Looking back at the COVID response shows a couple of different ways doctors approach medicine.
Public health officers, Doctor Francis Collins admitted, have a “very narrow view of what the right decision is, and that is something that will save a life.” He added, “You attach infinite value to stopping the disease and saving a life… You attach a zero value to whether this actually totally disrupts people’s lives…”
The COVID response plans threw a bright light on two poles of medical practice. At one extreme are the doctors who see disease as the enemy to be conquered. It’s as though they start their day with the solemn commitment, “In brightest day in blackest night, no illness shall escape my sight. Let every sickness, every blight beware my power, this doctor’s light.”
As Dr. Collins put it, they place “infinite value to stopping the disease.” They are prepared to pursue any therapy, try any treatment in the fight against sickness. If someone praises them for their heroic efforts, they respond humbly they’re just doing their job completely and thoroughly – and mentally add: doesn’t everyone do the job this way?
The job, in their view, is to pay any price, bear any burden, meet any hardship, oppose any virus or bacterium, to assure the success and extension of life over sickness.
But some doctors follow another pole on the spectrum of medical practice. These doctors realize they aren’t the ones paying the price and bearing the burden of ever more powerful therapies. The patients are. These doctors have seen how the war against sickness can enter “we had to destroy the village to save it” territory.
So they focus, not on fighting disease, but on caring for patients, people who have an illness keeping them from living the life they want to live. They see patients looking for help and respond by helping them get the best life they can.
These are the doctors who have conversations like, “This therapy could extend your life for 8 or 10 months, maybe more. But for three weeks out of those months, you’re not going to want to get out of bed much less leave the house. Are those extra months worth it?”
Doctors fighting disease don’t stop to ask whether it’s worth it: they assume it is. In the public debate, they have the best lines. Like New York Governor Andrew Cuomo, whose goal was “save lives, period, whatever it costs… we’re not going to accept a premise that human life is disposable.” If someone wonders whether it’s worth it to close the restaurants to fight disease, the answer “How many hamburgers is a life worth?” has great emotional resonance.
If only we could be sure closing the restaurant would save a life. Too many other things can happen.
A person could get hit by a bus crossing the street in front of the closed restaurant. One of the basic syllogisms people learn in logic class is: All humans are mortal, and if you are human you are mortal. No matter how hard we fight, sooner or later that painful reality asserts itself.
No matter how wise, skilled, or determined we might be in the struggle, we have no control over whether we’re going to die, and a lot less control than we think over when we’re going to die. What we can control is how we’re going to live. And maybe that hamburger shop is a place where people can remember why life is a truly good thing.
Our days may be seventy years, eighty if we’re strong, and we can treasure anything and everyone who makes them more than toil and trouble. In this world, we can’t fight disease forever. But we can make sure every day fulfills the gifts we have received. Make every day along the way a little victory we can celebrate and enjoy.
We do need health professionals concerned about fighting disease to keep us from getting complacent. Their drive is likely behind most of the innovations we depend on today. But the doctors who keep asking whether the benefit to the patient is worth the cost are in tune with an important reality. As Dr. Collins admitted, their perspective needs to be “more effectively” made part of our health conversation.
