Strictly speaking, what is a patient? A human machine in need of repair; all else is accidental.
Or, as has been suggested, man could best be defined as an ingenious assembly of portable
plumbing.
As a patient, what do I see when I see a doctor? Since I am essentially a machine, I see the doc-
tor as a plumber, whose task is to repair a tube in my system. What does the doctor encounter
when he examines a patient? He sees a case, a urinary case, an intestinal case, but not a person.
This, then, would be our philosophy: The world is a factory, man a gadget, and the doctor a
plumber; all else is irrelevant.
While such a philosophy of medicine may seem plausible, it is being refuted by the grandeur
and agony of man. And no one sees so much agony as you, gentlemen.
To accept such a philosophy would be to perpetrate euthanasia on the spirit of medicine itself.
The mechanics of medicine must not be mistaken for the very essence of medicine, which is an art
and not alone a science.
The human organism can accept an artificial leg or a transplanted kidney. But will a patient retain his identity if his brain is removed and a mechanized brain is put in instead? Will medicine retain its identity if reduced to engineering?
The doctor-patient relationship comes to pass in the dimension of personhood as it does in the dimensions of time and space. There is no escape.
It is not true that diagnosis or treatment of a patient comes about in a way completely unaffected by religious and philosophical commitments. The doctor’s commitments are as much
a part of it as scientific knowledge and skill. His attitudes are either sensitive or cruel, human or
inhuman; there is no middle course. Indifference is callousness.
The doctor is not simply a dispenser of drugs, a computer that speaks. In treating a patient he is
morally involved. What transpires between doctor and patient is more than a commercial trans-
action, more than a professional relationship between a specimen of the human species and a
member of the American Medical Association. Medicine is not simply merchandise, and the rela-
tionship between doctor and patient is blasphemously distorted when conceived primarily in
terms of economics: the doctor a merchant, the patient a customer. What comes to pass in the
doctor’s office is a profoundly human association, involving concern, trust, responsibility. The
doctor is commander-in-chief in the battle for survival.
Disease has been defined by Spencer as a state which prevents an organism from relating itself
to the conditions of its environment. A doctor who lacks the ability to relate himself to a patient
must be regarded as suffering from a serious deficiency.
The doctor enters a covenant with the patient; he penetrates his life, affecting his mode of living,
often deciding his fate. The doctor’s role is one of royal authority, while the patient’s mood is one
of anxiety and helplessness. The patient is literally a sufferer, while the doctor is the incarnation of
his hope.
The patient must not be defined as a client who contracts a physician for service; he is a human
being entrusted to the care of a physician.
The physician is the trustee holding the patient’s health in trust. In return, the patient’s earnest
is reliance, commitment. In other relationships trust may be replaceable by shrewdness or caution, in the doctor-patient relationship trust is the essence; distrust may spell disaster.
The work of a teacher is being judged by a host of students. The books of a scholar are critically
examined by reviews published in magazines. Yet the work of the practicing physician is seldom
subject to public evaluation. The patient’s reliance upon his doctor is often due to blind faith.
In our democratic society where every individual insists upon being independent, and authoritarianism is abhorrent, the doctor is the only person whose authority is accepted and even cherished and on whose judgment we depend. Sickness, like sin, indicates frailty, deficiency, scantity
in the make-up of man. The survival of the patient does not depend on the pharmacist alone.
The doctor’s position is formidable. He gives orders and demands strict obedience. The doctor
is not alone in his effort to conquer disease. The patient is a partner, not a bystander.
Disease is an assault, and healing is war. The doctor as an autocrat would be like a general without an army. The patient is both battlefield and soldier. Chemistry supplies the weapons, but
who will decide whether the enemy is defeated by strategy or valor?
The patient is a person. A person is not a combination of body and soul but rather body and
soul as one. The human body is personal.
Health is profoundly related to one’s way of thinking, to one’s sense of values. And physical
well-being, the chemistry of the body are not independent of the condition of the inner man.
The doctor must find out the pressure of the blood and the composition of the urine, but the
process of recovery also depends on the pressure of the soul and the composition of the mind.
Diet and physical exercise are important, but so are the capacity to praise, the power to revere,
self-discipline and the taste of self-transcendence—these are qualities of being human.
Sickness, while primarily a problem of pathology, is a crisis of the total person, not only a physical disorder. There is a spiritual dimension to sickness. At a moment in which one’s very liv-
ing is called into question, the secretions of character, commitments of the heart, the modes of
answering the ultimate question, of what it means to be alive, are of supreme importance.
How to be sick gracefully? The process of healing is war, and the first casualty when war comes
is moral pretentiousness. Peevishness, resentfulness, suspicion are not restrained by constipation. How to grow spiritually in distress?
Sickness ought to make us humble. In a world where recklessness and presumption are the
style of living, and callousness dominates relationships between man and man, sickness is a re-
minder of our own neediness and extremity, an opportunity for the cynic to come upon the greatness of compassion.
Life is mystery, the reflection of God’s presence in His self-imposed absence. Jacob on his sickbed bowed his head (Genesis 47:31) in acknowledging the invisible presentness of the Lord.
God’s presence is at the patient’s bed. His chief commandment is, “Choose life” (Deuteronomy
30:19). The doctor is God’s partner in the struggle between life and death. Religion is medicine in
the form of a prayer; medicine is prayer in the form of a deed. From the perspective of the love of
God, the work of healing and the work of religion are one. The body is a sanctuary, the doctor is a
priest.
Medicine is a sacred art. Its work is holy. Yet the holy disappears when reverence is disused.
Reverence for the doctor is a prerequisite for the sanity of all men. Yet we only revere a human
being who knows how to revere other human beings.
It is a grievous mistake to keep a wall of separation between medicine and religion. There is a
division of labor but a unity of spirit. The act of healing is the highest form of imitatio Dei.
To save human life is to do the work of God. To heal is to do the holy. There is nothing greater.
The glory of God is reflected in the majesty of medicine. It is for this reason that we must strive for
this majesty to remain immaculate, without fault, without blemish.
Moral sensitivity is neither inherent as grist in our bones, nor does it float in the air as an idea; it
is radiant energy, waves of a divine light. Our moral substance depends upon the process of emis-
sion and absorption, upon the witnessing or receiving, upon the outpouring of the goodness done
by human beings.
