Some of Plato's Views on the Art of Medicine

In Plato's Laws (Book 4, 720a-720e), he describes the differences between two types of doctors: the free-born doctor and the slave doctor. He says that both types of doctors acquire their art under the direction of their teachers or masters, by observation and practice, rather than by the study of nature. However, a free-born doctor is mostly engaged in visiting and treating the ailments of free people, and he does so by listening to their complaints, not prescribing any treatment without their consent. A slave doctor, on the other hand, is engaged in treating slaves and doesn't listen to any account of their ailments. He simply prescribes treatment based on his own experience and on what he thinks is best. He does so with the confidence and assurance of a tyrant or autocrat, then rushing off to see some other sick slaves so that his master won't be bothered by having to attend to them.

      In the same way, the Athenian lawgiver has a choice of two kinds of methods, persuasion or compulsion. The lawgiver has it in his power to use both methods, but he may mistakenly think that his legislation can be enacted by force alone. To ensure that those who are governed by his laws will actually obey them, the lawgiver must offer those whom he governs some kind of persuasion, just as a free-born doctor must offer his free-born patient a persuasive rather than despotic prescription.

      Plato's medical analogy has several implications for our current views of biomedical ethics. It indicates the need for doctors to listen to their patients, and to fully inform them about their conditions, as well as about possible diagnostic modalities, therapeutic options, and possible side-effects of treatment. It also indicates the need for doctors to obtain informed consent from their patients for treatment, and to fully engage and coordinate with their patients in order to ensure their compliance with treatment. It also indicates that the efficacy of treatment may depend on clear and effective communication between patients and providers, as well as on coordination of care, timeliness and appropriateness of care, compassionate care, respect for patient privacy and autonomy, respect for patient dignity, collaboration between patients and providers, and other components of the patient-provider relationship.

      In Plato's Republic, Socrates says that the physician studies only the patient's interest, and not his own (I. 342). Socrates also says that Asclepius treated patients by means of drugs or the knife in order to enable them to go on living as usual, but would not try to prolong the lives of those with advanced disease whose existence was miserable (III. 407). Socrates agrees with Glaucon that the best physicians may be those with the widest experience in treating healthy and sick patients, but he adds that physicians who have themselves suffered from various illnesses may be even more capable of treating those illnesses (III. 408).

Galen, on the Physician as Philosopher

Claudius Galenus (Kλάυδιος Γαληνός, 129-216 CE) was a Greek physician and philosopher who was born in Pergamum (now Bergama, Turkey). He traveled widely, to Smyrna, Corinth, Crete, Cyprus, and Alexandria, before becoming physician and surgeon to the gladiators in Pergamum (from 158-161 CE) and settling in Rome (in 161-162 CE), where he eventually became court physician to the Roman emperors Marcus Aurelius (161-180 CE), Commodus (180-192 CE), and Septimius Severus (193-211 CE). He died in Sicily in 216 CE.

      Galen combined the practice of medicine and philosophy, and he wrote an essay entitled Ὅτι Ἄριστος Ἰατρός καὶ Φιλόσοφος  ("That the best physician is also a philosopher"). In this essay, he argues that a physician must be practiced in logic in order to discover the nature of the body, as well as to know the differences between diseases and the indications for treatment. A physician must also be practiced in ethics in order to best serve his patient's best interests, rather than his own personal interests or financial gain. A physician must therefore know all the parts of philosophy: the logical, the scientific, and the ethical. If a physician doesn't put his own wealth before his moral virtue, then he won't put his own financial gain before his patient's benefit. If a physician despises money and practices temperance, then he will possess all the other moral virtues as well, since they all go together. Galen therefore asks: What grounds are left for any doctor not to be a philosopher?

      While Galen rightly explains that the pursuit of financial gain may be a corrupting influence on a physician and on the practice of medicine, some of the obvious defects in his argument that the best physician is also a philosopher include: (1) logic doesn't necessarily yield understanding of the physical nature of the body (although it may serve to promote consistency in thinking about the physical nature of the body), (2) he doesn't recognize ignorance as a cause of wrong actions on the part of a physician, (3) greed and intemperance aren't the only possible sources of wrong actions. Other vices, such as arrogance, carelessness, indifference, and bigotry may also act as sources of wrong actions, (4) possession of one moral virtue (at one moment or in one situation) doesn't necessarily guarantee possession of all the other moral virtues (at some other time or in some other situation), and (5) philosophy includes not only "the logical, the scientific, and the ethical," but also the metaphysical, the epistemological, the aesthetic, and the political, as well as other fields or domains.