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10 HEC F. 2 (1998)

handle is hein.journals/hecforum10 and id is 1 raw text is: H E C FORUM 0 1998 Kiuwer Academic Publishers. 1998; 10(1):2-9. Printed in the Netherlands. PART I EDITOR'S INTRODUCTION LAWRENCE J. NELSON, Ph.D., J.D. I became especially interested in the meaning and significance of conscience in the clinical context when I - along with dozens of other ethicists - tried to figure out what medical futility is all about (1). The practical meaning of medical futility inescapably lies in an understanding of the goals of empirically-based medicine itself: curing disease, healing injury, restoring human function, and alleviating pain in ways (more or less) established by observation, experience, experiments, and science - not by blind faith, idiosyncrasy, or therapeutic shots in the dark. In short, medicine is about benefitting patients above all, while, of course, not harming them as well. On the other hand, the practical significance of medical futility (its cash value, if you will) lies in the decisions of the clinician (physician, nurse, pharmacist, respiratory therapist) who is responsible for an individual patient's care; it lies in what that clinician does or fails to do for that patient, and nowhere else. If clinicians wait until society, legislatures, courts, or professional organizations tell them what to do when faced with a case where serious questions have been raised about the efficacy, benefit, harm, and wrong associated with certain medical interventions, they might as well wait for Godot, or for politicians to forgo raising huge sums of money for their endless quests after political power and influence. Each individual involved in patient care - whether attending physician, ICU nurse, social worker, ethics consultant, or HEC member - must decide every day what he or she will do or won't do (and, of course, why) when confronted with demands for non-beneficial treatment, with cases presenting dubious medical indications for medical intervention, with ethically suspect ways of relating to managed care patients, etc. This bioethics is never found in a book, but rather in a conscience-based decision by an individual clinician to do, or refuse to do, something for (or to) a patient for which that clinician must assume ethical responsibility. 2

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