REVIEWS–REPORTS
Justyna Czekajewska (rev.): Ryszard Fenigsen: Przysięga Hipokratesa [The Hippocratic Oath], Publishing house: Świat Książki, Warszawa 2010, pp. 336 Ryszard Fenigsen, a doctor and lecturer of Polish origin, the author of numerous the-ses on cardiology and internal diseathe-ses, very oft en combines specialized knowledge with medical ethics in his publications. His fi rst book entitled Eutanazja: Śmierć z wyboru? [Euthanasia: Death by Choice?] had a great impression on readers in Poland as well as abroad. By publishing the information about socio-legal acceptance for euthanasia and crypthanasia in the Netherlands the author began a vivid discussion concerning: patients’ rights, freedom of choosing the method of treatment, a doctor’s duty to-wards a patient or “Taigetian” mentality.
All the aforementioned issues, as well as many others are brought up again by the author in his latest book entitled Przysięga
Hipokratesa [Th e Hippocratic Oath]. In this work, he concentrates on explaining the reasons for the decline of traditional medi-cine, understood as the health service mod-el characterized by the main concern for patient’s good, reliable fl ow of information on a patient’s condition and methods of
treatment as well as educating doctors to-wards diagnostics and ethics. The above aims of traditionally perceived medical practice are being displaced by modern ways of its comprehension. It leads to the state where the doctor’s role as a clinician – although it should manifest in stubborn and tireless eff orts to deepen one’s knowl-edge, learning from observing the patient (ars medica tota in observatione)1 and the
obligation of providing a patient with help even if they cannot cover the cost of treat-ment – in reality is displaced by the modern medics with the activities that deny the di-rect patient-doctor contact during the med-ical examination.
R. Fenigsen points out the Dutch health service has numerous faults and accuses it of breaking with deontological tradition. Primarily, he notices that concentrating on laboratory and instrumental methods of
1 “Th ere is nothing special or extraordinary
in the gift of seeing. Th is “gift ” was a result of traditional way of doctor training. During the classes taught by a senior doctor student – by imitating the teacher – learned to look carefully at the patient and if they noticed anything par-ticular, investigate what that means”. Th e method mentioned above is called the gift of looking by the author. R. Fenigsen, Przysięga Hipokratesa [Th e Hippocratic Oath], Warszawa 2010, p. 148 – all the translations are mine [JC].
treatment do not really lead to objective and indubitable results. To the contrary, reject-ing palpation2 examination, additional
ba-sic tests (blood and urine tests, X-rays, elec-trocardiogram) and lack of interview with patient (asking about symptoms) in practice frequently results in medical mistakes that oft en end in patient’s premature death3.
According to the author, the behaviour of modern doctors – who claim medicine to be a (exact) science and therefore a com-plete, fi nite, and infallible knowledge and the results of its researches bring ready-made solutions – is the fi rst step towards recognizing the power of technocracy. Th e universal acceptance of medical progress, preceded by a quest for new discoveries and inventions, made us stop being critical about science. Its unrestrained development and detachment from the values and ethical standards, which characterize a given cul-ture, result in an insatiable expansion of power. Ivan Illich, the Austrian critic of contemporary society and the preacher of anti-medicalism, wrote in the 1970s about the subordination of social practices to the medical sphere. R. Fenigsen agrees with his precursor’s opinion and continues the con-sideration, concentrating on how medical knowledge infl uences the science. He no-tices that the medicine’s contribution to sci-ence is as signifi cant as its intellectual devel-opment. “Medical ethics formed 500 years
2 Th rough touching and pressing patient’s
organs.
3 Partial paralysis or inguinal hernia is
among illnesses that cannot be detected by labo-ratory or instrumental tests.
before Christian ethics […] without regard to the ethics of the Old Testament, and not without the infl uence of ancient Greek eth-ics, but it was primarily driven by the inter-nal logic of the medical profession […]”4.
Th e tradition of medical philosophy as early as Hippocrates’ time taught perfec-tionism, professional excellence, willing-ness to provide help, and proclaimed the value of every human life. Social respect to the master of the medical art was therefore a direct response to his readiness to provide medical care as well as subordinating all goods and values to one thing: the good of the suff erer.
Nowadays, we more and more often have the reverse situation: the doctor does not accept the traditional rules of normative ethics, allowing a patient who could still live to die is an example of moral fl aw and a re-sult of indoctrination. According to the au-thor of Th e Hippocratic Oath, concern for
the good of the patient should be accompa-nied by respect for their autonomy. In the cases when the patient refuses treatment and the doctor is convinced of the positive eff ects of the therapy, they should try to convince the patient, but not make deci-sions against patient’s will. Th e doctor has no right to impose his or her own opinion. If the patient is aware of his/her own condi-tion, he/she can refuse medical care and the doctor should accept their choice.
Th e confl ict between the will of an indi-vidual and responsibility of the physician is one of the most common reasons for
sations made by the patients. Th e main rea-son is the lack of boundary between the absolutization of individual freedom and ethical-medical imperative to protect hu-man life. Acknowledging both virtues equally causes contradiction. Th e right to self-determination (deciding about own life and death) is not uncommonly connected with one’s world outlook and most of all with patient’s current health state. Th us the doctor who has the wider range of rights is in the privileged position If the doctor’s be-liefs are diff erent from patient’s will, they may refuse to comply with patient’s request, but by no means should leave the patient without help and care.
In the Netherlands, according to R. Fenig sen, this principle is oft en not ob-served, especially when the patient con-sents to euthanasia. According to the regu-lations developed in the 1980s by the Royal Dutch Society of Medicine, which were supported by judicial decisions and ap-proved by the Parliament, we know that a “patient should be informed about the diagnosis and the possibility of alleviating his/her suffering. The physician should consult another doctor and also, if the pa-tient does not object to this, with his/her immediate family. Th e doctor should main-tain and keep a record of their proceedings as well as report the case to the authorities and declare that they acted under the pres-sure of higher necessity”5.
According to data provided by the au-thor, this rule was often disregarded in
5 Ibidem, p. 261
medical practice. A survey commissioned by the government in 1990 showed that physicians more oft en performed cryptha-nasia than euthacryptha-nasia. In the 1990s, there were as many as 5,941 cases of patients be-ing killed against their request for life-sav-ing treatment and as many as 5,459 cases of voluntary euthanasia. In addition, many doctors did not offi cially record their ac-tions in writing. Th erefore, based on death certifi cates, as many as 72 percent of physi-cians concealed the actual cause of death6.
When this information was made public, the general public was shocked. Dutch citi-zens began to suspect that euthanasia was a social experiment. Despite this fear, how-ever, no regulations forbidding the proce-dure were introduced.
According to R. Fenigsen, since 2002 – when good death7 was legalized by law –not
much has changed. Despite introducing greater control, which forces the doctors to adapt to the rules of the state, this law is not as restrictive in practice. More and more doctors are choosing to replace euthanasia with assisted suicide. Th is choice is mostly due to the fact that the punishment for assistance in committing suicide is less severe8.
6 In the Netherlands autopsy is not
per-formed on patients who died as a result of eutha-nasia.
7 Euthanasia (gr.) – good death.
8 Article 294 of the Dutch Penal Code
(Woet-boeck von Straft recht) provides for a penalty of three years imprisonment for assistance in com-mitting suicide, while Article 293 provides for up to twelve years imprisonment for performing eu-thanasia. Th e latter form of penalty applies to
Ironically, contrary to the aforemen-tioned data, the Dutch health service is one of the best in comparison to other Western European countries. In this country, all citizens are insured against sickness. Th e insurance covers all the costs of treatment, even in the event of chronic illnesses and those leading to death. Th us, economic is-sues do not play a role in decision making by patients regarding their own treatment. Moreover, as many as 60% of doctors work in basic healthcare service. Th erefore, health care is widely available. Th e Dutch health service lacks neither modern equipment nor qualifi ed staff . According to the author, the changing role of families, views on bioethics, and contesting the rules of de-mocracy are all causes of deterioration in the order and harmony of the discussed healthcare system.
Th e Hippocratic Oath is a valuable book,
worth recommending mostly due to the way in which the knowledge is relayed. Th e information is presented in a very clear and comprehensible manner; yet, despite all the aforementioned advantages of this book, I, personally, cannot agree with all author’s judgments. My opinion refers mainly to the following: “bioethics support the healthcare model that assumes the antagonism be-tween a doctor and a patient”9. R. Fenigsen
makes bioethics responsible for introducing
situations when a doctor fails to comply with the law in force, for example when they perform eu-thanasia on a patient under the age of 16. In such case a doctor cannot fulfi l patient’s will without their parents’ consent.
9 Ibidem, p. 21
the modern way of understanding medi-cine, i.e. giving its powers to technocrats. From my point of view, bioethics did not introduce a model based on antagonism into medicine. Its aim is not to prove that medicine is a contemporary problem that can only be resolved through ethical de-mands. Bioethics, as a fi eld of science and a branch of ethics, derives its wisdom not only from philosophy, but also law, sociol-ogy, and medicine. Th erefore, it cannot be detached from the exact knowledge. Not only does it deal with investigating the his-tory of creating ethical views, but also aims at establishing common evaluation criteria and standards of human behaviour (the doctor and patient) in a given culture.
Furthermore, I also disapprove of the author’s critical attitude towards the Dutch model of health service. According to infor-mation provided in the book called Systemy
zdrowotne. Zarys problematyki [Health Sys-tems. Th e Outline] by Cezary Włodarczyk10,
the Dutch health system between 1980 and 2000 was and still is regarded as one that was eff ective and progressive. Th e very good organization of the Dutch hospitals stems primarily from the combination of two dif-ferent models – the British and the German – and therefore the scope of short-term healthcare depends on the level of income achieved, while all citizens can benefi t from the long-term care, on the basis of compul-sory health insurance. Th e adopted model,
10 Cezary Włodarczyk, Systemy zdrowotne.
Zarys problematyki [Health Systems. Th e Out-line], Kraków 2001.
therefore, concentrates on the development of the private sector, yet – despite the pre-sumptions of private hospitals being com-mercially oriented with patients being treat-ed instrumentally, as R. Fenigsen claims – Dutch hospitals are autonomous, self-con-tained health care establishments, independ-ent of the governmindepend-ent administration.
No objective definition of the term
bioethics and indistinguishing it from the
word morality as well as inadequate expla-nation of the Dutch healthcare system mod-el make the readers mermod-ely acquaint them-selves with the author’s personal thoughts on this matter.
Justyna Czekajewska
(Nicolaus Copernicus University in Toruń, Poland)
Krystyna Szafraniec (rev.): Barbara Ciżko-wicz, Wyuczona bezradność młodzieży [Learned Helplessness of Young People], Publishing house of Kazimierz Wielki Uni-versity, Bydgoszcz 2009.
When a book including helplessness in its title was published in the 1990s, it drew the attention of everyone who wanted to understand the process of system transfor-mation – as helplessness was one of the most significant mental barriers in its course. When this book is published in 2009 and it concerns youth – it arouses a diff er-ent sort of interest. What does helplessness mean with reference to the generation which is doing quite well in the world that cannot be envied? Having read the first pages of Barbara Ciżkowicz’s Wyuczona
bezradność młodzieży [Learned
Helpless-ness of Young People], the reader becomes aware that although the book does not con-cern the relation between young people and the complex world of today, it focuses on an even more interesting issue – school help-lessness. We aspire to be the society of knowledge, we keep reforming our educa-tional system at all levels, and now someone indicates the problem of youth’s helpless-ness in school situations. It is truly intrigu-ing. Unfortunately, the book – although it has a vast empirical base and solid theoreti-cal foundations (the learned helplessness model developed by social psychologists: M. Seligman, M. Rosenbaum, G. Sędek) – is in fact pointless, inconclusive and linguisti-cally indigestive.
Th e author’s main assumption was the argument “that the school is an institution which fails to facilitate young people’s access to secondary and tertiary education” (p. 56). Th is thesis has been verifi ed in empirical re-search, the participants of which were age diversifi ed groups (primary and secondary school pupils, students) and teachers. Th e research – based on the the positivist canon of science – was conducted with the use of a wide spectrum of psychological scales and tests. One of them – which measures school helplessness – was originally developed by the author, and a large part of the book is devoted to the analysis and evaluation of psychometric characteristics of this scale.
Th e empirical evidence was subjected to thorough statistical analysis, which:
1. indicated low but constantly increas-ing (with the growincreas-ing level of
