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Renzo Bruni

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What should be the first law of medicine ?

Many wrongly ascribe "Primum non nocere/Do no harm" to the Hippocratic Oath, although it is NOT really found there. Hippocrates apparently did say that, or write that phrase, but it was in his "Epidemics". Should not the First Law of Medicine rather be "Primum bonum facere/First do good" (et secundum non nocere). Would this not summarize the role of modern physicians, nurses, providers and therapists better than a nostrum ("Primum non nocere/Do no harm") that might be interpreted as to justify holding back on any therapy which has side effects. Does not this new First Law of Medicine justify all interventions which might help, and allow more adaptability to the real situation by admitting that 'helping' is the moral role of providers?

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    Aug 25 2011: Promote life.
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      Aug 25 2011: Promote life... and living well and fully?
      Would this include social activism such as advocating for abolition of death penalties and illegality of war? Is that a righteous place for doctors and nurses to act?
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        Aug 26 2011: Renzo, for me it would but I think it is unfair for us to put medical professionals in the gap between legislation and social activism.
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          Aug 27 2011: Well, Debra, I don't mean that they should be in anyway required to act in the gap, but isn't it a place where they have a right or duty or the expertise needed to lead us?
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        Aug 27 2011: Hi Renzo, Yes, they do have the abilities and they should lead us, so I do not disagree with your points. My point was that as societies we are trapping them between their own moral choices and the stated law. We need to consciously and legally and legislatively decide what we feel about end of life issues instead of trapping medical professionals and famiilies between being 'humane' and breaking the law. We need to make the hard decisions rather than leaving them unmade so that medical professions are at risk.
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          Aug 27 2011: You are right. I agree. Well said.
          I would go further, in that we let 'lawmakers' (and lobbyists) write the laws. We should seek more input from nurses and doctors, and allied professionals - those with real experience and well reflected observations.
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        Aug 27 2011: We are paying the price as societies for letting the lobbyists. professional bureaucrats, politicians and interest groups decide our moral issues. There is an old adage that says 'We get the government we deserve."

        We have downloaded our responsibilty for creating a living society and we have to change this situation.
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      Aug 25 2011: but at what cost? and I don't mean monetary cost, but think of terminally ill patients who are suffering? should we do everything in our power to keep them alive, knowing this won't bring them back to health and only causes more suffering?
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        Aug 26 2011: Marcin, thank you for your cognent point about the end of life. I recently had an aunt who was terminally ill decide when she would die. She had been on dialysis for many years and developed cancer which spread to her brain. Before she lost her faculties she decided to stop dialyzing and made a dignified, peaceful, graceful and generous end to her life. She spoke to all of us and encouraged us to live good lives. I share this story to make the point that we have to change the way we think about the end of life. Prolonging it when there is no hope of improvement in terminally ill persons should be replaced by helping families get to a better place before the end. Doctors should not be in the position of guessing what the law and the 'right' thing to do is. As societies we should decide how to handle these situations and support the doctors and the patients in these difficult transitions.
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          Aug 27 2011: @ Debra and Marci (both)
          The arguments for focusing on quality and quantity of care at the end of life are appealing, humanitarian and self evident. What however of the application of these same ethics to other medically based problem areas of society: an embarrassingly high infant mortality rate, absent universal prenatal health care, hungry children (one fourth of American children by recent estimates), untreated addictions, birth control, sex education, et et et etc.
          Amartya Sen (Nobel Prize Economics 1998) believes that universal health care in the US is the single biggest contributor to social unrest, crime, political divisiveness and disaffectation (like not voting)(although in truth I am paraphrasing without a quote and from flawed memory, I got the gist of it correct).

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