From Hippocrates to Plato: The Swinging Pendulum of Healthcare Ethics

“A 10-year-old cystic fibrosis sufferer who has been given just weeks to live has learned that she cannot receive a life-saving transplant because she falls under the age limit for adult lungs.

Sarah Murnaghan, from Newtown Square, Pennsylvania, was born with the condition and she now lives at Children’s Hospital of Philadelphia as her lungs continue to deteriorate.

Sarah, who relies on a ventilator to breathe, has been on the waiting list for new lungs for 18 months – and is top of the priority list for children in Delaware, Maryland, New Jersey, Pennsylvania, West Virginia and northern Virginia.

But so far, none have become available – and because she falls two years below the cut off for adult lungs, she can do nothing but wait. She has been given just three to five weeks to live.”

To understand what is actually beginning to happen to patients like Sarah (and in our entirely new world of medicine, for that matter), it helps to reexamine the two distinct world views of Hippocrates and Plato.

Their writings describe two opposing schools of thought when it comes to treating the individual patient. And even though their writings are nearly 2,500 years old, their polarizing philosophies bring great clarity to the most medical dilemmas like Sarah’s. In fact, understanding the positions of Hippocrates and Plato is essential to all Americans as we undergo the “fundamental transformation” of our healthcare system (by way of Obamacare).

According to “The Battle for America’s Soul,” by Dr. C.L. Grey:

“Plato transferred power to the State and used the physician as a tool to protect the interests of society. He calculated the value of human life by determining its ability to enhance the State or improve the well-being of others. Plato’s ideal physician guarded the greater good of society by deciding when to let weak and infirm patients go untreated or die.

Because Plato’s worldview contained no higher “laws of nature and nature’s God,” patients and physicians, and ultimately the State were free to determine the value of a given human life. Infanticide and euthanasia were accepted and often socially encouraged. Plato knew no higher moral code that restrained such practices. Plato placed the good of the whole over the well-being of the individual patient.”

In Plato’s Republic we can find the first trace of State-ism (the greater good of the State trumping the individual well-being of its citizens) when it comes to medicine. According to Plato, patients who burdened society and “of no use of the State”–were identified and dealt with accordingly.

On the other hand, Dr. C.L. Grey explains:

“Hippocrates rejected this (Platonic) view. Following in the footsteps of the Pythagoreans, Hippocrates believed that human life was a gift from the gods. Infanticide and euthanasia played no part in his medical ethic. Hippocrates’ theological underpinnings precluded individual judgment on the value of human life, restricting the autonomy of the patients, physicians, and the State. For Hippocrates, the “laws of God” reigned supreme. This worldview provided a consistent and reliable fixed Truth under which Hippocrates’ patients experienced freedom. Patients knew their well-being lay at the center of Hippocratic medicine.”

Differing from Plato, Hippocrates placed the patient at the center of healthcare. For Hippocrates, the “greater good” of the State played no role in determining patient care.

From Dr. C.L. Grey:

“Propelled by the adoption of Hippocratic values by early Christians, the transition from pre-Hippocratic (Platonic) thought to what we now recognize as the Hippocratic tradition took place over several hundred years. For the next 2,000 years, Judeo-Christian philosophy remained a dominant force in the formation of the Western moral code, carrying Hippocratic ideals with it. By the fifth century A.D., the practice of non-Hippocratic medicine had vanished in the West. While proponents of a Platonic worldview always existed, Western civilization largely chose the Hippocratic path.”

However, the principles of Plato were resurrected at the end of the Nineteenth Century through the writing of Friedrich Nietzsche’s book Twilight of Idols. Following the philosophy of Plato and Nietzsche, physicians of the Third Reich abandoned Hippocrates from their practice altogether.

According to Robert Berger’s “Nazi Science-The Dauchau Hypothermic Experiments, in the May 17^, 1990 edition of The New England Journal of Medicine:

“ The result was horrors of the Dachau Hypothermic Experiments where they lowered subjects into ice water to see how long it would take them to freeze to death. Before they died, they were “rewarmed” using various methods. Physicians submerged some of the severely hypothermic patients in vats of hot oil or placed them under scorching lamps. For others, physicians forced scalding water into the victim’s stomachs, rectums, or surgically opened abdominal cavities. All this was done to allegedly determine the optimum method for treating hypothermic pilots.”

Needless to say, the unfathomable carnage of the Third Reich brought the Hippocratic tradition back into fashion along with the founding of the World Medical Association.

However, the single most important precept of the Hippocratic oath came to a screeching halt in 1973 when the United States legalized abortion, rejecting the Hippocratic ideal of the sanctity of life from conception to death.

Dr. Grey says, “For the first time in 2,000 years, the physician publically resumed Plato’s dual roles of healer and arbiter of life…..With this action the Supreme Court stripped medicine of its fixed point of reference. Patients were no longer guaranteed their well-being would remain at the center of American medicine.”

As a result, there has become a wide acceptance of euthanasia and infanticide among American medicine in recent years:

• First, Biochemist Peter Singer moved infanticide and euthanasia from the unthinkable to the thinkable in his writings, “Should the Baby Live” and “Rethinking Life and Death”.
•  In 1997, Oregon passed legislation to make physician-assisted suicide acceptable.
• In 2008, Oregon Health Plan refused a patient’s chemotherapy (instead, offering to pay for hospice care or physician-assisted suicide).
•  In 2008,Washington State legalized physician-assisted suicide moving the U.S. healthcare pendulum even closer to Plato.
• In 2009, The Lancet published an article where the National Institute of Health (NIH) introduced the below chart called the  “Complete Lives System”. As this system is implemented through our new health care law, it creates a priority curve on which individuals aged approximately between 15 and 45 get the most substantial chance of receiving medical intervention. Now, we have a better understanding why our 10-year old friend Sarah Murnaghan cannot receive a life-saving transplant she needs–   because she falls under the State-mandated age criteria for aggressive medical intervention.

Unfortunately, we will likely hear more sad stories like Sarah’s as Obamacare places Plato right at the center of our new government-run healthcare system. Sarah’s story stands as a warning sign to what lies ahead under the so-called, “Patient Protection and Affordable Care Act”:

• The STATE replaces individuality
• The “greater good” replaces personal liberty

….as all personal medical decisions become trumped by what is most “cost-effective” to the Government. This reality is especially important to senior citizens as we can see where they fall on the above “Complete Lives System” chart.

Dr. Grey concludes:

“Will America find a consensus view as applied to medical ethics and the role of the physician? There are only two choices. Physicians can either return to their Hippocratic roots and remain devoted to serve the individual patient’s well-being, or they will follow Plato and become servants of the State. The archives of history tell us there is no third alternative.”

Every American must also ask, “Which direction does my own ethical pendulum swing? What philosophy do I want for my own personal healthcare? Hippocrates or Plato, where do I stand?”