PloughCast 40: Hyperpartisanship and Hippocrates

About This Episode

Peter and Susannah talk to Justin Giboney of The AND Campaign about polarization in American political life. They discuss practical matters: How can we seek common ground without wimping out? How can we work across the aisle?

They also talk about the role of the Black church. What is the unique contribution that that tradition can make to our ongoing discussions of the proper interaction between faith and politics?

Then, Peter and Susannah speak with Lydia S. Dugdale. There are now no doctors in America who are required to take the Hippocratic Oath; generally, if doctors take an oath at all, it is one of their own devising, which changes from year to year. In a medical culture like this, what is lost? What is the purpose of medicine, anyway? Is there a purpose to it beyond treating patients as customers and giving them what they want?

[You can listen to this episode of The PloughCast on Apple, Spotify, Amazon Music, Google or wherever you get your podcasts.]

Recommended Reading

• Lydia S. Dugdale, “Bring Back Hippocrates,” Plough
• Justin Giboney, Michael Wear and Chris Butler, Compassion (&) Conviction
• The AND Campaign
• Church Politics Podcast

Transcript

Section I: Justin Giboney: On Polarization

Peter Mommsen: Welcome back to The PloughCast! This is the fourth episode in our new series, linked to our Vows issue. I’m Peter Mommsen, editor-in-chief of Plough.

Susannah Black Roberts: And I’m Susannah Black Roberts, senior editor at Plough. In this episode, we’ll be speaking with Justin Giboney about polarization, religion, and the politicization of everything, and with Lydia Dugdale about the Hippocratic Oath.

Peter Mommsen: Justin Giboney is an attorney and political strategist in Atlanta, Georgia, and is the co-founder and president of the AND Campaign. Welcome, Justin!

Susannah Black Roberts: So tell us about the AND Campaign. Tell us how this came to be.

Justin Giboney: Yeah, well, the AND Campaign is a Christian civic organization. I’m one of the co-founders along with Amisho Baraka and Pastor Angel Maldonado. And it really comes out of my experience in the public square.

So before I started the AND Campaign, I was an attorney, but also a political strategist here in Atlanta, Georgia for over a decade. As I was running campaigns and things of that nature, I just didn’t feel comfortable with how my community, the African American community, more specifically the African American Christian community, was kind of being pushed to the left on a lot of issues. It’s hard here to win a dog catcher’s race without that community, but because of resources and things of that nature, I felt like we were being pushed in directions that we wouldn’t otherwise go to the extent that I felt like when people ran for office, they just knew that there were some of their Christian convictions they would have to leave behind. And I wasn’t comfortable with that.

At the same time when I was creating the AND Campaign, I had friends who felt the same way on the Republican side when it came to the Tea Party. And so I began to see what I call a false dichotomy in American politics, where if you cared about justice issues or social justice issues, you’d have to go all the way to the right and kind of let go of some of your convictions; if you cared about moral order issues, then you’d have to go all the way to the right and let go of what I would say would be more compassionate side of what Christians should be doing.

I just didn’t think that was the way that the gospel worked. I didn’t think that was a choice that Christians should be making. I felt like the gospel was about compassion and conviction. It was about justice and order. And when I read Ephesians 4:14–15, it really hit me where Paul tells the church of Ephesus that we must speak the truth in love. And that’s really where our framework for the AND Campaign, that compassion and conviction framework, come from.

Susannah Black Roberts: That’s a different sort of bringing together of two things than another way of framing similar, although not identical concerns, which is more associated with the American Solidarity Party, which I’m a part of. That thinks of itself as economically on the left and socially on the right. And that’s not exactly the way that you framed it. And I’m interested in that. How do you see those distinctions?

Justin Giboney: Yeah, if you go back, I’m coming out of the Black church tradition. And if you go back, you do see obviously a real commitment to civil rights, to social justice, to saying, “Hey, where you see oppression, you have to fight against it.” But at the same time, it didn’t tie into progressivism to say, well, that also means that on all other social issues, you kind of take this leftward position. You still saw some, what I would call, traditionalism or conservatism when it came to social issues.

I think that’s one of the reasons that folks from the Black church have not really fit in with progressivism all that well. It had its issues with conservatism based on civil rights, but didn’t completely connect with progressives either, even though unfortunately a lot of our representatives federally especially would seem to fit that mold. I don’t think they’re necessarily representing the community when they do.

Susannah Black Roberts: Yeah. I mean, Fannie Lou Hamer is an obvious example of that where there’s like her life is that split or her life sort of demonstrated that split.

A lot of what you think about and write about and speak about is this question of polarization. Is polarization a problem? Why is it a problem? Is polarization the same thing that you were running into with the Black church and its political issues? It seems like a broader question that you’re noticing in a lot of different communities in America.

Justin Giboney: That’s a really good question. I mean, when you talk about polarization, the downside of it obviously is that if you’re too polarized, then the system doesn’t work because people aren’t talking, people aren’t working together and you have this zero sum mentality where you have to win everything or all is lost. And so you have no reason to ever compromise. You have no reason to have really good faith conversations. But then there’s another type of polarization which you may have seen in the coming of the civil rights movement where if one side is really wrong, I’m actually going to oppose you, right?

Susannah Black Roberts: Yeah.

Justin Giboney: So you’re going to have some level of opposition. I think the main part of it is, is it good faith and is it constructive? So there are differences that we’re always going to have. I wouldn’t call it the same type of polarization we have now, because are we trying to work through those differences?

So you take Fannie Lou Hamer, even when she was mistreated and beaten at the behest of police officers, she still saw their humanity. She still was able to be constructive and to wish the best for even them in what I think is an extraordinary amount of moral imagination.

So I don’t think polarization that we talk about now is really just about disagreement. It’s about, how constructive is that disagreement and are people trying to find ways to work together? Is there any sense or commitment to a type of civic pluralism?

Susannah Black Roberts: Yeah. So that’s a phrase actually that I’ve heard you use and I’ve seen you use, civic pluralism. Do you want to go into what your vision for that is?

Justin Giboney: Yeah. The fact of the matter is in this country, we have a lot of people with a lot of different views. My job, I’m not trying to make sure that we all agree on everything, but can we have respect for one another? Can we seek out ways to cooperate and to find common ground? It’s all about that search for the common ground. Not necessarily changing our opinions, but saying, “Where can I meet you? Can I still disagree with you and protect you? Can I disagree with you and make sure that you aren’t being violated in one way or another?”

The polarization that we see a lot of times today isn’t the kind in which I say, “Yeah, I disagree with you, but I’ll still protect you.” When I think of civic pluralism, I think of those differences, but also the search for common ground and the principles to say, “You having your rights and being treated fairly, it’s not just about me winning, I’m committed to you being treated fairly even if we disagree.”

Peter Mommsen: I’m just kind of interested. How much is this, specifically, a US issue … I mean, if you look at some of the literature on what they call affective polarization, so negative feelings towards the other party, that’s way higher in the US than it is in other democracies. Even after social media gets blamed for a lot of this stuff, but there’s social media in Germany and Australia and other places too, but you don’t have these same increased level of real negativity towards political enemies. What’s going on there? Because I see that affecting Christian churches a lot.

Justin Giboney: Yeah. I’ll be straight up with you. I don’t know a whole lot about what’s going on in other countries. My focus has been kind of what’s going on in the United States so it’s hard for me to compare and contrast. But I can tell you, I think the nature of what’s going on here very much comes out of the culture war. And what I see is opposition centered politics.

I mean, we’ve talked about me getting my way and me making sure I win, but it’s not even always about that. Sometimes it’s more so about making sure another side loses, whereas, “I would even hurt myself just to make sure that you don’t win. I’ve centered making sure the other side is humiliated. My politics is centered around that. Therefore, I go out and get the most extreme, most hated by the other side person to represent me because it’s not about being constructive, it’s about making sure that they’re pushed as low as possible. And everybody knows that they’re as bad as I say that they are.”

We really, in some instances, prioritize that over actually getting things done and sometimes even getting what we wanted in helping the broader community.

Susannah Black Roberts: I mean, it can sound very kind of pious and simple, but I don’t think it is. Just one of the things, I was actually having this conversation with a friend called Matthew Burdette yesterday and he framed it in terms of, do we think of friendship as ontological, like as the there there and enmity as situational, like friendship is the thing that we can try and get back to? Or do we think of enmity as being what politics is based on? So if we don’t have enmity, we don’t know who we are, we don’t know what we believe, we don’t know what politics is for?

And I think, I mean, there is just so many of these studies. Obviously, you can see it, I can see it in myself. You can see it on Twitter. It is very easy to notice this very specific phenomenon of people understanding who they are and what they believe because of what their enemies are and believe.

Justin Giboney: Yeah. We’ve, to some extent, based our identity on being the opposite or as far away from the other side as we can be. And that’s why I think you see our policies getting more and more extreme. Not because we really want those extremes started there, it’s because it makes the contrast between us and the other side more stark. And that’s what we’re really going for.

Peter Mommsen: So as you know, Plough shares that same desire to find common ground with people of goodwill even where we might disagree pretty strongly on some issues. If there’s some things we can find to work together on, we want to highlight that stuff. I don’t know what you’ve run into. I’d just be curious about your experiences. Very quickly you get accused of just being wishy washy, right? That you’re kind of Pollyannaish about what’s really on the line and you’re constantly both sides saying, or the accusations, “When are you going to nail your flag to the mast?” There’s this sort of implicit accusation of cowardice. Have you run into that? How do you deal with that? How do you help people think through that?

Justin Giboney: Absolutely. Where that comes from is, again, you have this culture war-created framework where the only two legitimate positions are what’s defined as conservative and progressive. And you stick to those, otherwise you’re not serious.

I just think that’s problematic to tell people that you have to choose one of these two, everything else is illegitimate. Everything else is either naive, or you’re tricking me right? You’re either trying to trick us or you’re incredibly naive and you’re not in the game. That’s just untrue. I believe in life there are some binaries. That’s not one of the binaries that I buy into, that there are only two ways to view it or else you’re not really in the game. You’re not really having an impact.

Now, I do see why that benefits the two “prominent sides” of this, right? To force you into one side or the other. But I just don’t buy it. And I think when you look at the work that the AND Campaign has done, when you look at the positions that we’ve taken, that’s what it’s about. So to us, we always talk about it’s not about taking a side. I could care less about taking a side. I could care less about either of these sides. It’s about taking the right position. And if you look at the positions that AND Campaign has taken, if you look at what we’ve done to work towards furthering those positions, it’s very hard to argue that we haven’t been in the game, that we’re not taking this seriously, and that we don’t have a point of view that’s legitimate even though it doesn’t fit into one of those two categories.

Peter Mommsen: Can you talk a little bit about the specifics of some of those things?

Justin Giboney: Yeah. I mean, one of the things that I always say and we talk about it in our book Compassion (&) Conviction is the world has a way of asking you a question with two wrong answers. If you answer that question, there’s no way to get it right. And so what AND Campaign has tried to do is we tried to reframe the question. So we would look at something like LGBTQ issues. We have the historic Christian sexual ethic, we’ve stuck to that. But we don’t buy the idea that means that we hate of our LGBTQ neighbors. We would say that you can absolutely disagree with someone and love them. You just may disagree on the issue. And we all go through that even in our day to day interactions. That we take a position, we don’t have an agreement but we say, “Guess what? I will do anything in my power to protect you and to make sure that you’re not mistreated.”

Again, that’s one of those false dichotomies where people say you either affirm everything or you hate it, right? Well, that makes for an easy argument for one side. But unfortunately … Fortunately, I should say, the world is more complex than that. And it doesn’t fit the narrative. We’ve always been focused not necessarily on fitting the narrative, but finding, number one, what is true, and then how compassion plays a role in communicating that truth but also acting it out.

Susannah Black Roberts: So I guess one of the questions that I want to push back on with this is, how is it possible for us to … There are some really strong and powerful disagreements on things like what a human being is. Obviously I’m thinking about the Dobbs decision on abortion. How is it possible with something like that to come to any kind of common understanding or any kind of a way forward?

Justin Giboney: Yeah. So the other thing to know about the AND Campaign is we’re not about finding some type of middle ground. When it comes to the sanctity of life and things of those issues, we stand on the ground that life is sacred, that the unborn lives have value, that they have worth. You can’t really compromise it, right? There’s no saying, “Well, they kind of have worth. Let’s meet halfway. Let’s cut the baby and meet halfway there.”

Peter Mommsen: Red light, green light on that. Yeah.

Justin Giboney: Right. You can’t do that. But what you can do is you can say, “Let’s look at what brings a woman into a situation where she thinks that’s her best option. Let’s look at our policies and the ways that our institutions are working that may put women in really bad situations.” So, whereas I can’t compromise on the sanctity of life, I can say there may be other ways to help fix this and I may be able to look to my brothers and sisters on the left and say, “What do you get right even when you get the sanctity of life wrong? What other things play into this position?”

Now, I’m not going to force myself to find something that they’re right on. But I do want to, with charity, look for common ground to say, “Maybe there is a better way to go about this.” What are they trying to accomplish? Because I think even on that issue, your average person isn’t out to take unborn life, right? There’s something that they’re seeing and that they’re trying to fix. What is that and how can we speak into that?

Susannah Black Roberts: Yeah. I mean, in my conversations with people about all kinds of stuff, the thing that I’ve tried to ask is what is the good that you’re seeing. Because everyone is aimed at a good. Everyone when they’re acting, is acting towards something that they perceive to be good, and that does have some of the nature of the good. So what’s that thing that you’re trying to protect or that you’re trying to go after? It doesn’t make sense to just look at someone who’s your political enemy and assume that they’re motivated by malice because people are jerks and very malicious sometimes, but that malice is not distributed according to political party and people are not universally malicious.

Section II: Justin Giboney: On Christianity and Politics

Susannah Black Roberts: I guess one thing that I’m interested in knowing what your thoughts are about is – I haven’t seen you participate much in the kind of post-liberalism discussion and the discussion about what the proper role of the church is, what the proper relationship between politics and religion is, or can be. How would you describe what you think the proper kind of interaction between politics and religion is?

Justin Giboney: Yeah, that’s a really good question. First and foremost, I would say that you can’t ever completely separate church from state. I believe there should be a separation. I believe there should be a healthy distance to a certain extent. But the fact of the matter is that there’s no law that’s created that aren’t based on values. And whether those are religious values or those are secular values, you can’t separate your politics from your values. So people are always going to use their religious values in how they vote, in how they communicate, and in their social action there. There’s just no separation of that, right? But at the same time, I do believe that we have, the establishment clause for a reason, right? We don’t want to establish religion. And I know for the Christian faith, you can’t really force somebody to be Christian anyway.

So what I normally tell people who I talk to in this regard, when it comes to how you vote, when it comes to what policies you promote, that’s got to come from your faith. It’s got to be rooted in your faith. But if you want other people to buy into it, you have to be able to articulate it in a way that’s practical to them. So I can’t just go around throwing Bibles at people’s heads. I have to articulate why even something like traditional marriage is something that’s beneficial to society. And in some instances, because that was never communicated in a way where other people saw it and agreed, well, you’re seen as just throwing the Bible and leaning on the Bible when there actually were practical reasons for it. But again, if you can’t explain that, if you can’t articulate it in a way people understand, then you almost deserve to lose on that issue because you haven’t spoken into it.

So always understand that how you vote and how you engage … your faith touches your whole life so your faith is going to have something to do with that, but you have to have respect for other people. You can’t impose your faith on other people. You have to be able to articulate it in a way that they understand and they see the benefit to them even if they don’t buy in to anything that has to do with your faith. So again, I think that not establishing religion is very important because I certainly wouldn’t want someone else’s religion imposed upon me.

Peter Mommsen: So when you think about Christianity in American public life, most people right now, especially over the last couple of months, there’s been a lot of talk about Christian nationalism, right? Increasingly, especially in, I’d say, kind of mainstream secular outlets, that is the way to think about Christianity’s role in public life, right? Now you were mentioning earlier that the AND Campaign comes out of the Black church tradition. And that is a different way of thinking about Christianity and public life and political impact. Could you talk a little bit more about that specifically?

Justin Giboney: Yeah. I think when you talk about the Black traditional church, one of the differences we would have with the Moral Majority and things of that nature is we were never trying to establish some type of Christendom. Number one, we never had the power to do so. So we were coming from a whole different point of view where what we were trying to do is get rights, right? We were trying to get our civil rights. We were either trying to get out of slavery and then trying to get out of the Jim Crow. What we were saying is, God as a liberator wants people to be free, right? But at the same time, understanding that there’s an obedience and an order that goes along with that.

But from our perspective, establishing Christendom and kind of lording over others almost was never even an option. So from that perspective, that’s not what our social action was about. It was more about getting out of oppression. It’s more about standing up for others and making sure that people were treated with dignity. It was about the human dignity side of it. Not necessarily creating kind of this ironclad system that benefited us and benefited and allowed us to do everything we wanted to do in accordance with our religion. I think it’s just two very different perspectives, really based on how much power one has in their social positioning.

Peter Mommsen: Outside the Black church, which is a minority in Christianity in America, how does that apply to everyone else? I mean, any lessons?

Justin Giboney: Yeah. I think it means that you don’t just fight for your own rights. You fight for the rights of everyone, which is to say, if you see anyone being oppressed, if you see anyone being marginalized, if you see anyone being stolen from, which is something that we went through quite a bit, that you stand up for them. What you saw from a lot of evangelicalism is this very protective “Protect what we have and grow Christendom,” to expand, while [the Black church is] saying, “No, no, no, no. Make sure, number one, that you’re not the oppressor. And number two, that those who are being oppressed, that you are standing up for them whether you agree with them or not.” And I think that goes for everyone. I think that’s a lesson that we all can learn and that people of faith in general should try to live out.

Susannah Black Roberts: What have been the conversations where you disagreed the most with someone and managed even through that to get to some kind of common ground or at least have a conversation?

Justin Giboney: Yeah. I mean, I think it’s been in conversations with some white evangelicals and the conversation about racial justice and just the inability or unwillingness to admit any fault, to admit historical facts to say, “Hey, we got this wrong as a church, the American church got several things wrong and there needs to be a reckoning.” I just see people running from that reckoning, not really wanting to deal with it. Now, there’s been people that I had those conversations with and I might not have gotten through to them on racial justice, but there may have been places where we were able to interact.

So for instance, not everybody that agrees with me on racial justice, but some of those people still gave … during the pandemic, we had something called Churches Helping Churches where we raised about $1.5 million for small churches in low income areas so that they could survive the pandemic. Not everybody who gave money to that agreed with me, but we were still able to come together and help smaller churches even with those disagreements. So things can get done even when there’s disagreements on very serious things. There are still ways to work together as we still try to find some common ground and understanding on the issues where we don’t see eye to eye.

Peter Mommsen: There’s been a lot of talk and analysis about partisan sorting even within churches, right? To get specific, the Southern Baptist denomination has gone through that in the last couple of years. Pastors that I’ve talked to have said they’re really nervous about whatever they say from the pulpit: “If I preach from the Sermon in the Mount, I’ll be accused of being woke. And if I talk about marriage or abortion, I’ll get written off by the other people.” So this, I guess, is a little bit of a depressing way of framing the question, but are we moving backwards or forwards?

Justin Giboney: I guess it depends on who you talk to. In some areas we are moving backwards because people are conflating their theology with their ideology. People are taking what they hear on Fox News and what they hear on MSNBC and creating standards for their faith leaders. They want their faith leaders, they want their faith, they want that interpretation of the Bible, that theology, to match their ideological narrative. And when a pastor or when the Bible or when other people violate that narrative, they react that way because the truth of the matter is, on both sides of the aisle you have narratives that have become idols. You have narratives that are fixed that are in large part fictional that we hold onto so tightly that nobody is allowed to touch it. And that’s exactly how people treat idols. And it’s unfortunate. But I think to be prophetic that every faith leader has an obligation to speak into those issues.

And I know it’s not easy. I mean, there are jobs on the line. There’s consequences that come along with it, but I think in a way it’s the cost of discipleship and you have to speak into those issues. You can’t allow people to protect their idols in the temple.

Susannah Black Roberts: Mm-hmm. Can you describe those idols? I feel like there’s two main idols that we’re talking about here. How would you phrase what it is that people have sworn allegiance to on both sides?

Justin Giboney: Yeah. So I think on one side you have … let’s take the progressive side first. You have this sense of progress and compassion. Conservatives are against everything that’s compassionate and everything that’s about progress. So when that becomes your idol, you start to push away truth. So you don’t want to hear about the sanctity of life. You don’t want to hear about moral order. You’re trying to protect this idea that compassion is God. And I’ve said it before that God is compassionate, but compassion is not God. God is more than just compassion. But when you’re holding onto that as an idol, any truth that dismantles that, you got to run away from it. You got to push it away because that kind of tears down the idol.

Justin Giboney: I think on the right, you have this sense, even with MAGA, even Make America Great Again, that America is in many ways superior. And anything from history or whatever that says, we may have gotten things wrong, we may have gotten things really wrong, even worse than other people groups, even worse than other countries, I can’t accept that. I can’t accept the idea that we weren’t at the forefront of being right and we weren’t at the forefront of freedom. Yeah, I know there’s small things that went wrong. Those are just little blips in American history. We are basically God’s people and we are doing the right thing. What we do is right. I think that’s the idolatry that we see on the right. And anything that dismantles that, whether it’s, again, historical fact or the Bible or anything else has to be thrown out, it has to be pushed away to maintain that ironclad narrative.

Susannah Black Roberts: So one of the things I guess I am interested in is how can we have profound politically-related convictions in ways that are not idolatrous? What are some of the practices almost, or disciplines that you use to not lose track of what you believe and what is actually objectively right but also not let those kind of become a kind of thing that takes you over?

Justin Giboney: Yeah, I think number one, you have to put skin on issues. We’re talking about people here. We can’t allow our opposition just to become political abstractions. Everybody has a testimony. Everybody has a point of view. Everybody’s been hurt and had trauma and have reasons in their head for what they’re doing. You’ve got to be willing to build relationships with people and understand that it’s bigger than just the issue. These are people who are affected by the issue.

The other thing that I say about this is, as somebody who is an activist … I don’t really call myself an activist, but somebody who is an advocate, you understand that advocates can become jaded. And one of the things that I think happens to us is when we see an issue, we see the activist behind that issue and they can be very ugly. They can be poor representatives of the people who are behind them.

What I think we should try to do is see the people behind them who are the hurting people that they’re trying to represent, instead of just seeing the face of the activists who’s on the front lines and has gone through all those things that happen when you’re on the front lines. Those are two things I think are very hopeful when we look at other people and when we deal with people who we see as our opposition.

And then as people of faith, we always have to remember that none of these are ultimate things. That at the end of the day, there’s something greater than our political battles. And so even if we lose, we need to have a correct public witness. That your public witness and doing things the right way and being just and righteous is more important than winning. And that’s something that’s very different than what we see in the culture war. Your public witness is more important than winning. Politics is important, but politics doesn’t deal with ultimate things and there’s something bigger. And so at the end of the day, you have to be willing to lose. And if you’re not willing to lose to stand up for what’s right, then we end up where we are right now.

Susannah Black Roberts: Mm-hmm. Can you tell us about what you’re excited about this week? What kinds of projects you guys have coming up on the horizon?

Justin Giboney: Yeah. So one of the things that we did and we just brought our first cohort through is we have a Christian Civic Leadership Academy. So we are training Christians who want to run for office, who want to run campaigns, want to get into policy. We’re training them on how to do that. So we’re really excited and we got some good partnerships going on with that. Excited about it. We’re about to come out with a new newsletter for faith leaders and lay folks too to just give more commentary from a Christian worldview.

So we’re excited about that as well. And then our whole life movement. We have a bunch of sisters who are very serious about the sanctity of life, who also understand that there’s other policies and factors that go into a woman’s decision and they’ve decided to step up and really educate our community on what it means to be whole life and stand up even in very progressive spaces for life.

Susannah Black Roberts: I am extremely excited about both those things I have to say.

Peter Mommsen: And we’ll drop links in the show notes with this podcast so our listeners can check that out. Definitely follow it. Really looking forward to that newsletter too.

Susannah Black Roberts: Yeah. If there’s a way that our listeners could subscribe, we’ll drop that link in as well. And I want to subscribe.

Justin Giboney: Awesome. Thank you.

Section III: Lydia Dugdale: The Hippocratic Oath

Susannah Black Roberts: Now, we’ll be speaking with friend of the magazine, Lydia S. Dugdale, a physician and ethicist at Columbia University in New York City. She’s also the author of the book The Lost Art of Dying, and she goes to my church. Welcome, Lydia.

This piece, which is beautiful and kind of fascinating is about the Hippocratic Oath and the lack of the Hippocratic Oath more precisely.

Peter Mommsen: “Bring Back Hippocrates.”

Susannah Black Roberts: Bring back Hippocrates. “The Hippocratic Oath has largely disappeared from modern medicine. What have we lost?” is the subtitle. Can you talk about your background in thinking about this. Just for our listeners, who are you? Why are you writing this? What is going on in life, et cetera?

Lydia S. Dugdale: Sure. Thanks so much for having me. My name is Lydia Dugdale. I’m a medical doctor at Columbia University in New York City. I take care of patients in a primary care clinic. I think a lot about what it means to be a good physician, what medicine requires of us, what it means to be a person in a body and to care for other people in bodies? All of those things weigh on me quite a bit.

In addition to that, I’m a medical ethicist, which means I’m called to try to help resolve sticky ethical quandaries in the hospital, which also then provokes such questions as Why do we do what we do? What is medicine for? That’s kind of what my day job is.

Peter Mommsen: What really surprised me when we first started talking about this piece, Lydia, was that the Hippocratic Oath has largely disappeared, because most of us think of the Hippocratic Oath as something like the Pledge of the Allegiance or Miranda warnings or just these types of things that are just always there and out there and helping us feel secure. We assume that doctors have this oath. We’re not quite sure what’s in it, but it’s …

Susannah Black Roberts: Sure sounds good.

Peter Mommsen: Do no harm, and that’s what we want to think our doctors are thinking when we walk in the office.

Susannah Black Roberts: Yeah. We can sort of use that as a kind of nag or benchmark or thing to tweet about. Or when we see an outrage, we can say, “This is in violation of the Hippocratic Oath,” even if we’ve never actually read it and we’re not sure what’s in it.

Peter Mommsen: But in your piece, you have this absolutely fascinating history of the Hippocratic Oath and its use in modern medicine. Could you just break that down for us? Because it’s quite a story.

Lydia S. Dugdale: Sure. The oath goes way, way back to antiquity and wasn’t even followed by all ancient physicians. There’s a debate about who originally wrote it and what the influences were. I give a little bit of that in the piece, but the main thing to note is that the oath has been attributed to the Hippocratic Corpus. It is likely that Hippocrates is responsible for some of it. It was common in antiquity to have a particular leader, teacher, figure, philosopher to whom scholars or apprentices belonged. The Hippocratic Oath was what the followers of Hippocrates, the doctors, the young doctors, the physicians in training, who were in his environment would have adhered to, they would’ve pledged.

Notably, for the modern thinker, the Hippocratic Oath has a prohibition against abortion and against administering a poison which could result in a patient’s death. We might think of that as euthanasia.

Now, even in antiquity, there were people who performed abortion and there were people who found it abhorrent, all the way back, going back thousands of years. This isn’t a new debate. We even know that some other texts in the Hippocratic Corpus outlined how to perform an abortion. You can see, even within writing attributed to Hippocrates or his followers, there was the debate even then. That’s first thing to note.

But then, we sort of jump ahead and have to ask, “Well, when did this Hippocratic Oath fall out of favor?” Sure, it talks about abortion and talks about euthanasia, but it talks about other things like keeping your patient’s secrets, not harming them, doing good to them, doing the kind of medicine that you are trained to do. There’s a comment about not performing surgery, which specifically refers to surgery that you are not trained to perform. Not to abuse your patients, specifically not to have sex with your patients, and you would think that doctors shouldn’t be told that. But it turns out, actually, they need to be told that.

This is a lot of the content that lies behind the Hippocratic Oath and, really, the oath exerted an influence over millennia, but not universally. In the eleventh century, I think it was that there were a bunch of Christian doctors who felt that the Hippocratic Oath, which is sworn to a host of Greek gods and demi-gods was not sufficiently Christian. If we’re going to take an oath and commit to something, as physicians who are Christians, then we should have an oath that, in a sense, swears to the Christian God. And so, there were changes like that made.

Now, what happened from the tenth or the eleventh century to the present moment is a little bit difficult to say. When I was doing research for the piece, I found an article published in an academic journal, an academic medical journal from 1928, where the article authors had surveyed medical schools in the United States in the 1920s, and they found that only fourteen of seventy-nine medical schools, in the late ’20s, still had their students declare the oath in the original form. That was interesting to me because, somehow, I would’ve thought that it was more than fourteen out of seventy-nine in 1928. But that’s the data that we have.

If we jump ahead now, nearly one hundred-years later, I can tell you, go on record to say, that no medical school, no medical student, takes the Hippocratic Oath in its original form. In fact, most medical students today write their own oaths, and there is no undergirding requirement for what goes into that oath. Some medical schools have their students swear two different oaths. It’s hard to find.

There have been people in recent years who have looked at the content of these Hippocratic Oaths or these faux Hippocratic Oaths that are being written and rewritten every year, and they try to determine if there are any underlying themes that are across all of them.

There’s nothing that is unifying all modern oaths. Now, many of them will say things like help and not harm your patients, but not all of them. And then, there are, in recent years, attention to social justice and reducing inequalities and inequities. That has become more common in oaths. So you can see that the content of the oath really is in flux depending on what social issues are dominating the consciousness of the average medical student.

Peter Mommsen: What was in the original oath? You mentioned euthanasia and abortion and a few other things. I guess what I mean is what have we lost by not having anybody take that original oath? What’s missing?

Lydia S. Dugdale: What’s missing is a shared or unifying sense of what doctors commit to and what medicine is for. We really have no idea now. Practitioners of modern medicine, in the year 2022, really have no idea what sort of project we have immersed ourselves in, what sort of practice is probably the better word. What defines the practice? What virtues inhere in the practice? What kind of excellences are we habituating ourselves to? There is no language like that in modern medical education or in modern medical practice. When there’s nothing that is unifying, I think in the church we have the creeds, and even across Protestants and Catholics, there’s a certain amount of doctrine that is the same that comes through the creeds, and professing Christians know what they profess.

Well, physicians, number one, aren’t professing anything in common and, number two, the content of that profession is constantly changing, which means it’s hard to know what you’ve signed up for. It’s hard to know what you’ve committed yourself to.

I think that translates not only into an alienation among practitioners, and certainly we know that things like burnout and moral injury are at all-time highs among healthcare professionals. Some 20 percent of doctors have left their jobs during the pandemic, and more than 50 percent of nurses have suggested that they plan to leave nursing in the next year. It’s a problem. It’s a problem that we don’t really know what we’re about. But this also affects patients. At the end of the day, every single clinician is also going to be a patient. It’s not that there’s a divide between healthcare practitioners and those that they serve. At the end of the day, we are all patients and we all will be patients.

I know I just recently had a conversation with some colleagues where I said to them, “This is the kind of doctor I try to be. I really try to get to know my patients.” I try to keep track of their stories. Even from the first appointment, try to remember their humanity, taking notes on personal things so that I can remember to ask them later. Although I’ve been in medicine for twenty years, I have never had a physician do that for me or my family ever. Even my children’s pediatrician, it’s a different one every year.

This sort of crisis in medicine, if you will, this lack of orientation, this lack of foundation, lack of telos, all of this translates, ultimately, I think into worse experiences for patients. By experiences, I mean the experience of healing, of being ill, and pursuing wholeness and health when the clinician doesn’t really know what the clinician is about. It’s hard to enter into a healing relationship.

Section IV: Lydia Dugdale: The End of Medicine

Susannah Black Roberts: You do use this language in the piece, and just in this conversation, repeatedly, of telos, and it’s impossible not to remember that Aristotle, whose language that primarily is, was a biologist. One of the very obvious professions that he discusses, after flute player I think, when he’s talking about what it means for a craft, essentially, to have a telos, is medicine. He thinks it’s really obvious that the end of medicine is the healthy and whole human person. And so, there’s a certain degree to which, and then, obviously, the Hippocratic Oath matches that sense of that’s the goal of medicine to make a healthy and whole person.

And so, it almost seems to me … but if you start to ask, “Well, what does a healthy and whole person mean?”, it almost starts to seem like you can’t find out what a doctor is unless you know what a human being is.

Lydia S. Dugdale: Yes, yes. I mean, that’s true. It’s funny when we start having these conversations about the aims or the goals or the purpose of medicine, the telos of medicine, this is such a huge area for debate. The World Health Organization talks about health, meaning every kind of health you can imagine, psychosocial, relational, public, all of these things are aspects of health. Although, interestingly, the World Health Organization omits spiritual health. There are other people who see the role of medicine as including spiritual health. Then, you get into questions of, “Well, what is the role of the chaplain or the priest, the clergy person?

I tend to see the telos of medicine as being toward health, the other side of the coin of which is mitigation of disease. I put those two together because if you strive solely to mitigate disease without having disease mitigation be in service to health, you end up with situations like we had during the Covid pandemic where we were protecting many folks in nursing homes from disease, but at the cost of isolating them from their loved ones for twenty months. To the extent that disease mitigation is a part of the goal of medicine, it has to be in service to health.

And then, my postdoc here at the Ethics Center, John Cahill, he’s working on an idea of the telos of medicine being health in the service of relational flourishing, which I think is also very interesting to think about. Leon Kass, the ethicist at University of Chicago, he has this idea of the flourishing of the creature. We all know what a healthy squirrel is because the squirrel chatters and runs around and buries nuts and things like that. It’s very easy to imagine what a healthy squirrel is, but he doesn’t talk about that squirrel in relationship to other squirrels. I think that’s an interesting omission and it’s an interesting insight on the part of John Cahill to consider the work of medicine as being one that also facilitates beings in relationship, I think is a good insight.

All of this to say, Susannah, there’s a lot of debate in medicine about what medicine is for. But on the whole, not many people are actually having this debate, which is part of the problem.

Peter Mommsen: Yeah, I’m just wondering how this search for a telos for medicine informs some of the things that medicine can do now that it never could do before, technically. I think around the time that we first discussed this piece, Lydia, there was a big article, I believe, in the New York Times about a surgeon out on the west coast somewhere who specializes in leg lengthening surgery to add height to men, particularly, who are born short and don’t like it and want to add a few inches so they’re not short anymore. No more short kings. It is an excruciating surgery, requires a year of physical therapy to get walking again. How do physicians think about things like this? Because as technology advances, more and more things become possible that weren’t even on the table twenty years ago.

Lydia S. Dugdale: You’ll be probably saddened to know how physicians think about this, and here is the answer. If a patient is informed and it’s medically indicated or medically possible, and it is legal, most doctors will do it. It has to do with patient autonomy and self-determination and being informed. The doctor’s role, most of my colleagues would say, is simply to be a good informer and let the patient choose. Which means that most physicians are not giving much moral guidance or ethical guidance or counsel in general.

It is not uncommon for patients facing even complex decisions that are not on the fringe of medicine. Let’s just say, do I have a valve replacement with one technique or the other technique, where the data are just laid out and the patient is left to weigh the data himself or herself.

Given the amount of education I’ve had to have just to be where I am, it feels a little bit like we’re selling ourselves short. But I think there’s so much reticence to actually assert our own opinions/morality that a lot of doctors fall back on just letting the patient choose. Just tell them, give them all the details, and let them choose. And then, what the doctor becomes is just a glorified vending machine. Push all the buttons you want and you’ll get what you want.

Peter Mommsen: Provided, of course, you have the money to pay for it. In this case, I think it was super expensive surgery that you had to pay for out of pocket.

Lydia S. Dugdale: That’s right. Although increasingly, anything that can be spun as, I don’t want to get into politics here necessarily, but as a matter of equal access and equity, there are many, many, many things that medicine can do that may or may not be good for people that are being covered by insurance. Maybe I’ll leave it at that.

Susannah Black Roberts: Fair. Have you, yourself, taken any oaths?

Lydia S. Dugdale: When we had our white coat ceremony, which was at the very beginning of medical school, we took an oath to something. But to be honest, I don’t remember who wrote it or if it was an oath that University of Chicago medical students had written. I remember it being sort of solemn and feel goody, but that’s problematic. Again, if you think about the creeds, we say them every week. When I took an oath, so many years ago, I don’t remember what I said and it has no hold over me, that’s telling. That’s telling for medicine.

Susannah Black Roberts: I mean, maybe it should be like baptism where when a new doctor is born into the world, you all reaffirm your doctoral status.

Lydia S. Dugdale: But it’s not the same script. That’s the difference with liturgy is that the liturgy, on the whole, doesn’t change that much, but the script is changing every year for the Hippocratic Oaths or the faux Hippocratic Oaths, and then it changes depending on the medical school, et cetera.

Peter Mommsen: You’re a teacher too, Lydia, and I know you’ve also worked with your own students on thinking through some of these things and thinking through what oaths they would like to take when they become doctors. Could you tell us about that? I mean, how do you start that conversation and how do you, I guess, evaluate what a good self written oath is versus what a not so good one is?

Lydia S. Dugdale: Oh goodness. So tricky. Because these are projects that are completely student run and student driven.

Peter Mommsen: You can’t grade them.

Lydia S. Dugdale: I can’t grade them, no. I have never been a direct faculty mentor to the team who is writing the oath, although I wonder if there is such a person because maybe I should try to get into that position. But where I have been involved with students is actually in my ethics teaching, both formally and informally, where I ask these questions. What is medicine for? No idea. No idea. It’s for giving patients what they want that’s medically indicated up to the limits of your license. That’s what medicine is for.

I had a session with a group of young doctors. I had two goals in going to the session. One was to start to ask themselves whether they had moral agency as physicians. Interestingly, they were much more tuned into their moral compasses than I had thought. They had very strong views about right and wrong. But they, on the whole, felt that they could not impose any of that on a patient.

Patients coming in and asking, let’s just say, a man comes in and asks for Viagra to facilitate his infidelity, they would think, “Well, it’s not great to cheat on your spouse but, at the end of the day, if he has erectile dysfunction, he should get Viagra.” That was one of my goals was to get them to start to think about their own moral agency and whether their moral agency enters into the doctor-patient relationship or the doctor-patient encounter.

My second goal in the session was to see if I could challenge the prevailing assumption that, at the end of the day, it’s about what the patient wants, patient autonomy or self-determination. That second part was the part that was much more challenging. It doesn’t matter what the doctor thinks. It only matters what the patient wants. And so, I press on having these conversations as much as possible, both formally and informally, often using a Socratic method. But there’s just such a prevailing way of thinking that it all comes down to what you want. You do you, and my job is to facilitate you doing you, and that’s the end, sadly. That’s where we are.

Peter Mommsen: You point out in your piece, and this is also interesting to me because I’d never thought about it, that the one line that most of us think is somewhere in the Hippocratic Oath, first do no harm, actually isn’t in the Hippocratic Oath. But let’s say that it was, the problem seems to be that we don’t even agree what harm is.

Lydia S. Dugdale: Mm-hmm. That’s right. That’s right. But even backing up, even backing up further, we don’t agree that we should acknowledge the harm that might be involved. A young doctor might have a certain revulsion to a request, “This guy’s cheating on his wife. I don’t want my spouse to cheat on me,” ugh kind of feeling. The young doctor does not think she should at all, at all, spend much time thinking about that. Stuff away the moral question and do what the patient asks.

Peter Mommsen: it’s even before we get to what is harm? It’s a willingness to listen to that internal, whatever you want to call it, that internal little voice that’s telling us, this just doesn’t feel right. Something seems off here, what is it? But maybe it’s because of the need to be efficient, the clinical encounter is enormously efficient. Maybe it’s because doctors don’t feel like they can engage moral questions or exercise their moral agency. Maybe it’s because it’ll come across as judgmental. We just don’t go there.

Susannah Black Roberts: It seems to me based on lawsuits, that people do, at least at some point, in retrospect sometimes, expect doctors to have had greater agency and to have known better what it meant to aim at their health. Do you guys talk about those sorts of things at all in your discussions with students?

Lydia S. Dugdale: Well, with regard to malpractice, to the extent that it’s talked about a lot with students, there are data that show that the better the relationship is between a doctor and a patient, that is if the doctor actually takes an effort to get to know the patient as a person, the surgeon calls the family after surgery or goes out to the waiting room to talk to them, explains things carefully, teaches, et cetera, to the extent that there’s a good relationship there, the threat of malpractice will be mitigated. That is, patients who like their doctors don’t sue them even when something bad happens.

That’s the way that malpractice is talked about in medical education. It’s not talked about in terms of, “Is this really for the patients flourishing? Because if it is for the patients flourishing, we should do it.” But if it’s not going to lead to their flourishing and it will feed their addiction or their obsession or whatever it is, you name it, we don’t have those kinds of conversations, no. Not if you’re talking about, let’s just say, something like that patients come and demand certain body sculpting interventions. We don’t talk about those with regard to patients flourishing. It’s really, this is a service medicine can offer and if someone wants to pay for it, we’ll do it.

Peter Mommsen: What would you say would be needed to nudge medicine, as a profession, toward reckoning with what flourishing means? Is there a path you can see? I mean, are there other professions that have done maybe a better job of staying focused on the ethics of what they do?

Lydia S. Dugdale: Pete, you ask such a great question. You would think we set this up, which we didn’t. Interestingly, we are launching just next week a new program at Columbia. Some colleagues and I have put together, I should say I have been thinking about this idea for a few years, but my colleagues have done most of the heavy lifting to bring it into reality, but we have formed something called the Columbia Character Cooperative. We’ve advertised it as a place of community and conversation, philosophy and the arts. We had students apply. We have very new students and senior students together, about 50/50. They had to apply, write some essays about why they wanted to be a part of this initiative and be interviewed. And then, we selected 15 students, and they will meet monthly to have some pretty rigorous discussions over dinner, along with faculty mentors.

And then, in between, there are informal activities designed to cultivate community and a community of inquiry, a place where people can enter into dialogue. Of course, the curriculum that we’re going to be doing over the course of the next academic year is curated around exactly the questions of this podcast. What makes a good doctor? What is medicine for? What happens when I’m harmed or when I harm others? There’s a curriculum that asks these big questions and helps orient students toward the cultivation of virtue in their personal lives, their collegial relationships, and with their patients. It’s a bit of an experiment, but we’ve been trying to think about how we can start to shape the next generation differently. And so, this is our pilot, so ask me in a year. I’ll let you know how it goes.

Peter Mommsen: Okay. That sounds exciting.

Susannah Black Roberts: Yeah, we would be very interested to hear how that goes, I think. What do you most ambitiously hope for from that project? Do you hope for a revival of something like the Hippocratic Oath being taken and being taken seriously?

Lydia S. Dugdale: Yeah, yeah. I mean, whether it’s the Hippocratic Oath, as you know, I didn’t title the piece, Bring Back Hippocrates. Is Hippocrates the right one to bring back is one question? If there was debate in antiquity about that, there’s going to be debate now. But could we have a medicine, a practice of medicine, and leaders in medicine who are habituated toward careful examination of practices and the cultivation of virtue, both professionally and personally, in their relationships with patients and with one another? To create that kind of ethos, I think, is something that I aspire for and hope that it won’t just stay with us at Columbia, but that it would be something that we could work at nurturing more broadly.

Susannah Black Roberts: Well, Lydia, thank you so much again, and I look forward to seeing you in the park on Thursday.

Lydia S. Dugdale: Perfect.

Peter Mommsen: Thanks so much, Lydia. This has been so much fun, and thanks again for the piece.

Lydia S. Dugdale: Thank you. Thanks, Pete. Thanks, Susannah.

Susannah Black Roberts: Thanks for listening. Be sure to subscribe on iTunes or wherever you get your podcast needs met and share with your friends. For a lot more content like this, check out plough.com for the digital magazine. You can also subscribe. $36 a year will get you the print magazine, or for $99 here you can become a Member of Plough. That membership cares a whole range of benefits, from free books to regular calls with the editors, to invitations to special events and the occasional gift. Our members are one aspect of the broader Plough community and we depend on them as a kind of extra advisory council. Go to plough.com to learn more.

Peter Mommsen: Join us next week when we’ll be talking with legendary philosopher and public intellectual Robert P. George.