In Abraham Kuyper’s day, medicine was still quite primitive by today’s standards. For the most part, treatments were judged effective based on anecdotal evidence given credence by the tincture of time. There were no antibiotics. Family doctors were the core of medical care for most communities. Nursing care was only beginning to carve out its own vocational territory, evolving from sanitary commissions and the care of wounded soldiers during the repeated wars on the 19th century European landscape. In this context, Kuyper’s notion of sphere sovereignty, particularly as applied to mutually beneficial human social relationships, was not likely considered in the context of medical practice in his day.

In my view, Kuyper’s insights have become very relevant and helpful for medicine in the century since his death. As its own sphere of relationships with a primary purpose of patient care, medicine has normative laws or standards of practice. In our day, this sphere of activity continues to unfold as communities of caregivers, interrelating directly with patients and with each other, while integrating multidimensional aspects of care toward a singular goal of care and healing. Today Kuyper might caution practitioners and hospital administrators not to confuse medicine with a business and its primary goal of economic gain. Medicine and business are sovereign spheres he would say; they should not merge but should maintain their own normative distinctiveness.  I think he would have warned that the growing commercialization of new therapies could threaten the sovereignty of medicine, its distinctive rules of practice and the integrity of its relationships.

Cancer care has become particularly complex in recent years. Breast cancer patients often form relationships with surgeons, medical oncologists, radiation oncologists, nurse practitioners and other specialists, often needing to trust them with administering intensive and risky therapies over months or even years. These relationships are symbiotic; that is, both caregivers and patients derive mutual benefit from the ethical act of caring. Such relationships can also be best expressed through covenantal relating, understood most fully through the scriptural notion of covenant.

Like clinical practice, other domains of medicine such as research and regulatory evaluation of new treatments have their own relationships and rules of interaction. Yet these domains can claim a legitimate role within the sphere of medicine if they keep patient care as the primary meaning of their activity.

I think Kuyper would have enjoyed witnessing the spirit of sphere sovereignty taking root as a guide to normative contemporary medical practice, research, and regulation, all improved by appropriate therapeutic applications of biotechnology while keeping a sharp focus on care for the needy.

Dr Rusthoven is a distinguished Canadian oncologist who has a PhD in theology and bioethics. He is an Associate Fellow of KLC.