Doctors on the Edge: Will Your Doctor Break the Rules for You? Fredrick R. Abrams, MD, 2006, First Sentient Publications, 202 pp., $23.95.
Fred Abrams is the father of modern medical ethics in the Rocky Mountain region. He has devoted much of his professional career to teaching ethics to healthcare professionals. It was therefore logical that he would put his stories together in the form of a book and entirely expected that everyone would benefit from the effort. What I didn’t expect was that he would put together such wonderful prose in doing it.
Abrams, an obstetrician in Colorado, heavily weights the patient stories he tells toward his specialty, but these real stories about real patients facing real dilemmas are universal in nature. The stories involve truth-telling, confidentiality, deception in medical records, obligations of doctors to report a crime, full disclosure, informed consent, beneficence, and sanctity of life versus quality of life. They are about reproduction, abortion, racism, euthanasia and the “right to die.”
Neurosurgeons will particularly enjoy the stories entitled “They Shoot Horses,” “Palliative Terminal Sedation,” and “Choosing”; the latter is about a man with paralytic disease who has lived for a year on a ventilator and then decides that he doesn’t want to live that way.
The best part of this book is the physician affirmation, which is reproduced here with the author’s permission. It has evolved from a lifetime of experience in dealing with ethical issues. It represents a dramatic improvement in the outdated Hippocratic oath, which most of us have been sworn to uphold. It is a thoughtful, readable, meaningful contemporary affirmation that all neurosurgeons would be wise to follow.
Gary Vander Ark, MD, is clinical professor of neurosurgery at the University of Colorado Health Sciences Center. He is the 2001 recipient of the AANS Humanitarian Award.
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A Physician’s Affirmation In order to be worthy of self-respect, I pledge to give the respect due to others who place their trust in me as a professional in the healing arts. Therefore: I will practice my art and my science to benefit my patients. I will disclose to my patients that which I know of their disease, and any hazards
I will offer care and comfort when they are ill, and when death becomes inevitable, I will ease their way as best I can in keeping with their expressed plan. I will recognize their right to self-determination, and if a conflict should arise with
I will intercede in their behalf within the scope of my authority if I perceive they
I will hold in confidence that which is seen or heard in my role as physician. I will ever be a student, sharpening my skills and knowledge to make me a
If I act in this way, I may aspire to join the men and women who through the ages
–Fredrick Ralph Abrams, MD |