-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: Amenorrhea From: Robert J. Woolley (wooll005@gold.tc.umn.edu) Thu Sep 5 09:52:23 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: sherifk@allegheny.edu: "cytolytic vaginosis" Previous message: T Dubose: "Re: u/s software" Maybe in reply to: Bill Katz: "Amenorrhea" Next in thread: T Dubose: "Re: Amenorrhea" In message <960905090106_194865507@emout14.mail.aol.com> writes: > <<Not to put too fine a point on it, but this statement of things makes it > pretty clear that you are putting your own interests ahead of the > patient's. I think that is a grave violation of our fundamental ethics.>> > > No, it's the old maxim of "First do no harm." Well, at the risk of starting an entirely new thread, this "old maxim" has neither the historical nor the philosophical weight that most modern physicians attribute to it. See, e.g., RM Veatch, *A Theory of Medical Ethics*, Basic Books 1981, pp. 141-176; or, more consisely, R Gillon, ""Primum non nocere" and the principle of non-maleficence," BMJ 1985; 291:130-131. A moment's thought will confirm this. If we really accepted this as an absolute principle, we would never prescribe any drug with any side effect (no matter how rare, no matter how minor, no matter what the benefit), never do any surgery, etc. It would render us completely powerless therapeutically. See ED Robin's interesting discussion of this, "Saltem plus boni quam male efficere conare: At least try to do more good than harm," Pharos 1987; 50 (1): 40-44. > > What we're talking about here is "How little harm can I get away with in this > patient who won't follow directions." We have to do the difficult calculus of summing all the possible adverse outcomes weighed by their probability and severity, for each possible treatment option (no treatment, prescribing OCs, etc.). And if your disagreement were merely over the results of this complex arithmetic, I wouldn't press the point. However... > > There IS a logical and philosophical difference between something someone > else does, and something YOU do TO them... A stroke is a stroke is a stroke. A death is a death is a death. If you had the power to prevent it, and failed to do so, you *do* share responsibility, even if you contributed to the bad outcome only by *failing* to write a prescription, rather than contributing to it by *writing* the prescription. You could make your same argument for, e.g., an uncomplicated teenager who is having unprotected sex and requests birth control pills. By your reasoning, if you write the prescription, and if she has one of the very rare serious adverse outcomes, you are reponsible; so therefore, by your reasoning, you should not write it, and just tell her to stop having sex to avoid pregnancy, and if she doesn't follow your advice and keeps having sex and gets pregnant, tough, it's her fault, it has nothing to do with you. The reasoning here is precisely the same as you are advocating; the only difference is the relative likelihood of the adverse outcomes. The reasoning is, IMHO, seriously flawed, and deeply unethical, since it is based on putting your own interests (keeping your hands clean) above those of your patient. --------------------------------------------------------------------------- --------------------------------------------------------------------------- Bob Woolley -- --------------------------------------------------------------------------- St. Paul, Minnesota "It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts. (Sherlock Holmes, in Doyle's A SCANDAL IN BOHEMIA.) Next message: sherifk@allegheny.edu: "cytolytic vaginosis" Previous message: T Dubose: "Re: u/s software" Maybe in reply to: Bill Katz: "Amenorrhea" Next in thread: T Dubose: "Re: Amenorrhea"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Wed Dec 2 05:17:16 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.