President's Page

President's Page
April 2008

What in God's Name am I doing?
22nd Annual Conference of Professions

By William J. Walton, MD
2008 DCMS President

Do you often ask yourself this question as you are wrestling with your faith and your ethics, trying to do what is best for your patients--patients who have different beliefs than you and who often poorly understand the difficult medical and philosophical issues that enmesh you and their belief systems? How do you resolve dilemmas of clashes of faith? Do you turn to your family, speak to a colleague, talk to an attorney, or counsel with your pastor, rabbi or amman? Do you run and hide?

Each year DCMS cosponsors the Conference of the Professions, an event supported by philanthropist Cary McGuire and held at Southern Methodist University. Clergy, lawyers and physicians brainstorm in an atmosphere that is stimulating and challenging. The 22nd Annual Conference, “Faith in the Professions: What in God’s Name am I Doing?” proved to be most thought provoking to the house of medicine; 93 of us registered, vs 8 from law and 11 from the clergy.

Daniel Foster, MD, was the keynote speaker. Dr Foster is modest and unassuming, with a deep faith and sense of medical ethics. His scientific and medical resume is as long as my arm and astoundingly impressive. He holds the John Denis McGarry, PhD, Distinguished Chair in Diabetes and Metabolic Research in Internal Medicine at the University of Texas Southwestern Medical School at Dallas, but his theological knowledge is the reason he was our speaker.

Basic science’s conflict with religion reached a splitting point during the Enlightenment when reason clashed with faith. Since then, atheism increasingly has flourished in the pure sciences. Dr Foster pointed out that, according to a 1998 survey of members of the National Academy of Science, only 7% have a God belief, 72% have disbelief in God, and 21% are doubters. This astounded me. A recent survey of US citizens pegged 78% as being religious (God belief). I suspect that physicians’ beliefs would be much closer to the 78% than the 7%.

Dr Foster believes the individual can merge faith and science. He made 5 points to guide us in our profession:

• Scientists should not use personal belief to cloud judgment of those who are religious.
• Mysteries in science do exist.
• There are serious ethical questions about science that need to be explored.
• Scientists need to control their tendencies to hype advances in science.
• Scientists need to be more active in giving.

Ellen Pryor, the attorney panelist, presented a most interesting ethical problem for an attorney. (I will present a slightly changed version of the story.) An attorney was helping a family sue for damages after their child was killed in a car wreck. The family was grieving in the worst way. It was clear that the other party was negligent. The family had been told that their daughter had died instantly and painlessly. In the course of discovery, the attorney learned that this was not true—she had burned to death. Our attorney cared for this family as a friend would. She knew it would hurt them to know the true circumstances of the death. She also knew that, by law, a painful death is worth more in damages. What should she do? What this ethical attorney did was approach the opposing attorney with these facts and ask him that the circumstances of the death not come to light but that the settlement reflect the difference. As it turned out, a good settlement was reached and the family did not learn of the suffering of their daughter. This story has stuck with me.

Since that morning, I have been thinking of ways that we physicians are confronted with situations that bring our faith system into play with our patient’s beliefs.
A basic problem we face is breaking bad news to a patient; cancer is the prototype. One must spend time with a patient and the family in order to know how to do this. A good doctor does not barge into a patient’s room and blurt out that the patient has cancer. On the other hand, he or she does not hide such a fact. The art of medicine demands a tactful and measured approach. I have found that “sneaking up” on the diagnosis while reading the reaction of the patient is extremely helpful. Along the way, often I ask what a patient believes about disease and how her or his religion plays into the formula. Some patients believe that God predetermines everything and we can do nothing. Some do not believe in God and resent any reference to God, although I have found such patients to be rare in the face of death. When I have learned where the patient’s beliefs lie, I have tried to mold my presentation to reflect these beliefs.

A universal ethical guideline, however, demands that a physician tell the patient in no uncertain terms when the physician’s beliefs clash with the patient’s and allow a bridge over the disagreement to exist. One that has repeatedly dogged me is the conflict I have with the patient who believes he is being punished by God for his disease. As a young physician, I made the mistake of belittling this, usually alienating the patient. I since have learned to gain the trust of the patient first, then tell him that I do not believe what he believes. I tell him that I value him and so does God. I often use the quote, “Bad things happen to good people.” With my Christian patients, I sometimes will quote the Bible. With those whose religion I do not understand, I ask them to speak with their theological mentor. I also have spent much time speaking with my Muslim friends and studying their religion; this has helped enormously when they realize that I respect them in their beliefs, even though I differ.

I know you have been confronted with ethical and theological clashes that stress you. Your approach to each ethical solution is different than mine. That is good; no one solution is absolute and always correct. As long as we remember to do our best for our patients, without sacrificing our beliefs, and ask ourselves, “What in God’s (the patient’s) name am I doing?” good will result.

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