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My use of the word "harm" has distracted you from the main point. The dilemma I am talking about is an emotional one, not a dilemma of decision. The therapist must persuade the patient that the treatment could work, but they know that it is quite likely not to work. They should be emotionally committed to the the therapy, and persuade the patient to be emotionally committed to the therapy, while at the same time recognising that there should come a point at which the therapist should recommend stopping and trying something else. And while it isn't working the patient is suffering. A patient isn't in a state of stasis, like a computer program being debugged. While they have a chronic illness, it uses up their resources, of energy, time, money, social and professional capital, and ultimately, will to live. and it's very hard for the therapist to be rational about when to stop. Because giving up on the therapy requires recognising that the therapy they chose to deliver, and advocated for, may have caused the patient to suffer for longer than some alternative. And if the patient's resources are depleted enough, they may not now have a good shot at getting the alternative to work. If people could be coldly rational about this, you'd be right, it's just a question of trying one thing after another until something works. But therapists have emotions, and those emotions cause them to commit to a therapy long past the time when rationally the patient would be better off trying something else. And that is harm. |