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Bridging Medicine and Theology: Daniel Sulmasy, O.F.M., M.D., PH.D.
By Barbara Beckwith
"Being a friar and being a physician go together like air and lungs," says this doctor and teacher of medical ethics. For him, medicine is all about continuing St. Francis' care for lepers.

Q U I C K S C A N

A Doctor and a Franciscan Brother
Living the Peace Prayer
Advances in Medicine Challenging
A Vocation to Serve People
Touching Christ's Big Toe
Audio Excerpts

PHOTO BY DAVID CHRISTOPHER, COURTESY OF THE UNIVERSITY OF CHICAGO MEDICAL CENTER

He's a medical doctor, a Ph.D. in ethics and a Franciscan brother. He's Daniel P. Sulmasy, an articulate bridge between medicine and theology. He's often consulted by other doctors and the media as an expert on controversial biomedical decisions, such as end-of-life care and stem-cell research.

Last November, Dr. Sulmasy, long associated with St. Vincent's Hospital in Manhattan, took up a new position at the University of Chicago: Kilbride-Clinton Professor of Medicine and Ethics in the Department of Medicine and Divinity School. He's also associate director of the MacLean Center for Medical Ethics.

He's a native of Queens, New York, and a member of the Holy Name Province of Franciscan Friars based in New York. He now lives at St. Joseph Friary in the Hyde Park neighborhood of Chicago.

Previously, he served as director of the Center for Clinical Bioethics, as senior research scholar of the Kennedy Institute of Ethics and as an associate professor of medicine at Georgetown University.

At a ceremony formally welcoming him to his new position in Chicago, Dr. Sulmasy commented: "In bridging theology and medicine, this newly created endowed chair links two of the three traditional medieval professions, invoking the spirit of the university that prevailed in the days when friars such as Bonaventure, John Duns Scotus, William of Ockham and Roger Bacon first taught at the universities of Paris and Oxford."

He will be launching the University of Chicago's combined degree program in ethics, offering medical students both a medical degree and a doctorate in ethics, along with a one- to two-year fellowship in ethics after medical training. "Our programs will be for doctors who have an abiding interest in ethics, or for medical students who were philosophy or theology majors," he says. "Through experience and training, people often become interested in the myriad of questions that face doctors, such as when to discontinue a ventilator and what to do about embryonic stem-cell research."

Dr. Sulmasy is editor-in-chief of the prestigious journal Theoretical Medicine and Bioethics. He has written or co-edited four books: The Healer's Calling, Methods in Medical Ethics, The Rebirth of the Clinic and A Balm for Gilead: Meditations on Spirituality and the Healing Arts.

He has also contributed to this magazine and been a medical ethics expert for American Catholic Radio, produced by St. Anthony Messenger Press for the U.S. bishops' Catholic Communications Campaign. In March he was a speaker at the Franciscan University of Steubenville's Institute of Bioethics conference for health-care professionals, speaking on "Appropriate Responses to Different Types of Suffering at the End of Life."

As a doctor and a teacher of doctors, Dr. Sulmasy is well-positioned to affect the future of health care. The fact that he's also a Franciscan gives him a unique perspective. He was interviewed by St. Anthony Messenger last December via telephone.

A Doctor and a Franciscan Brother

Q. How do you balance your life as a Franciscan brother with your medical practice?

A. It's not the easiest thing in the world. One of my minor proofs for the existence of God is that two of the most conservative organizations known to humankind—medicine and the Catholic Church—have had to compromise on my behalf for all of this to happen. Somehow it works.

For instance, within this friary and anywhere I have been, I can give the morning to the friary and the evening to the hospital or vice versa.

In most cases it works better to have the morning in the friary. In terms of time with community for community prayer, we have Mass and morning prayer, with morning meditation. I read the newspaper and do my exercises. That is all in the friary.

Then I go off to work, which takes a long time. I don't arrive at work until 9:00. That is late for a doctor to get to work, so I wind up staying later. Most days of the week, I miss evening prayer with the community. I say night prayer myself. I wind up eating leftovers from the dinner the community ate, but I'm grateful there are leftovers.

It's a big enough community that I'm rarely alone. There is always someone who comes in from an evening ministry or someone who will sit down and eat with me even to have a snack at 8:30 or 9:00 at night.

Thursday is a community night. I come home on Thursdays for evening prayer. We have Mass together, dinner and then some kind of house chapter or a little talk on Franciscan spirituality. It's been a busy day, but this is how I balance things—and it works.

Q. Are there conflicts besides the number of hours in the day?

A. Besides the time, no. I think being a friar and being a physician go together like air and lungs. Some of the first work of friars was working with lepers. This is central to the kinds of things that the friars have done for centuries. It may be a little more scientifically sophisticated today, but I think it's the same thing.

Q. Do you have much of an individual practice or is it mostly teaching?

A. I have a small individual practice, one half-day a week. Since I've moved to the University of Chicago, my practice is at a clinic for the underserved in the South Side of Chicago. It is staffed by the University of Chicago faculty.

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Q. Are there places where being a Franciscan benefits your work?

A. I think being a Franciscan benefits everything that any friar does. It brings a sense of my rootedness in being a friar and my Franciscan spirituality to patient care, teaching and research. I think it informs almost everything I do.

It's all for the positive to the extent I can live the Peace Prayer of St. Francis. A doctor who lives that and brings it to the practice of medicine is doing something significant. Do I measure up to that prayer on a daily basis? No. But I aspire to it; I aspire to be moved by that sowing of hope, bringing love to the care of patients. All of that is central to what it means to be a friar.

Q. With your new professorship and with ethics, what are you most concerned that the medical students learn from you?

A. In a certain sense I can teach them a lot of theory about ethics. But being able to analyze the ethics of a case is very good, but insufficient. Lots of people can do that. Certainly, I do, and it is necessary for the students to know how to analyze a case.

More importantly, the best teaching in medicine is role modeling—to the extent that students can learn from me the attitudes that are proper to have toward patients, namely, to be respectful toward patients, to be dedicated to their care, to be humble about the limits of medicine and their own limits as human beings, to really have love for patients in the gospel sense of agape (Greek for "altruistic love").

If they can learn that from me, then it is more important than any physiology or theoretical ethics I can teach them.

Q. How has the medical profession evolved since you earned your M.D. at Cornell in 1982?

A. It is amazing. Hippocrates once said, "Life is short; the art is long." Life seems to get shorter and the art gets longer every day. The things that have happened are just astounding. In 1982, the beginning of the AIDS epidemic, we hadn't discovered the virus yet. Lyme disease had not been discovered and named. There were no effective treatments for it.

Technology accelerates at a faster and faster pace. In 1982 nobody talked about stem cells. No one was doing surgery with a laparoscope. It is astounding the kinds of things that keep happening. I don't see the pace of technological progress stopping in the foreseeable future.

Q. Were there CAT scans or MRIs?

A. There were CAT scans but no MRIs.

Q. Think of all the invasive surgeries that were performed because we didn't have those diagnostic tools!

A. When I graduated from Cornell Medical School, ulcers were thought to be caused by stress. People were still getting surgery for them, getting part of their stomach removed and having the vagus nerve cut. Then we moved to an era with very effective treatments to decrease acid production. Now beyond that, we have discovered it is an infectious disease and with antibiotics we can cure people's ulcers.

Q. What would you call the most hopeful signs in medicine today?

A. It's a sort of mixed bag. As the technology has improved and gotten more sophisticated, ironically, patients, professionals and physicians are feeling more and more alienated from medicine. All the machines get in the way of the interaction, the really deeply human interaction between the physician and the patient.

It has gotten to the point where it is beginning to turn around. Both patients and physicians are feeling that so much has been lost, that there is a great hopeful sign of increased interest in spirituality in medicine. They realize that as technology has gotten better, the spiritual and interpersonal aspects of health care have diminished. I see this groundswell of interest in spirituality and health care, which is very hopeful.

Q. What drew you to medicine in the first place?

A. Complex story: When I was in high school, I was very interested in ecology. I thought I was going to be an ecologist, a biologist doing ecological research. By the time I was a senior, I had decided that I didn't want to spend all my life doing science. I had too much of an interest in working with people and I also thought I had a vocation. I thought I would go to a secular college in the 1970s and figure out where all this was leading.

It was while I was at Cornell University that I first got the idea that I might be able to combine my interest in science and serving people with a religious vocation. Medicine has always been for me a way of living the vocation I had perceived at an early age. It would be a way to use some of my scientific talents toward the service of people, eventually as a friar.

Q. Were there any medical figures or organizations that you most admired or inspired you?

A. There are no physicians in my family. While I was a medical student, I began to read the writings of Edmund Pellegrino. He's considered by many to be the father of modern medical ethics. He started writing about medical ethics in the 1950s. I was very taken by his writings and thought, This is the man I most want to be like.

I actually got a chance as a medical resident to meet him. I found out that he was genuine. It wasn't just all writing. I discovered that he was a towering intellect, a supreme clinician, a good and kind person who thought deeply about ethical questions in medicine. He eventually became my mentor.

I was able to start studies while at Johns Hopkins with Dr. Pellegrino, who was working at Georgetown. He eventually became my dissertation mentor. When I moved to my first faculty position at Georgetown, he became my boss. Now he is a close friend and colleague: a man whose big, big shoes I barely fit my feet into.

Q. Were you influenced by legendary doctors like Tom Dooley or organizations like Physicians Without Frontiers/Doctors Without Borders?

A. There is no heroic physician who inspires my medicine. It is more about St. Francis embracing the leper. That is the sort of way in which I'm inspired to be a physician.

Q. With medicine being such a stressful profession, what coping strategies have worked best for you?

A. I don't know how anybody can get through medicine without a prayer life. When I was an intern and working so hard, all I could manage was to do what hundreds of thousands of patients, their families and hospital staff do when they enter the main entrance of Johns Hopkins Hospital: touch the big toe of the 15-foot statue of Christ in the main lobby. I'd touch it and say, "God, get me through another day."

In many ways, a prayer like that can be as powerful as two hours of meditation. Because, I think, God wants our hearts.

I have more time these days and I'm able to be more reflective on the experience.

Poet T.S. Eliot said, "We had the experience and missed the meaning." I think it is very true for physicians. We have incredibly deep encounters with Christ in the work we do on a daily basis. All of us do. Too few have the chance or give ourselves the opportunity to reflect on that.

Typically, at the end of the day, during my night prayer I'm grateful to God for the opportunities I've had to serve people and to prayerfully remember those I've served during the day. That keeps me focused and balanced.

Barbara Beckwith is the managing editor of this publication.


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