The calling of a physician is to save lives and restore or preserve health. As such, our primary focus will be upon how we can give our patients the best outcome possible.
Unfortunately, there will also be times in which one cannot do all that one might wish to do. It may be the result of the hard limits of medical technology at any given time. It may be the limits of a lack of resources at that particular time, most often as the result of an emergency that leaves us having to prioritize the treatment of some patients over others. And it may be a matter of legal constraints, particularly when we are dealing with minors or other individuals who are not able to make their own medical decisions.
During what has come to be called the Great Outbreak or Great Sick, there were all too many situations in which legal issues constrained what we could do. This was particularly the case for those of us who were living and working in the various lunar settlements.
We had the obvious practical constraints of limited resources, since even the largest settlements — Grissom City, Coopersville, Gagarinsk, Edo Settlement, Shiloh — could not provide their medical centers with the full range of equipment that would be found in a dirtside Level I Trauma Center, or a specialist hospital for treating cancer or other serious diseases. There were some times where a patient who could not be transported back to Earth would have to be made comfortable while nature took its course.
With the disruptions of the diablovirus quarantines, these situations happened more often. Injuries that would’ve been survivable for someone at one of the larger settlements became a death sentence at smaller ones for the simple reason that those resources were not available where the patient was, and transporting the patient had become untenable.
Worse, we also had the situation of people with family members and friends dirtside who were in various difficult situations. Even when there were signed directives such as medical power of attorney, there was often little we could do to ensure that person’s wishes were carried out. It was even more difficult when we had reason to believe that a family member or friend on Earth was in danger, for instance, as a result of being forced into a risky housing arrangement by the closing of group accommodations, but the person making the inquiries about their safety did not have the necessary standing to qualify for release of information under privacy laws. Although it was difficult to tell them no in such emotionally charged circumstances, we had to prioritize the privacy of the individual in question.
—- Barbara Bhin Thi Thuc, MD, Col. USMC. Memories of a Frontier Physician. Carpenter Point, Tycho Crater: Kennedy University Press, 2044.