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So act as to treat humanity... in every case as an end withal, never as a means only... - Kant
From "The Fate of Idealism in Medical School," published in American Sociology Review:
As a result of the increasingly technical emphasis of his thinking the [medical] student appears cynical to the nonmedical outsider, though from his own point of view is simply seeing what is 'really important.' Instead of reacting with the layman's horror and sympathy for the patient to the sight of a cancerous organ that has been surgically removed, the student is more likely to regret that he was not allowed to close the incision at the completion of the operation....[654]
An article from Pediatrics describes a student who, after diagnosing a patient with cancer in the lung, was "disappointed" to discover his diagnosis was wrong upon viewing the X-ray. "About two seconds after I realized the sense of disappointment, I thought, 'You are really perverted! All your training has been screwed up!'"[655]
Medicine department chair L.W. Eichna:
I have saved this principle [of demanding the highest ethical conduct] until last because of its importance and the almost total neglect of it in medical-school education.... Patients are looked on not as ill people but almost as impersonal beings that exist for the students' own development. Faculty confirm this attitude in their teaching. They too have an ingrained ethical blind spot... the patients are treated as teaching material.[656]
He that is not free is not an Agent but a Patient - John Wesley
"Patients know that the worse their dilemma, the more interesting they are to the doctors who are talking about them," writes a doctor who fell ill. "I began to weep when I realized that I was the great case."[657] H. Jack Geiger, an MD, illustrates the feelings of depersonalization in hospital care by describing his own experience as a patient:
'I had to be hospitalized, suddenly and urgently, on my own ward. In the space of only an hour or two. I went from apparent health and well-being to pain, disability, and fear, and from staff to inmate in a total institution. At one moment I was a physician: elite, technically skilled, vested with authority, wielding power over others, affectively neutral. The next moment I was a patient: dependent, anxious, sanctioned in illness only if I was cooperative. A protected dependency and the promise of effective technical help were mine - if I accepted a considerable degree of psychological and social servitude.'[658]
From an article called "Behind the White Coat," published in the Humanist, "The patient [is]... not just anonymous... but devoid of any hopes or fears, and never did physicians express any emotional connection to the person with the disease."[659] From Spiro's article on empathy: "The physician begins by getting a story from a patient but the physician then 'abstracts' the patient, or... the patient is subtracted and becomes transparent." The patient is put in parentheses.[660]
According to an article in Pediatrics, a frequent defense against sharing the patient's vulnerability is to dehumanize him or her.[661] As soon as one dissociates one's personal self from the clinical situation, one makes the patient into an inanimate object.[662] From Humanization and Dehumanization of Health Care, "When people are defined as things, they are perceived as insensitive objects that psychologically, at least, do not exist at all."
The Handbook of Medical Sociology: "To be a patient is to be a man but not quite a man, to be human without the full responsibilities and privileges of humanity. This is beyond status inequality; it is the Patient as Nigger."[663]
[654] Becker, HS and B Geer. American Sociology Review 23(1958):50-56.
[655] Werner, ER and BM Korsch. "The Vulnerability of the Medical Student." Pediatrics 57(1976):321.
[656] Eichna, LW. New England Journal of Medicine 303(1980):727-734.
[657] Poulson, J. "Bitter Pills to Swallow." New England Journal of Medicine 338(1998):1844-1846.
[658] Medical Sociology:216.
[659] Bonsteel, A. "Behind the White Coat." Humanist 57(1997):15.
[660] Spiro, "What is Empathy and Can it Be Taught." Annals of Internal Medicine 116(1992):843-846.
[661] Werner, ER and BM Korsch. Pediatrics 57(1976):321-238.
[662] Needham, D. Canadian Medical Association Journal 156(1997):1179-1180.
[663] Howard, J and A Strauss Humanizing Health Care New York: Wiley, 1975:30.