Respect for weakness

Gonzalo Herranz.
department of Bioethics, University of Navarra.
II National Bioethics congress .
Madrid, 4 and 5 December 1999.

Index

Introduction

A wake-up call for the weak

Medical respect

Medical respect is a respect for the weakened human being.

The ethical value of human finitude

Introduction 

The respect we owe to the weak is topic which has not received much attention on bibliography bioethics, although it is perhaps a central issue in the ethics of the health professions and one of the major problems to be tackled in the years to come.

It is a topic that should be discussed from time to time, because, paradoxically, it tends to be forgotten that the most important thing for a doctor is not only to possess a complex science, whose theory and internship takes many years to master, but to be determined to use this expert knowledge for the good of those who are most in need of this financial aid, who are those who find themselves in permanent situations or in occasional situations of particular fragility. Doctors' interest in new technologies is growing daily. Many are fascinated by things: by data and images, devices, protocols and the latest journals. This inevitably leaves little time to enter contact with patients, especially those who present themselves with the depressed face of weakness.

But true professionals, true doctors and nurses know that the decisive thing in medicine is not to deal with things, but with people, even if those people are in a state of extreme weakness. They know that it is a human being that is placed in their hands, he or she, not simply his or her things. This creates a status in which the whole sick person, body and soul, is to be entrusted to the doctor: not his X-rays or his functional tests, not even his lungs or his pancreas. It is he, whole and sick, who abandons himself to the doctor. This obvious reality tends to be forgotten, or at least obscured.

Sometimes I think that, all things considered, informed consent, instead of being a circular process that goes back and forth from patient to doctor and from doctor to patient, in fact circulates in only one direction and by the wrong hand. It should not be the physician who is the main protagonist, the one who takes the initiative; the one who, after having informed the patient of the plan for making the diagnosis or applying the treatment, obtains the patient's consent. In a way, it should be the other way round: it should be the patient who, after having informed the doctor of how precious his own life and health are to him, of how much he values certain personal circumstances, will ask him if, after due reflection, he agrees to take care, with a clear conscience and manager, of that life, precarious and fragile, that he entrusts to him.

If this commitment, this explicit recognition of the particular weakness of each patient is lacking, it is easy to forget that the patient is just that, an infirmus, a fragile being. It is tragically easy to break this commitment to respect the patient's vulnerability, to exploit it, to allow oneself to be driven by other interests than the patient's interests.

But professional ethics constantly reminds the physician that he or she is bound by a specific and qualified duty of loyalty and respect to the patient, and especially to the unarmed patient.

Respect for weakness is a vibrant topical issue. Medicine is becoming intoxicated with efficiency. It is successfully fighting its enemies - disease and death - with formidable success. Medicine has profoundly changed the way of life in advanced societies, where it has been at work. Not only is the level of health very high and life expectancy longer. Many diseases have been conquered or almost eradicated. And many of those that remain are result of our excesses: of food or speed, of medicines or age, of tobacco, alcohol or drugs.

One thing is obvious: you no longer see on the streets of our cities the crippled, the malformed, the handicapped of yesteryear. We see far fewer of the weak than we used to. And when we see the few that are left, we are disgusted by them. People's attitudes to weakness and pain have changed; the threshold of tolerance to seeing suffering, to rubbing shoulders with the handicapped, has decreased. The opinion has taken hold that the right thing to do is to be independent, i.e. to be strong and autonomous at Degree so that one is not dependent on others. To be worthwhile today is first and foremost to stand on one's own feet. Despite appearances, tolerance towards those weakened by illness is decreasing, especially among young people1. And, as surveys on euthanasia show, there is now a widespread belief that some human beings are so impoverished by illness and suffering that their lives can be shortened and that it is no longer worthwhile to give them the care with which they have traditionally been treated. We are, therefore, faced with such an important and topical topic .

A wake-up call for the weak 

It has been said that the most fruitful and positive element, both of the progress of society and of the Education of every human being, consists in understanding that the weak are important2. The most brilliant moments in history have been those in which men have endeavoured to put on internship the generous conviction that we are all, absolutely all, wonderfully equal and endowed with a unique dignity3. This is a beautiful and gratifying thing to say. It is not easy, however, to live this doctrine. Despite two millennia of Christianity, it continues to meet with resistance to being practised within each of us and within society.

Today we are witnessing a rapid deterioration of things and values that have taken so long to win and will take so long to regain. In medicine, in many places, the weak are losing out. The clock of history has been turned back and, in some respects, we are returning to a pre-Christian medicine. It was blind to the medical needs of the incurable. Extreme, irreversible weakness was not then considered worthy of medical attention. The final sentence "nothing more to be done" was followed to the letter by the physician of pagan antiquity. The doctor abandoned the incurable: in the Hippocratic caste, no poison was provided to put an end to his life, but the doctor no longer cared for the terminally ill, for he had no medicine with which to help him. Therapeutic futility conditioned medical abstention: the doctor withdrew, leaving nature to take its inexorable course. Plato sums up the attitude of the Greek physicians in The Republic with these words: "Aesculapius taught that medicine was for those of a healthy nature but who were suffering from a curable disease. He delivered them from their malady and ordered them to live normally. But to those, however, whose bodies are always in a sickly internal state, he never prescribed a regimen which might make their life a more prolonged misery. Medicine was not for them: even if they were richer than Midas, they should not be treated".

Thus, being irreversibly weak or incurable was a criterion of exclusion and rejection in Greek physiological medicine. For, while this was the art of ridding the sick of their ailments and alleviating serious crises of illness, it was also the art of discerning those who were so overpowered by illness that the physician was no longer able to achieve anything in them. Laín points out that the physiological physician, governed by his beliefs about nature, man and art, believed it was his duty to refrain from treating the incurable and hopeless. It took Christian charity for téknê iatrikê to become, in an expression invented by Laín himself, téknê agapêtikê, adding the art of charity to the art of medicine. The hospital was born with Christianity as the framework where illness is patiently endured, where misfortune is turned into a happy occasion, where the compassion of the Christian is placed at test in the suffering of his neighbour4.

Being weak is, in the Christian deontological tradition, degree scroll enough to deserve maximum respect and privileged protection. Nowadays, in environments dominated by individualistic attitudes and economic efficiency, advanced fragility is becoming the mark for withdrawal. Many doctors, betraying their vocation as protectors of human life, try to rationalise the marginalisation of the weak. They seek to return medicine to pre-Christian times. And, at the same time, they assign to the new medicine the new project of health enhancement, maximisation of well-being, physical overachievement, psychoneurological power, bodily aesthetics.

The new trend replaces the notion of the sacredness of human life with that of quality of life. It demands that the life of each individual reaches a critical minimum level, below which life lacks dignity and becomes a negative and erroneous entity, dispensable. Excluded from medical services are those who are no longer able to benefit significantly from the new medicine, which embraces a strong concept of quality of life, a dominant value, elevated to absolute. The result is a medicine for the strong and well-endowed, but hard-hearted.

In my speech, after a very brief analysis of ethical respect in medicine, I will try to argue that medical respect is inextricably linked to the radical recognition that man is fragile and weak.

I will then try to show how this recognition must go hand in hand with an acute awareness of the limited, incomplete nature of therapeutics: the essential finitude of man is linked to the finitude of the medical art.

But it is, paradoxically, in the recognition and acceptance of these limits that lies the impetus to learn more about the debilitating disease and to treat it better. In the euthanasia of the elderly and the withdrawal of the newborn, all scientific hope for alleviating the ailments of old age and alleviating the pathetic errors of the embryo-fetal development is abandoned. Respect for weakness is the bridgehead to begin the arduous conquest, inch by inch, of the knowledge and remedy of extreme weakness, and to persevere in it.

I will conclude with some considerations on how to rebuild medical respect for the weak and by proposing that respect for weakness should become part of the basic principles of medical ethics.

Medical respect 

Today there is much talk of respect as a core element of the professional ethics of medicine. All the documents in which medical ethics has crystallised since the Second World War, those deriving from the Geneva Declaration, give respect a central position in the moral conduct of the doctor. In the Codes and Declarations, respect for the integrity staff of the patient, respect for human life from its beginning, respect for the secrets entrusted to the doctor on the occasion of his meeting with patients, and respect for colleagues are mentioned again and again.

What does the ethical respect imposed by the doctor's professional deontology consist of? Much has been said in philosophical ethics about respect after Kant, and it is quite disparate. We have an excellent programs of study on the elements of medical respect and the different senses in which the concept is used in the practice of the health profession5,6,7.

Simplifying things a great deal, we can accept that the respect most congruent with the Ethos of Medicine is a basic moral attitude of the doctor that allows him to discover and respond to the moral values enclosed, sometimes hidden, in people precisely in the decisive circumstance of their illness. Both the abundance and the quality of the ethical life of the health professional, doctor or nurse, depend on his or her ability to perceive these values. He, and only he, who cultivates respect has the sensitivity and judgement to discover, in the presence of each of his patients, the dimensions of the service he must provide.

On the contrary, a lack of respect makes the doctor obtuse to the ethical problems of medicine and rude or blind to the needs that each patient presents. Respect for the patient prevents doctors from hiding parts of reality, denying rights, capriciously assessing conflicting values, manipulating the ethical demands of patients, and putting their own interests before the higher, priority interests of the patient. Respect, finally, allows doctors and nurses to provide their services to the sick person with dignity, not because the patient can impose such responses on them by force or buy them with his or her money, but because the respectful professional bows in a dignified manner before the great ethical value and the immeasurable human dignity that he or she recognises in every sick person, in a gesture plenary session of the Executive Council of intelligence and professionalism. In the Christian tradition, respect is of a purely ethical nature, it is part of the art of agape, and transcends the legalistic submission to the patient's autonomy of which so much is spoken and written today.

Medical respect is a respect for the weakened human being. 

Genuine respect for human life impels the physician, in the first place, to perceive it under the pleomorphic appearances in which it presents itself, to discover it in the healthy and the sick; in the elderly and the terminally ill patient, as well as in the child or the adolescent; in the embryo no less than in the adult at the height of its fullness. In all, he sees before him human lives, enjoyed by human beings, all of whom are, irrespective of their legal rights, supremely and equally valuable. Respect has a compensating effect, substitute membe, on weakness; it restores dignity to all weaknesses. Whatever any human being may lack in size, in intellectual wealth, in beauty, in physical fullness, all of these, including all his deficiencies and handicaps, are made up for by the physician's respect.

This is a constant of the doctor's work . The doctor does not have to deal with the healthy. To him go the sick, the handicapped, those who live the crisis in fear of losing their vigour, their wellbeing, their Schools or their life. The lives he encounters are painful or decayed lives. His respect for life is respect for suffering life. His proper role is to be healer and protector of the weak.

This idea is clear to the physician who follows the Christian and humanitarian traditions. Respect for all patients without distinction was included in the Declaration of Geneva precisely in a clause of inexhaustible ethical content: that enshrining the principle of non-discrimination, whereby physicians may not allow the professional intensity of their service to patients to be interfered with by considerations of creed, race, social status, sex, age or political convictions of their patients, or by the feelings that patients may inspire in them, and they undertake to render to all patients equally competent attendance .

But it seems that doctors are not always willing to comply with such a lofty and demanding commandment, as there are many who cynically violate it or consider it to be of an unattainable moral standard. It should therefore be emphasised that the prohibition of negative discrimination is an absolute precept, which includes all human beings without exception. In other words, the right to life and to health care is the same for everyone; it is possessed by the simple fact of being human. Physicians do not practise negative discrimination; they do not deny any of their patients the measure of skill and respect demanded by human dignity. He does not submit to the strong man because he has the power to demand his right to be respected, or disregard the weak man because he lacks strength and rights. He serves and cares for all equally, not as an activist for political or social egalitarianism, but because Withdrawal, in the face of the fragility that illness creates in all, he takes advantage of his position of power over them.

For those of us who fight for respect for life, the letter and spirit of the Declarations of Human Rights and the Charters of the Rights of the Sick are clear and cannot be watered down. We consider unethical the conduct of those doctors who select their patients, who discriminate between them, who accept some and reject others, who care for some and abandon others. The ethical tradition admits, however, not exceptions, but priorities, what can be called positive, supererogatory discrimination. One, for example, is created by the status emergency. The doctor must first attend to the case most in need at financial aid. But this is a technical reason, as there are no dignities that are more urgent than others. All patients are equally worthy. Another reason is that of ordering patients according to a scale of weakness, in order to give more attentive and solicitous care to the one who appears more seriously damaged.

There is no lack of signs today that the appreciation of weakness is not in its golden age. The medical profession, born precisely as a humane response to human vulnerability, seems, under the influence of powerful economic and political factors, to be disinterested in the precariousness of the weak and is allowing itself to be drawn into an alliance with the powerful. The ethical value of human finitude should therefore be reconsidered in some depth.

The ethical value of human finitude 

The doctor, in each of his encounters with patients, is faced with a challenge: to recognise in the suffering humanity before him all the dignity of man. Illness tends to eclipse dignity: it hides it and sometimes even destroys it. If being healthy confers, in a certain way, the capacity for full humanity, on the other hand, being ill means, in a thousand different ways, a limitation of the capacity to become, or to remain, fully human.

A serious, limiting, painful disease, which undermines our humanity, does not only consist of molecular or cellular disorders: it is also, and mainly, a threat to our integrity staff or a permanent limitation of it. It subjects us to test as men. We should not forget this when we are ill, or when we are caring for them. The Hippocratic tradition, enriched by the Christian ethos, saw in the breakdown of humanity that is being ill the root of the fundamental mandate to use all available means to restore the sick person to human wholeness and health, or at least to alleviate as far as possible the consequences of that threat. The physician acts on behalf of and at the behest of mankind to save and relieve the sufferer. Often, the medical attendance cannot be reduced to a mere technical-scientific operation, but must contain a projimal dimension, it must be a response staff to the threatened staff of the sick person.

John Paul II, who on several occasions has experienced the crisis of weakness, has given a very suggestive version of patients' rights, staff . The seriously ill person is in the process of losing his subjectivity. He often does not have the strength to fight to regain it, to become the "subject of his illness" again, instead of resigning himself to being the "object of treatment". The Pope considered that doctors are not responsible for this state of affairs, because it is a question of the patient's weakened inner life, of his insufficient determination to want to be a person. But the Pope felt that doctors should be much more aware of the danger of reification that weakness causes the patient to run, and that they should therefore actively help him in his efforts to re-appropriate his personality, which is threatened or diminished by illness. This is one more aspect, John Paul II concluded, of the reification of the individual, a danger that we find everywhere. This is one of the greatest problems of today's Philosophy and one of the most serious problems of the modern world.

The sick person is res sacra miser. This Augustinian term, with its Stoic flavour, brought back from oblivion by Vogelsanger8 , magnificently expresses the special status of the sick person in the field of tensions of human dignity. It beautifully translates into medical language the permanent character of the sacredness of human life. When the human condition of the sick is considered in this light, we recognise the inviolability and, at the same time, the neediness of the sick and the related responsibility of the healthy towards the sick. Respect for the sacredness of the sick does not make them intangible, but impels us to pity, to compassion, to make them the object of active love.

There have always, then as now, been certain mentalities blind to the ethical value of weakness. The philosophies of power and vitality, whether ancient-pagan or modern, have always shown their contempt, sometimes disguised as compassion, for the sick and the weak. The sufferer is therefore not res sacra, but res detestabilis. The instinctive and vital will of the healthy man expresses itself, in the face of the sick, not in respect and consideration, but in contempt and rejection. Conversely, attention, care, compassion and loving service for the weak and the small belong for Nietzsche to the morality of slaves, to the morality of a decadent and instinctually impoverished humanity.

I believe that there is a specific dignity of the patient that emanates from his legitimate demand for protection for his precarious humanity, from his human right to recover as much of his integrity as possible staff. The doctor's respect must be proportionate to this need: the patient has a right to the doctor's care, to his time, to his ability, to his skills. And, throughout the course of the doctor-patient relationship, as the doctor fulfils, in the name of humanity, his healing official document , he must maintain what I like to call a binocular view of his patient. He has to maintain a constant awareness that he is dealing with a human being, that the doctor-patient relationship is a person-person relationship, a subject-subject relationship, an I-thou relationship. But at the same time as the patient demands to be accepted seriously by the doctor as a person, he needs to be examined and considered as a disturbed biological object. The patient can never be reduced to a collection of disarranged molecules or bewildered organs, or as an enigmatic diagnostic problem or a simple opportunity for therapeutic essay . But he or she is these things and, at the same time, a person who, under such precarious appearances, preserves his or her dignity intact.

If one did not share this conviction, one would come to the pessimistic conclusion that the weak, the terminally ill, the dying and the permanently comatose would lack human dignity. Indeed, to say that human dignity can be diminished or lost because of weakness and suffering is tantamount to saying that human dignity depends on the ability to control uncontrollable things such as ageing, handicap or terminal illness. Stolberg9 , analysing the relationship between human dignity and equality and status terminal, states that man cannot cease to be human, which means that dignity is part of his nature. The idea of considering natural phenomena as degrading or demolishing human dignity is based on the false dualism that presents dignity and nature as antagonistic, which turns the natural into an enemy and destroyer of what is properly human. This is equivalent to identifying dignity with physiological well-being or even with that psychic integrity that makes possible the exercise plenary session of the Executive Council of rationality, autonomy or self-awareness. But these qualities are very differently distributed among those who are ill or who are going to die, so that they cannot be the basis for equal rights and dignity in the trance of death.

In order to restore a truly realistic and indisputable foundation for the radical equality of human dignity, Stolberg turns to G. Marcel's idea of looking to man's mortality and precariousness as the yardstick of the common human condition. Mortality and precariousness place us all on the same level of value, in an essential equality. From the confrontation with the finitude that awaits us all comes the awareness that we men coincide and identify with each other in the experience of pain and sorrow, of illness, ageing and death; an experience that amalgamates us all in the experience of common dignity. Stolberg concludes that anyone who argues that these circumstances threaten human dignity, understood as an equal value, falls into contradiction.

Recognition of finitude, a platform for progress 

The formidable progress of modern medicine with its incredibly effective diagnostic and therapeutic methods has made this aspect even clearer and brighter. We must be on our guard against the temptation of anti-intellectualistic pessimism, against the jeremitic premonitions of those who speak loudly of a technological dehumanisation of modern medicine or of the factory structure of today's hospitals. Basically, the use of the technological-instrumental in medicine is a prodigious manifestation of humanity, a lofty ethical act, full of application. Unfortunately, one sometimes hears well-meaning criticism of the cold technology of modern hospitals and the apparent detachment of the doctor when he is separated from his patient by a large number of devices and a large number of co-workers. All this, it is said, has made medicine less human.

But nothing could be more false. Medical realism never abandons hope. Weakness itself, biological fragility, advanced old age or the vice of development cannot only be the subject of resigned and fatalistic commiseration. It must also be the subject of scientific analysis. It cannot be cured, but it can always be alleviated and made more bearable.

The care of preterm infants has made incredible advances. We are taking the first rudimentary steps to understand the epidemiology of senile weakness10 and also its pathophysiology: to discover the metabolic disorders that underlie the extreme lack of energy that seems intrinsic to it; to identify the homeostatic imbalances that weaken the response to environmental aggressions; to understand the hyper-expression of catabolic cytokines or the deficiencies of anabolic hormones, which disintegrate or impoverish reactions to stressful situations or the repair of lost bone and muscle mass11. The first tables stratifying functional reactivity along the continuum from independence and adaptive capacity to decline, bedridden, cachexia and pre-death are beginning to be developed12. Efforts are being made to develop a new gerontology13 and a new preventive gerontology14 based on preventive practices incorporating concepts ranging from molecular biology to lifestyle modification.

We cannot forget that medicine and doctors owe a particular debt to the weak. Over and above the general ethical principle of non-discrimination, we are bound by two qualified reasons.

The first is the already mentioned particular obligation of positive discrimination, which has been so beautifully formulated by the French committee National Ethics Committee for Life and Health Sciences in a declaration condemning the performance of experiments on that special subject of weak human beings which are patients in a chronic vegetative state15. The committee gave their particular weakness a high ethical value, stating that patients in a chronic vegetative coma are human beings who are all the more entitled to the respect due to the human person because they are in a state of great fragility.

The second reason is that, in a way, many of today's weak patients are victims of medical progress to which we are particularly obliged. This is a tribute that must be paid, particularly in the stages following the introduction of new therapeutic modalities. Maxwell has coined the expression "paradox of medical needs" to describe the fact that every medical advance creates new needs and increases future demand for medical services16 . But not only because every new finding creates hope for a category of patients and turns a latent need into an immediate and already permanent demand. It is also because every new technology has to go through a more or less long implementation phase, in time and space, until it reaches an optimal level of efficiency. While it does not reach that level because it is still in the leave part of the learning curve, or when it boldly extends the area of its applications to patients with increasing risks, it is inevitable that a more or less numerous contingent of treated patients will survive in more or less precarious conditions: large premature infants with pulmonary, cerebral or sensory insufficiency are the counterweight to countless lives saved in neonatal intensive care units; so many polytraumatised patients who leave ICUs in precarious conditions of greater or lesser disability; the very old who, thanks to geriatric care, end their lives in extreme Degrees of dementia or disability.

All of them require our special attention. No one would collaborate in the scientific progress of medicine if they did not have the assurance that we doctors would take on this special duty plenary session of the Executive Council . And this is not possible if the weak do not have full confidence in their doctors.

An effective medical attendance is only possible when the patient trusts the doctor. But today this trust is not based primarily on a certain subject sympathy of the doctor, on his humanity in the popular sense, but rather on his scientific objectivity, on the reliability of his knowledge, on his skill, on his familiarity with the accepted methods of treatment, on the full assumption of responsibility for the interventions he undertakes. The seemingly paradoxical fact is that the maximum of subjectivity, the patient's trust, is based on the maximum of objectivity of the doctor, i.e. on his skill and skill technique.

It is necessary to dispel the false confrontation between the doctor's skill technique, experience and science, which must necessarily be objective, and his ethical qualities, his humanity, his character. And, as far as we are concerned today, in his weakness for the weak. What a surprising coincidence! The Dictionary of the Royal Academy defines weakness as both a lack of vigour or strength of body or soul, and as affection, affection, which this condition provokes.

It is precisely the true suitability and authority of the doctor that lies in the meeting of both attitudes. Equally bleeding are the wounds that doctors can inflict on the ethical respect they owe their patients when they mistreat them with therapeutic shoddiness, or the lack of sensitivity to the human obscured by extreme weakness.

Rebuilding respect for the weak 

It is clear that the weak have no shortage of true friends. This may be due to the fact that there is little thought and writing about the dignity of the weak today. Perhaps very few medical schools in the world devote at least one class hour of their curriculum to teaching the ethical significance of weakness. It is important to develop the theory and the internship of respect for the weak, to collect ideas and experiences about this topic, to give it depth and to go around talking about it with substance.

The literature on weakness should also be explored in order to taste everything and retain the good. It will offer us very inspiring messages, but it will also inform us of extravagant tendencies. We will see, at times, how easy it is to succumb to the excesses of moral indignation when criticising the social, occupational or health marginalisation of the weak and handicapped. And we will see that it is just as easy to fall into eugenicist rampages aimed at cleansing the species of the burden of inherited weakness.

There is already a good issue of testimonial stories whose protagonist is the physically handicapped, the terminally ill or those who care for them. Some of these biographies or autobiographies are epics of willpower, hymns to muscular virtues, which have allowed heroes or heroines wounded by illness to triumph over their own weakness despite it and against it; denying it, not making it part of their personality. Such literature of supermen and heroines is not always comforting or hopeful. But there is no lack of truly human stories, which tell us how normal men and women of different ages and cultural backgrounds live and cope with their limitations, who have learned to overcome the daily difficulties of a deficient existence with wit, good humour and the will to live, revealing the friendly and familiar face of weakness. After reading these writings, one is even more firmly convinced that the world would lose humanity and compassion if these weaker friends of ours were to disappear from it.

Finally, we need to offer a serious philosophical justification for the phenomenon of human frailty and biological handicap, that often inevitable companion of our lives, the acceptance of which is the most human of adventures. No matter how much progress is made in rehabilitation techniques, no matter how generous the budgets for health and preventive services, it will never be possible to eliminate frailty from the earth, nor to abolish suffering, illness and death. It is an illusion to think that the slogan "Health for all" can change man's essentially weak and vulnerable condition, for to be a man is to receive each his share of pain and disability. Every man's life includes the capacity to suffer and the acceptance of limitation.

Faced with the inexorable weakness of the world, doctors strive to reduce the pain, anguish and handicaps of their patients, knowing that they will never know enough to completely defeat their enemies. Therein lies the human core of medicine: not to triumph absolutely over pain and death. Just as demanding of science and skill is the operation of applying the most modern therapies, almost miraculous in their effectiveness, as that of administering palliative care, which requires a great deal of knowledge and mastery of what I believe to be the most difficult part of the medical art: telling the patient that man is made to bear the wounds that illness and the passing of the years inflict on his body and spirit, and that acceptance of these limitations is part of the process of humanisation. One is not truly human if one does not accept a certain Degree weakness in oneself and in others. This is demanded of us as part of fulfilling the duty of being human.

But this is not a popular idea. One day, the accounts of what our time has meant for the respect of weakness will be made. Lewis Thomas, that most brilliant and paradoxical figure in American biological thought, gave us, in a brief article on the function of insane asylums, a revealing part of that judgement. "A society can be judged by the way it treats its most unfortunate members, the least loved, the insane. As things stand, we are going to be regarded as a very sad group . It is high time we made amends for our mistakes".

You have to put a lot of science and a lot of heart into the task. The great thing is that doing something for the biologically or mentally weak is like doing it to God made man. Christ said: What you did it to the least of these my brethren, you did it to me. Seen in the correct Christian ethic, every act of service to the weak and the little ones, every gesture of the téknê agapêtikê, is worth more than sequencing the genome of a bacterium or beating an Olympic record. Someone, with a mixture of jubilant poetry and profound theology, has said that such a thing is all that is required, from God's perspective, for Him to rise from His throne and fill the sky with sounds of divine joy. So much to Him are the weak worth.

Thank you very much.

Notes