I  am repeatedly asked the fairly straightforward question, “What should I do, doc? What would you do if you were me?”

On the surface, it seems like a pretty simple request and really doesn’t demand much except an honest opinion. Yet it gets at the heart of two of the four acknowledged principles of medical ethics.

Previously, we have discussed patient autonomy in this column, which many consider the lynchpin of medical ethics.

And in the future we will delve into the difficult area of justice in health care — the fourth pillar of traditional medical ethics as outlined by the American Medical Association.

But today I want to discuss the simple phrases “non-malfeascence” and “beneficience.” Translated into everyday English, the respective statements mean “do no harm” and “do good.”

They have been foundational for medicine and the healing arts since the time of Hippocrates.

While seemingly simple guides, they are increasingly difficult to implement in the current health care environment. Technology, pharmaceuticals, hospital competition, and physician preferences all are driving the machine.

Health care is like a runaway locomotive and we forget the roots that are our heart and soul. We all know intuitively that these mandates should be at the heart of every health care encounter.

As physicians, we like to think these are part of our foundations. As patients, we rightly expect them to be. Yet I would submit that for a myriad of reasons we are losing these ethical norms by the day.

Every time a new technology or drug is brought to market, it invariably is compared to older modalities. Often the simple message is “newer and better” which almost always translates into “more expensive.”

Yet to bring a new product or technology to market all a company is required is to demonstrate that the drug isn’t any worse than what is already available.

So the cost of a drug, which in many cases isn’t any better than an old one, always winds much more.

And bearing the burden of that cost is, of course, the consumer — through higher premiums, higher costs and newer technology, which in many cases duplicate what is already available.

One of the surprising things about health care economics is that an explosion of competition and technology doesn’t result in lowering of costs, but invariably raises them.

Health care doesn’t follow normal market supply-anddemand curves. So procedures, drugs, and equipment, which are perfectly good, are replaced with newer generations of products, which aren’t always better or safer.

In our drive to increase our market share and provide expanded services, we forget the two commandments: Don’t hurt people. Help them.

It seems simple, yet as technology and procedures become increasingly complex, the risk often escalates exponentially.

We have the ability to do truly miraculous things in medicine, but there is never a free lunch. The risk goes up with the reward, but we often are not honest and blunt with patients about that reality.

Patients and families want the best technology, but often the few lives we save with aggressive modalities are counterbalanced by the loss of lives or complications in others by the very same technology.

Physicians sometimes are reluctant to simply say, “We shouldn’t be doing this.”

This is not simply about a matter of adequate “informed consent.” It is about physicians and other health care providers not being intellectually honest with themselves about our new toys and opportunities.

In our desire to always have the best for our patients, we fall prey to a sort of mental laziness and don’t critically look at a larger picture.

In our zeal to heal, we often fall sway to market pressures and decisions get made that we often come to later regret.

We are at a time in the history of health care that we should be asking the more fundamental questions — does this procedure help the patient? Or will it hurt the patient?

Perhaps we need to look more critically at the forces that are pushing us in a direction in which we may not always be comfortable.

Michael Attas is a local doctor, a medical humanities professor and an Episopal priest. Email him at Michael_Attas@baylor.edu.