060809L - THE BALANCE OF INJURY AND BENEFIT IN MEDICAL INTERVENTIONS

Lecture for PPSD session on 09^th August for Year 2 Medical students Institute of Medicine Universiti Brunei Darussalam by Professor Omar Hasan Kasule, Sr.

FINE LINE BETWEEN BENEFIT and INJURY

Many situations, the line between benefit and injury is so fine that the physician may have to seek another opinion or consult his conscience to reach a solution since no empirical methods can be used. Ordinary medical care is a delicate balance between beneficial treatment and harmful side-effects of the methods used. The consideration of balance includes costs, health risks, and medical benefits. No therapeutic modality is free of risk. If we were to consider any risk as unacceptable there would be no medicine.

BENEFIT vs. INJURY

The Law gives us very clear guidelines on the balance between risks and benefits. A disease, considered an injury, should be relieved. Before occurrence attempts must be made to prevent its injury as much as is possible. The injury should however not be relieved by inflicting an injury of the same or higher degree. In cases of doubt about the relative importance of the benefits of treatment and the side-effects of the treatment, we follow the principle that prevention of injury has priority over pursuit of a benefit of equal worth. If the benefit has far more importance and worth than the injury, then the pursuit of the benefit has priority.

LESSER EVIL vs GREATER EVIL

If we cannot empirically compare the harm of continuing untreated disease and the possible harm from medical care, we follow the principle of selecting the lesser of two evils. If confronted with 2 actions both of which are harmful and there is no way but to choose one of them, the one with lesser harm is committed in order to block the way for the bigger harm. A lesser harm is committed in order to prevent a bigger harm.

PUBLIC INTEREST vs INDIVIDUAL INTEREST

This also implies that an individual could suffer in the interest of preventing a public harm since public interest has priority over individual interest. The individual may have to sustain an injury in order to protect public interest. This could occur in a situation of a contagious disease treated with potentially toxic medication in order to prevent its spread in the community.

THE PROHIBITED vs THE PERMITTED

Physicians sometimes are confronted with medical interventions that are double edged; they have both prohibited and permitted effects. The guidance of the Law is that the prohibited has priority of recognition over the permitted if the two occur together and a choice has to be made

DISCUSSION QUESTIONS

DISCUSSION #1

1. Give 3 illustrations of a choice between benefit and injury in a medical intervention
2. Give 2 illustrations of a choice between public and individual interest in a medical intervention

DISCUSSION #2

3. Give 3 illustrations of a choice between a lesser and greater evil in a medical intervention
4. Give 2 illustrations of a choice between the prohibited and the permitted in a double-edged / effect situation