Doctor’s Dilemma

by Jon H. Rouch, M.D.

The moral and ethical dilemmas posed by advancements in modern medicine are not those of the stateside practitioner alone. It’s not only the doctor at the medical center who puts someone on an artificial kidney who faces them, or the surgeon who selects a patient for an organ transplant, but also the medical missionary.

The moral and ethical dilemmas posed by advancements in modern medicine are not those of the stateside practitioner alone. It’s not only the doctor at the medical center who puts someone on an artificial kidney who faces them, or the surgeon who selects a patient for an organ transplant, but also the medical missionary.

How often I recall those days at Baptist Mid-Missions hospital in the Central African Republic, seeing long lines of patients needing surgery. Even operating from dawn to dusk, I could not do them all. I operated on some of these patients, but since all of them could not be accommodated, others were sent away to die. Even by training African medical and surgical assistants to do operations, all of the work that remained could not be done.

The people, who thought that in many ways the white man’s surgery was magic, could not comprehend my dilemma. Perhaps this dilemma, the matter of moral and ethical choices to be made with so many new life-saving tools and methods at our disposal, could best be expressed by a question, "Who will be allowed to live?"

Our increasing ability to keep people alive, including the very old and the very sick, is only one factor to consider in seeking an answer. What about our approach to inborn errors of metabolism, like the one connected with mental retardation? There is a test for this which can be done at birth, and the condition can be corrected by diet. Doctors know that more light makes for greater responsibility. If we know a cure for something, and it is easily applied, we cannot withhold it.

Or what about the problem of future genetic choice and who will make it? We already know that genetic damage occurs from radiation, producing mutations. It also occurs from LSD; and tie hippies say they know it and don’t care.

In view of these things, is it any wonder that an article in Medical Science says, "Unprecedented developments in science and technology have altered many of the circumstances upon which previous codes of behavior were based?"

But back to the missionary doctor’s personal dilemma. Dr. Gene Burrows at the leprosy center and hospital in Assam, India, says, "Too many sick! I have to turn people away, rejecting those who, to a casual glance, do not seem so sick, nor so pressing. Often I wish we could have the Master’s touch as Peter and Paul had, to heal all by word or touch."

Dr. Burrows uses Disulone, an effective medication for leprosy not available thirty years ago. Ire does as many tendon transplants in gnarled hands as time allows, or as he can teach the Indian assistants working with him.

Everywhere modern medical care is faced with what I would like to call the peril of success. A past president of the American Medical Association put it well when he said, "Nothing succeeds like success; and because medicine leas succeeded in so many areas, so much is expected from it."

It is exactly the distribution of this success that causes our greatest personal conflict as missionary doctors. Just what good did I do in Central Africa in the one or two thousand operations I did while there? By now the patients have probably died, even though they may have survived a bit longer than those I had to turn away with great turmoil inside me.

What good do you say? The same good that one drop of water can do in a desert. What is that, you ask? Can that quench all the thirst? No, but it can demonstrate that there is such a thing as water, and the missionary doctor can demonstrate that there is such a thing as love and compassion.

The Great Physician, Jesus Christ, faced the same dilemma caused by the peril of success. For example, according to Mark 1:32-38, Jesus was conducting what could be called a very successful clinic in Capernaum. None were hospitalized, since all were treated as out-patients, healed immediately and sent home. Realizing that this could go on endlessly, our Lord took a recess and went to a quiet place to pray. His disciples found Him there the next morning and urged Him to return to the "clinic," since many patients had already registered and were awaiting His healing touch.

But Jesus surprised the disciples by not returning; He chose to go on to other villages. In other words, He actually left people behind who were unhealed, people who were still sick, people who might soon die. Why? He had taken time to fellowship with His heavenly Father, and in that fellowship He had received His instructions; that made the difference.

This is the same problem Dr. Burrows has among the many lepers of India. It is the same problem I had in the Central African Republic. Our Lord faced this dilemma in the only possible way missionary doctors today can face it: by fellowship and prayer with their heavenly Father.

Missions can’t hide from the monstrous social and physical ills that confront the world. They can’t pretend that population increase and famine are not stark realities. In Christ’s name they must respond to suffering and need.

And while missionary medical people share the physician’s dilemma as a whole, there’s yet another compensation as they seek to have a part in filling the cavernous emptiness of the human heart everywhere. The new life that Jesus Christ gives cannot be forgotten.

From Assam Dr. Burrows adds this note to his plea for the Master’s touch in healing: "The people who do come are taking more Scripture portions and books than ever before. We are still waiting for the Lord’s harvest from among them."

Those who put on the white frock of the medic-nurse, doctor, technologist-on the mission fields of the world do so not only to preserve physical live, and to show love and compassion, but also to communicate spiritual life in Jesus Christ. This kind of life transcends the physician’s dilemma.

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