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The changing and complex relationship between paediatric cardiologists and life

This article was presented as the Edgar Mannheimer Lecture to the Association for European Paediatric Cardiology, Strasbourg, France June 2000. THE TITLE OF MY PRESENTATION IS, TO SAY THE least, ambitious and challenging. Before advancing further, I would like to clarify one point: I am neither a philosopher nor an ethicist. I am simply an old man, struck by the fact that the practice of paediatric cardiology as learned in the mid sixties with Abe Rudolph is not quite the same as the one practiced today. I am presently a fulltime fetal cardiologist having to face, on a daily basis, highly-emotional situations sometimes leading to interruption of what was an exciting project for a young couple. Of course, it is normal, and quite comforting, to realize that paediatric cardiology has changed tremendously during the past 40 years. This is called progress. Scientific progress carries sometimes with it worrying power. The Nobel Peace prize winner, Nelson Mandela, inserted these words in his inaugural speech "Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us". The challenge is to find an equilibrium between the power put in our hands by major scientific advances and our fundamental ethical, moral, or religious beliefs. This is not new. Aristotle, 300 years before Christ, thought that "there exists no static level that could be reached once and for all, neither in ethics nor in politics 'justifying' constant search for the just measure, for an equilibrium." This concept has been called the golden rule of philosophy.