360 - The Physician's Covenant: Images of the Healer in Medical Ethics

The Physician's Covenant:
Images of the Healer in Medical Ethics
By William F. May
Philadelphia, Westminster Press. 1981. 104 pp. $ 10.95.

In this book, the author studies the role of the physician as reflected in various images used over the centuries. The physician has been seen as a parent, a fighter, a technician, teacher, and a covenanter. The last image is inclusive of other images, and May feels that it is really the basic image.

The physician has stood out over the centuries as a parental figure. This included both a paternal and maternal dimension. More recently,

362 - The Physician's Covenant: Images of the Healer in Medical Ethics

the trend is away from this image It is even competing with a kind of anti-parentalism or anti-paternalism. This is a reaction to the tendency of the physician to become possessive in dealing with patients, as well as the tendency to deal with them as parents deal with children. In anti-paternalism, patients assert themselves and their own autonomy. It is one's own body that is being treated, so the patient wants to have a say in the treatment. In the extreme it aims at full freedom, even calling for the cooperation of others with the wishes of the patient apart from any moral restraints. The trend away from paternalism is also shown in the emphasis today which is put on the contract relationship between doctor and patient. But the paternal image still continues. There are many good features of the relationship which this image captures and insists on. It would be a shame to sacrifice these features of the relationship to escape some of the more objectionable features.

The second image is that of a fighter. The image is taken from the military and so has a military connotation. The physician is involved, for example, in the "fight" against cancer, the "battle" against disease, etc. This image tends to put a distance between the physician and the patient. The battle is with the disease, etc., and the danger is that the patient will be given secondary consideration.

The third image is that of the technician. The physician is seen as one practicing an art. This really says much more than the word "technician" implies as it is used today. It deals with medicine as an art and implies that the physician is practicing it in the best way possible, as a master of the craft. The term fastens on the practice of medicine as a means, so the emphasis is not on the goal of medicine or the aspects reflected in the other images.

May considers the image of the covenanter as most appropriate to the physician. This has a biblical background and emphasizes the role of the physician as a person who is indebted rather than as a philanthropist or a benefactor. The physician is indebted to superior powers and also to the community, including the patient. The relationship is one of response and reciprocity rather than philanthropy or condescension. It certainly seems to assume a healthier attitude for the physician. May feels the convenantal approach is far superior to that of contract. While the latter has its merits and has de-emphasized some of the more objectionable features of the parental approach, it is still objectionable and incomplete. For instance, it tends to suppress the personal dimension in the relationship, whereas the covenantal relationship is basically personal.

May sees in the "new covenant" of Christianity the expression of sacrificial love. This is what should be basic to the physician -patient relationship. This kind of covenant does not, of course, originate in the New Testament. It was basic to the relationship of God with Israel, and was to be symbolized even in the "old covenant" in the marriage relationship.

The final image is that of teacher. The physician plays this role primarily toward the patient. The doctor must teach the patient how to

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handle acute situations, how to prevent disease, how to be rehabilitated, and how to handle terminal situations.

The reader will profit greatly from May's analysis of the doctor-patient relationship. The present reviewer would have liked to see more reconciliation between the concept of contract and that of covenant. There is a tendency in today's society to see these two notions as incompatible, so more attention to reconciling them seems appropriate. Also, more human understanding of covenant, and the type of covenant that exists between physician and patient might have resulted from comparing and contrasting the physician-patient covenant with the marriage covenant.

John R. Connery, S.J.
Loyola University
Chicago, Illinois