One of medicine's deepest needs is health professionals who are willing to enter meaningfully into the lives of patients despite the risks – legally and otherwise – and treat these patients with the respect and honour they deserve. Theologians have long offered counsel for thinking about how medical professionals can respond faithfully to this need. I am interested in new insights into medical care for suffering people that arise when Christ is considered aesthetically – when christology is articulated as a result of an aesthetic encounter.

First, I will give a general account of how traditional christology has been operative in medical ethics; I will draw upon the theological work of Karl Barth and some contemporary ethical work offered by Margaret Farley in this regard. Then, I will articulate an aesthetic version of christology and reflect upon its added meaning with respect to care for the suffering; theological work by Serene Jones and Hans Urs Von Balthasar will be presented in this section of the article. I will also briefly suggest how traditional accounts and aesthetic accounts of christology can be seen as complementary rather than antagonistic perspectives.

Traditional christology and medical ethics

Agapeistic ethics, that is to say, ethical reflection upon how God's love in Jesus Christ is normative for human beings, is one example of traditional christology at work; we can identify features of God's love exemplified in Christ, and we are to imitate this love in our lives. In this light, agapeistic ethics ‘takes depictions of love in the Bible as its point of departure’.Footnote ¹ More specifically, agapeistic ethics hang on the Deuteronomic insistence upon loving God with all your heart, soul and mind and the Matthean insistence upon loving your neighbour as yourself. There is an initial effort to generate theoretical content and a subsequent effort to put that content into practice. Finally, our own efforts at Christian love ‘[aim] to correspond and attest, on our own level and with our own limited capacities, to God's agape’.Footnote ²

A Barthian recapitulation of the work of Christ – incarnation and atonement – is especially helpful with respect to articulating agape's christological content and its implications for medical praxis. First of all, Karl Barth's christological formulation is supralapsarian; God decided to be in covenant relationship with creation – this is Christianity's ‘God with us’ – before God decided anything else; ‘the ordaining of salvation for man and of man for salvation is the original and basic will of God’.Footnote ³ Christianity's ‘God with us’ represents Barth's basic understanding of God's agape.

The incarnation and the atonement are the ultimate historical expressions of God's agape. Incarnation for Barth means that God lovingly condescends to dwell among us so that sin does not destroy the possibility for covenant relationship between us and God. Barth summarises this way:

The incarnation is (1) the continuance of God's eternal covenantal will – God's agape – and (2) God's loving response to sin – a response to the ‘lost cause’ of humanity. The atonement represents a history which preserves humanity's ability to take part in the eternal will of God – to be covenant partners with God as a consequence of God's agape.

The incarnation/atonement story as exemplary of God's agape reveals at least two normative features of God's agape which have particular relevance for human agape displayed in medical care: (1) God's agape enjoins God to suffer with the sufferingFootnote ⁵ and (2) God's agape enjoins God to alleviate suffering. In incarnation, Christ suffers with all of humanity under the wrath incurred by sin. In the atonement, God alleviates the suffering of humanity as slaves of sin by allowing them freedom to become servants of God in Christ.

What does this description of God's love mean for human love in the context of medicine? Christian love demands first of all that we bear with the neighbour (the patient) in suffering; the worst we can do is abandon someone in need. Second, Christian love demands that we work to alleviate suffering where possible; although we are not as powerful as God in this respect, we have a responsibility to try our best to offer healing and relief whenever we can.

Margaret Farley's ethic of compassionate respect generates still more determinative christological content for ethics concerning how we should care for those who suffer.Footnote ⁶ I will briefly describe Farley's ethic of compassionate respect, and then I will explain how her ethic contributes to the task of generating meaningful christological content for medical ethics.

First, consider the background and content of her ethic. Increasingly tense relationships exist between those who favour the rights of patients and those who favour the responsibilities of providers in navigating the terrain of medical ethics; those who favour rights usually herald autonomy as the benchmark while those who favour responsibilities almost always herald beneficence as the benchmark. Quite obviously, however, rights and responsibilities are both important in medicine. Drawing upon both philosophical and theological resources, Farley carves out intellectual space where autonomy and beneficence are mutually dependent upon one another for enrichment; her ethic of compassionate respect occupies this space.

Compassionate respect is characterised by two fundamental tenets: (1) compassion compels people to ‘suffer with’ those in need – this is what Farley calls the religious meaning of compassion – and (2) respect provides essential normative criteria for compassion. Compassion charges health professionals to care sincerely about those who suffer, while respect sharpens caring such that its content is appropriate to the concrete realities of suffering patients. In short, respect ensures that compassion isn't unfocused, while compassion ensures that respect isn't unfeeling.

Compassionate respect shares the principal concerns of caring ethics: the importance of relationships and cooperation between people and an emphasis upon the general human responsibility to help others. But compassionate respect goes further than caring ethics, because compassion additionally encourages caregivers to ‘suffer with’ the suffering. This ‘suffering with’ should draw caregivers to full recognition of and identification with the deep needs of patients.

The ‘suffering with’ suggested by compassionate respect is the christological centre I perceive in Farley's ethical conception. Without a doubt the injunction to ‘suffer with’ – the injunction to display compassion – is present in other religious conceptions besides Christianity, as Farley makes clear, but it is important to note that the injunction to ‘suffer with’ is an important part of the content of agape. Farley writes:

The compassion exemplified in Christ is to be imitated by people, and this compassion has staying power in the midst of utter helplessness – even the helplessness of impending death. Christian testimony to the life of Christ reminds us that our commitments to compassion – our commitments to recognise and identify with the deep needs of those who suffer – should persist always.

The work of Barth and Farley here considered represents a traditional account of how christology should inform ethics. Both of them offer meaningful and important insights into the ways in which Christians are called to respond to those who suffer. For both of them, a doctrinal picture of who Christ is and what he is meant to teach us structures the moral life; imitation or practice motivated by reflectively generated normative content is the key for traditional Christian ethics in medicine.

An aesthetic christology

Theological aesthetics seek to include beauty and desire as doctrinal loci for theological consideration. While traditional theoretical work in theology is important, theological reflection upon the ways which imagination and sensual experience shape who we are as Christians is also important. Serene Jones's conception of doctrine as ‘lived imaginative landscape’ and ‘drama’, and Hans Urs Von Balthasar's poetic account of what it means to encounter Christ will be helpful for articulating an aesthetic version of christology. After I canvass Jones's and Von Balthasar's work in service of this aesthetic account, I will explain the unique contributions of such an approach to the work of caring for suffering people.

Aesthetic christology and ethics

So what is the significance of this aesthetic christology – this dramatic encounter with Christ in lived imagination – for our practices of caring for suffering people? In order to answer this question, I will offer some general remarks on two related questions. (1) How do encounters with people change us? (2) How does an encounter with Christ change us? With respect to the first question, I will suggest that encounters with people affect us in at least two connected ways: first, encounters entail cross-storying with the life of another and second, this cross-storying has impact upon the formation of personal desire. With respect to the second question, I will suggest that there is unique power in cross-storying with Christ and that this unique power results in generalisable effects upon personal desire. After considering these general questions, I will turn to Von Balthasar's description of Christ's gaze and consider the status of this gaze in terms of informing the care we get and give at the bedside.

If imitation or practice (of Christ) motivated by reflectively generated normative content is the key for traditional Christian ethics in medicine, then ethical formation in the midst of real encounter with Christ is the key for an aesthetically conditioned Christian medical ethics.

Principally, real encounters with another person affect us in that these encounters force our life-stories to intertwine with someone else's life-story. In other words, real encounters entail a kind of ‘cross-storying’. If we understand our lives as storylines – as histories of experience and relationship which shape and mould us as persons – then we also understand all of our experiences as somehow inscribed permanently within consciousness. In other words, every moment of a developing story remains a part of the story even as the story changes and moves through history. This means that a momentary encounter with a person inevitably occupies some functional space in a developing identity. However, a hallway-type encounter with a stranger which consists in brief eye contact and an exchange of hellos is far less significant than an encounter with a doctor who tells you that you have cancer. Further still, an encounter with a doctor who tells you that you have cancer may be less significant than an encounter with the saviour of the world.

Nonetheless, every encounter has some permanent, transformative quality to it – I am not the same person before an encounter as I am afterwards, because my life-history has changed and my life-history affects who I am – and especially meaningful encounters are especially transformative. Cross-storying can entail an intimacy and meeting of purposes which can change us. When we cross stories with another person, we share a piece of collective history, which is to say a piece of a collective imaginative landscape, which forces us to carry that person with us (and them to carry us) in some way ever after. Especially meaningful personal encounters, moreover, result in a deep sharing in collective history.

What does it mean to say that I change as a result of an encounter because my life-history changes? At one level, it means that, insofar as my identity consists in the sum of my experience in the world and my personal responses to that experience, I change in personal encounter because the sum of my experience and response to this experience changes.

Real encounter also changes me at the level of personal desire. Cross-storying, which is also inevitably an intertwining of personal desires and hopes, has the power to shape desire. As we encounter other people in our lives, these others – or these encounters with others – leave historical and emotional traces in us which shape and mould our pictures of who we are and who we want to become.

The power of real encounter is more vivid when considering an example. I offer an account of the first date I had with my then fiancée over six years ago. It was a normal date – dinner and conversation and a short walk from the parking lot to her apartment door. The power of this encounter was in the beauty of the conversation which took place. As we discussed things like our families and our respective lives as students in a liberal arts college, we recognised strong, almost overwhelming resonances in our stories.

She came from a diverse family and found herself surrounded by a very diverse, if a bit incoherent, group of friends. A major difficulty for her was finding a way to keep her various friendships intact because they stretched her in so many different directions socially, emotionally and spiritually. Furthermore, she explained how she drew strength from this diverse community of friends – it was how she wanted to live, but it could be quite challenging at times to honour the inevitably competing demands.

Coming from a similar family situation and having similar struggles with an incoherent community of friends, her story resonated with mine. Recognising our shared history, and also experiencing the power of this shared history in our actual encounter with one another, left traces upon our internal landscapes of experience – historically and emotionally. In times of difficulty, when the demands of friendship might feel burdensome, I can remember my encounter with her then (and beyond) and what we shared about why we choose to live the way we do. This shared history offers security and hope in times of distress or doubt.

Our encounter also affected me at the level of desire. Not surprisingly, I desired deeper relationship with her. But even more deeply perhaps, the encounter allowed me to see parts of myself in another and feel encouraged and enlivened by this shared picture. The beauty I encountered in her allowed me to see beauty in myself, and it made me want to continue living into myself as someone who seeks relationship and experience with people who are different from me.

If encounters with other people are significant in that they force us to cross stories and because they shape us at the level of personal desire, it is worth thinking about the power of a real encounter with Christ in particular.

Von Balthasar offers the experience of meeting Christ's gaze as a way of thinking about real encounter with Christ; this ‘gaze is perfectly tranquil, having nothing of magical power or of hypnotic compulsion: a questioning gaze, which allows me my freedom’.Footnote ²⁰ In the midst of the encounter with Christ's gaze, one comes into a place of shared history with Christ – a history in which Christ questions the one he encounters (perhaps Christ questions this person as to who they are, who they want to become) and also a history in which Christ offers this one whom he encounters freedom.

The gaze is a penetrating question. It cuts to the core of who we are as people and asks us to consider who we are and what we will make of our lives. And yet the gaze also offers presence and companionship to us as we consider these questions. The gaze causes us to consider how we approach the world around us, and it offers God as covenant partner to us in this process.

Christ's gaze also offers an answer – freedom. We are free to be ourselves and enter the drama of covenantal life of God. Christ's gaze is appreciative of the one with whom he is talking. His gaze allows this other the space to be herself. And finally, this Christ, this ray of light, ‘contains a promise: love, delight, and a vision extending over an immense and vertiginous distance. Liberation from the unbearable dungeon of my ego.’Footnote ²¹ Even as people reject the gift Christ offers, the ray of light gently persists – it softly pierces – and holds out an offer of liberation.

As Christ offers us an answer to the question he asks, his gaze inevitably moves us at the level of desire. His gaze moves us to want to approach the world in certain ways – certain questioning, liberating ways. In this gaze, a person can be taken up into life in God – into the heart of God. This life in God is both scripted and shaped by the gaze itself and by claims like ‘God is the creator of the universe and wills to be in covenant relation with humanity’. When we encounter Christ in this gaze, our evolving personal stories of identity and desire intersect with God's covenantal story in Christ. Further, when we respond to this gaze by taking part in the covenantal story, we desire to offer this same gaze – this questioning, liberating gaze – to the world.

The status of the gaze in care for the suffering

So if the effect of the gaze is that it motivates us to approach the world with the questioning, liberating gaze of Christ, what might it mean for how we approach those who suffer? What is the status of the gaze in thinking practically about care for the suffering?

Deborah Healey, a paediatrician who works mostly with children who are victims of child abuse, offers a consideration of how to respond to extreme suffering which is rooted in a commitment to offering patients real encounter; she is interested in exploring how medical caregivers can respond concretely and compassionately to the needs of suffering patients. She contextualises her approach within the frame of theodicy; she explains how many of her patients who suffer find themselves asking, ‘Why me, God?’ And, ‘How can God be real if I know such pain?’ My contention here is that Healey's understanding of caring presence in the face of extreme suffering – in the face of theodicy – offers us a way to hope for real embodiment of Christ's gaze in service of those who are in the throes of extreme suffering.Footnote ²²

Oftentimes, people question Healey as to how she can affirm the reality of God in her work and the world, given the depravity she encounters on a daily basis. Her approach consists in (1) an acknowledgement of evil's persistence in the world as a primary cause of great suffering even in the face of what she sees as God's goodness and (2) a conviction that she is called to respond to the evil perpetrated upon her patients by providing compassionate presence in the midst of suffering. Healey's practical approach to theodicy – the dispositional gaze she offers as care provider – cuts through the heart of the intellectual-conceptual problem of theodicy to the volatile and vulnerable reality of the sufferer caught up in theodicy by relying upon a fundamental commitment to care – to radically enter into the lives of patients.

Healey expresses the view that evil is unavoidable, but she maintains that the presence caregivers offer to suffering patients can have the last word. Grace for her is in the ‘intense moments of sharing’ she has from time to time with her patients as they are in the volatile and vulnerable realities of suffering which threaten to destroy them. I think that Healey suggests a clinically conditioned form of covenant partnership between doctor and patient in which the evils of suffering are always secondary to the solidarity ushered forth by a practitioner in offering caring presence – in offering a questioning, liberating gaze – to those who are suffering.

Embodying Christ's gaze at the bedside

Jay Katz has articulated what he calls a problem of silence in doctor–patient relations. Among other things, silence keeps a patient in the dark, it bars her from participating in her own life, and it reinforces a sort of blind-trust on the part of the patient which can lead to abuse of power on the part of the doctor. As Katz writes, ‘sharing with patients the vagaries of available opportunities [disclosure], however perilous or safe, or the rationale underlying judgments, however difficult or easy, is not part of the Hippocratic task. For doing that, the Art is too long and Life too short.’Footnote ²³ There is a long history of doctor–patient relations, and this history is characterised by silence on the part of doctors and ignorance and anger on the part of patients. Clearly, the type of silence Katz describes is a silence of denial rather than acknowledgement – a silence of feigned certainty rather than honest uncertainty.

This silence that Katz describes can also be recognised in the contours of a certain kind of gaze – an oppressive, denying gaze. The silence of denial is like the shifty, uncomfortable gaze of a doctor or nurse who is afraid of suffering. This gaze pushes the one who suffers into deep isolation. However, I think that there is a certain kind of gaze which can be offered by care providers that is good – even healing – for people who are sick and suffering. It is the gaze of Christ, and it is embodied in the example given by Deborah Healey.

The gaze of Christ is, first of all, a gaze of acknowledgement. In it, the one who suffers is acknowledged as a person worthy of respect and love. Furthermore, this acknowledgement communicates the truth of our human situation as people liberated from the grip of sin, welcomed into the open heart of God. Where the silent gaze that Katz describes is one of denial – the patient's life can still be saved, I will do whatever I can – Healey's gaze acknowledges the severity and (sometimes) the unchangeability of a person's condition while also affirming the enduring reality of forgiveness and liberation in Christ. This gaze is honest.

Second, this gaze is an intimate gaze. Sitting with someone in the midst of great suffering and acknowledging the severity of their suffering draws caregiver and patient into a place of deep unity, which is forged by honesty – caregiver and patient know what the patient is going through, and they are sharing in each other's pain.

Along similar lines, this gaze is also a communal gaze. A gaze of denial keeps a sufferer out of community; it forces a person to bear their suffering alone. However, this gaze allows the one who suffers to share pain with those who sit around him. The sufferer has company in suffering.

Last, this gaze is also a gaze of withheld words. In the story of Job, we see that after Job breaks the silence of Sitting Shiva, all of his friends end up trying to stifle their uneasiness with Job's suffering by finding rational explanations for it. But their initial silence hints at the possibility of withholding words – of fighting against the inclination to rationalise – and accepting the circumstances of the one who suffers for what they are – terrible, perhaps unchangeable, and irrational. A gaze of denial withholds words because it wants to keep the sufferer (and the caregiver) from acknowledging ambiguity and tragedy in certain kinds of situations. A gaze of acknowledgement (like Christ's) withholds words because it knows that words are futile at times, and presence – even if it is quiet presence – is almost always comforting.

Christ's gaze, even as it withholds words, extends an enduring promise of hope and redemption to all who are able to encounter it – a hope of liberation from sin, of covenant partnership with God, of a spiritual horizon of unity between God and humanity.

Suggestions: aesthetic christology and traditional christology in conversation

It is worth noting that I do not have space here to do justice to the question of how traditional christology and aesthetic christology relate to one another in ethical reflection. I will, however, offer a few preliminary suggestions as to how I think these two perspectives should be seen in light of one another.

The powerless times we encounter in the midst of suffering are frightening. Barth and Farley rightly suggest that in these kinds of situations (and in all others) we have an obligation (1) to demonstrate compassion for those who suffer by suffering with them – to identify with patients and appreciate their deepest needs – and (2) to deliver this compassion to sufferers in concrete ways informed by principles of respect.

In this light, agape has something substantial to say to us regarding how we care for people who suffer. First of all, professionals must demonstrate general respect for persons; caregivers should treat patients as ends in themselves. Second, these professionals must work to alleviate suffering where possible. Health care providers should also be ready to compassionately ‘suffer with’ their patients, and offer this compassion in concrete ways according to general principles of respect. These normative requirements in themselves leave a caregiver with much to consider.

However, I have also suggested that there is more to say with regard to how christology can inform medical care. I have used the lens of aesthetics to illuminate this ‘more to say’. The rubric of encounter was especially helpful in this respect. I suggested that an understanding of doctrine as lived imaginative landscape and drama provide a way to bring christology into our immediate experience in the form of aesthetic encounter, which affects us at the level of love and desire. Hans Von Balthasar's account of what it is like to encounter Christ's gaze informed my own articulation of how caregivers ought to offer this same kind of gaze to their patients.

This aesthetic account poses no threat to the traditional account. The aesthetic account serves to bring the traditional account into higher relief. Traditional christology underlies aesthetic christology; the traditional account offers some ‘landmark-type’ ethical suggestions which we ‘bump up against’ in the attempt to deepen ethical reflection with theological aesthetics.