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Treating the person, not the illness

The below blog is written by Dr Matthew Jakab, a Hospital Medical Officer in the Palliative Care Unit at Peninsula Health.

As doctors we must ask ourselves, what is the point of medicine? We could give a trite answer of “to heal people”, yet that in itself seems quite superficial. Perhaps the better question is, why should we care about the sick? It’s a question that seems antithetical to the mind of a doctor. But we know that for Victoria alone, the health budget is $4.2 billion, of which most is spent on the sickest people [1].  There are limited resources but seemingly limitless areas to spend it on. Could it not be spent on improving the prosperity of already productive individuals?

In Inuit culture, when someone got old or sick, they would leave them out in the icy cold to die [2]. It was necessary for the culture to survive in such a way in a limited resource setting. More simply, in order for a greater number to flourish, some must diminish. This is a story told often from a utilitarian perspective. On this view, the death of one is justified by the survival of the many.  It sounds horrific, yet cognitive studies with trolley problems confirm that most people would, if they had the ability, choose an option that would result in them being at least being partially responsible for one death instead of five[3]. One can easily impose such a principal onto various medical scenarios such as killing someone who is unwell, and likely to be unwell regardless of treatment, in order to give their organs to those that will likely do well and contribute to society more.  Yet as medical professionals, it is incredibly hard to justify and indeed seen as immoral, however we must still ask what is wrong with such a conclusion?

Those at the coalface of treating the sick know that such commodifying of suffering is counter to our intuitions. We don’t do medicine to treat just human bodies, for then we would be undertakers; we don’t even treat human bodies with illnesses. What we do treat is people. There are various definitions of what personhood is, but most have at least some kind of mental function attached to them.  Suffering from an illness without a sufferer is pointless, and a sufferer has to have the mental capability of recognising that they are suffering.  If medicine is therefore treating suffering, it requires treatment of the being with the mental capabilities to experience it, that is, a person.

As a doctor, this is what I always try to keep in mind. We treat people with units of suffering, not the units of suffering themselves. There is much literature around this concept, but the reason we care about suffering is because we care about people in a way that goes beyond emotional ties, or in a heavily laden philosophical term, they have essential value. Destroying people for the sake of other people deliberately takes away someone’s personhood to theoretically increase another’s, which defeats the purpose of treating suffering. We must always aim to help maximise personhood not in spite of others, but with others.  How we go about that is a different question entirely.

By Matthew Jakab

  1. Victoria, S.G.o. Health. 2018; Available from: https://www.budget.vic.gov.au/explore-our-priorities/health.
  2. Levy, N., Moral Relativism: A Short Introduction. 2014: Oneworld Publications.
  3. Singer, P., The Expanding Circle: Ethics, Evolution, and Moral Progress. 2011: Princeton University Press.