Veatch Hates Hippocrates

January-February 2010 Robert Veatch hates Hippocrates. In his new book, he gleefully imagines that Hippocratic physicians and all they believe will end up on “the ash heap of history” (p. 34). His animus towards all things Hippocratic is absolute and impassioned. He makes more references to Hippocrates—a total of thirty-three—than to all other physicians combined. He finds the Hippocratic ethic “esoteric, potent, and dangerous” (p. 35), “of dubious merit,” and “downright offensive” (both on p. 12). Why such umbrage? In Veatch’s mind, Hippocrates and his followers commit two unforgivable sins. First, they claim to know what is best for their patients. Worse, they feel a moral obligation to act on that knowledge. Veatch, by contrast, is quite sure that physicians almost never know what is best for patients. He writes, “We now know that even in the ideal case, physicians generally have no basis for knowing what would benefit their patients” (p. 35). And again, “There no longer exists any basis for presuming that the clinician can even guess at what is in the overall best interest of the patient” (p. 92). The Veatchean physician rejects the pretensions of old-school physicians who presume to know that it is bad to smoke or that it is good to exercise. All such opinions are based on values, not facts, and the post-Hippocratic physician should not bring values into her interactions with patients. Only the patient’s values should be considered. Puzzlingly, there do not seem to be any facts, either, in Veatch’s medical world. Since every socalled fact inevitably and inherently incorporates values, postmodern physicians must forswear those as well. To thrive in Veatch’s world, patients would not only need to have well-developed value systems. They would need to be able to communicate their values on the occasion of each and every clinical decision because they would not—and should not—trust their doctors to assume anything whatsoever about those values. One imagines the following dialogue between a Veatchean patient and her ideal physician: