Human Flourishing: Judaism, Medicine, and a Life Well-Lived

From the December 16, 2022 issue of the Transformational Times

Human Flourishing: Judaism, Medicine, and a Life Well-Lived

Sarah Root

The Kern Institute believes that human flourishing is central to the health of physicians, caregivers, patients, and society. In this essay, initially published one year ago in the Transformational Times, medical student Sarah Root shares some family stories that highlight her thoughts on faith, flourishing, and the practice of medicine from the perspective of Judaism ...

How can one do the most to help others and uplift the world?

 

Unlike in many religions, Judaism does not generally concern itself with what happens spiritually after death. As a seventeen-year-old reeling from the loss of her grandmother to cancer, this was a surprising comfort to me. From my dad’s eulogy where he reminisced about some of her best traits (the dedication of her life in support of the arts) and her most eye-rolling (her unwavering belief that Melba toast and cream cheese represented a complete breakfast), to the shiva services in which family, friends, and extended community gathered to share anecdotes, quirks, and fond memories (and of course, food), the focus was not on grief. 

That’s not to say that there weren’t tears, but they were intermixed with laughter as we sat there together, eating bagels and lox in celebration of a life well-lived. This emphasis on life is not unique to the Jewish mourning process, but is a central tenet in Jewish philosophy as a whole. Moreso than simple recognition, Judaism holds the preservation of life as one of its highest values. By Jewish law, the pursuit of saving a life supersedes all but four of the 613 mitzvot, or G-d’s commandments, in the Torah. It is this regard that exempts the sick from fasting on Yom Kippur (the Day of Atonement), permits Jews who might go hungry otherwise to break kashrut (the dietary laws), and allows abortions to save the life of the mother. But the simple concept of preserving life is meaningless without a Jewish concept of what it means to live, and perhaps even flourish.

In the Pirkei Avot (teachings by rabbis throughout the ages), Shimon the Righteous coined the idea of al shlosha d’varim, or the three principles on which the world stands: studying Torah, performing avodah, and practicing gemilut hasadim (Pirkei Avot 1:2). To study Torah is to read the fundamental Jewish religious text and learn how to live an honorable life. Historically, avodah referred to sacrificial rites performed in the temple. Throughout the centuries its religious meaning expanded more broadly to worship and divine service, while in modern Hebrew, avodah simply translates to work. Finally, gemilut hasadim are acts of loving kindness, a spiritual calling for Jewish people to help others.

There is interplay between the concept of an individual’s actions in following the al shlosha d’varim and the flourishing of broader society. In Jewish teachings, it is clear that the personal and the community are intrinsically linked concepts, and that one cannot find meaning without the other. From the Torah, we Jews learn the mitzvot and the stories of our people, providing an ethical framework and bringing us closer to our communities, our history, and to G-d. This is the fundamental basis for the Jewish concept of l’dor v’dor, a phrase which translates to “from generation to generation,” and encompasses the sharing of traditions, stories, and values between generations. In participating in l’dor v’dor, we enrich both our own lives and those of our communities by building bonds of love and respect.

In practicing avodah, we Jews find spiritual fulfillment, which may seem personal at first. However, communal worship is a requirement in religious Judaism. For public prayer, a minimum of ten people (historically men) must participate in order for the obligation to be met. 

But I would also like to point out that avodah means more than just worship; it also refers to divine service and work. These two concepts remind me of a story that my rabbi used to tell, in which every week a man would bring a loaf of bread as an offering to G-d and leave it in the ark, where the Torah scrolls are kept. And every week, another man would come pray to G-d, asking for food to feed his family. When he would open the ark, the bread would be there, his prayers answered. When the two discovered each other, both were initially upset; the first because G-d was not receiving his offerings and the second because G-d was not answering him. But their rabbi simply laughed. G-d, he said, was listening to their prayers. By offering the bread, the first man was acting as the hand of G-d to fulfill the prayers of the second.

The story illustrates that divine service is not passive, and that true prayer is not just holy words, but actions that emulate the divine. This understanding is fundamental to the third pillar of al shlosha d’varim: gemilut hasadim, or acts of loving kindness. The scope of this is broad, encompassing anything from caring for the sick, to volunteering at a food bank, to waking up to drive your brother to school at 6:00 AM so he doesn’t have to bike in the rain. Gemilut hasadim is about dedicating your actions to uplifting your community in a way that is personal. 

Gemilut hasadim is notably separate from tzedakah, generally translated as charity, one of the most important mitzvot. It is explicitly commanded in in the Torah to “open your hand to the poor and needy kin in your land” (Deuteronomy 15:11). But in modern translations, tzedakah means more than just charity. The root of the word is tzedek, meaning justice and righteousness. Giving charity can thus be seen as a facet of restoring justice to the world. With this interpretation, tzedakah has extended to not just mean giving money, but also giving time, reiterating the importance of actions in Judaism. This concept underlies Jewish support for many social movements: if we ourselves are to flourish, then we must ensure that everyone can flourish.

The concepts of al shlosha d’varim, l’dor v’dor, and tzedakah come together in turn to form the spiritual foundation for tikkun olam, the Jewish imperative to repair the world. In Kabbalistic Judaism, this moral mandate is explained through the shattering of the vessels, a revision of the creation myth. In this story, when G-d is creating the world, he puts his divine light into several vessels. These vessels were intended to be spread throughout the universe and make it perfect.

But the vessels were unable to contain G-d’s divinity and they shattered, sending sparks far and wide. Tikkun olam, Kabbalistic Judaism states, is the process of finding the sparks and gathering them, by acting as the hands of G-d in helping others. When enough of these sparks are gathered, the vessels can be restored, and the world can once again be made whole. Tikkun olam, in essence, is a directive for how to live a meaningful life. The concept of human flourishing in Judaism then becomes a simple question: how can one do the most to help others and uplift the world?

It is this cultural mindset that encourages many Jews, such as me, to pursue a career in medicine and informs our perspective on providing care. Medical practice inherently encompasses many critical Jewish values, namely an ultimate respect for life and acts of loving kindness. Healthcare workers dedicate their time, on nights, holidays, and weekends, to ensure that the ill can continue to receive life-saving care. Medical education is itself l’dor v’dor, as knowledge, passion, and ritual are passed down from each generation of physician to incoming medical trainees. And the medical field is a community intended to uplift patients, families, and healthcare workers, a direct extension to the communities that we as Jews are morally called to participate in.

The Jewish physicians that I know flourish when their patients flourish, but only so much can be done by the bedside. Thus, the concept of tzedek teaches us that as physicians we have a responsibility to ensure that patients are being treated with justice, both in the clinic and in the broader world. This is ever more important in a society where the cost of care continues to increase, and people are threatened with lack of access. We must strive for tikkun olam, to repair the parts of the system that are broken and advocate on a broader level as a community.

This past Thanksgiving, my grandfather pulled me aside to give me some words of wisdom as a lifelong physician himself. Remember, he said, that medicine is not just a practice, but a privilege. In this, I see a redefinition of the word avodah. Perhaps the distinction between worship, divine service, and mundane work is far smaller than one might initially imagine. When the work is serving others, is that not a form of worship in its own right? I hold all of these Jewish principles close when learning to provide care, when advocating for my patients, and when approaching difficult situations with respect and an appreciation for life. In becoming a medical practitioner, I am laying the groundwork for my own Jewish flourishing.

Sarah Root is an MD/PhD student at the Pritzker School of Medicine at the University of Chicago; she was in her second year of the program when this essay was published in December 2022. She is a graduate of the University of Pennsylvania and is passionate about the intersection of Judaism and ethics. Email: sroot@uchicago.edu

We have both a duty-to-care and a responsibility to care: what does that look like?

 From the 12/11/2020 newsletter

Director’s Corner

We have both a duty-to-care and a responsibility to care: what does that look like?

 

Adina Kalet, MD MPH

 

This week Dr. Kalet considers how today’s physicians, facing unacceptable fragmentation of care, need to recommit to an Ethics of Care for, with, and about the individual patient. Our Tripe Aim is Character, Care, and Competence.

 

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A good friend of mine is suffering. She recently underwent what was expected to be a relatively straightforward surgical procedure both she and her physician expected would correct a disabling problem and improve her quality of life. Instead, she developed a rare, perplexing, painful complication that significantly limits her mobility, interferes with getting a night’s sleep, and has not responded well to treatments. And she essentially has been abandoned by the surgeon who performed the procedure.

 When, months later, it became clear that she was not going to recover as expected, the surgeon did not make referrals to a pain specialist, and only referred her to physical therapy on the patient’s request. He does see her in “follow-up,” but focuses only on the immediate post-operative issues, not the new condition. When my friend reaches out to inform him of her progress and asks clarifying questions or for advice, the registered nurse on his team responds to her messages in a curt “just the facts,” perfunctory manner. Although the surgeon’s office has reached out to inquire about her progress through an impersonal “app,” no one has expressed care or concern that her pain continues. In my book, this is abandonment and, therefore, unethical. 

 As physicians, we have both an obligation and responsibility to care for, with, and about our patients. Like other service providers, we have a “duty of care,” which is a legal obligation requiring us to adhere to “standards of reasonable care while performing any acts that could foreseeably harm others.” From this perspective, strictly speaking, my friend’s surgeon did his duty. And given the current fragmentation of health care into sub-specialties, he can argue that by ensuring post-operative wound healing, he is discharging his obligations.  But this is not caring.  

The Ethics of Care, developed by feminist scholars including Carol Gilligan and Joan Tronto among many others, holds that moral action goes beyond meeting standards – being objective and justice orientated – but centers on the relationships and connection with others, especially when they are vulnerable and require expertise. The Ethics of Care emphasizes the importance of attentiveness and responsiveness to the individual and acknowledges the complexity of care taking. Rather than taking a narrow view on the obligation to refer my friend to a competent expert, I believe this physician had a responsibility to do the complex, skilled work of caring for her. He demonstrated no intention to do anything beyond his narrowly focused area of expertise.

When I told my friend’s story to a mentor who is an experienced surgeon, he said, “These are the patients you hold close, you give them your personal cell phone number, you respond and see them often until there is some resolution or even if there isn’t one. You are in this relationship for the long haul.” The wise and ethical physician makes the referrals, ensures the patient understands what needs to be done, has the difficult conversations, and “quarterbacks” the game until there is a resolution.  

By any measure, my friend is a “good” patient. She takes medication as prescribed, engages in physical therapy with enthusiasm and commitment (she is a “weekend warrior,” after all), listens carefully to the recommendations and advice of her physician, engages actively in decision making, and is extremely well informed. Luckily, she has caring pain management specialist and access to friends and relatives who are in health care. I have advised her to move on and consider the surgeon who operated on her as she would any high paid tradesman rather than as her physician. This is terribly disappointing, but common.

To be clear, while this isn’t likely “malpractice” it is, in my view, clinical incompetence. My friend’s current predicament was not likely due to a mistake in judgement or poor surgical technique, but her physician did not take responsibility to relieve her suffering by actively, assertively, compassionately, and competently caring for her. To do this well, he would need a mature, internalized professional identity to help him make morally informed choices in a therapeutic and caring relationship, especially when things got frustrating or went wrong. It would enable him to spend the time and make the effort to communicate with this patient directly, guide her to effective symptom relief, and sincerely empathize with her situation. This is not easy; sophisticated clinical communication skills are required. These include being capable of actively listening, while accurately identifying and appropriately responding to emotions, all while conducting clinical reasoning and creative problem solving. These are learnable skills, but require both a desire and practice to master. This physician is not trying hard enough. 

All physicians need to take responsibility for caring for patients, especially when the going gets tough, vexing, perplexing, and challenging, like when a patient, who should have recovered, does not. In one way or another, managing chronic pain is the responsibility of all physicians. Central to effective pain control from the patient’s point of view is being taken seriously, remaining hopeful and realistic, being listened to, and experiencing authentic empathy from a trustworthy physician or other health care professional. Anyone who has gone through childbirth understands that extreme pain – as long as it is going to be time-limited and will end with the birth of a healthy infant – can be “suffered” without medication, be well-tolerated, and can even be experienced as joyful when surrounded by trustworthy, caring, and competent health professionals. On the flip side, even mild to moderate pain can be unbearable when “suffered” alone or is a sign of loss of bodily integrity, increasing disability, or a terminal diagnosis. A mature and skillful physician has the potential to relieve suffering simply by staying in relationship with a patient. 

Modern medicine takes place within complex institutions and, even with the best intentions, the incentives can be perverse. If care and caring must happen within trustworthy relationships, then health care systems that divide the labor so that everyone works at the “top of their license,” are dividing the patient. I worry that as a side effect of “team care,” health care professionals are being encouraged, incentivized, or forced to destroy therapeutic relationships.  This is why physicians must have a strong character and a moral compass-sense of agency, and masterful communication skills to remain “the patient’s doctor” when there is rough going; staying put when it would be more comfortable to leave or send in someone else.

I have spent much of my career learning, teaching, and studying patient-physician communications. To motivate others to take this very seriously, I often point out that patients are more likely to sue a physician for “abandonment” of the type described here than for actual malpractice. I interpret this to mean that people will forgive mistakes, but not lack of care.

 

 

Adina Kalet, MD, MPH, is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

Kern Institute Renovations Under Way! Three New Labs, One New Pillar, and a New Post-Doctoral Fellowship!

From the 7/10/2020 newsletter

Director's Corner

Kern Institute Renovations Under Way! Three New Labs, One New Pillar, and a New Post-Doctoral Fellowship! 

 

 

Adina Kalet, MD MPH

 

In this week’s Director’s Corner, Adina Kalet describes changes to the structure of the Kern Institute that will supercharge the transformational work of the Kern Institute... 

 

 

Laboratories

 

It is with great excitement that I announce that the Kern Institute will now have three new  laboratories: 

• Medical Education Data Science Lab led by Tavinder Ark, PhD and profiled in the Transformational Times on June 19^th,
• Human Centered Design Lab led by Chris Decker, MD and Julia Schmitt.
• Philosophies of Medical Education Transformation Lab led by Fabrice Jotterand, PhD. To learn more, see the “Director’s Corners” on Practical Wisdom (April 10^th) and A Philosophy of Medical Education Transformation (May 8^th). 

 

 

Laboratories are places where people work together to understand how the world works. They are also relatively small bands of people who – with a range of specialized expertise and sometimes funky new equipment and technology – work  together with stakeholders to engage in experimentation, teaching, and wide-ranging and deep conversations. Where cross-disciplinary scholarship is conducted and disseminated, graduate students as well as mid- and late-career colleagues are nurtured. 

 

According to Wikipedia, the earliest laboratory belonged to Pythagoras of Samos, the Greek philosopher and scientist, who conducted experiments that discerned the different sound tones produced by the vibration of string. So, we join an ancient tradition of enabling those with deep curiosity to ask important questions and seek answers.  

 

 

Pillars

Our pillars are just that: the mainstays of the Kern Institute. The equivalent of divisions in a clinical department, pillars represent our stakeholders. 

• The Student Pillar, led by Catherine “Cassie” Ferguson, MD and Cassidy Berns, designed, implemented and now leads the REACH curriculum. This pillar houses our work on Holistic Admissions. It focuses on enhancing equity and belonging for all our students in our effort to become an anti-racist organization.
• The Faculty Pillar, led by Alexandra Harrington, MD and Vivian Dondlinger, builds MCW’s capacity to transform medical education through the rigorous KINETIC³ faculty development program, and will be the home for our Kern signature coaching program.
• Under the guidance of Jose Franco, MD and Joan Weiss, the External and Internal Community Pillar (profiled in the “Director’s Corner” on May 1^st) will work to enthusiastically engage all of our communities – especially patients – in the work of educating the next generation of physicians.
• In his leadership of the Outcome Based Medical Education Pillar (formally known as the Curriculum Pillar), Martin Muntz, MD and Kaicey von Stockhausen express deep commitments to ensuring a culture of psychological safety while building systems and structures to support learners aspiring to become masterful physicians ready to serve in this rapidly evolving health care environment. 
• Moving forward we are adding a Graduate Medical Education Pillar that will engage this critical stakeholder group in the work of the Kern Institute and ensure we are working all across the medical education continuum to build strong institutional alliances. This pillar’s leadership will be announced soon.

 

 

 

Postdoctoral Fellowship

 

Finally, I want to ask for your help in identifying candidates for the new Kern Institute Postdoctoral Fellowship in Transformation of Medical Education. Creating this postdoc is a first step in building a nationwide capacity working to transform medical education. By defining enhanced career paths for PhD-prepared foundational scientists, we will create the next generation of leaders that will reimagination curricula and support cutting edge pedagogies to integrate foundational and clinical sciences. We want to attract an enthusiastic scientist and teacher who will roll up his or her sleeves and create effective, inspiring methods ensuring that future health professionals have solid foundations of scientific knowledge.  

 

The announcement for the position is here.

 

 

 

Stay engaged!

 

We invite you to read and to contribute to future issues of the Transformational Times as we collaborate and learn, working through our Pillars and Labs to turn aspirations into realities. 

 

 

 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

Working Toward a Philosophy of Medical Education Transformation

From the 5/8/2020 newsletter



Working Toward a Philosophy of Medical Education Transformation


Adina Kalet, MD, MPH

The education of healers has always mattered to society. Over the centuries following Hippocrates, physicians received training as apprentices, each learning from a mentor and practicing precepts handed down in centuries-old texts. By the end of the 1800s, the U.S. was dotted with various types and qualities of medical schools and medical “sects.” No license was needed. Anyone could “practice medicine” in the U.S. Unstudied treatments were often toxic or deadly.


In 1910, Abraham Flexner, an American educational transformer supported by the Carnegie Foundation, released a report outlining how medical education should be structured, including periods of preclinical and clinical content with standardized, significant, supervised learning centered around the role of science. The report forced the closure or consolidation of almost half of US medical schools, improving the quality of medical education and practice across the US, but also effectively limiting training to upper class men and limiting high-quality healthcare access to those who could afford to pay. These are consequences we have yet to fully overcome.

Medical School Transformation Usually Focuses on the “How” Rather Than the “Why”
Because medical education is so vital, there have been constant efforts at transformation. Since Flexner, though, much of the “reform” has focused on the how of education rather than the why. For example, curricular reform has focused on content elements, reallocation of contact hours for curriculum, various instructional approaches and techniques (e.g. Problem Based Learning and OSCEs), and implementation strategies. There have been winners and losers, but by engaging in curricular reform without articulating the bigger ideas or respecting the social forces afoot, medical schools and their faculties are traumatized. Real transformation has not been accomplished; real paradigm shifts have yet to occur.


So, if we want to truly transform medical education, we must strike at the why. How will we decide when to heed the calls to make changes? What ideas and principles should guide the reforms? Who gets to make these decisions? How much consensus is needed before we act? When is it right or no longer defensible to keep things as they are? What is the purpose of medical education anyway? These are philosophical questions not technical ones.


Philosophy, Practical Wisdom, and a Focus on the “Why”
Philosophy (literally, “the love of wisdom”) is a way of thinking. It asks basic, general, probing questions about the nature of human thought, the universe, and the connections between them. It provides a lens to analyze complex situations and, therefore, a method to make good (i.e., moral and virtuous) decisions. Philosophy articulates the deeper thinking that underlies visible actions. It is a “superset of principles” that explores how to think, not what to think. It does not provide answers, but it does shape our decision making. For instance, how would such an approach guide our work if we acted as if medical education needs to prioritize people and learning, not structures? How would we change the structure of medical school curriculum?


In the Kern Institute, just as we explore creativity, innovation, cutting-edge faculty development, instructional design, and pedagogy, we are – at the same time – articulating a philosophy of medical education transformation. Four Kern faculty members are trained philosophers: Arthur Derse, MD, JD, Ryan Spellecy, PhD, Christopher Stawski, PhD, and Fabrice Jotterand, PhD, who bring together extensive experience in biomedical and research ethics, philosophy of medicine, humanities, clinical practice, community health, sociology, and character education. As part of the Institute’s Practical Wisdom Group, they meet regularly to explore how the Kern Institute’s values of character, caring and competence should guide transformation of medical education. A model is emerging.


As the Kern Institute’s resident philosopher, Fabrice Jotterand, PhD, will work with MCW faculty members, MCW students, and a group of international scholars to deepen the dialogue so we can articulate our philosophy of medical education. This kind of work is difficult. It takes time, a precious commodity for pragmatic, busy physicians and scientists. However, taking this time is critical and a great privilege in the modern world of medicine. The stakes are high.


Moving Beyond the Flexner Report
At the one hundred-year anniversary of the Flexner Report in 2010, a rigorous Carnegie Foundation study of American medical education by Cooke, Irby, and O’Brien made dramatic recommendations for changes in the medical school curriculum. These included:

• Standardizing learning outcomes and individualizing the learning process

• Promoting multiple forms of integration of basic medical and clinical sciences

• Incorporating habits of inquiry and improvement

• Focusing on the progressive formation of the physician's professional identity

These recommendations, if implemented, will enable us to move away from dictating the length of time each student spends in an educational program – the “dwell time” – and move toward an emphasis on accomplishing the needed learning, a pedagogical philosophy known as “competency-based, time variable medical education.” This, along with an unprecedented increase since 2002 in the opening of new US medical schools and regional campuses, would expand access to both the profession and to medical care, offering opportunities to articulate and act on medicine’s commitment to address societal needs as part of medical education transformation.


As an ancient profession, medicine finds itself in tension between holding firm to grand traditions versus embracing new ideas, social change, and cutting- edge pedagogy. There is no one best way to educate physicians but there are better and worse ways. As we deepen our understanding of how to address the big questions, we will need the courage to pursue the answers we uncover.



Ref: Irby DM, Cooke M, O’Brien BC, Calls for reform of medical education by the Carnegie Foundation for the Advancement of Teaching: 1910 and 2010. Academic Medicine. 2010 Feb;85(2):220-7. doi: 10.1097/ACM.0b013e3181c88449.


Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

It's Not About the Vent: Reflections on Resource Allocation in a Time of Crisis

From the 4/10/2020 newsletter

It's Not About the Vent: Reflections on Resource Allocation in a Time of Crisis


Mary E. Homan, DrPH - Bioethics and Medical Humanities
 

For those who remember Oprah on daytime television, she often surprised her audience members with a set of car keys under their chairs and pointed at individual attendees and shouted, “You get a car! And you get a car! Everybody gets a car!” Right now, there is a meme going around with a picture of Oprah yelling, “You get a vent, you get a vent! Everybody gets a vent!” Although it is a humorous – albeit macabre – sentiment, the actual concern over who will receive (and remain on) a ventilator differs depending on how you perceive equity in the health care system.

This week, ProPublica released a report regarding the mortality disparities of COVID-19 between black and non-black persons. Milwaukee County reported that as of 11:00 a.m. on Tuesday, April 7, of the 1,324 confirmed cases of COVID-19, 609 cases were persons who are black or African-American. Thirty-five COVID-19 deaths out of 49 were of persons who were black or African-American. To put this in perspective, black or African-Americans make up 27% of Milwaukee County’s population, but they represent 46% of COVID-19 cases and 71% of the deaths. Unfortunately, Milwaukee’s experience is not unique.

Early in my career, I participated in an ethics consult where the family was fearful of the medical system, and didn’t trust the “white coats.” If this family couldn’t trust their loved one’s care team when it was apparent the patient was in her last moments of life, how will families, who are kept physically distant from their COVID-19-positive loved ones, trust caregivers to make fair decisions about allocating resources?

Bioethicists have been struggling for weeks (some for years!) to help clinical decision makers, state emergency response teams, and health departments justly allocate resources. There are classifications, tiers, and even tie-breakers for hospitals when they are down to the last pint of blood, last dose of morphine, last isolation gown, or last ventilator. Even if the team making triage decisions is blinded to a patient’s disability status, payor source, race, or gender, the fact remains that societal inequities do not provide a level playing field. Not everyone has the same access to adequate insurance coverage. Social determinants of health are associated with lower access to health maintenance, higher rates of uncontrolled diabetes, more frequent environmental exposures, and higher rates of both heart and lung disease. The people allocating scare resources are not blinded to these health outcomes. The most vulnerable among us will suffer.
 

When I developed the Ebola ethics guidelines for my previous health system, I wrote that we must strive to ensure burdens are not borne disproportionately by any patient, patient group, care site, or community. I called for a protection from discrimination for those whose social or medical condition places them in the so-called margins of society. Sharing the burdens equally and protection from discrimination are two examples of character in action.


Triage officers will be forced to make tough decisions and those at the bedside will struggle with the consequences. We must continue to care even when we can’t cure. We must trust our patients’ distrust of the system and partner with their loved ones in this time of fear and anxiety.
 

Sadly, we are not Oprah. Not all resources will be available. We can, however, work to assure that everyone has an equal chance of being treated with justice, care, and compassion.



Mary Homan, MA, MSHCE, DrPH is an Assistant Professor of Bioethics and Medical Humanities in the Center for Bioethics and Medical Humanities of the Institute for Health and Equity at the Medical College of Wisconsin