To give a robust account for the

To give a robust account for the practice of medicine, one must explain why sick and debilitated strangers are worthy of attention and care, and how the medical arts contribute to human flourishing. For some Americans, such accounts begin in secular moral tradition, but for most they begin in religion; nine out of ten Americans endorse a religious affiliation’. Either way, medicine looks beyond science to find a vision that animates care of the sick, a moral framework that guides the application of medical technology, and practices that nurture and extend the human capacity to care for patients as persons rather than as mere objects. In this sense, even though religious concepts are rarely made explicit in public and professional discourse about medicine, they are everywhere implicit and operative, and necessarily so. Why care for the sick? Humans in all cultures are moved to care for the sick. The question is why? The concept of the social brain provides the beginning of an answer. The peculiar human need and capacity for constructive, complex and meaningful relationships seems to involve neurological structures and functions that also facilitate attending to the sick. For example, Epley describes the human capacity to pay attention to our own mindedness and the mindedness of others. We are not only conscious of ourselves, but we are conscious of others being conscious of themselves and of us. This capacity allows us to be mindful of others’ bodily suffering and mindful of their consciousness of our relation to them in that suffering. To mindfulness is added the capacity to empathize. Decety describes a neurological structure through which the sight of pain in another person triggers a response in our 140 Page own brains that mirrors (albeit at a level attenuated by training and other contextual factors) the response we would have if we were suffering the pain ourselves. These features of the human brain allow us to pay attention to and to some extent share in the suffering of others—capacities that are psychological building blocks for caring for the sick. Yet to explain medicine strictly on the basis of empirical science, one must solve a particularly thorny version of the more general problem of explaining altruistic human behavior. Decety notes, “The emergence of altruism, of empathizing with and caring for those who are not kin, is ... not easily explained within the framework of neo-Darwinian theories of natural selection.” Indeed one can scarcely imagine a practice less conducive to the reproductive fitness of a population than spending enormous resources caring for the sick, the deformed, the weak, and the aged. Natural selection and the physician would seem to be at cross-purposes: one works to eliminate the sickly, the other to save them from elimination. On this account, medicine appears to be the sort of dead end into which the evolutionary process sometimes blindly drifts. Cacioppo, however, argues that altruistic behaviors can be explained within evolutionary theory by paying attention to inclusive fitness and the multiple levels of selective pressure: ...for species born to a period of utter dependency [e.g., humans], the genes that find their way into the gene pool are not defined solely or even mostly by likelihood that an organism will reproduce but by the likelihood that the offspring of the parent will live long enough to HOUSE_OVERSIGHT_021386