Practicing Covenantal Love in Medicine

Why does being Reformed matter for the practice of medicine, in my case, in oncology? Because it provides the most meaningful understanding and expression of “beneficence of care” by which we reflect God’s never-failing covenantal love for us.

I was blessed with a Christian university education that opened my eyes to the meaning of Abraham Kuyper’s confession of “the sovereignty of the triune God over the whole cosmos, in all its spheres and kingdoms, visible and invisible.” Subsequent medical school education gave me a solid base for understanding the multidimensional nature of health and disease, but it focused primarily on the mechanics of diagnosing and managing patients with disease. Certainly technical competence is necessary for everyone in medical practice. However, the core of medicine is relational, and its core principle of care is beneficence.

Given this reality, the biblical theme of covenant provides a meaningful model for envisioning the relationships that constitute medical practice, particularly the complex web of relationships in oncology practice. In the Reformed understanding of covenant, our relationship with God is a model for our relationship with other human beings. Just as God graciously offered and faithfully keeps covenant with us, in medical practice care we offer care to those who are rendered vulnerable by disease and in need of care. And patients with cancer or other disease are best served in covenantal trust by being honest and forthright in relating the results and consequences of treatment. Caregivers should offer expertise that empowers and encourages patients to decide on the available therapeutic options based on their own beliefs and preferences.

Understood in this way, those who practice medicine must address and meet the needs of their patients beyond the physical, biotic, and physiological imbalance and distress associated with their disease and sometimes its treatment. I once cared for a woman with advanced breast cancer who lived with a psychotically possessive husband who kept her captive to his needs at the expense of hers. As her disease broke free from the cancer-suppressing effect of repeated therapies, she needed emotional and spiritual as well as physical care. Admitting her to hospice care earlier than the official rules prescribed provided a respite among giving, caring, and covenantally committed staff during her final months of life.

Covenantal relating also applies to other relationships in medical practice. Respect for the expertise of the growing number of new types of caregivers (physician assistants and specialized nurse practitioners, for example) is crucial to giving the most expert care to patients when most needed. While communicating the value of expert care available through nurses, social workers, and other health care professionals, it’s also important to acknowledge the limits of expertise to well-focused, total care. One can envision an interlinking web of care representing patients, different types of professional caregivers, and supportive family or church members.

The theme of covenant is deeply embedded in Islamic and Jewish faith traditions, but the inherent appeal of covenantal relating as an expression of common grace is also recognized by caregivers and medical professionals outside of those faith traditions. Developing an ethos of covenant can also help people of diverse beliefs who are engaged in medicine remain attentive to their other relationships outside of medical practice—relationships with family members, church, and community—that also must be covenantally met.

Web Questions

• What can a Reformed perspective offer health care providers beyond “the mechanics of diagnosing and managing patients with disease”? What difference would that make to you as a patient?
• Rusthoven says that “the core of medicine is relational, and its core principle of care is beneficence.” Do you agree? Can you give examples from medical treatment received either by yourself or someone close to you?
• How does the idea of “covenant” differ from, say, a strictly economic model of patient care? How can society at large, the health system, and people within it foster a covenantal understanding of health care?
• In traditional Chinese society, there was a time where you paid the doctor to keep you healthy. As soon as you became ill you stopped paying. Quite apart from whether that would ever be workable in our society, does that approach align with a covenantal understanding of the doctor/patient relationship? Why or why not?
• Rusthoven writes, “Those who practice medicine must address and meet the needs of their patients beyond the physical, biotic, and physiological imbalance and distress associated with their disease and sometimes its treatment.” Can you give concrete examples? Do your health care providers make room for that to happen?
• What roles should folks other than health care professionals play in the life of someone who is seriously ill? Should those also be covenantal? What does that look like?