Renowned French philosopher Michel Foucault （1926-1984） hits the nail on the head when he wrote in his book “The Birth of the Clinic” that a doctor is not able to look at the various physical signs in a patient and immediately know what disease the patient is suffering from. He can only do his best to give an assessment and diagnosis based on his “clinical gaze”。
Yet by virtue of his exalted status, the doctor is endowed with much power over his patients. In Foucault's view, a clinic is a place where knowledge is power.
Let's not go into the complex details of Foucault's theory.
Recent reports of unrelated incidents of unethical medical practices here are enough to set us thinking.
The first case that comes to mind is a clinical research project by the National Neuroscience Institute on Parkinson's disease which was accused of breaching rules of ethics.
The researcher conducted drug testing on 127 Parkinson's patients without their informed consent. Worse still, some patients experienced a drop in blood pressure, difficulty in moving and discomfort.
In another incident, a dental surgeon at an NTUC Denticare clinic refused to attend to a Tan Tock Seng Hospital executive.
These episodes may, in a way, well serve as examples of the negative consequences of the knowledge-power relationship elaborated by Foucault.
We can point the finger at the researcher and dentist for lacking in professional ethics or even question whether they subscribe to these ethics at all in the first place.
We can also accuse the dental surgeon of being unsympathetic and the researcher of being unscrupulous for selfish reasons. They have both failed in their duty.
As I see it, their conduct is just a manifestation of the preoccupation of modern medicine with the development of scientific knowledge and equipment which inadvertently or otherwise, overlooks the importance of human elements.
This is not suggesting that the present health care system should be rejected or abolished. There is, however, a need to be mindful of the shortcomings in this man-made and highly-institutionalised system in order to improve it.
An over-emphasis on scientific knowledge, modernisation, equipment and high technology may blind us to the fundamental fact that the system is created to serve human needs.
Ignore this and we are likely to see unethical conduct similar to the cases mentioned earlier repeat itself.
The research project may have good scientific and medical reasons. Still, the manner in which it was carried out was objectionable - the researcher was experimenting with precious human lives.
The dentist could argue that he acted in the interests of the majority of patients. But there is no denying that he has forgotten that his duty as a doctor is to help patients who are in need regardless of race, occupation, political affiliation or the fact that they may have diseases other than the one they seek treatment for.
Without this strong sense of duty, behaviour like selfishness （turning away patients） and avoidance （the recent untimely resignations of some Taiwanese doctors） will become inevitable.
Doctors should not be equipped only with the knowledge and skills required of the profession, they should always bear in mind the need to care for and feel a sense of compassion for patients.
Of course, doctors are only human and are not spared from unpleasant feelings and the ups and downs in life.
Patients also need to be understanding, reasonable, and cooperative for a healthy doctor-patient relationship to develop.
。The writer is a PhD candidate at NUS. Translated by Yap Gee Poh.
法國思想家?？拢?926-1984）在他的《診所的誕生》（1963）一針見血指出,現(xiàn)代醫(yī)學(xué)的診斷中,醫(yī)生并不能完全探知所有疾病“紙牌”的數(shù)量和圖案,他也只是通過自己的目光觀察病人,從而給出相應(yīng)的判斷與勾勒。
當(dāng)然,作為醫(yī)生,居高臨下的地位賦予了他無上的權(quán)力。在福柯看來,診所不過是知識和權(quán)力互化和轉(zhuǎn)換的社會機器,里面充滿了社會權(quán)力。
拋開?？路睆?fù)的理論纏繞不談,我們在仔細(xì)閱讀最近接二連三、看似偶然的醫(yī)學(xué)事件后,難免感觸良多。
首先是國立腦神經(jīng)醫(yī)學(xué)院一項帕金森臨床研究被指違反道德標(biāo)準(zhǔn),其研究員未經(jīng)批準(zhǔn),便在127名帕金森病人的身上進行藥物測試,而且,要命的是,該測試曾經(jīng)導(dǎo)致一些病人血壓驟降、產(chǎn)生運動障礙及身體不適的現(xiàn)象出現(xiàn)。
其次是陳篤生醫(yī)院職員牙痛到職總牙科保健合作社屬下診所求診,遭一名牙醫(yī)拒絕看診。
耐人尋味的是,恰恰就在我們力圖避開?？滤缘臋?quán)力關(guān)系時,我們發(fā)現(xiàn)上述事件恰恰仍然是現(xiàn)代醫(yī)學(xué)權(quán)力網(wǎng)絡(luò)生成并發(fā)展的惡果表現(xiàn)之一。
我們自然可以指責(zé)那名研究員和醫(yī)生缺乏職業(yè)道德,甚至可以追問和質(zhì)疑這種道德的底線。當(dāng)然,我們或許也可以憤憤不平地指責(zé)他們?nèi)狈ν樾?為了某種目的,違背了他們的職責(zé)。
在我看來,問題的關(guān)鍵在于他們的表現(xiàn)不過是他們整個學(xué)科走向科學(xué)化、機械化,而有時無意或故意罔顧了人性的弘揚的一個小小的注腳而已。我們自然不能完全否認(rèn)或*目前的醫(yī)療制度,問題在于,我們在推行這些人為的、長期延續(xù)下來的制度時,該怎樣反思并修補制度中的缺陷。
如果我們過分強調(diào)科學(xué)、現(xiàn)代、機械化、高科技等的巨大功用,忽略了所有的制度和制造,不過是為人類服務(wù)的工具這樣的本質(zhì)時,我們?nèi)匀粫掷m(xù)不斷的重蹈類似的覆轍,物于物而非物物。
毋庸諱言,哪怕那名研究員是真正為了研究的需要和科學(xué)精神而進行了實驗,他的這種標(biāo)準(zhǔn)與規(guī)范職業(yè)道德也自然有其可疑之處,因為,他還是將活生生的生命（盡管是有缺憾的）當(dāng)成了了無生氣的試驗品。而那名牙醫(yī)即使是打著為了大多數(shù)病人的利益的旗號,他仍然忘記了作為一個醫(yī)生的榮譽和精神生命是：不分種族、職業(yè)、政黨、病種等的對病人的熱忱的“救死扶傷”。如果不能以此作為神圣使命,自私（拒絕病人）和逃避（比如臺灣某些醫(yī)生不合時宜的辭職）則不可避免。
某種意義上講,我們灌輸給醫(yī)生的不應(yīng)僅僅是職業(yè)素質(zhì),他們的心中還應(yīng)該始終涌動著弘揚普遍人性的潮流。當(dāng)然,需要指出的是,作為凡夫俗子中的一員,醫(yī)生自然也有喜怒哀樂、七情六欲,作為（可能）病人的我們的體諒、尊重和積極配合也是人類整體得以長期共存的必需。
Yet by virtue of his exalted status, the doctor is endowed with much power over his patients. In Foucault's view, a clinic is a place where knowledge is power.
Let's not go into the complex details of Foucault's theory.
Recent reports of unrelated incidents of unethical medical practices here are enough to set us thinking.
The first case that comes to mind is a clinical research project by the National Neuroscience Institute on Parkinson's disease which was accused of breaching rules of ethics.
The researcher conducted drug testing on 127 Parkinson's patients without their informed consent. Worse still, some patients experienced a drop in blood pressure, difficulty in moving and discomfort.
In another incident, a dental surgeon at an NTUC Denticare clinic refused to attend to a Tan Tock Seng Hospital executive.
These episodes may, in a way, well serve as examples of the negative consequences of the knowledge-power relationship elaborated by Foucault.
We can point the finger at the researcher and dentist for lacking in professional ethics or even question whether they subscribe to these ethics at all in the first place.
We can also accuse the dental surgeon of being unsympathetic and the researcher of being unscrupulous for selfish reasons. They have both failed in their duty.
As I see it, their conduct is just a manifestation of the preoccupation of modern medicine with the development of scientific knowledge and equipment which inadvertently or otherwise, overlooks the importance of human elements.
This is not suggesting that the present health care system should be rejected or abolished. There is, however, a need to be mindful of the shortcomings in this man-made and highly-institutionalised system in order to improve it.
An over-emphasis on scientific knowledge, modernisation, equipment and high technology may blind us to the fundamental fact that the system is created to serve human needs.
Ignore this and we are likely to see unethical conduct similar to the cases mentioned earlier repeat itself.
The research project may have good scientific and medical reasons. Still, the manner in which it was carried out was objectionable - the researcher was experimenting with precious human lives.
The dentist could argue that he acted in the interests of the majority of patients. But there is no denying that he has forgotten that his duty as a doctor is to help patients who are in need regardless of race, occupation, political affiliation or the fact that they may have diseases other than the one they seek treatment for.
Without this strong sense of duty, behaviour like selfishness （turning away patients） and avoidance （the recent untimely resignations of some Taiwanese doctors） will become inevitable.
Doctors should not be equipped only with the knowledge and skills required of the profession, they should always bear in mind the need to care for and feel a sense of compassion for patients.
Of course, doctors are only human and are not spared from unpleasant feelings and the ups and downs in life.
Patients also need to be understanding, reasonable, and cooperative for a healthy doctor-patient relationship to develop.
。The writer is a PhD candidate at NUS. Translated by Yap Gee Poh.
法國思想家?？拢?926-1984）在他的《診所的誕生》（1963）一針見血指出,現(xiàn)代醫(yī)學(xué)的診斷中,醫(yī)生并不能完全探知所有疾病“紙牌”的數(shù)量和圖案,他也只是通過自己的目光觀察病人,從而給出相應(yīng)的判斷與勾勒。
當(dāng)然,作為醫(yī)生,居高臨下的地位賦予了他無上的權(quán)力。在福柯看來,診所不過是知識和權(quán)力互化和轉(zhuǎn)換的社會機器,里面充滿了社會權(quán)力。
拋開?？路睆?fù)的理論纏繞不談,我們在仔細(xì)閱讀最近接二連三、看似偶然的醫(yī)學(xué)事件后,難免感觸良多。
首先是國立腦神經(jīng)醫(yī)學(xué)院一項帕金森臨床研究被指違反道德標(biāo)準(zhǔn),其研究員未經(jīng)批準(zhǔn),便在127名帕金森病人的身上進行藥物測試,而且,要命的是,該測試曾經(jīng)導(dǎo)致一些病人血壓驟降、產(chǎn)生運動障礙及身體不適的現(xiàn)象出現(xiàn)。
其次是陳篤生醫(yī)院職員牙痛到職總牙科保健合作社屬下診所求診,遭一名牙醫(yī)拒絕看診。
耐人尋味的是,恰恰就在我們力圖避開?？滤缘臋?quán)力關(guān)系時,我們發(fā)現(xiàn)上述事件恰恰仍然是現(xiàn)代醫(yī)學(xué)權(quán)力網(wǎng)絡(luò)生成并發(fā)展的惡果表現(xiàn)之一。
我們自然可以指責(zé)那名研究員和醫(yī)生缺乏職業(yè)道德,甚至可以追問和質(zhì)疑這種道德的底線。當(dāng)然,我們或許也可以憤憤不平地指責(zé)他們?nèi)狈ν樾?為了某種目的,違背了他們的職責(zé)。
在我看來,問題的關(guān)鍵在于他們的表現(xiàn)不過是他們整個學(xué)科走向科學(xué)化、機械化,而有時無意或故意罔顧了人性的弘揚的一個小小的注腳而已。我們自然不能完全否認(rèn)或*目前的醫(yī)療制度,問題在于,我們在推行這些人為的、長期延續(xù)下來的制度時,該怎樣反思并修補制度中的缺陷。
如果我們過分強調(diào)科學(xué)、現(xiàn)代、機械化、高科技等的巨大功用,忽略了所有的制度和制造,不過是為人類服務(wù)的工具這樣的本質(zhì)時,我們?nèi)匀粫掷m(xù)不斷的重蹈類似的覆轍,物于物而非物物。
毋庸諱言,哪怕那名研究員是真正為了研究的需要和科學(xué)精神而進行了實驗,他的這種標(biāo)準(zhǔn)與規(guī)范職業(yè)道德也自然有其可疑之處,因為,他還是將活生生的生命（盡管是有缺憾的）當(dāng)成了了無生氣的試驗品。而那名牙醫(yī)即使是打著為了大多數(shù)病人的利益的旗號,他仍然忘記了作為一個醫(yī)生的榮譽和精神生命是：不分種族、職業(yè)、政黨、病種等的對病人的熱忱的“救死扶傷”。如果不能以此作為神圣使命,自私（拒絕病人）和逃避（比如臺灣某些醫(yī)生不合時宜的辭職）則不可避免。
某種意義上講,我們灌輸給醫(yī)生的不應(yīng)僅僅是職業(yè)素質(zhì),他們的心中還應(yīng)該始終涌動著弘揚普遍人性的潮流。當(dāng)然,需要指出的是,作為凡夫俗子中的一員,醫(yī)生自然也有喜怒哀樂、七情六欲,作為（可能）病人的我們的體諒、尊重和積極配合也是人類整體得以長期共存的必需。