I attended an organizational marketing meeting yesterday and an interesting topic was brought up for discussion.
The topic was ‘Ethics and Medicine’ and the evolution of traditional medical practices when viewed through an ethical prism.
To be sure, the AMA (American Medical Association) outlines a ‘Medical Code of Ethics’ for Physicians, considered by many to be the definitive work on this subject.
However, this wasn’t the bent of our discussion. Our discussion wasn’t germane to considerations on social policy issues, inter-professional relationships and physician/client confidentiality.
Instead, we discussed issues related to end of life decision making, including the resuscitation of end-stage patients (with or without specific DNR/DNH directives in the chart).
The consensus was that medical intervention has evolved from ‘Paternalism’ to an almost strict (perhaps even rigid) principle of patient (and family) autonomy.
At Regency Nursing Centers, our guiding philosophy is the overarching concept that life, in all of its permutations and through all of its vicissitudes, is inherently precious and worth sustaining.
While we honor specific directives and an already established protocol of care, our charter and mandate is to care for ALL of our patients with dignity and compassion and to strive towards facilitating a quality of life for everyone.
It’s interesting to note that just this morning on my drive in to work, I tuned in to a fascinating interview by Don Imus with Dr. Barron Lerner, who just authored a fantastic book called ‘The Good Doctor,’ dealing specifically with this topic.
Dr. Barron Lerner is a doctor and the son of a doctor. He grew up thinking his father was a wonderful, gifted and caring physician, which he was. But after Lerner started studying bioethics, he began questioning some of his father’s practices — practices which were typical of many doctors in the ’60s.
There were times when his father would conceal information from his patient if he thought that was in the patient’s best interest; there were times he didn’t reveal that a patient’s cancer was terminal; there were times, in the era before do-not-resuscitate orders, that his father would make that decision for a patient without consulting the family. This kind of paternalism would be considered a breach of ethics now.
In Lerner’s new book, The Good Doctor, he compares his father’s approach to medicine with the bioethics that are applied today. Lerner is a bioethicist, historian of medicine and internist at NYU’s School of Medicine. He’s the author of several books and has contributed to The New York Times column Well, The Atlantic and The Huffington Post.
His father, Meyer Lerner, was an infectious disease specialist and kept a journal in which he wrote about his medical experiences from 1961 until Parkinson’s disease ended his career in 1998. Lerner drew on those diaries for his book.