THE TEN COMMANDMENTS
The familiarity of the Ten Commandments may blind us to their applicability to the concrete circumstances of medical practice. Though they may be numbered variously, and phrased in numerous ways, here's a basic rendition.
- Thou shall have no false God's before me.
- Thou shall not take the name of the Lord your God in vain.
- Keep Holy the Sabbath.
- Honor your Father and Mother
- Thou shall not murder.
- Thou shall not commit adultery.
- Thou shall not steal.
- Thou shall not bear false witness.
- Thou shall not covet thy neighbor's spouse.
- Thou shall not covet thy neighbor's goods.
COMMANDMENTS APPLY TO EVERYONE
Insofar as the Ten Commandments apply to all people, they would clearly also apply to nurses, physicians, therapist, etc. Like any general principles, their application must be done with prudence, with insight into the concrete circumstances of the individual situation. Health care as a profession shifts and undergoes change due to shifting circumstances and developments in technology and other disciplines. It is possible, though, to translate the Ten Commandments into specific injunctions for health care professionals.
Thou Shall Have No False Gods Before Me.
Two false gods especially tempt those in the medical profession. Of course, I am not suggesting that I've seen doctors burning incense before golden calves or nurses bowing down before graven images. It would seem that this commandment is the most outdated, but in fact it may be the most relevant of all in day to day life.
In a certain sense, every person makes something or someone the be-all and end-all of existence, an Alpha and Omega. When we first awake we think about whatever this is and when we lie down to sleep it comes to mind again. Our very lives become ordered by and to this "ultimate end" that in which we can find true happiness, for if human beings seek anything it is true happiness.
CHOOSE BETWEEN SERVING MAMMON AND GOD
For many of my students money is this very thing. Why do they come to class? Ultimately money. What measures success or failure in life? Ultimately money. The same is sometimes found among medical professionals. The entered the profession on account of money, they remain only because of money, and they give themselves body, mind, and spirit to the pursuit of money-by means of the medical profession. Nothing is wrong with money. But to make money into the ultimate goal of life is to deny oneself what one really wants more than anything else, perfect happiness.
For money cannot give us this. God enjoins us to worship him alone not because God is some kind of cosmic egomaniac desirous of praise, fame, and glory but because the human person finds perfection and happiness in giving God praise, fame, and glory. God does not need us to worship him for his well being; we need to worship God for your own well being. In so far as our lives are ordered to money as a end-all and be-all, as the Alpha and Omega by which all success and flourishing is measured, to this very extent our own success and flourishing in life is compromised. For gold can be lost, and stocks can fall. And even if we had complete financial security, our hearts yearn for many things that money cannot buy. We want happiness, but not a partial happiness mixed with loneliness and ignorance and interrupted by death. Since we all want pure Light without the darkness of ignorance, pure Love without burning of hate, and pure Life without the shadow of death, our hearts as Augustine so long wrote are restless until they rest in the pure Light, Love, and Life which is God.
CONFUSION OF THE HUMAN LIFE WITH PURE LIFE: MEDICAL IDOLATRY
The other false god tempting many in the medical profession is a confusion of the human life with pure Life. Human life is a good, a basic good that is fundamental to all human flourishing. It is not however the highest good, a good that must be pursued at all times and places and to the fullest extent possible.
To mistake the human good of life for the good of divine life is to commit oneself as it were to a medical idolatry. Asked by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research: "Is it the duty of the physician to do everything for that patient until that patient is called to his or her reward?" pulmonary scientist Dr. Marshall Brummer answered, "Yes." Richard McCormick comments: "Behind such assertions lies a kind of medical idolatry, the absolutization of physical existence. This idolatry takes concrete form in the conviction that the inability to cure or prevent death is medical failure" (McCormick, Critical Calling, 366).
Vitalism absolutizes the value of human life, continued existence, without due consideration that some treatments burden patients and others tremendously while providing very little benefit. One can see the long-standing rejection of vitalism in the Catholic tradition in the insistence that extraordinary means need not be used in supporting human life. Of course, it is an another form of disrespect for God, and perhaps the more common one, to fail to see the image of God in each human life.
Thou Shall Not Take the Name of the Lord Your God In Vain.
This commandment enjoins a respect God's name and a respect of things and person's associated with God. Most clearly then this suggests that pastoral care involves a relevant and important dimension of treating the good of the whole person. Certainly it may not be the physician’s job to provide spiritual care, but it is also not the physician’s job to mock, undermine, or otherwise not support spiritual care, or those who provide spiritual care. Likewise, the spiritual needs and beliefs of patients deserve respect, acknowledgment, and where appropriate support.
The second commandment also enjoins us not to make false promises. Insofar as the doctor-patient relationship requires a certain bond of trust, health care works should, if it all possible, keep any and all promises. “I’ll be back to see you in a few minutes” should mean just that barring extraordinary circumstances. Perhaps it is better then to make conditional promises that one can assure are kept. “I’ll try to get back to you in the next few minutes if I can.” The building of trust by keeping promises is not just required by a moral sense but also by the demands of the medical profession itself which suggests that anxiety producing experiences, such as broken promises, should be eliminated as much as possible.
Keep Holy the Sabbath.
Few professions work longer hours than do doctors and those who support them. Nothing is wrong with hard work, long hours. But like a gas, professional work will expand to whatever space is allotted it. If the body and mind were not so weak, one could work 24 hours a day, 365 days a year. The man was not made for Sabbath but Sabbath for man, it says in the Gospel. Work is about what we do, but worship is about who we are--made in the image of God. The Sabbath rest allows time to recreate and recollect that we work to live not live to work. And we live not merely to live but to have the fullness of life that comes from an intimate relationship with the True, Good, and Beautiful.
Workaholic hours bring devastating consequences—divorce, breakdowns, on the job let down, and depression. The humanity of health care professionals demands that proper care of self, especially the self in relation to God, be accorded its due.
Honor Your Father and Mother.
"Thou doth stride the world like a colossus." These words fit overblown egos of many physicians. This importance of this commandment for health care physicians is in part to remind them of their origins. Health is such an important good that those who serve it are justly accorded great status, prestige, and wealth. Like Robin William’s character (movie where doctor got sick and became a patient). Many people contributed indeed were necessary for any health care professional to be in this position of prestige. Friends, teachers, and especially parents play a vital role. To them a debt of gratitude and honor is owed.
The fourth commandment also enjoins the discharge of family duties not only towards parents and grandparents but also towards spouses and children. Parents who are doctors, nurses, or other health care professionals should strive to be parents who deserve honor from their children in part because of the quality and quantity time they spend with their children.
Finally, respecting fatherhood and motherhood enjoins on health care professionals an obligation to respect the natural and original meaning of parenthood in an act of self-giving love that sometimes is named nine months later. In vitro fertilization, surrogate motherhood, other forms of child manufacturing and contraceptives all act to undermine the self-giving and life-giving meaning and nature that the reproductive act should have. As such, doctors, pharmacists, and other health care professionals should not participate in such activities. The health care professional's charge is the restoration of health and the elimination of disease. Fertility is not a disease; contraceptives actually induce pathology.
Thou Shall Not Murder.
Although the Hippocratic Oath historically taken by physicians prescribes both abortion and euthanasia, the practices have become not only legal but also all too common. The injunction always to help and never to harm forms the most basic and fundamental of all ethical duties of health care professionals. In so far as life as life is always a basic, intrinsic good for a person, taking someone’s life whether near its beginning or near its end is always gravely wrong.
In fact, no greater wrong can be done to a person insofar as all the other human goods — friendship, knowledge, play, etc—presuppose the life and existence of a person. Thus, intentionally killing an innocent person is intrinsically evil, in all times and places and can be justified under no circumstances. Given their prestige in the community as well as the opportunities for witnessing, conscientious health care professionals will avoid cooperating in any way with such procedures which presuppose a functional evaluation of human beings and undermine the very purpose of medicine as a healing art. As far back as the Hippocratic oath, the practices of abortion and euthanasia as contrary to the practice of medicine and the well-being of the human community which is measured in terms of its respect for the least in their midst.
Thou Shall Not Commit Adultery.
Insofar as the health care professional should be concerned with the patient’s medical good and not personal pleasure, taking advantage of patient sexually must be completely excluded. Such illicit relationships compromise the medical good of the patient and the service that a health care professional can provide by introducing elements that distract and complicate what is already by its nature an intimate relationship. The characteristic disparity of power between doctor and patient as well as the ordering of sexual acts to the context of marriage suggest the adultery or fornication is particularly to be avoided in the context of medical treatment.
Thou Shall Not Steal.
Of all the commandments, thou shall not steal may be the one most frequently transgressed. Health care professionals, particularly those with a disproportionate love of money, may be tempted to cheat insurance companies and patients alike. If not by outright stealing, some unjust doctors waste valuable resources through their lack care. Speaking about why there was a need to streamline the cost of medical care, U.S. News and World Report points out: "It was a system that encouraged unnecessary tests and surgery—a grave train for some unscrupulous doctors and a major drain on tax coffers. An estimated 30 percent of medical costs resulted from waste, duplication, fraud and abuse" (no.14, April 1986, p.60). Such actions steal not just insurance companies, but common citizens.
Thou Shall Not Bear False Witness.
Augustine defined a lie as “asserting what one believes is a falsehood with the intention of deceiving.” He held that it was always wrong to lie because God himself is the truth and lying, since it involves falsehood separates us from God. Secondly, he noted that lying is condemned in Scripture. Satan is called the “father of lies.” Christ only the other hand is called the way, the truth, and the life. Lying, Augustine argued, introduces a duality in the person between what is in the mind and what is communicated. Lying is a self-imposed schizophrenia, diving what should be joined together.
Two contexts in medical treatment bring this commandment to bear. The first is the temptation to lie to patients. Although it is indeed impossible to tell patients the whole truth about their condition, (unless they themselves be doctors) truthfulness in what is said is possible. Although some patients cannot understand the truth, most can understand and do want to know the truth. Knowledge about even the most difficult truths liberates the patient from ignorance and allows the patient to decide (in a worst case scenario) how death shall be met. Many people desire to put their affairs in order, financially, familially, and spiritually before their final breath.
Secondly, there is the temptation to falsify insurance forms. Again, linked with a disproportionate desire for money (violating the first commandment) lies on insurance forms are the means taken for breaking the commandment against theft. Thus sin begets sin, iniquity iniquity.
Thou Shall Not Covet Thy Neighbor’s Spouse and
Thou Shall Not Covet Thy Neighbor's Goods.
If the sixth commandment is to be followed, the ninth commandment must also for our deeds begin in our thoughts and cultivated desires. This commandment would also enjoin respect for the privacy and modesty of patients by impinging upon them as little as possible only when needed for the practice of medicine.
Just as the ninth commandment helps us to follow the sixth, so also the tenth commandment helps us follow the seventh. Thinking about and desiring the goods of another always precedes stealing. A detachment from riches follows from an understanding that the most important goods are not ones money can buy. Envy, a sadness at the goods of other and immoderate desire to have them oneself, leads to actions that are incompatible with love of neighbor. In the medical profession, this can be evident through a jealousy at the success of other doctors or a fear that other doctors will become as successful both of which may lead health care professionals to ceasing sharing information and/or support with one another to the disadvantage of patients and the human community.
COMMANDMENTS GIVE US GREATER FREEDOM
Don’t doctors live by enough rules? Ten more is quite a burden. Why not live and let live? Let all have a freedom compatible with every other person having the same freedom.
Far from undermining human freedom, these commandments support and indeed enable us to be free. What is freedom, after all, fundamentally for? Is it not for the sake of happiness, a deep, lasting, satisfying happiness? Insofar as this happiness cannot be had without a loving relationship with God, and insofar as a loving relationship with God is impossible without treating God as God (Commandments 1-3) and the image of God as the image of God (Commandments 4-10), the commandments help us attain that which we desire. Just as a soccer coach or violin teacher will give injunctions to help the players or the musicians achieve their goals, so too the commandments of God are not arbitrary hoops to jump through on the way to heavenly bill but are rather intimately connected without attaining this end. Health care professionals, like every conscious human being want this pure Life, pure Love, and pure Light. These commandments then help them and us achieve what we really want.