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The ethics of leadership for health care professionals in a post-modern context

Dr. Jim Denison is a cultural apologist who helps people respond biblically and redemptively to the vital issues of our day. He is also the co-founder and Chief Vision Officer of the Denison Forum, a Dallas-based nonprofit that comments on current issues through a biblical lens.

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Religious trends in the Western world are not encouraging. According to the latest American Religious Identification Survey (ARIS), the number of Americans who describe themselves as “Christian” has dropped from 86% to 76% since 1990. At the same time, the number who say they have “no religion” has nearly doubled to more than 15%. The number who call themselves “atheist” or “agnostic” has quadrupled, and is now almost twice the number of Episcopalians in our country.

The Pew Forum on Religion and Public Life recently released their “U.S. Religious Landscape Survey.” The survey reports that more than one-quarter of American adults (28%) have left the faith in which they were raised in favor of another religion, or no religion at all. Among Americans ages 18-29, one in four say they are not affiliated with any religion.

Spiritual trends in Europe are even more troubling. Harris Interactive conducted a large survey of religious beliefs on the Continent. Its results: in Italy, 62% say they believe in “any form of God or any type of supreme being”; in Spain, 48% of the population agrees; in Germany, 41% affirm the existence of “God”; 35% in England and 27% in France concur.

Why is Western spirituality in this condition? How are we to understand the ethics of leadership in our “postmodern context”? What is a “postmodern context”? What does any of this say to the issue of leadership for health care professionals?

Why do we think the way we do? Explaining the “postmodern” context

The first Christians held a clear and positive view of biblical authority, so that Paul could say that “All scripture is inspired by God” (2 Timothy 3:16).

The medieval world

However, the authority structures of the Christian movement soon shifted from the Bible itself to the Scriptures as they are interpreted by the Church. Ignatius, bishop of Antioch argued for the authority of the bishop over the church and a “college” of bishops as the ruling authority of the universal Church. Irenaeus further identified the Roman Church as the “preeminent authority” in Christendom, with her leaders emanating from Peter and Paul through the bishops who have succeeded them.

Soon (ca. 250) Cyprian of Carthage had separated the “clergy” from the “laity” and made his famous claim, “He can no longer have God for his Father, who has not the Church for his mother.” When Constantine made his conversion to Christianity in 312 and subsequently legalized the church, the institutional authority of the Christian movement was clearly defined as the Roman Church and her leadership.

Of course, this concept of ecclesiastical authority molded greatly the patristic and medieval concepts of Scriptural authority. As God gave the Scriptures through the Church, so (it was argued) he guided the Church through her leaders to the proper interpretation and application of his word. Creeds, councils, and papal rulings became the means by which the biblical materials were understood and transmitted.

And so the foundation blocks of the modern world were set in place: objective truth and absolute authority structures, centered in the teachings of the Church.

The Reformation project

In shorthand, the Protestant reformers sought to relocate authority with the Scriptures as they are interpreted by the individual believer. Martin Luther made the famous claim, “Only the Holy Scripture possesses canonical authority.” He discounted in turn the claims of magistrates, church councils, church fathers, bishops, and even the pope to authority over the Scriptures. John Calvin agreed: “God bestows the actual knowledge of himself upon us only in the Scriptures”; “Scripture has its authority from God, not from the church.”

With the reformers’ achievement the Protestant foundation blocks of the modern world were laid: a Bible which possesses objective meaning, theological positions which are certain and true, and Scriptural authority which is final and absolute.

The “modern” mind

While the religious world was experiencing this monumental conflict between ecclesiastical and Scriptural authority structures, the philosophical world was undergoing a struggle equally foundational and far-reaching.

Rene Descartes, a Catholic mathematician with an intense personal need to find foundational truth, sought that truth which he could not doubt. He determined that the existence of the thinking self was the first truth which doubt could not deny. As a result, he defined the human condition as one centered in the autonomous rational process. The “rationalist” worldview followed Descartes’ location of authority within human reason.

The empiricist reaction focused upon personal experience as the true authority for knowledge. John Locke asserted that the mind is born not with innate ideas (the Cartesian system) but as a blank slate, a tabula rasa. David Hume claimed that this empirical method cannot lead to true and certain knowledge. Every belief is derived from an object; our minds connect these objects into patterns on the basis of the appearance of unprovable causal relations. We cannot defend our reason by reason.

Immanuel Kant forged that merger between the rational and the empirical worldviews which organized the foundational building blocks of modernity into their final form. In short, his truce between mind and senses combined both into a larger whole: the senses furnish “raw data” which the mind organizes according to categories within itself, and the result is “knowledge.” However, according to this system we can have certain knowledge only of the “phenomena” (those objects which are present to the senses of the knower), not of the “noumena” (objects lying beyond sense experience). This distinction would prove to be crucial for the later shift from the “modern” to the “postmodern” world.

With the Kantian synthesis the philosophical foundation stones of the modern world were laid beside the Catholic and the Protestant. In all three, truth is certain and available, and epistemic authority is clear and absolute. Whether authority resides in the Church, the Scriptures, or empirical knowledge interpreted rationally, there is no question in the modern mind about its objective character.

The philosophical problem was this: there exists within the Kantian synthesis a subjective element undetected by most of its contemporary followers. In short, if knowledge is the result of our individual interpretation of our personal sense experience, then in what sense can this knowledge be objective? My sense impressions may be different from yours. My interpretation of this data is personal and subjective as well. Not only can I not know the “noumena” (the “thing-in-itself” which lies beyond my senses), I cannot claim objective authority for my interpretation of the “phenomena,” either.

The first “postmoderns”

First we must consider Friedrich Nietzsche, the “patron saint of postmodern philosophy.” According to this critic of the Christian faith, the world is composed of fragments, each one individual. We construct concepts which rob reality of its diversity and individuality (such as forming the concept “leaf” for leaves, an idea which can never do justice to the diversity of leaves). These concepts or laws are actually illusions or convenient fictions. “Truth” is solely a function of the language we employ and exists only within specific linguistic contexts. It is a function of the internal workings of language itself. The authority structure of the Church, whether centered on the Bible or the Church’s teachings, is therefore unfounded and irrelevant.

Nietzsche’s hermeneutical insights parallel Friedrich Schleiermacher’s earlier theological assertions. According to this “father of theological liberalism,” biblical texts are not systematic theological treatises but reflections of the minds and contexts of their authors. The interpreter must move behind the text to its author’s mind. The work of theology is therefore to “abstract entirely from the specific content of the particular Christian experiences.”

And so an entirely different epistemological foundation began to be laid by Nietzsche and Schleiermacher, one which rejected the objective building blocks of the modern world for a knowledge base centered in subjectivity. In their view, truth is not absolute and objective but relative and individual. Recent philosophers of language would soon finish this foundation and build a new house on it.

Finishing the new foundation

According to Wilhelm Dilthey, hermeneutics functions in a circle. We comprehend language by understanding its words, yet these words derive their meaning only within their holistic context. Objectivity in interpretation cannot be achieved, and should not be desired.

Hans-Georg Gadamer agreed that the interpreter must “fuse the horizons.” Meaning emerges only as the text and interpreter engage in dialogue, a “hermeneutical conversation.” Because each reader will conduct his or her own conversation with the text, objective meaning is obviously impossible.

Ludwig Wittgenstein rejected his earlier language philosophy (built on a scientific, mathematical, positivistic hermeneutic) for a view of language as “game.” Social rules determine the use of words and their meaning. Language is a social phenomenon which derives its meaning from social interaction. Since each “player” works from personal and subjective rules, there can be no objective authority within any speech act.

The “structuralists” further developed the social nature of language. According to Ferdinand de Saussure, language is like a work of music in which we focus on the whole work, not the individual performers of the musicians. As social constructs, texts are developed to provide structures of meaning in a meaningless existence. These structures form the foundation for hermeneutical theory and practice.

The movement known as “deconstructionism” moved even further toward subjectivity: meaning cannot be inherent in a text or speech act, but emerges only as the interpreter enters into dialogue with the author. One significant role of the contemporary interpreter is to deconstruct the modern epistemological structures with their mythical claims to objective authority.

In this century language philosophers have largely discarded the hermeneutical foundations which undergirded speech and faith since the time of Christ. Claims to objective truth and absolute authority have been dismissed, whether their source is the Church, the Scriptures, or interpreted experience. In their place we have seen the construction of a foundation and building called “postmodern.” The implications of this project for Scriptural authority are historic and monumental.

Building a postmodern world

The “postmodern” movement which has resulted from such foundational shifts is still evolving and ill-defined. However, three names stand above the rest in stature and significance: Michel Foucault, Jacques Derrida, and Richard Rorty.

Michel Foucault (1926-1984) was the most significant bridge figure from Nietzsche to the postmodern world. He insisted that all language expresses power. There is no objective “world” behind our speech; “truth” is the fictional fabrication by which we seek to make sense of a senseless world.

Jacques Derrida critiques the Enlightenment ontology with the approach known as “deconstructionism.” According to him, there is no fixed or universal reality. Not only can we make no objective claims to knowledge, given the subjective nature of the interpretive process; there is no independent reality to describe. We “create” our own world by speaking of it. Language possesses no fixed meaning and is not connected to a fixed reality. Our words do not carry meaning (“logocentrism”); rather, they create it.

For instance, the device on which I typed this manuscript is either a word-processor, a fancy typewriter, or a strange box which makes annoying clicks, depending entirely on whether I, my grandfather, or my preschool friend is describing it. We cannot get beyond the words to the “reality,” for the words create that reality for us.

Richard Rorty, one of America’s most popular philosophers, completes the postmodern foundation by demonstrating its pragmatic usefulness for our daily lives. Rorty agrees with Foucault and Derrida that language is a matter of human convention, not the mirror of an objective reality. Because no foundational truths or “first principles” exist apart from our linguistic creation of them, we must develop our personal ways of coping with reality as we see it. “Truth” for us is what works for us. Language is therefore to be judged by its pragmatic value, not its supposed representation of objective reality. Language is a tool for interpreting and coping with life.

To sum up, the postmodern worldview is built upon three foundation stones. First, the ontological and epistemological belief that no reality exists independent of the linguistic interpretation of our personal experiences. Second, the linguistic belief that we literally create our own worlds by the speech we employ to describe and interpret these experiences. And third, the pragmatic belief that such language acts, when affirmed as mutually acceptable and equally valuable, forge a community of tolerance and shared, created purpose.

Arguing for truth in a day of subjectivity

What does this evolution in worldview mean for the “ethics of leadership”? Clearly it challenges our understanding of both terms and their significance today.

In the postmodern view, “ethics” are personal, subjective, and relative. There is no such thing as absolute truth. You have no right to force your beliefs on me. So long as we are sincere in our beliefs and tolerant of the beliefs of others, we’ll get along. No objective ethics can be posited or defended.

“Leadership” is equally subjective as a term and category. Since the “will to power” is the basic drive in human nature, leadership all too easily becomes an expression of this power motive. To defend an objective, even biblical view of leadership ethics, first we must defend the notion of objective truth.

First, a philosophical response. Unfortunately, one approach to postmodernism among evangelicals is to accept its foundational beliefs and attempt to build a Christian structure upon them. This results in an intensely subjective faith which possesses no intrinsic or objective merit for others. Fortunately, there are other ways.

I suggest that the postmodern rejection of objective truth contains within itself the fissures which may lead to its collapse. In brief, if no objective truth exists, how can I accept this assertion as objectively true? According to postmoderns, no statement possesses independent and objective truth. And yet the preceding statement is held to be independently and objectively true. This seems a bit like the ancient skeptics (ca. 500 BC) who claimed, “There is no such thing as certainty and we’re sure of it.”

A second philosophical critique of postmodernism centers in its rejection of objective ethics. Since all ethics are purely pragmatic and contextual, no ethical position can be judged or rejected by those outside its culture. If this be so, then how are we to view events such as the Holocaust? Within the interpretive culture of the Third Reich, Auschwitz and Dachau were pragmatically necessary and purposeful. And yet they stand as the quintessential rejection of the tolerance and inclusion so valued by postmoderns. The postmodern must choose between his insistence on inclusion and his rejection of intolerance. Logically, he cannot have both.

The postmodern rejection of objective biblical authority thus rests upon illogical and mutually contradictory foundational principles. This “apagogic” apologetic (defending one’s position by exposing the weaknesses of its opponents) may prove effective with the postmodern who values logical consistency.

If, however, our postmodern friend simply shrugs her shoulders and says, “So what”? we can turn to a pragmatic response. Here the postmodern rejection of modernity is in our favor. The chief obstacle to faith posed by modernity was its insistence on empirical proof and scientific verification. The postmodern rejects such a materialist worldview, insisting that all truth claims are equally (though relatively) valid. The result is a renewed interest in spirituality unprecedented in our century. While this contemporary spirituality is unfortunately embracing of all alternatives, at least Christianity can function as one of these options.

How can we make an appeal for biblical authority in such a marketplace of spiritual competitors? By reversing the “modern” strategy. In modernity we told our culture, “Christianity is true; it is therefore relevant and attractive.” We invited nonbelievers to accept the faith on the basis of its biblical, objective merits. “The Bible says” was all the authority our truth claims required.

In the postmodern culture we must use exactly the opposite strategy: our faith must be attractive; then it may be relevant; then it might be true (at least for its followers). If we can show the postmodern seeker for spiritual meaning that Christianity is attractive, interesting, and appealing, he will likely be willing to explore its relevance for his life. When he sees its relevance for us, he may decide to try it for himself. And when it “works,” he will decide that it is true for him. He will then affirm the authority of the Scriptures, not in order to come to faith but because he has.

Can such an approach be effective? If we jettison our “truth first” approach to biblical authority and begin by appealing to our culture on the basis of attractive relevance, will we abandon our Scriptural heritage? No–we will return to it.

We live in a postmodern, post-denominational, post-Christian culture. The first Christians lived in a pre-modern, pre-denominational, pre-Christian world. They had no hope of taking the gospel to the “ends of the earth” by beginning their appeal to the Gentiles with biblical authority. The larger Greek world shared the postmodern skepticism of any absolute truth claim, let alone those made on the basis of Hebrew Scriptures or a Jewish carpenter’s teachings. And so the apostolic Christians build their evangelistic efforts on personal relevance and practical ministry. The result was the beginning of the most powerful, popular, and far-reaching religious movement in history.

I am convinced that we are now living in a culture more like that of the apostolic Christians than any we have seen since their day. They had no buildings or institutions to which they could invite a skeptical world, and so they went to that world with the gospel. They had no objective authority base from which to work, so they demonstrated the authority of the Scriptures by their attractive, personal relevance. We now live in a day when nonbelievers will not come to our buildings to listen to our appeals on the basis of Scriptural authority. But when we show them the pragmatic value of biblical truth in our lives, ministries, and community, we will gain a hearing.

Postmodernity offers us a compelling opportunity to “remember our future.” To remember the biblical strategies upon which the Christian movement was founded, and to rebuild our ministries on their foundation. To move into our postmodern future on the basis of our premodern heritage.

The ethics of leadership in a post-modern context

What are the practical implications of a culture which questions an objective understanding of “ethics” and “leadership”? My assertion is this: effective leadership today must be transformational rather than positional. Positional leaders assume an authority derived from their title or place within the organization. Postmodern culture questions all such assumed or inherent authority claims.

Transformational leaders, by contrast, earn the right to lead by enabling the organization to achieve its mutually-agreed upon measures of success. Such leaders empower and encourage those they lead, transforming the organization with a culture of community. This approach alone ensures sustained success in our post-modern worldview. How is transformational leadership achieved?

Choose servant leadership

First, our postmodern culture requires leadership built on relationship and servanthood. Bernard Swain describes the four types of leadership:

  • Sovereign: the leader determines both the vision and its implementation
  • Parallel: the leader serves the organization as it seeks and fulfills its vision collectively
  • Mutual: the leader serves as a member of a team which shares its duties and responsibilities
  • Semi-mutual: the leader defines the vision and direction of the organization, then serves its members as they achieve that vision through their own initiatives and efforts.

Our context requires and rewards a semi-mutual leadership style. Effective leaders know and define their passion and that of their organization, then serve and empower its members to fulfill that vision in a collective and collaborative spirit.

Oswald Sanders, in his now-classic Spiritual Leadership, claims that “true greatness, true leadership, is found in giving yourself in service to others, not in coaxing or inducing others to serve you.” Max DePree, the former CEO of Herman Miller and author of bestselling leadership literature, defines leadership:

The first responsibility of a leader is to define reality. The last is to say thank you. In between the two, the leader must become a servant and a debtor. That sums up the progress of an artful leader.

Would those you lead say that you serve them, or that they serve you?

Know your strengths

A collaborative servant leadership style builds mutuality and community. It requires that leaders know their strengths and weaknesses, and be enthusiastic about delegating responsibility and authority to those who complement and supplement their gifts. Peter Drucker, often called the “father of modern leadership theory,” distinguished four personalities needed for the tasks of top management:

  • The “thought” person
  • The “action” person
  • The “people” person
  • The “front” person

Drucker believed that these four temperaments are almost never found in a single person and warned, “the one-man top management job is a major reason why businesses fail to grow.”

A servant leader in postmodern context will celebrate the gifts and passions of those he or she serves in the organization. Who are you empowering and encouraging as they join you in fulfilling your organization’s vision?

Choose personal integrity

The leader’s personal character is foundational to success in a culture which disparages positional authority. Sanders quotes the great military leader Bernard Montgomery: “Leadership is the capacity and will to rally men and women to a common purpose, and the character which inspires confidence.” The second is essential to the first.

Warren Bennis is the University Professor and Distinguished Professor of Business Administration and Founding Chairman of The Leadership Institute at the University of Southern California. In 1976 he warned us about the “unconscious conspiracy” in every organization to maintain the status-quo for the future benefits of current participants. The solution is for leaders to empower their followers to fulfill the organization’s collective vision for the benefit of its members and customers. To do so, leaders must embody four critical competencies:

  • Management of attention
  • Management of meaning
  • Management of trust
  • Management of self

In a culture which depreciates leadership by position, it is essential that we earn the right to lead by virtue of our personal character. We cannot ask people to do what we are unwilling to do, or go further than we are willing to lead. What the leader is, the organization becomes.

DePree cites Mahatma Gandhi’s list of the seven sins in the world:

  • Wealth without work
  • Pleasure without conscience
  • Knowledge without character
  • Commerce without morality
  • Science without humanity
  • Worship without sacrifice
  • Politics without principle.

Because character is so central to effective leadership today, spiritual formation is now indispensible for leaders. If the members of your organization were as committed to personal integrity as you are, would that be good for your colleagues and customers?

Conclusion/Discussion

My argument is that the post-modern context challenges positional leadership assumptions, requiring leaders to transform their organization through service, community and integrity. Such leaders enable and empower their followers to achieve mutual goals in an environment of sustained success.

How does such an approach to leadership relate to the challenges facing those of you who lead professional health care providers? Let’s discuss three areas of application.

First, would you specify case examples of leadership challenges you face? Let’s discuss ways a transformational leader could approach these challenges.

Second, given the vital role which character and integrity play in post-modern leadership, what personal ethical and religious resources encourage you in your work?

Third, what professional and religious/spiritual community sources can you identify as assisting you as leaders in health care?

When Allied armies advanced on the North African port of Eritrea during World War II, the fleeing Axis forces did an ingenious thing. They loaded barges with concrete and sank them across the mouth of the harbor, making it impossible for the approaching troops to enter. But the Allies hit on an even more inventive solution. They emptied several gigantic oil tanks, the kind which hold one hundred thousand barrels of oil and more, and sealed them watertight. They attached chains to each of them. Then at low tide their divers attached the other ends of the chains to the barges sitting on the bottom of the harbor. And when the tides rose, their power was so great that they lifted the sealed oil tanks and the cement-filled barges with them. It was then an easy task to dispose of the barges and reopen the harbor.

This power of the tides inspired Shakespeare to pen these immortal words:

There is a tide in the affairs of men

Which, taken at the flood, leads on to fortune;

Omitted, all the voyages of their life

Is bound in shallows and in miseries.

On such a full sea are we now afloat;

And we must take the current when it serves,

Or lose our ventures.

—Julius Caesar, Act IV, scene II

If we embrace the challenge of servant leadership in the postmodern tides of our day as transformational leaders who serve, build community and lead by example, we will “take the current when it serves” and become the most effective leaders we can be. May it be so for each of us today.