Abstract

I end with another parable, but it is also a true story. Harvey Gushing, the famous surgeon after whom the Gushing Lectures are named, made an international reputation in his allegiance to quality. He badgered his profession to a higher standard of self-effacement and railed against the debasement of clinical skills and overemphasis on research and pursuit of personal gain. We honor him to this day because those were, and remain, important points. Yet, Harvey Gushing served as a surgeon during World War I and at Ypres. Although the Allied mortality was as much as 50,000 soldiers a day, not counting the wounded, Gushing refused to operate on any more than two patients each day, arguing that to do so would have lowered his standard of care for his patients a – standard that made sense in one time but that became strikingly insensitive, and I suggest even unethical, in another when confronted with a different reality