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Medicine and the Arts

Commentary

Parasidis, Efthimios JD, MBE

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doi: 10.1097/ACM.0b013e318276bb34
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The Ancient Greeks were the first to formulate a rational and theoretical system of medicine that was based on natural causes and, at the same time, free from religious elements. This was a significant advancement on the practice of medicine in neighboring cultures, such as Ancient Egypt and Mesopotamia, and furthered the evolution of medicine as a scientific discipline. The Ancient Greeks analyzed diseases in terms of their physical constituents rather than through reference to mythological or supernatural phenomena. The first known Greeks to subscribe to this approach were Thales, Anaximander, and Anaximenes, often referred to as the Milesian Natural Philosophers. Their ability to rationally describe and classify disease without recourse to divine interventions established a symbiotic relationship between the rigorous analytical practice of philosophy and the newly developing naturalistic approach to medicine.

The work of the Milesian Natural Philosophers was cultivated through the fifth, sixth, and seventh centuries BCE, through the writings and teachings of Greek philosophers that include Pythagoras, Heraclitus, Socrates, Hippocrates, Plato, Democritus, and Aristotle. Of the Ancient Greek philosophers whose work furthered the evolution of medicine as a science, Hippocrates emerges as perhaps the most influential. Born on the island of Cos circa 460 BCE, and widely regarded by his peers as the ideal physician, Hippocrates is most recognized through his famous work The Oath. The Oath has “for centuries served as an exemplar of medical etiquette and has influenced the attitudes of generations of doctors.”1 Although many physicians are familiar with The Oath, few have examined the extensive collection of writings known as the Hippocratic Corpus, a body of work that consists of approximately 60 treatises.

Contemporary medical ethicists often depict the doctor–patient relationship of Ancient Greece as paternalistic, arguing that ethical norms dictated that doctors should conceal diagnosis and prognosis from a patient. A close review of the Corpus reveals that this characterization is incorrect. To the contrary, Hippocrates’ writings in the Corpus promote an informed and respectful relationship between physician and patient.

As Hippocrates explains in the Aphorisms and Prognostic, physicians should be mindful to carefully explain both diagnosis and prognosis to their patients and should obtain informed consent prior to treatment. While Hippocrates’ remarks in the Decorum may seem to contradict the statements in the Aphorisms and Prognostic, there is an alternative and more plausible reading. Namely, the Decorum can be read to express the belief that, since no two patients are alike, it may be in certain patients’ best interest not to know the full extent of their illness.

The notion that some patients may benefit from not being fully informed—which underscores the benefits of positive psychological reinforcement—is found throughout Hippocrates’ writings. As he explains, for some patients, health outcomes may be improved through full disclosure of the underlying illness and possible courses of treatment; for others, positive health outcomes are more likely to follow from minimal disclosure. This position parallels Hippocrates’ view that the human brain is the source of pleasure, pain, and consciousness.2 According to Hippocrates, since the brain is “the interpreter of comprehension” and has the power to heal, in structuring a course of treatment for a particular patient, the doctor should focus on ensuring that the patient has peace of mind.2

Indeed, in Hippocrates’ day, over 2,400 years ago, the relative influence of a patient’s strong psychological state in the ability of a patient to overcome an illness was particularly significant. At a time where medication primarily consisted of roots, herbs, and nectars, the role of positive psychological reinforcement was tantamount to the ability of a patient to overcome his or her illness. In fact, such sentiments are frequently echoed in modern-day research.

The writings of Hippocrates make clear that, for the Ancient Greek physician, conflicting ethical theories and norms existed as to whether, and in what circumstances, full disclosure of diagnosis or prognosis was advisable. Whereas Hippocrates’ writings in the Aphorisms and the Prognostic emphasize the importance of securing the cooperation of the patient, the Decorum makes clear that certain patients will benefit from a lack of knowledge as to the nature of their illness or course of treatment. In other writings, Hippocrates examines the ethical dilemma that results from not providing a patient with sufficient knowledge as to their illness or treatment regimen. In the Canon, for example, Hippocrates goes as far as to criticize the lack of ethical and legal regulations in Ancient Greece.

The extensive writings of Hippocrates and other Ancient Greek philosophers provide physicians with valuable insight into the origins of medicine as a scientific discipline. In addition to formulating a naturalistic concept and explanation of disease, the Ancient Greeks demonstrated extensive devotion to building and evolving an ethical system of medicine that was based on the ideal of a noble and respected physician whose primary goal was to serve the best interests of the patient.

References

1. Longrigg J Greek Medicine: From the Heroic to the Hellinistic Age.. 1998 New York, NY Routledge
2. Lloyd GER Hippocratic Writings.. 1983 New York, NY Penguin Books
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