Limits to medicine

Abstract

Whilst in developing countries basic medical care is not yet available to all, in the affluent western societies discussions are already starting on the limits of medical care and cure. The limits that are being considered are not mainly economic, but have to do first and foremost with a delay in scientific progress, and also with restrictions imposed by moral considerations. People are also becoming gradually more aware of the applicability to medical practice of the famous Marxist law of diminishing returns. It seems, for instance, that the most arduous efforts in the field of oncology do not lead to breakthroughs. The investment of more energy and more manpower in many fields of medicine apparently results in only relatively small effects on health and wellbeing of the people. Next to these limits to medicine, there is also the problem of the scarcity of medical provisions, even in wealthy countries. This scarcity seems to be created largely by an almost built-in capacity of medicine for endless expansion, but is also influenced by a decrease of economic growth. On December 6th 1985, about 150 scholars and officials in the field of medicine and health care assembled in the Royal Palace of Amsterdam to discuss and evaluate the role of medicine in modem western societies in the presence of Her Majesty Queen Beatrix and her husband, Prince Claus. Four eminent scholars were asked to present papers on the real theme of the day (as the president of the symposium Prof. B. Polak rightly stated): What ought to be done (i.e. in health care)? What can be refused? Prof. Polak pleaded for a conscious consumership of the patient and also for a less unwieldy structure of health care in order to enable public authorities to react more adequately to changes in both the demands for and the supply of medicine. The first to comment on the theme was Prof. H. Galjaard (Rotterdam). He showed