Between Two Doctors, One Religious, One a Skeptic,
(11-15-2000) The surgeon author of the award-winning book How We Die said he once administered a fatal dose of morphine to a terminally ill woman to ease the suffering of her deeply religious family on the eve of the holiest day of their Jewish faith.
Dr. Sherwin Nuland of the Yale School of Medicine recalled the Yom Kippur 1977 incident at a Nov. 14 symposium sponsored by Boston College and The Atlantic Monthly on religious belief and non-belief in the practice of medicine.
"It was more than I could bear to leave that family out in the waiting room," said Nuland, a self-described agnostic, recalling his decision to administer a quadruple shot of morphine to hasten the death of a woman in the last throes of an incurable intestinal illness.
He said he was mindful that, for the womanıs family, the next day was the Jewish Day of Atonement, a solemn day that would be made more so by worry and grief.
"It was a personal response, perhaps a selfish response," said Nuland. "I was overwhelmed by awe and by the solemnity of the night. There was something about what the family was going throughIt would be torture for them all night long.
"I would not let them keep suffering through the night, [but would] end it 12 hours earlier," said the surgeon, who said legal proscriptions against such an action were not as clearly defined 23 years ago as today. "That may have been the wrong decision," he said, but "it came out of my own sense of responsibility to [the family].
Said Nuland: "I find myself, as a person lacking belief, overwhelmed by someone else's belief."
Nuland and Dr. Jerome Groopman of Harvard Medical School were the featured guests in a dialogue that focused on how religious belief or non-belief, and divergent understandings of the meaning of life, intersect with medical decisions.
The forum was the inaugural event in a new annual symposium sponsored by Boston College and The Atlantic Monthly on belief and non-belief in American Culture.
The symposium is modeled on a series of public conversations established in Milan by Cardinal Carlo Maria Martini, SJ, based on his supposition that within each person lies "a believer and a non-believer," each trying to convince the other.
Nuland, who won the National Book Award in 1995 for How We Die, and whose recent book The Mysteries Within describes the influence of myth, superstition and religion on the development of medical thought, occupied what Cardinal Martini has called "the chair for the non-believer" at the forum.
"I have never been able to convince myself that life has inherent meaning," said the veteran surgeon and self-described skeptic, who said he does indeed "wonder at the marvels of nature and of the human mind," but sees spirituality emanating from physiological need, not heavenly design.
Describing surgeons like himself as "Spitfire pilots" motivated by a desire to win the battle against illness, Nuland said he looks inward, not toward a heavenly God, in holding himself responsible for his actions as a doctor.
"I have never lost a patient when I didnıt honestly think it was my fault," he said. "That loss of my sense of power is devastating to meI stand, I square off my shoulders, and try to figure out what happened. There is no faith in these situations
"I can only hope to forgive myself the human lapses that come with my attempts to heal," Nuland said.
Putting the case for religious faith was Dr. Groopman, a cancer and AIDS researcher who teaches at Harvard Medical School and is experimental-medicine chief at Beth Israel Deaconess Medical Center in Boston. His best-selling book The Measure of Our Days: A Spiritual Exploration of Illness inspired this fallıs new ABC television series "Gideon's Crossing."
An observant Jew, Groopman said he doesnıt encounter "a large tension between being a scientist and a person of faith." From the religious wellspring of his Hasidic and Orthodox forebears from Eastern Europe, he said, he drew "a deep and abiding humanism, love for one's fellow man and woman, and a sense that each person you care for as a physician ismade in the image of God."
Groopman recalled the case of one patient, the devout wife of a Protestant minister, who was stricken with terminal cancer. "I worried as I cared for her that [her] faith would be tested and lost," he said. Instead, the woman "found in her faith tremendous strength," he said. "It allowed her to weather the storm of her illness and pass through it without flinching."
He said his own faith was tested by another case involving a young boy who survived leukemia only to be stricken with AIDS from a tainted blood transfusion. "His father, who drove a delivery truck, deeply believed in his Catholic faith, and waited for God to intervene to save his son," said Groopman. "We failed to save [the boyıs] life and therefore God failed. I had no answer for him. I found myself unable to rationalize in any way, as a believing person, such a horrific tragedy."
Yet the boyıs father was able to "create meaning" from his son's death by returning to the Church and working to help other children similarly afflicted, he said.
Groopman recited in Hebrew a prayer traditionally said in synagogue for the sick: "There should be healing of the soul and healing of the body." The order of the petitions is telling, he said. "All of us are mortal. The body will not survive. But the soul can always be healed, even to the last breath of a person.
"The greatest and always-present opportunity is to heal the soul, and then, if possible, the body," he said.
Skeptic Nuland allowed that religious faith is indeed a source of strength for many patients. "I'm just in awe of the power of people's belief," he said. But he maintained: "It's the power of belief and not the belief itself I subscribe to."
Nuland cited Freudian theory that the human subconscious canıt handle the idea of death. "People have to believe. Itıs a biological necessity," he said. "We have created an entire structure of belief that allows us to say, Something of me will continue. I cannot psychologically face the idea of perishing forever.'"
Where Nuland saw biology, however, his opposite number saw the hand of God. "Grounded within all human beings there is a divine spark," said Groopman.
Margaret OıBrien Steinfels, editor of the lay Catholic magazine Commonweal, served as moderator of the program, which drew an audience of 600 to the theater on Clarendon Street in Bostonıs Copley Square.
Boston College President William P. Leahy, SJ, and Atlantic Monthly Editor-in-Chief Michael Kelly offered welcoming remarks.
The event was simulcast on the Boston College campus and in Washington, D.C., for 100 alumni and guests of the Boston College Alumni Association.
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