Consumerism and autonomy

Dr. John Patrick is one of the finest and brightest individuals I've ever had the pleasure of meeting. These are excerpts from his paper Hippocrates and Medicine in the Third Millennium, which can be accessed by visiting his web site (I won't ever again lead you to a site where you can't get full access to the article!). He wrote this paper in the 90's although it seems as if he might have written it in the aftermath of the Terri Schiavo case.

In this narcissistic era where individual autonomy is always first it comes as a surprise to realize that patient rights have no place in Hippocrates' thinking. That, say the modern generation of bio-ethicists, is good reason to dismiss Hippocrates. But is it? Hippocrates lived in a pagan ethos where life was cheap and promises easy. His time did not have two thousand years of Christian thought anchoring it down. In such times patient autonomy was meaningless because the relationship was intrinsically unbalanced. All the power lay in the hands of the physician. The patient's safety therefore lay in the ethics of the physician. If the physician took the Oath of Hippocrates he swore to do no harm, to recognize the limits of his competence and refer appropriately, he swore to honour his profession by not abusing his opportunities for sexual gratification and he swore to treat all men equally. The patient's safety lay in doing everything to preserve the physician's integrity, to avoid even subtle coercion to kill or to abort. Remarkably there is little evidence that European culture did other than encourage physician integrity to the Oath of Hippocrates until the last century where once again rationalistic hubris began to erode this cultural gift...When one is ill, one needs someone whom one can trust to do what is best for us. No amount of verbal papering over the cracks by substituting client for patient will change the reality that sick people want someone else to handle the difficult problems. You may be a client when you choose who will fix your hernia but you are not a client when you have septicaemia and renal failure. This is where Hippocrates changed the direction of medicine. Ancient and modern pre- and post-Hippocratic physicians were and are willing to kill for a price, whether financial or ideological. There is, as Gerald Manley Hopkins put it,"a death dance in our veins"; Kevorkian illustrates this for anyone with eyes to see. Thus when you go to such physicians you must always worry whether someone else has paid more for your death than you have for your life. Those followers who took the Oath of Hippocrates removed this fear, generated a substantial trust and consequently became the physicians of choice. It was patient choice and the desire to have an income, which forced the medical profession to adopt the higher ethical standards of the Hippocratic community not the intrinsic nobility of the medical community.