I am sharing a video by Dr. Jay Joshi who is an astute observer and commentator on healthcare policy.
I would like to comment on what he says. A major distinction he makes between health care and the law is that one is essential or holistic and the other is elemental.
Elemental is like running a red light. Essential is asking why you ran the red light. Medicine is like the latter. Good medicine is understanding why someone is addicted to something rather than focusing only on the addiction. Or not only focusing on lowering high blood sugar in a diabetic but improving the patient’s lifestyle. The law will focus on the fact that you bought illegal drugs and put you in jail.
One is rule-based and the other is looking at the whole picture. Joshi uses the analogy of looking at a work of art. Do you want to look at the whole work as one piece and appreciate it or break it down into its components of color, line, shape, and composition? Although you can break it down into the elements the payoff comes more from looking at the whole.
In psychology, there is a way of looking at these differences by looking at what is called the “polarity scale” developed by Silvan Tomkins.
He says that human beings fall into two categories. One normative and the other humanist.
Normatives tend towards the authoritarian and teach that we are born weak and need guidance. An old testament idea of punishment and rules based on the 10 Commandments. “Thou shalt not”. The law focuses on specific infractions of rules.
The humanitarian might be said to be based on the New Testament or the Greek ideal that we need compassion and democratic ideals; that we are all in this together and we need to figure things out together. The essential.
These two ways of thinking overlap as we are all a bit authoritarian and we are all communitarian, but we will fall on one side or the other.
An example of overlap might be determining a murder charge whether it’s first, second, or third-degree murder or first, second, or third degree.
Such determinations do attempt to encompass the whole picture.
In medicine, the caregiver, if they are doing their job, doesn’t want to just give an opiate addict medicine to stop the craving. They want to know why and how they got to where they are.
Medicine has its rules and regulations through standards of care and best practices, but there’s always an ongoing debate about whether there is any standard of care or best practice because each case needs to be evaluated on its own merits and at least a substantial portion of those will fall outside what we have managed to codify.
That is the codification of medicine is much more plastic than the law. Medicine is focused on reintegrating the whole. We have learned that punitive action has no place in healing.
In essence, is a system of this is why the law and medicine often do not get along.
There is a system of thought and practice that does much to bring these two world views of normative and humanist together called Restorative Justice. Many of you may have heard of it or experienced it in school. The idea is to solve conflict through a humanistic and community-based process. As an introduction think of mediation.
This is a movement that is growing and as it grows it is being applied to many types of conflicts.
Conflicts are resolved by realizing all participants have a stake in learning the origins of the problem and how all stakeholders can benefit from communicating and learning, in detail what and how things happened.
Cases are resolved by contract or similar agreement and specific action on the part of an offender and something on the part of all involved. Sometimes there is no particular offender.
The idea is all parties learn and grow. The essential and humanistic inform the elemental and enrich it. I invite you to look into the principles of Restorative Justice and you will be hearing more about it here.
Dr. Jay Joshi 11 min video