[Note: Your comments and constructive criticisms are invited. Whether it be praise or disapproval, our only requirement is that it be done in the framework of a Christian spirit. All items under this heading reflect the personal views of the respective writers and not necessarily those of this journal or the denomination at large.—Editors]
Sanitariums versus Hospitals
AN ARTICLE in the October issue of THE MINISTRY titled "How Sanitariums Became Hospitals, and Why" touched upon issues that are basic to our understanding of our philosophy of medical missionary work. Because I do not believe that the treatment given these issues in this article represents the opinion of many of our workers and constituents, I wish to present another viewpoint on this important topic.
Things New and Old
It is true that the past is no more sacred than the present. An old way is not intrinsically better or holier than a new way merely because it is part of "the good old days." But neither are modern innovations and space-age trends inherently good or desirable because they are new. Scientific progress and technological change have profoundly altered our world, but they have not changed our objectives or the principles by which these objectives are to be achieved. In four counsel-packed volumes Ellen G. White has given the church the objectives and guiding principles for our denominational medical program. This Heaven-sent guidance is the only valid foundation on which any legitimate discussion of the medical work of the church can be based. The question that we are to ask ourselves then at the outset of this discussion is not, "Are we following the modern medical trends?" but rather, "Are we following the timeless principles given to us by inspiration?"
The Role of the Physician
The task of preaching, teaching, and personal witnessing that the church is called to do can be done only by consecrated human instruments. Without them, any institution is spiritually impotent. Because the Christian physician is a key figure in the medical program of the church, I would like to examine his divinely appointed role before approaching the subject of the medical institution itself.
Ellen G. White speaks of the Christian physician as "a minister of the highest order," 1 "an evangelist," 2 one who "bears a double responsibility; for in him are combined the qualifications of both physician and gospel minister," 3 and one of a class of workers who are called "to make the saving of souls their first work." 4 "Medical missionary work," she tells us, "is not to take men from the ministry, but is to place men in the field, better qualified to minister because of their knowledge of medical missionary work." 5 "The work of the true medical missionary is largely a spiritual work. It includes prayer and the laying on of hands; he therefore should be as sacredly set apart for his work as is the minister of the gospel." 6
Private Versus Denominational Practice
The question next arises, Where is the Christian physician to find fulfillment for such an exalted calling—inside or outside the organization of the church? We must let our counselor answer for us: "No line is to be drawn between the genuine medical missionary work and the gospel ministry. These two must blend. They are not to stand apart as separate lines of work. They are to be joined in an inseparable union, even as the hand is joined to the body."7 "Neither part of the work is complete without the other."
Can this inseparable unity, this completeness of effort, be achieved outside the denominational structure? The messenger of the Lord wrote to one physician who was perplexed about this question. She said, "You are not to set up in business for yourself. This is not the Lord's plan. . . . You are in an unsettled state of mind, and are tempted to do a strange work, which God has not appointed you to do. None of us are to strike out alone; we are to link up with our brethren and pull together."9 In writing of the Loma Linda school, she said, "It may not be carried on, in every respect, as are the schools of the world, but it is to be especially adapted for those who desire to devote their lives, not to commercial pursuits, but to unselfish service for the Master." "
It is apparent, I am sure, that not every graduate of our medical school will be taken into denominational employment, just as all men who study for the gospel ministry are not given salaried positions in the church organization. Further, I am not saying that a physician in private practice cannot fulfill an important place as a Christian witness and as a supporter of the church in his area of service. I am saying, however, that my reading of the Spirit of Prophecy writings tells me that it was the original design that our physicians should be united with our gospel ministers and our denominational organization in an intimate way that is not realized by a private practice arrangement.
Salaries and Sacrifice
The article referred to presents a chain of circumstances that supposedly is responsible for the loss of our salaried physicians. Several links in that chain trouble me. It stated that "many physicians had no choice but to enter private practice. This they did, and their wives purchased newer coats as their husbands bought longer and shinier cars. The wives of the institutional salaried workers looked on and wondered. More and more of our Seventh-day Adventist physicians entered into private practice." In other words, it seemed to be covetousness and materialism that cost us our doctors' services. If that is a fact, are we to conclude that our physicians as a group are self-seeking and are not spiritually motivated? Certainly our salaried denominationally employed overseas missionary physicians would deny this generalization. And if this explanation is offered to condone or justify the physician's private employment, how far can we safely carry this analogy? Can we justify other denominationally salaried workers, ministers, accountants, and college professors, if they all choose to leave the church organization in favor of more lucrative private employment? I cannot believe that all the graduates of our medical school have bowed the knee to mammon. In Medical Ministry sixteen pages are devoted to the subject of fees and wages. Perhaps we need to read this comment again and then repeat the appeal for dedicated men and women who will respond to the call of medical missionary work in the spirit of self-sacrifice that stirred our pioneers.
Definitions and Objectives
Our church has been instructed to operate a unique type of medical institution which Ellen G. White commonly referred to as a "sanitarium." She said of this type of institution, "The Lord years ago gave me special light in regard to the establishment of a health institution where the sick could be treated on altogether different lines from those followed in any other institution in the world. It was to be founded and conducted upon Bible principles, as the Lord's instrumentality, and it was to be in His hands one of the most effective agencies for giving light to the world. It was God's purpose that it should stand forth with scientific ability, with moral and spiritual power, and as a faithful sentinel of reform in all its bearings."
Whether we call such an institution a sanitarium or a hospital is not in itself a matter for any grave concern so long as we do not confuse nomenclature with function. Webster's Collegiate Dictionary defines a hospital as "an institution in which patients or injured persons are given medical or surgical care," and a sanitarium as "a health retreat; an institution for the recuperation and treatment of physical or mental disorders." As I read the Spirit of Prophecy writings, I find that a bona fide Adventist institution may be designated by either or both of these terms. Our institutions were meant to care for medical, surgical, and obstetrical cases, but were also to serve as health retreats where the mentally and emotionally ill and those whose sicknesses were the result of intemperance and the violation of the laws of health might find healing and re-education to a new way of life.
To praise the modern hospital because it cares for the acutely ill "horizontal" type of patient, and to dismiss and even ridicule the sanitarium because it cares for the "vertical" type of patient who is not really sick at all but only comes to be "rubbed, steamed, and fomented" is not a very fair or very searching analysis of the facts. In our stress-torn world there are thousands of "vertical" patients who are desperately ill, requiring the very type of sympathetic understanding Christian care and special therapeutic media that should characterize our institutions. If I were called upon to choose between which aspect of our medical institution best fits the divine blueprint, I would have to choose the sanitarium rather than the hospital. The short-stay, rapid-turnover aspect of the acute-illness patient certainly does not give the evangelistic potential provided by the sanitarium-type patient.
Ellen G. White clearly stated that "the purpose of our health institutions is not first and foremost to be that of hospitals," 12 and goes on to clarify this by writing, "Let every means be devised to bring about the saving of souls in our medical institutions. This is our work. If the spiritual work is left undone, there is no necessity of calling upon our people to build these institutions."13 The church must beware lest it be caught up in the entangling web of reasoning that tells us we are fulfilling our role in society if we are providing a humanitarian service to the world. Many hospitals that originally began as Christian institutions have followed this type of thinking and as a result have lost their distinctive Christian perspective and stand today only as community hospitals. We are not called upon merely to add to the total number of physicians and hospitals so that the world's sick may be healed. Ours is a wider ministry. "Our sanitariums are to be established for one object—the proclamation of the truth for this time." 14 This is the standard of achievement by which we must judge our medical workers and medical institutions.
Who Are Our Witnesses?
The institutional objectives can only be fulfilled by institutional workers. "Who are they?" is a question we might rightly ask. Many quotations could be cited regarding the personal spiritual qualifications of medical institutional workers at all levels of responsibility, but one perhaps will suffice to set the standard. "I am very anxious that all those connected with our sanitariums shall be men whose lives are wholly devoted to God, free from all evil works. . . . Great care should be shown in choosing young people to connect with our sanitariums. Those who have not the love of the truth . . . should not be chosen. . . . The influence of every worker should make an impression on minds in favor of the religion of Christ Jesus." 15
How can we harmonize this lofty objective with Adventist hospitals today where a large proportion of the patients, frequently the majority of them, are cared for by unbelieving physicians who have little understanding of, or regard for, our distinctive Christian aims. Perhaps the burden of Christian witnessing should fall upon our nurses? Yet here, too, we are below the mark. Within the past year the Bulletin of Nursing of the General Conference Medical Department reported the results of a study of nursing service personnel in 36 denominational medical institutions in North America. It was found that 26.5 per cent of all the graduate nurses are non-Adventists, and a few of these occupy the very top administrative positions. Furthermore 35.7 percent of all the other nursing service personnel (practical nurses, aids, and orderlies, who have the most prolonged and intimate personal contact with patients) are non-Adventists. The over-all percentage of Seventh-day Adventist workers in the 36 hospitals varied from 16 per cent (one hospital) to 100 per cent (two hospitals) with a median of only 57.8 per cent. How is it possible for such a mixed multitude of workers to successfully work, study, and pray together so that they might receive the unmingled blessing of God for the advancement of His cause? Would it not be preferable for us to heed the counsel, "Better for the work to go crippled than for workers who are not fully devoted to be employed." 16
One factor undoubtedly responsible for this alarming spiritual incongruity among our institutional personnel is our failure to follow the guidelines on the size of our institutions. Listen again to God's messenger, "Never, never build mammoth institutions. Let these institutions be small, and let there be more of them, that the work of winning souls to Christ may be accomplished." 17 "The proclamation of the truth in all parts of the world calls for small institutions in many places." 18 Someone has said increasing the size of a medical institution beyond certain limits decreases rather than increases the spiritual witness. If this is a fact, it is due in no small measure to the influx of unbelievers as hospital workers. And yet our medical institutions continue to expand in hundred-bed increments and more in the face of such specific instruction.
Closed Versus Open Staff
The goal to be achieved in staffing a distinctly Adventist medical institution is a select, closely knit group of consecrated Christian workers in all departments. This means a closed staff. In the article referred to the writer expresses the opinion that closed-staff institutions are not feasible today, having been outmoded by current medical trends. He says, "Organized medicine vociferously proclaimed that it was unethical for any physician to be salaried to a lay organization, and thus be subject to exploitation by the laity. No one should make a profit from the physician's service except the physician himself." Indeed! Whom shall we choose to be our arbiter of ethical conduct, organized medicine or the special messenger of the Lord to His church? We might also ask what "unethical" means here? My suspicion is that it is the type of ethics a doctor friend of mine spoke about when he humorously but wisely said, "Where there ain't no money involved, there ain't no ethics." We must also keep in mind that there are thousands of salaried physicians employed by lay organizations in the United States—in private industry, in the Government at all levels, and in the Catholic Church, and all this goes on apparently without any concern over the awesome threat of organized medicine. Furthermore, many of these lay organizations operate hospitals with staffs that are tightly closed.
The writer of the article also states, "A different type of staff organization was evolving. . . . The purpose . . . was to better the level of the practice of medicine, to curb the unscrupulous, and to limit the privileges of the incompetent." Was it necessary, I ask, to bring into our sanitariums non-Christian physicians in order to guard the scientific standards and ethical behavior of Adventist physicians? God forbid!
Follow God's Way
The expression "divine blueprint" is a part of Adventist terminology which, it seems, has largely fallen into disuse in recent years, but it is still a valid and helpful concept. We need to study that blueprint to know God's objectives that we might fulfill them, and to know His methods that we might use them. Herein lies our confidence, our safety, and our final success. I know that some will consider the viewpoint expressed in this article as unrealistic and visionary. To them I can only reply, "It is always best to endeavor to carry out the whole will of God as He has specified. He will take care of the results."19