Uncertainty is inherent to life
In life, there is always uncertainty, you can never be absolutely certain, there is always doubt.
In private life and in public life, there is uncertainty because it is not possible to define all the variables that affect the future of any decision/fact.
Humans respond to uncertainty by avoiding paralysis, a bit like Alexander the Great undid the Gordian knot, cutting it. In other words, with specific decisions, without considering all the infinite possibilities, since we cannot stop considering all the courses of action, nor can we make all the possible decisions simultaneously or consecutively, so we have to decide and, at some point, make a decision. concrete direction. That means accepting the inherent risks, of course.
It happens in private life and it happens in public life. Thus, for example, in clinical medicine in which the doctor cannot have a paralysis that leads him not to make decisions in the face of irreducible uncertainty. Faced with the suffering of the patient, the doctor has to decide prudently, and accept both, doctor and patient, that there are risks of errors and damages.
In the control of uncertainty in the clinic (and in life): science, conscience and courage
The prudence with which to make decisions should be based on science, conscience and courage.
Science, which allows us to have an idea of what is true and what is false, with its restrictions. For this reason, there is an ethics of ignorance that requires sharing with patients the scientific limitations of medicine, and of science itself.
Awareness, in the sense of responsible knowledge that leads to a commitment to the suffering of patients, families and communities, and to the medical profession itself. In one example, it is not a question of “passing a consultation” but of being witnesses, of accrediting the sick person and of professionalism that puts the good of the patient above the good of those who care for him.
Courage, in its double meaning of courage, decision and passion with which an action is undertaken, and anger when something that could have been achieved with another course of action has not been avoided/overcome.
All of this (science, conscience and courage), implies the consideration of inalienable ethical values, which in the case of the doctor imply a commitment such that it could land him in jail. For example, by refusing when the eugenics movement of a century ago led doctors to demand lists of “defective” people to be castrated or killed. Or, more recently, when it comes to asking doctors not to treat and report undocumented and sick immigrants.
A graphic summary, by Mónica Lalanda, based on the presentation by Mercedes Pérez-Fernández at the SIAP Seminar in November 2014 on “Preventive, diagnostic and therapeutic activities in women: uncertainty and scientific, technical and social complexity”:
Ethics
A Peruvian colleague and friend writes us, Elard Quispe, rheumatologist and ethicist. He titled his text just with the three keywords:
“Science, conscience and courage.
Juan and Mercedes, because they are more than two…
Friends “chosen family”…
Our pride for you…
I allowed myself to write this “decalogue” for my medical students in the Evidence-Based Medicine course and tell them on the last day of classes about their achievements and our friendship:
1- Dissenting and vibrant ideas that spring up at any age in an inexplicable way, in prepared, hard-working minds that do not blindly accept the “it is like that”…
2— Life is so short and wide… depending on how you want, think, work and enjoy…
3— Writing helps to think and mature ideas…
4— Doing the scientific from the ideas and works of a “wild and untamed eye”…
5— Having a teacher to understand, comprehend and modify this social, economic, scientific, ecological and ethical reality…
6— Knowing beyond Medicine…
7— Prepare to “do no harm”, do 100% of what needs to be done and not do 100% of what should not be done…
8— Trying to be a true sage, that by being so does not exhibit it…
9— Being outside the herd, against the current of the unique thought…
10— Educate in the value, awareness and dignity of defeat, to start over…”
To do, to do well, and not to do
To do, to do well, and not to do are three proposals that fill professional life in the sense of commitment to the suffering of individuals, families, and communities. Knowing what to do, doing it well, and knowing what not to do and not to do it.
If we move from the individual to the collective, the ultimate goal of the healthcare system is to offer “maximum quality, minimum quantity, appropriate technology, by competent professionals, at the appropriate time and place and as close to the patient’s home as possible”. There are seven proposals that fill professional life, but not only in the personal field, but in the field of professionalism, in the sense of commitment to one’s own profession and to society.
How to govern ourselves without burdening ourselves with these ten proposals?
Health professionals are capable of cutting the Gordian knot by deciding appropriately in the midst of the demands of real conditions. In fact, the health professional is highly qualified, requires permanent updating and, in daily clinical practice with limited time and resources, is capable of making quick and generally correct decisions in conditions of great uncertainty.
Synthesis
The suffering of the patient governs the clinician and the response should contain appropriate doses of science, conscience and courage.
The health professional is governed by suffering, like any person who makes daily contact with patients. In other words, what moves the health professional, what requires an attitude of continuous improvement, is the treatment with the patient, is the coexistence with human pain. This is what requires science, conscience and courage.
It is an ethical requirement and self-therapy. In their training, the health professional has internalized a certain anguish as a response to suffering, and the relief of this anguish can only be achieved with an effective response in the midst of uncertainty that calms or eliminates the suffering of the patient and their relatives. He achieves it by deciding with science, conscience and courage.
