Choice Outstanding Academic Title, 2000. and First Prize, 2000, American Medical Writers Association (AMWA) Medical Book Award in the category of Books for Allied Health Professionals.
"My mission is to analyze medicines ethical structure. I do so as both a physician and a philosopher. Of my two voices, it is the latter that is informed by the former. . . . As a physician I have sought professional solutions to the frustrations of fighting a medical system that has become increasingly hostile to my standards of care for my patients; as a philosopher I will explore here the ethical issues I believe are the root of our predicament." —from the introduction
In Confessions of a Medicine Man, Alfred Tauber probes the ethical structure of contemporary medicine in an argument accessible to lay readers, healthcare professionals, and ethicists alike. Through personal anecdote, historical narrative, and philosophical discussion, Tauber composes a moral portrait of the doctor-patient relationship. In a time when discussion has focused on market forces, he seeks to show how our basic conceptions of health, the body, and most fundamentally our very notion of selfhood frame our experience of illness. Arguing against an ethics based on a presumed autonomy, Tauber presents a relational ethic that must orient medical science and a voracious industry back to their primary moral responsibility: the empathetic response to the call of the ill.
In this collection of essays on the state of the modern health care system, Tauber, a physician and a professor of philosophy and medicine at Boston University, presents an engaging study of ethics and the medical system. Modeling his book on the Confessions of St. Augustine, Tauber presents his own confessions in a similar way: narrative personal history plus ethical and philosophical discourse. Tauber clarifies both metaphysics and the intricacies of medicine for the lay reader, and he does so with vivid, terse imagery. His narratives are poignant and amazingly real. His philosophy is well grounded in excellent scholarship, his discussions of the philosophy and history of science prove fascinating, and his conclusions are indisputable. The state of our health care system, a need for universal health care, the fractured and imperfect mechanics of health maintenance organizations, patient rights laws, economics, spirituality, interpersonal relations, and many other medical ethics issues are discussed here with alacrity. A fascinating and approachable study on a subject that touches everyone's lives. Michael Spinella
Alfred I. Tauber is Professor of Philosophy at the Boston University Department of Philosophy, Zoltan Kohn Professor of Medicine at the Boston University School of Medicine, and Director emeritus of The Boston University Center for Philosophy and History of Science. He also holds a visiting professorship at Tel Aviv University, where he teaches philosophy of science at the Cohn Institute for the History and Philosophy of Science and Ideas.
Dr. Tauber is a hematologist and biochemist by training. From his interest in basic immunology, he began a critical examination of modern biology and medicine. These studies have focused on scientific epistemology: positivism, reductionism, and the relationship of facts and values. Aside from over 125 research publications in biochemistry and immunology, Dr. Tauber has published more than 90 papers on 19th and 20th century biomedicine, contemporary science studies, and ethics. In 2008, he was awarded the Science Medal from the Institute of Advanced Studies of the University of Bologna for his critical studies of immunology.
A Summary of Research Interests:
My key works, which have spawned the rest of my scholarship for the past twenty years, consist of three intellectual biographies (Metchnikoff, Thoreau, and Freud) and an autobiography. These studies, while philosophically informed, align closely with other genres - the history of ideas and moral philosophy. The problems that intrigue me - personal identity, the value structure of science, the effort to find coherence in a world fragmented by competing notions of truth - have carried me into topics that each demand an interpretation guided by a self-conscious appraisal of our ethics, broadly construed. The inter-disciplinary nature of this work makes unusual demands on the reader. A bioethicist might not appreciate how discussions of patient autonomy relate to Thoreau's personal journey, or how a study of psychoanalysis complements a philosophical analysis of immunological theory, but for me, everything is of one piece. Below, I offer an outline of my work.
Typically, one's life experience shapes one's scholarship. In my case, to bridge two careers, namely, biomedical research and philosophy, became my central challenge. That transition occurred after I had established myself as a scientist, and thus my journey into the humanities was framed by an over-arching question: How might such a bridge be constructed and what drove me to build it?
In answer to that inquiry, I regard Henry David Thoreau and the Moral Agency of Knowing (2001) as my central work. There I explored the problem of translating scientific knowledge into personal meaning. Thoreau's reaction to the 19th century's professionalization of science and the ascendancy of new forms of objectivity offered me a case example of how science might be contextualized into its larger humanistic meanings and thereby present a picture of reality within human subjectivity. The effort does not pit scientific ways of knowing against other epistemologies, but recognizes how moral, aesthetic, and spiritual dimensions of experience might cohere within the reality offered by science. That effort built upon Thoreau's credo of imaginative individuality, one that I embraced as a powerful antidote to the nihilism born in his era and to the postmodern suspicions of individual autonomy so current in our own.
The basic message of Thoreau was extended in Science and the Quest for Meaning (2009). There I presented contemporary science from the perspective of current science studies, which generally maintains that science is unified neither in its methods, its standards, nor its interpretative strategies; that its various epistemologies fail any final form of objectivity; that theories and models evolve from loose creative strategies; and that the pragmatic assembly of facts relies on varying degrees of certainty and interpretative facility. These positions had been amply illustrated in my earlier critique of immunology's governing theory (The Immune Self, Theory or Metaphor? [1994]), but with Quest I had a larger agenda. Quest offered a humanistic account of how science must ultimately be integrated into notions both of social reality and of the existential placement of humans in their natural cosmos. The metaphysics of science and the metaphysics of personal experience can hardly be the same, but the effort to find coherence represents a critically important unfulfilled project.
This position had been inspired, in large measure, by the challenge of practicing humane medicine. As a research clinician, I faced the daunting task of integrating my scientific persona, and the demands of employing a scientific medicine, with the imperative of offering empathetic care. In Confessions of a Medicine Man (1999), I explored the emotional and moral tensions that resulted. This short book, my most popular, is a testament of my own professional awakening of the physician's moral identity. Readers appreciated the personal vignettes that I sprinkled in between my discursive descriptions of modern health care and my pleas for making medicine's science and technologies subordinate to the moral mandate of caring for the patient.
While Confessions combined autobiography and analysis, Patient Autonomy and the Ethics of Responsibility (2005) offered a detailed examination of the doctor-patient relationship coupled with a critique of current notions of patient autonomy. I argued that differing notions of autonomy depend on how personal identity is construed. In my view, politico-judicial models of citizen autonomy only confound the lived experience of illness and the realities of the clinic. I maintain that physician responsibility must be based on an interpersonal, relational construct of identity, not the severe autonomy of patient-as-independent-agent-and-consumer now so well adapted to the commodification of health care. To circle back: my Thoreau grounds this ethical position by highlighting a heightened moral sensitivity to everyday experience coupled with the sensitivity requisite to understanding not only others, but also ourselves.
Freud, the Reluctant Philosopher (2010) draws all of these issues together. Dispensing with arguments about the scientific standing of psychoanalysis, I seek to understand the abiding truth that Freudianism offers: We are strangers to ourselves, because we live largely unconsciously; and as we recall our past and recognize a reconfigured personal history, we gain the opportunity to assume responsibility for who we are and what we might become. That psychoanalysis has been called a "religion" seems perfectly apt to me: it holds that insight leads to redemption, a promise that despite the determinism governing our inner psychic life, a freedom beckons. The paradox - we are determined yet free - echoes Thoreau's own anthem.
I call my guiding philosophy a "moral epistemology," which tries to capture the inextricable weaving of personal values into our use of knowledge and into our ways of knowing. Why is that important? Simply, an improved understanding of this process offers us the potential freedom of better exercising moral responsibility.
Here is a short, resonant book on a topic that concerns us all: medical ethics.
Alfred I. Tauber is a biochemist and an M.D. (medical doctor). He is also a professor of medicine and a professor of philosophy at Boston University.
Tauber provides us with hard-to-get knowledge: (1) a thoughtful historical overview of the development of twentieth century medicine (1880 to the end of the 1990s), with particular focus on the doctor-patient relationship; and (2) a philosophically sophisticated analytical scheme that enables the reader to assess current developments (crudely: How is my HMO or managed care plan doing?).
Although Tauber subtitles his book "An Essay in Popular Philosophy," the word "popular" is somewhat misleading. The reader entirely innocent of twentieth-century Anlgo-American analyic philosophy as well as of its differences from Continental (European) philosophy, may intially have a bit of hard time following the argument.
Nevertheless, CONFESSIONS OF A MEDICINE MAN is the right book at the right time. Deeply philosophical and factually up-to-the-minute, it provides the compass we need to understand the real causes of the "crisis in medical care" that most average Americans face. For example, Tauber gives an extended--and brilliant--critique of one of those causes: the total acceptance of the idea of the "autonomous self" within the context of the doctor-patient relationship.
For the interested reader, Tauber provides a valuable (& wonderfully readable) section called "Bibliographic Notes." Here the reader can trace out the origins of Tauber's thinking on the key topics covered in the book: changes in American medicine over the past 120 years; the various concepts of "self" that doctors and HMOs adopt and how these varous concepts directly affect the patient's relationship with her doctor; the whole notion of "medical ethics" itself and what its various interpretations may mean to the patient and her family (one of Tauber fresh observations: "medical ethics" is fast becoming a specialty, just like surgery or gastroenterology--and that is just the direction we do NOT want to go).
A serious, needed book, one that challenges American medicine's dangerous and unacknowledged assumptions about exactly who the doctor is and who the patient is. Bravo!
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