You have never seen and will never see a multi-cultural patient. Every patient inhabits a cultural story of meaning, even though they are often unaware of this fact. The blue-collar neighborhood where I grew up lived by Judeo-Christian ethics. Though almost no one went to church, they did send their children to Sunday school as a kind of visceral acknowledgement of needing something more. Many of you remember when a blue-collar argument on morals would end when someone said, “The Bible says….” That doesn’t happen anymore, and that is the triumph of secular power.

A culture cannot be founded on differences but only on commonalities. Caliph Uthman (son-in-law and companion of the Islamic prophet Muhammad) realized this when he understood that different parts of his empire had different memories of what Muhammad had said and were fighting over those differences. His most trusted scholar suggested he gather together all the written memories and select the best (i.e. conducive to political peace and promoting unity), whilst destroying the rest. It was a politically astute move. Modern secularists want to do something similar, but their preferred story does not satisfy the spiritual depths of the “ignorant masses.” Today, there is only limited agreement among the great religions that clearly serve a spiritual longing. A culture that values a woman’s witness in court half as much as a man’s cannot be reconciled with modern Judeo-Christian Western concepts. If we try to hold onto the idea that all moral concepts are equally valuable, we may end up with groups of people living in the same country for solely economic reasons. No altruism can emerge. Trust will be minimal, and that trust will be exacerbated by the exploitation of influence by the group currently in power.

As healthcare professionals, it is increasingly important to understand the often-unspoken commitments and culture of the patient, especially in immigrant groups. A case history starkly illustrates this reality. Many years ago, I saw a little girl with a neglected septic knee; she was septicemic with osteomyelitis of the tibia and femur and a destroyed knee joint. The only hope in the remote mission hospital setting was to remove the leg and fill her with whatever antibiotics were available. When her parents were told that this course of action was the only hope of saving her life, they were understandably unable to handle the decision and decided to take her home. The nurses were not appalled, as I was, but when I asked whether the parents would have done the same with a boy, the answer was no. “Why the difference?” I asked. The answer was a moment of truth for me. “Because,” they said, “in our culture it is a woman’s job is to till the fields, fetch the water, cook the food and bear the children. A woman with one leg cannot do those things. Her life is not worth living.” A modern secularist has no way of responding to these ideas and, at the same time, holding on to the myth of multi-culturalism.

What does culture mean? It is not defined by race or ethnicity but, rather, it is better thought of as “tribal” wisdom. Until the Industrial Revolution, most people did not travel more than 25 miles from their birthplace; indeed, a good philologist in England can place a person within 25 miles of the birthplace simply by listening to their form of speech. In older times, we knew far more local people than we do today, not direct knowledge but familial knowledge and understanding: “You are the cousin of so-and-so who lives in the village of Ham. Everyone knows them.” That kind of knowledge allows assumptions about behavior and cultures to form around common practices, beliefs, taboos and a shared book, such as the Old Testament, the New Testament or the Koran. American philosopher Allan Bloom defined a community as something which invites high and low into a common story of meaning. In America, that common story was the Bible until the 1950s. All societies need ideas of truth, loyalty and honor, but they are not all the same. The ordering of the virtues makes a huge difference. If truth trumps loyalty, a job is secured by competence, but if loyalty trumps truth, a job is obtained by who you know (i.e. nepotism). A society dominated by truth will be more effective in every way.

Then again, honor has different interpretations. In the United Kingdom, 5,000 honor crimes are reported to the police every year. On the other end of the spectrum, an unknown number of women are murdered in Islamic families because they are deemed to have dishonored the family. The crimes are unsolved because they will not cooperate with the police. The point about this is that although moral codes are present in every culture, they are not ordered similarly, and that makes all the difference. British historian and philosopher Arthur J. Toynbee maintained that the first evidence of a decaying culture is the loss of moral consensus. When the Bible was removed from schools by moral intimidation, thereby putting tolerance as the only guide, it began the slide. For example, it is quite apparent in our own post-Christian culture that abortion and euthanasia, which were unthinkable before World War II, are now both normalized.

What we believe, as both healthcare professionals and patients, really does matter. Healthcare professionals will have to find sensitive ways to find out what patients believe, and in many cases, they will have to gently suggest another clinician. I think we need, right now, to start pushing for practices and hospitals to declare their positions on these issues. We must demand that the distribution of belief in the community is represented in the medical services we provide. We cannot medicalize killing and not expect it to change the entire ethos of our institutions.

American author Wendell Berry has been writing on these issues within the context of changing agriculture for many years. There is much to be learned from him about the dangers of applied science without a human context, as it has many unwanted and unpredicted outcomes. The brilliance of Wendell Berry is that in the Port William novels he writes, he simply tells the story of how a thriving community was dismantled in the span of a century by the results of applied science and big government, without any malice, just ignorance of local customs. In the same way, when the role Joseph played in saving Egypt from famine was forgotten, the children of Israel became slaves!

For those who love the Scriptures, it is amazing to realize that the law which defined the children of Israel was given as an act of grace to make the flourishing of Israel possible. This law is introduced with grace, “I am the Lord your God, who brought you out of Egypt, out of the land of slavery” (Exodus 20:2). That is grace. It was given so they would flourish when they obeyed God’s law. No rational explanation is given. God simply speaks-things you must do, and things you must not do, and when the stranger enters your gates, you must give him hospitality and he must respect your laws. Moral tolerance does not feature as a good thing, although its necessity in human society is recognized. Good citizens are not made good by laws imposed on them by government, but by rational obedience to a history they love. We learn to judge between good and evil things and good and evil people because by their fruit we shall know them.

Ethics lectures may make us more sophisticated as amateur ethicists, but they do not make us good people. C.S. Lewis, as so often, sums it up with a sentence. He says that he would rather play cards with a man who believes that gentlemen do not cheat than with a moral philosopher brought up among card sharpers!