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Sunday, September 03, 2006

Philosophy of Health

To begin with, this is not an academic paper but rather my philosophy of health education, which makes it a series of questions and considerations rather than facts or theory. It comes equipped with numerous opinions, assumptions, concerns, and personal bias with a hefty dose of cynicism thrown in for good measure. As with all operational methods, I strongly support it with carefully selected information which corresponds to my own ideas, beliefs, and “gut-feelings”. That covers the philosophy part. The education part is the ability to understand the philosophy of others in order to agree, support, and “pat each other on the back” or...most importantly...dispute. This brings me to “Shannon’s Maxim #1 ...Adversity is a far better teacher than agreement”. Here is a small sample of considerations (relevant to the field of health education) which I feel support this view:

• Health education is defined as the “combination of learning experiences designed to facilitate voluntary actions conducive to health” (Green and Kreuter, 1991). This definition raises several considerations that support Maxim #1:

• I assume most people would agree that the term “health” falls under the general guidelines of all medical practice and therefore is subject to the tenant to “first do no harm”. In fact, to do harm fundamentally opposes the purpose of health education. That of course is my opinion because many persons argue that in order to do the most good it may be necessary to do a little bit of harm. Who defines harm? Society? The individual? The researcher? The educator?

• The Hippocratic Oath stood as the fundamental consideration until the advent of W.W.II when the world was taught a grave lesson and responded with the Nuremberg Code and the Helsinki Standards. Adversity was able to clarify, educate, and teach what agreement was not. It is commonly known the Nazis sent millions of Jews (among others) to their death, but the “euthanasia” of their own citizens is less commonly discussed. Before W.W.I Germany had embraced the concept of euthanasia, or the right to die, for persons facing a terminal illness. This view eventually grew into the philosophy that it was “kinder” to end the lives of not only the terminally ill but also the lives of the mentally retarded, the mentally ill, and the physically disabled. During W.W.II, the act of killing, rather than healing, patients became acceptable to Nazi doctors by virtue of a philosophy which regarded death as kindness and the rights of society more important than those of the individual (Boyd, 1995).

• The questions were not resolved with the passing of ethical codes of conduct but only brought into the arena of open debate. Not only has the “right to die” issue not been resolved, but the debate itself is used to mask the lack of quality medical care capable of managing pain and not psychologically condemning to death the patient who fears becoming a physical and financial burden to their family. Adversity is teaching us that there are no easy solutions and it is impossible to meet the needs of society and the individual. Agreement would only indicate that society has deemed it acceptable to overlook the needs or rights of a specific group or segment of society.

Of course, innumerable violations of human rights took place far beyond even these examples and we (hopefully) ask ourselves HOW and WHY these doctors complied. This leads to “Shannon’s Maxim #2: We always think we are different but we rarely are...” and “Shannon’s Maxim #3: We really are different so stick to it, stand up for it, don’t push anybody around because of it, respect it, and thank God for it”.

Philosophy provides the framework for behavior...another opinion that I personally believe to border on fact. It is for this reason philosophical discourse it essential. When I ask myself “how could those Nazi doctors have complied with killing patients?”, I would like to believe they were innately evil and I, in my vast knowledge of good and evil and overwhelming love for humanity, would never be capable of such atrocities. It is pure pride. The same pride that likely assured the conscious of those doctors who killed their patients. Here are some supporting thoughts and antidotes on the matter:

• Science teaches that people are mere animals concerned with surviving at any cost, therefore all behavior is directed toward self preservation. Psychology instructs that those persons who have thought or behavioral patterns outside of those deemed appropriate by society have emotional or mental deficits/disease which make them less able to adapt to... and function in... society. Sociology tells us society itself is determined by sub-groups of individuals who have best “adapted” and therefore have “power” to decide the norms and values to be adhered to... and the degree of punishment or isolation bestowed on those individuals unable or unwilling to participate. Without going into the numerous other theoretical foundations for human behavior, it is sufficient to point out that these three alone explain the difficulty in upholding the concept of freedom of thought.

• Freedom of thought is essential to the concept of “voluntary action” in health education. Although most individuals would like to believe they are different; Evolution, Psychology, and Sociology make strong arguments for homogenous behavior and thinking. Modern day advertising, behavior modification, laws and legislation, education and other forms of propaganda, and various other methods of control and persuasion ensure most individuals are not as different as they would like to believe themselves to be. Science tells us it is necessary for the survival of the species: there is strength in numbers and the ability to adapt to the ruling class ensures survival and growth. So, while I would like to believe I am fundamentally incapable of perpetuating an atrocious crime on others, there is reason to believe I am a product of my environment. The more “socialized” I am, the more I have “bought into” the value system of my environment. The more “educated” I am, the more I have been exposed to and understand the pre-selected information which those in my ruling class find significant or important. For this reason, doctors would be especially vulnerable to these “crimes”...they are often the most socialized and educated of society. Of course this is a simplistic explanation. The issues are far more complex, but it does stipulate the basic premise of Maxim #2....We always think we are different but we rarely are.

• So, what about Maxim #3? If our minds are a product of society and environment and we are more alike that we commonly believe ourselves to be, then how can we be different? Religion teaches us that humans have a spirit and a soul. I believe this to be true. There is no “proof” in the typical sense of the word. The spirit/soul goes beyond the realm of science. It is not self-preserving but often characterized by self-sacrifice...even to death. Rather than ensure maximum adaptation through assimilation, the spirit/soul finds freedom even in confinement. It cannot be regulated.

“Shannon’s Maxim #4...When society is unhealthy--those in conflict are more healthy”. Health is a tricky concept. Educating people is even more difficult when issues like “freedom”, “belief”, and “soul” are considered. It is simple enough to speak of “good health” but I cannot truly define it and haven’t read a definition I like. My husband is blind but in very good health. I know other people in perfect physical health who are emotional wrecks and others with terribly debilitating physical health who have a profound and inspiring emotional health. It isn’t simple to define health. Often is described as an optimal level of adaptation or the ability to function at full potential, but that may conflict with willingly going to death or delaying gratification. The idea of self-preservation fails to account for the beauty, strength, and HEALTH of self-sacrifice. Even more difficult is the concept of adapting to a sick society. In the case of W.W.II, the prevailing attitude of the time allowed Nazi doctors to forget the mandate “first do no harm”. When society is sick, those in conflict with society may be more healthy despite their inability...or because of their conform to the norms and values of the time.

• “Shannon’s Maxim #5...It is more important to love than to agree or understand”. Philosophy is often defined as the love of knowledge. I try to remember it is possible to love knowledge more than people. I’ve been guilty of it before...I hope not to again. In my own life I have faced many challenges and have failed many times. I used to believe knowledge was the way to truth and went about collecting it like seashells. I finally realized nobody ever learned a thing from my little collection of constantly changing facts and figures, but I’ve found people listen to my failures. They understand it. People understand fear, loneliness, despair, failure, pain, hope, renewal, love; all those very real emotions that life is composed of. Education and counseling are very’s just the timing that is different. I have been so fortunate in my life to see, feel, and experience the full range of the good and bad in people; I found that I don’t’ understand as much as I think I do (another maxim), but it all works together (and yet another). Sometimes years later I have been able to comfort someone or say something that seemed to make a difference. I believe in the end my life will be defined by the smallest, least significant, and unlovable thing I help...or ignore.



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