Preface

 

Dear Andreas,

First-allow me to congratulate you and your colleagues; your first international Davos conference on Ethics and Medicine was an important and meaningful event. Although I could not stay until the end, I have heard enough statements to appreciate the high level of the entire gathering. All reflected a deep concern for the humanity of the patient and the urgency of the problems it poses.

Ethics and medicine ... On the surface, they may seem intriensically connected. How could one envisage the one without the other? Hasn't the physician been the bearer of moral principles in their immediate application? Can one imagine a good physician without a moral conscience to guide him or her in deciding what to say or do to the patient?

I owe you may sincerity: when I was younger, I have seen physicians betray their calling and serve the Angel of Death. They had graduated from the most prestigious medical schools in Germany - and ended up as executioners' helpers in the darkest of all dark places.

Some of my younger friends were so traumatized that, after the war, they need time to allow doctors to examine them.

To the shame of society, many if not most of the Nazi-doctors were allowed to return to their homes and reopen their practices.

The meaning of it all? Like with love or money, it all depends what one does with medicine. It is up to the doctor whether it does honor or dishonor to the human family.

Think of the patient - and you will never go wrong. Think of the singular relationship that is bound to develop between patient and physician. It is based on trust and gratitude. When you save someone's life, you too will be thankful.

The patient believes that only you understand him - that you alone pay attention to his complaints and woes. The hypocondriac himself is no exception.

Do not diminish a patient's self-respect by denigrating his pain. The French classical playwright Molière was wrong in ridiculing "the imaginary patient" who thought he had pain but didn't. A person who thinks he has pain DOES have pain. And fear. And hope. Medicine's problem become acute when one person's hope becomes another's distress.

When Alfred Kubrin, the novelist, fell mortally ill with cancer, he was told by his eloquent physician not to worry, to have no fear, he replied: Please, doctor, fear is the only thing I still have; don't take it from me.

This anecdote has bio-ethical connotations that concern modern-day medicine.

What would you do in that physician's place?

Will you tell a dying that he or she is dying? How far will you go in revealing or concealing the truth? And if the patient refuses to go on living in pain, at what point may his or her will become your own?

There again, it is the patient's desire that must come first. Respect his or her dignity. As long as they suffer, they are still alive. As long as they live, their mortal image is a reflection of God's immortality.

With medical technology being what it is - a magnificent instrument in the service of life and the sacredness of life - the surgeon will perform miracles. But he or she may also encounter obstacles, disappointments. In all cases and all tales, Death is the ultimate victor. And yet - as long as the living are alive, Death is being vanquished day after day, hour by hour, minute by minute.

It is being vanquished as long as the patient is seen as a person in anguish, a victim suffering not only from pain but also from solitude.

What must today's physician do to always remember that before him or her there is a man or a woman with a name, a face, a memory, a destiny, in other words: a human being worthy of compassion and solidarity, strangely vulnerable and mysteriously strong?

I am looking forward to our next conference.

Elie Wiesel

 

Prof. Elie Wiesel
Boston University, 745 Commonwealth Avenue, Boston, MA 02215, USA