View
Healing Medicine
on the Wisdom of the Good Doctor Edmund Pellegrino
"Some men think the earth is round; others think it flat. If it is flat, will the king's command make it round? And if it is round, will the king's command flatten it?"
—Thomas More, in A Man for All Seasons by Robert Bolt
When I joined the faculty at Georgetown University Medical Center nearly two decades ago, the principles and practice of medicine seemed to me to be in substantial continuity and accord, both technically and ethically, with the same of my father's era. Dad had been a general practitioner of the old school who, unaffected by the future blessings and curses of the Electronic Medical Record and of much regulatory oversight, was able to sit with his patients in his office, at the hospital, or in their homes, to look them in the eye, and to engage them with state-of-the art science and deep compassion.
He practiced during a unique time in our culture of medicine, when the "paternalistic physician" ethos of old was being tempered by and learning to walk—laudably—in step with the rising acknowledgement of patients' autonomous rights of self-determination. In contemporary ethics parlance, the beneficence of the physician was in balance with the autonomy of the patient. I believe, without a shred of impartiality, that my father struck precisely the right chord in his every patient-encounter. For his patients, he was, in art and science, a shepherding partner.
And in his day, the notion that any physician would intentionally end his patient's life was unthinkable.
Tectonic Ethical Shift
But his was a fleeting period in medicine, it turns out, and my assessment of it fraught with docetic error; the profession of medicine, and the public's expectations of it, had been on the move for some time. Behind the scenes, it was instead an epoch of tectonic ethical shift. The same generation of medicine and society that had jailed Jack Kevorkian for second-degree murder (charges stemming from his assisting a terminally ill patient to take his own life) was now rising up to call him blessed. Science as the authoritative arbiter of normal and abnormal was dispatched, when convenient, by personal preference.
With "medical aid in dying" (aptly abbreviated MAID, as in "hand-maid"), medicine and society had thus come full circle. Once we had presumed to determine the moment when life and personhood begin, it was a small matter, and of the same cloth, to determine the hour when we would mediate death. Indeed, physician-assisted suicide is now paradigmatic of the confluence of recent societal trends and is itself the inevitable result (if not, some might opine, the very telos) of those trends.
My dad's day, or such as I perceived it to be, had come and gone.
Ah, autonomy! We are living the secular beatific vision wherein an individual's autonomy is ascendant, glorious, and sovereign over a physician's or health system's beneficence, and is oblivious or indifferent to its own entropic effect on society. The ethical constraints and proscriptions of traditional Hippocratic medicine, their very authority, and the moral agency of physicians and of the profession are dismissed as irrelevant, paternalistic (and, one anticipates, supremacist) metanarrative. And our profession has been complicit. The visit to the doctor is now less relational, more fiscal and trade-utilitarian. There is a waning expectation by patients that they need shepherding and a fading desire by doctors to shepherd.
Our hand is being called: does there exist, finally, a binding philosophic North Star for the profession of medicine? Is there a moral agency of the profession that is now somehow voided by contemporary trends? Ethicist Arthur Caplan has opined that there is nothing that qualifies meaningfully as a "philosophy of medicine"; philosopher Kevin Wildes asserts that a philosophy exists but is socially constructed.
Allen H. Roberts II M.D., M.Div., M.A., is Professor of Clinical Medicine and Chair of the Clinical Ethics Committee at Georgetown University Medical Center in Washington, D. C.
A Journal of Mere Christianity—Delivered to Your Door
- Essays on theology, culture, and the Church
- Contributors from across the Christian traditions
Six print issues (one year) of Touchstone, plus full online access and PDF downloads for only $39.95.
Get a one-year full-access subscription to the Touchstone online archives for only $19.95.
bulk subscriptions
Order Touchstone subscriptions in bulk and save $10 per sub! Each subscription includes 6 issues of Touchstone plus full online access to touchstonemag.com—including archives, videos, and pdf downloads of recent issues for only $29.95 each! Great for churches or study groups.
Transactions will be processed on a secure server.
more on medicine from the online archives
33.3—May/June 2020
on the Wisdom of the Good Doctor Edmund Pellegrino by Allen H. Roberts II
more from the online archives
32.5—September/October 2019
Some Trivial Thoughts on the Study of Philosophy by Graeme Hunter
36.1—Jan/Feb 2023
A History of the Protestant Debate over Contraception by James A. Altena
calling all readers
Please Donate
"There are magazines worth reading but few worth saving . . . Touchstone is just such a magazine."
—Alice von Hildebrand
"Here we do not concede one square millimeter of territory to falsehood, folly, contemporary sentimentality, or fashion. We speak the truth, and let God be our judge. . . . Touchstone is the one committedly Christian conservative journal."
—Anthony Esolen, Touchstone senior editor
