“Too Little Life, Too Much Medicine"

Bioethicist Albert R. Jonsen, Ph.D., Professor Emeritus of Ethics in Medicine, School of Medicine at the University of Washington gave a talk day before yesterday at UCLA titled “Too Little Life, Too Much Medicine” in which he dissected the First Aphorism of Hippocrates in terms of modern medicine and the futility debate. I thought it would be valuable to give a little thought to this reinterpretation by Dr. Jonsen. The following is based directly on the talk and handout.

The First Aphorism of Hippocrates reads “Life is short; the art is long. Opportunity is fleeting, experience perilous and judgment is difficult. The physician must be ready, not only to do his duty himself, but to secure the cooperation of the patient, attendants and of externals.” The Classic Interpretation was that “one’s life is too short to learn all one needs to know about medicine. Therefore, take chances, don’t rely on experience and take responsibility for the consequences.”

Dr. Jonsen’s reinterpretation for modern medicine includes:
“Human life, not the doctor’s life, is always too short. [There are always doctors around.] There is always plenty of medical science and skill. The nature of science and technology is [considered] infinite and infallible. Therefore sometimes there is more medicine than life can bear.”

The point of the lecture, I think, was to remind us all is that medical technology has developed to such an extent in maintaining life, that just because technology has the potential to do what it can do is reason in itself to always employ it despite any other factors which might warrant its non-use. I can think of the current example of the case of Terri Schiavo, where the technology of being able to provide a life-sustaining potion of fluid and nutriments to someone who is unable to swallow on their own and can maintain life is reason enough to continue this technology in the patient even in the face of permanent unconsciousness and unawareness. One can see this irrational use of medical technology in other examples of treatments which will not achieve the goal the patient might have wanted but because it is there, use it! The push to use it comes from patients, families and even the companies that developed the technology or drug. And, under pressure from them, the physician may throw experience away and prescribe the therapy.

I didn’t read Dr. Jonsen as advocating diminishing the progression of the advancement of science and technology but just warning us of the possibility of its ethically non-beneficent effects in medical practice. ..Maurice.