Bioethics, Healthcare and the Soul

Henk ten Have, Renzo Pegoraro

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000440997
• Edition: 1
• Topic: Medizin
• Subtopic: Ethik in der Medizin

This thought-provoking book explores the connections between health, ethics, and soul. It analyzes how and why the soul has been lost from scientific discourses, healthcare practices, and ethical discussions, presenting suggestions for change.

Arguing that the dominant scientific worldview has eradicated talk about the soul and presents an objective and technical approach to human life and its vulnerabilities, Ten Have and Pegoraro look to rediscover identity, humanity, and meaning in healthcare and bioethics. Taking a mulitidisciplinary approach, they investigate philosophical, scientific, historical, cultural, social, religious, economic, and environmental perspectives as they journey toward a new, global bioethics, emphasizing the role of the moral imagination.

Bioethics, Healthcare and the Soul is an important read for students, researchers, and practitioners interested in bioethics and person-centred healthcare.

1 Introduction

The soul in healthcare and ethics

Surgeon and writer Sherwin Nuland published a collection of stories, first-person narratives of various medical specialists, titled The Soul of Medicine. [1] Nuland does not explain the title, but the stories illustrate his point. Physicians cannot be technicians. They play a diversity of roles: pastor, counselor, advocate, guide but also friend and confidant. Only at the closing page of the book, Nuland concludes that while diagnosis has much improved, and is faster and more accurate today than ever before, something has been lost in healthcare. More data, information, and, perhaps, knowledge will enable us to categorize patients but what is more important is clinical judgment: the particular understanding of the treating physician about what is best for this individual patient. Another medical writer, internist Jerome Groopman, points out how medicine desperately tries to combine two different dimensions, an objective, disease-centered one and a subjective, patient-centered one. Healing requires a mixture of science and soul. [2] A third medical writer, Atul Gawande, also a surgeon, explains that contemporary medicine has a narrow focus; it concentrates on repair of health, “not sustenance of the soul.” [3] This is especially important now that many people live longer and have chronic diseases and disabilities. They do not want treatment but care. First of all, they want an existence that is worthwhile and meaningful and has a purpose, rather than the continuation of treatment, or the safety and protection in a nursing home when they become dependent and vulnerable.

The above-mentioned authors of bestselling books continue a long tradition of physicians who are also writers and involved in literary activities. It is often assumed that doctors are good storytellers because they are, perhaps more than other people, able to observe intense and dramatic human experiences. They see, meet, and talk to people in the most vulnerable circumstances. In their writings, they may not directly focus on medical issues but they frequently highlight the travails of daily life and the precariousness of the human predicament. An example is Anton Chekhov (1860–1904). He practiced as a medical doctor and wrote many stories and plays to earn money to support his family and his education. He is regarded as the master of the short story, portraying human misery, tragic dimensions of life, and what is below the surface of everyday existence. Mikhail Bulgakov (1891–1940) is another example. He worked as a provincial physician but abandoned medical practice after a serious illness. He wrote feuilletons for newspapers, plays, and novels. Well known is his collection of short stories (A Country Doctor’s Notebook) about his experiences as a young doctor in a small village in Smolensk province. Louis-Ferdinand Céline (1894–1961) first worked in Paris at a maternity hospital and later started a private practice as obstetrician. His two most famous novels, Journey to the End of the Night (1932) and Death on the Installment Plan (1936), present a shocking vision of suffering and despair as well as the banality and absurdity of human life. All human weaknesses are exploited but at the same time there is compassion with suffering fellow beings. The Dutch writer Simon Vestdijk (1989–1971) worked as general practitioner and ship’s doctor. After 1932, he no longer practiced medicine but focused on writing literature and poems. He was one of the most productive Dutch authors, publishing approximately 200 books. Many doctors figure in his work, but usually not in a positive way. In his view, physicians as human beings are less interesting than their professional activities would suggest. An important Portuguese writer today is psychiatrist António Lobo Antunes (1942). He uses his experiences in the psychiatric hospital as well as in the colonial war in Angola as material for his novels, especially the early ones. Medicine and travel are frequent topics in his work.

Faced with the realities of human suffering, physician-writers show in different ways what they regard as essential for medicine. In his stories, Anton Chekhov outlines the details of suffering in order to emphasize that it is not acceptable. Human beings have the capacity of empathy so that they can share suffering. This capacity is fundamental for medicine. Chekhov as a materialist did not believe in the existence of the human soul. In his view, mental and physical phenomena are similar. Human life is characterized by stagnation, stupidity, degradation, and mediocrity. Nonetheless, the “soul” of medicine for him is not accepting indifference and detachment in regard to suffering. The medical perspective entails the conviction that life can and should be changed. Being a physician implies a sense of dignity that cannot accept these miserable conditions of human life. [4] The work of Louis-Ferdinand Céline is frequently regarded as dark and nihilistic. It celebrates the death of compassion. At the same time, it is paradoxical in that it struggles to reconnect with basic humanity. Bardamu, the main character in Journey to the End of the Night, and alter ego of Céline, is a dehumanized physician beyond compassion but he attempts to recover his lost humanity. [5] The soul is associated with darkness, exile, death, and weakness but is also the source of meaningfulness. Bardamu’s experiences as a physician, his lack of empathy, and his cynical interactions with patients can serve as a negative role model for medical students, while Céline himself apparently was a caring doctor for the poor. [6]

Physician-writers often have their own burden of disease. Chekhov suffered and eventually died from tuberculosis. Bulgakov was badly injured in the first World War; to deal with the chronic pain, he became addicted to morphine. Céline was also wounded in this war, making him disabled for the rest of his life. Vestdijk was plagued by depressions since his adolescence. As doctors, they see their patients at the most vulnerable moments of their life, but they likewise become aware of their own vulnerability. Writing and reading stories expand the worldview of physicians, making them aware of ethical dilemmas but first of all teach them the importance of subjectivity and the primacy of care. This is why, these stories refer to the notion of soul; they are concerned with what is the core, the essence of medicine and healthcare.

Talk of the soul is paradoxical. In contemporary culture and society, the soul is no longer regarded as an existing entity or substance. In the age of scientific materialism, the soul is dead. [7] According to the dominating worldview of science, it is a myth, an illusion. It should be erased since it is not a necessary or useful concept to explain the world. It can be reduced to something else, to brains or genes. There is only matter. Every mental phenomenon can be explained in terms of physical principles and laws. The soul or the mind therefore is the brain. The concept of soul is perhaps useful as a metaphor, a figure of speech. Nonetheless, despite these negative assessments, the soul is often addressed in a wide range of human activities: in philosophy, in religion, in poetry and art, in literature, and in music. Many people believe in soulmates. In some countries, there is soul music and soul food. The soul is connected to many positive images: a vital force, the core of individuality, the stream of consciousness, the persistence of things, the depth dimension of human experiences, the heart of things, breath, the live-giving principle. [8] If the soul is lost, something essential will be missing. Erasure of the soul generates alienation, rootlessness, apathy, inauthenticity, meaninglessness, and inhumanity. Even if we do not understand what soul is, it will be important to cultivate it, to contemplate what it means, and to sustain it with care. [9]

Soul is a fuzzy concept. It is associated with a wide range of ideas and themes. Its field of application is also very broad. Questions can be asked about the soul of medicine or the soul of a nation. [10] These questions are taken seriously because suggestions that the soul is missing signal that something crucial that used to be determinative has now vanished. The term “soul” is frequently connected to and exchanged with other words such as mind, spirit, psyche, and pneuma. It is not clear to what the soul refers. However, its basic function is that it identifies what is characteristic for an entity, substance, practice, or activity. The soul of medicine refers to what is the essence of medicine. It is what inspires, drives, gives life to medical activities. In this sense, soul is used as a metaphor. The purpose is to criticize and denounce the prevailing materialism of science, showing that more is at stake than simple physical interactions. The metaphor refers to another, more fundamental use of the notion of soul. This use applies to human beings. Soul is considered as the realm of unique human capacities and experiences. It identifies and explains what is typically human in human beings. The soul is the personal, individual essence of every human. Specific human capacities such as self-awareness, rationality, morality, language, memory, free agency, responsibility, future orientation, spirituality, and relations with other human beings and God are all attributed to the soul. The term soul is therefore used to refer not only to distinctive aspects of human beings as a special category of beings but also to characteristics of individual persons. The basic idea conveyed by the concept is that human nature transcends the physical and biological world. Human nature cannot be reduced to DNA or brain activities. How the soul is specifically conceptualized is a matter of long-standing debates, especially in philosophy and religion. Is it a real entity or force? How is it connected or interacting with the body? Is it a part of the self that continues beyond death?

This book will explore the connections between healthcare, ethics, and soul. It will examine the complaints that the soul has been lost in healthcare as well as in bioethics. These charges express the uneasiness, dissatisfaction, and disquiet that many people today experience with healthcare and also with the ethical queries that emerge in the medical setting. That such uneasiness is expressed in terms of loss of soul has something to do with the dominant scientific worldview that has completely eradicated any soul-talk and that presents an objective and technical approach to human life and its vulnerabilities.

The aim of this book is to use the notion of soul and its loss to review a wide range of familiar criticisms of contemporary medicine and bioethics in order to arrive at a broader understanding of bioethics. We do not intend to provide a rigorous philosophical or theological analysis of the concept of the soul, nor to scrutinize the philosophical foundations of medicine and healthcare, but our aim is to propose a moral vision for medicine and bioethics that goes beyond the narrow and technical forms of ethical thinking that dominate current practices, using a variety of sources and disciplines. Although we are attracted to the Aristotelian-Thomist concept of the soul, we do not develop a theoretical formulation of this concept, but use “soul” as container term and as a metaphor to essential aspects of human existence that are not accounted for in the practice of medicine and discourse of ethics, in the hope to recover these aspects.

The erasure of the soul

This book will first analyze how and why the soul has been lost from scientific discourses, healthcare practices, and ethical discussions.

The notion of soul has almost disappeared from theological and philosophical discourse. Theologians have substituted the word “spirit” for soul so that they can distinguish between secular and spiritual aspects of human life. For many philosophers, soul is the ghost in the machine, and no longer a serious object of reflection. Psychology has discarded the soul as a relic from ancient times, and is studying the mind and consciousness. Science is most radical: the idea that people have souls is superstition. Nonetheless, the term “soul” is widely used in ordinary life as well as in cultural and popular literature. In almost every culture, belief in the soul is persistent since ancient times. Nowadays, more than half of secondary school pupils in Britain (54%) believe that people have souls (with 23% disagreeing), with 45% professing to believe in God. [11] A survey in 2009 found that 70% of people in the United Kingdom believe in the human soul, while 53% believe in life after death. [12] In Western Europe, 76% of religious people say they have a soul, while 43% of people who are neither religious nor spiritual also affirm they have a soul. [13] While...

Table of contents

• Cover
• Half Title
• Series
• Title
• Copyright
• Contents
• 1 Introduction: the soul in healthcare and ethics
• 2 The erasure of the soul
• 3 The disenchantment of the world
• 4 The lost soul – images without soul
• 5 Moral imagination
• 6 Recovering the soul – inspiring images
• 7 Another bioethics
• Bibliography
• Index