Daniel Sulmasy

Research Project Title: Now and at the Hour of Our Death

Andre Hellegers Professor of Biomedical Ethics

Georgetown University

Washington, DC, United States of America

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Academic Biography

Dr. Sulmasy is an internist and an ethicist.  His research interests encompass both theoretical and empirical investigations of the ethics of end-of-life decision-making, cost-containment, and spirituality in medicine.  He has done extensive work on the role of intention in medical action, especially related to the rule of double effect and the distinction between killing and allowing to die.  He is also interested in the philosophy of medicine and the logic of diagnostic and therapeutic reasoning. His work in spirituality is focused primarily on the spiritual dimensions of medical practice.  His empirical studies have explored topics such as decision-making by surrogates on behalf of patients who are nearing death, and informed consent. He is the inaugural Andre Hellegers Professor of Biomedical Ethics at Georgetown University, Washington, DC with a joint appointment in Medicine and Philosophy, and serves as a Senior Research Scholar in the Kennedy Institute of Ethics and in the Pellegrino Center for Clinical Bioethics.  He continues to practice medicine as a member of the University faculty practice.  He completed his residency, chief residency, and post-doctoral fellowship at the Johns Hopkins Hospital.  He has previously taught at the University of Chicago and New York Medical College.  A Franciscan Friar for over 25 years, he was dispensed from vows and married in 2012. He has served on numerous governmental advisory committees, and was appointed to the Presidential Commission for the Study of Bioethical Issues by President Obama in 2010.  He is the author or editor of six books: The Healer’s Calling (1997), Methods in Medical Ethics (2001; 2nd ed. 2010), The Rebirth of the Clinic (2006), A Balm for Gilead (2006), Safe Passage: A Global Spiritual Sourcebook for Care at the End of Life (2014) and Francis the Leper: Faith, Medicine, Theology, and Science (2014).  He is also editor-in-chief of the journal Theoretical Medicine and Bioethics.

Executive Summary

Dying is part of living. Whatever lives, dies. This is as true for human beings as it is for amoebae. A project concerning the enhancement of life must therefore take account of death or else it risks ignoring perhaps the most salient feature of the phenomenon of life.

Contemporary medicine serves as an exemplar of the perils of ignoring death, behaving, functionally, as if death were not inevitable for human beings. Powerful technological advances have helped to foster this illusion. The costs, however, in such human experiences as pain, nausea, isolation, fear, and helplessness are evident to anyone who has ever visited a contemporary intensive care unit.

This project proposes to examine the relationship between life and death by exploring the ethical and spiritual care of dying human beings. It is proposed that many of the current practical controversies in care at the end of life (ranging from whether it is permissible to discontinue the use of implanted pacemakers to the ethics of physician assisted suicide) result from insufficient attention to the axiology, anthropology, and moral psychology at play. With respect to the axiological issues, the project suggests that the value of life is transcendental—the condition for the possibility of quality, flourishing, or enhancement. This understanding of the value of life provides a middle course—proscribing certain actions deontologically while still attending to the predicative values that concern the quality of human living. With respect to the anthropological issues, the project borrows from environmental ethics and suggests that all forms of life have an intrinsic value—the value they have by virtue of being the kinds of things that they are. This value for human beings is called ‘dignity’. With respect to moral psychology, the project takes very seriously the agency of human beings and adopts a non-consequentialist account of ethics, arguing that intentions and other propositional attitudes such as such as motive and desire matter in the moral evaluation of human acts. This proposed project will develop the implications of these foundational distinctions and arguments for the ethics of caring for the dying. Finally, by working in virtue theory and spirituality, the project will explore how these axiological, anthropological, and psychological theories can be integrated into a unified notion of the human being as a rational, affective, spiritual, free, interdependent, worshipping, aesthetic, and mortal being. The aim is a contemporary Ars moriendi that draws spirituality and ethics together.

The end product will be a book. Along the way, several papers will be submitted for publication in journals of medicine and ethics. The proposed course will be an interdisciplinary graduate seminar on topics related to the book, open to students of law, medicine, and divinity.

This project contributes to the Enhancing Life project as a whole by (1) bringing attention to the notion of death as necessary to understanding the phenomenon of life in all its forms, (2) proposing broad axiological and ontological distinctions that apply to thinking about the value of all forms of life, not merely human life, (3) keeping the project honest by pressing all participants to consider the enormous impact of contemporary medicine on human and non-human life.