The Sisters of Charity have just announced that they are quitting their three Dublin hospitals. They say from now on the hospitals will be governed by “national and international best practice guidelines on medical ethics and the laws of the Republic of Ireland.” (What does this imply about what is happening now?) This begs a very big question; what is the best kind of medical ethics? There is no medicine without ethics. Hospitals don’t need to be under church or religious influence but they cannot exist without an ethos.
Medicine has three main purposes: to prevent and cure diseases, and to take care of patients. It is not simply a science but also a practice inspired by ethical values. So, what is the difference with the other sciences? Take for instance mineralogy. It is the description of the chemical and physical properties of minerals. Medicine, instead, aims not simply at describing what a human body is but it is also based on the assumption that there is a natural order, which we call health, and the purpose of the medical practice is to keep or to restore this order. There is an intrinsic good (health) that we discover through science and we preserve and reestablish through practice.
For instance, anatomy and physiology tell us what is the proper function of the eyes, i.e. to see. This is not simply a description but it also contains a prescriptive element because the ideal eye is also the normative model that the doctor uses when she acts to keep the patient’s eyes healthy or to prevent their diseases.
This understanding of medicine doesn’t require a particular religious faith but it is nonetheless intrinsically ethical. It is inspired by a certain conception of the good (health) that we find in human nature through the correct use of reason. The principle of “do not harm”, which has guided health care since ancient times, has the form of an ethical imperative.
Not everything that happens (or might happen) in a hospital or a clinic is medicine, unless it aims at preventing and curing diseases, and also at the same time at taking care of patients. Not all interventions that alter our bodies surgically or chemically are medicine, even if a scientist (medical expert) might be involved. Getting your facial features surgically changed to look more like your music idol is not medicine. Killing the unborn because she was unplanned or is disabled is not medicine. Augmenting your muscles through drugs to win a weightlifting contest is not medicine. Removing a perfectly healthy organ to adjust your body to your perceived gender is not medicine. Facilitating suicide is not medicine.
In all these examples a certain level of scientific knowledge is necessary but they lack what makes medicine more than a science: the ethical value of health. They might involve someone who has a proper knowledge of the human body but his purpose, in these examples, is not to restore or preserve the good of the functioning body. They are instances of scientific techniques without good and true medical ethics.
There is a growing pressure by certain ideologies to transform medicine, which is necessarily led by an objective good that we call health, into the satisfying of the subjective requests and choices of the patient. If bodily autonomy (my body, my choice), rather than health, is the ultimate value then there is no reason why doctor should not amputate a healthy arm or leg, when requested, or administer a dangerous substance, for recreation or self-harm or death. Without the guiding principle of health, practitioners become simply the executors of someone else’s desires. Obviously, people can do what they want with their bodies but this is not medicine.
There is no good medicine without ethics. Hospitals don’t need to be under church or religious influence but they cannot exist without an ethos, without values. When their core value is not health – an intrinsic good indicated by human nature- they don’t serve medicine anymore but trends, ideologies, business.
To return to the question at the top of this article, what will be the governing ethos of the St Vincent’s Healthcare Group now that the nuns are quitting the three hospitals they founded and that come under this group?