Though the field of medicine during the times of ancient Greeks is very outdated, The Hippocratic Oath is one concept that remains important even to this day. Particularly, there is one line that the general public expects medical professionals to observe: “I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice” (Tyson). Interestingly, physicians are expected to judge the best interest of the patient in order to do no “harm or injustice,” but how can one person be expected to determine what is best for another person? Of course, any morally sound clinician wants to ensure that the patient receives the best treatment possible, but to accomplish this they must first combine their professional knowledge with the precise knowledge of every patient’s best interests – a feat that is simply impractical.
According to Veatch, in order to implement a treatment while simultaneously respecting the patient’s best interests, a medical professional must adhere to three principles. First, the clinician must ensure that the patient’s medical needs are met; second, the clinician must ensure that the patient’s other non-medical interests are respected; and third, the clinician must be able to uphold various other societal morals and laws even if these may conflict with the patient’s best interests (Holland 320). As Veatch states, all three of these assertions have the possibility of conflicting with each other. For instance, in a case in which a Jehovah’s Witness has a communicable intestinal disease needs to undergo a critical operation, the surgeon explains that the procedure would require an intestinal bacteria transplant (bacteria from the gut of a healthy individual is transplanted in another individual). He offers an alternative treatment regimen that involves cleansing the gut with potent medications, but this has a very high risk of serious irreversible damage. It is in the patient’s best medical interest to undergo the surgery because the risks are lower, yet this would not be in the patient’s best moral interest. The patient may refuse both treatments and may be willing to live with the disease, although she can spread this disease, which is deadly to other individuals. Thus, the clinician is obligated to treat the patient in order to benefit the greater good, yet this violates the patient’s religious interests and/or her medical and autonomic interests. The clinician and the patient could both agree to the alternative treatment, but this encroaches on the patient’s medical interests. The clinician could leave the patient quarantined for the rest of her life, but this would not be in her best medical and autonomic interests. Subsequently, which option is the best for the patient?
In addition to respecting all three of these factors, medical professionals are guessing to determine the patient’s interests. The most efficient way to diminish the amount of guessing which treatment may work best is for the clinician to strengthen their personal relationship with the patient. Unfortunately, even though the doctor can be “generally warm and caring,” patients may still feel as if there is a distance between them and their physician (Chen). Some people have problems that they would not even tell their best friend, let alone a medical professional who might be a stranger to them. To some patients, medical professionals are experts of their body and know what is best for them with regards to treatment. “Some even said they feared retribution by doctors who could ultimately affect their care and how they did” (Chen). An analogous situation is the classroom setting. Some students often feel afraid to question the authority of the teacher, even if it best serves their learning environment, because the teacher has the ultimate say in their grade. In the medical setting, however, the physician has the ultimate say on the patient’s life.
Essentially, it is nearly impossible for a clinician to act fully within the interests of any individual, especially if they do not know the patient on a personal level. In order for the physician to ensure that most of the patient’s needs and desires are met, the doctor-patient relationship must be strengthened. For this to occur, medical professionals should be more personable to patients in order to make them feel comfortable with divulging information. Meanwhile patients should view their physician as just an average human being with whom they can share their opinions and ideas.
Chen, PAULINE W., M.D. “Afraid to Speak Up at the Doctor’s Office.” Editorial. Well. The New York Times, 31 May 2012. Web. 23 Feb. 2014. http://well.blogs.nytimes.com/2012/05/31/afraid-to-speak-up-at-the-doctors-office/?_php=true&_type=blogs&_r=0.
Rosenberg, Jennifer. “Typhoid Mary.” About.com. N.p., n.d. Web. 23 Feb. 2014. http://history1900s.about.com/od/1900s/a/typhoidmary.htm.
Tyson, Peter. “The Hippocratic Oath Today.” NOVA. PBS, 27 Mar. 2001. Web. 21 Feb. 2014. http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html.
Veatch, Robert M. “Abandoning Informed Consent.” Arguing About Bioethics. Ed. Stephen Holland. New York: Routledge, 2012. 318-28. Print.
11 thoughts on “First, Do No Harm”
The theme of strengthening and personalizing the doctor/patient relationship has come up many times in the blog posts. It seems to be something that most people are concerned with and think needs to be addressed. I completely agree with this notion, and believe that it could open the door to solving other problems in the health care system as well.
The example you provided about conflicting ideals presents, like most bioethics cases, presents a difficult situation. Even leaving out the part about the disease being transmittable, the conflict between the procedure acceptable by the patient’s religion (the riskier surgery) is reason enough to cause conflict for the doctor. The patient has, in a sense, made two 2nd order decisions: their religion, and entering the hospital and seeking professional help. So which one should trump the other? Should the patient choose the riskier procedure, and hold true to their religious beliefs, or go with the more reliable procedure option, and allow their second 2nd order decision to override the first. Here again we see decisions as a process, susceptible to change, rather then events.
Your example of the Jehovah Witness stuck out to me because I’ve never thought about how a medical decision may be overrode by someone’s personal beliefs. I believe that if an illness is going to effect the population as a whole and the medical decision is necessary for the greater good, then the patient’s preferences should definitely be ignored. That’s like valuing someone’s moral rights over the health of many people in the population.
Your closing arguments about the doctor-patient relationship are very on point. Like I’ve mentioned in practically all of my comments, I also believe that the development of the doctor-patient relationship is extremely important and essential in creating a trustworthy environment. If the doctor and the patient build this relationship where they don’t even have to be labeled as “doctor” and “patient,” communication will be a lot more clear and decisions will be a lot easier and less stressful to make. However, if our health system doesn’t allow enough time for the physician to develop this relationship with his or her patient, what is the solution? We say that this relationship should be strengthened, however, is it really up to us? Or is it up to the whole health system as a whole? Doctors can’t spend all of their time with one patient even if they really want to. Rather than blaming the physician, we should look even more outside the box and blame the health system as a whole. In the end, it’s not the physicians fault if he’s working against the clock that’s not in his favor.
I like that you address the guesswork that is part of the reason that this dichotomy is problematic. When you cite “The most efficient way to diminish the amount of guessing which treatment may work best is for the clinician to strengthen their personal relationship with the patient,” it calls upon both sides of the relationship showing greater strength. As you start to hint at, “even though the doctor can be “generally warm and caring,” patients may still feel as if there is a distance between them and their physician”. I believe the patient should show more care as well. In other words, trust that the doctor has their best interest in mind and thus be honest with them so that they can help you better. It is alarming that some people “have problems that they would not even tell their best friend, let alone a medical professional who might be a stranger to them.”I think this is a big problem. People need to realize that if they share everything with a single person. it should be their doctor. While some may be embarrassed, for instance, to mention they are an alcoholic or have unprotected sex, these points of information are crucial when a doctor needs to make a decision. It is thus in the best interest of the patient to try to get closer to the doctor as well. When you say “patients should view their physician as just an average human being with whom they can share their opinions and ideas,” I agree to some extent, but believe that it is part of their training to do this at the very least. Physicians should take it to the next step by facilitating better conversations and patients will view them at a higher level, worthy of knowing how they really feel, again, for their own health benefit.
I like how you tie in the oath that states that doctors should do no harm to their patients, but they are expected to incorporate what is in the best interest of the doctor. The task is difficult because the idea of knowing what’s best for a person is slightly unrealistic as said by Veatch. How do we exactly know what’s best for a person without experiencing some of their issues first hand. Also, the doctors bias interferes wit the communication of the treatment. Although, the idea of the doctor knowing exactly what’s best for the patient is slightly unrealistic, the doctor can give their medical judgment in combination with what the patient has expressed and the patient’s treatment could be ideal. Sometimes a person doesn’t have to know exactly everything to get a good feel of how to prescribe the medicine.
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