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A Pagan Physician’s Perspective: The Ethics of Healthcare - Dragonstorm

 

I was a doctor before I became a Pagan. Or maybe I should say before I KNEW I was a Pagan. In fact I grew up with a Christian upbringing. A beloved family member of mine, also a doctor, asked the question many years ago, “How can one not believe in god knowing how well-organized the human body is?”

I understood this logic very keenly, having marveled at the magic that is the human body, and biology in general. But something over the years nagged at me more and more, and was a big factor in changing my path to Paganism and Druidry. That is the absolute irony behind the IMPERFECTION of the human body when disease sets in. For so many disease processes, including the 2 top killers of adults, cardiovascular disease and cancer, and the 3 top killers in children, cardiovascular disease, cancer and trauma, human behavior (or misbehavior) plays a major role in speeding one to their death.

But what of those many disease processes that are bestowed upon the unwitting, unborn child? Or the infant, the child? As a pediatric specialist who has had the misfortune to see too many children die of heart disease, often genetic or congenital, my perspective on the nature of our origin and biology has changed radically over the years. And moved me to find a spiritual path that understood this imperfection. Consider the story of one of the earliest Celtic healers, that poor vain god Diancecht, divine healer, who was able to craft a beautiful prosthetic arm of silver for King Nuada to replace his lost arm. But when Diancecht’s son Miach, an even more accomplished healer, bested his father by providing a new prosthetic arm of flesh and blood for the king, Diancecht killed Miach in a jealous rage.

Has anyone met this doctor in their own life?

I do not recount this tale to disrespect the gods. Far from it, the story is a lesson for us—a word of caution and warning to those who would think themselves any better, or those who would believe themselves to be freed from the chains of vanity. No, alas we are all human, doctors included. I have met a few arrogant physicians myself over the years. And I confess to my own arrogance from time to time. It is hard to go through the intense training that we have without building up our ego. But this essay is not an apology, nor is it a meant to justify that arrogance. It is to generate a discussion in the Pagan community about some important ethical questions raised when disease and spirituality collide.

Consider the recent case of a Wisconsin family who chose faith healing over “conventional” western medicine, and who lost their 11 year-old daughter to diabetes in that choice. Not to Child Protective Services, but to Death. The parents were found guilty of reckless homicide and sent to jail for 6 months, with 10 years of probation to follow. There is no question of whether they loved their daughter. The mother stated during the sentencing hearing, “I do not regret trusting truly in the Lord for my daughter’s health. Did we know she had a fatal illness? No. Did we act to the best of our knowledge? Yes.”

It’s pretty hard to argue with that sense of faith (not logic), if one truly believes in religious freedom. So here is the point of conflict: modern science and medicine have provided us with many tools to treat illness, improve quality and quantity of life, but these tools are not limitless, nor are they infallible. Most of us have experienced this all too well at one time or another, either with ourselves or our family. Indeed, many have developed a sense of distrust of modern medicine because of it. American society has put all the eggs in this basket, and has ingrained this implicit trust in our medical system to a degree that it has been fully incorporated into our infrastructure and even into our laws. Moreover, modern Christianity has incorporated western medicine into its faith to a degree that Christian conservatives have forgotten those limitations.

I’ve always been amazed by the so-called “pro-life” movement in Christianity, aiming to preserve life at all costs, even unto pushing prolonged artificial life support on the person in a persistent vegetative state. It has been, and continues to be, an oxymoron for the Christian community to behave in such a manner when they believe in a merciful, omniscient, all-powerful god, and eternal life after death. For instance, were they worried that Terri Schiavo would go to hell when she died? Her death at some point was a certainty, as it is for all of us. Do these conservative Christians believe that they were doing Ms. Schiavo a service in keeping her alive on tube feedings?

I had the experience of taking care of a very similar patient during my training. This person had been devastated by a stroke during surgery and was left in a persistent vegetative state. The patient had been in the hospital for many years—never left—and who was on tube feedings for all the necessary nutritional requirements. This patient’s brainstem function was intact, so the patient was able to breathe, and kept an appropriately regulated heart rate. But there was no communication whatsoever, no purposeful movement. I would round on the patient, ask how s/he was doing, and tell her/him I was going to do an exam. I would reach out to check her/his pulse, with no indication that there was any sensation or recognition of the contact. S/he was not able to eat—the tube was placed in her/his small intestine and continuously fed her/him. The nurses did an admirable job of keeping her/him cleaned and cared for otherwise, but I would ask them if they had ever observed any communication or purposeful movements, and the answer was always no. The patient’s family never came to visit. The other big difference in this case to that of Terri Schiavo’s is that my patient was hospitalized in a Catholic hospital. The cases of the Wisconsin girl who died of diabetes, Terri Schiavo and my own patient from all those years ago are all very dramatic illustrations of a much more common dilemma of how we adjudicate the conflict when faith and medicine collide. A much more common example I see in my practice is when patients want to avoid treatments that I recommend because they want to “keep it natural”. For many it’s a spiritual issue—perhaps they are Pagan or of some other religious tradition such as that of the Wisconsin family; for others, it relates to a simple lack of trust in modern medicine without regard to religious faith; and still for others, worries of how artificial medicines will affect their bodies.

I have learned to sympathize with these patients and families over these years, as I have experienced the limitations of what I have to offer patients firsthand. Also, I have had to do some “unlearning”. In our training, we were taught by some that no other medical approaches other than our own “conventional” western medicine were of any value. It is a shame that my own teachers have so quickly forgotten that many of the modern medical breakthroughs were from Mother Earth herself—salicin (aspirin) from the bark of the willow tree and other trees, penicillin from the penicillium mushroom, the cardiac glycosides from the digitalis plant (foxgloves). The list goes on… Of course, many of our treatments are synthesized from the modern pharmaceutical laboratory as well.

All of these issues ask very different ethical questions, but are illustrative of the very strong connection between faith and medicine, life and death. The question I’m most interested in is this: if these questions came up for the Pagan community to decide or adjudicate, what would we have done? What would the Druids of old have done? What would we do if we are to decide for the many situations that will arise in the future? Or is it even for us to decide? Should it be government that makes those decisions? Some other church? Or is it up to the individual?

I know what the Pagan physician in me would do in each case and I promise that I will bring my beliefs forward at the end of this essay. But if we are to have an honest debate about these questions, our beliefs on medical ethics, or more broadly the ethics of death and dying, need to be brought forward for the world to see. And lest we isolate ourselves from the greater community of humankind, they must be able to work within the basic constructs of society and the law. So let this essay be not a dissertation on how all of these complex questions should be resolved, but rather the opening to that honest debate within the Pagan community.

One of the wondrous aspects of this spiritual pathway that has attracted me from the beginning is the ability to tolerate a wide diversity of viewpoints, and the freedom afforded individuals to make their own decisions as long as no one is harmed. The problem with these life and death questions is that harm is difficult to avoid where disease processes are concerned. And what of the fact that we all must die at some point? Who of the wisest among us can say what is the best way and time to die?

In my practice of medicine, I have integrated new practice patterns, or strengthened old practice patterns I already had, based upon what I have learned in my reading and meditation during my travels on this spiritual pathway.

These include:

1. To have an implicit respect for others’ religious beliefs. This extends even to praying with families when they ask it of me. After all, in those cases we are all interested in what’s best for the patient, even when there is a disagreement as to what may be best! Let the Spirits, whether it’s the Spirits we work with in our Pagan rituals, the Christian Holy Spirit, or those of other spiritual traditions, send out their healing energies too!

2. To provide the best and most complete disclosure of the risks and benefits of the treatment I am offering within the time given for that visit. This includes a discussion of alternatives to that treatment.

3. To empower the individual to make their own healthcare decisions whenever possible, providing them with the facts as completely and concisely as I can. This can be quite difficult where children are concerned, and in many cases the parent(s) must make the decisions in their stead. In the U.S., the parents are legally entitled to make healthcare decisions for their children until their children reach the age of 18, or if they become an emancipated minor, or if they lose custody of the child. Having said that, I am often impressed by how a healthy parent-child relationship can work towards a mutual decision.

4. To work with patients and families on a treatment plan that incorporates natural and herbal remedies and other modes of healing when possible, when they wish. This has been perhaps the most difficult, because medical literature is so incomplete with regards to side effects of herbal remedies and interactions with other medications. This is something I hope to improve with further education in this area. Moreover, are there complications possible with “alternative” healing methods such as acupuncture? If so, there needs to be education of these issues in our training. But there also has to be a willingness for us to learn about these methods as we continue on in our practice. As a general rule, I can see no detriment whatsoever to prayer or meditation incorporated into a treatment plan!

5. To know when to say I have nothing further to offer to a patient of any medical value. This includes the dying patient, even if they are a child. In these most difficult cases, we must shift our focus on what is spiritually beneficial to the patient. And that brings us full circle back to respecting the religious beliefs of my patients and their families.

So I promised I would comment on what I would do in the cases I mentioned above. I may be sticking my neck out for the headsman’s axe, but this will give the reader the transparency to know what my values are as they read, and begin what will hopefully be a meaningful discussion for the future!

In the case of the Wisconsin child with diabetes, if I had been the physician of record and had examined the child before she died, I would’ve offered all of the treatment options available to treat her diabetes including conventional medical treatments, and dietary interventions in hopes that she would survive to live a productive life. If I was the judge sentencing the parents for the reckless homicide charges, I would’ve required them to write a lengthy essay explaining their beliefs for publication in the press (this would not harm them beyond the time taken to write, as the case was already public knowledge) so that others would understand their belief system and could open up the debate to the general public. Any publication monies made (if any) would be donated to a mutually agreed-upon public health charity or perhaps the WHO. I would not have sent them to jail. I’m quite sure they are suffering the loss of their daughter enough.

As for the more difficult question of what to do if the parents refused treatment before the child died, I think that would have required discussions with the girl both with and without her parents present (she was 11 years old) to see if she would give her assent to treatment. If so, a court order granting temporary custody to the court to allow her to be treated could be given, then restoring custody to the parents after treatment. For those who would be alarmed by this judgment, consider the case of Jehovah’s Witnesses: it is not uncommon for parents to bring their children for a needed blood transfusion to treat a blood disorder, give temporary custody to the court while their child is treated, then receive custody back literally a few hours later, preserving their child’s health, and preserving their souls in the eyes of their god. A seemingly silly exercise, but that is another debate altogether…

In the case of Terri Schiavo, ideally she would have written a Living Will in advance, rendering any treatments given following her devastating neurological injury subject to her own approval. I believe that as a society we should educate everyone on the usefulness of these important documents (regardless of what Sarah Palin may think). Too often, there is secondary gain to be had by other family members making decisions, or even the hospitals or other care providers. With the absence of a Living Will in Schiavo’s case, there was disagreement between her husband and the rest of her family creating a difficult situation to sort out. However, if my impression of her medical condition was correct (not having examined her), she was in a state of un-life—a persistent vegetative state with the only really functional part of her central nervous system being the brainstem. A sad state, to be sure. How is artificially feeding someone in that state doing that person a service? In my opinion, it is assault to place a feeding tube down into someone’s small intestine no matter what state they are in, unless they gave their consent to have it done. I think that providing any end-of-life care necessary to allow her to comfortably pass on without providing artificial life support would allow her spirit to transition to the next life. This is eventually what was done after a very expensive and visible legal battle that reached all the way to the U.S. Congress.

I would render the same opinion in my own patient during my training all those years ago. It wasn’t my choice to make at the time as a trainee, and even if it had been, I have changed quite a bit since that time. My values have evolved and grown in the fertile land of my new spirituality, and alas I do not know what happened to my patient. I can only hope that her/his spirit was given a chance to find rest and comfort!

In closing, I am so happy to have found a spirituality that reconciles the often painful ethical dilemmas that sometimes are imposed between families, care providers, and patients. A spirituality that promotes healing without imposing itself between the dying and their afterlife. I welcome the discussion and debate that I hope this essay will bring, because I believe that the Pagan path will shine brightly compared to other “life-affirming” religions when these questions are considered on the ethical front. Please feel free to write me with any comments and stories!

Bright Blessings to all, Dragonstorm