Learning for lifeBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7536.0-f (Published 02 February 2006) Cite this as: BMJ 2006;332:0-f
All rapid responses
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
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
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: No competing interests
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
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
Mohammed Morad, MD, is a family physician, the medical director of a
large area clinic in the city of Beer-Sheva, Israel. E-mail:
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: email@example.com Website: www.nichd-israel.com
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.
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
6. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine.
Quality of life and health. New York: Hippocrates Sci Publ, 2005, 378
Competing interests: No competing interests