|Year : 2001 | Volume
| Issue : 1 | Page : 103-109
The relevance of humanism in medical profession
Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry - 605 006
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Humanism is a system of beliefs concerned with the needs of people. Patients have clinical care needs as well as interpersonal care needs. Clinical care requires skills of diagnosing and treating. Interpersonal care requires qualities of integrity, honesty, respect, empathy, compassion and altruism. With continuing advances in science and technology, diagnosis and treatment are becoming more and more sophisticated and interpersonal care is neglected. Humanism in medicine aims to promote interpersonal care of patients. In this article, rationale and evolution of humanism are described, humanism in medical profession is discussed and ways for promoting humanism in medical profession are enumerated.
Keywords: Humanism; Human Rights; Patient′s Rights; Medical Profession.
|How to cite this article:|
Kumar S. The relevance of humanism in medical profession. Indian J Urol 2001;18:103-9
| Introduction|| |
Although the word human is derived from Latin word humanus which is based on homo or man, the term human being or human is used for a person when we want to emphasise his/her differences from animals and machines. Humanism is a system of beliefs concerned with the needs of people. The idea of humanism was initially developed during Renaissance in the fourteenth to sixteenth centuries to oppose the supremacy of religious ideas and absolute monarchies of the Middle Ages. A humanist is an adherent of humanism. The word 'humane' denotes treating people in a way that is not cruel and causing them as little pain or suffering as possible.' To humanise means to make a system more pleasant or more suitable for people.
The key concepts of humanism are depicted in [Figure - 1]. All human beings have certain needs. These needs are satisfied by human beings by being allowed to do something and by having something done to them. The satisfaction of human needs becomes human rights when society gives moral, ethical, legal or official recognition to it. The right to do something exists when we are morally, legally or officially allowed to do it.- Human rights are the basic rights that every person has to be treated in fair, equal way without cruelty, especially by their government.
In any human system or organisation consisting of two or more persons, power distribution is not equal. There is a chance of unfair and unequal treatment (discrimination) because of race, religion, age, sex or personal beliefs and exploitation (utilizing other persons for one's own ends). Humanism and human rights seek to prevent discrimination and exploitation.
Besides human rights which apply to all human beings, there are humanistic values and rights for specific groups of human beings such as women, children. workers, consumers and patients. [Figure - 2] gives key concepts of humanism as applied to patients as a specific group of human beings.
This article describes the rationale and evolution of humanism, discusses humanism in medical profession and enumerates ways for promoting humanism in medical profession.
| Rationale for humanism|| |
There are three schools of thought for logical basis of human rights.
1. Theory of Natural Law
People have certain basic rights because they are human beings created equal by God or nature.
2. Utilitarian Theory
Human rights are useful because society benefits from the free and open exchange of ideas.
3. Political State or Society Theory
Rights and liberties come from the political state or society to which a person belongs. A government gives and protects the rights.
| Evolution of Humanism|| |
1. Humanism in Political System
The English Parliament in 1689 passed a law that included a "bill of rights", following the English Revolution. The law provided that Parliament would be more powerful than the king and that the people would have certain basic liberties. In 1789 after the French Revolution, the Declaration of the Rights of Man and of the Citizen stated the rights of the French people. During the American Revolution, the American Declaration of Independence of 1776 stated, "All men are created equal and are endowed by their Creator with certain unalienable Rights." A bill of rights was passed by the United States Congress in 1791.
The philosophy of democracy is based on the beliefs that all should have the same basic rights and freedom and that people should be free to govern themselves.
In 1948, Universal Declaration of Human Rights was passed by the United Nations. Human rights consist of political (civil), social and economic rights. These Human Rights are also incorporated in the Indian Constitution as Six Fundamental Rights (Right to Equality, Right to Freedom, Right against Exploitation, Right to Freedom of Religion, Cultural and Educational Rights and Right to Constitutional Remedies). In 1975, USA, Canada, Western European and other countries signed the Helsinki Agreement which includes a clause that all countries will work to promote human rights. Amnesty International is a private organisation working for the protection of human rights.
2. Humanistic Psychology
In the psychophysiological model of psychology, behaviour is guided by physiological processes. In the psychodynamic model of psychology behaviour is motivated by heredity and early childhood experiences (Sigmund Freud) which is a pessimistic approach. According to behaviouristic model of psychology, behaviour is determined mechanically by environmental conditions. According to cognitive model of psychology, human behaviour is motivated by the processes of knowing (e.g. thinking, remembering, expecting).
In humanistic model of psychology, human behaviour is motivated by self-actualisation needs (Carl Rogers, Abraham Maslow), which is an optimistic approach. This model asserts that human potential is unlimited and human beings can be motivated under appropriate conditions for better performance (Human potential movement).
3. Humanism in Industrial Organisations
Interests of workers are protected by the Constitution of India. Under Fundamental Rights, Right to Equality states that the State cannot discriminate against anyone in the matter of employment by the State. Right to Freedom includes freedom to form associations or unions and freedom to practise any profession or to carry on any occupation, trade or business. Right against Exploitation states that children under 14 years of age should not be employed in factories or mines. Directive Principles of State Policy include the right to work and the right to equal wages for equal work. The instructions to government say that the government should secure a living wage, suitable conditions of work and a decent standard of life for all workers and should ensure that workers in factories can have a share in decision making.
Rights of workers are protected by various labour legislation in India (Trade Union Act, 1926; Industrial Disputes Act, 1947; Factories Act, 1948).
| Humanism in Medical Profession|| |
Patients have following expectations (needs or problems).
- Patients want to be listened to and understood.
- Patients want physicians to be interested in them as fellow human beings.
- Patients expect professional competence in medical science and technology.
- Patients want to be kept informed.
- Patients want not to be abandoned.
Patient care consists of definition or diagnosis and management of these needs or problems. These needs can be classified into two types:
- Clinical care needs
- Interpersonal care needs
Above stated need No. 3 comes under clinical care needs and needs 1, 2, 4 and 5 come under interpersonal care needs.
Clinical care refers to the application of clinical medicine to a personal health problem. Clinical care is oriented to biomedical aspects of the disease. Clinical care requires skills of diagnosing and treating diseases.
Interpersonal care comprises the management of the social and psychological interaction between the patient and the doctor. Interpersonal care is oriented to the social and psychological aspects of the disease. Following qualities are required for interpersonal care.,
Integrity is the quality of being honest and of always having high moral principles. Honesty is the quality of not telling lies, not stealing, etc. Respect is defined as the personal commitment to honour the preferences, choices and rights of others regarding their medical care and to recognise the dignity and freedom of the patient. Empathy is the ability to understand other people's feelings and problems.
Compassion is a strong feeling of sympathy for someone who is suffering and a desire to help them. "Genuine compassion is based on a clear acceptance or recognition that others, like oneself, want happiness and have the right to overcome suffering. On that basis one develops some kind of concern about the welfare of others, irrespective of one's attitude to oneself. That is compassion." Altruism is the practice of thinking of the needs and desires of other people instead of your own. Altruistic behaviour shows that you care about others more than you care for yourself. Altruism is regarded as the hallmark of the humane clinical encounter.
Traditionally, the doctor patient relationship has been in a paternalistic mode in which doctors make choices for patients based on professional values. However, with the emphasis on humanistic values, doctor patient relationship has become a more equal relationship of shared decision making in which doctors advise patients but ultimately patients make their own choices. Advantages of shared decision making include greater trust and loyalty in the doctor patient relationship, more cooperation in implementing shared decisions, greater satisfaction for patients from their health care and better clinical outcomes in several chronic diseases.
With continuing advances in science and technology, diagnosis and treatment are becoming more and more sophisticated and interpersonal care is being neglected. Since 1990s, there have been continuing efforts to reintegrate the scientist and the healer in the physician.
The idea of patient's rights is an extension of the concept of human rights. Patient's rights have been grouped into following categories:
- Right to health care and humane treatment.
- Right to information.
- Right to adequate prescribing information.
- Right to redress grievances.
- Right to health education.
Right to health care and humane treatment includes a clause that every patient should be treated with care, consideration, respect and dignity without discrimination of any kind.
Surgical Patient's Rights
Surgical patients have a right to ask following questions.
- What will this operation do for me?
- What will happen if I don't have the operation?
- What are the chances my problem will recur after surgery?
- Are there medical alternatives to surgery?
- Would changes in life-style help?
- Am I at greater-than-average risk?
- Is there another operation that is less expensive, painful or deforming?
- What's your experience with this operation?
- What happens during the operation?
- How much time will it take?
- What type of anaesthesia does the anaesthetist recommend?
- How can I improve my chances of success?
- What complications are possible?
- Am I likely to have much discomfort?
- How long should my recovery take?
Dr. George Crile, emeritus consultant at the Cleveland Clinic, advised patients:
Remember this about surgery:
There are risks.
There are benefits.
There are choices.
There are alternatives.
It is your body.
It is your life.
The final decision is yours.
Characteristics of a Profession
A profession has following characteristics.
- An organised body of knowledge and skills.
- A long training period to acquire knowledge and skills.
- Need for a life long learning approach.
- A concern for client welfare (social commitment).
- Professional code of ethics.
As medicine is a profession, humanism is an integral part of it as emphasised by the fourth and fifth characteristics. The Hippocratic Oath usually administered to medical graduates at their graduation embodies humanistic guidelines. Similarly, the abridged Charaka Oath, given below, incorporates humanistic principles:
"Not for the self,
Not for the fulfilment of any worldly material desire
But solely for the good of suffering humanity,
I will treat my patients and excel all."
The Medical Council of India has also prescribed a code of medical ethics which is to be administered as an Oath at the time of registration of a doctor."
Consumer Protection Act
As personal morals and professional ethics failed to redress grievances of patients, the government had to bring in Consumer Protection Act (1986) for the protection of patient's rights and the redressal of their problems. All doctors and hospitals who charge any of their patients for medical services come under the purview of Consumer Protection Act.'
| Promoting Humanistic Values in Medical Profession|| |
A value is defined as an enduring belief, a specific mode of conduct or end state existence, along a continuum of relative importance. Humanistic values include integrity, honesty, respect, empathy, compassion and altruism. Humanism in medicine, medical ethics, humanities and medicine and professionalism in medicine all endeavour to promote humanistic values in medical profession.
The prevailing belief says that it may be possible to improve the understanding of ethics and foster skills in recognising common ethical problems but it may not be possible to influence students' beliefs and values or ensure ethical conduct. But this view is being challenged. Beliefs and values form a part of medical culture and come under "hidden curriculum" which falls outside the formal curriculum. Hence there is a need to address both formal and hidden curricula.
A Course on Medical Ethics
Ethics is the science of moral principles and rules of conduct. Most of the medical schools in USA and UK teach medical ethics as a part of their curricula. The General Medical Council of UK stated in Tomorrow's Doctors that students by the end of the medical curriculum should "acquire a knowledge and understanding of ethical and legal issues relevant to the practice of medicine... and an ability to understand and analyse ethical problems so as to enable patients, their families, society and the doctor to have proper regard to such problems in reaching decisions. It also recommends that ethics teaching should "reinforce the overall aims of medical education: the creation of good doctors who will enhance and promote the health and medical welfare of the people they serve in ways which fairly and justly respect their dignity, autonomy and rights." The contents of medical ethics education include ethical theory, rights and duties of doctors, doctor patient relationship, informed consent, confidentiality, assisted conception, organ donation, etc.
A Course on Humanities
Human beings are collectively known as humanity and humanities denotes learning or literature concerned with human culture especially the study of Latin and Greek literature and philosophy. Humanities also mean subjects of study such as literature, history, philosophy, etc. Medicine is the most scientific of humanities and it is a discipline combining science with art.'
It is suggested that study of humanities should facilitate promotion of humanistic values. Literature helps students to gain an insight into experiences that they have not encountered or may never encounter. It can engage the emotions and reveals and challenges hidden values and prejudices enabling introspection and self awareness. Students can develop ability to cope with and express strong emotions., - Literature can inspire, evoke different emotional responses and perpetuate an interest in reading and writing. Assignments in humanities course include in-depth criticism of literary work and essay writing. The reading includes a mixture of prose, poetry and drama with a mixture of classics and modern writing. Subjects can include illness, disease, disability, doctors, patients and ethics. Leading journals (British Medical Journal and The Lancet) include humanities articles to promote humanistic values.
A Course on Human Rights
It is universally considered desirable to have respect for human rights. Human rights education is finding place in different educational curricula and the medical curriculum is no exception. The objectives of human rights course include providing students with a knowledge of human rights, making them understand how human rights abuses can occur, helping students understand the ways of protecting human rights, helping them to develop the capability of working in groups, assisting students to de velop communication skills and assisting them to develop an attitude which respects human rights as an integral part of medical practice. The topics in human rights course include medicine and human rights, mechanisms of redress, torture case study, medical involvement in torture, physician participation in death penalty, AIDS/HIV and public health, women's rights and rape in war and seeking asylum.; The human rights course is predominantly taught using self-directed learning methods.
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[Figure - 1], [Figure - 2]