Michael Potts's Blog: Bits and Pieces: Book Reviews and Articles on Writing, Horror Fiction, and Some Philosophy - Posts Tagged "medical-ethics"

Ethics and the Clinical Encounter by Richard M. Zaner

My rating: 5 of 5 stars


Professor Zaner was my master's thesis director at Vanderbilt University, and his book recalls both class discussions and private discussions with him. This is an enlightening book, holding that contemporary medicine has adopted an unnecessary dualism between body and mind, leaving only the "corpse," the body as mechanism, to treat. The person qua person who is ill is ignored--only clinical data count. Zaner rightly criticizes this model of medicine, noting that the man often identified with dualism, Rene Descartes, considered dualism only as a conceptual exercise, a part of philosophical meditation, and that the body treated in medicine is a mind-body unity. He calls for a re-modeling of medicine on the basis of the existing person in the actual world, who is a mind-body unity. This means that the doctor must listen to the patient--everything the patient says, in order to understand the patient's illness, not just whatever pathological lesion is causing disease. Illness disrupts not only the person's own life, but her social network of relations, both relatives and friends as well as co-workers; thus illness takes place in a social context. Understanding these dynamics helps the physician to better understand the patient as a whole--and in that way better understand the patient's illness and make wiser therapeutic choices.

There is a fascinating journey into ancient medicine between the Dogmatists and the Empiricists, and Zaner points out the similarities between their models of medicine and contemporary models. Then Zaner focuses on medical ethics, including the Hippocratic Oath, in order to understand its notion of medicine and ethics. Zaner proposes a bedside approach to clinical ethics in which the ethicist on consult not only interviews the patient and listens carefully to all that the patient says, but also interviews family members to better understand family dynamics that affect moral choice. It is a holistic approach to ethics that does not focus on ethical theory, but rather with a concrete encounter with an existing person embedded in a network of social relations. The existing person is ill and comes to the doctor for help overcoming her illness, not just the disease. This involves a power and knowledge disparity between doctor and patient that implies that the doctor use such power and knowledge to benefit, not harm, the patient. Thus medicine is an inherently moral enterprise.

My only criticism is that at times the book becomes repetitive, but that is a minor point. This book should be widely read by all medical practitioners as well as by medical ethicists and other members of health care institutional ethics committees.



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Coronary: A True Story of Medicine Gone Awry by Stephen Klaidman

My rating: 5 of 5 stars


One of the worst violations of medical ethics in the last twenty years occurred in 2002 at a hospital in California. Two doctors -- one a cardiologist who did the angiograms and other testing and referrals to surgery and a cardiac surgeon were doing bypass surgery on patients who did not need it. Some had complications; some died. Klaidman's book tells the story of this sordid case that reveals in detail the problems still haunting American medicine.

Although the evidence was overwhelming, many physicians were reluctant to testify against other physicians, and a few even defended them. The company that owned the hospital, which had put pressure on the doctors to gain more cardiac cases for money, paid out around $500,000,000 in fines, which it was allowed to do in increments. The doctors were never prosecuted, and while the cardiologist lost his license, the cardiac surgeon did not. Luckily he did not want to continue practicing medicine anyway. Justice was not done despite a major FBI raid and investigation. The U.S. Attorney did not prosecute the case because of the difficulty of proving conspiracy, but indictments may have been an incentive for other doctors to come forth and testify. The hospital had earlier kept its accredited status despite a known lack of peer review of its heart procedures because the agency that accredits hospitals teaches them, for a fee, how to pass their inspections.

This is a story of failed justice, of moral cowardliness, of moral courage shown by a few good people, and of the failure of American doctors to police themselves. Doctors, like other professionals such as lawyers, police themselves since they have the technical knowledge to make good judgments. However, there is a "thin white line" which forbids doctors to turn in other doctors. If the medical profession cannot police itself, what recourse to patients have to trust their physicians?

This book would be a valuable supplemental text to medical ethics courses and is worth reading by the general public as well. I highly recommend it.



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