Religious morality (and secular humanism) in Western civilization as precursors to medical ethics: A historic perspective

Miguel A. Faria
1. Clinical Professor of Neurosurgery (ret.) and Adjunct Professor of Medical History (ret.), Mercer

University School of Medicine; President, http://www.haciendapub.com, Macon, Georgia, USA

Copyright: © 2015 Faria MA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

How to cite this article: Faria MA. Religious morality (and secular humanism) in Western civilization as precursors to medical ethics: A historic perspective. Surg Neurol Int 16-Jun-2015;6:105

Abstract

In discussing bioethics and the formulation of neuroethics, the question has arisen as to whether secular humanism should be the sole philosophical guiding light, to the exclusion of any discussion (or even mention) of religious morality, in professional medical ethics. In addition, the question has arisen as to whether freedom or censorship should be part of medical (and neuroscience) journalism. Should independent medical journals abstain from discussing certain issues, or should only the major medical journals — i.e., the New England Journal of Medicine (NEJM), the Journal of the American Medical Association (JAMA) or Lancet — be heard, speaking with one “consensual,” authoritative voice? This issue is particularly important in controversial topics impacting medical politics — e.g., public health policy, socio-economics, bioethics, and

terms overlap and have thus become interchangeable in modern times. Nevertheless, in the liberal zeitgeist of our time, and with our modern emphasis on egalitarianism, the word “ethics” predominates; thus, we have the terms “bioethics” and “neuroethics” in vogue and the nuances of meaning those terms entail.[ 22 ]

PROPOSITION OF SECULAR HUMANISM AND THE COUNTER ARGUMENT

The editors welcomed the critical letter as bringing forth a controversial subject of importance in medical ethics related to the neurosciences. The letter-writer’s criticism begins with a quotation of Albert Einstein providing the gist of the disagreement:

A man’s ethical behavior should be based efectually on sympathy, education, and social ties and needs; no religious basis is necessary. Man would indeed be in a poor way if he had to be restrained by fear of punishment and hope of reward after death.[ 17 48 ]

An opinion rendered by such an exalted gure in the history of science should certainly be taken into consideration. Nevertheless, I must reply reluctantly that although Einstein was an undisputed genius in physics, and is in fact a hero of mine in the scientific pantheon, it should be noted Einstein, not a deity but a man of flesh and blood, has been wrong more than once, even in theoretical physics. For example, Einstein posited a “cosmological factor” explaining the supposed forces holding a static universe in place. He was wrong; the universe is not static, but expanding. He made a variety of other mistakes in physics: Errors in the formulation of his never completed unified field theory; in light refraction; and in quantum mechanics. More apropos, Einstein’s participation in his own family life was not a stellar performance. He was at times a cruel husband and a poor and neglectful father.[ 12 ] Furthermore, it should also be added that a man may be very knowledgeable in one or more areas of science, but this is no guarantee he may truly be a wise man or knowledgeable in all fields of knowledge.

In this regard, Socrates (469–399 B.C.) dealt exactly with this issue in Plato’s Apology. During his trial by the Athenians in 399 B.C., Socrates explained why the Oracle of Delphi ruled him the wisest man of his time. And to make sure the Oracle was not in error, Socrates searched in vain for wiser men. He found all the notable politicians, poets, and the greatest men in Athens were deficient of wisdom. Searching further, Socrates went to the lower ranks of artisans and found them, as he expected, knowledgeable in their trades. But he told his judges:

“However, Athenian men, it seemed to me that the workers also have the same fault as the poets; on account of performing the skill well each claimed also to be wise in other important matters, and this false note of theirs obscured that wisdom, so that I asked myself on behalf of the oracle, whether I should choose to be just as I am, neither wise in their wisdom nor ignorant in their ignorance, or to have both of what they have. Thus I replied to myself and the oracle that it is better for me to be as I was.” [ 38 ]

Socrates was the wisest of men because, unlike other men, he was aware of his own limitations and deficiencies in the possession of knowledge. Knowledge in one field then does not make one an expert in all fields of knowledge or wise.

FREEDOM OR CENSORSHIP IN MEDICAL JOURNALISM?

In the critical letter’s concluding second paragraph, Dr. Zrinzo sums up his objections in the manner of secular humanism[ 7 18 ] as follows:

“The editorial in question repeatedly suggests that morals are derived from religious principles. This is a common misconception…. Personal religious bias has no role in scientific discourse, including the neurosurgical literature.” [ 48 ]

First, as to “Personal religious bias has no role in scientific discourse, including the neurosurgical literature,” let’s remind Dr. Zrinzo that the piece in question was an editorial, and what is an editorial? By definition it is an opinion piece usually written by a member of the editorial board of a newspaper, magazine, or medical journal. Second, what I stated is historically accurate and factually correct. “Misconception” implies error or opinion unsupported by factual information. In the paragraph cited above and in another paragraph I asserted moral precepts have their origin in, or are intertwined with religious morality, and that religion is beneficial, supporting the moral code of a society. As to the last of these statements, I admit, it is an opinion, but it is an informed opinion formulated from years of study.[ 18 19 20 21 22 23 24 25 ]

The giants of medical ethics did not write their treatises without “personal religious bias,” nor without the influence of both the Oath of Hippocrates and Judeo-Christian ethics. The Oath of Hippocrates itself begins by invoking the Olympian gods, which, as I have related elsewhere, reminds the physicians themselves that they are not gods, that they are subservient to a power greater than themselves, and that they should invoke that power, whatever they personally hold sacred, in the service of their profession.[ 19 20 ]

The English physician and medical ethicist Dr. Thomas Percival (1749–1804), who wrote and anticipated the modern codes of medical ethics followed in the next two centuries, not only in Great Britain but in the rest of Europe and the United States, was a devout Christian, a fact which is reflected in his emphasis on humanity and charity in his Medical Ethics (1803).[ 37 ] A father of neurosurgery, Harvey Cushing (1869– 1939), wrote in his Consecratio Medici (1928), “From vain regrets good Lord deliver us,” and called medicine a “divine vocation” ministered by those inspired by “heaven.”[ 15 ] And another English physician, Sir Thomas Browne (1605–1682), who wrote during the secular 17th Century of Genius, could not have written his meditations (Religio Medici, 1635) without the inspiration of religious morality in almost every page of his book. It has been said, Browne’s “faith exuded tolerance and goodwill towards humanity in an often intolerant era.”[ 13 23 ] He was cited in the writings of Thomas Percival, William Osler, and Harvey Cushing.[ 15 37 ] It would seem, then, that the misconception about the separation of religious morality from medical ethics is itself the misconception, at least when the main figures of medical ethics are consulted.[ 13 15 19 20 22 37 ]

open mind about the alleged “biases” of others and to consider the implications of limiting academic debate. We published Dr. Zrinzo’s letters and comments. Most of my letters to JAMA and NEJM have never been published.[ 16 ]

In short, it seems the moral indignation is only politically, ideologically and unidirectionally vented, expressed only when countering conservative points of view or detecting “religious bias” against Judeo- Christian medical ethics or the constitutional issues they consider unsavory, such as the individual rights of citizens to own firearms, the right to private medical care, the right of doctors to write about the influence of religion in easing the suffering of their patients, etc. No complaints are heard in meetings and publications about progressive ideas, such as utilitarian bioethics, more funding for socialized medicine, “redistributive justice,” and secular humanism. I’m aware Dr. Zrinzo claims that he is not promoting censorship and that I’m unfairly rewriting his letter,[ 48 49 ] but the fact remains that his concluding remark carried to its logical conclusion leads to censorship – i.e., the restriction of ideas deemed politically incorrect. In an academic setting and a free society, we should all be affirming: Let all sides be heard in the cause for academic freedom and the perpetuation of liberty.[ 6 8 10 11 21 27 ] Dr. Zrinzo further wrote, “…morality and ethics do not require a religious basis. This fact will stand, whatever the length of any forthcoming ‘extended commentary’.”[ 49 ] This reafirmation suggests his mind is made up and closed, and that my attempt to inform, as well as exchange ideas, will be futile. Nevertheless, I hope the information will not be lost by all. He has also claimed I’m trying to teach morality to my neurosurgery colleagues.[ 49 ] I’m not. The vast majority of my colleagues are in no need of such instruction. What I am attempting is to restore the time-honored, individual-based, patient-oriented medical ethics of Hippocrates in the neurosciences, medical ethics that have been gradually replaced by utilitarian, collectivist bioethics. I am also attempting to reclaim the loss of morality that has been gradually lost in society at large leading to increasing violence and crime, injuries and death. I hope to encourage my colleagues to action in both the civic and professional arenas in these endeavors.

THE TWIN PILLARS OF WESTERN CIVILIZATION

I now propose to show that my first assertion is correct and factual – namely, that moral precepts have their origin in and are inextricably entwined with both philosophy and religion. I beg my readers in advance to excuse my indulgence in taking so much time in expatiating on these fields of history, ethics, moral philosophy, and in tracing development, at least in part, from religion. But how is one to counter such a loaded assertion as, “morals derived from religious principles is a common misconception,” with a cursory denial without delving fully into the subject at hand? It is easy and quick to throw in such a blanket statement, even a cordial and academic objection; it takes much more time, effort, and persuasive evidence to refute such affrmation – even if it is the real misconception, particularly one so accepted and now taken for granted by the prevailing secular popular culture!

RECONCILING ARISTOTELIAN ETHICS WITH JUDEO- CHRISTIAN TEACHINGS

It was because of this connection of philosophy and moral conduct to religion in part that St. Augustine was able to reconcile Plato with Christian dogma and even credit Neoplatonism with facilitating his spiritual journey toward Christianity. St. Thomas Aquinas [ Figure 4 ], for his part, reconciled Aristotle to Christianity in a momentous step in Western philosophy and Christian morality and ethics.

Figure 4

Painting of St. Thomas Aquinas (1225-1274), who reconciled Aristotelian philosophy to Christian theology and the father of scholasticism

It should not be left unsaid the Jewish physician, Moses Maimonides (1135–1204), and the Spanish Moslem physician, Averroës (1126–1198), attempted to reconcile Aristotelian rationalism and theology in Judaism and Islam, respectively, in a similar fashion as St. Thomas Aquinas accomplished more thoroughly in Christian theology. Maimonides went on to even compose an Oath of medical ethics (that begins with “Exalted God…”) still in use today.[ 23 ] Ironically, Averroës has been called “a father of secular thought,” not in the Islamic East, where his followers were persecuted as heretics,[ 23 ] but in Western Europe.

St. Thomas’ Christian moral philosophy came to a signi cant extent from Aristotle and remains dogma in the Catholic Church. St. Thomas Aquinas’ cardinal virtues – prudence, temperance, justice, and fortitude (courage) – are not too di erent from the moral virtues of Aristotle. Aristotle’s Ethics also included intellectual virtues such as intelligence, prudence, and wisdom. St. Thomas Aquinas instead listed the theological virtues – faith, hope, and charity. Any virtues with charity added becomes a “complete virtue” and “an object of God,” who is the cause and end of all things (Final Cause).[ 1 ] The Judeo-Christian tradition had been incorporated into the Greco-Roman world by the assimilation of Christianity into the empire in the 4th century A.D. It was subsequently spread throughout Europe after the collapse of the Graeco-Roman world in the West less than two centuries later [ Figure 5 ]. With the advent of St. Thomas Aquinas and the 13th century, nearly a millennium later, Graeco-Roman ethics would in turn be inserted anew into the teachings of Christianity.[ 19 ]

Figure 5

Graeco-Roman legacy: The Forum Romanum — the ruins of the forum and monuments of ancient Rome. Courtesy Wikipedia

other religious institutions. All good religions and moral philosophies teach variations of the Golden Rule: “Do unto others as you would have them do unto you” (Luke 6:31). In fact, close study of supposedly secular moral philosophies, derived from the teachings of ancient “pagan” Greek philosophers and even from their disciples in the Age of the Enlightenment, reveal them to be permeated with religious morality. Ethics and moral conduct are entwined with religious teachings in most cultures, with the notable exception of totalitarian tyrannies, particularly openly atheistic, communists dictatorships.[ 22 28 ]

ANGST, MELANCHOLY, AND MODERN MAN

The next assertion in the critical letter:

Amoral and unethical behaviour is often supported by religion; historical and contemporary examples are support for slavery and oppression of women and homosexuals.[ 48 ]

Historically, religion has made its share of mistakes. But by and large, the Judeo-Christian religion has been bene cial to those who have been nestled in Western civilization, and religious morality has been a partial bulwark against anarchy on the one hand, and the rise of totalitarian tyranny on the other. I have also expounded on this topic previously elsewhere.[ 30 ] This bene t is true also for other religions, particularly Buddhism [ Figure 7 ] and Hinduism, which have provided peace, moral guidance, and solace to an otherwise trying existence for countless millions in Asia and elsewhere over the centuries.

Figure 7

Statue of Gautama Buddha, “the enlightened one” (c. 5th century B.C.)

The length of this already quite extended historical review article precludes expounding on the possible e ects of skepticism, angst, irreligion, and the stress and fast pace of modern life on the state of mind and mental health of contemporary society. Let me just remind the reader that mental illness, random violence and senseless crime have been on the rise concomitant with modern technological advances.[ 25 29 31 ] And as early as the 19th century through the mid-20th century, eminent psychoanalysts, Sigmund Freud (1856– 1939) and Carl Jung (1875–1961); existentialist philosophers and thinkers, Søren Kierkegaard (1813–1855) and Albert Camus (1913–1960); not to mention numerous illustrious Catholic and Anglican theologians, such as G.K. Chesterton (1874–1936) and C.S. Lewis (1898–1963), discussed the toll that misunderstood science and learning, in association with moral vacuity, were exacting on the human spirit and in precipitating anxiety and other mental disorders of the modern age. Even poets and novelists were concerned. In the philosophic treatise, The Garden of Epicurus (1908), the French novelist, Nobel Prize winner in Literature (1921) and liberal social critic, Anatole France (1844–1924) discoursed on this topic. He noted: “Religions are

strong and bene cent because they teach man his raison d’être, the nal causes of his existence.” And not exempting himself, France expounded, “those who have rejected the dogmas of theological morality, as almost all of us have done in this age of science and intellectual freedom, have no means left of knowing why they are in the world and what they are come there to do.” For the French novelist, rational thinking without spirituality reveals “cruelly the tragic absurdity of living.” And it is to this cruel realization that France traced the roots of the “melancholy” of modern man and the preponderance of “physical evil, moral evil, the miseries of the soul and the senses, the prosperity of the wicked, the humiliation of the just man.” Nevertheless, “all this would still be endurable…if we could divine a providence directing the chaos.”[ 32 ]

Modern angst and anxiety aside, faith and religion provide an invisible support to the moral code, encourage discipline, and promote civility. Their in uence on moral conduct and overt behavior is certain.[ 7 22 25 30 ] Without the support of religion and our churches and synagogues, crime in Western society would certainly increase, forcing and giving the State the pretext to step in to combat the increased lawlessness and crime – steps that frequently end up restricting the freedom of lawful citizens and even establishing tyranny. This is no empty accusation; agent provocateurs have elicited violence and terror countless times from ancient Greece and Rome to the present age, instigating government reprisals that have resulted in the curtailment of freedom and the imposition of the brutal dictatorships of the 20th century.[ 8 26 27 28 ]

SLAVERY AND THE TYRANNY OF FALSE RELIGIONS

Slavery was also mentioned in the critical letter, and it is true that the system was supported by most religions and many thinkers and philosophers, right up until the era of the Enlightenment. Nevertheless, slavery was commonplace since ancient times supported by conquests and wars and again needing no religious support. The Catholic Church, in fact, ended slavery of Christian and Jews in most of Europe during the Middle Ages. And it was the Christian tenets of universal brotherhood, charity and compassion that gradually abolished the institution in most of the Western world.

And it is well known that the horri c conditions of black slavery in later centuries, including in the British territories and the United States, were ameliorated at least in part by those same Christians. It was also the Christian teachings of various denominations (e.g. Anglicans, Quakers, and other Congregationalists) that fueled the abolitionist movements which in Britain was led by the evangelical Christian convert William Wilberforce (1759–1833) and in the Northern United States by the black abolitionists and Underground Railroad leaders, Frederick Douglass, Sojourner Truth, and Harriet Tubman, who even attended the same African Methodist Episcopal Churches in New York and Washington, D.C.[ 46 ]

Horrible crimes were committed in war and peace in the name of religion, but much of this evil was committed by brutish individuals lacking self-control, acting on their own, presumably under the aegis of the Church or tyrannical governments. Aristotle admits there are wicked men who act and do evil for their own sake, although institutions or governments may be erroneously blamed.[ 4 ] The Church also erred as an institution, and religious inquisitions and wars conducted on her behalf are rightly condemned.

Nevertheless, the institutions, including religious establishments that survive the test of time, survive because in the balance of human experience they are found to be of net bene t to mankind.[ 18 30 ] Such is the case with the Christian churches, the synagogues, mosques, temples of various other sects – and the Judeo-Christian ethics of the West.

If we consult the history of man, we nd that those religions based on false or evil principles; that bring more mischief than bene ts to their followers; that bring more desperation and disquietude than solace and peace to the soul – are rejected or discarded to the dustbin of history, or eventually overthrown from within or from without. And so it happens that the dustbin of discarded religions is half-full containing such remnants of antediluvian religions as Aztec cannibalism, Celtic sacri ces, the pantheon of gods at Mount Olympus, thuggery in the Cult of Kali, as well as the even worse cults of civil religion represented by the cult of occultism and Aryan superiority of the Third Reich and the cults of personality of Lenin and Stalin in the USSR (and of Mao Tse-tung in China, moribund but still ostensibly in the books).

RELIGIOUS MORALITY AND THE AMELIORATION OF THE HUMAN CONDITION

In the West, the Christian religion also built the rst colleges and universities, as well as almshouses and later hospitals. The Saint days were and remain Catholic feast days, days of rest and hearty meals for the faithful in otherwise days full of sweat, toil, sickness and death. The legacy of learning, the preservation of the classics of ancient Greece and Rome, and the retention of the rudiments of the medical and surgical professions (e.g., practicing monks and barber-surgeons) were preserved in parchments and in actual service in the monasteries of Europe in the Middle Ages, until rediscovered by scholars in the late Medieval period and the Renaissance.[ 18 ] Knowledge was also preserved in Constantinople, capital of the Byzantine Empire, and in the Islamic East in translations of Aristotle and other Greek classical writers as well as in actual medical practices by Islamic physicians, such as Avicenna (A.D. 980–1037), Avenzoar (1094–1160), and others.[ 23 ]

Hinduism in India and Buddhism in Nepal, China, and the Far East provided the same service and guidance in the East. Mao Tse-tung attempted to eradicate philosophic tradition and religion, (e.g., Confucianism and Buddhism) in China. Despite exterminating 40–60 million Chinese, the Chairman failed to do so, and today tradition and religion are resurgent there. The former Soviet Union attempted to eradicate Islam from Chechnya and her southern Republics, such as the Uzbekistan, Kazakhstan, Tajikistan, etc. Despite exterminations and resettlements of Chechens and Tatars, the USSR was unable to eliminate Islam from its soft underbelly. The Soviet State collapsed but the people’s religious faith did not. Religion, and the moral conduct it engenders, may be suppressed but not easily uprooted from the people. The greatest bene ts of religion have been in ameliorating the hard life and trying existence for millions living in poverty, in providing solace to others in di cult times, and in soothing the soul of countless others living lives of quiet desperation in primitive as well as modern society.[ 29 30 31 32 ]

But there is even a more concrete evidence of the bene t of religion: What greater proof is needed than the fact that religious morality provided throughout the world the rst civilian hospitals in the history of humanity? Ameliorating the su ering in the human condition of the times, the rst civilian hospitals were all consecrated in the name of compassion and religious charity. In India, the great ruler Asoka (c. 273–232 B.C.) converted to Buddhism, created the rst charity hospitals there, and sent missionaries to proselytize the world. Likewise in China, a country without a religious foundation, it was nevertheless the Buddhist devotion of a prince that created the rst hospitals in A.D. 491.[ 42 ] Likewise, in Baghdad and Cairo in the Near East and Córdoba in southern Spain, Islamic public hospitals ministered with religious compassion to the sick, and provided shelter for the in rm during the Middle Ages.[ 23 ]

And in the Western world, the rst hospital experiences were most instructive. The formidable Roman legions were served by physician surgeons (medici legionis). The Roman military tradition created well- provided in rmaries and military hospitals (valetudinaria), some were even attached to gymnasia for physical exercise and to spas (thermae) for the recuperation and enjoyment of the convalescing legionaries,[ 42 ] but there were no hospitals for civilians until Christian times. Actually, there was an institution that at rst glance resembled a civilian “hospital” in the West, but it was, in fact, a pagan hospice dedicated to Asclepius, who was said to have come to Rome to combat an epidemic. It was built in 293 B.C. on the Insula Tiburina (an isolated island in the Tiber River) also known as “the Island of the Epidaurian Serpent,” where the indigent and “worn out” slaves were left to die.[ 18 36 44 ] The rst true hospital, though, was a compassionate Christian shelter also built in Rome by the Christian charity of Ladies Fabiola and Marcella ( . A.D. 4th century).[ 18 33 42 ]

Subsequently, after the collapse of Rome in the West, Byzantine facilities were built with the impetus and treasure of Christian charity in the Eastern Roman Empire. I believe no greater and more convincing proof can be found of the bene t of religious morality in general and Christian charity in particular in ameliorating human su ering than the rst hospital experience.[ 18 33 36 42 44 ]

In the Middle Ages, it was the Christian tradition that continued to build hospitals (e.g., Hôtel-Dieu hospital in Paris and St. Bartholomew’s in London) as well as founded the rst colleges and universities.[ 18 33 ]

As it regards the rst medical schools, the evidence is that they were initiated by Benedictine monks – i.e., Monte Cassino, becoming a religious, and Salerno, a lay medical school. Constantine Africanus (A.D. 1010– 1087), who translated ancient manuscripts from the Arabic into Latin (returning lost Greek knowledge to the West) and who made Salerno a great center of learning, had been a monk at Monte Cassino. Moreover, the order of barber-surgeons, who gave rise to the renowned Renaissance surgeon Ambroise Paré (c. 1510– 1580), originated with monks and monastic medicine in the early Medieval period.[ 18 33 37 ]

HUMANITARIANISM OR SECULAR HUMANISM?

Finally, the letter writer, expressing another contemporary view of secular humanism pregnant with casuistry, states:

Thus, like St. Thomas Aquinas, Aristotle, and other realistic and sagacious Greco-Roman statesmen and medical ethicists we have mentioned, I prefer individualism, freedom, and humanitarianism, even if stemming from religious precepts, and at last resort, the law of the State; rather than to depend on the secular humanist notions of collectivist utopias and the purportedly intrinsic goodness and capabilities of rational man.[ 7 9 11 27 ] These are misguided notions that failing in their dreams of creating paradises on earth, have been conducive, as history has shown, to the expansion of government, the use of force, curtailment of liberty, censorship, collectivist statism, and veritable hells on earth.[ 6 7 8 26 27 28 ]

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