title: Vitamin C: ascerbic ethical discussions.
abstract: The issue of a patient's rights to demand treatment has recently been raised by a dramatic case in which a patient made a remarkable recovery following the use of an unconventional treatment that the hospital staff initially refused to administer. The normal position in such cases is that the relatives can take part in a clinical decision but the medical staff are bound to make it according to a clinical assessment of the best interests of the patient. That assessment is only required to take into account what would be regarded as acceptable regimens of treatment for the patient's condition. There is no ethical or legal basis for the patient's relatives being able to demand any treatment that the clinical team do not consider indicated nor to demand a highly unconventional treatment The case therefore poses a problem. When should we allow ourselves to be persuaded to step outside the bounds of accepted medical practice at the urging of relatives or patients? There are plausible arguments that a demonstration of efficacy in a particular patient or some reputable evidence of probability of efficacy would both be good enough grounds. In addition, one could argue that where the patient's predicted clinical course is terminal, then desperate measures of unproven efficacy can be tried in that the balance of harm and benefit cannot be further worsened. The implication of the actual events in the case in question is that a certain humility in the light of the incompleteness of medical knowledge is always appropriate and an objective weighing of the facts of the case, free from prejudicial theoretical commitments, is needed in the face of medical uncertainty.
authors.affiliation: Dunedin Hospital New Zealand. grant.gillett@stonebow.otago.ac.nz
authors.forename: Grant
authors.initials: G
authors.lastname: Gillett
mesh_terms: D001205:Ascorbic Acid / Q000008:administration & dosage*; D001315:Australia; D003657:Decision Making / Q000941:ethics*; D006801:Humans; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D028701:Patient Rights / Q000331:legislation & jurisprudence*; D014815:Vitamins / Q000008:administration & dosage*; D028761:Withholding Treatment / Q000331:legislation & jurisprudence
chemical_list: D014815:Vitamins; D001205:Ascorbic Acid