Returning to Ancient Philosophy Preserves the Patient-Physician Relationship in a Technologically Advanced Society

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The following was a college essay written by Georgina DePugh. It has been edited and approved by Maureen Francois. If you have a Theology essay that you would like published that received a grade of an A- or higher, please be sure to contact us.

By Georgiana DePugh, University of Dallas

Man can inquire back into ancient philosophical ideas where some will find roots in the soil of his nation’s government, however others—he will find outdated. MacIntyre notes what Aristotle says in his Metaphysics, “a great many—in importing into moral philosophy…anticipated them being unable to give due recognition to affliction and to dependence.”[1] The question man faces is how can he take these ideas, and place them to issues that these ancient minds would have never thought? For example, the internet and its role in the life of a human as a patient. From end of life issues to self-diagnosing colds, one ought to wonder how technology has impacted ethics, and likewise, ethic’s impact on technology. It is important to find the ancient approach to the definition of a physician, his role in medicine, and apply it to today without changing the teaching. Medicine, for Aristotle, seemed to merely be the four basic qualities. Leon Kass defines medicine as “a rational activity that is bent towards a clear and identifiable end.”[2] This is significant, Kass says, because medicine must inherently serve the patient, but it must not make the doctor the servant of the patient. While the patients’ desires are held in mind as they are treated, the physician ought to not fulfill each request of the patient. The first goal of exploring the role of the physician in relation to his patient is one that inquires what he ought to do when a patient seeks medical information from the internet on his own prior to seeking professional care. Secondly, the inquiry into this relationship seeks to define the boundaries and rights of the patient, if he crosses those boundaries by means of self-diagnosing, and what is good for the relationship with his doctor. Due to increase of usage of the internet for medical information, a patient who diagnoses himself at home, and suggests medical treatment based on a desire of autonomy in medicine creates a two-fold problem for the physician-patient relationship.

Though the term bioethics has not always been in existence, the rise of autonomy and modern technology brought bioethics to light in a time that lacked the traditional ancient philosophies of man. The rise of technology has many negative effects on the human person, yet the worst among them is an enabled autonomous world. In a journal concerning the contemporary world and social media, the author sees “the social world as a succession of ego-centered networks in which ‘new media is the new neighborhood’;  here ‘people think they are individuals, but they are in networks’.”[3] The definitions of autonomy is in two senses: first, a person who is “said to be autonomous in virtue of his capacity to choose what to do, whether he will do X or refrain.”[4] In the second sense, a man is defined as such if “he may be autonomous in a certain sphere in that within it he is free from obligation, whether moral or legal.”[5] This notion of autonomy is prevalent among a post-modern secular society in which man possesses little to no obligation in the case of relationships. A lie of the enlightenment was that man could conquer, master, manipulate and control nature. Technology culture takes this lie and places man in a straitjacket in which he is shown his manipulative abilities. This implies the bending of the world to man’s desires. With certitude of the many dangers of technology and post-modern thinking, in the case of bioethics, autonomy is merely the ability of patients to make their own decisions. Autonomy in bioethics actually means man has not only has the ability, but also has the right to make his own decisions. Pondering ancient thought some more, it is plausible to say that those of ancient tradition and philosophy did not have the same questions, namely because man cannot ask himself if this technological treatment is right for him before it essentially existed. However, this does not mean that applying traditional philosophy to the relationship of the patient and physician has to change.

Considering the fact that every relationship has defined boundaries, it is necessary to define the condition of freedom, and how it exists specifically between the patient and his physician. Underlying Kantian philosophical arguments are not as common among the goal of inquiry for most patients. According to Immanuel Kant, to be free you must be autonomous by means of choosing based on reason.[6] Upon contemplating why man would turn to his technology prior to a medical professional makes one think there is a desire for reasonable control among his treatment. Though arguably, one can say man turns to technology after reasonably deciding, it seems there is no other explanation than aiming for desire from that decision. The patient desires an answer, control, and the best possible solution that he is comfortable with. Reasonable treatment decisions are logically made between a patient and his physician; thus, Kantian philosophy does not seem to fit here.

Observing a more-Millian philosophy with regards to the concept of freedom, J.S. Mill defines freedom as an “absence of external constraint.”[7]  A Millian philosophy is more appropriate to identify this issue with as it “emphasizes the necessity of autonomy, a variety of choices and possibilities, and means and opportunities for self-development and self-governance.”[8] As Mill aims to show the relationship between freedom and power, he ultimately implies the significance of choosing one’s own way. The right by Autonomy to choose one’s own way signifies a certain power by Millian philosophy. However, this power seems to be something that supersedes freedom. Observing the act of a patients choosing this own treatments, to an extent that the knowledge of his own condition is relayed—is good, but when the power of certitude and control by means of freedom set in, one can see Mill’s influence on contemporary relationships.

Where does this issue of a patient’s autonomy fit into this Millian-philosophical idea of freedom? The God-given freedom in unison with the modern liberal state’s allowed freedom a man possesses in American society signifies for man that he is free to act, however, merely within certain limitations. The moral relative plays a large role in the growing distortion of the vocation of a physician. The communication between a patient to physician contemporarily exists on the moral relative of the patient’s feelings towards his own situation. The moral relative is discouraging on a patient-physician relationship because of the theological fact of absolute love—the gift of true love bestowed on man by God in which cannot be known by reason alone. Karol Wojtyla’s pondered the subject to of the human person often. In his best philosophical days, Wojtyla produced a teaching on subjectivity that leads to understandings of the personhood of a human in a deeper sense.[9] It offers man the freedom to explore the person without the degrading moral relative. Thus, freedom is a necessary condition in this relationship.

Considering the necessary condition, the patient upon breaking the traditional limits of the relationship with his physician by desiring complete autonomy, creates a two-fold problem: falling into the moral relative, and ignoring the objective reality at hand. It is plausible to note that the patient’s goal of inquiry seeking first technology, then the physician, is most often guided by autonomy. Though the means can be said not always of negative intentions, the ends of this act does not preserve the physician’s vocation, role within his field, and in relation to the patient specifically. The goal of inquiry for the patient seems to an idea that makes them feel good. The internet provides a sense of self-security, lacking vulnerability and thus, necessity for dependence. This is a problem because in traditional philosophy man knows that the idea of what is best is not one that will to make him feel good. This control aspect is what the patient thrives on before seeking medical help. The mere nature of questions on part of the patient is not bad; questions are how we know God. In these questions we develop a further relationship with whom we are asking as well. The distinction between asking questions to oneself through the means of the internet against asking questions to a physician is significant upon the roles each play together. To understand the distortion of the patient-doctor relationship, man but first acknowledge the beautiful moment in which the physician is held to this traditional vocation.

In light of the moment where both the patient and his physician to each their role, vulnerability, and dependence are at stake by the growing gray area regarding the boundaries of technology. Alasdair MacIntyre recognizes the importance of this when he says, “Dependence on others is what we need in order to achieve our positive goals.”[10] Without a vulnerability to be dependent, these issues that follow are what a modern society can look forward to, if not already there: self-medication, growing depression and anxiety culture, autonomy among areas non-medical professionals ought to not have, and an ever changing view and use of medical professionals. Considering these effects are even now present in Modern America, the definition of medicine has been at stake for some time. Kass’ reminds his readers that if you want to know what medicine is, look at what medicine does.[11] You can see the “is” in the “ought”. The true end of medicine is health—the well working of an organism as a whole. If it’s not aimed at the well working of an organism as a whole, it’s aimed at pleasure, which is too small a goal for medicine.[12] Thus, among many more issues, man now arrives at another problem—false goals. As harmless as it seems, false goals usually begin with happiness or social adjustment, yet man overtime morphs his false goals by aid of the moral relative to the alteration of human nature, seeker of scientific truth, the perpetuation of life, and even the prevention of death. It is reasonable to conclude that flourishing is too much—it includes “social and emotional aspects,”[13] which is beyond medicine, thus again, the definition of medicine is at stake. Beyond the listed issues above, the religious world risks overlooking the objective reality of the issue if spiritual and moral means are the only answers.

The risks are far too many, however, there are true goals in which man finds himself seeking the traditional relationship: health or the “wholeness” of a body. This can be logically said considering the tacit reasoning process of man. This means to say, even those men with disregard for the traditional philosophy of relationships tacitly desire the true goals. The solution is not one that solves the issues at hand completely, but informal reasoning—man’s most natural     method of reasoning according to Cardinal Newman—brings about the transition of the abstractness to a concrete matter. By this process, a definite judgement can be made. This “illative faculty” in which Newman names informal reasoning can aid the solution to, at best, a definite judgement.[14] The problem lacking ancient ideas of philosophy is certain, but there is also a practical problem in which man cannot cut out technology as he acknowledges the benefits and upsides to it also. Thus, a bioethical approach being asking of open-ended questions directed at the physician first implies dependency upon the patient, and likewise is good because the beautiful and real and existential truths of man’s faith is the element of freedom. As beings who have free will, one has the freedom to choose. Trusting the church, and growing in moral theology and bioethics, is a child-like action in which man is accountable to the upholding the relationship that the patient-physician ought to have. The necessary development of a moral and spiritual life shapes man’s questions and answers that lead him to these traditional philosophies of dependency. Consider therefore, one’s own opinion of things—not necessarily in the right or wrong, but rather in a larger sense of submission. This concept of man who is created to submit to something, or better said, someone who might be wiser will shift with the growth of a moral and spiritual life. Conceivably now, the solution to stop the distortion of the patient-physician relationship isn’t solvable due to human natures being subject to error, yet, humility that comes in being a human person and the ability to ask questions is the greatest gift God has gratuitously given man. Theologically when man uses that which comes from above, only then can one grow and develop. The fundamental impact of this moral growth, in which attunes the mind outside of itself, is significant enough on the human person to change the perspective on the role as either a patient or a physician.

In finding of the spiritual solution, man can find himself willing to reject the objective reality—which for the physician is also detrimental to his vocation. Moreover, the objective reality can and should be acknowledge at the same time as the moral and spiritual. The practical problem of the situation likewise longs for a more tangible solution beyond the growth of a spiritual life, especially today considering technologies’ role in ethics. Regarding previous concerns on the goal of inquiry, the patient in a medically needed situation, naturally asks himself “What is the best thing to do?” It is important to arise that the idea of what is going to be best is truly subjective, in the practical sense, to the extent of the patient and his moderated autonomy. Subjectivity, as Wojtyla defined, is good in the medical dialogue with regards to the subject at hand—a human being. With the subjective, the patient has a right verbalize what he wishes to do. With the present issue being self-diagnostics, internet doctors, and medical suggestions to a physician by the patient, the physician should likewise be aware, if not more, to the objective reality at hand. The physician’s question, withing the boundaries of his vocation, ought to be “What is the patient’s goal?” contrasted with “What is my goal for the patient?” This comparison shows a shift in approach of treatment. The goal has not changed, rather the approach in which encourages the relationship and communication of an effective patient-physician relationship—despite the temptation of overstepping the limits of technology.

            Conceivably, technology will not reverse itself into ancient development, and man will not generally think as ancient philosophers once did, however, the relationship between men ought to remain the same. Collectively, man is called to share in his ability possess relationships through dialogue. Ultimately, the way a patient is using words, is the same way his physician ought to use words. The profundity of words and communication overrides previous internet searches, and language can change the way a patient sees his role in a relationship with a physician. One thinks about the act of self-diagnosing on the internet and recognizes the internal dialogue in which man is individualistically orienting his mind. The use of language is a superior privilege a physician has with his patient in which he can re-orient the patients mind to a more-interdependent means of solving the problem. Individual assessments of oneself by the patient prior to a medical visit seems to be acceptable to the extent of being aware of his own medical issue, treatments previously known to him, and hopeful efforts of new treatments. Nevertheless, man cannot deny his tendency to push the limits with technology through history, and the freedom to go beyond the limits of knowledge is rampant. There is a traditional patient-physician relationship where the patient comes to know himself more while the physician’s role is likewise preserved in what he ought to do. Each claims their own boundaries in which one does not naturally overshadow each other, and true goals are revealed in the spiritual growth of man: Mens Sana in Corpore Sana – a healthy mind in a healthy body.

Works Cited:

            Books:

Newman, Cardinal John Henry. 1913. An Essay in Aid of a Grammar of Assent. Longmans, Green, and Co. New York.

Brody, Howard. The Physician-Patient relationship. In The Healer’s Power, 44-65. New Haven, London: Yale University Press, 1992.

Kass, Leon. 1985. Toward a More Natural Science: Biology and Human Affairs Free Press.

Long, Steven A. 2007. The Teleological Grammar of the Moral Act. Sapientia Press of Ave Maria University.

MacIntyre, Alasdair C. 1999. Dependent rational animals: why human beings need the virtues. Chicago, Ill: Open Court. Ch. 1.

Maus, Ingeborg. Kant. In The Habermas Handbook. Edited by Brunkhorst Hauke, Kreide Regina, and Lafont Cristina. 75-91. New York: Columbia University Press, 2019. (Pg. 79).

May, William E., 1928-2014. 2013. Catholic Bioethics and the Gift of Human Life, Third Edition.

            Journal Articles:

AMA Principles of Medical Ethics: I, II, IV, VIII

Dulles, Avery. 2004. John Paul II and The Mystery of The Human Person in America Magazine.

Bishop, Jeffery P. The Dominion of Medicine: Bioethics, the Human Sciences, and the Humanities. In To Fix or To Heal: Patient Care, Public Health, and the Limits of Biomedicine. NYU Press, 2016.

Branson, Roy. 1975. Bioethics as Individual and Social: The Scope of a Consulting Profession and Academic Discipline. The Journal of Religious Ethics 3: no. 1.

Downie, R. S., and Elizabeth Telfer. “Autonomy.” Philosophy 46, no. 178 (1971): 293-301.

Miller, Daniel, Elisabetta Costa, Nell Haynes, Tom McDonald, Razvan Nicolescu, Jolynna Sinanan, Juliano Spyer, Shriram Venkatraman, and Xinyuan Wang. Individualism. In How the World Changed Social Media, 181-92. London: UCL Press, 2016.


[1] MacIntyre, Alasdair C. 1999. Dependent rational animals: why human beings need the virtues. Chicago, Ill: Open Court. Ch. 1. (Pg. 7).

[2] Kass, Leon. 1985. Toward a More Natural Science: Biology and Human Affairs Free Press. (Ch. 6).

[3] Miller, Daniel. Individualism. In How the World Changed Social Media, 181-92. London: UCL Press, 2016.

[4] Downie, R. S., and Elizabeth Telfer. “Autonomy.” Philosophy 46, no. 178 (1971): 293-301.

[5] Ibid.

[6] Maus, Ingeborg. Kant. In The Habermas Handbook. Edited by Brunkhorst Hauke, Kreide Regina, and Lafont Cristina. 75-91. New York: Columbia University Press, 2019. (Pg. 79).

[7] Baum, Bruce. J. S. Mill on Freedom and Power. Polity 31, no. 2. 1998. (Pg. 187).

 

[9] Dulles, Avery. 2004. John Paul II and The Mystery of The Human Person in America Magazine.

[10] MacIntyre, Alasdair C. 1999. Dependent rational animals: why human beings need the virtues. Chicago, Ill: Open Court. Ch. 1. (Pg. 3).

[11] Kass, Leon. 1985. Toward a More Natural Science: Biology and Human Affairs Free Press. (Ch. 6).

[12] Ibid.

[13] Ibid.

[14] Newman, Cardinal John Henry. 1913. An Essay in Aid of a Grammar of Assent. Longmans, Green, and Co. New York.

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