Eds’ Note: Dr. Belihar is a faithful Christian who completed a highly successful career in the United States Air Force, retiring with the rank of brigadier general. During his tour in the military, he held a wide range of positions, ranging from squadron flight surgeon to command surgeon at United States Central Command under General H. Norman Schwarzkopf.

Medical ethics is moral philosophy as it relates to the practice of medicine.  Synonyms for ethics include beliefs, conduct, customs, ideals, integrity, principles, standards and values.  What one perceives as being ethical is often defined by his life experiences, secular and religious and are often developed during the formative period of youth.  My childhood and adolescence were spent in a small farming community out West.  As I reflect upon life in my hometown, my thoughts are filled with fond memories of friends, family, and townspeople, who profoundly influenced my perception of what is right and wrong.  They were good people - honest, patriotic, hard-working and God-fearing.  One person who was particularly influential in my life was our family physician, a man loved and respected by the entire community.  He was the Marcus Welby, M.D. stereotype.  He did it all: surgery, obstetrics, pediatrics and general medicine and did so in a kind, gentle, caring manner.  A man of integrity, his reputation was beyond reproach.  I idolized him and dreamt of one day following in his footsteps by becoming a physician.  Through his encouragement and the support of others, that dream became a reality.  I remember vividly my medical school graduation and for the first time hearing the title ‘doctor’ preceding my name. As was the custom, upon graduating from medical school we took the Hippocratic Oath.  I was aware of the Oath, but until it was administered, I was not fully aware of its contents.  Upon hearing the words, I had no reservations and responded affirmatively.  Legend has it that the Oath was written in the fourth century B.C. by Hippocrates, who is considered the father of  “modern medicine”. The translation of the Oath from the original Greek text is as follows: 

I swear by Apollo, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath. To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.  I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death.  Nor will I give a woman a pessary to procure abortion.  But I will preserve the purity of my life and my arts. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.  All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

Several parts of the oath have been removed or reshaped over the years in various countries, schools, and societies as the social, religious, and political importance of medicine has changed. Most schools administer some form of the Oath, but the great majority no longer uses the ancient version, which forbade both abortion and euthanasia.  Also missing from the ancient Oath and from many modern versions are the seemingly complex ethical issues that face the modern physician.  Apparently there were similar issues in the field of medicine over two thousand years ago to the extent that the Oath was created to define a physician’s moral position thereby distinguishing him from unethical practitioners.

It is evident to me in my thirty-nine years of practice, that there has been a trend toward a grey-scale of medical ethics.  Less and less appears black or white, only shades of grey.  This erosion, as I would characterize it, is a reflection of what is going on in society in general.  We have moved far away from the values espoused by this nation’s founding fathers, all of whom were Bible-believers!

Like the majority of my medical school classmates, I pursued a career in medicine for altruistic reasons, as well as the intellectual challenges and the distinction of being a member of an honorable profession.  Medicine has generally been thought of as having two dimensions, the art and the science.  There is, however, a third dimension that is getting increased emphasis; that being the business of medicine.  In recent years there appears to be an increasing number of individuals entering the profession primarily as a means of making money.  The pursuit of increasing the ‘bottom-line’ has given rise to unscrupulous business practices that in my view constitute a serious breach of medical ethics.  I recently saw an elderly widow who was paying over nine hundred dollars a month for dietary supplements.  She said that they were recommended and sold to her by her physician.  There are many who likewise prey on the doubts, fears and lack of knowledge of their patients.  This abuse is not uncommon and is manifested in many ways.  It is shameful and unfortunate.   

Unscrupulous business practices, abortion, and end-of-life concerns, including euthanasia, are some of the primary medical ethics issues of today.  It has been my observation that those who engage in unethical practices are generally comfortable with their position and don’t perceive themselves as being unethical.  How is this possible? We each have our own moral compass that guides us.  Hopefully, that needle points in the direction of God’s will.  The Bible is replete with Scriptures that provide a firm foundation for the establishment of medical ethics.   The Word of God is not silent when it comes to the aforementioned issues.  In matters of business, there are many verses that provide guidance dealing with numerous aspects, including fairness (Deuteronomy 25:13-15), honesty (Ephesians 4:25), service (Matthew 20:28), personal responsibility (Romans 12:2) and reasonable profits (Luke 6:31).   The Bible teaches general sanctity of life principles such as: we’re made in God’s image (Genesis 1:26), we are not to murder one another (Exodus 20:13) and our body is God’s temple (1 Corinthians 3:16), along with some specific teachings that talk about the beginning and end of life. The following Scriptures are a few of many that mitigate against abortion:

God has a plan for every human being even before birth (Jeremiah 1:5, Isaiah 49:1, Psalm 139:16, Galatians 1:15)

Shedding of innocent blood is hated by God (Proverbs 6:16,17). 



There is a Biblical passage that relates to euthanasia, or so-called mercy-killing (1 Samuel 31:1 to 2 Samuel 1:16).   In this passage we learn of events surrounding the death of King Saul.  Here we find that Saul was wounded in battle and defeated.  He asked his armor-bearer to put him to death.  When that request was refused, he killed himself by falling on his sword.  The armor bearer did the same. David was subsequently told by an Amalekite that he had come upon a mortally wounded King Saul, and killed Saul to put the suffering king out of his misery. When David heard his rendition of the event, he had the Amalekite executed!  Mercy-killing is not justified by Scripture. 

End-of-life-related decisions, even in the waning moments of a hopeless circumstance are never easy, nor should they be.  Life is truly a gift of God and our goal must be its preservation. Since we all must die, every one of us will eventually have to personally experience the pain of having to make an end of life decision.   In spite of an abundance of fasting and prayer beforehand, one of the most agonizing decisions I have ever had to make was when my sister and I decided to discontinue our mother’s life support.  It is so hard to let go even in the face of inevitability.

As to medical ethics in my practice, I strive to serve my patients well, providing them the best advice, counsel and treatment I possibly can.  My aspiration is that at day’s end, I can head for home having merited the trust placed in me by my patients and having obeyed the will of the Father.

Man may define his ethics to serve his purposes, but in the end it is in light of God’s law that we will be judged.  (Ecclesiastes 12:14).