Healthcare providers use clinical practice guidelines — standards of care based on the scientific evidence that evolve with the advance of knowledge. These provide the current best practices for managing clinical conditions, such as congestive heart failure, heart attacks and strokes.
In any acute care hospital, there are standard investigations, medications and interventions for each diagnosis or problem. In obstetrics, we have standard approaches to babies requiring resuscitation at birth.
The case room nurses and physicians study the protocols until we know them by heart. We practise various scenarios together, and we repeat the Neonatal Life Support course and recertification examinations every two years.
When a problem arises, we are prepared, recognize it early and know how to respond.
So, clinical practice guidelines are essential to modern medicine. With ever-advancing research, the medications, investigations and interventions are better and safer than what we have used in the past.
But in our zeal to provide the best, state-of-the-art care to our patients, we sometimes forget that these are but the tools of healthcare. Ethics instructs us in how we ought to use them.
Medical ethics has been the heart and soul of medicine since ancient times. Though every healthcare provider is called to the profession by our desire to help others — to do good, the first rule of medicine is to do no harm.
That is one of the perpetual dilemmas of medicine. Every investigation and treatment — including blood tests, radiologic examinations, biopsies, interventional procedures, operations and scopes — comes with the potential for harm, side effects and risks, major and minor.
And central to any decision are the preferences and values of the individual patient. This is the principle of autonomy. It requires informed patients — who have been given and understand all of the information they require to make a decision. What is the purpose for this test, medication or procedure? What are the common risks? What are the most serious risks? What are the alternatives?
This is the information that a patient needs to provide informed consent for treatment, weighing benefits against risks and arriving on the choice that is best for that individual.
It is of course guided by your values. What gives your life meaning? (independence, connection with others, your work?) What treatments (i.e. blood transfusions, abortions, stem cells) are against your beliefs and values? What is a good and acceptable quality of life to you?
Davidicus Wong is a family physician and his Healthwise columns appear regularly in this paper
