Essay: Doing What Love Requires
by Don Stouder
As I sat down to begin writing this essay, my memory took me back to a day that must have been at least 25 years ago, when I was a trauma chaplain at Sharp Healthcare in San Diego, California. I remembered sitting down on a very similar day to write a sermon I was going to be guest-presenting that Sunday. Even as I was trying to write that sermon, I was challenged by pager call after pager call. I was carrying both the trauma pager and the ethics pager, and as the co-chair of the hospital’s Medical Ethics Committee, it was my job to help physicians and others make difficult ethical decisions using widely recognized protocols.
Medical Ethics is but one small branch in the whole discipline of ethics, mostly the realm of philosophers and theologians. But at the bedside, physicians, nurses, and even chaplains are called upon to become moral and philosophical decision-makers, especially when patients can’t speak for themselves. In one of the cases that day, I looked into the wide-open eyes of a 30-year-old woman with profound mental disabilities that left her in a permanent, vegetative state. She also suffered from end-stage muscular dystrophy, multiple infections, and respiratory failure. After looking at her case closely as I have been trained to do, and listening to everyone on her care team, I recommended that they withdraw ventilator support and allow the patient to pass peacefully.
Ending her suffering was the only moral choice available to us at that moment. I did this confident of my intellectual position, that of the futility of anything modern medicine had to offer her combined with the below minimal level of her quality-of-life, and I made this recommendation from my head while my heart hurt for her and her situation. A Hispanic woman, essentially dumped at the border when her family could no longer care for her, she had been shuffled from institution to institution without any family or friends around her, perhaps without even knowing where she was or how she got there. One of the duties of the discipline of ethics is to help us decide what is right and moral in such difficult cases.
My paperback Second College Edition of the American Heritage Dictionary defines ethics as “principles of right or good conduct or a body of such principles”. Additional definitions given include “a system of moral principles or values” and “the study of the general nature of morals and of specific moral choices”.
I then sped ahead and looked up “moral” and found that morals are concerned with the discernment or instruction of what is good and evil, and is also used in the context of being or acting in accordance with established standards of good behavior, or even rules or habits of conduct. In the case of medical ethics, the system of moral principles we bring to bear includes ancient wisdom from the Hippocratic Oath, reminding healers of their duty to assist those in need as well as to do no harm.
We also look at the ethical principle of autonomy, or the right of each individual to make their own choices when such choices do no harm to others. When an individual cannot exercise their right of autonomy, as was the case with my patient that Friday afternoon, others must consider the ethical principle of quality of life.
In all these considerations, it is ethical and appropriate to also consider contextual factors like culture and religion, and in the case of limited resources such as organ donation, or when we decide who should get a Covid-19 vaccination first, we must also examine the ethical principle of distributive justice, meaning the fair and equitable distribution of burdens and benefits within a community. But as I said earlier, medical ethics is just one small part of the overall discipline of ethics. There are business ethics, organizational ethics, professional ethics, and various codes of ethics. It seems that our society has embraced the notion of ethics as the best way to order behavior and relations, especially when trying to legislate such matters seems inappropriate or unworkable.
Two very helpful contributions to the ethics of human interaction and behavior have come from scholars living worlds apart; the first from a controversial Episcopal priest and the second from The Dalai Lama.
The first, written in 1966 by Joseph Fletcher, is called Situation Ethics: The New Morality. In it, Father Fletcher asserts that there are really only three approaches to follow when making moral decisions; the legalistic, or the notion that every decision-making situation that one enters into is resolved through the use of prefabricated rules and regulations, in not just the spirit but the letter of the law. The second approach is the polar opposite of legalistic; one enters into a decision-making situation armed with no principles or community standards whatsoever, to say nothing of rules. In every unique situation, this theory holds, one must rely upon the situation itself, then and there, to provide an ethical solution.
The third way, and the one advanced by Fletcher throughout his book, is called Situation Ethics. In this approach, the ethicist enters into every decision-making opportunity fully armed with the rules and ethical norms of his or her community and its heritage, and they are treated with respect as illuminators or guides about how to think about the problem. But just the same, the ethicist is prepared in any situation to compromise those rules or set them aside in the situation if love seems better served by doing so.
Situation Ethics, in other words, is doing what love requires.
Fletcher likes to tell the story of the rich married man who asked a lovely young woman he had just met at a bar if she would sleep with him that night. She, of course, said no. He then asked if she would do it for $100,000, and she said yes. He then asked if she would do it for $10,000 and she replied well, yes. Finally, he asked, how about $500? In a very insulted tone, the woman replied “what do you think I am” and the rich man answered, “we have already established that, Madam. Now we are haggling over the price.” He uses the story to ask if such situations as marital infidelity or taking money for sex always lead to a conclusion of immoral behavior in every single circumstance, or might the conclusion be different in different circumstances?
For the Dalai Lama, the foundation of ethics is, to use his term, positive ethical conduct. For him, the core of human conduct is all about the quest for human happiness. He makes the observation that everywhere, by all means imaginable, people are striving to improve their lives. Yet his impression is that those living in materially developed countries, for all their industry, are in some ways less satisfied, less happy, and to some extent suffer more than those living in the least developed countries. He worries that those with more material things are so caught up with the idea of acquiring still more that they make no room for anything else in their lives.
As a chaplain, I wonder if this isn’t true in the quest of some people to continue to want to keep their loved ones alive or continue to insist upon treatments for themselves or others long after those treatments would be helpful, no matter what the cost or quality of life. Those in underdeveloped countries have no such decisions to make because advanced medicine isn’t available to them.
In consideration of a foundational ethical statement, the Dalai Lama offers this: that an ethical act is one that does not harm others’ experience or expectation of happiness. He discusses the importance of taking others’ feelings into consideration, and of ideals such as restraint, virtue, and compassion. He does not claim that suffering has a purpose, and places it with equal footing in the circle of life, or in the cycles of the seasons and the universe. He encourages time spent in discernment and claims that society has certain universal responsibilities, as well as levels of commitment to those responsibilities.
Both of these ethical systems, the Situation Ethics of Joseph Fletcher and the Buddhist Ethics of the Dalai Lama, are present in the community norms, or ethics, of virtually every liberal religious movement.
That tends to be why such movements are welcoming to LGBTQ clergy, like me. The covenants of the Unitarian Universalist Association, with whom I am affiliated as a minister, and the covenants of many liberal religious organizations, call us to such high ideals as affirming and promoting the inherent worth and dignity of every person; justice, equity, and compassion in human relations, and many more. Almost all of these have deep roots in virtually every world religion. Our call, our charge, is to figure out how to live our lives within this ethic of freedom and compassion, and justice. How do we live a life that calls us to do what love requires?
One way is to make sure we have long memories. On the very last two pages of his book, in an appendix meant to contain case studies for further learning, Father Fletcher includes the following as a case study in doing what love requires:
Harry Truman had no knowledge of the [atomic] bomb until after his inauguration. A committee was appointed to decide how and when it would be used. Made up of distinguished and responsible people, they had a difficult time trying to agree on the terms of its use. Finally, in June 1945, they reported to President Truman. After wrestling with his cabinet, with his military officers, and with scientists, all of whom had differing and strong opinions about the use of this horrible weapon, it was the moment of truth. Joseph Fletcher asks, what does love require?
Obviously, we know what decision was made, but was it the right one? I am sure that question haunted President Truman all the days of his life that followed, regardless of the stoic face he painted for the electorate and for historians. Making decisions about the living or dying of others is as hard as it gets, but guided by an ethic of doing what love requires, of valuing the inherent worth and dignity of everything that lives, we can make easy or difficult decisions that resonate with our values and that stand the test of time.
When we take our liberal values out into the world, we are doing what love requires.
When we stand with the Black Lives Matter movement against racist systems and actions, we are doing what love requires. When we rally with women for basic equality and the right to choose, we are doing what love requires. When we are trying to save our environment from the effects of Climate Change, we are doing what love requires. When we clothe and feed migrants seeking a better life, we are doing what love requires. When we march with the LGBTQ community to raise awareness and show support, we are doing what love requires. When we take care of each other in our beloved community, we are doing what love requires. And when we stand strong as the historic peace and justice church that we are and insist on respecting the inherent worth and dignity of every living thing, we are doing what love requires.
As a gay man, I would argue that Coming Out is also doing what love requires.
It was at the height of the AIDS pandemic that I felt called to help the sick and dying and their families as a chaplain, but my church at the time refused to consider LGBTQ persons for the ministry. I kicked that dirt off my shoes and found a church that did, and that was doing what love requires. I have never completed a job interview for a chaplain position without outing myself so as to never have to compromise my values, and that was doing what love requires.
Being out has also allowed me to be able to openly care for the members of my own tribe, providing them with spiritual and emotional support whether they were guys my age decades ago dying of AIDS, or all the way up until now, when Covid-19 takes elderly LGBTQ couples. They say that if you want to know who your tribe is, speak your truth and then see who sticks around. My tribe has always been there for me, and I will always be there for them, and that is absolutely doing what love requires.
Late on that Friday afternoon so many years ago, when I had finally finished writing my sermon and hit the “save key” on my computer for the last time, I thought again of the recommendation I had made earlier that day about withdrawing life support from the mentally disabled Hispanic woman with Muscular Dystrophy and respiratory failure. It was a moral and ethical recommendation and I did what love required. But then I thought that, perhaps, I had omitted one more thing that love required.
I took my hospital Minister's stole and my holy oil that a friend had brought me back from Israel, and I went back to her room. I said the prayers for anointing and healing of her Catholic faith, and made a sign of the cross on her forehead with the oil, and prayed for her to heal in mind, body, and spirit. I asked the nursing aide if he would translate into Spanish for me because I still never knew what her actual language of origin was. I don’t know if she could understand my English or his Spanish, or even if she knew we were there.
I remember wanting so much to believe, whatever happened to her after she died, that some freedom of the tortures of her mind and body would finally be hers.
Her name was Criselda, and I will never forget her. Now that you know her name, I hope that you will remember her, too.