How Understanding Our Multi-Dimensional Humanity Clarifies Medical Ethics
Main Article Content
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: 04 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i5.3835.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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11. Curlin F, Tollefsen C. The Way of Medicine. Notre Dame Press, 2021.
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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
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