Quality of Life

Robin Downie

Description

The Covid-19 pandemic has shown the need for a fresh look at health and health care. This book offers a philosophical critique of medicine as applied science, but more positively it stresses the social causes of disease and argues for greater equity in the distribution of resources and the benefits of a wider evidence-base for medical treatments. The suggested approach requires a new direction for medical ethics, one which uses the arts and humanities and leads to a revised idea of medical education and medical professionalism. The suggested approach implies a move away from the individualistic philosophy of medicine towards a new aim - community-based quality of life. The achievement of this aim certainly requires an expansion of public health medicine and health promotion but it also requires medical co-operation with the many arts and other community agencies concerned with our health and well-being. Doctors and other health professionals must work through the community rather than on it.

Sujets

• Philosophie et théologie
• Doctor
• Medical sociology

Informations

• Publié par: Andrews UK
• Date de parution: 11 mai 2021
• Nombre de lectures: 0
• EAN13: 9781788360647
• Langue: English

Extrait

Quality of Life
A Post-Pandemic Philosophy of Medicine
Robin Downie
www.imprint-academic.com




Published in 2021 by
Imprint Academic Ltd
PO Box 200, Exeter
EX5 5YX, United Kingdom
imprint-academic.com
Digital edition converted and distributed by
Andrews UK Limited
www.andrewsuk.com
Copyright © 2021 Robin Downie
The right of Robin Downie to be identified as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication (except for the quotation of brief passages for the purposes of criticism and discussion) may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means without the prior written permission of the publisher, nor be otherwise circulated in any form of binding or cover other than that in which it is published and without a similar condition being imposed on the subsequent purchaser. Any person who does so may be liable to criminal prosecution and civil claims for damages.
The views and opinions expressed herein belong to the author and do not necessarily reflect those of Imprint Academic or Andrews UK Limited.



Sir Kenneth Calman
Foreword
One of the most rewarding aspects of being a Chancellor of a university is to be part of the tradition of graduation ceremonies where young men and women, from widely different backgrounds, are awarded their degrees. The ceremony for the medical student graduations is of special interest. In front of their family and friends, they stand and recite a version of the Hippocratic Oath. It is a powerful ceremony as the graduates set out their standards for their future practice in medicine.
One question raised in this book is whether or not this is an appropriate process in the twenty-first century, and in the midst of a most powerful pandemic. Perhaps a new approach should be taken, so much has changed. Team working is now crucial for good clinical practice. Professional groups in a wide variety of subjects in addition to medicine have a major part to play in caring for patients. How do they all fit together, and have they all had experience of learning about such a wide range of issues? The medical curriculum has changed and the role of quality in clinical practice has been redefined. At the same time quality of life has become more relevant, and what does that mean anyway?
Quality of life is a difficult concept and is linked to the related topics of happiness, choice and living standards. How do we define them, measure them and improve them? Even that short sentence leaves many questions open for debate, questions which this book discusses. Another facet of this relates to a real problem in the pandemic: who should be actively treated, and who not? This is a common problem in clinical practice, but the pandemic has given it sharper focus because so many individuals are involved. How am I going to choose when we recognise that not everyone can be cared for in the same way? What can a deeper knowledge of philosophy add to our understanding of such difficult issues affecting real people?
These issues have raised the question of the role of the arts in health, a role which is seen by many groups as particularly relevant, including an All-Party Parliamentary Group on Arts, Health and Wellbeing. In the old days, it was common for those wishing to study medicine to obtain an arts degree first, but that is unusual now. Does the change to an exclusively science-based education also change the way we think about those who are unwell, and what about ethical issues raised by the change? How are they to be approached, and can philosophy offer guidance?
I first became part of these discussions almost 40 years ago. I was involved with the teaching of medical ethics to medical students and my fellow teacher was Robin Downie. In this process I learned a number of things and the first was that philosophy was more than medical ethics. Second, my own thinking on quality of life began to change. I was at the time a professor of oncology and such issues were at the heart of the care given to individuals. Third, it was clear that the students enjoyed being involved in the debates and had much to contribute. Finally, I discovered the role of the arts in caring for those whose quality of life needed improving.
The inspiration of these thoughts began when we occasionally introduced literature to the medical ethics teaching process, using stories, poems, books. They enjoyed this and, as a consequence, we set up a programme of classes with the broad title of Literature and Medicine. The students were inspirational to listen to, and their comments and views on the readings were revealing. They showed how medical students, whose work was grounded in science, used these occasions to open up a range of questions and allow discussion of broader issues. They had so much to contribute. This initiative continued in many forms and other medical schools and organisations developed an interest.
A particular issue, relevant to many of the subjects raised, was how best to communicate with patients and the wider public. The use of the arts opened up new opportunities and methods of helping with these difficult issues, and shone a new light on quality of life, its meaning and ways of grounding it in practice. In addition, the wider impact of philosophy added extra dimensions to the care of patients and the public.
The current pandemic has opened up a range of new opportunities. As mentioned earlier the team approach was crucial in improving health and caring for individuals. The ethical basis of this care was generally dealt with in different settings, and not necessarily together. The scientists involved had probably not considered these issues fully, but here they were at the centre of a process of care, and with a significant role. The broader aspects of public communication became critical. How do you communicate if you don’t have all the answers? How can you tell the truth, and use words like ‘safe’? These are not new topics, and philosophers over the ages have tackled them. We can learn much from that experience.
This book integrates many of the thoughts noted above, and many more. It is a book for its time which can help in improving health and quality of life for all and encourage wider debate.
Sir Kenneth Calman
KCB DL FRCP FRCS FRSE FRCGP
Former Chief Medical Officer of Scotland and England



Preface
I have learned a great deal about how medicine works from joint writing ventures with doctors, and from being a member of many medical and government committees concerned with assorted medical policy questions. And I shall make full acknowledgement and reference in the text to what I have learned from these cooperations. Moreover, I am second to none in my admiration for the skills and dedication of the doctors, nurses, social workers, care workers and many other professions working in health care. Nevertheless, in all these interesting joint ventures it was always the medical point of view that prevailed, even if sometimes I had reservations. I therefore thought it might be of philosophical interest if I addressed some fundamental questions about medicine, but from a philosophical perspective. There is a need for this as we enter the post-pandemic period.
The fundamental questions I shall address are important because answers to them affect the future direction of medicine, the kinds of treatment we shall all receive, and the kind of social arrangements we might be willing to accept. Apart from these practical considerations the questions are in themselves of philosophical interest because they raise issues such as: how scientific is medicine? Can the complex ethical problems of medicine be resolved by the limited concepts of ‘medical ethics’? Have the problems of growing up been medicalised and turned into mental health problems? Is consumer choice in medicine consistent with the belief that medicine is a ‘profession’? Can health be improved without a more equitable distribution of resources and a greener environment?
Questions of the above kind and many others to be discussed lead to one which underlies them all: what is the basic aim of medicine? We might immediately think that the basic aim of medicine is to cure our diseases. But that will not do. Doctors assist with childbirth, ease the suffering of the dying, offer advice on diet and a host of other issues. Moreover, concepts such as ‘disability’, ‘mental illness’ and even ‘disease’ have elements not captured in a purely scientific approach. Many doctors therefore prefer a wider aim—to improve quality of life —and a great deal has been written on this as the aim of medicine. But the problem with the medical approach to the idea of quality of life is that it is distorted by the illusion that it can be treated as a purely medical idea and measured on a scale 1–10. I wonder how I might feel if I were to see my case-notes and learn that my quality of life was 6. I reckon I might feel as readers of the Hitchhiker’s Guide to the Galaxy feel when they learn that the meaning of life is 42! [1] Quality of life is a rich non-numerical concept with a social and environmental side to it and requires to be explored in a much broader way.
Medical practice is governed by codes of ethics. Yes, but what is taught and practised is medical ethics, or ethics from a medical point of view. But hospitals and general practices are microcosms of society as a whole—with heightened tensions. Dealing with the problems which arise requires more than learning up regulations from official bodies such as, in the UK, the General Medical Council or the British Medical Association. And the idea which has prevailed among teachers of me