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Friends, welcome to this space and to this moment dedicated to the inaugural Ware Lecture at Austin Seminary. I am Dr. Jose Irizarry, President of this institution, and on behalf of those who are present here, I extend greetings to those who are joining us today online. We are deeply grateful to the Ware family for the vision that made today's program possible.

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Karen and Dr. Elgin Ware were longtime friends of Austin Seminary. Dr. Ware enjoyed a distinguished 50-year career in urology at Baylor University Medical Center in Dallas, where he served as president of the Dallas County Medical Society and as a trustee of the Texas Medical Association.

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He was also a physician whose faith shaped his practice, serving as medical director of a clinic for people experiencing homelessness at First Presbyterian's Stewpot in downtown Dallas for more than a decade. Karen and Elgin were, by every account, deeply spiritual. Their generosity reflected that kind of faith.

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Together, they researched and donated the ware bell, which hangs in Shelton Chapel's bell fry. Through an estate gift, They established the Ware Endowed Lectureship, this lectureship, to explore the relationship between faith, religion, and science. We are honored today to have the Reverend Dr.

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Nathan Stephen Carling as our first Ware lecturer. Dr. Carling is a scholar of medical humanities with an interest in the psychology of religion. He is the Samuel Karff Chair and a professor at the McGovern Medical School at the University of Texas Health Science Center at Houston, where he directs the McGovern Center for Humanities and Ethics.

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He's also the editor-in-chief of the Journal of Medical Ethics and Medical Humanities. Dr. Carling has published 12 books, including the most recent titles, contemporary physician-authors exploring the insights of doctors who write, Pathographies of Mental Illness, Medicine, Meaning, and Identity, and the book that lends its title to today's lecture, The Secularization of Medicine: Ritual Salvation and Prophecy.

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I'm also glad to say that Dr. Carling is also a good friend of Austin Seminary. So join me in welcoming Dr.

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Nathan Carling to the podium. I'd like to thank the president the seminary for the privilege of giving this lecture. I'm grateful too to the Ware family for their generosity and making an event like this possible.

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Doctors and ministers should talk to each other. Medicine and theology have congruent work. I'm honored to be the first and what is sure to be a rich lecture series. The practice of trigger warnings is not customary where I work because so much of life and medicine is traumatic.

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So I'd like to advise before I begin that I'll be dealing with sensitive topics such as death, depression, suicide. I had undergone three heart surgeries and two years, Dr. Stephen Shi writes in his memoir, Closing the Chart. had numerous tests, dozens of visits to the doctor, extended stays in the hospital.

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He continues, I was 43 years old, a successful physician, married to a wonderful woman, had two fine sons, all of it assaulted by a rare heart disease of such catastrophic power, it did more than threaten my life, it nearly destroyed my family. Dr. Shi and his family coped well enough, but no one, he laments, not any of his doctors, asked him what he felt to be the most important questions. What has this disease done to your relationships, your work, your spirit?

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Regardless of the considerable compassion of many of them, Dr. Shi concludes, no one asked the questions that needed to be asked. Existential questions, questions about the meaning of life, the meaning of death, are essential to medicine, though these days such talk seems to be rare in medical circles. Indeed, Atul Gawande, a surgeon, recalls in his best-selling book, Being Mortal, that death was never talked about during his entire medical education.

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In a chapter in that book, Gawande writes, Our medical system is excellent at trying to stave off death with $8,000 a month chemotherapy, $3,000 a day intensive care, $5,000 an hour surgery. But ultimately, death comes, and no one is good at knowing when to stop. Gawande suggests that the best way to limit such expensive medical care is by helping health care professionals realize that people have goals besides longevity, such as saying goodbye and I love you. The suggestion that I would like to make today is that some of the problems that patients and providers experience today are related to secularization.

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This is because we don't know how to collectively talk about suffering, meaning, and death. In medicine, we have exchanged the personal for the technical, and with any trade, there are trade-offs. To understand secularization, I want to begin with existentialism. I understand existentialism in a very basic way as a philosophical movement that attempts to deal the question of the meaning of life after what Nietzsche called the death of God.

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The phrase the death of God can be found in aphorism 125 of Nietzsche's The Gay Science. Here, a madman runs into the marketplace with a lantern during the day. not at night, crying out that he is looking for God. The crowd mocks him.

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They say, Have you lost him? Is God hiding? Everyone laughs. But the madman then says, God is dead, and we have killed him.

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He continues, How shall we, the murderers of all murderers, comfort ourselves? That which was holiest and mightiest of all that the world has yet possessed has bled to death under our knives. Who will wipe this blood off us? Isn't the greatness of this deed too great for us?

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Must we not ourselves become gods simply to seem worthy of this deed? The crowd was shocked into silence. The madman went silent, too, and he said, My time hasn't yet come. Lightning and thunder need time.

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Deeds need time after they have been done, before they can be seen and heard. Now, Nietzsche did not think that God was a literal being who died. He meant something like what we now call secularization. While secularization has different meanings, it is most commonly understood as the decline of religion in some way.

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The word religion from the Latin means to bind together. Religion and ligament come from the same root. Just as ligaments bind bones together, religion binds people together. So the secularization can be understood as the loosening

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of social and religious bonds. Nietzsche's madman warns that without God, there is nothing to bind us together. What leads to secularization? Pluralism plays some role.

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This is because it doesn't seem possible to say anymore that Christianity is right and Islam is wrong, or that Buddhism is right and Hinduism is wrong. We just don't have any objective ways to judge these claims. Religious claims are subjective. And because we experience the world is smaller than it used to be, the claims of particular religions seem harder to believe when put in conversation with the claims of other religions.

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When one becomes cosmopolitan, religion can seem provincial. History also plays a role in secularization, specifically the history of religious violence. We typically date the Protestant Reformation as beginning on October 31, 1517, when Martin Luther posted his 95 Theses. Not only a religious movement, the Reformation had significant political ramifications

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because there was no separation between church and state then. Like divorce, dividing the church would be costly and painful. But unlike divorce, these conflicts would not be settled in the courtroom, but on the battlefield. One of the bloodiest of these wars was the French Wars of Religion, 1562 to 1598, between the French Protestants, called Huguenots, and French Catholics.

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At the time, these battles cost the most lives of any religious war. About three million. Three million people die. Deeply impacted by all of this bloodshed, Michel de Montaigne, the father of modern skepticism, advocated for religious tolerance.

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Historian Russell Martin explained Montaigne this way. Montaigne argued that we really cannot know what heaven looks like. He'd never been there. He'd never talked to anyone who'd been there.

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we just don't know if God is a Calvinist or a Catholic we just don't know what happens to the soul after death or what the nature of God is what the angels are and so forth and Martin concludes if we don't know how can we possibly kill about it how does that make any sense whatsoever so in the West Religious tolerance became a virtue. In addition to pluralism and history, science also plays a role in secularization. Once upon a time, human beings believed that the gods were responsible for the rising and the setting of the sun.

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Now we look to physics. What was once superstition and miracle is now explainable and reasonable. Galileo was right. The sun does not move around the earth.

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The earth moves around the sun. The church got that one wrong, perhaps because some Bible passages seem to imply that the sun moves around the earth. Joshua 10, Psalm 19. In 1992, Pope John Paul II apologized that the Church placed Galileo on house arrest for the rest of his life, almost 10 years, because he insisted that the Earth travels around the sun.

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So with all of these developments in Western culture, pluralism, history, science, came a change in values. We used to turn to the Bible for our morals, But now we can't agree on which sacred text to turn to, or if we should turn to one at all. This is what Nietzsche's madman was talking about.

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Nietzsche's madman is telling us that we don't have a father in the sky to tell us what to do. We need to construct a way of life for ourselves. It is striking to me that the displacement of religion as a central organizing force in social life is also reflected in city planning. In old Europe, the church steeple was the highest point in the city.

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Historian Franklin Ford writes that a traveler approach in the city of Strasbourg is greeted today, as others have been for more than five centuries past, by a wonderful sight. The famous cathedral with its single tower, a gigantic blade of rose sandstone thrust into the sky, where it changes color with each passing cloud and each advancing hour of the day. While beautiful, such construction fostered local patriotism. Medievalist Henri Pyrenees notes that these cathedrals were not only houses of God,

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They also glorified the city of which they were the greatest ornament. They were for the Middle Ages what the temples were for those of antiquity. Building on these insights, historian Russell Martin, whom I mentioned already, notes that these towers were not only about aesthetics and politics. They were also meant to teach a moral and spiritual lesson, which is this.

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When you are lost, look to the church. When you need direction, both geographical and ethical, you look to God. The steeple will set your compass. Today, church steeples no longer dominate our skyline.

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When I moved to Houston for graduate school, I found myself looking at the skyline of the Texas Medical Center while walking the campus of Rice University. And it occurred to me that the tallest buildings today are not churches, but quite often, hospitals. This suggests to me that our steeples today are no longer concerned with saving our souls, but our bodies. Oncologists, cardiologists, neurosurgeons, these are the high priests of our day.

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We look to them for salvation. This is how I got the idea for my book, The Secularization of Medicine. In the book, I'm interested in things in medicine that look religious but are not recognized as such. For example, clergy wear black robes while doctors wear white coats.

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Priests give the sacraments while physicians write prescriptions. People make long pilgrimages to medical centers, places like the Mayo Clinic, in search of salvation. There is a lot about medicine that is subtly religious. I'm not the first person to notice these connections.

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An important article for me was by theological ethicist Roy Branson, titled The Secularization of American Medicine. He makes many astute observations. Branson observes that the chief symbol of purity in medicine is the white coat.

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There is health and disease, cleanliness and illness, doctor and patient, and the white coat displays which side each person is on. Branson also points out that a key part of the ritual system of medicine is related to language. While the terminology the doctors use creates an efficient means to communicate, often patients cannot understand words like carcinoma, benign, hypoglycemic. In effect, clinical language is not unlike how the use of Latin functioned in the Roman Catholic Church prior to Vatican II.

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So in my book, I take Branson's article as a jumping off point and develop the idea that a specific concept in secularization theory called transposition can shed new light on the relationship between religion and medicine. This is a concept that I took from philosopher Larry Shiner. What is a transposition? A transposition occurs when religious material migrates to a non-religious sphere or secular space where what was once religious becomes absorbed by the surrounding culture.

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A contemporary example of a transposition is when a college with a religious affiliation is no longer affiliated with a specific religious tradition. Princeton University, pictured here, for example, was founded by Presbyterians. but it no longer has any formal relationship with the church or any religion. The Christian, often Protestant mission of education has been absorbed by institutions like Princeton, and so the values of the religious tradition live on, but in a secularized way.

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In my book, I explore transpositions of ritual, salvation, and prophecy as they manifest in medicine. As case studies in chapter 1, I view the Hippocratic Oath as a kind of medical scripture. In chapter 2, I explore how Houston heart surgeon Denton Cooley functions like a secular saint. And in chapter 3, I read a popular medical novel called The House of God in light of the Hebrew prophetic tradition.

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I don't have time to go into all of these chapters, but I'd like to go into a little more detail about Chapter One, the chapter on ritual, as it resonates the most with my previous comments. The thesis that I develop in chapter one is that recitations of the Hippocratic Oath on occasions such as the White Coat Ceremony are what I call instrumental transpositions relating to the Protestant Reformation doctrines of the priesthood of all believers and Sola Scriptura. So let me unpack that a little. The Protestant Reformation created a problem of authority by making all believers priests who could read the Bible for themselves.

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This crisis of authority was deepened during the Enlightenment, continuing to the present, giving rise to a related crisis, this one concerning epistemology that has affected all of Western culture. Still, the great hope of the Enlightenment was that human beings could discover through reason the truth about the world and human nature so as to establish a rational society upon which a secular, political, and economic system could rest. This included establishing ethics as a part from religion. And that ethos is very much still with us.

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and bioethics, for instance, the desire for a non-sectarian foundation is completely understandable. When there are competing values. systems, having a neutral language and a fair procedure to resolve differences is highly desirable. This is precisely what bioethicists Tom Beecham and James Childress, Principles of Biomedical Ethics, the most widely cited book in bioethics, seems to offer medicine.

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Beecham and Childress give us four secular principles grounded in common morality to apply to any clinical or research situation. They are respect for autonomy. The principles are respect for autonomy, beneficence, non-maleficence, and justice. Despite their influence, however, Beecham and Childress have been widely criticized, especially by philosopher Tris Engelhardt.

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Engelhardt views their efforts as a failed project of the Enlightenment because, Engelhardt argues, secular moral accounts presuppose what they seek to prove. Asking very basic questions about our contemporary political climate illustrates Engelhardt's point. If, for example, a pro-life Southern Baptist believes that abortion is evil, and a feminist atheist thinks that abortion is health care, how can we discern who is correct?

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If a Texas Republican thinks that immigration is an existential threat to our country, while a New York Democrat believes that Americans have a duty to help those in crisis, how can we know who is right? We cannot answer these questions outside of a particular moral perspective. Moreover, different political perspectives, whether they're liberal Christian, conservative Christian, feminist, consequentialist, libertarian, Republican, Democrat, and so forth, all of those lead to conflicting moral conclusions. This is what Engelhardt means by

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Secular moral accounts presuppose what they seek to prove. Drawing on philosopher Immanuel Kant, Engelhardt believes that this problem of perspective cannot be solved. Kant made a distinction between reality as it is and reality as we perceive it. arguing that we do not have access to reality as it is.

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All we have is our perceptions. On this point, I've found that theologian Diogenes Allen writes a bit more clearly than Engelhardt. Allen explains, The only way we can perceive is by processing the data that we receive through our senses. The result is that we experience and know things not as they are, but as they appear to us.

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How things are in themselves apart from us is utterly unknowable. So ultimately, this is the foundation for various expressions of postmodern thought that emphasize perspective. Engelhardt notes that principalism, that's Beecham and Childress, and other frameworks in bioethics continue to operate simply by ignoring the implications of Kant's thought. While not able to offer substantive moral guidance, Engelhardt suggests that bioethicists can offer descriptive, not normative, assessments of moral issues.

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So Engelhardt's point in a sentence is that the foundation of modern medical ethics is very weak. Medical educators and administrators, then, would need to find some secure foundation for young trainees. My suggestion is that they sought to build this foundation on ritual.

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One such ritual is the Hippocratic Oath. While the Hippocratic Oath is widely used in medical education today, it surprises many that this is a very recent phenomenon. Indeed, the oath was largely ignored for its first 1,500 years of existence, but it was when Christians discovered it during the Middle Ages it slowly rose to prominence. Medical humanist Howard Markel notes that the first recorded use of the Hippocratic Oath was at the University of Wittenberg in Germany in 1508, and that it did not become a standard part of formal medical school graduation ceremonies until 1804.

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In the United States, the widespread incorporation of the Hippocratic Oath is even more recent. One study noted that in 1928, only 14 of the then 79 medical schools used the Hippocratic Oath in graduation ceremonies. In 1958, this rose to 69 out of 96, and by 1993, all schools used some oath, not necessarily the Hippocratic Oath. Of note, the growth of the modern usage of the Hippocratic Oath coincides with the development of bioethics as an academic field, reflecting the search for a new foundation for medical ethics.

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Just as the Bible became the basis for religious authority for Protestants, the Hippocratic Oath became the symbolic basis for moral authority for doctors. What is striking, though, is that the fragmentation of Protestantism is also reflected in the modern usage of the Hippocratic Oath, in that there are wildly different interpretations and applications of it, not unlike biblical hermeneutics. I'll lift up two brief examples. Internal medicine physician Steve Miles has written a thoughtful book about the ethics of the Hippocratic Oath, reading it line by line.

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So one line that is widely known and invoked is this: And likewise, I will not give a woman a destructive pessary. Pointing out that many bioethicists interpret this passage as anti-abortion, Miles suggests that when viewed in historical context, some rationale would need to be given as to why the Hippocratic oath would be countering the surrounding culture, for abortion was widely accepted in ancient Greece. Also, Miles observes that the passage technically only prohibits pessaries. These may have been problematic because they were known to have the risk of lacerating the vagina and therefore causing infections.

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It's plausible that other means of abortion might have been acceptable, such as an oral pill or physical exertion. If pessaries as a means of abortion could be harmful to women, Miles also notes that the physician who used the pessary could have been held legally liable. Another key factor that must be considered is the patriarchal context of ancient Greece. Miles points out that it would be legally problematic if a woman wanted an abortion without the knowledge and consent of her male guardian, especially if she were trying to conceal a pregnancy.

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So this line in the Hippocratic Oath, when read in historical context, might not have anything to do at all with an embryo, fetus, or even child. It could be about the legal well-being of doctors and the rights of male guardians. So let's look at another passage. In remembering the Hippocratic Oath in surgical training, surgeons Linhoa Yip, Kelly McCoy, and Sally Carty applied the Hippocratic Oath to the context of residency, focusing on this line, To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to look upon his offspring as equals to my own siblings and to teach them this art if they wish to learn it,

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without fee or contract. When Miles focused on these lines, he suggested that medical education should be free without fee or contract. So I think medical students are going to become fundamentalists about the Hippocratic. But these authors interpret this line as a general affirmation of peer support.

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They go on to specify a specific form of peer support that is needed in surgical residency, namely parental leave. It's somewhat surprising that this text could be read as supporting parental leave and surgical residencies. In any case, whether their interpretation is convincing is not the key point for me. Rather, the key point for me is one,

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that these commentators felt the need to appeal to the Hippocratic oath at all, and two, that they assumed that that appeal would hold moral authority. So let's return to the idea of transposition. With the doctrine of the priesthood of all believers, The Protestant Reformation opened the door to the challenging of religious authority by empowering individual parishioners to discern religious meaning for themselves, apart from the clergy.

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Centuries later, this doctrine became transposed in a variety of places, including bioethics, where it took the form, above all, in the principle of respect for patient autonomy. Patients could discern moral meaning for themselves in deciding what is right for their bodies, just as clergy are no longer the sole arbiters. of God's truth, doctors are no longer the sole arbiters of the best interests of patients. Bioethics, then, my suggestion is, can be seen as a kind of modern-day reformation in medicine occurring during the Civil Rights era.

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However, While the Protestant Reformation splintered the Western Church into hundreds of factions with little to hold them together, the bioethics revolution sought unity. Doctors, educators, ethicists, almost everyone wanted something to bind everyone together, be it a code, principles, or an oath. Administrators and educators instrumentally use the Hippocratic Oath to bind a diverse profession together because it possesses a religious-like gravitas without the exclusiveness of contemporary religion.

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A university chapel would seem to be the perfect place for such a ceremony. And here on the screen is the white coat ceremony at Duke University's chapel. I'd like to loop back to the question of meaning that I raised at the beginning of the lecture, reflecting on issues not covered in the book, which may be of interest for discussion.

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One of the most influential existentialist philosophers is Albert Camus, who wrote The Myth of Sisyphus. Camus takes the name of his essay from a Greek story. While there are different versions of the story, the central image is of Sisyphus being punished in the afterlife by rolling a rock up a hill. And every time he gets to the top of the hill, the rock rolls down, and he has to do this over and over again forever.

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In the essay, the most famous line is this. There is but one truly serious philosophical problem. and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy.

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This is the question of philosophy. A remarkable claim by Camus. Commenting on this passage from The Myth of Sisyphus, the influential 20th century American fiction writer, William Styron, who suffered from depression and who wrote about his experiences of depression in his memoir, Darkness Visible, writes, Reading this for the first time, I was puzzled and continued to be throughout much of the essay, since despite the work's persuasive logic and eloquence, There was a lot that eluded me, and I always came back to grapple vainly with the initial hypothesis, unable to deal with the premise that anyone should come close to wishing to kill himself in the first place.

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In time, however, Styron did come to understand this wish more intimately when he found himself on the verge of suicide. After having survived his depression, Styron came to understand the central message of Camus's essay to be this, In the absence of hope, we must still struggle to survive, and so we do, by the skin of our teeth. Camus reinterprets this Greek image of punishment, this forever rolling a rock up a hill, as courage, an image of courage.

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How? How does he do that? Because existentialism deals with the question of the meaning of life after the death of God, Camus needed to ground his claims about meaning in something other than religion. He wants to argue against suicide without invoking religious morality.

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And he does this by grounding his objection to suicide, not in the meaning that can be found in a given religious tradition, but rather in the meaning that we create as individuals. And this is where the image of Sisyphus comes in. Rolling the rock up the hill is Camus's metaphor for creating meaning. Meaning will roll away.

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It always does. But for Camus, this is not a reason to despair. The meaning that we make, the rock that we roll up the hill, even though temporary, even though it will roll down again, it matters now. It gives us meaning now.

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And life is meaningful because we choose to make it so. Through small acts of courage, we make life worth living. Many people, however, are unable to make life worth living. Every day in the United States, over 100 people die by suicide.

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Most of them are middle-aged white men. About half of all suicides in the United States or by means of firearms. The next leading means of suicide is suffocation or hanging.

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When people die by suicide, it's not because they are weak or because they are immoral or sinful or because they are selfish. People die by suicide because they can't take the pain anymore. The image here is a man falling from the Twin Towers on 9/11. We don't know who this man was.

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We don't know if he fell by accident or if it was a suicide. If it were a suicide, who would judge him for jumping? When people die by suicide, it's because they see no other option. Maybe like this man.

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Death by suicide is the result of a disease process. But people die by suicide for reasons other than depression and mental illness as well, which leads us to the topic of assisted suicide, or as Right to Die activists now more commonly say, medical aid in dying. For better or for worse, the most famous name in recent decades associated with the Right to Die movement is Dr. Jack Kevorkian.

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While trained as a pathologist, Kevorkian helped over 130 patients die. He was arrested a number of times, but juries were reluctant to convict him. He was finally convicted in the late 1990s because he videotaped himself giving a lethal injection to a patient, which he then broadcast on CBS's 60 Minutes. The video was different than his previous killings.

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The difference was between physician-assisted suicide, which is passive, and euthanasia, which is active. Kevorkian created a machine that enabled patients to take their own lives, so patients pulled the trigger of their own lethal injections. Because Kevorkian's role was passive, no jury would convict him. Later, Kevorkian administered the lethal injection himself, showing it on the video.

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After doing so, he looked at the camera and challenged the legal authorities to put him in prison. They did. He was later released on good behavior. Few bioethicists respect Kevorkian because they feel he was sensationalist.

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Some feel that Kevorkian actually set the Right to Die movement back, in contrast to Dr. Timothy Quill, whom the bioethics community tends to praise because Quill helped only one patient die whom he'd known for years. Quill was not charged with or convicted of any crime. You can read about Quill's case, often called the case of Diane, published in 1991 in the New England Journal of Medicine.

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In the United States, 11 states plus Washington, D.C. permit medical aid in dying. Generally, to qualify, you must have a terminal illness with a prognosis of six months or less to live, you must have capacity, You can't be depressed.

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There can't be evidence of anyone pressuring you to make this decision. You need to be able to take the medication yourself. This last criterion, that you need to be able to take the medication yourself, can be problematic because if you are slipping into dementia or have advanced Parkinson's, you might not be able to take the medication yourself. In 2023, a dying man asked his wife to shoot him in a Florida hospital because dying was taking too long and no one would help him.

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So his wife shot him in the hospital. She served about a year in prison. More recently, an article in The Atlantic about our northern neighbors has had a significant impact on social media. It's titled Canada is Killing Itself by Elena Plot Calabaro.

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Calabaro examines the rapid expansion of medical aid and dying within the Canadian context. Currently, one out of 20 deaths of all deaths in Canada, it's 5%, one out of 25% of all deaths in Canada, is by means of medical aid and dying. Canada has recently included people who are not terminally ill with future expansions planned for people with mental illness and also possibly teenagers. The Quebec College of Physicians.

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also raised the possibility of expanding euthanasia for severely disabled infants, a practice that is already legal and has been for a long time in the Netherlands. Throughout the piece, Calabar surveys the emotional and ethical tensions among clinicians and policymakers. Some feel honored by the trust that patients place in them. Others feel unsettled by the growing routine of intentionally ending lives.

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The article rightly raises concerns about whether Canada has moved faster on expanding access than on securing social supports, things like palliative care, disability services, mental health resources. Calabar thoughtfully explores the ways in which Canadians are reconsidering what autonomy, dignity, and the role of medicine should mean at the end of life. I'll conclude by bringing various strands of this talk together. My comments have been mostly descriptive, not normative.

00:45:08.430 - 00:45:36.950

I think a variety of views about medical aid and dying illustrates the Protestant fragmentation of authority, as well as a secularization of the body, with the body no longer being a temple. It's a commodity. The normative perspective that I would like to offer is pastoral. It's my perspective.

00:45:38.070 - 00:45:56.510

But that's all that I have. For me it is not hard to see that modern medicine is our great secular golden calf. We worship medicine because it is in our nature to want more.

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The problem with always wanting more with regard to health and longevity is that these are not ultimate goals. These things, while good, need to be in the service of something else, something beyond oneself. The point of my life is not me. Nietzsche was wrong that we should become gods.

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The advances in medicine over the last century have been profound. Because of all of this progress, our hopes for what we want medicine to be have grown to idolatrous proportions. We want doctors to be, if not our angels, then our heroes. It strikes me in a way that maybe Gawande and Kevorkian and Canada are all pointing at a related problem.

00:47:04.990 - 00:47:25.710

We expect so much from medicine that we don't know how to live with each other in our suffering when medicine fails. Dr. Shi was right to want these conversations about meaning.

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In Pastoral Aesthetics, my first attempt to deal with religion and medicine in a substantial way, I argued for drawing on the resources of pastoral theology to enrich moral imagination and bioethics. With regard to medical aid and dying, if I were to do that now, if only in a suggestive way, I'd turn to Donald Capps, who taught me about pastoral care in seminary. In giving counsel, Capps suggested that caring for others requires, quote, a judicious frame of mind. He takes this phrase from psychologist Erik Erikson, who defines this as a frame of mind that is, quote, Tolerant of differences, cautious and methodical in evaluation, just in judgment and circumspect in action.

00:48:37.630 - 00:49:16.030

And in spite of all of this apparent relativism, capable of faith and indignation. Drawing on this definition, Capps lifts up two qualities. One is kindness, and the other is the ability to value another person's individuality. Drawing on this concept of a judicious frame of mind, I think that being kind means asking the questions that need to be asked, as Dr.

00:49:16.030 - 00:49:41.070

Shi yearned for. And valuing another's individuality means not only asking the questions that need to be asked, but also listening with sincerity. It is through asking and listening that we can discern moral judgments in particular circumstances in a judicious manner.

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And so what follows is this. If extending life can help people experience more love, then extending life is good. If people seek medical aid in dying because they are in pain and they are at peace with the end of their journey, then I don't see why people should be forced to suffer. That would seem unkind.

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But I also don't want people to die because they suffer from a lack of meaning and connection in their lives. The article about Canada contained terrible stories of just that. It takes, therefore, a judicious frame of mind to know when honoring a request to hasten death would be kind and when it would be cruel. I want my own faith to be a vehicle for gathering the lost and the lonely.

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I don't want people to make these requests unless they have to. If secularization has, to some extent, disenchanted the world due to the progress that we have made, it is the role of religious communities, communities like this one, to re-enchant the world by helping us to find new ways to bind us together in love. And when we create meaning with God, we might just save a life.

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Thank you. We have 10 minutes for questions. A lot of information shared with us to think about. First of all, thank you.

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As someone who's buried three people from the last five years, I am appreciative of your conversation about death and dying. I'm particularly reminded of my father's journey through dementia. and my conversation with a nurse who wanted to do all sorts of intervention on an 84-year-old man who didn't know where he was living and couldn't control his own bowels, said that this is a one-way journey, folks. He just kept telling me, I just want to go home.

00:52:23.790 - 00:52:53.550

So thank you for that. I'm curious about chaplaincy because it seems as though Medical doctors aren't trained in that sort of work and don't know how to do that sort of work. And so it takes students who come to places like this to then intervene at a time when doctors don't really want them in the room to begin with.

00:52:54.750 - 00:53:12.670

to have those questions? And is there a need for us to be in partnership with medical doctors to help them slow down enough? Or is it just that the financial model of medicine is such that doctors can't slow down anymore? Yeah, thank you for that question.

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That's a great question. Chaplains play a huge role. I think they should play a bigger role, just like you're saying. I think

00:53:23.910 - 00:53:46.270

When I moved into medicine roughly 18 years ago, you know, and when I sort of came into the context, I was very sort of insecure. You know, I thought, I'm not trained in science. I'm not trained in medicine. What do I have to offer here?

00:53:46.430 - 00:54:06.510

You know? And it surprised me how welcoming a profession that medicine really is. That it is so large and so complex that everybody in it knows that they can't know and understand everything.

00:54:06.710 - 00:54:20.830

Like even within a given department for Grand Rounds like internal medicine. There was a senior attending I was talking to one time. I was there for a lecture and I didn't understand anything.

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I got nothing out of it, you know? And I was talking to the doctor on the way out and I said, I got to tell you, I didn't get anything. I don't know what the hell they were talking about, you know? And then he told me, I didn't neither.

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You know, and so knowledge becomes so profoundly specialized sort of in medicine that it also leads to a recognition of This is truly multidisciplinary, interdisciplinary, and if you have something to offer, you're welcome here. And so I was always made to feel sort of welcome and that it was only my own. chip on the shoulder that I felt like I was sort of being sort of excluded and so and I think many many chaplains feel that way you know and but they I know that their contributions are very much welcome and I would also note sort of on that point as well that I've noticed a recent shift

00:55:24.990 - 00:55:46.110

just with younger students as well. And this may not be reflective of the country or anything like that, but because it is Texas, it is Houston, that I lead a Breaking Bad news session with medical students where they practice with actors. Kind of like at seminary, you do preaching, you record it and watch your sermon. They do that with a paid actor about how to break a cancer diagnosis.

00:55:46.150 - 00:56:08.510

And we debrief them. And in the debrief session, I noticed that students now are bringing out chaplains more sort of as a resource, as people that can sort of help. So one is just the importance of chaplains as they are sort of currently.

00:56:09.070 - 00:56:47.390

But then also, if you're here in seminary and you are going off into rural communities, you could, if you are interested in this kind of material, I know local hospitals are always looking for volunteers for community members for you to come in and serve as a sort of on their local ethics committee, which will sometimes only be one or two or three people. So you really can serve and kind of make a difference sort of in that way. And a community voice is needed and is very helpful.

00:56:48.670 - 00:56:57.390

Yeah. Thank you very much. Excellent presentation. Thanks for repping my hometown.

00:56:58.110 - 00:57:32.190

I think mine is, if you could, in the time we've got left, if you can make it practical for us. So I think a number of us come from communities where there's a large mistrust of the medical field that's crossed ethnic groups, sexual orientations, history of racism in that field. I think what's happened both in the United States in the last 15 to 20 years, there's also a growing distrust of Christianity as well. And so I think as we think about what it means for us to be Christians, to be the church, to be chaplains, we've got students who that are clergy that are about to graduate, they're stepping into a world that is increasingly mistrusting of both of those fields, both a theological world and a medical world.

00:57:32.190 - 00:58:01.990

So give us some practicals. What are some first steps to open the doors to conversations or trying to rebuild and regain some trust when those communities can be mistrusting of both of those Yeah, I mean, that's a great question. This analogy can seem sort of off base at first, but sometimes when people beat up on religion or the church or something like that too much, it irritates me a little.

00:58:02.990 - 00:58:49.870

And I remember after Hurricane Harvey in Houston, It wasn't atheist groups that were organizing and getting people in boats out of their houses, it was the churches, and it was that was the network that could help people, and that's sort of back to the ligament thing about sort of things, so that my point would be to actually... really help people in the community who have legitimate needs. I would say especially with disability, you know, if people are isolated or if they need help getting places or getting to medical appointments and things kind of like that, mobilizing in a way to help people with just very basic practical needs.

00:58:50.510 - 00:59:27.470

especially relating to disability, could be a way to regain some degree of trust. If there is some degree of trust in the religious sort of community, I think partnering with health organizations to nonprofits to have health fairs and things like that to get people Access to cheap diabetes kind of medication, and make sure that people understand that they need to take the medication, get it to them early, because if you don't, it leads to amputation, and it's just going it's getting worse and worse and worse. So, in Houston, we have the Institute for Spirituality and Health.

00:59:27.990 - 00:59:48.590

They have a major partnership with many multi-faith religious organizations around specifically targeting diabetes and things like that. So I would focus on the main problems that people have. Diabetes is going to be huge and trying to make the biggest impact that you can. But that's a great question.

00:59:48.830 - 00:59:58.630

And also I want to acknowledge that the mistrust is legitimate. what you're saying is of the medical profession and the abuses and things like that. It's 100% legitimate. Yeah, you know.

00:59:58.630 - 01:00:18.580

Well, I believe that we have come to the end of our time together. And let me thank you, Dr. Carly, for the rich presentation. And thank you, you all, for being here.

01:00:18.580 - 01:00:40.030

And remember that if you want to hear more about the thesis, presented in this lecture. The book is available through Oxford University Press to all of you who are here and also if you register online, we will send a code so you will have 30% on acquiring on the price of the book. So thank you once again and have a great day.