Medicine, Daniel Callahan argues, has become the sustainer of false hope in the face of death and dissolution. Callahan calls for a medicine more modest in its aspirations and more careful in its promises. Giving up the illusion that it can extend life indefinitely for a few, this new medicine would devote itself to making life better for the many. In making this argument Callahan raises an important theological question about the focus and claims of medicine. Without using explicitly theological language or making any proposals based on theology, he asks, "In what (or whom) do we hope?"
American medicine fails to take into account the biological limits of human life, and it is itself limited, since we do not have enough resources to offer it to more than a small group of the world's people. Callahan brilliantly exposes the "pathologies of hope" that surround our confidence in medical technology, and he relentlessly criticizes those who try to evade the consequences of introducing more and more of this technology. He is particularly good at pointing out how medical research, tied to a notion of unfettered progress, contributes to our difficulties.
Callahan's own idea of progress is focused on the health of populations, not of individuals. Medicine, he argues, should be available to all and should aim at enabling human beings to live through the whole natural lifespan. He adopts an environmental model for medicine. Instead of seeing nature as an enemy to overcome, we should learn to work with nature and within the limits of the natural world.
Callahan criticizes the influence of capitalism on medicine. Especially good are his comments on how the market approach works against personal responsibility and takes the focus away from public health. The market inevitably leads to injustice in the distribution of health care. It does encourage innovations, but not necessarily those that lead to a sustainable medicine.
One of the book's best chapters shows how the modern approach to suffering undermines feelings of solidarity. We imagine that enhanced choices will relieve dependency and suffering. Instead, they drive us further apart. And a medicine that encourages its healers to look at diseases instead of persons simply increases suffering.
Callahan is weakest at offering solutions. He shows the dangers of the current focus of medical research, but does not tell us how to change a system in which professional advancement depends on the publication of research results. The Enlightenment assumption that new knowledge will be our salvation permeates our society. Our colleges, universities and medical schools simply mirror this assumption. Only communities that sustain an alternative vision can really make a difference—and such a vision must be grounded in an alternative theology. Callahan gives us the critique of modern medicine; we must provide the theology that will give us a more just and sustainable system.