Standards of Excellence: Change

Standards of Excellence: Change

August 24, 2020

by David Williams, President, Taylor Seminary
 

We continue our conversation on standards of excellence in the Kairos Project. We have been working through some observations related to these standards. This week, we look at a third: standards of excellence aren’t static; standards of excellence change.

This might sound strange at first. Many of us were taught to believe that if standards change then they can’t really be binding and must be essentially arbitrary. But this isn’t true.

A stark illustration of this is from when I was younger and is related to my family’s experiences of the practice of medicine. My brother struggled with asthma. I remember many occasions when something would set off a quite serious asthma attack. He would find it harder and harder to get a deep breath. Sometimes, he had to work so hard to inhale that it was painful just watching and listening to him trying to get a breath. I remember our mother bringing him home from the doctor after a very serious bout with asthma. She remarked that the doctor had told her if we were away from home without his inhaler and he was really having difficulty breathing that she could give him a drag on her cigarette to help open up his lungs.

Before we get too critical of our family doctor, you have to remember this was back in the 1960s when the dangers of cigarette smoking weren’t medically acknowledged (whether or not they were known is disputed). For many people, cigarette smoking was a pretty normal part of life. The world has changed a lot since then. Now the harmful effects of cigarette smoking are so well accepted that any doctor telling a patient to take a drag from a cigarette to ease their difficulty of breathing during a fit of asthma might be subject to malpractice. You might suspect that our doctor wasn’t a very good doctor back then, but he certainly wouldn’t measure up today. 

Most of us have experienced this kind of change in medical standards. I am a bit of a “foody.” In talking about food, I often hear people complain about “not being able to keep up” with the latest medical advice on whether it is healthy to eat this or that food. Research changes our understanding of how food impacts us, so if we want to “eat healthy” we have to keep up with the research. One frustration my wife and I have had in this regard is that many doctors don’t keep up with the research. The advice we hear friends being given by their doctors about how to eat is sometimes shocking to us.

These are all the illustrations of the contingency of medical standards of excellence. As medical knowledge grows so does our conception of health, the standards for what we need to do to be healthy, and what it means to be a good doctor. These standards change but that doesn’t mean that they aren’t binding. After all, doctors can lose their license by violating applicable standards of good medicine even as those standards change over time.

So, I hope it is clear that standards can be binding even though we recognize them to be contextual, communal, and contingent. The importance of these observations can hardly be overstated. Next, we will spend a few weeks exploring the implications that these observations have on the Kairos Project. This is, perhaps, the most important practice in which we participate as the Kairos Project.