Med Soc must not lose their patients
The Wykehamist
First, do no harm... but then what?
Med Soc must not lose their patients
On 4th August 2016, a Charlie Gard was born in London with Mitochondrial DNA Depletion Syndrome( MDS), a rare and vicious genetic disorder without a cure, leaving him unable to see, cry, move, hear or swallow. His parents fought on his behalf, and with the help of a neurologist based in New York, as well as the infrastructure of the Great Ormond Street Hospital, experimental treatment was carried out. However, before long, GOSH reached the conclusion that treatment was futile and would only prolong suffering. Charlie’ s parents pushed to continue the treatment in New York, but this was opposed by GOSH at all levels of court up to the European Court of Human Rights, with judges concluding that further treatment would‘ continue to cause him significant harm’. Charlie was transferred to a hospice on July 27, 2017, and passed away a day later.
At the time, this case spurred much heated and emotional debate on how doctors can reconcile the right to live with the right to die. Many accused Michio Hirano, the American neurologist, for creating too much false hope, despite never having even met the boy in person. Even Pope Francis called for the‘ wish’ of Charlie’ s parents to‘ accompany and treat their child’ to not be‘ neglected’, perhaps providing a religious perspective on the matter. Importantly, unconditional parental love had to come at the expense of providing their child with a natural and humane passing.
We can now look back on such cases with the power of hindsight to understand the importance of medical ethics; there will come a point in most people’ s lives where difficult medical decisions will have to be made for themselves or their loved ones.
The earliest medical code of conduct is the Hippocratic Oath, a text from the fourth or fifth century BC attributed( by some) to the Ancient Greek doctor Hippocrates— though it does not actually include the often-misattributed phrase of‘ first do no harm’. Of course, this text has been since eclipsed by much modern, more thorough documentation, yet the fact that most UK medical schools still employ some form of oath speaks to the fact that doctors do, indeed, have guidelines to act by in cases of moral dilemma.
At the simplest level, there are four pillars of medical ethics: non-maleficence, beneficence, autonomy and justice. Non-maleficence simply directs medical professionals to‘ do no harm’, and is applied to assess the risks of medical procedures, a process that is especially important in determining whether an individual is capable and qualified to administer treatment. This varies slightly to beneficence, which guides practitioners not just to avoid harm, but also to act in the best interests of the patient. Practically, this means ranking available options based on considerations such as how well an option can resolve a patient’ s medical problem, whilst also being compatible with the patients’ individual circumstances.
Autonomy, meanwhile, is about recognizing the rights of patients to make decisions about their own healthcare, giving them ultimate authority on what happens to their bodies by employing a concept called informed consent. This is the process through which a patient will be educated about the risks, benefits and alternatives of a procedure in a way that is understandable and transparent. There are, of course, limitations to such patient autonomy. For instance, patients can be subtly but gradually coerced by family members, societal expectations, and even healthcare professionals into making decisions that are not their own. The capacity to make decisions can also be reduced by factors such as cognitive impairment, mental illness or age, and this may require a healthcare proxy to be appointed to make decisions in the patient’ s best interest. Finally, the pillar of justice weighs up whether a procedure is compatible with the law, and is fair and balanced. Importantly, this includes making sure that no one
12