American Journal of Medical Genetics Part C (Seminars in Medical Genetics) 151C:77 – 80 (2009) A R T I C L E Christianity, Health, and Genetics DAVID H. SMITH* Health is an intrinsic value that Christians should respect, but it is not the highest value. Christians should be willing to jeopardize their own health for the health of others, and should repudiate any idea that genetic problems are the result of sin. Rather, sin leads us to make genetic problems harder to live with than they should be. ß 2009 Wiley-Liss, Inc. KEY WORDS: health; religion; genetics; disability; theology How to cite this article: Smith DH. 2009. Christianity, health, and genetics. Am J Med Genet Part C Semin Med Genet 151C:77–80. Religion may be involved in the study and clinical use of genetics in several kinds of ways. It may motivate the work of counselors, physicians, and researchers. Religious institutions may provide education, counseling, or institutional support. And religious practice may be the basis for a way of looking at the world. Religions offer perspectives: ways of explaining the evil in the world, specifications of what it means to live a good life, models of and metaphors for structuring our moral behavior, proposals for how we ought to live together and what our basic duties to each other are. I will talk only about the perspectives aspect of religion, and the perspectives I talk about will be Christian. I appreciate that this may somewhat limit my audience, but religions are so diverse—even a ‘‘single’’ tradition like Christianity is so diverse—that it’s best not to pretend more scope than one can deliver. (I believe, however, that most, if not all, of the claims I make about Christianity have parallels at least within the other David Smith is Director of the Interdisciplinary Bioethics Center at Yale University. He is the first author of Early Warning, published by Indiana University Press. Grant sponsor: Ethical, Legal, and Social Implications of the National Human Genome Research Institute; Grant number: 1 R13 HG004689-01. *Correspondence to: David H. Smith, PO Box 208209, New Haven, CT 06520. E-mail: email@example.com DOI 10.1002/ajmg.c.30199 Published online 21 January 2009 in Wiley InterScience (www.interscience.wiley.com) ß 2009 Wiley-Liss, Inc. Abrahamic traditions of Judaism and Islam.)1 Religion is something that shapes our identities. I identify myself as ‘‘spiritual’’ or ‘‘Christian’’ or ‘‘nonreligious’’, Catholic, or Jew. To be sure, there is a very real possibility of selfdeception about one’s religion. I may like to think my views are Christian in the ways I am about to describe, but I may misunderstand myself. The truth may only come out when I am pressed or threatened, because it is our real commitments and religions, not those we may profess, that shape our identities. There is also a genetic component to our identities. I can imagine myself nurtured in a different womb, growing up in a different place, attending different schools, failing to meet the woman I love, or less lucky professionally. But I can’t really imagine myself with a different genotype—with a leaner or more hunky body, smarter, faster, or able to carry a tune. I have fantasies about those gifts, but the object of these fantasies would not any longer be me, for I am inescapably tied to this body. I don’t mean in this to fall back into a genetic determinism or essentialism. I do not think our genetics are the only or even the most important determinants of our identities. But they are an inescapable 1 Thus I am presuming a substantive rather than a psychological definition of religion. Contrast this with U.S. v. Seeger, in which religion is defined in terms of intensity of feeling. component of those identities, which may be the reason that we have so many fantasies about what it would mean to alter or ‘‘improve’’ them, even when those fantasies are ultimately destructive. Thus religion and genetics are both identity-shaping forces. Their competition or cooperation as theories is less interesting or important than their relative priorities as ways of understanding ourselves. My thesis is that Christianity supports a perspective or attitude towards the world in which vigorous genetic research and use of genetic knowledge to heal are essential. I will illustrate that claim with reference to three different points. First, Christians should affirm the value of health for themselves and others. This My thesis is that Christianity supports a perspective or attitude towards the world in which vigorous genetic research and use of genetic knowledge to heal are essential. I will illustrate that claim with reference to three different points. First, Christians should affirm the value of health for themselves and others. 78 AMERICAN JOURNAL OF MEDICAL GENETICS PART C (SEMINARS IN MEDICAL GENETICS) includes both physical and psychological health, genotype, and phenotype. Second, Christians should not think of health as the highest value in life. The greatest compliment to be paid a Christian at the end of her life is not: ‘‘my goodness she was healthy!’’ Third, a crisp distinction Second, Christians should not think of health as the highest value in life. The greatest compliment to be paid a Christian at the end of her life is not: ‘‘my goodness she was healthy!’’ between illness and morality, genetic problems and sin, must be established. The category of sin may be relevant to genetics, but not as an explanation or justification of genetically based disabilities. Rather it helps us understand the complexity of the social problems raised by genetic knowledge. Thus serious Christian faith requires us to work to reduce genetic pathologies and to help everyone live with the genetic limitations that we all have. Despite some excesses in the ascetical strand of Christianity, the tradition has consistently affirmed the value and goodness of health, with ‘‘health’’ taken to mean having a body that functions well, and a capability accurately to understand and effectively to act to accomplish one’s purposes in the world. Ill health is a bad reality, as are wounds and mental disease; these are things to be opposed. This commitment to good health would have been hard for Jesus the Jew to repudiate, and in fact he did not. It is true that Jesus can scarcely be seen as a precursor of the late 20th century health club or YMCA; in fact we know virtually nothing of Jesus’ physical health before the crucifixion. What we do know is that stories of his healing miracles are pervasive in both the synoptic tradition and in the fourth gospel. He clearly treated ill health as a bad thing, not as a discipline to be endured but as something to be got rid of. And by his presence, or his words, or the faith he engenders, he is presented as a healer. Nor is the concept of health ‘‘problematized.’’ The blind do see; the insane are made whole; problems of menstruation are corrected; even the dead are raised. Read ‘‘on the flat,’’ as a former colleague used to say, these healings are clear affirmations of the value of a healthy life. Theologically this conviction can find additional support in the doctrine of creation, that extraordinary mythological claim that despite all the injustice, sickness, pain, and poverty in the world, the world, and all that is therein are nevertheless good as God’s products. The goodness of creation suggests the goodness of individual created bodies and therefore the importance of their health. For centuries it was standard to express this point in Aristotelian terms: bodies have a telos toward functioning well. When human bodies and souls are not functioning well they are diseased or disordered. I believe that this notion of health as something objective is a legacy that it is important for Christians to preserve. Being healthy is not simply a matter of someone’s own opinion. People can be ill and not know it, and whole cultures may gloss over certain requirements of health. And people may think they are sick and not be—that is what it means to be a hypochondriac. Second, health is not the most important thing in the Christian life; the most important thing is one’s relationship to God. In some Christian writing that relationship is described as love for God; in other places it is described as faith in God. I have been most impressed by the idea that the ideal relationship between the self and God is one of trust and loyalty. The core idea goes back to Augustine’s analysis of human nature some 1,500 years ago. He argued that all people need something to love—or, as I am suggesting, something to trust, and loyally commit themselves to. He went on to suggest that no one’s happiness could be secure unless she or he had found an adequate ARTICLE object for such trust and loyalty and, finally, that only the God revealed in the Bible was such an adequate object. Augustine was an intellectual and, unsurprisingly, he thought that the next best thing to God was a wise person. But such a person might move away or die. So happiness built on love even of the best person in the world was precarious. In other words, insofar as we have to choose between health and a proper relationship with God, that choice is simple for the Christian and God wins. There are some complications here I quickly concede. Many Christian theologians insist that if one has a right relationship with God true health will follow; they argue that having faith or loving God will contribute to one’s health—as we ordinarily understand health. While I support their basic insight, I think we have to acknowledge that there are times when we have to make the choice between loyalty to God and health. Martyrdom is a clear case of people who have chosen faith over life, but so may be hard work for any worthy cause. In fact this is not a particularly rare occurrence. People jeopardize their health all the time in working for their families, their church, or their country. Laying down your life for another is scarcely good for your health. Put differently, trust, and loyalty in God allows us to see preoccupation with health as idolatry. It is putting health in the place of God. Mohrmann  suggests that this idolatry is shown in our ‘‘fickle shifting obsessions with diets and exercise machines and with jogging down every primrose path to perfect health, whether it is the path of vitamin C or brewer’s yeast or no yeast at all or oat bran. . .’’ She claims that this preoccupation with health ‘‘represents a failure of trust’’ and absence of ‘‘a fundamental attitude of confidence that we have been created as far less fragile creatures than we fear we are’’ [Mohrmann, 1995]. Children do not routinely need artificial vitamins; menopause is not a disorder that routinely requires therapy; a cough is ‘‘God’s brilliant mechanism for clearing the airways’’ and need not always to be suppressed [Mohrmann, 1995]. ARTICLE Most dangerously, as Mohrmann goes on to point out, preoccupation with health leads us to forget that death is something to be expected as part of a healthy life. If one lives to be healthy then death can only appear as the enemy to be fought at all cost, but if one lives with trust and loyalty to God, then death can be accepted because it is not the ultimate loss. I don’t mean to be glib about this; apart from unusual circumstances no one should (or does) want to die. Nevertheless, one’s attitude toward life affects one’s sense of the significance of death. If I live for health, when I die it’s all over; if I live for a cause—for example the cause of God—I die with a sense of meaning. As Mohrmann  writes ‘‘The question is not, ‘What can I do to live longer?’. . . [but] ‘How shall I live the life I have?’ Health seeking behavior is not death prevention; it is life enhancement.’’ So, for the Christian, health is a good but it is a secondary good. It is, So, for the Christian, health is a good but it is a secondary good. as the philosophers might say, an intrinsic good but not the highest good. But there is another complication about this point that I should raise. This complication arises from the fact of Christianity’s altruistic preoccupation. We can see the issue already in the example of Jesus: in the New Testament he is presented as concerned with the health of others, but not with his own. And his ethic has a decidedly heroic cast, urging lack of concern for self and greater concern for the needs of the neighbor. One important Protestant moralist, writing at about the middle of this last century, suggested that Christian ethics did not tell us what human beings need but rather that whatever it is we think they need— whether it be money or food or sex or health—the Christian should be preoccupied with securing that thing for the other, not for her or himself [Ramsey, 1952]. Whatever the theological formulation, the relevant point is that Christian AMERICAN JOURNAL OF MEDICAL GENETICS PART C (SEMINARS IN MEDICAL GENETICS) ethics seems to suggest that my neighbor’s health is more important and valuable than my own. It provides a rationale for nurses and physicians working long hours, for clergy and laity tiring themselves out visiting, and caring for the sick. The obvious implication for our purposes would be that the genetic health of others is something I should worry about more than I worry about my own. As Thomas Aquinas wrote The obvious implication for our purposes would be that the genetic health of others is something I should worry about more than I worry about my own. centuries ago, I rightly have more concern for my own soul than for that of another, but I should certainly worry about his body more than about my own body. More recently, Ramsey , the Methodist moralist to whom I referred above, argued that one should be concerned for oneself as an instrument or tool. The physician or nurse who doesn’t take care of herself won’t be around very long to take care of the patients whose health she wants to advance. Mohrmann  argues that we have a responsibility of stewardship to our own bodies. They are to be protected and nurtured for much the same reason we take good care of pets or livestock or the environment. My own sense is better reflected by asserting that we are concerned with our health because concern with ourselves is fundamentally legitimate. We turn to God because of our finitude and insecurities, including anxiety about illness and death. We seek help, something we can trust and dedicate ourselves to, and then we find that this trust and dedication exacts a price. The price may be bad for our health, but in the process of living for God and others we find that our sense of how important it is to be healthy has been put into perspective. 79 We won’t ever move to a plateau where we are indifferent to what happens to our own bodies—to how healthy we are— but we will see health in a new light and see ill health in a different perspective. The self is one of the neighbors worthy of love for its own sake. In fact, however, Christians and others often (perhaps usually) fail to care for others or ourselves, as we ought to. This relates to the sad fact that Christian theology can misuse genetic knowledge and has sometimes done so, if inadvertently. Our genes come from some persons and may be handed on to others. They are a part, but only a part, of the embodiment that is central to our identities. Christian theology has sometimes suggested a heredity connection between the bad things we do and harms our descendents suffer. ‘‘She has fetal alcohol syndrome; her problems are her mother’s fault.’’ A moralistic approach to ill health and disease, and a tendency to ask ‘‘was he a smoker?’’ or ‘‘did she drink?’’ when news of someone’s health related misfortune comes up is as common among devout Christians as among any other social group. Part of the impulse for this is self-protection. ‘‘His cancer was the result of smoking; I don’t smoke so I won’t get cancer.’’ Of course this is magical thinking. I concede that people have great responsibilities for their own health, but given that ill health seems distributed in ways that are inexplicable, if not exactly random, the moralistic tendency to blame the sufferer accomplishes very little. Perhaps responsibility for disease lies on a continuum and our moralizing tendencies tend to think at only one end of the continuum, as Joe Fanning has observed. Not only is the moralistic focus merciless in its moralism, it is pretty clearly repudiated in the New Testament. In John 9:2 the Christ is asked whether a man’s illness is the result of his own or his parents’ sins. Jesus responds that neither of those things is the reason, but the man is ill ‘‘so that the works of God may be manifest in him’’—presumably meaning that he will be the occasion for a demonstration of God’s healing power in the Christ. Note that 80 AMERICAN JOURNAL OF MEDICAL GENETICS PART C (SEMINARS IN MEDICAL GENETICS) Jesus does not repudiate the idea that illness might have any divine purpose; on that level the story is enigmatic. But a theory of the origin of illness in sin was repudiated. Nor is this moralism only a characteristic of popular Christianity. In the Augustinian tradition ill health and death are explicable as God’s punishment for human sin; in the Ireneaen strand of thought they are occasions for moral discipline that leads to our salvation. In both cases there is a connection between health, morality and salvation, but the Augustinian tradition puts God in the position of punishing well beyond any imaginable justification and the Ireneaen one makes God a somewhat bumbling moral instructor [Hick, 1966]. Neither of these theories breaks the connection between the heritability of sin and genetic disorders; neither captures the insight ascribed to Jesus in the Gospel of John. If we look to either for assistance or insight in coping with genetic disorders we come up empty. A more robust moral theology should enter into the realm of discussion of genetics. Use of what is arguably the most influential theory of sin developed in 20th century Christianity may illustrate a constructive connection between sin and genetic problems. Niehbur [1996, p. 150–264] argued that human beings are essentially finite spirits, ‘‘spirits’’ in that we are aware of ourselves and of the existence of others, and finite in that we know that we will die. The result of that knowledge is anxiety. Thus for all human beings the ‘‘human condition’’ is to be aware of ourselves, our mortality, and each other. Our consciousness is inevitably comparative, and Niehbur argued that we respond to anxiety by drowning out awareness in drugs, routine or selfdeception (a phenomenon he called sensuality), by trying to be superior to or to dominate others (pride and the will-to-power), and sometimes miraculously in love, when we put the interests of others above ourselves. For Niehbur love was truly miraculous; he claimed that our lives were more characteristically ruled by pride and sensuality. That is original sin—sin rooted in our nature as finite spirits. If we were to take a Niehburian approach to sin and genetics, we would find ourselves focusing on issues of power imbalance, disrespect for difference, and the importance of provision of moral and spiritual support for patients, families, and caregivers. Thus, for example, we might respond to the ‘‘disability critique’’—the idea that a focus on genetic health goes hand in hand with disrespect for and devaluing of persons with genetic or other birth defects—by affirming the basic data driving the critique: that we tend insufficiently to support persons living with genetic differences, that our social institutions make life with genetically rooted differences more difficult than they need to be, and that the only way to ameliorate these problems is through the use of social and political power. On the other hand, we would not ignore the tendency of biologically disadvantaged persons to do what we all do: engage in special pleading. We would not suggest that no genetic differences are objectively disadvantageous, or be reluctant to call congenital blindness or deafness disabilities. Moralism is replaced by ambiguity, but ambiguity does not mean insensitivity to injustice, the need for reform, or the importance of the miracle of love. ARTICLE In sum, I have argued that at a minimum Christianity can provide rationale for research into and use of genetic knowledge. Christians are dedicated to genetic health as we ordinarily use that term, but such health is not the highest good for which a Christian should aim. Genetic health should be seen by Christians in a theological context, one that avoids moralistic theodicies, notices what we can do to hurt or help each other, and stresses a realistic hope for a life of trust and loyalty. When we have to choose, we should choose personal integrity over improvements in our own health and seek care for those suffering from genetic disorders rather than enhancements of ourselves, or our descendents. ACKNOWLEDGMENTS This project was supported by conference grant 1 R13 HG004689-01 from the Ethical, Legal, and Social Implications of the National Human Genome Research Institute. The author offers special thanks to Laurie Hurshman, his colleague at Yale, for editorial assistance, and to Joseph Fanning, Ellen WrightClayton, and Larry Churchill of Vanderbilt University for a welcome invitation and a provocative symposium. REFERENCES Hick J. 1966. Evil and the God of love. San Francisco: Harper and Row. 403 p. Mohrmann ME. 1995. Medicine as ministry. Cleveland: Pilgrim Press. 128 p. Niehbur R. 1996. The nature and destiny of man. Louisville: Westminster John Knox Press. 680 p. Ramsey P. 1952. Basic Christian ethics. New York: Charles Scribner’s Sons. 448 p. U.S. v. 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