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David Pencheon: Moral offset

4 Oct, 10 | by BMJ

David PencheonI try to maintain my sanity, like many of us, by rationalising my own behaviour and trying to make sense of the world around me. I get to sleep at night by maintaining the likely myth that I have done more good than harm that day, either as a doctor or as a citizen, although it is never clear to me what that point of equipoise actually is, and with a footprint exceeding 7 tonnes a year, I know I am stealing from others, elsewhere and in the future.

I wonder if the good we do today as doctors is worth the cost for tomorrow? I have heard it said that doctors only started doing more good than harm in the 1920s. Are we set to regress, or have we already done so? Unless we can properly cost the effect we have on the future, it’s difficult to say. What would a sustainable health system look like? What would a sustainable life look like? What would a sustainble death look like? What would the ultimate measure of success look like: additional DALY or QALY per tonne of carbon …?

Most intriguingly, apart from the heroic efforts of the Climate and Health Council, many doctors seem surprisingly calm about what others desribe at the most strategic health threat we face in this century: the cholera of our time. We have led before on big social health issues; why not now? Perhaps we docs just don’t do the future, or perhaps we really are all victims of moral offset. (I had to look it up too.)

For an insight into a sustainable health system, see:
http://blogs.bmj.com/bmj/2010/09/29/richard-smith-creating-a-sustainable-health-system-learning-from-business/

David Pencheon

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  • Richard Smith

    Our problem is that clinical medicine has trumped public health. It's hard for doctors to conceive that they are doing more harm than good, but when Julian Tudor Hart, one of the great doctors of the century who cared for a community as well as individuals, audited his life's work he concluded that the balance was only just positive. It may be negative for many doctors, and it's surely a mistake to think that if a little medicine is good then more must be better. There is a point where more investment in medicine is counterproductive.
    And all this is without factoring in our overconsumption of resources.

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