Psychiatrists and mental health clinicians can be leaders in the process of saving lives, particularly during times of war.
PSYCHIATRIC VIEWS ON THE DAILY NEWS
One of the great moral dilemmas in medicine is how to distribute limited rations in taking care of patients. For me, that came to a head in leading an academic not-for-profit managed care system for years.1 I was relieved when our research indicated overall improvement of patients compared to the prior county public system.
There is an old Jewish saying in the Talmud (Sanhedrin 37a) that can be translated as: “Whoever saves a single life is considered by scripture to have saved the world.” It is a belief in the sanctity of life. It is most applicable in an identified person rather than a generalized population.
A similar saying can be found in the Quran, the Islamic Holy book: “If anyone saves a life, it shall be as though he had saved the lives of all mankind.”
In many ways, this goal has been the essence of medicine. In psychiatry, the challenge becomes most important in patients contemplating suicide. Traditionally, whatever could be done to prevent suicide was tried, including forced inpatient treatment. Often, patients I picked up from the emergency department after a determined, but failed, suicide attempt, were later grateful to have lived if they received good enough treatment.
This saving of a life, though, has been challenged with the role of physicians in suffering patients desiring to die with the aid of physicians in those states and countries that allow it. In some countries, that can fit mental suffering.
As 2 more of over 200 hostages were just freed yesterday in the Middle East conflict, trying to apply this saving-a-life principle can be full of moral and ethical anguish. How long to wait before risking more and more lives on both sides in the ongoing fighting using lethal means? How do leaders analyze the future saving of lives by current decisions? Are all lives of similar value? The essence of such a challenge seemed to be exemplified when a hospital in Gaza was bombed, with the outcome of misinformation of blame, patients dying, and valuable resources lost.
In the long run, it seems that the only way to save more lives is by finding a way to try to guarantee the existence of individuals of all cultures, with adequate and good-enough resources. That is where it seems that the model of medicine and psychiatry can help guide the process. How to get there, though, and lose more lives in the process and with uncertain projections for the future, is the question that can stop us in our tracks. Such is the dominant dilemma of any war.
Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry, and is now in retirement and refirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.
1. Moffic HD. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Jossey Bass; 1997.