To live and to let live

I am working at public health lab right now on a smoking cessation study. Up until a few days ago, I convinced myself that I was taking part in an important and beneficial service to society. After all, we were taking smokers off the streets and giving them an opportunity to quit that might otherwise not have existed. Smoking is deletrious to one's health, and I was doing something to prevent people from that health hazard. A few days ago, I read a brief article that turned my view on health, medicine, and role of health professionals completely around.

Growing up, I wanted to be a doctor for many of the glorified positions a doctor occupies in society. Getting through college caused me to bade goodbye to several of those naive ideas, but my general attitude towards medicine remained optimistic and reverent. I knew that exultant stature of the medical professions was blemished by the healthcare system, exorbitant fees, and stereotypes of greedy docs. Regardless, being a physician is a noble profession. As far as I knew, wasn't the undisputed role of doctors to heal the sick?

This article claimed that by encouraging people to quit smoking, they do end up living longer, but then incur diseases from old-age. The money saved from getting people to quit is almost equal to the amount spent on treating the elderly. Of course, while the underlying purpose of allowing people to lead more healthy and productive lives is met, this phenomenon forces us to ponder what a doctor's role truly is. Is it to improve the quality of life or prolong life? Modern medicine has allowed us to put up quite the fight with Yama. However, where is that line that determines whether treating someone actually improves their lives or simply prolongs it? The obvious example is the octogenarian grandpa who's facing congestive heart failure or lung cancer or renal failure that doctors can tackle and keep the patient alive, if barely. Another example, not to appear coarse, is a child with down's syndrome that is facing cognitive impairments and organ failures. Though we may have the capability to keep the child alive, is it truly improving the quality of his life?

These boundaries are hazy, and for good reason. Just imagine the outrage if there was a rule saying that no treatment is to be given for any person above the age of 90 or any infant born more than 20 weeks early. These boundaries are clearly not up to the physician to set, yet the questions these issues pose are important to consider.

I've been going to work with a different attitude the last couple days. True, by helping a smoker quit, I've probably only delayed his death to lung cancer by about five years, but perhaps I will have contributed to his own self-satisfaction in improving his lifestyle and leading a more productive life. Thankfully, when I hand him a package of nicotine patches, I can't tell what's going to happen to him thirty years from now. I can continue to rely on my optimism to get me to show up to work tomorrow.