An introduction to Essays in Medical EthicsModern medicine suggests omnipotence and an image of life as something that can be perfected at any time. Yet our view of things changes when disease throws us into an existential crisis. Then we seek human answers and feel misunderstood and abandoned in the system of modern medicine.

“Everything cannot be everything.”
(Ingeborg Bachmann)

Who would want to give up the opportunities that modern medicine offers us today? We owe a lot to them, from the very beginning of our life until its end. Indeed, advances in medicine are the major reason why many of us are alive at all and have not had to die of disease or in an accident. Medicine helps us to live our lives in a more unburdened manner. It saves us when we contract a disease that only a hundred years ago would have been a death sentence. To this extent, it is great achievement that modern, well-functioning medicine is available to us. And yet it is precisely this great and indisputable success that bears the seeds of skewed development of other aspects of modern medicine.

What do I mean by this? By skewed development, I mean the observation that medicine, giddy with its success, secretly promises to have everything under control. It increasingly suggests that today, in the age of highly effective modern medicine, one no longer needs to put up with anything. Cutting edge technologies have made it possible to vanquish diseases, extend life, make the body more beautiful, and permanently cure those suffering from hitherto incurable diseases. But does this mean it can really do everything? In the can-do euphoria trumpeted by many areas of medicine, we are increasingly forgetting one thing. Despite all technology, one aspect of being human is that we lack the ability to determine everything ourselves and that the essential things are not in our hands. A consequence of this “forgetting” is that we are increasingly failing to learn how to cope with this finiteness of our ability. The gap between the exaggerated promises of technology and our inability to deal constructively with limits is in no small measure responsible for great moral dilemmas as well as a growing discomfort with “medicine” that is becoming increasingly dominant in our society.

I have not written this book with the intention of joining the ranks of those “critics of medicine” who use this dissatisfaction in society as an excuse for muckraking. Instead, I would like to draw our attention back to the things that humans do not and can never really have under control despite all our technological capabilities. I would like to speak about the limits of what is feasible. Rather than complaining that humans cannot shape everything themselves, I will argue that it may even be good that the essential things remain beyond the grasp of engineering.

Sensitivity to Limits

The increasingly disturbing imbalance in modern medicine demands that we reflect on and question the basic premises of our current approach to the world. This questioning becomes all the more necessary as medicine tends to concentrate only on scientific facts when it deals with human beings. If, in the thinking of large parts of medicine, humans essentially represent only what can be described in scientific terms, then this almost inevitably leads to the attitude that this scientifically describable entity can be changed, manipulated, and transformed. Modern medicine concentrates on changing the external parameters while increasingly losing the ability to distinguish between what must be changed and what one can only react to with the acceptance of something given. Medicine develops entire arsenals for combating disease but offers no guidance in how to deal with and accept what is.

The more we concentrate on doing, the more we lose sight of what lies in front of us, of how important limited entities are for our orientation, and for shaping our lives. Man can only act or produce within the framework of what is given; he does not have absolute freedom to choose this framework. Yet, at the same time, we ourselves are less the result of our own action than an “event” on the substrate of immutable determinants. Modern medicine in particular has long since taken leave of this fundamental insight. The given framework, that which is not doable, that which simply exists—these are concepts that have no place in a medicine oriented toward functionality, programmability, controllability, and efficiency. Just how problematic it can be to banish these fundamental insights is what I would like to demonstrate in this book, which is expressly intended to be an “ethical” book.

Ethics—as a Guide to a Good Life

When we hear the word “ethics” today, we immediately think of the wagging finger, of prohibitions, of restrictions. And when one picks up a book with a title such as this one, one could easily imagine it to be another wagging finger defining limits, demanding we forgo things, and curtailing our options. Yet this is a false understanding of ethics. Since ancient times, the primary purpose of ethical thinking has been to help people lead a fulfilled life. Ethical thinking is thus a guide to a good life. And that is exactly what this book is about.

The following chapters are not about condemnations, prohibitions, and curtailments. On the contrary, they explore the question of how our life can become “fuller.” How can we lead a fulfilled life?

The media often give us very clear messages and very clear-cut solutions. Yet the problems that arise with respect to modern medicine in particular cannot be broken down into shallow messages. Let us look at the limit. It is easy to say that man does not need limits today because he is engaged and should therefore be able to choose everything himself. That sounds good: everyone may choose for himself! Indeed, this expresses the spirit of life in our age, and it was sociologist and philosopher Zygmunt Baumann who expressed this credo in this succinct manner: 

“Postmodern is the exciting freedom to pursue any arbitrary goal and the confusing uncertainty about which goals are worth being pursued.”

We already see here that merely by eliminating all limits we do not automatically come any closer to happiness. This is because happiness does not primarily have to do with feasibility, with the means of our dominion over the world, but with knowing something about the where to and why. Where do we want to go, why do we live, what is important in life, what really matters? These are the central questions that ultimately say something about human happiness. When we lose sight of this goal and simply do everything that is possible, then we subject ourselves to the dictatorship of feasibility. Awash in possibilities, we lose the sense of what is essential, namely the question of who we really are and want to be. If we could do everything and wanted everything we could do, we would be nobody. We can only develop an identity when faced with something we cannot do. Identity arises from and is shaped by the limit, the limit of what is feasible but also the limit of what we can wish for. 

 

Based on: Essays in Medical Ethics
by Giovanni Maio

Professor Giovanni Maio, the eloquent advocate of a new culture of medicine, poses fundamental questions in this book that no one can really avoid: Where are the promises of reproductive and transplantation medicine leading us? To what extent can health be made, and to what extent is it a gift? Does "prettier, better, stronger" promise us greater happiness? Why is the question of organ donation more difficult than is suggested to us? Does being old have its own intrinsic value? How can we acquire an attitude towards dying that does not leave us feeling powerless?

Giovanni Maio's profound plea for an ethics of prudence opens up hitherto unknown perspectives. In this way we could free ourselves from the belief in perfection and find our way to a new serenity as a condition for a good life.

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