The New Medicine and the Old Ethics
Spiro, Howard
EVANESCENT CERTAINTIES THE NEW NEDICINE AND THE 0LD ETHICS Albert R. Jonsen Harvard University Press, $18.95, 171 pp. Howard Spiro L ife and death issues have overwhelmed modern clinicians...
...It is clear in context that it is cited to illustrate one point of view...
...He was director of Catholic Relief Services in Haiti and now works for the Peace Corps...
...The New Medicine has fine and wise chapters on the beleaguered "fortress" of medicine, and on why doctors feel so set upon...
...He traces the personal ills of many physicians to such conflicts...
...To the Christian and Jewish camps have been added physicians of Muslim, Buddhist, and other heritages...
...Your editorial challenges the finding on methodological grounds...
...The fast edition sold out in eight weeks...
...What is one to make of it...
...Jonsen is one of those builders whose new ideas provide reinforced concrete for the medical tower...
...The explosion of knowledge is unrelenting, and who knows what new evanescent certainties will grip us doctors next year, for a year or two...
...He would have doctors read more, think more, and rejoin society as more than technicians...
...Wittgenstein somewhere contrasted the broad avenues of the "new science" with the cramped meandering alleyways of the "old science...
...In abandoning the trappings of the old order of simple mastery, I hope he does not want us physicians facing a patient to think too much of those who will follow...
...The second statement to which the editorial objects is: "The church is overwhelmingly portrayed [in the media coverage analyzed] as an oppressive or authoritarian institution...
...The new ethics, so he believes, may involve the limits of competence, how much can be done, and for whom, and when...
...The"oM ethics" of his title refers to competence, professional ability, the "mastery of data and method...
...He is the author of Doctors, Patients, and Placebos (Ya/e...
...That misses the point...
...JOSEPH O'CONNOR Media study misread Washington, D.C...
...Uncertainty remains the great tormentor of physicians who search always for certainty...
...But edifices can be structured to survive even in Santa Cruz if their architects respect new knowledge...
...Albert Jonsen, quondam Jesuit, leads a department of medical history and ethics, and is a widely influential professional ethicist...
...is a professor of medicine at Yale University and director o f the humanities and medicine program...
...In particular, it attributes to the study three "statements of fact" with which it disagrees...
...Media Coverage" does present this as one of its findings...
...He may have too quickly joined in the current hubris of medical statistics and controlled clinical trials...
...In the end Jonsen wisely turns to ambiguity...
...Ethics must now look at the limits of technology, and Jonsen tightly asks doctors to learn more about the meaning of technology and its impact on human life and institutions...
...Your editorial finds fault with the results of the study on several grounds...
...HOWARD SPIRO, M.D...
...Now he has written what he calls an "Aggadah, 'A magical rabbinic mode of thought in which myth, theology, poetry, and superstition robustly mingle.'" Others might have called this learned discourse a prolegomenon, for Jonsen seems to be leading us to new and far-ranging considerations in medical ethics...
...History and philosophy, he says (and I would add novels and stories), will make for better balanced doctors and for more prudent medical practice...
...The study's finding is that, in 98 of 115 stories in which the question of characterizing the church in terms of liberation and oppression rose atall, the church was painted as oppressive...
...DAVID CASTRONOVO is professor o f English at Pace University of New York, and author of several books of criticism including Edmund Wilson (Fredrick Ungar...
...Moreover, hospitals which were once the parochial hold of Catholics, Protestants, or Jews have become far more open than before...
...deserves at least a REVIEWERS EDWARD T. WHEELER is chairman o f the English department at the Williams School in New London, Connecticut...
...It was a pastoral gesture, not part of the research and publication of the official books directed by Vatican II...
...Fommately, he recognizes that clinical calculations are "in the realm of probability" and are not simply mathematical...
...The first statement is: 'r mass media image of Catholics is only slightly better than that of the Nazis...
...Medicine has become a more universal calling than in the 1940s, open to a far wider variety of people...
...That said, however, I must also say that your editorial seriously misrepresents "Media Coverage" and contributes little to discussion of the issues with which the study deals...
...There lies the fault line...
...What is man, that Thou art mindful of him...
...Alas, Jonsen sometimes seems to want the doctors of the new ethics to view patients as "representative of a class...
...Jonsen endorses more openness in medicine, less rigidity about methods of practice, fewer restrictions on those whom doctors ought to have conversatl'ons with, and more...
...When Jonsen asks that doctors be "gatekeepers" as well as caretakers, basing decisions on statistics, he may have more faith in numbers than many doctors who are skeptical about the variability of our control trials, or at least of their interpretation...
...express neither agreement nor disagreement...
...Although your editorial speaks of "evident agreement" on the part of the study's authors, they (appropriately) 14 June 1991:413...
...Similarly, when Jonsen states, "competence now extends beyond the care of the presenting patient," I hope he does not mean that doctors should become double-agents, working for government as well as for patients...
...Howard Spiro L ife and death issues have overwhelmed modern clinicians for more than technological reasons...
...More learned from discussions with colleagues like Jonsen, the physician at the bedside must face the limits of what can--and should----be done for a particular patient...
...Jonsen adopts the architectural metaphor, suggesting that the institution of medicine is built atop a fault like his native San Andreas rift, shaken from time to time by earthquakes...
...JOHN P. HOGAN has worked in development in Africa, South America, and the Caribbean...
...For the larger values of equity Jonsen is rightly concerned about are best secured by doing what is "reasonable" or "proportionate" for the patient before you...
...When earthquakes relieve the strains of the San Andreas fault, old buildings may collapse...
...The old absolutes may not have toppled, but it is not easy in a democratically secular profession which believes only in what it can see to get agreement on important issues, particularly at the extremes of life...
...Having watched and worked with doctors for twenty years, Jonsen spots our personal weaknesses, from substance abuse to marital failure, from isolation to suicide...
...The strain between self-interest (and I would add the entrepreneurial ethos foisted upon doctors by business metaphor and tradesman culture) and the altruistic ideals of the profession sometimes leads to collapse, he avows...
...Only 115 of 1,876 stories (five percent of the sample) dealt with the church in the terminology of oppression and liberation (with 98 coming down on the oppressive side...
...Retailer religious goods stores are marketing the missal as a pastoral tool...
...In asking us to look at our past if we want to look at our future with any kind of morality, Jonsen would lead physicians back to the grand old questions we have come to ignore...
...In an earlier book with Stephen Toulmin (The Abuse o f Casuistry, reviewed in Commonweal August 10, 1990) he helped restore casuistry to dignity, emphasizing to physicians how much our "caseapproach" method resembles that of medieval theologians...
...Memory, alas, seems to have gone from modern medicine--yesterday is already yesteryear, and the 1980s represent the distant past...
...Fuzzy around the edges" may challenge the molecular physicist, but it blinds the physician bedazzled by the hard edges of the CAT scan...
...All this will be difficult...
...This is said to be too few to show that the church was "overwhelmingly" depicted in a negative light...
...412: Commonweal thought...
...He would urge doctors to read more literature to understand their patients, and more history to understand themselves and to recall their perennial values...
...To the Editors: I am grateful to Commonweal for the quantity of attention given to the study "Media Coverage of the Catholic Church" and for printing the address at which copies may be obtained ["Thinskinned," May 17...
...Furthermore, data analysis is a subjective art, as any reader of the medical literature will know...
...But this statement appears in the study as a quotation attributed to a Catholic antidefamationist...
...That the rest of the sample was composed of coverage affording no opportunity to CORRESPONDENCE (Continued from page 386) agemore, Solesmes has just published a Latin/English Gregorian Missal for the revised liturgy...
Vol. 118 • June 1991 • No. 12
