August 5, 2018 | by Rev. Dr. Fritz Ritsch
I have been following with interest a push among doctors, hospitals, medical ethicists, and lawyers to encourage medical professionals to apologize to patients when they make mistakes. What? apologize? Yes. The head of a Veterans Hospital, Dr. Steve Kraman, was one of the first practitioners of this in the late 80s. A patient had died after receiving a dramatic overdose of potassium. It was “undeniable error,” Kraman said, but the family didn’t know that it had happened and would likely never know how their relative had died unless the hospital told them. “We weren’t going to get sued,” he said, “but I still didn’t feel it was right.” So he and the hospital lawyer told the woman’s two daughters what had happened, and they worked out a settlement of $250,000.
Since then, people who promote medical apology have made a number of arguments to support their position. At the most basic level, apologies are ethical. They can answer questions, ease family’s suffering, and possibly ease the conscience of the medical professionals. An apology is more honest: even the best doctors and nurses are only human. They make mistakes.
At another level, it’s arguable that they are less expensive and less stressful than lawsuits. Only about 20% of those who sue doctors or hospitals ever win their case, whereas in apologies there are generally financial settlements. And when patients do win cases, their awards are huge; whereas settlements are more manageable.
But perhaps the most important reason for apologies, say advocates, is that if no one admits mistakes, no one learns from them. A hospital lawyer, Richard Boothman makes this observation. “You have to normalize honesty to create a culture of continuous improvement.” Applying the lessons gleaned from those errors, he said, has helped make care safer. “Litigating a case for three years and telling everybody, ‘Don’t talk about it and don’t change anything,’ is immoral and counterproductive,” he added. “I don’t serve my organization well by defending care we shouldn’t be defending.”
Now I realize that we have doctors, nurses and lawyers in this room all of whom might have strong opinions one way or another on this topic, so let me assure you I do not raise this to tell anyone their business. But a lot of the points the advocates of medical apology make align exactly with how we Christians have always understood the importance of confessing our sins. Confessing our sins is more honest: it’s an admission that we are flawed. Confessing our sins can relieve the burden of guilt and the stress of keeping them hidden. And most important, confessing our sins opens the door to continuous improvement, to admitting our flaws so we can continuously better ourselves–as our Presbyterian documents say, so we can die more to sin and live more to righteousness.
Our Old Testament reading today is Psalm 51, and it is credited to King David, supposedly written after David had been confronted by Nathan the Prophet for his unethical behavior. As we talked about last week, David raped Bathsheba, got her pregnant, and then had her heroic husband killed. There would be consequences galore to this kingly misbehavior: David’s son Absalom would die. “The sword shall never depart from your house,” Nathan warns him. Problems would plague his lineage and when his grandson ascends to power, the nation will split in half, north and south, and never recover. At some level, all these things happen as result of David’s sin.
Perhaps the most amazing thing about the story of David and Bathsheba is that it is in the Bible at all. After all, David is held up as the ultimate king, the greatest hero. For us Christians, we claim that Jesus is the Son of David, descended from David through his earthly father, Joseph: but we also mean that Jesus is the right and proper inheritor of David’s crown of glory and honor. But in spite of all of this biblical hero worship, we have this terrible story of David’s inexcusable abuse of power and of people. It’s an embarrassing story that doesn’t cast David in a good light at all, yet the Bible tells it of one of its greatest heroes.
Let me tell you, it’s not normal for people writing a hero-worshiping history to present their heroes with so many warts. Look at the way we ourselves whitewash American history, with some textbooks not even using the word slavery to define how African Americans were treated for three hundred years. We tend to write our own history with no apologies. Yet that’s not the case with the story of David.
It is as if the Biblical writers are themselves confessing a historic sin, and apologizing on behalf of their history for David’s mistake and its tragic fallout. It is as if the Biblical historians are practicing the art of confession.
There’s good reason to do that. As we all know, those who forget their history are condemned to repeat it. At its most basic level, we need to know what we did wrong so that we don’t do it again. As was said earlier, if you don’t admit your mistakes you won’t learn where you can improve. That applies to countries as well as individuals.
But at another level, keeping secrets of any sort creates a vicious cycle where ultimately everything starts to revolve around keeping the secret a secret. This is true in organizational and family systems and in our personal lives. Family therapists describe secret keeping as a black hole that keeps sucking you back as you try to move forward. I have found myself that sometimes a whole family’s behavior for the last fifty years can be explained by a secret that people started covering up three or four generations ago. The family members today may not even know what the secret was, but fallout from it continues to be a blight on their families, resulting in dysfunctional behavior that often can be corrected once the secret is uncovered.
All this goes to show that the saying “Confession is good for the soul” is very solid, practical advice based on empirical evidence. The biblical authors not only believe it, but practice it. They do not present the saints of the faith in the most saintly of lights. Abraham and Sarah are cruel to the mother of Abraham’s son, Ishmael. Jacob was a liar and a cheat. David abused his power. Countless rulers of Israel and Judah are presented in a negative light. Peter denied Jesus three times and the disciples in general are depicted like the Keystone Kops. Our faith is not one that presents itself in the best light, and there’s a reason. It’s because we don’t idealize ourselves. We are human, which means we’re limited, we’re flawed, and we’re sinners. By the miracle of God’s grace, somehow God has chosen that God’s saints be sinners. In fact, the most important thing we believe in as Christians is God’s grace–God’s unmerited and undeserved love for us, love that is a gift with no strings attached, love that covers our sins and empowers us to be better people. The whole idea of grace presumes that we are sinners, flawed, unable to help ourselves–and so we don’t have any room to be proud: we’re absolutely dependent on the mercy of God. That is grace.
So we sinners aren’t supposed to be lying to ourselves, and God, by saying we’re saints when we aren’t. God expects honest self-examination from God’s people. We are to shine relentless light on our darkest qualities, not because we want to feel bad about ourselves or because God needs to punish us, but because without that honesty God cannot improve us.
In his book, Life Together, the German theologian Dietrich Bonhoeffer observes that “A person alone with her sin is utterly alone.”
He critiques the church: “The pious fellowship permits no one to be a sinner. So everybody must conceal his sin from himself and from the fellowship. We dare not be sinners.” This, he says, is the opposite of what a Christian fellowship needs to be. Instead of isolating the sinner with his or her sin, we should understand ourselves to be a community of sinners, whose common ground is both our sin and the unearned grace of God which redeems us and makes us the church. Sin, Bonhoeffer says, wants to remain in the darkness; it wants to remain unknown; it thrives in isolation. But public confession–even if it’s only to one person–shines the light of community onto the isolated sinner. They no longer have to wrestle with their sin alone.
The idea of confessing your sins to another person–especially someone who goes to church with you!–may sound shocking and like you’re asking for trouble. But the problem is that, even when we confess our sins to God, it is often not enough. As Bonhoeffer points out we can fool ourselves. We can for instance, forgive outselves—we often do that!—and believe that it was God who forgave us. Often it is only when we confess our sin to someone—OR, as in David’s case, we are confronted by someone who calls us to accountability—can real redemption take place. That means that not only are we forgiven of our sin, but we move to the next stage—repentance, where we turn away from our sin, reject it, and stop doing it.
I have to say I have always admired the 12-step approach to this. I have a friend who is a recovering alcoholic, and a Christian, and he has two friends through AA that he’s had more than thirty years, also Christian, who he can call up and admit, “I’m thinking about drinking.” But it’s more than that. He can also say, “I’m tempted to do something dishonest” or “I’m thinking about leaving my wife,” and these friends can talk him down. And he can do the same for them. It’d be ideal if Christian community was more like that.
I do encourage us all to find a confessor or two. But the thing to remember is, not just anyone can be a confessor. In fact, some of our kneejerk reactions may seriously work against us. It is not always a good idea to confess your sin to the person you sinned against immediately, and then hope that he or she will immediately forgive you. No, no, no. Don’t let your guilt drive you to make an impetuous mistake that may not only hurt you but quite possibly someone else, who may be crushed to discover what you’ve been up to. Find someone else—a good friend, a pastor, a counselor. Someone who you know will hold you accountable. Someone whose advice you value. Someone you know will still be your ally when all is said and done.
But make sure it is someone who will hold you accountable. One of the problems of modern psychology and counseling is that people can confess their deepest secrets and then believe that simply confessing them is enough. The counselor doesn’t necessarily hold them accountable to change. And indeed, that can be good, because a lot of things we think of as sins may not be sins at all, but things that we have mistaken for sin, or that society defines as sin, but may not really be wrong.
Still, we need to confess to someone who will challenge us and not let us off the hook. Someone who will call us to be better people. As a genral rule, the best person for that is another Christian, someone who stands under the cross of Christ, aware of his or her own sin, and so they do not judge, but can still call us to to a better way to live.
So today I invite you to reflect seriously on the importance of confessing your sinfulness–to God, to yourself, and also to another. But I also invite you seriously to examine yourself: are you the sort of person to whom another person could confess their sin? Are you someone with the kind of humble awareness of your own flaws that you wouldn’t judge another person for theirs?
All of us have that person inside of us, someone who can listen to a confession. And all of us need to confess.
And all of us will certainly receive God’s grace.