Faced With Terrible Decisions, But Making The Right Choices

Faced with the prospect of not being able to provide all COVID-19 patients with the life support that they may need, physicians and nurses are working in conditions that have been described as “hell.”

How are providers to cope with the trauma they are experiencing in New York and Italy, and presumably other nations as well? How are they to cope with the moral implications of the brutal decisions they will be called on to make if two critically ill patients compete for the same life-sustaining treatment when only one is available?

Each one will do what they can, of course, and be supported by their peers and institutions. But faced with a situation that may be paralyzing and traumatizing to skilled and sincere providers, I have been reminded of some spiritual teachings that may offer some help.

The Song of God, or the Bhagavad Gita, tells the story of a great warrior Prince called Arjuna. Arjuna was renowned in ancient India for his skill and honor, but, on this occasion, he was immobilized by indecision. On one side of a battlefield were his brothers and their allies. On the other side were many of his extended family, as well as his revered teachers and their allies. If he did not fight with his brothers, he would be abandoning what was right. If he did fight for their cause, he would kill other family members, dear mentors, and friends.

What was the right decision? His moral algorithm wasn’t set up for a situation like this, but he needed to act, so he turned to his spiritual teacher, Krishna. Krishna’s teaching on the battlefield extends for 18 chapters, so forgive me if I summarize. What freed Arjuna from indecision was the teaching; “established in Being, perform action.”

The capital “B” gives us a clue that Krishna’s directed Arjuna to reach down deep inside himself and connect with that source of intelligence and life within. Being is that aspect of our lives that Krishna says, “fire cannot burn it, water cannot wet it…” Being is both eternal and transcendental. It is beyond the senses, and yet it is what animates our life in the field of the senses and allows us to act in the physical world.

To accomplish his worldly task, Arjuna needs to orient to his eternal self, his soul, and the field of life that is beyond the world. Then he can take the action that he knows he must take. He must take a human life or sacrifice the life of his brothers and his own honor. And with this teaching—poorly summarized here, I’m afraid—he is able to uphold his honor, fight the good fight, and remain whole in himself even though the consequences are too terrible to consider.

If there is a way for a physician or nurse to take comfort in this, perhaps it is to trust in her goodness and her training, to acknowledge that while the consequences of some decisions are too terrible, the right decision produces the right action. In these days of COVID-19, you really are a warrior on a battlefield. If you can, reconnect with your Self at the level of Being, through meditation or prayer, perhaps.

The Gita goes on to say that no one has any control of the outcome of action. The Serenity prayer may be helpful in this regard; “God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.” You can only do so much. When doubt comes to plague you, if it comes, honor your professional competence and good intention, remember the facts and that you are making the best decisions you can in a terrible circumstance.

To end, I wish you the Buddhist blessing of Loving Kindness: May you be well. May you be free of suffering, and May you be at peace. May your patient be well. May your patient be free of suffering. And may they be at peace. May all beings be well. May all beings be free of suffering. And may all beings be at peace.

Geoff Tyrrell is a palliative care chaplain. This article represents his private opinion and not that of the VA, his endorser, or board certification organization.

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