In the Service of Human Life
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Applied Bioethics in stylized text
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In the Service of Human Life

Proportionality

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When we face challenging diagnoses, it can be hard to judge between artificially prolonging life and justly extending our life by overcoming illness. It’s good to apply a test of ordinary versus extraordinary means to a treatment, but there’s a secondary standard that may crystallize the right path forward. That standard is one of proportionality.

Proportionality requires that the burdens and challenges of a treatment must be likely to produce an equal or better outcome. So, proportionality would require a 40 year old first-time cancer patient to aggressively treat their cancer. It would not require a 90 year old who has been through four rounds of chemotherapy, to attempt a fifth round.

Proportionality keeps the patient at the nexus of the decision. It reminds us that we are talking about a person, and each person is unique. It also invites us to step out of the clinical setting and weigh the burdens of treatment.

Even better, this principle doesn’t deal solely with matters of life and death. Proportionality can be applied in the every day practice of medicine, to the benefit of the patient.

Pharmacies are required, when available, to substitute brand name drugs for generic ones. (There’s an exception when the doctor specifically asks for the brand name drug.) Brand name drugs and generic drugs are completely interchangeable. By requiring this simple substitution, the financial burden on the patient is reduced while in no way effecting the treatment outcome for the patient. It’s a law that’s proportional.

When a child is admitted to the Neonatal Intensive Care Unit (NICU), neonatologists will often start the child on antibiotics and send blood samples to the laboratory for analysis. One of the antibiotics that is commonly used can cause deafness. Without definitive proof that the child is free of infection, physicians err on the side of caution and begin treatment with antibiotics. This decision weighs the possibility of deafness with the possibility of an undiagnosed infection that could prove fatal. It’s a proportional decision that’s reevaluated when the results from the lab come back.

Life is a gift and our bodies are an extension of who we are as people. We are obligated to care for our bodies and to do our best to manage our health. In doing this, however, we are not required to utilize any and all means to hold on to life. By processing our individual circumstances through a bioethical framework, like the principle of proportionality, we’re better prepared to make decisions in managing our care.