No Harm

Ninety percent of the people who die in La Crosse County, Wisconsin, have an advance directive, telling doctors what their wishes are for their end of life. Nationally, only 30 percent of people who die have an advance directive.

NPR recently ran a story on what they're doing right in La Crosse and how it got started -- the Town Where Everyone Talks About Death.

This recent Washingtonian article, Lessons in the Art of Dying, is a good accompaniment. The author is a Baby Boomer second-generation doctor who compares his own experiences with those of his father, whose office was attached to their home and who often did house calls. But more importantly for the subject of the article, his father was comfortable with the fact that people die.

The more one does, the more that can go wrong. Like trying to turn around an enormous ship, it’s hard to stop the momentum once the system gets going. So today we violate primum non nocere [first do no harm] because “we did everything we could” has typically come to mean we’ve done more than we should.

It made me think of a recent MPR Daily Circuit conversation about incidental medical findings, those times when a medical test turns up a terrifying result the doctors weren't asked to look for. Do doctors have a "duty to hunt?", one of the guests asked.

No hunting, no screening tests. Live until you die. First do no harm.