Social and ethical issues in medicine
J. AMALORPAVANATHAN
THE FORGOTTEN ART OF HEALING AND OTHER ESSAYS: Farokh Erach Udwadia; Oxford University Press, YMCA Library Building, Jai Singh Road,
New Delhi-110001. Rs. 695.
It is not often that distilled wisdom is presented in such an elegant style. Farokh Erach Udwadia is a well known clinician and teacher of medicine in Mumbai. This book deals with medico-social and ethical issues that are seldom taught in medical schools but which are essential for practising physicians.
Udwadia has put together nine of his best essays in this volume, and it deals with what many of his generation assumed to be self-evident truth — that compassion is as important as medicine in healing. He repeatedly refers to the subtle, yet vital, difference between healing and curing.
He emphasises that technological advances are meaningless, if patient-care lacks compassion and love. The art of getting to know the detailed health history of a patient, which formed the corner-stone of diagnosis in the past, is, sadly, vanishing fast. Medical students should read this to realise what they would miss and how disastrous the consequences would be, if they fail to have a detailed personal session with the patient.
The oft-debated question whether medicine is a science or an art is discussed very nicely by the author who holds that “the practise of its science without an equal measure of its art dehumanises medicine, robs it of its essence” and hence advises young doctors to “have a little less of science and a little more of art.” Sound advice indeed!
Prerequisites
The address Udwadia delivered at the convoction of the Benares University, which finds a place in the book, is what every intern must read. According to him, “competence and humanity, honesty and integrity, charity, humility, judgment, [and] equanimity,” are the prerequisites of a caring physician. Note that the marks secured in the examinations do not find even a casual mention. His advice to young doctors to avoid expensive tests and drugs is relevant in the Indian context.
Euthanasia
The essay on euthanasia is a thoroughly researched one. It would be useful to medical personnel, lawyers, and others who have special interest in this subject. He says that in India “Brain Death is recognised but support systems can only be taken off and the patient declared dead, if the patient concerned has consented to be a donor for any transplant. If not, death occurs legally only when the heart, circulation and respiration cease.” I am a bit puzzled by this statement. Can there be two separate criteria for death — one for those who donate organs and another for those who don’t?
In “Landmarks of Modern Medicine,” the author chooses to write on three major advances in medicine that revolutionised medicare in recent times — the discovery of penicillin and cortisone and the unravelling of the structure of DNA. One gets to know about the role of weather change in the discovery of penicillin. I did not know that Watson and Crick were physicists! I thought they were physiologists. This essay contains more such interesting information.
“Art and Medicine” starts by describing great works of art depicting diseases (‘Science and Charity’ by Picasso, for example) and then goes on to explore the link between artists with illnesses and their outstanding works. T.S. Eliot, Nietzsche, Emily Dickinson, Sylvia Plath, and Von Gogh are some of those whose great works are the result of their illnesses. One can read about Monet’s choice of colours before and after his cataract surgery; and Beethoven’s compositions before and after his deafness.
Anaesthesia
“The Story of Anaesthesia” is another delightfully written essay. One of the earliest attempts in anaesthesia took place in India. In 1845, John Esdaile, a Scot, used hypnosis to perform 261 painless surgeries on Hindu prisoners in Bengal! Several famous persons like Humphry Davy, Oliver Wendell Holmes, Samuel Colt, and Michael Faraday were involved in the development of anaesthesia. But my heart goes out to Crawford Williamson Long, that dedicated surgeon from Georgia (so ‘dedicated’ that he was late for his own marriage and as soon as it was over, went back to be with his patient again and did not see his lady till the next day!) who was undoubtedly the first one to administer anaesthesia to a patient and remove a tumour but lost out because he did not ‘report’ this to a scientific journal.
“Religion and Medicine” describes how established religions especially the Church “may well be considered as an important cause of decline of medicine and of a temporary end to the spirit of enquiry.” Udwadia goes on to assert that the Church “was least interested in science; in fact it stifled or tried to destroy free scientific enquiry.”
“Medicine and Future” deals with the exciting researches that are going on — the human genome project, nanotechnology, cloning, immunomodulation and so on. The developments on the horizon are truly mind-boggling.
I commend this elegant book to medical fraternity.
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