Recent posts (Here and here) on this blog referred to the “ends” of medicine, and last week Dr. Holmlund challenged us to explore more systematically just what those ends are. As I have considered that challenge, I have been stymied by the herculean magnitude and complexity of the task, especially given my limited knowledge of, and reading in, the relevant philosophical, theological, sociological, and historical disciplines. However, having been a practicing physician for about twenty years, I will tentatively start on the project, based more on my experience than on any great learning or reading; I hope that those who have the advantage of the learning and reading will make up for and (gently) correct my deficiencies.
One of the hurdles to overcome in defining the ends of medicine is that there are many views held by different groups of people, and they have changed over time. So the question becomes more focussed: What are the proper or correct ends of medicine? Is this something we can discover, or must we merely define it? If so, on what basis? Also, what do we mean by medicine? Are we talking just about the actions of physicians? Or does it include the actions of, say, hospital boards? Biomedical researchers? Public health departments? Medicare utilization reviewers?
My impression of the history of this subject is that the ends of medicine were originally narrowly defined in regard to physicians, and their goal was to help the sick. The Oath of Hippocrates, from around the 5th century BC, speaks of dealing with “the sick” and “sufferers.” There seems to be no reference to preventive medicine or promoting health. This view of medicine’s ends was taken up by the Christian medical tradition: “Care of the sick, grounded in the compassionate sharing of the sufferer’s pain and seeking ways of alleviating and perhaps curing it, is a witness to God’s work of redemption in Jesus Christ.”*
As modern science developed, its founding fathers such as Francis Bacon and René Descartes thought that by gaining power over nature, people could go beyond treating disease to preventing disease and preserving health. Measures to prevent disease were of course known from antiquity, as the health regulations in the Pentateuch demonstrate; and magic charms to ward off disease have probably always been widespread. But somewhere along the way, this idea of not just treating disease but preventing it, and in so doing promoting health, was taken from the priest’s job description and inserted into the physician’s. Thus, the physician’s ends expand to become, “Caring for the sick, preventing disease, and promoting health.” A Tall Order indeed. And one that adds umpteen layers of ethical considerations, such as, What does it mean to “Do no harm”? What is “health”? And many others that I can’t begin to mention in a 500-word post. But in future posts I will attempt to chart a course through this maze , and with Jon Holmlund I invite fellow bloggers and commenters to help us along the way.
*Robert Song, Human Genetics, 13.