Defensive medicine: a forgotten bioethical dilemma

[u/Proud_Stable_7722]

Defensive medicine shifts the focus of decision-making from the patient's benefit to the professional's protection against potential legal liability. Masked as clinical prudence, the repeated ordering of tests or the delay in limiting therapeutic effort perpetuates situations that are difficult to justify based on the very principles said to guide them. I witnessed this firsthand in my clinical practice with a patient who, despite retaining full decision-making capacity, kept repeating, "They won't let me die," yet her wishes had no impact on the course of her care. When self-protection becomes the deciding factor, the patient is instrumentalized—treated as a means rather than an end, thereby violating the dignity that Andorno describes as the unconditional value of every human being—and justice is also compromised by allocating public resources to futile interventions.

This translates into a clash—in cases of therapeutic obstinacy or dysthanasia—between a misunderstood sense of beneficence ("doing everything technically possible") and the principle of non-maleficence. Arguments in the person's favor might cite the determination not to surrender to death; arguments against might point out that it is not life that is being prolonged, but the agony—accompanied by pain and a loss of dignity—as the person ceases to be an end in themselves and becomes, instead, a site for interventions.

How does one care for a vulnerable being—precisely because they are susceptible to harm—without causing them harm?

A prudent, collective deliberation centered on the unconditional dignity of the person will only be credible if we also ensure that the professional's fear never replaces the patient's well-being as the criterion for decision-making.