Virtual Mentor. November 2001, Volume 3, Number 11.
Profile of a Role Model
Guarding the Art: Edmund D. Pellegrino, MD
Commemorative Issue: Reconnecting to Essential Ideals
"What you freely assert, I freely deny. Sustain your case!" Pointing his finger at the 12-year-old Edmund Pellegrino, the Jesuit priest at Manhattan's St. Francis Xavier school challenged the boy to think about his answer--to reason and to argue for his position based on logic and evidence, and not to be swayed by mere opinion. It was a lesson the Brooklyn-born son of Italian immigrants would carry with him throughout his life, using it to frame his compelling argument for the moral nature of medicine and the ethical obligations of physicians.
Today, Dr. Edmund Pellegrino is recognized throughout the world as one of the most prolific and passionate spokesmen on ethics and the medical profession. His argument is deceptively simple: medicine is at heart a moral enterprise founded on the covenant of the patient-physician relationship. He has spent a lifetime sustaining his case--in hundreds of philosophical writings, in his clinical teachings to countless students and, most importantly, in the care of his individual patients. His perspective has pitted him against those who would argue that medicine is a business and health care a commodity, subject to the caprices of the marketplace.
Dr. Pellegrino identifies 3 aspects of medicine which define it as a moral enterprise:
It is this fundamental vulnerability of the patient and the need for trust in the healing relationship that constitutes the moral imperative for the physician to serve the patient with the patient's best interest in mind.
By accepting the privilege of medical education, physicians enter into a covenant to use their medical knowledge for the benefit of society.
It is these 3 aspects--the nature of illness, the nonproprietary character of medical education, and the oath of fidelity to the patients' interests--that define medicine as a moral community and determine the ethical obligations of the individual physician and the profession as a whole.
According to Dr. Pellegrino however, the prevailing social milieu runs contrary to this fundamental nature of medicine. The legitimization of the profit motive has transformed the patient-physician covenant into the patient-physician contract. He argues forcefully that today's physicians must choose between doing good and pursuing profit. The profit motive is irreconcilable with the patient's best interests because when the covenant between physician and patient turns into a business contract, "the end result is a physician who is an employee whose loyalties are divided between organization and patient, and whose self-interests are pitted against the patient to curb costs or make profits" .
Ironically, this elder statesman of the medical profession was almost not admitted to medical school. Despite his outstanding grades at St. John's University, where he graduated summa cum laude, he was not invited for interviews at any of the schools to which he applied. A letter from one Ivy League school complimented young Pellegrino on his grades but declined his application stating that he would be "happier with his own kind." Italians, said his academic advisor, were no more welcome than Jews in the major medical schools, and he might fare better if he changed his name. Pellegrino refused. His admission to New York University Medical School was due in part to his father's ingenuity. A salesman in wholesale foods in New York, the senior Pellegrino approached one of his customers who owned a restaurant near the campus of NYU and asked to be introduced to one of the regular customers. That customer--the dean of NYU Medical School--asked Mr. Pellegrino to send along his son's grade report. The junior Pellegrino was none the wiser and the rest, as they say, is history.
Since his graduation from medical school in 1944, Dr. Pellegrino's career has been as broad as his range of interests. He was president of Yale-New Haven Medical Center, chancellor and vice president for Health Science at the University of Tennessee, founding chief executive of the Health Science Center at SUNY Stony Brook, founder of the Department of Medicine at the University of Kentucky, and president of the Catholic University of America.
But it is his work as a physician with which he most strongly identifies. At the age of 81, he is the John Carroll Professor of Medicine and Medical Ethics at Georgetown University and arrives at the office each morning by 6 AM to sit at his 60-year-old Olivetti typewriter and wage his crusade for the recommitment of the medical profession to its core ideals. A man of deep faith and conviction, he draws on the lesson of his schoolboy days to argue passionately--but with evidence--for the importance of physicians' virtues, such as intellectual honesty and fidelity to the patient, as the ethical basis of the clinical encounter. For him the mandate for professional behavior is straightforward:
To Dr. Pellegrino, who has honored this trust for decades and has spent a lifetime defining and defending the core values of professionalism, your case has been sustained. QED .
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© 2001 American Medical Association. All Rights Reserved. This article first appeared in January 2001.