Medicine is a Moral Enterprise
Anne-Louis Girodet de Roussy-Trioson, Hippocrates Refusing the Gifts of Artaxerxes, 1792.
“Medicine is a moral enterprise.” This quotation from the late professor Edmund Pellegrino, one of the pioneers of Catholic bioethics, encapsulates a key insight. All are called to lead a moral life and to achieve the holiness of the saints. This obviously means that ethics is important in all professions and walks of life. Yet, we rightly hold physicians and other health care workers to higher standards of professional ethics. It is profitable to reflect in a deeper way on this moral intuition.
When a mechanic or a used car salesman lies to us or makes a mistake that they hide from their client or employer, it is certainly blameworthy, but we usually do not view it with the same gravity as a surgeon who recommends an unnecessary operation or a health care worker who violates the confidentiality of a patient. Why is this? Most obviously, the patient’s life or health are put at risk from unethical practices in medicine in a very different way than is the case with most other professional relationships. The need for trust and honesty takes on a whole new level of importance for a patient seeking advice and treatment or when facing a life-threatening illness.
Patients often confide in their physicians the kinds of secrets and fears that only spouses or priests could expect to hear. Patients are uniquely vulnerable in a health care relationship. It is not unusual for them to literally place their lives in the hands of doctors. On a different level, intimate physical examinations are often an appropriate part of this professional relationship. One doctor told me that at times he feels like he is in a confessional rather than in a medical examining room. I have always found the description of priests as “doctors of the soul” very illuminating. Our Catholic doctors of the body cannot neglect the spiritual aspects of those who come to them for medical care.
One of the great temptations and mistakes of modern secular medicine is to treat only the bodies of patients and disregard their minds and souls. We instinctively feel revulsion for doctors who have no interest in getting to know their patients, do their jobs mechanically, treat those in their care as “pieces of meat,” or think of them solely in terms of their pathological conditions. It is simply inadequate for a surgeon to see himself as a kind of high-tech plumber even if he is objectively fixing physical arterial blockages. The health care professional is interacting with or operating on a human person with an immortal soul and not an object or an animal. This direct and intimate contact with human beings, especially when they are at risk of dying, has a sacred character that rightly calls for the highest ethical standards of care, respect, and compassion.
We correctly think of our medical caregivers as engaged in the healing professions. That is why it is a sick perversion of medicine when pressure groups or governments seek to force doctors to become killers, most notably in the cases of abortion, euthanasia, and physician assisted suicide. Ethicists can rightly point out the moral problems of requiring a physician to be present at a prisoner’s execution in a professional capacity, but this pales in gravity when compared to requiring them to become executioners by performing abortions as part of their training or professional duties. It was seen as particularly shocking that the Nazi state received so much health care worker collaboration in its euthanasia campaigns and grisly “medical” experimentation on prisoners. The Nuremberg war crimes trials included medical doctors in the dock as especially reprehensible criminals.
Physicians have a very high calling, one that rightly includes taking a special oath focusing on ethics at the end of one’s studies. Hospitals and health care workers should focus on healing. This also means continuing to help persons who are ill beyond our capacities to cure so that they receive compassionate care that truly prepares them for death and comforts grieving loved ones. There is simply no way this mission can be accomplished without ministering to the spiritual and emotional needs of persons.
What a difference it makes when we have complete confidence that a doctor or nurse caring for us is not only professionally skilled but a holy man or woman. How specially blessed is an encounter with a physician who is not only concerned with our body but also our psychological and spiritual well-being. A cousin of mine worked for decades as an anesthesiologist for especially high-risk surgeries. He made a special point of meeting his patients beforehand to explain the procedure and its risks and benefits. He assured them that he would be doing everything physically possible to keep them alive, and … he offered to pray together with them there and during the operation. This last request was entirely optional, but he told me that not a single patient among the large number he met refused. Even if they were not particularly religious or believers, far from being offended at the thought of their doctor praying for them, they were usually very grateful for this unexpected spiritual assistance.
True medicine is a moral enterprise. In our Catholic tradition this means Christ-centered care that focuses on the good of the whole person—body, mind, and spirit. There should be an abundance of compassion for the suffering and fears of sick persons and their families. The consciences of the physicians, the patients, and the Catholic health care institutions should all be respected. This is the way the Church envisioned health care historically when she founded the first hospitals. It would be quite transformative if more individuals and institutions made a conscious effort to provide this kind of health care.
