Religio Medici

Picture a woman who has just given birth prematurely. Her baby boy was born by cesarean section, and now she has a surgical incision that needs to heal. Her son, who is in the neonatal intensive care unit, has trouble breathing and regulating his body temperature. Both mother and son are in the process of healing. In order to become well, they need many things that modern medicine can offer. But they also need each other.

When my medical students visit the N.I.C.U. for the first time, they expect to find evidence of our technological prowess, which is considerable. What always surprises them is that one of the most powerful “treatments” in this highly technical space is something almost disarmingly simple: a baby sleeping on someone’s chest.

We call it “skin-to-skin” or “kangaroo care.” The premature infant is placed on the bare chest of his mother, father, or another caregiver and held there, sometimes for hours. Preterm babies who receive this kind of care have better temperature regulation, more stable heart rates, and fewer breathing problems. We now have data showing that skin-to-skin contact can reduce mortality in hospitalized infants who weigh less than four pounds by forty percent. This isn’t the result of a new drug or device; it is simply what happens when one body is pressed close to another, out of love.

Even sound can heal relationally. Research has shown that preterm infants have fewer episodes of slowed heart rate and unstable respiration when they hear their mothers’ voices. We often talk as if the things we are able to measure—heart rate, respiratory rate, and blood pressure—were purely autonomous processes, as if the body were an isolated machine. But that is not how bodies actually behave. From our first moments, our bodies anticipate and respond to relationships. A baby’s lungs, heart, brain, and skin all “assume” the presence of another. The body does not merely contain relationships; it is structured for them.

If that were true only at the visible, macro level, it would already be striking. But something even more mysterious is going on. Our health is relational not only in the warmth of a conscious embrace but even at the cellular level.

Consider again the mother recovering from a cesarean section. Her incision has been carefully sutured. Her immune system has begun the familiar but astonishing work of repair: collagen deposition, tissue remodeling, restoration. We know this general story well. But in recent years we have learned that she is not the only one working to heal her wound.

During pregnancy, cells from the baby cross the placenta and travel into the mother’s body. Some of these fetal cells take up residence in her organs—thyroid, breasts, liver, even brain—and can remain there for years, sometimes for the rest of her life. This phenomenon, known as fetomaternal microchimerism, means that after pregnancy, a mother’s body carries traces of the child she has borne.

These are not inert artifacts. In some cases, fetal cells contribute to tissue repair; in others, they appear to participate in immune responses. The author Abigail Tucker has drawn attention to a case in which these cells were responsible for rebuilding a whole lobe of one woman’s liver—a case made even more poignant by the fact that the baby had been aborted. The child’s body, in a mysterious, hidden way, continued to serve the mother’s. This radical mutuality at the level of the cell is truly beautiful.

Nor is the traffic one-way. The child carries maternal cells in his tissues as well. Many human beings, without knowing it, walk around in bodies that are mosaics of more than one person’s cellular material. To say that we are present in one another is not an abstraction or a poetic description but a literal, observable brute fact about the world.

From a theological perspective, it is hard not to see this as a kind of embodied parable. “For none of us liveth to himself,” Saint Paul wrote in his Epistle to the Romans, “and no man dieth to himself. For whether we live, we live unto the Lord; or whether we die, we die unto the Lord: whether we live therefore, or die, we are the Lord’s.” God is the author of all creation, of humanity, including our biology; and God’s own being is relational. It is not surprising, then, that creatures made lovingly in His image should bear traces of innate relationality. Biology is not arbitrary. Our bodies “speak” a truth about who we are: not isolated self-owners but beings whose existence is interwoven with the lives of others.

Even to those who do not share our theological commitments it is, I think, becoming obvious that we all do better when we are actively engaged in meaningful relationships with others. It is not an exaggeration to say that we are facing an epidemic of loneliness. In bare clinical terms, loneliness can be considered as much of a “risk factor” for what might be called “adverse health effects” as smoking, for example.

Yet contemporary medicine tells a very different story about human nature. In his book The Anticipatory Corpse, the philosopher and physician Jeff Bishop argues that medical training and practice have been shaped by a view of the human being as an object to be controlled and explained rather than a mystery to be received and served. The first “patient” most medical students encounter is a cadaver on the table in an anatomy lab, a human body rendered silent, inert, and open to dissection. In that space, death becomes the normative condition of the body.

If death is medicine’s ultimate horizon, then the living patient’s body is only a temporary arrangement of matter destined for futility. Medical practice still seeks to fight disease and postpone death, but it does so without any coherent account of what life is for. Christian faith offers a very different ontology. Christians believe that human beings are created in the image and likeness of God, capable of a dignity that does not depend on their abilities, productivity, or level of physical or intellectual development. We also believe that we have been “bought with a price”—that our bodies and lives belong to the God Who created us and to the Son Who took on flesh to redeem us. In this view, medicine is not a nihilistic fight against an absurd fate. It is a hopeful practice because it cares for creatures whose origin and destiny lie in the love of God.

If this account is true, it has immense implications for how we think about the body, about technology, and about what counts as “health.”

In many contemporary debates, the body is treated as property. “My body, my choice” is one slogan; a more recent variation treats the person as an “autonomous landlord” managing a portfolio of “biological stuff” whose parts can be altered, removed, or repurposed at will. The language of rights and ownership takes the place of an older register focused on gifts and obligations. On the contemporary view, the good life is one in which we are maximally unencumbered—no unchosen obligations, no limiting attachments, no claims upon us we did not pre-authorize. Dependence on others, especially in bodily ways, is treated as a kind of failure or indignity to be endured at best but ultimately to be overcome.

The Christian religion tells us that the opposite is true. We did not create ourselves. Our bodies, our histories, our relationships are given before they are chosen. They have a radically “thrown” quality; we come into the world already dependent on parents and other caregivers, on the natural world, on social structures we did not design, and above all on God. Our lives are not things we own so much as vocations we receive.

To forget this is not only a theological error; it has practical consequences that are both numerous and baleful. When the body is seen as raw material for self-expression or self-construction, any limit—mortality, disability, vulnerability, infertility, aging—becomes a kind of insult. Technology then appears as the liberator that can free us from these indignities. The goal of medicine shifts from caring for the body as given and toward redesigning it.

The constellation of ideas often referred to as “transhumanism” makes this drift explicit. In its popular forms, transhumanism treats human nature as just one more stage in an evolutionary process, something we can and should transcend. If we can overcome the limits of aging, illness, and even death through technology, artificial intelligence, and human–machine integration, then we are morally obligated to do so. The “can” of technological possibility quickly becomes a “should.”

This vision depends on a low anthropology. If the body is merely an upgradeable platform, there is nothing sacred about our current form. The only meaningful goods are increased power, control, capability, and longevity. Transhumanism offers a kind of secular eschatology: not resurrection of the body, but indefinite extension or digitization of consciousness.

According to this framework, goods such as charity, sacrifice, and ultimately holiness are category mistakes or (at best) anachronisms. Redemption is not something God has won for us; it is something we secure for ourselves, using whatever tools we can build. But in seeking this parody of redemption, we risk losing precisely what makes us human. The Christian claim is that Christ came to redeem and fulfill our humanity, not to erase it. Transhumanism, by contrast, tends to obscure—and at times even to deface—the image of God present in us for the sake of “improvement.”

This logic has been at work in medicine for some time in ways we do not always recognize. The author Mary Harrington has argued that the birth control pill functioned as the first widely adopted transhumanist technology. The pill did not cure disease; rather, it set out to interdict normal healthy female fertility in the interests of “choice” and “autonomy.” Rather than healing a pathology, it re-engineered women’s bodies to make them conform more closely to the demands of a technocratic, market-driven (and indeed male-dominated) society.

The result was not a simple story of liberation. As Harrington has pointed out, separating female embodiment from fertility changed relationships between women and their own bodies, between men and women, and between adults and children. It also created new markets in which the reproductive capacities of poorer women could be bought, rented, and sold. When “nature” is treated as a set of supply-and-demand problems, someone’s body becomes raw material, and a whole range of human relationships that were previously not reducible to economics becomes nothing else.

This vision has had consequences far beyond the artificial regulation of women’s fertility cycle. Surrogacy contracts now treat wombs as rentable containers; a dizzying array of elective surgeries remove healthy organs for the sake of claims made about personal identity; body modifications seek to erase normal processes such as menstruation or pregnancy as if they were defects. And if there is no need for menstruation, why is there a need for digestion, for sleep or hunger, or for saliva? Why have flesh at all when we could be steel or titanium?

Antinatalism and transhumanism are nesting dolls. If transhumanism achieves its ultimate goal—a world in which no one dies and we all live forever—then birth will no longer be necessary either. The abolition of death would in fact require the abolition of birth, of which antinatalism is the logical starting point. If birth is not necessary, then we had better start inculcating the idea that giving birth is bad, and that babies and kids are bad for you, bad for the environment, bad for the economy, bad for everyone and everything. Our culture increasingly endorses what Harrington calls “meat Lego gnosticism,” the belief that our bodies are collections of interchangeable parts meant to be snapped together or pulled apart according to preference. We can’t have transhumanism without abandoning humanism.

Christian medicine cannot accept this. If the body is indeed the “temple of the Holy Spirit,” if we are fearfully and wonderfully made, then our embodiment is not an accident or a flaw. It is the reality of a world in which we are called to love and be loved.

One practical consequence of a Christian vision is a commitment to nonviolence in medicine. To say that the human person is an image-bearer of God is to say that there is something inviolable about each human life. The physician’s vocation, in this light, is to heal, alleviate suffering, and accompany the sick—not to aim at their death.

Yet many contemporary medical practices blur or even erase this distinction. The unborn child is treated in law and in medicine as expendable if his or her existence conflicts with the wishes or perceived well-being of others. Abortion on this view is obviously medicine, as well as a legitimate exercise of a woman’s bodily autonomy. But if the prenatal child is also an image-bearer, also a member of the human family, then abortion can never be a medical procedure. It is simply an act of violence against a vulnerable person, against the mother’s own body and heart, and a grave sin against the God in Whose image both mother and child are made. Similarly, contemporary medicine often presents physician-assisted suicide as a compassionate option. In Canada, for example, people are being offered death as a solution to disability, chronic illness, homelessness, and poverty. It is of course much less expensive—and easier—than the hard work of social reform, community building, and sustained compassionate care for the poor as well as the poor in spirit.

These developments signal a change not just in laws and customs but in our collective imagination. They involve a radically different conception of what a human being is. When medicine endorses killing, it ceases to be a purely healing art. The figure of the physician resisting the onslaught of death is replaced by that of a clinician who can, in some circumstances, become death’s agent. Christian physicians, by contrast, must see each patient as a vessel of God and as someone entrusted to their care. This is true whether he or she is born or unborn, disabled, healthy, terminally ill, or apparently thriving.

Everything that I have said so far presupposes some definition of what health actually is. That definition is in fact widely contested. Ask a room of medical students for their respective definitions of the word, and you will hear many different answers: perhaps the mere absence of disease or the optimization of physical and mental performance. What I wish to propose instead is a definition based on the biblical concept of shalom, or “peace.”

Shalom does not mean mere peace in the sense of the disappearance of conflict, nor does it mean some kind of ideal optimized vision of peak physical functioning. It means wholeness, harmony, right relationship—with God, with one’s neighbors, with creation, and even with one’s own self. A Christian account of health is less about perfection than about communion.

If health is ultimately a matter of right relationship, this definition has radical implications for what we call health care. How could abortion be health care? Can anything be health care as long as we have the technical expertise to do it? Removing healthy limbs or organs from patients who do not wish to have them, performing surgeries that sterilize or otherwise mutilate healthy reproductive systems for the sake of ideological conformity, offering lethal drugs to patients whose underlying suffering is relational or existential rather than physical: These are not neutral uses of medical skill. They are, I would argue, forms of medicalized violence.

To discern the difference requires wisdom. Secular bioethics has often concerned itself with two perceived imperatives: to relieve suffering and to expand the realm of individual choice. While the elimination of suffering and the promotion of choices are both laudable, these goals are currently pursued in the absence of a moral framework that allows for deliberation. “Which forms of suffering should be eliminated?” is a question we should ask ourselves. Ditto “Which choices are best?” In the absence of wisdom, the paradigm becomes non-relational, focused on individuals, who find themselves invited to ask, “What is best for me?” and “What do I want?”

All of these questions—both the right ones asked too infrequently and the wrong ones asked so frequently that they have become axiomatic—remind us that we are too afraid of dependence. Many people who seek physician-assisted suicide claim that they are motivated not by the experience of physical pain that is past bearing (though many of them do indeed suffer enormously) but rather by their fear of becoming a “burden.” They do not want their children to have to care for them. They do not want to be helpless in front of others. In a society that celebrates autonomy above almost everything else, a person who needs help may feel like a failure.

The Christian tradition sees dependence differently. The philosopher Alasdair MacIntyre draws attention to how during the course of our lives everyone falls somewhere on a continuum of vulnerability and disability. We begin life entirely dependent on others, and most of us will become dependent again before we die. Our flourishing, he suggests, is bound up in the ways we receive care and the ways we give it. There are, in his account, “networks of uncalculated giving and graceful receiving” in which our humanity is most fully realized.

The theologian Gilbert Meilaender once wrote an essay titled “I Want to Burden My Loved Ones.” The headline was provocative, but his argument was an important one: Our lives are truly and unavoidably interwoven with those of others; it is not a terrible misfortune for one person to bear responsibility for another but simply a concomitant of love.

I am not suggesting that we should romanticize suffering or deny the real difficulties involved in caring for others, much less the real pain that comes with physical decline. But we must resist the notion that being a “burden” is shameful or that the loving response is always to remove burdens rather than share them. In Scripture and in Christian art, we are not presented with a solitary autonomous individual achieving a tidy, self-engineered death. Instead we see Simon of Cyrene pressed into service to help carry Jesus’s cross, the privilege of bodies supporting bodies.

I believe one of the most powerful ways Christian physicians can help shape our culture over the next several decades is by providing an alternative approach to suffering and death. We cannot fight for the status quo, for the overuse of technology, with people stuck on machines forestalling natural death. People know that this is not how they want to die. But as the author Leah Libresco Sargeant once put it, when there is an error in our culture, our “no” often sounds louder than our “yes.” Everyone has heard our “no” to euthanasia, but they don’t know what Christians are saying “yes” to when we talk about death. If we do not articulate a positive vision of a good death—one in which relationships are honored and repaired, in which technology is used thoughtfully and judiciously rather than reflexively and in which the reality of dependence is neither denied nor despised—this will always be the case.

It doesn’t help that physicians themselves are often indifferent to what philosophers have to say. Many of them won’t have conversations about medicine with people who are not themselves physicians or even with fellow doctors who employ conceptual language from other disciplines. Even my most educated colleagues tend to roll their eyes at me when I use words like “goods” or “conscience,” which they claim not to understand. When I mention the imago Dei, they twitch. At best these things are dismissed as extraneous baggage rather than necessary tools for thinking about the human being. Ethics is easily reduced to compliance with regulatory guidelines or risk management strategies rather than serious moral deliberation.

Yet if Christians believe what we say we believe about the human person—created, fallen, ultimately redeemed—then we cannot leave these convictions at the clinic door. We are part of a larger story, one that does not begin with our first conscious choices or end with our death certificates. Medicine, too, must be part of that story if it is to serve transcendent supernatural ends.

The ethicist Paul Ramsey once warned against what he called “frivolous consciences”—consciences that pretend to be engaged in serious moral reasoning but are in practice simply finding ways to justify whatever technical possibilities happen to be at hand. A serious conscience, he suggested, is willing to say that there are some things human beings must never do, no matter how great the promised benefits. The good we do is defined as much by what we refuse as by what we attempt.

Christian physicians and bioethicists, then, are called not only to compassionate bedside practice but also to a kind of creative dissent. We are called to resist the reduction of the human being to a “meat Lego,” the reduction of health to individual choice, and the reduction of medicine to a technology of control. We are called to insist that the body is a gift, that dependency is not only compatible with but capable of conferring dignity, and that the goal of our work is not simply to extend life but to foster right relationship.

Let us return once more to the image of the mother and her preterm son. Amid the hum of machinery and the presence of doctors, nurses, and technicians, one of the most powerful interventions is simply the mother who rests the baby on her chest, allowing him to hear her heartbeat. Her own wounded body is also the place of his healing, just as his own cells, working silently within her tissues, will help repair hers.

This is more than a beautiful and touching picture. It is a description of what medicine is at its best: a practice that honors the givenness of the body, the depth of human relationships, and the mystery of our shared dependence on a God Who made us for communion. A Christian vision of medicine does not despise technology; it simply treats it as a means, a series of tools employed in service of a supernatural end rather than a self-justifying set of new possibilities. It refuses to treat the body as raw material and the vulnerable as expendable. “Does it not make a great difference,” C. S. Lewis asked, “whether I am, so to speak, the landlord of my own mind and body, or only a tenant, responsible to the real landlord? If somebody else made me, for his own purposes, then I shall have a lot of duties which I should not have if I simply belonged to myself.”

These are duties none of us can afford to forget. In a world that seeks to engineer away our humanity, such a conception of medicine will appear strange. But it is precisely this strangeness that we must offer the medical profession and the wider culture.

This essay was originally given as an address to the Society for Christian Bioethicists.