Hard conversations are not easy and certainly take thoughtful consideration to be meaningful and effective. Understanding the art and science of having hard conversations begins with the conviction and motivation to have it in the first place.

One of the most common crossroads I encounter when counseling those dealing with anticipating a hard conversation is helping them “want to want” to have the conversation. Of course, I empathize—you would have to be spiritually masochistic to enjoy the possibility of an uncomfortable conversation. Hard conversations range the spectrum from awkward moments to unwelcomed confrontations. However, there is a crossroad of conviction that we must navigate to compel ourselves to pursue something unlovely with genuine love.[1] Let’s consider a few of the compelling reasons and practical considerations for having the hard conversation.
1. We Have a Responsibility to One Another (1 Cor. 12:16; Heb. 3:12-14)
A foundational motivation towards having a hard conversation is a sincere concern about the wellbeing of our brothers and sisters in Christ. The belonging we share in Christ compels our love to move towards those in need of insight or care. These moments are not always welcomed or easy. The difference between immaturity and immorality can be difficult to discern in understanding people and their problems. The motivation to move toward one another is a familial-based motivation moving beyond friendship and collegial niceties. Belonging that is mutually dependent and interrelated is the blessing of the redeemed household of God.
2. We Have the Ability to Live in the Truth (Col. 3:1-4, 16-17; Rom. 12:1-3)
The defining characteristic of the transformational work of the gospel is our ability to live in the truth. Our hearts are prone to deception because of our sin, but the renewing of our minds, according to the Word and the Spirt, brings the capacity to both understand and live in the truth. The recognition of reality is a sobering task, but the gospel reframes and always gives pathways with eternal hope. Living in the truth of the gospel (as applied to the realities of the human experience) does not remove the harsh realities of life. Still, it does categorically and practically give perspective and pathways to living rightly with confidence and hope. Having a hard conversation is not simply addressing hardships but pursuing hope and help to live rightly in the truth.
3. We Have a Calling of Gospel Witness (1 John 4:11-12; John 13:35)
How we live matters. The truth of Scripture is visible not only in the pages of God’s Word but in the actions of our lives. Pursuing one another through the challenges of hard conversations to live rightly before God and others is counter-cultural. When the church displays unity within an immense diversity of cultures, personalities, and life experiences, it proclaims the transforming work of our reconciliation with God and one another. Moving towards one another through hard conversations is motivated not primarily by interpersonal health but the testimony of the gospel.
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Programming on “structural racism” and the “need for a diversified workforce” is now part of a core content area, according to the academic head of the American Medical Association. A mandatory three-semester course at the University of Pennsylvania medical school, Doctoring I, looks at such topics as “race/racism in medicine,” “narratives,” and “structural competency” (the last means that, if you are white, you are structurally incompetent to give optimal care to underrepresented minorities). The Diversity Strategic Action Plan at the Case Western Reserve medical school trains faculty and students to address implicit bias and microaggressions. The DSAP was developed in response to the changing demographics of the student body, explains the school. None of these courses will help physicians diagnose obscure tumors or prescribe the proper course of drugs.

On March 16, 2024, surgeons at Massachusetts General Hospital transplanted a genetically modified pig kidney into a 62-year-old man suffering from end-stage kidney disease. The groundbreaking operation was, among much else, a refutation of the STEM diversity crusade, which threatens the medical progress that lay behind the landmark procedure.
Transplant recipient Richard Slayman had endured the usual debilitating effects of kidney failure for years. Healthy kidneys filter toxins and excess fluids from blood and excrete those waste products as urine. When kidneys fail, if no donated human kidney is available to replace them, patients spend hours a week hooked up to a dialysis machine that filters their blood mechanically. Slayman had already spent seven years on dialysis before receiving a human kidney in 2018. That transplanted kidney itself faltered, however, and by 2023, Slayman was back on dialysis. This time, though, he required biweekly visits to the hospital to keep his blood vessels open. He developed congestive heart failure. And he rejoined the more than 100,000 Americans waiting, often futilely and fatally, for a human kidney.
If Slayman’s new pig kidney continues to function, the capacity to transplant animal organs successfully into humans (a process known as xenotransplantation) will be as significant as curing cancer, says nephrologist Stanley Goldfarb. Getting to this point required 125 years of scientific creativity and an ever more complex understanding of molecular biology. None of that development had anything to do with racial identity.
Slayman’s genetically modified pig kidney represents a return of sorts to the origins of transplant science. When surgeons started contemplating organ transplants in the early twentieth century, they initially focused on organs from other mammals, since harvesting human organs was considered problematic at best. The French surgeon Alexis Carrel began a series of transplant experiments on dogs after discovering how to connect arteries to arteries and how to widen narrowed vessels—prerequisites to organ transplantation. For the next several decades, surgeons in France, Germany, Russia, and the U.S. transplanted goat, sheep, and monkey kidneys into dying human patients, but the organs (and patients) quickly failed. It would take the evolution of another branch of medical science—immunology—to understand why.
It turned out that the human immune system was attacking the foreign tissue. The more distant the donor mammal from the human species, the more vehement the immunological response against the transplanted organs. Within minutes after transplant, a rejected organ might swell up and become discolored under a barrage of antibodies and white blood cells attaching to its surface and destroying the interloper.
In response, chemists and microbiologists began developing drugs that lessened the risk of organ rejection by suppressing the immune system. In 1961, the American plastic surgeon Joesph Murray used immunosuppression to transplant a kidney between genetically unrelated humans. The recipient survived a year—by contemporary standards, a resounding success.
But the drugs and other procedures used to suppress the immune system could themselves prove fatal by leaving a patient unprotected against overwhelming infection. What was needed was a way to avoid triggering an immune response in the first place. The following are a handful of the most notable (and also Nobel Prize-winning) of the thousands of discoveries that would make that possible. The Venezuelan-American immunologist Baruj Benacerraf, along with Jean Dausset and George Snell, identified key proteins on cell surfaces that trigger immune defenses. The British biologist John Gurdon learned how to transfer nuclei among cells, thereby transferring the genetic code from a donor cell to the target cell. Gurdon also confirmed that a nucleus from a fully differentiated somatic cell would revert to its initial state and trigger the process of cell division leading to an adult organism all over again, if that nucleus is transferred into an undifferentiated, enucleated zygote. Biochemists Emmanuelle Charpentier, Jennifer Doudna, and Feng Zhang discovered how to edit genetic code using bacterial enzymes, in a process that came to be known as CRISPR.
Thus it came to be that eGenesis, a biotech company in Cambridge, Massachusetts, produced a pig kidney that the human immune system, it was hoped, would not recognize as alien. The company extracted a cell from a pig’s ear and removed genes from the cell’s nucleus that produce proteins offensive to that human defense system. As insurance, the company added human genes to the pig nucleus that would mimic human biochemistry. eGEnesis inserted that edited nucleus into a dividing pig zygote. That zygote grew up into a bespoke pig, with the edited genetic code from the pig ear in every cell of its body, including its kidneys. The goal: those kidneys, denuded of their capacity to produce especially problematic pig molecules, would find a welcome home in a human being.
Before the Slayman procedure, genetically modified pig kidneys had been transplanted into brain-dead patients and had started filtering those patients’ blood. Slayman was the first living recipient of an edited pig kidney. When he came out of the operation successfully, the leaders of Mass General Brigham (the umbrella entity for Mass General Hospital) rejoiced. The hospital’s clinicians, researchers and scientists had shown “tireless commitment . . . to improving the lives of transplant patients,” said the president of the complex’s academic hospitals. One of the transplant surgeons acknowledged the history behind this latest scientific milestone: The “success of this transplant,” said Tatsuo Kawai, is the “culmination of efforts by thousands of scientists and physicians over several decades. . . . Our hope is that this transplant approach will offer a lifeline to millions of patients worldwide who are suffering from kidney failure.”
According to STEM diversity dogma, however, none of this should have happened. Slayman is black; his transplant surgeons were not. The scientists who pioneered the biological and surgical advances that made the transplant possible were also nonblack. Worse, before the mid-twentieth century, those pathbreaking scientists were overwhelmingly white.
These demographic facts mean, according to today’s medical establishment, that Slayman was at significant risk of receiving substandard care from a medical and scientific enterprise that is racist to its core.
According to the National Academies of Science, America’s most prestigious science honor society, “systemic racism in the United States both historically and in modern-day society” produces “systematically inequitable opportunities and outcomes” in medicine. Such medical racism privileges white patients and white doctors, explains the National Academies of Science, and is “perpetuated by gatekeepers through stereotypes, prejudice, and discrimination.” The Journal of the National Cancer Institute and its sister publication, Journal of the National Cancer Institute Spectrum, blasts the “systemic and institutional racism within health care” responsible for “inequities” in medical outcomes.
The best way to guard against such inequities, according to the STEM establishment, is to color-match patients and doctors. Similarly, the best way to advance science is to select scientists on identity grounds. The National Institutes of Health, which funds biological research, argues that a “diverse” scientific workforce will be better at “fostering scientific innovation, enhancing global competitiveness, [and] improving the quality of research” than one chosen without regard to racial characteristics. The National Institute of Allergy and Infectious Diseases, another federal funder, seeks scientists of the right color to “develop a highly competent and diverse scientific workforce capable of conducting state-of-the-art research in NIAID mission areas.” It is a given, per the National Academies of Science, that “increasing the number of Black men and Black women who enter the fields of science, engineering, and medicine will benefit the social and economic health of the nation.”
Slayman’s transplant surgeons—Leonardo Riella, Tatsuo Kawai, and Nahel Elias—came from non-European, non-white countries: Brazil, Japan, and Syria. Don’t think that those surgeons count as “diverse,” however. In the scientific establishment, as in all of academia, diversity at its core refers to blacks, with the other “underrepresented” minorities—American Hispanics and Native Americans—occasionally thrown in for good measure. When medical associations, medical schools, and federal agencies conduct diversity tallies (which they do obsessively), their primary concern is the proportion of blacks in medical education and practice. The American Medical Association’s chief academic officer, Sanjay Desai, is scandalized that “only” 5.7 percent of doctors identify as black, though blacks make up over 13 percent of the population. The American Society of Clinical Oncology’s March 23 bulletin complains that only 3 percent of practicing oncologists identify as black. By contrast, nearly 90 percent of hospital leadership “self-identify as White,” according to doctor Manali Patel. The National Institute of Allergy and Infectious Diseases sees a crisis for medical science in the fact that “only” 7.3 percent of full-time medical faculty come from “underrepresented backgrounds,” though those “underrepresented backgrounds” constitute 33 percent of the national population.
The team leader in the Slayman transplant, Riella, directs a kidney transplantation research lab at Mass General. Its members look like a United Nations gathering, with researchers from Turkey, Lebanon, China, Spain, Japan, and other non-U.S. countries. Though white Americans are a small minority in the Riella Laboratory, it would not count as “diverse” for purposes of science funding or political legitimacy, because it has no blacks in it. We are to believe that this absence of blacks comes from white supremacist machinations, though those backstage white supremacists didn’t do a very good job of maintaining numerical advantage in the lab. And without blacks, the Riella Laboratory has never functioned at the highest levels of scientific achievement, according to diversity thinking.
Slayman may have had a positive outcome this time, despite being treated by nonblack transplant surgeons, but other black kidney patients have no guarantee that they will be as lucky in the future. In early April, the New York Times wrote about new techniques for keeping donated organs functioning outside of a body before transplant, a process known as perfusion. The transplant doctors whom the paper quoted—Daniel Borja-Cacho (originally from Colombia), Shimul Shah, Shafique Keshavjee, and Ashish Vinaychandra Shah—also don’t resemble the members roster of a Greenwich, Connecticut, country club, circa 1955. The Times undoubtedly tried to find a black source. Its inability to do so reflects a medical ecosystem that, according to the establishment, lacks diversity and, as such, puts black lives at risk.
So medical schools, hospitals, and funders are working overtime to change the racial demographics of the medical and science professions. First job: rewrite the past. The history of medicine and science is scandalously Western and scandalously white. To be sure, the ancient Egyptians and Babylonians made early contributions in mathematics and folk medicine, and Arab and Indian cultures introduced our present number system and some rudimentary algebra. But the essence of science—the “mathematization of hypotheses about Nature,” in historian Joseph Needham’s words, coupled with hypothesis testing and controlled experimentation—sprung from ancient Greek critical thinking and gathered unstoppable momentum in early modern Europe. That great, rushing onslaught of discovery remained for centuries exclusively European—i.e., Caucasian. And that is an embarrassment. To protect medical students from the traumatic effects of that historical lack of diversity, medical schools are trying to conceal the demographic reality of what was once (but is no longer) a Western phenomenon.
A portrait of Joseph Murray used to hang in the main teaching amphitheater of Brigham and Women’s Hospital. (Murray was the Nobel-winning plastic surgeon whose organ transplant work in the 1950s and 1960s laid the groundwork for the Slayman pig kidney operation.) After the Slayman operation, the leaders of Mass General Brigham (which manages Brigham and Women’s Hospital) may have celebrated their forebears’ boundary-pushing science, but in 2018, the president of Brigham and Women’s Hospital, Betsy Nabel, removed Murray’s portrait from its place of honor. Murray was not the only Brigham scientist purged from the school’s portrait gallery. Twenty-nine other paintings of the hospital’s medical giants—including trailblazing brain surgeons and pathologists—were also taken down, because, like Murray, they were offensively white. (A Chinese scientist in the portrait gallery who had slipped past the white supremacist gatekeepers was also removed, due to guilt by association.) Other components of Mass General will be repositioning now-unacceptable visual tributes to their medical past.
Yale’s Sterling Hall of Medicine contains 55 portraits of Yale’s medical luminaries. They, too, are doomed. A Yale professor and two medical students interviewed 15 other Yale medical students about those white (though not all male) faces in the Sterling Hall gallery.
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Transferring human obedience, creaturely obedience, into the life of God implies his creaturehood. That implication must be rejected. As the Bible tells us and consent of the church has confirmed, the Father and Son are distinguished by Fatherness and Sonness. Their relation is one of Fatherness and Sonness. 

In 2016 Evangelicals debated about the best way to affirm that God is one and yet Father and Son. The old answer is: the Father begets the Son eternally; the Son is eternally begotten. Beget and begotten are old words to describe how fathers generate children. A mother births them; a father begets.
In recent years, evangelicals attempted to find a new way to talk about Father and Son. They said that the Father relates to the Son because he has paternal authority; the Son relates to the Father in a mode of submission. Authority and submission distinguish Father and Son.
For the most part, people found the new approach insufficient. It implied eternal inferiority of the Son, implied two wills, and inserted the human life of Jesus where he obeyed the Father into God. It unintentionally implied a creaturely characteristic in God since Jesus’s creaturely obedience to the Father gets imported into how God is eternally!
Recently, however, a theologian reaffirmed that the Father eternally has authority over the eternally submissive Son. Interestingly, the theologian cited Augustine and Hilary of Poitiers as proponents of his position. 
Two Reasons Why Eternal Submission Does Not Work
First, Jesus submits to the Father in his role of Mediator, one who became obedient to the point of death in the form of a slave (Phil 2:7). But he was equal to the Father in the form of deity (Phil 2:6).
To transfer submission into God as the way the Father and Son differ is to transfer a creaturely characteristic into God. Because Jesus took on humanity, he obeys the Father vicariously in his role of Mediator for our sake.
Second, the church Fathers such as Augustine and Hilary made the above distinction clearly. They affirmed the obedience of the Son according to his humanity. But they did not pass through this obedience into God to explain how the Son and Father eternally related.
Just one example. Augustine in The Trinity writes: “In the form of a servant which he took he is the Father’s inferior; in the form of God in which he existed even before he took this other he is the Father’s equal.” Elsewhere, he says “the Father is greater than is the form of the servant, whereas the Son is his equal in the form of God.”[1]
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