As a nurse and health care ethicist privileged to work on Georgetown’s campus and consult with health care professionals and systems internationally, I am always moved by the plight of patients, families and health care teams who struggle to make treatment decisions that promote health, well-being and good dying. Today’s patients are confronted with myriad diagnostic and treatment options: neuroimaging, diagnostic gene chips, ventricular assist devices, cyberknife surgery and transplants, to name a few. How is anyone to know which treatment method is most likely to yield tangible benefits? Life-sustaining medical technologies are easier to establish than to discontinue and therefore often outlive their prime of effective use — in some cases, painfully prolonging the process of dying.
Although health care professionals know this, many of us simply aren’t skilled in talking with patients and families about stopping a therapy that has become ineffective, disproportionately burdensome or seemingly futile. Moreover, even the most effective communicators have encountered families that demand continued life-sustaining technologies even when compassionately confronted with their futility. And what happens when family members and health care professionals disagree about treatment goals and plans of care? I know innumerable families haunted by decisions they made or failed to make that resulted in prolonged and needless suffering.
At Georgetown, we are careful to challenge our medical and nursing students to be faithful to the Jesuit concept of cura personalis. This entails a decision to become a humane healer rather than merely a technical expert. In “The Lost Art of Healing,” Bernard Lown laments, “Healing is replaced with treating, caring is supplanted by managing and the art of listening is taken over by technological procedures.” My husband, Robert Barnet, a cardiologist and ethicist, often references the five P’s that motivate medicine: power, position, prestige, profit and politics. Strikingly absent are the human person, the patient and the public.
The Affordable Care Act is challenging us all to create new processes for delivering higher quality care at reduced costs. Increasingly we look to the airline industry and NASCAR pit stops as models of excellence and efficiency. But a physician in the American University in Beirut recently remarked, “Every airplane engine is the same, but no two persons are.” Our challenge as health professional educators is not only to ensure that our students excel in basic and clinical sciences but also to ensure that they master the art of healing, of standing “consciously and compassionately in the present moment with another or with others, believing in and affirming their potential for wholeness, wherever they are in life,” (The Art of Being a Healing Presence, James E. Miller and Susan C. Cutshall).
This entails addressing gaps in knowledge, often by asking what healings looks like in the current age of high-tech medicine. We must also ask if the routine and pressures of daily practice desensitize us to the central importance of our being healing presences, which is a common shortcoming of attitude. Improving upon certain skills can also help us determine which communication skills best facilitate the art of healing. “The Ethics and Religious Directives for Catholic Health Care Services” are careful to note that “in a time of new medical discoveries, rapid technological developments and social change, what is new can either be an opportunity for genuine advancement in human culture, or it can lead to policies and actions that are contrary to the true dignity and vocation of the human person.” I invite all our health professions’ students to ponder this at the end of the day: Are our patients and families better because they had me, my attention and my service? Did I make the critical difference in their care? And an equally important question for educators here at Georgetown: Are our students better because they have us?
Carol R. Taylor is a senior research scholar at the Kennedy Institute of Ethics, a professor in the School of Nursing and Health Studies and founding member and former director of the Center for Clinical Bioethics. This is the final appearance of ENGAGING BIOETHICS this semester.