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A new path for humanistic medicine

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Abstract

According to recent approaches in the philosophy of medicine, biomedicine should be replaced or complemented by a humanistic medical model. Two humanistic approaches, narrative medicine and the phenomenology of medicine, have grown particularly popular in recent decades. This paper first suggests that these humanistic criticisms of biomedicine are insufficient. A central problem is that both approaches seem to offer a straw man definition of biomedicine. It then argues that the subsequent definition of humanism found in these approaches is problematically reduced to a compassionate or psychological understanding. My main claims are that humanism cannot be sought in the patient–physician relationship alone and that a broad definition of medicine should help to revisit humanism. With this end in view, I defend what I call an outcomes-oriented approach to humanistic medicine, where humanism is set upon the capacity for a health system to produce good health outcomes.

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Notes

  1. Quoted by [14].

  2. See also [19] for a detailed criticism of the use of conceptual analysis in the philosophy of medicine.

  3. The reduction of science to biology alone is often found in the narrative medicine literature. Science is described as capable of dealing only with the biological aspect of disease.

  4. By contrast, Ashrafunnesa Khanom et al. merely claim that narrative inquiry will lead to more “humane discourses in the context of health services research” [28, p. 555].

  5. It should made be clear, however, that this critique does not aim to cast doubt on the whole narrative medicine enterprise: extremely well-done and interesting analyses of patients’ stories exist (see, e.g., [28]). My target is merely the key theoretical basis of the narrative approach: criticizing biomedicine. It should also be noted that narrative works do not have to make specific claims against biomedicine or in favor of humanism, although they often do.

  6. The term “bald naturalism” is also found; see [34].

  7. The terms “ontological” and “epistemic” are sometimes found in place of “metaphysical” and “epistemological,” respectively; see [35].

  8. Although I agree that it is not clear, see below.

  9. It should be noted that my argument here stands only against the criticism of biomedicine found in the current approaches to the phenomenology of medicine. The phenomenology of medicine encompasses a complex and rich bundle of claims, the descriptions and assessments of which are outside the scope of this paper.

  10. I discard two other meanings: humanism as in the study of humanities, and humanism as in the intellectual movement during the Renaissance. Although less relevant, these two connotations are often implicitly present in the background, especially, for instance, in the case of narrative medicine and other types of medical humanities; see [17, pp. 31-32].

  11. See also Carel [6, p. 54]: “The complaint that seems to appear near-universal in this context is: why am I not treated as a person?”.

  12. Much of psychology, however, is not focused on the subjective experience, as elaborated below.

  13. Daniel Sulmasy would also add patients’ spiritual needs [17].

  14. Solomon sees in this theme the cultural importance of individuality in the Anglo-Saxon world, especially in the United States [14].

  15. It should be noted that there is a whole movement in psychology called humanistic psychology. This movement, introduced by Carl Rogers [40] and Abraham Maslow [41], aims to emphasize the subjective individual and the importance of the self in psychology. Although humanistic psychology is beyond the scope of this paper, my argument against the compassionate use of humanism in narrative medicine and the phenomenology of medicine could probably be applied against the use of humanism in that movement as well. However, I see no reason to restrict medical humanism to what humanism means in that specific psychology movement.

  16. Despite Carel’s insistence that she is not asking for warm fuzzy doctors, it is unclear how exactly she can avoid the criticism. “My revolt against the attitude towards illness that is common in the medical world is not a sentimental one. I am not suggesting that health professionals' precious time be wasted on feel-good chatting…. Could some genuine care be introduced to the exchange?” [6, p. 50].

  17. Health systems are indeed extremely different from one country to another.

  18. This question can be understood in different ways. Whether medicine’s aim is to treat illness or to promote health is not directly pertinent to my argument, so I will not address this here.

  19. I refer to the naturalistic trend in the philosophy of science according to which, briefly speaking, science is what scientists do.

  20. It is not necessary to defend Engel’s biopsychosocial here. It is enough to show that public health—albeit being a scientific approach that relies on statistics and the study of populations—does not reduce patients to their physical bodies. This also illustrates that focusing only on patients as individual psychological beings is insufficient even on humanistic approaches’ own terms as it clashes with their social environment.

  21. The Institute is unique in French health policy. It is distinct from the government and open to private sector organizations like professional and patient associations as well as to health insurance funds.

  22. Herceptin is used to treat breast cancer.

  23. It should be noted that it is often administratively difficult for a patient to go through this protocol in cases where there is no political will to facilitate the procedure for one specific drug or in the case of early or pre-trial drugs.

  24. The Pharmaceutical Benefits Scheme provides subsidies for prescription drugs to residents of Australia.

  25. See [46, 47].

  26. In fact, individual-centered approaches are traditionally suspicious from a humanistic point of view. For instance, Jean-Paul Sartre’s existentialism (and subjectivist approach) was strongly criticized by tenants of humanism. His famous short book, L’existentialisme est un humanisme was written precisely to address their attack.

  27. This reformist and progressive view of humanism can be credited to Pierre-Joseph Proudhon and to later thinkers such as John Dewey, Charles Francis Potter, William James, Karl Jaspers, and Maurice Merleau-Ponty.

  28. Article 11 of the Preamble to French Constitution of 27 October 1946, Fourth constitution of French Republic.

  29. Article L11110-1 of French Public Health Code, law of 4 March 2002.

  30. Compare this to the polemical compassionate use of drugs in the recent Ebola pandemic, where pre-experimental drugs were given in and out of clinical studies [50, 51]. In these cases, drugs were given not because they were the best drugs available but because no other drugs were available. Here “compassion” is taken in a strong emotional sense.

  31. It goes without saying that the “best” treatments are determined by physicians based on scientific data and not by lawmakers. Furthermore, there are obviously limits to the resources that need to be compromised.

  32. I do not mean to imply that doing so is easy, but it seems clearly possible.

  33. However, Charon argues that narrative skills allow physicians to work faster.

  34. It should be noted that ethics has already provided extensive analyses about how the clinical encounter should and should not occur.

  35. The conditions and consequences of said blood testing in a particular situation could, however, be studied.

  36. See WHO report on the performance of health systems [43].

  37. Of course, defining what a good doctor or a good medicine should be is ambiguous between good as in “efficient” and good as in “morally good.” It seems that a morally good doctor should be as efficient as possible, but I will leave this question aside for now.

  38. Examples have also shown that health systems are consistently built on difficult compromises and difficult decisions. Additionally, it should be noted that patient-centered care is one type of humanistic approach that has been successfully implemented in France and elsewhere. They can both emerge from local initiatives or from higher impulses.

References

  1. Charon, Rita. 2001. Narrative medicine: A model for empathy, reflection, profession, and trust. JAMA 286: 1897–1902.

    Article  Google Scholar 

  2. Charon, Rita. 2006. Narrative medicine: Honoring the stories of illness. Oxford: Oxford University Press.

    Google Scholar 

  3. Hunter, Kathryn Montgomery. 1991. Doctors’ stories: The narrative structure of medical knowledge. Princeton: Princeton University Press.

    Google Scholar 

  4. Svenaeus, Fredrik. 2000. The hermeneutics of medicine and the phenomenology of health: Steps towards a philosophy of medical practice. Dordrecht: Kluwer.

    Book  Google Scholar 

  5. Svenaeus, Fredrik. 2009. The phenomenology of falling ill: An explication, critique and improvement of Sartre’s theory of embodiment and alienation. Human Studies 32: 53–66.

    Article  Google Scholar 

  6. Carel, Havi. 2008. Illness: The cry of the flesh. Stocksfield: Acumen.

    Google Scholar 

  7. Carel, Havi. 2011. Phenomenology and its application in medicine. Theoretical Medicine and Bioethics 32: 33–46.

    Article  Google Scholar 

  8. Carel, Havi. 2012. Phenomenology as a resource for patients. Journal of Medicine and Philosophy 37: 96–113.

    Article  Google Scholar 

  9. Toombs, Kay S. 1987. The meaning of illness: A phenomenological approach to the patient–physician relationship. Journal of Medicine and Philosophy 12: 219–240.

    Article  Google Scholar 

  10. Toombs, Kay S. 1988. Illness and the paradigm of lived body. Theoretical Medicine and Bioethics 9: 201–226.

    Article  Google Scholar 

  11. Toombs, Kay S. (ed.). 2001. Handbook of phenomenology and medicine. Dordrecht: Kluwer.

    Book  Google Scholar 

  12. Toombs, Kay S. 2001. The role of empathy in clinical practice. Journal of Consciousness Studies 8: 5–7.

    Google Scholar 

  13. Marcum, James A. 2008. Reflections on humanizing biomedicine. Perspectives in Biology and Medicine 51: 392–405.

    Article  Google Scholar 

  14. Solomon, Miriam. 2015. Making medical knowledge. Oxford: Oxford University Press.

    Book  Google Scholar 

  15. Engel, George L. 1977. The need for a new medical model: A challenge for biomedicine. Science 196: 129–136.

    Article  Google Scholar 

  16. Halpern, Jodi. 2001. From detached concern to empathy: Humanizing medical practice. New York: Oxford University Pres.

    Book  Google Scholar 

  17. Sulmasy, Daniel P. 2002. A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist 42: 24–33.

    Article  Google Scholar 

  18. Khushf, George. 2007. An agenda for future debate on concepts of health and disease. Medicine, Health Care and Philosophy 10: 19–27.

    Article  Google Scholar 

  19. Lemoine, Maël. 2013. Defining disease beyond conceptual analysis: An analysis of conceptual analysis in philosophy of medicine. Theoretical Medicine and Bioethics 34: 309–325.

    Article  Google Scholar 

  20. Marcum, James A. 2008. An introductory philosophy of medicine: Humanizing modern medicine. Dordrecht: Springer.

    Google Scholar 

  21. Svenaeus, Fredrik. 2003. Hermeneutics of medicine in the wake of Gadamer: The issue of phronesis. Theoretical Medicine and Bioethics 24: 407–431.

    Article  Google Scholar 

  22. Taylor, Charles, Franco A. Carnevale, and Daniel M. Weinstock. 2011. Toward a hermeneutical conception of medicine: A conversation with Charles Taylor. Journal of Medicine and Philosophy 36: 436–445.

    Article  Google Scholar 

  23. Schramme, Thomas, and Steven Edwards (eds.). 2017. Handbook of the philosophy of medicine. Dordrecht: Springer.

    Book  Google Scholar 

  24. Solomon, Miriam, Harold Kincaid, and Jeremy Simon (eds.). 2017. The Routledge companion to philosophy of medicine. London: Routledge.

    Google Scholar 

  25. Longino, Helen E. 1990. Science as social knowledge: Values and objectivity in scientific inquiry. Princeton: Princeton University Press.

    Google Scholar 

  26. Longino, Helen E. 2001. The fate of knowledge. Princeton: Princeton University Press.

    Google Scholar 

  27. Wylie, Alison. 2002. Thinking from things: Essays in the philosophy of archaeology. Berkeley: University of California Press.

    Google Scholar 

  28. Khanom, Ashrafunnesa, Sarah Wright, Frances Rapport, Marcus Doel, Clare Clement, and Melanie Storey. 2015. “Lives at risk” study: Philosophical and ethical implications of using narrative inquiry in health services research. In Handbook of the philosophy of medicine, ed. Thomas Schramme, and Steven Edwards, 1–18. Dordrecht: Springer.

    Google Scholar 

  29. Lemoine, Maël. 2011. La désunité de la médecine: Essai sur les valeurs explicatives de la science médicale. Paris: Hermann.

    Google Scholar 

  30. Dupré, John. 1983. The disunity of science. Mind 92: 321–346.

    Article  Google Scholar 

  31. Solomon, Miriam. 2001. Social empiricism. Cambridge: MIT Press.

    Google Scholar 

  32. Kuhn, Thomas S. 1962. The structure of scientific revolutions. Chicago: University of Chicago Press.

    Google Scholar 

  33. Kuhn, Thomas S. 1977. The essential tension: Selected studies in scientific tradition and change, rev ed. Chicago: University of Chicago Press.

    Google Scholar 

  34. De Caro, Mario, and David Macarthur. 2010. Naturalism and normativity. New York: Columbia University Press.

    Google Scholar 

  35. Papineau, David. 2016. Naturalism. In Stanford encyclopedia of philosophy, Winter 2016 Edition, ed. Edward N. Zalta. Stanford: Metaphysics Research Lab, Stanford University. https://plato.stanford.edu/archives/win2016/entries/naturalism.

  36. Sholl, Jonathan. 2015. Putting phenomenology in its place: Some limits of a phenomenology of medicine. Theoretical Medicine and Bioethics 36: 391–410.

    Article  Google Scholar 

  37. Svenaeus, Fredrik. 2013. Naturalistic and phenomenological theories of health: Distinctions and connections. Royal Institute of Philosophy Supplements 72: 221–238.

    Article  Google Scholar 

  38. Boorse, Christopher. 1975. On the distinction between disease and illness. Philosophy and Public Affairs 5: 49–68.

    Google Scholar 

  39. Giroux, Élodie. 2010. Après Canguilhem: Définir la santé et la maladie. Paris: Presses Universitaires de France.

    Google Scholar 

  40. Rogers, Carl. 1951. Client centred therapy: Its current practice, implications and theory. London: Constable.

    Google Scholar 

  41. Maslow, Abraham H. 1962. Notes on being-psychology. Journal of Humanistic Psychology 2: 47–71.

    Article  Google Scholar 

  42. Stempsey, William E. 2008. Philosophy of medicine is what philosophers of medicine do. Perspectives in Biology and Medicine 51: 379–391.

    Article  Google Scholar 

  43. World Health Organization. 2000. World Health Report 2000. Health systems: Improving performance. Geneva: World Health Organization. http://www.who.int/whr/2000/en.

  44. Khayat, David, and David Kerr. 2006. A new model for cancer research in France. Nature Reviews Cancer 6: 645–651.

    Article  Google Scholar 

  45. Pearson, Sallie-Anne, Clare L. Ringland, and Robyn L. Ward. 2007. Trastuzumab and metastatic breast cancer: Trastuzumab use in Australia—Monitoring the effect of an expensive medicine access program. Journal of Clinical Oncology 25: 3688–3693.

    Article  Google Scholar 

  46. Medicines Australia Oncology Industry Taskforce. 2013. Access to cancer medicines in Australia. Deloitte Access Economics.

  47. Wonder, Michael. 2014. Reimbursement success rates and timelines for new medicines for cancer: An international comparison. Medicines Australia. http://medicinesaustralia.com.au/files/2013/07/140323_OIT_Wonder-Report_FINAL.pdf.

  48. Préambule de la Constitution du 27 octobre 1946. Constitution de la IVe République. https://www.legifrance.gouv.fr/droit-francais/constitution/preambule-de-la-constitution-du-27-octobre-1946.

  49. Code de la santé publique, Art. L. 1110-1. Créé par Loi noº 2002-303 du 4 mars 2002, art. 3, J.O. du 5 mars 2002, p. 4118 et seq. https://www.legifrance.gouv.fr/eli/loi/2002/3/4/MESX0100092L/jo/texte.

  50. Folayan, Morenike, Brandon Brown, Aminu Yakubu, Kristin Peterson, and Bridget Haire. 2014. Compassionate use of experimental drugs in the Ebola outbreak. Lancet 384: 1843–1844.

    Article  Google Scholar 

  51. Rid, Annette, and Ezekiel J. Emanuel. 2014. Compassionate use of experimental drugs in the Ebola outbreak—Authors’ reply. Lancet 384: 1844.

    Article  Google Scholar 

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Acknowledgements

I would like to thank the two anonymous Theoretical Medicine and Bioethics reviewers for their comments. I would also like to thank the participants of the “Medical Knowledge in a Social World” workshop held in 2016 at University of California, Irvine for their helpful comments and encouragements. Special thanks go to Guillaume Didier and James Angove for proofreading earlier stages of this work. Finally, I extend my most sincere gratitude to the managing editor of the journal Katelyn MacDougald for her fabulous work on the final version of this paper.

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  1. Sciences, Normes, Décision, Sorbonne Université, 1 rue Victor Cousin, 75005, Paris, France

    Juliette Ferry-Danini

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Ferry-Danini, J. A new path for humanistic medicine. Theor Med Bioeth 39, 57–77 (2018). https://doi.org/10.1007/s11017-018-9433-4

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