Live and let die: why leaving ‘private’ convictions behind in public health is a terribly disintegrating idea

When you were young and your heart
Was an open book
You used to say live and let live
(You know you did)
(You know you did)
(You know you did)

But if this ever changin’ world
In which we live in
Makes you give in and cry
Say live and let die
Live and let die — Paul and Linda McCartney

There’s a piece in the ABC’s Religion and Ethics this week about an abortion doctor who’s a Christian who checks her private religious convictions in at the door of the public hospital and so participates in abortion procedures. Doctor Carol Portmann is also appearing on an SBS show that brings a bunch of Christians with different convictions together in one house as an experiment. She’s been lauded in some quarters as an exemplary figure because what she’s doing is being the ultimate picture of a certain sort of secularism — the type where religion is only, and absolutely, a private matter — a conviction in the heart to be kept at home, or in religious space — never to be brought into the common life of our nation. It’s the same sort of secularism that saw questions raised about whether or not kids in public schools should be able to talk about religion in the playground — the secularism where our common life defaults to atheism (and where Christians wanting to pursue civic goods are left making religion-free natural law arguments rather than saying what we really believe which assumes and then reinforces the idea that religion is private not public and so leads to the disintegration of religious persons).

Doctor Portmann says:

“The way I look at it is: I have a job to do as a doctor, regardless of my personal feelings about something. It’s not my decision, because it’s not my pregnancy or my body. Ultimately, the one thing God really granted us above anything else is free will.
Early on in medical school, we were not given opportunities to speak with people considering termination of pregnancy. So, as a student, you tend to start off with just your own personal beliefs.

But the more that you interact through your job with these women, the more you recognise it’s just as important to provide people with support and openness, information and guidance, and being Christian shouldn’t stop me from doing that.”

I can understand Doctor Portmann’s position — she has a job to do, and an employer (ultimately the state), who are employing her to do a job; her employer sets the parameters, and, at one level, a Christian wanting to participate in the secular state and its institutions might have to make compromise (that’s my position on why Christians should join the Labor Party rather than abandoning it after Labor changed its abortion policy recently). But there’s ‘compromise’ that looks like working in an institution that conducts abortions while not conducting them yourself, and there’s compromise that is conducting the abortions yourself — the difference to joining the Labor Party is you’d be joining, as a Christian, to give voice to your personal religious convictions, seeing them as a view that must inevitably shape the ‘public’ life of a person, not just as a private matter. We need to be better at making the distinction between participating in institutions that involve sin and participating in sinful actions. So I can understand Doctor Portmann’s position, I just think it is wrong, and I think it would be wrong for our approach to public health to be built from a belief that you can separate private personal beliefs from public action.

Firstly, I think it’s wrong for Christians to adopt a position like this — to think you can have personal convictions that do not shape your public life. The New Testament approaches public ethical quandaries like this one on the issue of food sacrificed to idols. Paul, in 1 Corinthians, draws the ethical line when it comes to eating such food at the point at which the people around you see that your public actions (even if they’re in a private home) as necessarily participating in idol worship. So he’ll say ‘eat idol food that is sold in the public market’ and ‘eat with your friends’ until the point comes where your friends believe that by eating it you are participating in the public actions of idolatry (1 Corinthians 10:23-33); and he’ll say ‘don’t share at the altar in an idol temple’ because that is inevitably participating in idol worship (1 Corinthians 8:1-13, 10:14-22). Abortion is a question of idolatry, or theology, because all beliefs about the nature of human life or personhood are implicitly linked to a belief about the nature of God or gods. Our anthropology comes from our theology.

I admit that it’s also hard for me to see a case where a Christian doctor working in a public hospital and conducting abortions is able to make the case that they are doing so according to Paul’s overarching ethical paradigm in 1 Corinthians: “So whether you eat or drink or whatever you do, do it all for the glory of God.” (1 Corinthians 10:31). But I can see, further, that for some Christians even working in a public health setting where abortions are conducted and referring people to others, to protect one’s own conscience, is also to be complicit in some process that is not glorifying God, or that is idolatrous. I can see an argument that a public hospital could be analogous to an idol temple on the issue of abortion, if there was a very clear policy that every doctor working there must participate in abortions, and I can see, then, a case for Christian doctors withdrawing into parallel institutions (private hospitals); but so long as a Christian (or Muslim) doctor might be present in that public, common, space, holding and acting according to their own religious convictions about the public good, then we should be able to make the distinction between ‘working in a contested space’ and ‘compromising one’s integrity and so disintegrating one’s self’. Because we see the good of a faithful Christian presence in those public institutions, for the common good (in much the same way that Paul thinks it is a good thing that his friend Erastus is part of the government in idol-worshipping Corinth, Romans 16:23). The danger of creating parallel institutions that just service Christians, or that allow us to operate as Christians without compromise, is that they tend to stop us participating in the world in ways that allow us to bring the sort of change that adorns the Gospel — the sort of change that led Christians to build hospitals where there were none. Hospitals that treated everyone, not just the rich or those likely to get healthy again — that did this because of the dignity of all people, and because our story teaches us that sickness and death are marks of a deep brokenness in the world.

Now, if this position Doctor Portmann arrives at — being a “Christian doctor who helps people have abortions” — is her personal conviction about how faith and public life intersect, that’s fine. If it actually reflects a personal view where she somehow reconciles her faith with the dehumanisation of an unborn child, then it’s her right to arrive at that position and to participate in public accordingly… that’s pluralism. A pluralist approach to abortion recognises that people will come to different (theological) convictions about the nature of human life and that my own personal conviction should not necessarily be imposed on others; there’s a different between imposition and accommodation. A Christian approach to the question of abortion might be one that seeks to impose a view of the personhood of an unborn child on the public, via legislation and persuasion about what is good and true and should be a commonly held and loving position for all in our ‘public’ — but that’s not the only possible approach to a contested public space, nor is it the issue arising from Doctor Portmann’s position. It seems to me that she’s arguing that you can have your own private, personal, conviction about the morality of abortion (and the personhood of the unborn child) and not bring that to the public space or conversation, or your performance of your work, or life, in public. And I’m not sure that is ‘fine’. It’s certainly not pluralism. It’s the eradication of difference in public.

Speaking as a Christian, using theological categories, it seems she has embraced a particular view of God, and the world, that places ‘free will’ over and above any other moral categories. I believe she is wrong to adopt this particular hierarchy, and this particular approach to her participation in public life, and her example is a terrible pattern for Christian medical professionals, or any medical professionals, because it’s a terrible approach to shared, common, public, space for anybody with moral convictions.

Speaking as an Australian, using political categories, I think flattening out personal conscience in pursuit of public consensus, and making no space for objection and participation in public is a shortcut to very bad things. At risk of breaking Godwin’s Law, there’s not a huge jump from acting as though unborn children are not persons, even if you’re personally convinced they are, because the system tells you to, and participating in other systemic evil that revolves around depersonalising or dehumanising other categories of human. It seems more likely to me, at this point, that it’s not so much that Portmann has personal convictions that compete with her public role, but that her personal convictions or personal beliefs are a bit more malleable around the question of whether or not an unborn child is a person.

Now, I’m on the record as not believing abortion is a good thing; because I think it cheapens how we as a society view life, and because, ultimately, I believe it involves taking the life of a person. I would like to persuade our legislators and society to see things my way, but I also recognise that there are competing human rights at play and that the current legislative status quo is more likely to protect the conscience of religious doctors than to enshrine the views or religious people as widespread social norms… but, I hope the argument I make here is one that people of any faith conviction can agree with, and one that doesn’t actually rest on the moral status of abortion, but rather how we as a society allow people to bring their moral convictions into the public square so that each of us is free to act with integrity (within certain limits, for example, to prevent individuals doing harm to others according to common objects of love or broadly shared beliefs about ‘the good’).

I’m arguing that the ultimate good here is not ‘unlimited freedom’ that co-opts the ‘public life’ of all, causing people to act against their private convictions, but ‘integrity’ — encouraging people to live and act with their public and private (or secular and sacred) convictions integrated and aligned; I’m suggesting that forcing people to split ourselves and our convictions into ‘public’ and ‘private’ is actually not a good thing for our secular democracy because we do not want people operating in public against their private convictions. I’d suggest at least three universal reasons this is bad, and two reasons it’s a bad position for Christians to adopt. In the ‘universal’ space I’d suggest it’s bad:

First, because to do so ‘disintegrates’ people, forcing them to act without integrity in order to participate in our common life. We actually want people to be acting with integrity as much as possible rather than harbouring private disagreement that leads to resentment or builds towards a corrective ‘revolution’.

Second, because it turns moral and political issues into zero sum games and creates ‘winners’ and ‘losers’ and an enslaved populace (the minority) who are forced or manipulated into acting against their personal moral convictions — and that’s a pathway to a certain sort of tyranny, or to a totalitarian state where an ideological vision of life, death and morality is imposed from the top down in a way that brooks no opposition, and refuses to make space for any public behaviour outside that norm.

Third, this also forces people who wish to act with integrity, according to their ‘private’ beliefs into ‘private’ practice, fragmenting the ‘commons’ and sending people into ghettoes, which robs us of the benefit of their skills and contribution to life together, and also serves to reinforce the views that keep us apart, and so the polarising division of groups and identities within our community. The choice to retreat into Christian, or religious, enclaves and parallel institutions is not a great one for Christians, or religious people, to make for the sake of the world nor is it a good one for the world if those enclaves are places that foster resentment and disunity where an alternative is a true commons where public life is richer because moral visions are contested and we allow people the space to act with integrity. Our public space becomes poorer if, in order to participate in it, one must adopt the positions or will of the majority against one’s own conscience. This is the sort of social engineering that makes tyranny possible because it makes tyrannical positions unquestionable, and forces people to conform and adapt until they lose their distinctives.

In terms of reasons for Christians not to follow Doctor Portmann’s lead, I’d suggest, firstly, that to adopt her position one is not choosing a ‘live and let live’ approach to public life and difference, but a ‘live and let die’ approach where it’s not just the unborn child, but the ability to believe and maintain that an unborn child is a person that dies with such a capitulation. This is not pluralism, where the public is contested, but capitulation, where the public is ideologically shaped by a particular view of personhood; a view that like all “private views” is inherently theological. Portmann is accepting a division or distinction between the secular (public) and the sacred (private) that is ultimately incoherent, because all public life expresses some view of the ‘sacred’ that is, frankly, both unChristian and unhuman — if we do not publicly embody our private convictions then either we are disintegrated hypocrites or those private convictions aren’t actually convictions at all. This also buys into the idea that there is ‘sacred’ work — that done by clergy in religious spaces, and ‘secular work’ that done by ordinary Christians in public or private enterprise. Her position is the sort of position that will force religious people of moral conviction out of contested public space — into ‘sacred’ or ‘private’ space, and so make that public space uncontested. There’s already a ‘contest’ to do this, without Christian doctors adopting Doctor Portmann’s position (and not just in public hospitals, though this is a particular battleground for a particular ideological ‘culture war’). To force Christian doctors to conduct abortions if they want to work in public hospitals, or even to argue that they should keep their personal convictions out of the job (even if they’re convinced of this stance as a personal conviction) is not a case of ‘live and let live’ but ‘conform or die’. To, act, as a Christian doctor, as though your personal convictions have no place in your public life is to disintegrate your faith from your practice; it’s to buy into a certain sort of secularism that evacuates anything substantial from religious belief.  For the Christian, convinced of the moral absolute of the pro-life position, who operates in public as a doctor there are better solutions than adopting a ‘live and let die’ posture; there should, instead, be freedom to clearly articulate one’s convictions, act according to them, and for public patients with different convictions to seek treatment from a doctor who is not acting against their personal convictions.

Second, I’d suggest that her model of public practice is not faithful presence in that while she remains present in the public space, she is not, if she does hold personal religious convictions about the personhood of the unborn child, essentially faithful; her public actions are not her expression of her own faith (as articulated in the piece), but a giving over of herself and her body to the faith, or will, of others (be it the patients or the system). In James Davison Hunter’s work To Change The World, where he makes the case for ‘faithful presence’ as our paradigm for engaging, participating in, and changing the world for the good, Hunter says that while there’s much in the world we can participate in and affirm without question, we Christians — the church — must always remember we are a ‘community of resistance’ — people who act in public in order to subvert and challenge theological or political views of ‘the good life’ that we disagree with; that our job is not to evacuate the commons or the ‘public’ but to participate in it, and in its institutions in ways that are not just negative but creative and constructive. He says:

“…the church, as it exists within the wide range of individual vocations in every sphere of social life (commerce, philanthropy, education, etc.), must be present in the world in ways that work toward the constructive subversion of all frameworks of social life that are incompatible with the shalom for which we were made and to which we are called. As a natural expression of its passion to honour God in all things and to love our neighbour as ourselves, the church and its people will challenge all structures that dishonour God, dehumanise people, and neglect or do harm to the creation. In our present historical circumstances, this means that the church and its people must stand in a position of critical resistance to late modernity and its dominant institutions and carriers; institutions like modern capitalism, liberalism, social theory, health care, urban planning, architecture, art, moral formation, family, and so on. But here again, let me emphasise that antithesis is not simply negational. Subversion is not nihilistic but creative and constructive. Thus, the church—as a community, within individual vocations, and through both existing and alternative social institutions—stands antithetical to modernity and its dominant institutions in order to offer an alternative vision and direction for them. Antithesis, then, does not require a stance that is antimodern or premodern but rather a commitment to the modern world in that it envisions it differently. Such a task begins with a critical assessment of the metaphysical, epistemological, and anthropological assumptions that undergird modern institutions and ideologies. But the objective is to retrieve the good to which modern institutions and ideas implicitly or explicitly aspire; to oppose those ideals and structures that undermine human flourishing, and to offer constructive alternatives for the realization of a better way.” — James Davison Hunter,  To Change the World: The Irony, Tragedy, and Possibility of Christianity in the Late Modern World, 235-236.

The tragedy of Portmann’s position, from a Christian perspective (apart from the question of the social cost of abortion), is that it gives up the chance for Christians to be subversive and different — to bring our personal convictions about what is good, true, and beautiful — about what the nature and kingdom of God looks like — into the public domain as we embody it, to settle for some ideal of ‘individual freedom’ as a greater good than the restoration of all things. We Christians have a chance to be different and to model something different to our world, to bring life into our public institutions, but we won’t do this if we don’t act with integrity, acknowledging that our personal beliefs have a public dimension such that they must shape our actions.

The author

Nathan runs St Eutychus. He loves Jesus. His wife. His daughter. His son. His other daughter. His dog. Coffee. And the Internet. He is the campus pastor at Creek Road South Bank, a graduate of Queensland Theological College (M. Div) and the Queensland University of Technology (B. Journ). He spent a significant portion of his pre-ministry-as-a-full-time-job life working in Public Relations, and now loves promoting Jesus in Brisbane and online. He can't believe how great it is that people pay him to talk and think about Jesus.

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