Was Perowne Ethical?

Ah, the blurry realm of medical ethics.  Scholars, sitting comfortably in their armchairs, develop staunch perspectives on the hottest items of debate within the field; abortion, organ donation, right to life, among others.  The issue of duty to treat can be easy to overlook, since we have all had Hippocrates’ maxim, “first, do no harm,” drilled into our heads.  We perceive physicians as servants to injury, individuals who must place the interests of one in need over his or her reservations (whether relevant or not).  However, McEwan crafts a unique situation in Saturday which, undeniably, foils any attempts at a simple resolution to the problem: should Henry Perowne be obligated to operate on Baxter?

Admittedly, Perowne is the most talented neurosurgeon on his hospital’s staff – even though the British Prime Minister mistook him for an artist.  What patient would deny the services of the most skilled physician around?  Well, perhaps someone who held the surgeon’s knife at gunpoint… or someone who forced the doctor’s daughter to fully undress and, oddly, read a poem.  Clearly, there is a legitimate conflict of interest in Perowne operating on Baxter.  But does this conflict outweigh the possible benefits of Perowne operating on Baxter?

Henry is very familiar with Baxter.  He understands that the man has Huntington’s disease and is able to make a cursory diagnosis of the condition while examining Baxter’s brain-scan.  Also, the physician at the hospital at the time of Baxter’s arrival is a novice junior surgeon, Rodney.  Perowne is an upgrade over the fledgling neurosurgeon, enough of one to spur Strauss to call Perowne in for the operation.  Jay uses his professional discretion to intervene on behalf of the patient, a move which indicates that Perowne, or someone of his caliber, should handle Baxter’s complicated surgery.

However, the breaking point on this issue is the fact that – as Perowne acknowledges – another capable, experienced physician could be called in and perform Baxter’s surgery.  Henry is by no means the last option; rather, he is one of many neurosurgeons on staff.  Basically, if he denies Baxter care, the patient will not die.  Also, it is important to recall that Henry has consumed alcohol.  While he claims that his adrenaline and focus can overcome the physiological effects of alcohol, I would be leery of having brain surgery performed on me by someone who is less than 100% sober.

In the end, Perowne does not act ethically in operating on Baxter.  Compared to other problems in medical ethics, this may not be such a complicated issue after all.

~ Jeff

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~ by jsj1313 on April 2, 2010.

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