Hippocratic and Ideological Medicine
HIPPOCRATIC AND IDEOLOGICAL MEDICINE
The Hippocratic Oath
I swear by Apollo the Physician
And Aesculapius — and health — and all-heal — and all the gods and goddesses — that according to my ability and judgment — I will keep this oath and this stipulation—to reckon him who taught me this art equally dear to me as my parents — to share my substance with him — and relieve his necessities if required — to look upon his offspring in the same footing as my own brothers — and to teach them this art — if they shall wish to learn it without fee or stipulation — and that by precept — lecture and every other mode of instruction — I will impart a knowledge of the art to my own sons and those of my teachers — and to disciples bound by a stipulation and oath according to the law of medicine — but to none others — I will follow that system of regimen which — according to my ability and judgment — I consider for the benefit of my patients — and abstain from whatever is deleterious and mischievous — I will give no deadly medicine to anyone if asked — nor suggest any such counsel — and in like manner I will not give to a woman a pessary to produce abortion — with purity and with holiness I will pass my life and practice my art — I will not cut persons labouring under the stone — but will leave this to be done by men who are practitioners of this work — into whatever houses I enter I will go into them for the benefit of the sick — and will abstain from every voluntary act of mischief and corruption and further — from the seduction of females or males — of freemen and slaves — whatever — in connection with my professional practice —or not in connection with it — I see, or hear — in the life of men —which ought not to be spoken of abroad — I will not divulge as reckoning that all such should be kept secret — while I continue to keep this oath unviolated — may it be granted to me to enjoy life and the practice of the art — respected by all men — in all times but should I trespass and violate this oath — may the reverse be my lot.
The legislation to liberalize abortion which is spreading like wildfire marks a victorious phase of ideological medicine over Hippocratic medicine. The political authority, presuming that it can intervene even in the sacred area of life, applies the play of majorities and consequently assumes, in the name of all, decisions which actually are not in its sphere of competence, in view of the nature of the interest in question.
As if that were not enough, it claims to entrust the material execution of sentences of abortion to one category of citizens alone, physicians, deeply distorting the purposes of a professional activity born for life. Conscientious objection is granted, it is true, but through bureaucratic mechanisms which, whatever their inspiration may be, tend in actual fact to discourage it, putting the doctor in the disagreeable position of one who refuses to carry out what is unilaterally declared to be a "social duty".
It is impossible to understand what this event means nor can a line of resistance and an ideal programme be drawn up unless we examine the nature of Hippocratic medicine, as opposed to ideological medicine.
The history of medicine is rich in complex counterpoints, often coexisting in the same period, in the same medical school and sometimes even in the same physician. Only the necessity of a scholastic schematization can inspire classifications aimed at pinpointing within it precise movements of thought that do not concern the purely scientific aspects but embrace medical science in its multiform aspects. Since it opposes a Hippocratic medicine—an expression which alludes to medical practice of ancient "good" inspiration—to an ideological medicine—an expression which, on the contrary, alludes transparently to a medicine that is negatively conditioned—it is an operation which already runs the risk of superficial dogmatism.
It cannot be denied, however, that the history of medical science, as always happens in history, moreover, contains in the flow of the vicissitudes and men that have been its protagonists, the seeds and developments of trends, which if not always conflicting are at least divergent and can be determined.
Physicians have consciously referred to these trends throughout the ages, causing, as a result of the temporary prevalence of one tendency over the other, considerable differences in the content of medical art and even giving it very different rates of development.
"Hippocratic medicine" and "Ideological medicine" wish to be, obviously, significant expressions and claim to condense trends, by means of the use of two adjectives, one of which refers to a "father" of rational and individual medicine, while the other is derived from a noun (ideology) in common use, the meaning of which is well known.
It is with these trends that we intend to deal. We shall try to clarify, in the first place, with more details what their features are. Subsequently we shall try to establish if actually, in the course of the history of medical science, these trends are always present and in what forms, to what extent one prevails over the other, for what reasons, and with what consequences; to ascertain if this dualism is still present today and if there are rational and ethical reasons to operate an alternative choice between the two trends, or else a choice that disregards both; in particular to ascertain if this choice is justified also by the present juridical, political and social context...
By Hippocratic medicine can be designated a trend of thought and medical practice which finds not only in the oath attributed to Hippocrates, but also particularly in the scientific and professional approach of the great Greek physician, one of the most ancient and complete representations. It is characterized substantially by Galileo's principle of free and not preconceived observation, of equally free and independent evaluation, and of a consequently logical practice: everything in so far as historical contingencies and the laws of society allow.
This line can be considered opposed, as has been said, to another one that is even more ancient, but still re-emergent. This latter cannot be attributed particularly to any ancient or modern physician and is characterized by scientific, and even professional, approaches that are strongly conditioned by ideology of any type.
The term ideology came into being in 1798 with the "Mémoire sur la faculté de penser" by Antoine Louis Claude Destutt de Tracy, read at the "Institut National des Sciences et des Arts" in the section dedicated to the "Analysis of sensations and ideas". It was seen to be necessary at that time to find a new name to designate the "science of thought", and the author thought of substituting a science of the effects of thought—ideas and their expressions—for a science of thought as formal cause. These were the intentions, but the author himself, in his "Eléments d'idéologie", published between 1803 and 1805, brought up again what he had endeavoured to suppress, the problem of the first and absolute cause.
This is certainly not the place to retrace the ground which, from philosopher to philosopher and from age to age, was covered by the term "ideology". All we need, in fact, is to ascertain its present meaning, often characterized by disparaging tones, of an "abstract doctrine not founded, on practice", "collective ideas of a party" or better, according to Mannheim, "system of ideas of a group or an age". Less used, on the other hand, is the Marxian meaning of "masking of interests".
If the term is, therefore, comparatively recent, the meaning it has assumed at present is such as to make it possible to apply it to very ancient situations in the history of man and the history of sciences, especially of medicine and biology, in which ideology has played an essential role, often as a cause of error in doctrine and in practice.
It seems to us useless, as they are so well known, to recall the innumerable errors committed by medicine in the course of its now long life... What is interesting is to consider some of the causes of these errors.
There obviously figure among them gaps in knowledge and in technique, which have been filled to an appreciable extent only in the last two centuries. It is equally true that there are others which are not identified in those gaps, but go back to preconceived approaches in doctrine and method which are in themselves limitative, capable of pushing into the background and sometimes even neutralizing the scientific and practical goals already reached.
These approaches were often borrowed uncritically from other sectors of human thought. We are alluding to the negative influences that have always been exercised on medicine in all ages by the dominant ideologies: philosophical, political and even scientific—obviously pseudoscientific—ideologies.
Along the way
A short survey of some outstanding moments of the history of medicine will make it easier to prove the reality of this supposition.
In the millennia that cover the span of the civilizations best known to us, two sufficiently distinct periods can be determined. The first stretches approximately from the beginning of known civilization, that is from the dawn of medicine, up to the end of the eighteenth century; the second one from the beginning of the nineteenth century to our own days.
In the first of these periods the conflict between Hippocratic medicine and ideological medicine concluded with the domination of the latter, often prolonged for many years. An effect consisted in the arrest, sometimes for centuries, of medical scientific development, although ideological medicine was not the only cause of this effect.
In the following more recent period, Hippocratic medicine, drawing advantage from the impressive development of all sciences, especially in physics, chemistry and technology, shook off in the most strictly technical and scientific fields the shackles of ideological medicine. Ideology, on the other hand, ousted from the mainstream of medical development, has appeared again arrogantly in those areas of medicine that are most closely connected with the ethical foundations of medical thought and practice: just think of the problems of abortion, contraception, experimentation on man, euthanasia.
That does not represent, of course, anything new and is, in fact, the repetition of ancient models of influence of ideology. These today are more or less skillfully camouflaged and updated in the ways and in the purposes declared. Ideology, on the other hand, has not exhausted its influence even in the more specifically scientific sector and even today it is important in those restricted areas of medicine in which there is still space for its action, as, for example, psychiatry.
In the long period that we took as ending at the beginning of the nineteenth century, medicine went through phases that varied considerably, more or less closely connected with those phases that determined man's thought as it took shape in the different cultures and civilizations. Medical progress was irregular, interrupted by long, barren periods of stagnation, marked by an interminable series of attempts and withdrawals, successes and failures.
Archaic medicine which has lasted up to our time in certain populations (and which flourishes again perennially in the civilized world through magicians and healers) was identified everywhere with magic and religions. Illness was considered a possessive manifestation, extraneous to man, inflicted as a sanction by evil genii. So recovery inevitably required the intervention of personages who declared they were capable of having contact with supernatural powers; magicians, soothsayers, "priests". Pathology and therapy were, therefore, only aspects of mythology, even though the marginal principle of recourse to elementary empirical means was accepted. We are, therefore, in the absolute predominance of ideological medicine.
A subsequent phase witnessed the desacralization of medicine. This phase corresponds in the Graeco-Roman world, to the six centuries that separate the innovating work of Hippocrates from that of Galen. Passive but intelligent observation of the facts takes the place of blind mythological beliefs. Illness is humanized, it stops being extraneous to the person who is ill and is identified with him.
It is opportune to meditate on these historical events and above all on the work of Hippocrates, whom we have taken as the emblem of a movement of medical thought, successful in the end, but threatened again today. We intend to refer not so much to the deontological aspects but rather to the more specifically scientific, and, in particular, methodological aspects of the work of Hippocrates, as it has come down to us.
Desire to know
Hippocrates is now traditionally the personified expression of' medicine which, having emerged front the empiricism-ideologism of the school-temples, becomes "rational" and takes its place in the wide movement of the "philosophy of nature". In this case what is meant by philosophy is the "desire to know": the whys and wherefores of illnesses, their cure, of the effects of the therapy and so on. Because of this series of "whys", it can be stated that for Hippocrates it represents the very necessity of medicine that it should assert itself in that dimension that is characteristic of it, a necessity that has no age and which is more valid than ever today.
Hippocrates, in making the great effort to free medicine as a science from "priestly" influences, did not neglect philosophy, however, and in fact used it widely: but related to experience, not outside it. To investigate is recognized as a fundamental part of medical art, and investigation is carried out both through passive observation of phenomena and through the observation of provoked phenomena. From the study of particular cases, conclusions of general significance are reached in a rational way.
The technical insufficiencies of the Hippocratic age are obviously enormous and inevitably limit the field of investigations. But Hippocrates knows his fallibility and is aware of the insufficiencies. This is the essence of modern science, which arrives at the truth because it is ready to recognize its mistakes.
The work of Hippocrates was soon suffocated by a powerful movement of ideology. No sooner had medicine freed itself from mythological beliefs than it fell under the influence, only seemingly more rational, of philosophical systems based on an arbitrary logic. Thus the acquisitions of empiricism were put in the service of preconceived theories formulated in such a way as to furnish a systematic justification.
In this way there began a long period of ultraconservatism, in which religious and philosophical beliefs once more dominated medicine, at least indirectly, imposing upon it unconditional respect for dogmas inherited from antiquity or borrowed from contemporary disciplines imprisoned in dogmatics.
The very works of Hippocrates, and even more those of Galen (alongside those of Aristotle) became an ideological instrument.In this long lethargy of science, instead of using what was new on the plane of methodology in the work of these and other scientists, all that was done was to ideologize the result, very often fallacious, of their researches and scientific considerations, crystallizing it and imposing it in an intolerant and apodictic way. Science itself, therefore, becomes ideology.It was another way, not a new one, of conditioning medicine and science in general to dogmatic doctrinal schemata which are imposed and which are contrary to the free development of knowledge.
Victory of the Hippocratic spirit
During this long period of immobility, which only for the sake of exposition in schematic form we have considered the domain of ideological medicine, the opposite trend, that is, true Hippocratic medicine, was not dead. It remained alive like an underground torrent not dried up, nourished on Greek thought. About the end of the Middle Ages it succeeded in bringing its fresh waters to the West: through the Jewish, Byzantine and Islamic culture, transmitted through Spain, Salerno and Montpellier.
This ancient stream, never completely extinguished, frees its energies in the Renaissance, favoured by the discovery of printing and the deep renewal of religious and philosophical thought.
The great revolution of Renaissance thought involves medicine, in fact, giving rise to a deep critical revision of method, with increasing recourse to the experimental method.
Within this line ofrenewal we find, it is true, two trends coexisting for many years. One gives primacy to reasoning over the scientific fact observed and provoked. The other, which will subsequently yield the maximum results, continues research, particularly in the experimental field, with logic and patience and makes a clean sweep of all preexisting dogma; it dedicates itself to the morphological study of healthy and diseased organs, to exploration of the functions of the human body and utilization of the progress of chemistry and physics.
This line becomes evident and is emphasized particularly at the end of the eighteenth century, having been preceded, after the enthusiasms and hopes of the Renaissance, by yet another period of weakening and dogmatic dependency. It is a question of new spasms of ideological medicine in a phase of decline, made possible above all by the continuing technical insufficiencies of the age.
Revolutions are, by definition, critical moments, sudden turning-points, prepared for a long time but then condensed in events that happen quickly. For this reason also the scientific revolution of the nineteenth century had its phases of relative stagnation, its slow periods, which preceded the new leap forward that started about 1930. After that there came an age, such as the present one,in which the Hippocratic spirit seems to have definitively overcome all the temptations of ideological medicine.
New features of ideological medicine
Even if itmust be recognized that ideological medicine has assumed new ways of being and acting today, there are, however, symptoms of dangers evengreater, perhaps, than those that characterized the dark ages.
These new features of ideological medicine are obviously of particular interest, because they are the heart of the concerns of medicine today. It is necessary, therefore, to identify them and analyze them carefully.
It has already been said that today ideological medicine affects mainly those gray areas of the medical profession which leave a margin for its action... Historical analysis shows that the harmful influences of ideology on the development of medical science were derived not so much from its absolute and exclusive causal efficacy as rather from the intrinsic weakness of knowledge and above all of technical instruments which encouraged conditioning by ideologies. In other words the first cause of the conceptual and practical errors of medicine lay, perhaps, in the very difficulty of the subject of medicine and the general backwardness of scientific knowledge on those matters which were not, as on the contrary mathematics was, mainly the product of the human intellect.
Therefore it can and must be recognized that the recourse to ideological "solutions'' was sometimes the effect and not the first cause of the backwardness of medicine. For ideological medicine represented a convenient refuge for the disappointments of the doctor-scientists of the past who so frequently saw the brilliant precursory intuitions of the best of them, such as Hippocrates, shattered by the objective difficulties of the general problems of science and the particular problems of individual clinical cases.
In this sense, it is certainly possible to speak of the escape of medicine into philosophy and ideology as a remedy for frustration. This mechanism is only apparently set aside in the positivist enthusiasm aroused by the scientific and technical progress of the nineteenth century and even more by the breakthroughs in the latter part of this century. It is apparently set aside, because the temptation reappears before the inevitable failures that accompany successes, even today. This is, it seems to us, one of the explanations, certainly not the only one, of the destructive fury of modern psychiatry, the fruit, on the one hand, of the prevailing sociology, and, on the other hand, of the too many disappointments suffered by a discipline which has often looked on helplessly at far greater successes in the field for example of internal medicine, surgery, biochemistry, physiology and immunology. Society is held up then as the only cause of mental illness and there follows the inevitable dogmatic conclusion that to eliminate mental illness it will be enough to treat the whole of society with ready-made political proscriptions, declared to be infallible, even if their failure is before everyone's eyes.
A similar ideological influence was manifested in the vast and multiform field of psychology as has recently been stressed by Jean Bernard (Jean Bernard ; Grandeur et tentations de la médecine.Buquet Chastel, Ed. Paris). Bernard recalls very shrewdly the radicalization of trends that has come about in this field. There is the distinction on the one hand of the medicine of organic diseases, limited to a few extremely serious cases; this medicine "very simple on the intellectual plane, can be entrusted to capable technicians who operate in a well-equipped hospital". There is on the other hand a medicine of functional disorders, extended to nearly all the ailments that give rise to consultation. This has been touched but little by the recent progress of science and needs the determinant aid of psychologists and physicians formed in their school.
It is possible to arrive, Bernard points out, at a final stage, which he defines "imperialistic". In this the existence of organic disorders is questioned and it is suggested that the whole of medicine should be subordinated to psychology. There follows a terroristic action, so to speak, which takes on the form of ousting all those who are unable to accept the absolute priority of psychology. The latter are considered disparagingly "organicists" who exercise a hospital medicine that is "material, reactionary, limited to a few exceptional cases, the property of robots hardly able to think", and who reject, on the contrary, an extrahospital medicine, modern, spiritualized, which has recourse to the very new techniques of the psychological approach. The "terrorists" are trained in dialectics and succeed in putting doctors in the wrong, often obtaining the opposite effect of causing people not to recognize the importance and usefulness of psychology when used correctly.
A further, perhaps clearer, example is represented by the interferences of sociology in the sphere of science and of the medical profession.
That the study of the relations between a man who is sick, or a subject for sickness, and his environment is indispensable, is unquestionable. Therefore the birth of medical sociology, in the sphere of which physicians, demographers, economists, teachers and sociologists cooperate, is to be considered positive. But this has led, with the usual mechanism, to abuses, always inspired by ideological predilections, as a result of which the attempt is made, on the one hand, to attribute to the environment an exclusive role in the genesis of diseases, and on the other hand even to change radically the concept of disease, asserting, for example, as Foucault does (quoted by J. Bernard) that "a disease takes on the reality and value of a disease onlywithin a culture that recognizes it as such". These apodictic and dogmatic positions, often assumed with intolerant arrogance, aim at intimidating the free researcher, who pursues the Hippocratic method of the search for non-preconceived truth and utilizes the most varied sources of information, including sociology. A study of pathology, in actual fact, shows that it involves the collectivity and the individual at the same time: "Every human action starts from the individual and goes beyond him towards the collective; then it returns to the individual since the diagnosis and therapy depend to a great extent on the specific molecular structure of every human being (J. Bernard. loc. cit.).
These examples prove that the temptations and influences of ideological medicine are still operating and that they are actually exercised in those gray areas of Hippocratic medicine in which knowledge is still limited, and do not fear even to face Hippocratic medicine in its most valid and indisputable bulwarks, expressed in so many diagnostic and therapeutic successes.
Medicine and Political ideology
It is notthis, however, that is particularly worrying: the major danger is represented by the relationship that has been established between medicine and political ideology.The latter, with or without the mask of philosophical ideology, most often with the ancient mask of dogmatic pseudo-science, has discovered in medicine, in fact, one of the most powerful instruments for the exercise of power.
There is, nothing new under the sun, since everyone knows how much the medical art, through its individual practitioners, was used in the distant past to perpetrate abuses or crimes. It was usually a question, however, of individual cases and clearly localized matters, not because the men and structures of power were better, but only because the power of the physician and of medicine was limited, with a modest radius of action.
Today medical science, with the support and help of the chemical industry, can decide to a large extent the destiny of the human population of the globe and also that of animal species: their increase, which can be controlled or turbulent, their state of well-being or illness, the average length of life.
This immense power arouses the interest of politicians and administrators and the greed of industrialists and financiers. And so we get the political and economic power including among its ideological and practical instruments medicine as a science and as a profession, claiming to interpret its content and purposes and to turn them to suit its purposes, working upon the medical category by means of enticements or blackmail, and on the rightful hopes and expectations of the populations.
The physician and medicine are therefore at the centre of an operation of instrumentalization which is wrapped, and wishes to be wrapped in the eyes of the collectivity, in humanitarian and protective tones. Anyone who opposes it, and it may often be the physician himself, is a heretic held up to public condemnation. In this action it may happen that the political authority does not limit itself to carrying out that organizational and promotional action—of care and prevention—which makes it the natural and obligatory ally of medicine. On the contrary, it trespasses on the very domain of medicine as a science, trying to change its principles and transform its aims, touching the most crucial areas of the physician's personal freedom and, in any case, proposing once more the repressing domination of ideological medicine.
It is no mere chance that those very areas of medical science that we have just mentioned as examples of new ideological medicine, are the ones on which the interest of the political authority is focused. The latter encourages the new dogmatic positions and uses them as a means of ideological indoctrination exercised upon physicians, patients, and on the healthy collectivity, often with terroristic tones the effectiveness of which is assured by an orchestrated use of the mass media.
It is a question of a real battle, with its strategy, its tactics and arms wisely chosen, capable of striking the imagination and the sensibility of the masses, who have previously been "sensitized". In the front row among these arms there figure those chapters of medicine which concern most closely the ethical sphere of the physician and the populations, since they regard central points of the existence of the individual and of collectivities.
Legalized medical abortion, indiscriminate birth control, politicization of psychiatric problems, criminal use of Pavlovian conditioning and so on are, therefore, only aspects of manoeuvres of a vast strategy of domination. It is not desired to deny in the latter, a priori and always, illuministic good faith which sees in progress at any cost the good of humanity; but substantially it forces its way into the flank of modern medicine, transforms its purposes, injects into it toxic doses of ideological poison, and prepares a new period of decadence for it. For, contributing to exalt its functions beyond the limit of the reasonable and the materially possible and partly distorting its purposes, it opens the way to new disappointments with subsequent reactions of destruction or escapism. In short, it prepares new medieval temptations, and that in the best of hypotheses.
We have spoken of political ideologies without giving any specification of identity. There would be a great deal to be said about what ideologies.But the task is a difficult one and the analysis would be long and complex. Scientific objectivity requires at least that among the guilty there should be pointed out not only those who plead guilty—Marxist ideology and its derivations—but also, though in a different form, the more composite pragmatic and liberal ideologies of the West. In these latter the distressing and inexorable logic of profit often makes medicine slip into the consumer ideology, exercising in this way another form of instrumentalizing power, which must also be picked out, analyzed and condemned. The question of the contraceptive "pill" on which Marxist ideology, on the one hand, and industrial capitalism cloaked in illuminism, on the other hand, agree, is the most obvious example. It is a question of a form of association which, with official motivations that are not medical but almost exclusively social, subjects a good part of the female population of the globe to massive "experimentation", brazenly passing over individual risks in silence, in the name of political ideology and of the consumer ideology.
Necessity of a choice
So far, therefore, we have seen that there actually exist two trends in the history of medicine, which can be distinguished from each other and which can be called Hippocratic medicine and ideological medicine. We have been able to ascertain, though briefly, that they face each other with alternate vicissitudes in the whole span of the history of medical thought; that certainly in the last century, and in particular in the last half century, Hippocratic medicine has met with enormous success, but that in the meantime ideological medicine is still flourishing... In drawing this picture, a judgment of positive value has explicitly been given to Hippocratic medicine and a negative one to ideological medicine. It is necessary to come back briefly to this point to ask ourselves if there are ethical reasons, in addition to rational ones, for the physician to make a choice, and if this choice is legitimate in the present political and social context.
There is nothing to be added about the rational motives for the choice,since it is sufficient to have ascertained that the enormous development of medicine and biology was the fruit of the abandonment of every preconceived ideological bond, eliminating the possibility of an alternative choice.
But in this choice ethical motivations,too, can and must intervene , with regard to which agreement will not perhaps be easy within the medical category, where there exist divisions and alignments which go back to different ideological inspirations. The attempt must be made, however, not by means of a priori choices, but on the basis of an analysis of the actual situation and of the legitimacy of some principles of medicine.
It is necessary to refer once more to Hippocrates to ask ourselves if the oath attributed to him, possibly in the updated forms of present-day national deontological codes, can still be a univocal point of reference for physicians today. And in the case of an affirmative answer, if there are motivations other than the sentimental and emotional ones that refer "to the good old times", to the "physician of the past" and so on.
The oath of Hippocrates, as is known, consists of a few essential points which concern: the "one aim" of the physician which is "to treat and cure the sick without abusing them", prescribing for them "the regimen" that he "will judge" suitable for their situation according to his "science and conscience" and avoiding everything that could harm them. In this aim is included the physician's ban upon himself to provide deadly poison and procure abortion; professional self-limitation by means of a precise determination of one's own limits of competence ("I will not operate those suffering from stones but will leave this operation to the persons charged with it); professional secrecy; integrity of life and honour of the art; relationship with colleagues and their family, and the relationship with disciples; the relationship with the religious origins of medical art.
The official oath of the physicians of many nations is still modelled today on this ancient oath. But it is important to point out that in some of the present-day deontological oaths there are waivers or omissions which, on the basis of clearly ideological inspirations, are. in deep conflict with the general Hippocratic principles. The oath of the Soviet physician is a clear example. Not only is there no mention in it of the ban on the procuring of abortion, but, though following a series of declarations that coincide completely with the Hippocratic ones, there appears another one that challenges the very heart of the Hippocratic oath. In the latter, the relationship between physician and patient is based exclusively on this dual concept without any substantial external interference, according to the "science and conscience" of the physician, obviously brought into line and updated to the particular historical moment, with the one aim of the individual interest of the patient.
In the oath of the Soviet physician there appears, therefore, the commitment to develop "the noble traditions of national medicine" and particularly that of basing all medical acts "on the principles of Communist morality", always keeping in mind "the high title of the Soviet physician" and being aware of "responsibilities towards the Soviet people and State". In other words, the following is a fundamental principle of Soviet medical deontology: "if the interests of the patient are in conflict with those of the State, the physician must give preference to those of the collectivity because health care is not addressed only to treatment of the sick person but also to prevention of diseases in the interest both of the individual and of the collectivity" (cf. Gromov A.P. (1975): Deontologia e responsabilià professionale del medico Sovietico. Coop. Libr. Ed. degli Studenti, Padua).
No physician, of course, can affirm today that his diagnostic and therapeutic action must disregard the interests of the society in which he lives, but the Hippocratic principle of the primary and prevalent interest of the patient is irrevocable and the motivation can easily be given.
The medical profession, unlike all others, administrates the life and death of men. The healthy man who fears disease and the sick man entrust themselves to other men who possess a set of cognitive and operational instruments which, in order to pursue the aim of the cure, may often put the patient even in the condition of risking his life. A relationship of this type confers on the individual physician, and on the medical category as a whole, quite special duties and responsibilities.
The religious origins of medicine find here a logical explanation which is still valid. Those references of the Hippocratic oath which are clearly connected with the rules of the priestly caste, cannot have the mere meaning of a contingent compromise that Hippocrates tried to make with the Asclepiadae, but can and must be interpreted as a sign of the awareness of the sacredness of the medical act inrelation to the sacredness of life.
There is therefore a real ethical justification for a deontological code that is independent of historical contingencies and of the influences and suggestions of the political authority as well as ideologies of all types. There remains, in fact, unchanged, even in the vicissitudes of history and in the expansion of scientific knowledge, the nature of the relationship which is strictly interpersonal (it does not matter whether it is a question of one or several physicians in a team) between the physician and his science, between the physician and his patient because the aim is one only, direct in professional practice, indirect in the sphere of scientific research: the aim of preserving the good of life.
This does not mean that the physician is not subject to the laws that the community has given itself. On the contrary, he is more strictly subject to them than others, just because the laws, and especially penal law, set themselves the same purpose, that is, maximum protection of the integrity of the individual human person. Nor does it mean that there cannot be, as in fact there are, branches of medicine that study the problems of the life and health of the masses and that suggest for this purpose actions of an organizational character with preventive, diagnostic and curative aims. But these actions in the operational phase are carried out by individual relationships.
It is now necessary to raise the question whether the medical category really abides by these principles and, if not, if there is a motive for yet another battle under the banner of Hippocratic medicine.
In all ages, unfortunately, there is present the image of the uncultured physician, an exploiter, or the servant of power: the medical category inevitably repeats within itself the variety of human types. It is not surprising, therefore, if it also repeats the ideological and political divisions of a society such as the present-day one, composite, full of growing tensions, characterized all over the world by deep divergences of inspiration and concepts which do not necessarily coincide with the two great blocs of the Marxist world and the Western world, but pass through the two blocs themselves. The position assumed on the problem of abortion by many European and American physicians is a proof of this.
It is, therefore, in the first place within medicine, rather than outside it, that it is necessary to combat the great new attack of ideological medicine which casts shadows on the lights of medical progress in this last part of the century, announcing new medieval threats. This attack is made with the technique of all times. Once more, crime is carried out in the name of the sacred principles of short-lived philosophies, with pressure and infiltrations operated by the other disciplines that medicine utilizes, by the sciences it inspires, and even more by the political authority, often with up-to-date methods of ideological terrorism.
The essential duty of medicine today is to affirm its own unity and independence, recognizing indispensable alliances and rejecting temptations. If this unity is lacking, it is necessary courageously to recognize the fact, and the physicians inspired by Hippocratic medicine must take the field again by means of a common strategy, expressed in public, in group and individual stands.
Conscientious objection is one of the instruments that must be used whatever the personal cost may be. In the field of abortion it can be foreseen that physicians will be subjected to increasing operations of ideological terrorism to induce them to withdraw their objection. There will be objection to objectors. But anyone who has the deep conviction that the matter of the liberalization of abortion is only a passing phase, another of the eternal returns of human error in history, knows that nature always has its inevitable revenge. The abortion-euthanasia binomial is bound to lose in the long run. The medical category must, therefore, appeal to conscience and to the ideal charge that comes from it and take its place on the front line of resistance. It will be a long, difficult and painful way. But physicians are not new to these tasks, because their daily life is interwoven with obstacles of every kind. The question is just not to lose the way of Hippocratic medicine.
Weekly Edition in English
11 May 1978, page 10
18 May 1978, page 10
L'Osservatore Romano is the newspaper of the Holy See.
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