Florence Gelo
Philadelphia, Pennsylvania, United States

The Fatal Wounding of Sir Philip Sidney is a painting that I have used often to teach close looking to medical and theological students. The painting is full of details: color, lines, and textures. Faces and body language serve as vessels for emotion and are abundant and finely detailed. It was not until recently, when discussing the painting in preparation for a class called “Learning to Care for Patients Using the Arts,” that I noticed a facial expression in the painting that held new meaning and is core to humanistic qualities that I have been teaching. This impressive history painting by Benjamin West tells the story of Sir Philip Sidney, a nobleman, poet, philosopher, and soldier in the 1586 Battle of Zutphen in the Netherlands, a country seeking independence from Spanish rule. Sidney, a zealous Protestant, was a leader of the English forces against Catholic Spain.

A viewer’s eyes are immediately drawn to the figure of Sidney. We see him in the center of the canvas, in white garments, a meager shield covering his chest. His left leg is raised; a soldier’s hand on Sidney’s armored chest steadies him while a doctor treats his wound. A man who stands to Sidney’s side pours water from a flask into a bowl. Sidney’s left arm is extended upward, fingers spread apart, the palm positioned as if blocking the bowl from reaching him. Sidney’s right arm points to another wounded soldier being carried and waiting for care.

Not only is the hero of this painting vividly depicted in the center of the canvas, but we witness an important moment, one that surprises and inspires. Surrounded by infinite chaos and pain from an open wound, this painting captures the moment when Sidney reportedly spoke these words: “Thy necessity is yet greater than mine.” He then ordered the water to be given to the collapsing, wounded soldier.

According to legend, a contributing factor to Sidney’s wound was the result of his insistence on equality and a moral sense of duty to protect his soldiers. A witness is said to have claimed that during the battle near the town of Zutphen, Sir Sidney observed that another soldier was not wearing his cuisses, a piece of armor for the thigh. Sidney discarded his armor, judging that it was wrong to be better armored than his men. He removed his leg armor and was shot in the upper thigh, which this painting portrays. The wound became gangrenous and he died twenty-six days later, at the age of thirty-one.

Pausing and looking closely at Sidney, I noticed for the first time the complexity in his facial expression. His head is down slightly, his eyes focused on the bowl of water. He appears absorbed, quiet, and reflective in contrast to the urgent activities depicted in the background scenes. The densely populated scene of figures and activity do not correspond with the composure of Sidney’s face. We can imagine that Sidney is in pain, yet there is no outward expression of pain that one might expect his wound to cause. Instead, we perceive singular purpose, untouched and resolute. In this head (and heart) space, Sidney shows concern for another. It is a thoughtful choice made from the core of a matured self. It is a difficult choice, possibly an agonized choice, to do what is right or what is compassionate.

It is a question I ask first- and second-year medical students viewing this painting. The painting invites them to explore the question of self-sacrifice. These medical students are learning medicine three years into the COVID-19 pandemic. They have witnessed friends, family, physicians, and strangers sick with the virus, and some have died. They have been vaccinated at least twice and trained to protect themselves with medical gear and safety procedures. They have been confronted with public unwillingness or reluctance to support efforts to reduce the threat of the virus. Yet students have witnessed, as one student, Sonam, wrote, “the ways that physicians and many other healthcare workers were unabashedly and automatically sent to the front lines of the fight. Especially when there was so much unknown about the disease and its short-term and long-term consequences, first-line healthcare workers were constantly putting themselves at significant health risk to care for those around them.” Another student, Dominic, remarked, “During the pandemic, physicians spent days away from their loved ones to treat patients with a disease they did not fully understand themselves, putting their own health at risk. One cannot tell me this was solely because they took an oath year one of their medical education.”

The student in this later comment raises the question itself: why do physicians act in self-sacrificing ways? And, I would add, what inside them leads to this decision? These questions were aimed at helping students confront the tendency to overlook or minimize the process of making a difficult decision. It challenges them not to accept the notion that self-sacrifice is automatic, because of taking an oath. It is learned. It requires thought and intention that integrates one’s values and beliefs and reveals who one is becoming.

In The Fatal Wounding of Sir Philip Sidney, as we witness the self-sacrifice of a martyr, we are forced to introspectively consider the motivations and implications of self-sacrifice in our own lives. A sampling of student comments illustrates the variety of motivations that they believe can result in self-sacrificing behaviors.

Faith: “For anyone making a self-sacrificing decision, it requires them to see that the needs of others may outweigh their own self-interests in the moment. They may be persuaded by a desire to help others or see the greater need of the other despite their desire not to. Ultimately, the skills of inner strength and decisive thinking are ones we all need to develop in our years of medical training.”

Bryce: “In the context of medicine, it is this calling that leads individuals to pledge an oath to serve others. As a physician, there is a certain responsibility to serve those in need with all the knowledge and tools you have. Though there may be a risk present, there is the question of who else could possibly provide the way I can in this situation. I owe it to my patients and my community to serve them to the best of my ability, because that is the life and role that I chose.”

Jessica: “As physicians, we have the responsibility to care for our patients to the best of our ability; still, as human beings, we have the right to our own security and happiness. Professional ethics may not be enough to motivate altruism in a physician. We require personal ethical development and a deeper understanding into the dignity and worthiness of every human being to receive care to be truly altruistic and self-sacrificing. I firmly believe that the personal and professional ethics of many physicians are often naturally aligned and inspire us to make self-sacrificing decisions for the sake of our patients.”

Sara: “As a critical thinker, my first concern and primary motivator for attending to the patient would be a respect for their life, their right to live without pain or suffering, and my ability as a physician to aid in achieving this. However, given that a situation might be dangerous or risky, I would want to be relatively certain that the aid I could provide would help and be welcome in the first place. Take, for example, the painting of Sir Sidney, in which the more important figure, who by all accounts is the primary concern of those around him, seems to refuse care and instead pass it on to those who might need it more. Recognizing where one’s efforts are needed and wanted is an important consideration.”

Dominic: “As a future physician, I often wonder what drives us to put our patients before ourselves, what drives us to help people without reward? Are all physicians naturally altruistic or is this a quality we are taught through years of training? The reason we act in a particular manner is a culmination of all the intersections and experiences that make us an individual. When we get our white coats, we take an oath and follow a code of ethics, which guides how we will treat the patients we encounter throughout our career. Although this oath is what most future physicians dream of saying, I struggle believing that this code of ethics alone is what motivates physicians to act altruistically. I do believe this set of rules helps keep a physician within the scopes of acceptable practice and acts as guide, but there are additional innate qualities and life experience that guide us to treat patients in a manner that appears selfless and altruistic.”

Aida: “Professional ethics, in my opinion, is only one component of being an altruistic and self-sacrificing physician. [It is more about] giving the best care for a patient based on professional principles and duties but also morally feeling good about helping them. Once these are merged, it is then that being altruistic and self-sacrificing for the patient becomes a simpler task.”

Erica: “I believe that we, as future physicians, must take a balanced approach to prioritize our patients’ best interests in a way that is both effective and sustainable. Professional ethics provides a basis for how healthcare professionals should be providing care. However, simply reading and knowing the code of medical ethics is not enough to motivate one to be altruistic and self-sacrificing … one must possess an inner desire to be this selfless. My motivation to enter medicine and thus, sacrifice parts of my life, comes down to one main purpose; to serve others. To me, that is what it means to be a warrior in this life, by contributing towards something much greater than myself.”

Matthew: “The capacity for sincere self-sacrifice and altruistic behavior is not universal … Professional ethics, the requirements of a job, and other extrinsic motivators may provide temporary reasons to partake in such behaviors, but I don’t believe they are enough to govern actions over a lifetime. I believe the propensity for individuals to participate in such behaviors stems from their personal values and ethical/moral ideals.”

Caitlyn: “Professional ethics alone would not suffice to motivate you to be altruistic and self-sacrificing. In order to sign yourself up for a career that requires altruism as well as self-sacrifice, you need to have the personal qualities that elicit compassion, empathy, and courage to be able to take on the role of service.”

Trish: “I realized that what my father did during this time was not simply due to professional ethics, but rather more so due to a deep desire to alleviate the pain and suffering of others, a desire rooted more so in our family’s past and history than in professional ethics.”

My request of students to ponder the notion of self-sacrifice portrayed in the painting The Fatal Wounding of Sir Philip Sidney stimulated introspection and resulted in this rich set of reflections.

Most students agreed that self-sacrificing behavior by physicians is likely based on a variety of personal ethics and values, beyond a sense of responsibility or innate altruism. They cited personal and moral values based on life experience and ethical reflection, including the desire to alleviate others’ suffering or to serve others, personal satisfaction as a helping professional, considering the patient’s needs and preferences, commitment to the dignity and worth of every person, and the development of inner strength, compassion, empathy, and courage. These comments provide another example of how a painting can evoke important reflection and self-development when integrated into medical education.

Acknowledgement

I am grateful to the students from Drexel University College of Medicine for their comments.