The Great Ambiguity of “Medicine”: Science? Art? Magic? Technique? Mechanics? Guild? Profession? Other?…or All?!
Moderator: Matthew Vest, PhD, Senior Lecturer, Ohio State University, Division of Bioethics
Panelists: Autumn Ridenour, PhD, Assistant Professor, Religious and Theological Studies, Merrimack College; Nicole Shriller, MD, Palliative Care, Ohio State University; and Ethan Schimmoeller, MS-4, U of Cincinnati College of Medicine
There is not a single philosophical method, though there are indeed methods, like different therapies, as it were. — Wittgenstein, PI 133
What do we mean by “medicine?” In the modern world, doubtless the first answer that comes to mind is science; modern medicine predominantly seeks to be evidence based. Recollecting various uses of the term in different historical periods, however, leads to a plethora of different answers. For the ancient Babylonians, medicine seemed to be a blend of spiritual and physical as the magical expertise of priests (Āšipu) and physicians (Asu) seems difficult to separate along the simple lines of rational vs irrational. Amidst the Hippocratic traditions, medicine was integrated with philosophy in a complex way that defies any simplicity of pseudo-patient-centered moralisms, rendering “do no harm” far from an agreed-upon universal and cosmopolitan truth. With Aristotle, medicine is an art, and there are categories of arts that require careful delineation. For Hugh of St. Victor, medicine is also an art, and yet it is a mechanical art rightly placed alongside agriculture, fishing, and hunting. At various times, medicine has been emphasized as a guild, bringing to light the role of masters, apprentices, and the collegium of peers who guard the nature of medical craft.
These are but a few examples surrounding the ambiguous term “medicine” that emphasize the critical need to identify carefully the nature, methods, and end goals of medicine. Inevitably, there are rival understandings and definitions of medicine with far-reaching implications; what we seek to know epistemologically and what we seek to do methodologically inevitably affect our ways of being. Medicine is a practice necessarily revealing anthropological assumptions and inevitably carrying out theological ways of life.
What is disturbing, however, are occasions when this rich connectivity of medicine to anthropology and theological thinking are glossed or ignored, and one such occasion seems to be arising in medical ethics discourse. A forthcoming publication from a fairly well-known bioethicist, Rosamond Rhodes, is innocuously titled The Trusted Doctor: Medical Ethics and Professionalism (Oxford University Press, 2020). On the one hand, Rhodes’ book seems to be yet one more text in the wake of Beauchamp and Childress’ touchstone work, Principles of Biomedical Ethics (1979) now flourishing in its seventh edition. A number of texts have followed Beauchamp and Childress (1979) that challenge the authors’ assumptions on “common morality” as the shared ground of ethics from which universal moral claims may be founded. Indeed, Rhodes’ book may elicit little attention yet one more such response, but on the other hand an article publication leading up to Rhodes’ forth coming book highlights a narrative no doubt familiar to many and an argument worth noting:
When I began work as a bioethicist at an academic medical centre, I felt secure that my knowledge of traditional moral and political philosophy provided me with the theoretical background for addressing moral problems in medicine. I uncritically accepted the reigning views of medical ethics as ethical theory applied to issues raised by technological advances in medical practice. Over the years however, I started to notice that the standard approaches did not fit with good clinical practice. One by one, counterexamples began to accumulate until I reached the conclusion that everyday ethics and medical ethics were incompatible. That insight led me to conclude that a new theory of medical ethics was needed… (Rhodes, “Why Not Common Morality?”, JME, Sept. 2019).
In clear language, Rhodes calls for a new theory of medical ethics quite disconnected from the “everyday ethics” of human experience. The call to professionalism in Rhodes’ message is far from concerning, and yet the isolation of medical ethics from “everyday ethics” signals an ethical flux that can only stem from the ontological fluidity of postmodernity. Moving beyond the Enlightenment hope in discursive or theoretical rationality to secure meaningful thought and lives, the postmodern era is marked by a fluidity of meaning that surfaces amidst skepticism about reason and acknowledgement of ideologies and discourses of power. Moreover, the tale of this Enlightenment-action followed by postmodern re-action seems to be neatly mirrored in Rhodes’ challenge to common morality. Against Beauchamp and Childress’ claim for a morality common to all mankind, Rhodes emulates something of a postmodern move by grounding ethics within a particular discourse of the medical profession. …The common morality view that all bioethics is traditional ethics applied to novel circumstances amounts to a universal claim. It asserts that there is nothing distinctive about medical ethics and that all of medicine’s ethics is explained by common morality. According to the laws of logic, a single counterexample refutes a universal claim. Because I am challenging the deeply entrenched and widely accepted view that medical ethics is just common morality, here are a week’s worth of counterexamples (Rhodes, “Why Not Common Morality?”, JME, Sept. 2019).
The examples Rhodes offers are winsome for their accessibility: everyday people may appeal to horoscopes, Tarot cards, a favored radio personality, but medical professionals rely on scientific evidence; ordinary people are selective with friends based on character and reputation, but medical professionals are to be non-judgmental; probing personal questions asked in social settings are often rude, but medical professionals necessarily inquire about age, weight, sexual history, etc. In short, Rhodes makes an extension from the uniqueness of medicine into the uniqueness of ethics, and yet the ontological and theological implications of such an extension cannot be ignored. Is a “new” theory of ethics such as Rhodes’ a (mere) likely citation for some new updated definition of medical professionalism from the ABMS, or is this new theory more a Trojan horse gift, replete with nascent assumptions of immanentized, postmodern ways of being?
With Rhodes as a starting point, this panel session extends well beyond Rhodes to raise comparative questions on the nature of medicine. Does Rhodes’ proposal represent a contemporary argument for medicine that aligns with a progressive view of medicine from irrational, pre-modern science (where medicine is imbued with magic and spirituality) to a place where medicine is techno-scientific and objectively based in evidence sans value judgments? Is Rhodes’ proposal a redux of postmodernism as yet another reaction to Enlightenment-styled common morality? Are the various definitions of medicine and medical ethics parallel to Rhodes also case studies in postmodernism? Are “new” theories of medical ethics in a postmodern world really new? From a comparative vantage point, how are the understandings of medicine as art, science, techne, mechanism or other likely to inform or contest modern medical practices?
This panel brings together a panel of two women (one a palliative care physician; the other a professor of ethics) and two men (a professor of ethics and a fourth-year medical student soon to complete an MA in ethics). The moderator is a physician, professor, and director of an ethics center. All five have backgrounds and/or represent multiple Christian denominations, traditions, and practices. This panel would be attractive to healthcare practitioners, chaplains, theologians, academics, and others interested in ways of understanding from a Christian vantage point the nature of medicine in contemporary society.
What do we mean by “medicine?” In the modern world, doubtless the first answer that comes to mind is science; modern medicine predominantly seeks to be evidence based. Recollecting various uses of the term in different historical periods, however, leads to a plethora of different answers. For the ancient Babylonians, medicine seemed to be a blend of spiritual and physical as the magical expertise of priests (Āšipu) and physicians (Asu) seems difficult to separate along the simple lines of rational vs irrational. Amidst the Hippocratic traditions, medicine was integrated with philosophy in a complex way that defies any simplicity of pseudo-patient-centered moralisms, rendering “do no harm” far from an agreed-upon universal and cosmopolitan truth. With Aristotle, medicine is an art, and there are categories of arts that require careful delineation. For Hugh of St. Victor, medicine is also an art, and yet it is a mechanical art rightly placed alongside agriculture, fishing, and hunting. At various times, medicine has been emphasized as a guild, bringing to light the role of masters, apprentices, and the collegium of peers who guard the nature of medical craft.
These are but a few examples surrounding the ambiguous term “medicine” that emphasize the critical need to identify carefully the nature, methods, and end goals of medicine. Inevitably, there are rival understandings and definitions of medicine with far-reaching implications; what we seek to know epistemologically and what we seek to do methodologically inevitably affect our ways of being. Medicine is a practice necessarily revealing anthropological assumptions and inevitably carrying out theological ways of life.
What is disturbing, however, are occasions when this rich connectivity of medicine to anthropology and theological thinking are glossed or ignored, and one such occasion seems to be arising in medical ethics discourse. A forthcoming publication from a fairly well-known bioethicist, Rosamond Rhodes, is innocuously titled The Trusted Doctor: Medical Ethics and Professionalism (Oxford University Press, 2020). On the one hand, Rhodes’ book seems to be yet one more text in the wake of Beauchamp and Childress’ touchstone work, Principles of Biomedical Ethics (1979) now flourishing in its seventh edition. A number of texts have followed Beauchamp and Childress (1979) that challenge the authors’ assumptions on “common morality” as the shared ground of ethics from which universal moral claims may be founded. Indeed, Rhodes’ book may elicit little attention yet one more such response, but on the other hand an article publication leading up to Rhodes’ forth coming book highlights a narrative no doubt familiar to many and an argument worth noting:
When I began work as a bioethicist at an academic medical centre, I felt secure that my knowledge of traditional moral and political philosophy provided me with the theoretical background for addressing moral problems in medicine. I uncritically accepted the reigning views of medical ethics as ethical theory applied to issues raised by technological advances in medical practice. Over the years however, I started to notice that the standard approaches did not fit with good clinical practice. One by one, counterexamples began to accumulate until I reached the conclusion that everyday ethics and medical ethics were incompatible. That insight led me to conclude that a new theory of medical ethics was needed… (Rhodes, “Why Not Common Morality?”, JME, Sept. 2019).
In clear language, Rhodes calls for a new theory of medical ethics quite disconnected from the “everyday ethics” of human experience. The call to professionalism in Rhodes’ message is far from concerning, and yet the isolation of medical ethics from “everyday ethics” signals an ethical flux that can only stem from the ontological fluidity of postmodernity. Moving beyond the Enlightenment hope in discursive or theoretical rationality to secure meaningful thought and lives, the postmodern era is marked by a fluidity of meaning that surfaces amidst skepticism about reason and acknowledgement of ideologies and discourses of power. Moreover, the tale of this Enlightenment-action followed by postmodern re-action seems to be neatly mirrored in Rhodes’ challenge to common morality. Against Beauchamp and Childress’ claim for a morality common to all mankind, Rhodes emulates something of a postmodern move by grounding ethics within a particular discourse of the medical profession. …The common morality view that all bioethics is traditional ethics applied to novel circumstances amounts to a universal claim. It asserts that there is nothing distinctive about medical ethics and that all of medicine’s ethics is explained by common morality. According to the laws of logic, a single counterexample refutes a universal claim. Because I am challenging the deeply entrenched and widely accepted view that medical ethics is just common morality, here are a week’s worth of counterexamples (Rhodes, “Why Not Common Morality?”, JME, Sept. 2019).
The examples Rhodes offers are winsome for their accessibility: everyday people may appeal to horoscopes, Tarot cards, a favored radio personality, but medical professionals rely on scientific evidence; ordinary people are selective with friends based on character and reputation, but medical professionals are to be non-judgmental; probing personal questions asked in social settings are often rude, but medical professionals necessarily inquire about age, weight, sexual history, etc. In short, Rhodes makes an extension from the uniqueness of medicine into the uniqueness of ethics, and yet the ontological and theological implications of such an extension cannot be ignored. Is a “new” theory of ethics such as Rhodes’ a (mere) likely citation for some new updated definition of medical professionalism from the ABMS, or is this new theory more a Trojan horse gift, replete with nascent assumptions of immanentized, postmodern ways of being?
With Rhodes as a starting point, this panel session extends well beyond Rhodes to raise comparative questions on the nature of medicine. Does Rhodes’ proposal represent a contemporary argument for medicine that aligns with a progressive view of medicine from irrational, pre-modern science (where medicine is imbued with magic and spirituality) to a place where medicine is techno-scientific and objectively based in evidence sans value judgments? Is Rhodes’ proposal a redux of postmodernism as yet another reaction to Enlightenment-styled common morality? Are the various definitions of medicine and medical ethics parallel to Rhodes also case studies in postmodernism? Are “new” theories of medical ethics in a postmodern world really new? From a comparative vantage point, how are the understandings of medicine as art, science, techne, mechanism or other likely to inform or contest modern medical practices?
This panel brings together a panel of two women (one a palliative care physician; the other a professor of ethics) and two men (a professor of ethics and a fourth-year medical student soon to complete an MA in ethics). The moderator is a physician, professor, and director of an ethics center. All five have backgrounds and/or represent multiple Christian denominations, traditions, and practices. This panel would be attractive to healthcare practitioners, chaplains, theologians, academics, and others interested in ways of understanding from a Christian vantage point the nature of medicine in contemporary society.