Professor Roger Gil, neurologist
Director of A Space for Ethical Reflection (France)
Lessons for life,
drawn from Paul facing Sickness and Death
The vocation of the New England Journal of Medicine (NEJM) is to publish articles belonging to what may be called the scientific side of medicine; its objective is innovations in diagnostic both preventative and curative. But from time to time it happens that the periodical opens itself to the human and ethical realities of medicine. The most famous example of this is certainly the article of Henry Beecher published in 1966,(1) which provoked a crisis of conscience in western medicine by reporting a certain number of scientific works related to research on human beings which had not respected the dignity of the human person. In 2016 the NEJM gave it glowing homage(2) by showing that ethical reflection is not a curb on research but a condition of its human importance.
In August 2018 the NEJM published an article which also considered the human aspect of medicine, by telling a clinical story entitled ‘Life Lessons from Paul in the Face of Death’.(3) Paul was a rabbi who died three years after the diagnosis of a widespread cancer of the colon. He was 64 years old when stomach pain led to the discovery of an already widespread stage 4 cancer of the colon. He underwent a colostomy (articifial anus), followed by the most modern treatments, but died 34 months after the diagnosis. The author of the article, a doctor and in addition Paul’s own brother, outlined the three lessons which Paul had given his people during the additional months of life which medical treatment had given him.
Look back in order to learn to live for the future
Paul had never detected the cancer of the colon. He had no regrets about this, but was rather in agreement with the philosophy of Kierkegaard, according to which life must always look to the future, although it can be understood only on the basis of the past. He encouraged his wife and children to make this discovery. He knew that nothing could change what was happening to him, but he realised also that by telling his story he could allow others to escape the same destiny as himself. He helped others who were afraid of detecting a cancer of the colon to realise that the distress of the discovery was passing, but the reward was lasting.
Go on with your work
Paul, a rabbi, belonged to the conservative branch of Judaism, midway between the reformed and the orthodox: he held to openness and inclusion, respect for diversity and the faith of others. Despite his illness, and even in the face of heavy chemotherapy he continued to serve the community and to preside at religious ceremonies. Three months before his death he officiated at the funeral of a member of his community. Before his death he said that he hoped that the same would be done for him. And so it was.
Keep an aim in life
Because of his illness the marriage of his daughter was postponed, but forty-eight hours before the wedding he was taken to hospital because of internal bleeding. A few hours before the wedding he gathered his strength to be present. His close family helped him dress and be present in a wheelchair. He addressed his family and friends and said to them that this week-end belonged to the young married couple. In his disarming manner he spoke in a way which put everyone at their ease and injected humour into a situation which could have been experienced as sad. That night, when his family helped him to bed, it was clear that he had reached the end-point. And, wrote his brother, in the ten days which followed he was called to God.
His brother insisted that he had made the best possible use of the time of good health which medical skill had granted to him. Like him, his brother was grateful to the scientists, the doctors, the patients who had risked making clinical experiments and achieved this prolongation of life which he had achieved, thanks to new treatments. He lived for two more years, with an illness which twenty years previously would have led to a painful death in a few months. He used this time to teach how to live, and his family used the time to learn how to live.
The progress of medicine receives its full sense only as permitting people in the grip of illness to continue to give sense to their life. Only thus is it possible that medicine said to be ‘personalised’, but which is in fact highly exact, to the point exceeding any individual, can be allied to personal treatment. One of the purposes of bioethics is to promote this alliance.
(1) H. K. Beecher, ‘Ethics and Clinical Research’, The New England Journal of Medicine 274, No 24 (16th June 1966): 1354‑60, https://doi.org/10.1056/NEJM196606162742405.
(2) David S. Jones, Christine Grady, et Susan E. Lederer, ‘“Ethics and Clinical Research” – The 50th Anniversary of Beecher’s Bombshell’, New England Journal of Medicine 374, No 24 (16th June 2016): 2393-98, https://doi.org/10.1056/NEJMms1603756.
(3) Jeffrey M. Drazen, ‘Life Lessons from Paul in the Face of Death’, The New England Journal of Medicine 379, No 9 (30 August 2018): 808‑9, https://doi.org/10.1056/NEJMp1808695.