Last week, the LA Times printed this true story:
A fellow with a cold came to see Dr. John Santa asking for antibiotics. Santa carefully explained that antibiotics wouldn't do the man any good because his cold was caused by a virus, and antibiotics only work on bacterial infections. The patient stomped out of the office, fulminating bitterly . . . .
Every day, in offices all around the country, patients request antibiotics that will do them no good, and all too often their doctors, unlike Santa, prescribe them. "Sadly, the easiest solution, rather than to just say no and potentially anger the patient, is to do what they ask," says Santa, now the director of the Consumer Reports Health Ratings Center.
The same solution explains the overuse of ICU resources: it is easier to just cave-in and do what the family wants. But in both cases the strongest argument for resisting demands for inappropriate medicine does not relate to autonomy or beneficence but to justice.
Over-prescribing antibiotics helps create resistant bacteria that lead to illnesses that can't be treated. It is a threat to public health. Similarly, keeping permanently unconscious patients in the ICU means that other patients are left with higher risks of morbidity and mortality in the ED or community hospitals.
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