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Friday, March 12, 1999 Published at 13:57 GMT


Health

Doctors play God at their peril

BBC Doctor Colin Thomas: "Doctors must not be too heavy handed"

Doctors have it instilled into them during their training that they must serve the best medical interests of their patients irrespective of their personal feelings either towards the patient, or the treatment.

This is one of the cornerstones of medical ethics, and, for that reason, you should be able to trust any member of the profession in this way.

It is interesting to note that a study undertaken last year showed that doctors were still the most trusted members of society.

This is a very privileged position for us, and we should guard it wisely.

Ethical dilemma

However with "ethics" comes a problem. Notwithstanding that a doctor will recommend the best treatment for a patient, what happens if the patients themselves have an ethical dilemma about the treatment?

A Jehovah's witness who believes he or she will be sinning if they have a blood transfusion, even to save their life, is just such an example, and their beliefs should be respected.

This stance however poses doctors an ethical dilemma - save the patient? Or compromise a patient's deep seated belief?

It does, of course, depend how strong the belief is, but if that is what the patient demands - even in life threatening circumstances - then so be it.

That is why I'm sure the guidance issued this week by the Association of Anaesthetists will be welcomed by all doctors, but especially those in intensive care medicine, where the problem of life saving blood transfusions is most likely to occur.

Of course doctors will continue to offer the correct treatment in an emergency, but here is recognition that it is acceptable for doctors to respect these types of wishes from patients with less fear of criticism for not doing everything possible.

One could indeed say that the passages in the Bible about not accepting another's blood do not seem totally daft based on our experience of diseases such as HIV and hepatitis B today.

First principles

As long as doctors remember that our purpose is to serve our patients medical needs, but not ride roughshod over their beliefs or wishes then I hope we won't go far wrong.

It reminds me of an old medical story told to me by a wise old physician.

A famous brain surgeon died and went to heaven. When he arrived at the pearly gates he had to take his place at the back of the queue.

Not used to waiting, he approached St Peter and demanded to be let in.

Sorry mate was the answer, we get famous people in every day. Go to the end of the line like everyone else.

The surgeon reluctantly retreated, but was furious when he spotted a scrawny young doctor go straight through without being challenged.

How could you possibly let that young houseman in before a man of my standing he protested!

That was no houseman corrected St Peter, that was God, she just likes to play doctor sometimes.



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