The Doctor’s Worldview
by John Wyatt
Is Western medicine based on a particular worldview?
This is a large and complex topic and it is not possible to deal with it in any depth in this File. However, it is very clear that the history of Western medicine is based primarily on an alliance between the ancient pagan craft cult of Hippocrates (which was probably in turn based on Pythagorean philosophy) and the ethical tradition of Judaeo-Christianity (.
- Naturalism – the philosophical position that everything can be explained in terms of natural causes and laws
- Utilitarianism – the belief that good actions are determined by maximizing the total happiness and satisfaction and minimizing the total pain and suffering in the world
- Theism – Belief in the existence of a personal God who created and sustains the physical universe
- Transcendent – a form of reality which is beyond and independent of the physical universe
The earliest version of the Hippocratic oath starts with an invocation to the gods: ‘I swear by Apollo Physician, by Asclepius, by Hygeia, by Panaceia and by all the gods and goddesses, that I will carry out, according to my ability and judgement, this oath…’ In the first centuries after Christ the oath was Christianised, and the introduction was changed to the words: ‘I swear by Almighty God…’ but the basic structure is unchanged.
It is clear that at the heart of the Hippocratic oath is a recognition that the individual doctor is practicing before a higher power – a power to whom he or she is accountable. But it is striking that Hippocratic doctors did not swear by the Emperor, by the State, or by local lords and authorities. Their oath was taken before the highest possible authorities. In philosophical terms it is a recognition of transcendence, an appeal to ultimate authority. So, historically, the moral framework of medicine fitted within a theistic worldview, where moral accountability lay not with the State, but in the realm of the transcendent, the divine.
The Hippocratic oath also reflected moral presuppositions about the significance of human lives. It reflected a reverence for the sanctity of all human life; for the intrinsic value of human existence, however affected by disease, suffering or disability; and for an absolute requirement on doctors to respect and protect the integrity of their patients, even at the cost of their own wellbeing.
The UK General Medical Council
The GMC guidelines Good Medical Practice () uphold the Hippocratic values of sel-sacrificial caring and respect for patients, whatever their life choices and beliefs; together with the duty to protect patients from all kinds of harm or threat; and to act in their best interest. The GMC also recognizes that doctors have a legal right to conscientious objection to perform certain procedures (such as abortion). (
The GMC has recently published more detailed guidance called Personal Beliefs and Medical Practice (). It recognize that ‘personal beliefs and values, and cultural and religious practices are central to the lives of doctors and patients’ and that ‘all doctors have personal beliefs which affect their day-to-day practice’. However, the GMC states that doctors who practice in the UK must be prepared to set aside their personal beliefs where this is necessary in order to provide care in line with the principles in the official guidelines Good Medical Practice.
The GMC also recognizes that ‘for some patients acknowledging their beliefs or religious practices may be an important aspect of a holistic approach to care’, but warns: ‘You should not normally discuss your personal beliefs with patients unless those beliefs are directly relevant to the patient’s care. You must not impose your beliefs on patients, or cause distress by the inappropriate or insensitive expression of religious, political or other beliefs or values.’
In essence, the GMC recognizes that doctors have different worldviews and that this will inevitably lead to differences in attitudes and practices. However, GMC registration as a doctor requires that all doctors agree to follow the broad ethical principles and practices within Good Medical Practice guidance. Implicit within this is the assumption that despite differences of worldview, a large measure of agreement and convergence in medical practice is possible.
Implications and Conclusions
Although worldview are rarely discussed or mentioned, they are crucially important in medical ethics and practice. It is therefore helpful to become more consciously aware of, and to reflect about, our own fundamental beliefs, commitments and presuppositions, and to encourage others to be more honest and transparent about their own presuppositions and assumptions. When discussing ethical issues with colleagues or fellow-students, we should be encouraging one another to identify our presuppositions and how they influence our ethical beliefs.
Despite holding different worldviews, it is usually possible to collaborate with other healthcare professionals and seek agreement in practical action, provided we maintain a respectful and tolerant attitude. However, we must recognize that, while rational and respectful debate between opposing ethical views is helpful, there will be times when agreement is not possible because of a fundamental divergence of worldviews. In these situations we must respect the integrity of the other and agree to disagree, whilst requesting that others respect our integrity by granting us the right of conscientious objection to actions which fundamentally conflict with our moral values.
From a Christian biblical perspective, our goal is to guard our heart, to ensure that it is continually moulded and transformed by the truth and power of Christ. ‘The good man brings good things out of the good good stores up in his heart, and the evil man brings evil things out of the evil stored up in his heart. For out of the overflow of his heart his mouth speaks-(Luke 6:45).
John Wyatt is Professor of Ethics and Perinatology at University College London
Futher Reading :
- Naming the elephant, Worldview as a concept by James W Sire. IVP, 2004
- The universe next door by James W Sire. IVP, 2004
- Worldview, history of a concept by David Naugle. Eerdmans, 2002
- Matters of Life and Death (2nd Edition) by John Wyatt. IVP/CMF, 2009
Christian Medical Fellowship (CMF) Files No:40 2009