6 Jul, 09 | by Iain Brassington
For quite a while now, I’ve had the idea that I’d like to write something about the purpose of medicine - it’s something I’ve been adding on job applications for about 5 years, but I’ve not got around to doing all that much about it yet. The question as I saw it was whether medicine is properly concerned with making us well, or with assisting us in our projects. The latter may be a condition of the former - indeed, it may be a criterion of the former - but it’s not the same, because we could have all kinds of odd projects that’re only tenuously health-related. For example, cosmetic surgery - and here I mean potentially quite extreme body modification - might potentially belong to medicine if we go for the latter option. It might not be the sort of thing that medics should prioritise, but it could still be on their list of concerns.
Where’s this preamble leading? Well, Alice Dreger has been considering a similar sort of question over on the Hastings Center’s blog. It’s cosmetic surgery that worries her:
I’m not naïve; as an historian of medicine, I know that medicine has always advanced itself by offering improvements of patients’ social status, primarily by making patients healthier, but also by legitimizing their complaints.
But the noble profession has historically been primarily about something nobler than boob jobs and Botoxing wrinkles. The medical profession’s primary goal, historically speaking, has been prevention and relief of real suffering.
I can’t believe I even have to assert that. If the great men and women of medicine could come back from the dead and watch television today, what would they make of the fact that a large percentage of the medicine that is represented is cosmetic?
They might conclude, reasonably, that this reveals medicine’s success. Only in a world of astonishingly good anesthetics, infection management, and surgical technique would patients dare seek these procedures. But they might also reasonably conclude that something very strange has happened.
There’re some interesting considerations raised in the piece - I do recommend it. However, there’s also a couple of things with which I’d pick a dispute. The conclusion doesn’t strike me as powerful, for example.
Let’s just call these practices what they are: barber surgery. That way, when one of my idealistic, smart, principled students hears that the student next to her is going into “cosmetics,” she can just answer, “Really? And here I thought we were in medical school.”
Dreger is fairly clear that she goes along with the first of my options above - that medicine is about wellness - but I’m not sure that that’s right: I don’t think I see wellness as an end in itself. Rather, I see it as something that’s valuable (and comprehensible) only within the context of a certain set of projects. So it’s those projects that do the work - in which case, cosmetic medicine (or barber surgery - call it what you will) is, if not exactly back on the menu, at least chalked up on the “Specials of the Day” board. The “and I thought we were in medical school” retort wouldn’t stick.
And I think that the tone of the article more generally suggests something important and interesting about the cultural background of bioethics as pursued on the other side of the Atlantic. more…