By John Brewer Eberly, Jr., MD and Ben Frush, MD
We recently published a case commentary in the AMA Journal of Ethics titled, “What Should Physicians and Chaplains Do When a Patient Believes God Wants Him to Suffer?” which has us thinking about suffering, medicine, and our own convictions as Christians. As new graduates of medical school, we’ve found it important to take up these conversations not only with our fellow medical workers, but with our friends and pastors, both that we might learn from the suffering within their work and offer an inside perspective on modern medicine—an enterprise which we see as a particularly powerful, trust-shaping force rarely addressed from the pulpit. If those in medicine really do function as the “new priests” of modernity, we hope pastors, priests, and fellow believers will enter, take to task, and challenge these conversations at the intersections of theology, medicine, and culture.
Witnessing a person suffering is a common experience for medical workers. At times the suffering is quite ordinary (the cough or small cut). Other times it is intractable, excruciating, and nonsensical—the spine riddled with tumors, the pediatric cancer, the infant abuse. Folks in the healing profession are a strange bunch, for they feel a peculiar urge (the ancients would say “call”) to move toward such pain in hopes of healing.
To aid those in suffering offers a high that is difficult to describe. There is a deep and immediate rightness to it—a sense of goodness, professional accomplishment, and vicarious euphoria that can serve as fuel for long nights in the library, ward, or operating room. It is hardly surprising then that many Christians pursue a vocation in medicine as a means to follow Christ. What better way to act as Christ’s hands than to serve the suffering and the sick—to work as healers against the powers and pathologies that threaten the body’s integrity?
Yet, the desire to pursue any good in excess should give us pause. Anglican theologian Rowan Williams recently named this “the toxicity of goodness.” Aristotle would deem it “vice,” while Paul labels it idolatry. Regardless of the terminology, the desire to pursue a seemingly good goal or eliminate a bad end, unhindered and unchecked, can produce paradoxical harm. To borrow a metaphor from our days in chemistry, when we strive to dissolve problems in solution, a new problem is often quick to precipitate out.
Given the admonitions of Williams, Aristotle, and Paul, we wonder what such precipitation looks like in our age, in which medicine’s powerful solutions to suffering have become so culturally embedded that they are rarely examined (let alone challenged) by either the institutions of medicine or the bodies of the church. Indeed, ought we even question a goal (eliminating suffering) which enjoys near-universal acceptance, a rare area of consensus in an increasingly fragmented culture?
We think yes—for without such examination we are prone to overlook the ways in which modern medicine’s attempts to relieve suffering can paradoxically beget more suffering. Moreover, we can fail to see the ways in which Christian healthcare workers and patients are called to distinctive practices in the face of suffering—practices that make sense only in light of the life, death, and resurrection of a Savior who sought neither to avoid nor extol suffering, but to transform it.
The Baconian Project
Our cultural obsession with the alleviation of suffering is neither recent nor accidental. As Catholic theologian-ethicist Gerald McKenney writes in To Relieve the Human Condition: Bioethics, Technology, and the Body, Sir Francis Bacon (16th century scientist and philosopher) was the first to explicitly champion the relief of suffering of humankind as both an explicit goal and a moral imperative. Bacon advocated for a “technological utopianism,” a philosophy which viewed no ailment or disease (at least in principle) as incurable. While suffering and death were accepted as “given” elements of the human condition prior to Bacon, the new “Baconian Project” espoused a view of the human that rejected these anthropological contingencies and viewed humankind as agents harnessing their ingenuity and resources to overcome or “relieve” their condition.
Importantly, Bacon’s vision was initially embedded within a tradition that placed limits on it—namely Christianity. Christians in Bacon’s day bound the goal of relieving human suffering within the larger understanding of life and death found in the creeds and in Christian tradition. A concern for the sufferer and the sick was backlit by et in pulverem reverteris—“To dust you shall return.” But in the centuries after Bacon, Western society maintained the moral imperative to relieve suffering even as it lost any common moral tradition or language that would qualify or urge moderation in that goal.
Modern medicine’s inheritance from Bacon is a technological mythos that rejects “the limits of healing” and “the mortality of the body,” seeking only to maintain life and relieve suffering, but for a telos it cannot define, and often at the cost of the very life it seeks to protect and the suffering it seeks to eliminate.
Suffering and Medicine Under the Project
McKenny’s analysis in To Relieve the Human Condition was published over two decades ago. How then, we must ask, does the Baconian Project manifest here in 2018, and what are the consequences of this ethic that champions an unbridled relief of suffering? We need look no further than some of the most pressing and well-recognized issues facing medicine today.
The opioid crisis, while complex and multifactorial in origin, serves as a concrete testimony to the perils of a limitless elimination of suffering. As narcotic drugs gained traction as a supposedly safe and effective treatment for pain of any sort, patients and physicians alike came to view physical suffering as a problem to be eradicated rather than an unpleasant but unyielding part of certain conditions. The pressure on physicians to alleviate suffering has ironically led to an epidemic of suffering.
The physician-assisted suicide (PAS) conversation is likewise haunted by Bacon’s legacy. As our nation’s states contemplate laws which would permit its widespread use, proponents of such legislation frequently appeal to language involving the alleviation of suffering (rather than the pursuit of health), forgetting perhaps, “the indignity of ‘death with dignity.’” The relief of suffering is elevated to the highest good, even greater than life itself (and in the case of PAS—often at the expense of the very life it seeks to honor).
Or consider the recent legislation engaging prenatal screening technology for the purposes of detection and subsequent termination of children with disabilities. Much of the justification for protecting the rights of parents to the information gained from such screening focuses on the suffering that a child with a disability like Down Syndrome would putatively involve—both for the unborn child and his or her family. Thus, benevolence is invoked as justification to protect against the unborn’s presumed suffering. But such protection is achieved through destruction—evidence of theologian-bioethicist Stanley Hauerwas’s unsettling claim that we increasingly seek to eliminate suffering by eliminating the sufferer. T. S. Eliot wrote, “Humankind cannot bear very much reality,” and deny it though we might, our finitude, sickness, and the death we all will ultimately face forces contact with bodily realities. It should be little surprise that the Baconian Project has not fulfilled its promises to fully “relieve and benefit the condition of man,” given the fact that suffering is a fundamental and ineradicable component of our physical reality. The unmitigated relief of suffering is not only harmful in its pursuit, but practically impossible—inevitably fostering disillusionment when suffering or death arrives for ourselves or for others.
Suffering Faithfully After the Project
Given the dangers that an unhealthy desire to eliminate suffering begets, what does a faithful response to physical suffering and bodily limitation look like from those who would follow Christ?
Martin Luther demonstrated that the Christian life is fundamentally one of thanksgiving and repentance. Meister Eckhart said something similar—that is, if you’re going to pray one prayer, pray “Thank you.” Perhaps the first step then is thankfulness for our anatomy and the physical, gritty, sometimes awkward reality in which we find ourselves as creatures both made in the image of God and operating within a fallen physical world. We also might offer thanks for medicine itself, for the wonder of it, those who practice it, and the health of our own bodies and the bodies of our neighbors.
A second faithful response is the (perhaps surprising) call to repentance. In “A Theology of Illness,” Orthodox theologian Jean-Claude Larchet argues that modern medicine, in its power and obsession with alleviating suffering, has turned the physician into a “new priestly class,” effectively sealing a permanent idolatry of health in the hearts of Christians and non-Christians alike. In a similar vein, ethicist-theologian Stanley Hauerwas has written that medicine is a “pseudo-salvific institution,” maintained by physicians as the “new priests.” Patients understandably place strong hopes in physicians and healthcare institutions, particularly when they find themselves in vulnerable states of illness and suffering. At the same time, common phrases like “That surgeon saved my life” carry a strangely salvific tone. We may worship in a church building, but often we confess at the altar of health, receiving medicine in exchanges that can be eerily sacramental. Transplants and transfusions take on new meaning as literal “body and blood.”
Amidst this temptation, we must be reminded of the sobering fact that, as Larchet writes, “the health of the body in this world can only be precarious and ephemeral.” We serve a bodily-resurrected Lord whose own body endured suffering and was broken on our behalf, who taught that, as ethicist Allen Verhey puts it, life was a good but not the greatest good, that death was an evil but not the greatest evil. We ought therefore to repent of putting undue hope in health, and to turn anew to Christ, constantly reminding ourselves and our neighbors in Christ that our ultimate joy lies not in our ability to obviate suffering, but in learning to worship well in sickness or in health.
A third step is a commitment to presence. Presence in the face of suffering is one of the most morally taxing endeavors any person can engage in—requiring great patience, time, and imagination. This is likely one reason why caregivers and doctors face burnout in such high numbers. “Being-there-with-others” and “suffering-there-with” are long, difficult labors, particularly in the face of a culture which increasingly seeks to avoid suffering or outsource the task of “presence” to social media. As Kate Bowler recently wrote in Everything Happens For a Reason: And Other Lies I’ve Loved, she is grateful for the presence of a Mennonite community in her upbringing because “they insist that suffering never be done alone.” Or as 2007’s Lars and the Real Girl put it, “We came over to sit. That’s what people do when tragedy strikes. They come over and sit.”
It is worth asking then whether we are, in fact, sitting with our suffering neighbors. Suffering together, particularly when suffering has no clear end, hope, or purpose, is foundational to the Christian story, from the sitting of friends in silence and sackcloth in Job to the way Christ waited and wept before resurrecting Lazarus.
And with Christ’s weeping in mind, a fourth and final response is recovering lament. There is a danger inherent in the critique of modern medicine’s Baconian goal to eliminate suffering that risks an overcorrection into something like suffering aggrandizement or suffering pursuit. This is a crucial distinction: Christian martyrs did not pursue suffering, they endured it and received it. Sometimes the most faithful thing a Christian can do when they are in pain is to cry.
The psalms provide an important framework for how this can be done: an honest conveyance of our deepest pains and grievances, with the knowledge that such cries are heard by a God who will not “break a bruised read” (Isaiah 42:3). If the “dirge” is the practice of raging inwardly in the echo-chamber of self, then lament is bringing our honest and raw feelings before the Lord and in community—weak and withered and half-hearted as our trust and hope in those moments might be. Lament refuses to give suffering the dignity of clean, theodical explanations while also refusing to look away. It means when we find ourselves or our neighbors in Psalm 40’s “slimy pit” or Psalm 6’s “bed wetted with tears” (images that are less metaphor than reality for many who are sick), we cry out—confident that our creator, sustainer, and redeemer grieves suffering and remains steadfast.
In a world in which it is increasingly easy to resort to solipsism, truism, despair, or denial in response to pain, lament allows us to exhibit grief that is honest, grounded in faith, with the knowledge that the Lord’s enduring promises are true, that his word will not return void, even in those painful instances in which “the darkness is my only friend” (Psalm 88), “my bones burn like glowing embers” (Psalm 102), and “outwardly we are wasting away” (2 Cor 4:16).
The Witness of Patients
It is doubtful that medicine alone can harness the moral resources necessary to allow its practitioners and patients to cultivate acceptance of the finitude of bodily existence, repent of an insidious idolatry of health, acknowledge the importance of mere presence in the face of suffering, and recover lament. Therefore, if there is hope to inspire a better response to suffering, perhaps it is faithful patients, grounded in faithful habits and practices, who can serve as examples for those participating in their care. As moral theologian William E. May once wrote, “The heavy burden of heroism in medicine falls not on the physician but on the patient and the patient’s family.” For those who would follow Christ, such heroism is evidence of the cross-burdened King to whom we owe our ultimate hope in the face of suffering.
John Brewer Eberly, Jr., MD and Ben Frush, MD are recent graduates of medical school and fellows of the Theology, Medicine, and Culture Fellowship at Duke, which offers “theological formation for those committed to engaging health, illness and disability in light of the good news of Jesus Christ.” Dr. Frush is a first-year resident in Internal Medicine–Pediatrics at Vanderbilt University, while Dr. Eberly is a research assistant with the Maternal-Fetal Medicine Units Network at UNC Chapel Hill. Their writing has appeared together in Academic Medicine, JAMA, and the AMA Journal of Ethics.