JAMA Revisited October 21, 1974
Be Your Own Philosopher Samuel Vaisrub, MD Contrary to prevailing impression, medicine’s concern with ethical problems is not a by-product of recent advances in medical knowledge and skills. True, problems such as allotment of a limited organ supply among the many in need of a transplant or deciding to terminate an artificially sustained life did not exist in the past, but abortion, euthanasia, and other issues have always presented dilemmas. Some of these, such as the decision to save the life of a mother or the newborn, were even more frequent than they are now, when medical treatment makes it possible to save both. Confronted with ethical dilemmas, the physician of bygone days would generally follow familiar guidelines provided by the canons of his faith. Practically every religious denomination had its ready answers to the then existing problems. Sometimes answers might conflict with those of other denominations, sometimes they would accord. In the latter case, similar conclusions may have been drawn from different assumptions. For example, both the Jewish and Catholic doctrines condemn contraception and abortion but for different reasons. The Catholic ban stems from the belief that life begins at conception; the Jewish proscription is based on the Biblical injunction: “Be fruitful and multiply and replenish the earth.” The situation is not so simple now. Many physicians and patients do not feel firmly bound by religious precepts. Furthermore, many current dilemmas had not been foreseen by the founders of the great religions. Thus, their solutions remain stranded in the no-man’s land of exegesis. Left with little religious guidance, to whom should the physician turn for counsel? To the philosopher, perhaps? After all, ethical problems are, or should be, one of philoso-
Editor’s Note: JAMA Revisited is transcribed verbatim from articles published previously, unless otherwise noted. 2026
phy’s main concerns. It is not surprising, then, that colloquia and conferences have been held recently to bring practicing physicians and academic philosophers together for an exchange of views. Have these dialogues provided solutions to the ethical problems of medicine? Pondering this question, Professor Harrison in a communication in this issue1 finds little to comfort us. Traditional philosophers offer no new insights while semantically oriented logical positivists are preoccupied with meanings of words and the process of knowing rather than with knowledge. Philosophers who are concerned with medicine’s ethical dilemmas find them particularly perplexing because the choices are not between good and evil, but between one good and another, entailing painful sacrifice of a laudable goal for one that may seem more commendable. Perhaps we should not expect philosophers to resolve medical-ethical perplexities but to articulate and clarify them. They could put ethical problems into perspective by analyzing not only the immediate consequences of a decision, but also its wider implications. Withholding antibiotics from a demented child, a vegetating nonagenarian, or a “terminal” cancer patient may then become a decision affecting not only a particular case but other less extreme cases in which the line between what is beneficial and what is not cannot be easily drawn. Ethical dilemmas of medicine often defy rational solutions. They create situations that are the stuff of classic Greek tragedy, more in need of the intuitive perceptions of an Aeschylus rather than of the logical analysis of an Aristotle. At the moment, without the guidance of either, the physician facing such dilemmas must be his own dramatist and his own philosopher. 1. Harrison FR, III. Dilemmas and Solutions. JAMA. 1974;230(3):401-403. JAMA. 1974;230(3):443-443.
Section Editor: Jennifer Reiling, Assistant Editor.
JAMA May 21, 2014 Volume 311, Number 19
Copyright 2014 American Medical Association. All rights reserved.
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Be Your Own Philosopher Samuel Vaisrub, MD Contrary to prevailing impression, medicine’s concern with ethical problems is not a by-product of recent advances in medical knowledge and skills. True, problems such as allotment of a limited organ supply among the many in need of a transplant or deciding to terminate an artificially sustained life did not exist in the past, but abortion, euthanasia, and other issues have always presented dilemmas. Some of these, such as the decision to save the life of a mother or the newborn, were even more frequent than they are now, when medical treatment makes it possible to save both. Confronted with ethical dilemmas, the physician of bygone days would generally follow familiar guidelines provided by the canons of his faith. Practically every religious denomination had its ready answers to the then existing problems. Sometimes answers might conflict with those of other denominations, sometimes they would accord. In the latter case, similar conclusions may have been drawn from different assumptions. For example, both the Jewish and Catholic doctrines condemn contraception and abortion but for different reasons. The Catholic ban stems from the belief that life begins at conception; the Jewish proscription is based on the Biblical injunction: “Be fruitful and multiply and replenish the earth.” The situation is not so simple now. Many physicians and patients do not feel firmly bound by religious precepts. Furthermore, many current dilemmas had not been foreseen by the founders of the great religions. Thus, their solutions remain stranded in the no-man’s land of exegesis. Left with little religious guidance, to whom should the physician turn for counsel? To the philosopher, perhaps? After all, ethical problems are, or should be, one of philoso-
Editor’s Note: JAMA Revisited is transcribed verbatim from articles published previously, unless otherwise noted. 2026
phy’s main concerns. It is not surprising, then, that colloquia and conferences have been held recently to bring practicing physicians and academic philosophers together for an exchange of views. Have these dialogues provided solutions to the ethical problems of medicine? Pondering this question, Professor Harrison in a communication in this issue1 finds little to comfort us. Traditional philosophers offer no new insights while semantically oriented logical positivists are preoccupied with meanings of words and the process of knowing rather than with knowledge. Philosophers who are concerned with medicine’s ethical dilemmas find them particularly perplexing because the choices are not between good and evil, but between one good and another, entailing painful sacrifice of a laudable goal for one that may seem more commendable. Perhaps we should not expect philosophers to resolve medical-ethical perplexities but to articulate and clarify them. They could put ethical problems into perspective by analyzing not only the immediate consequences of a decision, but also its wider implications. Withholding antibiotics from a demented child, a vegetating nonagenarian, or a “terminal” cancer patient may then become a decision affecting not only a particular case but other less extreme cases in which the line between what is beneficial and what is not cannot be easily drawn. Ethical dilemmas of medicine often defy rational solutions. They create situations that are the stuff of classic Greek tragedy, more in need of the intuitive perceptions of an Aeschylus rather than of the logical analysis of an Aristotle. At the moment, without the guidance of either, the physician facing such dilemmas must be his own dramatist and his own philosopher. 1. Harrison FR, III. Dilemmas and Solutions. JAMA. 1974;230(3):401-403. JAMA. 1974;230(3):443-443.
Section Editor: Jennifer Reiling, Assistant Editor.
JAMA May 21, 2014 Volume 311, Number 19
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a Simon Fraser University User on 06/01/2015
jama.com
