The power of modern medicine displayed itself last year in
beautiful form when a newborn, given only a five percent chance of survival,
was saved in a last-ditch effort by his doctors. Claire Ives discovered her son
Edward’s heart condition—supraventricular tachycardia, which manifests itself
in an irregular and rapid heartbeat—while seven months pregnant with him, and
an emergency cesarean was performed on her soon after. Shortly after his birth,
Edward’s heart began beating dangerously rapid again. Doctors performed all the
“conventional methods” to save Edward, but when none worked, they decided to
try an utterly unconventional technique. They effectively “froze” his body (to 91
degrees) to slow his heart rate. The first time they warmed him back up, his
heart resumed its former pace, but after a second attempt, his heartbeat slowed to a safe speed. Ten days later, Claire was finally able to hold her son, who is a
“healthy baby” today.
Edward will doubtless be grateful to his doctors when he
grows to comprehend the choices they made; they rescued his life. The irony of
the situation lies in the fact that, according to ethical standards laid out by
documents like the Belmont Report, Edward’s doctors violated medical principles
by saving him. Their well-intentioned trespass lies in the nature of the
procedure used on Edward, a “method that had never been used on patients” like
Edward. In the Belmont Report, the section differentiating between practice and
research notes that, while a “[departure] in a significant way from standard or
accepted practice” is not necessarily research, it must be extensively reviewed
by a formal committee. In retrospect, application of this law seems perhaps
immoral. After all, the doctors saved their patient’s life. But consider an
alternate outcome, one in which the doctors bungled their treatment of Edward
such that he not only died, but passed much more horrifically than he would
have naturally. In that case, the public would have been raising their
pitchforks to the chanting of ethics code violations. Are ethical guidelines
themselves in danger of being unethical, in light of the implications of both the
real and fictional cases? For a statement that condemns untried and hasty
treatments will be guilty of the lives of Edward and many others, while an
opposing one that allows desperate actions will also be responsible
for the death of countless human guinea pigs (as earnest as the doctors might
have been about their patients’ wellbeing).
A solution, albeit rather unsatisfactory, may be found in
the WMA’s Declaration of Geneva, which pledges that “the health of my patient
will be my first consideration.” Thus, while laws controlling medical practice
are useful for keeping doctors accountable, this excerpt from the Declaration
of Geneva essentially places doctors above itself. In other words, when push
comes to shove, the doctor should shove medical ethics out the door in order to
save his patient. In the end, morality cannot be legislated or enforced. The
primary aim of documents like these, other than giving a general guideline for
moral assessments, is to establish grounds for remuneration of those
unquestionably indifferent to ethical considerations. The trade-off, however,
is simple: if we expect doctors to save us, like they did Edward, we must hold
off on our witch-hunts when they make mistakes.
Sources:
3 comments:
Ideally, doctors should do everything in their power to save the lives of their patients, even if the treatment does not strictly obey ethical guidelines. When it comes to the health of the patient, the doctor is the final source of authority on the right course of action. Ethical or not, medical decisions in the heat of the moment ultimately come down to the physician’s best judgment. But with doctors given such enormous power over human life, should we stay silent when we believe an injustice has been committed?
I believe the role of the public in holding societal leaders accountable for their actions is absolutely crucial. After all, doctors are human beings capable of making mistakes—and they certainly have in the past. We tend to forget that doctors once willingly performed eugenic sterilization and allowed “defective” newborns to die. These decisions were all made based on what the doctor perceived as ethical and in the patients’ best interest. Only after society contested these medical opinions did the standards change. Another factor to consider is the fact that doctors’ treatments establish precedence over one another. The decision made by one medical professional can have a huge influence on what is considered acceptable in a similar situation.
Take the case of Ashley’s treatment, for example. Since the first success of growth attenuation for Ashley, the treatment has been used at least 12 other times worldwide. Therefore, it is perfectly permissible for the public to judge new and perhaps controversial medical procedures, since they have implications beyond the health of just one patient.
In the case of Edward Ives, evidently that the treatment used to save his life was based on excellent medical judgment. The doctors who treated the baby deserve acclaim for their shrewd decision. Due to its proven success, the “freezing” treatment pioneered by these doctors will most likely be used in similar cases. However, despite the justifiability of the doctors’ actions in this case, the public has the right, even the responsibility, to question exceptional medical decisions in society.
http://www.guardian.co.uk/society/2012/mar/16/growth-attenuation-treatment-toms-story
I totally agree with you when you say that at the end of the day, doctors are people, and they are bound to make mistakes. Hence, it clearly isn't right to just condemn them when they fail while using an unconventional procedure (against accepted guidelines such as the Belmont Report) as a final attempt to save the lives of their patients. As long as 'the health of their patients is their final consideration,' and 'they have taken official consent from the legal caretakers of their patients,' I believe doctors should not be held responsible for the unpredictable outcomes of previously untested medical procedures. Yes, they should definitely be answerable to the society about why they did what they did, but they cannot be blamed for things going wrong.
However, not every doctor has the best interests of his/her patient in mind. In places where government regulations aren't properly executed, a lot of medical malpractices occur. My father is doctor, and when he went to this small village called Paddhari (in India) for free consultation, he came across patients who were unwilling to go for even simple diagnostic endoscopies, because they were afraid...they had seen other doctors remove healthy kidneys from the bodies of their patients for institutional research while performing surgeries of organs completely unrelated to the kidneys. And I have heard stories like these from many of my dad's doctor friends. There was a gynecologist who, for monetary benefit, wrongly convinced the patient that unless she opts for a cesarean procedure, her child's life would be at risk.
Cases such as these do not always get registered in the media, and thus, it is very important to raise awareness, at least in countries such as India, where the common man knows too little about medicine. Despite the presence of an additional layer of protection in the name of 'informed consent,' this lack of awareness has made patients extremely susceptible to doctors who do not have the best interests of their patients in mind, because in crunch situations like Edwards', the patients have very little time and very little knowledge, which makes it very easy for doctors to manipulate them for personal gains.
This issue poses a very tough decision on the doctors. The technology today just hasn't reached a point where we can treat every medical condition. Therefore, should doctors perform unconventional treatments on patients if all else has failed? Suppose that the patient has a 1% chance of surviving his condition, and doctors have tried all the available treatments that are commonly used, but none could heal the patient. Now also suppose that there is an unconventional treatment that has a 10% chance of succeeding. According to the Belmont Report, this unconventional treatment wouldn't be considered as medical "practices", which are "interventions that are designed solely to enhance the well-being of an individual patient or client and that have a reasonable expectation of success." With such a low chance of success, this intervention may be considered as research.
So, should the doctors continue with the treatment? If the treatment succeeded, one life will be saved, and the families of that patient will be indebted to the doctors for life. However, if the treatment failed, the doctors may face harsh criticisms from the society, media, or even from the family members themselves.
There is also a principle that many doctors follow: do not harm. If the treatment increases the patient's chance of survival, then after weighing the potential benefits and harms, there will be some doctors who will suggest the treatment to the patient. Since this is a tough decision, I don't think that the doctors should be blamed in anyway.
In my opinions, rules, laws, and guidelines are created for people to follow, so people should be the ultimate judge for these regulations. The ultimate purpose of these rules is so that the human can live coherently in a society. For an issue like this, which is in the gray area, the society should take moral responsibility in respecting the decision of the doctor. The least we can do is to hold back our criticisms should any unconventional treatments fail. After all, some treatments work and some don't. Maybe one day, when we have the technology to treat all medical conditions, these complicated issues can be resolved. For now, we can only hope.
http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.html
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