IT IS SAD that Johns Hopkins Hospital has chosen to discipline the director of its intensive care unit. Here Hopkins is, uncharacteristically, setting a bad precedent for the other hospitals that look to its example. The physician, Dr. Warren Summer, talked candidly and at length about his work in a recent series of articles in this newspaper describing the choices that advanced medical technology poses in the care of very ill patients. Dr. Summer has now resigned under pressure as head of the unit, although he continues to be a member of the hospital's staff and the medical school's faculty.
The real issue here is not one of medical ethics or, as the hospital has suggested, protection of patients' privacy. It is part of the sharp debate among doctors over how much to tell patients, their families and in general the public. The older view was to say as little as possible on grounds that details only got people upset for no good purpose. There was something to be said for that in a time when a physician's resources were limited and the average patient understood little about medical technique. The best that doctors could provide was reassurance that they would do their best.
But today that phrase "their best" has become ambiguous. Their best--or their most? The principal subject of the articles was the care of terminally ill patients. Technology can sometimes keep the dying patient alive for a long time. How long is best, and by what standard?
Traditionally physicians never discussed these matters outside their profession. But in recent years many have concluded that it is far wiser to let people come to understand the nature of these decisions not when they are ill or waiting anxiously in a hospital's waiting room, but rather when they are well and simply reading the newspaper. While medicine has become much more sophisticated, creating new moral complexities, patients and their families have also become more sophisticated, and most of them want to know exactly what the doctors are doing. Many doctors believe that full and accurate explanations are helpful to the public. Perhaps that was why Dr. Summer and others talked to our reporter, Benjamin Weiser; certainly that is why The Post printed the articles.
Another doctor at Hopkins is quoted as saying that if he were ill and needed intensive care, he would want Dr. Summer as his physician. To judge from the mail we have received in response to the articles, others who read them share that view. Johns Hopkins is a great hospital that has performed historic services in leading medicine from the 19th century into the late 20th. In this instance, unfortunately, there has been some backsliding.