Christian Ethics in a Secular Environment

Can Christian ethics and a secular environment be reconciled? Here are some thoughts on the meaning of the “law” within Christianity and how it applies to Social Work ethics or even life in general.

Imagine that you see a sheep in a field. You see the sheep and exclaim “ah, there is a sheep in that field”. However, unbeknown to you, the sheep that you thought you saw was actually a rock in the shape of a sheep; and behind the rock in the shape of a sheep, there was actually a sheep.
-      Did you know that there was a sheep in the field?
-      Were you correct that there was a sheep in the field?
The statement was technically correct that there was a sheep in the field, but what you had in mind was incorrect.
Epistemology is the study of “how you know that you know things” and applies to ethics as much as anything else. As the sheep in the field scenario illustrates, knowledge is largely subjective, meaning that it is from our personal perspective.

Ethics and Social Work
Ethics in Social Work likewise are also subject to interpretation. Not every person will see all aspects of a given situation before them.
For example:
What does it mean to act in the client’s best interests? We may have a vague understanding of what it means, but how that is perceived and outworked varies greatly. This is largely due to our own interpretations.

Context plays a huge role in determining which ethical action to take. Depending on the context, what may seem in the client’s best interests may require an action that will vary from case to case. This calls for humility when working in these situations. We will never have all the knowledge in a given context. We may think we do at times, but one must remember that knowledge is largely from our perspective, even if we may think it is “common sense”… Knowledge is heavily influenced by our cultural background and life experiences. You can say that you believe there is a sheep in the field, but in actual fact, because of our fallible natures and limited knowledge, we should be aware that we could be very wrong. 
Depending on how much we can see of a given scenario or even how we see it from our perspective, no universal ethic will necessarily look the same. We may have a general understanding of what to do, just like we have a general understanding that there was a sheep in the field, but we are ultimately limited in our knowledge.


Even worse than working with a lack of knowledge, ethical practice may even directly conflict with itself. What if you thought you were looking at a sheep in the field and your client or colleague saw a rock in the shape of sheep? Both are looking at the same scenario. Who says who is right?

The Duck/Rabbit picture is a great example. Some people see a rabbit and some people see a duck. Both appear equally correct from each perspective. In an ethical dilemma one must be chosen and each choice with its own consequences.     
So how do we decipher what any particular ethic practically looks like when working with clients?  


Human rights v Moral rights.
Marie Connolly shares an understanding of practical Social Work values that I particularly like, which comes from a rights based perspective. She claims that there are two types of rights, human rights and moral rights. Human rights are concerned with the wellbeing of people, whereas moral rights are concerned about smaller issues in the grand scheme of things. From my understanding, moral rights which could come from asking “what is the right thing to do”, can become troublesome in Social Work because they are often from our personal values and don’t necessarily impact wellbeing greatly. On the other hand, human rights tend to be more helpful when making ethical decisions in Social Work. Instead of asking “what is the right thing to do”, a Social Worker coming from a Human Rights base may ask “what would be most helpful thing to do to produce wellbeing?”. Doing this enables us to sieve through the various decisions available.
An example could be a parent’s rights over their children. It is a moral right for parents to provide for their children, but if the children’s wellbeing is compromised, then the child’s human right comes into effect and overrides the moral right of the parent. It wouldn’t be helpful for the Social Worker or the child to value moral rights over human rights in this situation.

Difference in Christian thought.
Marie Connolly comes from a secular perspective, which I generally agree with. But what about Christians? Much of my upbringing consisted of encountering a variety of Christians that come from different schools of thought. Many Christians come from an objective law focus when it comes to moral rights and I did too for much of my life. Think back to the sheep in the field. An objective outlook would claim that there is definitely a sheep in the field, but a subjective outlook would believe there is a sheep in the field and would admit that due to limited knowledge, they could be wrong.

Congruence
An objective outlook is fine - we are all entitled to our opinion - but this type of Christianity may find it difficult to do social work in a secular context, because of the limitations that an objective outlook creates. I wrestled with this earlier on in the degree. How can I work in a manner that honours the “morals” of Christianity at the same time as “supporting” someone else’s opposing morals? Carl Rogers thought that a person’s psychological well-being was connected with how well they were able to live congruent lives. A person who is able to be congruent between their perceived reality and with their actual experiences, results in less anxiety. For me this has been true. The more I can reconcile my conscience with reality, the more at ease I feel with myself. This makes the place of ethics in Social Work and my interpretation of what these ethics mean to me, very important.


Laws made for man
The more I have studied the Bible I have found that I have misunderstood a huge part of the gospel, and much of what Jesus emphasized. Many Christians try to preach the Ten Commandments as a list of written “rules” from God. However, I over looked that Jesus Himself denied that these were “rules” per se. Jesus revolutionised the purpose of a law when he and his disciples picked heads of grain in a field on a Sabbath (which breaks the Sabbath law of doing no work). Jesus said that the Sabbath was made for man, not man for the Sabbath (Mark 2:27). Likewise I believe that laws are made for the benefit of people (therefore making them more like principles), rather than people being made for laws.


Fulfilled in love
To me, what the law produces is a motive of self-concern. E.g. if I follow this law then God will value me. However, more recently I see that Christianity teaches a rather different way of understanding morality and ethics.
The apostle Paul talked about how Jesus fulfilled the law, and summed up the law in what he called one word: “ For you were called to freedom, brothers. Only do not use your freedom as an opportunity for the flesh, but through love serve one another. 14 For the whole law is fulfilled in one word: “You shall love your neighbor as yourself.”(Galations 5:13-14),
Living with the principles of dying to our selfish selves helps me to naturally look outward towards the needs of others, rather than following a law “just because”. This outlook ties in well with Human Rights ethics. Jesus was concerned about people’s wellbeing rather than a set of arbitrary rules. The “rules” or principles Jesus and the writers of the New Testament expected us to live by were for our wellbeing!

I have at times wrestled with Corrie Ten Boom type scenarios regarding lying versus telling the truth. For those who don't know the story, Corrie lied to the Nazis in order to protect Jews in her care. At times like these, I believe it is helpful to look at ethical dilemmas within their context and looking at things from a wellbeing perspective. Sure, it may not be right or helpful generally speaking to ourselves and society to be a false witness, but when it comes down to the wellbeing of another (like hiding Jews from the Nazis) wouldn’t it be more Christ-like to break a law for the wellbeing of another? I ask this remembering of course Jesus’ attitude to towards the law of the Sabbath. 


So how does this outlook relate to Social Work ethics? Just like with Social Work and ethical dilemmas, as a Christian, I will inevitably encounter ethical dilemmas. However, the difference is that I can work with more flexibility regarding what might be considered “Right” or “Wrong” in a given situation. I can live with greater congruence between my personal and professional values.

Following are some of the verses I found helpful to consider when thinking about ethics:

Matthew 5:43-44
“You have heard that it was said, ‘You shall love your neighbour and hate your enemy.’ 44 But I say to you, Love your enemies and pray for those who persecute you,” 

Matthew 7:12
“So whatever you wish that others would do to you, do also to them…”

Ephesians 4:29
"Let no corrupt communication proceed out of your mouth, but that which is good to the use of edifying, that it may minister grace unto the hearers."

Romans 14:4-6, 14-15
4 ”Who are you to pass judgment on the servant of another? It is before his own master that he stands or falls. And he will be upheld, for the Lord is able to make him stand…
 “14 I know and am persuaded in the Lord Jesus that nothing is unclean in itself, but it is unclean for anyone who thinks it unclean. 15 For if your brother is grieved by what you eat, you are no longer walking in love…” 

Mark 12:31
“You shall love your neighbour as yourself.”



I would also like to conclude with some words of wisdom from Captain Barbossa:

"The code is more what you'd call 'guidelines' than actual rules"

Musings on Vaccines

The vaccine debate is important to me. 

I have spent a considerable amount of my time, money, and energy to train and work as a doctor, largely because I genuinely care about helping people, especially those who are most disadvantaged (i.e. children from poor minority-ethnic families). Generally speaking, I am persuaded that  vaccines are one of the best means to this end. The vaccine debate is about more than just vaccines though. Its about how we as Christians interact with the health-care system, indeed with any secular system. I think more damage than good has resulted from those who are publicly anti-vaccine, and even MORE damage results from those displaying unhelpful attitudes (even if their vaccine-specific rhetoric is more 'moderate').

Below are some of my musings :) 

Just a few points to note before we begin. Obviously there are legitimate concerns about vaccines (and about the secular health-care system) that need acknowledging and addressing. And despite (mostly) exemplary motives, the health care professions do frequently fall short of the high ethical and communication standards society sets for them. And Christians do have a complex mix of responsibilities that are difficult to balance - which includes a responsibility to think and act differently within the world. This is far from a complete discussion on vaccines, and my aim is mainly to provide some balance to some specific biases I believe already exists. So I won't be delving into the legitimate concerns I acknowledge above - but I'm happy to discuss them if they become relevant in the comments. Also, these musings belong to me and do not officially represent any professional consensus (though I think it closely matches the medical consensus). 

I would like to see a robust discussion in the comments! We're all in need of ongoing learning, and even if our beliefs remain unchanged, I would like us all to become more understanding and empathetic of those who disagree with us. 

Ultimately I just want Christians to be able to navigate this issue well, while remaining Christlike, and without damaging the health of the most vulnerable in society.

NO 'BENIGN' POSITIONS

Refusing vaccines and promoting refusal is not a benign 'natural' decision - just like 'vaccines' are reported to do, refusal has potential to contribute to diseases and death in children, particularly amongst the most deprived. We can't hide behind the excuse of 'not rushing into an unjustified decision', since both are decisions claiming huge consequences. 

And we can't hide behind our individual isolated 'rights' to choose - we also have ethical responsibilities to those around us. The effects of vaccine refusal on our community is not spread by disease, but by rhetoric and attitude as well - and so our responsibilities to others require us to take all these things seriously.

INFORMED RISK-TAKING

We all take informed risks all the time (think about driving a car). Acknowledging risk in no way makes a decision a bad one. And 'risk' has a pretty broad definition when it comes to contemplating different choices - this is important to remember when considering the alternatives to a choice that is deemed risky (i.e. taking vaccines, or driving a car). The 'risk' of NOT driving your car, for example, includes having less time free to work and play and do household chores, and being unable to attend your favourite band's concert in a neighbouring city. Refusing vaccines carries its own risks - not only to you, but to others - and not only of risk of disease, but of spreading ideas and attitudes and rhetoric. People have a right to make their own choice between the various risks, and other members of their community also has the right to ask them to behave in a way which (they think) maximises the wellbeing of the community.

We should never take any risks based on fear or pressure, even if your decision may happen to line up with what's best - don't take vaccines based on fear, but equally don't avoid vaccines based on fear. The motivation behind the legal requirement to interview adolescents away from their parents, and parents away from each other or their midwife / friends etc, is to remove very common external pressures. Its the motivation for 'probing' into the reasons for refusal. People are rarely emotionally coerced into choosing vaccines (though it does occasionally happen, unfortunately) - but this is a common reason for refusal. Obviously it is difficult to achieve freedom from emotional coercion - while still providing information - when one believes there are serious risks behind various choices. But we need to try.

GETTING INFORMATION

The best chance of making an informed decision about risk, is to trust the summaries provided by those who have trained hardest to interpret the evidence and provide such summaries, and who are genuinely motivated by your wellbeing without being too emotionally attached. 

Extensive training is required to make any progress in avoiding our ingrained human biases and interpreting evidence properly. Even with extensive training, it is a headache to navigate these turbulent waters. Its not a simple matter to 'reading' studies or personal anecdotes. We are designed to jump to conclusions quickly, and from that point on to doggedly (subconsciously) interpret the world in a way that supports our conclusions. We can be drastically unreasonable about this. We can't avoid it altogether (doctors suffer from the same human condition), but at least we can minimise it through training, and through maintaining some level of emotional objectivity.

Attempts at providing information for informed risk-taking should avoid the converse problem of information overload. If doctors find it difficult to interpret that evidence, how do we expect those without training - or those with emotional investments - to do so properly? Often people react to this overload by making a decision they deem as a 'natural middle ground' - which actually means sticking with their pre-existing position i.e. vaccine refusal. 

This is why doctors find it difficult to provide 'evidence' for vaccines to concerned parents. The evidence is not simple to navigate (anyone who claims otherwise is lying), but this doesn't mean that conclusions can't be drawn which are overwhelmingly supported. And they have to navigate parental emotional investment, an inclination to refuse vaccines when faced with information overload, and powerful vaccine-refusing rhetoric (claiming that their evidence IS straightforward).

'EXPERIMENTAL' MODERN MEDICINE

The supposed tension between 'modern experimental' medicine and 'alternative' medicine is an illusion - all foods, drugs, and treatments have a degree of uncertainty associated with their effects, but this doesn't mean reasonable conclusions can't be drawn from the evidence. Honesty about the evidence is what leads doctors to recommend what has come to be known as 'modern Western' medicine, over alternatives - there's just more evidence available for the former. Our conclusions about modern medicine are actually more robust than those that can be formed about alternative approaches to health - even IF those conclusions end up being are a complex mix of negative and mildly positive effects. This doesn't mean we've found the best treatments - it just means that, with the greater body of evidence, we can make more certain claims. Homeopathy and vaccine refusal may end up with greater health benefits than vaccines, but they can't meaningfully talk about it because they don't have as much data. Unfortunately money does drive most research, so it is difficult to gather data about treatments that can't be patented - but this doesn't change the fact that we have a better chance of being right about our conclusions regarding modern treatments, than about any claims from alternative medicine. 

Money can cause most people (not only doctors, but alternative treatment proponents as well) to become untrustworthy, including doctors. NZ has one of the least medical biased systems in the world precisely because the money side of things is removed from the picture. The politicians deal with money and advertising and purchasing. This means doctors are restricted in which treatments they can offer, but this is a reasonable sacrifice for the benefit of being free from monetary pressure and advertising bias. We are free to act based on our genuine concern for people's welfare. This is why we recommend vaccines. There is nothing more sinister going on - for most of us as individuals, anyway. 

NEGATIVE EFFECTS

The 'side effects' of vaccines have always been exaggerated - but they are gradually getting minimised by the accumulation of evidence. By far the majority of concerns regarding vaccines have been systematically and thoroughly disproven as we gather more data, and the position in favour of vaccines becomes stronger and stronger. There are still some unanswered questions and uncertainty - particularly surrounding newer vaccines - but the track record of allaying fears is encouraging.

Studies that demonstrate side-effects are often poorly designed to produce bias. Or, when incorporated into the big picture of all the OTHER evidence available, they don't produce significant results. Many of the studies are also taken out of context and interpreted in a way that was never intended - for example, most countries have a system for reporting adverse effects to medicines and vaccines. Even when legally 'mandatory', the data collected is still ultimately volunteered by health professionals or patients - so the system is automatically biased to collect data confirming patient's suspicions. There are no measures in place to confirm the validity of this reporting, or to discover the 'real' incidence of such 'adverse effects' in the vaccinated / unvaccinated populations. These systems can highlight areas for further robust research, but they can't produce conclusions on their own because of the rampant bias.

An important consideration is incidental correlation (as opposed to causation). People really do just randomly die, have seizures, develop influenza, get early menopause, have headaches and nausea, etc - all for no apparent reason. A certain proportion of vaccine takers will also have these things, but not caused by the vaccine. But those that occur after vaccines will get noticed, remembered, and reported (unlike many of the others). This is especially true for childhood vaccines, which are given around the time that such symptoms / effects can become obvious (e.g. learning disabilities, epilepsy, etc), leading to the assumption that the vaccine was causal.

Vaccines can contain heavy metals, but at lower concentrations than many foods. They contain immune-stimulating molecules (some call these 'toxins'), but vastly fewer than what babies encounter through their normal external environment. Very few vaccines have any link to human embryos, but some do require normal human cells to culture - these cells are almost always obtained from replication after replication stemming back to two aborted foetuses decades ago. They are normal human cells, the don't make their way into the finished vaccine product, and no further embryos are aborted for vaccine development or research.

HPV VACCINE

There has been recent debate over the HPV vaccine, a relatively new vaccine which differs to most others in that it doesn't prevent a nasty childhood disease. It prevents infection with the HPV virus - a sexually-transmitted virus which is the major cause of cervical cancer. So the vaccine prevents adult cancer which is typically seen as a consequence of behavioural choices - hardly the virtuous image of vaccines we typically recognise. Because it is new, we have less data available for this vaccine than for other vaccines. And we are still learning (as we should) about the full effect of the vaccine - both positive and negative.

Some take issue with the idea that children are vaccinated to prevent an STD. Why assume they will contract the disease? Why not aim for abstinence until marriage instead? However, HPV is NOT a disease only of sexual license - any number of partners >1 can pass it on (and likely will, given that most people are infected). It can also be passed on without sexual contact. And multiple 'partners' doesn't necessarily equal immorality - think of divorcees, remarried widows, victims of abuse, and those used to live in sin but have now repented. Its not that we're questioning a child's morals - we're trying to protect them from future worry.

NZ cervical cancer rates are very high (internationally speaking). While the numbers may seem small, the risk of cancer needs contextualising - its higher than the risk of dying on our roads. This priority of cervical cancer probably resulted in more 'rush' for the HPV vaccine than for other drugs/vaccines. But this doesn't make the rush unreasonable - we just need to inform parents that there's slightly more uncertainty about its effects.

CHRISTIAN ATTITUDES

Christians are called to love, gentleness, submission, grace, humility, and a focus on the good God has preserved in society. Whereas in-submission, speaking your mind too quickly, being prideful about your viewpoint, and not giving people the benefit of the doubt is seen as anti-Christian. There's no simple formula about how to integrate these things with our commands to be wise and to stand against injustice and societal evils. But its something we should feel the weight of. This should come through our discussions.

The rhetoric I hear around vaccines all too often demonstrates the opposite - we don't 'feel the weight' of getting our attitudes right. We just blurt our minds out. We just assume we (somehow) know better. We automatically distrust others. We are happy to use misleading rhetoric (choice of words, selective reporting of facts, distraction techniques, etc) to maximise the powerful effect of our opinions till it is way out of proportion to what they deserve. For example, doctors aren't out to 'bully' you into taking vaccines, or to 'experiment on little girls' - we genuinely want to help. But stating the facts (we try to talk to pre-sexual girls away from their parents about the vaccine in order to minimise emotional coercion) just doesn't have the emotional impact. Would Christ be pleased with such rhetoric? Does it display Christ-like attitudes? I don't think so.

What frustrates me most is that displaying these opinions on the internet contributes to much of the devastation I have to deal with daily, and makes it more frustrating and difficult because the people I'm trying to help don't trust me. Those most affected by these opinions are the poor and disadvantaged - something people often don't realise when they make such statements.

Obviously I need to have the same attitudes in my promoting of vaccines. That's something I'm working on :) Hopefully the discussion in the comments below will be help!