The Yale Journal for Humanities in Medicine

The Benevolent Doctor*

Rev. John W. Love, D.Min.
frjlove@gmail.com

I would like to propose to you today the following:  doctors are in an almost unique position to mirror God’s goodness and love the world through benevolent helping.  Now, just to focus things here, I want to tell you that I am not proposing anything new, especially to a group of Catholic doctors.  There is, however, a twist to the concept that I hope will prove interesting and food for further thought.  For this, I rely today almost entirely on the insights of one theologian.  He is a living German Catholic moral philosopher by the name of Robert Spaemann, and he has written extensively on the subject of benevolence as it relates to our happiness.  As luck would have it, an American Jesuit (living in Japan who speaks German) has translated his major work Glück und Wohlwollen (Happiness and Benevolence)1 into English within the last couple of years.

What I hope to do today is not make a bid that this element of benevolence in ministry or medical practice will solve all of the problems of pain and suffering of the people we encounter. Rather, I propose to simply offer another piece of the puzzle as to what can make you, as a doctor, and me, as a priest, more effective healers, because although the means and arts and training are all different, the immediate end of “helping people” in some sort of distress, and sending them on their way, is a big part of what it means to be benevolent.  There are others – Georgetown medical professor Edmund Pellegrino, Benedictine doctor and Oxfordian medieval scholar Luke Dysinger, and Franciscan brother and Johns Hopkins trained doctor Daniel Sulmasy – who have written and spoke about this subject and could offer profound and integrated statements about this subject of virtue and ministry as it relates to medicine. But I am hopeful that I can rely on Spaemann, who will provide his own unique twist on the subject.

So, what does Professor Spaemann say?  He asks the same question the Greeks asked: How must one live in order to experience the very best things life has to offer?  The title of Spaemann’s first chapter - "Ethics as Teaching How Life Can Turn Out Well" - contains the Greek idea that ethics is the study not so much of what is right and wrong, but of developing a practical science that teaches how life can turn out well.2 So, if we subscribe to this theory, then the first point to be made is that we are to live our lives each day so that we will not have regrets for having lived a life half-spent or mediocre.  But, what does this specifically mean in the context of a medical practice?   This is where benevolence as helping becomes important as a virtue, because "healthy people do not need a doctor, sick people do."3  Patients are generally not making appointments with their doctors when life is turning out well in the physical sense, even when not seriously ill or injured.  To wit, unless you happen to be completing an annual physical for a 21 year-old Olympic swimmer or cross-country skier, a lot of patients come to you with bodies falling apart or not working well, their minds often a jumble of anxieties, and when in some sort of physical or mental pain, their guts turning and courage wilting at the prospect of a bad diagnosis.

Without oversimplifying, Spaemann holds that our happiness is related to the idea that we matter to one another because we have to the ability to help one another in the first place; that God has created us in such a way that we exist for each other here in the created world to give and receive help.  We do not know this because of God’s law or because the world is ordered, and we do not comprehend this because of a religious principle of love or an a priori understanding of benevolence.  Rather, we know it because we have a sense that we are connected and “matter” to each other.  This is so, says Spaemann, because when we help another, meaning about our nature and purpose comes to light.  We know this to be true especially in the two most precarious moments of life: our birth and our death. We are literally carried into the world and carried out of the world, two moments laden with existential meaning.  But we also are aware that helping people in the more mundane moments of life actually define not only human function, but can also be a key ingredient for a recipe to find happiness and a sense of purpose.

When we help someone, says Spaemann, we help ourselves as well, and through this act, we find meaning in life. I think Bishop Fulton Sheen made a similar point about eating and happiness.  He pointed out that among certain Polynesian cultures, one of the greatest sins is to eat without others present, and so villagers will search out another simply to not have to eat alone. Taking this idea of feasting, philosopher John Milbank of the University of Virginia sees this theme illustrated by understanding the difference between giving food to someone who is starving out of charity - something which is certainly altruistic but a “one-way” sort of charity - versus actually joining him in a banquet and thus, receiving and sharing in the feasting.4 So, we see benevolent helping as a means by which others become members of our human family and not just anonymous recipients of our help.   This is Spaemann’s idea transposed into practical living in a nutshell:  Are you confused?  Searching for meaning?  Want lasting happiness?  Dry on the idea of God and religion?  World not making any sense at all?  Then, as a doctor, think again about what it means to help someone so they can help someone, and thereby create a social atmosphere in a sort of “pay-it-forward” scheme by which we begin to understand God’s Divine Character in love and benevolence.

This idea of finding the deepest meaning of our lives by simply “helping one another” is a key concept of Spaemann’s and I think an original element of his work.5 We don’t just exist as individual agents, wondering why we are here on earth floating through space.  On the other hand, we cannot pretend all the mysteries of our life are laid out objectively in a perfectly ordered philosophical system, or the Catechism, or even in the Holy Bible.  We don’t start from a question of epistemology; that is, trying to figure out in a Sartrean way why we exist and how much we can know and asking questions about the meaning of life.  No, for Spaemann, we start by helping people, and only then do we come to understand that our ontology - our reason for being - is wrapped up in this help.  From this, we can uncover a simple, but profound lost concept of Christian motivation: our joy derives from acting as Christ acts, and from doing as he does in service for the people we encounter.  This seems to me to be a great way to reach and touch the hearts of people who are perhaps bitter from life’s trials and pain, confused and lacking faith in the goodness of their fellow man and woman because of the effects of illness.

To reframe this concept, think about the core reason you decided to go into medicine: probably to help the suffering soul or assist your fellow man in a real and concrete way.  The doctor, as a scientist working with people, is chiefly a problem solver.  People come to you because they can’t solve a medical problem on their own.  A paper cut is one thing…a deep gash wound is another.  A headache is one thing, a brain tumor another.  There is pain, fear of the unknown; maybe some anger about being ill or injured or sick, and there is, thus, a need.  People need doctors, and usually need them right away.   However, you do not really need your patients at the same moment.  They need you, and it follows logically that a reason other than your personal need must come into play, because you are not bartering your need against your patient’s.  Perhaps for some doctors it is money or fame, but we know these things don’t seem to take hold of our deepest longings.  Fame is truly fleeting, and money is soon spent.  In the end, there must be something more noble.  Again, to drive home the spike of this talk, Spaemann says this reason centers around our ability to help one another find meaning through benevolent helping.6

Spaemann sees the medical profession as a chief provider of not just medical treatment, but as the primary means by which we understand this principle of showing mankind his true nature as helper.7 Why is this?  Medicine seems to be one of the very few professions in which a person’s weakness and humanness is laid bare, and where some pretty profound life changing meetings occur.  People are often undressed and hanging on the words of the doctor (usually) to reassure and even comfort and give direction to a life.  It is a vulnerable moment in which the doctor has almost total control of another’s well being and destiny.    So, just like mechanical or jaded priests and rabbis, it seems that there are mechanical and jaded doctors who can weaken or destroy this notion of what it means to help.  Here is Duke University author Reynolds Price writing about his “frozen” oncologist at Duke University and his inability to empathize in any way with his patient after Price is diagnosed with a malignant spinal tumor:

It’s often said by way of excuse that doctors are insufficiently trained for human relations. For complex long-range interaction with damaged creatures, they may need a kind of training they never receive, but what I wanted and needed badly, from that man was the frank exchange of decent concern.  When did such basic transaction between two mammals require post-graduate instruction beyond our mother’s heart?8

Conversely, when the doctor is able to express this concern, something beautiful happens.  It reminds of something I read by the Protestant ethicist James Gustafson:

In the sense of gratitude the goodness provided by the natural world, by cultures and societies, by other persons…is the glass through which religious persons perceive the goodness of God.  The occasions of thankfulness to others for what they have done for us are at the same time occasions of thankfulness to God.  [These occasions] testify to the religious consciousness of the goodness of life.  We recognize that we have been loved by others beyond our deserving…we have benefited from nature and society more than we have contributed to them.  We have received more than we have earned or deserved and we are grateful.9

Now we understand why benevolence is so important to the doctor.  Because the doctor acts ideally from benevolence - a willed act to help - and not an exaggerated love of self, this help shows us something about who we are as human persons and helps us to describe God’s kingdom. We understand that benevolence is not chiefly understood by moral theologians as just being kind (although this is also important,) but also to be charitable: a sort of friendship in which one who has the ability to help another does just this so that the receiver in turn may help others.  I also think it is a wonderful tonic for the tired health care professional as she or he tries to make sense of patients who do not make any sense at all due to hang-ups, noncompliance with your words and treatments, and that ever-present human tendency to wreck the body through addictive behaviors.  You, perhaps even more than a priest or rabbi, are in a unique position to help them see and understand that dissolute lifestyles most often lead us patients away from happiness and peace.  By the way, Spaemann understands that we who give this sort of help must also receive it from time to time to fully understand its meaning for our happiness.

This “selfish” need people have for you and your art, and your corresponding love of your patient through self-giving benevolence is not met simply by what you do, but how you do it.  Again, I refer to my own vocation as a parish priest by understanding that I can go through the motions of marrying a couple, or I can truly want and act on the good for a couple through benevolence.  I may tell them certain things they don’t want to hear.  I may delay their wedding date.  I may refuse to accede to certain requests they make, but I do this in the name of benevolence with the underlying notion that I am somehow called to help people.  I want what is good for them in the long run, not just to meet what they might think they need at the moment.  Doctors have to do this same thing by telling patients to take care of their bodies, by refusing destructive requests like abortion-on-demand, prescriptions for artificial contraception, needless plastic surgery, or being frank and honest about a prognosis when it would “easier” on the patient’s immediate well-being to couch a truth or to even withhold the truth.  Of course, other virtues in the medical practice become evident:  compassion, prudence, and wisdom to name a few, but benevolence seems to be the primary operative hidden virtue of finding happiness and fulfillment in medicine today.

There is much more to Spaemann, but I hope that today we have at least begun to uncover the relationship between acting in benevolence as defined by our ability to help, and our desire to be happy and fulfilled providers of help as these requests come across our bow, even if our original intentions for entering our respective vocations are brought into question.

NOTES

1 Robert Spaemann, Happiness and Benevolence, South Bend: University of Notre Dame Press.

2 Ibid., p. 3.

3 Mark 2:17.

4 John Milbank, “The Ethics of Self-Sacrifice,” First Things, no. 91 (March 1999), p. 36.

5 Ibid., p. 183.

6 Ibid., p. 104. “The paradigm of acting from benevolence is any action by which we come to the help of human life which requires this help”.

7 Ibid., p. 163.

8 Reynolds Price, A Whole New Life, New York: Scribner, 1994, p. 56.

*This article is adapted from a talk given to the Philadelphia chapter of the Catholic Medical Association, St. Francis Xavier Church, Philadelphia, Pennsylvania, March 28, 2004.

Published: September 8, 2007