How Understanding Our Multi-Dimensional Humanity Clarifies Medical Ethics

Main Article Content

Christopher Joseph Lisanti Sebastian Galante, MD Allen M. Betts

Abstract

Medical ethics is increasingly culturally subjective.  A clear understanding of medical ethics must be grounded in a clear philosophy of medicine and philosophical anthropology.  Philosophically, medicine is a profession dedicated to the patient’s health.  A better understanding of health or wholeness will lead to better healing.  Health or wholeness is best understood as well-functioning.  The philosophical and anthropological biopsychosocial-spiritual model informs the roots of well-functioning.  These four interrelated dimensions must be balanced and work in harmony, ultimately aimed at the basic goods (e.g., health, life, and personal integrity among others) and should be strived for but never harmed.  This holistic approach helps determine the primary cause of unwellness while also explaining that biologic healing frequently relies as much on the other dimensions as the biologic treatment.  Historically, physicians refined their skills ensuring that the best biologic means addressed the most well-defined biological diseases. This dimension-specific philosophical framework formed the basis of a physician’s diagnostic investigation.  If the source of unwellness was primarily in another dimension, then appropriate therapeutic referrals to dimension-specific experts were offered.  This framework prevented or corrected egregious excesses due to medicalization of social issues.  Traditional boundaries of medicine are now challenged by contraceptives, elective abortion, cosmetic procedures, and euthanasia/physician-assisted suicide, steering medicine away from treating biologic problems with biologic solutions towards treating psychologic and/or social problems with biologic solutions.  Countries now inconsistently require their physicians to provide biologic means aimed at specific psychologic and/or social goals to advance sexual and/or economic goals, the country’s laws, or patient autonomy.  This is conceptually flawed requiring special exemptions from the profession of medicine while also resulting in biologic harm, damage to the basic goods, and negative psychologic and/or social effects, while transforming medicine into a commodity.  Physicians have an ethical obligation to provide effective biologic means to treat biologic diseases while promoting healing and wholeness among all four dimensions.  On the other hand, physicians have no obligation to use biologic means for non-biologic problems.  This multi-dimensional model with dimension-specific therapies is conceptually consistent, socially agnostic, empirically sound, and provides a clearer understanding of medical ethical obligations.   

Article Details

How to Cite
LISANTI, Christopher Joseph; GALANTE, Sebastian; BETTS, Allen M.. How Understanding Our Multi-Dimensional Humanity Clarifies Medical Ethics. Medical Research Archives, [S.l.], v. 11, n. 5, may 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3835>. Date accessed: 28 mar. 2024. doi: https://doi.org/10.18103/mra.v11i5.3835.
Section
Research Articles

References

1. Abortion Law: Global Comparisons. Council on Foreign Relations. 24 June 2022. https://www.cfr.org/article/abortion-law-global-comparisons

2. Coppen L, Brockhaus H. How does U.S. abortion law compare to those in European countries? Catholic News Agency. 11 October 2021. https://www.catholicnewsagency.com/news/249247/united-states-europe-abortion-law-comparison

3. Van Mol A. United Kingdom Closing the World’s Largest Pediatric Gender Clinic. Christian Medical and Dental Association. 25 August 2022. https://cmda.org/united-kingdom-closing-the-worlds-largest-pediatric-gender-clinic/

4. Sapir L. Yes, Europe Is Restricting “Gender-Affirming Care”. City Journal. 13 February 2023. https://www.city-journal.org/yes-europe-is-restricting-gender-affirming-care

5. Abbruzzese E, Levine SB, Mason JW. The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed. J Sex Marital Ther. 2022:1-27. https://doi.org/10.1080/0092623X.2022.2150346

6. Belloni G. Transgender Youth Care Targeted in Culture Battle Sweeping US. Bloomberg Law. 21 February 2023. https://news.bloomberglaw.com/health-law-and-business/transgender-youth-care-targeted-in-culture-battle-sweeping-us

7. Kass LR. Regarding the end of medicine and the pursuit of health. Public Interest. 1975;40:11. https://www.proquest.com/openview/d804439a2c70467647ffd7a4d792ebe9/1?pq-origsite=gscholar&cbl=1817076

8. Pellegrino, ED. Medicine Today: Its Identity, Its Role, and the Role of Physicians. In: Engelhardt HT, Jotterand F, eds. The Philosophy of Medicine Reborn: A Pellegrino Reader. Notre Dame Press; 2008:127-146.

9. Kaldjian LC. Practicing medicine and ethics: integrating wisdom, conscience, and goals of care. Cambridge University Press; 2014.

10. Camosy CC. Resisting Throwaway Culture: How a Consistent Life Ethic Can Unite a Fractured People. New City Press; 2019.

11. Curlin F, Tollefsen C. The Way of Medicine. Notre Dame Press, 2021.

12. Aristotle A. Nicomachean Ethics Translated by D.P. Chase. Quaternion Books; 2020:17.

13. Pellegrino, ED. Philosophy of Medicine: Should It Be Teleologically or Socially Constructed. In: Engelhardt HT, Jotterand F, eds. The Philosophy of Medicine Reborn: A Pellegrino Reader. Notre Dame Press; 2008:49-61.

14. Cantor JD. Conscientious objection gone awry—restoring selfless professionalism in medicine. NEJM. 2009;360(15):1484-5. DOI: 10.1056/NEJMp0902019

15. Stahl RY, Emanuel EJ. Physicians, not conscripts—conscientious objection in health care. NEJM. 2017;376(14):1380-5. http://www.cathmeddallas.org/uploads/5/7/6/4/57643889/conscientious_objection_-_stahl___emanuel.pdf

16. Snead OC. What it means to be human: The case for the body in public bioethics. Harvard University Press; 2020.

17. Engelhardt HT. The foundations of Christian bioethics. Taylor & Francis; 2000.

18. Koch T. Thieves of virtue: when bioethics stole medicine. Mit Press; 2012.

19. Minerva F. Cosmetic surgery and conscientious objection. J Med Ethics. 2017;43(4):230-3. http://dx.doi.org/10.1136/medethics-2016-103804

20. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 385 November 2007: the limits of conscientious refusal in reproductive medicine. Obstet Gynecol. 2007;110(5):1203-8. doi: 10.1097/01.AOG.0000291561.48203.27.

21. Bayefsky MJ, Bartz D, Watson KL. Abortion during the Covid-19 pandemic—ensuring access to an essential health service. NEJM. 2020;382(19):e47. DOI: 10.1056/NEJMp2008006

22. Fiala C, Arthur JH. “Dishonourable disobedience”–Why refusal to treat in reproductive healthcare is not conscientious objection. J Psychosom Obstet Gynaecol. 2014;1:12-23. https://doi.org/10.1016/j.woman.2014.03.001

23. Ringel EW. The morality of cosmetic surgery for aging. Arch Dermatol. 1998;134(4):427-31. doi:10.1001/archderm.134.4.427

24. Hatala AR. Towards a biopsychosocial–spiritual approach in health psychology: Exploring theoretical orientations and future directions. J Spiritual Ment. 2013;15(4):256-76. https://doi.org/10.1080/19349637.2013.776448

25. Pennington J. A biblical theology of human flourishing. Institute for faith, work and economics. March 2015. https://tifwe.org/wp-content/uploads/2015/03/Pennington-A-Biblical-Theology-of-Human-Flourishing.pdf

26. Sulmasy DP. A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist. 2002;42(suppl_3):24-33. https://doi.org/10.1093/geront/42.suppl_3.24

27. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA. Early palliative care for patients with metastatic non–small-cell lung cancer. NEJM. 2010;363(8):733-42. DOI: 10.1056/NEJMoa1000678

28. Matthewson J, Griffiths PE. Biological criteria of disease: Four ways of going wrong. J Med Philos. 2017;42(4):447-66. https://doi.org/10.1093/jmp/jhx004

29. Mental Health Information. National Institutes of Mental Health. March 2023. https://www.nimh.nih.gov/health/statistics/mental-illness#part_2539

30. Eronen MI. Psychopathology and truth: A defense of realism. J Med Philos. 2019;44(4):507-520. https://doi.org/10.1093/jmp/jhz009

31. Goyal M, Singh S, Sibinga EM, Gould NF, Rowland-Seymour A, Sharma R, Berger Z, Sleicher D, Maron DD, Shihab HM, Ranasinghe PD. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357-68. doi:10.1001/jamainternmed.2013.13018

32. Seligman M. Flourish: A Visionary New Understanding of Happiness and Well-being. Atria, 2011.

33. Gazzaley A, Rosen LD. The distracted mind: Ancient brains in a high-tech world. Mit Press; 2016.

34. Wachholtz A, Rogoff M. The relationship between spirituality and burnout among medical students. J Contemp Med Educ. 2013;1(2):83. DOI https://doi.org/10.5455%2Fjcme.20130104060612

35. Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: reaching national and international consensus. J Palliat Med. 2014;17(6):642-56. https://doi.org/10.1089/jpm.2014.9427

36. Miller L. The Awakened Brain. Random House; 2021.

37. Ryff CD, Singer BH. Know thyself and become what you are: A eudaimonic approach to psychological well-being. J Happiness Stud. 2008;9:13-39. https://doi.org/10.1007/s10902-006-9019-0

38. Tollefsen CO. Practical Reason, Basic Goods, and Natural Law. Public Discourse. January 9, 2018. https://www.thepublicdiscourse.com/2018/01/20745/

39. VanderWeele TJ. On the promotion of human flourishing. Proc Natl Acad Sci. 2017;114(31):8148-56. https://doi.org/10.1073/pnas.1702996114

40. Van Voren R. Political abuse of psychiatry-An historical overview. Schizophr Bull. 2010;36(1):33-5. https://doi.org/10.1093/schbul/sbp119

41. Kennes J, Knowles J. Can Technological Change Account for the Sexual Revolution? Centre for Population Working Paper Number 34. Centre for Population. 2013. https://eprints.soton.ac.uk/354974/1/2013_WP34_Can_Technological_Change_Account_for_the_Sexual_Revolution_Kennes_et_al.pdf

42. Campo-Engelstein L. Reproductive technologies are not the cure for social problems. J Med Ethics. 2020;46(2):85-6. http://dx.doi.org/10.1136/medethics-2019-105981

43. Keenan L, Kerr T, Duane M, Van Gundy K. Systematic review of hormonal contraception and risk of venous thrombosis. Linacre Q. 2018;85(4):470-7. https://doi.org/10.1177/0024363918816683

44. Shah PS, Zao J, Knowledge Synthesis Group of Determinants of Preterm/LBW Births. Induced termination of pregnancy and low birthweight and preterm birth: a systematic review and meta‐analyses. BJOG. 2009;116(11):1425-42. https://doi.org/10.1111/j.1471-0528.2009.02278.x

45. Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of hormonal contraception with depression. JAMA Psychiat. 2016;73(11):1154-62. doi:10.1001/jamapsychiatry.2016.2387

46. Mohammed H, Blomquist P, Ogaz D, Duffell S, Furegato M, Checchi M, Irvine N, Wallace LA, Thomas DR, Nardone A, Dunbar JK. 100 years of STIs in the UK: a review of national surveillance data. Sex Transm Infect. 2018;94(8):553-8. http://dx.doi.org/10.1136/sextrans-2017-053273

47. Westroem L. Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. Am J Obstet Gynecol. 1980 Dec 1;138(7):880-92. https://doi.org/10.1016/0002-9378(80)91077-7

48. Trueman CR. The rise and triumph of the modern self: Cultural amnesia, expressive individualism, and the road to sexual revolution. Crossway; 2020.

49. Murray C. Coming apart: The state of white America, 1960-2010. Crown Forum; 2012.

50. Reeves RV, Smith E. The male college crisis is not just in enrollment, but completion. Brookings. 8 October 2021. https://www.brookings.edu/blog/up-front/2021/10/08/the-male-college-crisis-is-not-just-in-enrollment-but-completion/

51. Yarrow AL. The Male Non-Working Class A Disquieting Survey. Milken Institute Review. 30 July 2020. https://www.milkenreview.org/articles/the-male-non-working-class

52. Smith J, Wolfinger NH. Re-Examining the Link Between Premarital Sex and Divorce. J Fam Issues. 2023:0(0). https://doi.org/10.1177/0192513X231155673

53. State of World Population 2020. UNFPA (United Nations Fund for Population Activities). https://www.unfpa.org/publications/state-world-population-2020

54. Down Syndrome and Social Capital: Assessing the Costs of Selective Abortion. Social Capital Project. March 2022. https://www.jec.senate.gov/public/_cache/files/ade656cc-206b-4624-a51b-10eeca1d1f28/down-syndrome-report.pdf

55. Stone L. The Global Fertility Crisis. National Review. 2020. https://www.nationalreview.com/magazine/2020/01/27/the-global-fertility-crisis/.

56. Beauchamp T, Childress J. Principles of Biomedical Ethics. Oxford University Press, 2019.

57. Komrad MS. First, Do No Harm: New Canadian Law Allows for Assisted Suicide for Patients with Psychiatric Disorders. Psychiatric Times, 7 July 2021. https://www.psychiatrictimes.com/view/first-do-no-harm

58. Kass LR. Professing ethically: On the place of ethics in defining medicine. JAMA. 1983;249(10):1305-10. doi:10.1001/jama.1983.03330340047030

59. Krikorian A, Limonero JT, Maté J. Suffering and distress at the end‐of‐life. Psycho‐Oncol. 2012;21(8):799-808. https://doi.org/10.1002/pon.2087

60. First annual report on Medical Assistance in Dying in Canada. Health Canada. 2019. https://www.canada.ca/en/health-canada/services/medical-assistance-dying-annual-report-2019.html.

61. Oregon Death with Dignity Act: 2018 Data Summary. Oregon Health Authority. 2018. https://www.oregon.gov/oha/ph/providerpartnerresources/evaluationresearch/deathwithdignityact/documents/year21.pdf

62. American Medical Association. Opinions on Caring for Patients at the End of Life. The AMA code of medical ethics. 2016. https://www.ama-assn.org/system/files/2019-06/code-of-medical-ethicschapter-5.pdf.

63. Snyder Sulmasy L, Mueller PS, Ethics, Professionalism and Human Rights Committee of the American College of Physicians*. Ethics and the legalization of physician-assisted suicide: an American College of Physicians position paper. Ann Intern Med. 2017;167(8):576-8. https://doi.org/10.7326/M17-0938.

64. Coleman D. Assisted suicide laws create discriminatory double standard for who gets suicide prevention and who gets suicide assistance: Not Dead Yet Responds to Autonomy, Inc. Disabil Health J. 2010;3(1):39-50. https://doi.org/10.1016/j.dhjo.2009.09.004

65. Plastic Surgery Statistics Report 2019. ASPS (American Society of Plastic Surgeons. 2019. https://www.plasticsurgery.org/documents/News/Statistics/2019/plastic-surgery-statistics-fullreport-2019.pdf.

66. Shakespeare T. A Point of View: Does Cosmetic Surgery Really Make People Feel Better about their Bodies? BBC News. January 22, 2016. https://www.bbc.com/news/magazine-35380469

67. Cosmetic Procedures: Ethical Issues. Nuffield Council on Bioethics. 2017. https://www.nuffieldbioethics.org/publications/cosmeticprocedures

68. Van Mol A, Laidlaw MK, Grossman M, McHugh P. Correction: Transgender Surgery Provides No Mental Health Benefit. Public Discourse, 13 September 2020. https://www.thepublicdiscourse.com/2020/09/71296/

69. Miller FG, Brody H, Chung KC. Cosmetic surgery and the internal morality of medicine. Camb Q Healthc Ethics. 2000;9(3):353-64. https://doi.org/10.1017/S0963180100903074

70. Joseph AW, Ishii L, Joseph SS, Smith JI, Su P, Bater K, Byrne P, Boahene K, Papel I, Kontis T, Douglas R. Prevalence of body dysmorphic disorder and surgeon diagnostic accuracy in facial plastic and oculoplastic surgery clinics. JAMA Facial Plast Surg. 2017;19(4):269-74. https://doi.org/10.1001%2Fjamafacial.2016.1535