A medicine of personal meaning does not necessarily depend on health or healing

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Published: Sep 30, 2011
DOI: https://doi.org/10.5750/ijpcm.v1i3.53

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Stephen Buetow
University of Auckland

Abstract

A decade ago I called for a medicine of meaning (MOM) but incorrectly deduced that MOM always depends on healing and helping.  I now wish to suggest that the practice of medicine need not promote the healing or health of individual patients in order for them to find or create meaning in their lives.  Personal meaning can be enhanced by medicine in the presence of ill-health, but enhancement medicine is increasingly used to help healthy patients add meaning to their lives.  Debate on the moral legitimacy of the medical enhancements has yet to furnish agreement, yet person-centred medicine reminds us how patients, as people, have a right and responsibility to freely make and act on subjectively rational choices about how to do and be what they want.  It respects their autonomy to select from medical options that can enhance meaning for them.  My paper sketches the content of a new MOM before anticipating and answering objections. 

Article Details

Issue
Vol. 1 No. 3 (2011): September
Section
Regular Articles
Author Biography

Stephen Buetow, University of Auckland

Stephen Buetow is an Associate Professor in the Department of General Practice and Primary Health Care, University of Auckland, New Zealand, having also held academic positions in primary care in Australia (National Centre for Epidemiology and Population Health) and England (National Primary Care Research and Development Centre in Manchester). With a PhD in Demography from the Australian National University and a broad background in the humanities and social sciences, Stephen produces health services research in diverse areas, with a particular analytical focus on challenging the clinician-centric discourse underpinning modern health care.  He has published two books and 100 peer reviewed papers (H-index of 16) in Journals including the Lancet and British Medical Journal.  Stephen is both a member of the Editorial Board and a regional (Oceania) Editor for the Journal of Evaluation in Clinical Practice and the International Journal of Person-Centred Medicine.  In New Zealand he is a Public Health Research Committee member of the Health Research Council and has chaired several of its public health assessing committees.  He coordinates a postgraduate research methods course and has contributed significant service to his University, for example as Acting Head of Department during 2009-10.

References

Hanson, M., Callahan, D. (1999). Project report. The goals of medicine: setting new priorities. In: The Goals of Medicine: The Forgotten Issue in Health Care Reform. (eds. M. Hanson, D. Callahan D.), pp. 1-54. Washington DC: Georgetown University Press.

Buetow, S. (2002). Beyond evidence-based medicine: bridge-building a medicine of meaning. Journal of Evaluation in Clinical Practice 8, 103-108.

World Health Organization (WHO). (1948). Official records of the World Health Organization. Geneva: WHO.

Flew, A., Priest, S. (2002). A Dictionary of Philosophy. London: Pan Books.

Boorse, C. (1977). Health as a theoretical concept. Philosophy of Science 44, 542-573.

Nordenfelt, L. (1995). On the Nature of Health: An Action-Theoretic Aproach. Dordecht: Kluwer.

Pörn, I. (1993). Health and Adaptedness. Theoretical Medicine 14, 295-303.

De Grazia, D. (2005). Enhancement technologies and human identity. Journal of Medicine and Philosophy 30, 261-283.

Chan, S. (2008). Enhancement, evolution and the possible futures of humanity. EMBO Reports 9, S70-S74.

Greely, H., Sahakian, B., Harris, J., Kessler, R. C., Gazzaniga, M., Campbell, P., Farah, M.J. (2008). Towards responsible use of cognitive-enhancing drugs by the healthy. Nature 456, 702-705.

Sadler, J., Jotterand, F., Lee, S., Inrig, S. (2009). Can medicalization be good? Situating medicalization within bioethics. Theoretical Medicine and Bioethics 30, 411-425.

Frankl, V. (1962). Man's Search for Meaning. An Introduction to Logotherapy. Boston: Beacon Press.

Buetow, S. (2007). Non-attendance for health care: when rational beliefs collide. Sociological Review 55, 592-610.

Muldoon, M., Barger, S., Flory, J., Manuck, S. (1998). What are quality of life measurements measuring? British Medical Journal 316, 542-545.

Veatch, R., Miller, F. (2001). The internal morality of medicine: An introduction. Journal of Medicine and Philosophy 26, 555-557.

McLaughlin, L., Braun, K. (1998). Asian and Pacific Islander cultural values: considerations for health care decision-making. Health and Social Work 23, 116-126.

McMillan, R. (1995). Responsibility to or for in the physician-patient relationship. Journal of Medical Ethics 21, 112-115.

Madder, H. (1997). Existential autonomy: why patients should make their own choices. Journal of Medical Ethics 23, 221-225.

Tilburt, J. (2011). Shared Decision Making After MacIntyre. Journal of Medicine and Philosophy 36, 148-169.

D'Amico, R. (2007). Disease and the concept of supervenience. Philosophy and Medicine 90, 35-45.

Ioannidis, J. (2005). Why most published research findings are false. PLoS Medicine 2, (8), e124.

Upshur, R. E. G. (2000). Seven characteristics of medical evidence. Journal of Evaluation in Clinical Practice 6, 93-97.

Elwyn, G., Buetow, S., Hibbard, J., Wensing, M. (2007). Respecting the subjective: quality measurement from the patient's perspective. British Medical Journal 335, 1021-1022.

Frankl, V. (1963). Man's search for meaning: an introduction to logotherapy. Boston: Beacon Press.

Mezzich, J., Snaedal, J., van Weel, C., Heath, I. (2009).

The International Network for Person-centred Medicine. Background and first steps. World Medical Journal 55, 104-107.

Glenn, L. (2003). Biotechnology at the Margins of Personhood: An Evolving Legal Paradigm Journal of Evolution and Technology 13. Available at: http://jetpress.org/volume13/glenn.html (last accessed 2 August 2011).

Frankfurt, H. (1971). Freedom of the will and the concept of a person. Journal of Philosophy 68, 5-20.

Reznek, M. (1987). The nature of disease. New York: Routledge and Kegan Paul.

Brudney, D., Lantos, J. (In press). Agency and authenticity: Which value grounds patient choice? Theoretical Medicine and Bioethics.

Jonas, H. (1984). The imperative of responsibility: in search of an ethics for the technological age. Chicago: University of Chicago Press.

Boudon, R. (2003). Beyond rational choice theory. Annual Review of Sociology 29, 1-21.

Williams, W. (1978). Behavioural anomalies in patients and doctors. II Secondary gain, or the advantages of being 'sick'. In: Psychiatry for the non-Psychiatrist. (ed. J. Ellard), pp. 167-172. Sydney: Geigy Pharmaceuticals.

Parsons, T. (1951). The social system. Glencoe IL: Free Press.

Apter, M. (1982). Reversal theory: Motivation, Emotion and Personality. New York: Routledge.

Buetow, S. (1995). What do general practitioners and their patients want from general practice and are they receiving it? A framework. Social Science and Medicine 40, 213-221.

Jarrett, L. (1999). Nourishing destiny. Stockbridge, Mass: Spirit Path Press.

Parens, E., ed. (1998). Enhancing human traits: ethical and social implications. Washington D.C.: Georgetown University Press.

Edwards, J. (2000). Passion, activity, and "the care of the self". Hastings Center Report 30, 31-34.

Hanson, M. (1999). Indulging anxiety: human enhancement from a Protestant perspective. Christian Bioethics 5, 121-138.

Wolbring, G. (2005). The triangle of enhancement medicine, disabled people, and the concept of health: a new challenge for HTA, health research, and health policy. Edmonton: Alberta Heritage Foundation for Medical Research.

Buetow, S., Roland, M. (1999). Clinical governance: bridging the gap between managerial and clinical approaches to quality of care. Quality in Health Care 8, 184-190.

Heath, I. (2007). Family medicine should focus on the 'sick': Affirmative position. In: Ideological Debates in Family Medicine. (eds. S. Buetow, T. Kenealy), pp. 73-81. New York: Nova Biomedical Books.

Caplan, A., Elliott, C. (2004). Is It ethical to use enhancement technologies to make us better than well? . PLOS Med;1(3):52. 1, (3), 172-175.

Pence, G. (1991). Virtue theory. In: A Companion to Ethics. (ed. P. Singer), pp. 249-258. Oxford: Blackwell.

Buetow, S., Elwyn, G. (2008). The window mirror: a new model of the patient-physician relationship. Open Medicine 2, E20-25.

Ginn, F., Demeritt, D. (2009). Nature: a contested concept. In: Key Concepts in Geography. (eds. N. Clifford N., S. Holloway S., S. Rice, G. Valentine), pp. 300-311. London: Sage.

Sandman, L., Munthe, C. (2010). Shared decision making, Paternalism and patient choice. Health Care Analysis. 18, 60-84.

McNutt, R. (2007). Shared decision-making: optional v mandatory autonomy of patients. Family medicine should support the optional autonomy of patients in decision-making: the negative argument. In: Ideological Debates in Family Medicine. (eds. S.Buetow, T. Kenealy), pp. 251-259. New York: Nova Science Publishers.

McNutt, R. (2004). Shared medical decision making. Problems, process, progress. Journal of the American Medical Association 292, 2516-2518.

Emanuel, E. J., Emanuel, L. (1992). Four models of the physician-patient relationship. Journal of the American Medical Association 267, 2221-2226.

Seedhouse, D. (2006). Health: The foundations for achievement. Chichester: John Wiley and Sons.

Feldman, M. (2011). From the Editors’ Desk: Physician Heal Thyself. Journal of General Internal Medicine 26, 823.

Williams, B. (1994). Patient satisfaction: A valid concept? Social Science and Medicine 38, 509-516.

Veatch, R. (1996). Modern vs. contemporary medicine: The patient-provider relation in the twenty-first century Kennedy Institute of Ethics Journal 6, 366-370.

Patrick, J. (2008). Hippocratic medicine today. Available at: http://www.hippocraticregistry.com/index.html (last accessed 2 August 2011).

Savulescu, J. (1997). Liberal rationalism and medical decision-making. Bioethics 11, 115-129.

Buetow, S. (1998). Four strategies for negotiated care. Journal of the Royal Society of Medicine 91, 199-201.

Buetow, S. (1999). Unsolicited GP advice against smoking: To give or not to give? Journal of Health Communication 4, 67-74.

Greene, J. (2007). Mixed methods in social inquiry. San Francisco: Wiley.

Chervenak, F., McCullough, L. (2009). Ethical distinction between direct and indirect referral for abortion. The Female Patient 34, 12, 46-48.