Who determines what benefits a patient?

What is it that classifies a treatment as unethical? Sure, an easy question to answer, but its history has proven us wrong time and time again. In any medical decision, “good” is weighed with the “bad”. When the benefits outweigh the risks, a procedure is deemed ethical. Now this is a very simplified version of the conversation that takes place and ultimately leads to a patient and doctor making a decision, but who decides whether a treatment is more beneficial or does not cause significant enough harm?

Rewind about 2,400 years ago, the Greek physician Hippocrates made an attempt to answer this question with an impact still seen today (Hippocrates, 2006). During the advent of modern medicine, Hippocrates outlined the structure of what physicians ought to do:

• I will educate
• I will apply my knowledge to treat
• I will not take a life
• I will perform no injustice
• I will not violate privacy
• If I do not violate this oath, I will enjoy life and art

This is a loose translation, but the message he created has lasted thousands of years and is still the base of many practicing physicians (Hippocrates of Cos, 1923). Even with a lasting impact, this fails to answer the question as to who makes the correct decision. The difficult answer is the practitioner. For years, research and procedures have been conducted in the same of science or “the greater good”, and when we look back, we are astonished to see how far away our ethics have been pushed to the side. In reality, it is the knowledge and understanding of the time, that physicians made the appropriate call. Early practices of bloodletting, lithotomies, and lobotomies are seen as horrendous acts of mutilation, but the balance of beneficence and non-malfeasance was often tipped in favor of the surgery (Taylor, 2017). 

The point is, ethical discussions of what we ought to do are based on how we perceive them in the current scientific community, but requires forward thinking to propel medicine forward. From the discovery of anesthesia, to applying a less invasive surgical approach, more can be done to ensure a patient is truly benefiting from a decision (Sprouse, 2010). In 20, 50, 100 years, what will we look back on as unethical? Could it be the use of radiation or chemicals to treat cancer, or the use of transplants to treat organ failure? When weighing the balance of doing no harm, remember Hippocrates, I will perform no injustice.

References:

Hippocrates (2006) [400 BCE]. On the Sacred Disease. Internet Classics Archive: The University of Adelaide, archived from the original, translated by Francis Adams, retrieved from, https://web.archive.org/web/20070926213032/http://etext.library.adelaide.edu.au/mirror/classics.mit.edu/Hippocrates/sacred.html 

Hippocrates of Cos (1923). The Oath. Loeb Classical Library, 147. 298-299. Retrieved from, https://www.loebclassics.com/view/hippocrates_cos-oath/1923/pb_LCL147.299.xml

Sprouse, E. (2010). What will medicine consider unethical in 100 years? How stuff works. Retrieved from, https://health.howstuffworks.com/medicine/modern-treatments/unethical-medicine.htm

Taylor, A. (2017). Five bloodcurdling medical procedures that are no longer performed…thankfully. Lancaster University. Retrieved from, https://theconversation.com/amp/five-bloodcurdling-medical-procedures-that-are-no-longer-performed-thankfully-75818