Curing cancer and healing hearts: thoughts inspired by Dr. Mark Greenberg

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.

Recently, 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.  ChB, MB, LMCC, FRCPS(C), FAAP.

The acronyms 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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This entry was posted in Medicine & Bioethics, On Humanity: Events, Policy, Ethics. Bookmark the permalink.

One Response to Curing cancer and healing hearts: thoughts inspired by Dr. Mark Greenberg

  1. Amit says:

    Sophia!
    This is thought provoking. I love it 🙂

    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?

    To this question, we cannot find the answer in a yes or no. A patient cannot be left entirely oblivious of his or her medical condition; they might pass away without making arrangements, leaving family to suffer. Yet, to avoid further complication/mental trauma, it might not be right to provide the full detail. I think doctors should be allowed to make a character judgement of the person; assess the patient’s mental and emotional stability and accordingly disclose as much information as the patient can safely handle. I think it’s a question of how the medical professional presents the case to the patient. Rather than saying “your chances of survival are slim”, perhaps we could try something more motivating and optimistic. Perhaps something like “We’ve done all we can. Now it’s all a question of your strength and will power. While I’m sure we’ll pull through, make arrangements just in case”. Here we’re hinting at the possibility that the patient might not survive and recommending that they make arrangements (settle debts, write will etc.) Yet we’re not violating their rights; they are still well informed about their medical condition. It’s the difference between saying “you’re terrible at drawing” versus “I think you can improve by sketching this way instead”. The message is essentially the same; its the difference between being flat/truthful (“your chances of survival are slim”) versus constructive and optimistic (“I’m sure we’ll pull through, but make arrangements just in case”).

    Should parents carry the majority of the responsibility where childhood cases are concerned?

    Definitely. a: The child is too young to make their own decisions. b: Parents have the most at stake; they will most likely make the best decision. Society shouldn’t intervene unless it’s a criminal case (abuse/violence etc.).

    Are courts of any true merit where the resolution of medical dilemmas is concerned?

    In making legal decisions, courts almost always rely upon testimony by expert witnesses (doctors and medical professionals). They are normally well thought out and fair. However, I think many of these ethical dilemmas fall beyond the jurisdiction of a court. Doctors should be allowed the freedom to make professional judgements about the mental stability of patients. While they shouldn’t be allowed to conceal facts, nothing should prevent them from presenting the case in an optimistic manner.

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