**4. Concrete ideas for contemporary medical ethics**

We argue that Plato may help us reconsider contemporary medical ethics in two ways at least. First, useful input might come by revisiting the respect for autonomy. Nowadays, respecting a patient's autonomy includes making sure there is decisional capacity, agency, reasonable information, lack of coercion and all conditions for a meaningful deliberation between options. Plato taught us that "doing what seems best" and "doing what one really wants" are two different ways of acting. And what separates them is a will being directed towards the good, in contrast with a false

**333**

*himself/herself.*

*Plato in Contemporary Medical Ethics: Holism and Care DOI: http://dx.doi.org/10.5772/intechopen.93889*

sufficient for a competent (i.e. wise) decision.

might easily turn into unintended paternalism [23].

into matters of knowledge22 [9].

sense of choice in doing what looks best to one's opinion (δόξα). However, the will is

In a platonic reading, an autonomous choice is a *wise* choice. To the extreme, we might argue that some implicit definition of beneficence is present in the very substance of the wise choice. Doing what seems best and not what is good for oneself is not an exercise of wisdom, thus not an autonomous choice in the new semantics of this term. Even when all reasonable information is provided, a lack of virtuous character might prevent a potential patient from seeing what is genuinely good for oneself, thus invalidating what should have been a wise choice. Therefore, the question arises if respect for autonomy as we understand it nowadays is, indeed,

The closest medical practice to this ideal would be the deliberative model of the patient-physician relationship. In contrast with paternalistic and informative models, in this type of relationship, the objective of the physician-patient interaction is to help the patient determine and choose the best health-related values that can be realized in that situation. The physician helps identify the values included in the available options but also suggests why certain health-related values are worthier of consideration. However, in this model, the physician discusses only health-related values and considers that many other values are unrelated to health and disease. The deliberative model allows the doctor to act as a teacher or friend who sees respect for autonomy as moral self-development. Objections to this model include the fact that physicians would not possess privileged knowledge of those values which should have priority in health situations. This objection is intimately linked to the pluralistic moral reality of modern societies. Other objections emphasize the fact that the physician should never engage in moral deliberation or that this type of endeavor

However, Plato offers us more. And it is not mandatory to adopt his theory of Forms or his ideas about learning as remembering to figure out that people can be accompanied towards more truth and better choices. Cushman explains to us what Plato means by his theory of αναμνέσις21: "however valid true opinion may be, επιστήμη requires a community of kindred minds, wherein truth is jointly acknowledged and so, is removed from the closet of merely private surmise" [9]. In leading the other towards the truth, it is never a matter of coercion. Opinions arise in the individual soul, and it is by friction with other minds, that these become converted

The deliberative model allows the patient and doctor to discuss the worthiness of different health-related values. It also aspires to a certain moral self-development in a patient. These features match the message in the platonic dialogs. However, critics of this model argue that physicians do not possess privileged knowledge of values which should have priority in health situations. Inspired by Plato, I argue that they *should* possess this privileged knowledge. A certain type of wisdom *should* be a part of their build as doctors. This is especially true because, as Cushman explains23, one is unable to share the perspective of his own virtue unless they are in possession of true knowledge as an integrating part of their virtuous character [9]. In short, a physician would do his job properly when they are able to help a patient become wiser. In a platonic reading, we equate true autonomy to wisdom. Therefore, to help patients become wiser, the physicians themselves should have a virtuous character. *The only way a doctor can respect patient's true autonomy is for this doctor to be wise* 

directed towards the good when and only when one's character allows it to.

<sup>19</sup> pp. 84-85

<sup>20</sup> p. 115

#### *Plato in Contemporary Medical Ethics: Holism and Care DOI: http://dx.doi.org/10.5772/intechopen.93889*

*Bioethics in Medicine and Society*

task [21].

our social world" [22].

took on weight and solidity. No light could now dissolve them in ideal truths, but the gaze directed upon them would, in turn, awaken them and make them stand out against a background of objectivity. The gaze is no longer reductive; it is, rather, that which establishes the individual in his irreducible quality. And thus, it becomes possible to organize a rational language around it" [12]. The almost complete deterioration of the holistic attitude came to be as a natural consequence of another limiting principle: the separation of sciences and the separation of disciplines of study. Inside a certain discipline, the rules got more constraining. The production of discourses to cover global or holistic attitudes became an almost impossible

It is Gadamer19 that links us back with Plato with respect to medicine. He shows that Plato tried to find the connections that tie the spheres of the soul, the city and the Universe as a whole. This type of awareness must be regarded as a superior type of wisdom compared with the arrogance inspired by our ever-expanding technical skills. The German philosopher denounces a crisis of humanity: we developed the technical aptitudes in such an extent, so they became an all-encompassing attitude [22]. Gadamer shows that doctors are, by virtue of their profession, involved with two key aspects of our life: life and death. Plato has shown us that is impossible to cure the body without knowing something about the soul. Or, more precisely, one cannot heal without knowing something about the nature of the whole. The notion of the "whole", here, does not mean a mere methodological concept. It speaks about the unity of being itself20. "It is the whole in the sense of the movement of the stars above and the changes of weather below, the rise and fall of the oceans and living nature of the woods and fields. It is what surrounds and encompasses the nature of human beings that determines whether they find themselves in a condition of safe health or exposed to dangerous threats. Medicine seems to be a genuinely universal science, especially if this whole of nature is extended to include the whole that is

Nowadays, we understand medical beneficence in terms of functionality, mobility, absence of suffering, alleviation of symptoms and removal of organic causes. But it is obvious that many medical acts fail to restore true health in an individual. The doubt in the physician-patient relationship, the psychiatric comorbidities, the side effects of various treatments, the lack of compliance in diet and lifestyle and the changes in a patient's social network often make healing impossible. Philosophy teaches us that holism has survived for a long period of time in medicine, despite less scientific medical knowledge in the past centuries. But its presence was not a mere artifact of a primitive world. It was strongly connected with the intent of a genuine beneficence. Plato believed that healing occurs in the

We argue that Plato may help us reconsider contemporary medical ethics in two ways at least. First, useful input might come by revisiting the respect for autonomy. Nowadays, respecting a patient's autonomy includes making sure there is decisional capacity, agency, reasonable information, lack of coercion and all conditions for a meaningful deliberation between options. Plato taught us that "doing what seems best" and "doing what one really wants" are two different ways of acting. And what separates them is a will being directed towards the good, in contrast with a false

whole of an individual and even in the whole of society itself.

**4. Concrete ideas for contemporary medical ethics**

**332**

<sup>19</sup> pp. 84-85 <sup>20</sup> p. 115

sense of choice in doing what looks best to one's opinion (δόξα). However, the will is directed towards the good when and only when one's character allows it to.

In a platonic reading, an autonomous choice is a *wise* choice. To the extreme, we might argue that some implicit definition of beneficence is present in the very substance of the wise choice. Doing what seems best and not what is good for oneself is not an exercise of wisdom, thus not an autonomous choice in the new semantics of this term. Even when all reasonable information is provided, a lack of virtuous character might prevent a potential patient from seeing what is genuinely good for oneself, thus invalidating what should have been a wise choice. Therefore, the question arises if respect for autonomy as we understand it nowadays is, indeed, sufficient for a competent (i.e. wise) decision.

The closest medical practice to this ideal would be the deliberative model of the patient-physician relationship. In contrast with paternalistic and informative models, in this type of relationship, the objective of the physician-patient interaction is to help the patient determine and choose the best health-related values that can be realized in that situation. The physician helps identify the values included in the available options but also suggests why certain health-related values are worthier of consideration. However, in this model, the physician discusses only health-related values and considers that many other values are unrelated to health and disease. The deliberative model allows the doctor to act as a teacher or friend who sees respect for autonomy as moral self-development. Objections to this model include the fact that physicians would not possess privileged knowledge of those values which should have priority in health situations. This objection is intimately linked to the pluralistic moral reality of modern societies. Other objections emphasize the fact that the physician should never engage in moral deliberation or that this type of endeavor might easily turn into unintended paternalism [23].

However, Plato offers us more. And it is not mandatory to adopt his theory of Forms or his ideas about learning as remembering to figure out that people can be accompanied towards more truth and better choices. Cushman explains to us what Plato means by his theory of αναμνέσις21: "however valid true opinion may be, επιστήμη requires a community of kindred minds, wherein truth is jointly acknowledged and so, is removed from the closet of merely private surmise" [9]. In leading the other towards the truth, it is never a matter of coercion. Opinions arise in the individual soul, and it is by friction with other minds, that these become converted into matters of knowledge22 [9].

The deliberative model allows the patient and doctor to discuss the worthiness of different health-related values. It also aspires to a certain moral self-development in a patient. These features match the message in the platonic dialogs. However, critics of this model argue that physicians do not possess privileged knowledge of values which should have priority in health situations. Inspired by Plato, I argue that they *should* possess this privileged knowledge. A certain type of wisdom *should* be a part of their build as doctors. This is especially true because, as Cushman explains23, one is unable to share the perspective of his own virtue unless they are in possession of true knowledge as an integrating part of their virtuous character [9]. In short, a physician would do his job properly when they are able to help a patient become wiser. In a platonic reading, we equate true autonomy to wisdom. Therefore, to help patients become wiser, the physicians themselves should have a virtuous character. *The only way a doctor can respect patient's true autonomy is for this doctor to be wise himself/herself.*

<sup>21</sup> p. 93

<sup>22</sup> p. 103

<sup>23</sup> p. 93

Critics might argue that the definition of *good* is, often, a political one. They are right. But the platonic reconsideration of the doctor-patient relationship in terms of wisdom is not meant to violate the principle of permission. This principle remains the *sine qua non* condition of a peaceable secular community [14]. I argue that doctors have a duty to try, to the best of their ability, to stir a moral (not religious) development in their patients, as the only way to enable true autonomy. To do that, doctors have a duty to stir moral development in themselves. They cannot escape the essential universality of medical science Gadamer24 speaks about [22]. If we are to believe Plato, failure to accomplish either of the two duties is, in fact, failure to respect the principle of autonomy. It becomes a "blind leading the blind" situation.

Secondly, Plato helps us rethink beneficence in more holistic terms. What is beneficial in a medical act should be beneficial for the entire human being but also for the entire community of beings. The over-specialization of medicine has helped scientists to expand knowledge and discover new and revolutionary treatments. However, I argue that, when it comes to medical practice, this partitioning of medical interventions represents a high risk of doing more harm than good. Patients often lack treatment compliance. They are, often, unable to change their lifestyle to make a treatment work or to avoid complications. What is mended by a medical specialty often gets broken by behaviors outside the medical area of expertise. It is the case with smoking, drug abuse or generally unhealthy behaviors. Multiple comorbidities get treated by separate specialists, with different protocols. They often result in a high number of drugs getting ingested daily. Similarly, depression is usually accompanied by lack of interest in one's health and self-care behaviors. Psychosocial problems and difficulties are both causes and effects of depression and anxiety. Moreover, poverty, lack of education, different forms of discrimination and abuse towards minorities, all diminish or altogether block access to healthcare.

A more holistic approach should be able to put together the pieces of this medical, social, behavioral and spiritual puzzle. The nexus of information about disease, lifestyle, behaviors, genetics, social status, economic status and so on might be in the hands of the general practitioner in their role as the family doctor. They might be the most suitable physician to take on the difficult task of accompanying patients on their way to true, better lives. Besides technical skills, the family doctor might be particularly trained in deliberating values and shared decision making. They should be able to have a good understanding of spiritual, social, economic and educational aspects of life. This will enable them to direct the use medical and non-medical resources to empower patients to make beneficial decisions in the web of all medical specialties and non-medical realities. This would also give a special place to psychotherapies as a resource that might favor life-changing personal leaps. In short, multidisciplinary approaches cannot and should not become the patient's task. The reason for it is that the patient is not able to build the holistic approach needed for their care on their own. The task of approaching things holistically should be in the hands of a doctor. This doctor is not required to be over-specialized in some areas of the human body. They are expected to be a wise mentor in the health of the human being.

## **5. Conclusions**

The advancements in medical ethics and bioethics allow for more precise useful frameworks to judge different ethical dilemmas and questions. These frameworks are also easier to include in codes and regulations pertaining to the medical

**335**

**Author details**

Tudor-Ștefan Rotaru1,2

1 University of Medicine and Pharmacy "Gr. T. Popa", Iași, Romania

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

2 "Alexandru Ioan Cuza" University of Iași, Iași, Romania

\*Address all correspondence to: tudor.rotaru@umfiasi.ro

provided the original work is properly cited.

*Plato in Contemporary Medical Ethics: Holism and Care DOI: http://dx.doi.org/10.5772/intechopen.93889*

and reductive formulas of autonomy.

profession. However, it is still not clear what exactly an autonomous patient does when making a health-related choice. Nor it is clear what the moral content of beneficence is, since the patient is a whole in themselves and is part of a larger system of relationships and interactions. I have shown that Plato, twenty-four centuries ago, spoke about a type of choice that we can construe, today, as genuine autonomy. This type of choice has been cultivated inside a relationship of care between the doctor and the patient. The philosophy of care about one's genuine want of something good for oneself has traveled the history. It almost got lost once disease (and not the ill human) became the central focus of the medical profession. Plato also harbored a holistic approach about people and their illnesses. This holistic approach was present before him and survived after him, in parallel with an atomist view that began with the first Egyptian surgical attempts. Holism was almost completely lost in the 18th century. Recovering both holism and care is an endeavor that might dramatically change the way medicine is practiced but also the moral choices it implies. Empowering a patient for an autonomous choice means caring about them making a wise choice. Healing is not due to parts but to the whole of patients, communities and to the environment. It seems that Plato had this type of wisdom. We might want to recover something our Western culture had back at its roots. This content was lost once the scientific revolution promoted partitioned technical skills

<sup>24</sup> p. 115

#### *Plato in Contemporary Medical Ethics: Holism and Care DOI: http://dx.doi.org/10.5772/intechopen.93889*

*Bioethics in Medicine and Society*

Critics might argue that the definition of *good* is, often, a political one. They are right. But the platonic reconsideration of the doctor-patient relationship in terms of wisdom is not meant to violate the principle of permission. This principle remains the *sine qua non* condition of a peaceable secular community [14]. I argue that doctors have a duty to try, to the best of their ability, to stir a moral (not religious) development in their patients, as the only way to enable true autonomy. To do that, doctors have a duty to stir moral development in themselves. They cannot escape the essential universality of medical science Gadamer24 speaks about [22]. If we are to believe Plato, failure to accomplish either of the two duties is, in fact, failure to respect the principle of autonomy. It becomes a "blind leading the blind" situation. Secondly, Plato helps us rethink beneficence in more holistic terms. What is beneficial in a medical act should be beneficial for the entire human being but also for the entire community of beings. The over-specialization of medicine has helped scientists to expand knowledge and discover new and revolutionary treatments. However, I argue that, when it comes to medical practice, this partitioning of medical interventions represents a high risk of doing more harm than good. Patients often lack treatment compliance. They are, often, unable to change their lifestyle to make a treatment work or to avoid complications. What is mended by a medical specialty often gets broken by behaviors outside the medical area of expertise. It is the case with smoking, drug abuse or generally unhealthy behaviors. Multiple comorbidities get treated by separate specialists, with different protocols. They often result in a high number of drugs getting ingested daily. Similarly, depression is usually accompanied by lack of interest in one's health and self-care behaviors. Psychosocial problems and difficulties are both causes and effects of depression and anxiety. Moreover, poverty, lack of education, different forms of discrimination and abuse towards minorities, all diminish or altogether block access to healthcare. A more holistic approach should be able to put together the pieces of this medical, social, behavioral and spiritual puzzle. The nexus of information about disease, lifestyle, behaviors, genetics, social status, economic status and so on might be in the hands of the general practitioner in their role as the family doctor. They might be the most suitable physician to take on the difficult task of accompanying patients on their way to true, better lives. Besides technical skills, the family doctor might be particularly trained in deliberating values and shared decision making. They should be able to have a good understanding of spiritual, social, economic and educational aspects of life. This will enable them to direct the use medical and non-medical resources to empower patients to make beneficial decisions in the web of all medical specialties and non-medical realities. This would also give a special place to psychotherapies as a resource that might favor life-changing personal leaps. In short, multidisciplinary approaches cannot and should not become the patient's task. The reason for it is that the patient is not able to build the holistic approach needed for their care on their own. The task of approaching things holistically should be in the hands of a doctor. This doctor is not required to be over-specialized in some areas of the human body. They are expected to be a wise

**334**

<sup>24</sup> p. 115

**5. Conclusions**

mentor in the health of the human being.

The advancements in medical ethics and bioethics allow for more precise useful frameworks to judge different ethical dilemmas and questions. These frameworks are also easier to include in codes and regulations pertaining to the medical

profession. However, it is still not clear what exactly an autonomous patient does when making a health-related choice. Nor it is clear what the moral content of beneficence is, since the patient is a whole in themselves and is part of a larger system of relationships and interactions. I have shown that Plato, twenty-four centuries ago, spoke about a type of choice that we can construe, today, as genuine autonomy. This type of choice has been cultivated inside a relationship of care between the doctor and the patient. The philosophy of care about one's genuine want of something good for oneself has traveled the history. It almost got lost once disease (and not the ill human) became the central focus of the medical profession. Plato also harbored a holistic approach about people and their illnesses. This holistic approach was present before him and survived after him, in parallel with an atomist view that began with the first Egyptian surgical attempts. Holism was almost completely lost in the 18th century. Recovering both holism and care is an endeavor that might dramatically change the way medicine is practiced but also the moral choices it implies. Empowering a patient for an autonomous choice means caring about them making a wise choice. Healing is not due to parts but to the whole of patients, communities and to the environment. It seems that Plato had this type of wisdom. We might want to recover something our Western culture had back at its roots. This content was lost once the scientific revolution promoted partitioned technical skills and reductive formulas of autonomy.
