Selected Speeches

Ethics and Religion in Health Care

Nov. 1, 2016
SMC Campus Center


I’m so glad I can join you once again for this annual forum, such an important convening of people from different organizations, and disciplines, and faith traditions—all exploring what it means to care for others ethically, humanely, and lovingly. It’s a wonderful thing.

I’m so grateful to the Living Legacy Foundation for their tremendous partnership and support of this effort. I’d also like to acknowledge the extraordinary collaboration among the schools here at UMB, working with their colleagues at the University of Maryland Medical Center, and with Rabbi Silber and the Institute for Jewish Continuity. Your partnership is creating an important legacy here in Baltimore.

I know you have a full day in front of you, so I won’t take up too much of your time.

Last year, when I addressed this conference, I shared a personal story relevant to the theme, which centered on issues of dignity, respect, and family cohesion as patients age. My mother-in-law had just died the week before, and I told the story of her illness with Alzheimer’s. I talked about the care she received at the end of her life, and how that care affected my wife, her siblings, my children, and me.

Today—as you explore the complicated ethics of organ donation and transplantation—I’d like to tell a quick story that might provide fodder as you talk with one other.

Years ago, when I chaired the Department of Pediatrics in our medical school, I had a 17-year-old patient, Daniel, with prolonged jaundice. I ultimately diagnosed Daniel with primary sclerosing cholangitis, unusual for a young man that age. The diagnosis meant that Daniel had severe liver disease and might one day require a liver transplant. He was big and tall—didn’t really look sick at the time. But he was. He was very sick.

And so, as he was going off to college, I counseled Daniel. With his mother in the room, I said, “Daniel, you’re going to college, and I know you’re going to want to be one of the guys. And you’re going to want to drink like one of the guys. But you can’t—you just can’t. It’ll destroy you.”

As Daniel was taking this in, his mother leans over to me, nudges me a little, and says: “Tell him about the sex, too.”

That’s not why I’m telling you this story. I’m telling this story because, about six weeks ago, I got a letter from Daniel’s wife. Now, I’m a pediatrician—and pediatricians don’t often get letters from the spouses of their patients. But this is 16 years later, so Daniel is now a 33-year-old man.

And I’d like to read just a portion of the letter his wife, Melissa, sent to me.

Dr. Perman:

A year ago today my husband, Daniel, received his second liver transplant at the University of Maryland Medical Center. If not for the medical center, and his donor, Daniel would not be alive today.

Daniel was double-listed at the medical center and at another facility in Washington, DC. When Daniel reached the top of the list for his blood group, we received a phone call from the Transplant Hepatologist at the DC facility. He told us that Daniel would be inactivated from their list, because after meeting with the transplant surgeons that week, the team decided that “the benefit did not outweigh the risk.” He said the only reason that the University of Maryland Medical Center was not doing the same was because they were heavily invested in Daniel’s case.

Hanging up the phone that day, I felt so grateful that we had this “heavily invested group of doctors.”  Thank you for creating the environment that allowed Dr. Darryn Potosky, Dr. Rolf Barth, Dr. Joseph LaMattina, Dr. Josue Alvarez-Casas, Dr. Steven Hanish, Dr. David Bruno, Dr. William Hutson, and the rest of this outstanding transplant team go above and beyond for their patients. They saw the benefit of giving Daniel a second chance, and felt it outweighed the risk.

Daniel was 16 years old when you first diagnosed him with Primary Sclerosing Cholangitis. I find it remarkable that 16 years later he was cured, via a  lifesaving liver transplant at the same facility you’re with once again.

Melissa then goes on to quote the Talmud: He who saves a life, it is as if he has saved an entire world. The quote is on a plaque that hangs outside the boardroom in the medical center.

Melissa said: I’m certain you recognize this quote. I’ve read it countless times waiting for the elevators to go up to 8 Gudelsky. Each time I read it, I am moved with the thought of someday doing what doctors like Daniel’s do every day. I want to be a physician. I want to be heavily invested in my patients, and I want to practice medicine in a hospital like the University of Maryland Medical Center, where doctors can innovate more ways to overcome the risks, so that they never outweigh the benefits.

Of course the considerations around organ transplantation are enormously complex, and I’m in no way suggesting the risk-benefit analysis should always—or even usually—be weighted toward the benefit.

I just thought you should be reminded that what you’re doing matters; that what you’re talking about today matters to Daniel and Melissa, to the hundreds of people you’ll meet and care for—and to the many thousands more you never will. There is great care to be taken with this gift of life, of love, the best of our humanity, and I thank you for giving it the attention it deserves.

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