The healthcare industry is a difficult place for conscientious people. Nurses, physicians, and therapists often face tough moral choices. Many of them deal with life and death issues every day. Some of them are called on to make decisions about complicated bioethical issues. Some face disciplinary measures or even dismissal for refusing to violate their beliefs.
It is possible, though, to bring moral clarity back into health care by simply rediscovering the Ten Commandments. We can translate them into specific injunctions for the industry, tailoring them to the specific challenges and temptations that this work presents.
Like any general principles, their application must be done with prudence, with insight into the concrete circumstances of the individual situation. Here are the Ten Commandments as applied to health care workers.
1. Thou Shall Have No False Gods before Me
Two false gods are especially tempting to those in the medical profession. The first is money. Medical professionals often entered the profession and gave themselves to it body, mind, and spirit in the pursuit of money. Of course, there is nothing wrong with money but only with making it into the ultimate goal of one’s life, thereby denying oneself a better goal: perfect happiness. Money cannot give this to anyone.
God enjoins us to worship him alone not because he is a 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 him for our well-being. If money is our measure of success, our very success in life is compromised. Our hearts yearn for many things that money cannot buy. As Augustine wrote, our hearts are restless until they rest in the pure Light, Love, and Life that is God.
The second false god tempting many in the medical profession is a confusion of human life with divine life. Health care professionals often treat human life as the highest good, which must be pursued always, everywhere, and to the fullest extent possible. But to mistake the good of human life for the good of divine life is idolatrous. When pulmonary scientist Dr. Marshall Brummer was asked if it is the duty of the physician to do everything for a patient until that patient is called to his reward, he answered, “Yes.” But this attitude absolutizes the value of human life—its continued existence—without considering that some treatments burden patients and their families tremendously while providing very little benefit. The Catholic tradition has long insisted that extraordinary means need not be used in supporting human life.
2. Thou Shall Not Take the Name of the Lord Your God in Vain
To respect God’s name and the people associated with God, we recognize that pastoral care is an important dimension of treating the whole person. It may not be the physician’s job to provide spiritual care, but it is his job not to mock, undermine, or otherwise fail to support spiritual care and those who provide it. The spiritual needs and beliefs of patients deserve acknowledgment and respect.
The second commandment also enjoins us not to make false promises. The doctor-patient relationship requires a bond of trust, and health care workers should strive to keep promises. “I’ll be back to see you in a few minutes” should mean just that, barring extraordinary circumstances. It may be better to make conditional promises: “I’ll try to get back to you in the next few minutes if I can” is more likely to be kept. Keeping trust is not only a moral requirement but also a medical one. Broken promises from someone as important as one’s doctor produce anxiety, which is not good for any patient.
3. Keep Holy the Sabbath
Few professions work longer hours than doctors and those who support them. Man was not made for the Sabbath but the Sabbath for man, as Jesus says in Mark 2:27. Work may be about what we do, but worship is about who we are. The Sabbath rest allows health care professionals to recreate and recollect that we don’t live to work but work to live in the fullness of life that comes from an intimate relationship with God.
Workaholic hours wring devastating consequences—divorce, breakdowns, disillusionment, and depression. The humanity of health care professionals demands proper care of self, especially in relation to God.
4. Honor Your Father and Mother
Health is such an important good that those who serve it are justly accorded great status and wealth. But many people are necessary for any health care professional to be in this position of prestige. Friends, teachers, and especially parents played a vital role, and a debt of gratitude and honor is owed them.
The fourth commandment also enjoins the discharge of family duties to spouses and children. Parents who are doctors, nurses, or other health care workers should strive to deserve honor from their children for the quality and quantity of time they spend with them.
Respecting fatherhood and motherhood also calls for health care professionals to respect the natural meaning of parenthood as an act of self-giving love that is sometimes named nine months later. In vitro fertilization, surrogate motherhood, other forms of child manufacturing, and contraceptives all act to undermine the life-giving meaning that the reproductive act should have. The health care professional’s charge is the restoration of health and the elimination of disease; fertility is not a disease. Doctors, pharmacists, and other health care workers should not participate in these activities.
5. Thou Shall Not Murder
Although the Hippocratic Oath, historically taken by physicians, proscribes abortion and euthanasia, these practices have become not only legal but all too common. The injunction to always help and to never harm is the most fundamental of the ethical duties of health care professionals. 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. Intentional killing of an innocent person is intrinsically evil in all times and all places and cannot be justified under any circumstances. Conscientious health care professionals will avoid cooperating with these procedures, which presuppose a “functional” evaluation of human beings and undermine the purpose of medicine as a healing art.
6. Thou Shall Not Commit Adultery
Taking advantage of patients 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 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 that adultery or fornication is to be particularly avoided in the context of medical treatment.
7. Thou Shall Not Steal
Health care professionals may be tempted to cheat insurance companies and patients. Besides outright stealing, they can be tempted to waste valuable resources. Discussing the need to streamline the costs of medical care, U.S. News and World Report pointed out:
It was a system that encouraged unnecessary tests and surgery—a gravy 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. (U.S. News and World Report, April 1986, 60)
Such actions steal not only from insurance companies but from our fellow citizens.
8. Thou Shall Not Bear False Witness
Augustine held that it was always wrong to lie because God himself is the truth, and lying, since it involves falsehood, separates us from God. He also noted that lying is condemned in Scripture. While Satan is called the “father of lies” (John 8:44), Christ is called “the way, and the truth, and the life” (John 14:6). 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, dividing what should be joined together.
The first context in medical treatment in which this commandment is brought to bear is the temptation to lie to patients. It may be impossible to tell patients the whole truth about their condition—unless they are doctors—but truthfulness in what is said is possible. That includes truthfulness about any medical mistakes. Most patients can understand and do want to know the truth. Knowledge about even the most difficult things liberates patients from ignorance and allows them to decide, in a worst-case scenario, how death will be met.
The second context is the temptation to falsify insurance forms. Linked to a violation of the first commandment, lies on insurance forms then are the means of violating the seventh. Thus sin begets sin.
9. Thou Shall Not Covet Thy Neighbor’s Spouse and 10. Thou Shall Not Covet Thy Neighbor’s Goods
Our deeds begin in our thoughts and desires. These two commandments enjoin respect for the privacy and modesty of patients by infringing upon them as little as possible and only when needed strictly for the practice of medicine.
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 the ones money can buy. Envy is a sadness at the goods of others and an immoderate desire to have them. It can lead to actions that are incompatible with love of neighbor. In the medical profession, this can show itself as jealousy at the success of colleagues or fear that they will become as successful. Either feeling can lead health care professionals to withhold information and support from one another, to the disadvantage of patients and the human community.
Happiness Is . . .
Happiness cannot be had without a loving relationship with God. Since 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 what we truly desire. Just as a soccer coach or violin teacher gives rules to help players or musicians achieve their goals, so too the commandments of God are not arbitrary hoops to jump through on the way to heaven but the rules that will help us attain this end. Health care professionals, like every conscious human being, want pure Life, pure Love, and pure Light.