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John Lantos is a pediatrician, a teacher, and a bioethicist. He is, most of all, a sensitive and literate human being. Person and role are integrated providing us with a picture of how changes in medicine and in the larger world of economics, politics, science, and technology affect practice and practitioner.
Lantos's provocative title is not mere rhetoric. He begins: "Put another way, all of the emotional or spiritual qualities of the doctor-patient relationship that once were the essence of healing are no longer always necessary for healing to take place. The new medicine can work on patients who don't know their doctors or don't like their doctors. It can work on patients who are unconscious. It can make people unconscious. It can change the way people think, see, or feel emotions." (p.4) The essay is a serious exploration of why we do and do not need doctors and, above all, of what kinds of doctors we need. In others words, the book is neither a reverie on bygone days nor an ode to the techno-scientific medicine of the future. So, in a tender reflection on his daughter's Bat Mitzvah (the Hebrew coming-of-age ceremony for girls), he quotes her commentary on "honor thy father and mother," "What should you do if your mother and father are just wrong?" And Lantos continues, "My daughter's question, embedded in a ceremony that affirmed ancient traditions that she was only beginning to discern and understand, poignantly embodied the perennial dilemma of youth. How do we affirm the awesome power of tradition but also acknowledge the inevitable limitations of received wisdom"(p.133) This memory is for me the book's metaphor. Between the title's question and the confrontation of old and new, Lantos, drawing on a rich mine of stories and cases, reveals both the benefits and disasters of the newer medicine. He challenges the nostalgia for a medicine of the past that was hardly effective and the romance of a doctor-patient relationship that bears scant resemblance to history. And yet, he recognizes the values embedded in our longing for a disappeared time and place.
Along the way, we are treated to relevant references to novels and poetry. Lantos, like other physician poets and philosophers, brings together his clinical experience, his biography, and his literacy in order to tell the story. He recognizes that medicine was always a social, religious, political and economic event and will become even more so. He comments sadly, even angrily -- on the failure of Clinton initiatives for universal access to health care; the moral disasters of limited access; he points to the alienating effects of specialization, the problems of an over-stuffed medical education. His is a usable passion.
In short, Lantos is not a prisoner of the clinic -- as many care-givers know, medical practice, can easily consume all time and energy. He does not pretend to cover all the issues facing modern medicine and biomedical ethics. But he focuses on the salient ones -- clinical, social, technical -- through a lens that is instructed, personal and critical. He know his stuff but he understands that knowledge is a rich brew of idea and information, of passion and practice. So, ironically, Lantos is the answer to his own title and I suspect he knew this all along.
Of course, we will still need doctors. Lantos puts it, ". . . . There may not even be doctors as we know them today. And yet, doctors today do some of the same things that doctors have always done. . . . That permanence, it seems to me has nothing to do with science, nothing to do with technology, nothing to do with where we work in fee-for-service. . .[or] HMOs. . . or the Veterans Administration. . . . And oddly enough, it doesn't even have much to do with whether what we do works or doesn't work. Instead, it has to do with whether, like William Carlos Williams [also an M.D.], we nurture the capacity to respond to "the haunted news" we get from "some obscure patients eyes." No matter how good our science gets or how our health system is organized, someone will have to do that. "(p. 114) Given the evidence of his text, Lantos is one of those "some-ones." And his book is a good read!
HOWARD B. RADEST, PHD, is Adjunct Professor of Philosophy at The University of South Carolina-Beaufort. He is Ethics Consultant to Hilton Head Hospital and Chair of its Biomedical Ethics Committee. He is the Dean Emeritus of The Humanist Institute, a member of the Council of Ethical Culture Leaders and of the Highlands Institute for American Religious and Philosophic Thought. Dr. Radest was the founder and chairman (1983-1991) of the University Seminar On Moral Education, Columbia University. He is a member of the Board of the North American Committee for Humanism. From 1978-88 he was Co-Chair of The International Humanist and Ethical Union. He is on the editorial boards of The Humanist, Religious Humanism, and Free Inquiry. His books include Toward Common Ground (Ungar, 1968), Can We Teach Ethics? (Praeger. 1989), The Devil and Secular Humanism (Praeger, 1990), Community Service: Encounter With Strangers (Praeger, 1993), Humanism With A Human Face (Praeger, 1996), Felix Adler: An Ethical Culture, (Peter Lang, Publishers, 1998) and From Clinic to Classroom (Praeger, 2000}.
Dr. Radest received his B.A. at Columbia College, his M.A. in Philosophy and Psychology at The New School For Social Research and his Ph.D. in Philosophy at Columbia University. He is listed in Who's Who.
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