The infant who comes to the ER badly damaged by being shaken hard by a relative weighs in so heavily with us that we give scant thought to the actual risk. Our state has a program against shaken baby syndrome that is, I believe, ethically ill-conceived.
Now, I am not in favor of shaking babies! But the zeal of those who are out to reduce the damage from this practice has led them to publish a brochure recommending, among other things, that small children not be dandled on an adult's knee! Perhaps somewhere there is a case report or two of a child who had brain damage accurately traced to dandling. I doubt it. But, anything can be dangerous! Children drown in toilets. They fall down back steps. They pick up copperheads in the back yard. What is the net effect of dandling? Are there no good effects from the interaction between toddler and adult? I'm guilty. I've done it with our own children. I plan to be guilty if we have grandchildren. Are there no downside effects from further eroding the confidence of parents to take care of, provide for, to nurture their own children? What is the net effect? To know that you have to slide a denominator beneath the numerator. All children injured by dandling over all children dandled. The fraction must be infinitesimally small. Further, from this small fraction must be subtracted whatever diffuse but definite benefits there are in dandling.
When we are trying to provide medical information to our patients so that they can make an ethical decision, we need to be mindful of the skew our own viewpoint sometimes takes. We don't think normally, sometimes, especially when we are estimating very small numbers – the risk that a given 60 year old woman has a cervical cancer, that a breast lump in a 14 year old girl is a cancer, that an intraocular pressure of 24 represents glaucoma in a 55 year old man. And so on. Are we merchants of fear?
As finite beings who do not know everything, we need to help our patients know relative risks. Life is risk. Health care decisions are often decisions of prioritization. No path is risk-free. We should not so focus upon the most fearful risk and back away from it without looking behind us to see what risks we are backing into. For a Christian, good stewardship means making the most of the resources we have to further the kingdom of God. That means making risk/benefit estimates.
Excerpt from "Counseling Persons with Questions on Medical Ethics"
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