At this point, U.S. Federal healthcare legislation is in a state of . . . confusion, shall we say? One broad policy question that remains unanswered is whether healthcare in America is a right or a privilege.i Although debate on this issue typically devolves quickly to inane, political bickering, I understand this as an essential part of the framing of our approach to healthcare. Further, I believe the Gospel and Seventh-day Adventist theology positions us on the "rights" side of the issue. But healthcare in America is an "industry," one in which we Adventists are deeply embedded even if we take a not-for-profit approach. American healthcare is a capitalistic, business venture that has morphed itself toward customers and away from its historic attention to patients. Americans have a lot of rights as patientsii ,but ironically, in order to assert those rights, they have to pay for them.
When we think of healthcare as a privilege, yet something for which one must pay, an immediate question arises: what to do about those who cannot afford it? An answer I often hear is that these unfortunate souls should not look to the government for help. Government, according to this line of thinking, should not be in the business of paying for healthcare. Unlike the government's obligations to provide education and military security, unmet healthcare needs should be picked up by the private sector. If anyone is supposed to care for society's poor and vulnerable, it should be charitable organizations, not the government. Of course, Medicare and Medicaid are government programs, but part of the political theater we are living through includes an ideological debate about the role and size of these government healthcare programs.
The argument for getting government out of healthcare puts the burden of caring for society’s poor and vulnerable on the private sector. The argument asserts that if our charitable organizations would step up to the plate and fill the societal role that they ought to, then things would be just fine. Thus, for those in lower socio-economic groups in American society, if and when they need healthcare, they could go to free clinics, charitable hospitals, or other community services. Although I do not believe this is a viable solution, there are, even now, millions of people getting care in free and/or charitable clinics across the country. The National Association for Free and Charitable Clinics (NAFCC) reports as many as 1,200 such places. This association was “founded in 2001 by a group of grassroots medical providers and organizers who recognized that local health care was not adequately available to the working poor, uninsured, and under-insured in our country in a way that was cost effective, accessible, and affordable.” Their mission is clear: “to ensure that the medically under-served have access to affordable quality health care.”iii
Whether they operate year-round or only for a couple of days at a time, free and charitable clinics are no way to solve the country’s healthcare crisis. Nonetheless, they do help those in need. Adventist healthcare providers are right in the mix of this effort, and they provide a good deal of free and charitable service to their communities. Free clinics take many forms and are provided by many groups. One such group calls itself Adventist Medical Evangelism Network (AMEN). Though I do not know how it chooses which communities to go to, I’ll assume a good deal of thought and research goes into the selection process. Physicians, nurses, and allied health professionals, dentists and associated caregivers, social workers, and others take time out of their routinely busy lives and dedicate themselves to the effort to provide one- or two-day free clinics in the targeted town. Like the NAFCC, AMEN does not lack clarity in its mission statement: “To motivate, train, and equip Seventh-day Adventist physicians and dentists to team with pastors and members, uniting the church to restore Christ’s ministry of healing to the world, hastening His return.” The organization’s website goes on to identify its vision: “The training of Seventh-day Adventist physicians and dentists to be effective medical evangelists. Christ’s methods of loving service through the ministry of healing will naturally open hearts to the gospel and the truths of the Bible.”iv
This is extraordinary work and should be applauded loudly and at length.
So, what's good about it?
People who cannot afford healthcare, get it. And they get it without the absurd financial burden that our national system places on them. Readers may know that I am not a fan of our national obsession with making money from sick and vulnerable people. The fact that these free clinics are offered is an immeasurable blessing to millions of Americans. It is the admirable thing to do—the Christian thing to do in the face of this national crisis. But what, exactly, do we mean by the term “medical evangelist"? In the context of Adventist congregational and mission evangelism, the answer would seem clear: we are intending to introduce people to Jesus, the Gospel, and our Remnant faith. Notice, however, that the AMEN website never uses the word “witness” or “salvation.” Nowhere does it assert that the end goal of this evangelism is for the recipients of this clinical care to become members of God’s remnant church. I want to point out the fact that medical evangelism is not primarily an evangelistic enterprise. It is a medical endeavor. Too many of us ignorantly believe that, in the offering of clinical care, if we just pray for and witness to our patients, we are doing God and the patients a tremendous service. Too many of us ignorantly think that medical evangelism is about saving souls for God and gaining members for the Church.
Perhaps an illustration would help: I was recently asked for an ethics consult on a case involving a woman in her 50s with a complex diagnosis involving cancer and liver problems. Her prognosis was not good, but she went to see a specialist as one element of her care. The physician spent a few minutes clarifying her situation and then opportunistically encouraged her to come to his Church. Being in a church community would be good for her, he said. Being with God would help her stop the habits that had resulted in her illness. Both perhaps true (I do not believe the physician was an Adventist). This ill woman was not religiously inclined and was not the least bit interested in hearing about supposed benefits of belonging to a Church. She did not know the man, his church, or his god. She did, however, want to know the medical response for her illness and was anticipating the doctor's suggestions for her treatment plan. So, she waited out his witnessing in the hope of getting his medical expertise. He never got there. The only treatment plan she was offered was this, “Quit what you're doing and go to church.” She reported to her oncology physician that she “felt violated” by this Christian physician’s efforts to witness to her. She felt she had not received clinical care that rose to a level of routine competency. And she also wondered if she had, in fact, followed his advice and attended his Church, would she have received better clinical care from him.
What the physician did was wrong. Not just awkward or poorly executed, it was wrong. Here is why. He did not know her; he had no relationship with her. If Christian healthcare professionals think that witnessing to our patients is our divinely appointed duty, I suggest we take some effort to learn how to do it well, with moral appropriateness. A free, day clinic is not the way to do it well. As our tradition has taught us, when we care for people in their distress and vulnerability, we must come to know them. We must understand them as persons, whole persons. Does anyone remember "whole person care?" Does anyone believe that free, day clinics provide "whole person care"? To believe that medicine in the form of day clinics is evangelistic is absurd. Alternatively, caring for whole persons in the authenticity of a long-term commitment to them embedded in their local communities is indeed an evangelistic enterprise.
Day clinics are good for the immediate, physical health needs of those who are seen. So, please, by all means let us keep doing that. But let us set our hopes for evangelism and witnessing into the secondary category to which it belongs. We offer such clinics for their health needs, not spiritual. Let us be content with this. I am reminded of our old phrase, "dis-interested benevolence," as it relates to giving. We offer our finances and then trust it will have long term positive effects for good, for the spread and maintenance of our Church. Of course, in caring for the physical needs of patients, we are caring for their spirit, hoping for their eternal peace and salvation. But the goal of providing clinical healthcare must be paramount. We are not making political statements in the process. We are not simply giving students people to practice on. We are not doing it to maintain a tax category or pat ourselves on the back for being altruistic.
Authentic Adventist free, day clinics are not in the business of political subterfuge of the Planned Parenthood system. Authentic Adventist free day clinics are not in the business of partnering with anti-abortion rights political groups. Even the most conservative Christian healthcare professional group in America, the Christian Medical and Dental Associations (CMDA), has a specific code of ethics for its witnessing endeavors. Nowhere in its code does the word “witness” appear. It begs the question of what exactly we mean when we imagine ourselves witnessing through healthcare. For CMDA members, their witnessing or evangelism means this: “With God's help, I will love those who come to me for healing and comfort. I will honor and care for each patient as a person made in the image of God, putting aside selfish interests.” Why are they committed to their work? Their code says they “aspire to reflect God's mercy in caring for the lonely, the poor, the suffering, and the dying.”v
So, why are we in the work of medical evangelism? Mixed motivation is part and parcel of our Adventist healthcare legacy. The same is true of our Adventist Development and Relief Agency work. More than a few professionals in both of these streams have gotten into conflict with Church Administrators who are clear about where we ought to focus our motivation: eternal salvation. Is it enough for ADRA to provide clean water or must workers show increased Church membership to justify their expense? Is it enough for these free, day clinics to provide medical and dental care to the needy? Or must they show some evangelistic success for us to support them?
Healthcare professionals must prioritize the immediate physical needs of their patients, by professional obligation, by ethical codes of practice, federal and state regulatory agencies, and by legal standards. Witnessing to patients who are strangers to us, in the context of a clinical visit that lasts from 10 to 30 minutes, should be considered unacceptable. Of course, if the patient first expresses a faith orientation or commitment that opens the door for prayer or discussion of our good Lord, this is surely a blessing to be appreciated. But when there is no established relationship whatsoever, our concern should be altruistic service: clinical care with no strings attached.
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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