Spring 2001, Vol. 2, Issue 1.
By Shlomit C. Schuster *
A review of Alfred I. Tauber's Confessions of
a Medicine Man: An Essay in Popular Philosophy. Cambridge, Mass., MIT
Press, 1999. pp. 159
If a medical ethics can have a logo, then the ethics proposed in Confessions of a Medicine Man has one. The front piece of the book, a copy of Sir Luke Fildes' painting "The Doctor" ushers in its main theme, and this image accompanies the reader throughout the book: a concerned, pensive-looking physician sitting attentively beside the bed of a patient.
In these confessions, Professor Alfred Tauber describes his life and career as an M.D.: his development from a young medical prince, empowered with technological and scientific knowledge, into a wise and empathetic witness of human suffering. Tauber sees his book as an autobiographical and philosophical essay in which he, as the son of a doctor, compares the medical world in which he grew up with that in which his own children are growing up.
The exemplary life of Dr. Tauber senior seems to have been a major guiding light in the clinical practice that his son advocates. The father was confronted with exceptional moral dilemmas during the Hitler era in Europe, when he felt morally obliged to give the best medical treatment, not only to those close to him, his Jewish friends, family and community members, but also to the Nazis who would persecute and kill them.
In his book, Tauber Jr. describes his own initiation into the American medical bureaucracy, where he too had to confront grave moral dilemmas and deal with policies that contradicted the humanistic and charitable ideals impressed on him in childhood. To resolve the conflicts between care givers, patients and involved third parties--those who see medicine mainly in terms of big business--Tauber's radical reorientation offers a return to old-fashioned basics: "I am a physician, not a health care manager, nor a politician. My interests concern serving the patient. Medicine is a calling based on a special social relationship." In short, he advocates a relational philosophy that supersedes the scientific and technical ideology pervading clinical practice today.
Confessions of a Medicine Man differs from the usual autobiographical essay. About 20 autobiographical anecdotes, each about one page in length and not necessarily in chronological order, powerfully illuminate the author's arguments by portraying particular problematic situations he has encountered in his clinical work. However, the author's critical and philosophical reflections also draw abundantly on his personal and professional development.
In his search for a new ethics Tauber first explores the growing public awareness that science cannot be the sole basis for clinical care. The perception of self, in particular one's perception of oneself as healthy or sick, is seen as contributing to physical well-being. An essential part of the book is devoted to understanding the modern person's concept of self from a historical philosophical perspective.
One may of course wonder how many people do in fact identify with these philosophical concepts of self. But the text does provide examples of persons living the ethics of post-modern individualism: there is the man who apparently had no one else other than his wife's physician to whom to confess his feelings of guilt; and there is the female ex-patient who extended an invitation to the physician for an intimate "worthwhile" house visit.
Essential in relating philosophical concepts of self to medical practice is that it demonstrates the consequences of "understanding who we are" within the physician-patient relationship. Tauber strongly favors ideas of intersubjectivity and is critical of present day medical ethics conferring on the patient almost absolute autonomy. He traces the idea of autonomy back to Descartes, Locke, Newton, and Kant; but the notion of the autonomous self is considered to have become superfluous in the Romantic era, when "the self, no longer set, established, or structured, was now an organic process of experience. . . . Relation has replaced entity."
From Tauber's perspective patient autonomy is a farce, since by the very fact of becoming ill people become dependent on medical care. The illustrative example for this is Tauber himself: while suffering severely from a kidney stone, and after several emergency room visits and hospitalization, he had to decide alone to "pass" the stone with an operation or not. Though a physician, he was unable to decide. Only after his sixth emergency room visit did his colleagues make the needed decision for him.
Tauber contends that the doctor-patient relationship would be more realistic and more ethically informed by recognizing patients' loss of autonomy and adopting instead absolute respect and loving care for the patient. In a previous era Savonarola characterized expressed this task as follows: "The physician that bringeth love and charity to the sick, if he be good and kind and learned and skillful, none can be better than he. Love teacheth him everything. . . ."
For practical use in this age Tauber looks to Levinas' ideas on recognition of the infinite in the face of the other. But as Tauber also points out, the inequality in the doctor-patient relationship (caused by the assumed loss of autonomy) does not agree very well with Levinas' thought.
Nietzsche's idea of "the eternal return" is also relevant in the new ethics, since it teaches the physician true responsibility in clinical care. To me, Tauber's greatest achievement is in having shown the need for physicians to become practicing philosophers themselves instead of relying heavily on professional advice from medical ethicists.
I must confess to feeling quite uncomfortable thinking
about "the reality" of the patient's loss of autonomy, and having this
formally recognized in a medical ethics. On the other hand, the image of
the benevolently caring physician that Tauber returns to the current technocratic
medical industry seems to me of such value, that I cannot but endorse it
as worthwhile. The book is well argued and excellently documented; it is
a philosophically and clinically responsible attempt to bring about a much
needed change in present-day clinical practice.
[(c) 2000 Shlomit C. Schuster,
All rights reserved.]