Suffering Absence: The Challenges to a Hauerwausian View of Medical Practice for an Intern in 2018
Benjamin W. Frush, MD, MA, Resident, Internal Medicine and Pediatrics, Vanderbilt Children’s Hospital and Vanderbilt University Medical Center
Stanley Hauerwas’ work in medical ethics has proven influential for a generation of physicians and aspiring physicians seeking to practice medicine morally and faithfully. One of Hauerwas’ primary arguments undergirding much of his writing is propounded in his 1986 essay collection entitled “Suffering Presence,” in which he claims that constitutive role of the physician consists in being present to sick and suffering patients rather than in her ability to alleviate suffering per se.
Hauerwas’ claim is normative and if he is correct, ought to hold true for physicians regardless of time or setting. However in the three-plus decades since his writings, the challenges to such a view of the role of the physician (including the provider-consumer paradigm, the electronic medical record, and the paucity of time available at the bedside) beg the question as to whether such a vision is tenable today. This issue is particularly salient for training physicians for whom many of these obstacles precluding the practice of suffering presence are even more significant than for their senior counterparts.
In this piece my goal will be to describe some of these obstacles to the Hauerwasian vision of suffering presence through the lens of an intern acutely aware of such a struggle. In Hauerwasian fashion, my argument will be primarily narratival, drawing upon specific instances I have encountered this year which highlight the significant challenge of the young physician-in-training to offer presence in the midst of suffering. I will moreover describe how the moral formation process of intern year can implicitly dissuade the pursuit of offering presence in suffering as a normative model of the excellent physician practicing today.
After describing these challenges, I will conclude by drawing upon another important Hauerwasian thesis as a mode of maintaining the young physician’s commitment to presence in the midst of suffering. That is, I will describe how the role of a moral community outside of medicine can serve to sustain medical practitioners amidst their taxing work, and to remind them of their primary moral commitments which can become clouded when the medical establishment alone serves to dictate the goods toward which they ought to strive.
Hauerwas’ claim is normative and if he is correct, ought to hold true for physicians regardless of time or setting. However in the three-plus decades since his writings, the challenges to such a view of the role of the physician (including the provider-consumer paradigm, the electronic medical record, and the paucity of time available at the bedside) beg the question as to whether such a vision is tenable today. This issue is particularly salient for training physicians for whom many of these obstacles precluding the practice of suffering presence are even more significant than for their senior counterparts.
In this piece my goal will be to describe some of these obstacles to the Hauerwasian vision of suffering presence through the lens of an intern acutely aware of such a struggle. In Hauerwasian fashion, my argument will be primarily narratival, drawing upon specific instances I have encountered this year which highlight the significant challenge of the young physician-in-training to offer presence in the midst of suffering. I will moreover describe how the moral formation process of intern year can implicitly dissuade the pursuit of offering presence in suffering as a normative model of the excellent physician practicing today.
After describing these challenges, I will conclude by drawing upon another important Hauerwasian thesis as a mode of maintaining the young physician’s commitment to presence in the midst of suffering. That is, I will describe how the role of a moral community outside of medicine can serve to sustain medical practitioners amidst their taxing work, and to remind them of their primary moral commitments which can become clouded when the medical establishment alone serves to dictate the goods toward which they ought to strive.