The Way of Medicine: Ethics and the Healing Profession
Farr Curlin and Christopher Tollefsen, University of Notre Dame Press, 2021.
ISBN: 978-0-268-20086-2, 232 pages, Paperback, $30
ISBN: 978-0-268-20085-5, 232 pages, Harcover, $100
Sometimes a book has pages filled with the reality of truth. The Way of Medicine: Ethics and the Healing Profession, by Farr Curlin and Christopher Tollefsen, is one such work. In a relatively short and readable volume, the authors explore and analyze the how’s and why’s of medical practice, from the ancient model of Hippocrates to the modern “service-provider model.” Using case examples, moral theory, foundational ethics, and experience, they charge after the conflicts between the modern model and the more ancient “way of medicine,” which they espouse as “a practice oriented toward the patient’s health as one basic human good” (p. 54). Their central questions are: “what is medicine?” and “what is medicine for?” They answer these by embracing clinical practice as a profession, not a job.
The intent of the authors is to redefine how we see the sick. They are not consumers of our product or our clients. They are patients: suffering persons in the midst of an illness, in need of relief, which physicians are called upon to provide as well as they can. In a chapter exploring the “Doctor-Patient Relationship,” Curlin and Tollefsen bring into focus both the dangers of paternalism and the emergence of autonomy. They show how physicians are often swayed from using beneficence as their dominant ethical principle. They defend the idea that medicine is essentially a relationship among persons.
The rest of the book explores the nuances of some important ethical issues confronted by physicians at the bedside: autonomy and authority, the principle of double effect, sexuality and reproduction, abortion and unborn human life, and conscience-based medical practice. They do an excellent job of identifying the facts, the ethical issues, and the rationale for their opinions. For those, however, not persuaded by their “way of medicine,” Curlin and Tollefsen might come across as rather biased, leaving little room for the modern service-provider model.
Indeed, the authors of The Way of Medicine stand firmly in the trenches of the Hippocratic approach, with a strong sense that it has always been how medicine was best practiced, and how it still should be. They strongly endorse medical practice committed to the physician-patient relationship, founded on trust, integrity, and mutual respect for the dignity of one another. They show that in contemporary medicine and the service-provider model, there is little room for such virtues. Younger physicians who have never experienced the “way of medicine” may not understand nor feel comfortable changing or even adjusting their clinical practice. Perhaps more examples of how to do so without becoming disillusioned might help the authors’ thesis. After all, this book resonates more with the “senior” physician with decades of experience rather than junior residents or attendings. Having medical students read this book before they encounter the service-provider model might be the best way to give them a lens to see what medicine should be. Medical practice is based on empirical facts, but seeing our patients as real people is based on our values.
The strength of this book is its honest, authentic, and genuine acceptance of a “way of medicine” focused on a profession of caring rather than the mere job of providing a service. For clinicians asking themselves whom they are serving, what they are doing, and what medicine is for, this will give them fodder for thought. They may need to look at themselves in the mirror and ask, “Am I a provider or a healer?” Answering the latter may be a hard taskmaster for some or even a fool’s errand for others. Yet for those brave enough to see themselves how others see them, this book might just give them a lens to focus on the task. The most important tool we bring to the bedside is ourselves: humble physician-healers practicing medicine with and for our patients.
Cite as: David H. Beyda, review of The Way of Medicine: Ethics and the Healing Professions, by Farr Curlin and Christopher Tollefsen, Ethics & Medicine: An International Journal of Bioethics early access.
About the Author
David H. Beyda, MD
David H. Beyda, MD, Chair and Professor, Department of Bioethics and Medical Humanism, University of Arizona, College of Medicine-Phoenix