BOOK REVIEW / The wounded surgeon: 'The Healer's Power' - Howard Brody: Yale, 18.95 pounds

Share
Related Topics
AT THE heart of medicine lies the physician's power: the technical power to heal; the charismatic power exerted by the doctor's personality and presence; and the social power to remodel the world through genetic screening, selective abortion, or euthanasia. But doctors understand, and so increasingly do their patients, that with power may come its abuse. The ethical practice of medicine is about the responsible use of the physician's power, and in his latest book Howard Brody, a family practitioner who is also trained in moral philosophy, has set out to write a prescription for just such good practice.

Until the Second World War it was generally agreed that disease was an unmitigated evil justifying the forceful, aggressive use of all the doctor's powers. In the absence of many effective specific remedies, the exertion of charismatic power, a good bedside manner, was about all doctors had to carry out their tasks. All that has changed. Doctors have increasingly effective remedies and procedures; their technical power to do good has increased enormously, but so has their ability to cause undesirable, sometimes catastrophic side-effects.

Out of this change has come what Brody calls 'the new medical ethic' - the notion that what is done to patients, however good the physician thinks it might be, ought only to be done with the patients' own consent. Much of the western world now accepts a medical ethic of patient autonomy, even if it is more honoured in the breach than the observance.

Brody is at his best in the first part of this book, where he mounts a critique of this ethic of patient autonomy. He finds it feared by doctors and not much desired by patients; and believes that the transfer of power inevitably deprives the doctor of charismatic healing power, the placebo effect, one of the most important tools of the doctor's trade.

To remedy this, Brody sets out to develop an ethic of the virtuous physician, based on the explicit recognition and responsible use of the physician's power. 'We can have the highest degree of confidence that the healer's power is being used ethically and responsibly,' he writes, 'when that power can be described as acknowledged, shared, and aimed.' For the remainder of his book Brody describes the ways in which a virtuous physician, responsibly seeking to exercise the powers for which patients come to him, might actually do so in various problematic situations in which a general practitioner may find himself. The author's fond hope is that doctor and patient will arrive at agreement by conducting a conversation.

Although his book may be a comfort to many doctors, Brody never adequately deals with the crucial question addressed by an ethic of personal autonomy: when is a physician justified in forcing risks and harms upon a patient without his or her consent, or even against his or her will?

For all his interest in the history and literature of doctor-patient encounters, Brody seems to have misunderstood the sorts of medical dilemmas for which the ethic of respect for personal autonomy was designed. The reason may lie in his medical speciality: general practice. GPs tend to have known their patients and their families over time, and their patients know them. Moreover the GPs' medical choices are often uncontroversial, his alternatives minor, and the risks to patients rather limited.

As Brody knows, this is emphatically not the case for many seriously ill, hospitalised patients who are suffering from conditions whose therapy invariably carries unwanted risks, costs and harms, and who are faced with doctors who cannot be expected to know much about their patients' individual values or preferences. Such patients are truly without power.

It was for this scenario, one where it is principally the physician's great technical power that decides the outcome, that the 'new medical ethic' was developed. But under these circumstances physicians will never have the opportunity to engage in the kind of extended conversation with patients that Brody sees as necessary for the sharing of power.

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
SPONSORED FEATURES
iJobs Job Widget
iJobs General

Recruitment Genius: IT Support Engineer

£18000 - £26000 per annum: Recruitment Genius: This is an opportunity for an I...

Recruitment Genius: Project Assistant

£17000 per annum: Recruitment Genius: They are a leading company in the field ...

Recruitment Genius: DBA Developer - SQL Server

£30000 - £35000 per annum: Recruitment Genius: This is an exciting opportunity...

Recruitment Genius: Office Manager

£26041 - £34876 per annum: Recruitment Genius: There has never been a more exc...

Day In a Page

Read Next
Larry Fink, the boss of fund manager BlackRock , is among those sounding the alarm  

Not all discounts are welcome: Beware the myopia of company bosses

Ben Chu
Cilla Black lived her life in front of the lens, whether on television or her earlier pop career  

Cilla Black dead: A sad farewell to the singer who gave us a 'lorra, lorra laughs'

Gerard Gilbert
Turkey-Kurdish conflict: Obama's deal with Ankara is a betrayal of Syrian Kurds and may not even weaken Isis

US betrayal of old ally brings limited reward

Since the accord, the Turks have only waged war on Kurds while no US bomber has used Incirlik airbase, says Patrick Cockburn
VIPs gather for opening of second Suez Canal - but doubts linger over security

'A gift from Egypt to the rest of the world'

VIPs gather for opening of second Suez Canal - but is it really needed?
Jeremy Corbyn dresses abysmally. That's a great thing because it's genuine

Jeremy Corbyn dresses abysmally. That's a great thing because it's genuine

Fashion editor, Alexander Fury, applauds a man who clearly has more important things on his mind
The male menopause and intimations of mortality

Aches, pains and an inkling of mortality

So the male menopause is real, they say, but what would the Victorians, 'old' at 30, think of that, asks DJ Taylor
Man Booker Prize 2015: Anna Smaill - How can I possibly be on the list with these writers I have idolised?

'How can I possibly be on the list with these writers I have idolised?'

Man Booker Prize nominee Anna Smaill on the rise of Kiwi lit
Bettany Hughes interview: The historian on how Socrates would have solved Greece's problems

Bettany Hughes interview

The historian on how Socrates would have solved Greece's problems
Art of the state: Pyongyang propaganda posters to be exhibited in China

Art of the state

Pyongyang propaganda posters to be exhibited in China
Mildreds and Vanilla Black have given vegetarian food a makeover in new cookbooks

Vegetarian food gets a makeover

Long-time vegetarian Holly Williams tries to recreate some of the inventive recipes in Mildreds and Vanilla Black's new cookbooks
The haunting of Shirley Jackson: Was the gothic author's life really as bleak as her fiction?

The haunting of Shirley Jackson

Was the gothic author's life really as bleak as her fiction?
Bill Granger recipes: Heading off on holiday? Try out our chef's seaside-inspired dishes...

Bill Granger's seaside-inspired recipes

These dishes are so easy to make, our chef is almost embarrassed to call them recipes
Ashes 2015: Tourists are limp, leaderless and distinctly UnAustralian

Tourists are limp, leaderless and distinctly UnAustralian

A woefully out-of-form Michael Clarke embodies his team's fragile Ashes campaign, says Michael Calvin
Blairites be warned, this could be the moment Labour turns into Syriza

Andrew Grice: Inside Westminster

Blairites be warned, this could be the moment Labour turns into Syriza
HMS Victory: The mystery of Britain's worst naval disaster is finally solved - 271 years later

The mystery of Britain's worst naval disaster is finally solved - 271 years later

Exclusive: David Keys reveals the research that finally explains why HMS Victory went down with the loss of 1,100 lives
Survivors of the Nagasaki atomic bomb attack: Japan must not abandon its post-war pacifism

'I saw people so injured you couldn't tell if they were dead or alive'

Nagasaki survivors on why Japan must not abandon its post-war pacifism
Jon Stewart: The voice of Democrats who felt Obama had failed to deliver on his 'Yes We Can' slogan, and the voter he tried hardest to keep onside

The voter Obama tried hardest to keep onside

Outgoing The Daily Show host, Jon Stewart, became the voice of Democrats who felt the President had failed to deliver on his ‘Yes We Can’ slogan. Tim Walker charts the ups and downs of their 10-year relationship on screen