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Goal of medicine
The guidelines on Decisions Relating to Cardiopulmonary Resuscitation1 begin with a reassuringly objective view of medicine: its “primary goal” is to benefit patients by “restoring or maintaining their health as far as possible, thereby maximising benefit and minimising harm”. Some might want to add that medicine has several goals,2 not all of which relate to promoting health; however, those who see the aim of the profession as more than consumer satisfaction will welcome the suggestion here that not just any choice counts as medicine.
In the same way, the statement which heads the next paragraph would be rejected by very few readers if “quality of life” were suitably defined. If all we mean by “quality of life” is the patient's level of wellbeing, with no suggestion that the value of his or her “being” can fall to zero or below, it is uncontroversial that “it is not an appropriate goal of medicine to prolong life at all costs with no regard to its quality or the burdens of treatment on the patient”.3
Harms and benefits
This is, however, an overly benign interpretation of “quality of life” observations as they appear in the guidelines. Paragraph 10.2 is explicit in saying that extending life is of no benefit to patients who are (for example) in a state of permanent unconsciousness. Again, a charitable reader might try to interpret this statement as referring only to medical benefit: benefit in terms of what the guidelines describe as the “primary goal” of medicine. It seems from the reference to experiencing benefit, however, that the guidelines are saying that this is the basis of benefit: that one cannot benefit unless one can experience the benefit in question.
This view is not well founded: there are benefits which do not require conscious experience. A person deprived of …
Helen Watt, PhD, is Research Fellow at the Linacre Centre, London.