Whenever I can, I attend lecture series, conferences, and seminars. These events may seem to bear no immediately worthwhile rewards when one’s schedule is packed with premed problems, but I’ve promised myself that I will always put aside at least some time to invade university campuses, public libraries, and other specialized locations in search of interesting things.
Yesterday, I was fortunate enough to, while visiting the University of Toronto, stumble upon Dr. Mark Greenberg. Dr. Greenberg is, for those who are as yet unfamiliar with him, an internationally recognized paediatric oncologist, Professor of Surgery and Paediatrics at the University of Toronto, and an executive member of varied professional organizations. Former head of Haematology/Oncology at the Hospital for Sick Children. Current medical director of the Paediatric Oncology Group of Ontario. Former North American President of the International Society of Paediatric Oncology.
The positions say it all. Almost. Dr. Greenberg also happens to be an outstanding human being; it is for this reason that, upon hearing him speak at the U. of T., I was inspired to contemplate some of those integral aspects of medical ethics that he so insightfully – and compassionately – remarked upon. My thoughts led me to ask questions to which I’m not certain anyone has very coherent answers, but which I will nevertheless pose in this post.
To begin, then – Dr. Greenberg’s talk primarily concerned the difference between healing and curing. He defined the process of curing as one primarily biological in nature. In the case of healing, he says, we go beyond fixing the biological problem. Healing is essentially a return to well-being – to a state of being that deals with the whole incident, and that essentially rehabilitates all those involved. Healing, he says, needs to happen regardless of whether or not a cure can be found.
What about psychological disorders, then? The distinction between healing and curing is so incredibly fine even in the case of those conditions dominating highly tangible parts of the body. The endpoint for a psychological disorder is so nebulous, so where is the line between healing and curing the mind?
Dr. Greenberg also discussed the need for “both compassion and ration”, as he terms the two. One can’t, he says, have a doctor who is solely competent or only empathic. Both qualities are absolutely necessary to the medical practitioner.
This tidbit, not surprisingly, reminded me of the MCAT. An approximately-five-hour-long test, it may seem comprehensive enough already. However, in recent years, it has been thought that the MCAT should seek to place greater value on the behavioural, social, and psychological sciences in the hopes of ensuring that future doctors are more “well-rounded”. Is the new MCAT format to be implemented in 2015 for the better where this compassion-ration balance is concerned?
As Dr. Greenberg spoke, I found myself asking more and more questions. I was made to, for example, consider information transfer. Is a patient’s lacking knowledge of his or her condition necessarily unfortunate in the face of an extremely slim chance of survival? By extension, if we agree that withdrawing information in this case is permissible, then are we not undermining the importance of truth and, in essence, ridding the patient of knowledge where one of his or her fundamental rights is concerned? Healing and curing is another important area of thought. Should we administer cures that may make healing difficult, or may even cause partial physical damage? If a cure that was requested by family members fails to save a child, should we ensure that these people understand the irrationality of their decisions so that global knowledge may be heightened, or should we leave them to heal, uninformed? Questions of responsibility also come to mind! Should parents carry the majority of the responsibility where childhood cases are concerned? Are courts of any true merit where the resolution of medical dilemmas is concerned? Must we always believe in competence, and invest all of our trust into medical professionals, or are there cases in which doing so is simply too difficult?
To these questions, I have no answers. I can only state that they are crucial to consider. As a student of science, ethics, or any form of knowledge, what say you?
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Patients and supporting family members need the truth. The complete truth. Future Drs. need to be taught this. Keep the family in the know. Educate them, involve them, ask them, listen to them. Yes, of coarse the professional specialist is the one to make the best decision possible for a “cure” but he/she also must have the courage to explain the consequences of what that “cure” involves. For a family to make such decisions concerning a patient as to which course of treatment should be chosen is asking for a lifetime of regret and little or no healing. In such a time of monumental emotional upheaval and fear of what the future holds the family and Dr. need to form a team so that there is complete understanding of all actions chosen. Dr. Greenberg was our daughter’s oncologist in the past. He was incredible. She survived, blossomed and we all healed. But, we were under the care of a magnificent human being as well as a brilliant Dr.. Then my husband developed an aggressive cancer. We were basically told what was needed to be done. We were caught in a whirlwind of radiation, chemo and surgery. Brilliant Drs. , yes in terms of skill. But no one told us out right how awful life was going to be afterwards. Everyone was so busy with their tests and readings it felt like no one looked at us as a family. No one was concerned with our healing regardless of what the future held….and it held horror. My husband retreated into a horrible place as I ran around in a state of hyper -fixing trying to figure what is the best way to deal with all of this. Then one day I came home from a dental appointment to find he had hung himself. I and our two daughters will never be healed. Our family is broken and life is a constant struggle as I blame myself for not being more vocal or knowledgeable or anything that would have produced a different outcome. Nothing in the form of followup from his medical team at the Cancer Centre Aside from the courts having to intervene due to age, I think the questions you have brought up are important to all, not just the children. Every aspiring Dr. should be made to study under Dr. Greenberg so then there would be a greater amount of compassion in the profession and healing in the families. This never would have been the outcome our family faces if Mark Greenberg was in charge. Thank you for your interest. Keep up the good work.