On beauty and medical ethics

John Brewer Eberly Jr.
Anderson, South Carolina, United States
Lydia S. Dugdale
New York, United States

 

Darian Goldin Stahl, “The Scan and the Mirror,” Stone lithography and silkscreen, 22″ x 28,” 2013. Private collection. www.dariangoldinstahl.com.

Philosophers know that beauty is moving, arresting, enrapturing. It captures the attention and then calls the viewer to action—pursuing, partaking, creating. Beautiful things invite participation; we find ourselves lingering and listening long. We leave inspired and moved to respond. As artists and poets have always known, beauty makes a claim on us that is far from neutral. It seems to call us to something.

In a limited sense, the language of the medical academy already reflects the value of attending to beauty. Senior clinicians are called “attendings” because they teach a way of exercising attention. In other words, they teach an aesthetic—what to look for, how to read the room, listen to the patient, perceive the diagnosis, craft the therapy. Just as attendings connect the way they pay attention to the way they make decisions, beauty demands more than mere observation; it inspires and often requires a moral response. Beauty is inherently ethical. Yes, it can provoke bad actions such as destructive jealousy, voyeurism, or greed. But more compellingly, beauty motivates the beholder toward the good.

What would it mean for medical trainees to learn ethics this way: not solely from a list of principles on a PowerPoint slide, but from beauty itself? The philosopher Elaine Scarry contends in her book On Beauty and Being Just that “beauty is a starting place for education.”1 Could aesthetics, likewise, serve as a basis for teaching ethics? A medical ethics born of beauty far surpasses mere intellectual assent to a traditional curriculum of patient autonomy and “first, do no harm.” Instead, it requires that healthcare practitioners share the beauty they have experienced. A medical ethics of beauty locates the clinician not in a place of glitter and gloss—what is merely “pretty”—but in that deep place of wonder, awe, desire, and conviction. It starts with the assumption that beautiful things touch us at our core—in the place where our moral orientation and imagination is formed. It starts with the assumption that one must first see rightly in order to respond rightly.

To be clear, a medical ethics informed by aesthetics does not imply simple recourse to what each clinician finds subjectively pleasing. If beauty is in the eye of the beholder, then beauty as a foundation for ethics could be a dangerous game. Rather, a medical ethics born of beauty wrestles with the claim that some things are beautiful and some things are not. It recognizes that beauty heightens our awareness of the way things should be—it points us toward the good—and therefore helps us perceive and articulate the way things should not be, and how we might heal those things that are ugly.

Along the same lines, a medical ethics that begins with beauty is not reductive to the medical humanities. It is true that medicine is an art and that the arts have much to say to medicine about the human experience, empathy, ambiguity, and suffering. Few would deny this. But concern exists that aesthetics simply perpetuates the myopia already bemoaned in modern medicine, turning doctors into ever more efficient data collectors who, even in front of a work of art, increasingly see only that which can be instrumentalized.

What is more, the medical humanities can seem like an optional afterword, distant from the warp and woof of medicine. The arts are there as a burnout remedy, aesthetic escape, processing tool, or post hoc addition to professional formation—“window dressing” engaged only by the interested few who were already reading poetry and visiting museums before entering medicine.2

But what if this hierarchy were reversed? What if beauty were seen as a foundation rather than a frosting?

Artists seem to know implicitly that art provokes, clarifies, and sustains moral action. When visual artist Darian Goldin Stahl reimagined her sister’s multiple sclerosis MRI scans, she hoped to “foster an ethical turn in medicine.”3 She understood that a link exists between what clinicians see and what they do—between aesthetics and ethics—and that imagery divorced from “the flesh, bones, and sinew of a real, whole person” can harm both patients and the clinicians who care for them. Stahl wanted to increase empathy in medicine, so she used beauty.

Or consider the work of the poet Christian Wiman, himself in remission from a rare blood cancer diagnosed in 2005. Wiman claims that “a poet’s technical decisions are moral decisions . . . [M]atters of form and sound have existential meaning and consequences.”4 The ethical consequences of poetry are precisely why it is so important in the world, even for those who do not read it. Poetry is “as natural and necessary as a stand of old-growth trees so far in the Arctic that only an oil company would ever see it; and just like those threatened trees, its reality ramifies into the lives of people for whom it remains utterly irrelevant and/or obscure.” Just as the body bends involuntarily toward the artist’s canvas, so beauty exerts a gravitational pull, changing us without our even realizing it. We stand and stare, leaning in.

Or we may turn to musical metaphors. While some beautiful things cause us to pause and slow down, others can literally move us to our feet to seek out a dance partner. Scarry describes the “forward momentum” created by beautiful things such as sonnets and dances. She says, “[T]hey incite the desire to bring new things into the world. . . . [Beauty] creates, without itself fulfilling, the aspiration for enduring certitude. It comes to us, with no work of our own; then leaves us prepared to undergo a giant labor.”5

And labor will surely be required, for the most obvious criticism of an aesthetic for medical ethics is medicine’s sheer ugliness. The necrotic foot wound. The hidden curriculum. The languishing child. Medicine can be a dark, ugly, unjust place in which talk of beauty can feel impotent and brackish.

Yet it is a curious truth about artists (and the arts in general) that they seem well-attuned to suffering. Artists have always been canaries in the coal mine; but they can also be coal miners in the aviary. Artists bewilder the comfortable and comfort the bewildered. They remind optimists that there is real injustice demanding attention, and they remind sufferers that shadows can prove the sunshine.

As Eric Cassell writes in The Nature of Suffering and the Goals of Medicine, “the most immediate role of aesthetics in medicine is to show us the ugly and disordered.”6 To this we may add not only anatomic disorder but also ethical disorder. The hospital offers hospitality both to a woman welcoming a new life into the world and to a woman cradling the body of a child born dead. This is medicine. It is also the world of aesthetics, learning to name what is desirable and good and fitting while also naming what is awful and unjust and disordered. An aesthetics-informed ethics enables us to see—and respond—to hope and despair, to health and unhealth.

Still the question persists: what to do about the ugliness? There remains a very human impulse to avert one’s gaze from putrefying flesh. But if ethics demands attention—that is, if we must see rightly in order to respond rightly—then we cannot afford not to see. Scarry says that the work of beauty is a collective accomplishment. Its pursuit can stretch us to the virtue of forbearance: “When one goes on to find ‘better,’ or ‘higher,’ or ‘truer,’ or ‘more enduring,’ or ‘more widely agreed upon’ forms of beauty, what happens to our regard for the less good, less high, less true, less enduring, less universal instances?”7 She supplies the answer to her own question by quoting the philosopher Simone Weil: “He who has gone farther, to the very beauty of the world itself, does not love them any less but much more deeply than before.” The challenge is not to be put off by ugliness but to labor to see and respond with greater clarity, greater profundity. We must look not only at the necrotic foot but also into the eyes and arresting complexity of the one who bears it. As Thoreau put it, “The question is not what you look at, but what you see.”8

In a moral economy characterized by competing ethical principles, an ethic launched from the platform of beauty offers a compelling corrective. The language of “autonomy,” “beneficence,” “non-maleficence,” and “justice” only rarely inspires medical students to better medicine. But beauty has a particular force. It is a call to delight and to attend. It burrows its way into the conscience, holing up in the mysterious alcove of the mind where things become unforgotten and enduring. It becomes the immovable still point from which character and justice and wonder emerge—a starting place for education.

 

 

References

  1. Scarry E. On Beauty and Being Just. Princeton, NJ: Princeton University Press; 1999:31.
  2. Moniz T, Golafshani M, Gaspar CM, et al. The prism model: advancing a theory of practice for arts and humanities in medical education. Perspect Med Educ. 2021. https://doi.org/10.1007/s40037-021-00661-0.
  3. Stahl DG. Lived Scans. In: Stahl D. Imaging and Imagining Illness: Becoming Whole in a Broken Body. Eugene, Oregon: Cascade Books; 2018:40–1.
  4. Wiman C. He Held Radical Light. New York, NY: Farrar, Straus and Giroux; 2018:26.
  5. Scarry, 46, 53.
  6. Cassell E. The Nature of Suffering and the Goals of Medicine. Oxford, UK: Oxford University Press;1991:203.
  7. Scarry, 51.
  8. Thoreau H. I to Myself: An Annotated Selection from the Journal of Henry David Thoreau. Cramer S, ed. New Haven: Yale University Press; 2007:86. In: Christie D. The Blue Sapphire of the Mind: Notes for a Contemplative Ecology. New York, NY: Oxford University Press; 2013:171.

 


 

JOHN BREWER EBERLY JR., MD, MA, is a PGY-3 and chief resident in Family Medicine at AnMed Health Family Medicine Residency in Anderson, South Carolina. He is a former fellow of both the Theology, Medicine, & Culture Fellowship at Duke Divinity School and the Paul Ramsey Fellowship with the Center for Bioethics & Culture. He has been published widely, including Academic Medicine, JAMA, AMA Journal of Ethics, Christianity Today, The New Atlantis, and elsewhere. After graduation, Brewer plans to practice and teach at the intersections of family medicine, theological bioethics, medical ethics, and aesthetics, with interests in medical trainee formation, beauty, and practical wisdom.

 

LYDIA S. DUGDALE, MD, MAR (ethics), is the Dorothy L. and Daniel H. Silberberg Associate Professor of Medicine at Columbia University Vagelos College of Physicians and Surgeons and Director of the Center for Clinical Medical Ethics. She also serves as Associate Director of Clinical Ethics at New York-Presbyterian Hospital/Columbia University Irving Medical Center. A practicing internist, Dugdale’s scholarship focuses on end-of-life issues, medical ethics, and the doctor-patient relationship. She edited Dying in the Twenty-First Century (MIT Press, 2015) and is author of The Lost Art of Dying (HarperOne, 2020), a popular press book on the preparation for death.

 

Summer 2021  |  Sections  |  Ethics