Develop. Med. Child Neirrol. 1975, 17, 419-420
EDITORIAL HELPING ONE OR HELPING MANY THEusual definition is that the doctor’s duty is to help his patient, that is to give help to the person who has come to him and asked for help. This includes the child for whom his parents have asked for help. This personal relationship involves a duty of confidentiality, but it is not an absolute duty for it is subject to exceptions laid down by law for the benefit of the community. But in general the doctor’s duty to his patient takes priority. But many believe that the doctor also has a duty to go out to find people he could help and to offer help without being asked. Such duties can be included in the first definition if the physician has a population for which he is responsible. So he will search out all the children on his list and induce parents to bring them for immunisation shots and medical surveillance, because of the benefits to the individual of such procedures. But these procedures have wider importance. Immunisations of individuals also prevent the spread of infections to others in the community, whether they are on the doctor’s list or not. This brings an addition to his duty as a physician; he has medical duties to serve his patient and to serve the community. Usually the two duties are in agreement, but not always. The parents of a baby born with severe myelomeningocele may ask for everything to be done to keep him alive. This can be done, but most doctors today advise against it because they feel that the child is being rescued for a life of very poor quality, with difficult child care, many operations and inevitable considerable handicap, and possible break-up of the family from the stresses involved in caring for a handicapped child. But there is another aspect. The care given to the spina bifida child will take much time of paediatricians, surgeons and therapists. In most cases it is the community and not the family which will meet the heavy costs of the time of professionals. To put it in a different way, should the community decide if it wants to use its money thus? As medical facilities are not infinite, giving care to this child means denying it to others. 419
DEVELOPMENTAL MEDICINE AND CHILD
NEUROLOGY. 1975, 17
New priorities in medicine bring new ethical implications which need to be considered because they are not so apparent or so immediate as are decisions about individual patients considered in isolation, but they are there. Medical students and doctors need to discuss such ethical implications with philosophers, sociologists, priests, parents and senior physicians before they meet the problems in clinical practice. Only so will wise decisions be made. RONALDMAC KEITH
420
EDITORIAL HELPING ONE OR HELPING MANY THEusual definition is that the doctor’s duty is to help his patient, that is to give help to the person who has come to him and asked for help. This includes the child for whom his parents have asked for help. This personal relationship involves a duty of confidentiality, but it is not an absolute duty for it is subject to exceptions laid down by law for the benefit of the community. But in general the doctor’s duty to his patient takes priority. But many believe that the doctor also has a duty to go out to find people he could help and to offer help without being asked. Such duties can be included in the first definition if the physician has a population for which he is responsible. So he will search out all the children on his list and induce parents to bring them for immunisation shots and medical surveillance, because of the benefits to the individual of such procedures. But these procedures have wider importance. Immunisations of individuals also prevent the spread of infections to others in the community, whether they are on the doctor’s list or not. This brings an addition to his duty as a physician; he has medical duties to serve his patient and to serve the community. Usually the two duties are in agreement, but not always. The parents of a baby born with severe myelomeningocele may ask for everything to be done to keep him alive. This can be done, but most doctors today advise against it because they feel that the child is being rescued for a life of very poor quality, with difficult child care, many operations and inevitable considerable handicap, and possible break-up of the family from the stresses involved in caring for a handicapped child. But there is another aspect. The care given to the spina bifida child will take much time of paediatricians, surgeons and therapists. In most cases it is the community and not the family which will meet the heavy costs of the time of professionals. To put it in a different way, should the community decide if it wants to use its money thus? As medical facilities are not infinite, giving care to this child means denying it to others. 419
DEVELOPMENTAL MEDICINE AND CHILD
NEUROLOGY. 1975, 17
New priorities in medicine bring new ethical implications which need to be considered because they are not so apparent or so immediate as are decisions about individual patients considered in isolation, but they are there. Medical students and doctors need to discuss such ethical implications with philosophers, sociologists, priests, parents and senior physicians before they meet the problems in clinical practice. Only so will wise decisions be made. RONALDMAC KEITH
420
