Andrew Sloane, Vulnerability and Care: Christian Reflections on the Philosophy of Medicine (London: Bloomsbury T & T Clark 2016) 224 pp. £84.99 PDF, EPUB , £85.00 Hb. ISBN: 9780567316776
Andrew Sloane’s Vulnerability and Care: Christian Reflections on the Philosophy of Medicine is a brave attempt to redefine our approach to one of civilisation's most enduring endeavours. Many readers will likely assume the goal of medicine to be the curing of disease and infirmity and the attainment of 'health'. We expect our medical industries to provide means for the alleviation of suffering whilst striving for permanent cures, and ultimately we expect medicine to extend our lives to their fullest possible limits.
But Sloane’s argument (which is controversial, but not unwelcome) is that medicine is not about health care, but about health care (153). Sloane suggests that when positioned within a Christian understanding of the world, incorporating our need for relationships with God and each other, medicine can only be about caring for vulnerable and isolated members of our community. The aim is not to cure illness (although Sloane doesn’t by any means belittle the great advances that have been made in medical and technological research) but to enable those who are ill to fully partake in relationships with those around them to the fullest extent. For Sloane, to think medicine is about fighting disease or improving a community’s health is to mistake the means for the end (165).
By Sloane’s own admission, the book cannot answer many of the questions that may arise regarding his thesis (181), but that’s perfectly acceptable from a book that deals with topics as large as medicine, and the philosophical and theological approaches to it. What Sloane does offer is a very engaging and accessible book that can be reasonably understood by someone from outside of these three academic and vocational areas. He does not offer a detailed, lengthy survey of related literature, or expansive technical footnotes, but clear and contemporary case-studies that most of us will identify with, for example the Ebola crisis of 2014 (14).
Sloane begins his argument with this example, exploring the disparities in how medical care is delivered across the world. Sloane highlights the contrasting health care offered to a Westerner and a Sierra Leonian to try and uncover what medicine is about. The Westerner was offered first rate health care and survived, whereas the Sierra Leonian died from the Ebola disease. But as Sloane makes abundantly clear, both examples must be seen as failures if medicine is about improving 'health' in our communities. His justification for seeing the successful treatment of a Westerner as a failure stems from the resources consumed in the process: the Westerner’s treatment came at the cost of a great deal of time, money and material, and as Sloane points out, this surely would have had a greater impact in improving health if this had been allocated to relieving the burden of disease through better infrastructure, education and facilities (18-19). Sloane then looks to Gerald McKenny’s view of the Baconian approach to medicine concluding that the focus is on technical development and the elimination of suffering and illness (24-25). But as Sloane suggests, medicine’s focus becomes technical expertise rather than patient care (26).
Sloane then deconstructs the current idea of 'health' and Evidence Based Medicine (EBM). Starting with the World Health Organisation’s definition of health, Sloane makes the point that the concept of health is too uncertain. For Sloane, it’s a portmanteau term holding together too many disparate ideas. He raises the issues of education and relationship with God as being equally critical for allowing humans to flourish, ideas not normally subsumed under health or healing and yet fully relevant to human flourishing (57). Sloane also warns that EBM can risk losing the qualitative and subjective evidence needed in medicine and ignores the suffering of people (64). On the other hand, phenomenological accounts, for Sloane, suggest the significance of the doctor-patient relationship within a Christian perspective (73).
Sloane then turns his attention towards theological accounts of medicine, taking a look at the accounts of Pope John Paul II, Nigel Cameron and Stanley Hauerwas. Pope John Paul’s view centred on the attitudes to the vulnerable displayed in medicine. Cameron’s theology is similar to Pope John Paul’s and argues that medicine has left its moral foundation and is preoccupied with technical mastery. Hauerwas, similarly supports the call to focus more on care rather than cure, suggesting that medicine is lusting after an idolatrous goal in trying to overcome human limits and has fallen foul of the false narratives of modernity. Sloane then moves on to look at Neil Messer’s work in Chapter Six on the theology of medicine.
In Chapter Seven, Sloane sets out his framework for a Christian perspective on medicine, championing the idea that we must accept our limitations: we are bound by death and the brokenness of the world. We can look to Christ, however, and see the transformative work which has begun, and recognise our own calling to transform the lives of others around us (albeit recognising that the work we do is temporary and partial) (133). Biblical theology reminds us that we are relational beings, created for community with God and each other (133). For Sloane, we should act as Christ, caring for the vulnerable in their times of need, including them in communal life and acting in compassion whatever the medical outcome (138).
Sloane references Deuteronomy 10:12-22 and Matthew 25 to support his assertion that a properly formed community is one that cares for its vulnerable members and in doing so, reflects the character of God (132-133). He uses Jesus’s healing of an unclean woman in Mark 5: 25-34 to provide an illustration of his thesis in action. Here the medical knowledge of the day is unable to provide a cure for her menorrhagia. Sloane confirms her isolation from both the mode of production as a woman and social affairs due to the side effects of her illness as well as a perceived uncleanness (136). Sloane sees Jesus’ healing as not just a physical healing, but a spiritual healing, she is pronounced as saved (137). Jesus, in publicly calling out to her in the crowd, symbolises her restoral to society. She can now be addressed and included in relationships with those around her (137).
All in all, this is a thought-provoking book that sets the stage for future discussions around Christian medical perspectives, an area set to grow commensurate with technical advancements and the bioethical concerns these raise. Sloane reminds us of the old medical saying early on in his book and it could be used to summarise his thesis accurately: cure sometimes, relieve often, care always (7).
Ben Masters-Stevens, University of Hertfordshire