Medical worldviews, as mentioned in Part I of the Metaphysics of Modern Medicine Series, is important when it comes to how we perceive our patients. There are two main models: the biomedical and the humanistic models. The biomedical model sees the patient as a mechanical body with individual components that only work functionally. The humanistic model perceives the patient as an integration between mind and body. This article will elucidate and summarize the perceptions of the patient: is the patient a body or a mind? 

Descartes is considered the source of treating the body as a machine, splitting the mind from the body which is a notion that was later adapted into the Newtonian mechanical philosophy of medicine, where it was proposed that physicians should use the same methods astronomers do. This way, the body has been transformed into a scientific object reduced to a collation of parts built into a hierarchy of systems, organs, tissues, cells, and molecules, respectively. 

It is important to note that the biomedical model has allowed for the rise in medical technology and has allowed physicians and scientists to obtain objective and quantifiable data regarding health and disease. This model has helped progress modern surgical and medicinal therapeutics and has been the perspective used to make major breakthroughs, such as open heart surgery, dialysis machines, and insulin. However, this model can subsequently result in the colonization the patient by the physician. The person that is within the patient is removed so that the physician can objectively assess the health of the machine in front of them. 

On the other hand, the humanistic model of medicine looks at the patient as an organism that is split in two: the physical and the mental. This creates the perspective that the patient is an organism within a socioeconomic environment. The perspective of phenomenology, or the concentration on the science of experience, is that the patient is embodied within the world of experience. The patient is concretely in the present and not in the objective physical world, perceiving the body as a physical medium with which they experience the world. However, although the experiences of a patient are valuable, stating that the patient is solely a collection of experiences fails to address important questions such as existence. 

Another perspective within the humanistic model is Cassell’s notion, in which he states that asking how the mind affects the body is the wrong question, as the body is not passive to the mind, and the mind is not separate to the body. In this case, it can be said, then, that the physiological responses are a part of emotion, not caused by emotion. Therefore, a person is an individual and a person within social context, which, according to Cassell, means that the measure of a person must include their moral values and personal aesthetics. Science has been largely considered to be value-free, and since medicine has followed the perspective of science, medicine can also be argued to be value-free. But Cassell claims this is a contradiction, as in medicine, the health of society’s members, professionalism, treating the ill, and caring for our fellow humans are all value based. 

Finally, there is a third perspective within the humanistic model, which is the notion of self. This notion, like Cassell’s, also rejects the dualistic perspective of the person. Alfred Tauber, who developed the notion of self, states that curing illness is essentially an issue of ethics. He states that the self is not an independent, autonomous agent, but is an individual in relation to those around him, whether “they are physical, social, or divine”. Therefore, the self is not objective or subjective, but it is reflexive to its surroundings. Tauber proposes that there needs to be a balance between individual rights with an ethics of responsibility, creating “relational autonomy”.

Currently, modern medicine predominantly follows the biomedical perspective where the person must be taken out of the patient so that a diagnosis can be concluded in an objective manner with no social or personal biases. However, this has caused a quality-of-care crisis, where patients do not perceive physicians as compassionate or empathetic towards their suffering. The perspectives of the humanistic model are proposed to cure this crisis. The patient needs to be viewed within their lived experiences according to phenomenology, within a value-based system to honor the unique individual with social features according to Cassell, and with relational autonomy. The incorporation of these views can help physicians do our jobs, which is to truly understand and treat human suffering.

Reference

Marcum J. A. (2008). An Introductory Philosophy of Medicine: Humanizing Modern Medicine. Philosophy and Medicine. 99. Springer Netherlands. doi: 10.1007/978-1-4020-6797-6