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

  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Ashdown Group: Data Scientist - London - £50,000 + bonus

£35000 - £50000 per annum + generous bonus: Ashdown Group: Business Analytics ...

Ashdown Group: IT Project Coordinator (Software Development) - Kingston

£45000 - £50000 per annum: Ashdown Group: IT Project Coordinator (Software Dev...

Ashdown Group: Editor-in-chief - Financial Services - City, London

£60000 - £70000 per annum + benefits : Ashdown Group: A highly successful, glo...

Ashdown Group: Junior Application Support Analyst - Fluent German Speaker

£25000 - £30000 per annum + benefits: Ashdown Group: A global leader operating...

Day In a Page

Read Next
Nicola Sturgeon and her former boss Alex Salmond  

I voted Yes in the referendum – but that doesn't mean I'm going to vote for the Tory-esque SNP

Alasdair Clark
 

If I were Prime Minister: I'd shrink the gap between the highest and lowest paid

Marina Warner
General Election 2015: Ed Miliband's unlikely journey from hapless geek to heart-throb

Miliband's unlikely journey from hapless geek to heart-throb

He was meant to be Labour's biggest handicap - but has become almost an asset
General Election 2015: A guide to the smaller parties, from the the National Health Action Party to the Church of the Militant Elvis Party

On the margins

From Militant Elvis to Women's Equality: a guide to the underdogs standing in the election
Amr Darrag: Ex-Muslim Brotherhood minister in exile still believes Egypt's military regime can be replaced with 'moderate' Islamic rule

'This is the battle of young Egypt for the future of our country'

Ex-Muslim Brotherhood minister Amr Darrag still believes the opposition can rid Egypt of its military regime and replace it with 'moderate' Islamic rule, he tells Robert Fisk
Why patients must rely less on doctors: Improving our own health is the 'blockbuster drug of the century'

Why patients must rely less on doctors

Improving our own health is the 'blockbuster drug of the century'
Sarah Lucas is the perfect artist to represent Britain at the Venice Biennale

Flesh in Venice

Sarah Lucas has filled the British pavilion at the Venice Biennale with slinky cats and casts of her female friends' private parts. It makes you proud to be a woman, says Karen Wright
11 best anti-ageing day creams

11 best anti-ageing day creams

Slow down the ageing process with one of these high-performance, hardworking anti-agers
Juventus 2 Real Madrid 1: Five things we learnt, including Iker Casillas is past it and Carlos Tevez remains effective

Juventus vs Real Madrid

Five things we learnt from the Italian's Champions League first leg win over the Spanish giants
Ashes 2015: Test series looks a lost cause for England... whoever takes over as ECB director of cricket

Ashes series looks a lost cause for England...

Whoever takes over as ECB director of cricket, says Stephen Brenkley
Fishing for votes with Nigel Farage: The Ukip leader shows how he can work an audience as he casts his line to the disaffected of Grimsby

Fishing is on Nigel Farage's mind

Ukip leader casts a line to the disaffected
Who is bombing whom in the Middle East? It's amazing they don't all hit each other

Who is bombing whom in the Middle East?

Robert Fisk untangles the countries and factions
China's influence on fashion: At the top of the game both creatively and commercially

China's influence on fashion

At the top of the game both creatively and commercially
Lord O’Donnell: Former cabinet secretary on the election and life away from the levers of power

The man known as GOD has a reputation for getting the job done

Lord O'Donnell's three principles of rule
Rainbow shades: It's all bright on the night

Rainbow shades

It's all bright on the night
'It was first time I had ever tasted chocolate. I kept a piece, and when Amsterdam was liberated, I gave it to the first Allied soldier I saw'

Bread from heaven

Dutch survivors thank RAF for World War II drop that saved millions
Britain will be 'run for the wealthy and powerful' if Tories retain power - Labour

How 'the Axe' helped Labour

UK will be 'run for the wealthy and powerful' if Tories retain power