Viewpoint: Sanitariums vs. Hospitals

The monthly viewpoint column.

HERSCHEL C. LAMP, Medical Secretary, Middle East Division

[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

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HERSCHEL C. LAMP, Medical Secretary, Middle East Division

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