Christian Ethics: Universal Health Care

by John Ellis

Even during a pandemic when medical resources are often stretched thin and medical care providers are stressed and overworked, some of us have access to medical innovation and care that seems nearly miraculous when compared with the medical options and standard of care afforded our ancestors. Our society’s ability to preserve and prolong life, deepen standards of living via medical interventions (including preventative approaches to medical care), and cure diseases and other physical ailments that for the longest time in human history were a death sentence is a mercy of God. Beautifully, modern medical science is one of the ways in which humanity collectively (and individually) images God by exercising dominion. Sadly, though, with the Fall’s Curse still in effect, resources are not infinite, and medicine can only do so much; apart from King Jesus’ return, we will all still die.

That truth, however, – that apart from Christ’s return death calls on everyone – is not justification for an ethical nihilism. God’s people are not called to huddle together in darkened, musty monasteries denying the needs and desires of the material world. This truism extends to serving the sick and the poor, too. While it’s a sad fact of sin that until Jesus’ return we will always have the sick and the poor with us, loving God and loving our neighbor are Kingdom ethics that require action in the here and now. Questions abound, though, as do, of course, disagreements.

How do we allocate the limited resources of medical care? Do we have a responsibility to even try? Do we chalk up economically produced inequities in health care to the cost of doing business in a fallen, finite world? For that matter, who holds the bulk of the responsibility for the health care of others? Family? Friends? Neighbors? Governments? Churches?

Questions of healthcare are (should be), first and foremost, questions of ethics – moral philosophy – and not economics. Unfortunately, much of the discussion amongst evangelicals in America about health care centers on economics. Ethics, if considered at all, is relegated to a subservient position to preferred economic theories. Or rather, economic theories reveal self-serving ethics. Economics are, after all, under the domain of moral philosophy; economic practices reveal our ethical priorities. Don’t believe me, then ask Adam Smith of all people.[1]

This boils down, then, to my claiming that the starting point in discussing healthcare is via the pedagogy of the realm of ethics (moral philosophy). Now, to be clear, I believe that ultimately this is a discussion of ontology, which I’ll explain later (and I’ll explain in ways that are far less opaque than you may fear, so please bear/stay with me).

An important principle to keep in mind is that our ethics are largely products of how we define flourishing. Philosopher Charles Taylor opens his book Sources of the Self with the claim in the opening paragraph that, “Selfhood and the good, or in another way selfhood and morality, turn out to be inextricably intertwined themes.”[2] Our definition of self – how we describe ourselves – drives our ethical categories and ethics. Prior to that, though, in defining “self,” we reveal what we consider flourishing to be and look like. Already, I hope readers can see how ontology not only precedes ethics, but also controls ethics. At the moment, then, the question must be asked, how do people define self/flourishing?

While the boots-on-the-ground specifics may vary, the overall framework for selfhood/flourishing is consistent throughout our society. We are products of specific philosophical revolutions that took place during the time period called the Enlightenment.[3] If you were raised in the West, specifically in the Enlightenment’s greatest and most successful experiment the United States of America, this fact is almost inescapable (I’ll leave the door open for exceptions). In fact, I’m not aware of any historian, philosopher, or social scientist who would argue otherwise, even if they would quibble over my definition/time period for the Enlightenment. For the sake of this article’s thesis, I’m going to telescope into some specific, related philosophical revolutions that bear directly on our definition of self/flourishing and, hence, our ethics. Ultimately, these philosophical revolutions gave rise to what’s referred to as expressive individualism.

Our ethics are not just shaped by our expressive individualism, the idol of idols in classical liberalism, our ethics are in servitude to our expressive individualism. If it’s true that our moral philosophy is an extension of who we believe we are and how we define flourishing, and I believe that it is, then expressive individualism is ontological in an idolatrous way that seeks to unseat God from His throne. Here’s an example that may help make clearer what I mean:

For many of us, when we make the ethical claim “thou shalt not steal,” we believe that we are expressing a biblical ethic. Unfortunately, we are (likely) not. What we are (likely) revealing is our precommitments to anthropocentric ideologies that, while present in humanity’s hearts since the Fall, had a specific flowering during the Enlightenment. The question needs to be asked, what philosophies are foundational and formative to the anthropocentric ideologies that flowered into expressive individualism? What follows is going to be highly truncated, but enough to make my case I believe. And my case starts with John Locke.

It’s inarguable that John Locke’s writings are part of the sacred canon of classical liberalism/the West. The Second Treatise of Government shaped the beliefs that formed the United States of America as much as any other work of philosophy. In fact, an argument can be made (and has frequently been made) that Second Treatise is the most important expression of political philosophy embedded in the soul of America. Locke’s thesis/argument in the book can be summed by saying that government(s) and, by extension, human societies (including families) exist for the sole purpose of defending private property.

Parroting part of my footnote about Adam Smith (footnote # 1), it’s imperative that readers of John Locke read all of John Locke, and not just Second Treatise (and An Essay Concerning Human Understanding, although I suspect far more people have read Second Treatise than his much longer epistemological treatise). Both immensely popular and highly influential in the 18^th century, yet rarely read today (and that’s assuming that people even know of their existence), Some Thoughts Concerning Education and Of the Conduct of the Understanding provide important framing for their author’s overall program. As Ruth Grant points out in her introduction to Hackett Publishing’s single volume of Education and Understanding, “The works published here, read together with Locke’s better-known political and philosophic writings, will allow the reader to develop a deeper appreciation of the various interconnected concerns at the core of Lockean liberalism.”[4]

Read together, Locke’s writings reveal not only the purpose of government(s) existence, but also his beliefs that autonomous liberty is part and parcel of private property, liberty is discovered and determined via the exercise of reason (rationalism), and there are no innate hierarchies in humanity. The denial of hierarchies is foundational for his political philosophy. It’s so important, that he opens chapter 1 of Second Treatise with the obviously contra-biblical proposition that, “It having been shown in the foregoing discourse: Firstly. That Adam had not, either by natural right of fatherhood or by positive donation from God, any such authority over his children, nor dominion over the world, as is pretended.”[5] With the rest of chapter 1, he goes on to argue that even if Adam did have authority or dominion, there is no reason to believe that authority and dominion extended to his children and his children’s children. For good measure, he adds that even if a convincing argument could be put forth that Adam’s descendants did inherit authority and dominion (which, to be clear, an authority and dominion Locke did not believe Adam held – an explicit rejection of Genesis 1:28-29), we’re so far removed from his initial descendants as to make figuring out whose line is the firstborn an impossible task (keep in mind that part of what he was doing was pushing back on hierarchies of Kings – the Divine right of Kings, and all that). He concludes chapter 1 by writing, “Political power, then, I take to be the right of making laws, with penalties of death, and consequently all less penalties for the regulating and preserving of property, and of employing the force of the community in the execution of such laws, and in the defense of the commonwealth from foreign injury.”[6] The rest of the book (if not books) expound on this.

In Some Thoughts Concerning Education, Locke argues that the job of parents is to educate and raise children in a manner that enables them to enter society as profitable autonomous individuals. Similar to birds, the job of parents is preparing their children to be able to leave the nest and education should be shaped by this objective – the objective of turning children into profitable and autonomous individuals. For most reading this article, Locke’s claim sounds familiar and intuitive. This is owing to how far removed we are from covenantal hierarchies embedded in familial (and, by extension, societal) relationships prior to the Enlightenment. On the other hand, autonomous individuals are anachronistic in society when turning our gaze prior to the 17^th and 18th (possibly 16^th) centuries. It’s also anachronistic when looking at the Bible. Beginning with the devilish claim of Cain that, “I am not my brother’s keeper,” and supported by the covenantal structure (and theme) of the entirety of God’s Story, being bound and responsible to and for another (extending from being bound and responsible to God), autonomous individualism is the opposite from what the Bible teaches. Within Kingdom ethics, human flourishing is communal (and eschatological). For those of living in the West in the 21st century, however, the notion of our being autonomous individuals is inseparable from our definition of human flourishing. And for many of us, that definition can be summed up in the phrase “the American dream.”

“Life, liberty, and the pursuit of happiness,” the foundation for the American dream, is a platitude based on Lockean philosophy. In fact, in chapter 3 of Second Treatise, Locke prioritizes private property to the point of arguing that property owners have the right to kill would-be thieves, even if the would-be thief, “has not in the least hurt him, nor declared any design upon his life.”[7] For Locke, the pursuit of happiness (property) is more valuable than human life during instances when property, and only property, is threatened. If you try to steal my lawnmower, I have the right to kill you.

Thankfully, the United States of America hasn’t followed John Locke that far. Lex talionis is an important legal principle in this country. I do not have the right to kill you if you try to steal my lawnmower. Although, many proponents of the “stand your ground” laws are not that far removed from John Locke on this. The current political divide is replete with arguments and beliefs that reveal that partisans believe that lex talionis should only apply within certain frameworks bounded by specific definitions/goals of human flourishing.

For Locke, private property and the individual are almost inseparable. Who I am (the pursuit of happiness) and the right to private property cannot be divorced within classical liberalism.[8] Our ethics, including the ethics of healthcare, are an extension of this.

My point in the above undercooked explanation of Lockean philosophy is to, A. acknowledge that John Locke is arguably the most influential philosopher in the making and defense of classical liberalism, and B. to help shine a light on how our society is founded on contra-biblical ideologies, an argument I turn to now. As a result, owing to the primacy of our anthropocentric individualism, our societal ethics of healthcare (and most everything else) are suspect, at best.

I’ve already pointed out that Locke grounded his arguments in Second Treatise in his rejection of Genesis 1:28-30, 9:1-7. Lockean political philosophy divorces anthropology from what it means to be made in God’s Image. His autonomous liberty (the parent of expressive individualism) is expressed in the meaning of emphasis we have when we say, “Thou shall not steal.”

For those of us steeped in classical liberalism (which is all of us if you were born and raised in the West), “thou shall not steal” is read through the interpretive grid of a Lockean priority of private property/autonomous individualism. But that’s not the Bible’s emphasis.

Without question, Kingdom ethics are others focused at the expense of the self; autonomy does not exist in Kingdom ethics. Starting in the Old Covenant, and expounded on by Jesus, as well as by the Apostle Paul, serving others is part of the telos of being an image bearer. Operating ethically under the belief that my individual rights are a priority is foreign to the Bible. So, “thou shall not steal” can be restated as, “thou shall not take what doesn’t belong to you.” It’s other focused, and not individual rights focused. According to both the Old and New Testaments, we owe others their life because life is a gift of God that we do not have the right to take nor undermine. If our “private property” is needed to sustain the life of our neighbor, we do not have the right to steal from our neighbor by withholding our “private property.”  

Shamefully – shamefully for professing Christians – atheists operating in the field of moral philosophy and sociobiology often express an innate understanding of what the Biblical command to love our neighbor means in practice. Philosopher and noted atheist Philip Kitcher writes in a book intended to explain how morality exists in a world devoid of God that, “Secular society might respond to the problems of economic and social justice, honoring the egalitarian ideal of the provision for all of the preconditions for a meaningful life. … Beyond declaring abstract rights, we should demand that the world’s resources be shared so as to allow all people (or, more exactly, to all the people except those whose biological limitations cannot be overcome) the opportunity for a meaningful life.”[9]

Part of what’s wrapped up in Kitcher’s statement is an innate understanding that even lex talionis is ultimately not a Kingdom ethic – it only points/prefigures the Kingdom ethic of justice. It’s important to note, though, that the Kingdom ethic of justice is intimately connected to serving others, including, and importantly, in regards to preserving the life of others. Matthew 5:38-39 records the anti-classical liberalism words of Jesus that, “You have heard that it was said, ‘An eye for an eye and a tooth for a tooth. But I say to you, Do not resist the one who is evil. But if anyone slaps you on the right cheek, turn to him the other also.” The concluding verses of chapter 5 include the famous ethics about going the extra mile, not refusing to help those in need, and even the command (yes, command) in verse 40, “And if anyone would sue you and take your tunic, let him have your cloak as well.” There go all the lawyers in a society living out Kingdom ethics.

Those verses are well known, and I could include a host of verses commanding followers of Jesus to serve others by feeding the hungry, clothing the naked, and defending the oppressed at the expense of our own individual rights. Or I could turn back to the Old Testament and point out things like the parapet law and restrictions on harvesting the corners of your (private property) field so that the poor and hungry can have food (that you paid for and worked hard to provide). A cursory reading of the Bible alongside a cursory reading of John Locke should reveal that Kingdom ethics are at extreme odds with classical liberalism. Unfortunately, because we are so unaware of how shaped we are by our social imaginary, we read the Bible through the heuristic of classical liberalism; in our American reading of the Bible, Kingdom ethics are subjected to classical liberalism. The golden calf of the American dream is a stand-in for God. Except, stand-ins for God are rebellion because they are worshiped as god. Thus, the emphasis on individual rights is a stand-in for serving God and others via a sophisticated remolding of Kingdom ethics into serving ourselves; we worship ourselves.  

But so far, this is all backwards – intentionally so. Ethics are an extension of ontology, not epistemology. But I wanted to lay some epistemological groundwork before getting to my main argument: Christian ethics are because of who God is.

That’s a clunky sentence because it has to be to contain ontological weight that avoids an epistemological emphasis. To help explain that, think back to Plato’s Euthyphro. Written in the 4^th century B.C., the Socratic dialogue presents an enduring dilemma of ethics. Is something good because God wills it, or does God will it because it is good? If you answer, yes, to the first, God is revealed to be arbitrary in often cruel and senseless ways. If you answer, yes, to the second question, then God is revealed to be subject to something that transcends Him. I won’t go into it, only mentioning it for those who are curious enough to chase this out, but this dilemma is one of the main reasons we’re now inflicted by nominalism. Plato’s (Socrate’s) questions are also to blame for many of the apologetics YouTube videos we’re inflicted by.

The Bible rejects Plato’s questions as invalid. God IS good. Morality is His nature. Moral philosophy/ethics is (should be) the study of who God is. Charles Taylor accuses the moral philosophies of the West of, “tend[ing] to focus what it is right to do rather than on what it is good to be.”[10] Kingdom ethics are ontological in that they reveal “what it is good to be.”

Being made in God’s image means that we are to reflect who God is. God is love, so we are to love. God is just(ice), so we are to enact justice. God is merciful, so we are to impart mercy. God is faithful/trustworthy, so we are to operate with integrity. And so on and so forth.

Steering this back to healthcare, God prioritizes life because He is life. “For in him we live and move and have our being” (Acts 17:28). Part of imaging God through our ethics is doing whatever we can to preserve life, not preserving our private property; whatever private property we have been given by God exists to serve God first and serve others second. And this extends to preserving the life of others via healthcare.

As an abstract, universal health care is a Kingdom ethic. A health care system based on theories of capitalism is not a Kingdom ethic. The fact that some of us have access to better health care than others isn’t a bug in the system that we need to work to improve; it’s reflective of how sinfully selfish and idolatrous our society is. The fact that some of you believe that you shouldn’t pay for the healthcare of strangers reveals that you are not submitting to Kingdom ethics. And you can’t get away with saying, “Hey, I believe it’s good and right to pay for the healthcare of strangers, but the government shouldn’t force me to.” That claims provides evidence of how controlled you are by a classical liberalism that denies the government’s role in imaging God. Firstly, government was instituted by God, not by social contracts/humans. Secondly, humans make up the government. Bifurcating – or trifurcating (sigh!) – the responsibilities/roles of being an image bearer is highly problematic. Governments are to image God because governments are mediated by image bearers for other image bearers for, ultimately, the glory of God, and all because of who God is.

I recognize that I have opened myself up to charges of oversimplifying a complex issue. Fine, I get that – setting aside that those accusations are likely covered by the ethical umbrella called consequentialism, a family of ethical theories I believe are in rebellion against Kingdom ethics – so I’m going to conclude with a defense (somewhat) against that accusation.

Healthcare in modern society is complex and nuanced, and I’m not even talking about the ethical dilemmas faced in triage care. This article should not be read as a defense of any politician’s program for universal health care. As stated near the beginning of this article, I believe that economic theory should be considered as under the authority of moral philosophy. And remember, because this is important, just a couple of paragraphs above I made the claim that moral philosophy/ethics is (should be) the study of who God is. Ergo, economic is (should be) the study of who God is. Our entry point into economics (and home base within economics) should be ontological, not epistemological. This, of course, would require a nearly complete dismantling of both capitalism and Marxism (and everything in-between). So, as a sidenote, in answer to the question of whether John Ellis is a capitalist or Marxist, the answer is neither, but also, paradoxically, a little bit of both.[11]  

So, questions abound. An overarching question is how do we navigate Kingdom ethics in a fallen world that is groaning under the weight of sin and sin’s Curse. For example, how do we provide access to healthcare that reflects who God is while taking into account that sinful humans are not always motivated by selflessness – as in, how do we encourage continued medical innovations without some sort of carrot (or stick, I guess)? I understand that simply announcing, Oprah-style, “you get healthcare, and you get healthcare, you ALL get healthcare” would run the high risk of accomplishing the opposite goal of preserving life as a means to image who God is.

With this article, though, I’m not arguing for specific applications of the ethic; I’m arguing that the ethic be the control for followers of Jesus in conversations about healthcare. This means, and disappointing probably everyone, I don’t know how to construct a Kingdom ethically healthcare system. What I do know is that using capitalist theories as the main reason for the rejection of competing proposals and theories reflects idolatries of expressive individualism that is baked into classical liberalism/the founding of the United States of America. Likewise, using Marx’s[12] theories as the main, if not sole, driver of healthcare ethics is an idolatrous elevation of humanity onto God’s throne. Instead of allowing a tribalism of Enlightenment and post-Enlightenment theories/philosophies drive the conversation, followers of King Jesus should seek to glorify God by articulating applications of Kingdom ethics within discussions of healthcare.

I recently read a comment that said that any actual contextualization of the gospel won’t result in acceptance but will result in being nailed to the cross. I believe there’s much truth in that. King Jesus told us the world will hate his followers. Applying Kingdom ethics to healthcare will not win followers of King Jesus friends on either side of the political aisle. The eventuality of societal rejection should not deter us from serving God first and others second. By definition, followers of King Jesus will be counterculture, including within discussions about healthcare. Neither Republican nor Democrat.

Soli Deo Gloria

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[1] At the risk of touting Adam Smith more than I intend, it’s unfortunate that most people who have read The Wealth of Nations have never even cracked open Smith’s first (and last) book The Theory of Moral Sentiments – it was also his last book because he published an expanded and revised 6^th edition just a few months before his death in 1790. Without an understanding of Smith’s work in moral philosophy (ethics), it’s easy to (mis)read libertarianism, even on just a scale, into his economics. Also, an understanding of Smith’s ethics reveals how out of step he was/is with our Rawlsian belief in the need to answer the questions, “what do just institutions look like and how do we construct those institutions?” That line of questioning – the line of questioning that undergirds the ethics of classical liberalism – devolves into libertarian utilitarianism/consequentialism.   

[2] Charles Taylor, Sources of the Self (Cambridge, MA: Harvard University Press, 1989), 3.

[3] In the academy, the Enlightenment is a specific period of time – pretty much only within the 18^th century. At its popular level colloquialism, though, the Enlightenment covers a much broader time and schools of thought. For me, I think of the Enlightenment as extending from the late Renaissance through Hegel – roughly the 16^th century through the first decades of the 19^th century – which might be a larger time period than most.

[4] Ruth W. Grant, “Introduction” Some Thoughts Concerning Education and Of the Conduct of the Understanding ed. Ruth W. Grant and Nathan Tarcov (Indianapolis: Hackett Publishing Company, 1996), xvi-xvii.

[5] John Locke, The Second Treatise of Government (New York: Barnes & Noble, 2004), 1.

[6] Locke, Second Treatise, 2.

[7] Locke, Second Treatise, 11.

[8] After I finish this article, I’m going to write an article tentatively titled “Cancel Culture is Not New.” While not the point of this forthcoming article, it will serve to help unpack the seeming contradiction between the government’s absolute role in defending private property – ergo, also defending expressive individualism – and the fact that society does have restraints on expressive individualism.

[9] Philip Kitcher, Life After Faith: The Case for Secular Humanism (New Haven: Yale University Press, 2014), 117.

[10] Taylor, Sources of the Self, 3.

[11] Paradoxically in regards to the “neither” part. Being a little bit capitalist and a little bit Marxist isn’t a paradox (nor a contradiction). Both belong to the same Hegelian coin; they’re just different sides.

[12] Here’s a sidenote in the form of an open letter: Dear conservative friend or family member, Stop demonizing Marx and Marxism. Karl Marx was a genius; a genius in a way that separates him from most of the rest of humanity. Likely, your critiques and criticisms are laughable compared to his genius. This isn’t to say that he’s right; this is to say that, at the least, if you haven’t read Das Kapital, you probably shouldn’t allow any negative statement about Marx cross your lips because you don’t know what you’re talking about. Unlike your favorite GOP politician, exercise some epistemic humility and shut up about Marxism; you don’t realize it, but you’re making a fool of yourself.