Toward a Contemporary Confession of Good Medicine
Three practitioners speak.
There is much to celebrate in the practice of contemporary medicine, from remarkable feats of technological progress, to solidifying a proven training process for disciplined competency, to inhabiting a locus of rare moral consensus in our society—that sick patients need care.
And yet it is also true that our practice is beset by ills that it lacks the ability to define and has repeatedly failed to cure. Medical training increasingly leaves its learners morally injured and vexed. There is a deep distrust of health-care institutions and disorientation over what constitutes health or a “medical” intervention. The enterprise of medicine consistently fails to cover the poorest and most vulnerable.
In light of these pathologies, Western medicine has turned to the self-therapy of its own moral resources. Yet the available treatment regimen is thin. Narrative medicine, mindfulness, and yoga are proposed as antidotes to practitioner burnout. Appeals to “professionalism” are championed to counteract ethical lapses, even as trainees lack a firm sense of what, and to whom, they profess. Most distressing, the hard work of conscientious medicine is foregone in favour of easier questions reducible to patient preference and legal protections.
Simply put, it has become clear that the practice of contemporary medicine cannot “heal thyself.” As patients recognize, medicine needs the help of other traditions to work toward restoration.
A Turn Toward Virtue and Moral Tradition
Where, then, should we look? We submit that it is in a radical turn backward—both with an eye toward the wisdom of our forebears and an unflinching recognition of the injustice perpetrated in the name of medicine—that we can reasonably hope to heal what ails our practice. Ironically, it is through this rediscovery of tradition—what G.K. Chesterton calls the “democracy of the dead”—that medicine might find new life, through a collective reclamation of the moral language, imagination, and virtues that have set apart the medical profession for millennia.
The three of us have each sworn an iteration of a doctor’s oath during medical school. The inspiration comes from the Hippocratic Oath, the work of a minority community of doctors in the fourth century BC. These healers crafted the Oath to establish an internal ethic of practice that they found missing in the culture of medical antiquity: an unqualified moral commitment to the sick, a prohibition against hastening death, and a respect for the privacy of those who suffer.
We do not claim the authority to pen a new oath with universal application. Nevertheless, as we stand at the threshold of a new generation of physicians, we see a need for renewal, especially in light of forces that have eroded the medical profession for decades: an overemphasis on efficiency and utility, an illusion of control over death and suffering through science and technology, and the commodification of patients and medical workers alike. As we dig deep into the ethical and theological resources that have formed us as medical students and resident physicians, we offer the following principles as a confession to one another, to our patients, and to all who seek a shared moral vision of the way of good medicine.
1. For the restoration and preservation of health
We first seek to heal. We will care for the sick, the vulnerable, and the broken, pursuing chiefly the health of the individual patient above those concerns that perennially compete for our time and attention: the bureaucratic, institutional, gainful, and political.
2. For the establishment of a covenant
We recognize that medicine is not merely the detached discussion of facts and options but a moral partnership between patient and physician. We appreciate that the trust that grounds this work is hard-earned and seasoned by patience and forbearance.
3. For the affirmation of the embodied self, constituted by others
We will care for the patient in the fullness of his or her biological, social, psychological, and spiritual self and see him or her as part of a larger milieu of family, friends, and community with an equally important influence on his or her health.
4. For respecting the dependency of the patient
Against the modern habit of reduction and decontextualization, we strive to perceive the dependency of the sick and the well, even as we honour and respect each patient’s capacity for self-direction, thoughtful refusal, and active participation.
5. For the practitioner’s need for community and healing
In recognizing the patient’s dependency, we recognize our own, seeking to build and embed ourselves within a community capable of absorbing the suffering we are privileged to witness. When we are sick, we seek healers ourselves, knowing that it is neither virtuous nor wise to pursue the health of others while neglecting our own.
6. For the acknowledgement of limitations
We respect the limits of our role, recognizing that care exists even when cure evades. We will resist any vision of medicine that treats the patient as only a body to be fixed and disability as merely a problem to be solved.
7. For due respect to death and cultivating an ars moriendi
We will offer hope to the dying, sick, and well alike. We will speak truthfully about death, lending it neither undue anxiety nor flippancy, encouraging patients to cultivate the virtues for dying at peace with others and with God.
8. For presence to both life and suffering
In so seeking the good death, we respect the distinct goodness of life. We will not intentionally cause the death of any human being. Rather than destroying new lives, we will welcome them. Rather than eliminating the suffering, we will seek to be present to their suffering.
9. For language that honours the patient
We speak of patients in an edifying manner, amid a culture sometimes prone to cynicism and degradation. We defend those patients who are denigrated, even and especially those whose care we find most taxing.
10. For intellectual freedom
In our role as teachers, we welcome the free exchange of ideas. We steward and develop with creativity, humility, and gratitude the intellectual, emotional, and technical gifts we have been given to practice this art and science. We assume good faith in those who disagree, recognizing that it is often from those with whom we disagree most fiercely that we most learn.
11. For the role of conscience and the protest of injustice
We will diligently live with integrity, and when our conscience requires it, we will be prepared to object to that which threatens the health of the patient or the coherence of our practice, even when those violations are perpetrated by those with power over us.
12. For the preferential consideration of the most vulnerable
We will learn, with careful attention, from the past abuses of power in which medicine has cooperated. We will practice our craft always with an eye toward the disenfranchised, abused, poor, and oppressed, recognizing that, at times, they may be the patients in most need. We commit ourselves to some form of pro bono work. We will embrace and exude hospitality; seeking to reimagine the hospital as a home that serves all who seek healing.
We recognize that we will fall short on many occasions in this charge, imperfect and always in need of healing, growth, and grace. May we acknowledge our limitations, stand ever ready to forgive one another and ourselves, and still hold one another accountable to this high view of medicine. May these words be more than words.
Detail of The Garden of Saint-Paul Hospital by Vincent van Gogh, 1889.Subscribe