Is "Medicine" A Normative Community?
Jeremy Sabella, PhD, Dartmouth College
Should clinicians and other healthcare providers be conceived as a normative community? What is at stake for the practice of medicine in asking and answering this question?
Consider Paul Griffiths’s definition of a normative community. According to him, a normative community is “one that sets up norms, either of doctrine or practice, to which persons must adhere in order to be considered members of that community. Its purpose is to exclude some and include others, to set up conditions that must be met in order for membership in the community to occur and be maintained” (1991, 4-5). In one sense, medicine is a normative community, for physicians take the Hippocratic Oath. Physicians have obligations to their patients wherein their care has not only scientific but also humanistic dimensions: medicine, the Hippocratic Oath tells us, is not only a science but also an art. These humanistic dimensions, moreover, signal what a physician must and must not do when providing care; they also assess whether something is good or bad, right or wrong.
Formally, what the Hippocratic Oath entails seems clear: e.g., do no harm. But contentfully, what’s entailed isn’t so clear. What counts as harm or benefit? Given that physicians don’t treat (only) an illness but a sick human being, how should we make sense of the Hippocratic Oath’s normative demands amidst philosophical and religious diversity in which differing (or competing) notions of harm and benefit obtain?
Starting from the premise that medicine is a normative community, we draw from debates in theology between ressourcement and aggiornamento to think anew about medicine as a normative community. On the one hand and consistent with ressourcement, medicine needs to be reminded of and uphold axiomatic commitments, for example, about who the healthcare provider is and what they will and will not do. On the other hand and consistent with aggiornamento, healthcare providers need to calibrate to our particular contingent circumstances, that is, where people “deeply and lovingly embedded in their traditions can and must speak with those analogously embedded in other traditions” (Heron 2019, 134).
Strangers and sojourners alike (Lev 19.34), how do we remain (or become) stakeholders in the normative community that is medicine? In asking this, we’re reminded of the normative salience of the Hippocratic Oath for the practice of medicine. Both classical and modern versions hold that physicians are obligated to every individual who is ill and yet millions are un- or under-treated; both emphasize prevention before cure and yet millions are left undiagnosed or ignored; and both prioritize that the patient is a person to be cared for and yet many physicians instead only see an illness as a problem to be solved. In these and other examples, we witness divergences between the Hippocratic Oath’s normative ideal and the actual practice of medicine, between physicians and patients as members of a covenant and physicians and patients as mutually estranged.
Envisioning medicine as a normative community begins the work of bridging between normative ideal and sinful non-ideal.
Consider Paul Griffiths’s definition of a normative community. According to him, a normative community is “one that sets up norms, either of doctrine or practice, to which persons must adhere in order to be considered members of that community. Its purpose is to exclude some and include others, to set up conditions that must be met in order for membership in the community to occur and be maintained” (1991, 4-5). In one sense, medicine is a normative community, for physicians take the Hippocratic Oath. Physicians have obligations to their patients wherein their care has not only scientific but also humanistic dimensions: medicine, the Hippocratic Oath tells us, is not only a science but also an art. These humanistic dimensions, moreover, signal what a physician must and must not do when providing care; they also assess whether something is good or bad, right or wrong.
Formally, what the Hippocratic Oath entails seems clear: e.g., do no harm. But contentfully, what’s entailed isn’t so clear. What counts as harm or benefit? Given that physicians don’t treat (only) an illness but a sick human being, how should we make sense of the Hippocratic Oath’s normative demands amidst philosophical and religious diversity in which differing (or competing) notions of harm and benefit obtain?
Starting from the premise that medicine is a normative community, we draw from debates in theology between ressourcement and aggiornamento to think anew about medicine as a normative community. On the one hand and consistent with ressourcement, medicine needs to be reminded of and uphold axiomatic commitments, for example, about who the healthcare provider is and what they will and will not do. On the other hand and consistent with aggiornamento, healthcare providers need to calibrate to our particular contingent circumstances, that is, where people “deeply and lovingly embedded in their traditions can and must speak with those analogously embedded in other traditions” (Heron 2019, 134).
Strangers and sojourners alike (Lev 19.34), how do we remain (or become) stakeholders in the normative community that is medicine? In asking this, we’re reminded of the normative salience of the Hippocratic Oath for the practice of medicine. Both classical and modern versions hold that physicians are obligated to every individual who is ill and yet millions are un- or under-treated; both emphasize prevention before cure and yet millions are left undiagnosed or ignored; and both prioritize that the patient is a person to be cared for and yet many physicians instead only see an illness as a problem to be solved. In these and other examples, we witness divergences between the Hippocratic Oath’s normative ideal and the actual practice of medicine, between physicians and patients as members of a covenant and physicians and patients as mutually estranged.
Envisioning medicine as a normative community begins the work of bridging between normative ideal and sinful non-ideal.