The art of medicine and a portrait of stem cell research

In his classic painting, The Doctor and the Doll, Norman Rockwell preserves in heartwarming tones a glimpse into the special relationship between physician and patient. Many will recall the scene. A little girl stands before a gray-haired country doctor seated in a cozy hardwood chair, his black leather bag by his side. Loosely arranged across his desk’s top shelf are books well worn from frequent use. Framed between two candles, his medical diploma’s faded parchment suggests many years of clinical experience.

The child’s first concern is not the doctor’s level of scientific knowledge. She wants to know, rather, how he will treat her doll. Intuitively she knows that the doctor’s attitude toward her doll, who to her is the smallest and weakest member of her community, reflects what his behavior would be toward her if she were to become ill and vulnerable. The kind doctor leans forward, places his stethoscope to the doll’s chest, and listens tenderly. With bushy eyebrows raised and cheeks aglow, his gentle demeanor imparts a sense of security, of compassion, of hope. Smiling pleasantly, he has earned her trust.

Rockwell’s painting expresses a timeless ethic in American medicine. Would anyone dare vandalize it by painting it over with the harsh strokes of a contrary ethic? If Rockwell’s illustration were stolen, not from the art gallery, but from the conscience of medicine, would it be replaced by something of comparable beauty, or of stark utility?

Consider how that scene might play out in an era of embryonic stem cell medicine. Imagine that the doctor’s desk is now piled with journals giving editorial priority to papers on embryonic stem cell research. In the revised portrait, science provides the doll. But this time it is a living doll. Held between the doctor’s fingers is a plastic dish containing a glistening new human life – an embryo grown from the girl’s own tissue and developing in her genetic likeness. Reaching across the desk, the doctor’s other hand is poised to pinch the wick of one of the freshly lit candles. His subtle gesture signifies that the “therapeutic cloning” process entails the human embryo’s creation and subsequent destruction for the harvest of stem cells. The girl curiously stares down at his black bag stocked with syringes teeming with regenerative cellular treatments derived from disaggregated human embryos.

To test the doctor’s ethical commitments, the child must now come with more probing questions. She should ask, for example, what is the difference between a toy doll and a living embryo cloned sister? She should ask how old was her embryo sister when she was taken apart and given to medical science?. She should ask why, if stem cells were needed, her own multipotent “adult” stem cells could not have been used instead? She should ask whether good ends justify unethical means? She might be too embarrassed to ask – after all, she is a polite and shy young girl – whether the doctor ever thought of taking her stem cells when she was just a young embryo?

In art as in medicine, it matters to patients how their physicians treat others, even when their actions are symbolic. On the new canvas of American medicine, this matters as never before. The brushes of a new biotechnology are busily painting in brilliant detail a new doctor to treat the new doll as science unfolds wonders that are reshaping the contours of medical practice. What has not changed is the girl. Ever present are her imaginative desires, her health needs, her sensitive humanity. Therefore care must be taken to paint with a steady ethical hand. We must not allow our enthusiasm for science to splatter the doctor’s medical books, obscuring beyond recognition the long-honored Hippocratic ethic contained in their pages. The Hippocratic precautionary principle, “First, do no harm,” has for thousands of years guided the art of medicine and, if guarded, will continue to preserve a noble profession.

How will we explain the coming applications of stem cell technology to the trusting minds of young children? Can we be honest with them? Perhaps it is they who, through their innocent presence and penetrating questions, will encourage their elders to reflect more deeply and to aspire to a higher ethical standard. One day our children will paint the next generation of portraits commenting on the current era of medical science. How will they judge us? Will their brushstrokes flatter, or will they sting?

the Rockwell image is from