ETHICS-MEDICA (Cont..): Non-maleficience: In practice, however, many treatments carry some risk of harm. In some circumstances, e.g. in desperate situations where the outcome without treatment will be grave, risky treatments that stand a high chance of harming the patient will be justified, as the risk of not treating is also very likely to do harm. So the principle of non-maleficence is not absolute, and must be balanced against the principle of beneficence (doing good). The most extreme example in history of the violation of the non-maleficence dictum was Dr. Jack Kevorkian, who was convicted of second-degree homicide in Michigan in 1998 after demonstrating active euthanasia on the TV news show, 60 Minutes. In some countries euthanasia is accepted as standard medical practice. Legal regulations assign this to the medical profession. In such nations, the aim is to alleviate the suffering of patients from diseases known to be incurable by the methods known in that culture. In that sense, the Primum no Nocere is based on the realization that the inability of the medical expert to offer help, creates a known great and ongoing suffering in the patient. Not acting in those cases is believed to be more damaging than actively relieving the suffering of the patient. Evidently the ability to offer help depends on the limitation of what the practitioner can do. These limitations are characteristic for each different form of healing, and the legal system of the specific culture. The aim to not do harm is still the same. It gives the medical practitioner a responsibility to help the patient, in the intentional and active relief of suffering, in those cases where no cure can be offered. Non-maleficence is defined by its cultural context. Every culture has its own cultural collective definitions of good and evil. Their definitions depend on the degree to which the culture sets its cultural values apart from nature. In some cultures the terms good and evil are absent: for them these words lack meaning as their experience of nature does not set them apart from nature. Other cultures place the humans in interaction with nature, some even place humans in a position of dominance over nature. The religions are the main means of expression of these considerations. Depending on the cultural consensus conditioning (expressed by its religious, political and legal social system) the legal definition of Non-maleficence differs. Violation of non-maleficence is the subject of medical malpractice litigation. Regulations thereof differ, over time, per nation. QUESTION: A 76-year-old man of foreign extract goes to see his primary care physician complaining of chest pains, difficulty breathing, and general fatigue. When interviewed, he answers the physician’s questions respectfully in a soft voice with little eye contact. When questioned about any pain, he indicates that it is always with him. Subsequent examination and testing leads the physician to suspect that the patient might have lung cancer. When the possibility is mentioned to the patient, he becomes very quiet, stares at the floor and says softly, but distinctly, “I do not think I want to know this if it is true.” At this point the physician’s best reply would be which of the following? A. “I know cancer can seem a bit frightening, but modern advances in treatment give us some options you may not be aware of.” B. “I understand the custom of your culture is not to discuss these things, but I’ll need you to work with me so we can beat this.” C. “I understand your hesitation, respected Grandfather. I will work with your family if that is what you direct.” D. “I’m sorry, but I will need your cooperation as we arrange treatment. I will need to tell you and you will have some decisions to make.” E. “If it is your wish, I will not tell you. Whom in your family should I talk to in your place?” F. “In this country, patients have to be told everything. I’ll let you know when we have more definitive information.” G. “Let’s wait until we know something definitive and then we can talk about things further.” H. “OK, I’ll respect your wishes and not tell you.” I. “Tell me a bit more about why you do not want to know.”
Posted on: Mon, 15 Sep 2014 08:40:45 +0000
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