The 'medicine is war' metaphor.

Abstract

As the Berlin Wall fell and the Iron Curtain was raised, we entered the post-Cold War era. Adapting to this new situation will require reconceptualizing how we interpret political events and make political decisions. Experiencing life in terms of war is more than mere rhetorical flourish. Metaphors may influence which ethical issues we raise, how we interpret problems, which alternatives we notice, how we rank those alternatives, and how motivated we are to carry out a solution (1) (2). The war metaphor affects more than foreign policy. It pervades our thinking about many areas of life. U.S. Presidents declare wars on poverty and on drugs, or offer us "the moral equivalent of war." In business, countless products are advertised as fighting some enemy from dirt to dandruff. We hear of football linemen engaging in "trench warfare," and of basketball rebounders fighting "the battle of the boards." We are frequently reminded of "the battle of the sexes." And G. Lakoff and M. Johnson note that my own profession is hardly pacific. Academic philosophers talk about attacking their opponent's premises and about finding a claim to be indefensible -- as part of the "rational argument is war" metaphor (3, pp. 61-65, 77-81, 87-96): The war metaphor has a powerful effect on medicine. The 'medicine is war' metaphor influences not only our language, but also our attitudes, moral beliefs, and actions relating to the physician-patient relationship and to medicine generally. I will examine the pervasiveness of the 'medicine is war' metaphor (section I), identify three issues affected by it (section II), critique the metaphor and explore another model for understanding medicine, based on caring (section III), and propose what might be done to limit the use of the war metaphor in medicine (section IV). Throughout, I will identify the relevance of this metaphor for hospital ethics committees (HEC). Once we see how the war metaphor shapes one area of life -- medical practice -- it will be easier to see its influence on the rest of life, including politics and personal relationships.