The Physician-Patient Covenant: Love as an integral part of Modern Healthcare

The physician – patient[1] relationship is sui generis, unique. Patients bare their souls, relaying details they have never told anyone else, even their spouse, about their feelings, hurts, hopes, and dreams. Yet the relationship does not end with words. A visit to the doctor may necessitate examining even the most hidden and sacred parts of body, perhaps even to permit oneself to be put into a paralytic coma and incised for surgery. A relationship this encompassing mandates a morality and an etiquette, but where does one even begin to find the language to describe such complex interaction?

What is needed is a powerful way to encompass everything at once, a rich word containing compassion, altruism, professionalism, empathy, comfort, encouragement, humility, and competency. I argue that word is love, however modern healthcare strongly disavows any connection. We are quick to recognize love as an integral component of every other important relationship, so why is it not included here? Perhaps it is a misunderstanding to be remedied; clarified though analysis of what it means to demonstrate true love. Humanity has historically done a poor job of this, so I believe it is necessary to look to God to find characteristics of a genuine love.

For people of the Christian faith there is no deeper meaning of love than that of God’s love for us. In fact, God is love. (1st John 4:8) No group of people understands this better than the Israelites who developed their language in the context of God’s love, which sustained them for ages. (2nd Timothy 2:13) In Hebrew, there are several words for love; ahab (impulsive love, affectionate love), raham (compassion, brotherly love), and hesed (choosing affection and kindness).[2] I propose hesed, sometimes spelled chesed, is the word we have been looking for.

Hesed doesn’t translate well into English, but it encompassed ideas such as grace, compassion, covenant-love, and kindness.[3] In Judaism, hesed is a primary virtue and in his book on Jewish law and ethics Eugene Korn writes, “The entire Torah is characterized by chesed, i.e. it sets forth a vision of the ideal life whose goals are behavior characterized by mercy and compassion.”[4] Rabbi Moses Cordovero listed qualities and actions one might undertake to exemplify hesed:

  • love God so completely that one will never forsake His service for any reason
  • provide a child with all the necessities of his sustenance and love the child
  • visiting and healing the sick
  • giving charity to the poor
  • offering hospitality to strangers
  • attending to the dead
  • making peace between a man and his fellow[5]

Hesed is a covenant relationship in which the holder of the covenant acts out his responsibilities by demonstrating unfailing compassion, mercy, competence, empathy, comfort, service, and love. This encompasses ideas central to medicine and does so with a depth and grace not found in other words.

Covenantal ideas are foreign to us in the Western world because our interactions are primarily based on contractual obligations. In contractual obligations, two parties agree to terms which if one of the parties fails to uphold their end the contract is voided. To the contrary, in covenantal ideology one person agrees to terms which they will uphold regardless of the other party’s actions. Covenantal language is particularly helpful when relationships have a large difference in power. In medicine, the physician is in a position of great power with respect to the patient. In his book, The Physicians Covenant, William May says, “The modern doctor’s authority derives chiefly from a grim negativity, that is, from the fear of suffering and death and from the retaliatory powers that modern biomedical research places at his or her disposal.”[6] The results of this power difference is a strained physician-patient relationship. The physician either feels pride from being more powerful or fear from not wanting to abuse his/her power while the patient feels either stupid, belittled, or uncomfortable. The result in modern medicine is a denial of the problem. Physicians are taught to never be paternalistic, always learn from the patient, and give options rather than suggestions. The solution is not to ignore, but rather to reorient the dynamic.

Medicine is a wonderful profession, but it is fraught with difficulty and the physician-patient relationship is no exception. Modern medical thought attempts to mold it with words rooted in ideas that have limited meaning and are not rooted in contexts of any substance. A switch from compassion and professionalism to hesed completely reorients the relationship. While all physicians could benefit from using love as the focus of their practice, the true depth of hesed is only recognizable to those who understand the story of God’s love and commitment to them. If Christian physicians could begin loving their patients in the manner God loves them, we would begin to see a shift in all of medicine. Patients would flourish, even amidst terminal diagnoses, and the rest of medicine would come looking, wondering what was different.

[39] And when did we see you sick or in prison and visit you?’ [40] And the King will answer them, ‘Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.’

(Matthew 25:39-40 ESV)

[1] Not limited to physicians. The idea includes anyone involved in direct patient care, although the physician relationship often carries with it the most problems.
[2] “LOVE.” Christ in You. Accessed October 24, 2016. http://www.christinyou.net/Outlines/love.pdf.
[3] “Chesed – Wikipedia.” Accessed October 24, 2016. https://en.wikipedia.org/wiki/Chesed.
[4] Eugene Korn, “Legal Floors and Moral Ceilings: A Jewish Understanding Of Law and Ethics,” Edah Journal 2:2, page 10 As quoted in Wikipedia
[5]The Palm Tree of Devorah (Heb. Tomer Devorah). Cordovero, Rabbi Moshe. 10 As quoted in Wikipedia
[6] May, William F. The Physician’s Covenant: Images of the Healer in Medical Ethics. Philadelphia: Westminster Press, 1983

 


Andrew Miller is a fourth year medical student at UNC Chapel Hill and a 2016-2017 TMC Fellow. He is hoping to incorporate his year of studying theology at Duke Divinity School into his future career in pediatrics.