The Application Matters: Medical Ethics and Counterfactual Utilities

I believe, as applied statisticians, we need to get our hands dirty and immerse ourselves in the applications we try to address. This post is mostly about medical ethics and the famous “first, do no harm” principle. It is also an attempt to understand how statistics can serve medical practice. The motivation for this comes from a recent debate in the statistics literature about counterfactual losses, which often invokes this “first, do no harm’’ principle as a motivation. Much has been written about the theory of these counterfactual losses — and I’m sure they will find a fruitful application — but do they actually speak to the challenge of medical decision-making that the “first, do no harm’’ principle seeks to address? I will argue that they cannot, because this principle is concerned with medicine at its most human: medical practice centered on the relationship between an individual patient and an individual physician. But what can statistics help with? Modern medical obligations…