Re: First, do no harm
On Thu, Sep 3, 2009 at 9:09 AM, Dan Mdsummersmi...@comcast.net wrote: -Original Message- From: brin-l-boun...@mccmedia.com [mailto:brin-l-boun...@mccmedia.com] On Behalf Of Andrew Crystall Sent: Monday, August 31, 2009 4:25 PM To: Killer Bs DDavid Brin et al Discussion Subject: Re: Ben Bernanke, fearless leader On 30 Aug 2009 at 12:22, John Williams wrote: One of a doctor's fundamental guidelines is do no harm. A responsible doctor would never operate on a patient to remove the appendix simply because the patient complains of a stomach ache. More information about the state of the patient is needed before an operation is justified. An excellent example. Doctors are expected to remove a certain percentage of healthy appendixes. I can't remember the exact percentage, but it's significant. Why? Because the effects of an acute burst appendix are so nasty. If a doctor isn't removing enough healthy ones, then he is actually not serving his patents properly. You may wish to reflect on this as regards your stance. There is one other point that clearly falsifies the first do no harm taken as an absolute rule for medicine. Take, for example, the fact that there are always unknown factors and low probability events in medicine. For example, even with the most common surgeries, there is a chance the patient will die in surgery. Thus, if we first do no harm, we never do surgery. That is absurd. No one claimed that do no harm is an absolute rule. Nevertheless, doctors are expected to consider the risks of what they do, erring on the side of caution. The comparison of removing healthy appendixes is ridiculous. What percentage are we talking about? 25% of appendixes removed did not need to be? Less? The doctors should be cautious enough to keep that number relatively small. In contrast, economists have NO IDEA what the number even is, because they are unable to reliably predict what would have happened if there were no intervention. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: First, do no harm
On Thu, Sep 3, 2009 at 9:09 AM, Dan M dsummersmi...@comcast.net wrote: There is one other point that clearly falsifies the first do no harm taken as an absolute rule for medicine. Take, for example, the fact that there are always unknown factors and low probability events in medicine. For example, even with the most common surgeries, there is a chance the patient will die in surgery. Thus, if we first do no harm, we never do surgery. Clearly, I'm not arguing with you here, its just that your point made me reflect a bit. I think you got this wrong, Dan. This is an area of ethics I'm well versed in, having been a paramedic (where it comes up constantly) and as a student of medical ethics. The reason your example doesn't falsify the absolute rule is that in your example, the surgery, the treatment, is the doctor's primary purpose, not the harmful side effects. That's exactly why it doesn't say Do no harm. The word first is in there to mean that no doctor should do something in which the *primary* intent is to harm or the risk of harm exceeds the potential benefit (a hard call to make often). Thus, doctors have a real ethical dilemma if they even consider assisting in executions, court-ordered castrations and other areas where the primary purpose is indeed harmful, even fatal, and a somewhat less difficult dilemma when considering treatments with the possibility of unintended (or unknown) consequences. Nick ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: First, do no harm
On Sep 3, 2009, at 9:09 AM, Dan M wrote: -Original Message- From: brin-l-boun...@mccmedia.com [mailto:brin-l- boun...@mccmedia.com] On Behalf Of Andrew Crystall Sent: Monday, August 31, 2009 4:25 PM To: Killer Bs DDavid Brin et al Discussion Subject: Re: Ben Bernanke, fearless leader On 30 Aug 2009 at 12:22, John Williams wrote: One of a doctor's fundamental guidelines is do no harm. A responsible doctor would never operate on a patient to remove the appendix simply because the patient complains of a stomach ache. More information about the state of the patient is needed before an operation is justified. An excellent example. Doctors are expected to remove a certain percentage of healthy appendixes. I can't remember the exact percentage, but it's significant. Why? Because the effects of an acute burst appendix are so nasty. If a doctor isn't removing enough healthy ones, then he is actually not serving his patents properly. You may wish to reflect on this as regards your stance. There is one other point that clearly falsifies the first do no harm taken as an absolute rule for medicine. Take, for example, the fact that there are always unknown factors and low probability events in medicine. For example, even with the most common surgeries, there is a chance the patient will die in surgery. Thus, if we first do no harm, we never do surgery. I think First, do no harm is intended to be like something like the law of the Iroquois Confederacy: In our every deliberation, we must consider the impact of our decisions on the next seven generations. It acknowledges that there will be times when it is unclear whether the decision to act now or to delay in performing a procedure on a patient is going to do harm. It's an injunction against acting rashly rather than an absolute rule against taking any action with a non-zero probability of causing harm down the road. This is all well and good in the theoretical, but it's not always theoretical: may you never be in the position that we were, fourteen years ago, with our first and only son, where we had to make exactly these kinds of decisions over and over again, week after week, often with agonizing consequences no matter what we decided. Should we subject him to whole- brain radiation treatments, knowing that it might extend his life at the risk of reducing his IQ, permanently, to double digits? And that was just the relatively easy, obvious one. The only direct experience I have with what some insist on calling government interference with the health-care system is COBRA. Without it, I'd have been financially ruined, twice over, by medical disasters. First, Kevin's brain cancer, which was covered by COBRA extension of my extraordinarily fine coverage from Apple in the mid '90s. Second, my own brain cancer, which was covered by COBRA extension of my also- darn-fine coverage from Sun in the early 2000s. Thus, unlike a little more than 50% of Americans, I favor some form of government interference with the so-called free market for health care. Dave ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: First, do no harm
There is one other point that clearly falsifies the first do no harm taken as an absolute rule for medicine. Take, for example, the fact that there are always unknown factors and low probability events in medicine. For example, even with the most common surgeries, there is a chance the patient will die in surgery. Thus, if we first do no harm, we never do surgery. I think First, do no harm is intended to be like something like the law of the Iroquois Confederacy: In our every deliberation, we must consider the impact of our decisions on the next seven generations. It acknowledges that there will be times when it is unclear whether the decision to act now or to delay in performing a procedure on a patient is going to do harm. I think both yours and Nick's post are two takes on a liberal interpretation of that provisions; which does make sense in medical ethics. When I wrote the post, I was arguing against a fundamentalist use of that text, if you will. I know when Teri did her chaplan internship at M.D. Anderson, there were a lot of questions concerning medical ethics and there would be medical ethesists involved in working with the rest of the staff and the families on these decisions. So, I was arguing against a literalistic interpretation of the phrase itself, not the tough decisions you and Nick talked about. But, I would also argue that the first do no harm idea has morphed in society into a call for inaction until one proves no harm from something new in a number of areas. As Richard mentioned on the Culture list, there are inherently safer, cheaper forms of nuclear power that are rendered ecconomically unfeasible by the cost of satisfying safely test requirements of new designs, even when it is clear that newer designs are safer than what we are doing now. Or, the inability of NASA to adopt in a timely fashion more reliable technology because of the money and years it takes to pass official NASA reliablilty tests. Dan M. mail2web - Check your email from the web at http://link.mail2web.com/mail2web ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
