Spirituality and the Doctor-Patient Relationship
The Human Cost of Competition: How Do Patients Suffer When Rivalry Trumps Humility? Suggestions from Two Case Studies in Experimental Hand Transplantation
Emily Ruppel, PhD(s), University of Pittsburgh
The world's first successful hand transplants were performed by competing medical teams in Louisville, Kentucky, and in Lyon, France. While the French team’s patient was non-compliant and requested amputation of the graft two years out, the transplant performed by the Louisville team has survived over fourteen years with high patient satisfaction. Comparing the narratives of these surgeries has opened questions as to whether the French team rushed patient selection to perform their surgery first. Interviews with doctors and their own written accounts show that their patient’s known duplicity on various issues before surgery should have been a counter-indication for candidacy, yet the tenor of doctors’ recollections is one of blaming the patient for failure of the operation.
These high-profile case studies offer occasion to consider two pertinent ethical problems in experimental medicine; 1) How should we define “success” for non-lifesaving elective procedures? Holistic patient satisfaction and rehabilitation? Or do technical concerns precede the psychological and spiritual healing such interventions are intended to provide? 2) How does our current academic climate—one of striving, fierce competition, and a “publish or perish” attitude—contribute to the suffering of patients desperate for change and unable to adequately process risk? Can the religious values of humility and poverty inform medical ethics over and above the maxim “Do no harm?”
This talk will relate the stories of now-famous hand transplant patients Clint Hallam and Matt Scott as a way of opening conversation on the ethical and spiritual dimensions of caregiving in experimental settings.
30-Year Experience of Introducing Spirituality in Medical Practice
John Graham, MD, DMin, Institute for Spirituality and Health
Does the integration of spirituality in healthcare really make a difference? This paper will look at the 30 year experience of the author as a practicing physician before and after he began integrating spirituality in his medical practice. How did this change in approach affect the doctor and the relationship with his patients, his staff, and the professional staff in the hospital settings? What can be learned by reflecting on that experience? What was of value and might be used by other professionals in their own setting? What would the author not recommend or do differently? The issues explored in this talk should be beneficial to the professional who would hopes to integrate spirituality in his or her healthcare setting.
Asymmetric Spiritual Gains in the Physician-Patient Relationship: An Islamic Perspective
Abbas Rattani, Mbe, MD(c), Meharry Medical College
Within the Sacchedina hermeneutical approach,[1] it can be interpreted that the Islamic duty to protect life/nonmaleficence,[2] establishes the ethics foundation for the practice of medicine by Muslim physicians. Concurrently, the act of healing and caregiving is a form of enacting this principle and can be defined as a form of worship. Therefore, the spiritual component of physician-hood is “worship through service.” However, the act of providing care can be seen as a unidirectional service performed by the agent to a recipient. This unidirectional relationship of physician as “worshiper” introduces an asymmetric dynamic in the physician-patient relationship; the patient serves as the physician’s means to a spiritual end.
I explore the role of the Muslim physician in healing and caregiving as worship and the patient as a means toward physician spirituality. This work hopes to challenge the spiritual motivations in the practice of medicine as “worship through service,” and explore ways of promoting a mutual spiritual value between giver and recipient.
First, I examine motivation and whether the physician’s spiritual relationship to the patient is instrumental versus pure means. Using an Islamic mystical interpretation, I use the concept of divine interconnectedness among human beings [3] to discuss the duties within the physician-patient relationship. Is the relationship between the physician and patient equal? How is the spiritual relationship they share affected? Should the act of healing be an intrinsic or an instrumental good?
I argue that the patient is being used instrumentally, not purely as a means, by the physician to achieve dual spiritual ends of “worship through service” (personal motivation) as well as the patient’s end of being healed (social motivation). The relationship between the patient and physician still presents the issue of asymmetric spiritual gains, where the physician gains spiritually by “saving” a life, but the “saved” patient gains only in the material/physical sense.
Second, I discuss the alternative possibility of mutual spiritual gains between physician and patient by suggesting that the practice of medicine/healing is an instrumental good (versus being good in/of itself—intrinsically). Using the Parson’s model of the ideal patient,[4] I suggest that the act of seeking treatment is a form for worship by the patient because of a duty to self. Hence, the spiritually symbiotic relationship between the physician-patient relationship may improve overall caregiving, wherein being informed about one’s illness and compliance is part of a patient’s worship.
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[1] Sachedina A. Islamic biomedical ethics: principles and application. New York: Oxford University Press, 2009.
[2] The Qur’an: chapter 5 (Al Ma’idah) verse 32. I.e., taking one life is equal to killing all of humankind; saving one life is equal to saving all of humankind (paraphrase).
[3] The Qur’an: chapter 38 (Saad), verse 72 is a direct reference of the divine spirit entering man to give him life. This spirit is arguably shared among mankind giving rise to the mystical concept that all human beings are interconnected through the same divine spirit, i.e., divine-interconnectedness. I will be using this concept to discuss the responsibilities humans have to each other in light of this interpretation.
[4] Parsons T. Illness and the role of the physician: a sociological perspective. Am J Orthopsychiatry. 1951; 21(3):452-460.
Not Empathy, but Thou Shalt Not Kill: Buber and Levinas in Dialogue, and its Relevance for Medical Ethics
Janeta Tansey, MD, PhD, University of Iowa
Martin Buber’s concept of I-Thou mutuality has continued to impact medical humanism as scholars and practitioners alike reflect on the necessity and restoration of empathy to spiritual practices in medicine. For Buber, being-in-relation, with the apprehension of empathy and activities of dialogue and reciprocity, is metaphysically oriented in dialectic with the non-relational, impersonal, ego in I-It, in which the world and all its contents are objectified by the subject. The significance of this tension cannot be overestimated in its relevance to healing practices, as it orients the healer to the reality of relation, even as the practice of medical science has “the sublime melancholy of our lot that every You must become an It in our world.” (I and Thou).
What has not been sufficiently noted in the literature are significant criticisms by Buber’s contemporary, Emmanuel Levinas, which are of high relevance to the healer’s spiritual posture. The three criticisms considered in this paper are as follows: 1) Buber’s I-Thou disembodies the ego, and in so-doing, subjugates the virtues of bodily activities and work, as well as their cradling in space and time, to a category removed from the sublime. 2) Buber’s I-Thou is only and always a fortunate and accidental encounter with human relation; for Buber, being-in-relation cannot be habituated, but remains ever-elusive to human intention. 3) Buber’s I-Thou fails to recognize the asymmetry of relation, in which the neighbor is apprehended as being unlike—radically and irreducibly unlike—the subject, and in which the face of the Other calls not primarily to empathy, but first and always to Thou Shalt Not Kill. Each of Levinas’s criticisms offers potent correctives to current practices in medicine, with calls to the sacrality of the body, the intentionality of spiritual virtue, and the prohibition against harm as the greatest moral duty of being-in-relation.
The presenter will draw upon original texts of Buber and Levinas, and upon many years of work as medical educator and physician to illustrate the clinical relevance of Levinas’s criticisms to spiritual practices in healing. Particular attention will be drawn to Levinas’s appreciation that violence against the Other is an intrinsic risk to being-in-relation, and that recognizing the embodiment, agency, and assymetry of both the I and the Thou is required to secure against the boundary violations of naïve empathy.
Emily Ruppel, PhD(s), University of Pittsburgh
The world's first successful hand transplants were performed by competing medical teams in Louisville, Kentucky, and in Lyon, France. While the French team’s patient was non-compliant and requested amputation of the graft two years out, the transplant performed by the Louisville team has survived over fourteen years with high patient satisfaction. Comparing the narratives of these surgeries has opened questions as to whether the French team rushed patient selection to perform their surgery first. Interviews with doctors and their own written accounts show that their patient’s known duplicity on various issues before surgery should have been a counter-indication for candidacy, yet the tenor of doctors’ recollections is one of blaming the patient for failure of the operation.
These high-profile case studies offer occasion to consider two pertinent ethical problems in experimental medicine; 1) How should we define “success” for non-lifesaving elective procedures? Holistic patient satisfaction and rehabilitation? Or do technical concerns precede the psychological and spiritual healing such interventions are intended to provide? 2) How does our current academic climate—one of striving, fierce competition, and a “publish or perish” attitude—contribute to the suffering of patients desperate for change and unable to adequately process risk? Can the religious values of humility and poverty inform medical ethics over and above the maxim “Do no harm?”
This talk will relate the stories of now-famous hand transplant patients Clint Hallam and Matt Scott as a way of opening conversation on the ethical and spiritual dimensions of caregiving in experimental settings.
30-Year Experience of Introducing Spirituality in Medical Practice
John Graham, MD, DMin, Institute for Spirituality and Health
Does the integration of spirituality in healthcare really make a difference? This paper will look at the 30 year experience of the author as a practicing physician before and after he began integrating spirituality in his medical practice. How did this change in approach affect the doctor and the relationship with his patients, his staff, and the professional staff in the hospital settings? What can be learned by reflecting on that experience? What was of value and might be used by other professionals in their own setting? What would the author not recommend or do differently? The issues explored in this talk should be beneficial to the professional who would hopes to integrate spirituality in his or her healthcare setting.
Asymmetric Spiritual Gains in the Physician-Patient Relationship: An Islamic Perspective
Abbas Rattani, Mbe, MD(c), Meharry Medical College
Within the Sacchedina hermeneutical approach,[1] it can be interpreted that the Islamic duty to protect life/nonmaleficence,[2] establishes the ethics foundation for the practice of medicine by Muslim physicians. Concurrently, the act of healing and caregiving is a form of enacting this principle and can be defined as a form of worship. Therefore, the spiritual component of physician-hood is “worship through service.” However, the act of providing care can be seen as a unidirectional service performed by the agent to a recipient. This unidirectional relationship of physician as “worshiper” introduces an asymmetric dynamic in the physician-patient relationship; the patient serves as the physician’s means to a spiritual end.
I explore the role of the Muslim physician in healing and caregiving as worship and the patient as a means toward physician spirituality. This work hopes to challenge the spiritual motivations in the practice of medicine as “worship through service,” and explore ways of promoting a mutual spiritual value between giver and recipient.
First, I examine motivation and whether the physician’s spiritual relationship to the patient is instrumental versus pure means. Using an Islamic mystical interpretation, I use the concept of divine interconnectedness among human beings [3] to discuss the duties within the physician-patient relationship. Is the relationship between the physician and patient equal? How is the spiritual relationship they share affected? Should the act of healing be an intrinsic or an instrumental good?
I argue that the patient is being used instrumentally, not purely as a means, by the physician to achieve dual spiritual ends of “worship through service” (personal motivation) as well as the patient’s end of being healed (social motivation). The relationship between the patient and physician still presents the issue of asymmetric spiritual gains, where the physician gains spiritually by “saving” a life, but the “saved” patient gains only in the material/physical sense.
Second, I discuss the alternative possibility of mutual spiritual gains between physician and patient by suggesting that the practice of medicine/healing is an instrumental good (versus being good in/of itself—intrinsically). Using the Parson’s model of the ideal patient,[4] I suggest that the act of seeking treatment is a form for worship by the patient because of a duty to self. Hence, the spiritually symbiotic relationship between the physician-patient relationship may improve overall caregiving, wherein being informed about one’s illness and compliance is part of a patient’s worship.
---
[1] Sachedina A. Islamic biomedical ethics: principles and application. New York: Oxford University Press, 2009.
[2] The Qur’an: chapter 5 (Al Ma’idah) verse 32. I.e., taking one life is equal to killing all of humankind; saving one life is equal to saving all of humankind (paraphrase).
[3] The Qur’an: chapter 38 (Saad), verse 72 is a direct reference of the divine spirit entering man to give him life. This spirit is arguably shared among mankind giving rise to the mystical concept that all human beings are interconnected through the same divine spirit, i.e., divine-interconnectedness. I will be using this concept to discuss the responsibilities humans have to each other in light of this interpretation.
[4] Parsons T. Illness and the role of the physician: a sociological perspective. Am J Orthopsychiatry. 1951; 21(3):452-460.
Not Empathy, but Thou Shalt Not Kill: Buber and Levinas in Dialogue, and its Relevance for Medical Ethics
Janeta Tansey, MD, PhD, University of Iowa
Martin Buber’s concept of I-Thou mutuality has continued to impact medical humanism as scholars and practitioners alike reflect on the necessity and restoration of empathy to spiritual practices in medicine. For Buber, being-in-relation, with the apprehension of empathy and activities of dialogue and reciprocity, is metaphysically oriented in dialectic with the non-relational, impersonal, ego in I-It, in which the world and all its contents are objectified by the subject. The significance of this tension cannot be overestimated in its relevance to healing practices, as it orients the healer to the reality of relation, even as the practice of medical science has “the sublime melancholy of our lot that every You must become an It in our world.” (I and Thou).
What has not been sufficiently noted in the literature are significant criticisms by Buber’s contemporary, Emmanuel Levinas, which are of high relevance to the healer’s spiritual posture. The three criticisms considered in this paper are as follows: 1) Buber’s I-Thou disembodies the ego, and in so-doing, subjugates the virtues of bodily activities and work, as well as their cradling in space and time, to a category removed from the sublime. 2) Buber’s I-Thou is only and always a fortunate and accidental encounter with human relation; for Buber, being-in-relation cannot be habituated, but remains ever-elusive to human intention. 3) Buber’s I-Thou fails to recognize the asymmetry of relation, in which the neighbor is apprehended as being unlike—radically and irreducibly unlike—the subject, and in which the face of the Other calls not primarily to empathy, but first and always to Thou Shalt Not Kill. Each of Levinas’s criticisms offers potent correctives to current practices in medicine, with calls to the sacrality of the body, the intentionality of spiritual virtue, and the prohibition against harm as the greatest moral duty of being-in-relation.
The presenter will draw upon original texts of Buber and Levinas, and upon many years of work as medical educator and physician to illustrate the clinical relevance of Levinas’s criticisms to spiritual practices in healing. Particular attention will be drawn to Levinas’s appreciation that violence against the Other is an intrinsic risk to being-in-relation, and that recognizing the embodiment, agency, and assymetry of both the I and the Thou is required to secure against the boundary violations of naïve empathy.