Background

Palliative care as/and the ethos of medicine

Conclusion

References

Background

In this paper I propose to discuss the conceptual particulars of moral leadership and the way in which this relates to palliative medicine as both a clinically and morally distinctive form of medical practice. To my mind such ideas turn on a specific, broadly sociological, conception of morality, understood as a – perhaps the – defining characteristic of a social field or cultural domain. This idea relates to the way in which a number of anthropologists of medicine, notably Kleinman [1] and Fox and Swazey [2], discuss the idea of medical morality, as distinct from medical or bio- ethics. They also suggest that the morality of medicine varies in differing times and places, something that also applies to differing healthcare professions, such as nursing, as well as the divisions or sub-domains of practice: the medical specialties. As is the case with these authors, I will be discussing the morality of medicine or, we might say, its moral order [3]. Such terms are used to refer to the normative structure of medicine, and healthcare more generally. However, rather than use the term morality, I prefer to use a slightly different concept. Thus rather than speak about ‘medical morality’ or the morality of any sub-domain, such as palliative medicine and palliative care, I tend to speak of the specific and morally or normatively defining ethos of a field. In what follows, then, I will be discussing the ethos of palliative care, and of medicine as a whole. More specifically, I will be discussing the way in which the ethos of palliative care apparently differs from that of medicine. A similar contrast can be found in Randall and Downie’s philosophy of palliative care [4]. In their work they set up a contrast between two medical traditions: the Hippocratic and the Asklepian. Their view seems to be that the rise of modern, professional, scientific, specialist and, perhaps most importantly, curative medicine has meant the Hippocratic tradition has come to dominate. They consider the inception and development of palliative care to represent a reinauguration of the Asklepian tradition in modern medical practice. Whilst I think that many of their points are well made, there is a concern that this way of looking at things has the potential to set up a false dichotomy between the Hippocratic and the Asklepian, whilst also offering an insufficiently critical perspective on medical practice, its present and its historical traditions. Instead, I suggest that both curative and palliative medicine represent a practical realisation of the medical ethos.