Doctors have ethical obligation to put their patients first

DEAR DR. ROACH » I was shocked recently when I read an article from a reputable source implying that sooner rather than later (and maybe already), doctors who have a patient who could be treated successfully only with massive doses of antibiotics would be required to allow the patient to die rather than run the risk of creating a generation of bacteria that are resistant to antibiotics. In other words, one person must die for the sake of many.

While I understand the logic of this, I also find it profoundly disturbing on many levels, and wonder what your comments might be.

DEAR READER » As physicians, we are obliged to act primarily in the best interests of our patients — not ourselves, and not society. Therefore, in the case of a patient who would die without the only effective antibiotic, our primary duty would be to use the antibiotic in hopes of saving our patient, recognizing that this may reduce the effectiveness of the antibiotic in the future. Of course, we should take great pains to isolate the patient so that this hypothetical resistant superbug does not get out and spread to other people. This happens in hospitals every day now.

Hospitals have systems in place to restrict certain antibiotics to life-threatening situations when only those antibiotics are effective. This is done to minimize the risk of developing bacteria that are resistant to all our antibiotics. Unfortunately, despite this, there occasionally are times in the hospital when there are no effective antibiotics, and people die because of highly resistant bacteria despite all our best attempts. We would never let someone die because of the possibility of resistance. We would never withhold a potentially useful antibiotic if it was expected to help. This is part of the physician’s ethics.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.