No medical diagnosis is more fearsome than the
diagnosis of cancer. The very mention of the word is enough to trigger a
confluence of physical, emotional, spiritual, and financial crises. The
resulting maelstrom of life-changing events engulfs patients, their families,
and their doctors. If the cancer involves the head and neck, fear of physical
disfigurement augments the patient’s dread of alienation from the world of
purposeful existence.
In this book, Dr. Roy Sessions reflects on his
life as a dedicated head and neck surgeon living daily within the disrupting
milieu of his patients’ cancer. He describes how cancer confronted and
challenged his own technical and personal resources as a professed healer.
Sometimes he cured, sometimes ameliorated or palliated. All too often, he
traveled with his patient along the path of human finitude of the patient’s
death.
Repeatedly, Sessions recognizes the need to
join surgical and medical competence with the capacity to enter into the
patient’s real-world predicament, and for this a strong bond on trust is
essential. He laments the weakening of trust between physicians and patients in
a contemporary world. Without trust it is difficult for a physician to be
healer, helper, and friend. Without trust it is difficult to sustain patient
and doctor in their journey through the cancer experience.
Sessions lays a good part of the responsibility
to build the requisite trust on the physician. To be authentic this trust must
proceed from the physician’s personal dedication to the primacy of the
patient’s welfare. To be authentic this trust must rest on a moral commitment.
Dr. Sessions outlines his own moral commitment in terms of the traditional
Hippocratic ethic. Thus he expresses unapologetic opposition to inducing the
death of patients. For him the legalization of assisted suicide is the “dark
side” of end of life care in patients with cancer. There is fine line between a
physician helping a patient die and actually inducing death. He fears that the
growing economic strictures on the care of dying patients will hasten the push
to death in cancer victims.
This is a book replete with clinical wisdom
earned through the author’s dedication to the care of some of medicine’s most
desperately ill patients. It will be of interest and instructional value to
medical students, aspiring and practicing oncologists –medical, surgical,
radiation–as well as physicians generally. But Sessions intends his book for the
general public as well. Importantly, he makes the case that a better
understanding of doctors by patients and their families is beneficial for all
concerned. The cases Sessions describe will resonate with our own experiences
or those of our families and friends. His thoughts extend well beyond the
cancer experience to include other serious life-threatening trauma and illness.
Some may disagree with the author’s firm adhesion
to the traditional norms of professional ethics. Few however can deny the moral
nature of medical practice for anyone who “professes” to be a healer. Medical
students, those “physicians in utero,” should ponder the author’s unrelenting
moral commitment to the patient’s welfare. As we approach the revolutionary
changes now occurring in the way we care for patients, we need to be reminded
that all our efforts must finally be channeled toward the help and relief of a
human in distress. Anyone who “professes” to possess the requisite knowledge to
heal must use it to the advantage of the one who seeks and needs it.
The “final common pathway” of the doctor’s
effort is the good of the patient. This is its moral lever. Current proposals
for evidence-based, personalized, value-based, or systems care must traverse
this ancient pathway if it is to be morally justified. The sick will always
need physicians who practice technically correct, humanely administered, and
morally guided personal care. Sessions’s book provides the compass that must
not be lost in the current zeal for change in how physicians and society care
for the sick, the most vulnerable of our fellow citizens.
Edmund D. Pellegrino, MD, MACP
Professor Emeritus of Medicine and Medical
Ethics, Georgetown University
and Interim Director, Center for Clinical
Bioethics, Georgetown University Medical Center, USA
