Attempting Miracle Cures with Unproven Treatments: Should Doctors Do It?
Let’s get down to brass tacks regarding miracles in medicine. We need to review the ethics of an issue physicians can face in their career. Patients and their families are looking for miracle cures when the illness has been treated, the treatment and additional treatment fails or as in the case of some diseases, such as symptomatic rabies, there is no treatment but only death. And the patient or their family will look at the physician and say “how about trying…?”, “I read about..”, “What else can you prescribe..?” How should the physician respond when the physician suspects the prognosis is nil. Should the physician respond frankly with “I have done all I can do.. there is nothing else to do for a cure.. but I can make you comfortable..”? Or should the physician under pressure from the patient and family not give up and perhaps concur with their requests or recommend a treatment that is unproven? After all, is there anything to lose? This action will demonstrate to the patient and family that the physician has their true interest at heart, he or she has listened to them and is willing to enter this adventure with them. Should this make the physician feel more comfortable and have no regrets regarding the outcome? Would the comfort also extend to the idea that there might be less chance for malpractice liability as initiated by the family?
But what is there to lose? What about providing an unproven therapy? Is there a scientific or an ethical rationale for experimenting a theory on a single patient? If the response is successful, what does this prove? And if not? Or does this not matter? What are the burdens to the use of unproven therapy in such cases as I have described? Would the toxicity kill the patient and not the underlying disease? Or should we look at the harms of treatment as irrelevant if the benefit is a miraculous recovery? What are other potential losses we can consider? How about an element of the profession of medicine that deals with society’s understanding that physicians practice under scientific principles and not as some irrational “witch doctor”? Would medicine lose society’s respect? And another question: who will pay for the unproven treatment? This deals also with justice and shepherding scarce resources such as providing that care and treatment is available to other patients? Would patients lose something they need by the act of utilizing unproven treatment on another patient?
Many questions but what are the answers? Miracles are miracles because they may be hoped for but realistically never expected to happen and if occurring are simply unexplainable. How far, if ever, should physicians go to reach for a miracle? ..Maurice.
posted by Maurice Bernstein, M.D. @ 2:59:00 PM
3 comments
3 Comments:
I think it's important to address an issue that arose earlier -- namely, the fact that the term 'miracle' is used in a variety of ways. Sometimes, as Alyssa noted, things are called miracles even though we know there's nothing miraculous about them. Hoping that laetrille will cure one's cancer is not the same thing as hoping that one's cancer will be miraculously cured. If, contrary to all the evidence, people did experience cures related to laetrille treatment, it would presumably be something about the treatment (i.e., laetrille) that brought about the cure; _not_ a miracle. That's why the medical community looked at the clincial evidence and the theoretical underpinning of the laetrille phenomenon. They did not simply say, "Oh, here we have a miracle." Rather, they turned to critical investigation to arrive at a conclusion about whether in fact laetrille could produce the sorts of effects being claimed for it.
Patients should not be discouraged from hoping for miracles, but they should be given to understand that miracles are not the province of medicine. Doctors don't know how to perform miracles, and they don't know how to create the conditions in which miracles might occur. Whatever doctors or the rest of us mere mortals might have it in our power to bring about, it's not miracles.
I know this doesn't really address the questions that Maurice has raised. I doubt that we can do better when dealing with patient/family requests for untried treatments than to proceed on a case-by-case basis.
Bob, but it is on a "case by case" basis most physicians practice and it is the case where dying is unexpected, unscheduled or frankly unwanted where often the request for a "miracle" is made. Even though it might be professionally sufficient to state to the patient or family that "doctors don't know how to perform miracles", would that be sufficient to placate or act in a beneficent manner towards them? If doctors could be allowed or even encouraged to treat, on a case by case basis, with fully unproven therapy what should be the criteria in the case or therapy to permit such an act? ..Maurice.
Maurice -
My comments were really addressed to the situation where a doctor is challenged with "But doctor, don't you believe in miracles." If I were a doctor, I'd probably have to say, "Even if I do believe in miracles, I can't perform them -- I can only hope and pray for them." (I don't have any problem at all with physicians praying for miracles, either on their own or with patients/families.)
But you're right to look beyond questions of the miraculous and to seek criteria doctors can apply to decide when or to what extent they should go along with requests for unproven (but plain old non-miraculous) therapy. Of course we should ask whether there are any risks or benefits that might be anticipated in light of theoretical considerations -- but often we have too little to go on here. And of course we need to consider economic factors, including the use of medical resources that might be better employed elsewhere. And finally, and for me most problematic, is the delicate issue of trying to understand the hopes and fears that underlie requests for unproven therapy. Sometimes, it's a "simple" matter of being willing to try something new when none of the old approaches are viable. But sometimes, it's a much less simple matter of patients or families struggling with all their might, grasping at any straw, to avoid facing the fact that we are all fragile and mortal, and that even if we "rage, rage against the dying of the light," it will nonetheless fade from view.
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