Monthly Archives: May 2014

How to ‘Reconstruct’ Medicine: Healing the Healing Arts, Part I

EarlyCancerTreatmentLOLLately, I’ve been giving a lot of thought to the idea of the “Christian reconstruction” of medicine.

Namely, what does that mean and what does that look like (or what would it or should it look like)?

Now, to those of us who subscribe to the theology of applying our faith to every area of life, it doesn’t seem strange at all to apply the same comprehensive biblical world-and-life-view that we apply to religion, education, business, politics and economics (to name a few), to the practice of medicine — a field that at first blush seems far removed from the philosophical, theological and ideological turbulence that usually goes along with any discussion of faith, morality and (therefore) ethics in those areas.  After all, “medicine” is scientific, isn’t it?  A purely rational, objective, “evidence-based,” empirically-driven discipline, right?  And it attracts only the most caring, compassionate, empathetic, highly intelligent individuals who love humanity and wish to direct their formidable talents, skills and training towards the practice of medicine in order to serve and help (and to heal) their fellow man and visit him in his physical affliction, right?

If only.

If there is one kind of medicine that is NOT characterized by the idyllic characterization described above, it is the type of “western” (specifically American), allopathic, corporately-driven, technologically-sophisticated, mainstream “modern” medicine that is practiced today in the United States, the most historically and culturally (but not covenantally) “Christian” nation on earth.

Medicine and Morality

Yet how can we, as Christians, deny that the comprehensiveness of our faith, and the biblically-informed system of morality and ethics that flows from it, constrains us to give it a very prominent and decisive role in our understanding, interpretation and implementation of that great body of knowledge and empirical evidence and experience that we’ve garnered through the centuries in those areas of natural science — biology, chemistry, anatomy and physiology — that have a direct bearing on our theory and practice of medicine, an area that deals intimately with the highly personal issues of a man’s health and the treatment of his diseases?

It is actually pretty easy to see the disconnect that exists today between faith and medicine.  The most visible evidence is the absence of — or at least the steady erosion of — a universal or “standard” code of ethics and morality to guide healing professionals in their respective capacities as they make inherently ethical and moral decisions regarding their patients, and interact with them on the express notion (or the notion implied by the relationship) that the “healer” is there to help his patients in any way that he can, and, if possible, to heal them.

Physician, Heal Thyself

In doing some background reading for this article, I came across a rather fascinating and helpful academic paper published in the Journal of Medical Humanities in 1987 and republished in the American Journal of Bioethics in 2006: “Toward a Reconstruction of Medical Morality.”  It deals philosophically with the ethical and moral issues that inevitably arise in the practice of medicine, touching only briefly on the theological aspect of it — and not at all on the ethical or moral validity or invalidity of certain approaches or methods.  But it is a good place to start the discussion.

The author, Edmund D. Pellegrino, MD, was a leading bioethicist and professor of medicine and humanities at Georgetown University before he died in 2013 at the age of 92.  (Georgetown posthumously named its Center for Clinical Bioethics after him.)  His paper deals with what he views as the root causes of the ethical and moral dilemmas which face healthcare professionals today, owing to the fact that, (a), there is no longer a unified, common understanding of what is “moral” and “immoral” in the practice of medicine as well as what is “ethical” and “unethical” — not just among physicians and other healthcare professionals but also between the professionals and their patients — and, (b), a “fracturing” has taken place of the traditional Hippocratic image of the physician as “a benign, benevolent, all-knowing, authoritarian figure who decides what is best for his patients,” being replaced by one or more of the following competing medical models: the “John Locke” philosophical model that pits doctor and patient as “two autonomous individuals entering a contract for service”; the overtly commercial, for-profit model favored by so many of his colleagues, where “medical knowledge is held to be a proprietary possession of the physician” and he makes it available “as the baker would make bread available” to the public, “when he pleases, in what manner he pleases,” “purveying it for a price on his own terms” — “for those who can purchase it if they please” — and if they don’t like the bread he is selling, “they can go to another baker.”  Lastly, there is the purely transactional model, where your dealings with your doctor are considered to be no different than your dealings with your auto mechanic.

Regarding this model, Pellegrino says:

To those who argue for the auto mechanic version of the healing relationship, I would suggest that, as distressed as we may be with the carburetor and the perverse things automobiles do to us in cold weather, the illness of our autos doesn’t have the impact on our very existence that illness does.

Indeed it doesn’t!

Pellegrino rejects all of the above and proposes instead a solution to this hodge-podge of disparate medical models: a return to a more “holistic” understanding of the true nature of the “healing relationship” that exists (or should exist) between doctor and patient — one that, historically speaking, according to the author, dates back to antiquity: First Century A.D. physician to the Emperor Claudius, Scribonius Largus, who said that the true nature of medicine can be summed up in two words: humanitas and misericordia.  “Humanity” (love of mankind) and “mercy” or compassion.  These, Scribonius Largus said, were supposed to be the aim of the physician “in the same way that justice was the end and aim of the judge and the lawyer.”

Hmmm…  Humanity (love of mankind) and mercy (compassion).

Sounds like a good CHRISTIAN model for medicine to me!

He goes further.  The emphasis in this healing relationship is to be on obligations and responsibilities that are “mutually incurred by both physician and patient,” not on mutual rights.  In this relationship, a duty is owed by both.  The physician must first possess the knowledge necessary to help his patient, and then he must use that knowledge and the scope of his competence wholly “in the patient’s interest and not his own, for the patient’s good.”   And the patient, though he is the more “vulnerable” party in this unequal relationship (due to his state of illness) and in spite of his obvious disadvantages, is as much a responsible “moral agent” as the physician is.

Pellegrino, in fact, starts his essay by saying that medicine is a moral enterprise, having been conducted as such since Hippocratic times “in accordance with a definite set of beliefs about what is right and wrong medical behavior.”  Ethics, being a branch of philosophy and “a formal, rational, systematic examination of the rightness and wrongness of human actions” comes into play here as a “code” of medical ethics or bioethics.   But, medical ethics, as a distinct area of study, he says, was practically unknown in medical schools as late as 1963, and still remained untaught at about a dozen schools by the time of his writing 24 years later.  By the way, Pellegrino is considered not only a pioneer in medical ethics, he is viewed as the preeminent authority on it.

A couple of other points.  He talks about the need for a fully-informed consent on the part of the patient, acknowledging that “one of the realities of illness is the gap of information that separates the patient and the physician.  Certainly one of the physician’s obligations is to close that gap…”  This, he says, is a “moral imperative” that enhances the patient’s “moral agency” and his capacity “to make his own moral and value decisions based on a knowledge of the alternatives.”

At the end of the essay, Pellegrino deals briefly with how we can find moral and ethical agreement on “specific medical moral dilemmas” such as abortion, euthanasia, prolonging of life, birth defects, genetic engineering, etc., stating flatly that we can have NO agreement on these kinds of dilemmas until we can have agreement on the following:

  1. What we believe about the nature of man.
  2. What we believe about God.

In our pluralistic society, Pellegrino says, Good luck with that!

Still, he is hopeful that we can begin (in 1987) to “reconstruct” our ethics and morality of medicine by returning to the historically understood “true nature” of medicine as being a holistic healing relationship that is based on compassion and a love of mankind, with a clear conception of what the roles and responsibilities are of “those who profess to heal.”

His paper is worth reading.  In fact it is worth downloading, printing and reading.

You can do that here: “Toward a Reconstruction of Medical Morality.”

Toward a Christian Reconstruction of Medicine

Now let me give you some of my initial thoughts on this.

I think the “Christian reconstruction” of medicine goes way beyond merely getting everybody to agree (good luck with that!) on a common system of ethics and morals by which to examine actions in the practice and pursuit of it.

It goes beyond merely populating the medical schools and hospitals and clinics of America (and, while we’re at it, of the world) with “Bible-believing,” theonomically-minded, eschatologically-informed, Kingdom-of-God-driven, Christian doctors, nurses, chiropractors, therapists, practitioners, veterinarians, lab technicians, etc..

What is required in order to “remake” the present medical system (in America, primarily, since ours is the most egregious example of ethical and moral — and medical — failure) is the same thing that is required to remake, reconstruct and “recreate” every other human institution and system that we wish to remake and recreate, be it in education, government, economics or business.

We do it from the ground up, from the grass-roots, bottom-to-top reform, one person at a time, in an organized but decentralized, thoughtful, informed and deliberate fashion.

And we do it like any good Reconstructionist worth his presuppositions would do it.  We apply the five-point biblical covenant model to our study, and we thereby discover and learn: how we got where we are today, how we ended up with the outrageously expensive, inept-but-superficially-successful, bureaucratically-controlled, self-protecting, self-enriching, monopolistic, corrupt and ineffectual system that we have, and how we can replace it, and what with.

That’s definitely a tall order, so I will expand on it further in Part II.  Stay tuned!