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  • Goals of Medicine in the Course of History and Today: A Study in the History and Philosophy of Medicine
  • Jeremy Sugarman
Kurt Fleischhauer and Göran Hermerén . Goals of Medicine in the Course of History and Today: A Study in the History and Philosophy of Medicine. Stockholm: Kungl. Vitterhets Historie och Antikvitets Akademien, 2006. 480 pp. SEK 366.00 (91-7402-353-5).

This volume is the product of collaboration between a physician (Kurt Fleischhauer) and a philosopher (Göran Hermerén) who set out to address the deceptively complicated task of understanding the goals of medicine. Of course, at times these goals may be obvious. Take, for example, a patient seeking care from a physician for an acute medical problem such as appendicitis, where the goals include relieving pain and avoiding future complications. While the means of achieving such goals, and perhaps the nomenclature for such maladies, may change with time and place, it appears as if the goals themselves are constant, or are essential to the practice of medicine. Nevertheless, in other settings the problem can be more difficult. For instance, what goals of medicine justify quarantine, or genetic screening, or abortion? How ought competing goals to be balanced and adjudicated, such as the obligation to treat individual patients with compassion while safeguarding the health of the public, or to avoid suffering while preserving life? Does a proper understanding of the goals of medicine help us to understand historical changes in the practice of medicine, or vice versa? Clearly, this is an important problem!

The book has two main parts: historical and philosophical. The historical section sketches selected aspects of medical history, suggesting the goals associated with medicine at different periods of time and in different settings. Throughout the text, medicine is broadly considered to include clinical practice, public health, research, and at times broader areas such as medicine in war. The historical review begins with early Greek medicine and spans to the current day, emphasizing Northern and Western traditions. The contemporary topics selected for review include cosmetic surgery, abortion, contraception, medical genetics, and medical research. While the material covered here may be familiar to medical historians, and may be unsatisfying in the depth to which any particular topic is examined, the review adumbrates some of the goals of medicine, illustrating the emphasis of some goals at particular times and settings.

The philosophical section introduces a rich collection of material. Of initial concern is whether there are essential goals inherent to medicine that are immutable, and that in a sense define the practice. Answering this question demands not only a historical perspective, but also an understanding of philosophical arguments with roots in ancient Greek philosophy that have been challenged by more contemporary conceptual approaches. The authors review these approaches and their implications for assessing the nature of the goals of medicine, demonstrating the complexity of the task at hand while forcing an important critical examination. The task also involves normative and value questions. Through careful argument, the authors "show that (a) goals play a central role in medicine, (b) goals presuppose values, (c) values and ranking orders of values are sometimes contested, (d) to argue for or against goals or particular ranking orders of goals [End Page 907] introduces the same kind of moral and philosophical problems as any argument for or against any values or ranking orders of values" (p. 392).

Finally, the authors offer an approach to understanding the nature of the goals of medicine that begins with the obligation to restore and improve health, in situations where this is possible, but that also involves the aim of reducing pain and suffering. However, they recognize that such claims must be considered and be limited by a range of considerations such as the type of encounter (clinical or other), medical and nonmedical suffering, characteristics of disease, and enhancement of the social and health-care systems. This approach is obviously sensitive to context and has direct implications for ethical arguments and policy decisions that may invoke, explicitly or tacitly, the goals of medicine. Thus, this project, while still incomplete, is an important contribution to the literature and will be useful for those working in many...

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