Cartesian Dualism and the Current Crisis in Medicine — A Plea for a Philosophical Approach: Discussion Paper

The practice of medicine, as it has moved ineluctably from empiricism to science, has become increasingly criticized for having become, at the same time, less humane, less sure of itself and 'directionless'. There has been, not surprisingly, no lack of critics. Illich (1981) has stated: 'The medical establishment has become a major threat to health. The disabling effect of professional control over medicine has reached the proportions of an epidemic'. Foucault (1961, 1963) has spoken of the modern physician abandoning his moral role and assuming, instead, the role of an enlightened scientific entrepreneur. Kennedy (1983) has observed: 'The nature of modern medicine makes it positively deleterious to the health and well-being of the population'. Others have spoken of distrust, depersonalization, failure to self-regulate, the medicalization of life and the mystification of disease (Jaspers 1931, Sontag 1979). Indeed, it is fair to say that it is only comparatively recently that the medical profession has been called upon to justify its two and a half thousand year claim to being a benign but authoritarian authority. The spectre of seeing the traditional image of a peculiarly humane profession gradually eroded should in itself engender, at the least, feelings of doubt and uncertainty while at most providing an inspiration to ask questions about many of the presuppositions which provide the rationale for the exercise of modern therapy. Inasmuch as modem medicine tends to bridge both the technological and scientific study of man while being itself deeply entrenched in human values, there inevitably exists an underlying tension. This tension represents, in turn, the crisis of modern technologically-orientated medicine which, it is contended here, can only be solved by applying a philosophical methodology solidly grounded in the practice of medicine itself. Unfortunately, for some time now, Anglo-American philosophy has been in the main concerned with analytical philosophy, and it has been left mostly to continental philosophy to concern itself with the central issues of human existence. It follows that the source of philosophy most relevant to a philosophy of medicine per se would come from the continental mainstream. The development of such a philosophy clearly can only be evolved from the practice of medicine itself a posteriori; it cannot be independently imposed externally by arbitrarily applying existing philosophies. Nor, indeed, should any particular philosophy be applied abstractly and independently of medicine; on the contrary, it must be constructed essentially through the practice of medicine itself. Bernard (1937) has clearly stated that a philosophy divorced from the reality of medicine would be a useless enterprise and one which would only encourage an antagonism between the two disciplines (an antagonism, it should be noted, that already exists). Thus professional health-carers must be able (or made) to understand that they do not have the analytical tools to formulate a suitable critique of the medical profession: this would be the function of an external philosophy acting through medicine itself. Conversely, the problems currently confronting medicine should be seen by philosophers as thoroughly legitimate for their critical scrutiny. Because philosophy is dialectical it establishes a dialogue or interplay in its methodology, thus ensuring an objective critique of accepted principles and received wisdom. It is important,