Chapter 1 continued…The ethical moment

Pat arrived in the ICU at about 3 am. 15 minutes after arrival he had a respiratory arrest, was intubated and sedated. His hospitalist arrived shortly afterward, pieced together the history (again) and adjusted fluids, antibiotics, pressors and vent settings and ordered 2 units packed cell transfusion. He also initiated a screening evaluation for internal bleeding and heart attack and consulted specialists from critical care and hematology. Blood cultures were cooking and he was settling in for a long bumpy ride. “Who is this guy, man is he sick”, thought the hospitalist.

Theologian and ethicist Stanley Hauerwas in his book “Suffering presence” says, “it is useful to reflect on our reaction to someone suffering: suffering makes the other a stranger…but it is exactly the ability to make the suffering mine that is crucial if I am to be an integral self” (p.25). In this ethical moment, in the 3 am post code sedated momentary calm of the ICU, after the medical intervention has been fully initiated, the heart of the physician is challenged. Before her lies a marathon running septic leukemic. But even deeper lies a lonely and vulnerable person who is totally abandoned by body, philosophy and god. Hauerwas states further, “[doctors] must always live between two worlds: that of their particularist convictions (private conscience) and the public morality needed for the maintaining of a peaceable community” (p.9). Additionally, writing as an ethicist and not a clinician, Hauerwas (as do most philosophical ethicists) implies that this tension is not necessarily important to resolve. In his book “Naming the silences” he states outright that the moral rationale for a physician making sense out of this type of ethical moment (p.118-126) is not his emphasis. But how clinicians create for themselves a moral rationale to be at the bedside of a lonely and vulnerable patient like Pat is of the utmost importance in keeping the medical profession morally and rationally grounded and people focused. Dr. X can and should not stifle her theological motivation for being at Pat’s bedside. Disciplined adherence to the Hippocratic oath without personal philosophical justification while laudable is not conducive to creating a moral center to ones actions or an “integral self”. Additionally, the classical ethical principles are too general to build empathy in this situation. If one does not reconcile a moral center with their clinical actions, especially when those actions are mentally and physically demanding, we run the risk of allowing the patient to transform from a person to a problem.

So from where can we gather an existential purpose to support our rational professional commitment to a patient’s welfare? Again, in “Naming the silences”, Hauerwas approaches this from the point of view of the patient. But this approach can be also applied to the clinical community as well. In reviewing the issue of theodicy, that is in trying to understand and defend why the illness and loneliness effecting Pat can happen in a universe where there is an all knowing, all loving and all powerful God, Hauerwas puts forth 2 possibilities. We can either view this problem as a logical conundrum which needs to be solved or as relational challenge that requires the presence of a supportive (for Hauerwas, faith tradition) community. The intentional presence of a clinical community or even a single clinician at the bedside providing a physical presence representing community to Pat is actually theodicy in action. If it appears god is absent, the presence of a Godly clinican at the bedside becomes a proxy for God’s presence. God empowers His people to be his arms and legs and in so doing embraces His lonely and suffering child.

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