Medicine and Morality: A Battle of the Modern World
Historically, the practice of the applied science of medicine began with the recitation of the Hippocratic Oath; highly skilled physicians would swear to "do no harm," and to generally perform their art with honor and integrity. In his book War and Peace, Tolstoy depicts a set of moral choices which current and future physicians ought to contemplate. Medical doctors must focus their efforts on the diagnosis, treatment, and prevention of illness. Having access to high-tech equipment, they are first-class health care providers capable of defying the normal course of life. Nevertheless, doctors remain humans who must make important moral decisions and develop virtuous behavior in order to provide the greatest help to their patients. While Pierre and Marya are great examples of generous individuals who choose to sacrifice themselves for the well-being of others, Natasha and Platon Karataev are two somewhat different characters who both exhibit compassion and extraordinary optimism. Doctors should, however, avoid acting like the greedy Hélène and the opportunistic Anatole who are solely concerned with the fulfillment of their own immoral desires. Consequently, in order to master their craft, physicians ought to exhibit self-sacrifice and great generosity, adopt a humane and optimistic attitude, and refrain from solely pursuing their economic personal interests.
Princess Marya is a human representation of Christian virtue in the novel; she is spiritually committed to living according to the will of God. Upon surprising her potential husband, Anatole, embracing Mlle Bourienne in the winter garden in the year 1805, Marya does not exhibit any malevolence toward her maid. On the contrary, she decides to commit an act of self-sacrifice: “I shall do everything to arrange her marriage to him” (232). Similarly, following the difficult passing of her father and brother, she decides to suspend her relationship, and the possibility of love and happiness, with Nikolai Rostov, and prioritizes her friend by promoting the future marriage between Natasha and Pierre. Doctors must be ready to make similar sacrifices as they work long hours for the good of their patients. While speaking about Natasha’s love for Pierre, Marya states, “Let’s talk about you” (1125). The benevolent woman is ready to postpone her own love and focus all of her energy for the happiness and prosperity of others. Even once married to “the man she loved,” Marya abandons her inner peace in order to take care of her children (952). She assiduously writes “everything from the children’s life … expressing the children’s character or inspiring general thoughts about methods of upbringing,” just as doctors would note the evolution of their patients’ conditions and propose more effective treatment options (1171-2). Her husband, Nikolai, describes her work as a “tireless, eternal inner effort, aimed only at the moral good of the children…” (1172). In all these instances where Marya dedicates her existence to the benefit of others, it may well be that she is going overboard. Yet one must remember that the stereotypic gender roles established in Tolstoy’s nineteenth-century society did not give as much freedom to women as it did to men.
While physicians often put their own mental and physical health at risk and should be willing to make sacrifices for the good of their patients, there should be a clear distinction between professional and personal life. Pierre emphasizes this idea following his business trip to Petersburg during which he accomplishes great things as he works to solve political problems. Although miles away, he never forgets his loved ones as he takes pleasure in purchasing small presents for “the whole household” (1162). When he returns home, he plans time with his family and children, whom he loves more than anything: “the baby … absorbed all Pierre’s attention” (1160). Pierre demonstrates the ability to effectively manage both his personal life with his family and his professional life in political spheres, just as physicians would focus entirely on their family at home and their patients at work. Another instance of self-sacrifice occurs earlier when Pierre decides to help a sobbing woman who lost sight of her youngest daughter while evacuating her blazing home in Moscow. His goodness and generosity are obvious as he unhesitatingly risks his own life to save someone else’s. He even surrenders his freedom by defending an Armenian woman from the hands of abusive French looters: “Pierre … [seized] the tall, stooping soldier by the shoulders and [flung] him away” (930). His exceptional generosity and usefulness and, later, his will to sacrifice some time with his family are traits worthy of a modern medical doctor.
Held in high regard by many citizens, physicians should also refrain from solely pursuing their personal desires in a professional context. Hélène definitely would be the worst doctor of all! Give her the keys to the hospital pharmacy, and all the valuable narcotics will miraculously disappear within seconds! Hélène would take advantage of her authoritative position to satisfy her greed. This unacceptable behavior would not only have a detrimental impact on other health care professionals, such as pharmacists and nurses, whose duties include preparation and delivery of drugs, but also the patients whose medical conditions might deteriorate quite rapidly if they are not given the appropriate medicine. Marrying the newly socially desirable Pierre is only a scheme to obtain part of the naïve fellow’s enormous inheritance. The mere goal of the manipulative Hélène is to avail herself of Pierre’s innocence in order to replenish her own bank account. Her faithfulness is questioned as she frequents other men such as Dolokhov and Boris, perhaps to further vex her husband. When Pierre finally confronts her, she says, “We’ll part, if you please, but only if you give me a fortune” (320). What a role model!
Medical school graduates must display self-restraint as they choose their internships and residency programs; they cannot base their decisions on momentary desires such as the paycheck they might receive in the future. On the contrary, young residents ought to specialize either in a field that is in demand, such as rheumatology, endocrinology, or family practice, or in an area of study in which they find particular interest. After all, if every student does as Hélène and seeks the highest possible income, there will not be any cardiologist to perform diagnostics and refer patients to cardiothoracic surgeons! As long as passion guides medical students in their domain of specialization, they will be most helpful to their patients as they will be able to offer a more effective and beneficial service. The opportunistic Anatole would be just as immoral as his sister since he initially comes to town “with the aim of marrying a rich bride” (546). This doctor would most probably be corrupt as he would accept bribes from patients in order to fast track their files. Where has all the equality and fairness gone? Sexual desire is also obvious as Anatole, on a visit to the wealthy Bolkonskys for a potential marriage with Princess Marya, is tempted to wed the ugly princess and have Mlle Bourienne as a bonus: “She’s not bad at all this demoiselle de compagnie. I hope she’ll bring her along when she marries me” (223). Manipulating patients in order to have sexual relations is not only unethical but also prohibited by any health care provider’s professional code of conduct. Patients should have access to safe medical facilities where they are not at risk of being molested by their doctor!
A similar occurrence takes place as Anatole is ready to make a compromise; instead of money, he will accept physical beauty. His new prey becomes the innocent Natasha, whom he seduces and persuades to elope. This behavior does not match in any way that of a responsible physician. Doctors should not accept patients to their clinic on the basis of appearance; those who need medical attention must be prioritized. Even less should they brainwash their patients into opting for treatments from which they can profit. At the theater, Anatole approaches Natasha quite rapidly in order to satisfy his sexual desire: “after five minutes she felt terribly close to this man … she felt with horror that between him and her there was no barrier of any sort” (565-6). Anatole is careless of the effects his obnoxious actions might have on other individuals. Physicians must ensure that their patients are comfortable with them in order to gather as much information as possible and design an effective treatment plan. In this innovative twenty-first century, medical doctors ought to remain professional—and strive for excellence in their chosen fields of practice as the patient is their primary concern.
Offering a humane service and displaying an optimistic attitude are also characteristics that fit into the general mold of the modern physician. After the Battle of Borodino, Natasha generously decides to allow wounded soldiers to rest on the family estate. To the superior officer responsible for the convoy, she asks, “May the wounded stay in our house?” (853). Natasha understands the value of respecting human dignity; she does not hesitate to offer help to those in need. She even humanely orders servants to unload “more and more carts” in order to carry the wounded out of Moscow, thereby facilitating their recovery (863). Upon learning that her former fiancé is among the wounded soldiers, Natasha decides to watch over him; she wants him to survive. The young Miss Rostov accomplishes various physically and morally difficult tasks such as monitoring and nursing the man whom she “had never ceased loving” and informing the doctor of any changes in the patient’s behavior (958). Just like a twenty-first century general practitioner providing palliative and end-of-life care, she looks after Andrei until the very end, even through the extremely difficult days preceding death during which the man is detached from reality and becomes involuntarily cold and unaffectionate. Despite Andrei’s changing mood, she remains compassionate and optimistic and attempts to demonstrate her “boundless love for him” (977).
Doctors must always exhibit respect and sympathy, regardless of the outlook of a patient’s condition. And in the case that possibilities of convalescence are unfavorable, they should hope against hope with the family for a miracle. That is part of their duty! Nevertheless, physicians must also accept death when it has to happen, just as Natasha recognizes its inevitability during Andrei’s final days. Another character who displays radiating optimism is Platon Karataev, a Russian prisoner of war. Although he is held captive in a French camp, deprived from all the comforts of family life, he remains cheerful and encourages other prisoners to stay hopeful and see the glass half-full. Modern physicians often end up in similar situations as they must remain true and humane even when their patients have lost all hopes of recovery. Pierre changes for the better as he gradually absorbs Karataev’s understanding of the unfathomable truth; the captives only learn the true meaning of life when their freedom and possibilities of love and happiness have been stripped away from them. The weak old prisoner also relates entertaining childhood memories and moral narratives, sings “as birds do,” and assembles warm clothes and footwear in an attempt to keep the morale of his fellow inmates as high as the circumstances allow, just as physicians and nurses would try to reassure any low-spirited patient (973). Karataev “loved and lived lovingly with everything that life brought his way, especially other people” (973). The old man has the ability to erase the downturns on others’ lips as he shares their sufferings and promotes positivism. Pessimistic thoughts are more than common—but Platon decides to adopt an opposing mentality for the good of all. Stating humorous proverbs in the morning and evening is also part of his daily routine and contributes to raising the overall spirit of the prisoners, just as interns must radiate positive energy as they check on their patients for possible changes in their conditions. Karataev sees every individual as a human being, each and every single one of which is “a part of the whole”—yet he remains unattached to those around him, an important quality as doctors may unfortunately lose several patients during their career (974). Like Platon, physicians must accept the mortal nature of human beings and understand that death is sometimes God’s forgiveness for “suffering … guiltlessly and needlessly” (1062). The compassionate and optimistic attitude of Natasha and Karataev, as well as their acceptance of death, are without a doubt part of the toolbox of any modern health care provider.
Like many characters in Tolstoy’s War and Peace, doctors must make important moral decisions. In order to be at the top of their game, modern physicians must be willing to commit acts of self-sacrifice, similar to those of Marya and Pierre, for the well-being of their patients; however, they ought to draw inspiration from Pierre and find a balance between professional life at the hospital and personal life at home with family. Adopting a humane and optimistic behavior like Natasha and Platon is also vital as medical professionals will often treat low-spirited patients. Additionally, unlike Hélène and Anatole, medical doctors should display self-restraint and impartiality as they focus their efforts on the recovery of their assigned patients, with whom they must constantly maintain a professional rapport. And when medical dilemmas arise, doctors can rely on the help of nurses and specially trained bioethicists, among many other health professionals, to find solutions. Medical doctors must respect human life from its very beginning to its very end. Whether the medical intervention is aimed at a woman giving birth or a terminally ill patient, passion, generosity, and commitment must remain. As Chancellor of Germany and former research scientist Angela Merkel once said, “When it comes to human dignity, we cannot make compromises.”
Tolstoy, Leo. War and Peace. Trans. Richard Pevear and Larissa Volokhonsky. Toronto:
Random House of Canada Limited, 2007.
Professor Christine Southmayd (Consulted)
Professor Michael Duckett (Consulted)
Professor Paul Hawkins (Consulted)