Book title: Embracing Ethical Moments; how medicine can confront crises and empower hope
Augustine, Barth, Schweitzer and the crisis of the ethical moment…
Posted on February 1, 2012
Classical medical ethics has focused on the application of normative principles in guiding a clinician’s actions. As summarized in Annals of Internals Medicine (2012;156:73-104), the principles of beneficence (the interest of the patient is first priority), nonmaleficence (do no harm), autonomy (empowering a patient’s own decision making) and justice (equitable distribution and access to health care) provide a guideline for polite clinical behavior in the public square. But polite public behavior becomes intensely personal in a moment of crisis, in that moment when a person encounters life changing events that cause introspection into the meaning, purpose and end of life. In speaking of the ministry of Ambrose to his ethical moment Augustine says, “…it was by him (Ambrose) that I had been brought thus far to that wavering state of agitation I was now in, through which…I should pass from [spiritual] sickness to health, even though it would be after a still sharper convulsion which physicians call the crisis.” (Confessions 6.1.1) As Ambrose was present with and spoke words into Augustine’s ethical moment, Augustine was able to process and bring to resolution his crisis. He says, “But, just as it happens that a man who has tried a bad physician fears to trust himself with a good one, so it was with the health of my soul, which could not be healed except by believing. But lest it should believe falsehoods, it refused to be cured, resisting your (god’s) hand, who have prepared for us the medicines of faith and applied them to the maladies of the whole world, and endowed them with such great efficacy.”(Confessions 6.4.6) Karl Barth, in his commentary on Romans, implies that crisis is the point at which life’s events cause us to realize and then reach out to fill up that sense of “there has to be more than this”. It is in this moment of crisis, when the science of medical practice merges with the demand for theological truth, that principles beyond beneficence, nonmaleficence, autonomy and justice must speak. This is why a patients’s choice of a physician is so intensely personal. In the management of hypertension there is not much of a need for theological truth. But in that moment when a physicians sees the uncertainty in a patient’s eyes or hears the wavering in his voice during a discussion of a serious test result Schweitzer would imply (Anthology p.140) that our “inner light” should speak. The application of the inner light speaking to an ethical moment takes experience, wisdom and a solid doctor/patient relationship. But this unique intersection between the science of medicine and its ethical practice should not be avoided, but embraced.
Henry David Thoreau writes in Faith in a Seed about the “natural order” (shearwater books 1993 p.104) of his writing, namely that his works involved “pulling together observations from all he had and melding them in a way that created what he called a natural order”.(cramer, xxii) This conglomerate picture, true in its parts, did not reflect in actuality any consistent or chronological single set of events or persons. In writing a book on the interface of medicine with theology at the locale of the patient bedside, this approach seems appropriate as well. The impact of real clinical moments in illustrating crises and hope can not be avoided.
Meet Pat and Pati. Both of these people, archetypal by design and shorthand for the word “patient”, are used in the pages that follow to personify the male and female components of these clinical moments. They do not represent any single event or person but rather “a pulling together of the natural order” as Thoreau would put it. As Pat and Pati share their stories against the backdrop of theological critique, it is hoped that the loneliness, despair, joy and compassion they experience will resonate with those who encounter or become Pat and Pati regularly or rarely; and in studying these encounters put all in a better position to demystify, detechnologize and ultimately enhance personal medical care in this age of the depersonalizing of medical practice.
As a professionally trained physician and theologian, I hope I am in the position to offer insight into this medicine theology interface. While some of the points may be idealistic or even unattainable, I hope they can offer a fresh look at the relational core of the medical profession. But in speaking of the relational power of an ethical doctor patient moment, I hope to re-focus our professional values discussion on what it is that makes the practice of medicine such a special calling; the people we are called to serve.