Reflections on responsibility

Abstract

The great William Osier once remarked that what distinguished man from the apes was a propensity to take medicines. A more pervasive distinction is man's need for explanations. It is this need which accounts for the almost universal existence of religions which attempt to explain our birth, our death and the pain of the journey in between. This need for explanations underpins the fallacy of association. Because things are associated it is tempting to convert the association into a causal relationship. For nineteen years I made my livelihood in whole - time general practice. Patients consulted me, I prescribed, and for the most part they got better. Both they and I believed that the medicines were largely responsible for their recovery, whereas this was only true in a minority of instances. The failure to discriminate between association and cause is part of the reason that learning from experience is nothing more than learning to make the same mistakes with increasing confidence. It is a commonplace to describe the aetiology of disease as multifactorial. This is usually a euphemism for ignorance. Everything that happens to us has a multifactorial aetiology. My writing this paper depends, in the first instance, upon the accidental conjunction of sperm and ovum some years ago. It depends upon a great deal else besides. Before I continue, I would like to acknowledge my debt to the late Petr Skrabanek. He was not only a most remarkable intellect, but also a warm and wholly delightful companion. His death, from aggressive prostate cancer, at the age of 54 is a great loss both to medicine and to his family and friends. © 1998 Informa UK Ltd All rights reserved.