Putting a patient under general anesthesia is a dangerous business. Waking a patient up from anesthesia is an ugly one.
After I turn off the gas the patient typically thrashes and writhes like a sinner in Hell. Yet such resistance has never bothered me.
I don’t want good and submissive patients. On the contrary, I want patients with the will to live. Passivity while waking up from anesthesia usually means a complication of some kind.
Anesthesiologists are unusual in this regard. Most physicians prefer patients who are submissive, pleasantly civil, and who do as they are told. This is probably why the medical profession has traditionally resisted a public health approach called “harm reduction.” Rather than try to end dangerous behaviors, harm reduction simply tries to mitigate the damage they cause. It accepts that many people will act against physician advice—thrash and writhe, so to speak, in their search for happiness—and irrationally court danger.
For example, rather than try to eliminate substance abuse, needle exchange programs recognize that some people will inevitably become addicted to drugs. These programs seek to lessen the spread of disease by giving users clean needles. Harm reduction accepts that some people will engage in ill-advised sex; rather than push abstinence, it promotes contraception to make ill-advised sex safer. Rather than ban cigarettes, harm reduction takes the desire for nicotine as a given and promotes vaping as the less dangerous alternative.
Ronald W. Dworkin – Quillette – 2022-03-17.
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