Chesed in the Clinic: Covenantal Medicine in Light of Karl Barth’s Theology
Travis Pickell, PhD, Associate Director of University Engagement, Anselm House
In The Physician’s Covenant, William F. May offers a stirring apology for the importance of understanding healthcare in terms of “covenantal” relationships. Within the early years of the field of bioethics, he was not alone. In Patient as Person Paul Ramsey also noted the significance of “covenants,” some natural and some revealed, in medicine in terms of fidelity and loyalty, which refuses to treat the patient as anything other than an end-in-herself. Similarly, Pellegrino and Thomasma pointed to the covenantal aspects of the clinical encounter, out of which arises an “ethic internal to the practice of medicine.” But, for some, there is a rising sense that the notion of covenantal relationships is being replaced by other types of relationships, with regrettable effects across the medical landscape.
Covenant is, of course, also a theological term. As May argues, within the the ancient Hippocratic writings, the covenantal aspect arises from the donative relationship between the physician, her teacher, and the gods. The covenant motif is also central to all three Abrahamic traditions.
This essay explores the nature of “covenant,” theologically understood, in order to evaluate the challenges to and possibilities of “covenantal” relationship within medicine. This essay takes it bearings from the Reformed tradition within Christianity, and, more specifically, from the work of Swiss Protestant theologian Karl Barth. Barth is notable within Reformed theology insofar as he articulates the nature of the divine covenant with humanity in terms of God’s primordial election of Jesus Christ. Covenant is, for Barth, “the inward basis of Creation”—a theological expression with notable implications for Christology, Christian anthropology, and ethics. In this paper, I first articulate what is distinctive about Barth’s doctrine of covenant—especially the contested theological notion of “covenantal ontology.” Next, I will briefly explain how Barth understands the relationship between “doctrine” and “ethics” in terms of “correspondence” with divine action. (As the term itself suggests, this has more to do with “response” than it does with “imitation”). Finally, I will draw connections between Barth’s notion of “covenant” and the healing arts. The central question is: “What does correspondence to the divine covenant entail within the realm of health and healthcare?”
Answering this question from within the Reformed Christian tradition, and with the thought of Karl Barth in mind, opens up possibilities for dialogue across difference in our pluralistic context – which, it is hoped, will itself provide a useful framework for understanding and exploring the enduring role of tradition in “a secular age” of medicine, in which no particular religious perspective can be taken-for-granted in our day to day lives and personal encounters.
Covenant is, of course, also a theological term. As May argues, within the the ancient Hippocratic writings, the covenantal aspect arises from the donative relationship between the physician, her teacher, and the gods. The covenant motif is also central to all three Abrahamic traditions.
This essay explores the nature of “covenant,” theologically understood, in order to evaluate the challenges to and possibilities of “covenantal” relationship within medicine. This essay takes it bearings from the Reformed tradition within Christianity, and, more specifically, from the work of Swiss Protestant theologian Karl Barth. Barth is notable within Reformed theology insofar as he articulates the nature of the divine covenant with humanity in terms of God’s primordial election of Jesus Christ. Covenant is, for Barth, “the inward basis of Creation”—a theological expression with notable implications for Christology, Christian anthropology, and ethics. In this paper, I first articulate what is distinctive about Barth’s doctrine of covenant—especially the contested theological notion of “covenantal ontology.” Next, I will briefly explain how Barth understands the relationship between “doctrine” and “ethics” in terms of “correspondence” with divine action. (As the term itself suggests, this has more to do with “response” than it does with “imitation”). Finally, I will draw connections between Barth’s notion of “covenant” and the healing arts. The central question is: “What does correspondence to the divine covenant entail within the realm of health and healthcare?”
Answering this question from within the Reformed Christian tradition, and with the thought of Karl Barth in mind, opens up possibilities for dialogue across difference in our pluralistic context – which, it is hoped, will itself provide a useful framework for understanding and exploring the enduring role of tradition in “a secular age” of medicine, in which no particular religious perspective can be taken-for-granted in our day to day lives and personal encounters.