Teasing Out Relevant Medical Information

One of the matters we need to know in counseling persons with medical ethical questions is the relevant medical information. This information is our unique contribution in helping people make ethical decisions. At some risk to being caught up in the example, I will proceed to illustrate this with an example. The example I chose is screening for prostate cancer, a hot topic in medicine now. I mentioned earlier as an ethical matter what to do when a 75 year old man without urinary symptoms asks about screening for prostate disease as he heard on the radio. I chose the example because I have faced the question often enough. This is not a baboon liver sort of issue. Further, it is one in which the relevant medical information is key.

I happen to be convinced that screening for prostate cancer in asymptomatic 75 year old men with current tools of PSA, digital rectal exam, ultrasound, and biopsy, or any combination thereof, ought not to be done. There are perhaps urologists or others who want to argue. I love to argue, but I do not wish to let one example capture the whole. I grant that there is another view of the data. The point is that this is an ethical question because it seeks an “ought” answer. The patient asks, “Ought I to have the screening?” And the doctor asks, “Ought I to recommend and do the screening?” Of course, there are additional implied “oughts” in the question: “I ought to seek to extend my life and my health if I can” is one of these. If the doctor and the patient are agreed on this implied “ought” about life and health, then the ethical matter hinges on the empiric information. Does screening of asymptomatic American men aged 75 years improve their health or longevity?

I suggest to you that a number of the conundrums of medical ethics, particularly those that are grouped under “distributive justice” – who gets what when resources are limited – can be reduced in size by attention to the empirical information – physicians, doctors, insurance, hospitals, drugs, nursing, and so forth. Many articles and talks today agonize over how to distribute “scarce medical resources.” I am repeatedly drawn to inquire as to the actual effectiveness of the resources. Medicine is not as solidly based in unequivocal scientific empiricism as we like to think. Much is done by consensus – we think so, we hope so, it seems so, we've usually done it this way, it is considered good practice to...


Excerpt from "Counseling Persons with Questions on Medical Ethics"