The New Medicine: Life and Death after Hippocrates
Crossway Books, Wheaton, IL, 1992), 192 pp., $11.95.
Nigel de S. Cameron has provided the American medical community with one of the finest recent treatises on medical ethics. Cameron (now at Trinity Divinity School) has been one of the leaders among biblical ethicists in the UK. Now in this book, he traces the consequences of jettisoning the Hippocratic approach to medicine. His beginning chapter presents and expounds this Oath, which has been in the descendancy for the past few decades. Cameron vividly warns the reader of the consequences of such abandonment, as well as the inferiority resulting from replacing Hippocratic medicine with the New (relativistic) Medicine. As C.E. Koop in the Forward summarizes, "How will patients be served in the future? That's what this book is all about: the rise and fall of Hippocratic medicine. Where should we go? Where will we go?" (p. 16). This book is a warning to the public of what happens when medical personnel are no longer anchored by covenanted ethical norms.
Cameron acquaints the reader with the rise of Hippocratic medicine, and is helpful when he points out that the "Hippocratics were a minority, a reforming movement whose distinct professional and ethical characteristics came ultimately to dominate the development of the western medical tradition" (p. 38), at least until the 20th century. He views medicine as a profession or a 'calling' (p. 53), and consistently asserts the inextricable relation between underlying faith and ethical practice, for example, "Only if medicine is narrowly conceived in terms of technique - a set of skills, a matter of expertise - could this be so. If, by contrast, medicine is actually constituted by its commitment to a set of values, then the dropping of those values marks the beginning of the end of medicine itself" (p. 12). Lamenting the loss of the Hippocratic framework of values, he suggests "that after Hippocrates - when medicine departs from the values of the Oath and ceases to be Hippocratic - it looses something essential to its character; in fact, it begins to cease to be 'medicine' at all" (p. 23). Rather, Cameron asserts that all medicine is fundamentally value-driven, and ineradicably theological. He contends that Hippocratic practice, even if founded by pagans, is theistic, and resulting in the twin values of philanthropy and the sanctity of life (p. 64). This medical ethicist is clear when he heralds, "The displacement of its covenantal structure leaves the Oath a naked ethical code" (p. 62), so intrinsic is the vertical dimension to the ancient oath.
The third chapter describes the most blatant example of the forsaking of Hippocratism, in a chapter which frighteningly portrays the thought and practice of Nazi medicine. In this "stark occasion in the western medical tradition when the profession turned its back on the Hippocratic legacy" (p. 69), we can see what to expect from New Medicine, if unleashed from some sufficient, transcendent covenant. It is painful, eerie, and threatening to read about some of the experiments and medical abuses by the Nazis, all under the name of progressive medicine. Further, the consequent answer to such was the 1948 Geneva Declaration, which is "a pallid affirmation made by the Physician in the presence of man alone ... its only reference points are horizontal. The act of displacing an oath with a declaration bears powerful witness to the secularising of western medical tradition" (p. 86). In sum, what is needed is a "transcendentally medical faith" with a covenantal structure (p. 87). The difference between the two approaches is stated by Cameron: "The Hippocratic Oath, with its transcendental, covenantal structure, holds firmly together as an integrated whole. The Declaration of Geneva is a series of ethical assertions which invite amendment and revision" (p. 87). Indeed, such is the degenerative history of medicine since 1948. Moreover, Cameron laments, "By abandoning the transcendent and covenantal character of the Oath, those ... have turned the principles of medical ethics into one long composite motion to be debated year on year at representative medical assemblies." (p. 88).
In his fourth chapter, Cameron chronicles the most dominant feature of post-Hippocratic medicine as the "progressive marginalization of those who are weakest and most powerless in the clinical situation" (p. 92). In this chapter and the next, he treats abortion and euthanasia as exhibits of this characteristic. These chapters are supplemented by the author's knowledge of and reporting on the legal status quaestionae in various western countries (p. 108). His alternative in the final chapter, "Paternalism and Pluralism," is a call for a return to concern for the patient's healing, and not mere relief of suffering, subjectively measured. Borrowing from Thomas Kuhn, Cameron urges the medical practitioner to rally "back to the future," by once again assuming a reformist and minoritarian paradigm, until the day can be recaptured. The Appendix sets for a positive statement of the necessary anthropology and theology of healing to support these.
This book is well-researched, well-documented, and the author is quite plausible in his appropriation of history, theology, and medical ethics. While at times, the British thoroughness may irritate American readers, this work is supplemented with flashes of stylistic brilliance, for example when Cameron writes, "In fact, we see in the negative aspects of the Oath's moral injunctions (as in the Ten Commandments) sophistication that is born of realism" (p. 65), or in reference to the Geneva Declaration, that it "reads as a lament to a lost medical tradition" (p. 86).
This is a fine, well-conceived contribution to the debate. I only have one question about it, and that is the critical dependence on a pagan Oath. This book, while helpful, also raises the larger apologetic question about a Christian's reliance on non-Christian sources. Is this a form of medical evidentialism, seeking common ground in an ancient pagan Oath? If so, the thesis is apologetically questionable. Yet, even this question should not prevent one from benefiting from a fine work. It could even have been more strongly supported if the author had sought to relate the Hippocratic Oath to the OT covenantal form, which only predated the Oath by c. 200 years. It could even be discovered that the Hippocratic Oath, so covenantal in character, is precisely so in that it is a pagan version, or a heresy, of Old Testament covenantal outworkings. This book is as good an explanation as I've read of the Hippocratic oath in service of a Pro-life ethic.
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