Doctor and Brother
Daniel Sulmasy Discusses His Role on President’s Commission
President Obama has appointed Franciscan Brother Daniel Sulmasy to the Presidential Commission for the Study of Bioethical Issues.
Brother Daniel, who holds both an M.D. and a Ph.D., is the Kilbride-Clinton Professor of Medicine and Ethics in the Department of Medicine and Divinity School at the University of Chicago. He’s also associate director of the MacLean Center for Clinical Medical Ethics and adjunct professor of medicine at New York Medical College.
He is the author of numerous books and academic papers, including The Healer’s Calling: A Spirituality for Physicians and Other Health Care Professionals, published by Paulist Press.
He spoke with Register correspondent Joan Frawley Desmond.
You are best known for your work on end-of-life issues.
My work has been in clinical ethics, largely about the care of patients at the end of life and about “surrogate decision-making”— the experience of family members making decisions about end-of-life care for a loved one. I’ve also studied the principle of double effect and the distinction between killing and allowing someone to die. Ethical and moral questions regarding the enrollment of people in medical experiments is another area of research.
Most of my books are about spirituality in health care — the spiritual framework that exists prior to ethics. In one of my books, a chapter on ethics and spirituality quotes from Pope Benedict XVI’s first encyclical, Deus Caritas Est. The Pope writes, “Christianity is not in the first instance a moral code, or a philosophy of life. It is an encounter with a person.”
My work in spirituality looks at the spiritual experience of being a physician: Where can a person find an experience of transcendence and ultimate answers to questions of meaning, value and relationship?
In a Nature magazine article on President Obama’s new bioethics commission, one commentator suggested that President Bush’s bioethics council was too “narrowly” focused on the moral status of human embryos — within the context of the embryonic stem-cell debate. Would you agree?
President Bush’s bioethics council also took up other issues, and it’s unfair to say it only addressed the ethics of embryonic stem-cell research.
The council issued a number of publications, including On Being Human, a collection of literary and philosophical reflections, as well as Human Dignity and Bioethics, a series of commissioned essays. I provided a contribution to that work — an analytical and philosophical look at the concept of human dignity, and whether or not it was intrinsic to the human person. I suggested there was a philosophical conception of dignity independent of Scripture and magisterial pronouncements that is consistent with the Catholic conception of human dignity.
The White House has suggested the focus for the new bioethics commission will be more practical than philosophical. Have you contributed to the development of ethical guidelines on policy issues?
I served on the New York State Task Force on Life and the Law from 2005 to 2009 and on the Ethics Committee of the Empire State Stem Cell Board from 2007 to 2009.
The Ethics Committee of the Empire State Stem Cell Board recently approved the sale of human eggs.
I had left the Ethics Committee by then. But had I remained, I would have been one of the dissenting votes on that issue.
Today, when policy-makers address issues — like the selling of human eggs — there’s often an unacknowledged but implicitly utilitarian way of thinking that accompanies the decision-making process. When you question practices that commodify the human person — like the selling of human body parts — no one seems to think it matters. They are concerned with the good that can be achieved, and they only measure the harm to human persons in concrete, measurable ways. The hardest work is convincing people that an ethical problem exists despite the net gain.
The modern utilitarian mindset has led one critic to observe that if asked to consider the ethics of using trains to transport prisoners to Auschwitz, most bioethicists would evaluate the safety of the trains and ignore their actual purpose. How can someone who believes in the intrinsic dignity of the human person shape ethical discussions on policy matters?
When I was on the Empire State Board, half the members were bioethicists. Father Thomas Berg of The Westchester Institute and the late moral theologian Msgr. William Smith were on the board. We tried to find allies, and we had some success — mostly on process issues.
After very tedious debate, the committee unanimously endorsed the idea that the human embryo is a human organism at the earliest stages of its development and worthy of respect. Some members didn’t even want to endorse that position, but we pointed out that the National Institutes of Health defined human embryos that way, and people had to accept it.
The ethics committee staff would grumble that we were wasting time. But if you don’t get the basic questions right, you won’t get the applications right: Small errors at the beginning of an argument lead to errors at the end of the argument.
We have spent much of the last year engaged in a difficult, divisive legislative struggle for health-care reform. How would you characterize the substance of our national debate on this issue?
At one level, there was a general consensus that we needed to cover more people, and that was the position of the U.S. bishops.
Regarding the debate about federal funding of abortion: I’m not sure the bishops’ objections were fairly aired, widely understood or responded to in an appropriate way.
On the other hand, the discussion about death panels was absolutely bizarre — it was sloganism. What was called the “death panel” was actually a measure designed to cover the cost of physicians counseling patients on end-of-life issues. Right now, as a physician, I do not bill for that advice, but I might spend a lot of time talking to patients about it.
How did you come to join the Franciscans?
While I was in college, I thought about a vocation and becoming a physician. When I got to medical school, I got in touch with the Franciscans. I thought I might be a missionary. But after I was accepted into the friars, I worked in a Cambodian refugee camp and didn’t like the heat.
Gradually, as I completed my formation, it dawned on me that I would be an academic — and I also realized that I was called to be a brother.
Do you continue to have faith that you can make a difference in a field that has become increasingly polarized?
Sometimes it gets lonely, but I continue to have faith in basic human reason and good will. It’s my job to make the best arguments than I can, and to ask questions that bring people down to the fundamental questions they would rather ignore.
I try to help people understand that content matters, not just process. Despite what our society sometimes seems to think, freedom is the context for morality, not its content. The more free we are, doesn’t mean the better we are: It only gives us the possibility of choosing.
Joan Frawley Desmond writes from Chevy Chase, Maryland.