At the Crossroads: Medicine, Ethics and Religion, Part 1.

Last updated on: April 24, 2017 at 4:53 pm by Paul Louis Metzger

At the Crossroads: Medicine, Ethics and Religion, Part 1. 2017-04-24T16:53:01-07:00 Paul Louis Metzger

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I was waiting in a hospital waiting room this morning. The mission of the hospital was posted on a wall right in front of me. The mission read, “We carry on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering, and treating each person in a loving and caring way.” For those who think science, ethics and faith can never overlap, these words might cut like a knife.

There is a whole lot of theology and ethics embedded in that hospital mission statement. It reminded me of the work of Robert Lyman Potter, M.D., Ph.D. Over his distinguished career, Dr. Potter has served as a national pioneer in palliative care, in addition to serving as an internist and medical ethicist. He also holds a Ph.D. in Religion, Psychology and Ethics from the University of Chicago. Dr. Potter now serves as a science advisor for an American Association for the Advancement of Science/Templeton grant at Multnomah Biblical Seminary where I teach.

This post is part of a series of interviews I am doing with Dr. Potter titled “At the Crossroads: Medicine, Ethics and Religion.” The posts in this series bring together his interests and concerns in these fields.

Paul Louis Metzger (PLM): Dr. Potter, before you were a medical ethicist, you were a medical doctor. How often were you making ethical determinations?

Robert Lyman Potter (RLP): I was constantly making decisions that ought to be understood as ethical. I prefer to label all human decisions to have ethical import because every choice we make reflects our values and every choice we make has consequences for ourselves and others. That makes all human decisions ethical. Some folks prefer to limit the ethical to some particularly tension-filled, conflicted, culturally charged decision, such as life and death. But for me, all human decisions are ethical decisions.

PLM: Were you aware that you were making such determinations?

RLP: Not as aware as I became when I fully realized that even deciding which dose of an antibiotic to prescribe had moral implications. To start with, I had to admit that prescribing a medication meant that I had to avoid harming the patient with side effects and not causing financial strain by using an expensive drug. When I finally woke up to the heavy moral burden of making choices. it was a definite shift in the way I practiced.

PLM: How often would you say medical doctors make ethical decisions?

RLP: If you accept my formula that makes all decisions ethical, then doctors are doing ethics constantly.

PLM: In your experience, are other doctors aware that they are making ethical decisions?

RLP: Early on, I don’t think most of my colleagues were aware of the constant ethical demands of medical practice. No doubt, this was due to how ethics was often placed outside the day-by-day routine decisions in life; all too often, ethics was called upon only when the medical decisions involved problems with dicey conflicts and tricky consequences.

PLM: You have said that to think ethically is to think holistically, and that sound ethical determinations require time and empathy. Could you please unpack these notions? Would you wish to add anything to them?

RLP: Over the years I have worked up an ethics strategy for managing moral problems. The basis for my thinking comes from the two questions that H. Richard Niebuhr taught us all: What’s going on here? and What is the fitting response to what is going on here? I learned how to use these two questions from my teacher James M. Gustafson, who was also a pioneer in bioethics and the primary editor of Niebuhr’s writing on ethics. I recognized this two-part approach to be the same scientific inquiry that doctors use: what’s the diagnosis, and how can we fix it? However, it dawned on me that in the rush from diagnosis to treatment, medical doctors will often short-circuit the necessity of empathically checking out just what we ought to care about. In other words, we need to pause and consider just what this all means to the patient. With this point in mind, the philosopher Harry Frankfurt in a short essay entitled, “What We Ought to Care About,” convinced me that Niebuhr’s two questions require an intermediary question. So, here is my ethics strategy in outline:

What is going on here? Describe the situation.
What ought we to care about? Empathically encounter the patient.
What is the fitting response to what is going on? Make the decision, and then take action. Ethics is having good reasons for action.

PLM: The second or intermediate question would seem to suggest or introduce religious and psychological considerations. Given that your PhD is in religion, psychology and ethics, how might religion and psychology come into play in caring empathically for patients’ needs.

RLP: Empathy is biologically based in a neurological pattern of attachment and bonding. But the clues that trigger empathic behavior are not limited to physiological stimuli. Rather, we can adopt beliefs—that is, be guided by an idea that we ought to behave with empathy. Religious teachings and commitment to religious behavior that is others-oriented is exactly what motivates many people to act with empathy. People can care without being committed to a religious precept, but religion is a powerful and reliable resource for guiding us to be empathic.

PLM: How much pushback have you received from doctors during training in medical ethics? Further to this question, have you witnessed signs that the medical profession is sensing the need for greater awareness and expertise in ethical matters?

RLP: When I began speaking to physician groups around the country in 1994, I was deeply disappointed in how inattentive the audiences were. It was common for me to speak at a luncheon or dinner meeting; usually, I was competing with the table conversation. On one occasion, I was to give a noon lecture to medical students. When I entered the building, I asked a student where the noon lecture was to be held. He said, “There is no lecture—just some guy talking about ethics.” Over the years, during which time more attention was given to palliative care at the end of life, doctors began to listen more intently. I can confidently say that in the past twenty years, medical education and continuing medical education of practicing physicians in the use of ethics to solve moral problems has been firmly established.

The old pushback used to be, “You can’t teach ethics—students just arrive at medical school with or without them.” Further to what was stated above, times have changed. I have now seen solid reports that all medical schools have an adequate curriculum load of ethics to create a learning environment where ethics cannot be ignored. I recall a report that 75% of medical graduates say that they have “enough” instruction in ethics. Of course, the real test comes when developing professionals meet the thorny moral problems that will drop in front of them.

PLM: Speaking of thorny problems, how have you helped medical doctors in training engage ethical issues with keen awareness?

RLP: The best way—the most effective way—to teach ethics is to be present when the developing doctor meets the moral impasse. Just wait until their own mother dies—at that point, ethics becomes real.

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