Over the last 30 years many new threats to health have emerged: AIDS, drug resistant pathogens and Ebola to name but three. Consider AIDS; it has surfaced, been identified and thousands of treatments developed within the last 30 years. In this short time, AIDS has had a huge impact with 35 million people worldwide living with HIV/AIDS (2013) and approximately 42 million having died from related illness.
Perhaps more notably, the attitude of medical profession to AIDS has likewise changed, when AIDS was first identified, then named “Gay related immune deficiency” (GRID), one physician suggested (professionally) that male homosexuals should reconsider their “actions” and implied the disease was the wrath of God. The physician was able to keep his job, with many other doctors publically agreeing with his position. Today this could never happen. With hindsight we can see that Medicine has been revolutionized by new scientific discoveries and, combined with the civil rights movements, our outlook is very different.
With Medics able to do more and more, an arguably more pressing issue has emerged: where do the boundaries of Medicine lie? Today, doctors have access to scanning equipment, drug therapies and surgeries unimaginable just fifty years ago and consequentially the survival rate of deadly diseases are better than they ever were. Such advances create good news headlines, however the media publicising these medical marvels has not helped the public’s health. Despite physicians striving to enable their patients to make informed decisions, the false perception of infallible operations has caused Medicine to, in a way, fail its patients.
Today’s medicine is advanced enough to give many people control over their own bodies and lives, however, people must be able to make an informed decision. It is everybody’s right to have autonomy over their own bodies and in a way, the development of medicine, in offering more treatments, has enabled this to happen. The biggest change medicine has had in the recent past, it seems, is not the advances in technology, but the maturation of its attitude: Medicine is not now centered on pushing boundaries to overcome disease at whatever cost, but knowing where the boundaries are, and maintaining the patient’s quality of life. The saying ‘gives the best chance for the patient” has been replaced by “best interests of the patient” and medicine has, consequentially, become more “humane”, validating the patient as a person, rather than the ailment they possess: symbiotically, the development of medicine, in general, have shown the way for doctors to become better physicians.
Arguably, one drawback of the advancement of medicine comes when the person is dying: the process is inevitable, but can now be turned into an experience of medical expertise, often with little avail. As discussed in Atul Gawande’s book, Being Mortal, patients have become are less accepting of death and less prepared for it, he details a case where the patient chose to undertake a complicated operation that “didn’t stand a chance of giving him what he really wanted: his continence, his strength, the life he had previously known”, but likely to leave him with serious complications such as paralysis or a stroke that could prove fatal. Thus, medicine enabled him to pursue a fantasy of life that came with great pain and a prolonged death – it was his right to choose what he did, but was this right?
With terminal disease, people can no longer think in terms of survival or statistics, instead, must consider their quality of life: a patient with Stage 3 or 4 oesophageal cancer has, fundamentally, two options: treat or relieve symptoms, letting nature take its course. A treatment for this type of cancer is a total oesophagectomy – removing the entire oesophagus and stretching the stomach into the chest or instead using a piece of resected bowel, replacing the oesophagus. This is an incredibly invasive procedure with (at the time of writing); no option for “keyhole” surgery. Thus the operation has a long recovery period accompanied by great pain. Furthermore infection at the site of the operation poses a risk of death, especially given the patient’s weakened immune system. Chemotherapy or radiation therapy often accompanying this operation, carrying many debilitating side effects. Near the end of a patient’s life, this treatment option may be presented to them, and it is up to the autonomous patient whether to accept it. The patient may choose to spend the rest of his life fighting the cancer, taking chemotherapy and invasive treatments as they come whilst remaining in hospital, or alternatively to be treated with palliative care, spending the rest of their life in comfort at home.
Doctors now have to make sure that informed consent is given based on information delivered impartially and clearly. A doctor’s job today is not to strive for survival, but to promote wellbeing and quality of life. Palliative care and hospices have developed just as medicine has: originally dedicated to the aging population; these methods may now apply to all those with terminal illnesses.
With this in mind it can be argued that “Medicine is not only a science; it is also an art. Medicine does not consist of compounding pills and plasters; it deals with the very processes of life” as Paracelsus, a Renaissance physician, claimed. Today his message is still applicable: with the extended life span we enjoy and the medicine filled experience that dying can be in today’s world, doctors must remain centered on what is in the best interests of patient. The new technologies we have, the new diseases we battle and the new drugs cannot distract us from the ultimate goal of medicine: “first do no harm”.
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