Gustav Niebuhr
Director of the Religion & Society Program, Syracuse University

Gustav Niebuhr

Niebuhr is an associate professor of religion and the media at Syracuse University and directs Religion & Society Program, an interdisciplinary undergraduate major.

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What If More than the Doctor and Patient Are Involved?

The libertarian in me wants to say, Let the patient's judgment rule. (Martin Marty puts this with considerably more elegance when he speaks of the "covenant" between patient and physician.) Problem is, medical decision-making is often not so neatly simple as to be a clear, two-party affair. The primary players may be the doctor and patient, but the patients' family is as likely to be involved, particularly in critical medical issues. And guess what? The family may not always agree among themselves (including with the patient), particularly when there are religious, ethical and moral issues involved.

If anyone thinks this is a rarity--and made even more difficult when the patient may not be fully in control of his/her faculties--then think again. In some cases, family members may bring in lawyers, pushing critical care issues into the courts. We live in a litigious society.

In a question like this, we might also do well to try to think beyond the rather limited frame of middle-class America. In many areas of the globe, other, considerably more formidable actors may get involved. Police, armies, governments: there are many parts of the world where armed individuals make their way into hospitals and feel perfectly at liberty to offer medical advice to doctors treating patients considered politically suspect for some reason or other. And then the physician will face questions involving her religious convictions that go well beyond whether to refer the case to another doctor. We ought not to forget that in the former Soviet Union, the state security apparatus used drugs to "treat" certain political dissidents.

We might also recall the incident that followed the Khmer Rouge's victory in Cambodia on April 19, 1975. Within days of capturing the country's capital, the victors emptied the city, driving its entire population into the countryside. That included the bedbound patients in the city's hospitals, who would face near-certain death in the process. I can imagine that a good Buddhist doctor, when confronted with such an order, might well bring his or her religious convictions into play, acting out of compassion (and not just for the patients), by killing the officer who issued such a command. After all, the doctor, in so doing, might well spare the officer the negative karma that would otherwise accrue to him for his role in creating such suffering and so possibly also save him from enduring a terrible re-birth.

As I say, these decisions can be a complicated business.

By Gustav Niebuhr  |  August 14, 2007; 9:48 AM ET  | Category:  Morality
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Posted by: Ann-tt | December 19, 2007 1:07 AM
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As a Nichiren Buddhist, I would not have killed or advised the killing of the Khmer Rouge officer, as heinous as his plans were. Rather, I would have sought some way to help people escape, avoiding violence if at all possible.

While the decisions are, as Niebuhr says, complicated, the ethics and morality are not. Patients who are mentally competent, and not otherwise incapacitated, have the right of control of their own bodies and what happens to them, unless they have legally ceded all or part of that power to family, friends, etc. through a medical power of attorney or similar instrument.

The transgressions - by the Soviets, the Khmer Rouge, and earlier by Nazis and others - against this basic human right should be viewed not in consideration of how such activities complicate decisions but for the sheer immorality and evil they personify, with an eye toward protecting the rights of individuals against this form of violence.

As a Buddhist, I believe we need a clear-eyed idea of what is good and what is evil, and anything that militates against the dignity and sovereignty of the human being seems to me to belong to the latter category.

Posted by: Sam Davis | August 20, 2007 11:55 AM
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Richmond T. Stallgiss quotes: "Genesis 7: "Never again will I curse the ground because of man, even though every inclination of his heart is evil from childhood. And never again will I destroy all living creatures, as I have done."

But if Noah survived, along with all the animals he had with him, then this so-called god didn't destroy all living creatures now did he?

How can I rely on something that doesn't even make a modest amount of sense?

Posted by: TJ | August 15, 2007 7:38 AM
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What a pathetic piece! A stupid argument if any was ever given! May I rephrase this sentence?

Gustav Niebuhr is an associate professor of dead religions.

Posted by: HeyYOU | August 15, 2007 1:18 AM
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Richmond T. Stallgiss, that's nice. But how sure are you that story is so? Who was there recording God's words? How do you know it was God speaking? And, yes I know the whole story. You left out the part about the rainbow. Was the rainbow added later?

That web site has a lot of information I don't need to repeat here. The particular page referenced, (I use it as reference) above says the Bible is a hoax, however. If the Bible is NOT a HOAX then the being in the fire was Devil and NOT God.

One reason for mentioning that little tidbit is to solicit evidence to the contrary. The story of the fallen angel, just as reliable as Noah's arc, says Lucifer and all the other "bad" angels were cast into a sea of fire, hell no less. Now how come God appears to Moses in a ball of fire? Is heaven on fire too?

The minister said to the atheist, "tell me what you believe and we'll call that God." I'm not an atheist. I believe it was the leader of Devils, Lucifer in that ball of fire, the being Moses made the deal with. See. We're in perfect agreement, what I believe is what ministers call God. It's NOT.

This panelist like many others ASSUMES that the Bible is the word of God and therefore acceptable as an instrument of argument. Not so. Either the Bible is a hoax, not usable for more than starting fires in one's fire place or it's the word of Devil and should be burned.

Evidence to the contrary will be considered. I have a very open mind. Convince me it was God in the fire, the being Moses made the deal with.

Posted by: BGone | August 14, 2007 6:29 PM
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BGONE, Your faith in that website is unshakable. In all your posts, you seem to promote it as if it were your religion.

The words 'rely' and 'religion' have the same etymology. Some people rely on themselves as the source of truth. Some rely on Sam Harris. ... others rely on God. What you rely on is your religion.

The Lesson of the Old Testament (which you cite in the Noah story of Genesis) is that people, no matter how hard they try, are going to fall short of the ideal. Time and time again, the "pillars of faith" fall short of the glory of God. It is no suprise, then, that people continue to be "sinners" following the flood. The problem wasn't those particular people; the problem is that people are naturally sinful and rebellious against their creator.

The big detail you forgot in your summary was that following the flood, God made a covenant (promise) that he would never again wipe out humanity. Whether or not you believe the details of the story, you miss the point of the story if you omit mention of the covenant.

Genesis 7: "Never again will I curse the ground because of man, even though every inclination of his heart is evil from childhood. And never again will I destroy all living creatures, as I have done.

"As long as the earth endures,
seedtime and harvest,
cold and heat,
summer and winter,
day and night
will never cease."

It's a promise that you are supposed to *rely* on.

Posted by: Richmond T. Stallgiss | August 14, 2007 3:05 PM
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Hey Pagan, this isn't the exact Biblical quotes but close enough for government work. It's something like this, "God looked down upon the earth and saw nothing but sinners,, and Noah of course. So God flooded the earth killing every living thing,, except for Noah and what he had on his boat of course."

But of course, there's nothing but sinners now. We can we trust the president, "we are all sinners" says he. This time God will do it right and end up with no sinners at all left on earth and no one at all either,, if Mr Bush knows what he's babbling about.

Maybe religion IS the problem? If only everyone would faith the correct faith?

Posted by: BGone | August 14, 2007 1:31 PM
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Great essay. I think one very strong argument against physician assisted suicide is that oftentimes the patient may be influenced by family wishes and economics (rather than their own personal pain or financial situation) when making the decision to throw in the towel.

Morality, which is perhaps distinct from religion, should always play a role in the physician's decision on how (and whether) to treat a given patient with a given medical solution.

Posted by: Richmond T. Stallgiss | August 14, 2007 1:28 PM
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I think all these examples only show where the patients' rights are in fact the right of the matter.

It's not unknown here in America for people to be subjected to psych meds and things like ECT, even 'exorcism' torture, against their will *because* of doctors bringing religious 'convictions' into play.

Hardly comes off like the Khmer Rouge, but there have been instances of patients in need being refused treatment in emergency rooms because the religions involved didn't 'approve' of their 'lifestyle,' for instance, (not to mention the almighty dollar,)

...I think anything that legitimizes these religious intrusions is a problem America's already-troubled health care system doesn't need.

What happens when you somehow have a doctor that doesn't 'believe' in evolution when there's TB going around? You let him breed resistant strains in a population by not telling people why they need to finish the full courses of antibiotics?

Maybe he thinks the world's going to end anyway, or even needs to be rushed along the way so his Jesus can come back, or that being poor is a sign of divine disfavor, or that suffering brings people to his God....

And, well, I don't know about the Buddhist doctor faced with the Khmer Rouge hypothetical, ...I've never heard a Buddhist rationalize killing that way.

Posted by: Paganplace | August 14, 2007 11:35 AM
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Realize it or not what you've done is make a really good case that religion is a serious medical problem. I can only agree with you. Healing must begin with a good attitude that never happens when Devil's servants are assumed, deemed even to be God's agents.

Maybe http://www.hoax-buster.org/sellyoursoul is wrong? There really was a supernatural being in that ball of fire? Consistent with what your essay says, the biggest Devil of them all was in there and now faith in Him creates chaos in the doctor's office.

Is faith, faith? Perhaps we could say what faith is in? A smidgen of evidence to verify that please.

Posted by: BGone | August 14, 2007 11:22 AM
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