Book Review: “God, Medicine, and Suffering” by Stanley Hauerwas

In God, Medicine, and Suffering, Stanley Hauerwas tackles theodicy: how humans can make sense of suffering and evil if God is indeed all powerful, all loving, and all good. His solution is simple--he thinks that we should stop trying to make suffering make sense and do away with the question of meaning and evil entirely. His overarching proposal is for humanity to reclaim narrative as a way of adapting to suffering. He believes it is the telling of stories in the context of community that allows us to own our suffering and thereby take control in circumstances that seem to leave us powerless, if not make sense of it. He applies this medicine by showing how Enlightenment thought--rationality--robbed doctors of the ability to care for their patients and instead pushed doctors towards striving for cures at all cost. Then when inevitably doctors are faced with the inability to provide a cure in all circumstances, doctors become impotent gods underneath the Christian God, supposedly loving and powerful yet failing to make sense of the suffering before them. He asks the reader to shift their perspective, therefore, and view medicine as an endeavor of care along the life journey, however long or short. He implies that doctors exist to help their patients tell the story of their life journey, if the patient and doctor are willing, and that doctors are a part of the community that surrounds patients in suffering so the patient is not isolated by pain. 

As a Christian and a doctor who has espoused Hauerwas' views of the medical system myself for some time, I think I agree rather than argue with him on many of his points in this book. In fact, I approached this book from those two perspectives--Christian and doctor. As a Christian, I find Hauerwas correct in his assessment of modernity's effect on Christian community--that is, that the focus on the individual's autonomy and rationality has deprived Christians of a transformative and redemptive community that can bear the suffering of one as a whole. Community, Hauerwas argues, is essential for the Christian faith to practically encounter and manage suffering without letting it lead them into despair of God's goodness. God's goodness is manifest in the context of a community that shares joys and sorrows, not apart from it. Hauerwas finds Enlightenment rationality removed this communal aspect of Christianity and instead made it a system which explains "the way things are is the way things are meant to be for any right-thinking person, converted or not." Instead of a family, it became a way of thinking. 

I saw all this on vivid display personally during the COVID lockdowns in 2020, where forced isolation and the deaths of loved ones forced lots of fellow believers into questions theodicy, having to come to the defense of a God who would allow such awful things to happen. I find, as Hauerwas finds, that when I try to answer for God in that way I cannot possibly come to a satisfying answer. Either God is real or indifferent, real and impotent, or false altogether. None of those answers bring peace. What brings peace, and what brought peace during COVID, was the prayer time and laughter over Zoom calls with my fellow believers, where we talked together about how much it all hurt and begged God to intervene. It became a story about waiting on God to be the faithful One we believed them to be, and knowing we were not alone but with God and with each other. Having a community in which to share that narrative was healing and did help it all seem purposeful, even for a moment.

I believe  "community of faith as healer and purpose giver" is not a delusion peculiar to those of us with strong faith in the Christian God or otherwise. My best friends are not Christians, but in times of pain in my life, it has been their faith in my strength and the story they have seen me living that has sustained me on the journey. Similarly, my co-workers in the hospital during hard times revive me as they say, "You are seen, we are with you, and we believe in you." Does suffering make sense after ? Of course not. However, making sense is not the goal Hauerwas would have me achieve. His goal for us in suffering is that I would be able to deal with what is in front of me practically, He would have us acknowledge our pain and face it. He would have us express our pain to God, our families, and our friends, and move forward through it with their support, learning lessons if any exist and taking on the suffering as part of our individual and collective narrative. 

From a doctor's perspective, I found Hauerwas' argument for the changing role of "doctor" in society to be saddening and all too familiar. Hauerwas' central thesis regarding doctors is as follows: Attempts to make sense of evil have caused us to reject the existence and supremacy of God--there cannot be a good, all powerful God who allows evil to occur. As we have rejected God, we have begun to think of ourselves as gods. If we are gods, we are in control and must be able to "cure" suffering and evil. Disease is a manifestation of suffering and evil, so this extends into medicine. Doctors must be able to not only act on all diseases, but CURE all disease. As more and more people have come to believe that doctors should be able to provide cures for everything, and as technology has ALLOWED doctors to cure more things, the relationship between doctor and patient has transitioned from a care relationship to a cure relationship. It is not enough to compassionately treat disease--doctors need to eradicate it all together. 

The sad side effect of the cure relationship is that doctors feel pressure to provide every intervention possible, even when they know interventions may not help. Hauerwas goes into this in detail, spending the last chapter of this book detailing how this shifting perception of doctors and medicine has changed humanity's relationship to death. Death is not the natural end of life but a spectre to be avoided. In prior times, it was almost a blessing to see death coming because then one could prepare one's affairs, including preparation of the soul through last rites. Now, we want death to come unexpectedly and painlessly--as Hauerwas says, "a car crash"  rather than cancer. So, not only must we avoid death, but we must even turn our eyes away as its coming--and doctors are placed on the front lines of this war to make us live forever. Heroic measures may be performed with full knowledge by the medical team that the measures will not save the patient, but they must be done, in a sense as a performed, to prove we tried to cure death. 

As I read this last chapter, I vividly imagined so many patients from my short pediatrics career --so many parents who wanted me to cure their child.  The patients that come to mind are not just the patients with cancer or brain damage. Parents of children with severe mental illness, chronic pain, and common colds have all asked me to provide solutions for their child beyond the realm of what is medically possible. It was not enough to offer "supportive care," as is often the practice standard, or resources for coping and a compassionate ear. I had to get rid of the sickness affecting their child, and when I could not, I became not just an ineffective doctor, but the enemy. Some of this pressure to cure is also self inflicted--there have been many times when I have felt that I did not do enough for a patient, when in reality, I likely did all that could be done. 

This book made me want to communicate more effectively and compassionately with my patients what medicine can and cannot do for them. I feel sometimes I can get frustrated with requests to do more and in my frustration, argue rather than inquire about the mindset driving the requests. In truth, I know that parents who ask for more measures are as desperate as I feel in moments of a child's crisis, and it might help to acknowledge a mutual desperation and frustration with the limitations of science. In that way, we become a community of pain sharing and we can seek solace together. This is so hard when it comes to children, who represent hope and a future in a particular way. The threatened or real loss of that hope and future is painful and those affected by a child's death do suffer. Even as I write this, however, acknowledging that truth feels powerful. Hauerwas ends the book with a plea not to run from pain but to accept and sit with it, and if I could do that with and for the parents of my patients, I think it would ease not only their pain but mine.