The Good Samaritan and the Christian Physician, Part 2: Humanizing Medicine

The Christian Physician

Pope John Paul II has said that “the humanization of medicine” is central to the practice of medicine.¹ Here, I think, we find the heart of the meaning of the parable of the Good Samaritan for the physician.

At the end of the parable, Jesus points out that the important thing was not the binding of the wounds or the taking of the half-dead man to shelter, but mercy—not the external act, but the internal disposition which moved the Good Samaritan to act. The person who is neighbor to the half-dead man is the one who has mercy on him through action.

Physicians, more than those in most other professions and vocations, confront daily and constantly a particular category of vulnerable human beings, the sick. The half-dead man lying on the side of the road is unquestionably one of the sick. Those working with the poor might be able to clothe them and find them a bed; those working with the dying might be able to tend them until they die; but the physician is able to heal them and to preserve their life giving them new life, or at least further life. For that is the physician’s vocation, that is what he is trained for, what he is knowledgeable in: healing the sick. Human life, after all, is one of the highest goods, it is a gift from God and is sacred, and it is deserving of our respect and defense (Catechism of the Catholic Church, no. 2258ff).

The association of the physician to the Good Samaritan is apropos and easy to make. But it is just as productive, if with a less obvious connection, to associate the physician to the lawyer who stood up and asked Jesus about eternal life. The physician, just as the lawyer, is expert in a form of law, that is, in the laws of biology, chemistry, organ systems, human bodies, which make up medical science. He even has principles or norms that address his relationship with his patients, the most popular secular theory of which is principlism with its four principles: beneficence, nonmaleficence, justice, and autonomy²—which all seem to emphasize the minimums needed.³ But just as the Ten Commandments are only the first step (the Old Law), so are medical science and principlism only the first step in the physician’s vocation. Physicians who follow only civil laws or bioethical norms, not only do not know the whole law, the eternal law from which the civil law and the bioethical norms come, but also do not know the application of the law. The physician who only knows and practices medical science and principlism will fail to fulfill his vocation, the “law,” if you will, of medicine. For the practice of medicine involves not only science and norms but also human beings. Human beings, composed of body and soul, are physical beings of a rational nature that is both philosophical and theological, thinking and believing.⁴ Recall the sting of wine and the soothing quality of oil in the parable. Gregory the Great used this as an allegory to illustrate being both firm and kind to those under us: “In the wine he [the Samaritan] applies the sharpness of constraint, in the oil the softness of mercy. By wine let the corrupt parts be washed, by oil let the healing parts be assuaged; we must then mix gentleness with severity, and we must so combine the two, that those who are put under us be neither exasperated by our excessive harshness, nor be relaxed by too much kindness.”⁵ Just so, the physician must sometimes cause pain or discomfort in order to facilitate healing and do so in a way that instills trust in the patient (i.e., have a good “bedside manner”). This seems then to be a part of the answer to Pope John Paul II’s call to humanize medicine: to bring consideration of the rational and the theological aspects of human nature into the physician’s practice to enhance the physical sciences and bioethical theory and in a way to fulfill medicine and bioethics.

The second issue addressed above in discussing the parable is that of mercy. The physician as Good Samaritan has mercy on his patients. One characteristic of this mercy is that the Good Samaritan does not avoid the half-dead man, he acknowledges his need for aid by moving to help him. One could even say that he acknowledges him as a human being, he recognizes his humanity. There is more to the Good Samaritan’s response than what one would normally expect if an animal (or a plant) was lying half-dead on the side of the road. The use of oil and wine (both probably not inexpensive), the binding of wounds, the trip to the inn, all point to a recognition that this being is a fellow human being who is deserving of, and even owed, respect, care, and personal attention. The physician who accompanies the human embryo to birth or provides food and water through a tube to those unable to feed themselves also recognizes this patient as a fellow human being. The half-dead man is probably not a Samaritan, so the recognition crosses national, racial, or religious boundaries. The physician’s obligation is to all humanity, not just Americans or Caucasians or Catholics. The half-dead man is probably not conscious or only semi-conscious, so consideration of mental capacity or rationality or state of consciousness is irrelevant. The physician may not exclude from care the PVS patient or the two-year-old or the mentally handicapped. There is no consideration of the half-dead man’s autonomy—whether he wanted to be beaten or not, whether he wants help or not, or what kind of help he wants. The aid is bestowed, not offered; there is no opportunity for the half-dead man to refuse it, nor does the Good Samaritan expect repayment (instead he offers more money on his return trip). The physician could enter into a contract with a patient to provide a commodity and to receive payment. The rich spend plenty of money to keep or gain good health, and the poor too would spend money on good health if they were able, even to the extent that health and long life are almost given utopian signification. Just so, the physician could extort much from his patients in the name of good health, or he could make a reasonable living and follow the example of the Good Samaritan in generosity without expectation of payment when the opportunity presents itself. Consequently, to facilitate good health becomes a vocation and a service, rather than a job.

Additionally, in the parable, to be half-dead is assumed to be a bad thing, and bad not just personally (considered bad by the Good Samaritan) but bad for all human beings. To render aid to someone who is vulnerable, sick, and in need of help is more than generosity or beneficence. The priest and the Levite do not render aid and are considered to have broken the law of love of neighbor, they are not neighbor to the half-dead man. “‘Which of these three, do you think, proved neighbor to the man who fell among the robbers?’ [The lawyer] said, ‘The one who showed mercy on him.’ And Jesus said to him, ‘Go and do likewise’” (Lk 10:36–37). To render aid is an obligation derived from the laws of moral conduct, specifically love of neighbor. Not only does the physician render aid to his patients, but he has made rendering aid—in the form of medical expertise which not only renders aid but also promotes good health, cures, and cares, with all that entails—his life’s work, his vocation. He has made the second greatest commandment—love of neighbor—central to his life and his livelihood.

Another aspect of the Good Samaritan’s mercy is that of solidarity, of an ongoing relationship that may have only just started but is expected to continue in the future. “The next day he took out two denarii and gave them to the innkeeper, saying, ‘Take care of him; and whatever more you spend, I will repay you when I come back’” (Lk 10:35). The Good Samaritan will be back. He does not abandon the half-dead man to the innkeeper but assumes the responsibility for his future needs. He does not say “I’ve done my duty” or “I’ve done enough,” instead he accepts as part of the relationship he has established with the half-dead man an evocation of permanence. The responsibility for his neighbor that he has taken up does not end with the binding of wounds and finding of shelter. The relationship that a physician establishes with a new patient also takes on this air of permanence. But the physician who sends his dying patient home with a lethal prescription is in effect saying “Our relationship ends here and now,” for a physician cannot take care of a dead patient. But a physician who journeys with his dying patient to the natural end of his life, as the Good Samaritan journeyed with the half-dead man to the inn, is saying “I am with you, I am here for you, you are not alone, you are not a burden.”⁶ Human beings are not monads, isolated and solitary. The priest and the Levite forgot that; and instead of giving mercy, they obtained guilt under the law. The opposite is this: in uniting ourselves with the other human beings we encounter, whether friends, acquaintances, or strangers, we find harmony with God and neighbor.

Here then is another part of Pope John Paul’s humanization of medicine: to have mercy, a mercy which entails treating the patient with solidarity as a fellow human being and a neighbor, who is to be respected, cared for, and loved as we love God. For the second greatest commandment—“You shall love your neighbor as yourself”—is like the first—“You shall love the Lord your God with all your heart, and with all your soul, and with all your mind” (Mt 22:37–40).

Following the example of the Good Samaritan, the physician humanizes medicine by taking care of the patient as a complete human being, going above and beyond medical science and bioethics to include the philosophical and theological facets that make up a whole human being. In accompanying the patient as the Good Samaritan journeying with the half-dead man, the physician brings a human touch to his patient. In this way he both fulfills the law, found in the moral obligation of his vocation to the sick, and has mercy thereby fulfilling the law of love of neighbor. “Do this, and you will live” (Lk 10:28).

Notes

¹ Pope John Paul II, Address to the Italian Surgical Society (October 15, 1998), no. 2, https://www.vatican.va/content/john-paul-ii/en/speeches/1998/october/documents/hf_jp-ii_spe_19981015_cong-chirurgia.html.

² See Tom Beachamp and James Childress, Principles of Biomedical Ethics, 7th ed. (New York: Oxford University Press, 2012).

³ See, for example, ibid., 6. One is not required to do one’s best but only to do what is obligatory: “moral ideals … are not required of any person.”

⁴ See Livio Melina, “Bioethics and Religion: Preliminary Epistemological Question,” Communio 25 (Fall 1998): 386–96.

⁵ Gregory the Great, Moralia in Job, bk. 20, no. 14, quoted in Catena Aurea: Commentary on the Four Gospels, vol. 3, Luke, eds. Thomas Aquinas and John Henry Cardinal Newman (1841; London: The Saint Austin Press, 1997), 374–75.

⁶ The reasons given most often by those requesting physician-assisted suicide in Oregon in the early years of its physician-assisted suicide law were feelings of helplessness and being a burden on others. Oregon Department of Human Services, “Sixth Annual Report on Oregon’s Death with Dignity Act,” table 4, “Death with Dignity Act Participant End of Life Care and DWDA Utilization,” http://www.ohd.hr.state.or.us/chs/pas/ar-tbl-4.cfm.

⁷ As an aside, it would be interesting to explore how a surgeon, who is supposed to be more detached in order to perform surgery well, could also have mercy and support the patient as a whole human being.