Hippocratic vs. Utilitarian medicine?

[rev ronin]

The poll should speak for itself.

[Boatswain2PA]

It is looking like the Nazis and Sanger following genetic purists are making a comeback. 

[EMEDPA]

interesting article related to the topic:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809094/

[Boatswain2PA]

It is one thing to be utilitarian in a crisis mode.  For example - military triage may red tag a minor injury so the injured can get back into the battle, meanwhile black tag someone who is still alive but would need extensive resources in an austere environment. 

It is another thing entirely for medical providers to believe in utilitarianism versus the sacred duty to their patient as proscribed by Hippocrates.
 

[ventana]

Utilitarianism is an ethical theory that states that an action is moral if it provides the greatest good for the greatest number of people compared to other alternatives. Utilitarian theories share four elements: Consequentialism, Welfarism, Impartiality, Aggregationism.

 

 

 

The Alliance for Hippocratic Medicine (AHM) upholds and promotes the fundamental principles of Hippocratic medicine.  These principles include protecting the vulnerable at the beginning and end of life, seeking the ultimate good for the patient with compassion and moral integrity, and providing healthcare with the highest standards of excellence based on medical science.

 

 

 

[ventana]

Interesting theory question

 

Is sort of the same as the question of rationing care ..........

 

 

I think we must have some utilitarian input into decision making because money is a limited resource and out entire system is driven by money.  Left unchecked and the rich will have great care and the poor nothing.

BUT 

We also need to make decisions based on doing what is right/best for the patient.

 

 

Overall I think we need to remove the profit motive from health care, seriously cut out the 200k-million dollar executives that do nothing to deliver care, and reign in providers who are not following simple guidelines.

[EMEDPA]

32 minutes ago, ventana said:

Interesting theory question

 

Is sort of the same as the question of rationing care ..........

 

 

I think we must have some utilitarian input into decision making because money is a limited resource and out entire system is driven by money.  Left unchecked and the rich will have great care and the poor nothing.

BUT 

We also need to make decisions based on doing what is right/best for the patient.

 

 

Overall I think we need to remove the profit motive from health care, seriously cut out the 200k-million dollar executives that do nothing to deliver care, and reign in providers who are not following simple guidelines.

agree- we (in the US) are especially terrible at end of life care. Someone who has been a productive member of society for > 50 years should not need to bankrupt themselves and their family to get basic care and housing in their time of need. 

[rev ronin]

6 hours ago, Boatswain2PA said:

It is one thing to be utilitarian in a crisis mode.  For example - military triage may red tag a minor injury so the injured can get back into the battle, meanwhile black tag someone who is still alive but would need extensive resources in an austere environment. 

It is another thing entirely for medical providers to believe in utilitarianism versus the sacred duty to their patient as proscribed by Hippocrates.
 

Right, and that's the difference the poll is getting at:

Is it OK for us as medical practitioners to do whatever to an informedly consenting adult who can pay? Or, are there lines that we will never, by the definition of our profession, cross?

 

[ohiovolffemtp]

I tend to think I have elements of both in my practice.  Probably mostly Hippocratic, some utilitarian, guided by my professional judgement, where I'm working, and how busy the ED is at the moment.

[Boatswain2PA]

9 hours ago, rev ronin said:

Or, are there lines that we will never, by the definition of our profession, cross?

Never say never.

And never never say always.

[SedRate]

17 hours ago, EMEDPA said:

agree- we (in the US) are especially terrible at end of life care. Someone who has been a productive member of society for > 50 years should not need to bankrupt themselves and their family to get basic care and housing in their time of need. 

Yes, independent and assisted living costs for chronically ill and disabled elderly is insanely expensive. I wonder if there will be a shift in which more families take in their elders during their last years.

[rev ronin]

8 hours ago, Boatswain2PA said:

Never say never.

The Hippocratic Oath doesn't say "never" but it does say a lot of "will not" and similar sentiment:

"I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion."

"I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft."

"Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves."

"Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private."

[EMEDPA]

8 hours ago, SedRate said:

Yes, independent and assisted living costs for chronically ill and disabled elderly is insanely expensive. I wonder if there will be a shift in which more families take in their elders during their last years.

IF they are just old and frail it is doable. If they have complicated medical issues or dementia and require 24/7 care it just really isn't feasible if you and your spouse need to work. Costs can be $10,000/month for this. 

[SedRate]

3 hours ago, EMEDPA said:

IF they are just old and frail it is doable. If they have complicated medical issues or dementia and require 24/7 care it just really isn't feasible if you and your spouse need to work. Costs can be $10,000/month for this. 

Indeed. In your initial post about end-of-life care forcing bankruptcy, were you referring to the basic needs and housing of the general aging population causing bankruptcy or bankruptcy for those who need advanced care at $10k/month? 

Edited January 21 by SedRate

[EMEDPA]

11 hours ago, SedRate said:

Indeed. In your initial post about end-of-life care forcing bankruptcy, were you referring to the basic needs and housing of the general aging population causing bankruptcy or bankruptcy for those who need advanced care at $10k/month? 

both