary emphasis toward sharing the three angel's message around the world. The fact that these two subcultures within the Church have different initial priorities doesn’t necessitate conflict. All significant institutions have multiple, interactive priorities to balance. Recognition and appreciation of this reality is step one toward partnership renewal between our clerical, medical, and business subcultures. You will read much more of this in future columns, and likely will note my analysis of what I call "subcultures" within our Church.

I'll admit some confusion about the fourth myth, that the Church, per se, doesn’t own or offer healthcare to the public. As I understand it, in the late 80’s and early 90’s, the Church aligned legal ownership from the General Conference to the several corporations in order to avoid ascending liability.[ii] There remains, to be sure, a deep connection respected on both sides. The governing boards of Adventist Health, Adventist Health Systems, Kettering Health Network, Loma Linda University Health, and Adventist Healthcare may be chaired by Church leaders, but the corporate, and therefore legal, structures of these Church institutions is not traced back to the General Conference of Seventh-day Adventists. The one, notable exception to this rule is Loma Linda University Health. Ideologically, although these systems remain thoroughly committed and authentically Adventist, they are not owned by the General Conference similar to Division, Union and Conference corporations. The effect this corporate and legal reality has on our healthcare institutions is incredibly complex and I don't pretend to fully understand it – few people really do. As social institutions offering care to the public, we have an immense responsibility to the states and countries within which we work. And note that my comments are necessarily limited to the context of healthcare in the United States.

The "health message" of the Church was initially conceived to be the "entering wedge" for the three angels message. The goal wasn't just to help people be healthy it was to also have them join our faith community and commitment. A worthy goal to be sure. But this is no longer the case. I suspect if we were to poll younger generation Adventists about the "health message," most would not (or could not) give a coherent answer. I don't take this as some sort of failure – it's just the way it is. I suspect, however, that the vast majority of our younger people know that we offer them careers in healthcare. We used to focus a great deal of effort steering our young people toward healthcare professions (e.g. physicians, nurses) but today, we do an equally (if not better) job steering them toward the healthcare business. Whether we speak of the business or medical end of our public healthcare offerings, we must do more as a Church to help build into their personal and professional development the core values and mission orientation of our healthcare institutions. If we say our mission is to extend the healing ministry of Christ, we must tell our clinical and corporate leaders what exactly that means to us. It is impossible to offer our “brand” of healthcare with a 100% Adventist population at the clinical, managerial and executive levels. We, like every other faith-based healthcare corporation in America, must hire from outside our faith at almost every level. What are we doing to help non-Adventists working with us to fully understand what the "health message" means to us?

And scripture does not directly address many of the most vexing issues of our time. How, for instance, can we help the physicians, nurses, and managers on a labor and delivery unit decide which precious human life to save when a pregnancy has progressed to the point that both mother and baby cannot be saved? Of course there is nothing new about this and ethicists and medical professionals have been dealing with it for a very long time. But this is part of my point, we need scripture carefully interpreted and deeply imbued within our ethical frameworks to properly address this and other issues. There are newer medical technologies for which we need a more expansive method of hermeneutics. For me, the Wesleyan quadrilateral is helpful. How does medical science, church teaching, and reason work together with scripture to help us navigate present day issues? Artificial wombs, reproductive technologies, life extending medical equipment and research, social responsibility toward those who cannot afford healthcare, and assisting people to end their lives –  names just a few of these issues.

Finally, I'll admit I'm a bit touchy about having no distinctive Seventh-day Adventist ethic, given the fact that I self-identify as one. Some of my own colleagues disagree with me here, suggesting that there is no need for a specific approach to ethics for Seventh-day Adventists given the broader field of Christian ethics, and I get their point. Similarly, we have argued for a very long time over the idea that some points of Adventist theology are very particular, unique to us, and not found elsewhere in Christianity. But I believe it is helpful to mine our story for elements of thought and approach to our present, complicated lives, particularly in our engagement with healthcare.

Well, this has been an extensive introduction to issues and concerns I plan to examine in coming months. I invite you to journey with me, interactively, to explore and rehearse our stories, problems and collective future.



[ii] Duska, R. 1982. "Autumn council creates 7th largest health system," Spectrum13:69–70. See also, Greene, J. 1990. "Adventist Health/U.S. dismantles system, forms new association," Spectrum20:35–36. And Evans, R. A. 2000. "Adventist hospitals: An ailing system? Part I," Adventist Today8:12–22

 

Mark F. Carr is an ordained minister and theological ethicist with experience as a pastor, pilot, commercial fisherman, professor, and now clinical ethicist. He writes from his home town of Anchorage, Alaska. 

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