Toward a More Natural Science by R. Kass M.D

Author:R. Kass, M.D.
Language: eng
Format: epub
Publisher: Free Press

What Is the Patient’s Good?

In reflecting on the nature of the medical vocation, we have come via a somewhat labyrinthine path to a not very startling assertion: The doctor, by teaching and technique, through patient understanding and astute judgment, promotes the patient’s good. Our third perplexity follows directly: What is the patient’s good? More precisely, of the many things that are good for the patient, which is it the physician’s business to promote? We are no longer asking about medicine’s foreign or domestic relations, but about its very constitution: What is the purpose of medicine?

This is, in a way, a strange question to be asking, since most of the time physicians can go about unreflectively doing their proper business, tacitly if silently clear about their goals. But because new technological powers permit physicians to serve multiple ends, and because much of medical practice is so fragmented and specialized, there is today some confusion and uncertainty about the nature and limits of the purposes of medicine. In the previous chapter I argued that this confusion was a serious cause of the malaise of American medicine. Against the growing tendency to enlarge the medical mission, I argued that health was the proper end of medicine, whereas other albeit worthy goals—such as pleasure, contentment, happiness, civil peace and order, virtue, wisdom, and truth—were false goals for the healing art. Against the narrow perspective of the high-technology, highly specialized therapy-centered predilections of recent decades, I also tried to outline a functional notion of health and argued that health, understood as the “well-working” of the organism as a whole, is not just the absence of disease, but a positive good and the proper norm for medical practice, one that implies that there is more to healing illness than curing disease. I will not repeat that part of the argument here and will trust that few physicians would deny that health is the main purpose of medicine or that some tacit notion of the norm is latent in every attempt at healing—“healing” meaning literally, “a making whole.”

Instead, I want to look at difficulties that arise when healing is not fully possible, say, in the case of chronic and irreversible illness, or, especially, with those who are dying. But first, it will be useful to extend and refine the argument about the meaning of healthiness, by dealing briefly with an obvious and previously unaddressed problem with the conclusion itself—or with any proposed functional definition of health—namely, which well-working activities or functions of the living body should be considered? Is it possible to articulate, let alone define, the specific bodily excellences and fitnesses for a being as complex as man, whose activities are so highly diversified and differentiated? In short, when seeking a functional definition of health, which functions count? The answer of the medical profession and its followers will not always be the same as that of the so-called unenlightened layman, as the following story reveals:

Two friends meet on the street. Says one: “Did you hear? Smith died.

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