Pursuing Health in an Anxious Age E-Book

Bob, MD Cutillo

• Herausgeber: Crossway
• Kategorie: Ratgeber
• Sprache: Englisch
• Veröffentlichungsjahr: 2016

Seitenzahl: 332

Beschreibung

A Redeemed and Renewed Vision of Health Despite all the care available to us, our society is more concerned about health than ever. Increased technology and access to health care give us the illusion of control but can never deliver us from the limitations of our bodies. But what if our health is a gift to nurture, rather than a possession to protect? Drawing from decades of medical experience in many different contexts, Dr. Bob Cutillo helps us cultivate a biblical understanding of the relationship between faith and health in the modern age, reorienting us to a wiser pursuit of health for the good of all. Weaving in his own story of serving the most vulnerable, he leads us to a bigger view of health care and a hope that is more secure than our physical wellness—hope with the power to transform our communities.

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“Based on his Christian convictions and years of treating the marginalized, Dr. Cutillo calls for reorienting the philosophy and practice of medicine. A society consumed by a delusional drive for invulnerability needs to look to the truths of creation and the fall and of the incarnation and resurrection of Jesus: humans are finite and mortal, yet there is hope in the fact that God took on flesh and conquered death. Eloquently argued with references to philosophy, literature, and theology, this volume urges readers to redefine the relationship between faith and medicine. A profound, timely book.”

M. Daniel Carroll R., Professor of Old Testament, Wheaton College Graduate School; author, Christians at the Border

“Dr. Cutillo challenges his medical colleagues and the Christian church to look at how health care is provided in the context of modern medicine and in light of what the Bible teaches about caring for one another in today’s global society. His heart for and experience in caring for the poor and underserved along with his study of the Bible inform this excellent presentation of the issues as they have evolved historically.”

Grace J. Tazellar, Missions Director, Nurses Christian Fellowship; author, Caring Across Cultures

“Few people could have written this book with the penetrating perspective of Dr. Cutillo. He has a unique viewpoint from medical practice in some of the best Christian health centers in the US and abroad that helps him to understand health care. His medical perspective leads him to an eloquent but gentle lament for medicine’s impersonal ‘disembodiment,’ as it divides patients into organ systems, statistics, and computerized templates. However, his theological training and wide reading of the classics help us clearly see ways in which the integration of faith into health care can make it more truly caring. Dr. Cutillo’s conclusion draws on the hope he has learned from suffering patients and the joy he has witnessed as the result of true Christian community. He offers a positive change of direction I find very compelling. Read and be inspired.”

John Payne, MD, President, Medical Ambassadors International; Former Family Medicine Residency Director, University of California, Davis

“Health care has begun to feel like a zero-sum game. Struggles over coverages and copays have often supplanted thoughts about health itself. Our focus on the technologies, institutions, and politics of health care delivery have superseded considerations (and conversations) about the integration of health with biblical faith, community, and justice. Into this fraught space, Dr. Cutillo has introduced an astute thoughtfulness that is challenging, refreshing, and deeply grounded. His incisive analysis is delivered in a way that is caring, open, and inviting. This doctor has great bedside manner!”

David M. Erickson, President and CEO, Echo, Inc.

“This excellent resource, beginning with the simple conviction that health is a gift given by God, will challenge the way you and our culture look at medicine and health care. Whether Dr. Cutillo is discussing the proper care for our bodies, the proper place of science in health care, how we face death, or how to properly steward precious health care resources for the good of all, this book will inform and challenge some of your most basic, and perhaps incorrect, assumptions about medicine and health care.”

Walt Larimore, MD, best-selling author, 10 Essentials of Happy, Healthy People and Workplace Grace: Becoming a Spiritual Influence at Work

“Cutillo’s vision of how faith and medicine can cooperate offers an anecdote to the anxiety that diminishes personal health and contributes to defensive medicine. Of particular interest is Cutillo’s treatment of how anxiety and fear lead to self-absorption, consequently contributing to health disparities and injustice. With the church having the antidote to anxiety in the gospel, what might happen to the health of our communities if we lived fully into that message? A must read for those who are concerned about integrating faith and health in their professional practice or ministry.”

Mary Chase-Ziolek, Professor of Health Ministries and Nursing, North Park University and Seminary; author, Health, Healing, and Wholeness

“Bob Cutillo is an amazing doctor with vast experience in delivering health care in several contexts. He is extremely well qualified to guide us in our understanding of health care in the anxious days ahead. Dr. Cutillo uses his expertise and experience to help us think through health care with a hopeful mind-set. I highly recommend Pursuing Health in an Anxious Age.”

Wayne “Coach” Gordon, Pastor, Lawndale Christian Community Church, Chicago

“Reflection on the moral meaning of medicine sometimes results in contrived collections of guidelines or flowcharts to assist in making difficult medical decisions. In a refreshing alternative, Dr. Cutillo has woven a wise and engaging meditation with the power to transform how we imagine the meaning of health and of community. By situating the practice of medicine in the context of modernity’s preoccupations, obsessions, and blind spots, he reminds us that health is neither an entitlement nor a reductionist solution to an engineering problem. It is, rather, a gift—given by one who took on human form himself—to be received and cherished with wonder and love.”

Ken Myers, host and producer, Mars Hill Audio Journal

Pursuing Health in an Anxious Age

Pursuing Health in an Anxious Age

Bob Cutillo, MD

Foreword by Andy Crouch

Pursuing Health in an Anxious Age

Copyright © 2016 by Bob Cutillo, MD

Published by Crossway1300 Crescent StreetWheaton, Illinois 60187

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopy, recording, or otherwise, without the prior permission of the publisher, except as provided for by USA copyright law. Crossway® is a registered trademark in the United States of America.

Cover design: Tim Green, Faceout Studio

Cover image: © AGorohov / Shutterstock

First printing 2016

Printed in the United States of America

Unless otherwise indicated, Scripture quotations are taken from The Holy Bible, New International Version®, NIV®. Copyright © 1973, 1978, 1984, 2011 by Biblica, Inc.™ Used by permission. All rights reserved worldwide.

Scripture references marked NRSV are from The New Revised Standard Version. Copyright © 1989 by the Division of Christian Education of the National Council of the Churches of Christ in the U.S.A. Published by Thomas Nelson, Inc. Used by permission of the National Council of the Churches of Christ in the U.S.A.

All emphases in Scripture quotations have been added by the author.

Trade paperback ISBN: 978-1-4335-5110-9ePub ISBN: 978-1-4335-5113-0PDF ISBN: 978-1-4335-5111-6Mobipocket ISBN: 978-1-4335-5112-3

Library of Congress Cataloging-in-Publication Data

Names: Cutillo, Bob, 1955- author.

Title: Pursuing health in an anxious age / Bob Cutillo, MD ; foreword by Andy Crouch.

Description: Wheaton : Crossway, 2016. | Series: The Gospel coalition (faith and work) | Includes bibliographical references and index.

Identifiers: LCCN 2016012083 (print) | LCCN 2016022137 (ebook) | ISBN 9781433551109 (tp) | ISBN 9781433551130 (epub) | ISBN 9781433551116 (pdf) | ISBN 9781433551123 (mobi)

Subjects: LCSH: Health—Religious aspects—Christianity.

Classification: LCC BT732 .C88 2016 (print) | LCC BT732 (ebook) | DDC 248.4—dc23

LC record available at https://lccn.loc.gov/2016012083

Crossway is a publishing ministry of Good News Publishers.

2022-03-03 03:53:33 PM

To my mother, Francine

Contents

Foreword by Andy Crouch

Preface

Introduction: What Is Health For?

The Hope for Health

 1  Taking Control of Health: The Need to Feel Invulnerable

 2  The Desire for Certainty in an Uncertain World

 3  As It Was in the Beginning

What You See Depends on How You Look

 4  Disembodiment in Health Care, Part 1: The Clinical Gaze

 5  Disembodiment in Health Care, Part 2: The Statistical Gaze

 6  The Gaze of the Gospel

The Greatest Fear

 7  In the Shadow of Death

 8  Death Defanged and Defeated

Reimagining the Good of Health

 9  Just Community: Is There Enough?

10  The Cooperation of Faith and Medicine: The Hope for Salvation in the Midst of Pursuing Health

Conclusion: The Recovery of Wonder

Notes

General Index

Scripture Index

Foreword

Perhaps once a year, if I am lucky, I encounter a book that addresses a supremely important topic and does so in a supremely helpful way. This is such a book, and I am thrilled to be introducing it here.

What are we to do with our bodies, fearfully and wonderfully made as they are, in times of illness, vulnerability, and death? That question has always been with us. But it is becoming especially urgent for the citizens of the technological world—or, more baldly put, subjects of the technological empire that holds out to us a vision of the good life buttressed by scientific knowledge but also demands from us ever more loyalty and obedience. 

As a citizen of that empire, it feels almost subversive to observe that there is something uniquely tragic about our age of modern medicine—tragic in the old sense of genuine greatness and good intentions turned awry by a fatal flaw. 

In so many ways, medicine has delivered real cures and relief of suffering. It’s likely that I am here to write this foreword, forty-eight years into my mortal life, only because of the direct and indirect contributions of medicine, starting with the vaccines that warded off many a childhood illness, the antibiotics that effortlessly cured many another, the anesthesia that has made minor but essential surgeries possible, and the more mundane benefits of dentistry and ophthalmology, just to name a few. And for the most part, the human beings who have prescribed and delivered these treatments have been people of intelligence, wisdom, patience, and kindness—bearers of the imago Dei at their best.

Yet in so many other ways, medicine falls ever short of our expectations that it will deliver us from the basic human condition, the morbidity and mortality that are our inheritance as fallen creatures. There is an abiding tension between medicine’s achievements, which are tremendous; its promises, which at the limit are nothing less than “You shall be like God” and, above all, “You shall not surely die”; and its strangely persistent failure to bring the real flourishing that we long for, either for practitioners or for patients.

The increasingly crushing demands on many medical professionals, the dwindling time available for real encounter and empathy between physicians and patients, the costs that escalate year after year beyond many families’ (and perhaps, ultimately, our whole society’s) ability to afford, the heroic but expensive attempts to stave off the end of life that often lead to persons spending their final days enmeshed in a brutalist matrix of life-support machines—all of this seems to suggest that something has gone wrong in the story of medical progress. And on the horizon are potentially catastrophic developments, including the possibility that our time will be remembered as the single brief moment when antibiotics actually were effective, before the rise of invulnerable bacteria that escaped from the hospitals (where they are already alarmingly entrenched) into the wider world. 

Then there is the question of what lengths we will go to, as our expectations from medicine continue to escalate, to keep the stream of medical breakthroughs coming. What if it turns out that creating, exploiting, and destroying human lives can provide us the raw material—from stem cells to entire organs—to cure the diseases, or even just satisfy the desires for enhancement, of the wealthy and powerful? Why and how will we resist that new and more sophisticated form of child sacrifice?

We will only realize the real promise of medicine, it seems to me, and resist its transformation into the most horrifying of idolatries, if we discover a new vision for being human, one that values vulnerability as much as control, community as much as autonomy, and mystery as much as certainty. 

That is the way that Dr. Bob Cutillo offers in this book, and one of the many great gifts of this book is that rather than simply critiquing our current medical culture (as I fear I’ve done in these paragraphs), he offers a positively beautiful account of how a human-scale practice of medicine can actually fulfill our deepest desires in ways that merely technological medicine, for all its grandiose promises, can never achieve. This is a vision of health that is far richer than mere test results or statistics—it is embedded in community, informed by story and literature, and ultimately rooted in prayer and praise.

It is crucial that Dr. Cutillo’s own story, and the perspective of this book, includes providing care to the most vulnerable, especially those who live in neglected neighborhoods in our own country. By constantly reframing his assessment of medicine through the experience of people whose lives do not fit any neat picture of affluent flourishing, he recalls all of us to a picture of health that goes deeper than you’ll find in carefully crafted pharmaceutical advertisements or expensive downtown gyms. By telling their stories of life and death, illness and health, with sympathetic attention, he invites us to pay deeper attention to our own stories, slowing down our frenzied pursuit of relief from every small distress.

What we see in these pages is the beginning of a better way for all of us, a kind of health that we’ve almost forgotten is possible. One of my favorite phrases in the whole Bible comes when Paul is instructing his younger partner Timothy in how to pastor the wealthy in his congregation. He urges Timothy to lead them toward “the life that really is life” (1 Tim. 6:19 NRSV). If there is a life that really is life, there must also be a health that really is health. If we read and heed this book, we may still be able to find it.

Andy Crouch,

author; executive editor, Christianity Today

Preface

It was during my years as a medical student in New York City that I first began to wonder: Why do we fragment a patient into pieces to give good medical care? And why do we segregate the rich and insured from the poor and uninsured to deliver good health care?

One night during the first year, worn out by the overwhelming number of facts I was learning in books about the human body, I took a walk to the hospital, where I met a young man from Harlem. He was in the medical ward, a large room with fifteen to twenty beds, where the only privacy available was a curtain pulled around the bed. (Not surprisingly, the rich and famous of New York were in another part of the hospital.) He was there in a sickle-cell crisis, and I was there in a personal one. Though I was too early in training to offer anything of medical value, I offered my interest in him and a desire to sit and talk. Listening to his story that night and hearing of the things that had hindered his health and the way he had been treated in the health care system, I knew I needed a bigger view.

The years since have only confirmed these suspicions. I see it on the faces of patients who fear that the institution of medicine and those who work within it will forget them as persons while treating them as patients. I feel it in the loss of many good colleagues who leave the practice of medicine too young and too soon, still with so much care to give but too tired to focus on patients while trying to follow the rules and regulations of a complex and unjust health care system. And I know it in the failure of our culture to offer a reasonable view of who we are as human beings and how we fit in the communities we inhabit.

Instead of accepting the thinking that medicine and religion should remain apart, perhaps it is only a theological turn that can save us. But a theological investigation can never be a simple application of ready-made, clear-cut answers to human questions. If applied science demands direct results, applied theology first asks for a change in vision. In wrestling with a particular darkness but always moving toward a particular light, a new vision will change what we are doing, but only after clarifying where we are going.

As a practitioner of medicine and a student of the cultural context in which we pursue health, this venture in applied theology depends on two points of reference. The first vantage point is that of orthodox Christian belief. Thus it is toward the light of Christ that this work looks, using that light to explore how we pursue health and practice health care. Some will by upbringing or personal faith be attracted to this perspective; others may find it a strange and unlikely place from which to look.

The other vantage point is from the margins, with the medically disenfranchised, where I have been for most of my career. In trying to bring the least, the lost, and the left out into our models of care, I have found many barriers but also a great deal of health and healing just by being in their midst. Some who find the former stance comfortable may be uneasy with some of the conclusions drawn here. Yet those who start from an uneasy view of theology may find much with which they resonate in this latter perspective.

Whatever the case may be, for those who desire to see a deeper response to the care of the sick and the protection of the healthy in an anxious age, I invite you into this exploration. We will always be limited to the vision given by the particular vantage points from which we look. This book reflects my love of medicine and my belief in the church. My highest hope is that I have been faithful to what I have seen and heard from the places where I have stood.

A book of this nature, with hard questions concerning big issues, cannot come into being without many arms outstretched to lift up, to hold back, or to point the way. In the beginning there was Bethany Jenkins at The Gospel Coalition, who first saw that this book was important, that it was possible, and that someone like me could write it. Others may have thought so sooner, but she was the first one who knew what lay ahead yet still believed despite the obstacles. Her comments throughout the preparation of the manuscript helped to sharpen and balance it on numerous occasions.

I am indebted beyond measure to the thoughts of others, particularly those who wrote before me, many far back and, often in accord with the distance, with penetrating prophecy. The printed word, as Edmund Fuller says, “gives us extraordinary freedom to choose the intellectual company we will keep, to select those with whom, in spirit, we will walk. It is a privilege . . . in the highest sense it is a duty. . . . Paraphrasing Joshua, ‘Choose this day whom you will read.’”1 I was fortunate to choose wisely on many occasions.

Several of the authors whose words became windows through which to make sense of my world I met through the excellent work of Mars Hill Audio Journal. With host Ken Myers’s interviews carefully revealing his guests’ best ideas, it often led me on a fruitful journey of further reading. I am indebted to Gary VanderPol for introducing me to the work of Charles Taylor and also thank him for his thoughtful feedback on the early stages of this book.

Writing is also soul searching, with unknown passages and caves where bottoms suddenly drop out, and you don’t know where you are. That can be frightening. I thank Cindy, Dave, Gary, Jennifer, Mark, Pam, and Steve, whose promise of prayer often strengthened me, smoothing out many a bump and pushing me forward when I wasn’t sure where I was going or whether I could get there.

The skilled and gifted team at Crossway have performed a remarkable service in directing me through the labyrinth of publication. They suggested and directed, and, like the push and pull of sandpaper across rough wood, smoothed and polished the writing into better form. But above all and before any of this, it was their courage to risk I most admire, when they first entertained the idea of publishing this book.

I have been warmed at the hearth and fired in the furnace of several health care homes. I am indeed grateful for the formation I received at Lawndale Christian Health Center in Chicago; Kintambo Centre de Santé in Kinshasa; Christ House and Columbia Road Health Services in Washington, DC; and Inner City Health Center and Colorado Coalition for the Homeless Stout Street Health Center in Denver.

My deepest gratitude is for my wife, Heather. Because of her constant companionship over the last thirty years of the journey, only she knew what I was trying to say even before I could say it. Over countless conversations at breakfasts and much longer walks in the parks and mountains of Colorado, she kept reminding me what I meant to say, and as the first reader of everything I wrote, she gave me constant hope that I could do it. If richness is in relationships, no one can exceed the wealth I have in my wife.

I thank my children, Kate and Steve, and their spouses, Tim and Rachel, for their love, their support, and their ongoing commitment to live life honestly and faithfully in a challenging age.

Finally, I stand in awe of the courage and candor of numerous patients over many years. Though I would like to say that everyone taught me something, it is more honest to admit that I wasn’t always listening. But I never stopped believing that what the next patient might say or do was important, and so much of what was offered I was able to receive. Seeing life through their eyes—the eyes of those in fear and hope, in love, in pain and suffering, and in passive resignation or righteous indignation that no one cared about those like them at the margins—was a gift of great value. It was they who opened the window through which I could see my own culture in sober view.

Introduction

What Is Health For?

The greatest wealth is health.

Virgil

Health has always been cherished but never controlled. In 19 BC, Virgil, one of Rome’s greatest poets, went to Greece to work on revisions of his most famous poem, the Aeneid. On his way back home, he caught a fever, arrived in Italy weakened by disease, and died in harbor. Though he was only fifty years old, he had already lived longer than expected for his time.1 With little to do when sickness arrived, his awareness of the value of health only emphasized how fragile and precious life is.

American poet and essayist Ralph Waldo Emerson also believed, “The first wealth is health.” When he died in 1882, life expectancy was still less than fifty years. He, too, did not expect a great deal of control over health, living before the discovery of painless surgery under anesthesia, or the knowledge of a microbial world whose infections could be prevented with hygiene or treated with antibiotics.

Things have changed a great deal since then. We now live in a world with greater health and more health care than ever before. Life expectancy in most industrialized countries nears eighty years of age. Diseases such as tuberculosis, which caused the death of Emerson’s wife at age nineteen, can now be cured. Never before has the horizon for health looked so bright or the choices for health care been so varied. From organ transplants to respirators to cancer treatments to genetic mapping, the future seems unlimited, each boundary but a temporary pause in the march of progress.

Yet higher levels of health and greater quantities of health care, rather than creating greater peace and prosperity for all, have been associated with some troubling side effects—greater worry, increased waste, and a waylaid commitment to care for the health of our neighbor.

More Control but Greater Worry

When Joyce and her husband, Samuel, discovered they were pregnant for the first time, she was a graduate student in philosophy. Having delayed starting a family for several years while they pursued further education, getting pregnant at an older age was not as easy as they had planned. But over a year of waiting only made the positive pregnancy test that much more exciting.

They shared their joy with family and friends. Joyce’s sister, a mother of three, told them how important it was to start getting checkups right away and recommended that they see her midwife. But Samuel’s brother, Jacob, a doctor, was concerned that she was high risk because of her older age and recommended a friend of his who was an obstetrician. As usual when the family was dealing with medical issues, Jacob’s advice could not be refused, and on a Tuesday morning one week later they went to see Dr. Abernathy.

He entered the room with apologies for being late. Despite feeling rushed by a full schedule of patients, he took time to review the forms Joyce had filled out, asked one or two questions for clarification, and performed a careful exam and ultrasound. Afterward, he returned to the room to discuss next steps. “Joyce, the ultrasound confirms the date of your pregnancy at two months. Though I see nothing abnormal at this point, I recommend doing further testing to see if the baby is healthy. After all, you’ve waited so long. There are always risks of abnormalities, but at your age it is more likely. Down syndrome is the most common, but there are other problems that are much more severe, even incompatible with life. You do want to take advantage of all the options to insure the health of your baby, don’t you?”

Later that day, as Joyce and Samuel thought back on their visit, three things stood out. First, though Dr. Abernathy was harried, he was genuinely interested in providing high-quality care. Second, they remembered how efficient everyone was, particularly the nurse who came in later to answer their questions about the recommended testing. Finally, and most significantly, they realized something had changed. Tuesday morning they had gone to the office happy and excited, wondering if they would find out whether they were having a boy or a girl. Tuesday night they were worried and afraid. Was their baby physically deformed or mentally defective? Had they waited too long to get pregnant? What tests should they do? What would they do if they found something wrong?

What happened to Joyce and Samuel is not unusual in today’s health care encounter. On several occasions I have met parents-to-be just like them. The joy of discovering they are pregnant can be one of the purest in life. But upon entering the medical system, their wonder and awe at a gift received shrivel before efforts to calculate unknown risks, worries about what bad things could happen, and fretful decisions about how to manage the pregnancy to obtain a quality outcome. How quickly the power to control an unpredictable future and the great possibilities to maximize health can transform joy and hope into calculation and concern. Whether in preparation for childbirth, making preventive health choices, or considering treatment options for cancer or end-of-life decisions, worry has become one of the marks of modern health care.

More Health Care but Increased Waste

Not surprisingly, more health care costs more money. From 1960 to 2010 the percentage of the Gross Domestic Product (GDP) spent on health care in the United States more than tripled, to nearly 18 percent. At about 2.8 trillion dollars, it was more than four times the amount dedicated to defense and three times the amount for education.2 On top of that, individual consumers spend an additional one hundred billion dollars on fitness programs, anti-aging procedures, dietary programs and supplements, and cosmetic skin care products.3 Are we spending too much for health care? If health is our greatest wealth, can it ever be too much? That’s hard to say—unless what we spend is wasteful.

The best estimates are that up to 30 percent of the money we spend on health care is of little or no value.4 Many factors contribute to this problem. Much of health care is fragmented—tests are often repeated and unnecessary medicines prescribed because one health care provider does not know what the other is doing. Unfair pricing produces costs that have little to do with value—patients are often shocked to look at an itemized hospital bill and find a gauze pad costing ten dollars. Doctors practice defensive medicine for fear of being sued, provide treatments to fulfill standard protocols irrespective of particular situations, or order tests rather than talk to patients, because they have so little time. The list goes on, but the result is the same—we end up paying for health care that conveys little or no benefit. And if that weren’t enough cause for concern, what if wasteful spending and too much health care for some means too little for others?

More for Some, Less for Others

The third disturbing trend is our waylaid commitment to caring for our neighbor. As some of us worry about what we can do to insure our personal health and spend larger amounts on things that have little or no benefit, others struggle for even the most basic services. Over the last thirty years, in conjunction with the rapid growth in health care spending and services, the number of uninsured in the United States has steadily climbed.5 The uninsured have greater difficulty finding access to health care than those with insurance, causing neglect of health problems, sickness at more advanced stages, and higher death rates.6 This seems unwise and unjust in a country that spends as much money on health care as the United States does.

Yet the plight of the uninsured in this country, or the poor and marginalized in general, is easily lost in the heated debates over health care reform. In 2012 we spent more than twice per person on health care than most economically developed countries, including France, Germany, or Japan,7 and more than five hundred times what is spent for a person living in economically depressed countries such as the Democratic Republic of Congo.8 Yet the gap continues to grow as fear of losing control of our personal health strains the fabric of concern for the common good. With tunnel-vision focus on how changes in the financing and delivery of health care will affect my health care, we have little room for our neighbor at home and even greater neglect of the huge disparities in global health for our neighbors far away.

The Many Faces of Health Care

As we struggle to understand the worry, waste, and waylaid commitment to others in an age with more stability, certainty, and safety in health than ever before, it may be helpful to consider how complicated health care has become as our expectations for it have grown. No longer just a doctor-patient relationship, it is a complex system with many faces. Spend one day in a hospital bed and you will see it from many angles.

In the morning your doctor visits you. Her careful attention to the facts of medicine gives you confidence that you are receiving the best tests and treatment. If health care is to be dependably good, it must be scientifically sound. Health care requires good science.

But today the science is not certain. Yesterday’s CAT scan showed a spot on your lung and, though it is hopefully nothing, she cannot be sure. It can be observed and reexamined in three months or biopsied now. Since it is unclear what is best, she leaves it up to you. You choose to have a biopsy. You also decide to stop smoking. Health care includes choice.

An hour later the nurse comes in with your medicines. When you ask why one of them is different from what you take at home, he tells you that the hospital has a contract with a company that makes this less expensive one. You are not comfortable with the change and ask for what you usually take. He promises to tell his supervisor about your concern. Health care is expensive, making cost controls and standardization of services a required part of sound business practice. Health care is an industry.

Around 10:00 a.m. a specialist arrives to explain the biopsy procedure. He spends very little time talking to you, instead putting information into the electronic medical record on his portable computer. You’ve noticed that doctors are spending more time looking at computer screens and less time talking to you.9 New demands for data require electronic record keeping so that performance measures can be documented and new reporting requirements met. Health care needs to be a measurable and efficient system.

After he leaves, the nurse’s aide comes by to ask you if you are comfortable, if you are getting the food you ordered, if you need help going to the bathroom, and if your family is coming by to visit soon. This personal touch makes a big difference in how you feel. Health care is caring.

After lunch, an administrator pays a visit. Unfortunately, if you want your usual medicine, you will need to pay the one-thousand-dollar difference, since your insurance will not cover it. You remember the problems you had last year when you had no health insurance—you couldn’t afford to pay for your diabetes and high blood pressure medicine, and you had a stroke. You decide to be grateful for the medicine the insurance does cover. Health care is a safety net with many holes.

The reason you have health insurance now is that after your disabling stroke, you were eligible for a government program that was unavailable when you were healthy. If a new law currently under debate is passed, being disabled won’t be necessary to get this insurance. You think of your uninsured friends with chronic illness and hope they vote for approval. Health care depends on politics.

In the afternoon, after your biopsy, someone from the public health department comes in. Your doctor heard you wanted to stop smoking and solicited the support of those involved in a new smoking cessation program. After looking at the data, they saw that smoking, along with obesity, was contributing to a large amount of disease in the community. Dedicated personnel have been trained to help people to be healthier. Health care includes prevention and has social and community impact.

The following morning your doctor has some concerning news—the biopsy was positive for cancer. You feel overwhelmed by the diagnosis and break down in tears. Your doctor knows you well from years of caring for you and your family. She listens to your concerns, asks if you want her to be present when you tell your husband and daughter, and carefully answers your questions. You trust her and tell her that you are afraid of dying and never seeing your unborn grandchild. She assures you that she will be with you every step of the way. You are comforted that you will share this experience with someone who knows you intimately. Health care can be a sacred encounter of vulnerability and trust.

Health as Possession or Health as Gift

Each face of health care has a unique perspective on what health care should be. But like carnival mirrors at an amusement park, their individual views distort the image. For health care to be good, we need the pieces to fit together. But our image of health care, giving proper place and proportion to each piece, depends on our understanding of health. And this—at its most basic level—begins with an important question: Is health a possession or a gift? The answer makes all the difference.

If health is a possession, it is my health—something to have and hold, a thing like any other substantive reality, such as money, cars, or houses. It is a good definable in my own terms and, as a material value, obtainable at whatever level our societal resources and my individual purchasing abilities allow. Health like this depends on choice—which makes having many choices essential. Coinciding with this view of health is a strong trend to make health care a commodity and the patient a consumer who chooses among a menu of options to control health. This is the expanding world for much of health care today. As long as we remain here, we are in danger that our worries will increase, our wasteful spending will multiply, and our waylaid commitments to neighbor will become wanton disregard.

But now consider another way, where health is received as a gift. Rather than seeing health as a material good managed for our personal happiness, we receive it as a precious endowment. What would that mean for why we pursue health and how we shape health care?

First, endowments are not given in equal portions; therefore, health will not be received in equal amounts. This is verified by our everyday experiences; some are born with longevity in their genes and strength in their bodies, while others struggle almost daily with disability and disease. If we begin in different places, this necessarily means that there is no abstract ideal of health. Rather than pursuing perfect health, we will nurture the health we have received. In addition, we will create health care in ways that strengthen what we have been given instead of reaching for what we do not have or tightly grasping what we cannot keep.

Second, as we increasingly see health as a gift, we become better able to discern its deeper reason—it is given for a purpose, to accomplish some good beyond itself, even specific things with which we have been entrusted. It is not protected for its own sake or hoarded for fear of losing it. Instead, we nurture it so that we can use it to gain and grow other goods and benefits. We may even go so far as to see a relationship between the proportion of health we have received and the purposes we are meant to accomplish.

This is an ambitious set of assertions and will force us to grapple with many complex issues.What do we do when the endowment seems small? How do we respond when our endowment is diminished through bad choice, bad luck, bad care, or all of these? Or when we risk our investment and experience loss, or our health diminishes as a part of aging?Acknowledging that there are a multitude of factors along the way that can alter our health, the view of health as gift appreciates the value of good health care. The maintenance of health and prevention and treatment of disease—endeavors we have begun to grasp with increasing clarity and success—will be sound goals when reasonably and wisely pursued. But if we lose track of what health is for, our personal pursuits will remain selfish and unsatisfied, and our health care systems will continue to grow in fragmented, irrational, and unjust ways.

The Corruption of the Best Is the Worst

“The corruption of the best is the worst” is a proverb found in many forms, from Aristotle to Aquinas to Shakespeare, but never more quaintly phrased than by English poet John Denham: “’Tis the most certain sign the world’s accurst, that the best things corrupted are the worst.”10 A basic premise of this book is that health is one of those things. It is a good, one of our highest goods. But like most goods that are gifts, our efforts to insure, guarantee, or possess it will corrupt it.