Tag Archives: Dr. Joel Hamstra

Medical Ethics – A Reformed Perspective

Biblical Doctrines In Medical Ethics

Last time I left off with the plan to present somewhat of a framework that may be helpful when working through ethical dilemmas. This framework is not my own. It is drawn from a book that I recommend, Bioethics and the Christian Life, by David VanDrunen.1

VanDrunen suggests that there are four key doctrines found in Scripture that can help to inform our decisions. There are many other doctrines that are found in Scripture that can apply in different situations. In fact, for each dilemma or decision that we face, we must do our utmost to prayerfully consider the whole counsel of God before proceeding; however, these four doctrines are a starting point.

1. THE SOVEREIGNTY OF GOD

The first is the doctrine of the sovereignty of God and divine providence. The Bible makes it very clear that God is in control of all things. Not one sparrow falls to the ground without the will of our heavenly Father (Matt. 10:29). He ordains every detail of our lives. The hairs of our head are numbered (Matt. 10:30). What we perceive as “good” or even what we perceive as evil is under His control. We often find it easy to see the providential hand of God and acknowledge His sovereignty in the good things that happen to us; but in times of adversity, this is much more difficult. As the Heidelberg Catechism states in Question 27, the providence of God is “the almighty and every- where present power of God; whereby, as it were by his hand, he upholds and governs heaven, earth, and all creatures; so that herbs and grass, rain and drought, fruitful and barren years, meat and drink, health and sickness, riches and poverty, yea, and all things come, not by chance, but by his fatherly hand.”

Scripture also tells us that God’s providence and sovereignty are directed toward the upbuilding of His people. “All things work together for good to them that love God” (Rom. 8:28). Even the evil that befalls His children works to their good.

One of the most vivid examples that we find in Scripture of someone submitting to the sovereignty of God is the story of Job. He received much evil at the hand of Satan, allowed by God. After all the awful things had happened to him, he could still say, “Though he slay me, yet will I trust in him” (Job 13:15). So, first and foremost when a challenge arises, consider this: God is in control. However, if one is not united to Christ, then all things will not necessarily work together for good. This provides us with a place to begin in our counseling.

2. THE IMAGE OF GOD

Another key biblical doctrine to keep in mind when deal- ing with medical ethics is that man is created in the image of God. God made this entire wonderful, awesome creation with all its vastness, beauty, and incredible diversity. But out of all of it only man was created in the image of God. Psalm 8 comes to mind as an exposition of how man truly is the pin- nacle of God’s creation. Today, most physicians—in fact, most people in our society at large—fail to see much of a distinction between human beings and the rest of creation. Human beings are often held in much the same regard as other animal life. The reality that a human being is special because he or she is created in the image of God has largely been lost.

To most physicians, the concept of an eternal soul is for- eign. But in reality, human life is radically different from any other life that we find on this earth. From the moment that new life is formed at conception, God creates a unique human being with both a body and a soul, which remain together until separated by death. No other creature has a living soul.

We live in a very visual culture; we thrive on images. If we can’t see something, we tend to disbelieve it or minimize its importance. This can have a subtle yet profound influence on how we think about the beginning and end of life issues. Human embryos, only a few cells in number, invisible to the naked eye, look nothing like a human being. In our visually driven culture, these are not given the respect that they deserve. These tiny, microscopic collections of cells are a living person, incredibly precious, deserving of honor and protection as God’s image-bearers. The elderly person, curled up in a fetal position in bed, too weak to rise with his mind clouded by Alzheimer’s and his voice too weak to speak, is also an image-bearer.

Perhaps this sounds a little too man-centered or almost as man-worship. That is not my intention. Mankind as image-bearers has tarnished this image by the Fall. The Bible teaches that our natural state is totally depraved. As Psalm 9 teaches us, we need to recognize ourselves to be “but men.” Our true, full glory as image-bearers will not be seen until we are risen again when the Bridegroom returns and we are found among the com- pany gathered around the throne of the Lamb. We must view mankind from this balanced perspective. Every image-bearer bears the image of God and because of this deserves our respect.

3. THE REALITY AND NATURE OF DEATH

This is the third doctrine that is often helpful to consider when thinking about medical ethics. This is somewhat difficult to explain. In our current society, perhaps even more so in Europe than in North America, we normalize death. Death is con- sidered to be a very natural thing. Much has been written to define the stages of dying and coming to terms with a terminal diagnosis; the goal of this is to help lessen the sting of death, to take away the fear associated with death. We are told that those suffering from chronic diseases should welcome death as a means to escape this suffering. Yet is this understanding and attitude toward death scriptural?

Death first entered into the world through sin. It is a punishment for sin, man’s sin. Man was created to live. God breathed into his nostrils the breath of life. Life (both physical and more importantly eternal life) is what humans were created for. It is in life that we bear the image of God. Therefore, we as Christians should always act to affirm life—to choose life over death. We need to accept that death will come to all, but death in and of itself should not be embraced. Death is a fearsome thing. It is an awful thing. It separates soul and body. This, in the deepest sense, is wholly unnatural.

I agree that, in one sense of the word, death is natural. It is natural in that it happens to all creatures; no one will escape it. Perhaps it is better to say that death is inevitable (as a result of sin) but not natural. In fact, Jesus has come and conquered death so that His people do not have to suffer eternal death. For His people, even the sting of physical death has been taken away. Now death, instead of being a portal to eternal woe, is a portal to eternal life in anticipation of the resurrection and the world to come.

This biblical concept of death is utterly foreign to our society. By focusing on how we die—free of pain, dignity intact, in full control of our faculties—society has distracted us from the fearsome reality of what lies beyond the grave. Accord- ing to this view, death is good if it is noble and preserves our autonomy or pride.

We too can be drawn into this misguided focus on the manner of death. Now, please don’t misunderstand me. Physicians, healthcare workers, and family members, when caring for those who are experiencing a great deal of pain and suffering, have an obligation to provide comfort, support, and care for those at the end of their lives. We must hold firm, however, to the belief that life, even when it may involve suffering or pain or incapacity, is still an inherent good, a God-breathed gift worth protecting.

4. THE REALITY OF SUFFERING

The fourth key doctrine to consider is the reality of suffering. Suffering is inevitable. To quote VanDrunen: “For Christians the question is not really whether we will suffer but how we will suffer. Will we suffer in a godly way or not?”2 Scripture says, “In the world ye shall have tribulation” (John 16:33). Many issues that give rise to difficult ethical dilemmas involve suffering. Issues regarding infertility, chronic pain, and chronic illness all can cause those struggling with these matters to experience great suffering.

Our natural response to suffering is often to question God. Reflexively we ask, “Why me?” or “How could a loving God allow, even ordain that such a thing should happen?” Yet we must accept, through prayerful submission, that God is lov- ing and wise. “For [as] the heavens are higher than the earth, so are my ways higher than your ways, and my thoughts than your thoughts” (Isa. 55:9). Think again of the example of Job. When Job questions why all these things have happened to him, God reminds him in chapters 38–41 how great He is and how small Job is.

Although we are not called to look for suffering, we should pray for grace to bear a burden if God chooses to place it upon us. Suffering is not the ultimate evil. We may not necessarily do all that we can to avoid suffering; at times we must accept it as God’s will. Think, for instance, of the suffering that a person with a spinal cord injury experiences. Such a person may be unable to walk, possibly unable to perform even basic self-care. Now suppose medical science had found a way to use embryonic stem cells, derived from “spare” human embryos, to cause regeneration of the nervous system and treatment of the injury. This would provide immense relief and heal the suffering of many, yet it would be wrong because it involved taking innocent life.

Suffering must be endured if the means that we would use to end it are contrary to the revealed will of God. In fact, it is in times of suffering that God’s people are often drawn closer to Him, made more dependent on Him, and become more gloriously aware of their adoption as His children. “Yea, though I walk through the valley of the shadow of death, I will fear no evil for thou art with me” (Ps. 23:4).

So, to briefly recap, we should keep in mind four important biblical doctrines: first, the providence of God—He controls and directs all things; second, man is an image-bearer of God and as such deserves respect; third, the reality and nature of death—that it is wholly unnatural and that the only way for the sting of the grave to be lost is through redemption by Christ; and fourth, the nature of suffering—at times we are called to suffer and we must do so in a God-honoring way.


1. David VanDrunen. Bioethics and the Christian Life: A Guide to Making Difficult Decisions (Wheaton: Crossway, 2009).
2. Ibid., p. 62.


Dr. Joel Hamstra is a member of the Free Reformed Church of Dundas, Ontario and is Assistant Clinical Professor of Anesthesia at McMaster University and Director of Obstetrical Anesthesia, St. Joseph’s Healthcare, Hamilton, Ontario. This article is reprinted from The Messenger.