Spiritual Issues in the Care of the Dying

6 April 2005

Daniel P. Sulmasy, O.F.M., M.D., Ph.D.
St. Vincent's Catholic Medical Centers, Manhattan
and the Bioethics Institute of New York Medical College

Spiritual issues arise commonly in the care of the dying patient, but clinicians often fail to address them and many do not believe they fall within the scope of clinical practice. Dr. Sulmasy will address some fundamental spiritual themes dying patients face, and discuss what role clinicians should have in assisting patients with these issues.

Daniel P. Sulmasy, a Franciscan Friar, holds the Sisters of Charity Chair in Ethics at St. Vincent ’s Hospital, Manhattan,  and serves as Professor of Medicine and Director of the Bioethics Institute of New York Medical College, Valhalla, New York.  He received his A.B. and M.D. degrees from Cornell University and completed his residency, chief residency and post-doctoral fellowship in General Internal Medicine at the Johns Hopkins Hospital. H e received his Ph.D. in philosophy from Georgetown University in 1995. From 1991 to 1998, he served on the faculty at Georgetown,  where he was Director of the Center for Clinical Bioethics and Senior Research Scholar of the Kennedy Institute of Ethics. He was a Soros Faculty Scholar of the Project on Death in America, and is presently a member of the Board of Directors of the American Society for Bioethics and Humanities. His research interests include both theoretical and empirical studies of end-of-life decision-making, ethics education and the ethics of cost-containment in medicine. He is the author of a book on spirituality for health care professionals entitled The Healer’s Calling, and is co-editor of Methods in Medical Ethics , published by Georgetown University Press in 2001. He serves as editor-in-chief of the journal Theoretical Medicine and Bioethics . His numerous articles have appeared in medical, philosophical, and theological journals and he has lectured widely both in the U.S. and abroad.

From the 2 April 2005 issue of the New York Daily News:


Friar Doc Tackles Schiavo Debate

When he reaches that critical moment when it is time to talk about a terminally ill person's options, the first thing Daniel Sulmasy does is assure everyone that he and his colleagues are not there to pull any plugs.

"We're not the God squad," he tells patients and their families and friends. "We are here to help you decide."

Sulmasy, 49, is qualified to speak about end-of-life issues from several perspectives. Not only is he a practicing physician at St. Vincent's Medical Center in Greenwich Village, he is a moral philosopher, teacher, writer, bioethicist and Franciscan friar.

This week, Terri Schiavo was very much on his mind.

"Her case raises some very significant issues," he said, only hours before her death Thursday. Those issues involve medicine, ethics, faith, philosophy, technology and family. As Sulmasy puts it, "Things are so complicated that it probably is impossible to legislate anything we all can agree upon."

Not only that, he said, but advances in technology make it possible to prolong life perhaps indefinitely. "Technology gives us a terrible power, for good or bad," he said, "and we must find the dividing line between the two."

Medicine and faith go hand in hand for Sulmasy, who decided at 18 that he wanted to somehow combine the two. The son of a New York City cop, he grew up on Long Island, was educated by Franciscans and briefly thought about becoming a priest.

"I thought I could serve people better as a doctor," he said, "but I didn't want to give up on religion."

He pursued both callings. He began formal religious training at a Franciscan residence in the Bronx in 1984, after receiving a medical degree from Cornell University. Later, he would become chief resident at Johns Hopkins University School of Medicine in Baltimore, where he met the man who would lead him to concentrate on medical ethics.

"I went to hear a lecture by Dr. Edmund Pellegrino (a much-admired expert on the subject from Georgetown University) and afterward we talked a bit," Sulmasy recalled. "The next day, I got a two-page typewritten letter from him, telling me why I should study ethics."

In 1995, Sulmasy received a doctoral degree in philosophy from Georgetown - after writing a two-volume dissertation titled "Killing and Allowing to Die." He has drawn from it for dozens of essays and articles on the life-and-death issues it raised. But many people in the medical ethics field know him better for "The Healer's Calling," a book he wrote on spirituality for health care professionals.

Sulmasy has been a friar since 1990. He is called "Brother," not "Father," because a friar is not an ordained cleric. He does not usually wear his long, dark brown habit to St. Vincent's, and so, many of his patients do not know of his religious life.

He is active in a dozen bioethical associations, and juggles a schedule that includes lecturing at the New York Medical College in Valhalla, Westchester County, and organizing interfaith dialogues on spirituality and healing.

Sulmasy joined St. Vincent's six years ago, both as a doctor specializing in internal medicine and as the Sisters of Charity chairman of ethics. St. Vincent's also has a separate department of ethics, which he heads.

He also organized an ethics consulting committee that is always available to discuss possible end-of-life decisions. When a call comes, Sulmasy said, a committee of three, four or more, including at least one doctor, goes to the patient's bedside.

"Most cases are resolved before we intervene," he said. "But it's still very stressful. Patients ask their families what they should do, and that is a very, very tough thing."

About 75% of all deaths, he said, come after a decision to halt or refuse any extraordinary means to prolong life. This, he said, makes it even more important for people to prepare living wills or name a proxy to act on their behalf.

And as time goes on, he said, this will become even more important.

"We can always do something to prolong somebody's dying," Sulmasy said, "but there comes a time when we must say enough and let the natural dying process occur."