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The problem of consciousness
- Søren Ventegodt, Mohammed Morad and Joav Merrick (3 February 2006)
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Limitations for clinical decisions.
- Ángel J. Romero Cabrera, Orestes Fresneda, Francisco Olascoaga (25 February 2006)
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Søren Ventegodt, Medical director Quality of Life Research Center in Copenhagen, Teglgårdstræde 4-8, DK-1452 Copenhagen K, Denmark., Mohammed Morad and Joav Merrick
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EDITOR--- The editorial in this week's BMJ (1) is asking how much our moral values influence clinical decisions. Seen from a holistic perspective, the human being is much more than his body. Mind has psychic dimensions difficult to measure and turn into science, especially the soul, the spiritual level of man, that is normally acknowledged to be a wordless domain of our existence. Unfortunately, consciousness is a soul-thing. The place within our self, where we take the final judgment of our life values and major decisions in life, is hidden, unpredictable, and un-material (2). Consciousness is the source of our being and the way we deal with our own consciousness often become our destiny, also concerned with our physical and mental health. The Danish existential philosopher Søren Kierkegaard (3) recommended to always make the most arduous and difficult choice, when confronted with a choice of something easy or something challenging. The physician (usually the family physician) will often be the person discussing these life-forming decisions with the patient. Unfortunately, the modern physician is so absorbed in his own profession that it can be very difficult to understand how it is to be a truck driver, a cleaner, or a shopkeeper. Often the physician is not really taking the hardest of alternatives himself in his own personal life. So the person that the patient is most likely to entrust his or her life to might be the person least able to give the inspiriting advice of seeking the challenge and running the risk. In life the real emotional risk is too lose yourself. To put you own existence to the test. To go beyond your own limits. To upgrade your attitudes and personal belief system. This is the game of consciousness in which every physician should be involved for the sake of his or her patients. This is what creates the real, full and rich life. And this is also what creates health and prevents diseases according to our research from the Copenhagen Prospective Birth Cohort (4). How can medical students be taught this? Well, it is not too complicated. In the recently published first and second volumes of our new book series "Principles of Holistic Medicine" (5,6), we have dealt explicitly with the philosophy of life needed for being able to handle these difficult aspects of medicine. Philosophy can be read and understood, and it can be taught at medical school. Allow us to recommend that all medical students get such training. AFFILIATION Søren Ventegodt, MD, is a general practitioner and the director of the Quality of Life Research Center in Copenhagen, Denmark. E-mail: ventegodt@livskvalitet.org Website: www.livskvalitet.org/ Mohammed Morad, MD, is a family physician, the medical director of a large area clinic in the city of Beer-Sheva, Israel. E-mail: morad62@barak-online.net Joav Merrick, MD, DMSc is professor of child health and human development, director of the National Institute of Child Health and Human Development and the medical director of the Division for Mental Retardation, Ministry of Social Affairs, Jerusalem, Israel. E-mail: jmerrick@internet-zahav.net Website: www.nichd-israel.com REFERENCES 1. Godlee F. Learning for life. BMJ 2006;332:0-f. 2. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Merrick J. The life mission theory VII. Theory of existential (Antonovsky) coherence: A theory of quality of life, health and ability for use in holistic medicine. ScientificWorldJournal 2005;5:377-89. 3. Eremita V, ed. Enten-Eller. Et Livs-Fragment [Either-Or: A fragment of life]. Copenhagen: CA Reitzel, 1843. [Danish] 4. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Nielsen M, Mohammed M, Merrick J. Global quality of life (QOL), health and ability are primarily determined by our consciousness. Research findings from Denmark 1991-2004. Social Indicator Research 2005;71:87-122. 5. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Philosophy behind quality of life. Victoria, BC: Trafford, 2005, 228 pages. 6. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Quality of life and health. New York: Hippocrates Sci Publ, 2005, 378 pages. Competing interests: None declared |
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Ángel J. Romero Cabrera, Physician (Internal Medicine) Gustavo Aldereguía University Hospital, Cienfuegos, Cuba, Orestes Fresneda, Francisco Olascoaga
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Dear Sir, Godlee (1) asks an interesting question for the medical profession about the influence of our moral values on clinical decisions. Definitively, our response is positive since the physician’s formation and performance has always been and will always be ruled for moral values. The bioethical principles of beneficence, non maleficence (primum non nocere), justice and autonomy (2) should always be present in our medical practice, although, sometimes they become controversial and limiting , in fact, the doctor’s performance. In the case of the footballer, who had an expensive liver transplant for alcoholic liver disease, this patient made fun of doctors when he continued drinking, contradicting the bioethical principles. First, physicians work in good faith when trying to cure this patient and comply with the principle of autonomy when respecting the patient’s decision to continue drinking after the transplant although he was explained about the danger of the drinking habit in the prognosis of his medical problem, but the principle of justice is violated when giving him resources he didn’t deserve, which could be assimilated successfully by another member of society. Modern Medicine limits the medical work and sometimes it doesn’t allow freedom enough to vary our practice with our moral values. Medicalization of life, the primacy of diagnosis, evidence based medicine (3), the guides for a good clinical practice lead our steps making rigid our practice which is sometimes lacking of an affective doctor – patient relationship that can provide moral values and positive ways of action. It is necessary to rescue the art of Medicine that has been lost and substituted for technology. The physician’s classical proceedings by means of a good doctor – patient relationship in which communication and confidence have a major role is the kind of behaviour. We thing doctors should developed in medicine students in such a way that the moral values of our human profession could be transmitted through generations. References: 1. Godlee F. Learning for life. BMJ 2006; 332(7536): 0-1. 2. Ribera Casado JM. Ethics aspects in geriatric assistance. In: Farreras Rozman: Internal Medicine. Masson Edit. Barcelona 2000: 1300-7. 3. Goodwin JS. Geriatrics and the limits of Modern Medicine. N Engl J Med 1999; 340: 1283-85. Competing interests: None declared |
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