The Image of God and The Practice of Medicine
Then God said, "Let us make man in our image, according to our likeness...And God created man in his own image, in the image of God He created him; male and female He created them."
Our attempt to develop biblical principles for the practice of medicine is necessarily based upon systematic theology. When one puts together the pieces of a puzzle, they will not fit anywhere except where they were made to contribute to the whole. A system requires that pieces fit, not be randomly placed anywhere. When Christians speak of a world view, they are speaking of a unified system of knowledge. It is not enough to understand Bible verses or the ethics that are derived from them. One must fit each piece of knowledge into the whole; otherwise, one never has the completed picture (worldview) and, worse, one does not know what pieces may be present that do not belong, and what pieces may be missing. Christians are too often satisfied with a pile of pieces, some of which don't belong and others that are missing. Dr. Dough Heimburger has given examples of an application of the Biblical world-view to medicine in a previous issue.1
Man made in the image of God is a crucial piece to the puzzle for the practice of medicine. This article will make a beginning attempt to shape the piece and determine where it interdigitates with medical practice and ethics. It is with some embarrassment that this concept does not appear in my foundational book!
The image of God in man is extremely important within a culture dominated by an evolutionary hypothesis for the development of man. It is not carrying this image too far to say that it is the one factor, even for the creationist, that separates man from the animals. If, as God created living things, He had created man without this distinction, then man could indeed be placed with the animals and the focus on man in the Bible beginning with the second chapter of Genesis would seem strange and without basis. Even the theistic evolutionist (and probably the majority of Christians hold this position) must confess that God did not merely develop man by progression up the phylogenetic ladder, but did something unique in His creation of man.
What Is It?
Theologians are not entirely agreed upon the answer to this question. Further, their answer is predicted upon their "brand" of theology. Generally, they fall into three categories: Armenian, Roman Catholic, and Reformed.2 I will focus on the latter as the more complete and biblical. Even so, the subject is not simple. Certain assumptions are necessary. (This references cited will discuss these assumptions for those interested.)
(1)"Image" and "likeness" are synonyms. All the references are agreed upon this point. (2) The image of God, even though severely marred, is still present in man after his Fall (1 Cor. 11:7, James 3-9). (3) Man is dichotomous, consisting of body and soul (or spirit)3 A trichotomous view of man (body, soul and spirit) would not necessarily change the following presentation, but would make it more complicated.
We shall begin with a simple list of all the possibilities and then work our way through them. The image of God could include the physical body, the mind and all its faculties (intellect, judgement, rationality, understanding, communication or fellowship, will, emotions, morality, intuition, and self-consciousness), dominion over the earth, the soul or spirit, and righteousness. The easiest to exclude as the image of God is the body. God is a spirit without form or physical substance. The body, as the dwelling place of the soul and the Holy Spirit in the believer, has great significance, but it cannot be the image of God.
At first glance the soul, as the immaterial or non-physical dimension of man, might seem to be the image of God. Further consideration, however reveals that animals have a soul. In fact both words used for soul and spirit in the Old Testament are ascribed to animals: soul (nephesh) in Gen. 1:21,24, 6:17. 7:15 and spirit (ruach) in Gen. 6:17, 7:15; Eccl. 3:19, 21. Further, angels and demons are spirits, but are never identified in the Bible as being made in the image of God. Thus, the simple presence of the soul or spirit is not the image of God in man.
Man's righteousness can be viewed in two ways: perfect or complete righteousness and a degree of righteousness. Obviously, when Adam and Eve fell, man lost all identity with perfect or complete righteousness. Thus, this definition of righteousness cannot be the image. Then, might some degree of righteousness be the image? Many men and women do at times behave in both ordinary and extraordinary ways that would seem to please God. Further, they have some understanding of the law of God written on their hearts (Rom. 2:15). These two arguments, however, will not hold as the image. First, righteousness consists of more than behavior; it consists of one's standing before God and one's motives. Second, man's sinful nature prevents a clear perception of the law of God and a willingness to obey it. This argument concerns the central tenets of justification and sanctification and is more extensive than we can manage here. It will stand, however, as a fundamental of orthodox Christianity.
Dominion over all living things and the earth is one dimension of the image. Man is God's vice-gerent, exercising a limited authority of God's total authority. This dominion, however, is only possible be a more important part of the image.
Finally, and most importantly, we come to man's mind and its faculties. Conservative theologians almost (if not all) agree that man's mind is a function of his soul (spirit). Although I have listed various faculties of the mind, they can be simplified into two: rational (logical) though and knowledge (intellect). To "think God;s thoughts after Him" requires knowledge of them and the ability to follow his reasoning process. Although Adam and Eve did not have total knowledge (as we can never have either), they were able to reason infallibly.4 Obviously, we are not now able to reason infallibly, and this loss represents a major tarnish upon that image. Nevertheless, we are able to know some things truly and to reason accurately.
The other faculties that we have listed are predicted upon these two. Judgement is reasoning based upon available knowledge. Understanding is the reasoning that gives explanation and coherence to knowledge. Morality is judgment of right and wrong according to on;e knowledge. Intuition is inborn knowledge5 and probably subconscious judgment. Self-consciousness is the knowledge that "I" exist as an entity distinct from all other things. Communication is the ability to reason what knowledge is or is not to be given to someone else and how it is to be stated. The will is more complex than can be presented here, b simply it is truth put into action (energized, if you will). In other words what is actually believed to be true will be acted upon by the will. Similarly, the emotions are more complex. With some careful thought, however, it can be demonstrated that God does not have emotions because He is immutable and emotions represent a change in psychological state.6
Fellowship needs special attention. Surprisingly, it is almost absent from discussion of the image of God, even though it is orthodox belief that the Trinity is the ultimate fellowship. This ability may be closer to the reality of the image than anything considered so far. Simply, fellowship is conveyed in the New Testament as the Greek koinonia as sharing or having something in common (Acts 2:44;Phil.4:14, John 1:3,6,7). It is surely not coincidental that koinonia is the word for Communion (ICor.10:16), the most intimate fellowship between God and man.
Through careful reasoning fellowship is recognized as shared knowledge, or better, shared truth. Shared possessions may exist among people who otherwise hate each other, often exemplified when inheritances are divided. So, physical sharing is not fellowship. What is it that causes joy and happiness when certain people are together? It is not just the physical presence of the person, but the knowledge of thoughts (beliefs and experiences) that are valued by both. The more extensive that knowledge and experience, the greater the fellowship.
Applied to man's relationship with God, close fellowship existed between Adam and Eve and God before their sin. Gen. 3:8 implies that "the presence of the Lord" was common in the Garden. After their sin God continued to reveals Himself throughout biblical history until His revelation (the Bible) is completed. Even at the very moment of their sin, He provided a way to know (fellowship with) Him again (Gen. 3:14, "He shall bruise you on the head," the first prophecy of the forgiveness to be provided in Jesus Christ). IT is not without meaningful intent that being a "new creature" in Christ is conveyed by a transformation of the mind (Rom. 12:2) and repentance (II Cor. 7:10, literally a change of mind).
The Presence of the Image
The next question that must be answered is whether or not this image is present throughout the life span of the individual. Adam was created as an adult, but pro-life Christians have argued rightly that individual human life begins at conception. How is the image of God present, then, in the conceptus (union of the sperm and egg), the embryo (the first two weeks after conception), and the fetus (the medical term for the unborn child). The argument is both biblical and physiological. We deal with it briefly in order to focus on the application.
The simple but decisive argument is that man is the image of God regardless of what that image is conceived to be, not that he manifests or contains or achieves the image of God.7 A person is not wholly defined by what he is at a given point in time, but his potential, his actuality, and his experience. Each of these is not only determined by the life of the person on earth, but his eternal destiny.
Perhaps, the concept that every human being is a member of the human race most clearly demonstrates the presence of the image of God in the mentally retarded, those with severe birth defects and those who otherwise do not seem to have any readily identifiable characteristic with the image of God. As Christians, we know that all people of all times are divided into the saved and the unsaved (Mt. 25:31-46) or those who are in Christ and those who are not (Rom. 5:12-21). Further, Christ speaks of the entire church as a person, that is, one body (I Cor.12:12-30) and one bride (Mt. 9:15). Thus, there is a definite sense in which every person, regardless of his or her characteristics, has identity with the whole "image" of the human race.8
Other lesser arguments may be simply stated because of space. In the womb man is "fearfully and wonderfully made" (Ps. 139:14), an indirect correspondence to the image. A person may be regenerated from the time of conception.9 John the Baptist in his mother's womb was "filled with the Holy Spirit" (Lk. 1:15b) and showed a conscious response the Jesus' presence (Lk. 1:41). Throughout life each person has the innate ability of knowledge and reason, even though his physical condition may not allow the expression of his abilities.10
Applications in Medicine
The first, and possibly the most important, is that man is unique. Simply, man is or his is not. The technological dilemmas created by modern medicine have compelled some scholars to derive categories for man under certain conditions where he may be treated differently than at other times. Even Christians have been swayed under this compulsion. Dr. Norman Geisler describes the unborn child as "not fully human," "a potentially human being," and "pre-human,"11 As he discusses people with severe medical conditions (e.g. the permanently comatose and terminally ill), he uses the description "sub-human," "post-human," and not "truly-human."12 Dr. Gareth Jones in his discussion of abortion and early gestational life uses "potential person," "personhood," and "personal and non-personal fetuses."13 Dr. Jones even states that "the fetus is being built into the image and likeness of God."14
These descriptions, which are also categories, are inconsistent with the presence of the image of God in man even with the distortion of that image by sin. The only allowable categories for human beings are alive or dead. The union of an egg and sperm produces a person who is fully human regardless of defects or lace of "normality" until the time of his or her death. No philosophical or moral qualification of a "person" is possible. A person is (alive) or is not (dead). To make a category for humans other than alive or dead is to allow abortion for a variety of reasons, to allow experimentation of the unborn (as is current in England with the human embryo up to two weeks), and to allow the use of a drug or other means to kill or aid in the suicide of a terminally-ill person.
The second application is a prohibition of the union of a human gamete (egg or sperm), with a non-human gamete (sperm or egg). First, God created every "kind" to procreate after its own "kind" (Gen. 1:11, 12, 21, 24, 25). Second, He specifically proscribes the mixing of kinds in certain situations (Lev. 19:19, Dt. 22:9). One distinction, however, is necessary in this prohibition: the substitution of parts rather than the whole is allowable. That is, a whole person is an entity that is entirely distinct from his isolated liver or heart. Pertaining to our discussion, parts of animals (from whole organs, such as hearts, to sequences of genes) sequences could be transferred to humans.15
The third application is the elevated status given to all humans, especially those encountered routinely in medical practice who are markedly deformed. Physically, they may be children who are severely retarded or otherwise brain-damaged, adults crippled with metastatic cancer, or the elderly patient whose mind no longer functions rationally or responds minimally to external stimuli. Spiritually, they may be the obnoxious alcoholic who presents at the emergency room in the middle of the night, the persistent hypochondriac who defies any concrete diagnosis or response to treatment, or the devastated wife who has been infected with gonorrhea by her unfaithful husband. The contrast in behavior wrought be differences in the terms that describe man is striking. A health care worker either approaches patients first to determine whether they are persons and then treats them accordingly or he approaches patients first to determine whether they are persons and then treats them accordingly or he approaches them with the conscious attitude that they are created in the image of God. In other words does "personhood" or "image of God" more greatly enhance the treatment of the patient. Further, which concept gives direction to solutions to their problems?
The fourth application is that the image of God does not require that everything medically be done for all people. Sickness and injury are directly or indirectly a result of the sine of Adam and Eve and personal sin.1 The state of sin is spiritual, not physical. That is, medicine cannot restore the fullness of the image of God in man. The image conditions man's treatment of other men, but it should not be the goal of men to restore it physically. The dream to cure all medical problems and make man immortal can be seen as an attempt to restore the image of God in man. The care and treatment of the body is not to be minimized, but it must be considered along with the other biblical responsibilities of individuals, families, churches, and societies.
A fifth application concerns eugenics. Although the application of this concept to genetic engineering seems new, eugenics has been a focus of some social planners for the last hundred years. Most states still have laws that certain people who are mentally retarded or have mental illness may not have children and may even be sterilized. Eugenics, then, is the attempt to breed men and women in ways that will enhance certain characteristics, such as intelligence and athletic ability. Again, however, the major problem with man is his deformed spirit, not his physical limitations. Is a mental retardate who is faithful to his wife "better" than the Nobel laureate who is unfaithful to his marriage? This position is not, however, to exclude the correction of genetic abnormalities that have been clearly identified with physical problems. A chapter in a book soon to be published by me will discuss eugenics at some length.
At certain points we reach our limitations. We have reached that limitation in current expenditures, as indicated by the forced cutbacks in federal and private spending for medical care. We reach that point when medical treatment no longer offers a reasonable chance of cure in terminally ill patients or prolongs their inevitable death. We are not God who can restore that image; neither are we God to harm or destroy that image. We are finite in our ability even to correct the physical damage of sin upon that image. The image of God both enhances our attitude toward patients and places God-ordained limits on what we are able to do.
1. Heimburger, Dough, "A Biblical Model for Medical Ethics," 1(1):5-10, 1987.
2. If any reader is not familiar with these categories, he cannot seriously pursue biblical ethics in medicine. Many principles are necessarily different according to which category is believed. My primary sources for the Reformed position are:
Berkhof, L., Systematic Theology, Grand Rapids: Wm. B. Eerdmans Publishing Co., 1939. pp.202-210.
Calvin, John, Institutes of the Christian Religion. Vol. I. Trans. by Henry Beveridge, Grand Rapids: Eerdmans Publishing Company, 1979, pp. 162-167.
Clark, Gordon H., The Biblical Doctrine of Man, Jefferson, MD: The Trinity Foundation, 1984, pp. 5-19.
Kuyper, Abraham, The Work of the Holy Spirit. Trans. by J. Hendri De Vries, Reprint. Funk and Wagnalls Company, 1900. Grand Rapids: Eerdmans Publishing Company, 1979, pp. 203-251.
Murray, John, Collected Writings. Vol. II., Edinburgh: The Banner of Truth Trust, 1976, pp. 34-46.
3. Adams, Jay E., More Than Redemption. Phillipsburg, New Jersey: Presbyterian and Reformed Publishing Company, 1979, pp. 108-118.
4. Kuyper, Abraham, Principles of Sacred Theology. Trans. by J. Hendrik De Vries, Reprint. Encyclopedia of Sacred Theology Its Principles. Charles Scribner's Sons, 1898. Grand Rapids: Baker Book House, 1980, pp. 106-149; Clark, The Biblical Doctrine of Man. pp. 14-19.
5. Clark, The Biblical Doctrine of Man. pp. 34-46.
6. The Westminster Confession of Faith, II.I., states that God is "without body, parts, or passions." See a discussion of this description in What Presbyterians Believe. Gordon H. Clark, Phillipsburg, New Jersey: Presbyterian and Reformed Publishing Company, 1965.
7. Clark, Biblical Doctrine of Man, p.9.
8. Kuyper, Principles of Sacred Theology, pp. 150-182.
9. Kuyper, Work of the Holy Spirit, pp. 107-308.
10. Clark, Biblical Doctrine of Man, p.15.
11. Geisler, N.L. Ethics: Issues and Alternatives, Grand Rapids: Zondervan Publishing House, 1971, pp. 219, 234.
12. Ibid., p. 234.
13. Jones, D>G., Brave New People, Leicester, England: Inter-Varsity Press, 1984, pp. 156-184.
14. Ibid., p. 172.
15. This statement is not to endorse every substitution of animal parts for humans' parts. The issue is a separate ethical subject in itself. For example, the brain, testicles and ovaries may come so close to the identity of the whole, that these should not be transplanted.
16. Payne, F.E., Biblical/Medical Ethics, Milford, Michigan: Mott Media, 1985, p. 79--83.
The image of God in man is not his body. “This image cannot be man’s body for two reasons. First, God is spirit or mind and has no body. Hence, a body would not be an image of Him. Second, animals have bodies, yet they are not created in God’s image. If anyone should suggest that man walks upright so that his bodily position could be the image, the reply is not merely that birds also walk on two legs, but that Genesis distinguishes man from animals by the image and not by physiological structure." Gordon Clark, A Christian Philosophy of Education, The Trinity Foundation, Revised 1988, page 132.
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