APPENDIX VII:
Medical Morals
IN MEDICINE TODAY, there are four great moral questions involving the conduct of medical practice. One is abortion. Another is euthanasia, the killing of a patient with a terminal and incurable illness. A third concerns the social responsibility of the doctors to administer care to as many people as possible. A fourth concerns the definition of death.
The interesting thing is that all these problems are new. They are products of our technology, moral and legal problems which have sprung up within the last decade or so.
Hospital abortion, for example, must now be regarded as a relatively inexpensive and safe procedure, carrying a mortality rate roughly similar to a tooth extraction. This was not always true, but in the modern context it is, and we must therefore deal with it.
Euthanasia was once much less serious a problem. When doctors had fewer “supportive” aids, artificial respirators, and knowledge of electrolyte balances, patients with terminal illnesses tended to die quickly. Now, medicine faces the fact that a person can be kept technically alive for an indefinite period, though he can never be cured. Thus the doctor must decide whether supportive therapy should be instituted and for how long. This is a problem because doctors have traditionally felt that they should keep their patients alive as long as possible, using every available technique. Now, the morality—and even the humanity—of such an approach must be questioned.
There is a corollary: whether the patient facing an incurable disease has the right to refuse supportive therapy; whether a patient facing weeks or months of terminal pain has a right to demand an easy and painless death; whether a patient who has put himself in a doctor’s hands still retains ultimate life-and-death control over his own existence.
Social responsibility in its modern terms—responsibility to a community, not an individual—is something rather new to medicine. Formerly patients who were indigent were treated by kind doctors, or not at all; now, there is a growing feeling that medical care is a right, not a privilege. There is also a growing number of patients who were once charity cases but are now covered by health insurance or Medicare. The physician is today being forced to reconsider his role, not in terms of those patients who can afford to seek his help, but in terms of all the people in the community. Related to this is the increased medical emphasis on preventive care.
The definition of death is a problem with a single cause: organ transplants. As surgeons become more skilled in transplanting parts from the dead to the living, the question of when a man is dead becomes crucial, because transplantable organs should be removed as rapidly as possible from a dead man. The old, crude indicators—no pulse, no breathing— have been replaced by no EKG activity, or a flat EEG, but the question is still unresolved, and may not be for many years to come.
There is another problem involving medical ethics, and that concerns the doctor and the drug companies. This is currently being fought over in a four-way tug-of-war involving patient, doctor, government, and drug manufacturer. The issues, and the eventual outcome, are still unclear.
MICHAEL CRICHTON graduated from Harvard Medical School and served his internship before deciding to devote himself full-time to writing. A CASE OF NEED was first published when he was twenty-six years old. His more recent novels include DISCLOSURE and JURASSIC PARK
Michael Crichton, A Case of Need
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