First, Do No Harm (to the One You Train)

Abstract

Primum non nocere or “first, do no harm” is perhaps the most well-known aphorism in the culture of medical education. While its application to patients is well known, the injunction can also be read with medical trainees in mind. Teaching physicians have an obligation to recognize their role as moral teachers and coaches, who must consider “first, do no harm” not only when considering their patients but also when weighing the moral formation of their trainees, especially in a season in which medical educators are attempting to clarify the “harms” of medical training. This multi-valent vision of “first, do no harm” offers an alternative way to frame the contemporary difficulties of medical education while inviting a more candid, nuanced discourse between teachers and learners about the experiences of medical training, in which it can be difficult to discern between that which is truly harm and that which is merely “hard.” For those situations in which it is unclear—or indeed when harm is unavoidable—it may be through communal practices of reharmonization, reincorporation, and “reharm” that master educators might learn to tell the story of good medicine with their trainees anew, fostering moral articulacy for the trainees to whom they must also “first, do no harm.”

Summary

Primum non nocere or “first, do no harm” is among the most well-known proverbs in medical education. While its application to patients is well known, the injunction can also be read with medical trainees in mind. Teaching physicians might consider “first, do no harm” not only when considering their patients but also when considering the moral formation of their trainees. In a season when medical educators are attempting to clarify the “harms” of medical training, this reading can invite a more candid, nuanced discourse between teachers and learners about the experiences of medical training.

They are not Gods

though they would like to be;

they are only a human

trying to fix up a human.

Many humans die.

They die like the tender,

palpitating berries

in November.

But all along the doctors remember:

First do no harm.

— Anne Sexton, Doctors (Sexton 1960)

The First Lesson

Medical educators enjoy a treasury of well-worn idioms, aphorisms, and maxims to teach the art of medicine to trainees (Fortuine 2001). As recent graduates from residency, we have shaped our own moral lives and practices from many of these phrases (“Don't just do something, stand there”). Others have proven less helpful (“When in doubt, cut it out”).

Aphorisms hold surprising moral power in medical education. The Hippocratic Corpus and the portfolio of William Osler both contain collections titled “Aphorisms” designated for teaching (Conrad et al. 1995, 22; Osler 2001, 32). These phrases (“Measure twice, cut once”; “All bleeding eventually stops”) are what the poet and pediatrician William Carlos Williams might have called “a small machine … made of words”—micro-poems in which no part can be replaced (Berry 2011, 89). When the aphorism is not just true but beautiful, such phrases become small works of art that make known an interlocking set of assumptions and practices beyond what the words themselves seem to carry at first glance. This is especially true when such proverbs are reflected in superiors who embody their truth and import.

Of these medical aphorisms, there is one that seems to rise above the rest, capturing the attention and imagination of fledgling practitioners and seasoned clinicians alike—primum non nocere—“first, do no harm.” This is likely the first imperative pre-medical students hear about the practice of medicine, repeated with enough frequency that many mistakenly believe it to be part of the Hippocratic Oath itself (Fortuine 2001, 185; Veatch 2012, 166).

Traditionally, “first, do no harm” has applied to the care physicians offer patients—conveying the importance of considering the potential morbidity of medicine's interventions. While the wisdom and relevance of “first, do no harm” in patient care has been debated vociferously (Sokol 2013), our intent in this essay is to explore the application of this maxim to a different population—that of medical trainees.

Five Decades of Clarifying Harms

In many ways, today's medical educators are enduring a reckoning with the moral state of contemporary medical training. It has been fifty years since the word “burnout” was coined in 1974, defined in its most well-known iteration as a syndrome characterized by emotional exhaustion, depersonalization, and a decreased sense of professional accomplishment (Shanafelt et al. 2012). Despite fifty years of commentary, the term continues to suffer much scrutiny and clarification (Dean, Talbot and Caplan 2020; Edú-Valsania, Laguía and Mariano 2022; Malesic 2022; Peterson 2020; Shanafelt et al. 2022).

Beyond burnout, the “harms” of contemporary medical education have been documented with increasing attention, particularly within the past decade and reaching an apex in the wake of the COVID-19 pandemic (Buchbinder et al. 2023; Cahill, Moyse and Dugdale 2023). Claims of “moral injury” and “moral distress” among medical students and trainees abound, often implicating the very institutions tasked with their teaching and career satisfaction and invigorating renewed attention in public discourse as a result (Rosenbaum 2024, “Injured…”; Ong et al. 2022).

Given the historical precedent of “first, do no harm,” ongoing debate over the moral challenges of medical training, and the power of medical maxims to propagate in the culture of medicine, we argue that clinical educators should consider the first lesson of “first, do no harm” with medical trainees in mind. When one imagines a physician teaching “first, do no harm” to a room full of students, the precept echoes not only in the “major key” of patient care but also in the “minor key” of a trainee's formation.

We recognize that, at least traditionally, the harm principle was limited only to the consideration of patients (Veatch 2012, 177). At the same time, a multi-valent reading of primum non nocere might refresh the moral discourse in contemporary medical education, not only regarding the care of patients but also the responsibilities shared between learners and teachers—particularly among educators eager for new ways to frame the phenomenon of burnout and clarify the nature of the moral burdens endured in medical training. In revisiting this famous maxim, we not only aim for a richer moral discourse but look toward what we believe is fundamentally a need for spiritual renewal—aiming to “bring the love back” to the great work of teaching the art of healing (Rosenbaum 2024, “Tough…”; Tate and Clair 2023).

First, Teach No Harm: The Teaching Physician as Moral Exemplar and Coach

Before considering “first, do no harm” in medical training, it is important to name the physician's duties to the one she teaches. While the constitutive role of the medical doctor is typically viewed as one who seeks to preserve or restore the health of the sick (from mederi, “to heal”), the pedagogical responsibilities of the physician have also been emphasized historically (Kass 1985, 240–1; Marti-Ibáñez 1968, 5; May 2000). It is well known that docere, from which “doctor” is derived, means “to teach.” A medical doctor is, at least etymologically, one who heals and teaches to heal. ¹

We see in the Hippocratic Oath a promise made not only to care well for patients, but to consider the fundamental responsibility to teach others within the guild and to foster an enduring respect for one's teachers (Edelstein 1967; Marti-Ibáñez 1968, 9). It is perhaps overlooked just how surprising it is that the Hippocratic Oath describes obligations to one's teachers before clarifying obligations to one's patients (Kass 1985, 240).

This pedagogical foregrounding and responsibility are not confined to mere inculcation of technical knowledge. Physician-teachers have a profound hand in the moral formation and character development not only of their patients (Edelstein 1967; Kass 1985, 241) but also of their trainees (Eberly and Frush 2019; Kinghorn 2010). This feature of contemporary training has largely been characterized in its negative form, now well known as the “hidden curriculum” (Hafferty and Franks 1994).

The implicit language and behind-the-scenes actions modeled by superiors often hold more purchase in the formation of trainees than the explicit ethical curricula taught in medical professionalism seminars or clinical ethics PowerPoints (Kinghorn et al. 2007; Lehmann et al. 2018). Many of the conspicuous, formal lessons of medicine smuggle in inconspicuous, informal lessons that shape the character of one's life and practice. The word “character” itself comes from the image of branding, charassein—of hot metal making a lasting impression upon the self (Han 2017, 49). Many have described medical training as a crucible that burns away the dross to forge something tempered and resilient; medical training is also the kind of process that can leave scars.

A first step in attempting to apply “first, do no harm” to one's trainees is for the physician to acknowledge her identity not merely as a gatekeeper of medical information or purveyor of technical skill, but as a role model and teacher of the moral art of healing. The tradition of medicine depends firstly on commitment to the good of the sick and secondly on a commitment to the good of those who take up the art after us. This is not an optional role that can be shrugged off on chaplains, humanists, or clinical ethicists (though we welcome and yearn for our colleagues in these disciplines to also recognize their role in a medical trainee's moral formation). The physician's role as moral exemplar is a reality that will manifest regardless of the seriousness with which the teacher takes responsibility for it. To forsake one's responsibility as a moral model would be akin to rejecting one's duty to the health of the patient, as the tradition of medicine includes the recognition of passing on what habits one has learned (or inured) in caring for the health of patients—captured in another of medicine's most famous aphorisms: “Watch one, do one, teach one.” To ignore or downplay this role undermines a physician's central duty to their trainees, and by extension—to their patients (Ramsey 1970). ²

Like a good surgeon recognizing her patient in pre-op, the good teacher gazes upon her student with “first, do no harm” in mind. The physician-as-moral-teacher recognizes her trainees as moral agents, knowing they may experience an irrevocable “scar” on their lives simply by going through medical training. The physician-teacher does not look at her students merely as empty vessels to fill with information and technique but as moral friends to whom she has the privilege of willing and seeking their good (Curlin and Hall 2005; Kinghorn 2010).

The teaching physician has the opportunity to embrace a richer vision of medical education, taking up the moral adventure of encouraging and prudently challenging their trainees for the sake of the learner's moral edification, character growth, and training in conscience (Eberly and Frush 2019), especially in a season of medical education we sense is desperate for hope, fortitude, and joy while hesitant to employ the language of “love” (Rosenbaum 2024, “Tough…”; Tate and Clair 2023). There is precedent for this: as the American Medical Association policy on teacher–learner relationships in medical education reads:

In the teacher-learner relationship, each party has certain legitimate expectations of the other. For example, the learner can expect that the teacher will provide instruction, guidance, inspiration, and leadership in learning. The teacher expects the learner to make an appropriate professional investment of energy and intellect to acquire the knowledge and skills necessary to become an effective physician. Both parties can expect the other to prepare appropriately for the educational interaction and to discharge their responsibilities in the educational relationship with unfailing honesty (AMA 2020).

We appreciate the AMA clearly naming both “inspiration” and “unfailing honesty.” This hints at both character formation and moral awe undergirding the teacher–learner relationship in medical education. A parallel vision has been put forward by master medical educators who have proposed the physician-as-teacher role best be understood as a master musician or coach (AMA 2024; Gawande 2011; Kinghorn 2010).

Coaches play a central role in helping those who learn from them recognize that the inherent difficulties of training may be edifying, while also distinguishing those burdens that harm without constructive benefit. In the world of writing, music, and athletics, for example, trainees learn to embrace what is hard in order to achieve the kind of mastery, intuition, and confidence that can only come with enduring challenge and submitting to the hard-won wisdom of a skilled master or moral exemplar (Gioia 2021, 249; Kinghorn 2010^; Lewis 2008). We have in mind here the dancers who receive the austere teaching of a prima ballerina; the metalworkers hammering through long repetition under the watchful ideals of the seasoned blacksmith; the martial artist enduring the expectations of a grandmaster; the writer who learns slowly and painfully to embrace the cuts of a good editor.

And yet, the “no pain no gain” mentality that often marks the athletic or artistic worlds has been rightly called into question within the realm of medical education (Rosenbaum 2024, “Injured…”). Obviously, the analogies can only be drawn so far. In medicine, the lives of others are at stake. Medical students and residents are not training for a race or a recital—but a life in service to others at their most vulnerable. Moral stumbling blocks abound.

If “first, do no harm” is to be applied to the teacher's relationship to the learner, it raises the question of what we mean by “harm” in the context of medical training. It is to this challenging task of the teaching physician that we now turn—to distinguish what is merely “hard” in medical training from what is truly “harm” to the medical trainee.

“Harm” vs. “Hard”

At the risk of stating the obvious, medical education is difficult. Trainees willingly delay reward, take on debt, and embrace a work that will hold them under constant scrutiny and threat of litigation—walking what theologian William May called the “high-wire between deep respect and deep resentment” (2000). Medical trainees sacrifice time, geographic freedom, financial stability, bodily health, familial delights, and communal obligations to take up the demands of caring well for the sick and suffering.

The challenges of medical training have been historically understood as intrinsic and irreducible—one need only engage any popular depiction of residency training on television, in sociology, or in memoir to appreciate this assumption (Bosk 2003; Elliott 2024; Hafferty 1991; Kalanithi 2016; Lawrence 2001). As physician Lisa Pryor writes,

The job of a doctor in training is unspeakable. It is hard to find the words to describe what we do. It is hard to work out whom to tell. We cannot speak of these things to people outside medicine because it is too traumatic, too graphic, too much. But we cannot speak of these things within medicine, either, because it is not enough, it is just the job we do, hardly worth commenting on (2017).

And yet, there is a resurgence of attempts to not only “speak of these things,” but disentangle the inherent difficulty of training from excessive “harm” (Rosenbaum 2024, “Beyond…”). To a large degree, contemporary medical education parlance frames the harm of medical training as moral in nature, drawing on military, nursing, and other contexts to employ a wide spectrum of descriptors including moral “suffering,” “injury,” “trauma,” “stress,” “distress,” “disorientation,” “dilemma,” “loneliness”—even “moral bruising” (Cahill, Moyse and Dugdale 2023; Kim 2024; Kim, Shelton and Applewhite 2023; LiVecche 2021; Mason 2024). “Moral injury,” for example, is defined as “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations” (Litz et al. 2009). Bound up in this idea is an insult to one's own moral agency, of operating in an environment that constrains fitting action.

Examples include the complicity and lack of agency trainees feel as “cogs” within corporate medical systems seemingly prioritizing throughput, bureaucratic efficiency, and profit over patient health and meaningful work (Blythe and Curlin 2018; Rosenbaum 2024, “On Calling…”); of obligatory administrative and documentation responsibilities obscuring clinical care (Mamykina et al. 2016); of trainees tasked with difficult decisions of resource utilization under conditions of scarcity, made most overtly manifest in the COVID-19 pandemic (Buchbinder et al. 2023; Farrell and Hayward 2022); of participation in actions that trainees come to regret (Kim, Shelton and Applewhite 2023); of disproportionate burdens endured by female trainees working within a historically male-dominated field, and particularly those dealing with the unique challenges of childbearing while training (Casilla-Lennon et al. 2022).

Such moral experiences do not always involve ethical dilemma. Moral descriptors are often employed to capture the quotidian experiences of training: the existential dissonance between what one aspired to and what they have become; participation in dehumanizing humor and misanthropy; overt verbal abuse, discrimination, or coercion experienced at the hands of one's superiors (Curlin 2016; Eberly 2020; Ellis 2021; Elliott 2024, 2–5; Finn et al. 2022^; Hu et al. 2019).

The sound teaching physician who considers her trainees under the auspice of “first, do no harm” must undergo the challenging work of close listening, watching, and self-assessment in the teaching environment—seeking to identify those potential sources of moral harm she might be prone to impart on the trainee with whom she works. This task looks different for the intern, supervising resident, attending physician, and program director. For the intern, it might involve an honest reflection upon the language she uses when describing challenging patients or frustrating co-workers, and the recognition that such language powerfully frames the way her future learners may come to imagine these relationships.

For the supervising resident, it might involve seeking to protect the intern and student from work they are not yet sufficiently equipped to handle, while also shepherding them through the work they must do regardless of their readiness. It might involve creating a workroom culture or atmosphere of rounding that fosters curiosity, excellence, and mutuality rather than cynicism, insecurity, or belittlement (Frush 2010).

For attending physicians, this might mean setting an example in moral description, recognizing they will set the tone for the teams they supervise, naming not only clinical expectations but moral ones (Curlin and Hall 2005). For the program director, detecting and avoiding harms might involve systems-level questions of how to structure just and humane work conditions while cultivating a culture open to honest feedback from trainees (AMA 2020) and resistant to passivity or conformity (Harven 2024). Such initiatives should involve opportunity for open conversation, but should also reflect material commitments to resident health, including robust parental leave programs, protected areas for breastfeeding within workspaces, and housing subsidies to ensure safe and proximate housing during training.

This leads the conversation to an important point of clarification and grammar. In this essay, we are turning the primum non nocere aphorism in the light to cast its reflection on medical trainees. As one imagines what different forms “harm” can take for young physicians, it is worth noting that we have observed the language of “moral injury,” “trauma,” and “harm” being used in ways we sense are not only imprecise but inaccurate—at risk of becoming an umbrella term by trainees who seem to be merely perceiving discomfort (Rosenbaum 2024, “Building Up…”).

For example, it is not clear to us that trainees are “morally injured” or “harmed” by having to stay late to finish notes because a patient became sick, or because an attending physician provided clear but critical feedback, or because a colleague became ill and a last-minute change in coverage was needed, disrupting a long-awaited weekend off. To us, such examples seem part and parcel of the “hard” of becoming a good physician. We see the “umbrella-fication” of these moral descriptors to be further evidence of the lack of moral discourse within medical training—contemporary learners and teachers are grasping for what they sense deeply but cannot describe clearly. As one medical trainee put it to us, “We know it is hard. We need someone to tell us why it is hard.”

We do not mean to belittle or undermine the experience of trainees who sincerely draw on the spectrum of these moral terms to capture what they feel and perceive—especially the way seemingly trivial challenges can wear one down overtime. Rather, we recognize the complexity of these moral descriptors and contemporary attempts to disentangle them, even as we do not take up such a task in this paper. We celebrate those who are wondering if and when “injury” or “trauma” are appropriate words to support a trainee's agency, or whether terms such as “moral distress” or “dilemma” are more fitting for the experiences at hand (Cahill, Moyse and Dugdale 2023; Kim, Shelton and Applewhite 2023).

In a contemporary context struggling to find moral articulacy for the challenges of medical training, “first, do no harm” may offer a fitting place to begin such a conversation anew with medical trainees. Nuanced and messy as it is will be, we hope medical educators will invite students and residents to wonder together what “hard” parts of training can be distinguished from true “harm,” and how one might, in relationship and camaraderie, embrace what is difficult about medical training with candor and grit while resisting what is harmful with courage and reform.

Harm Despite “First, Do No Harm”

It is here that an uncomfortable truth must be acknowledged—that harm cannot always be avoided, even when conversation and community are opened to name and anticipate it. This reality is central to considerations of the primum non nocere injunction itself and its attendant controversy.

It is increasingly rare to identify a medical intervention (either diagnostic or therapeutic) that does not entail some possibility of harm. An easy example is surgical intervention, which involves direct morbidity visited upon a patient while seeking to preserve or restore their health. Yet even more seemingly benign forms of intervention—from a chest radiograph to antibiotics to even talk therapy—entail some risk of harm (Stegenga 2018). Intention, accountability, and communal wisdom (both inside and outside of the medical guild) are critical for discerning harms and right practices (Boyte 2009; Doherty and Mendenhall 2006; McCarty 2018).

To be sure, the presence of such potential or definite harms has amplified in the millennia since the genesis of the “first, do no harm” precept, given the expansive technological advances made since that time, and in which the “number needed to harm” is given far less attention than the “number needed to treat” (Stegenga 2018). This fact calls into question the appropriateness of primum non nocere as a guiding principle to patient care today.

In a similar vein, we argue that there are not merely irrevocable “hard” elements of medical training, but that there are also ineliminable “harms” that trainees will sustain in their education despite the best efforts of even the most thoughtful and exemplary supervisors. We hope naming this reality offloads some of the burden we have placed on the physician as moral exemplar and coach. We recognize it is the empathetic, spiritually attuned, and morally sensitive teacher who gazes upon her trainees with “first, do no harm” in mind who might also be the most prone to ascribe upon herself an inappropriate guilt for those harms which are unavoidable in the lives of those she is teaching.

Examples of clearly avoidable harms involve physical abuse to trainees, verbal denigration, and sexual coercion and harassment (AMA 2020). Examples of unavoidable harms are more difficult to neatly delineate, and especially difficult to distinguish from what is “hard.” For example, medical students and trainees will inevitably witness profound and intractable suffering throughout their training. They will participate in care that will seem to them futile. They will be asked by patients to do something they cannot do or instructed by superiors to participate in practices that may conflict with their moral vision of good medicine. Medical trainees will be exposed to bodily fluids of every type, sicknesses with varying degrees of infection risk, and will, regardless of specialty choice, experience long hours, sleepless nights, rushed meals, and errors in judgment and communication.

These realities bear a mix of what is hard and what might make for harm—crossing a spectrum of relational, clinical, and ethical frictions inherent to the story of medical training as we have experienced it both as interns and as chief residents. In some cases, potential harm for trainees strikes us as unavoidable in the way that suffering itself is unavoidable in the life of any human being. In recognition of this, we hope teaching physicians will recognize the role of relationships open to moral discourse and debriefing. We envision the physician who might say to both patient and student, “Can we speak together about what you worry will be harmful and what you sense will be hard? Here is how I am going to first avoid harm; and here also is what I expect will be hard. But in both, I will walk alongside you as long as you would have me do so.”

From Harm to “Reharm”: Reincorporating the Story of Good Medicine

Earlier we drew on the discomfort one experiences learning to dance or practicing an instrument as a metaphor for accepting the hard parts of medical training and practice. We also drew on a musical metaphor to consider the aphorism “first, do no harm,” in both the “major key” of patient care and the “minor key” of trainee education and moral formation.

To further extend a musical allegory, the concept of reharmonization or “reharm” has captured our imaginations as we consider “first, do no harm.” In the jazz tradition, when a song is “harmed” by an aggressive change to the original melody, a master musician can “reharm” the music, composing such that what was once thought a mistake or notes thought dissonant and discordant can become the passing notes or grace notes of the final composition. The mistakes are not rendered “good” in and of themselves—but might become good in so far as they are brought into the fullness of the final musical experience. The harm is somehow tempered (though not expunged) as it is “reharmed” through reharmonization (Berliner 1994). A similar example from the theatrical tradition is that of reincorporation. This is a form of storytelling that “does not set out to create the future, but responds to the past, reincorporating it to form a story” (Wells 2004, 147). Reincorporation and reharmonization are both acts of imaginative response to prior harms.

Both metaphors also hint at the importance of storytelling in a moral community—of harms interrogated and healed in collaboration with others who share in the work. This is not a vision of moral formation dependent on more polished reflection exercises, individual wellness days, or other techniques to avoid burnout in private. Rather, this captures a vision of harms reharmonized or reincorporated in partnership, mentorship, and friendship.

We realize this vision can only go so far. As the poet and essayist Wendell Berry writes, a metaphor must be “controlled by a sort of humorous intelligence, always mindful of the exact limits within which the comparison is meaningful” (Volck 2022, “Examine…”). We do not want to suggest that the harms of medical training can be easily covered up or neatly baptized in poetry or metaphor (Benson 2011, 317–8; Carlton 2014). And yet, even the “notes” that might be heard as harmful error can be reharmonized in the community of master musicians and trusted poets into unexpected lessons and transformative encounters (Berliner 1994; Floyd 2021; Lear 2008).

As recent medical trainees, we have both experienced this phenomenon. Some of the most negative experiences we encountered in training—experiences that were not just hard but harmful—have over time allowed us to see things we would not have seen otherwise. Through instances in which “first, do no harm” failed, we have developed our own pedagogies in intentional counterpoint. Whether these experiences entailed verbal abuse, situations where we felt compelled by superiors to participate in care we viewed as wrong, or perceived complicity in providing insufficient care to the most vulnerable patients we served, we nevertheless gleaned important moral lessons from these instances even if we would not choose to endure them again.

Indeed, it often took master teachers, spiritual directors, clinical coaches, and trusted peers to give us the eyes to see and ears to hear such lessons. For here is a final difficult truth: while medical education may enjoy a treasury of aphorisms and clinical pearls, it is not clear to us that contemporary medical education sets a table for healthy moral and spiritual formation. Medical education seems more likely to harm than to merely expose one to what is hard. As such, the primum non nocere aphorism, like all medical maxims, depends on the moral soil over which it is sown.

There exist traditions of wanting to make clear and apparent terrible harms even as they are reincorporated into the surrounding culture as a necessary practice of remembering and retelling the story of that culture (Stevenson 2016). We draw on this to counter the suggestion that “reharmonization” is an easy, pleasant way to resolve what has been truly harmful. Rather, we argue it is a demanding and communal task, calling for a thick, nuanced account of the good that faces the truth head on and seeks to “reharm” where possible. Like good medicine itself, such work requires competence, courage, honesty, and humility.

We are mindful that such reflections might be perceived by some as a means to rationalize harms as ultimately beneficial. We reject this, pointing to the wisdom of Richard Rohr, “Don't go looking for suffering. It will find you. But when it comes, don't waste it” (Volck 2022, “The Gift…”). Where harm has been done, reharmonization is possible. But “first, do no harm” remains the first step.

We believe that even the most harmful experiences of medical training might bear redemptive potential—if the community that holds the medical trainee and teacher has the moral resources and spiritual depth to receive and heal such harm in companionship, truth-telling, and love. As Leon Kass wrote, “One cannot attach the man to the best precepts of the mind except by first winning his heart” (1985, 242). It would seem then that the physician-teacher who aims to pass on “first, do no harm” is bound by an earlier injunction: first, win the heart. Perhaps this is where the secret lies in contemporary medical education's struggle with burnout and moral injury, bringing love back to the art of healing and teaching alike.

Biographical Notes

J. Brewer Eberly, Jr., MD, MACS, is a third-generation family physician at Fischer Clinic in Raleigh, NC, and a McDonald Agape Fellow serving the Theology, Medicine, and Culture Initiative at Duke Divinity School. He is a former fellow of the Theology, Medicine, and Culture Fellowship at Duke Divinity School and the Paul Ramsey Institute with the Center for Bioethics and Culture Network. His scholarship focuses on the intersection of beauty, Christian practice, and medical education.

Benjamin W. Frush, MD, MACS, is an internist and McDonald Agape Fellow in Bioethics at the Kennedy Institute of Ethics at Georgetown University. He completed his hospice and palliative fellowship with the University of North Carolina Hospitals. He is a former fellow of the Theology, Medicine, and Culture Fellowship at Duke Divinity School; Paul Ramsey Institute with the Center for Bioethics and Culture Network; and Fellowship at Auschwitz for the Study of Professional Ethics (FASPE).