When treating a patient, a doctor has to consider not only what is possible, but also what is ethical. A doctor’s code of practice is founded upon a modern restatement of the Hippocratic Oath, known as the Declaration of Geneva, that defines a doctor’s duties towards his patients. This was first formulated in 1947 and has since been twice amended by the World Medical Assembly. In essence, the Declaration of Geneva binds the physician with the words ‘The health of my patient will be my first consideration’. Sometimes the distinction between what is possible and what is ethical is clear-cut and is in any case governed by law. But sometimes the two aspects come into conflict. Doctors are being increasingly forced into a position where they may have to make decisions that are more truly moral than medical; decisions that may be influenced by social, religious or even political considerations, and consequently may have social as well as medical consequences. They may have to decide not only how to treat but also who to treat: to weigh up the resources available for treatment, for instance, and the quality of life that a particular form of treatment can give.
Doctors may even, in some cases, have to balance the relative ‘worth’ of their patients. Which kidney patients should receive dialysis and which should be recommended for a kidney transplant? The concept of ‘doctors playing God’ is increasingly more real, as conflicts arise between theoretical and practical possibilities.
Is it a doctor’s duty to keep a patient alive as long as possible, or should he avoid treatment for the dying that may marginally prolong life at the expense of the patient’s comfort? How does a doctor decide what to do when faced with the problem of a baby who is so seriously handicapped that, even with treatment, his quality of life will never be high? Also, the question of cost needs to be considered. How just is it to treat one person with a rare disease for an enormous amount of money, that otherwise could be spent on the cure of thousands of patients with simpler diseases?