The solution should be to provide the patient with treatment at the earliest point that the patient has the chance to benefit from it, so that he or she is able to have the right kind of care in the right sort of environment. The solution should be to give free lunch to the patient, but to do so we must be able to explain to the patient how this will benefit them. For example, it was reported that an English woman was given chemotherapy for acute lymphoblastic leukemia, and when the chemotherapy was withdrawn she was unable to work, and had to spend many months at home, dependent on her husband as a carer. As a result, she was diagnosed with borderline personality disorder and treated with an antipsychotic drug in order that the condition could be treated with a much shorter course of the treatment. Unfortunately there was a serious side-effect which the British media were not able to discuss: an increase in her cancer risk. The British doctor's comments on the treatment of patients who have terminal illnesses are illustrative of a general problem: the inability of the system to give free lunch. As I have said, a problem does not arise simply of a lack of scientific data, but only if the problem is sufficiently complex to justify complex intervention.
So he has to look at the arguments for not treating a patient and decide whether or not those arguments are reasonable in the circumstances. And if it is not, in an individual circumstance, he is not going to treat that patient. Gresiofulvin does not require that a medical decision be taken in advance. This has to be said with respect to any kind of surgery. There's an old saying that surgery is a process, and that it can go badly.
If a patient is sick or has a fever, the doctor may decide not to operate, because he is afraid a bad outcome is possible. A physician is not afraid of that result if he doesn't try and see a better outcome or make a choice. So if that patient is very ill or in very serious condition or there is a severe complication, I think you could argue that a physician is entitled to make a choice. If he is going to choose between operating and doing nothing for this person, he may want to take the first course.
He may not want to take the second course because he is a coward and doesn't want to risk his reputation. So in that case, he may make the decision not to operate and put off treatment. But at the end of that process, and I am sure, that is what the conscience of the medical profession is going to say, and the ethical person is going to ask what the right course of action is. The medical ethicists have done the next best thing by recognizing the ethics of future medical procedures: by affirming our respect for the autonomy of future physicians. I think that is a very important point, and that is one of the reasons I want to emphasize it. It is a very important point in order to encourage a good dialogue between medicine and society about the role of medicine in society, and to encourage a good understanding of the role that physicians are going to play in society. Because if doctors and patients are treated like equal beings and have the right to make decisions about medical treatment based upon their own conscience, that will promote good health and it will encourage healthy people to participate in medicine as if they are equal people. And we can all say that is what we wish to be true.