Should Doctors Play God?

SHOULD DOCTORS PLAY GOD? JAN VAN EVS* "Should doctors play God?" is the frequently unwritten but often quoted question posed to all groups debating, considering, or contemplating the impact of modern knowledge upon medical practice. The question is almost always asked in a tone that allows only the response "of course not," after which ethical analysis proceeds to show how such an arrogant stance by doctors can be avoided or averted. It must be clear that there is a concept behind that question that implies a negative connotation for the word "play." Playing is envisioned as impersonating, pretending to be what one is not. The implication is that play will have permanent consequences, that play is more than make believe. The concept of play is in fact enormously complex. The word is used as a noun, a transitive verb, and an intransitive verb. It is a performance and the script for a performance; it can denote a serious act or ajest, a pronouncement or a pun. In the phrase "Should doctors play God?" play is defined "to act the part in real life"—one of seventy-four definable usages. North Carolina allergist Claude Frazier edited a book titled by our phrase. In that book Mrs. Billy Graham wrote in the foreword: "IfI were an actress who was going to play, let's say, Joan of Arc, I would learn all there is to learn aboutJoan ofArc. And, if I were a doctor or anyone else trying to play God, I would learn all I could about God. When one does this, one learns one cannot play God. One can only obey him or disobey him" [1, p. vii]. There is another concept embodied in the verb "to play": "to exercise or employ oneself in diversion"—playing is not altogether serious. Play is associated with children. It is pleasurable. For children these two concepts of play are in fact intertwined. Children play very seriously. They act out the world they do not understand. They imitate their parents to master the ideas that their parents convey. They imitate their parents to *University of Texas System Cancer Center, M. D. Anderson Hospital and Tumor Institute, 6723 Bertner Avenue, Houston, Texas 77030.© 1982 by The University of Chicago. All rights reserved. 003 1-5982/82/2503-0294$0 1 .00 Perspectives in Biology and Medicine, 25, 3 ¦ Spring 1982 | 481 understand what it must be like to be parents. Play is "the child's natural medium of self-expression" [2, p. 9]. When that element of play in children is the focus of observation by adults, we have nondirective play therapy. As Axline says: "Since play is the natural medium for selfexpression , the child is given the opportunity to play out his accumulated feelings of tension, frustration, insecurity, aggression, fear, bewilderment , confusion" [2, p. 16]. All child's play has an element of unburdening pent-up emotions and struggling with understanding. Much of children's playing is nondirected play therapy. But so is some of the play ofadults. It is important to view the question "Should doctors play God?" with that concept of play in mind. It is not inconceivable that in the development of the mature physician a period of playing God is necessary to reach an understanding of a God who is infinitely more incomprehensible to an adult than the inscrutable and capricious parent is to a child. Playing God as a doctor implies acting powerfully, authoritatively, knowingly, and presciently in the face of suffering and death. God is inscrutable when suffering touches the human. For a while Job could say: "The Lord gives and the Lord takes away; blessed be the name of the Lord" (Job 1:21). But that did not suffice, and ultimately Job had to say to the Lord who proclaimed his majesty: I know that thou canst do all things and that no purpose is beyond thee. But I have spoken of great things which I have not understood, Things too wonderful for me to know. I knew of thee then only by report, But now I see thee with my own eyes. Therefore I melt away; I repent in dust and ashes. [Job 42:2-6...