“The Enormity of the Moral Mission of Medicine”

As I write, Paul Kalanithi’s book When Breath Becomes Air sits atop the New York Times Bestseller List. I highly recommend it. It is beautiful.

This book was written by a dying man. All books are, I suppose, but this author knew with more certainty than most that his time was short. Paul Kalanithi was finishing a grueling neurosurgery residency and on the cusp of a brilliant career when he discovered he had advanced lung cancer. In this book, written during the last months of his short life, he tells his story, a story of his search for meaning. He initially looked for meaning in the study of words, as he collected degrees in English and history and philosophy. But he discovered that meaning is not just read about, but lived, lived in relationships with others. As he thought about relationships, words, minds, and the brains through which words and minds are expressed, he writes that he “couldn’t let go of the question: Where did biology, morality, literature, and philosophy intersect?” The answer wasn’t to be found, for him, in the classroom: “. . . I found myself increasingly often arguing that direct experience of life-and-death questions was essential to generating substantial moral opinions about them. Words began to feel as weightless as the breath that carried them. . . It was only in practicing medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action.”

And this illustrates one of the great strengths of the book: the profound understanding that medicine is at its heart a moral practice. Kalanithi writes of “The enormity of the moral mission of medicine . . .” He pursued one of the most technical of specialties, neurosurgery, yet he did not let the technical aspects obscure the moral core of medicine, the patient-physician relationship. As he writes, “When there’s no place for the scalpel, words are the surgeon’s only tool.”

As he explores the moral practice of medicine, Kalanithi writes insightfully of informed consent, not as “a juridical exercise in naming all the risks as quickly as possible . . . but an opportunity to forge a covenant with a suffering compatriot.” As a neurosurgeon he writes of the experience of life and death from the bedside. He learns that “the physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.”   Then he receives his own terminal diagnosis, and writes eloquently of his experience of life and impending death from the patient’s bed. The ending of the book, along with his wife’s epilogue, is deeply, deeply moving, but not maudlin.

(Quotes from pp. 32, 43, 44, 87, 88, and 166)


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John Kilner
John Kilner
5 years ago

Thanks for calling people’s attention to this book, Joe. The author, Paul, worked with Stanford professor Bill Hurlbut, who is a Fellow at CBHD; and Bill says that Paul was the real deal–that what you see in the book is an accurate portrayal of who Paul was.