Today we deviated for a while on the idea of consequentialism and non-consequentialism; I wonder why some philosophy hasn’t been required for the LIM students, at least, or having a glossary of terms available in the Giant Book of Doom? Might have saved us a lot of debate on whether or not these terms are actually in existence, real, true, etc and so forth (to list three of the basic arguments offered). Lisa Newton has a great, three or four page explanation of the terms, in a basic ethics book, that would work really well as a simple explanation and catching up document for people. That’d be today’s suggestion for improvement.
Anyhow, this comes up because Bob wants to look at actions we can use, aside from the guidelines of the Hippocratic Oath, to practice medicine. What is there aside from beneficence/non-maleficence? I’m looking forward to this, because I find the Hippocratic Oath limiting. I think not enough people take enough consideration in the restrictions about deadly drugs, abortions, and surgery — these things are there, and I’ve read several explanations as to why, but few people seem to acknowledge it. My favourite pet theory is that the Hippocratic Oath was the oath for one variety of doc, and there was likely oaths available for people who provided abortions, performed surgery and were apothecaries. But, I am also very indoctrinated into the idea of there being four principles to the ethics of medicine, and I feel like the Hippocratic is missing the principle of autonomy (in fact, it’s heavily paternalistic) and justice. Of course, if you have a theory of medicine that doesn’t recognize autonomy, you have no concept of informed consent.
Another issue I do have with the Hippocratic Oath is that gender stereotyping is built in to our early medicine, and because of that, it is also built into the Oath. How useful is something written in heavily gendered language? Yes, we can understand the culture and the time and say “this was the norm” — but the norm was to treat women as a second class, and that’s in the language itself; should we continue to respect that language? (The AMA certainly doesn’t. While you might argue that it’s a Hippocratic-derived oath, it’s nothing like the Oath itself, and in fact seems to drift away from Bob’s quadrant of individual consequentialist on his diagram and towards a more middling social non-consequentialist oath.)
Bob left us with the first of four distinctions to avoiding killing, and in our conversation after I jumped the gun to the third distinction, which is the doctrine of double effect, an idea I still find extremely interesting — I wish we had been able to spend more time on it, especially time reflecting on the ethics of double effect.
“There is, I assure you, a medical art for the soul. It is philosophy.” —Cicero
Aaah, Cicero, Epicurus, and laughter — it must be time for Glenn to lecture again. The amount of off-the-cuff quotes I have in my notebook are amusing, but I’ll spare you those and just add them to my signature file.
Today Glenn passed out Martha Nussbaum, bringing me back, once again, to my undergraduate education. Of course, I’ve never read this particular Nussbaum, but I’ve read enough and I’m not terribly fond of her. It was hard to not visibly groan and roll my eyes at the idea of a two hour lecture on Nussbaum; hearing that it was going to be a dramatic misreading was, at least, a cheery note.
The misreading itself is very interesting, and based on the Cicero quote above: medicine is just a philosophy, and that ultimately, medicine is philosophy. You must treat the holistic body, and in order to truly heal the body, you must treat the soul. Chrysippus, whose name I’m undoubtedly misspelling, says that “philosophy is supranumerary to medicine in therapeutic treatment.” The person who seeks to assuage suffering, then, must understand philosophy — an argument I suspect that Eric Cassell would strongly agree with. Suffering, after all, is distinct and separate from pain. Pain is a physical response, something that echoes through-out the body, in the nociceptive system. Suffering, on the other hand, is a non-corporeal concept, something that depends on several non-tangible and non-physical criteria. You must have enough consciousness to be aware of time, of past and present, as well as future, because you must be able to apply an experience of pain to the future, anticipating further pain. This anticipation is suffering.
Treating suffering, then, is not the same as treating pain. I think we most clearly see this in the treatment of chronic pain diseases, or painful terminal illnesses. It’s been shown, time and again, that simply the knowledge that adequate pain relief is available is enough to reduce the suffering of those in pain — without having to take any medications. So you can treat pain all you want, but still have a sick, suffering patient. The patient needs to be assured that their fears of future pain have been addressed, and are not valid. To do that takes more than just psychology, I think it does take the techne of philosophy.
I do have to wonder if the most difficult thing in this world really is being trustworthy. A quote from Buffy the Vampire Slayer says that the hardest thing in this life is simply to live, which rings a lot truer and broader than ‘simple’ trust.
* This must, of course, be said as Val Kilmer’s Doc Holliday (Tombstone) would say it, for maximum humour.