Every man should expend his chief thought and attention on his first principles; are they or are they not rightly laid down? And when he has duly sifted them, all the rest will follow.
Socrates, Greek philosopher (496-399 B.C.)
There are many occupations that one may choose, but few will find their choices as rewarding, exchanging, exciting, meaningful, frustrating, and overwhelming as those who take up the practice of health care provision. Health care practice is the best of science, the noblest of human arts, and offers careers that never stop growing, challenging and providing opportunities for personal development.
If one were to examined the health care team prior to the twentieth century one would find a few assigned practitioner roles. The role of the physician, dentist, nurse, and pharmacist was reasonably well established though evolving. During the century, as a result of technological and therapeutic advances, over 100 specialists were added to the health care team under the umbrella title known as Allied Health. Some of these specialists, such as physical therapist and dietitians, are well known to the public, while others (cytologists, extracorporial perfusionist, athletic trainers, and music therapies) provide meaningful services but are virtually unknown outside of their specialty areas. The growth of the allied health specialists is the important aspect of health care as they , along with nursing personnel, provide over 80 percent of the direct patient care.
To enter the practice of health care provision is to enter into a social compact not only with the patients you serve but with all other practitioners and the community at large. The honoring of this social compact will require a commitment to excellence in clinical practice and a commitment to a set of appropriate moral, ethical, and social behaviors. For those that meet this obligations , the practice of health care is personally and physically rewarding.
Often in clinical practice the appropriate answer is the product of evaluating, understanding, and utilizing scientific information. Many of the clinical questions have been reduced to formulas, and when one plugs in the appropriate volume, tidal volume, rectal temperature, or whatever data you are collecting a reproducible answer comes forward. This is the science of our practice, and advances in health technologies and therapeutics in the twentieth century have brought the practice of health care from folk nostrums to magic bullets. And, as it has been said, “the best is yet to come”.
Prior to the twentieth century, the patient has less than an even chance of benefiting from an encounter with a physician. Often early health care practitioners had little else to offer than a caring attitude as they sat by the beds of the afflicted and watched disease processes mankind for ages have been brought under control and some even eradicated. Yet, for all the advances of the last century, as we face the new millennium it appears that even greater wonders lie ahead. Will the puzzle of cancer be solved? Will genetic engineering allows us to live longer and healthier? What are the future implications of technology of cloning? Will we find the mechanism for aging and have a longevity of Methuselah? Where will the science of health care takes us in the twenty-first-century?.
The wonders of scientific advances are not just interesting questions that exist in a vacuum but rather have implications for our practices, our patients, the health of our communities, and for the very fabric of our common humanity. the uses of science and technology in health care must always be assessed. We must not only ask where will the science of health care take us, but do we really want to go?.
For most of us, to clone or not to clone is not a question. Our practice will be filled with for more mundane ethical dilemmas.
- When, if ever, is it permissible to take a gift or gratuity from a patient?
- When is it legitimate and perhaps mandatory to break a patient’s confidentiality?
- Is it permissible to lie to a patient if it is for his or her own good?
- Can i worked at a hospital and refer a patient to a durable medical supply company that I have contracted with to provide outpatient services?
- What must I do if I make a medication error that no else knows about and it appears harmless to my patient?
- What obligations do I have as a colleague and fellow practitioner when I suspect that the therapist that I am working with is abusing alcohol or appears chemically impaired?
- What if I come upon a practice that is legal but appears to me personally to be unethical?
Unlike matters of science, where the scientific method will often reveal reproducible answers, the answers to questions regarding values are not subject to comfortable formulas, and rarely will you come to an answer with which everyone agrees. Health care ethics reside in the realm of human values, morals, individual culture, intense personal beliefs, and faith. Often the individual finds the answer not by examining and substantiating the external facts but by checking within their particular worldview.