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.cb MEDICINE AND THE INDIVIDUAL

 	In this section, we will take the same rationalist approach to
improvements in medicine that we have taken to improvements in other
areas.
However, this is in sharp contrast to the dominant ideology of
medicine, both among doctors and among the public.

	Our view is that we should look to medical science and technology
for ways of making humans live as long as possible, as healthily as
possible, and with as great as possible physical and mental powers.  This
may seem uncontroversial at first glance, but the way people think about
medicine is dominated by certain ideological attitudes peculiar to
medicine that seem to me irrational and harmful.

	The first of these is the notion of %2normal health%1 vs.
%2sickness%1.  The idea is that there is a %2normal%1 state of health for
a human being and that deviations from normality are to be prevented and
corrected.  There is no serious consideration of the idea that there are
states of health better than normal, and medicine should be just as alert
to opportunities to produce better than normal states of health as with
correction.

	The second ideological vice of medicine is moralism.  Liking to
eat and disliking exercise are regarded as vices to be punished by
ill health rather than as matters of personal taste.  Doctors naturally
acquire such attitudes, because when the patient gets sick, it is
less unpleasant for the doctor to consider it the patient's fault
than his own, or even to believe that the patient has been wasting
his time and money with expensive visits and laboratory tests.
The intellectual tendency to moralize is exacerbated by the desire
to believe that one will live forever if only one does everything
exactly right.
Medicine should seek ways of letting people live as they wish
and still enjoy good health.  Naturally, at a given state of medicine
the individual may still be confronted with hard choices, but
doctors often don't do all they can to let people live as they wish.

	A third problem is the attitude towards death.  Death is
the most unpleasant aspect of life.  There is said to be
a failure of our society to face death - whatever that may mean.  In my
opinion, the biggest failure is to squarely face the fact that death is
unpleasant and that society should contribute as much as possible to the
individual's desire to postpone it.  There seems to be some kind of "death
is nice" lobby.  Maybe it is a residue of the belief in life after death
according to which death is just a transition to a happier life.  There is
an unjustified belief that unless death can be popularized, people will be
so unhappy that they will refuse to live.
This one is less prevalent among doctors than among writers.

	Finally, medicine suffers to an extreme degree from the
tendency of professionals to regard their patients as objects
and to make decisions for them.

	
	Our second theme is that individuals should
have as much knowledge and control of their own states of health as
possible and that cost-benefit-risk decisions should be made
as much as possible by the individual, and he should take the
responsibility for the consequences.
This means that %2medical advice%1 should as far as possible be just
that - %2advice%1, with the decisions made by the advisee.  Therefore,
when alternatives exist, the doctor should write out what he knows
of the alternatives and their consequences, and the advisee should
sign a paper choosing a treatment and stating he is aware of the
uncertainties.  This paper should have the legal effect of immunizing
the doctor against suit if an unfavorable result occurs.  The only
possibility of suit should be if the treatment was incompetently carried
out, and the doctor had misrepresented his competence or if a
danger mentioned in the "Manual of Medical Risks" were omitted from
the statement.

	Conservatism might suggest limiting complete freedom of patient
decision to people posessing a certain amount of medical knowledge.  A
person could become master of his own medical treatment if he passed an
exam; the qualifications for this being far less than those required by a
doctor licensed to treat other people.  Such a licensee could prescribe
drugs for himself and contract for medcal procedures with anyone who would
perform them, taking the responsibility for their success himself, and with
only ordinary commercial rights to sue someone who performed them
incompetently.

	Children and people below a certain level of educatability and
interest in their own medical life would not pass the exam.  I would hope
that the exam would be passed by ten percent of the population after some
years, but I would consider the idea a success if only .01 percent were
able to take advantage of its provisions.

	Here are some developments that would help realize the twin ideals
of supernormal individuals and individual responsibilit↓ for their own
medical future:

.item←0
	#. Medical books for the layman

	#. The ability to get diagnostic tests done independently of
a doctor.

	#. Individual ownership of his medical records.

	#. The development of conveniently wearable condition monitors.
The biggest single development might be a continuous blood chemistry
analyzer whose results would be displayed when the individual pressed the
appropriate buttons on his "digital watch", and which would alarm on
conditions for which this had been requested.  The analyzer would
presumably have to be surgically implanted.  Blood pressure, pulse, and
electrical activity of the heart and brain would also be monitored.

	#. The next step beyond monitoring blood chemistry is controlling
it.  This could be done by servo-mechanisms that released appropriate
chemicals in the blood stream when called for.