The Lutheran Tradition Religious Beliefs and Healthcare Decisions Edited by Deborah Abbott Revised by Paul Nelson uring the Middle Ages, most of western Europe Dwas united, however tentatively, under the lead- ership of the Roman Catholic church. In the early sixteenth century, this union fractured, due in part to the work of a German monk named Martin Luther. Luther had striven to guarantee his salvation through ascetic practices but slowly came to believe that Contents salvation can come only through the grace of God, The Individual and the 4 not through any human effort. This fundamental Patient-Caregiver Relationship principle of Luther’s thought, “salvation by grace through faith alone,” diverged from the traditional Family, Sexuality, and Procreation 6 Roman Catholic belief that both faith and human Genetics 12 effort are necessary for salvation. The other funda- Organ and Tissue Transplantation 14 mental principle of Luther’s thought, that the Bible is the sole rule of faith and the only source of authority Mental Health 15 for doctrine, contrasts with the Roman Catholic Medical Experimentation 15 reliance on both the Bible and tradition. Luther and Research translated the Bible into German and, thanks to the Death and Dying 16 recent invention of the printing press, it was distrib- uted widely and became a best-seller. The availability Special Concerns 19 of a Bible in the language of the common people, coupled with Luther’s idea of the Bible as the sole source of authority, marked the beginning of a signifi- cant shift away from Rome as the final source of reli- gious authority for many Christians. Part of the “Religious Traditions and Deborah Abbott, M.P.H., formerly with the Park Ridge Center, is Healthcare Decisions” handbook series currently affiliated with Georgia State University. published by the Park Ridge Center for the Study of Health, Faith, and Ethics Paul Nelson, Ph.D., is Professor of Religion and Chair of the Department of Religion at Wittenberg University. THE PARK RIDGE CENTER Luther first presented his ideas publicly in traditionally built hospitals and been open to 1517, when he nailed to the church door in scientific developments and cures, but those Wittenberg his Ninety-five Theses protesting endeavors and attitudes have not retained a the corruption he saw reflected in both the specifically Lutheran flavor (Marty 1986: 171, teachings and the practices of the Roman 18–19). Catholic church. Although Luther was not the Luther himself respected doctors and first reformer of the church in this era, many promoted close working relationships between cite the posting of his theses as the beginning them and pastors in caring for the sick. He of the Protestant Reformation, which ultimately expected doctors to identify and treat medically resulted in the formation of many non–Roman the natural causes of sickness, but he believed Catholic, or Protestant, churches in northern that more underlay sickness than a doctor could and western Europe. In 1530, the German address (Lindberg 1986: 177–78). Luther saw princes who supported Luther presented to the illness as both a result and a sign of that which Holy Roman Emperor the Augsburg Confession, separates humans from God (Marty 1986: 48) an official statement of Lutheran faith; following and understood the meaning of suffering, both that event, congregations identified with Luther personal and social, as somehow tied to God’s could formally be called “Lutheran” churches. decision to redeem sinners and the world Soon thereafter, Lutheranism spread through the death of Christ on the cross throughout Germany, Sweden, Denmark, (Lindberg 1986: 176–77). Finland, Iceland, and Norway, and in the mid- The first draft of a proposed ELCA social seventeenth century, to the American colonies. statement understands “healing in terms of Today, Lutheranism in the United States is God’s work of creating, redeeming, and divided among two large and seven relatively sustaining humankind” (ELCA 2001b: 4). small denominational groups. The largest, the “Providing good quality health care for all is Evangelical Lutheran Church in America a social obligation and responsibility compelled (ELCA), has 5.3 million members in more by justice” (ELCA 2001b: 9). The proposed than 11,000 congregations; approximately statement finds “current forms of health-care 270 hospitals, nursing homes, and other social resource distribution . ethically indefensible” service organizations are affiliated with the and calls for reforms that would assure ELCA. The Lutheran Church—Missouri Synod “universal access to a comprehensive decent (LCMS), which is more conservative than the minimum of health care for all persons” (ELCA ELCA on many theological and moral issues, 2001b: 9-10). The draft does not stipulate has 2.6 million members in more than 6,000 particular mechanisms for achieving universal congregations. Collectively, the smaller Lutheran access but encourages ELCA members to partic- churches have about half a million members in ipate “vigorously and wisely . in the public 1,700 congregations (Nelson 1991: 123). discussion on how best to fulfill this obligation” (ELCA 2001b: 10). These matters are explored in an ELCA congregational study booklet, Our FUNDAMENTAL BELIEFS CONCERNING Ministry of Healing: Health and Health Care HEALTH CARE Today, prepared by the task force that drafted the proposed social statement (ELCA 2001d). Lutherans as a group do not hold distinctive The LCMS, generally leery of an emphasis on views on health care or healing. In many “social ministry” lest it obscure the central focus respects, including their acceptance of modern on proclaiming the Gospel and administering medicine, Lutherans blend in with the largely the sacraments, nevertheless directs attention to secular culture (Marty 1986: 18). They have the church’s “communal Christian care.” Parish 2 THE LUTHERAN TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS nurse programs are identified as one of its wrong is uncorrupted” (Schneider 1990: 16); possible expressions in a study document titled the potential for error within individual Faith Active in Love: Human Care in the conscience is tempered by the Scripture as Church’s Life (LCMS 1999: 29). understood in the Lutheran tradition. The following statement by the American Lutheran Church, one of the bodies that merged to INSTITUTIONAL AUTHORITY AND form the ELCA, emphasizes the importance INDIVIDUAL CONSCIENCE of subjection to God’s law: “One remains subject to God’s law not only for one’s personal good Issues of institutional authority and individual but for the good of the entire body of Christ. conscience are rooted in Lutheran ethics, which A caring community cannot sanction or condone is inseparable from Lutheran theology. a situation where each member does what According to Lutheran pastor and writer Edward appears good, right, and self-satisfying simply in Schneider, “A basic word in the vocabulary of that member’s own eyes. No one can be a law Lutheran theology is the word ‘and.’ Our solely to self; each lives in relationship with theology speaks of law and gospel, of the others” (ALC 1980: 10). believer as saint and sinner. It insists upon Lutheran church bodies in the United States faith and work. It deals with the kingdom of often issue statements or other documents that God and the kingdom of the world. The genius reflect internal deliberation on moral and ethical of this theology is its ability to dialectically issues of importance to church members. These relate aspects of the faith which often tend to are normally designed to educate and guide be separated and thereby deprived of their full members in developing their own positions on meaning” (Schneider 1990: 15). This issues. Within a particular church, various docu- “both/and” approach shapes the way Lutherans ments may differ in the degree to which they exercise their conscience in this imperfect world. reflect the “official teaching” of the church. Lutheran professor of religion Paul Nelson has Sometimes the churches publish works by a written, “The sober recognition that we are less single author which are intended to provide than perfect people living in a far from perfect information and encourage reflection but do not world, along with the conviction that we are, represent an official position of the church. The nevertheless, forgiven sinners are the two history of mergers within the Lutheran church benchmarks of a Lutheran moral vision. may also complicate the status of various state- The former precludes self-righteousness and ments. For example, the ELCA was formed in underlies the sense that often we can do little 1988 by the merger of the Lutheran Church in else but choose between greater and lesser evils. America (LCA), the American Lutheran Church The latter makes choice and action possible (ALC), and a smaller body, the Association of despite the attendant ambiguities” (Nelson Evangelical Lutheran Churches (AELC). The 1993: 151). A statement by the ELCA empha- ELCA elected to accept and encourage the sizes this point when it says that Christians must continued use of the “social statements” issued face complex ethical decisions “in all their by the ALC and LCA while it developed its own ambiguity, knowing we are responsible ulti- teachings (Nelson 1991: 123), and continues mately to God, whose grace comforts, forgives, to use these statements as “part of the basis of and frees us in our dilemmas” (ELCA 1992: 1). ELCA advocacy on health care” (ELCA 2001d: Lutherans, like other Protestants, emphasize 52). Statements by the ALC and LCA, although the importance of individual conscience over those churches no longer exist, will therefore institutional authority, but “Luther makes no be cited here when the ELCA has not made a claim that one’s natural sense of right and statement on a particular topic or when an ALC THE PARK RIDGE CENTER 3 or LCA statement adds significantly to the teaching function builds upon and seeks to nurture substance of an ELCA statement.