del Pozo, Rodriguez MD, PhD, JD; Fins, Joseph J. MD
Dr. Rodriguez del Pozo is associate professor of public health, Division of Medical Ethics, Weill Medical College of Cornell University in Qatar, Doha, Qatar.
Dr. Fins is E. William Davis, Jr., MD Professor of Medical Ethics, chief, Division of Medical Ethics, and professor of medicine, public health, and medicine in psychiatry, Weill Medical College of Cornell University, New York, New York; e-mail: firstname.lastname@example.org.
In the fall of 1896, José Ruiz, an art professor and rather mediocre painter, placed a substantial bet on the talent of his son Pablo Picasso, then a 15-year-old fine arts student at the Llotja school in Barcelona. Don José invested his savings in renting an atelier to allow the teenager to work on a painting to compete in the XVII Exposición General de Bellas Artes of 1897. The father knew that if his son won a medal in the Exposición, the young Picasso would be virtually guaranteed a tenured teaching position in a provincial capital, perhaps even in a suburb of Madrid. And Don José had a plan: The young Picasso would paint a large-format piece, preferably of a hospital or clinical theme—popular with judges and the public alike at the time—and imbued with the current of social realism.
Through the final months of 1896, Picasso frenetically drew sketches of the painting. The composition would include a dying mother, a nun holding a child, and a doctor. Don José would pose as the doctor. For the mother and child, Picasso probably recruited a street beggar and her son; an adolescent boy likely impersonated the nun.1,2 By March 1897, the work, now bearing the name Science and Charity, was shipped to the Exposición in Madrid, where it obtained an honorary mention, 1 of 125 given by the judges2—surely a disappointing outcome for Don José. But fortunately for the history of art, Don José’s paternal dreams of Picasso becoming a salaried educator in a dusty provincial capital were derailed.
Today, Picasso’s Science and Charity is housed in the Museu Picasso in Barcelona. We each encountered it during visits to the museum nearly 100 years after Picasso completed the painting, and in subsequent years we have both devotedly stopped many times to contemplate the work. As true masterpieces do, the painting offered new insights with each viewing over the course of a lifetime.
The scene depicts, in a very austere palette, a hopelessly dying woman lying in bed in a small room. The walls are dirty, and old water leaks may be seen beneath the closed window. The bed has no foot or headboard; the blanket looks coarse and worn. It is a poor, degraded place, yet a mirror with a baroque, golden frame suggests that the family once knew wealth. A nun offers the patient a cup, probably containing warm broth, while she holds the patient’s child, who innocently looks down at her. To the right of the patient’s death bed, a doctor takes her pulse with his left hand, looking at a watch he holds in his right, a marker of the day’s technological advance.
Doctor, nun, child, and patient form a simple and persuasive contrast between medicine, represented by the doctor, and charitable help, personified by the nun. In contemporary terms, we would call this the contrast between curing and caring. Unlike other representations in the hospital and clinical genre, there is no hope for the patient in Science and Charity, and thus the role of science is at best limited. Nonetheless, the doctor sits at the bedside, taking his patient’s pulse, apparently oblivious to the fact that her hand appears lifeless. As one acidic critic put it, the doctor “is taking the pulse of a glove!”2 In a very consistent manner, the doctor’s clothes and body language give him the calm and dignified air of one who is no longer fighting but, rather, waiting for the inevitable, noting that time will unavoidably lead to his patient’s passing. The doctor’s severe frown reveals his concern. He has exhausted his science, so he offers the patient all he can provide at this point: a warm hand holding her moribund wrist. The image of the doctor in Science and Charity represents, in our view, charity taking over when science has little or nothing to offer. In present-day terms, the doctor has substituted palliation for acute care.
Though we would probably disagree, some may claim that the Picasso of 1897 was too young to capture these nuances. In that case, perhaps the fact that Picasso’s father was the model made the young Malagueño endow the doctor with such a worried, caring, and deeply paternal attitude. Some could speculate that the fact that the model for the nun was likely a boy trying to make some pesetas prevented Picasso from depicting anything but calm indifference in the nun’s face. But the lesson from the picture remains intact to us.
What resonates with us is that the nun’s face expresses the habit of charity, resigned to imminent death. It could also express hope, symbolized by the child she holds in her arm.
We believe that the image is instructional and an inspiration for palliative medicine where science and compassion meet, mix, and become a mosaic of sorts. This is why one author (J.J.F.) chose the painting for the cover of his book, A Palliative Ethic of Care: Clinical Wisdom at Life’s End.3
A very young Pablo Picasso painted Science and Charity as part of his father’s plan to increase his chances of becoming a tenured educator by winning a medal at the 1897 Exposición. Although neither the medal nor the tenured position materialized, Picasso’s work has taught doctors lasting lessons about the art of both curing and caring. We have been lifelong students of this Spanish master.
2. Gual M. Carrera de artista: La obra en contexto. In: Ciencia y Caridad al Descubierto. 2010 Barcelona, Spain Museo Picasso
3. Fins JJ A Palliative Ethic of Care: Clinical Wisdom at Life’s End. 2006 Sudbury, Mass Jones and Bartlett