The Dark Kenosis of Medical Education

Despite the lip service given to the “all are welcome” ethos of medical education, the culture of the medical profession typically implies that there is actually a very narrow set of “acceptable” anthropological perspectives that a physician can have—and that you had better get in line or risk being ostracized. In a profession that is still so hierarchical and dependent on subjective measures for advancement, the pressure to fit in and subjugate oneself to established norms can be powerful. 

But what are these norms when it comes to the formation of medical students? They certainly do not encourage students to give further formation or shape to who they already are as individuals who each bring something unique to medicine. Instead, students are made to think that they need to empty themselves of those things that define them and instead conform to a sterile identity, namely, that of an archetypal “medical professional.” There is an expected kenosis, or “emptying of the self,” and for those who bring a uniquely Christian identity to the profession, there is an understood assignment: forget about the richness of your Christian identity and personhood. 

This is a dark kenosis, one in which those aspects of one’s personhood that are explicitly of God must be emptied out, leaving only a bio-reductionistic machine that medicine can deploy toward its goals of efficiency, pragmatism, and nihilism. The hidden cultural curriculum of medicine silently, and sometimes not so silently, demands that students forsake their deepest, most treasured personal, moral, and religious commitments, disintegrating their persons in the name of contemporary medicine’s hollow, bio-mechanistic anthropology. 

From Human-Centered to Technical

Medicine was never supposed to be master and commander over our person. Yet somehow, medicine has overstepped the threshold of its proper boundaries and become all-consuming, taking on an almost cult-like religious identity and hollowing out the marrow of the God-honoring purposes we hope to bring into medicine. This leaves in its wake only the anemia and burnout of bio-reductionism.

I would argue that the “professional identity” and outlook typically expected of physicians is not only hollow and lacks moral commitments and conviction rooted in God, but is akin to our becoming like machines. Machines have no divine anthropology. They have no memory of God. Machines exist only in the present, without any comprehension of what it means to be a human being. By their very nature, machines are not humans, but things. 

Medicine takes care of persons. Yet modern medicine is becoming infatuated with things—machines, AI, and other non-human things—all while allegedly in the service of caring for human beings.

As Warren Kinghorn has written, medical school “professionalism statements are written to capture consensus, and they rarely acknowledge the external moral traditions on which the virtues depend, because doing so would, in a pluralistic culture, entail the risk of moral disagreement and division.” He goes on that “meaningful education in professionalism must look beyond the consensus statements and deeply engage the particular cultural traditions external to the practice of medicine that sustain the professional virtues.” But instead, secular humanism has become the ruling religion of medical education.

As Hendrik Van Riessen, commenting on Nietzsche, wrote in 1960, “The humanist philosophers have attempted to understand and justify the values which they wished to hold as ‘good’ but this attempt was made within the framework of reason. Religious faith is no longer accepted as a thing that could give certainty to values. But what has weakened the validity of humanistic values, in the long run, was humanism’s failure to retain an objective lawgiver. And the more these humanistic ‘values’ simply became constructs of human reason the vaguer they became.” So these words that are used in medical education such as “justice,” “freedom,” and “love” have taken on a secularized meaning. Van Riessen writes, “This process is what we would call the transition from real values to fictitious values, from reality to pretense.”

This is utterly frustrating for Christian physicians because, while being told to mechanize ourselves, embrace technology and AI, and perform and produce like a machine, we are also being told to provide whole-person compassionate care attending to the deepest, most corporal needs of our patients. This is not a provocative paradox to be worked out by cunning physicians; this is an anthropological crisis. What is a human being? What is medicine for? These questions are being trampled down without answer by the contemporary medical profession as it stampedes onward.

We cannot allow the anthropology of the medical profession to slide from a sacred human one to a merely technical one, dominated by machines and machine-like physicians. We are already witnessing how the bio-mechanistic anthropology presupposed by many physicians and educators comes to bear on the day-to-day practice of medicine. From the dehumanizing language we use to describe ourselves and our patients, to the low numbers of trainees choosing careers in primary care and instead specializing in technical fields, to the crisis level of physician burnout coupled with the high rates of dissatisfaction by patients who seek our care, the consequences of seeing ourselves and our patients as machines are obvious and alarming.

Unfortunately, our colleagues who are good at adopting the sterile medical professional identity are often the successful ones in medicine: those on whom the academy has lavished all types of awards and who are held up as models of “success.” It is those who manage to empty themselves and their patients of God who are lifted up in the profession. These are the people who often become the role models, the course directors, and the deans who predominantly shape the milieu of professional identity formation.

If medicine is no longer working from a divine anthropology, what then happens when learners are given big terms and concepts that are important to patients and medicine: terms like “justice,” “humane,” “dignity,” “compassion,” “ethics,” or even “person?” Modern medicine, with only a mechanistic anthropology, cannot possibly have any idea what these terms really mean because they are no longer rooted in the source that renders them intelligible concepts. These words are often thrown around during professionalism lectures, but they are mostly understood, if at all, only in a vague, hollow sense. Additionally, certain words like “humanity,” “dignity,” and “compassion” have been used as pretexts to encroach on the conscience rights of religious physicians who are compelled to opt out of procedures like elective abortion or physician-assisted killing. Afraid of anything having to do with God, medical professionalism and even ethics have been reduced to following a set of superficial professional rules, maxims, and administrative tasks.

R. J. Snell has written pointedly about the hollowing-out of education in general (something like what I’ve called “kenosis”) and I think his words apply especially powerfully to the state of medical education. He argues:

[T]he university often manifests that thinness which tends to occur in procedural liberalism. In the absence of a substantive vision of the good life, moral categories and language veer to the formal and procedural, thinned out until transparent, unable to bear the weight of actual living. Whenever the university retreats to a thin proceduralism, which refrains from any sort of debate, or whenever the university insists on a kind of political orthodoxy, the university fails in its task. Given the risks entailed in that task, it’s understandable why many would rather avoid it all together, retreating instead into the world of knowing that or knowing how, which is, supposedly, more value neutral or pluralistic. In doing so, however, the university contributes to the students’ sense of moral vertigo, of not occupying the moral space of a tradition, and their education is stifled and truncated. 

Supporting Moral Formation in Medical Education 

Instead of submitting to the “thin” proposal for medical professional identity formation now advocated by the medical educational establishment, we should encourage our learners to lean into the richness of the various religious moral and faith commitments that are already manifest in them as they enter the profession.

So as we think about solutions, moral formation in medical education should be based on what is already present in our learners, what is already rooted in their faith commitments that already existed before they entered the medical vocation. A proper medical education should not even imply that learners from various faith traditions need to “empty themselves” of their God-rooted anthropology. In fact, those who come into medicine with a zeal for science while holding onto a proper, God-rooted anthropology of mankind should be championed as those who are best able to provide compassionate care that is loving and good for humanity.

In the open pluralism that the academy supposedly endorses, a robust anthropology of mankind informed by a personal religious or spiritual identity should be the model of practice under DEI. Not only will this be important for students and faculty, but for the people around them who will see the richness that these religious traditions can bring to caring for patients. As Jesus says in Matthew’s Gospel: “Neither do men light a candle, and put it under a bushel but on a candlestick, and it giveth light onto all that are in the house.” There are plenty who have come into medicine with their lights burning, but through a dark kenosis have effectively put their light under a basket. Some have even put their light out.  

In my discussions with medical students from across the country, they often tell me they are looking for people who can help them think through what it means to be a Christian physician. Too often they lament that there seems to be no one at their schools or in their communities who can help them think through that question.

But I know that just cannot be true. I know there must be and that there are other Christians in these places. So that must mean only one thing: Christians are hiding, self-silencing and therefore complicitly condoning the dark kenosis of the modern medicine curriculum. And this is the central challenge: the lack of people visibly living out their lives as physicians who bear authentic witness to a Christian understanding of human dignity and the human person.

This essay is adapted from a presentation given at the Society of Christian Ethics meeting in Chicago in January 2024.

Image by thanakorn and licensed via Adobe Stock.