Reconceiving Healthcare

In the Orthodox Christian tradition, God is described as being the “Great Philanthropos,” and Jesus Christ, as a healer of body and soul, is described as the “Great Physician.” Being adopted by early Christians, the Hellenic idea of philanthropia, or being an “unconditional lover of humankind,” was used as a way of describing God Himself and became intimately intertwined with the notion of diakonia, or service, which highlights the uniquely social and inter-personal dimensions of Christian love. Mimicking the life of Christ, philanthropically serving the needs of the sick was a central component of the lifestyle of the early Christians. Both the idea of diakonia and the institution of the diaconate were so foundational to the Church’s presence in the world that in the second century, St. Ignatius of Antioch described the diaconate as representing Christ on earth by performing his ministries of healing, teaching, and selflessly tending to the needs of the sick and the poor. In the fourth century, it was under the auspices of philanthropic diakonia that St. Basil the Great established hospitals and hospices as charitable institutions, a practice that spread throughout Byzantium and later in the West as well.

Coupled together, the empiricism of modern science and the financial corporatization of contemporary medical practice threaten to eradicate the relational, philanthropic, and ascetic dimensions of healthcare. What is needed is an outlook that views the sick as suffering persons and not as mere consumers of medical services, while it views healthcare providers as healers serving the health-related needs of the sick rather than functioning as “merchants of medicine.” Although all Christians are called to engage in diakonia, in a certain sense physicianship entails a special diaconical responsibility in that it entails healing and a transfiguration of persons’ states of being. In that Christ is the Great Physician and deacons are representatives of Christ on earth, the Church might consider reinvigorating the diaconate by reimagining the current purview of deacons’ responsibilities and expanding the role of deacons to include, for instance, a vocation of healthcare-provider or physician, where deacons trained in medicine could perform medical ministries.

In its disambiguation, healthcare implies caring for and about health and hence involves a disposition that will propel the provider of such care to work toward the restoration of well-being so that the patient lacking health can continue to flourish as a person and a member of the community s/he belongs to. Rather than simply repairing a physical “dysfunction” or correcting a physical abnormality, the Christian understanding of healthcare does not neglect the ethical and spiritual dimensions of medical practice. Medicine is a practice whose telos, or aim, is healing, or to “make whole.” Healing is not simply curing or treating, but involves a restoration of personal and interpersonal well-being. As a practice, medicine is not simply an “art” or a “science” but is an askesis, which comprises both. As an askesis, or practice, medicine or healthcare is inherently relational and other-oriented and contains within itself sets of technical skills but also an implicit set of virtues to be cultivated by those persons engaged in the delivery of healthcare. If we come to think of responsibility as the ability to respond to another’s needs with compassion and generosity, and think of healthcare as implying an authentic concern for the health and flourishing of patients, these ideas can come to bear on our understandings of physicianship, and what it means to be a “Good Physician” in the moral sense.

To this end, I believe there is a moral distinction between different types of work that is relevant for healthcare ethics. Drawing on the Greek notions of δουλεία (douleia), έργα (erga), and διακονία (diakonia), I would like to suggest that there exists a distinction between the interrelated concepts of labor, work, and service. We might think of δουλεία, or labor, as consisting of those activities that cultivate and sustain biological life and hence contribute to the reproduction and maintenance of human vitality; in this sense authentic labor contributes to the sustainability of natural well-being. Έργα, or work, are those activities that build and construct social artifacts, systems and mechanisms that people use as a means of achieving a state of flourishing and hence, virtuous work becomes a means to achieve higher social goods; from this perspective virtuous work will be that which contributes to the cultivation of excellence and human flourishing. Finally, there is the aforementioned notion of διακονία, or service, which comprises actions taken and work or labor performed with the explicit goal of fulfilling human needs and hence, entails actively serving the needs of persons and communities.

In the context of medicine and healthcare, medical research would fall under the auspices of έργα insofar as it entails discovering and developing resources, techniques, systems and materials with the goal of better enabling human well-being, and therefore it can be construed as work undertaken and performed with the aim of human flourishing. From this point of view, clinical healthcare can be conceptualized as a form of work or labor aimed at attending to the human need of health and hence, can come to embody the notion of διακονία as healthcare service seeks to increase human well-being, restore and maintain human vitality and contribute to persons’ ability to flourish by ensuring that their need for health is fulfilled.

Within this conceptual framework, the idea of philanthropic healthcare would indeed still imply that “virtuous” individual practitioners engage in pro bono work, yet must go beyond this to address persons’ communal and social health needs as well. For instance, on the social level philanthropic healthcare could involve the creation and establishment of local healthcare centers and non-profit networks of diaconical healthcare providers to staff them on voluntary rotations. In this way the idea of philanthropic healthcare can go beyond discussions of how we ought to redistribute material resources to the reconfiguration of our understandings of the ethical and ascetic dimensions of medicine. From this perspective, healthcare is capable of being a philanthropic social force that seeks to bring about, restore and preserve biological as well as personal and communal vitality so that it may assist in cultivating human flourishing and more deeply reconnect medicine and physicianship to the Church’s philanthropic mission.

Some of the ideas expressed in this post were presented at the 2016 OCAMPR (Orthodox Christian Association of Medicine, Psychology & Religion) conference at Hellenic College Holy Cross and appear in a chapter entitled: Philanthropic Healthcare: Christian Conceptions of Social Responsibility & Healthcare as chapter 5 in the book: Religious Perspectives on Social Responsibility in Health: Towards A Dialogical Approach. Advancing Global Bioethics Series. Springer Publishing.