What is good medicine?

May 2021

Interview with Prof Dr Giovanni Maio. He is a doctor and philosopher and holds the chair of medical ethics at the Albert Ludwig University in Freiburg. In his writings he advocates a system of medicine that listens, and criticises the increasing economisation of health care.

Photo: © Charlotte Fischer

Erziehungskunst | We all know this from our own experience, but we don’t think about it that often: what is health and where does it actually come from?

Giovanni Maio | Health is the ability of people also to cope with adversity in such a way that they can continue to shape their lives. Health is not simply a fixed status but rather the result of an emerging equilibrium. In this respect even the impaired person can still feel healthy if they manage not to feel at the mercy of their impairments but to realise through the latter what is important to them. Health therefore has not only to do with what happens to us but above all with how we deal with what happens to us.

EK | Why is it so difficult for us to live with a disease?

GM | Illness is first of all the collapse that can plunge a person into a bottomless pit. Becoming ill means having the ground pulled away from under you by suddenly losing all certainties and everything becoming questionable. In the acute state of being ill, one initially becomes disoriented and loses one’s footing. It takes time to reorient oneself and for that one needs help, conversations, understanding, opportunities for exchange, glimmers of hope on the horizon.

EK | How does medicine make you healthy or what about it makes you healthy? Are there conditions for this?

GM | Medicine does not make people healthy by itself. It can help a person to make themselves healthy. Medicine needs the sensitivity to discover the healthy parts in the sick person in order to promote precisely these healthy parts and to help the person mobilise their inner resources. Health is a holistic concept.

To help a person return to health you have to see the whole human being, you have to enter into a relationship with them to show them how much potential they contain and where a lifeline pulsates. And this lifeline pulsates not through medication but through the awareness that there are so many things that are important to you and that are worth living for. Medicine has the task of familiarising people with their bodies and giving them back the responsibility for their bodies, to listen to themselves and to do what their bodies tell them to do. Of course, medicines and interventions are often very important for the healing of illnesses, but they are not enough because we are plunged into a crisis through becoming ill and it is therefore necessary to treat the body with technical means and at the same time the soul and the consciousness with the means of human interaction. So a good conversation is therapy in itself.

EK | What are the ethical and instrumental limits of modern medicine? What can it not do?

GM | Modern medicine has developed many arsenals in order to change bodily processes, and this is also very beneficial and represents progress as long as the change is made to the body with the aspiration to see the whole human being in the process. Unfortunately modern medicine follows a mechanistic view of the human being and reduces the latter to their body without sufficiently reflecting that their consciousness influences the body and vice versa. Body, soul and spirit are closely connected to one another and it is not possible to change one without influencing the other spheres at the same time. A person becomes healthy through the balance of these three spheres of the human being. If the focus is purely on the body and overlooks the existential need, it will not be possible to help properly. The problem of modern medicine is that it does not see itself as interpersonal practice, but as a repair discipline. That is the error in its thinking.

EK | What is good in medicine, where does it come from?

GM | What is good in medicine results from what medicine does for the other. In order to do something good for the other, medicine must first put aside its expert knowledge and listen completely to the other. In order to be able to really help, we has to acknowledge that the other person is an other who cannot be the same as what is already familiar to us, but every person is new in a certain way. In order to realise the good, we have to be interested in this newness in the other person, to engage completely with them, to recognise their uniqueness, in order to then realise the good in such a way that we give the other person answers to their questions.

Medicine has to be responsive from the ground up, it has to allow itself to be addressed, to be able to listen, in order to gain a feeling for what kind of answer would be appropriate after listening. The answer cannot be taken off the shelf but arises in envisioning the individuality of the other person. This is help for the other person, that we understand their concern and makes it our own concern.

EK | Why is it so difficult to find the good in medicine?

GM | Only in the concern to seek the good can we convey to the other that we take their need seriously. By listening to the other, we make them understand that they matter, and alone by listening we already respond to their need because by listening we communicate. By listening, we say that the other person is important to us, that what they say is significant. And when a conversation then gets going, comfort arises because through genuine conversation the other person gets the feeling that they are no longer alone with their distress. That is the healing aspect of caring for the sick person.

EK | How can children and young people learn what is good for their health? What do we adults need to consider?

GM | Children should be made to feel that they are special in their own right and that it is a joy to preserve what is special about them. Being healthy must be conveyed as something beautiful. The joy of being healthy must be awakened because only through this joy can health-conscious behaviour be taught. Pleading for asceticism and renunciation will not get us very far. You have to have a positive attitude towards health and be enthusiastic about it. After all, our health is a small miracle that we are far too quick to overlook and take for granted. We should relearn this marvelling view of the well-ordered whole within us.

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