I will never forget our first meeting at his Georgetown office. It was a Thursday. At age 91, his piercing eyes and attentive demeanor were surprisingly intense during our ninety minute conversation. His was a soul “haunted by conscience” as he put it. He said this by way of assuring that he would get back to us on some of material he promised to review despite the crowding demands.
Dr. Edmund D. Pellegrino possessed an Arthurian vision for the profession of medicine which forced a soldier-like responsibility, a restless watchman for the well-being of his practice. Having almost singlehandedly created the field of study known as the “Philosophy of Medicine,” he understood that medicine, like all professions, operates based on philosophical assumptions.
And when those assumptions change, the profession will change. Some say he was one of the founders of the field of bioethics. If that is true, then his recent observation to my colleague and I during a conversation is all the more startling, “Bioethics is a bastard.”
This was a diagnosis devoid of all bravado, not a colloquialism. What he meant was that the “study” has no moral basis, no mutually accepted objective standard by which to consider the application of new discoveries and technologies in clinical care in any meaningful or consistent way.
Be that as it may, I remember sitting in his Spartan office, only later finding out that his walls could have been auspiciously covered with his fifty plus honorary doctoral degrees. I was humbled by his deference, earthy and genuinely interested in the person in front of him. Ever the physician ready to act on his profession’s promise, he stretched out his hands using his elbows as fulcrums on the arms of his chair. With his native New York accent still discernible, he invited us in to his practice, “What seems to be the problem? How can I help you?”
“I believe medicine has lost its soul,” I said.
With his elbows still firmly planted on the arm rests and his folded hands held to his chin he observed me. Then came his careful affirmation: “I agree.”
Before he died I had the honor of getting to know this man who many considered to be the father of modern medical ethics.
His colleague, H. Tristram Engelhardt, Jr., was so convinced of his importance that he edited a book The Philosophy of Medicine Reborn distilling Pellegrino’s writings insisting in the introduction that, “Bioethics and the medical humanities . . . cannot be understood apart from Edmund D. Pellegrino.”
Why was Pellegrino such a pivotal character in the study of medicine?
Perhaps it is because he aspired to incarnate the fact that, in his words from his article Apologia for a Medical Truant, “. . . good medical care needs more than its scientific orientation.” Combined with the 20th century technological explosion generating unprecedented thousands of ethical challenges, the time was ripe for Pellegrino’s fighting passion to address moral dilemmas of our age.
“I wanted to be a boxer,” he told me. “But my father put a stop to that.” I wonder . . . perhaps he just asked his son to fight for a greater cause; the plight of the patient, the preservation of the medical profession that a pluralistic culture would inevitably threaten.
Just because medical technology can do something does not necessarily mean that it should.
Pellegrino warned of the danger of a medical profession that permitted scientific advances, economics, politics, social convention, or anything else to eclipse the human side of clinical practice. This human side of medicine holds the key to how clinicians handle the inequities between the helper and the one being helped, the healer and the cured, the comforter and the sick, the educator and the confused.
Pellegrino pursued his Arthurian vision of a deeply human and humane medical profession with rigor to the end, lamenting in his Apologia the fact that traditional medical ethics, being consumed by bioethics, is “on the verge of disappearance.”
And so after promising to help in the battle for ethical standards of care in women’s reproductive health at the end of our first meeting, he leaned forward to stand from his chair and mid-way stops, looks up, and calmly remarks, “C’est la vie. C’est la guerre.”
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What does the future of medicine hold: highly skilled technicians performing tasks on complex organisms devoid of meaning and dignity? Or something higher, more noble where a thoughtful clinician cares for the good of the patient without violating the good of humanity, the good of medicine itself and the ultimate spiritual good.
Perhaps Pellegrino will be headed as a prophet and medicine will recognize that there is something deeper and more important that lends levity to the profession, something beyond the shallow and muddy pleasure or pain of our consumer driven corporeal existence.