The sounds from the fetal heart monitor assure the surgeon that all is well with his patient-an infant still in the womb. At Vanderbilt University Medical Center in Nashville, Joseph Bruner makes an incision in the fetus' skull and places a shunt, or small tube, in the fluid space of the brain. The surgery is designed to treat a potentially fatal condition known as congenital hydrocephalus, or water on the brain. Dr. Bruner saves the baby by successfully performing a first-ever medical miracle: in utero fetal brain surgery. Whoosh-whir. A frightened teenager listens to the systematic labor of a suction machine as she lies on the chrome table. Another doctor makes an incision in the fetus' skull without anesthesia. This time the intent is not to heal. The doctor is draining the life out of her womb through a partial-birth abortion. As we prepare to exit a millennium of medicine, we witness a preposterous paradox. One doctor works heroically to save an imperfectly formed baby while another literally dissects a healthy, living baby. It's appropriate to ask: How did we get to this point? The Middle Ages (1000-1300)
At the dawn of this millennium, patients trusted their doctors-if not to heal them, at least to bring a measure of comfort. The Hippocratic Oath, established around 429 B.C., had helped transform medicine from magic and manipulation to a reasonably respectable science. Through both spiritual and political means, the church powerfully exerted its moral influence upon medicine. It fostered the development of medical science during the Middle Ages, helped establish many university medical schools and hospitals, and at times assumed the role of physical and spiritual healer. The Benedictine order of monks, for example, stressed the study of medicine and provided health care for lepers and the poor. Italian physician and Benedictine monk Constantine the African (1015-1087) translated many Greek medical classics into Latin. As late as the 12th century, monastic clinics provided the only means of health care available to many communities. But some church leaders also at times impeded the march of medical science, viewing it as a threat to doctrine and spirituality. French church leader Bernard of Clairvaux, for example, forbade his monks to study medicine and banned the use of any remedy except prayer. Echoing the views of church father Tertullian, who held that the revealed gospel made experimentation unnecessary, the church banned dissection and experimentation until 1240 A.D. Gregory of Tours believed that seeking secular medical aid amounted to blasphemy. The human body was commonly viewed with contempt as a vessel for evil, and disease as divine retribution or the result of demonic forces. Renaissance, Reformation, and Revolution (1300-1800)
A crucial test of both the church and the medical community arrived with a series of plagues that first appeared in Europe in 1348 and extended well into the 1600s. The Black Death plague in the 14th century wiped out roughly half the population of Europe. Epidemics dominated daily life and culture. Even children sang of the symptoms and sights surrounding the Black Death: "Ring around the rosies [pink rash], A pocket full of posies [flowers thought to protect against disease-causing "vapors"], Achoo, Achoo [sneezing symptom], We all fall down [death]." The distant, graceless view of God that enslaved many in the Dark Ages led to interpreting the plague as an awful divine judgment. Dante's Inferno, completed in 1321, had come to life: "All hope abandon, ye who enter in!" One sect of monks known as flagellants would whip and abuse their bodies as penance to stave off the judgment. Other individuals disdained faith in favor of nihilism: "Eat, drink, and be merry-for tomorrow we may die." Only the bravest and most compassionate clergy and lay Christians cared for the sick and dying at great personal risk. But while the church struggled to provide interpretation and spiritual consolation for the plagues, medical scientists investigated and debated its physical causes. The plague and subsequent epidemics throughout the centuries-smallpox, tuberculosis, malaria, pneumonia, and influenza-would serve to prompt the medical community to search for and develop breakthrough treatments. The schism that intensified between medical science and the church during this period was lamentable. After all, both sought truth. Many prominent scientists, including astronomers Nicolaus Copernicus (1473-1543) and Johannes Kepler (1571-1630), chemist Robert Boyle (1627-1691), and mathematician Isaac Newton (1642-1727), saw God's fingerprints in the natural order they investigated. Medicine naturally complemented the church's role. In the 1500s, for example, Ambriose Paré, a scientific giant who introduced advanced surgical and dental techniques, reportedly lent perspective to his efforts by saying, "I dressed him, God healed him." Yet like the Pharisees of old, some church authorities seemed fixated on enforcing their traditions and political dominance. The battle between church and science was painfully illustrated by the plight of Italian Renaissance leader Galileo. Aided by his new telescopes, Galileo challenged the Aristotelian model of the solar system, which had placed Earth at the center of the solar system. Galileo instead promoted the Copernican view (published in 1543), which placed the sun at the center. Church authorities, however, clung to a wrong view of Scripture. Citing verses like Joshua 10:13, "[T]he sun stopped in the middle of the sky," the clerics insisted the Bible taught that the sun revolves around Earth, not vice versa. So they ignored Galileo's evidence and pleas for proper biblical understanding. Instead, the church condemned Galileo as a heretic and banned his works from Italy. The 1700s proved to be a period of consolidation and assimilation. The century yielded notable improvements in medical education. Rational explanations were developed for digestion, maternal labor, and other processes. Despite a lack of anesthesia, surgery progressed as well. In 1796, Edward Jenner inaugurated a series of breakthroughs that would aid in combating epidemics when he gave the first officially recognized vaccination-against smallpox-to a young boy. Before the century ended, Marquis de Condorcet's (1743-1794) Sketch for a Historical Picture of the Progress of the Human Mind maintained that "the perfectibility of man is truly indefinite." He promoted the notion that the march of medicine would be one of unstoppable progress-perhaps even leading to immortality. (Ironically, the quintessential positivist Condorcet died in jail; the suspected cause of death was self-administered poison.) So as the 18th century yielded to its successor, a new day seemed to be dawning when man presumed that he could indeed battle nature without God and win. Modern period (1800-present)
For the greater part of the modern period, medical science shunned religion like a boy resolved not to follow in his elder brother's footsteps. Scientists seemed determined that reason and research would reign in their own light-not in the shadow of religion. Research scientists Bernard, Pasteur, and Koch dominated the 19th century. In 1862, French scientist Louis Pasteur (1822-1895) realized the pathogenic nature of bacteria. He threw out the prevailing theory of spontaneous generation and developed the germ theory of disease. Pasteur's discovery that bacteria only arise from bacteria and can be destroyed by heat profoundly affected the progress of medicine. Pasteur contributed equally to the general progress of medicine by emphasizing objectivity. He preached to his students, "Do not put forward anything that you cannot prove by experimentation." Reflecting the bold humanist spirit of his day, Pasteur seemed to elevate science to a religion: "I beseech you to take interest in these sacred domains so expressively called laboratories. Ask that there be more and that they be adorned, for these are the temples of the future, wealth, and well-being. It is here that humanity will grow, strengthen, and improve." Claude Bernard (1813-1878) strengthened experimental physiology and research in general by maintaining that experiments must consistently produce the same results. This insistence on observable, repeatable results seems fundamental, but it actually contrasted with the approach of long-venerated classical mentors. Aristotle, for example, reportedly maintained through philosophical reasoning that men have a different number of teeth than women-but never bothered to observe the clear evidence to the contrary. Using a microscope birthday gift from his wife, German country doctor Robert Koch (1843-1910) discovered the cause of anthrax and, later, the causes of tuberculosis and cholera. Koch founded the field of bacteriology and helped establish the disciplines of hygiene and public health. The 19th century also witnessed the ascent of psychiatry. Austrian Sigmund Freud (1856-1939) revolutionized doctors' concept of human personality by emphasizing the role of the unconscious. Although his work has generated tremendous controversy and his influence has waned, Freud's therapeutic procedures for treatment of neuroses and psychoses are still employed today. Charles Darwin (1809-1882) reflected the century's growing sense of invincibility and optimism when he wrote in The Origin of Species, "... [W]e may feel certain that the ordinary succession by generation has never once been broken, and that no cataclysm has desolated the whole world. Hence we may look with some confidence to a secure future of great length. And as natural selection works solely by and for the good of each being, all corporeal and mental endowments will tend to progress toward perfection." Fighting disease, suffering symptoms of the Fall Twentieth-century scientists took up the march toward perfection and the eradication of disease. Streptomycin combated tuberculosis. Penicillin could cure pneumonia and other deadly infectious diseases. The polio vaccine wiped out polio. Ritalin controlled hyperactivity and Prozac curbed depression. And the Pill could even prevent pregnancy. Despite amazing biotechnological advances, as the century and the millennium ended, sexually transmitted diseases ranked just behind colds and the flu as the most common contagious illnesses. HIV infection rose to be a leading cause of death among persons aged 15-24. Major depression became the leading cause of disability worldwide. And each year around the globe, an estimated 50 million babies lost their lives in abortions. The United States Supreme Court legalized abortion in 1973, opening the door to over a million murders annually across the nation. The court's Roe vs. Wade decision was based on the testimony and apparent plight of Norma McCorvey, known to the Court as Jane Roe. Responding to the persistent Christian witness of pro-lifers, Ms. McCorvey later professed faith in Christ and revealed that her story of rape had been a lie encouraged by pro-abortion leaders. By that time, however, neither lies nor abortion seemed to trouble Americans as they once had. The court's decision had taught society a lethal lesson: that personal autonomy outweighed absolute moral values and even the value of human life. The battle for the right to life soon slid down the slippery slope into the battle for the right to die. The relative success of medicine in advancing life expectancy, coupled with millions of abortions, had dramatically shifted the demographic profile of countries like the United States. The number of retired individuals was increasing at a faster rate than the number of working-age individuals, portending tremendous stresses to the economy and health-care delivery. With modern generations plainly less inclined than their ancestors to care for ailing elders, physician-assisted suicide arose as an attractive alternative. Former Surgeon General C. Everett Koop put it this way: "At greatest risk are the poor, elderly, disabled, disadvantaged, and others without access to good medical care for whom the 'choice to die' could become a 'duty to die.'" In Holland, the government reported thousands of killings at the hands of doctors apart from patient consent. Elderly Dutch began carrying cards pleading not to be euthanized if hospitalized. Promoted as the ultimate freedom, physician-assisted suicide proved to be the quickest path to a fatal loss of freedom. Ignoring the lessons of contemporary Holland and also Nazi Germany, in October 1997 Oregon took the first step in the United States toward euthanasia and infanticide by legalizing physician-assisted suicide. In June 1997, the Supreme Court declined to declare assisted suicide a constitutional right. Unlike their sweeping federal edict in Roe vs. Wade, however, the justices kept the door open for states to experiment with assisted suicide. A spiritual RX
While medical ethics provided a platform for Christian principles, new data linking health and faith also generated interest in spirituality. Studies fueled the spiritual awakening with scientific evidence of strong links between faith and health. An American Academy of Family Physicians poll showed that 99 percent of physicians agreed that religious beliefs can make a positive contribution to the healing process. Clergy were back in favor, too: 91 percent of doctors surveyed said they had patients who also seek help from a spiritual leader such as a minister in dealing with their health problems. Patients clearly expected more of their doctors than pills and ointments. One poll revealed that 82 percent of Americans believed in the healing power of prayer and 64 percent thought doctors should pray with those patients who request it. For years, an unwritten prohibition against spiritual discussions discouraged doctors from taking up faith issues with patients. Now, the new evidence linking faith and health meant that a conscientious doctor would logically inform interested patients about potential spiritual benefits. As a result, thousands of doctors sought training from the Christian Medical & Dental Society in its "Saline Solution" seminars about integrating faith and practice. Participants learned how to ethically discuss faith issues with patients by raising "faith flags"-low-key conversational references to God, prayer, and the Bible-and how to develop spiritual consultation networks involving pastors and lay counselors. Meanwhile, many patients reacted to the anti-spiritual reputation of modern medicine by exploring the underworld of pseudo-scientific medicine. This stagnant pond of New Age quackery included reflexology, iridology, touch therapy, homeopathy, tongue button, and a host of other treatments steeped in mysticism. While scientists complained that the therapies remained unproven in scientific studies, users banked on anecdotal evidence and the allure of taking control of their own health care. To the practitioners of New Age medicine and other disillusioned patients, organized medicine had become the enemy. The descent from savior to enemy could be traced to several factors. First, the disdain of religious faith demonstrated by many scientists simply clashed with the religious values of many patients. Besides, shutting out the spiritual side of life simply did not seem reasonable-supposedly the defining characteristic of the objective scientist. Second, market factors had squeezed out the personal, covenant relationship that had characterized the patient-physician association in Hippocratic medicine. Expensive technology, malpractice awards, greed, and swelling patient expectations had led to managed care. Before the end of the century, over half of all Americans were covered by managed care plans. The covenant between doctor and patient had been replaced with a contract. Managed care also often creates ethical stresses for many doctors who feel prevented from fully caring for patients. Reports have begun to surface blaming managed care abuses for severe patient mistreatments and even deaths. The loss of autonomy and ability to care for patients so infuriated many doctors that in June 1999 the American Medical Association voted to form a doctors' union. Despite the increasingly obvious limitations of medical science, many persist in worshipping biotechnology as savior. The most powerful biotechnology-genetics-offers tremendous promise and peril. Unraveling the chemical sequences that map human traits promises to give humans an eerie control over their destiny. This newfound power poses a critical question: Will technology guide humanity? Or will humanity guide technology? Professor Ian Barbour, recipient of the 1999 Templeton Prize for Progress in Religion, noted, "Saint Augustine said that the Bible is not a textbook in astronomy; it tells us 'how to go to heaven, not how the heavens go.' I think both scientists and theologians today are more willing to recognize that neither field has all the answers, and that they can learn from each other. Science can tell us what is possible but not what we should do." Semantic gymnastics
Central to the bioethical debates was the fundamental question, "When does life begin?" Although biology offered unambiguous evidence and the historical consensus among scientists had been that life begins at conception, political activists used verbal semantics to obfuscate the evidence. They redefined the beginning of life at arbitrary points such as implantation of the embryo in the uterus or viability-when the baby can survive outside the womb. New terms such as "pre embryo" or "product of conception" took the focus off a living human being. These redefinitions, initially used to helped advance the abortion agenda, also served to break down ethical resistance to genetic testing of cells from destroyed human embryos and discarding "excess" embryos resulting from fertility treatments. Genetic technology seemed to race past ethics without so much as a second glance, as scientists worldwide clamored for experimentation without any restrictions. For example, adult human stem cells offered an ethical option for genetic experimentation that could produce medical breakthroughs. Yet many researchers insisted instead on using embryonic stem cells, which could only be gained through elective abortions or the deliberate destruction of living human embryos. Despite a ban on federally funded human embryo research, in 1999 the Clinton administration provided a semantic cover for federally funded scientists to use embryonic stems cells even though the cells had been obtained from someone else who destroyed the human embryos. Celebrating the landmark cloning of Dolly the sheep in 1997, some geneticists began clamoring for the golden calf of biotechnology: human cloning. Human cloning offered these research-priests a tantalizing means of embezzling eternal life. Yet even Dolly "creator" Ian Wilmut was initially quick to point out the shortfalls of cloning: "Overlooked in the arguments about the morality of artificially reproducing life is the fact that, at present, cloning is a very inefficient procedure. The incidence of death among fetuses and offspring produced by cloning is much higher than it is through natural reproduction-roughly 10 times as high as normal before birth and three times as high after birth in our studies at Roslin. Distressing enough for those working with animals, these failure rates surely render unthinkable the notion of applying such treatment to humans." Within days, the lure of power and money had apparently reversed the unthinkable to the doable. Nine days after Time published Dr. Wilmut's comments opposing human cloning, reports surfaced that Dr. Wilmut appeared ready to pursue human cloning with the Geron Corporation, a U.S. company funding embryo cloning for medical purposes. BBC News reported that the deal provided Dr. Wilmut with approximately $800,000 in Geron stock. Asked if he felt comfortable about creating a human embryo clone, Dr. Wilmut now replied simply, "Yes, I do." Choosing death
As the curtain closes on a millennium of medicine, can it be considered a triumph or a tragedy? Just as medicine appeared poised to clear some of its final hurdles in the battle against disease, human nature snatched defeat from the jaws of victory. All the chemicals in the world proved powerless against the human propensity toward self-destructive behavior. The allure of sexual promiscuity proved greater than the threat of death. Self-centeredness propelled individuals past all moral boundaries, including killing one's own offspring. The greatest disease of man-sin-proved immune to all of medicine's inoculations. So our bodies paid the price for the neglect of our souls. With life and death set before us, we chose death. The prognosis?
After centuries of breathtaking progress, modern doctors are beginning to realize what their Middle Age counterparts knew far better-that medicine is actually quite limited in treating the human condition. It should have been obvious. After all, every patient a doctor treats eventually dies. There is far more to the universe and the human condition than what can be observed, tested, and proven. In fact, it turns out that the greatest reality, the greatest proof, is the evidence of things not seen. So as medical science reaches the end of its incredible millennial journey, it finds itself far short of its goal, dangling helplessly at the edge of a great chasm. A chasm that can only be bridged by a cross.
-Mr. Imbody is director of advancement for the Christian Medical & Dental Society (www.cmds.org). Michelle Wingfield, a CMDS researcher, contributed to this article.