We thank Prof.Thomasma and Prof.Pellegrino for their serious attempt to bridge cultural and linguistic rifts. I have asked the writers of the bookreview to comment on the remarks of our American colleagues.
Prof.Broekman is of the opinion that a decision made by a doctor for and with the patient is already characterized by the medical model. He upholds his objection against the equalization of that decision with other decisions pertaining to life events. He objects to the individualistic starting point of the authors in their discussion of the doctor-patient relationship, again an expression of the medical model. It is wrong to make a choice between ‘metaphysical priority’ of individual and society; this would suggest that an individual might exist prior to a society.
Dr.Endtz and Dr.Verbrugh wrote long replies, from which I select the following remarks.
Dr. Endtz: my cry for definitions remains unanswered. Since medicine is universal and medical practice ideally is tending to be so, the first thing to do is to define the words for use. As for me, I am not against a personal approach and I do not object to changing our axioms, but if we want to be understood, we have to know what we are talking about. I am still puzzled by the easiness shown by Prof.Thomasma and Prof. Pellegrino in their use of the terms ‘medicine’ and ‘medical practice’. I eagerly try to follow their discourse but they do not make my trying easier in this way.
Much remains to be said about the supposed identity between ‘medical practice’ and the ‘healing aims of medicine’. Times have changed since Hippocrates stressed the importance of prognosis and we are better armed to intervene in prognosis; but is not this intervention, and thus the healing aim, only part of medical practice?
One word on psychiatry. I am aware that American psychiatrists today are ready to bridge the rift between psychiatry and the rest of medicine.
Dr. Verbrugh: I still have great misgivings about a venture in ‘a philosophy and ethic of the healing professions’ presented under the title of ‘A philosophical basis of medical practice’. One can describe how people go about setting medical matters, particularly how they deal with situations in which there are conflicts of interests and other ‘ethical’ issues. This is not a ‘philosophical’ ethics, however, it is sociology or journalism, not philosophical reasoning. This is my main objection to the book.
The authors see ‘the actual phenomena of medicine primarily in the clinical event’ (page 4), and although this is historically certainly a valid procedure, I would argue that many, perhaps even most issues which are medically-philosophically controversial and relevant have their roots outside the phenomena of the clinical event. The roots of the reasons why people think and feel and act in the way that they do about such issues as euthanasia, abortion, artificial procreation, psychiatri-/psychosomatic treatment, the coping ability in the case of cancer and other serious diseases, etc., are not to be found in the phenomena. It can be fruitful to start the discussion on the basis of the phenomena, but I would also want many more examples taken from practice than Thomasma and Pellegrino provide in their book. Indeed, having a second (or, rather a third or fourth) look at their book while writing this reply to their comment, I am again impressed by the paucity of actual medical cases and phenomena. It is from such case-studies that the reader is incited to discover for himself the actual phenomena of philosophy.
This brings me to another point. I ‘seem puzzled by a personal, “first person” approach in a scholarly work’. On the contrary, I dearly miss the ‘first person’ where it would be appropriate, that is to say, in the narration of personal experiences and in the explicit taking of sides in issues. What I consider to be a defect in the book, is the lack of equilibrium between (subjective) personal experience and engagement on the part of the authors, and the absence of any objective philosophy, in the sense that the great lines of philosophical thought as it has developed in the last 25 centuries are not summarized with reference to medicine today.
De filosofische basis van de geneeskunde
Amsterdam, July 1986,
We thank Prof.Thomasma and Prof.Pellegrino for their serious attempt to bridge cultural and linguistic rifts. I have asked the writers of the bookreview to comment on the remarks of our American colleagues.
Prof.Broekman is of the opinion that a decision made by a doctor for and with the patient is already characterized by the medical model. He upholds his objection against the equalization of that decision with other decisions pertaining to life events. He objects to the individualistic starting point of the authors in their discussion of the doctor-patient relationship, again an expression of the medical model. It is wrong to make a choice between ‘metaphysical priority’ of individual and society; this would suggest that an individual might exist prior to a society.
Dr.Endtz and Dr.Verbrugh wrote long replies, from which I select the following remarks.
Dr. Endtz: my cry for definitions remains unanswered. Since medicine is universal and medical practice ideally is tending to be so, the first thing to do is to define the words for use. As for me, I am not against a personal approach and I do not object to changing our axioms, but if we want to be understood, we have to know what we are talking about. I am still puzzled by the easiness shown by Prof.Thomasma and Prof. Pellegrino in their use of the terms ‘medicine’ and ‘medical practice’. I eagerly try to follow their discourse but they do not make my trying easier in this way.
Much remains to be said about the supposed identity between ‘medical practice’ and the ‘healing aims of medicine’. Times have changed since Hippocrates stressed the importance of prognosis and we are better armed to intervene in prognosis; but is not this intervention, and thus the healing aim, only part of medical practice?
One word on psychiatry. I am aware that American psychiatrists today are ready to bridge the rift between psychiatry and the rest of medicine.
Dr. Verbrugh: I still have great misgivings about a venture in ‘a philosophy and ethic of the healing professions’ presented under the title of ‘A philosophical basis of medical practice’. One can describe how people go about setting medical matters, particularly how they deal with situations in which there are conflicts of interests and other ‘ethical’ issues. This is not a ‘philosophical’ ethics, however, it is sociology or journalism, not philosophical reasoning. This is my main objection to the book.
The authors see ‘the actual phenomena of medicine primarily in the clinical event’ (page 4), and although this is historically certainly a valid procedure, I would argue that many, perhaps even most issues which are medically-philosophically controversial and relevant have their roots outside the phenomena of the clinical event. The roots of the reasons why people think and feel and act in the way that they do about such issues as euthanasia, abortion, artificial procreation, psychiatri-/psychosomatic treatment, the coping ability in the case of cancer and other serious diseases, etc., are not to be found in the phenomena. It can be fruitful to start the discussion on the basis of the phenomena, but I would also want many more examples taken from practice than Thomasma and Pellegrino provide in their book. Indeed, having a second (or, rather a third or fourth) look at their book while writing this reply to their comment, I am again impressed by the paucity of actual medical cases and phenomena. It is from such case-studies that the reader is incited to discover for himself the actual phenomena of philosophy.
This brings me to another point. I ‘seem puzzled by a personal, “first person” approach in a scholarly work’. On the contrary, I dearly miss the ‘first person’ where it would be appropriate, that is to say, in the narration of personal experiences and in the explicit taking of sides in issues. What I consider to be a defect in the book, is the lack of equilibrium between (subjective) personal experience and engagement on the part of the authors, and the absence of any objective philosophy, in the sense that the great lines of philosophical thought as it has developed in the last 25 centuries are not summarized with reference to medicine today.