Do No Harm: Stories of Life, Death, and Brain Surgery

by Henry Marsh

‘Informed consent’ sounds so easy in principle – the surgeon explains the balance of risks and benefits, and the calm and rational patient decides what he or she wants – just like going to the supermarket and choosing from the vast array of toothbrushes on offer. The reality is very different. Patients are both terrified and ignorant.

Neuroscience tells us that it is highly improbable that we have souls, as everything we think and feel is no more or no less than the electrochemical chatter of our nerve cells. Our sense of self, our feelings and our thoughts, our love for others, our hopes and ambitions, our hates and fears all die when our brains die. Many people deeply resent this view of things, which not only deprives us of life after death but also seems to downgrade thought to mere electrochemistry and reduces us to mere automata, to machines. Such people are profoundly mistaken, since what it really does is upgrade matter into something infinitely mysterious that we do not understand.

‘Surely,’ I wanted to say to the hard-nosed health economists and public health doctors around me, but did not dare, ‘the real utility of the drug is to give dying patients hope? The hope that they might be statistical outliers and live longer than average? How do you measure the utility of hope?’