In an endeavor to explore the many shapes a career in medicine can take, Virtual Mentor will, in the coming months, profile medical doctors whose major contribution to medicine lies outside clinical practice and research. This month, VM looks at the career of H. Tristram Engelhardt, Jr, PhD, MD
Professor Engelhardt is among the pioneers of the movement known as bioethics, though that term characterizes the scope of his work far too narrowly. He has written more than 300 books, chapters, and articles that examine personhood and identity, bioethics, genetics, secular humanism, the deprofessionalization of medicine, Christian theology and ethics, animal rights, health policy, and much more. Professor Engelhardt has written and presented in 3 languages and been translated into 7 more. His Foundations of Bioethics, first published in 1986, was translated into Chinese in 1996 co-incident with the appearance of its 2nd edition in English. He is currently professor of philosophy at Rice University and professor emeritus at Baylor College of Medicine.
In answer to the rather bluntly posed, "Why did you decide not to pursue the practice of clinical medicine?" Professor Engelhardt answers that he is and has been a licensed physician since 1972 and enjoys clinical encounters with patients. But, he says, loosely quoting Spinoza, "to be one thing, a man must decide not to be many others." Engelhardt decided to be a doctor of medicine in the broadest sense of that term. To explore, as for centuries medicine had allowed physicians to do, the condition of human beings, their finite nature and the inevitability of suffering. At the time and place Engelhardt entered medicine—the 1960s and the American South—medicine still applied itself to understanding the human condition and not merely the diseases and dysfunctions of the human body. His internist father, Dr. Engelhardt senior, combined clinical practice in Texas with the translating of medieval Latin texts into "Texan." Engelhardt junior studied medicine at Tulane University, deep in the heart of physician-philosopher-writer Walker Percy's New Orleans. "There simply was no distance between studying medicine as a means for understanding the human condition and studying it as a science," Engelhardt says. "The profession attracted and fostered development of extraordinary men and women, permitting them—encouraging them—to be egregiously different." Engelhardt's anatomy instructor invited the 4 students assigned to 1 corpse to select a novel to read and discuss as they dissected their cadaver. The group chose Lawrence Durrell's The Alexandria Quartet.
Taking a leave of absence from medical school, Engelhardt attained a PhD in philosophy at the University of Texas in 1969, writing his doctoral dissertation on Kant, Hegel, and Husserl and the mind-brain problem. He returned to Tulane and completed his medical education, graduating with honors in 1972.
Medicine's course over the second half of the 20th century has been one of increasing deprofessionalization, as Engelhardt sees it, moving from a self-governing professional guild to a trade governed by society, the legislature, and the Supreme Court, itself. The main reason Engelhardt writes and teaches and studies and lectures rather than spending his days at the bedside is so that he can study medicine in the classical sense, as a scholar who comes to understand the framing context of medicine. This leads him to the history and philosophy of medicine. Western medicine developed in a Western Christian culture that believed in a divine creator, author of nature and humanity; it developed in a social context that trusted in the power of reason to uncover universal truth. "In our secularized, postmodern world, both a common belief in God and a trust in a common notion of moral rationality are absent," he says. How does medicine proceed when its foundation, its framework for posing and resolving problems, has crumbled? Pursuing such questions, Engelhardt wrote, in 2000, The Foundations of Christian Bioethics in which he asserted the need for a Christian ethic in a post-Christian world. He is currently working on a history of medicine project.
Can medicine regain a rightful claim as one of the learned "professions"? Engelhardt wants to say yes, but he doesn't see much encouraging evidence. For medicine to become a profession again, he says, physicians must reflect on their power, not respond and adapt uncritically to the morality around them. And they must begin by talking about the limits of life and the inevitability of suffering and death. As long as physicians turn their backs on these essential aspects of the human condition in doomed attempts to extend life at all cost, to dispense with all suffering, and to mend everyone's problems with medicine, they are, in Engelhardt's words, "uttering pious nonsense" and further eroding confidence in the profession. If physicians were to begin talking honestly about what medicine can and should do, Engelhardt believes that people would listen. As an example of someone who has done so, Engelhardt offers Dr. John Kitzhaber, governor of Oregon since 1995. Recognizing that no society can provide all the care that every citizen might like, Kitzhaber authored the ground-breaking Oregon Health Plan while he was president of the State Senate in the early 1990s, leading the citizens of Oregon in deliberating and coming to consensus on a system for rationing health services.
"Well, that's only one," Engelhardt says, "but it's a model of the expert, scientist, humanist, scholar, politician who can restore medicine to professional status." For his part, Tris Engelhardt, heading to Australia for a series of lectures on bioethics in February, continues to be, though not a clinician, most certainly a doctor of medicine.