Page 52 - Contribution To Phenomenology

PHENOMENOLOGY AND THE CLINICAL EVENT 45

tempting^ for the physician to take advantage of the multiply dis-
advantaged patient (family, household). Having the power-to-alter, the
physician is obviously able to take advantage. Clearly understood by the
ancient empiric and skeptical physicians, a significant moral cognizance
undergirds the Oath's strong injunctions: not to take advantage, but rather
to act on behalf of the patient.^ For the physician to take care of the
patient, thus, signifies the moral responsibility to care for the specific
patient encountered in each clinical situation. It may well have been just
this that prompted those ancient physicians who developed the Oath to
understand the "Art" as governed by the virtues of justice (dike) and self-
restraint (sophrosyne), and to take these as the core of wisdom ([5], pp.
36-37).
Medicine is an inherently moral enterprise, at the core of which is a
striking moral insight. Physicians are in the nature of the case involved
in a complex moral relationship with persons who, due to impairment
and to the relationship itself, are uniquely vulnerable, exposed to the
power of those who wield the "art"—^who must themselves always act
justly and with restraint.

rv. Circumstantial Understanding

Neither patient nor physician (nor other health care provider) is focused
on the relationship itself as the primary theme. Just that, however, is
precisely the focus of the clinical ethics consultant. This needs to be
clearer.
Experienced by the impaired person, the impairment is interpreted by
and has meaning for that person. Others also experience and interpret

^ Consider the Laches myth related in Plato's The Republic (Book II): finding
the ring with which he could become invisible, Laches promptly goes to the palace
of the Lydian king, seduces the Queen and, with her help, kills the king and
assumes the crown for himself. This tale stands dramatically opposed to that at the
heart of ancient medicine, that of Aesclepius. In the one, possession of power over
others is promptly used; in the other, its possession to the contrary prompts
stringent restraint (sophrosyne) and the exercize of justice (dike) [47].

* The Oath's injunctions are quite specific: e.g., to refrain from having sex
with the patient and members of the patient's family and household, and to refi-ain
from "spreading abroad" what is learned in the intimacy of the relationship with the
patient. Although expressed in this way, there is no reason to understand the Oath
as limited to just these acts, as they express the more generic responsibility never
the take advantage of the disadvantaged person, family, or household.