Journal of Research in Peace, Gender and Development (ISSN: 2251-0036) Vol. 1(7) pp. 210-215 August 2011 Available online@ http://www.interesjournals.org/JRPGD Copyright ©2011 International Research Journals Full Length Research Paper The concept of human person as a challenge in establishing a multi-disciplinary approach in medical care: The Lebanese example 1 Fadi Abou-Mrad*, MD, PhD and 2Lubna Tarabey, PhD 1 * Head Neurology Division Saint Charles Hospital – Lebanon, Professor of Neurology and Medical Ethics, Lebanese University and Laboratory of Medical Ethics and Legal Medicine – University Paris Descartes - Paris 2 Professor of Sociology Faculty of Medical Sciences, Lebanese University Campus UL, P.O.Box # 2 Hadath Accepted 17 June, 2011 The Human Person is a concept that acknowledges and upholds the unity of the human being’s faculties including the spiritual, psychological and physical aspects. This concept is acknowledged and accepted by all the different denominations in Lebanon – a diverse multi sectarian country where religious identity is central to all people. Yet upon examination of the Lebanese society, a lack of application of this concept is noticed especially within the medical domain where it is greatly needed and requested. The paper aims at examining this discrepancy utilizing in-depth interviews and seminars involving a number of professionals. The factors that were considered to be relevant to the modification of the concept in Lebanon were examined with a particular emphasis on the medical domain, suggesting venues that would function to reintroduce the human person and to reestablish the two cardinal values of respect to the Human Person and solidarity within society. Limitations to the possibility of realizing this aim are acknowledged along with the importance of exerting effort on behalf of all society to realize the Human Person. Keywords: Human person, unity, patient autonomy, liability, medical care, diversity, Lebanese milieu. INTRODUCTION The concept Human Person (HP) is a term that refers to the true essence of a human being – namely the Unity and Integrity of a human being. Looking at the human being from the perspective of the HP allows one to perceive the human individual as one complete whole person. This is very important particularly within the field of medicine because approaching the patient as a HP permits the medical professionals to treat him/her as one whole – a Unity. Medical care as such should not target just the patient’s sick body or the ailment but his whole being – psychological, spiritual, mental, as well as physical. Real, building upon Plato’s ideas concerning the value of the HP within the medical domain, considers that doctors must treat the whole of the patient’s body and not just the sick part taking into consideration the *Corresponding author email: fadiaboumrad@gmail.com soul which also must be healed (Reale Giovanni, 2002). In other words, for a true healing process to occur the whole of the human body alongside the soul must be treated. This is why contemporary medicine is aware of this problem and promoting a new medical pedagogy to approach this dilemma (Llorca G, 2003). Therefore, one cannot separate the sick individual from the HP with all his/her faculties (Plourde S, 2008). In Lebanon, the realization of the concept of the HP is of utmost importance particularly so since all religious leaders adopt the reality of the concept. Nevertheless, both socially and within the medical domain, we find a certain lack in the application of the value as an understanding of the individual human being as well as of society at large. Lebanon is a multi sectarian country that seems to suffer from constant dissent among members of the same society, yet, all denominations seems to agree upon the HP as a concept for establishing better human beings and thus a better society. The realization of the Abou-Mrad and Tarabey 211 HP within the field of medicine is crucial because it allows for the re-establishment of the main values that build a health system. The notion of value has been modified since its early conception with Plato because of the deviation in medical practice mainly in the research domain abusing the human person. This led to the declaration of Nuremberg and Helsinky (Doucet, Hubert, 2000). The aim of medicine cannot overcome two cardinal values concerning the person in suffer. The first value relies on the respect of HP. The second value is the sense of consciousness of belonging to the chain that binds the persons of the human community (Llorca G, 2003). It is, therefore, the solidarity induced by the responsibility, and the foresight that leads inevitably to adhere to an essential dimension of medical care which is preventive medicine. A Lebanese survey revealed that there is a lack of understanding of these values (95%) within the nursing profession (Abou-Mrad F, Atallah C, Antoun N, 2010). It is only through acknowledging the value of the HP that allows for the re-establishment of the social bond within the medical domain. This bond has been weakened because of different variables including the health care support system (including social security, welfare, and medical insurance), hospitals, physicians, industries, as well as the application of legislative texts and the way of sorting out these bioethics laws. There is an evident loss of the HP within the medical field and there is a need to shed light on this fact with the aim of reinstating the value of the HP. One becomes more aware of the need for such an endeavor when one knows that in the recent national survey of nurses mentioned above only 2.5% of the nurses were able to properly define human dignity while 56% of these totally rejected the value of vulnerability within their patient evaluation. This refers to the physically and mentally fragile persons who need protection such as handicapped individual and patients suffering from psychiatric disorders. Moreover, 73% of nurses were not able to properly distinguish the concepts of ethics, deontology, and value. They failed to distinguish ethics as a new multi disciplinary emerging science that reflects a clinical action. They could not perceive of deontology as code of behavior and duties relating to the health care profession. They further, were not able to conceive of value as the belief or attitude underlying the importance that society gives to an aim, an object or a principle. They even were not able to determine what is meant by neither informed consent nor the repercussions of not implementing the principle of autonomy (Ibid). The above clarifies the extent to which the HP has been lost – eradicated from the whole patient- health profession portrait. There is an eminent need to reintegrate the person into its body through raising forgotten concepts including values, human dignity, ethics, vulnerability and through reinstating social solidarity which would lead to the acculturation of medicine that is a corpus exceeding mere knowledge. The aim of this paper is to provide some insights into the importance of incorporating the value of the HP into the Lebanese society at large and in the medical domain in particular. This would function as a platform for a common ground of action that would aim at restoring unity to society and value to the medical profession. By examining the lack in the application of the principle of the HP, we wish to bring the topic more into medical discourse and dissiminate the real meaning of forgotten concepts and vocabulary relating to human dignity that might restore equilibrium to the human being. METHOD A comprehensive literature review on the topic was carried out. These revealed that there is a limited – lack of – targeting of the HP from within the medical field in Lebanon. Lebanese philosophers and clergy dedicated writing to the topic of the HP adopting a moral-theological background. However research that tackles the issue from a socio-medical perspective remains limited. This fact revealed the need to approach this topic and the method utilized for this purpose was the use of semistructured interviews with a variety of professionals so as to acquire the information required. Fifteen professionals, religious authorities from both Christian and Muslim religions, physicians, social workers, lawyers, legislators and members of parliament concerned with the medical profession and human rights, were interviewed (AbouMrad F, 2008). The interviews aimed at finding out the professional’s understanding of the HP and the extent to which the concept is upheld within Lebanon. In addition to semi structured interviews, five seminars and open discussion panels were organized in order to broaden the understanding of the HP. RESULTS AND DISCUSSION The conceptual basis The individual is referred to in Greek philosophy as atomos which means indivisible. “The soul is not independent from the body; it lives in this unique body that is in communication with it” (Touma Jean; 2008). The Greek philosopher Plato not only dealt with the HP from the philosophical perspective, but further related it to the field of medicine in his two famous works Charmides and Timaeus (For more on contribution look into Reale’s article According to Plato, the Evils of the Body cannot be Cured without also Curing the Evils of the Soul in eds. Taboadas P, Cuddeback K and P, 2002). Further, no person, or “figure” in Christian theological thought, is like any other person: it is unique, belongs only to itself and to God and, therefore, is not submitted to possession by others “because sanctified persons in the kingdom are 212 J. Res. Peace Gend. Dev. not opaque to each other, but one is integrated to the other according to the doctrine of the Saints’ communion” (Touma Jean; 2008). In other words, Khodr confirm that opacity which was the rule of the earthly belief disappears in favor of total light that enlightens glorified people and illuminates at the same time the essential cosmos to the world of enlightenment Ethical values are for the human being an expression of life that is represented by the human communion with the other, who in turn is represented by the divine communion between the persons of the Trinity (Khodr G, 2008) than. Orthodox (Touma Jean, 2008) and Catholic (Maalouf J, 2008). churches share the same teachings regarding the human being. The HP concept is based on the vision of Trinity, hence Unity, Distinction and Communion. At this level, Divine persons are constituted and interlinked: Unity is based on God’s entity; Distinction guarantees the Person’s independence whereas Communion cannot be stabilized in the absence of equality based on the unique and integral nature in this communion which is itself an expression of life amidst the communion of different persons (Touma Jean, 2008). Christian philosophy succeeded in deepening the HP reality, especially through the current of Personalism that links dignity to the spiritual reality of the human being who is a legal entity and not a mere instrument or product of science. Pope John Paul II in his Encyclical Evangelium Vitae, states that “human life is sacred…”, (Encyclicals of John Paul II on the basis of morality, "Veritatis Splendor" Catholic Documentation, November 7, 1993 n.2080 on the value and inviolability of human life, "Evangelium Vitae" (D.C. April 16, 1995 nb.2114) motivating hence physicians and researchers to respect the human body and not to use and manipulate it at any time. Systems have then to be at the service and benefit of the whole person, body and soul. This concept is not restricted in its application to Christianity alone but extends to Islam. In Islam, a rule, the fiqh, states the obligations required in various fields from all Muslims by the Quranic law or Shari’a which aims mainly at respecting the HP, preserving life and safeguarding the human body and its sanctuary. The HP has a sacred character. The respect of the person’s physical and mental integrity is based on the principle that life is a gift from God. As for the body, it has been given by God to man who is responsible for preserving it from any harm. The whole human being enjoys, therefore, absolute inviolability and, it is not allowed, unless otherwise stipulated by legal authorization, to harm it, for as stated in the Qur’an “We have created Man in the most perfect fortune” (95thSu ra, The Fig, 4th verse). These declarations seem to be evident postulates; however it is still necessary to define the way of translating them within the Lebanese society where opinions and controversies soon change all concepts into problems. The only possible avenue for the overcoming any problem in agreement with the Lebanese society lies in the realization of two important notions that deepen our understanding of the concept of the HP – namely that of freedom and liability. The HP is not currently an integral part of the health care profession and society at large in Lebanon. If a person acknowledges and is aware of the fact that what makes him/her a HP is directly related to, and connected with the “other” in society, then that person is capable of accepting and valuing the other. A Lebanese individual assumes that he/she is a free agent, capable of free choice and would agree that the choice that he/she makes is the result of rational thinking that ‘supposedly’ took into account his/her rights granted to him/her by the mere faculty of being human. This, in a twisted sense, denies the very foundation of a HP and the very basis of that person’s justification for his/her line of action. What would restore the balance to the basis of the concept requires that this same individual fully comprehends that liability is associated with freedom. Of course a person is free to act in whatever way he/she deems most suitable to oneself. However, the most suitable line of action chosen by that individual may not necessarily reflect the ‘just’ or ‘right’ action. The concept of liability is being aware that every action/decision entails certain consequences which cannot be separated from the action/decision itself and to which the individual is necessarily held liable to. When an individual becomes aware that any act of harm entails with it consequences, would exceed the influence of which the whole society reflect on the person him/herself, there will be a bigger chance for a reconsideration of the act of harm. This liability – i.e. being held responsible and being aware of one’s liability towards the other, God, society, but mostly oneself, is part and parcel of man’s freedom and influences ones conception of him/herself as a HP and at the same time being aware of the other as also being a HP. Welkins claims that “the concept of free agency is the notion of one’s actions being up to one in such a way that one is, in a basic sense, responsible and accountable for them” (Nelkin, Dana, 2004). Taking the above as a basis – confirming that embedded in the concept of the HP is the freedom to act, but also responsibility for ones action particularly when it hinders the realization of the humanity and unity with the other – why do Lebanese people continue to seem inconsiderate of that aspect? This inconsideration is revealed by wars, killing and continuous political turmoil that appears to be unending? The problem seems to be in assuming responsibility – or in reality avoiding doing so. French points out in his book Responsibility Matters that it seems to be part of human nature to avoid assuming responsibility: “We spend a considerable amount of time trying to avoid responsibility wherever and whenever possible” (French, Peter Responsibility Matters; 1992). If Lebanese continue to avoid recommendations and Abou-Mrad and Tarabey 213 to blame everything on the other, then it becomes very hard – almost impossible – to aspire towards the realization of the HP. Thus the concept HP cannot be fully realized unless people understand the true meaning of the unique line of ethics – that calls ‘man’ in every ‘man. In Lebanon, all attempts to bridge the gap between different factions have failed. Political round tables, religious forums, social reform attempts … have all proven to be futile in their outcomes. Ethics seems to be the only gauge for a resolution to “live well” – which is the real aim of ethics. (Herve C, Thomasma, D and Weisstub ; 2001) Factors that led to the modification of the concept of the HP in Lebanon Regarding the causes behind the modification of the concept of the HP in the world and in Lebanon in particular, the late Lebanese Shiite Imam, M’md Hussein Fadlallah said that the problem that confronts the human being in general resides in the movement of his interior humanism. The human being has always been influenced by his entourage or his instinctive feelings that would affect his discipline and interaction in his everyday life. Whenever the human being opens up to the instinctive elements, he deviates from the ethics that give constant balance to his personality; the utmost derivatives are equally increased by exogenous elements generated by his environment (M’mh Hussein Fadlallah, Late Uléma Chiite in Lebanon 2008). An Arab is a person of history (Ibid) historical events, especially religious and community related events, affect his thoughts. His/her thoughts will be then oriented towards the community, even in the absence of community related background. Emphasizing the religion while ignoring its essential element, the spiritual, is the characteristic of the life in the East. Let us note that the human being, though cultivated, collapses in front of problems and becomes solely a community person (Ibid). Respect of the values of the human being, to whatever faith, religion or political position he/she belongs, seems to be threatened by the fanaticism of each person who is attached to its own opinion, believes in it and strives to realize it. The series of murders and assassinations that aimed to eliminating the other has moreover initiated the problem of mutual violence, both on the individual and societal levels. Violence towards the other leads to a planned violent reaction, hence the other becomes in Lebanon a community or societal block involved constantly in violence and confrontations that deny the human being freedom, value, ability, vivacity and dialogue (Touma Jean; 2008). The problem that a Lebanese suffers from and which denies him/her the possibility of operating within the boundaries of humanity is the accepting of diversity within the same society. Diversity is rejected and equated with a different other who is imagined to be operating within a framework of ‘destruction and annihilation’ of others. If one is not like me – different – then that person necessarily wants my destruction. This imagined threat is the cause of Lebanon’s misery. However, one must be aware that this threat – though imagined by most – is nothing but the product of the Lebanese socio-political situation that has through years of war bred a strong sense of mutual distrust that needs to be uprooted or at least attended to if the Lebanese people wish to live up to the ideal of the HP. There must be a conscious effort on part of all the different aspects of the Lebanese society and the state particularly within the scope of education and religion to work towards the realization of the ideals of HP. It is only when the Lebanese accept diversity and embrace the other as adding to one’s cultural experiences, will there be a hope for the mutual acceptance and realization of humanity and the value of the HP in him/herself and for him/herself. Civil war led for years to the development of a negative culture as to the human value. Society suffers from so many ills that the person’s integrity and value, even a disease, as important as it is, are being trivialized (Mokheiber G; 2008 ). This leads therefore to the risk of development of the “elimination” experience among youth, an experience which is in contradiction with the integration of the concept of HP in everyday life, under the pretext of preserving the concept of heritage in an obvious neglect of the underlying cause behind the existence of the country: its human being, its value, respect and dignity. The Human Person within the Medical Profession in Lebanon The civil wars, political and socio-economic instability that have characterized the Lebanese society and that led to the marginalization of the HP as a whole and extended their effects to the medical domain. The medical domain did not and could not remain immune to the negative influence of the war and the on-going bigotries that led to the de-humanizing of the human being. The medical field itself got tarnished with this dehumanization of the person whereby the patient was not considered a HP but simply an individual with a sick body that requires treatment and once the disease – not the person – is dealt with, cured or otherwise dealt with the doctor-patient relationship comes to an end. The dehumanization or the disregard of the HP within the Lebanese medical field is not only a result of the repercussion of war, dissention and divisions within the Lebanese society in general It is embedded within the medical approach itself which upheld the scientific objective method to the disregard of the human. Misler maintains that physicians have wrongly adopted the 214 J. Res. Peace Gend. Dev. rational, objectivity and neutrality principles of the scientific method in their clinical work. This implies a work that is “guided primarily by objective scientific rules and orientation and, therefore, is relatively unaffected by wider social, cultural and political forces. This view is often phrased normatively: that is medicine ought to be independent of and protected from these forces because they would undermine or distort its essential features as scientific” (Misher Elliot; 2008). The utilization of the scientific objective method did indeed create a revolution in the realm of knowledge dividing the fields on knowledge into particular specialties. A person specializes in one field, learning the methods of that particular field, and applying his knowledge within a particular situation. However, this approach in science – called the reductionist – has led to the drifting apart of the different fields of knowledge under the pretence of the scientific approach, objectivity and specialization. In the medical field, this has led to dissociation between the medical domain and the human aspect. A sick person is looked upon as a patient – a body with a disease – with a disregard to the person within. Many researchers are aware of the ‘unhealthy’ repercussions of this approach. “A concern shared by many authors interested in this topic is the need to overcome the old reductionist models of health and to provide an approach that does justice to the HP as a whole” (Taboada Paulina; 2002). The Western world was conscious of this problematic situation and suggested the Quality Decision Model which seeks to develop the quality of care (Husted GL and Husted JH; 1989). In Lebanon this situation has not yet received enough attention. If doctors and all those concerned with the health domain in Lebanon acquire such awareness, the patient would be transformed back into a HP and would get the necessary treatment that would in reality add value to the patient’s life and not simply cure a disease. Doctors can play a particular important role in the restoration of the HP within the medical profession. They can do that simply through listening to their patients with the awareness that the patient is not simply a medical case – a sick body – but a complete human being. Charon clarifies the importance of paying particular attention to the patient as a whole and not just focusing on medical symptoms. She suggests to physicians to train themselves to listen to patient’s stories and to attempt to re-tell the anecdotes told by the patients. This allows doctors to acquire the perception of the patient and even empathise with the patient. Listening to patients and understanding their experiences, limit the possibility of making diagnosis errors since doctors are able to gain in depth information regarding the basis of the illness. This can only be done if the doctor treats the patient as a person – not just a sick individual. According to Charon, this is the only way through which a doctor – who has knowledge – can become a complete doctor who knows how to heal. “We recognize symptoms, emergencies, and the need for action. If we complete this with recognition of the people in the midst of their distress, we become better complete doctors” (Charon Rita, 1989). In Lebanon, there is an inherent disregard of the right of the patient as is revealed by the fact that out of 136 hospitals, 82.5% do not have any sort of ethical committee even in its deontological dimension that is usually the generator and protector on informed consent. Moreover, out of the 17.5% which did have such a committee, half revealed no solid application in conducting the informed consent through appropriate pedagogical method (Abou-Mrad F; 2008). These statistics, when added up, further reveal the lack of respect of the principle of autonomy within the medical and healthcare domain showing the extent to which the rights of the patients are ignored and the manner in which doctors’ behavior is still strongly influenced by the paternalism of Latin countries. Limitations within the Field of Ethics Attachment to a religious community which provides warmth and security did not guarantee peace in the country. Religions affect “believers and physicians behavior” (Boustani F; 2008). They are coherent as to a number of fundamental principles of life but they do not imply real ethics because they are insufficient to structure anthropology by themselves” (Ducruet JSJ; 2008). Fadlallah said, in his analysis of the problem caused by the lack of integration of the religious factor in daily life, that man does not dig into the depth of religion and rather restrict himself to the superficial context. Fadlallah calls the human being to abide by his ethical and spiritual religious principles while assuming his responsibility within a communal society. Religious commitment of the contemporary person, whether he/she is a Muslim, a Christian or other, is not therefore deeply rooted in the consciousness he/she has of his religion and its interactive cultural aspects but is rather based on his emotional commitment to inherited rituals. Islam recognizes these differences and an author, like Mohammed Arkoun, acknowledges that the Qur’an does not impose solutions to the human existence practical problems (ARKOUN Mohammed; 1978). It aims at inciting man to have a certain vision of himself and of the world. Moreover, Christians also have on this subject a similar point of view: The Second Vatican Council declared: “In respect to the conscious, Christians must, along with other human beings, seek together the truth and the adequate solution to the moral problems encountered in private and social life” (Vatican II, Gaudium et Spes. nb.16). CONCLUSION What constitutes a person is the sum total of his/her Abou-Mrad and Tarabey 215 experiences that most often exert pressure – unconsciously sustained – on an individual ‘forcing’ this person to take one line of action or another. The Lebanese person is in no sense an exception in this regard. Yet, what distinguishes the Lebanese citizen is the long history of war and conflict that had somehow adopted a religious character and was perceived as a war of existence by many. This in itself has bred a sense of mistrust and hatred among citizens of a single nation who should value and uphold that which unites them without eliminating that which makes them different – which continues to be the cultural richness of Lebanon. The question that seems to pose itself is how one ever hopes to achieve this. Amin Maalouf (Maalouf A; 2003). seems to offer a very accurate resolution to this dilemma. If everyone acknowledges the diversity within his/her own identity, then it becomes easier for that person to accept diversity in society and embrace that diversity as a source of richness and not a threat. Recognizing the importance of reinstating the value of the HP within the Lebanese society at large and the medical domain in particular constitute the right step towards reinstating balance within the Lebanese society. This can be accomplished only when the Lebanese people learn to accept and value diversity and assume responsibility for their action. Within the medical profession, the main responsibility lies on those directly involved with the curing of patients – doctors and nurses. The patient must be valued as a person with dignity and freedom and as such must be listened to. A common reflection is essential for assuming our responsibility, whether in the medical field or in the organization of our social, economic, political and emotional life. The ethical line is unique and refers to the human dignity which is defined by the respect of manhood in each man. Such a vision cannot but gather believers and nonbelievers because “light is for each human being”, a light defined by dignity which is “a value that I decided to acknowledge”. For Jean Bernard, it is the freedom of the moral subject associated with the quality given to the human body. It is the obligation of all living persons who listen to their senses. 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