After nine years working to complete her M.D.-Ph.D. in philosophy at Georgetown, Jennifer Walter penned an article for the AMA Journal of Ethics (formerly Virtual Mentor) titled “The Body and Blood of Medical School: One Student’s Perspective on Jesuit Education.” She highlighted the school’s emphasis on care for the whole patient, on how different religious traditions intersect with health care, and on a physician’s responsibility for society’s forgotten.
Walter completed her residency in pediatrics at the University of Chicago Comer Children’s Hospital in 2010, and then continued her studies as a Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan, earning a Master of Health and Health Services Research. In 2012 she joined the University of Pennsylvania Perelman School of Medicine as an assistant professor of pediatrics, with her clinical work based at the Children’s Hospital of Philadelphia (CHOP). She has a joint appointment in the Perelman School of Medicine in the department of medical ethics and health policy and in CHOP’s department of medical ethics.
She recently spoke with Georgetown Medicine to reflect on the role of spirituality and faith in her work today.
IN GOD’S HANDS
The tiny newborn girl is small enough to fit in the palm of her father’s hand. Fragile and weak, she was born preterm at just 24 weeks, and she came with complications.
With several serious anatomical abnormalities, the doctors say it’s unlikely that she will survive beyond infancy. Her parents listen with worry as a parade of clinical specialists come to them and describe a variety of complex procedures that may—or may not—extend the life of the child. There are grave risks, they explain, and likely continued discomfort for the struggling infant, with many questions remaining about what that life might be like if she does survive for some time beyond the surgeries.
Heartbroken and overwhelmed, the grieving parents turn to their deep well of religious faith. After considering the many options, together they explain to the clinicians that they are praying for a miracle, and they are putting themselves and their daughter in God’s hands.
The highly skilled medical specialists turn to each other in confusion. How will this solve anything? How is this even a way forward?
Some clinicians are unsure how to respond in this kind of situation, when families request an end to conversations about whether or not medical interventions are helping their child, explains Jennifer Walter (M’07), a palliative care pediatrician and medical ethicist at Children’s Hospital of Philadelphia (CHOP).
“Statements from families describing a really strong religious faith become anxiety-provoking for many science- minded, agnostic physicians,” she says. In these kinds of circumstances, her Catholic, Jesuit medical training informs another approach.
“What we learned and appreciated as students at Georgetown is the importance of engaging families, respecting them, and hoping with them that there could be a miracle,” says Walter. “We don’t try to encourage them to think differently about their relationship with God. We engage our chaplaincy to work with families within their own faith systems, helping them identify the limits of their medical expectations while supporting them in their faithful beliefs and discussing with them where we think the limits of human intervention are.”
The limits are real, and Walter’s palliative care team works to build partnerships with families to help them remain grounded as they struggle to make loving decisions for their children.
“Instead of talking them out of hope for a miracle, or convincing them that humans have greater power than God does in these situations, we support them in their spiritual beliefs,” Walter says. “We also prepare them for the possibility that God can both continue to love them and support them and their child, but at the same time the child may not be healed.”
CARE ROOTED IN CURA PERSONALIS
Walter credits her time in medical school at Georgetown with developing her ability to make sense of these difficult circumstances. The whole-patient approach informs her definition of what medicine includes—cura personalis means not only addressing traditional medical concerns but also the patients’ and families’ spiritual well-being. It also prompts health care providers to consider access to care and the social determinants of health.
Georgetown’s emphasis on the Jesuit, Catholic commitment to social justice and caring for the poor is one that Walter continues to prioritize, even at a state-of-the art facility that offers cutting-edge care for the most complex medical conditions.
“While CHOP is a real quaternary care hospital, with an emphasis on treating children who require very complicated care, we also serve the surrounding area—a diverse community with many marginalized and vulnerable populations,” explains Walter. “I advocate for those patients in my own practice. Thinking about ways in which being vulnerable in society impacts people’s access to health care, or how they engage in receiving health care, or how they are able to maintain children’s health and a family’s ability to provide complicated care to children who are sick—all of these sensitivities were raised at Georgetown.”
As Walter reflects back on her time in medical school, she appreciates that Georgetown offers the opportunity to learn about a variety of faith traditions and their influence on patient decisions. In addition, she says, her work today is informed by the university’s focus on the human aspect of caring for people, as well as the ethics teachings.
“We received a strong foundation at Georgetown, learning to think critically with our ethics education about how we identify the values of patients and then set them within the values of what’s considered ethically acceptable within the medical practice.”
This framework helps her guide families as they make these hard decisions.
“We’re often discussing with families in the most difficult situations what their values are, what role their religion or spirituality may play, and how they understand what’s most important to them,” she says.
In some circumstances, putting a child in God’s hands means choosing not to pursue treatments that are more likely to cause harm than benefit to their child. With the support of the palliative care team, the parents can come to this difficult choice in good conscience.
“The family doesn’t feel they’ve had to betray their God, and they’ve made a loving decision for the child,” says Walter.
Recognizing the importance of living up to one’s religious beliefs, Walter sees that faith is often central to a family’s well-being. Caring for families using a broad approach that embraces spirituality builds successful partnerships, says Walter.
“It helps us support them in this horrible journey that they’re on.” How do parents make it through? Walter pauses. “I don’t think any of these families think they can do it. But they have more coping skills and strengths than they realize.”