Moral theories and medicine for the person
International Journal of Integrated Care, 29 January 2010 - ISSN 1568-4156
Section on Conceptual Bases of Person-centered Medicine
Moral theories and medicine for the person
George Christodoulou, Prof., President, Hellenic Centre for Mental Health and Research, Athens University, Greece
Correspondence to: George Christodoulou, E-mail: gchristodoulou@ath.forthnet.gr

The purpose of this paper is to examine to what extent medicine for the person [1] is related to Medical Ethics.

Medicine for the person conceptually represents an attempt to bring to the foreground attention to the person (basically the person of the patient but also that of the physician) as opposed to the inattention, disrespect and disregard of the person, an attitude that prevails in modern Medicine [25] (but also in modern Society as such). This is a consequence of a variety of factors but, as refers to Medicine, fragmentation of care and hyperbolic dependence on technology seem to be major contributors [1].

It would certainly be naïve to deny the importance of specialization (a prerequisite to achieving expertise in a specific field of scientific knowledge) and disregarding the advantages of technological achievements with their immense contribution to Medicine. Yet, as Hippocrates has stressed many centuries ago, it is important to avoid excesses (‘παv μέтρоv άρıσтоv’—nothing in excess). In certain cases, overspecialization has deprived the physician of his (her) holistic vista and excessive and disproportionate dependence on technology has reduced the patient to a ‘case’ and the physician to a mere technician of health and not a person ‘equal to God’ (‘ıσόθεоς’) (as professed by Hippocrates).

These developments certainly have ethical implications that should be carefully considered, especially with reference to the quality of care that we provide to our patients.

One of the components of good quality of care is satisfaction of not only the biological but also the psychosocial needs of the patient. The importance for this holistic approach has again been strongly advocated by Ancient Greek philosophers and physicians like Socrates, Plato and Aristotle [6] but also by Ayurvedic and Chinese medical traditions [1].

Good quality of care is also promoted by attention to concepts and, more importantly, practices like positive mental health (that keeps people healthy, in contrast to ones that cure an illness after its appearance) as well as empowerment, resilience, recovery [7, 8] and values-based medicine [9] that promote the active involvement of the person in maintaining health, protecting him (her) self from illness and recovering from it. Clearly, this is consistent with the ethical principle of autonomy as put forward by Beauchamp and Childress [10] in their Principlism theory of Ethics.

The existing Moral theories in Medicine, as summarized by Green and Bloch are Virtue Ethics, Casuistry, Deontological Theory, Utilitarianism, Principlism and Ethics of Care [11]. The importance of each of these theoretical frameworks depends on the criteria for their evaluation but it is generally believed that Virtue Ethics is “the only approach that has retained relevance over the course of history” [12]. This is because ethical principles are filtered through the individual practitioner and it is up to the practitioner and his virtuous or non-virtuous personality to implement or undermine the ethical concept behind each moral theory. Implementation is personified and individualized and the ethical message can be enhanced, highlighted, differentiated distorted or even neutralized and abandoned altogether. This is why the personified approach should concern not only the patient but the physician as well. Clearly, there is need not only for Medicine for the person but also Medicine by the person.

In conclusion, Ethics is a sine qua non component of medicine and psychiatry for the person. This is particularly true of Clinical Medicine and Clinical Psychiatry where there is (or more accurately, should be) active interpersonal interaction between two persons, the physician and the patient. Those of us who believe in the substantial therapeutic effects of this interaction, have the obligation to provide convincing evidence towards this direction and persuade our hesitant colleagues that being ‘nice’ to the patient does not serve only the needs of civilized social behavior, does not serve only a philanthropic purpose but, more than that, has a substantial therapeutic effect. Spending a little time with the patient to facilitate compliance to medication can have tremendous beneficial advantages for the patient and can be very rewarding for the physician as well. Is it ethical to ignore the therapeutic potential of the doctor-patient interpersonal relationship? Is it ethical to deprive the patient of the advantages of a therapeutic intervention because we do not (want to) have time to discuss compliance to this intervention with the patient? Is it ethical to practice defensive medicine and disregard our Hippocratic obligation to consider the patient's well-being as our first priority? And how about the relationship of the physician with the rest of the staff? Is it ethical to allow interpersonal disputes and dysfunctions arising from a non-personified (and often ignoring, depreciating and humiliating) attitude to interfere with the treatment of our patients? There are questions that should be in the focus of our attention, if we want to bring our theoretical “Ethics of person-centered Medicine” ideas into practice.

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