The Way of Medicine
Ethics and the Healing Profession
232 Pages, 6.00 x 9.00 in
- Published: August 2021
- ISBN: 9780268200862
- Published: August 2021
- ISBN: 9780268200855
- Published: August 2021
- ISBN: 9780268200879
- Catholic Media Association Book Award: Faith and Science, Second Place
Today’s medicine is spiritually deflated and morally adrift; this book explains why and offers an ethical framework to renew and guide practitioners in fulfilling their profession to heal.
What is medicine and what is it for? What does it mean to be a good doctor? Answers to these questions are essential both to the practice of medicine and to understanding the moral norms that shape that practice. The Way of Medicine articulates and defends an account of medicine and medical ethics meant to challenge the reigning provider of services model, in which clinicians eschew any claim to know what is good for a patient and instead offer an array of “health care services” for the sake of the patient’s subjective well-being. Against this trend, Farr Curlin and Christopher Tollefsen call for practitioners to recover what they call the Way of Medicine, which offers physicians both a path out of the provider of services model and also the moral resources necessary to resist the various political, institutional, and cultural forces that constantly push practitioners and patients into thinking of their relationship in terms of economic exchange.
Curlin and Tollefsen offer an accessible account of the ancient ethical tradition from which contemporary medicine and bioethics has departed. Their investigation, drawing on the scholarship of Leon Kass, Alasdair MacIntyre, and John Finnis, leads them to explore the nature of medicine as a practice, health as the end of medicine, the doctor-patient relationship, the rule of double effect in medical practice, and a number of clinical ethical issues from the beginning of life to its end. In the final chapter, the authors take up debates about conscience in medicine, arguing that rather than pretending to not know what is good for patients, physicians should contend conscientiously for the patient’s health and, in so doing, contend conscientiously for good medicine. The Way of Medicine is an intellectually serious yet accessible exploration of medical practice written for medical students, health care professionals, and students and scholars of bioethics and medical ethics.
1. The Way of Medicine
2. The Requirements of Practical Reason
3. The Doctor-Patient Relationship
4. Autonomy and Authority
5. The Rule of Double Effect
6. Sexuality and Reproduction
7. Abortion and Unborn Human Life
8. Medicine at the End of Life
9. Last-Resort Options
10. Conscientious Medicine
“The Way of Medicine is a book that I wish I could put into the hands of all medical students and health care professionals. In a winsome and persuasive way, it places the disputed questions of contemporary medicine within the broader context of the profession of medicine whose goal is the health of patients, not merely fulfilling whatever desires the patients happen to have.” —Christopher Kaczor, author of Disputes in Bioethics
“The Way of Medicine is a bold intervention into what has become commonplace in medicine: the physician as service provider, the physician as a mere cog in the wheel of social functioning.” —Jeffrey P. Bishop, author of The Anticipatory Corpse
"This work is . . . engaging, offering a clear exhortation to reinsert common sense into medical practice. The book should be an inviting read for both experienced doctors and clinically naïve students." —Choice
In building from foundational considerations to a moral vision for medical practice, this book is a welcome addition to the literature on medical ethics. Curlin and Tollefsen articulate the philosophical underpinnings of the Way of Medicine both in contrast to and in conversation with major current thinkers across the spectrum of medical ethics traditions, with extensive references providing further commentary and citations for additional reading. —Family Medicine
This short but highly insightful volume is a welcome addition to the literature onthe philosophy of medicine and ought to be recommended reading for both bioethicists interested in debates about morality in medicine as well as physicians seeking abetter understanding of their own professional vocation. —The New Bioethics
We argue that the medical profession has neglected a question that anyone thinking about going into medicine must consider: what is medicine? The question is really about medicine’s point: we understand what medicine is by understanding what it is for: what is its point, purpose, or end? —Farr Curlin and Christopher Tollefsen, The Pillar
"The Way of Medicine offers an engaging account of an ancient approach to medicine that seeks to care for people through caring for their health. . . . In order to deepen the argument for adopting this approach, I hope that others will build on this project by more robustly articulating the moral and philosophical vision within which the Way of Medicine is at home." —Public Discourse
"Curlin and Tollefsen provide a sound diagnosis of one of the major problems facing society today: the erosion of the practice of medicine. While not an overtly theological work, The Way of Medicine equips Christian medical trainees and physicians with language that helps them better situate the practice of medicine within their faith and then reconcile that practice with the pluralistic society in which they practice." —Christian Bioethics
Every culture gets the medical practice it deserves, and in our culture medical practice is dominated by a consumerist understanding, where well-being is understood in terms of the patient’s desires being satisfied. Efforts to identify an ethical framework capable of guiding practitioners and patients in our time have resulted in consequentialism, contractarianism, and, most prominently, principlism—the framework that gives us the familiar “four principles” of medical ethics. In the context of an individualist and consumerist environment, however, these efforts all tend to default to three norms: what the law permits, what is technologically possible, and what the patient wants.
Thus, for the provider of services model, if an intervention is permitted by law, technologically possible, and autonomously desired by the patient, then medical practitioners should provide the intervention. Indeed, they may be professionally obligated to do so. After all, these norms fit our expectations for other providers of services. The good folks who provide us with Wi-Fi or who make our double soy lattes do not bring further considerations to bear on whether to give us what we want. They do not consider the appropriateness of our desire for a double soy latte; they do not ask what websites we’ll be visiting. We expect them to obey ordinary norms of law and not defraud or deceive, but beyond that we expect them to do as we wish (provided that they can perform the service, and we can pay). There is no distinctive professional ethic for these practices, because there is no profession, no deep orientation to a good or set of goods that gives meaning and purpose to what they do.
Thus, in the provider of services model, the work of physicians becomes demoralized, and its ethic becomes what the philosopher H. Tristram Engelhardt has identified as a “morality of strangers.” One does not knowingly do violence to the unconsenting innocent, to be sure. But within the boundaries of law and consent, what is technically possible is ethically permissible. That which is permissible and also desired may even be ethically obligatory. Medical ethics reduces to a set of procedures for negotiating noninterference with patients’ wishes to the greatest possible extent. Medicine itself devolves into a powerful set of means to be used to satisfy the preferences and desires of those who are authorized, legally and procedurally, to choose.
Among the many consequences of the provider of services model, the following three loom. First, professional authority has steadily eroded. If there is no objective standard or end for medicine, then physician expertise is merely technical. Thus, instead of exercising the authority of expertise within a sphere constituted by their professional commitments, physicians become increasingly subject to the exercise of power by lobbyists and political advocacy groups. Medical professionals come to work in a highly regulated domain in which the exercise of clinical judgment and prudence is neither possible nor desirable.
No surprise, then, that declining professional authority is followed by a second consequence: a crisis of medical morale. Insofar as medicine merely provides desired services, then its pretense to moral seriousness is a charade, and its attempts at professionalism a façade. The practice of medicine is characteristically grueling, with long hours spent under taxing circumstances. Is it surprising that physicians who experience themselves largely as mere functionaries—asked to set aside traditional medical norms, religious convictions, and their best judgment—suffer high rates of burnout?
Finally, when medicine is understood as the provision of health-care services, the physician’s judgment—and particularly the physician’s claims of conscience—come to be seen in competition with the fundamental, but minimal, norms of the profession. The exercise of physician conscience is treated as the intrusion of “private” or “personal” concerns into transactions that should be governed by physicians’ professional commitment to provide legally permitted services to patients who request those services. Michael and Tracy Balboni note that this artificial separation of the personal and professional leads patients and clinicians to suppress and ignore their moral and spiritual concerns, to the detriments of both. As a result, the medical profession and society at large appear increasingly ready to abandon the idea of the conscientious physician, and to use the coercive powers of the profession and the state to compel physicians to participate in practices that violate norms that have guided medical practitioners for millennia.