Since Hippocrates in early 5 B.C., Medicine has carried an ‘angel on its shoulder’; a reflexive gaze on the skill, and phenomenologies of healing between the doctor and his patient. Ethics is a code, a practice, and a guide amid the terrain of the hands that tend to the body using instruments of medicine’s enterprise. Referring to the Oath:
‘I will preserve the purity of my life and my arts’.
Daniel Sokol, Honorary Senior Lecturer at Imperial College, London and recently qualified barrister, undertook the challenge of fitting ‘ethics’ into our contemporary medical practice; whereby Medicine is confronted by a body unprecedented in relation to the ways in which we can perceive, examine, intervene, create, and prolong the existence of our bodies; our lives.
‘Doing Clinical Ethics’ is a negotiation; a way of uniting the clinicians who either “have a passion for medical ethics” or “could not give a fig for it”. Clinicians need to learn to “do” ethics. ‘Doing Clinical Ethics’ is a valid, contemporary, and explanatory guide for practicing ethics in medicine and Sokol provides subtle yet convincing arguments for why clinicians need to focus on the body of doctrines, principles, and theories that is ethics alongside the descriptive (and prescriptive), intricate, and verifiable discourses about the human body.
Decisions need to be made about how to treat the body – regardless of our contemporary knowledge about the body, this information is bracketed from the ‘lived-ness’ that the body is socially, culturally, and historically contextualized in.
Written in a seemingly casual writing style to grip even the most tired of minds, there is also an intriguing and captivating rhythm to Sokol’s words. He uses case-studies throughout, which are illustrative of the stories that medical practice is narrating; the telos of the surgeon, for example, is to craft the body possessing “technical skill” but also inherently directed to execute the ethical principles of beneficence and non-maleficence. Moral perception is necessary for moral action.
Though Sokol attempts to present ethics on a surface level – of what we may see in medicine – there is also a pretext, a sub-conscious presence in the case-studies, the illustrations, and explanations of ethical frameworks that becomes its centrifugal point; why we must care about ethics; our virtues of actors in scenes where the audience are vulnerable; juxtaposed between their lives and their deaths. Not all of medicine has been good medicine; our history of medicine has been limited during its development, and as Shaprio (1978) famously stated the history of medicine is a history of the placebo.
Undoubtedly, though, contemporary medical practice is dealing with a body with a “metaphysics that is shrouded in darkness” (McMahan 2003) and the moral status of the beginnings and endings of life are obscured further by the ability of machines, medication, and medical technology to push these boundaries; our definitions of life are altering and so must the way we operate ethically; Sokol’s book shows us the new generation of the ‘ethical body’.
Most essential to practicing ethics in our contemporary academic and clinical settings is the latter half of the book that focuses on issues such as publishing, teaching clinical ethics, and submitting an application to a Research Ethics Committee (REC).
Rarely do we have access to such insightful and experienced advice on these crucial tasks. Though ‘ethics’ comes across as somewhat an ‘object’ in these contexts, it does highlight the demands that are being made in our contemporary environment; practicing ethics is representative of the entire medical discourse, and not reducible to particular cases that have been brought to the forefront due to a ‘tension’ or ‘conflict’. Sometimes, our ethical questions are set in clinical uncertainty and unchartered terrain. However, Sokol shows that ethics can be practiced even amid the ambiguity posed by of ‘shades of grey’ and be ethically fulfilling.
Overall, ‘Doing Clinical Ethics’ should be an integral part of medical education as well as facilitating both the newer and older generations practicing medicine today. We cannot shy away from the lives that transcend the reductive body in medicine; ethics is married to medicine; ‘Doing Clinical Ethics’ certainly provides the sustenance required to make this a long-lasting relationship!
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