‘Just because something is technically possible doesn’t mean we should do it’
In a world where medical advances are progressing rapidly, Professor of Obstetrics and Gynaecology Ben Cohlen argues that these must always go hand in hand with ethical reflection and careful decision-making. Because behind every technological advance lies hope, uncertainty and sometimes sadness.
What is the core message of your inaugural lecture?
‘The core message of my lecture is that just because something is technically possible doesn’t mean we should do it. And just because something is available internationally doesn’t mean it should be used for every individual patient. We are capable of more and more, which is impressive, but it also raises medical and ethical questions. Who determines the limits of our actions, both at the level of society and in the consulting room?
‘My message is that medical progress is important and that ethics is not the brake but the steering wheel. Technological progress and ethical reflection must go hand in hand. In my lecture, I use developments in reproductive medicine to illustrate this.’
What are some of the key research areas that you and your team are working on?
‘At the Department of Obstetrics and Gynaecology, we have identified four research themes, all relating to different stages in a woman’s life. Our motto is: Healthy pregnancies and healthy ageing. By concentrating our research around these four themes, we can sharpen our focus and support one another more effectively.
‘The first theme is periconceptional care, including research into growing egg cells in the laboratory from frozen ovarian tissue, as well as research into recurrent miscarriage. The second theme focuses on foetal health and disease, including research in the field of foetal therapy.
The third theme centres on healthy and unwell pregnant women, for example through studies on early detection of pre-eclampsia. The fourth theme concerns healthy ageing, including improving outcomes for gynaecological cancer.’
What role do education and patient care play in your vision of this field?
‘For me, education and patient care are just as important as research. Good care starts with listening carefully, providing clear explanations and making decisions together with patients. In a field where technology is changing rapidly, doctors need not only to understand what is possible, but also learn to think critically about what is desirable.
‘Education helps young doctors combine medical knowledge with responsibility, empathy and ethical awareness. Those who go on to work at the boundaries of life must also learn how to deal with the limits of what medicine can achieve.’
What is something from recent years that has really stayed with you?
‘What has stayed with me most is the speed at which technology is developing. That is impressive, but it also makes decision-making more complex. What affects me most is that behind all this technology there are always people: patients with hope, uncertainty and sometimes sadness. It constantly reminds me that progress must not only be technically possible, but also careful and responsible. Another striking development is the growing for women’s health conditions.’
What will patients and society notice from your work?
‘Our work should lead to safer treatments, better information and greater attention to the individual needs of patients. The role of the doctor is increasingly shifting from that of a decision-maker who knows what is best for the patient to that of an expert coach who helps patients navigate difficult choices. Ultimately, as a field, obstetrics and gynaecology aims to contribute to care that is not only more effective, but also remains careful, appropriate and responsible.’
Where do you hope the field will be in 10 to 15 years?
‘Personally, I hope to be enjoying a well-earned retirement by then. I also hope that, as a society, we continue to deal wisely with new developments. As healthcare budgets are likely to grow more slowly in the years ahead, we will have to make choices. I hope we can make it clear that not everything that is possible should necessarily be done. My dream is a field that is innovative, but also humble enough to keep asking: where should the line be drawn?’
Ben Cohlen’s inaugural lecture, ‘Over de grens?’, will be held on 19 June (16.00–17.00) and will be streamed live on the Leiden University website.