Abstract
Following the Introduction, the second section of this essay lays out Tom Cavanaugh’s helpful and convincing account of the enduring significance of the Hippocratic Oath in terms of how it responds to the problem of iatrogenic harm. The third section discusses something underemphasized in Cavanaugh’s account, namely, the key role of the virtue of piety within the Oath and the profession it establishes, and argues that this virtue should be regarded as integral to an authentic Hippocratic ethic. The fourth and final section briefly examines the connection between medicine and philosophy, focusing on how both should be seen as wisdom-seeking ways of life, and shows the relevance of this for regarding the virtue of piety as the key virtue of medical practice.
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Notes
Cora Diamond writes: “The notions of piety and impiety are complex … One part of the notion of piety is the idea that we should treat the natural order of things with respect and awe. Another element is the idea of respect and gratitude as due to the sources of our life, which may be conceived to be God or the gods, our parents and ancestors, and our country. Another part of the notion of piety is the idea that actions that violate piety are properly regarded as outrageous or shocking. This outrage may manifest a sense that a wholly wrongful posture has been exhibited, a kind of will to dominate the natural order, a refusal to accept limitation, a challenge to God’s sovereignty or to honored and honorable traditions that should be taken as sacred” (2017: 31). See also Roberts 2017 for a helpful discussion of filial piety and religious piety.
For more on these matters see McPherson 2020: 91–104. I am dealing here at the level of moral phenomenology (or sensibility), and it is then a further question – which I am not exploring – of what worldview might best support the moral phenomenology of the sacred or the reverence-worthy. Since I am not saying here that one has to believe in God or the gods in order to affirm the virtue of piety, my argument does not raise the “Euthyphro problem” (from Plato’s Euthyphro) of whether God (or the gods) loves piety because it is pious, or whether it is pious because it is loved by God (or the gods). My own view is that a theist should say that God loves piety because it is pious, that is, because it is inherently good or excellent (the other option makes morality arbitrary). I don’t think this makes God irrelevant for morality – as is often supposed – for four main reasons that a theist can affirm: First, God creates the world in light of a perfect understanding of the good and as ordered toward realizing this good. Second, God perfectly exemplifies the good, such that we can say that God is good (or the Good). Third, our responsiveness to God’s grace enables us to realize the good more fully in our lives. Finally, God perfectly loves the goodness that is inherent in the world, including in humanity, and in doing so helps to make manifest this goodness to us. See McPherson 2018: 94–96.
Leon Kass similarly remarks that there can be “no benefit without a beneficiary” (2002: 34). But earlier he also comments: “For the [Hippocratic] physician, … human life in living bodies commands respect and reverence—by its very nature. … The deepest ethical principle restraining the physician’s power is neither the autonomy and freedom of the patient nor the physician’s own compassion or good intention. Rather, it is the dignity and mysterious power of human life itself, and, therefore, also what the Oath calls the purity and holiness of the life and art to which the physician has sworn devotion” (32).
The virtue of piety is overlooked in the most prominent defense of a virtue ethic approach to medical practice, namely, Pellegrino and Thomasma 1993, which discusses the following list of virtues: fidelity to trust, compassion, prudence, justice, fortitude, temperance, integrity, and self-effacement (Hippocrates’ “exhortation to lead a ‘pure, holy’ life” is mentioned on p. 184, but this is not explored, let alone defended; though the Hippocratic tradition is defended). The same is also true of Pellegrino and Thomasma 1996, which discusses the “theological virtues” of faith, hope, and charity in the context of medical practice.
Leon Kass writes that on the Hippocratic view “the doctor is nature’s cooperative ally and not its master” (1985: 234).
I am indebted to Cora Diamond (2017) for bringing these Anscombe passages to my attention.
On this point, consider again Anscombe: “[A] woman of today may find a possibility of becoming pregnant, letting the baby grow to twenty eight weeks (because bigger ones are worth more) and then going somewhere where they will pay her for a late abortion, which yields the foetus for resale, say, as valuable material. If you act so, are you not shewing that you do not regard that human being with any reverence? Few will fail to see that. But the same is true of one who has an abortion so that she can play in a tennis championship; or for any reason for which someone might choose to destroy the life of a new human being. This lack of reverence, of respect for that dignity of human nature so wonderfully created by God, is a lack of regard for the one impregnable equality of all human beings. Lacking it, you cannot revere the dignity of your own human-ness, that is the dignity of that same human nature in yourself. You may value yourself highly as a tennis player or a natural scientist, but without a change of heart you cannot value yourself as being a human, a Mensch. For you have shewn the value you set on a human life as such. You are willing to extinguish it as suits you or as suits the people who want you to do so” (2005: 72).
I am echoing Kurt Vonnegut here: “I was some of the mud that got to sit up and look around” (1963: 221). I thank John Houston for this reference.
In fact, there is an etymological connection with “the holy” as well, and Kass remarks: “The insight that drew the holy, the healthy, and the whole from a common etymological root may point to the deepest wisdom, not only for medicine but perhaps also for how we are to live” (1985: 246).
Consider these remarks from Hadot on one instance: “[For] Aristotle the life of the mind consists, to a large degree, in observing, doing research, and reflecting on one’s observations. Yet this activity is carried out in a certain spirit, which we might go so far as to describe as an almost religious passion for reality in all its aspects, be they humble or sublime, for we find traces of the divine in all things” (2004: 82). As Aristotle puts it in Parts of Animals: “In all natural things there is something wonderful” (645a18; trans. I. D. M. Balm).
References
Anscombe, G. E. M. (2005). In M. Geach & L. Gormally (Eds.), Human life, action and ethics: Essays by G. E. M. Anscombe. Charlottesville: Imprint Academic.
Anscombe, G. E. M. (2008). In M. Geach & L. Gormally (Eds.), Faith in a hard ground: Essays on religion, philosophy and ethics by G. E. M. Anscombe. Charlottesville: Imprint Academic.
Cavanaugh, T. A. (2018). Hippocrates’ oath and Asclepius’ snake: The birth of the medical profession. Oxford: Oxford University Press.
Chesterton, G. K. (1986 [1908]). Orthodoxy. In The collected works of G. K. Chesterton, vol. I. San Francisco: Ignatius Press.
Diamond, C. (2017). The problem of impiety. In D. McPherson (Ed.), Spirituality and the good life: Philosophical approaches (pp. 29–46). Cambridge: Cambridge University Press.
Hadot, P. (1995). Philosophy as a way of life: Spiritual exercises from Socrates to Foucault, A. Davidson (ed.), M. Chase (tr.). Oxford: Blackwell Publishing.
Hadot, P. (2004). What is ancient philosophy?, Michael Chase (tr.) Cambridge: The Belknap Press of Harvard University.
Kass, L. R. (1985). Toward a more natural science: Biology and human affairs. New York: The Free Press.
Kass, L. R. (2002). “I will give no deadly drug”: Why doctors must not kill. In K. Foley & H. Hendin (Eds.), The case against assisted suicide: For the right to end-of-life care (pp. 17–40). Baltimore: The Johns Hopkins University Press.
McPherson, D. (2018). Transfiguring love. In F. Ellis (Ed.), New models of religious understanding (pp. 79–96). Oxford: Oxford University Press.
McPherson, D. (2020). Virtue and meaning: A neo-Aristotelian perspective. Cambridge: Cambridge University Press.
Pellegrino, E. D., & Thomasma, D. C. (1993). The virtues in medical practice. Oxford: Oxford University Press.
Pellegrino, E. D., & Thomasma, D. C. (1996). The Christian virtues in medical practice. Washington, DC: Georgetown University Press.
Roberts, R. C. (2017). The virtue of piety. In D. McPherson (Ed.), Spirituality and the good life: Philosophical approaches (pp. 47–62). Cambridge: Cambridge University Press.
Sulmasy, D. (2006). The rebirth of the clinic: An introduction to spirituality in health care. Washington, DC: Georgetown University Press.
Vonnegut, K. (1963). Cat’s cradle. New York: Dial Press.
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McPherson, D. The Virtue of Piety in Medical Practice. Philosophia 49, 923–931 (2021). https://doi.org/10.1007/s11406-020-00264-9
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DOI: https://doi.org/10.1007/s11406-020-00264-9