Summary:

The New Medicine and the Old Ethics, in Albert Jonsen’s own words, is a "secular aggadah." Jonsen explains that one Talmud reviewer defined aggadah as "a magical rabbinic mode of thought in which myth, theology, poetry and superstition robustly mingle" (4). The book begins with a personal essay entitled "Watching the Doctor." Jonsen establishes his premise that the moral history of Western medicine is best understood as a paradox between altruism and self-interest, a paradox alive and well entering the 21st Century.

He then takes the reader on his "secular aggadah," blending history, myths, and stories that trace important moral developments in the practice of Western medicine. In "Askelepios as Intensivist," we learn of the early Greek values of competence in shaping medical practice. Through the influence of the Church in the medieval period, Western medicine incorporates the value of compassion through the Biblical Good Samaritan, struggles with problems of justice in the care of the poor, and further elaborates the meaning of benefit.

In "The Nobility of Medicine," Jonsen describes the contribution of Sir William Osler and other knighted medical men of the 19th Century who established the ethics of noblesse oblige in the medical profession. He traces this noble tradition to the medieval Knights Hopitallers of Saint John of Jerusalem, a group of religious who provided hostels for pilgrims to the Holy Land and cared for the sick. With essays on John Locke and Jeremy Bentham, Jonsen brings us to the 20th Century and the play of individual rights and utilitarian values in the moral life of Western medicine.

In the final essays, Jonsen describes the mingling of these traditions as a means to establish a moral frame for Western medicine in our current times where technology and science have achieved and threatened so much. Ethics, he argues, "is disciplined reflection on ambiguity" (130). In the last essay, "Humanities Are the Hormones," Jonsen brings his "secular aggadah" full circle.

He argues that the paradox of altruism and self-interest that runs through the moral history of Western medicine must continually be vitalized and examined through the Humanities. The Humanities are "the chemical messengers that course through the complicated institution of medicine and enable it to respond to the constantly changing scientific, technological, social, and economic environment" (147).

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An extraordinary phenomenon began to emerge a century or so ago, which, as it proceeded, allowed us a glimpse into what a society would look like when most of its members, rather than a select few, lived to, or more precisely, near, the limit of the human lifespan. Now we are facing the possibility of extending the upper limit of the human lifespan. How we live within this new world will be the result of numerous individual as well as corporate (in its fullest sense--business, professional societies, religious organizations, political bodies) decisions.

Stephen Hall, through compelling and clear writing takes us behind the scenes and into the lives and labs of the researchers and entrepreneurs who are seeking to slow down, stop, or reverse the aging process--those who intend to bring about, if not actual, then practical immortality. Figuring prominently throughout the book are Leonard Hayflick, early pioneering researcher on aging cells, and the charismatic (and former creationist) researcher-entrepreneur, Michael West. Rounding out the narrative are commentaries by noted ethicists and the chronicling of the political responses to these scientific and business developments, especially in regard to stem cell research.

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This is a selection from "The Call of Stories" in which Robert Coles argues for a medical ethics rooted in particular lives and particular situations, rather than (or to supplement) the ethics of abstract rules and principles. He tells the tale of an "uppidy nigger" in Clarksdale, Mississippi, in 1967 who took issue with her clinic doctor because he was insulting and condescending toward his patients: "I told him I expected more of him. Isn’t he a doctor? If he can lord it over people, being a doctor, then he ought to remember how our Lord, Jesus Christ behaved . . . did He go around showing how big and important He was . . . ?"

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Laqueur argues that in the course of medical history there has been a shift from the one-sex to the two-sex model. Prior to the seventeenth century, scientists of all kinds believed that there was only one kind of human body. Men and women were the same.

In drawings made during dissections, for example, scientists from Aristotle to Galen identified female genitalia as male genitalia which were simply inside the body rather than outside of it. Thus, the vagina was identified as penis and the uterus as testes. Women’s organs were internal, it was believed, because they were colder (and therefore inferior). It was possible for a woman to turn into a man if she over-exerted herself and became hot. After the seventeenth century, this one-sex model slowly transformed into the two-sex model popular today according to which men and women have different bodies and different attributes that follow from those bodies.

Laqueur does not think that earlier scientists were mistaken. They carefully performed dissections and recorded what they saw. Their drawings are correct. However, because their world view did not allow for two sexes, the parts are identified differently. In later centuries it became politically necessary to create a greater, natural distinction between men and women, a distinction that could not be remedied by greater heat. The material evidence of the body was thus interpreted differently.

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Dr. Slocum leads his readers through some of the high (and low) points of his 34 years of general medical practice in the Hell’s Kitchen neighborhood of Manhattan. The work opens as he and his wife and nurse of as many years close the office they have shared for the last time. Then moving backward for a few chapters, the author discusses briefly his training, including a critical four-month period in Vienna in the year 1932. Slocum was awaiting the results of his Medical board examination and while doing some advance study, experienced first hand the early stages of Nazi activity against Jews in Austria.

After their return to the states and the doctor’s completion of his internship, the young couple located office and home in Manhattan. The remainder of the book is devoted to descriptions of critical events and important professional encounters in more than three decades, organized by chapter, most of which encapsulate a patient and, when present, his or her family.

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This is a story of injury in the midst of exuberant good health, followed by a progressively darkening journey. The writer experiences a period of isolation from normal life by his hospitalization, isolation from a part of his body by neurosensory damage to the injured leg, isolation from the security of medical colleagues by their insensitivity to his anguish. Sacks reaches a psychological nadir before beginning his return. He chronicles, retrospectively, the stages of this trip. As in the classical journey myths, the traveler returns with new insight and an altered vision of the meaning of disease.

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This posthumously published short (132 pp) collection is by a former New York Times book reviewer and essayist who was diagnosed with metastatic prostate cancer in 1989 and who died the following year. Broyard responded to his illness by writing about the experience. The book is comprised of six parts:

Part 1: Intoxicated by My Illness

Part 2: Toward a Literature of Illness

Part 3: The Patient Examines the Doctor

Part 4: A Style for Death: Journal Notes, May-September,1990

Part 5: The Literature of Death

Part 6: What the Cystoscope Said

Parts 1, 2 and 5 appeared in slightly different form in the New York Times between 1981 and 1990.

Parts 2 and 3 are in part from a talk Mr. Broyard gave at the Univ. of Chicago Medical School in April 1990. Part 6 is a short story written by Broyard in 1954 about his father’s death.

Mr. Broyard had long been fascinated with death and dying, before his prostatic cancer, publishing "What the Cystoscope Said" in 1954, some 35 years before his own diagnosis. It is as though he had been preparing for what he knew would be his finest work. Always an engaging essayist and reviewer, Mr. Broyard here offers what he did best--a discursive (in the best sense) soliloquy on disease, suffering, the majesty of the educated, reflective person with illness--all amplified with widely ranging withdrawals from the broad literary bank account one would expect of a professional reader and reviewer: one reads about personal fate vis-à-vis D. H. Lawrence’s Women in Love; one reads, as one can read nowhere else, about illness, dying and sexuality and its relevance to Hemingway’s The Sun Also Rises.

Part 1, Intoxicated By My Illness, is a personal statement about the effect of this illness on Broyard’s attitude and is rich with his own and others’ literary sense of how he should and did react to it. Part 2, written later than Part 5, deals with literature and illness as opposed to the emphasis on death in Part 5. Within Part 2 are references to Susan Sontag, Norman Cousins and Siegel, among other students of this subject. It is interesting to compare the more powerful and personal and moving appeal of the later writings on illness (Part 2) to the more abstract, critical ruminations on death (Part 5) at a time when, in fact, Part 5 was a literary exercise. Part 2 is written with the pen of the heart.

Part 3 is a wonderful account of Broyard’s first meeting with his personal physician. While Broyard analyzes this man, he reflects on what he would like in his ideal doctor. Part 4 is a brief (7 pages) collection of short diary entries reminiscent of Dag Hammarskjöld’s Markings. Part 5 includes essays on death and dying in literature and what these books, e.g., Robert Kastenbaum’s Between Life and Death and David Hendin’s Death as a Fact of Life and Ernest Becker’s Denial of Death, have to offer us.

Part 6 is a short story about his father’s death, the son’s sexual escapades and the relationship between the two. Clearly sex, death and their nexus have long been on Broyard’s mind. This is a welcome reflection and is of interest more as it compares to Broyard’s later writings on the subject, especially in Part 2, than for its intrinsic worth as a short story.

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Sontag argues against the use of illness as metaphor. She states her main point on the first page of this long essay : "The most truthful way of regarding illness--and the healthiest way of being ill--is one most purified of, most resistant to, metaphoric thinking."

Tuberculosis and cancer serve as her two central examples of the human tendency to use metaphoric thinking about illness. In the 19th century, tuberculosis was considered a disease of passion, of "inward burning," of the "consumption" of life force. Sufferers were thought to have superior sensibility; the illness purified them of the dross of everyday life. The romantic image of the TB sufferer became "the first widespread example of that distinctively modern activity, promoting the self as an image" (p. 29). Metaphoric thinking about TB declined in the early part of the 20th century as the disease succumbed to science and public health measures.

Cancer has now become the predominant disease metaphor in our culture. Cancer is considered a disease of repression, or inhibited passion. The cancer sufferer characteristically suppresses emotion, which after many years emerges from the unconscious self as malignant growth. As in Auden’s poem, Miss Gee, reproduced on page 49, (see annotation in this database): "Childless women get it, / And men when they retire . . . . " Sontag uses the 19th century view of insanity as another example of malignant metaphoric thinking, while metaphor related to syphilis was somewhat more benign. She concludes the essay with an eloquent prediction that, as we learn more about the etiology and treatment of cancer, its metaphorical system will die on the vine. (I wonder if Sontag would consider my "die on the vine" an appropriate metaphor here?)

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This book is an autobiographical account of an abrupt and painful injury that completely transforms the author’s life. Berger in 1985 was a healthy woman who enjoyed ice skating and canoeing, a published poet, wife, and mother of a toddler. She bent over one day to pick up her daughter and felt a tearing "within the thickness of flesh, moving in seconds across the base of the spine." No longer able to run, walk, or even sit, she is forced into a life spent lying down.

Hers is now a world of boundaries and barriers--physical, psychological, and societal. The book chronicles her struggle to parent her child (they make gingerbread creatures lying down on the kitchen floor), to relate to her husband (she has to deal with the constant feeling of being the recipient of his care), to live with pain, and to regain her mobility.

Because hers is not a visible injury and because she must frequently lie down in public places or use her carry-along lawn chair, she suffers the stares and scrutiny of people who cannot pigeon-hole her into a tidy handicapped-wheelchair category. After seven years of physical therapy (she calls her therapists "angels of attempted repair ") she is able to walk and drive, though she is still limited in activity and lives in fear of re-injury.

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This work is an adaptation and abridgment of a classic work of Chekhov scholarship by Vladimir Kataev published in Russia in 1979 and presented here in English for the first time. Professor Kataev is concerned primarily with Chekhov’s perspective and methodology, the manner in which Chekhov looks at the world and, hence, the kinds of stories he tells and the methods by which he tells them.

The characteristic Chekhovian perspective first appears in recognizable form in stories that Chekhov wrote in his breakthrough years of the mid-1880s, yet it continued to develop and deepen throughout his writing career. Thus, If Only We Could Know is arranged chronologically. In each chapter the author discusses one or more stories or plays, using them as grist for his topical mill, beginning with "Kashanka" (1887) and ending with The Bishop (1902) and The Cherry Orchard(1903).

According to Kataev, the key to understanding Chekhov is to understand his epistemology or philosophy of knowledge. Basically, in Chekhov’s world the characters do not have access to a privileged perspective or to ultimate truth. "The relative, conditional nature of ideas and opinions, and of stereotyped ways of thinking and behaving; the refusal to regard an individual solution as absolute; and the baselessness of various claims to possession of ’real truth’: these are constants in Chekhov’s world." (p. 164) Thus, the characters communicate poorly and often end up inadvertently causing pain, or sabotaging their own life projects.

Nonetheless, Chekhov’s vision is not pessimistic. Chapter 16, "Chekhov’s General Conclusions," summarizes Kataev’s analysis of the author’s overall approach. Chekhov’s conclusions "may be negative {no one knows the real truth), or affirmative (seeking the truth is an inalienable part of human nature), or they may take the form of indicating the criteria and conditions necessary for establishing real truth." (p. 168) Thus, Kataev expresses here, as well as in his analyses of individual works, the dialectical (my term--JC) relationship between the facts of Chekhov’s stories (i.e. failed beliefs, failed communication, missed opportunities) and his compassion for human nature that searches endlessly for love and meaning in life.

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