Last week I had the incredible opportunity to participate in a medical ethics conference hosted by University of Notre Dame Center for Ethics and Culture at their Rome campus. As you may recall, this is the second year that I have been able to attend this medical ethics conference. I had a bit of deja vu returning to the conference that helped fuel my desire to study bioethics, and more broadly, healthcare from the perspective of the humanities. To be fair though, this had a much different feel since we were just a block away from the Colosseum. 😉
The Colosseum by night.
I was impressed with how far I have progressed in my understanding of medical ethics in a year’s time. Don’t misunderstand this as me thinking I’ve got it all figured out. Far from it! But I much better understood the language of this field and have become a bit more comfortable making bioethical arguments. I guess my studying is paying off. 😉
I could write a book about what I have taken away from the conference discussions and then fill a few other volumes about tasting delicious Italian food… (click for enlargements + captions)
Day 1 dinner – Trattoria Pizzeria just north of the Vatican. Roasted/fried artichoke, pizza (roasted peppers, zucchini, eggplant, and something that looked like seaweed but tasted like deliciously marinated leeks), and a glass of beer that would be deemed children’s size in London 😉
Breakfast at Pizzia Navona
Dinner at Restaurante Vino e Cammino with two wonderful seminarians (T&M) studying with the Pontifical North American College. Pictured are frittelle di fiori di zucca (fried zucchini flowers) with fresh buffalo mozzarella cheese. This was the night for a full fledged Italian meal so we followed this with two other courses. I had a pasta with lamb sauce and then T and I split the ‘secundo’ (seared tuna) because we were so full. Didn’t actually make it to dessert, but the waitress presented each of us with a housemade truffle saying we couldn’t leave without something sweet.
A quick lunch in the Jewish quarter. White lasagna (vegetarian with a cream sauce) + Carciofi alla giudìa (Jewish style fried artichoke; even better than the one I had on Day 1)
Gelato for dinner? I think yes! From Monti.
My ‘final supper’ in Rome. Gnocchi with a house pesto at Hosteria la Vacca M’Briaca (‘The Drunken Cow’) in Monti
…strolling through beautiful museums, piazzas, and villas…
Pantheon. An engineering marvel. Totally geeked out.
Walking over bridge (Castle S’Angelo in the background)
Leaving Villa Borghese
Victor Emmanuel Monument
…standing in awe as a pilgrim in Rome (and Vatican City)…
from side chapel in Gesu (Jesuit) Church
Pa-pa Fran-ces-CO! Pa-pa Fran-ces-CO!
The sunlight doing marvelous things to the Transfiguration fresco in St John Lateran (San Giovanni Laterano) the Pope’s church
Seeing Michelangelo’s Pieta in person was one of the most moving experiences of my visit to St Peter’s. I’ve seen this image 1000s of times. (My high school had a mural– painted by my cousin, Joe Macklin, during his senior year.) Following along with mass in Italian (of which I have mastered ~10 words) one of the few phrases that jumped out to me was from the Kyrie: “Signore, pietà. Cristo, pietà. Signore, pietà.” (in English: “Lord, have mercy. Christ, have mercy. Lord, have mercy.”)
Basilica di Santa Maria Maggiore – Pope praying in front of the nativity
Looking out into the piazza in front of St Cecilia’s in Trastevere
…but I might have to drop out of my master’s program in order to make time for that. Instead, I present to you a snapshot at the intersection: is spirituality relevant to healthcare, medicine, and the understanding of bioethics?
This sends me back a few weeks ago when I was invited to speak to KCL’s Life Society about palliative care. From their website:
“We exist because universities are important spaces for the exploration of ideas and opinions, and it is important that the Pro-Life voice is heard on campus. Our message is a positive one, it is not about shaming or blaming, it is about discovering the beauty of human life, and protecting it.”
To be honest with you, I was pretty freaked out: why are you asking me? How am I qualified to speak? To which the student in Life Society replied rather straightfowardly: You study bioethics right? And you’re going into medicine? Seems like you would have a better idea about the topic than any of us!
It is amazing how much you can learn when you have to ‘teach’. I didn’t just want to speak on my own authority since, despite her encouragement, I honestly didn’t think I had much authority at all. In search of good reference material, I consulted a voice for whom I have profound respect, Ed Pellegrino, whose name I was introduced to little better than a year ago and whose literature continues to be a source of guidance in my study of bioethics.
Though I wouldn’t do justice to ‘summing up’ Pellegrino’s philosophy in a blog post, a central aspect is that:
Cure may be futile, but care is never futile.
The optimal end of healing is the good of the whole person– physical, emotional, and spiritual. The physician, manifestly, is no expert in every dimension. He or she, however, should be alert to the patient’s needs in each sphere, do what is within his or her capabilities and work with others in the health care team to come as close as clinical reality permits to meeting the several levels contained in the idea of the good of the patient. 
Considering the fact that a patient’s physical condition often provides the trigger to visit a doctor, it follows naturally that doctors have a reputation of focusing on the physical aspects health. Sometimes they are so focused though, that the patients’ emotional and spiritual needs are forsaken. Although this applies to all aspects of medicine, I think it is particularly relevant to healthcare at the end-of-life which provided a good framework for my talk with the Life Society. It was also helpful for the conference last week where the keynote lecture was about international perspectives on the euthanasia debate… AND this week’s topic in my Case Studies module: “Ethics at the end of life– the biopolitics of dying.”
This post would get out of control if I tried to summarize all of the points relevant to this topic, so instead I’ll leave you with some important questions that I’ve been mulling over:
- Does care change when cure is futile? Should it change? How so?
- Aquinas’ Doctrine of Double Effect is often cited as a reason to prohibit euthanasia. Is there really a difference between [a] giving medication to a person that is intended to give them comfort but has a foreseeable outcome of shortening his life and [b] giving medication that has the intended effect of shortening his life? If there is a difference, how should this inform our ethics and legality of end of life care?
- Conversations about emotional components of health (and even more frequently, spiritual components of health) are often omitted from clinical encounters. How does this effect patients’ care? Should physicians be responsible for providing this care? If yes, in what capacity? If no, who (which member of the health care team) would better be able to provide this care?
Until next time,
 If you have access to a university library or other collection of journal articles, I highly recommend reading this full article! –> Pellegrino, E. (2001). The Internal Morality of Clinical Medicine: A Paradigm for the Ethics of the Helping and Healing Professions. The Journal of Medicine and Philosophy, 26(6), pp.559-579.
Featured image: St Peter’s by night