Few individuals are called upon to be heroes like Ukrainian president Volodymyr Zelenskyy who, in choosing to stay and fight a massive, invading army, faces a real possibility of imprisonment and death. This is true courage.
Within the medical profession, there are also wars to be fought that require true courage. One thinks of the late Dr. Paul Farmer, who worked tirelessly throughout his career to bring high-quality health care to Haiti, Rwanda, and other resource-poor nations around the world.
Even if one does not seek out situations that call for courage, they will knock on one’s front door. Such was the case when I was asked by the Quinlan family, in 1976, to care for their daughter. Karen Ann Quinlan was in a persistent vegetative state, and there had never been a right-to-die case before.
Aware of worldwide media coverage, I was uncertain at first, and hesitant. But how could I deny this bereft family the medical support necessary for a more satisfactory palliative outcome? Didn’t I always stop at accidents and offer my help? From a moral standpoint, wasn’t this the same thing? What cemented my willingness to help was that six of my most respected colleagues at Morristown Medical Center unhesitatingly said they would support me.
That was nearly a half-century ago. Today, there are many other challenges that also require courage. First and foremost, in my mind, are the gross inequalities of health and health care in America, which have been exposed by the COVID-19 pandemic. In the 1980s, I served as vice-chair of a New Jersey group, Citizens Committee on Biomedical Ethics, that labored in this area. Today, I feel a renewed call to enter the fray of this modern, medical civil war and support public groups dedicated to expanding affordable, effective care to all.
Another challenge is the way the medical-industrial complex has eroded our ability to serve our patients, the public, and our profession. We must fight to tame the powerful behemoth of high-tech care driven by profit that has contributed to the demise of relational, educational, and preventive areas of patient care. Creating a more proportionate balance between hi-tech and hi-touch will not only improve the quality of care for patients but will also improve career satisfaction for physicians. The doctor-patient relationship is the heart of medicine, and physicians have suffered moral injury from the demise of relational medicine. Restoring this balance will provide us the energy and conviction to improve our charge to society.
To paraphrase the poet David Whyte, in an essay on courage appearing in the book, Consolations: Courage is the measure of our heartfelt participation with life, with work, with a profession; and yes, with a future. Whyte observes that the word courage originates from couer, or heart.
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