This book is about the transformation of traditional medicine into the modern "scientific" variety, and the patients' and doctors' adventures on this journey. It is also about losses. The ethical and intellectual costs of modernization are proving painfully high. The curative powers of medicine have enormously expanded, but doctors' clinical skills have suffered, resulting in a medical practice that is less rational, less beneficial to patients, and more expensive than it need be. Doctors' practice and bed side manners have deteriorated, making the medical treatment a trying experience for many patients. Traditional ethics, to which the profession owed its good name, is being forcefully challenged.
The losses incurred in the process of modernization are understandable, but such losses were not necessary. I am convinced that many losses could have been avoided. And 1 firmly believe that the doctors' lost skills and high ethical standards can be restored. To bring this goal a little closer is the main purpose of the present work.
I shall also try to dispel certain misconceptions. In recent decades, medicine, health care, and the medical profession have been blessed with the attention of scholars from various domains: lawyers, philosophers, theologians, psychologists, sociologists, and business managers. A number of "models" of medical practice have been proposed and utilized in the debate. The genuine physician does not recognize himself in these proposed models. He finds his motives misread and his reasoning grossly simplified. I shall try, therefore, to throw some light on doctors' motivation, and that little known subject, the functioning of the medical mind.
The acceptance of euthanasia or physician-assisted suicide would profoundly change the practice of medicine and the physician's very calling. I shall try to show that the choice for euthanasia or assisted suicide is a choice for a medicine, a society, and a world that would be different from the ones we know. I shall also argue that the legalization of euthanasia will ultimately require a change in the system of government now prevailing in Western nations.
Part One: In Defense of Medicine
Chapter I. Bioethics Versus Medicine
Lay Adventures in the World of Medicine. What the public thinks of doctors and medicine is often true, sometimes wrong, and at times touchingly amusing. A lady once told me: "Oh, doctor, you are so marvelously calm, even when 1 get sick, or when I tell you of the terrible things that have been happening to me. You have such a soothing influence on me!" And I thought, "Holy innocence! Were you to know what doubts, tensions, what boiling anger I stifle inside myself in order to show you that calm face, you'd flee this place screaming!"
I recall leaving a concert hall on a winter night in the company of R, a musician who was an acquaintance and a patient of mine, and his wife. Walking a few steps in the street provoked R's chest pain, he had to stop, and we all stopped, watching him and waiting for his pain to subside. A few days later Mrs. R said to me: "Oh, you have so much empathy, I saw you were suffering when you watched my husband in pain."
What I really thought when we stopped near that concert hall was that in cold weather R was getting angina pectoris with the slightest exercise, like walking, but he never had pain while conducting the orchestra at the opera house, vigorously throwing his arms about for three or four hours. Apparently the simplifications that had been our most fruitful approach to coronary heart disease, the "plumber's view" of pipes clogged and flow impaired, the imbalance between oxygen demand and oxygen supply, did not explain everything. Other mechanisms supervened. Some have thought that in cold air the contraction of blood vessels in the skin increases peripheral resistance to blood flow, raising the workload--and the oxygen demand--of the heart's left ventricle, thus provoking an attack of pain; and I tried to recall whether this was just an educated guess, or was it a mechanism actually shown in physiological studies. …