Medicine as a Moral Art: The Hippocratic Philosophy of Herbert Ratner,M.D.

The New York Times, March 25, 1998, “Patients’ Lives on the Line in Battle Over Transplants,” by Sheryl Stolberg.

Letter of Tonelli Mark R. M.D. , in The New York Times of March 31, 1998.

See, for example, “A Medical Resistance Movement,” by Reed Abelson, in The New York Times, March 25, 1998. The same newspaper, in reporting the disbanding of the California Medical Association's managed care company, California Advantage, said: “…the medical societies of at least a dozen states, and tens of thousands of their physicians, have been forming organizations like California Advantage to manage patient care” (“Doctor-Owned Managed Care Plan Collapses,” by Peter Kilborn, June 17, 1998).

July 1, 1997, “Doctors Organize to Fight Corporate Intrusion,” by Peter Kilborn. During the past decade, the number of physicians working for managed care companies has grown by about half. Surveys by the American Medical Association indicate that by 1997 more than 90 percent of physicians had contracts with at least one managed care provider, up from less than 60 percent in 1989 (“A Medical Resistance Movement,” by Reed Abelson, The New York Times, March 25, 1998). The companies have had severe problems, not to say scandals. The largest health care company in the country, Columbia/HCA Healthcare Corporation, has seen wholesale resignations in its top management: by July 1997 its chairman and chief executive, its president and chief operating officer, its senior vice-president and general counsel, and its chief financial officer all had either resigned or declared the intention to do so (The New York Times, August 25, 1997, “Columbia/HCA Is Abandoning National Focus and Tough Image,” by Kurt Eichenwald).

“Doctors’ Group Considers Forming Union in California,” by Andrea Adelson, February 22, 1998. The same report noted that some physicians employed by the state are already represented by the Union of American Physicians and Dentists. This competing group, most of whose members are in private practice, first negotiated contracts in 1972. In August 1977 the union became affiliated with the American Federation of State, County and Municipal Employees, which is the second-biggest affiliate of the A.F.L-C.I.O.

See “Texas Will Allow Malpractice Suits Against H.M.O.'s,” by Sam Howe Verhoven, The New York Times, June 5, 1997.

The victory of Lois Capps over State Assemblyman Tom Bordonaro, a Republican who emphasized his prolife convictions, had been widely taken as a sign that the abortion issue had played itself out. For Mrs. Capps's own explanation, see “Voters’ Anger at H.M.O.'s Plays as Hot Political Issue,” by Kilborn Peter T. , The New York Times, May 17, 1998.

The board of the Moscati Institute includes Bishop Raymond Burke of La Crosse, Bishop Roger Schwietz of Duluth, Msgr. William B. Smith of the New York Archdiocesan Seminary at Dunwoodie, Yonkers NY, and the Editor of this review. Its address is 301 West First Street, Suite 526, Duluth MN 55802; phone (218) 728–5991, fax (218) 724–7528.

New York Times, Jan 6, 1998, “Panel Seeks H.M.O. Overseer For the Bellwether California,” by Todd Purdom.

New York Times, respectively June 27, 1998, “White House Adds Broad Protection in Medicare Rules,” and July 7, 1998, “Clinton to Punish Insurers Who Deny Health Coverage.” Both reports are by Robert Pear.

See, for example, the report of Sam How Verhoven cited above, and The New York Times, May 22, 1997, “Connecticut Votes to Restrict Denials Under Managed Care,” by Jonathan Rabinovitz.

The Weekly Standard, July 27, 1998, page 3.

“The Natural Institution of the Family Challenged”, Journal of the North American Montessori Teachers’ Association, Vol. 19, No. 2 (Spring 1994), p. 121.

De anima, II, iv.

I Metaphysics iii, 984b15–17. A less literate if more literal translation is given by Hugh Tredennick in the Loeb Classical Library series: “…he seemed like a sane man in contrast with the haphazard statements of his predecessors.”

“The Natural Institution of the Family Challenged”, Journal of the North American Montessori Teachers’ Association, 19,2, p. 122. Dr. Ratner is quoting from Fragment 327 of Pascal's Pensees in the Everyman's translation by W.F. Trotter. It reads in part: “…The sciences have two extremes which meet. The first is the pure natural ignorance in which all men find themselves at birth. The other extreme is that reached by great intellects, who, having run through all that men can know, find they know nothing, and come back again to that same ignorance from which they set out; but this is a learned ignorance which is conscious of itself. Those between the two, who have departed from natural ignorance and not been able to reach the other, have some smarter of this vain knowledge, and pretend to be wise. These trouble the world and are bad judges of everything.”

Probably the. most frequently cited passage from Aquinas on connatural knowledge is from the Summa theologiae II-II, 45,2: “…Right judgment…can occur in two ways: one, by the perfect use of reason; the other, because of a certain connaturality with those things about which one has to judge. Just as he who has dedicated himself to moral science judges rightly by rational enquiry those things pertaining to chastity, so, but through a certain connaturality to those things, does the man with the habit of chastity judge rightly about them.” To grasp St. Thomas's point, we must bear in mind that habit, for him, is a kind of second nature. The least that can be said here is that the “second nature” of the virtue of chastity steadies a man's judgment about the Tightness or wrongness of genital behavior. St. Thomas is supplying a reason for the Aristotelean dictum that if you want to know the right thing to do, consult the just man. For knowledge through empathy, see Edith Stein, On the Problem of Empathy, transl. Waltraut Stein, (The Hague: Martinus Nijhoff, 1964) ch. IV; also translator's introduction, esp. pp. XVII and XVIII. For a history of the concept in psychology and philosophy, see Nancy Eisenberg and Janet Strayer, eds., Empathy and Its Development (Cambridge: Cambridge University Press, 1987), ch. 2.

A study published April 15, 1998 by the Journal of the American Medical Association reported that more than 100,000 patients a year die in U.S. hospitals from drug reactions. That would make adverse reaction to medication a leading cause of death in America. An author of the report, Dr. Bruce Pomeranz, said: “We want to increase awareness that drugs have a toxic component.” He told The New York Times of April 15 that drug reaction was underreported as a cause of death because it is rarely reported on the death certificate, which might list stomach hemorrhage as the cause of death without mentioning that the hemorrhage was caused by a drug. He estimated that there were from 76,000 to 137,000 deaths from medication a year, while the number of deaths attributed to that cause on death certificates in 1994 was 156. Dr. Pomeranz, a professor of neuroscience, and his colleagues at the University of Toronto combined the results of 39 smaller studies in a technique called meta-analysis, which gives researchers the possibility of drawing statistically significant conclusions. The method has its critics, and the authors noted that the results of their study should be taken viewed with caution. This was echoed by an editorial in the Journal by Dr. David Bates, an associate professor of medicine at Harvard. According to the Times, Dr. Bates speculated that the death rate reported in Dr. Pomeranz's study might be exaggerated because the study focused on large teaching hospitals with the sickest patients. Patients in intensive care, he noted, might receive 20 or 40 drugs. He said that drugs probably save millions of lives yearly. Drs. Bates and Pomeranz agreed that benefits from drugs far exceed risks in the great majority of cases.

The Natural Institution of the Family Challenged, Journal of the North American Montessori Teachers’ Association., p.143.

Editor's Note in Nature, the Physician, and the Family (Rockford, Illinois: TAN Books, 1998), the collected works of Herbert Ratner.

“Dutch Physicians’ Protest against Nazi Regulations,” Child & Family, Vol 11, No. 2, 1972. The review, edited by Dr. Ratner, said the statement was “reprinted from Repression and Resistance — The Netherlands in Time of War, Vol. II, p. 352,” and that the translator was Conrad W. Baars, M.D.

“Dutch Physicians’ Protest against Nazi Regulations,” Child & Family, Vol 11, No. 2, 1972. The review, edited by Dr. Ratner, said the statement was “reprinted from Repression and Resistance — The Netherlands in Time of War, Vol. II, p. 352,” and that the translator was Conrad W. Baars, M.D.

Reproduced in Healthline, March 1995.

As well as being a physician, Moses Maimonides (1135–1204) was a philosopher and theologian highly regarded by Christian theologians of the Middle Ages. St. Thomas quotes him often, under the name of Rabbi Moses. According to a study by Fred Rosner (“The Physician's Prayer Attributed to Moses Maimonides” in Legacies in Ethics and Medicines, ed. Chester Burns [New York: Science History Publications, 1977]), this prayer “first appeared in print in a German periodical in 1783,” with the note: “From the Hebrew manuscript of a renowned Jewish physician in Egypt from the Twelfth Century.” Seven years later it appeared in a Hebrew translation from the German. Half a century later it was published in an English rendering of the Hebrew. Rosner traces the adventures of this prayer over a period of almost two centuries, and after an analysis of external and internal evidence concludes that it very probably is “a spurious work, not written by Maimonides but composed by an eighteenth century writer.”

Roe v. Wade, 410 U.S. 130, 93 S. Ct. 705 (1973), at 132.

Edelstein L. , Ancient Medicine, eds. Temkin Owsei , and Lillian Temkin C. , transl. C. Lilian Temkin (Baltimore: Johns Hopkins Press, 1967), p. xii, Editors’ Introduction.

Prophetically, one might think, Edelstein held that two stipulations of the Oath “seem to point to the basic beliefs underlying the whole program,” namely renunciation of complicity in suicide and in abortion” (op. cit., p. 8). Hence he held that they could “provide a clue for historical identification of the views embodied in the Oath of Hippocrates,” and based his study and his conclusions on that clue.

Op. cit., p. 327, in “The Professional Ethics of the Greek Physician.” This lecture was first published in the Bulletin of the History of Medicine, 1956, vol. 30, pp. 391–419.

Op. cit., p. 63, in “The Hippocratic Oath.”

Op. cit., p. 63, in “The Hippocratic Oath.”

Editors’ introduction to Ancient Medicine, p. ix.

Ancient Medicine, passim.

Op. cit., pp. 327–328, in “The Professional Ethics of the Greek Physician.” For Edelstein's attention to translations, see editors’ introduction, p.xiii.

An article in the New York Times, Dec. 16, 1997, “New Way of Doctoring: By the Book,” discusses attempts to harness the medical research available on the internet, and to base treatment on it. It is termed “evidence-based medicine.” The writer, Abigail Zuger, quotes a comment by Dr. Sandra J. Tanenbaum of Ohio State College of Medicine that “no one thing works for everyone all the time,” adding that that's where the art of medicine comes in. To this Dr. David L. Sackett, director of the Centre for Evidence-Based Medicine in Oxford, England, responded, “art kills.” He added: “It was the art that gave us purging, puking, leeches, the gastric freeze, all that sort of stuff…. There's a science to the art of medicine.”

“The Oath V. Why?” Child & Family, Vol. 10, No. 4, 1971, p. 290. This is the fifth in a series of six articles by Dr. Ratner on the Hippocratic Oath.

I Metaphysics I, i (981b29–982a1).

Op. cit. (981a14–18).

Op. cit. (19–24).

Op. cit. (24–30).

Op. cit. (981b2–5).

Summa contra gentiles, II, 75,15.

Poetics, iii, 4, begins as follows: “It is clear that the general origin of poetry was due to two causes, each of them part of human nature. Imitation is natural to man from childhood, one of his advantages over the lower animals being this, that he is the most imitative creature in the world, and learns at first by imitation. And it is also natural for all to delight in works of imitation…. The explanation is to be found in a further fact: to be learning something is the greatest of pleasures not only to the philosopher but also to the rest of mankind, however small their capacity for it…” (1448b1–5). (I have followed the translation of Ingraham Bywater because its rendering of mimeomai and its cognates in terms of imitation rather than representation not only fits the text better but more fully substantiates our point.)

In Boetii de Trinitate V, 1, ad 3. For much the same argument see Summa theologiae I—II, 57, 3, ad 3. There St. Thomas also holds that they are called “liberal” to distinguish them from “those arts which are ordered to works carried out by the body, which are in a certain sense ‘servile’ insofar as the body is subject to the soul as a servant, and man is free [liber] because of his soul.”

Chadwick John , and Mann W.N. , The Medical Works of Hippocrates (Oxford: Blackwell, 1950), p. 81.