At The Juncture of Faith And Medicine
From their respective fields of medicine and bioethics, physician scholar Richard Payne and professor-author Allen Verhey have joined Duke Divinity School’s renowned faculty at the intersection of these important fields.
Two of Duke Divinity School’s newest faculty members, Richard Payne and Allen Verhey, began their lives and careers on strongly contrasting tracks.
Payne is a pioneering physician in pain management and palliative care, a member of the African Methodist Episcopal Church, and has spent much of his career in the New York City area. Verhey is an ordained theologian and professor who spent most of his life and career in the Midwest.
Yet these two scholars have come to Duke Divinity School united in purpose: to study and teach about the ways in which medical and faith communities care for the sick and dying. Each hopes to reach out through his own expertise to improve that care.
“End-of-life care isn’t just about medical care,” says Verhey, a professor of Christian ethics. “It’s about congregational care.”
“We all need to share knowledge and influence better treatment for the terminally ill and their families,” says Payne, director of the Duke Institute on Care at the End of Life, a multi-disciplinary program based in the divinity school. “Currently there is far too much fragmentation in the system.”
Superficially, these two scholars might appear to have little in common, said Dean L. Gregory Jones. “But when you consider the full body of their academic work, their accomplishments, and what they have to say about the way our society should be taking care of people, you realize that they complement each other wonderfully.”
Payne and Verhey have joined the divinity school’s already strong faculty working at the intersection of religion and health—Amy Laura Hall, assistant professor of theological ethics; Stanley Hauerwas, Gilbert T. Rowe professor of theological ethics; Keith Meador, director of the school’s Theology and Medicine program; and James Travis, clinical professor of pastoral care.
In the Shadow of New York City
Payne grew up in the shadow of New York City with 13 brothers and sisters. His home was in a segregated neighborhood of Elizabeth, N.J., which, fortunately, offered an advantage to a young man interested in science and medicine. Because many of the city’s African American residents were neighbors, Payne says, his role models included three physicians and a mortician who also was head of the local branch of the NAACP.
“I had plenty of models who lived just down the street,” says Payne, now 53. “It wasn’t an enormous imaginative leap to think that I could be a doctor too.”
Payne earned an undergraduate degree in molecular biophysics and biochemistry at Yale University in 1973 and his medical degree at Harvard in 1977. He then embarked on a distinguished medical career that led him to become the head of pain and palliative care service at Memorial Sloan-Kettering Cancer Center in New York—the post he held until coming to Duke Divinity.
Although he had planned to become a neurosurgeon, Payne’s experiences in medical residency led him to consider more deeply issues such as pain management and care for those near death. Sometimes he formed his opinions based on observing excellent care and pain relief; at other times, examples of less effective treatment were equally instructive.
“That ... was a window for me into the world of pain and suffering and how the impact of disease was reflected in individuals,” Payne says. “Some people could be undergoing a bone marrow transplant and endure excruciating pain, but stay optimistic because they had hope. Take the same person without hope and they saw their pain very differently.”
He also learned that doctors must do more than perform operations and prescribe medicine. Each patient needs to be considered as an individual, he says, especially those who are near death.
“You can’t just give morphine and think you’re going to impact every patient the same way,” he says.
In the following years Payne wrote more than 200 peer-reviewed papers, book chapters, abstracts and reviews. He also has lectured around the world on research and clinical aspects of pain treatment and other forms of care and has been recognized with dozens of major awards.
He serves on the executive committee of the board of the National Hospice and Palliative Care Organization, the board of the National Coalition of Cancer Survivors, and he is a commissioner with the National Quality Forum task force on long-term care. These appointments—as well as his leadership role in the Institute on Care at the End of Life—position Payne to help shape national policy and public opinion on issues related to treatment of chronic illness and the relief of suffering.
Mixing Ministry & Bioethics
Allen Verhey, one of four children raised in a Grand Rapids, Mich. family, attended a day school supported by the Christian Reformed Church. When he was a high school senior attending a summer Bible camp (because, he admits, a certain young woman—who later became his wife—had decided to attend) a minister said that Verhey should join the clergy. The idea stayed with him long after that summer.
“Try as I might, I just never could get that idea out of my head,” says Verhey, now 59. “I already was formed in the church, but what that minister said shaped my life.”
Verhey graduated from Calvin College in 1966 and Calvin Theological Seminary in 1969. He earned a Ph.D. in religious studies and Christian ethics from Yale in 1975. He was ordained to the ministry of the Christian Reformed Church; in 1994 he became a minister in the Reformed Church of America.
Verhey spent the better part of 30 years teaching at Hope College in Michigan, where for the last decade he was the Evert J. and Hattie E. Blekkink professor of religion. He began following the developing field of bioethics early in his career, at least partially because of dinnertime conversations with his wife, a registered nurse. She often would bring home stories of difficult decisions made in the hospital.
“Choices had to be made about which infants were going to be saved and which were going to die; which would receive intensive care and which would get palliative care,” he says. “There were a lot of hardships and a lot of joys in her work. I became interested in bioethics that way.”
Author of the acclaimed 2003 book Reading the Bible in the Strange World of Medicine, (for a review, see Bookmark, p.25) Verhey has published extensively. He has written, edited or co-edited 12 books; a listing of his articles, papers and major lectures fills 20 pages.
A well-traveled academic, he has spoken across the country on topics such as stem cell research, spirituality and medicine and ethical issues in hospice care. He has long been at the forefront of issues such as understandings of Scripture and Christian life and Christian voices in medical ethics.
A Call to Collaboration
Through their experiences and studies, Payne and Verhey say, they have reached similar, troubling conclusions about care at the end of life: our society and its institutions generally do far too little to support people who are near death. Families that must prepare for those deaths and carry on after the loss also are underserved, especially in many minority communities.
The problem often isn’t a lack of compassion, skill or effort, Verhey says. It’s a lack of coordination among the groups and individuals who most need to collaborate.
“In care for the dying there are a lot of Lone Rangers who run in and out and there’s hardly time to ask ‘Who was that masked man,’” he says.
Doctors may be good at prescribing medicine or performing operations, he says, but few medical practitioners are equipped to fully inform families about their options and needs when a death is imminent. Clergy tend to be skilled at conducting funerals, but congregations rarely follow up for long with grieving loved ones. Hospice can provide a supportive environment for the dying, but availability across the country is spotty. And rarely do all of these and other communities work together effectively so patients and their families are prepared for the religious, ethical, social, financial and other implications of death.
“Right now there are many gaps in the system,” Payne says. “Often families don’t even know what they don’t know until they are in the middle of a situation of caring for someone who is near death. We need to improve literacy.”
The Institute on Care at the End of Life will be Payne’s platform for addressing these shortcomings, as well as creating knowledge and wisdom about care for those near death. Founded in 2000 and sustained by gift commitments totaling more than $15 million arranged by Hugh A. Westbrook D ’70, the institute brings together far-flung disciplines, schools and professions to study care for those in the last stage of life. It works with doctors and nurses at Duke Health System, theologians and ethicists from the divinity school, humanities scholars from Duke’s arts and sciences departments, clergy and other caregivers from across the nation, and social work faculty from the nearby University of North Carolina at Chapel Hill, among others.
Although Payne and other institute leaders are still working out a specific agenda for coming projects, they have no shortage of ideas. They plan to push for changes in end-of-life care—and views of what it means to die a good death—through health care systems, churches, academia, popular culture, and other institutions across our society.
“One of our missions is to contribute to public discourse on caring for our fellow human beings who are terminally ill and dying, and to explore ways that faith-based communities will contribute to caring for them,” Payne says.
One possibility is a competition to encourage filming of movies that tell the stories of people who managed to live well and transform others in the face of death. Payne plans to work with Duke faculty and staff who have expertise in film and intends to work with other national programs in this regard.
The idea is to share widely inspirational stories that show death as an inevitable part of the cycle of life rather than a cause of debilitating fear.
“People can learn that you can live while dying,” Payne says. “You can transcend the terror of dying. There are people who have created entire branches of mathematics while they were dying. The experience of dying has moved people closer to God.”
Another possibility, Payne says, is a partnership between the institute and St. John’s Health System, a Detroit-based system with strong ties to the Catholic Church. The ultimate goal would be to improve access and quality of end-of-life care, and to affect both caregivers and patients.
Details of the project still must be worked out, but that process is exciting to Payne.
“How do we inculcate the values inherent in Catholicism and translate them so they inform specifically the way all patients who are dying and are seriously ill are cared for?” he asks. “There are good things that can come about from that. Look at what Mother Teresa did.”
Verhey, who has worked with the institute, seeks many of the same ends through his work in the classroom and through publishing.
“Our community needs to be less about the denial of death,” he says. “We need to form communities for the dying and for those who will care for them.”
Such communities should be able to help families address both practical details, such as determining power of attorney before a medical crisis reaches its apex, and spiritual needs.
Verhey also points out that suffering and dying are part of the human condition. Despite its best efforts with technology, humanity will not master nature or overcome mortality, he says.
“If we did eliminate our mortality, we’d be taking the human condition out of the human condition,” he says. “One of the problems is the medicalization of dying. We tend to think that dying is about medicine—and its failures. We think that the story is about medicine and about mastering nature, but, for Christians, the story we want to tell and own of our dying is always the story of Scripture.”
As they agree about inadequacies in current care systems, Verhey and Payne also agree that the partnership of church and medical communities has the power to change the way people live and die. Creating that partnership in the most effective way will take a great amount of study, reflection and collaboration. But that intersection is where these two scholars say they will make their mark.
“Medical centers and communities of faith need to come together in new ways,” Verhey says. “We all can find something instructive in this. That’s so much richer than these communities working alone.”
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