Confident Pluralism and Medicine

One of our most important examples of common ground still confronts deep differences

Cardiac surgery operating room by Pfree2014

My 2016 book Confident Pluralism: Surviving and Thriving Through Deep Difference argues for the civic postures of humility, patience, and tolerance as we engage with others across deep differences. Over the past few years, I have spoken about these ideas to groups of scholars, educators, students, philanthropists, administrators, and lawyers. I have also been asked to speak to various health care professionals, including my colleagues in Washington University’s Department of Neurology.

Why are health care professionals interested in learning to work across deep differences? It’s one thing for scholars and journalists to talk about the need to set aside differences to find common ground. But health care professionals must routinely bridge those differences to succeed in high-pressure situations where lives are literally at stake. Avoiding people who think differently from them is usually not an option.

Many health care professionals also enter their line of work because they desire to help people. And they know they will need to work alongside others to provide care that most often requires a team of people to be successful. The practice of medicine may thus be one of the best places for turning the aspirations of humility, patience, and tolerance into civic practices.

In the News

Earlier this week, Dr. Kristin Collier delivered the keynote address for the University of Michigan Medical School’s White Coat Ceremony, a rite of passage in which medical students recite their oaths and receive their white coats. Dr. Collier has served on Michigan's faculty for seventeen years, and according to a report on NPR, “on her Twitter, she has written about racism, ageism and ableism in medicine and advocated for better healthcare access for incarcerated people and residents of rural America.” She has also spoken publicly about her pro-life views.

After Dr. Collier was named the speaker, 340 students, alumni, and faculty petitioned to have her invitation revoked. They asserted:

While we support the rights of freedom of speech and religion, an anti-choice speaker as a representative of the University of Michigan undermines the University’s position on abortion and supports the non-universal, theology-rooted platform to restrict abortion access, an essential part of medical care.

The university stuck to its invitation. Dr. Collier’s keynote did not address abortion but instead “urged incoming students to retain their humanity as they move through their medical education and career.” Nevertheless, dozens of students walked out as she began speaking:

Scorpiio @PEScorpiio

Incoming medical students walk out at University of Michigan’s white coat ceremony as the keynote speaker is openly anti-abortion

(You can watch the video here.)

Some of those reacting to the walkout heralded the protesting students as “brave.” Others questioned the wisdom of ignoring Dr. Collier’s address:

Warren Kinghorn @WarrenKinghorn

If you're reacting to the tweet video of @UMich students walking out from @KristinCollie20, please take the time to watch her speech starting at 1:45:50 here, and ask, "Is this what we want to prevent being said in medical education?"

youtube.comU-M Medical School White Coat Ceremony

In my Head

The walkout at Michigan provides a useful case study of the need for confident pluralism in medicine. Effective medical care depends upon collaboration and cooperation. But health care professionals also have deep differences about important matters. Sometimes they encounter these differences with their patients; other times, as illustrated by the Michigan walkout, they surface with their peers and colleagues.

Assuming the white coat ceremony was intended to be more celebratory than instructional, the students were free to walk out or to skip the ceremony altogether. And Dr. Collier successfully delivered her remarks after the university refused to rescind her invitation. For these reasons, it’s hard to take seriously the National Review’s charge that the protest damaged academic freedom. That said, it’s hard to know what the students were protesting other than Dr. Collier’s personal views. Neither the school nor Dr. Collier had established a policy with which the students disagreed. And if the relevant baseline for staging walkouts is “speakers who hold views we don’t like,” it’s difficult to see how an institution as diverse as the University of Michigan can ever hold a protest-free event.

The greater challenge in the coming months will be for the protesting medical students to work toward finding common ground with Dr. Collier and many other pro-life health care professionals, and vice versa. Since neither pro-choice nor pro-life beliefs are fringe views in medicine, the odds are high that these students and teachers will find themselves learning and working with those who disagree with them on this issue.

My friend Eboo Patel’s new book We Need to Build: Field Notes for a Diverse Democracy includes a thought experiment he poses to undergraduate students:

Imagine you are a heart surgeon and you are scheduled to be part of a team of surgeons that is performing a life-saving operation. Let’s say you discover that one of the other surgeons or a nurse supporting the surgery disagrees with you on a political issue dear to your heart. Maybe that person voted differently in the last election and advertises it with a bumper sticker on her car. Do you refuse to do the heart surgery?

Eboo recounts that he frequently poses this scenario and “to date, not a single person has said they would walk out of the operating room.”

We might ask the same question to doctors and medical students who differ in their views about abortion but who still come together to train and practice around a broad range of patient care that promotes human flourishing and alleviates human suffering.

In the World

Today I’ve chosen to highlight two values-centered health care initiatives that seek a pluralistic approach to the practice of medicine. The Kern National Network for Caring & Character in Medicine and Duke Divinity School’s Program on Theology, Medicine, and Culture both explore theoretical frameworks for navigating differences within and throughout various medical contexts.

Duke Divinity School’s Theology, Medicine, and Culture program (TMC) draws from theological sources with an emphasis on the school’s Christian identity. The Kern National Network (KNN) is non-religious. Both programs seek to give health care professionals resources to navigate disagreement and understand the moral frameworks through which they serve patients. For example, KNN hosted a summit two years ago that considered “questions, themes and controversies in medical professionalism” related to caring and character. And a recent TMC event explored “how medicalizing risk may distort the practice of medicine and the clinician-patient relationship, and how this distortion may have particularly problematic consequences for underserved communities.”

KNN’s commitment to caring and character provides a cornerstone for relationships that respect genuine disagreements but also seek to bridge those differences through compassion and connection. TMC encourages health care providers to engage with their patients in ways that challenge the transactional approach dominant in much of the practice of medicine. These kind of authentic connections across differences are essential to the current and future practice of medicine.