The Western medical tradition has held to, and to a large extent still echoes, the Hippocratic tradition enhanced by the Judeo-Christian ethic. Unfortunately, many medical schools now teach very little about appropriate ways to handle the power disparity that defines the relationship between the medical practitioner and the patient. Several schools have even taken to modifying the oath, one might argue arbitrarily, if the students are even asked to take an oath at all.
We have lost a standard for physician conduct because we no longer possess a common understanding of the purpose of medicine. This loss of purpose and attendant confusion of behavior has eliminated the filters needed to understand and manage the ethical dilemmas. The problem is only exacerbated by the explosion of technological advances, the heterogeneity of culture and actual human rights abuses. This situation has provoked government regulation as the final arbiter of what is considered acceptable medical care in place of the physician.
Some obvious examples of medicine permitting government intrusion into clinical care are stem cell research, abortion, euthanasia, and physician assisted suicide. The medical community has consistently knuckled under the cultural pressure and submitted itself to being used as a tool for ends traditionally considered the opposite of the purpose of medical care. The original Hippocratic Oath states, “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.”
Inadequate reflection on those few phrases applied to current use of medicine has yielded no small amount of institutional transgressions. The medical profession permitting this degree of malpractice to be mainstreamed demonstrates a severe collective waywardness. It is in danger of being usurped as a tool for the powerful to control and intimidate a population in the name of “access” and “choice.”
We need to look no further than Obamacare and the HHS contraception mandates forcing individuals to violate their deeply held moral convictions. If the physician does not define healthcare, it becomes the handmaiden to the wishes or whims of another, someone like the consumer, the scientist, the economist, or the politician. If medicine has not lost her soul she is in dire straits.
To lose one’s soul is to lose one’s way or true purpose in life. Aristotle called this sense of purpose “telos.” Telos helps us understand how we should behave in order to accomplish our good purpose both as individuals and societies. The kind of life-long disciplined behavior that leads one closer to one’s ultimate purpose Aristotle called “virtuous,” while the kind of behavior that leads one away from that good purpose he called “vice.” Good behavior patterns, those that lead to the good purpose of man, also collectively lead to the good end of a civilized society, since virtuous behavior apart from a virtuous community has no context or meaning.
But what happens when the individuals in a society no longer agree on the good purpose of a human nor are able to articulate a shared vision of how a good society ought to look? Or worse, what happens when the shared concept of the “good of man” is characterized by hyper-individualistic relativism; whatever you think is good for you is “your” ultimate good and anyone who suggests otherwise is a bigot?
At this point the concept of “vice” or socially unacceptable behaviors are eliminated, even mainstreamed as virtuous. Absolute freedom from constraint becomes the prerequisite for accomplishing one’s “good.” The standard by which to evaluate good and bad, virtue and vice, is intentionally sacrificed on the altar of some shallow notion of tolerance, even to the extent that it becomes difficult for a civil justice system to make penal decisions apart from pure sentimentality.
The social fabric that once maintained order becomes tattered and threadbare as faith gives way to pluralism, family gives way to individualism and liberty buckles under the ever increasing load of state law enacted, at best, to maintain some semblance of order. And democracy metastasizes into tyranny.
American society has lost her concept of what a good person looks like and therefore how a good society ought to act. One could say that America has lost her way.
This Orwellian social tragedy plays out in every corner of culture, wherever there are people; medicine is not immune. The helping professions such as education, ministry, law, and medicine reflect the culture and the people they are dedicated to serve.
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But what is service if society’s sense of ultimate good is service to oneself without respect for another? Sure, we continue to selectively use some of the old words in medicine, but the good purpose of medicine becomes measured by ‘patient autonomy.’
Definitions are re-contextualized for a consumer society and are interpreted to mean something like “whatever the patient wants,” or “the customer is always right,” or unquestioned, limitless reproductive “choice” without regard for anyone other than self. In fact, even the physician’s rights of conscience are obscured or ignored in subservience to the initial stated expectations of the consumer as mandated by government regulatory agencies.
Can medicine recover from this wasting disease of purposelessness? If it is to survive this crisis of identity it must reawaken to a clear understanding of its good end. Once medicine rediscovers its end it will become obvious how the clinician should behave.
Both the Hippocratic tradition and modern medical ethical giants like Pellegrino and Thomasma agree, the good purpose of medicine can be summed up in the concept of beneficence—“the healing, helping, caring and curing” of a patient. Absent the goal of healing and maintaining the health of individual humans medicine would not exist.
Hence the goal inherent to medicine’s existence dictates how the clinician ought to behave without violating the dignity of the human person in the process. Medical technology can all too easily be misused and patients too easily manipulated without this penetrating and simple awareness of medicine’s purpose. In the absence of beneficence, the role of the physician will diminish into the application of mere technical skills done upon the mere virtually inanimate biochemical reactions we used to call human persons.
Without a clear and vigorous maintenance of the purpose of medicine in service to the patient, the invisible protection we all enjoy called inviolability fueled by a belief that we are all made just “a little lower than God” is replaced by a hollow pragmatism able to justify abuses consistent only with the pathology of an ailing society (cf. Psalm 8:5).
 Pellegrino, E. D. and D. C. Thomasma, For the Patient’s Good: The Restoration of Beneficence in Health Care. New York; Oxford University Press, 1988.