Over the past several years I have written about the evolving changes in medicine that have occurred with the replacement of traditional medical ethics—think the Hippocratic Oath for example that is almost never used anymore at Medical School graduations, with a secular humanistic ethic that early in the nineteen sixties evolved into medical consumerism and the medical mercantilist symbiosis that now drives the pharmaceutical—government—medical—industrial complex.
The coming together of first principles, and the differences in the moral predicates that are at the bases of the great political divide in our country today, were nowhere more evident than in the different opinions rendered by the majority and minority in last week’s U. S. vs Skrmetta Supreme Court Decision. The differences in which “first principles” aka John Adams, what we today call moral predicates, are what drives our political, legal, and business conflicts. In the case of THE LAW, it becomes ever more apparent that “The Facts of Law—not the facts of the Case, are perceived differently by accomplished jurists who see the world differently, because unlike at other times in our country’s history, the moral predicates by which they understand the bases for “The Facts of Law” are different.
Several times I have noted the change from a patient centric treatment model to a public health model. This was never more prevalent than the way most of our private and public institutions addressed Covid. In THE WAY OF MEDICINE by Dr. Furr Curlin a Professor of Medicine at Duke University and also in an article he wrote for the Wall Street Journal last week another important difference is being played out in medicine today. I have pointed out before that in any endeavor there is always a what (are we going to do or build), how are we going to do it (planning and executing the project), but most importantly and so often forgotten is the WHY (what purpose is served by the proposed activity). When any person looks at their work of life as a vocation that question is answered.
We who have participated in the training of young physicians need to reemphasize the why as explained by Dr. Carlin in both his book and article and I paraphrase:
The Supreme Court’s 6-3 decision in U.S. v. Skrmetti, upholding Tennessee’s ban on medical gender interventions for children, reflects a split in the Justices’ views of medicine: Is it about restoring patients’ health or satisfying their wants? The court held last week that the Tennessee law permissibly distinguished between different medical uses of puberty blockers and hormones for children. Writing for the majority, Chief Justice John Roberts explained that medical treatments are defined not only by the drug used but by the purpose for which it is prescribed. Administering testosterone to a boy with delayed puberty is categorically different from giving it to a girl. Justice Sonia Sotomayor wrote in dissent that the law impermissibly discriminates based on sex: “Male (but not female) adolescents can receive medicines that help them look like boys, and female (but not male) adolescents can receive medicines that help them look like girls.” In her view, the goal of testosterone for boys and girls is the same: it helps that the Statistical Manual categorizes and codes gender dysphoria as a mental disorder. Those who suffer it perceive healthy secondary sex characteristics as disordered, when seeking to “look more masculine.”
Behind the justices’ rift is a fundamental question: What is medicine for? In the traditional view, the purpose of treatment is the patient’s health—the well-working of the body. We don’t decide what health is. We observe health, recognize its goodness, and protect it. Yet the rise of the “patient autonomy” model in the 1960s and ‘70s along with the change from a person-patient centric to a public health model helped to direct physicians to administer treatment at their patients’ behest. This model led to a consumerist approach to medicine, that which sees physicians as “providers” instead of healers. Providers of services fulfill customers’ wishes, regardless of whether doing so restores or compromises patient health. Conflicts over “gender-affirming care” reveal how irreconcilable these models are.
Every aspect of our lives requires the extrapolation and application of a moral law and ethical predicates that will define and inform our actions. Not just in the law and medicine, but in every institution and every individual whose foremost “why” should be “TO GLORIFY GOD “and to make the world a better place for us and everyone else.
WHAT IS MEDICINE FOR?
