Sr. Nuala Kenny
EDMONTON — Health care providers are facing ethical challenges unheard of a generation ago.
One of those challenges, said Sister Nuala Kenny, is the desire of many patients for treatments that are bigger, faster, stronger.
Like the fictional character Buzz Lightyear of Toy Story fame, many patients adopt the motto, "To infinity . . . and beyond," Kenny told a conference on health care ethics June 16.
Patients frequently believe that what is in their best interest is the biggest, newest and most expensive treatment, she said.
In fact, access to health care is not a major factor in determining one's overall health, Kenny said. It ranks about eighth or ninth in importance, well behind other factors such as good nutrition, proper sleep and fresh air.
She gave a keynote address at Covenant Health's conference, Great Expectations?
Following an extensive career in pediatrics and medical education at the University of Toronto, Kenny, a Sister of Charity of Halifax, founded the department of bioethics at Dalhousie University's faculty of medicine. She has written more than 100 papers as well as two books.
Traditional practice of medicine, she said, involved the doctor answering to his peers and to the patients' best interests.
Life was simpler for doctors serving the Hippocratic tradition. They sought to preserve life, alleviate suffering, do no harm and recognize when a disease had overmastered a patient.
A major goal of medicine was to cure, when possible. Until the last century, cures were rarely anticipated and usually considered miraculous. But even with all of the wonders of 21st century medicine, cures are rare. As an example, she cited diabetes.
"The discovery of insulin did not cure diabetes. It was a halfway technology. You didn't die, you lived longer and you're now dependent for the rest of your life on medical science and technology."
Many people have the false notion that organ transplants are the same as a cure, Kenny said. The fact is that a patient on dialysis who receives a new kidney is not getting a cure. He is merely replacing the need for dialysis with the need for anti-rejection drugs.
Years ago, another goal was care always, especially at the end of life. Today, both aging and death are viewed as diseases. In some countries, euthanasia for suffering patients is accepted as standard medical practice.
Difficult issues have arisen in modern medicine. Consumer society has different expectations and health care has become big business. A value of medical ethics is autonomy, meaning the patient has the right to refuse or choose a treatment.
"Respecting patient autonomy does not mean selling them what they want," said Kenny.
Patients have become customers, doctors are vendors and care is deemed a commodity.
Medicine has become a commodity, she said. Care is a drug, device or procedure.
That leads to the depersonalization of the patient and only valuing that which can be measured, she said. Also in jeopardy are doctor-patient trust and the moral agency of the doctor.