MS520-2009 A Biblical Theology of Medical Mission
Table of Contents
Is a Theology of Medical Mission Necessary? 1
Questions Raised by Medical Mission 2
Should Mission Include Social Action? 4
God’s Plan for us to be Whole 5
What the Bible Says About Health 6
The Pentateuch 6
Books of History and Wisdom 7
The Prophets 9
The New Testament 9
Is Medicine the Same as Healing? 11
An Integrated View 13
Appendix: Bible Passages Addressing Sickness 16
Medical mission has been a controversial subject in missiology. Some have argued that it takes resources and personnel away from evangelism, saying that our responsibility as Christians, and especially as missionaries, is to put all our energy into sharing the gospel. Certainly the practice of medical mission raises a number of questions about its role. In my own experience, it is easy to be so busy caring for the physical needs of patients that there is not time for spiritual activities. This is made more serious where missionaries are working among cultures which do not perceive a divide between physical and spiritual concerns. This paper will, therefore, consider what the Bible tells us about sickness and death and how this might affect medical mission. The aim is to provide a Biblical basis for those involved in medical mission, which will help them to prioritise and to ensure that their medical practice helps them achieve their missional aims.
Is a Theology of Medical Mission Necessary?
There have been few attempts to develop a theological basis for medical mission. Previous attempts have focused on the history of medical mission.1 Wilkinson concluded that such a theology was not necessary, arguing that Christians could be involved in medicine in God’s name, because God gave men means to help the body heal in creation and because God created the body, used it in the incarnation and intends us to live in bodies in eternity. However, he suggests that medical mission is just a passing phase and that, as the state takes on a responsibility for health, it will disappear.2
Others have challenged the very concept of medical mission, arguing that it is a distraction from preaching, which takes many resources so that spiritual needs are sometimes ignored. They have also questioned the competence of medical personnel in preaching, and the ethical difficulties of preaching to people when they are sick and vulnerable.3 Arulappan argued that scripture does not suggest that medicine should be part of the work of the church, stating that references to healing in the gospels refer only to miracles. He states that any argument for treating the whole person is derived not from the Bible but from New Age teachings.4
Questions Raised by Medical Mission
Despite this, medical care has been a significant part of mission. Two centuries ago, there was a rise in interest in mission, coinciding with the development of scientific medicine and its increasing effectiveness. As a result the first medical missionaries left the United Kingdom (UK) in the late 1700s.5 As medicine developed, mission hospitals became increasingly expensive and required more personnel. In the wider medical world, prevention and community medicine were receiving more attention. In response to these two pressures, missionary doctors began to train local practitioners and to place more emphasis on public health.6 However, practice continued to focus on the body, reflecting their western training.7
Today, many missions provide some medical care. Missionaries continue to live amongst those who are in medical need and may seek to demonstrate Christ’s compassion for these people, by responding to this need, considering this as a means of winning the attention of their community.8 Medical mission may also be used strategically, enabling missionaries to live in countries that would otherwise not give them visas.9
However, medical mission is associated with a number of problems. Mission hospitals have generally been found in cities, where governments are most likely to provide alternative services. They may be unable to provide follow up for patients who have travelled to reach them. Medical care is expensive, especially if the hospital is competing with other providers and missions may struggle to provide enough money and personnel to maintain the service. If costs are very high, they may find themselves caring mainly for the rich.10 Medical mission may also complicate the relationship with the local church, due to the cost and to different views of medicine. Government regulation may dictate priorities and restrict evangelistic activities. When the gospel is shared, the workload in the hospital and the distance between it and the patients’ homes may make discipleship difficult.11
Many medical missionaries admit that they are unsure whether to present themselves as medics or as missionaries.12 This can be a problem in raising interest at home, as well as in taking opportunities for witness in their country of service. Opportunities may be missed because of the burden of medical need in the community13 and as Escobar says, “When the human dimensions of the missionary task overtake and determine the way in which mission is conducted, mission becomes a human activity without redemptive power.”14
Should Mission Include Social Action?
Much of this discussion about medical mission reflects a wider debate within missiology about the place of social action in mission. In the first part of the twentieth century, there was a move towards a social gospel, which stripped away all that was distinctive about Christianity.15 One response was to assert that evangelism is all that the church should do and that anything else is a distraction. For example, Lindsell says that the church’s role is to preach the good news, to win souls for Christ and to form them into church.16 He derives this from the clear commands given to us to preach and from the priority the apostles placed on proclamation. He claims that the New Testament teaches that the kingdom of God is a spiritual entity and not a political one.17 Extreme versions of this view argue that evangelism is the only appropriate interaction between Christians and the world.18 However, it depends on a division between spiritual, physical and social needs, derived from enlightenment individualism and from Greek dualism.19 It also fails to take the Old Testament seriously. There, we see that God is deeply concerned about social injustice, legislating against it in the law, sending prophets to reprimand the people for ignoring it, and answering the cries of his people who are oppressed. To see our task only as evangelism suggests that we believe that God has turned aside from these concerns and is now only interested in the spiritual.20
God’s Plan for us to be Whole
In response to this, Wright argues that we should examine the whole story of God’s intervention in the world, seeking to understand “the story of God’s mission through God’s people in their engagement with God’s world for the sake of the whole of God’s creation.”21 God is concerned with every aspect of human life. He created us in his image, intending us to live together, without shame, either before him or one another.22 He declared that his creation was good.23 However sin has damaged every part, bringing sickness and death, as well as breaking our relationship with God, destroying creation and distorting our relationships with one another.24 These consequences of sin are so intertwined with one another that they cannot be treated in isolation. This is reflected in Fountain’s analysis of health, which he defines as wholeness, requiring right relationships with God, man, the environment and ourselves.25 This is a broader definition than that usually recognised by healthcare professionals, which is confined to the physical, mental and social dimensions.26
What the Bible Says About Health
In view of all this, we will trace health and healing through the Bible, seeking to discover how the Bible understands them and what response it advocates. We will see that sickness and healing are recurrent themes in the Bible, but are rarely the main focus of the narrative. More commonly they are a tool used by God to teach his people.
Death is first mentioned in the second chapter of Genesis, where it is declared to be the consequence of eating the fruit of the tree of good and evil.27 This is seen to be true, when Adam and Eve eat the fruit and soon after, Abel is murdered by his brother. It is not long before others are listed as dying, although there is no discussion of why they died.28 Later in the book, God makes a number of women infertile because of sin and he injures Jacob’s hip leaving him limping, as he teaches Jacob to depend only on him.29
It is in the book of Exodus that sickness first appears, where it is part of God’s strategy to make himself known to Israel and the Egyptians. First, God makes Moses’ hand leprous and immediately heals it. Then he sends a plague of boils on the Egyptians.30 Once the Israelites have left Egypt and are in the desert, God sends plagues on them for their disobedience. Each time they repent, he heals them.31 When he gives them the law, it contains warnings against disobedience and sicknesses are promised as a consequence.32
So the message of the Pentateuch is that sickness and death are a result of sin and sometimes are directly related to specific acts of disobedience against God. Healing is a gift from God, which is linked to repentance.
Books of History and Wisdom
As Israel’s history continues, sickness continues to be related to sin. God sends tumours on the Philistines when they steal the Ark of the Covenant, he sends a plague on Israel after David disobeys him and he takes the life of the son, who results from David’s sin with Bathsheba, through an illness.33 In the Psalms, David attributes illness to his own sin – either from his failure to confess it or as a direct punishment from God.34 By contrast, Proverbs describes good health as being due to fear of the Lord, respecting elders and speaking wisely.35 Job’s story is an exception to this understanding. The narrator says that Job’s sickness is a test from God, who is seeking to prove that Job’s faith is real and not dependent on God’s blessing. God, therefore, hands him over to Satan who causes the illness, but is not permitted to kill him.36
Throughout this section of scriptures, the commonest response to illness is to seek help from God. On four occasions, God intervenes through a prophet to bring healing, or even new life, to the sick. Two of the individuals concerned were not even Israelites. The first was the widow of Zarephath. She assumes her son’s death is a punishment for sin. Elijah revives him.37 Elisha performs a similar miracle for the Shunammite woman when her son dies.38 Naaman, the commander of Aramean army, is healed after he seeks the help of Elisha for his leprosy. This act clearly demonstrates God’s power to the nations around Israel.39 In the fourth example, the king, Hezekiah, is sick. No reason is given for this and Hezekiah sees it as unjust. He seeks the Lord and is healed, living for fifteen more years.40
There is one case which contrasts with these others. Asa, king of Judah, makes a treaty with the king of Syria, in order to attract his help when the king of Israel attacked. He uses treasure from the temple to purchase this assistance and does not seek God’s help. Even when
he becomes ill, he still refuses to seek God and so he dies.41
Sickness is, therefore, usually sees as a punishment from God, but it can also be a random event or something with spiritual consequences, intended to glorify God, which those involved are unaware of. In these passages, whenever a afflicted person seeks after God and repents of their sin, God intervenes and heals them.
Twice in his book, Daniel describes sicknesses. The first time refers to the illness God sends as judgement on Nebuchadnezzar because of his arrogance. When Nebuchadnezzar repents, he is restored.42 Later, Daniel has a vision which disturbs him and leaves him sick in bed for some days.43
Elsewhere in these books, sickness is considered in the messianic passages, where God promises to send his anointed one. He will bring justice, a new creation, and healing. God is seen to be the only source of healing and the promise of restoration brings hope.44 Ezekiel has another approach, condemning the leaders of Israel, who care only for their own comfort and have therefore abandoned the sick.45 It is clear that God intends that healing and health are part of the new covenant and the new order he promises to bring to pass.
The New Testament
Once Jesus begins his ministry, healing and sickness become a prominent part of the story. Jesus launches his ministry by quoting Isaiah, claiming a messianic prophecy for himself and declaring the holistic nature of his work, which was to include “recovery of sight to the blind”.46 His preaching is interspersed with healing miracles and the casting out of demons.47 Some of these incidents teach us about the nature of illness. When a paralysed man is lowered through the roof to Jesus’ feet, he declares at first, not that the man is healed, but that his sins are forgiven.48 Here, Jesus follows the Old Testament view that sickness is due to sin. However, elsewhere, he says that suffering is not necessarily due to sin49 and in one case, he even teaches that a blind man was blind in order that God might be glorified.50
Jesus passes on the mandate to heal and cast out demons to his disciples.51 In the story of the Good Samaritan, he describes a Samaritan man providing nursing care for an injured man and then commends this action to his hearers, telling them to behave in the same way.52 After his resurrection, Jesus sends out his disciples telling them that they are sent as he was sent and instructing them to teach the disciples they make to obey the commands he gave them.53 There is no reason why this would not include healing. In fact, Jesus had earlier described judgement as being based on care for the weak, including the visiting of those who are sick.54 The disciples obey Jesus, continuing to offer healing to those they meet55 and, in his letter, James advocates calling the elders to pray for healing.56 However, Paul implies that not all sickness will be healed. He himself has a “thorn in the flesh” which God has not healed, but instead uses to demonstrate his grace in Paul’s weakness.57 Yet, he also continues to teach that sickness may be a result of sin, telling the Corinthians that their illness relate to their unworthy attitude at communion.58
Scripture, therefore, sees sickness and death as a problem, largely a consequence of sin. God would like to see us whole and uses his people to achieve this. But he also uses sickness as a tool for punishment and to glorify his name. It is for this last reason that he may not always heal, although his intention is that we are whole. Jesus certainly saw health and healing as a priority, making it a key part of his ministry, as he saw the suffering of those around him and responded with compassion. (See diagram on next page which summarises the Biblical view of sickness).
Diagram: The biblical view of sickness
Is Medicine the Same as Healing?
However, this all refers to miraculous healing. Medical care is almost absent from scripture. The only Old Testament reference is in 2 Kings where Isaiah advocates the use of a fig poultice to help the sick king, Hezekiah.59 In the New Testament, there is a woman who had spent all she had on medical care. Mark declares that she had suffered under physicians.60 Luke, himself a physician, has some sympathy with his colleagues, declaring that no-one could heal her.61 Jesus seems to suggest some kind of medical care by the Good Samaritan in tending the injured man’s wounds and Paul also hints at a biomedical approach when he advises Timothy to take some wine for his stomach.62 With so little evidence from scripture, we can only make a biblical argument for or against medical care from silence.
However, if we examine the question and consider the assumptions underlying it, we will find that it assumes that there is a fundamental difference between the spiritual and the practical or physical. This assumption derives, not from the Bible, but from a western understanding of the world and ultimately from Greek philosophy.63 Most people in the world do not see a division between the spiritual and everything else. Instead, they understand that the whole of life has spiritual significance and that what goes on in the spiritual realm has consequences for life. Therefore when someone becomes ill, it is necessary to look for both a spiritual and a practical response.64
This view is seen in the Bible too. David provides, perhaps, the best example when he confesses to God that,
“While I kept silence, my body wasted away
through my groaning all day long.
For day and night your hand was heavy upon me;
my strength was dried up as by the heat of summer.
Then I acknowledged my sin to you,
and I did not hide my iniquity;
I said, ‘I will confess my transgressions to the Lord’,
and you forgave the guilt of my sin. ”65
He has been physically unwell, but he sees that his unconfessed sin was the cause and so he confesses what he has done wrong and receives forgiveness. Although it is not explicitly stated, the fact that, in the next verses, he turns to praise indicates that physical healing resulted from this confession.66
If we examine the way in which Isaiah and Hezekiah deal with Hezekiah’s sickness closely, we find that they also see this inter-relationship and are happy to use medical care, whilst at the same time turning to God. When Isaiah tells Hezekiah that he will dies, he immediately turns to God in prayer. When God speaks to Isaiah a second time, declaring that he has heard Hezekiah’s prayer, Isaiah’s response integrates the spiritual and the physical. He speaks the word of God to Hezekiah and also recommends a medical treatment.67 Perhaps this can provide us with a model for using medical skills in combination with spiritual ministry.
An Integrated View
A number of authors have advocated the integration of evangelism and social action arguing that either is incomplete without the other. Wright describes a number of situations where evangelism has not been accompanied by the application of the gospel to the problems of society. He shows that a purely personal gospel can lead to corruption and injustice in wider society, even where Christians form the majority of that society.68 Bosch and Lindsell both see that Christ must be our model for expressing both aspects of our concern for those outside the church.69 In him, God took human form in order to minister to the people in a specific context and in the same way, missionaries should live their lives in a specific context, as incarnations of Christ in their situation.70 They should follow him in speaking out the truth, in bringing those who hear into a redeemed community, and in ministering to those are suffering.71
Medical care is one way in which we can demonstrate Christ’s compassion for those who are sick and dying. This compassion should also stir us to address the cultural and community problems which have led to suffering, working with communities to promote good relationships, healthy behaviour and better economics. It will also cause us to see that death is not the end, nor is it necessarily a complete failure. Instead, we need to learn that we are privileged to share our lives with those who are in desperate need of the truth. As we care for them and get to know them, we may have opportunity, without preying on the vulnerable, to demonstrate Christ’s love, to speak words of compassion and truth, to help them find reconciliation in their relationships and to pray with them. This is what “incarnational kingdom Christianity”72 should look like for medical missionaries.
Medical mission is a common mission activity, using significant resources, in terms of both money and personnel. It is, therefore, important that those involved in it should integrate their medical activity with evangelism and outreach. The Bible clearly teaches that sickness and death are intimately related to the spiritual condition of mankind, divided as we are from God by sin. Sometimes sickness may be a direct punishment for sin, but it is more common that it relates to the general distortion of our world caused by sin. Occasionally, illnesses are used by God to glorify his name and to teach us to depend on him.
Jesus spent much of his time on earth healing those who he met. He linked this activity to the forgiveness of sins and declared that these healings brought God glory. Miraculous healing had been seen previous to Jesus’ coming in the Old Testament and continued in the ministry of the disciples. However, on occasion, we also see the use of medical techniques. In one case, this is in combination with prayer for healing which God answers. As God has given us these skills to care for the body, there does not seem to be enough in scripture to argue that we should not use them in his service, to bring wholeness to the lives of those we minister to, even as we share the gospel with them. Christian doctors need to move beyond the dualistic thinking taught in their medical schools and develop a practical approach to patients that considers the whole person, thus opening up opportunities to share the wholeness and reconciliation with God that they have found in Christ. They must not neglect the soul, but should also not be embarrassed that they care for the body as well, affirming that as “God Incarnate thought he could – no, must – devote large amounts of potential preaching time to the healing of sick bodies, then surely we are unfaithful disciples if we fail to follow in his steps.”73
Appendix: Bible Passages Addressing Sickness
Gen. 1:31 – it is good; 2:25 – open relationships.
Gen.2:17 – a consequence of eating the fruit; Gen. 4 – murder and the first deaths.
Infertility and injury
Gen. 20:17-18; 29:31 – infertility as a punishment for sin.
Gen. 32:25 – God injures Jacob.
Exod. 4:6-7 – Moses’ leprous hand.
Exod. 9:8-12 – Egyptians with boils.
Exod. 32:35; Num. 11:33-12:16; 21:6-9; 25:8-9 – plagues as punishment for sin, healing follows repentance.
Exod. 23:25-26; Lev. 26:16; Deut. 28:22, 35, 59-61 – the law promises sickness if Israel is disobedient.
History and Wisdom
Sickness as punishment
1 Sam. 5:6-12; 1 Chron. 21:1-17; 2 Sam. 12:15-23 – tumours afflict the Philistines who stole the Ark, a plague on Israel for David’s disobedience and Bathsheba’s son dies.
Ps. 32:7-8; 38:3 – David sees his sickness as due to his sin.
Prov. 3:7-8; 4:20-22; 12:18; 13:17; 16:24- good health follows fear of the Lord, respect for elders and wise talk.
A test from God
Job 2:1-8 – to prove his faith is real.
1 Kings 17:17-24; 2 Kings 4:8-37; 5:1-14; 20:1-11 – Elijah, Elisha and Isaiah are involved in raising the dead or healing sickness. Two cases are non-Israelites.
But: 2 Chron. 16:1-14 – Asa refuses to seek God’s help and dies.
Sickness as punishment
Dan. 4:31-37 – God’s judgement on Nebuchadnezzar.
Sickness from dread
Dan. 8:27 – Daniel lies in bed after a disturbing vision.
Isa. 11:1-9; 35:5-6; 42:7; 61:1-2; Jer. 17:14; 30:17; 33:6; Hosea 6:1-2; Mal. 4:2 – the anointed one will bring justice, a new creation, healing and restoration.
Ezek. 34:4 – promised to the leaders of Israel because they have not cared for the sick.
Luke 4:18-19 – Jesus claims the messianic mandate, including restoration of sight to the blind.
Matt. 8:5-13 (Luke 7:1-9; John 4:46-54); Matt. 8:14-15 (Mark 1:30-31; Luke 4:38-39); Matt. 9:18-25 (Mark 5:22-43; Luke 8:41-56); Matt. 12:10-14 (Mark 3:1-5; Luke 6:6-10); Mark 7:31-35; Luke 7:11-17; 8:1-2; 13:11-13; 22:50-51; John 5:1-9; 11:1-44 – specific healing miracles.
Matt. 4:23-25; 8:16; 9:35; 12:15; 15:30-31; Mark 1:32-34; 3:9-11; Luke 4:40; 5:15; 6:17-19; 7:21 – many healed.
Matt. 8:2-4; Mark 1:40-44; Luke 5:12-14; 17:12-18 – healing of lepers.
Matt. 9:27-30 2; 20:30-34 2; Mark 8:22-26; 10:46-52; Luke 18:35-43; John 9:1-7 – healing the blind.
Matt. 8:28-34 (Mark 5:1-17; Luke 8:27-36); Matt. 9:32-33 (Luke 11:14); Matt. 12:22; 15:22-28 (Mark 7:25-30); Matt. 17:14-18; Mark 1:23-26, 39; 9:17-27; Luke 4:34-36, 41; 9:37-42 – demons cast out.
The cause of sickness
Matt. 8:28-34 (Mark 5:1-17; Luke 8:27-36) – demons.
Mark 2:3-12 (Luke 5:18-25) – sin.
Luke 13:1-9 – not sin.
John 9:1-7 – for God’s glory.
Matt. 10:8; Mark 3:14-15 – authority to cast out demons and heal given to disciples.
Mark 6:12-13 – the disciples heal many.
Luke 10:30-37 – told to do as Good Samaritan did.
Matt. 28:19-20; John 20:21 – disciples sent out to teach others to obey his commands.
Matt. 25:31-46 – judgement on the basis of our care for the weak.
Acts 2:43; 3:1-8; 5:14-16; 6:8; 8:6-13; 9:18; 9:33-34; 9:39-42; 13:11-12; 14:8-10; 16:16-18; 19:11-12; 28:8-9 – offering healing to those in need
James 5:14-16 – instructing us to ask the elders to pray for healing.
The cause of sickness
2 Cor. 12:7-9 – Paul’s thorn in the flesh intended to demonstrate God’s glory in Paul’s weakness.
1 Cor. 11:27-32 – the Corinthians are sick because they take communion unworthily.
Medicine in the Bible
2 Kings 20:7 – used in combination with prayer.
Mark 5:26; Luke 8:43 – a woman who spent all she had on medical care.
Luke 10:34 – the Good Samaritan treats wounds.
1 Tim. 5:23 – Paul advises Timothy to use wine for his stomach.
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