Abstract

This chapter explores some of the many doctor-writers who have reflected on the practice of medicine and the qualities of a good doctor. Beginning with a discussion of the merged scientific and humanistic sensibilities of these writers, it examines the work of five prominent figures: William Carlos Williams, Richard Selzer, Kate Scannell, Danielle Ofri, and Pauline Chen. Then, with a focus on their pleas that we attend to the patient’s illness and life world as well as to the patient’s ailing body, it considers how their work helps us to think about what it means to practice purposefully.

WILLIAM CARLOS WILLIAMS

William Carlos Williams (1883–1963) is best remembered today as a revolutionary modernist who wrote poetry in the American idiom – poetry that reflected the distinctive way Americans speak the English language. He was also a prolific writer of prose – novels and essays – and a playwright. But Williams’s day job was as a doctor who practiced general medicine and pediatrics for four decades and composed stories emanating from his practice experience. Williams’s “doctor-stories” reveal a physician seeing patients during office hours in his home clinic and making house calls in and around Rutherford, New Jersey, especially among the often immigrant poor. The physician is genuinely interested in his patients (“fascinated” would not be too strong a word), intrigued by their lives, touched by their humanity, and struck by their authenticity. The narrator speaks in the story, “Ancient Gentility”: “In those days I was about the only doctor they would have on Guinea Hill. Nowadays some of the kids I delivered then may be practicing medicine in the neighborhood. But in those days I had them all. I got to love those people, they were all right. Italian peasants from the region just south of Naples, most of them, living in small jerry-built houses – doing whatever they could find to do for a living and getting by, somehow.”

The history of medicine is the oldest discipline of medical humanities. Actually, medical history, whose origins lie in the late nineteenth century, long predates and helps us to understand medical humanities, which is barely forty years old. At the turn of the twentieth century, distinguished American male physicians and educators first turned to history as a means of humanizing medicine. Although there are now serious doubts, debates, and visions, and the field has grown more diverse, this mission in medical education has remained remarkably stable. With the recent rise, however, of medical humanities and bioethics, and the professionalization of the field of the history of medicine, the influence of history in medical education has been overshadowed by ethics, literature, the social sciences, and to a growing extent, religion/religious studies and media studies. One counterbalancing trend has been public policy historians such as Susan Reverby (1946–), David (1937–) and Sheila Rothman (1939–), David Rosner (1947–), Gerald Markowitz (1944–), and Howard Markel who have been active in developing programs in history, ethics, and public health, housed outside of medical schools. Another is the testimony of physicians whose lives and work have been shaped by their knowledge of history. History is an exciting and essential way of understanding medicine and health care, which are never static but rather constantly changing and evolving.

Abstract

This chapter explores the brief history of religion and bioethics. Beginning with a discussion of the religious roots of the field, it examines the key contributions of early figures such as James Gustafson, Paul Ramsey, Joseph Fletcher, Karen Lebacqz, William May, H. Tristram Engelhardt Jr., and Daniel Callahan. Then, with a focus on contemporary debates surrounding religion and bioethics, it notes some recent developments in the field, including the “conservative turn” and the emergence of non-Christian perspectives.

INTRODUCTION

The purpose of this chapter is to introduce the reader to the role that religious thinkers have played, and, to a lesser extent, still do play, in bioethics. This chapter is historical and thematic and has three parts. In part one, we provide a brief overview of the history of religion and bioethics. In part two, we explore some of the writings and themes of key thinkers in this history. And in part three, we outline some current debates and discussion.

Abstract

This chapter explores the emergence of bioethics as a distinctive form of moral philosophy. Beginning with a discussion of the public’s mounting unease with the applications and implications of “big” science and “rescue” medicine, it examines the birth of bioethics in the 1960s and the subsequent contributions of key thinkers such as K. Danner Clouser, Daniel Callahan, Tom L. Beauchamp and James F. Childress, Robert M. Veatch, and H. Tristram Engelhardt Jr. Then, with a focus on contemporary exchanges between recent ethical approaches, it considers how we might address some of the moral challenges facing medicine in the twenty-first century.

INTRODUCTION

As we have seen in previous chapters (4, 6, and 14) concerns about the ethics of clinical and research medicine began to surface in the 1960s. Revelations of abuse led to a call for public mechanisms to govern medical research involving human subjects. Surgical and pharmacological advances in the transplantation of vital organs generated new uncertainties about the definition and determination of death. And public unease mounted regarding the use of new technologies that often seemed to prolong life at the expense of dignity in dying. Medicine was becoming morally unsettled.

Abstract

This chapter explores how doctors have been depicted on American television. Beginning with a discussion of existing scholarly literature, it examines the origins of the doctor show formula on programs such as Medic and Ben Casey; the shift toward shows, like M*A*S*H, that focused on the lives and problems of physicians rather than patients; the new emphasis on the doctor’s family life on programs like The Cosby Show; the growing sense of disillusionment presented on shows such as ER; and the representation of the doctor as antihero on shows like House, M.D. Then, with a focus on The Mindy Project, it considers some recent developments in the doctor show formula.

INTRODUCTION

Police shows and doctor shows have been a staple of American television for well over fifty years. It is striking that while police shows tend to focus on the taking of life (i.e., murder) doctor shows tend to focus on procedures for saving life (e.g., surgery). The ongoing popularity of both genres seems to indicate that the American public never seems to grow weary of watching the extremities of life.

Abstract

This chapter explores the issue of equity in the organization and distribution of health care. Beginning with a discussion of various presidential attempts to establish greater equity, it examines what Paul Starr calls “the American health care trap” as well as the reasons why America, alone among postindustrial democracies, has failed to enact a universal health insurance program. Then, with a focus on recent work in the field, it considers how we might find our moral and political compass amidst the complex network of actors and institutions that determine how we organize and distribute health care.

INTRODUCTION

In Chapters 11 and 12, we discussed the virtue of care in doctor-patient relationships. But what of equity, or fairness, in the organization and provision of health care? This chapter critically examines the requirements of justice in the allocation and distribution of health care services.

Abstract

This chapter explores how we narrate our experiences of illness. Beginning with a discussion of how narrative shapes our experience of brute fact into intelligibility and meaningfulness, it examines four narratives of illness: Oliver Sacks’s A Leg to Stand On, William Styron’s Darkness Visible, Lucy Grealy’s Autobiography of a Face, and Aaron Alterra’s The Caregiver. Then, with a focus on the relationship between narrative interpretation and our encounters with illness, it considers how reading narratives of illness attentively, expectantly, and reflectively can heighten our powers of perception, deepen our self-knowledge, and thicken our understanding of what it’s like to suffer through an illness or cope with an injury.

INTRODUCTION

This chapter discusses a type of illness narrative known as “pathography,” a subgenre of autobiography and biography. And it offers “readings” of four such narratives, each with a different focus – loss of bodily integrity, mental collapse, disi guring cancer, and incurable degenerative disease – and all authored by professional writers.

Abstract

This chapter explores portraits of aging and old age in film. Beginning with a discussion of early Hollywood’s cult of youth, it examines the slow emergence of aging characters in the 1950s and 60s; the themes of intergeneration and regeneration that frequently drove the plots of films depicting old age in the 70s and 80s; and the variable and complex images of aging presented in more recent age-related films. Then, with a focus on issues such as late-life sexuality and the trope of the “aging cowboy,” it considers some of the ways that contemporary film has challenged negative stereotypes and images of old age.

INTRODUCTION

In the last quarter of the twentieth century, western societies entered an unprecedented era of mass longevity and aging. Most people could expect to live into their seventies in reasonably good health, while those eighty-five and older became the fastest-growing age group in the population. Yet as we have seen in Chapter 5, “The Health of Populations,” the dark side of this triumph was an epidemiological transition in which chronic disease replaced infectious disease as the primary cause of mortality. Mass longevity came with a price tag: many older people now experience periods of disability, frailty, dementia, pain, and may suffer a prolonged death in intensive care units. In addition, western (and especially American) culture remains plagued by ageism – a pattern of prejudice and discrimination toward older people and old age, analogous to sexism and racism. Ageism and hostility toward the aging process are clearly reflected in the contemporary medical and popular ideal of “anti-aging” – the notion that one can grow old without aging. Despite our cultural illiteracy about how to grow old, the modernization of aging has generated a host of existentialand moral questions that are largely suppressed in popular culture: Is there an intrinsic purpose to growing old? Is there anything really important to be done after children are raised, jobs left, careers complete? What are the avenues of spiritual growth in later life? What are the roles and responsibilities of older people? Who should care for old people who are frail and sick? Is wisdom an illusion or an accomplishment of those who pursue it? Is there such a thing as a “good old age?”

Abstract

This chapter explores suffering and hope in the context of medicine. Beginning with a discussion of Eric Cassell’s claim that physicians should attend to pain and suffering, it examines possible religious answers to patients’ existential struggles to find meaning in their illnesses; the practical theodicies that health care professionals often construct or hold onto to help them deal with suffering; and the nature and role of hope in patients’ lives and clinical practice. Then, with a focus on the inevitability of suffering, it suggests that we should do our best to create the conditions for hope.

Abstract

This chapter explores the topic of medicine and power in the context of race, gender, and class. Beginning with a discussion of quantitative methods of addressing medicine and power, it then examines Michel Foucault’s description of how knowledge/power objectifies human beings by means of dividing practices, scientific classification, and subjectification; John Money’s description of how gender identity is “completely malleable”; Mary Daly’s description of how American gynecology is part of a larger tradition of the social control of women’s bodies and minds; and various issues raised by the Tuskegee Syphilis Study. Then, with a focus on contemporary research in emergency rooms, it considers some of the challenges facing us in the twenty-first century.

Abstract

This chapter explores the history of public health. Beginning with a discussion of the health of populations in prehistory and antiquity, it examines how religious institutions of the medieval period took on the obligation to care for the poor, the needy, and the sick; how public health officials responded to plague outbreaks in the early modern period; how infectious disease devastated New World populations; how a democratic, person-centered view, which established health as a right of citizenship, arose in the eighteenth and nineteenth centuries; and how various states have dealt with the health of populations since then. Then, with a focus on some contemporary issues such as climate change, it considers some of the challenges facing public health efforts in the twenty-first century.

Introduction

“I had undergone three heart surgeries in two years,” Dr. Steven Hsi writes, “numerous tests, dozens of visits to doctors’ offices, extended stays in hospitals and long recuperative periods at home.” He continues:

Dr. Hsi and his family coped well enough, he writes, but no one, especially none of his doctors, asked him what he felt to be the most important questions: “What has this disease done to your life? What has it done to your family? What has it done to your work? What has it done to your spirit?” “Regardless of the considerable compassion and caring of many of them,” Dr. Hsi concludes, “no one asked the questions that needed to be asked. I have come to believe this oversight was the single most grievous mistake my doctors made.” Existential questions – questions about the meaning of life and death – are essential to medicine. This book is designed to help you engage the most important questions.

The term “the arts” derives its meaning from the context in which it is used. “Fine arts” refers to activities and products of the imagination such as music, painting, and sculpture, which appeal to a sense of beauty. Branches of learning such as history, languages, literature, philosophy, and religion are traditionally known in academic parlance as liberal arts. “Arts and sciences” distinguishes the humanities, also known as human sciences, from natural sciences and social sciences. Similarly, in an older idiom, “letters and sciences” draws the same distinction but gives literary learning pride of place in the humanities. And there are “arts of,” as in martial arts and healing arts. This section explores some contemporary connections between humanistic study and the healing arts, giving special attention to relationships between visual and verbal meaning.

Art both mirrors and challenges our settled perceptions. John Berger (1926–) writes, “Seeing comes before words ... [and] the way we see things is affected by what we know or what we believe. We only see what we look at. To look is an act of choice. As a result of this act, what we see is brought within our reach.”