Abstract
The dominant unspoken philosophical basis of medical care in the United States is a form of Cartesian reductionism that views the body as a machine and medical professionals as technicians whose job is to repair that machine. The purpose of this paper is to advocate for an alternative philosophy of medicine based on the concept of healing relationships between clinicians and patients. This is accomplished first by exploring the ethical and philosophical work of Pellegrino and Thomasma and then by connecting Martin Buber's philosophical work on the nature of relationships to an empirically derived model of the medical healing relationship. The Healing Relationship Model was developed by the authors through qualitative analysis of interviews of physicians and patients. Clinician-patient healing relationships are a special form of what Buber calls I-Thou relationships, characterized by dialog and mutuality, but a mutuality limited by the inherent asymmetry of the clinician-patient relationship. The Healing Relationship Model identifies three processes necessary for such relationships to develop and be sustained: Valuing, Appreciating Power and Abiding. We explore in detail how these processes, as well as other components of the model resonate with Buber's concepts of I-Thou and I-It relationships. The resulting combined conceptual model illuminates the wholeness underlying the dual roles of clinicians as healers and providers of technical biomedicine. On the basis of our analysis, we argue that health care should be focused on healing, with I-Thou relationships at its core.
Highlights
IntroductionOne unspoken philosophical position underlying modern healthcare is a form of Cartesianism[2](p 99), the idea that bodies are machines and that clinicians are technicians whose job it is to repair those machines
In a recent essay about his diagnosis of prostate cancer, New York Times editor Dana Jennings wrote, "Doctors tend to default to mere competent professionalism, forgetting to talk directly to the scared flesh-and-blood man bearing the disease[1]." Such criticism of medicine in the United States is not new, but it is becoming increasingly clear that the medical philosophical position that "considers human beings merely collections of organ systems and deposits of disease entities"[2] is not meeting the needs of patients or health-care professionals
While this medical Cartesian reductionism has had undeniable success in advancing biomedical knowledge, and has led to important interventions to relieve human suffering, it is at the same time the root of many of the problems in our health care system
Summary
One unspoken philosophical position underlying modern healthcare is a form of Cartesianism[2](p 99), the idea that bodies are machines and that clinicians are technicians whose job it is to repair those machines While this medical Cartesian reductionism has had undeniable success in advancing biomedical knowledge, and has led to important interventions to relieve human suffering, it is at the same time the root of many of the problems in our health care system. Pellegrino and Thomasma propose an alternative philosophy of medicine They define medicine as "a relation of mutual consent to effect individualized well-being by working in, with, and through the body"[2](p 80). "Competence must itself be shaped by the end of the medical act a right and good healing action for a particular patient[2](p 213)."
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