The Doctor’s Worldview
by John Wyatt

Worldviews are the understandings each one of us has about the way the universe is. All our thoughts, beliefs, and actions are based on these fundamental presuppositions about reality, and they are therefore critical in medical ethics. Different worldviews will sometimes lead to radically different decisions. But worldviews are not just to do with philosophical questions about belief. They are inextricably tied to the way we behave, the choices we make, and the way we interact with others. The philosophical idea of the worldview links up with the biblical concept of the heart.

The story is told of an Indian sage who taught that the world rested on the back of a giant elephant that stood in turn on the back of an even larger turtle. A cynical Westerner asked the sage:
‘And what does the turtle stand on?’
‘Another turtle.’
‘And what does that one stand on?’
‘Another turtle’ and so on…
‘But what about the bottom turtle, what does that one stand on?’
‘Young man, it’s turtle all the way down…’

Modern societies are often described as ‘pluralistic’. They encompass people from many different cultures and backgrounds, from different ethnic and racial groups, with different attitudes and beliefs. Whether we like it or not, this is a feature of the modern world, and of modern healthcare systems. Behind the more obvious cultural differences between people, there lie much more profound differences in presuppositions and beliefs; there lie different understandings of right and wrong and of the nature of reality. These hidden presuppositions are much harder to identify and understand, but they play a crucial role in the way we think and behave, and they are at the root of many current ethical controversies in medicine and healthcare.

You may think that this subject is too abstract and philosophical to be interesting, but it is directly relevant to modern debates in medicine and ethics!


The concept of the worldview (Weltanschauung in German) has been around in philosophy and the social sciences for more than 200 years, but it is difficult to provide a clear and coherent definition. In essence, someone’s worldview is their understanding of the way the universe is. It encompasses the fundamental presuppositions about reality on which all their thoughts, beliefs and actions are based (whether those presuppositions are logically consistent or not). It’s not possible to be neutral, uncommitted or ‘agnostic’ when it comes to a worldview. There is no neutral ground on which it is possible to stand. ‘Everyone is coming from somewhere’, whether they are prepared to recognize their presuppositions or not.

Some philosophers, such as Nietzsche (1844-1900) and Foucault (1926-1984), have used the idea to argue that every person’s understanding of truth and of reality was relative to their particular time, history and social circumstances. In other words, there is no such thing as absolute truth. But we can use the concept of the worldview without accepting this relativistic understanding.

One way of understanding the concept of worldview is as the answer which each of us give to a series of ultimate questions:

  • What is ultimate reality?
  • What is a human being?
  • How is it possible to know the difference between right and wrong?
  • What is the point of existence?
  • What happens to people when they die?
  • What is the meaning of human history?

It is obvious that an orthodox Christian believer, an atheist scientist, and a traditional Hindu would give radically different answers to these questions.

In essence, someone’s worldview is their understanding of the way the universe is

But worldviews are not just to do with philosophical questions about belief, and systems of thought. They are inextricably tied to the way we experience the world and the way we behave. If you want to know what someone’s worldview is, look at the way they behave, look at the choices they make, look at the way they interact with others. This is where the philosophical idea of the worldview links up with the biblical concept of the heart.

Biblical Perspectives

In biblical thinking a person’s ‘heart’is the core of their innermost being. The Hebrew word (Leb) occurs more than 800 times in the Old Testament, and the Greek equivalent (cardia) occurs more than 150 times in the New Testament. To the New Testament authors, the heart is the center of human affections, the seat of the intellect and the will, and the source of the spiritual life.

It was a central concept in the teaching of Jesus: ‘The good man brings good things out of the good stored up in his heart, and the evil man brings evil things out of the overflow of his heart his mouth speaks.’ – Luke 6:45; ‘…the things that come out of the mouth come from the heart…For out of the heart come evil thoughts…These are what make a man “unclean”.’ – Matthew 15:18-20; ‘I know that you do not have the love of God in your hearts.’ – John 5:42.

For Jesus, the heart is the place where a treasure resides. Alternatively it is seen as a tree which produces fruit of various kinds, and from which words and deeds emerge. The heart is the unseen core, the nucleus of the person, from which all their thoughts, actions and words overflow. In the biblical language, all the experiences of life flow into the heart. As a child grows, learns and experiences the world, their heart is formed and moulded by the flow of information, sensations and relationships. In fact our hearts are continuing to be moulded and formed throughout our lives. In Christian thinking, conversion involves a radical change of heart, and sanctification is the ongoing process in which the heart is being moulded and formed by the Holy Spirit.

But just as our hearts are moulded by the experiences of life, our hearts are also the source of our thoughts, actions and words. These are what flow out of our hearts and they reveal the nature of the treasure within. This is why the writer of Proverbs instructs: ‘Above all else, guard your heart, for it is the wellspring of life’ -Proverbs 4:23.

In passing, it is interesting to compare this Hebraic understanding of the human person, with the heart at the center, with the ancient Greek philosophers such as Plato, who tended to emphasize thought, consciousness and mind (nous) as the most important aspects of human existence.

As the philosopher David Naugle has pointed out, the ancient Hebraic and biblical concept of the heart links in closely with recent philosophical thinking about worldviews, as a life-determining vision of reality.

they are critically important in determining our attitudes to fundamental ethical questions

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