Few transactions require quite so high a degree of trust as those between medical professionals and their patients. In placing their lives and wellbeing in the hands of doctors, patients must forgo a certain degree of bodily autonomy to a another. To ensure that this trust is not abused, doctors have for years taken a promise to put the wellbeing of the patient above all else. This promise is, of course, the Hippocratic Oath.
In taking this promise, medical professionals vow to improve the wellbeing of the patient as best they can, without causing undue damage or injury; the line ‘do no harm’ clearly underlining this salient principal. At first, this may seem rather straightforward. Naturally, one expects a doctor to behave solely in a way which puts the patient’s welfare first, and would never consider a doctor to deliberately cause harm.
The issue, however, is the fact that ‘harm’ as a concept is rather subjective. An invasive procedure may be seen as harmful and unnecessary to one patient, whereas another may consider it an acceptable risk. In order to avoid causing harm, it is crucial that a doctor be able to gain the consent of a patient. Communicating this consent allows a patient to decide for themselves what they consider to be harmful, and allows the doctor to stay true to his or her promise. Thus, one can see that the Hippocratic Oath and patient consent must go hand-in-hand.
In a simple doctor-patient relationship, this runs fairly smoothly. Communication and consent is kept between two people, and each individual is able to mutually agree upon the best course of action. The patient receives correct and consensual treatment, and the doctor sticks to the Hippocratic Oath. However, things become somewhat muddied when a third actor, the state, comes into the picture.
All too often in the field of medicine, the state takes an active role in deciding what a patient may or may not consent to, thus depriving the patient of their right to choose and, in some cases, forcing a doctor to cause undue harm and break their oath.
Take, for example, a hypothetical scenario. A patient is diagnosed with a terminal illness, and will likely not survive into the foreseeable future. With the outlook so bleak, the doctor decides that the path of least harm and of most welfare is to simply care for the patient, ensuring their comfort in their final days. The patient, however, learns of an experimental new treatment, which may prolong their life. They decide that they wish to attempt this new treatment, despite the risks involved in trying a new medication. They consent to any harm which may be incurred, as they value their survival above comfort.
However, the state has decided that the new treatment is simply too young and potentially dangerous to be used in hospitals, and the patient is denied the right to try. The patient is forced to accept death, and must now continue down a path of care they would not otherwise consent to. Forced to deny the patient the treatment to which they have consented, the doctor is unable to comply with the Hippocratic Oath. They must harm the patient through denying them their chosen path.
The Hippocratic Oath and, by association, good medicine are dependent upon a solid, consensual doctor-patient relationship, whereby no parties are forced to take a route they would otherwise not choose. State regulations in this area, which deny the patient the right to try new medications, procedures, of even the right to willingly end their own life, distort the relationship. The Hippocratic Oath depends upon consent to function; it cannot do this when patients are denied of the right to choose.
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This piece was originally published at RJMason.blog