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Aristotle's Ethical Theory & Modern Health Care

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Aristotle's Ethical Theory & Modern Health Care Bull.lnd. Inst. Hist, Med. Vol. XXVI pp. 75 to 80 ARISTOTLE'S ETHICAL THEORY & MODERN HEALTH CARE SISIR K. MAJUMDAR* ABSTRACT The Greek physician of antiquity - Hippocrates (460 - 356 B.C.) is called the Father of Modern Medicine and the Hippocratic Oath to which doctors of modern medicine traditionally and formally express their allegiance. forms the basic founda- tion of medical ethics. The tradition of Western ethical philosophy began with the ancient Greeks. Form Socrates (469-399 B.C.) and his immediate successors, Plato (427-347 B.C ) and Aristotle (384-322 B.C.), there is a clear line of continuity, through Hellenistic period (from the death of Alexander the Great (323 B.C.) to the end of Ptolemic dynasty (30 B.C.) and the Roman annexation of Egypt - broadly post- Aristotelian) and medieval thought to the present day. But the society has qualita- tively and quantitatively changed since the Industrial Revolution in the late 18th and 19th centuries. Society, today, is just a collection of discrete individuals, each with his or her own purposes and interests. Hence it has become almost imperative to apply the principle of autonomy to issues in the ethics of health care. The aim of this short essay is, therefore, an attempt to explore the relevance, if any, of Aristotelian ethical theory to the modern health care. Aristotle's ethical theory, in the main, 1978). This socio-political scenario in represents the prevailing opinions of edu- Greece of the day reflects the limitations cated and experienced men of his day in of Aristotle's ethics and its relevance to Athens and other city-states of Greece. the modern society of today. Ethics is derived from the Greek word Aristotle's concept of justice in "Ethos" meaning custom and, in antiquity, his most famous ethical treat se "NICOMACHEAN ETHICS" is still widely it was a systematic account of the prin- prevalent (Russell, 1946). He thought that ciples by which decent, well-behaved citi- each thing or person had its or his proper zens would regulate their conduct. Even sphere, to overstep which is unjust. Some in those days, society was not homoge- men, in virtue of their character and apti- neous. In the City-state of democratic Ath- tudes, have a wider sphere than others, ens, the citizens with voting rights num- and there is no injustice if they enjoy a bered about 50,000 and the slaves have greater share of happiness (eudaimonia). been calculated at about 100,000 (Tofallis This view is taken for granted in Aristotle. • "Hasiniketan", 200, Summernouse Drive, Wilmington Dartford, Kent DA2 7PB, England, U.K. 76 Aristotle's Ethical Theory - Majumdar In a society, as it is today in most parts of state to achieve its purpose. Aristotle's the world, particularly in this country, this celebrated description of man - a "politikon concept of justice has definite relevance zoon" - an animal that naturally lives in a to the distribution or 'availability of re- state - "Polis". Medical or health care sources in the health market. Ability to system as one of the essential institutions pay is the determining factor, discrete in- of the state should also assist that state dividualism rules over everything else in to achieve its purpose, in this case, the modern health care. "happiness" or eudaimonia for the individual Autonomy and the principle of re- citizen. "Eudaimonia" or "happiness" is spect for autonomy is important in con- "a virtuous activity of the soul". temporary medical ethics. Autonomy On "Virtue"(arete}, Aristotle classi- (meaning "self rule") is the capacity to think fied human character into five types, rang- (autonomy of thought), decide (autonomy ing from the great souled man to the moral of will) and act (autonomy of action) on the monster. Medicine has a moral tradition basis of such thought and decision, freely dating back to Hippocrates and Galen (131- and independently and without any. hin- 200 A.D.). Good health of the society de- drance. Autonomy is, therefore, a sub- pends on the good health of the individual class of freedom or liberty, but not all free- member of the society. Aristotle's con- dom or liberty is autonomy. According to cept on virtues could be the guiding phi- Aristotle, the concept of autonomy may losophy of modern health care manage- be termed as man's specific rationality. ment. Thus, the role of doctors is to provide good Modern health care systems are dif- expert advice concerning various available ferent in different countries. In most coun- options and then to support the patient's tries, health care is a purchasable, private or his/ her legal guardian's (when the commodity, depending on the individual's patient is incapable of exercising his or her ability to pay. Private medicine, as in the autonomy). Coercion or malicious way of U.S.A. is the classic example of this influencing in such matters by doctors is laissez faire medicine. In Great Britain, not acceptable. This is the usual norm in the National Health Service (N.H.S.) es- current medical practice in this country. tablished in 1948 is undergoing tremen- Aristotle's "teleology" (Greek-telos, dous changes and is slowly and steadily 'end', 'purpose') flavours all his work, includ- proceeding towards privatisation. When ing his ethical theory. The "end" of man is Britain is departing from the socialist health to live "well" or "happily" (Eudaimonia); the system, the U.S.A. is rushing fast today state arises naturally as assistinq and to some sort of socialist health system. working towards that end; and the various The Marxist doctrine - "from each accord- institutions of the state should be judged ing to his ability to each according to his by the standard of how far they assist the needs" is still lurking in the psyche of those Bull. Ind. Inst. Hist, Med. Vol. XXVI 77 who formulate health care systems in dif- to their financial ability to pay, but not ac- ferent countries. This is what is likely to cording to social status. It is money and happen in the U.S.A. in the near future money alone which holds the key in se- under the proposed health care system. lection. It fits well into libertarian and utili- In Great Britain, market economy is tarian theories of justice so long as it is guiding every system - health, medical, approved by the individual's purse education, etc. Patients, rather clients Justice is one of the central concer- (from the Greek word "Klin" meaning 'bed) ns of philosophers and Aristotle's formal are consumers in the health market. Trust principle of justice is still widely accepted. hospitals are providers. Ability to pay for The formal principle of justice or equality the care is the criteria. Individual choice attributed to Aristotle is that equals should in the selection of doctor or health care or be treated equally and unequals unequally hospital gets priority. The care needs to in proportion to the relevant inequalities be cost-effective. The carers - hospital (Aristotle, Politics, Book3,Chapter 9, managers, fund-holding general practitio- P.193, Penguin Books, London, 1988). But ners (G.P.'s) are shopping around in the this Aristotelian principle of justice with market place - the corridors of private and demands for equal consideration, fairness Trust hospitals. It is just? Just or unjust, and impartiality is interpreted by different market forces will regulate accessability authorities in different ways to justify their to hightech modern medicine on the basis own thinking on the matter. of people's ability to pay. All these fit well With enormous scientific advance- into Aristotle's concept of distributivejus- ment in the 20th century, medical treat- tice. ment has become expensive. Costs pro- Aristotle's concept of doctors is as hibit the supply of hightech medicine uni- foliows (Temkin, 1953) and is still preva- versally. Resources are scarce. There is lent in the world of health and medical care disparity between supply and demand. in many parts of the world: Morality dominates the allocation of rare 1.0rdinary Practitioners (Demiourgos) resources, Inequality in health care is the 2.Master of the Craft (Architektonikos) result in the end. Private medicine flour- 3.Man who studied medicine as part of ishes for the rich few and shies away from general education. the maximum number of people and thus The third category of doctors fits into unequals are treated unequally. On top of the making process of modern doctors. everything else, market economy or forces Others are self-styled or self-trained or rule the world of modern health care. In quack doctors/village healers, still preva- this respect, privatisation of health services lent in many parts ofthe developing world. seems to be consistent with Aristotle's Doctors of today, in private practice, may ethical theory on distributive justice. But select their patients or clients according it is in conflict with the prevalent situation 78 Aristotle's Ethical Theory - Majumdar in modern health care in Briltain and also versial issue. in some West European countries where In modern times, the physician has the cradle-to-grave welfare state is consid- become the confidant of the healthy and ered as a mark of a civilized society. Re- the sick, the expert of social agencies, the cession and again population threaten to counsellor of the judge, the authority to make it all unaffordable. It is a moral di- whom even the planners of foreign and lemma for the society and the state. In this domestic policies look up. To the Greek sphere, 'Aristotle's concept of distributive philosophers like Plato and Aristotle, the justice is under considerable strain.
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