Freedom

The Prime Minister despised the idea that someone teaches him how to spend the money in my last story. But could it really be wrong to exercise his freedom of choice? This reminds me of the argument on clinical freedom, long cherished by medical doctors as essential to effective practice. Can a doctor be as noble as the Prime Minister to claim (or reclaim) the freedom to make his/her own choice in terms of medical expenditure?

If you wish to (it is not really necessary), we can regard the clinical freedom as the right – some seemed to believe the divine right – of doctors to do whatever in their opinion was best for their patients.

Thoughts such as these have led many to conclude that the quest for a professional independence or autonomy is praiseworthy. On closer examination, the suspicion is that such "freedom" is merely personal (rather than professional) preference, fashion, snobbery or elitism dressed up as an objective judgment. Don't get me wrong. I am never an advocate to badmouth the trust in medical doctors' effort to put patients' interests first. On the other hand, we should never forget the lessons that we learned from the lawsuit story of Vioxx, the once-popular drug which had been promoted as an effective and safer alternative to the traditional painkillers, and then turned out to double the risk of heart attacks and strokes (and thus taken off the worldwide market).

I do not have a neat solution to the tricky question of clinical freedom. There is no denying that medicine is both science and art. We can argue all day about where to draw the line between them. Sure, we should at least allow for some version of clinical wisdom, or at least for a certain degree of preferences. On this view, if you ask me what the bottom line would be, the answer seems to heed the advice by the famous cardiologist John Hampton, "if we do not have resources to do all that is technically possible, then medical care must be limited to what is of proved value and the medical profession will have to set opinion aside."

John Hampton bade farewell to the clinical freedom 25 years ago, insofar as resource is concerned, with the resonating words "clinical freedom is dead, and no one need regret its passing." To which we may add, Amen.