The Physician's Covenant: Images of the Healer in Medical Ethics, 2nd Edition

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The Physician's Covenant: Images of the Healer in Medical Ethics, 2nd edition William F. May Louisville, Kentucky: Westminster John Knox Press, 2000 ISBN 0664222749, 249 PP., PAPERBACK, $19.95

William F. May is professor of ethics and founding director of the Gary M. McGuire Center for Ethics and Public Responsibility at Southern Methodist University in Dallas, Texas. The second edition of his book The Physician's Covenant is directed toward accomplishing a paradigm shift in the medical profession as well as the entire health care industry. To that end, he makes excellent use of five metaphors describing physicians, and extends the idea of covenant to include far more than the physician-patient relationship.

The author looks sequentially at the physician as parent, fighter, and technician, and finds all three images wanting. May rightly points out the pitfalls of paternalism in the medical model, stating that such a model "keenly experiences the absence of divine providence and substitutes a providence of its own" (p.54). The physician as fighter is aptly described by May, and he presents plausible evidence for the genesis of this view so prevalent in medicine today. The contrasting of the two contenders, suffering and the fear of death, as the summum malum provides rich imagery as well as enriched understanding of who we are as a people. His differentiation between "maximal care" and "optimal care" is most helpful (pp. 73-8). Although May does not dismiss the importance of technical skill for physicians, he disagrees with the process, stating, "The cumulative impact of the training filters out the personal, not merely the patient as person but the physician as person" (p. 103). These three metaphors of physicians as "types" are summarily discounted by the author.

While I understand his reasoning, and concur with many of his conclusions, as a physician and patient I have witnessed both the excesses and the need for some aspects of paternalism in medicine. May recognizes the importance of some paternalistic values in medicine, but his defense of them pales in comparison to his opposition of the same. He argues eloquently against the concept of physician-as-fighter in terms of end-of-life issues. I am confused by his statement that there is "after all, a time to live and a time to die, and a right to die well" (p. …