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Archived Comments for: Foni phronimos - An interview with Edmund D. Pellegrino

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  1. Prudent medicine in imprudent times

    Miguel Kottow, Universidad de Chile

    25 January 2011

    Hardly anyone could fail to honor Edmund Pellegrino as an erudite, prolific and grand initiator of bioethical thought, persistently stressing the importance of preserving the humanity of medicine as recalled in Foni phronimos. Professor Pellegrino has repeatedly emphasized the distinction between philosophy of medicine and philosophy in medicine. Of the latter, he has insisted that the dominant focus of philosophy in medicine has been on medical ethics and bioethics. His contributions to medical ethics centered on beneficence-in-trust and the virtuous commitment to the common good are well known and firmly enmeshed in contemporary bioethics. As for philosophy of medicine, Pellegrino has set the scenario and invited thorough and on-going debate on such issues as health, illness, suffering, pain, the physician-patient relationship, the nature of medical knowledge and many other themes. In doing so, he may have induced a convergence of philosophy in and of medicine, perhaps even an inextricable compound.
    As medicine enters a new millennium, these questions have become crucial and deliberation is urgently needed, whereupon J. Giordano`s interview appears as interesting as it is disquieting. Pellegrino repeatedly speaks of moral truths, moral realism, and his confidence that there will always be those that believe that one can apprehend moral reality, and find out about moral truth by study of the real world. Such trust is unsettling and, according to J. Dewey, R. Rorty, H. Putnam and others, perhaps even misguided and anachronistic.
    It is equally surprising to read that E. Pellegrino should express his personal inclination towards bench science, even though he is quite aware that more science may lead to less ethical certainty. As empirical knowledge increases, we become more irresolute about how we ought to deal with it. Even sharing Pellegrino`s emphasis on knowledge tempered by medical prudence, one misses the archaeology of a bridge between both realms. Consequently, it is hard to share Giordano`s optimism that Snow`s two cultures show a tendency to converge and become less dissonant; it may well be that science and the humanities are more estranged than ever, and that medical education, steeped in molecular insights and evidence-based data, pays mere lip-service to the humanities. Pellegrino`s concern with the impact of the biotechnologies is but one of many new challenges that philosophy and the ethics of life must face without delay.
    If medicine`s basic vocation is to care for the sick, how come it is deviating ever scarce human and material resources to super-healing the healthy by providing ever increasing temptations of enhancement pharmaceutical, surgical, genetic-? How are we to deal with so-called new public health moving from traditional preventive public policies to a clinical realm infatuated with individual risk factors, the obsessive unveiling of lanthanic disorders, the exacting detection of predispositions, genetic markers, statistic probabilities and laboratory findings, all of which correlate rather poorly with overt disease conditions, still less with the phenomenology of illness?
    And, of course, philosophy of medicine must deal with medical practice as a market value, the physician-patient relationship as a contract, and the experience of patients as litigious customers whose care is fragmented by sub-specialists, diagnostic gadgets, and telecare. Should health, disease, care, and therapy be redefined by insisting that they are culturally and contextually determined and on the move, or are organismic derangements and restorative efforts to be understood and salvaged as anthropological realities that ought to be approached with prudence in the wake of an utterly imprudent and explosive technoscientific evolution? In view of these pressing issues, it becomes questionable how relevant and timely Pellegrino`s quest to understand what it is to be human might be for present-day medicine and its philosophy. Is medicine really to be concerned whether it is dealing with atheists who believe humanity to be but a transitory link in the evolutionary chain, agnostics who avoid metaphysical questions, or convinced believers in transcendence? These queries distract from the specific concerns of philosophy of medicine; if transdisciplinary migration is needed, it should most probably involve medical sociology and anthropology.
    In spite of his avowed realism, which has not lived up to the expectation of providing some solid and universal certainties, it is to the credit of Edmund Pellegrino that he should prefer to challenge by posing questions rather than offering unconvincing answers, thus reminding us of urgently pending homework.
    Miguel Kottow
    Universidad de Chile

    Competing interests