Dear Dr. Roach: I was shocked recently when I read an article from a reputable source implying that sooner rather than later (and maybe already), doctors who have a patient who could be treated successfully only with massive doses of antibiotics would be required to allow the patient to die rather than run the risk of creating a generation of bacteria that are resistant to antibiotics. In other words, one person must die for the sake of many.
While I understand the logic of this, I also find it profoundly disturbing on many levels, and wonder what your comments might be. J.F.
Answer: As physicians, we are obliged to act primarily in the best interests of our patients not ourselves, and not society. Therefore, in the case of a patient who would die without the only effective antibiotic, our primary duty would be to use the antibiotic in hopes of saving our patient, recognizing that this may reduce the effectiveness of the antibiotic in the future. Of course, we should take great pains to isolate the patient so that this hypothetical resistant super-bug does not get out and spread to other people. This happens in hospitals every day now.