Triage in the Trenches

In doctrinal terms, certain doctrines (first tier) are essential for the life of the church. If you deny such a doctrine, you lack life; you’re outside the Christian faith. Other doctrines (second tier) are essential for the health of the church. If you deny such a doctrine, it doesn’t mean you’re spiritually dead, but instead that you’re spiritually sick. Finally, some doctrines (third tier) are essential for the practice of the church. These are matters which don’t directly bear on life or health but do relate closely to how we order and structure our churches, and thus there is need for significant alignment on these matters among members of a given church.

As Christians face the fragmenting of some churches, denominations, and movements, many have turned to the concept of “theological triage” to help navigate the turbulent waters of doctrinal disagreement.

In a recent article, Scott Hubbard ably distills theological triage, drawing the basic category from Al Mohler and then using Gavin Ortlund’s book to distinguish four ranks or tiers of doctrinal difference:

First-rank doctrines are essential to the gospel itself.
Second-rank doctrines are urgent for the health and practice of the church such that they frequently cause Christians to separate at the level of local church, denomination, and/or ministry.
Third-rank doctrines are important to Christian theology but not enough to justify separation or division among Christians.
Fourth-rank doctrines are unimportant to our gospel witness and ministry collaboration. (Finding the Right Hills to Die On, 19)

Finally, Hubbard draws on Rhyne Putnam for three tests to aid in our discernment process:

The hermeneutical test: the clearer the Bible teaches a doctrine, the more likely it belongs on a higher tier.
The gospel test: the more central a doctrine is to the gospel, the more likely it belongs on a higher tier.
The praxis test: the more a doctrine affects the practice of a church, the more likely it belongs on a higher tier.

This basic framework is helpful. Still, it frequently leaves us with a puzzle concerning the second-tier issues. In most contemporary uses of theological triage, differences over baptism and differences over manhood and womanhood are both regarded as second-tier issues. In actual practice, however, there seems to be a substantive difference between these two issues. Organizations and conferences like The Gospel Coalition and Together For the Gospel treat these two issues differently. In both cases, baptismal differences are not regarded as barriers to participation, whereas differences over manhood and womanhood are. What might account for this difference (and others like it)?

Theoretical Triage: Thinking About the Body

I believe that further refinement of theological triage can clarify why we would treat certain second-tier disagreements differently than others. (Note: this refinement focuses on the theoretical side of triage. In application to any particular situation, there will be critical concrete and practical considerations in play as well.)

The language of triage is drawn from the field of emergency medicine. In keeping with this imagery, we can consider how we assess the life, health, and practice of the physical body, as an analogy for assessing the life, health, and practice of the body of Christ. (In principle, this same analogy could be used to assess the doctrinal health of an individual as well; for simplicity’s sake, we’ll focus on the church as a body.)

First Tier: Are You Alive?

Thinking in terms of bodily life, health, and practice enables us to identify why certain doctrines are “of first importance” (1 Corinthians 15:3). Paul uses that phrase to refer to the gospel by which we are being saved, if we hold fast to it. He refers specifically to Christ’s death for sin, as well as the historicity of his burial, resurrection, and subsequent appearances. To falter on such gospel truths is to “believe in vain.”

Thus, first-tier issues are matters of gospel significance. Manifest errors on or denials of such fundamental doctrines places one outside the Christian faith. We often summarize the basic gospel in terms of either God-Sin-Christ-Faith or Creation-Fall-Redemption-New Creation. Both of these reveal the foundational doctrines to be embraced and confessed in order to be Christian. The doctrine of the Trinity, the deity and humanity of Christ, his work on the cross and in the resurrection, and salvation by grace through faith are generally regarded as first-tier issues. To deny such doctrines is to fall short of the Christian faith completely.

However, often overlooked in our discussions of gospel issues are fundamental errors on the nature of creation, humanity, and sin. Such issues of anthropology (what C.S. Lewis referred to as the Tao, or the moral order of the universe recognized by all people) could also fall into the first-tier category. Paul explicitly says this when he mentions that “Christ died for our sins” as a matter of first importance. Similarly, the Bible points in this direction whenever it makes clear and manifest violations of the moral law grounds for excommunication from the church and exclusion from the kingdom (1 Corinthians 5–6; Galatians 5:22–23). These moral issues are not merely a matter of special revelation, but are universally known and binding through general revelation in creation and conscience.