For Patrick Smith, associate research professor of theological ethics and bioethics, senior fellow at the Kenan Institute for Ethics, and newest faculty affiliate of the Theology, Medicine, and Culture Initiative, words of advice from his uncle, Rev. Dr. Nelson H. Smith Jr., civil rights activist and lifelong pastor, made a formative impression in his career. “Don’t forget about the people,” his uncle told him.
“His encouragement to me as well as to many others, was that the intellectual life should have a purpose or an end to it—and it is for the betterment of our communities, to really help people flourish as human beings, as image bearers [of God],” he says. As a professor, philosopher, and aspiring public theologian, Smith seeks the well-being of people, as his uncle urged, especially vulnerable communities such as those facing the end of life, and those on the margins. He is the recipient of the prestigious 2019 Paul Ramsey Award for Excellence in Bioethics for his work in these spheres.
“A lot of my work stems from my background and my childhood in some ways,” says Smith. “The values that were cultivated within my family were formed by the generation before me. Education was huge, music is something that was huge. A number of folks were also involved in Christian ministry as their life vocations and engaged in civil rights with various movements, campaigns, and organizations.”
Before coming to Duke, Dr. Smith taught philosophical theology at Gordon-Conwell Theological Seminary and medical ethics at Harvard Medical School. Early in his career, concerned about the level of abstraction in his work, Smith became the director of the ethics department of Angela Hospice Care Center in Livonia, Mich. This experience was a turning point, as it brought together in a concrete way his work in ethics, moral philosophy, and theology, and it was the seed for a book on which he is working titled Valuing Human Life at the End of Life: Theological Ethics and Hospice Palliative Care.
During the time of his work in clinical hospice spaces, Smith also encountered the work of and met Dr. Richard Payne, beloved former Duke Divinity professor and internationally known expert in palliative care, who became a mentor.
“A lot of times, at least in our ecclesial spaces, we do a good job of teaching people how to live, but we don’t teach people how to die very well,” he says. “The reality is, as Rich Payne often said, the dying process is not just merely biological or physiological, but it is also a spiritual experience.” In the hospice context, Smith encountered end-of-life issues as complex human experiences that are not fully captured by academic reflection only. “This should foster in those who want to do this work well a certain kind of humility,” he says. “Look, the work in this area is hard, and humility should lead us not to be overly judgmental or dogmatic in many of these situations.”
The complexity of these issues became particularly apparent as his family faced the passing away of his own father, Rev. W. F. Smith, Sr., last year. Smith says he is grateful not only that his family was able to prepare for difficult decisions in conversations prior to his father’s crisis of health, but that their faith allowed them to see “God’s grace at work in ways I’m not sure we would have been able to see otherwise.”
“I think it’s a mistake,” he says, “to suggest that valuing life at the end of life means doing anything and everything we possibly can for as long as we can regardless of any other considerations. I think that becomes a form of idolatry because it suggests that this life is the summum bonum or highest good. But this life is a penultimate good in a theological sense.”
For Dr. Smith, theological bioethics is inseparable from social ethics. “As I started wrestling with these issues, and as I was working with other groups or communities who were either poor or disenfranchised, it became increasingly difficult, if not impossible, to talk about what it means to value life at the end of life for those who are on the margins without asking the question, ‘what does it mean to value life before the end of life?’” he says. Noting sobering statistics around the claim that a significant indicator of health outcomes is based on ZIP code, Smith recognizes that to care about health we must care about the material circumstances of people—from housing, to education, to transportation, to food.
His sense of vocation is grounded in the high Christology and deep anthropology of the African American Christian experience. “The Biblical language says that Jesus is the image of God, and all other human beings are made according to the image of God,” he says. “For many African American Christians the significance of that is that if Jesus is the image, the earthly Jesus, the embodied Jesus, the Jesus who had hands and feet and particularities, then our particularity, our bodies matter. When you think about the kinds of atrocities that have taken place not only with African Americans but also those who are impoverished, those who are disenfranchised for other reasons, their embodied-ness matters. I think it’s irresponsible for Christians, given the theological resources that many of us rely on, not to think about and address these issues.” Smith proposes a social ethic grounded in the Biblical concept of shalom, or flourishing.
Working at Duke has brought Smith a “greater sense of synergy,” he says. “The school is seeking to be a university—to find unity in diversity, to have conversations across schools, across departments, and to bring together people from very different backgrounds.” The Theology, Medicine, and Culture Initiative, he adds, is a microcosm of this synergy, being one of the few places where medical doctors are humanists as well. It’s a “unique and tremendous resource in that medicine itself is existential, theological, and humanistic. TMC is a gem,” he says.
Smith’s musical heritage has played an important role in his pursuit of unity in diversity. His father taught voice and piano, and Smith used to play saxophone for a few years when he was younger (though he thinks it is more like he played at a saxophone). “The universality of music can transcend linguistic spaces,” he observes. He loves jazz, particularly, for the model of democracy it displays in combining individuality of expression with unity of sound. He got excited when one of his neighbors told him that Branford Marsalis doesn’t live too far from them. Branford Marsalis, if you’re reading this, Patrick Smith would like to buy you a drink sometime.