The Seventh-day Adventist Tradition Religious Beliefs and Healthcare Decisions Edited by Edwin R. DuBose Revised by James W. Walters ost Adventists trace their religious ancestry Mback to the Millerite movement of the early 1840s, when William Miller (1782–1849), a Baptist farmer-preacher from upstate New York, aroused the nation with his prediction that Christ would return in 1843 or 1844. The movement split into several factions when the event did not occur as expected. Contents One of these factions evolved into the Seventh-day The Individual and the 3 Adventist church, distinguished by the observance of Patient-Caregiver Relationship Saturday as the Sabbath and the spiritual leadership of Ellen G. White (1827–1915), who as a 17-year-old Family, Sexuality, and Procreation 3 reported visions during which she received divine Genetics 5 instruction. In part, these instructions, as presented Organ and Tissue Transplantation 6 by White, supported the evolution of the church’s distinctive philosophy of health by elevating health- Mental Health 7 ful living into a moral obligation for Seventh-day Medical Experimentation 7 Adventists.1 Healthful living as a feature of religious and Research and moral conviction was given institutional form in Death and Dying 7 the establishment of the Battle Creek Sanitarium, whose most famous director was John Harvey Special Concerns 9 Kellogg.2 By 2001 membership swelled to more than twelve million, roughly 92 percent of whom dwell outside of the United States. Edwin R. DuBose, Ph.D., is Senior Ethics Consultant and Director Part of the “Religious Traditions and of Clinical Ethics at the Park Ridge Center for the Study of Health, Faith, and Ethics. Healthcare Decisions” handbook series published by the Park Ridge Center James W. Walters, Ph.D., is Professor of Religion with a specialty for the Study of Health, Faith, and Ethics in bioethics at Loma Linda University. He cofounded Adventist Today, an independent journal. THE PARK RIDGE CENTER FUNDAMENTAL BELIEFS CONCERNING basis outside of Christian teaching.7 While sup- HEALTH CARE portive of scientific medicine, Seventh-day Adventist theology is particularly compatible The church’s views on health reflect a theology with ideas associated with health reform, for its that holds that all things must be interpreted holistic view of the human being dispenses with finally with reference to the Bible. Practically, the traditionally sharp disjunction between body one should have a sound body and mind to ren- and soul that influenced the development of der the most effective service to God and to oth- biomedicine. ers. One central Adventist belief is that men and Recent studies show that Adventists who fol- women are made in God’s image with the free- low church teaching on healthful living have dom and power to think and act.3 Though each increased longevity. White male and white 1 is created a free being, every person is an indi- female Adventists in California live 7 /4 years 1 visible unity of body, mind, and soul, dependent and 4 /2 years longer, respectively, than their upon God for life and all else. According to California contemporaries. Further, Adventists Adventist theology, the care of the body—either who live a low-risk lifestyle—high physical activi- personally, socially, or institutionally—is fully an ty, vegetarian diet, frequent consumption of expression of Christian commitment. Since nuts, medium body mass—show a 10-year Adventists believe that personal health is a God- advantage in life expectancy, compared to those given trust essential to one’s personal prepara- Adventists who have a high-risk lifestyle.8 tion for the Second Advent, people have a The church’s posture on many clinical issues responsibility to care for their bodies. This is generally consistent with that of many other responsibility includes attention to diet, as well Protestant Christian groups. The positions out- as abstinence from alcohol and tobacco.4 The lined below are not church dogma but represent person who knowingly violates simple health a reasonable summary of Adventist belief. They principles, thereby bringing on ill health, dis- are based in many cases on articles that ease, or disability, is living in violation of the appeared in Seventh-day Adventist publications laws of God.5 In many ways, therefore, the and then were assembled by Albert S. Whiting, Seventh-day Adventist patient is ideally recep- former director of the Health and Temperance tive to holistic, preventive, and rehabilitative Department of the General Conference of regimes. As a ministry, the church operates Seventh-day Adventists. Many of the documents more than 650 health institutions throughout cited were prepared by a special committee and the world.6 approved by church officers or the denomina- The church’s commitment to matters pertain- tion’s executive committee as guidelines or edu- ing to health and health care remains strong. cational material to provide information to Generally Adventists favor rational, scientific church members. It should be emphasized that approaches to health care over pseudoscientific these statements do not necessarily represent ones because “laws of the natural world are of church policy or mandates to members but divine origin.” Adventists accept the concept rather should be considered as guidelines and that there are natural remedies that may be ben- information. eficial for the treatment of disease, particularly in the home situation. Such remedies should be rational and in harmony with the laws of physi- ology. Adventists would reject many of the cur- rent new age forms of disease treatment because of their pseudoscientific nature and mystical 2 THE SEVENTH-DAY ADVENTIST TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS THE INDIVIDUAL AND THE PATIENT-CAREGIVER RELATIONSHIP ecause the church believes that individuals Adventists believe that trust must be main- Bare created in God’s image as free beings, in tained in human relationships. Since the protec- most matters relating to health care the individ- tion of confidentiality is essential to such trust, ual church member makes his or her own choic- Adventists believe that information about a per- es. No hierarchy stands over the individual to son’s medical condition or other personal infor- dictate to him or her in such decisions. mation should be kept confidential unless the person elects to share the knowledge. In cases where others may suffer serious and avoidable CLINICAL ISSUES harm without information about another person, there is a moral obligation to share the needed Self-determination and informed consent information.12 For Adventists, God has given humans freedom of choice with the proviso that they use their Proxy decision making and advance directives freedom responsibly. This freedom extends to Adventists believe that decisions about human decisions about medical care. As a requirement life are best made within the context of healthy for responsible decision making, persons should family relationships after considering medical be adequately informed about their condition, advice. When someone is unable to give consent the treatment choices, and the possible out- or express preferences regarding medical inter- comes.9 With consideration for the interests of vention, an individual chosen by the person others and with the help of divine guidance, a should make such decisions. If no one has been person should be given the respect deserved by chosen, someone close to the person should self-determining individuals. make the determination. Except in extraordinary circumstances, medical or legal professionals Truth-telling and confidentiality should refer decisions about medical interven- Patients, families, and caregivers should be truth- tions for a person to those closest to that indi- ful in their relations with each other; “the truth vidual. Wishes or decisions of the incapacitated should not be withheld but shared with Christian individual are best made known in writing and love and with sensitivity to the patient’s personal should be in accord with existing legal require- and cultural circumstances.”10 In medical matters ments.13 such as assisted reproduction, “health care profes- In general, Adventists agree with current sionals should disclose fully the nature of the pro- practices in health care concerning informed cedure, emotional and physical risks, costs, and consent, self-determination, truth-telling, confi- documented successes and limited probabilities.”11 dentiality, and advance directives. FAMILY, SEXUALITY, AND PROCREATION ased on what Adventists see as God’s origi- a physical union possible for them. It represents Bnal plan for the lives of Adam and Eve, the closeness the couple can know emotionally Seventh-day Adventists advocate sexual union and spiritually as well.14 only through lifelong, monogamous, heterosexu- For most Adventists, the hope of having chil- al marriage. In their drive to be joined, in other dren is powerful. Because of their conviction words, each couple reenacts the first love story. that God is concerned with all dimensions of The act of sexual intimacy is the nearest thing to human life, they are committed to the principle THE PARK RIDGE CENTER 3 that procreation is God’s gift and should be used Medical technologies that aid infertile cou- to glorify God and bless humanity.15 According ples, however, may be accepted in good con- to the Adventist tradition, it is God’s ideal for science when they are used in harmony with children to have the benefits of a stable family biblical principles.19 Procedures such as in vitro with active participation of both mother and fertilization require prior decisions about the father. At the same time, childlessness should number of ova to be fertilized and the moral bear no social or moral stigma, and no one issues regarding the disposition of any remaining should be pressured to have children with or pre-embryos.20 without medical assistance. Decisions about At the same time, the church notes that adop- family and family life are personal matters that tion is one of the alternatives that infertile cou- should be made mutually between husband and ples may consider.21 wife.