Moral Courage in a Pandemic: a 14th Century Physician and Health Care Workers Today

What does it mean to be human? What values should we live by? How should we respond to those in need during a time of crisis? What would I do?

A physician during the Black Death.

As a hospice social worker who loves the humanities, I find that historical figures often come to mind when there’s a parallel with things that are happening with patients and their families. Amidst the COVID-19 pandemic, I’ve been thinking a lot about a 14th century French physician named Guy de Chauliac.

Although little known today, in his time he was one of Europe’s most respected medical practitioners. In fact, his text Chirurgia Magna was a standard part of medical education for 200 years.

I came across de Chauliac’s story years ago while researching the ‘Black Death,’ the plague that decimated Europe in the 1340s, killing up to a third of its population.

Those who have read Giovanni Boccaccio’s contemporary account of this plague in his work Decameron are often left with a cynical impression that, as Boccaccio puts it, “such fear and fanciful notions took possession of the living that almost all of them adopted the same cruel policy, which was to entirely avoid the sick and everything belonging to them.”

Braving plague-ridden streets to serve the ill and study a disease.

Living in Avignon at the time, de Chauliac is a prime example that there were many who, rather than run away from others who were infected, ran toward them. Rather than hide behind his privileged position as personal physician to the pope (back then, the papal court was controlled by the French throne and had been relocated to Avignon), he went into ‘the streets’ to serve those who were suffering and dying from the disease.

As the plague mowed down the city’s population and panic spread, de Chauliac experimented with treatments and assessed their efficacy, eventually identifying and describing two variants of the disease (bubonic and pneumonic; there was also a septicemic variant).

A call from history to contemplate the hardest questions.

Many saw the pestilence as an expression of God’s wrath, but de Chauliac understood that it was spread by an unknown agent of contagion. He also knew he was placing himself at a very real risk of death.

One of the benefits of studying history is that it introduces us to individuals like de Chauliac who challenge us to think about important questions –

What does it mean to be human? What values should we live by? How should we respond to those in need during a time of crisis? What would I do?

They illustrate and inspire a path of courage, integrity, and service during times of upheaval, becoming what Kim Strom-Gottfried, PhD, a researcher into moral courage, calls ‘moral exemplars.’

After happening upon de Chauliac, I wondered what I would have done were I in his shoes. Of course, I imagined myself rushing into the homes and bedsides of those who were suffering, freely and consciously placing my safety at risk in order to live by the values I hold dear.

In the back of my mind, I knew it was safe and easy to play a game of hypotheticals. We all see ourselves acting with courage and conviction when the stakes exist only in the imagination. Who knows how we respond when those stakes are raised?

When hypothetical questions become real, how will we react?

Working in health care during this pandemic has raised these questions and many I’d not imagined. What is my responsibility to patients living in their homes to whom I do not want to be a ‘vector for transmission’ but who have requested my support? What is my responsibility to the family to whom I return each day and who I want to protect from any possible infection? How do I support my coworkers, particularly nurses and nursing assistants who do more hands-on care than I do, and those who have elderly loved ones at home?

What if the health care system in which I work ‘redeploys’ me to serve one of the hot spots as this pandemic spreads and colleagues become sick and need to quarantine? As someone with a history of asthma and who’s a stone’s throw from being considered “at high risk” on the basis of age, I am scared. Though ready to do my part, there’s a little voice inside that wants to run the other way.

Today’s moral exemplars.

I can only imagine that my anxiety is shared by the countless nurses and other medical staff already in the middle of it. All are keenly aware that they are placing themselves and their families in the crosshairs of a threat to their health and, particularly for those in high-risk categories, to life itself.

Yet there they are, staffing emergency departments and urgent care clinics, heading out in ambulances to care for strangers. Some are changing bedsheets and giving bed baths. Others are working in nursing homes and assisted living facilities or providing psychological and/or spiritual counseling to patients, caregivers, and frontline staff. My colleagues and I in hospice and home health settings are entering patients’ homes to keep them out of overcrowded hospitals and ensure good symptom management and support.

If we define moral courage as a willingness to put one’s self in harm’s way in order to do what’s right, these are today’s moral exemplars. They stand in a long tradition shared by people like Guy de Chauliac and countless other men and women whose names we will never know.

De Chauliac’s story occurred in the mid-1300s. Ours is now.

The author of this post, Scott Janssen, is a clinical social worker with UNC Health Care Hospice in Chapel Hill, North Carolina.