The Problem from a Protestant
The following remarks do not attempt to treat either Protestant ethics or the problems of allocating resources within the health care system in their entirety. Rather, my purpose is to draw attention to particular aspects of this broader issue that are of fundamental importance to Protestant ethics. One of the central insights of Protestant theology is the foundational need to develop health care policy that explicitly recognizes the fallen character of this world. Such a recognition allows us not to be tempted to seek to do the impossible. It focuses us on responsibly accomplishing what we can realize and, with respect to problems of allocation, leads us to seek an ethical program for those patients who will be directly affected.
Luther's teaching on the two kingdoms reveals the idea of the “perfect life” as an eschatological concept and concludes that the only means by which we can partake of it on this earth is “through faith.” Thus, here on earth only a relative order is possible, the goals of which are essentially defined by the avoidance of discord. Within the framework of this worldly and temporal order, it is necessary for every Christian to accept his or her lot in life. As Luther points out, “No one should lament that he is poor or his estate too low.” The blessings of God, he adds, are “manifold and therefore unequal” (1913; WA 49, 609, 15; WAI 2, 334, 2).
Nevertheless, Lutheran theology and jurisprudence have always considered it a salient task to chart a design for the relative order of this world. A significant paradigm therein is necessarily the problem of the distribution of limited resources, especially the distribution of land. Likewise, there must exist a public order capable of protecting private property from arbitrary violations. Here, two models are of particular salience. The first is the contract model, as it originates primarily with Hobbes. Here, public peace is ensured by a monopoly of power in the hands of the state. However, the particular private holdings of individuals are left entirely to chance; all that is guaranteed is the protection of that which