Emeritus Professor Miles Little has had an illustrious career as a surgeon, academic, author, ethicist and philosopher. More than this he is a great humanitarian if this Reader sample of his work is indicative. …
Professor Little depicts modern medicine as having lost the very values society expects of its practitioners – humane values. The outcome is a wholesale decline of public trust … His papers challenge current practices and orthodoxies. The ethics of surgery, euthanasia, research funding, treating cancer survivors – all are dissected. Little sees a profound dichotomy at the heart of modern medicine: a reductionist, as opposed to a wholistic approach to illness and care in our society – a search for objectivity, which is part of the problem not the solution. …
Added attractions in this Reader are commentaries by an assortment of authors, including Little’s peers, sociologists, ethicists, even a poet. The range of writers is not surprising when Little’s own sources are appreciated. He moves with ease through the ideas of a who’s who of philosophers, ancient and modern, linguistic scholars, scientists, theoretical sociologists, and the so-called post-modernists of our time. His commentators sometimes agree, sometimes disagree with him.
Chapter 6 subtitled “A gentle critique of evidence-based medicine” (EBM) should be mandatory reading for medical litigation lawyers. Little portrays EBM as having reached cult status. He then demolishes its claims as paternalistic, arrogant, and yet to show validity. EBM’s purpose is to benefit doctors, not patients, and it encourages defensive medicine, which diminishes patient care. It replaces professional judgment with treatment protocols, which become ’the gold standard’ and form the career path for lawyers in an adversarial system where the distinction between legal and moral is often ignored. But, as Little notes, the ‘truth’ about what constitutes ‘best’ treatment can shift radically every few years, a point taken up gleefully by commentator Professor Stephen Leeder in predicting EBM will go under to “the current epidemic of genetic reductionism”.
Importantly, Little does not just expose the weaknesses of the system. He aims to reconcile rather than entrench division. The crux of this Reader is that modern medicine is greedy, fallible, dishonest and driven by vested interest, but his writing is a plea for change, with constructive proposals to effect it. …
You will not be the same after reading this book. The insights are at once of the 21st century and timeless. Justice Michael Kirby’s foreword notes a personal family experience with Professor Miles Little. To his Honour, Little’s work evidences the love of human beings at the heart of human dignity and universal human rights, which is the root of ethics, especially perhaps bioethics. Little’s clarion call is for the restoration of exactly those humane values to medicine by rebalancing science and ethical values. Let us hope that what Little fears and calls ‘moral indeterminacy’ does not instead prevail.
– Angela Mende, NSW Law Society Journal, Dec 2004