Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 1
CHAPTER 44
Treating Others:
Human Sciences in Theory and Practice
Glenn W. Geelhoed
How Can We Treat Others?
Most theories of ethical behavior assume interaction among equals with principles
of respect for autonomy without patronizing the recipient of services, especially
when the relationship appears asymmetric. If one of the parties is empowered
by authority or expertise and the other disadvantaged, there are additional burdens
of caution in respect of conduct involving power imbalance, whether that authority
is conferred by intentional systems—such as institutions of state, education, economic
or moral/religious suasion—or by some biologic factors—such as age, strength,
or the capability of the healer—the assumptions of a fundamental equality residing
in the human personhood on each side of the interaction remain intact, generalized
through Kantian principles or Golden Rules governing the caregiver, ruler, or authority
figure over the disadvantaged, but equally autonomous human being helped
or subjugated.
This may have seemed a self-evident principle despite nearly universal exceptions
in its applications. At no time in the contentious eras of empires, or economic
colonialism was symmetry self-evident to support the theory, and even less so today
with the magnification of differences in political, economic and life/death/health
power enhanced by technology and applied to help or hurt one side of the bipolar
relationships. These disparities have become ever more exaggerated despite the curbs
civilizations have placed upon excesses in mistreatment, and today there is a greater
gulf between the treaters and treated in the complex of technology-assisted societies.
When these economic and power disparities are within the borders of any given
state, there may be codified rules set down by the society as formalized in a state or
judicial entity or standards set by professional societies of practitioners. When the
relationship occurs across lines of recognized states or rules promulgated by ethnic
or religious common assumptions, the theory governing the practice of “treatment”
becomes less clear and often exhibits sphere clashes in deontology.
A Case in Point
I have been involved in the practice of health care for over a third of a century,
and in the professional capacity of caring for the sick, I have had a special interest in
populations that are further disadvantaged by poverty in surroundings of very meager
resources in which subsistence itself is often difficult. While some of these destitute
people (whom I might come to consider as “patients” in attempting to treat
them) live within the same citizenship I share, most have been abroad. I further lead
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.