{"id":27,"date":"2008-10-30T12:46:00","date_gmt":"2008-10-30T11:46:00","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=27"},"modified":"2008-10-30T12:46:00","modified_gmt":"2008-10-30T11:46:00","slug":"what-can-doctors-do","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2008\/10\/30\/what-can-doctors-do\/","title":{"rendered":"What Can Doctors Do?"},"content":{"rendered":"

An area of research with which I’ve been toying for quite a long time now is to try to provide an answer to the question “What are doctors for?”.\u00a0 (Admittedly, the possibility of a cheap’n’nasty Heidegger pun in the title, Wozu Doktor?<\/em>, has a reasonably high place in the list of\u00a0the project’s attractions…\u00a0 Ho-hum.\u00a0 It’s probably been done already, of course…)\u00a0 Are they there to provide health, or function, or to make us feel good, or what?\u00a0 All these things may imply, entail or relate to each other, of course, but they’re separable, and may be put into any order of importance.<\/p>\n

As is the way with these things, the project has been on the back burner – or forgotten about completely – for a while; but it was brought to mind again by reading this piece in the BMJ concerning cosmetic surgery<\/a> (and labioplasty in particular).<\/p>\n

Lest Daniel Sokol, the author, think that I’m tracking and attacking everything he writes here as it appears – I’m not: I think that there’s a lot to admire about his line of thought.\u00a0 Nevertheless, I’m not sure I agree with every aspect of his argument, or his claim that, in the light of requests from women who “are requesting surgery to alter their intimate appearance[…]\u00a0medical professionals, whether <\/sup>working in the private or public sector, should not succumb <\/sup>to these requests.”<\/p>\n

One of the reasons that he offers for this is that<\/p>\n

it is plausible to argue that patients\u2019 autonomy <\/sup>is often diminished by strong social or peer pressures. A female <\/sup>friend once told me how fat and ugly she felt after reading <\/sup>a popular woman\u2019s magazine. She was neither fat nor ugly. <\/sup>A drug company promoting a drug for hair loss\u2014an issue <\/sup>close to my heart\u2014urged balding men to consult their doctor. <\/sup>In a leading website on hair loss, sponsored by a drug company, <\/sup>a poll asks: “Have you felt less attractive since you started <\/sup>losing your hair?” Women seeking cosmetic genital surgery often <\/sup>bring pictures of their ideal vagina from advertisements or <\/sup>pornography. <\/sup>\u00a0Creating or exploiting insecurities is a lucrative <\/sup>business. <\/sup><\/p><\/blockquote>\n

That’s perhaps true; but the normative power of the point is – I’d suggest – moot.\u00a0 The worry that Dan expresses is that perhaps some could be cowed – and this is true.\u00a0 But then we have to ask ourselves where this leaves us.\u00a0 We could interpret matters in such a way as to imply that doctors should be at least hesitant to respond to requests for treatment from people whom they have a reason to believe to be unduly influenced by some external factor.\u00a0 Fine – but this looks formalistic, leaving wide open as it does the question of what would count as undue: after all, all of us are malleable.\u00a0 That’s part of being human.\u00a0 (And when it’s pointed out that “[a]dvertisements for cosmetic surgery are also manipulative”\u00a0– well, yup.\u00a0 That’s how\u00a0ad. men earn their money.\u00a0 Clever, aren’t they?)\u00a0\u00a0It also looks a bit weak as a claim: would anyone really think other than that doctors ought not to provide treatment to those whom they have a reason to believe to be pressured into it by others?<\/p>\n

Another possible interpretation would be that doctors ought not to perform certain procedures period<\/em>, just because of the likelihood that people might seek them for the “wrong” reasons (whatever they turn out to be).\u00a0 But that looks too strong.\u00a0 The thought goes like this: that, even if you think cosmetic surgery in this (or any) instance would be stupid, still, all else being equal, there is a right, or entitlement, or whatever you want to call it, that agents possess to do or have done to themselves whatever stupid thing they want.\u00a0 (We might cash this out quite straightforwardly by an appeal to the harm principle, or something along those lines.)\u00a0 To rule out certain procedures on the grounds of an appeal to people’s possible vulnerability seems to be as much as to say that I can legitimately be prevented from doing that to which I have a legal and\/ or moral right because of worries about what might happen to another person.\u00a0 And that seems to mislocate the problem – or, rather, say that a problem that that other person had can legitimately be mirrored in me: that doesn’t seem correct.\u00a0 (“Fair enough,” we might say.\u00a0 “Do\u00a0something to\u00a0protect the easily-cowed.\u00a0 But leave me and my entitlement to do stupid stuff out of\u00a0it.”)\u00a0 Problems of undue pressure, it seems, could be\u00a0avoided or minimised by a period of cooling off.<\/p>\n

(Incidentally – on the subject of wanting treatment for the right reasons, I’m reminded of the doctor from the final series of The League of Gentlemen<\/em> who bullies his patients to the point of tears just to check that they aren’t malingerers.\u00a0 *Wanders off to YouTube*)<\/p>\n

\u00a0There’s another interesting point that Dan makes, which is related to the Hippocratic Oath.<\/p>\n

As medical science progresses, <\/sup>the oath retracts further into the communal consciousness of <\/sup>medicine, a distant star whose brightness is fading. Many medical <\/sup>students now only know its name. We should not let it fade, <\/sup>for it is the medical profession\u2019s guiding star. Although <\/sup>some parts of the oath are out of date, others contain unchanging <\/sup>truths: “I will use treatments for the benefit of the ill in <\/sup>accordance with my ability and my judgment, but from what is <\/sup>to their harm or injustice I will keep them.”\u00a0 <\/sup>The key phrase is “for the benefit of the ill.”<\/p><\/blockquote>\n

It’s admitted here that much of the oath has been ditched, and the world seems no worse a place for that.\u00a0 On what grounds, though, should we keep other aspects of it?\u00a0 Even if it’s true that doctors have a role to play in curing illness, it doesn’t follow that this ought to be the limit of their role.\u00a0 It seems to me that there’s two ways we could go with this: one would be to say that, irrespective\u00a0of the opinion of\u00a0 a long-dead and semi-mythical Greek bloke,\u00a0there’s more to medicine than curing people – and the WHO definition of health would seem to reflect this.\u00a0 Maybe, that is, we could have\u00a0an account of the iatrike tekhne<\/em> that can accommodate a wide sense of tekhne<\/em>.\u00a0 If people believe that they’d feel better after labioplasty or anything else, what would be so deeply crazy about allowing that better feeling to inform the role of the medic?<\/p>\n

Or perhaps we don’t have to be that radical.\u00a0 I’ve suggested elsewhere that there’s no apparent reason why a surgeon shouldn’t, from time to time, be able to take off his medical hat and put on something more… well… artisanial.\u00a0 A surgeon is someone with a certain set of skills.\u00a0 He might well put those skills to one use for some of the time, and to another use the rest of the time.\u00a0 After all, surgery was once something that came hand-in-hand with the entirely cosmetic pursuit of shaving men’s faces.\u00a0 Labioplasty is different in extent – but I’m not completely convinced that it’s different in kind.<\/p>\n","protected":false},"excerpt":{"rendered":"

An area of research with which I’ve been toying for quite a long time now is to try to provide an answer to the question “What are doctors for?”.\u00a0 (Admittedly, the possibility of a cheap’n’nasty Heidegger pun in the title, Wozu Doktor?, has a reasonably high place in the list of\u00a0the project’s attractions…\u00a0 Ho-hum.\u00a0 It’s […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[575,576,472],"tags":[],"class_list":["post-27","post","type-post","status-publish","format-standard","hentry","category-bmj","category-the-art-of-medicine","category-thinking-aloud"],"yoast_head":"\nWhat Can Doctors Do? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2008\/10\/30\/what-can-doctors-do\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What Can Doctors Do? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"An area of research with which I’ve been toying for quite a long time now is to try to provide an answer to the question “What are doctors for?”.\u00a0 (Admittedly, the possibility of a cheap’n’nasty Heidegger pun in the title, Wozu Doktor?, has a reasonably high place in the list of\u00a0the project’s attractions…\u00a0 Ho-hum.\u00a0 It’s [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2008\/10\/30\/what-can-doctors-do\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2008-10-30T11:46:00+00:00\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2008\\\/10\\\/30\\\/what-can-doctors-do\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2008\\\/10\\\/30\\\/what-can-doctors-do\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"What Can Doctors Do?\",\"datePublished\":\"2008-10-30T11:46:00+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2008\\\/10\\\/30\\\/what-can-doctors-do\\\/\"},\"wordCount\":1232,\"commentCount\":24,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"BMJ\",\"The Art of Medicine\",\"Thinking Aloud\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2008\\\/10\\\/30\\\/what-can-doctors-do\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2008\\\/10\\\/30\\\/what-can-doctors-do\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2008\\\/10\\\/30\\\/what-can-doctors-do\\\/\",\"name\":\"What Can Doctors Do? 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