Is medicine losing its way? A firm foundation for medicine as a real therapeia

Abstract

Is medicine losing its way? This question may seem to imply a serious warning, one needing a further explanation. What I mean to say by the title of this paper is that we can detect an undeniable shift in medicine in the last forty to fifty years. Medicine used to focus on what we call “health care” in a classical sense, that is, the treatment of people suffering from diseases, injuries or handicaps, or the alleviation of pain and other symptoms. In addition to this, in the last half century, it has begun to offer more and more treatments aiming to perfect the qualities of people who are otherwise healthy.

Summary: Due to the rapid progress of research in the biomedical field, medicine is already and will ever more be able not only to cure diseases, but also to improve the characteristics of healthy human persons. This seems to be justifiable from the point of view of the contemporary view of man. This considers the mind as the actual human person and the body as an object of which he may dispose as he likes. However, serious and convincing objections exist against this view, because it does not do justice to the fact that we experience ourselves as a unity. Aristotelian-Thomist anthropology explains man as a substantial unity of a spiritual and a material dimension, of body and soul, which implies that the body is an essential dimension of man, participates in his intrinsic dignity and is never to be instrumentalized in order to improve the characteristics of healthy people. Medicine should apply all new medical techniques availed, but remain true health care.

Keywords:

• Medical-technical progress
• Therapy
• restitutio ad integrum
• Enhancement
• Instrumentalization
• Manipulation
• transformatio ad optimum
• Culture of expressive individualism and authenticity
• Ethical impact of human biological nature
• Mind-body problem
• Dualism
• Aristotelian-Thomist anthropology
• Christian view of man
• Therapeutic principle

Notes

1. The next paragraphs concerning Dorrestein’s novel have partly been taken from Eijk (1998).

2. The Latin verb “manipulare” merely occurs in one text; that is, in the Miracles of Holy Genulphus, a French bishop in the third century, where it means to “lead somebody by the hand.” See Miracula S. Genulphi auctore Gonzone Abb. “Unde tam hospes quam maritus satis admirati, postquam gratias retulerunt tali curatori, mulier illa quae prius marito manipulante advenit, libero et inoffeso gressu domum rediit,” here quoted from Du Cange (s.v. “manipulare; manu ducere”, 1678, 655). Du Cange thinks by the way that “to manipulate” derives from “manu ducere.” See Glossarium Mediae et Infimae Latinitatis (Du Cange 1678, 655). See also Niermeyer and van der Kieft (1976), s.v. “Manipulare”: “guider un aveugle à la main” (to conduct a blind man by the hand).

3. This mainly results from the third definition of the verb “to manipulate”: “to manage by dexterous contrivance or influence, especially to treat unfairly or insidiously for one’s own advantage” (Oxford English Dictionary 1971. See also Oxford English Dictionary, s.v. “manipulation”).

4. These Latin expressions are derived from Wiesung (2006).

5. Much of the list of examples has been taken from Eijk (2016).

6. The term was introduced by Manfred Clynes and Nathan Kline (1960, 26–27, 74–75), which was reprinted in The Cyborg Handbook (Gray and Figueroa-Sarriera 1995).

7. “CRISPR” means: clustered regularly interspaced short palindromic repeats. It consists of pieces of RNA that correspond to specific pieces of DNA in the genome. The pieces of RNA serve as a guide to find a specific place in the genome. Cas9 is a nuclease, an enzyme, able to cut DNA at a specific site.

8. CRISPR-Cas9 consists of pieces of RNA that serve as a guide to find specific places in the genome, and of a nuclease, an enzyme that is able to cut DNA at a specific site. In this way one can modify, switch off, remove genes, or replace them by healthy exemplars. This system, originally an immune system of bacteria to defend themselves against the infection with viruses, is already applied in food industry to render bacteria, used in producing yogurt, immune against viral infections. It is also used in research aimed at the removal of retroviruses that are present in the genome of pigs, by which their organs might be made safe for transplantations to humans. And last year, Chinese scientists reported editing the genomes of human embryos with CRISPR-Cas9. In order to avoid ethical objections, they used non-viable human embryos, especially created by local fertility clinics fertilizing one ovum by two sperm cells (by the way, the creation of embryos in this way does already raise a fundamental ethical question). They aimed at modifying the gene responsible for β-thalassaemia, a blood disorder, which is potentially fatal; see Liang et al. (2015). The method was not without failures, but seems to have already been improved, and other perhaps more effective methods are available (see Cyranoski and Reardon 2015).

9. See Ashley (1985), particularly Chapter 3, in which he explains that the most difficult problems of humanism in the last three centuries were:

how to overcome the dualism of Mind and matter proposed in the seventeenth century by René Descartes, a proposal that is commonly said to have initiated “modern” thought. In order to solve this problem humanists have either reduced the whole of human reality to Matter, or conversely the whole of physical reality to Mind, but today the former reduction predominates. (52)

See Braine (1992):

It is little realized that the principal objections to dualism apply equally to the kind of materialism which for some is now philosophical or scientific orthodoxy … before mental states and events can be identified with brain-states or events, or regarded as “realized in the brain,” these mental states and events must be conceived in a way that makes them purely “inner,” logically segregated from the “outer world” and the “outer man” with his behavior in the way which is characteristic of dualism. (23)

10. See Thomas Aquinas Summa theologiae I, q. 85, a. 7; as we will still see, Thomas explains man as a substantial unity of soul and body. Thomas, following Aristotle, considers the soul as the substantial form of the human person. Differences concerning the soul as substantial form would imply that there were differences between diverse species of human beings. This would lead to the absurd conclusion that human beings do not all have the same value. He explains the difference in intelligence and insight between human beings not on the basis of different souls (substantial forms), but by differences in expression of the same substantial form, caused by differences in the disposition of the matter, that is, by differences in the body (see Aquinas Scriptum super Libros Sententiarum II, d. 32, q. 2, a. 3).

11. Thomas Aquinas, Quaestio disputata de anima, aa. 10-11; Aquinas, Summa theologiae I, q. 76, aa. 1, 3, 4, and 8; Aristotle, II De anima, 1, 412b4-6. Assuming different life-principles for the diverse spiritual and material functions in the human being would lead to a dualist anthropology (Aquinas, Summa theologiae I, q. 76, a. 3, 1978; Aquinas, Summa Contra Gentiles, bk. II, chap. 58, 1934).

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Notes on contributors

Willem Jacobus Cardinal Eijk

Willem Jacobus Cardinal Eijk, M.D., Ph.D., S.T.L., is archbishop of Utrecht, the Netherlands. He has Ph.D.s in medicine and in philosophy, and a licentiate in theology.