Values and choices
In our society, there is a broad consensus that medical treatment should be of equal quality and equally available to all, irrespective of money, position and power. To apply this thinking also in a global context, however, requires more of a stretch of the imagination.
In recent years, ideas and attitudes from the manufacturing industries have penetrated the healthcare services. Patients are turned into a commodity, services are subjected to competitive tendering, therapies are assessed on the basis of their cost and the social burden of diseases is estimated. This mindset can lead to a blunted view of human life and be a threat to core values (4).
The doctors of antiquity ruled over life and death, and were therefore regarded with suspicion (5). Hippocrates, and in a later era Christian teaching, broke away from this and introduced a strict distinction: The doctor’s duty was to heal, assuage and comfort – never to take life. Today, the ideals of absolute human value are challenged at both ends of life’s span. The real test of human value is not how long the healthcare services are able to keep a person alive, but the dignity with which every human is treated.
For aspiring doctors, the recognition of human nature as an arena for the struggle between good and evil is an essential insight into understanding themselves as well as their patients. The distinction is not one between the good and honourable on the one hand and the hopeless and intolerable on the other. Both aspects are found in every human being.
When people are affected by misfortune or disease, they are affected biologically, psychologically and relationally. Per Fugelli describes his experience of a broken ankle in very apt terms: «Suddenly you lie there without the tasks and illusions that block out the existential drama. Suddenly you are in a sort of laboratory of truth, where values and ways of living are put to the test. The disease turns into an existential crystallisation process, where everything transient, the things and the ornamentations fall away. What remains is the core of existence, what you believe in and the people you love» (6).
Health workers on a daily basis face a stream of people who are afflicted in body and soul. Few professions get to be familiar with the darker sides of life as frequently as the doctor: irrational acts, violence, conflicts, tragedies, self-destruction and mendacity. Our training has barely prepared us for this demanding daily situation. Time constraints provide little room for reflection and thought. Some choose to place their values and doubts on the shelf, and carry out their daily work in an instrumental and steadfast manner. Others think that staying within the boundaries of laws and regulations and satisfying the authorities’ norms of acceptability is what matters most.