Medicine and Morals

by Herbert Ratner, M.D.

Medicine is not an island unto itself. In the hierarchy of disciplines, it is subalternate on the one hand to the laws of nature, as discovered by physics and biology, and on the other hand, to natural law, ethics and morals. The word physician is derived from phusis, the Greek word for nature. It is from nature that medicine obtains its norms. Not everything in nature, however, is natural. We must distinguish between what occurs in nature, e.g., malformed newborns, from what occurs according to nature, e.g., well-formed newborns. The latter establishes the abnormality of the former and the general goal of medicine, namely, high-level wellness. The normal is the correspondence of acts and functions to basic design or nature. It is a qualitative, not a quantitative determination.

For the most part, nature achieves her goal of optimum health. That is why living things have thrived through the ages. When nature does not, she may benefit from assistance. The art of medicine tries to supply that assistance by ministering to nature—by sharing nature's ends, and by cooperating with the active, homeostatic, vital forces in nature ordered to her ends. Medicine, then, can be categorized as a cooperative art which does for nature what nature would like to do for herself if she could. For example, medicine provides an emetic when an ingested poison is not regurgitated. As seen from the example, nature still does most of the work. Parenthetically, it may be added that occasionally what the physician prescribes may not only not help, but may actually hinder or handicap nature in the cure. Perhaps this is what Benjamin Franklin was trying to communicate in his witticism, "There is a great deal of difference between a good doctor and a bad doctor, but. very little difference between a good doctor and no doctor at all". The medical profession could not exist without nature as its ally. The profession is also a fortunate beneficiary of nature's industry and wisdom. Nature does the primary work and sometimes overworks to overcome bad therapy; the physician, however, collects the fee.

As medicine is subalternate to nature, nature, in turn, is subalternate to the laws of God immanent within her. God, who gives order to the world, gives natural sciences their objects. Man, too, is subject to the laws of God, both as part of nature and as a free and intelligent agent. To have a good life both as animal and as spirit, man must make right choices. To make truly right choices he must discover and choose the teachings of God, teachings conformable to man's natural and supernatural needs and necessary for man's fulfillment, as a creature of God. These teachings, or prescriptions for life, are to be found in the script or book of nature and by a learned and guided reading of Scriptures, the Book of God.

Freely chosen, these moral and ethical teachings are as necessary to the good life of man as tropisms are to the good life of plants and instincts to the good life of lower animals.

In Christianity and Medical Sciences, an address delivered in November 1858 to the students of medicine at the Catholic University of Ireland, of which he was Rector, Cardinal Newman exposits the subalternation of medicine to morals, of physician to priest. As prelude he observes, "all professions have their dangers, all general truths have their fallacies, all spheres of action have their limits, and are liable to improper extension or alteration. Every professional man has rightly a zeal for his profession, and he would not do his duty towards it without that zeal. And the zeal soon becomes exclusive, or rather necessarily involves a sort of exclusiveness. A zealous professional man soon comes to think that his profession is all in all, and that the world would not go on without it."

Cardinal Newman then introduces a recognizable example of the subalternation of one discipline to another, "we have heard, for instance, a great deal lately in regard to the war in India, of political views suggesting one plan of campaign and military views suggesting another. How hard it must be for the military man to forego his own strategical dispositions, not on the ground that they are not the best... but because military success is not the highest of objects, and the end of ends—because it is not the sovereign science, but must ever be subordinate to political considerations or maxims of government, which is a higher science with higher objects, —and that therefore his sure success on the field must be relinquished because the interests of the council and the cabinet require the sacrifice, that the art must yield to the statesman's craft! Yet what the soldier feels is natural, and what the statesman does is just. This collision, this desire on the part of every profession to be supreme—this necessary, though reluctant, subordination of the one to the other—is a process ever going on, ever acted out before our eyes. The civilian is in rivalry with the soldier, the soldier with the civilian".

The Cardinal then makes an analogy to the medical profession: "and as the soldier must yield to the statesman, when they come into collision with each other, so must the medical man to the priest; not that the medical man may not be enunciating what; is absolutely certain, in a medical point of view, as the commander may be perfectly right in what he enunciates strategically, but that his action is suspended in the given case by the interests and duty of a superior science, and he retires not confuted but superseded" (Italics added).

This is an important distinction precisely made. The priest's decision is not a confrontation of an independent but subalternate science, but an overruling by a superior science. The fundamental issue is not the rectitude of the physician's therapeutic decision—though ultimately good morals is good medicine and bad morals bad medicine—but the priority of the moral over the medical judgment.

The Catholic doctor, given the contemporary babble of diverse theologic tongues, may well ask at this point, "Who is the priest?" The answer must perforce rest on whether the Catholic Church is a "community of faith" or a "community of opinion. If a community of opinion the physician can shop around —moral theologians are many and talented—to find the opinion he seeks, the "principle" that will justify his practice. If, however, the Catholic Church is a community of faith, it is not the lesser voices—physicians and the masters and doctors of theology—who decide, but the voice that comes from The Rock, the Magistral voice that guarantees authenticity, The physician must turn, not to any priest, but to The Priest who established the authentic Magisterium to transmit his teachings to us.

The preamble and the constitution of the National Federation of Catholic Physicians' Guilds states in its essential parts the following: "We, Catholic Physicians of the United States and Canada; in order to grow in the spirit of Christ in our personal and professional lives, and to bring his Spirit to all that is touched by our science and art, desiring to assist the Vicar of Christ, the Bishops and the whole Christian Community with leadership. . .do hereby convene and agree to form a society. . . The purpose of which shall be,

What is common, then, to the Catholic physician is the Catholic faith and the supremacy of the Vicar of Christ. The Catholic physician, with or without the assistance of moral theologians, does not assume an "infallibility" he denies the Pope, Rather, when the Pope speaks, he accepts it as a special wisdom distilled from a deep and informed understanding and from the extent of his medical knowledge, the Catholic physician seeks faithfully to explicate and elucidate the conclusions of the Magisterium to his colleagues and to the world at large.

Originally appeared in the February 1977 issue, of "Linacre Quarterly", reprinted in the July 6, 1978 issue of L'Osservatore Romano, Via del Pellegrino, 00120, Vatican City, Europe, Telephone 39/6/698.99.390.

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