Politics, Philosophy and Economics explored

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How is philosophy best applied to medicine? Which philosophical ideas are most inherently connected with the aims of medicine? Can philosophical theories be used alone?

Introduction

Medicine is more than science. It is a life-saving form that is undeniably linked with philosophy. Teleology promotes human flourishing, yet we still can’t be sure exactly what that means. Kant focuses on the intention which is of paramount importance in the practice of medicine. Phenomenology promotes consciousness and lived experience, yet rules are put in place to prevent the full extent of the possibilities of phenomenology. Overall, the different philosophical theories work together to build this coherent and beautiful form of medicine, yet cannot exist as a driving force for medicine on their own.

The Three Elements of Medicine

Medicine can be split up into three aspects; the theory, the research and the practice. Theory in itself is inherently philosophical, being viewed as a form of “productive art”, as it questions the existence of certain forms of sickness that would previously have been classified as stemming from one of the four humours. It forms the basis of our conceptual understanding of medicine, health and illness. Theory allows us to fully recognise the different elements of sickness, presenting a mental representation of symptoms, which is greatly needed due to viruses being too small to be seen. The ability to recognise causality helps us to unite different processes or symptoms that ultimately mean research and treatment will be more effective. Secondly, there is research. Philosophy plays a major role in guiding ethical boundaries in biomedical research, such as CRISPR and the development of drugs, which will be explored later. Research emphasises the importance of evaluating medical tests, introducing ideas about sensitivity and specificity which is crucial in the consideration of which philosophical idea can be correctly and fairly applied to make these terms and points adhered to. Finally, the most prominent and visible aspect of medicine, the practice. The practice covers day to day clinical decisions all the way to major or lifesaving surgeries. There is clear guidance on the aims of practice, with those being the relief of pain and suffering, the promotion of health, the prevention of disease and the care of those who cannot be cured¹. Philosophy can again be used as an ethical framework with some support falling in the arms of Managed care, which promotes and designs a system to control costs, but with much support suggesting otherwise and suggesting that this is not compatible with the goals of medicine and therefore should not be supported. 

Teleology

Teleology defines an action as right if it leads to human flourishing, yet it recognises the duty or moral obligation derived from what is good or desirable as an end to be achieved². The objective is happiness, yet the outcome is not always that. Teleology replicates a level of causation and effect, yet the explanations are not in competition with each other³. This demonstrates the benefits of using an approach which considers different causes and symptoms, therefore showing the importance of recognising the widely different ways of presenting the same illness. In the premise of theory, teleology is crucial. Evidence of this can be seen in the biopsychosocial model. The biopsychosocial model is effectively recognising a person’s medical condition as being more than their biological symptoms, also exploring their social and psychological symptoms which explores the interconnectedness. This emphasises the importance of understanding human health completely and comprehensively, allowing scientists and doctors to recognise the duplicitous impact of certain illnesses, as can be seen in the fact that a long-term physical illness is more likely to result in anxiety or depression which don’t explicitly manifest physically but can still lead to more damaging consequences. Therefore, this allows treatments or interventions to be put in place with a consideration of all the effects of the injury or illness. The link to teleology arises as, by encompassing all the side effects and symptoms of an illness, you are showing a desire or motivation to appeal to what is going to bring the person suffering the most joy with a more rounded approach, which would therefore result in the most human flourishing for this person, regardless of the resources. Teleology plays a lesser role in research but is still important. It effectively fights for the patient’s priorities to be respected, and this enhanced focus on doing the right thing to create human flourishing creates a more human-centred approach to research, rendering the use of cost-efficient research that is inconsistent with the aims of medicine less relevant. Teleology is useful in research as it promotes an aim which is motivated by the desire for general human flourishing, rather than by a desire to conform to the standards of the government, a small number of people, whose aim is cost efficiency and maintenance of the status quo, rather than human flourishing, as can be seen more broadly in the government’s attempt to give itself the power to break the law. This shows that the government’s reason for cost cutting is not as simple as being done to benefit the masses, it is a ploy to maintain the status quo and keep society in a designed order, therefore showing us the usefulness of teleology. Moreover, teleology, once again, proves its importance in the practice of medicine. The practice of medicine is a highly outcome-based approach and recognises the importance of symptom relief, such as end of life care. Does this therefore classify euthanasia as morally good and there is the question of whether death really equates to human flourishing. What counts as human flourishing? It is the sanctity of life or is that purely a religious construct? Is it simply living or is it a relief of suffering. I would argue that it is when the person is in the least amount of pain. Philosophical ideas often separate the mind and body⁴, which will be referred to later, therefore showing that the ending of the physical body could cause a transcendence of the mind. However, there are pitfalls to teleology, one being the fact that the greatest good is up for interpretation. It evokes questions surrounding whether decisions made are medical neglect or simply mass happiness. In the COVID 19 pandemic there was a shortage of ventilators, costing over 208 thousand lives⁵, with priority being given to specific members of the community for said ventilators, some of which were older. In the name of teleology and the greatest good, the people most at risk have been chosen to be saved, yet how can this approach justify the long term benefits of another person’s life being saved. Yes, while they are less likely to die, there is still the possibility and medical practice, something which should be certain and clear cut is filled with maybes. Teleology attempts to counter this by setting standards of capacity and ability to pursue goals, but then once again we are reminded of ideas about the value of one’s life and who is worth more which in terms of the equality act, no-one is. 

Deontology and Kantian Ethics

Deontology refers to the duty-based ethics and focuses on intention and adherence to universal moral laws⁶. Kantian ethics specifically focuses on harm as being unacceptable, irrespective of its consequences. In this regards, there is evidence for something being appropriate for the individual but does not produce a good outcome for society. There arises the conflict between Kantian ethics and medical practices. While in theory, treating every patient as an end promotes the true meaning of medical care, in practice it is not as simple. The NHS is a prime example of this, with a target to reduce base costs by 1% and for integrated care boards to cut their budgets by 50%⁷. The effects of this are a greater strain on hospitals, increased health risks and wider health inequality which effectively does reduce a person down from an end to a means to an end which contradicts Kantian ethics. Kantian ethics exemplifies a type of rigid morality that tries to enforce patient autonomy, respect and dignity which is undermined by criticisms across healthcare, with a greater focus on the role of the GP. Over the last few years there have been increasing criticisms surrounding lack of information, explanation and involvement, alongside poor relationships with the GPs themselves, emphasising the imbalance between the expectations of practice and the actual version of practice. Moreover, Kantian ethics and deontology highlight the shortcomings of the UK healthcare and medical system as it brings to the forefront medical negligence and how this is a breach of deontological practices. Over more recent years, positive risk taking in mental health has become increasingly more prevalent, with hospitals and outpatient teams using it in order to benefit more mental health. However, there are strict guidelines set out by the terms of the “Best Practice in Managing Risk” which state that positive risk taking should be a collaborative process. Yet outpatient services are falling victim to the cost effectiveness approach of the government as parts of the NHS are being sold off. The CQC has stated that the safety of services has decreased dramatically⁸, showing the implications of using a conventionally “bad” method of treatment, not aligning with Kantian or deontological ethics which prioritise the safety of the patient. 

In relation to the theory of medicine, Kant recognises a third form of autonomy, something that promotes “dangerous self-reliance” to the point where one is able to disengage from inclination and take on the role of rationality, affording someone autonomy⁹. However, interpretations have formed of Kant suggesting that a patient’s request must always be complied with, leaving medical professionals more liable to appear as neglectful. There is the issue of capacity, and the autonomy one deserves when lacking capacity. There are questions that should be asked, one of which being does the person or the patient have the ability to take on the multi-faceted aspects of decision making. However, Kantian ethics may also look at this problem from the lens of intention. The doctor or healthcare professional making a decision would not be acting in the most morally good way in some circumstances by listening to the desires of the patient and appealing to them. They are instead enforcing their patient and physician relationship of the student and the teacher. It is not possible for decisions to be fully informed in the case of the patient as, according to the psychosocial model, there are other factors involved, demonstrating that what is morally good and morally dutiful changes on a regular basis.

Principlism, an emerging ethical framework for decision making that places emphasis on four core principles: Autonomy, beneficence, non-maleficence and justice, is linked to Kant’s belief in autonomy. Principlism does not always appeal directly to moral principles and is used only in deliberation and justification of new situations however, criticisms of this belief is founded on the fact that the criteria for moral judgement can be contradictory. Moreover, it acts as a simplification for the intricate healthcare system. Principlism would accept a system such as CRISPR, a type of genome editing or “designer babies”¹⁰, which would mean that a foetus would be genetically altered to the parent’s preference. It does not violate the criteria for arriving at a bad moral judgement,  in some perceptions based on how people view the status of an unborn foetus, yet there would be uncertainty regarding the freedom of the foetus. However, this is ultimately not a restriction of freedom and an argument would effectively be that one is prioritising the rights of an unborn foetus over the rights of a human. Yet, this isn’t medicine, this is manipulation. Foremostly, it is premature and unsafe and would defeat the aims of Kantian ethics and its required intentionality. The intention for parents would not be founded on a desire for human flourishing, but instead a desire to create their idea of perfection without truly knowing the consequences and the risks of such an operation. In this regard, principlism on its own doesn’t work as a philosophical thought for medicine due to its reduction of medicine’s complexity into something basic that doesn’t account for the complexity of the real of healthcare. 

Phenomenology

Phenomenology is the focus on lived experience the study of structures of consciousness¹¹. Furthermore, it is the study of consciousness as experienced from the first-person point of view. Phenomenology describes the ability to classify, describe, interpret and analyse structures of experiences in forms of awareness in relation to time, space, own experiences and self. This builds on Kant’s ideas and recognises the importance of autonomy, yet also alludes to the idea that phenomenology is becoming overtly less conscious. This therefore suggests that medical decisions should be made before the time to maintain autonomy but also recognises the fact that in the moment of sickness there would be a lack of rationality and inability to make decisions. This becomes more prominent when a Power of Attorney is introduced, so one is capable of making decisions for as long as they are able to do so, giving them autonomy in their care and treatment while also providing support in case something were to happen. 

Descartes becomes significant in the introduction of phenomenology as he begins the argument of the mind and body as being two distinct kinds of being¹². This could be interpreted as suggesting that medical treatment on the body is therefore not an invasion or intrusion of the freedom accompanied by the mind, therefore recognising the need for Doctors to take on the role as the authority but also maintaining a level of certainty about the patient’s own position and how they are, what Kantian ethics strived to promote, not just a means to an end. The importance of phenomenology in healthcare, and research specifically, gives us the ability to have a “pathic understanding” or an understanding of a range of factors that don’t just affect the patient, but the patient’s relationships as well. This therefore allows a more global and subjective vision of each illness, collating all the different symptoms and presenting them as easily accessible in a way that isn’t as oversimplified as principlism. 

Phenomenology is crucial in the research of medicine also. It gives the body a greater role and allows healthcare research methods to be focused on individual and lived experience, including a consideration of all symptoms. This is needed greatly within the research field, especially as there are more reports of symptoms of illnesses in women presenting differently to symptoms of men, particularly regarding strokes and heart attacks. By taking on a more phenomenological approach and looking at the symptoms from a variety of people rather than the illness itself, one is allowing for a increasingly universal and comprehensive guide to illnesses which then would have a better chance of being treated properly, ultimately leading to human suffering. However, Phenomology does somewhat also prevent the individual approach, reinforcing a wider range of happiness, rather than an explicit focus on the individual with effects being seen in the regulations governing drugs that hinder patients from receiving new treatment. This makes treatment therefore standardised, eradicating any form of personalised treatment that is truly reflective of the nature of the causes and symptoms. 

Conclusion

In conclusion, all philosophical arguments prove somewhat unsuccessful in aiding healthcare and medicine and should be used in tandem, not individually. While Kantian ethics provides a good theory, based on intentions, the practice of such philosophical thought doesn’t inherently create good results and values the individual over the majority. Teleology, a duty driven philosophical thought that prioritises human flourishing, is too ambiguous and up for debate while principlism is too simplistic to be used on its own. Phenomenology plays an important role in the development of medical research but is difficult to apply across every aspect. Therefore, the combination of philosophical arguments to create a backdrop that promotes the alleviation of human suffering in a way that is universal is when philosophy is most applicable.

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