Ethics

Love of Enemy, Natural Law, and Medicine

Igor Kiss

 Palisady 46811
06 Bratislava
Slovakia

From : Perspectives on Science and Christian Faith 49 (June 1997): 105-107.

Medicine belongs to those vocations which are not possible to implement without altruism. Medicine needs the self-sacrifice of one's own life. In medicine, for example, many radiologists put their own life on the altar of service for their neighbors. The theme of my communication points to another ethical aspect of medicine which is sometimes overlooked. Medicine sometimes asks for the love of enemy from doctors and nurses. This is shown in the Hippocratic oath, in which doctors pledge to help all who need medical care. Sometimes the person who needs the doctor's help could be an enemy. According to the Hippocratic oath, a doctor is required to provide the necessary medical care to all patientsˇeven an enemy.

During World War II, a German civilian doctor who was living in Slovakia provided medical care not only to German soldiers, but also to Slovak partisans in the mountains. Information about him came to the ears of the Gestapo. This doctor defended himself to the Gestapo with the words: "The Hippocratic oath binds me to cure all people without differencesˇalso my enemies." This story shows us that medicine is a special vocation and science, which in contrast with many other vocations and sciences, pledges the doctor to the love of an enemy. In moments of combat, soldiers and police do not have this duty. An enemy has to be overcome with the power of guns, bombs, swords, and sometimes knives. But a knife in the hands of a surgeon can be used during surgical combat only for the benefit of the patientˇeven if this patient is an enemy.

Medicine as a vocation has its own unique ethics. Medical ethics have their end beyond the borders of traditional humanism which does not require the love of enemy. Medical ethics are in some measure transcendental ethics. Their demands are sometimes superhuman. They are not only the strict ethics of natural law; sometimes they are the ethical imperatives of absolute ethics. Theologically speaking, they are the ethics of lex Christi (law of Christ) of the Kingdom of God as taught in Jesus' Sermon on the Mount: "Love your enemies." The strict historical understanding of natural law does not know such a principle.

Many people think that Jesus' commandment to love one's enemies is too utopian for this world. We cannot rule the world with the Sermon on the Mount and the love of enemies, says Martin Luther. He tried to solve this utopian character of love of enemy through his doctrine of the two kingdoms. The absolute norm of love of enemy belongs to a Christian's individual and work ethics. Vocations (e.g., medicine) belong to the worldly things. In the secular kingdom, absolute ethical maxims cannot always be valid. The secular kingdom is the area of the principles of natural law. In the historically-understood strict natural law, there is no place for love of enemy. Therefore, natural law knows the use of force and power against the enemy.

Luther's doctrine of the two kingdoms is in my opinion the correct ethical solution to this problem. In this world, we cannot always use the ideals of the absolute ethics of the Kingdom of God. The ethical imaginations of the Anabaptists in Luther's time, as well as the ideal principles of Tolstoy's ethics, are not implementable in this world. Because of human sin, it is sometimes necessary to defend society from enemies or criminals by power. The ethics of the Sermon on the Mount are usually useless in this world.

 If we should apply the principles of strict natural law to medical ethics, the German doctor in Slovakia, of whom we spoke earlier, would not have been able to treat both German soldiers and Slovak anti-Nazi partisans in the time of war. But from the oldest times of the pre-Christian era of Stoic ethics, many humanists have felt that medicine must transcend the strict natural law ethics, the ethics of historically-understood natural law. For this reason, Hippocrates demanded that doctors help all who need medical assistance. Medicine cannot differentiate between friends and enemies in its activities, as do other secular vocations.

This searching for the right medical ethics, whether to see medical ethics under the commandments of absolute ethics (with its love of the enemy) or under the commandments of natural law (with its relative ethics, which do not know the love of enemy), has continued through the ages. Enemies have been denied medical care many times. After battles, the wounded and injured have not always received medical care from the side of the winners. A new milestone in medical ethics was Jean Henri Dunant and his idea which became the Red Cross. The Red Cross has helped soldiers on the enemy side. The theological consequence of its activities is amazing. It showed that in the secular kingdom (if we are thinking in the terms of Luther's two kingdom doctrine), there are some vocations, such as medicine, which are applying love of enemy. In this sense, something is present in medical ethics from the ethical norms of the Kingdom of God. Medicine does not differentiate between friend or enemy. It serves all people equally. In this area, medical ethics are more than ethics of strict natural laws. In the question of healing one's enemies, it is an ethic of absolute moral norms. It knows not only the love of neighbor, but also the love of enemy. Dunant showed us that it is possible to transcend the traditional historical understanding of natural law and to create a new, more humanized understanding of it, which is nearer in some aspects to Jesus' Sermon on the Mount.

Mahatma Gandhi also showed us that the love of enemy is sometimes rational in the realm of natural law. For this reason, Gandhi and Dunant are both significant in the history of humankind. Through them humanity is one step forward in its understanding of the usage of the love of enemy in the world.

All this is in full accord with the healings which Jesus performed. When we watch the healing activities of Jesus, we see that he connected his healing with the love of enemy. When the Apostle Peter cut off Malchus' ear in Gethsemane, Jesus healed Malchus. Even to his enemy, Jesus showed merciful love. Similarly in his parable of the Good Samaritan, Jesus showed the example of a man (a Samaritan), who gave medical help to his enemy (a Jew), despite the enmity between Samaritans and Jews in that time. Jesus ends this parable with the words: "Go and do likewise." We can explain Jesus' words in this sense: "Heal also you your enemies!"

The love of enemy will play an even greater role in medical ethics in the future. Some new medical achievements require the love of enemy. For example, if somebody gives blood for a transfusion, it is given to an unknown person, perhaps even to an enemy. Also, people who give permission to donate their bodily organs for medical transplantation after their death, give them for all peopleˇperhaps even their enemy. So in some situations, medical ethics transcend all common moral norms and stand on the principles of absolute morality, the ethics of the Kingdom of God and Jesus' Sermon on the Mount.

Now we are standing before the final and most difficult question: Are all medical ethics perhaps ethics of absolute norms? We know that, according to Hippocrates, all medical ethics have to fulfill the ideals of absolute ethics. For this reason, Hippocrates rejected medical help in abortions. The Roman Catholic Church stands on the same position: medical ethics have to be led by the principles of an absolute morality. Roman Catholic ethics are strictly deontological, knowing no situational teleology in ethics and, therefore, no exceptions in ethical behavior. Roman Catholic doctors and nurses are forbidden not only to participate in abortions, but also in in vitro fertilization in all forms (even in the framework of matrimony), the prescription of contraceptives, and active euthanasia. On other hand, Protestant medical ethics see the elements of absolute ethics in helping an enemy only as a fragmentary and partial breakthrough of the absolute ethics of the Kingdom of God in medicine. Normally medicine is a secular science guided through the ethics of natural and state laws, which are relativized due to the situation of the sinful world. In fact, Protestant ethics are also deontological, the same as Roman Catholic ethics. They are also against abortions, but they allow some teleological and situational exceptions. Therefore, Protestant medical ethics acknowledge some situations connected with life problems, where a doctor must deviate from the principles of absolute ethics and participate in an abortion.

It does not mean that Protestant ethics are for free abortions but that they know some situational indications for abortion. In the questions of in vitro fertilization and contraceptive use between husband and wife, Protestant ethics do not see them as the demands of an absolute ethic as Roman Catholics do. Therefore, according to Protestant ethics not all medical ethics are built on absolute moral norms.

Medical ethics must sometimes follow the relativized moral of natural law, but medical help to the enemy is a special case. Here medical ethics fulfill the criterion of Jesus' Sermon on the Mount and apply the principle of love of enemy. From the traditional historical understanding of strict natural law (which does not know the love of enemy) we go to the more humanized understanding of natural law (which in some cases knows the love of enemies). So in the historical development of humankind, there is gradually found the optimal humanized understanding of natural law, which in some aspects is nearer to the norms of absolute ethics than was the historical strict understanding of natural law in the past.

Jesus' teaching on the love of enemy is useful after all. There are vocations and sciences in the world where we must use it, as in medicine. The false solution is only to use it generally, as Tolstoy did.