This is from Thinking About Medicine – An Introduction to the Philosophy of Healthcare, by David Misselbrook:
A VERY HIPPOCRATIC CONCERN:
Medicalisation alerts us to a problem. We cannot just think of healthcare and mediicaI intervention as by definition “good”. As we saw in Chapter 8, the Hippocratic oath recognised this almost two and a half millennia ago. The oath stated: “I will use my power to help the sick to the best of my ability and judgement; I will abstain in harming or wronging any man by it.…”
Thus the two-pronged statement — I will do good — I will not harm.
Any intervention (including both investigations and treatments) must consider both sides of the coin; reasonably expected benefits and harms.
The large majority of our evidence base concentrates on the possible benefits of intervention. The most obvious harms are side effects of interventions and possible risks from interventions. However, it is only in recent years that treatment burden has been considered. Claudia Dobler and her colleagues described this: “Although the burden of disease is a well known epidemiological concept, the burden of treatment is a less known and fairly recently coined term. Burden of treatment is the [patient’s] workload of healthcare and its effect on patient functioning and wellbeing. The cumulative treatment workload for patients with chronic conditions when enacting all recommendations in disease specific guidelines can be overwhelming”.
Dobler continues: “Guideline recommendations, however, are traditionally made from a perspective that places the highest value on achieving certain clinical out-comes (such as reducing shortness of breath or increasing survival). More recent guidelines may consider patients’ values and the acceptability and feasibility of the recommended action, but the treatment burden is not made explicit. This makes it hard for patients to make informed decisions about treatments in line with their values and capacity”.
We must include treatment burden, together with a proper scientific scepticism for the evidence of treatment benefits (see Chapter 5), when we compare expected benefits with the possible harms from medical interventions.