May 1985 VI/9
THE VALUES INHERENT IN MEDICAL CARE
Values influence -- and in many cases determine -- human behavior; they give direction and meaning not only to individual actions but also to our personalities. What values are associated with health care? Are there any values so closely associated with medical care that to neglect them would frustrate the effort to offer that care? In order to study these questions adequately, we shall consider basically the concepts of health, human function, and health care.
Health and health care are interdependent; hence, to understand the values associated with health care, one must possess a clear notion of human health. Ask the physician, nurse, or hospital administrator, "What is health?" and you are liable to receive a blank look in reply. Henrik Blum concludes a searching analysis of the concept of health with the brief formula, "Health is the state of being in which an individual does the best with the capacities he has, and acts in ways that maximize his system." Because a human being is an organism, it is an open system. Hence, in maintaining balance or homeostasis, a human is continually relating to environment. For our purposes, then, we conceive of health as optimal human functioning, which implies not only an internal harmony and consistency of function, but also the capacity of the organism to maintain itself in its environment.
What is conveyed by the term human function? Human beings are born with the need to eat; and because we feel hunger (the need for nutrition in order to survive), we perform the function of eating. We have a capacity for knowledge; and because we feel a need for truth in order to understand and fulfill our purpose in life, we perform the function of learning. It is widely acknowledged that there are four categories of human needs and corresponding functions: (1) biological or physiological; (2) psychological; (3) social; and (4) spiritual or creative.
Given these basic needs and functions, it is extremely important to discern how they are related for this will provide a blueprint for the quest for health and the limits of medical care. Is one function more important than another? If so, it will contribute more to health. Are the relationships among the various functions cooperative or competitive? Can one function be sacrificed for another without impairing the individual's health?
These four functions are not stories in a building, one on top of the other, but rather interrelated dimensions of human activity. Just as the length, height, and depth of a cube can be distinguished conceptually for sake of study, but not separated in reality, so the four functions of the human act are interconnected. Every truly human act involves all four functions. A human spiritual act, whether it be the creative act of a scientist or the loving act of a parent, at the same time involves a biological, psychological, and social function. True, one type of function will predominate in a human act, but all types will be present.
The task of the creative function is to integrate the biological, psychological, and social functions. Thus creative functions are the deepest, most central and most complex. At the same time, however, these activities are rooted in and dependent upon the other functions in a network of interrelations. One cannot think unless one's brain is physiologically sound. Moreover, each function is to a certain extent autonomous, structurally and functionally differentiated, so that when help in restoring function is needed, each function is served by a different discipline. To restore the physiological function, one trained in medicine is called; for the psychological function, one trained in psychology or psychiatry; for the social function, a social counselor or lawyer; for the creative-spiritual function, a teacher or spiritual director.
Clearly, physicians and all other medical care professionals must be concerned primarily with healing the physiological and psychological functions. However, their efforts at restoring these functions must be performed with the awareness of the interrelatedness of all human functions. Physicians who do not realize the interrelatedness of all human functions might think they have the right to make all decisions for the patient; health planning might be directed only to the amelioration of physiological problems without regard for their relation to psychological, social or spiritual problems.
Even though patients present themselves in a wounded state of health, as a result of which they have lost some degree of self-determination, the patient's power to make his or her own decisions must be respected by the physician and all other persons in health care. Because of the good in question, and because there is need to respect the spiritual integrity of the person who comes for help a specific type of relationship arises between the physician and the patient, known familiarly as the professional relationship. The heart of this relationship is the avowal (professio) on the part of one person that he or she is willing to help another person attain a very important human good while at the same time respecting the personal worth and dignity of the person. Given the service value in the relationship between the professional and the human person in need of help, it is evident that the relationship must be built upon trust. This is especially true in medicine where the patient's vulnerability is multidimensional and the patient-physician relationship is intrinsically imbalanced.
If our brief account of the values inherent in the medical relationship is accurate, then it is clear why profit cannot be the primary basis of any profession but must be considered a secondary and highly variable feature. Traditionally, a principle fundamental to all professions has been that the professional must be ready to give services free to those who are in need but cannot pay. Indeed, official codes of medical ethics usually state that fees should be adjusted to the ability of the patient to pay.
In view of the foregoing analysis of health, medical care, and the professional patient relationship, the following value statements are normative for individuals and corporations involved in health care:
1. Those offering medical care must remember and respect the worth and higher functions of the individual;
3. The primary and overriding purpose of medical care must he a desire to strive those whose physiological or psychological health are impaired in order to enable them to lead a better life;
3. The patient-physician relationship must be permeated by trust;
4. Medical care should not be considered a commodity, something to he bought or sold in a market system, because it is a precious and vital good to which no price can be attached and because it is a prerequisite to the attainment of other human goods as well as to the pursuit of a meaningful life.
Kevin O'Rourke, OP
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