 First and foremost, I believe that for any physician to be effective, he or she must take the time to understand who it is we're trying to help. And Dr. Bergen touched on some of this, but let me go over it in a bit more detail. Dr. Erica Sell, an internist in bioethicis, has this to say, unlike other objects of science, persons cannot be reduced to their parts in order to better understand them. Yet it is useful in understanding the relation between suffering and the goals of medicine to look at a simple topology of persons. Dr. Cassell reminds us that a person has a family and a past. A person has roles. A person has a cultural background that contributes to beliefs and values that can play a part in the effects of disease. A person has a relationship with himself or herself. Persons do things in the world. Each of us has a secret life. Sometimes it takes the form of fantasies and dreams of glory, and sometimes it has a real existence known only to a few. Everyone has a transcendent dimension, a life of the spirit, however expressed or known. Every person has a perceived future. Hope is one of the necessary traits of a successful life. Every person has a body and a mind. Disease can so alter the relationship that the body... The body and mind is no longer seen as a friend. Healing is human also lessens the frail sickness and the disease that's flying and the personality of the sicknesses and the haters that predate the illness. A result from, as I mentioned, family dynamic is unique in each individual circumstance. Well, this is what it is, what it's meaning is, what doctrine is all about. When I founded the heal and negotiate effective meetings, often fraught and difficult around me, one was to be able to call on philosophy or psychology on religion and literature rather than just science. There are no algorithms, blowcharts, tables, or graphs to guide away. To be effective, one must have an empathic response to us, a learned patience, an attitude of humility, a stance of honesty, and a willingness to reflect on one's failures in order to do better the next time. What else is one to do? As a doctor, when one is just down to something, a stranger, yet for the first time, someone is sick or in pain or worried or heartbroken or depressed, someone who is suffering. I make a connection to that person. I'm establishing a relationship with that person. One of the things that we do understand is respect and trust. What does that mean to the face of the form? What does it mean that I'm getting this on and asking these questions about his life, the family, the background, the work life, personal habits, state? It means that I care enough to ask, but I want to understand that particular individual. I'm looking for clues that if this person's life, knowing that I might not ease or pain or suffering, make the correct diagnosis, forming the head of the language about it, meaning that he needs to cure it. But this is not enough. It's delineated by the four principles of medical ethics that Dr. Bergeron touched on. Autonomy, which in a free society puts the ultimate decision-making power into the hands of the patient or a legally appointed surrogate decision-maker. Non-maleficence admonishes physicians as to what we must not do as professionals or stated in another way as it is in the Hippocratic Oath. First, do no harm. Justice, the fair allocation of scarce resources, operates on a higher plane than the doctor-patient relationship, and while all of us have a responsibility to work to change the paradigm where need be in the main, these justice issues are ultimately societal and legal ones. Beneficence, which can also be defined as doing the right thing, the kind thing, the compassionate thing for that individual, unique human being that comes for help, is the ethical principle that requires a positive emotional investment on the part of a medical professional as we teach our medical students here. And as Dr. Bergeron mentioned at this center, we must be able to imagine the patient's experience. Imagine the patient's experience. This is our mantra. As physicians, we must be patient, we must be present, must give of ourselves and of our time. No matter the hour, our level of fatigue, the terminal in our personal life, our own needs at the moment, we must reach deep inside to the well and empathic responsiveness. The idealism that we know is there, that essence of humaneness that brought us into medicine in the first place. As long as human doctors minister to human patients, the intuition and the empathic responsiveness required to successively negotiate the doctor-patient relationship will be a cornerstone of medical care. And the wisdom that my colleagues, the Rinpoche and the Rabbi on this panel tonight bring to our discussion and our ongoing self-analysis and self-discovery are essential to this process. Thank you very much. Should I just leave this here? There's a whole bunch of stuff up here. Computer with all kinds of pictures. I don't know whether I'm supposed to appreciate it, but it looks great. Thank you all very much. I'm delighted to be here. My understanding is that the purpose of this conference is to situate suffering within the context of three perspectives, first and foremost within the perspective of the practice of medicine, and then in clarifying and evaluating Western and Eastern religious approaches. That at least is my understanding of what we're doing. Now what does disease mean to a person? A doctor has to somehow ask and answer that question. And how does a person who is ill integrate this illness into his or her sense of self? And my point of view here is to somehow ask and answer the question of how can religion provide a context within which such an integration can take place? Now as I understand my responsibility, it is to provide the perspective of the Western approaches. Now let's be clear to speak about Judaism, Christianity, and Islam, which is the approaches I'm supposed to be discussing within the context of 15 minutes is not going to be not only difficult, it's impossible. It's impossible not only because of the limitations of time, but even more so it's impossible because of my personal limitations. I'm in no sense an expert really in any of these three religions. Even within Judaism I only have some deep knowledge within one small aspect of it. But if we were to look at what the Western world is, the Western world is a product of a number of spiritual and intellectual resources. It's not just Greece and Rome, Judaism, Christianity, Islam. And all these traditions have much to say and there's a vast literature when it comes to what they have to say about suffering. Now my definition of suffering because I think if we're going to be talking about suffering let's at least agree on some definition. And here there may be an issue as to whether this is a definition that would be universally accepted. But I would define suffering is that which hinders the full realization of the true or authentic self in an authentic society which is organized to bring about such a realization. So that suffering isn't just an individual thing. It isn't just whether I'm in pain or not in pain, whether I'm fulfilled or not fulfilled, but whether I have some contact with that which makes me authentically me and do I fulfill that and am I in the context, in a social context where such a fulfillment is possible. Now from a Jewish perspective and here I would say we have similarities in both Christianity and Islam and I'll say some words about that presently. Suffering comes from trying to realize a false or inauthentic self. That is doing what is destructive to oneself. And suffering comes from doing often not the wrong thing, not the destructive thing, but suffering also takes place from doing the right thing. Now that's a very interesting paradox. Why is it that suffering also comes because there is unconscious mechanical suffering and there's conscious, self-conscious suffering? Now let me try to illustrate that by telling a midrash about Moses. Now a midrash is a rabbinic way in which they try to make a point. The story is told that Moses who had gone through the wilderness freed the people of Israel, the Israelites from Egypt and one of the kings who really have heard about Moses he sends his most famous portrait artist and he says make a portrait of Moses and when we look at that portrait we will then be able to bring that portrait to the physiocrats and the physiocrats will use their science to tell us what Moses was, what made him such a great leader, what made him such a great hero. So the fellow goes, he makes this portrait and he comes back and the physiocrats have their way at it and they come to the following conclusion. Moses is dogmatic, he's arrogant, he's selfish, he's angry, he's hot tempered, he's vicious, in other words he's no good. He can't believe it. So what does he do? He then himself goes to see Moses as he says to Moses, I can't believe it, the portrait is accurate, it's exact and the physiocratic science is certainly true. So how can you explain it? And he says I'm even worse than what your physiocrats have said. He says I am selfish and he says no that can't be the king says after all how can you be selfish when when Joshua said to you don't you see these people of prophesying that they're taking your place and didn't you say would that all God's children be prophets? He says yes that's true, I did say that and isn't it true when the children of Israel were ready to go back to Egypt and say we're going to captain and they started stoning you and I said I'll make a great nation out of you a great nation out of you and I'll destroy them he says wait a minute you can't do that because you're a God who keeps his promises. Isn't it true this king says to him that when you were ready to go into the promised land you were unhappy because God brought you out of Egypt to take you into the promised land he wouldn't let you enter and didn't you say I understand why I cannot enter because by entering the children of Israel would remain children and never grow up so how can you say to me that you're even worse and he says let me tell you something the hardest thing that I've ever had to do is to confront the worst in myself and overcome it to confront the worst in myself and overcome it see there's suffering that you do because we do stupid things we do silly things we do selfish things but there's also suffering that comes from doing the right thing isn't it interesting when you have the prophets of Israel take Jeremiah for example or Amos or Isaiah or any of them they say seek good and not evil that you may live that's what Amos says look at the imprisoned Jeremiah so the question that dawns on us that there's also suffering because we do the right thing it is by trying to make ourselves better because we have to look at the worst in ourselves and also we have to make the world better because from a Jewish perspective this is an unfinished world now let me tell you the great sage Hillel put it very well if I'm not for myself who will be for me but if I'm only for myself what am I now I think in a way that's very true because most of us say that the most important thing is to be selfless and try to be good to others when in reality we have to stand for ourselves but most people misunderstood what Hillel really meant let me tell you what I think he meant he meant the following he said if I'm not for myself and this is very interesting he says perhaps a quote a sage said that what Hillel meant was that perhaps one of the most embarrassing and disconcerting experiences that anyone can have is when a person is counted on to do something of importance or when we're in a predicament where we were counted upon and asked to fulfill a task and we were not up to it for lack of self-preparation we didn't think enough of ourselves to be able to prepare ourselves to really stand up and be counted and so therefore what happens is you feel guilty and there's two kinds of guilt two kinds of guilt there's guilt which is experienced when I'm called on by another and another makes a demand on me that I recognize the legitimacy of that demand and I fail to respond when someone counts on me and I didn't do the right thing and I feel guilty but there's another kind of guilt and that is when I lead my life and I wake up one day and discover that I never really did much with it that God gave me a soul God gave me a divine spark and I missed I failed to be fully and really myself there's a wonderful story about Rabbi Socia he says when he was ready to die he was crying and the disciples say how could you be crying you are a saint, you're a wonderful person he says when I die and go to heaven God isn't going to ask me why weren't you Moses or why weren't you Joshua but he's going to ask me why weren't you Socia and what does it mean? it means that when a person dies on judgment day he will have to account in a very specific way what did you do you who had the power to ameliorate so much pain and didn't do it you who had the power to rectify the evils in the world you who had the power to do it now that's suffering of a different nature there's this sad profound feeling that I've missed it now the point that I want to make here is this that if a person who feels that their life has been fulfilled engages has a disease or is troubled or goes through the whole agony that doctors deal with if a person feels that their life has meant something that they have loved and they have been loved that they have been understood you see most people think that people want to be praised that's not true what people really want is to be understood they want to know that there's someone there who really knows them from within but if they've locked that then disease can be a terrible terrible terrible experience because I would say that it's the religious context within which makes one capable of understanding what that disease will do to you and so my own fundamental approach to this is that we have to actually find a way in which we can be in touch with our creativity which that which makes us fully human which that which makes actualizes the true self the soul of a person and by actualizing that soul of a person then perhaps we can face and confront that disease whatever the disease may be whatever the pain may be whatever the suffering may be with a sense of hope with a sense of trust with a sense that there's an ultimate meaning to life and to the world if you don't believe that because then life is a tale told by an idiot in Shakespeare's words full of sound and fury signifying nothing Judaism believes that one should never cure one's own hurt by hurting others on the contrary one should cure one's own hurt by helping others and isn't it true the very people who have done the best who have suffered I have a friend who died because he was he had a disease that ravished him so what did he do he built a center the Columbia University Diabetes Center which has become a state-of-the-art center he wasn't bitter he said what ravishes me I have to do what I can to help others who suffered like me and perhaps the worst thing that can happen to a person he's not worthy or merits being dependent on there's a rabbinic statement that says if a man has two cows one strong and one weak who is he going to put the burden on on the strong or on the weak well the answer is pretty clear he's going to put the burden on the strong and the great tragedy it seems to me is that there aren't that many people who will take upon themselves this burden because perhaps the sentiment gradually established itself that the mark of the grandeur of a human being is to be asked to bear more than his share of the burden and by the same token the supreme degradation of the low and the base is to be taught not worthy not worthy of being ennobled through bearing the sins and sorrows of others in this sense I think that the Jewish tradition establishes a base which is built upon in the Christian tradition in a way it's different because the emphasis is different but you see what Christianity as I understand it and I teach in a Catholic school for 16 years I've taught at St. Thomas Aquinas University I don't understand it what Christianity says is a God who simply promises redemption cannot engender the same depths of conviction as a God who not only promises but as it were delivers through incarnation and resurrection you see the difference in Judaism the great great prophet takes on the suffering and the guilt whereas what you have in Christianity is something radically different what you have in Christianity is where through the incarnation you have a human being God becoming a human being who then takes on the guilt not just the suffering and this is a difference it's a fundamental difference between Judaism and Christianity in Judaism we believe that each individual takes on the guilt and has to find his own redemption in Christianity you have it secondly I would say that you have a different concept of judgment because as I said before in the Jewish tradition judgment means basically that you are judged but you have a chance to say you know you have a chance to render an account of yourself it almost it's like a dialogue with God and in the Muslim tradition it's very interesting the judgment day in the Muslim tradition is where all and final justice takes place namely God's justice will be fully and finally shown and that basically is that every time we are tested and from the Muslim point of view we are continually tested we have to somehow pass that test so in conclusion I would say that the Jewish tradition basically affirms that God is behind everything God creates everything God gives us a soul God gives us the possibility to realize that soul through free will and in trying to do that we make a lot of mistakes but we have an opportunity yearly on Yom Kippur which we just recently celebrated to come to terms with who we are and to be a different person because of the opportunity to change so in a sense the Jewish tradition is both tragic and prophetic tragic because yes we have some infirmity some flaw that may do us in but it's not over we can also look at that flaw we can look at that infirmity and become a different person become a new being become a new creature and through becoming that new creature and I think the Jewish tradition says to everyone who is in pain and who is suffering you are more than your pain you are more than your suffering you're even more than your body you're a soul that is eternal thank you very much just kidding good evening as I understand that I'm supposed to speak here and represent the view of Asian philosophy or spiritual traditions understanding of what is happiness no suffering so if you still feel that we need more discussion on sufferings some more and so well like Rabbi said earlier that it is a huge sort of a treasury of wisdom to cover when you say the Asian tradition we have Hinduism Buddhism Jain Jainism Islam and so on there's so many and so what I have been trained in and also most familiar with is the the Buddhist tradition I was trained in Buddhism Buddhist philosophy and meditation I will speak mainly from the Buddhist point of view which also in many ways is shared with Hinduism and also you know for example where I grew up in India we have so many religious schools and spiritual traditions even within India like Hinduism Buddhism, Sikhism and so many you know I don't know if I can even count so anyway I will basically mainly from Buddhist tradition and a little bit of Hindu and so suffering in Buddhism the word for suffering is dukkha dukkha dukkha sorry speak right into the microphone let me change this one I think that's better so is that loud enough or louder so the word for suffering is dukkha dukkha it's really interesting because the connotation for this word in Sanskrit ancient Indian language does not really translate into what we call suffering the word dukkha means this quietude or not at ease or dissatisfaction or a condition of being disturbed okay that's how we sort of understand the word in what we call suffering okay and so in this point of view the primary problem so to speak is the is not really a suffering itself but the concept of suffering right the concept of suffering that the label that we give to this experience you know which we call dukkha then when we label it and have this concept of suffering then that actually brings more suffering that is the problem basically and the spiritual view here is that whether we realize it or not all of our experiences have slight how do you say quality quality or this element of dukkha this element of dukkha provides all our experiences whether we call it suffering or happiness right there is the sense of dissatisfaction there is the sense of sometimes uneasiness anxiety or even a state of condition being a little bit disturbed and so therefore suffering is not seen as something unique situation or state in our life it's a kind of funny question to say do you have suffering or I have suffering or not because the belief here is that all our experiences have this underlying quality of dukkha to a certain degree the sense of dissatisfaction right and so therefore the sense of suffering here is discussed in three different aspects there is the sense of suffering of suffering which we usually call suffering the pain the mental pain and in the real sense uneasiness or disturbed state and this is what we call the suffering of suffering which we are mostly discussing about in let's say healthcare situation as well as the spiritual care for people in pain and so on dealing with the situation of suffering of suffering which is very wonderful experience isn't it and secondly we have this presentation or understanding that the suffering of change suffering of change which we always discuss in the context of let's say aging for example aging is a suffering of change and so the Buddhist teaching and also I think we share with the Hinduism is that the fundamental suffering really is this suffering of change you see change that we cannot avoid right whether it's a positive change or negative change it doesn't matter but whenever there's a change there's some suffering, there's some pain there's some uneasiness there's some anxiety that's what we call suffering here again change and thirdly it's a little bit more kind of subtle level of suffering which we call all pervasive suffering all pervasive all pervasive suffering is this sense of a basic heart of dissatisfaction right basic experience of dissatisfaction whether we have ten dollars in our pocket or a million dollar in our bank account both guys who have ten dollars or million dollars we both have certain suffering of dissatisfaction and so anyway I won't go into the details of these categories and so I hope the basic idea of what Dukka is is clear for us at this point it's basically this fight dissatisfaction and so from the hardest point of view the problem here in the beginning is we have difficulty in accepting the suffering we go through a lot of it tonight and so the first stage the first point I want to talk about here from the hardest point of view is accepting the suffering you know accepting the suffering which is basically acknowledging who we are right acknowledging who we are we as a human being a sanctioned being go through these stages of changes you know each stage of change brings different experiences of suffering sickness illnesses in the old age and so on I've been experiencing wonderful suffering recently from my old age back pain when I first came here to Texas earlier this week I had a really bad very strong pain and it's interesting I want to share this story that many years ago I was in upstate New York at another conference with the three again like three speakers myself presenting the Asian philosophy as usual and we had one a phenomenon what you call phenomenologist and then another one really interesting materialist I'm sure you all know he's pretty well known Dr. Daniel Dennett and so we had a very wonderful discussion and at the end he told me that he himself does analytical meditation with his I think like five year old daughter they practice analytical meditation and he said it really helps it really helps and one year I was having a severe headache like the pain that I had this year on my back and I couldn't get to my Tylenol I was very irritated I got the suffering of suffering for not finding my Tylenol right on top of my headache the other suffering was not getting to my Tylenol and anyway then I was stuck with a group of people on some meetings and so I tried to do some meditation like analytical meditation on pain it was a really interesting experience because at that point when you're stuck with such pain there's nothing we can do isn't it? it's something we cannot deny and so first thing I need to do is to accept that I have such pain you know I have such problem and then to see what I can do with this suffering what I can do with this pain and so next stage is to see how we can use this pain for something positive right how we can use this pain for something positive how we can transform this or discover the usefulness of pain and suffering rather than just getting irritated and wishing that we don't have such pain right of course we don't want this pain I mean I don't want this pain the back pain but that doesn't help I'm stuck here with the pain and so must find a way to make useful something useful of this pain and this is what we call transformation transforming our pain and so for example working with the pain of our own the pain of other people that we take care of as healthcare professionals or as a family member and how can we make the best use of this situation of our pain you know how can we make it a little bit more fun right why not if we have the skills we can turn every situation into something little bit of a fun that even religion we don't have to be too serious you see and so therefore it seems to be quite important that we have some understanding of the usefulness of this pain how this pain brings the heart compassion love when we feel our own pain then we can feel more sympathy we can feel more compassion more love does that mean my time's up or I have no clue okay sorry okay thank you thank you