Being Human: Readings from the President's Council on Bioethics

Chapter 3: To Heal Sometimes, To Comfort Always

Introduction

We have considered the enduring human dream of perfecting nature. We have seen how some great scientists perceive the potential of the methodical pursuit of useful knowledge to make this dream a reality, even as others seek to shield scientific inquiry from utilitarian purposes. In our third chapter we turn to medicine, where we see, among other things, the dream of using knowledge to achieve perfect wholeness applied to the vulnerable, mortal human body.

This is a dream that comes naturally both to doctors, who see firsthand the suffering brought by disease and death, and to the sick and dying, who seek deliverers. But can doctors serve this desire for deliverance from the “natural shocks that flesh is heir to”? Is that all they do? Is it what they should do? Readings in this chapter explore the purposes of medicine, from the point of view of both doctor and patient. Taken together, they explore a vocation summoned to the work of healing and comforting.

Our readings begin with the Hippocratic oath, which for centuries encapsulated the ideals of medical purpose and physicianly conduct. Fittingly, the oath begins and ends with an attempt to locate the practice of medicine and the doctor himself within the greater order.

But human beings have always wondered about the source of healing and the relation between the doctor and the divine, and Hippocrates’ word on these questions was not to be the last. Our next two readings—one from the Book of Sirach, which appears in the Catholic Bible, and one from Albert Camus’s The Plague—further explore these mysteries.

Our fourth reading, “The Surgeon as Priest,” by surgeon and writer Richard Selzer, offers a doctor’s view of what it means to practice medicine. W. H. Auden follows with the point of view of a patient, in this case a patient eulogizing a beloved practitioner in “The Art of Healing.”

A doctor, however, does not always heal. A physician confronts perhaps his hardest task when he knows he cannot be the deliverer for whom his patient hopes. What are his obligations when the news is bad? In the next three readings—“To One Shortly to Die,” by Walt Whitman, and excerpts from Thomas Mann’s Buddenbrooks and George Eliot’s Middlemarch—we find doctors (or others) confronting the continuing illnesses or certain deaths of those in their care. What should be done for the patients themselves? What should be said to their families?

Finally, doctors stand in a privileged relation to their patients, and the privilege is fraught with danger for both. In our final reading, “Invasions,” doctor and writer Perri Klass ruminates on one such privilege: the necessary invasion of the patient’s privacy.

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Sample Reading

The Hippocratic Oath

translated by Leon R. Kass, M.D.

This oath, the oldest and best-known expression of a medical ethic, was for centuries regarded as the guide for proper medical conduct. Although the accomplishments of modern medicine appear to have taken the discipline far from its ancient roots, the oath continues to offer a powerful account of what it means to be a doctor.

The oath begins by invoking ancient Greek deities. The specific deities invoked are Apollo, (here, “Apollo Physician”), the god associated with light, truth, and prophecy; Asclepius, child of Apollo, the “father” of medicine; Hygieia (whose name means “health,” “living well”) and Panaceia (“all heal”), both daughters of Asclepius and associated with what modern readers might call “prevention” and “treatment.” The oath concludes with a plea, acknowledging that the physician’s fortunes depend on his fulfillment of its terms.

The six substantive paragraphs in between address first (in the oath’s longest paragraph) how the physician should comport himself with respect to his teachers, as well as his teacher’s offspring, his own, and all other students of medicine. Physicians are here, literally, called into fraternity with one another; the gift of the medical art is equated with the gift of life. The five subsequent paragraphs indicate how the physician should conduct himself with respect to his patients and their households. The first three deal with the ends and means of treatment, appropriate and inappropriate, the last two with decorum.

Why begin the oath with an invocation of the gods? Why these gods? What does this beginning suggest about the powers of the physician and their source?

Parents, rightly, often resent the authority teachers have over their children. Yet, here, physician-teachers are explicitly equated with fathers, medical students with their sons. Is this equation or analogy justifiable? Why or why not?

What attitude toward the medical arts is expressed in the oath’s five paragraphs on ends, means, and conduct toward patients and families?

What, according to the oath, is the true purpose of medicine?

Can you explain and justify the limits the oath places upon the uses of medical technique?

Except to say that a doctor must neither kill nor suggest killing, the oath is silent on the subject of death. What can one infer from the oath about a doctor’s obligations to the hopelessly ill?

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The Oath

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:

To hold the one who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

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.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Into whatever houses I may enter, I will come for the benefit of the sick, remaining clear of all voluntary injustice and of other mischief and of sexual deeds upon bodies of females and males, be they free or slave.

Things I may see or hear in the course of the treatment or even outside of treatment regarding the life of human beings, things which one should never divulge outside, I will keep to myself holding such things unutterable [or “shameful to be spoken”].

If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.~