REVIEWED BY CARL BRENNAN, MD
David C. Thomasma and Judith Lee Kissell, eds.
Georgetown University Press, Washington, DC, 2000, 320 pp., $65 (hardcover),
$24.95 (paperback)
Having reached the enviable age of fourscore years, Edmund D. Pellegrino,
MD, might have relegated himself to his dusty shelves of trophies and accolades
and enjoyed his just rewards. Instead, this titan of medical, philosophic, and
ethical thinking has continued his campaign against the contemporary tendency
(misguided in his view) to turn the traditional physician into a positivistic
technocrat — sans empathy, compassion and humanity.
David Thomasma, MD, and Judith Kissell, PhD, editors of the book under review
here, have undertaken to build on Dr. Pellegrino's tenets and principles. They
note in the preface that contributors were invited to consider the wide-ranging
field of Dr. Pellegrino's interests and to describe the way his ideas have influenced
their own thinking. The editors seemingly searched the capacious mysteries of
Mount Etna and, from the 100 hands of the mythological Enceladus buried beneath
it, chose 22 candidates from a variety of disciplines and asked them to expound
on the myriad expressions, themes, and publications of this prolific academician.
Let me emphatically state that this book is not a Festschrift in his honor.
Nor is it an eclat or an assemblage panegyric. Indeed, the book is none of these,
but rather a recognition of Dr. Pellegrino's prominence in health care as a
role model, friend, and healer. Still, in spite of the honorific disinclination,
the contributor listing is a subtly encomiastic tribute in itself.
My own background — first as a pediatrician for 38 years serving the tiny and
helpless and, more recently, as a clinical bioethicist — gives me a certain perspective
in these matters. I have witnessed the extraordinary transformation of the classical
physician, a friendly champion of God's sick and helpless, into the more distant,
less empathetic clinician I find among my peers in today's medical arena. This
is a splendid volume of differing approaches to Dr. Pellegrino's vast and influential
outpouring — some of it directed to the demise of the traditional "MD" of years
gone by.
I first met Dr. Pellegrino in November 1986. He had been invited to speak
to the staff of St. Joseph's Hospital, Savannah, GA. He immediately captured
his audience's attention by noting that decision making is much easier — and much
less scary — in the classroom than it is at a patient's bedside. His presentation
of what he sees as the imminent collision of morality in medicine with the rising
griffin of the mechanical, technological patient-care syndrome made a tremendous
impact on his listeners. The fear he expressed that day — that faith and medicine
would travel increasingly separate roads — was prescient indeed.
Gotthold Lessing, an Enlightenment philosopher, wrote that "if God held all
truth in his right hand and persistent striving for that truth in his left and
said, 'choose'. . . ?"1 Many of the authors in this volume would
perhaps agree that Dr. Pellegrino, if offered the same choice, would choose
the left hand without regrets.
These essays are presented in four sections. Each is succinct, and their consistent
brevity makes this a comfortable "read," a book that one can easily set aside
and then retrieve at the next free moment. The volume has an unstated but strong
general theme to which each of the authors then adapts his or her own views.
The introductory commentary describes the role Dr. Pellegrino has played in
contemporary medicine — as an exemplar of that significant word trust in
both senses of the word, noun and verb. The writer of the introduction notes
that a moral community built on trust must look to a truly common good. Subsequent
essays then develop the many issues raised by the theme of physician-patient
trust.
Part I of the book addresses the nature of the health care professional, exploring
the traditional physician-patient relationship in depth. Physicians initially
established their own code of ethics and expelled members who transgressed.
This was the basis of physician autonomy. A certain ennobling as a moral agent
marked the rite of passage in which a new member joined the physicians' peer
group. In those days, a patient was understood to be a person suffering from
some sort of illness. The patient's existential status demanded privacy and
response from the physician. Treatment was a mutual patient-physician endeavor
to achieve a "right and good action." The relationship of physician to patient
was beneficent. The classical ideal was for the physician to be the patient's
friend.
Part II of the book contains an excellent description of ethical nursing comportment.
The authors of these essays, first, explore the necessity of engendering trust
in a pluralistic society and, second, conduct a penetrating search for the internal
and external sources of morality in medicine. One provocative essay considers
the role of umbrage in physicians' denial of treatment failure. Another assesses
physicians' moral courage vis-à-vis the multiple changes in U.S. health care
over several centuries. An essay on the principle of physician domination offers
a superb examination of the responsibilities involved in the practice of medicine — and
may be summed up by Psalm 8:5: "You have set us over the work of your hands.
. . ." The conclusion reached by the writer of an essay on organizational ethics
and its pertinence to medicine is akin to Dr. Pellegrino's well-known rejection
of the idea that a physician can ever be both a healer and a killer.
Part III offers eight essays on current challenges in reproductive technologies.
This is not the stuff of scandal-sheet sensationalism. Included here are a moralistic
piece that asks where these developing technologies are likely to take us; a
praxeologic "interpretative probe" into human nonsubject research (which I read
twice); and an intriguing, asseverative consideration of the healing role played
by philosophic hermeneutics.
Part IV explores the role of ethics in medical history and their likely role
in the future. This section, although the briefest, is full of sparkling prose
on society's continuing need for perspicuous humanities programs.
Although this volume is perforce not a tribute to Dr. Pellegrino, these distinguished
contributors have nobly met the editorial request to follow in his footsteps.
As Horace puts it in his Epistles:
Good Athens gave "his" art another theme
To sort what is from what might merely seem
And search for truth in groves of Academe2
I believe the reader will find this book a profitable and fulfilling armchair
companion. Ad multos annos Dr. Pellegrino.
Carl Brennan, MD
Clinical Ethicist
St. Joseph's Hospital
Savannah, GA
NOTES
- Felipe Fernandez-Armesto, preface to Truth, St. Martin's Press,
New York City, 1999, p. vii.
- Felipe Fernandez-Armesto, p. xiii.
Copyright © 2002 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.