Book Review

The New Medicine

N Engl J Med 1993; 328:363February 4, 1993

Article

The New Medicine
By Nigel M. de S. Cameron. 182 pp. Wheaton, Ill., Crossway Books, 1992. $11.95. ISBN: 0-89107-645-X

What does it mean to be a good physician? Nigel Cameron, a theologian at Trinity Evangelical Divinity School in the United Kingdom, attempts to answer this complex but timely moral question by examining the relevance of the Hippocratic oath. Although many physicians today probably recited the oath at their commencement ceremonies, it is likely that few appreciate the radical departure that Hippocratic medicine represented at its inception and how its values are, according to the author, in danger of being subverted.

The book begins with a discussion of the primary tenets of the oath, the proscription against killing and the correlative commitment to the principle of the sanctity of human life. After explaining how such duties have infused the core of medicine historically and presenting Christian and Islamic adaptations of the oath, Cameron asserts that, in whatever guise it takes, Hippocratic medicine “becomes synonymous with healing, and forswears absolutely the option of taking human life.” He cites medicine practiced under the Third Reich as the most notorious example of how this commitment was turned on its head.

Much of Cameron's critique of contemporary medical practice focuses on the moral duty to relieve human suffering. If, he argues, the physician is above all else a healer, the primary moral commitment of the physician must be to avoid the destruction of human life. It follows, he claims, that it is unethical for physicians to participate in abortion and euthanasia. In summoning the image of the healer and drawing parallels between Hippocratic medicine and Christian theology, Cameron echoes William F. May's literary treatise The Physician's Covenant: Images of the Healer in Medical Ethics (Philadelphia: Westminster Press, 1983). Like May, Cameron uses the metaphor of the covenant to explain the physician's tripartite responsibility: to patients, profession, and deity. The moral implication of this bond, he holds, is clear: “Whatever doctor or patient may wish, there is no option for the taking of life.”

Unfortunately, Cameron's analysis is flawed in two important ways. First, it is difficult to understand how a book that purports to be a scholarly analysis of Hippocratic medicine could fail to include a discussion -- or even a mention -- of the work of Robert M. Veatch, arguably its most important contemporary critic. Veatch has shown that the Hippocratic principle “I will apply dietetic measures for the benefit of the sick according to my ability and judgment” fails to acknowledge the values and preferences of patients. Another contemporary ethicist, H. Tristram Engelhardt, Jr., notes that physicians and patients no longer come together as members of the same moral community. In short, Hippocratic medicine can function only when the two groups hold the same values and rank them in the same way. It is simply not the case that the physician can accurately determine what is best for the patient without knowing the patient's unique values and preferences.

Second, by attacking abortion as a violation of Hippocratic medicine, Cameron reveals a strong bias against the majority of patients, women. In his attempt to show that medicine is the worse for replacing the principle of the sanctity of human life with one of reducing human suffering, the author fails to acknowledge that the lives of women are also at stake in this issue. In other words, one can argue that abortion is morally justifiable by appealing to the very principle, the sanctity of human life, that he claims makes abortion an unacceptable moral option. By failing to acknowledge that the rights and welfare of women have a vital role in the debate, he exposes the sex bias in Hippocratic medicine. The Hippocratic principle is paternalistic in the truest sense of the term.

For all its flaws, including the author's use of sex-exclusive language, The New Medicine may be of interest to medical ethicists and to clinicians who wish to reflect on the values that have shaped medical history. For a balanced view of where we are and where we need to go, interested readers would do well to consult Veatch's A Theory of Medical Ethics (New York: Basic Books, 1981) or Death, Dying and the Biological Revolution (rev. ed. New Haven, Conn.: Yale University Press, 1989), Engelhardt's Foundations of Bioethics (New York: Oxford University Press, 1986), and Susan Sherwin's No Longer Patient: Feminist Ethics and Health Care (Philadelphia: Temple University Press, 1992). The debate is not merely an academic one, for in deciding what part Hippocratic values should play in the clinical encounter, we will be determining what kind of health care system we ought to fashion.

Bruce D. Weinstein, Ph.D.
West Virginia University, Morgantown, WV 26506