Antidote to depersonalised medicine

Miles Little’s distinguished credentials and past experience as a surgeon, poet, philosopher and humanist make him particularly qualified to address the restoration of humane values to medicine. The origin of threats to values in medicine today is addressed in depth and in an analytic and reflective way. His essays are well chosen to accomplish this, but are difficult to read, as the language at times seems purposefully abstruse. Nonetheless, the importance of the topics covered makes the effort worthwhile. The technique of adding commentaries by thoughtful people in the field is helpful in putting Little’s views in perspective and in a contemporary context.

One of the unique contributions to the book is Little’s discussion of the ethics of surgery and the analysis of its five moral domains. These follow the progression of the surgeon–patient relationship through the process of surgery and the patient’s response to each stage. As Russell Gruen points out in his associated commentary, they “help us to understand why surgery cannot be practised as a purely technical exercise.” In medicine, which is increasingly technology-dependent, the promotion of humanism in physicians and surgeons must be a strong antidote to the impersonalisation and deprofessionalisation which technology can bring.

The other essays address the conflicts and dilemmas facing the practitioner in contemporary medicine. As one reads each essay there is an opportunity to reflect and gain a better understanding of the issues, whether the subject is euthanasia, death, the place of evidence-based medicine and epidemiology, the real issues of consent and whether it can be informed, the impact of resource restraints, or the demand for accounting logic in medicine leading to “ethonomics.” Physicians need to reflect on these issues if they are to bring care, compassion, and integrity to their practices. These essays are particularly useful to those in academic medicine where the teaching of the physician as healer and professional require humanism and reflection if these qualities are to be imparted.

Sylvia R CruessAssociate Professor of Medicine McGill University, Montreal, Canada