Friday, April 24, 2009

House M.D.: Modern Tyranny

The Cockroach Catcher had the honour of being mentioned in DrRich’s Blog Post regarding my post: House M.D. : 95% vs 5%

DrRich looked at patient autonomy, beneficence, medical ethics and how in our modern “enlightened” society “tyranny” still manages to find its way into our governments. The following is my extract from his post.

The notion that the patient’s autonomy is and ought to be the predominant principle of medical ethics, of course, is entirely consistent with the Enlightenment ideal of individual rights. This ideal first developed in Europe nearly 500 years ago, but had trouble taking root there, and really only flowered when Europeans first came to America and had the opportunity to put it to work in an isolated location, where rigid social structures were not already in place. The development of this ideal culminated with America’s Declaration of Independence, in which our founders declared individual autonomy (life, liberty and the pursuit of happiness) to be an “inalienable” right granted by the Creator, and thus predating and taking precedence over any government created by mankind. And since that time the primacy of the individual in American culture has, more or less, remained our chief operating principle. Individual autonomy - or to put it in more familiar terms, individual freedom - is the foundational principle of our culture, and it is one that is perpetually worth fighting and dying to defend.

So the idea that the autonomy of the individual ought rightly to predominate when it comes to making medical decisions is simply a natural extension of the prime American ideal. Of course, most think, this ought to be the governing principle of medical ethics.

But unfortunately, it’s not that easy. There’s another principle of medical ethics that has an even longer history than that of autonomy - the principle of beneficence. Beneficence dictates that the physician must always act to maximize the benefit - and minimize the harm - to the patient. Beneficence recognizes that the physician is the holder of great and special knowledge that is not easily duplicated, and therefore has a special obligation to use that knowledge - always and without exception - to do what he knows is best for the patient. Dr. House is a proponent of the principle of beneficence (though he is caustic and abrasive about expressing it). DrRich believes House is popular at least partly because the benefits that can accrue to a patient through the principle of beneficence - that is, through medical paternalism - are plain for all to see.

Obviously the principles of beneficence and of individual autonomy will sometimes be in conflict. When two worthwhile and legitimate ethical principles are found to be in conflict, that is called an ethical dilemma. Ethical dilemmas are often resolved either by consensus or by force. In our case, this dilemma has been resolved (for now) by consensus. The world community has deemed individual autonomy to predominate over beneficence in making medical decisions.

DrRich’s point here is that Dr. House (the champion of beneficence) is not absolutely wrong. …….Perhaps, some (like House) would say that their autonomy ought not be their chief concern at such times. Indeed, one could argue that in a perfect world, where the doctor indeed has nearly perfect knowledge and a nearly perfect appreciation of what is best for the patient, beneficence should take precedence over autonomy.

It is instructive to consider how and why autonomy came to be declared, by universal consensus, the predominant principle of medical ethics. It happened after World War II, as a direct result of the Nuremberg Tribunal. During that Tribunal the trials against Nazi doctors revealed heinous behavior - generally involving medical “research” on Jewish prisoners - that exceeded all bounds of civilized activity. It became evident that under some circumstances (circumstances which under the Nazis were extreme but which were by no means unique in human history) individual patients could not rely on the beneficence of society, or the beneficence of the government, or the beneficence of their own doctors to protect them from abuse at the hands of authority. Thusly was the ethical precept which asks patients ultimately to rely on the beneficence of others starkly revealed to be wholly inadequate. The precept of individual autonomy, therefore, won by default.
…… Under duress, the Nuremberg Code admitted, societies (and their agents) often behave very badly, and ultimately only the individual himself can be relied upon to at least attempt to protect his or her own best interests.

When our founders made individual autonomy the organizing principle of a new nation, they were also making a negative statement. From their observation of human history (and anyone who doubts that our founders were intimately familiar with the great breadth of human history should re-read the Federalist Papers), they found that individuals could not rely on any earthly authority to protect them, their life and limb, or their individual prerogatives. Mankind had tried every variety of authority - kings, clergy, heroes and philosophers - and individuals were eventually trampled under by them all. For this reason our founders declared individual liberty to be the bedrock of our new culture - because everything else had been tried, and had failed. In the spirit of the enlightenment they agreed to try something new.
…… Autonomous individuals often fail - either because of inherent personal limitations, bad decisions, or bad luck.

Modern Tyranny:
Those of us who defend the principle of individual autonomy - and the economic system of capitalism that flows from it - all too often forget where it came from, and DrRich believes this is why it can be so difficult to defend it. We - and our founders - did not adopt it as the peak of all human thought, but for the very practical reason that ceding ultimate authority to any other entity, sooner or later, guarantees tyranny. This was true in 1776, and after observing the numerous experiments in socialism we have seen around the world over the past century, is even more true today.
More: Jobbing Doctor, NHS Blog Doc, Dr Rant, Ward 87, The Witchdoctor, Northern Doc, Dr Grumble.
Mid-Staffordshire: Media Media Media.
The full post here:
Why We Love Dr. House

New mention in Witch Doctor: End Stage Creep.
Other Posts:
Mid-Staffordshire: Media Media Media.
Mid-Staffordshire: Unbelievable! Unbelievable! Unbelievable!
Mid-Staffordshire: Where Are The Doctors?
House M.D. : 95% vs 5%
Humber Mental Health Teaching NHS Trust: Learning From The Past.

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