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----------------------------------------------------------------------- People who affected today's health care ----------------------------------------------------------------------- (December 9, 1997 00:30 a.m. EST) -- To get on Life magazine's list of the most important people of the last thousand years, a man or woman had to "divert the great stream of human history." Ranging from Leonardo da Vinci to Frederick Douglass, the list is intriguing for the named included and left out. It also turns an abstract idea -- millennium -- into an awesome parade. What can you say about a list that includes both Abraham Lincoln and Adolf Hitler? Also on the list are at least a dozen people of special interest to those of us who follow the connections between science, medicine and ethics. All of them belong on the list, even though there's a downside to the way we interpret the work of some: Galileo Galilei: Copernicus had already found out that the earth traveled around the sun, and not vice versa. But he hadn't spread the word because the Church declared that it and the world it ruled were at the center of the universe. Talk, and Copernicus would be toast. Around 1609, armed with a telescope and more courage than was healthy, Galileo found that Copernicus was right on both counts: the Earth really did revolve around the sun. And when he broadcast the news the Church did come down on him, like Godzilla on Main Street. He eventually reversed his public statements, but the methodical studies that had led him to truth paved the way for modern science. The bad news is that for the next 350 years most scientists were antagonistic toward any discussion of their work that used the words "values" "ethics" or "morals." Rene Descartes: Descarte's fascination with a clock may have done more to limit your medical treatment than the bean-counters at your managed-care office. A lawyer and a teacher of both math and philosophy, he helped reform the half-baked science of his and Galileo's day by insisting that it must be based on sound philosophical principles. At a time when both philosophers and scientists were struggling to understand the human body, he proposed the clock, a simple machine. Unfortunately, this idea took hold and never let go. It is blamed for the overemphasis on high-tech fixes for the body-as-machine view prevailing within modern medicine. The tendency of specialists to treat body parts, without regard to the whole, is another legacy of Descarte's clock. Meanwhile, there is little research on the kind of healing that treats the body as an organism, with constant interaction of mind, body and spirit. (Yes, as a matter of fact, Descarte before dey horse.) Descarte was a great pioneer of scientific ideas, but his mechanistic picture of the body still may be limiting what your doctor can -- or will -- do for your aches and pains. Immanuel Kant: He was a philosopher of the 1700s who is ranked with Aristotle and Plato. His writings are the basis for understanding all the philosophers since then -- which are, in turn, the foundation of the ethical decisions we make in the ICU. Kant's guideline was simple: We should live our lives so well that our behavior could be the basis of a universal law. Florence Nightingale: When this well-bred young English woman decided to be a nurse, her parents forbade her even to visit a hospital. It wasn't a job for decent women; the hospitals were more for warehousing the ill than for treating them. The great wave of patriotism from the Crimean War gave her an opening; she volunteered herself and a covey of friends to treat the wounded. She found the men lying on bare floors, untreated for days. Her unit's first requisition was for scrub brushes. When they were done, their combination of cleanliness and caring had dropped the death rate from 45 percent to 2 percent, and she was a national hero. She used her audience with Queen Victoria to plead for better conditions for the soldiers. Crimean fever left her an invalid when she returned to England, but for the next 54 years, living in seclusion, she campaigned by mail for clean hospitals, nursing as a profession for respectable women, and humane care for the patient. Otto von Bismarck: You may not be too happy about Bismarck's accomplishments in creating a strong Germany out of a gaggle of weak states. But he left all us patients a promise yet to be fulfilled in the United States: the world's first universal health care system. That system might eventually convince Americans that such a system really is possible. After all, it is still working in Germany, some 90 years after the Iron Duke established it. By BRUCE HILTON, Scripps Howard News Service (Bruce Hilton, director of the National Center for Bioethics, has been an ethics consultant to doctors, hospitals and patients since 1972. He welcomes your letters via Compuserve (70523,1071) or America Online (Ethctee). Copyright 1997 Nando.net Copyright 1997 Scripps Howard http://www.nando.net/newsroom/ntn/health/120997/health10_17002_noframes.html ----------------------------------------------------------------------- janet [log in to unmask]