Sticky ethical question

[Rayven]

I do understand that the tax dollars are coming from the same pocket in the long run. But there IS a specific budget to serve the needs of this individual, and it is not coming from the health ministry's budget and I do not feel from the posts in this thread that others understand the distinction.

To be honest, I just don't think it matters. It feels like one of the Physical Science questions on the mcat where the Tax Dollars are the constant and thus the budgets for each ministry changes in order to keep the equation happy.

 

Tax Dollars = Health budget + Social Services budget + everything else

 

Where Tax Dollars is a constant. So decreasing Social Services budget would mean we'd get more for Health or everything else.

 

Perhaps the tragedy is that more people are not being served in the MCSS because funding is tied up in one individual. Still...from personal experience, I know two things: the squeaky wheel will get the grease and that there is a lot of waste in how resources are used. You will argue that 'waste' is not an argument, and ultimately on its own it is not but the biggest problem is that full systems need to be rehauled to eliminate the waste of resources.

 

Sometimes I wish we could just take the system apart (health system, social services system, whatever) and knowing what we know today, put it back together to form a more efficient and effective whole. Of course, this would cost a lot of money on its own and is just a pipe dream. It can and is extraordinarily frustrating to be told 'there is no money to do X and Y' when you see money being flushed down the toilet in areas that do not go towards improving quality of life for either the extremely high needs developmentally disabled person OR for the healthcare starved populace. I cannot post my specific examples so you will have to take my word for it that it is occurring, but I'm sure you can come up with some of your own examples if you have experience in either field.

I completelyyyy agree with you that the whole system should be revamped, preferably from scratch. It's frustrating that in 2009 that elementary schools and high schools can have your marks saved in a computer system for quick access but your medical information is still a complete mess, locked away in drawers, between different doctors. I wonder if it's even safe yet to say that half of our medical records have been digitized.

 

The reason I addressed wasteful spending as not being an answer is because it isn't an answer on its own. Of course we should address being more efficient, of course we should address scandals and people awarding outrageously expensive contracts to friends, of course we should address how much people are being paid and this includes all the perks and benefits (ie $50 credit for lunch). But when future_doc brought this up as the answer she failed to even address the real question of this debate. Cutting wasteful spending is not the answer but rather something we should've logically been doing anyways. That's why it's called "wasteful".

 

LOL...never have I thought you were out to throw anyone off cliffs...no worries! I completely concede that $300K is an extraordinary amount and would not be surprised if the same work could be done with less $$$(see above). But keep in mind, as well, that institutionalization would be more expensive and less desirable option. Further, many families are undertaking the majority of care of individuals (for months, years, and even decades), thus saving taxpayers money but at their own personal/emotional/financial costs. In a sense, they need to know that their governments will be there to help them when they need it.

Personally, I don't like the idea that someone would stay home all the time but sometimes I know there's no way around it. I don't like it really because it means that they're not working which means they contribute no taxes and they earn no income themselves. Suddenly everything's being covered by society. I'd much rather have parents alternate shifts or turns if possible or if they have other family (kids, their parents, etc) that always helps.

 

I'm not so sure if institutionalization would be more expensive. I would think it's cheaper because the nurses and staff are already there and thus the cost is shared and distributed by the number of patients in the facility.

 

However, you do raise a good point regarding desirability. Since they're already relying on tax dollars primarily, what level of comfort should they be allowed? What I'm asking is, if for example being institutionalized would cost taxpayers $100,000/year but the parents want their disabled kid to live at home at the cost of $300,000/year... who foots the difference?

 

I think it is a much greater loss when I hear about parents killing their (young or adult) children and sometimes themselves because they can no longer handle or sustain the care required. At a point like this, $300K seems like a small price.

Well, it's definitely a tough decision. No doubt about it. On the one hand you have a family trying to live with the fact that their child will always require care even after they're gone. But on the other hand, there's so many other people that we don't see that are indirectly hurt because the funding is tied up somewhere else. $300k seems like a small price to save one life.. but an even smaller price to save 10.

 

That's why there is no god.

[Rayven]

^

There is no substitute for life experiences to give one perspective.

 

 

 

^

There is no substitute for life experiences to give one perspective.

That's just annoying.

[future_doc]

Its not your $300,000, it is our $300,000 and your share is less than a penny. Moreover, you don't pay taxes of any significance if anything, so don't complain.

 

I will defend the weak and feable to my last breath while you protect the money. We will all make tough decisions in our future practices, but here we are trying to expand our minds and enter into meaningful discussion.

[future_doc]

That's just annoying.

 

(Rayven)

[AndrewB]

Moreover, you don't pay taxes of any significance if anything, so don't complain.

 

When you're a physician, come back and tell me that your taxes aren't significant.

 

Even though I value the services my tax dollars provide, it's still disappointing to watch your earnings vanish.

[future_doc]

Well, I expect and hope to pay a couple of hundred thousand a year. Its just the way things operate in a democratic society, somebody has to pay the bills and its us. This is better than the alternative. I lived in a country where freedom did not exist and am happy to pay the bill, I am happy to be Canadian, I owe Canada so very much.

[Rayven]

Its not your $300,000, it is our $300,000 and your share is less than a penny. Moreover, you don't pay taxes of any significance if anything, so don't complain.

Really? Is this your best argument now? That because, at my age, I haven't paid "significant" taxes yet that I'm not allowed to participate in any debate that involves taxes?

 

Dang.. I'm pretty sure that's just about 95% of traditional pre-meds and even non-trads usually won't be making significant income to be taxed by the time they apply to meds.

 

But you know who did pay a lot of taxes? My parents.

 

The day that the government tells you that you don't pay "significant" taxes so you don't have a say is the day that Canada is put up for sale. Seriously wow. You're impressing me, future_doc. Not really in a good way though.

 

I will defend the weak and feable to my last breath while you protect the money. We will all make tough decisions in our future practices, but here we are trying to expand our minds and enter into meaningful discussion.

Expand our minds? Meaningful discussion?? lol??

 

All you do is talk about how altruistic you think you are. You repeat the same things over and over. You won't harm your patients but you give no regard to other patients, how you expect the government to be able to pay for everything since you clearly have no concept of the word 'finite' or 'limited', how you believe that the government is a evil corporation who has the ability to speed up wait times and fix everything but they just won't for whatever reason..

 

You skirt around pretty much every question that's been posed to you. The latest one was AndrewB asking you if you'd save a 9 year old boy or a 75 year old senior if you only had one OR to work with. Of course you skirted around that by changing the question and making it easier by saying that if the boy had a good prognosis then you'd treat him first. No ****. But what if they they were equal? You know, like how AndrewB posed the question prior to your editting?

 

And don't insult me. I just posted between LostLamb and me that I'm not after the money for myself as I said I wouldn't push the $300,000/year patient over a cliff to cash in. Are you really that dense that you still haven't understood that we're talking about using that money to save more lives? You're seriously accusing me of wanting that money for myself? Are you kidding me? Really???

 

Seriously, I can't believe you're one of the people helping to critique writing samples in the mcat writing samples thread. I wasn't going to say anything earlier but your inability to make a good argument is becoming all too apparent anyways. I remember reading ladeeda's essay to the prompt about how the good of a society depends upon the defense of individual rights and for his or her anti-thesis they wrote too much freedom and rights would lead to chaos and you criticized them for using too extreme of an example. Sooo what do you do in this thread near the very beginning? You used the extremeeee example that people should have some kind of voting system to see who lives or dies and that we harvest their organs after which numerous people said was too extreme of an example. I found that very funny.

[future_doc]

don't insult me

 

Are you really that dense..... You're seriously accusing me of wanting that money for myself?

 

and that we harvest their organs after which numerous people said was too extreme of an example. I found that very funny.

 

Rayven, you are reading what is not there, I did not insult you, for sure I never intended to, I never accused you of wanting money for yourself and my comment about harvesting organs was clearly a facetious remark to make my point and was made on this thread.

 

It is sad that you are taking matters so personally and that you are linking unconnected threads, attacking me personally, questioning my intelligence and finding things funny. I have not and will not attack you personally or question your intelligence, on the contrary, I wish you every success in MCAT, getting into med school and being a successful physician.

[Rayven]

Rayven, you are reading what is not there, I did not insult you, for sure I never intended to, I never accused you of wanting money for yourself and my comment about harvesting organs was clearly a facetious remark to make my point and was made on this thread.

Yeah, okay. You only said that I was "complaining" (which is quite different from 'debating') about Canadian federal and provincial budget that I should have no say in because I apparently have practically no share in because like most people my age we don't pay significant taxes. You then go on to say that you'll be the hero and protect the weak "till your last breath" while I'll be the one to "protect the money".

 

Yeah, nothing insulting thereee.

 

It is sad that you are taking matters so personally and that you are linking unconnected threads, attacking me personally, questioning my intelligence and finding things funny. I have not and will not attack you personally or question your intelligence, on the contrary, I wish you every success in MCAT, getting into med school and being a successful physician.

The threads are connected in the sense that you're giving advice to people on how to write strong essays by telling them not to use extreme examples but that's exactly what you did here with your dial-a-death and harvest the organ campaign. So yeah, I do find hypocrisy a little funny. Either you're wrong for telling someone not to use extreme examples in their mcat writing samples or you're wrong for using it here.

 

To be honest, I generally wish everyone the best in all their endeavors. I can't say I hate you since I don't really know you. All I know is that you debate very horridly. Like the original OP, microbiodude, lostlamb, and andrewb have all said, you clearly avoid answering questions at every chance. So debating you is feels like I'm pulling my own teeth out because you totally dismiss addressing most of my posts, you skirt around issues either by hiding behind regurgitating the patient-first clause over and over and over again or the sanctity of life line. Both these things are obvious and irrelevant to answering anythinggg. And to make matters worse, you make "light" of things a lot of the times when we're looking for a real answer which you clearly don't have... and the humor is running really really dry by now. Like AndrewB said, it's very frustrating reading your replies.

 

This is like my 3rd time asking what you would do in AndrewB's proposed scenario without changing the question itself or adding in details to make the choice obvious.

 

And this is like my 4th time asking you to give me sources.. in particular how Superwoman is Superman's sister. >.>

[Avalanche]

I don't usually post but I find this exchange between Rayven and future_doc too hilarious to pass on.

 

To put it bluntly, I fully side with Rayven. I am just about to start med school this fall and I intend to devote a large portion of my life to my patients and our health care system. However, I believe that recklessly allocating resources to just one of my patients without considering the toll it can take on the rest of society is senseless. As posed, if I had to choose between $300,000 for one patient or using that same amount to train other health care providers, I would choose the latter.

 

In an ideal world where resources is not limited, this would be a no-brainer - treat the patient and train as many qualified health care providers as possible. However, this is not the case. We need to maximize our limited resources to help as many people as we can.

 

 

I have a problem with the ulitirian approach in determining the allocation of resources. Who is expendable, what are the standards, who makes the decision? Are the elderly expendable b/c they are no longer productive, will only need more care and treatment and they are closest to death compared to the youth? So, do we neglect the elderly from whom we have inherited society anfd throw them away at their weakest? Their value is no greater in the sne of productivity than the severely impaired physically and mentally. And do we neglect the people suffering from Alzheimer's, MS, muscular dystrophy, the blind-deaf, those suffering from cancer over a certain age, do we shut down our neonatal intensive care units that are so expensive, do we dispose of the people who are in a persistent vegetative state but are fighting to stay alive? Who decides to withhold or withdraw treatment or care by the healthcare system that reasonably will result in death?

 

 

I'd also like to read a response from future_doc regarding the boy and old man/lady. It is a fairly common interview question and usually interviewers won't let you get away with changing a question like that. No pressure though; I am just curious.

[future_doc]

The reality is that under the scenario of the OP, the physician would have absolutely no power or authority to choose to re-allocate the $300,000 toward the training of other health care providers. This is b/c the physician has not been empowered to be the bean counter, only to ensure that the patient receives the best care and/or treatment the health care system provides.

 

Given that you consider the expenditure “reckless” – your words Avalanche, not mine – you would have to recuse yourself from being the patient’s physician as your view is biased and therefore, you are unable to represent the patient as physician and to advocate the patient’s best interests which would put you in an untenable ethical position. Your own prejudgments and subjective views disqualify you and you would need to recognize this so as to avoid doing harm to your patient by deliberate acts of omission and commission. While you do not have an obligation of result, you certainly have an obligation to use the best means available to promote the welfare of your patient.

 

You could not in all good conscience while being there to protect the patient’s best interests, and without the patient’s prior knowledge and consent giving informed consent of which he is incapable, sell the patient down the river for the sake of more beans going toward perhaps what you consider to be the greater good. There are others to make utilitarian and futility arguments, someone needs to represent and protect the patient.

 

Your ethical duty would not allow you to do this and should you so proceed and an advocate for the patient be aware of your intentions or actions, you would be too busy attending conferences with your lawyer with respect to defending as multimillion dollar lawsuit and in preparing for and giving pre-trial testimony than attending to your normal practice. It is a no-brainer that a lawsuit against you for $300,000 plus cost of living increases x no. of years left in calculating life expectancy plus damages for loss of life early, etc. would occur. If you were able to live with yourself selling your patient down the river so and believe that you had performed your ethical duty to your patient doing no harm, you shall have indeed started an avalanche, internally and externally. Moreover, it is more likely than not that in addition to a malpractice suit, you would be brought before the disciplinary board of the medical association for either removal or censure and one would look into whether there is criminal responsibility should the patient die because of your intervention to ensure the withholding or withdrawing of care and/or treatment. The mere fact that you find the expenditure both “reckless” and “senseless” ensures at a minimum your liability in damages beyond doubt.

 

As physician, you can seek to become bureaucratic head bean counter but would have to remain away from patient care b/c you cannot serve both the needs of your patient and those needs you perceive of society. If you as physician would not protect the patient, then whom? Your efficiency would be judged by the auditor general and his efficiency would be judged by the legislator and there might even be many committee meetings and jaunts to other jurisdictions to investigate how bean counters there do their jobs, perhaps better – and easily more than $300,000 per year could be spent on these useless activities.

 

The reality is that the $300,000 per year saved would be squandered elsewhere, not spent as you would hope or like to save the lives of others. It is not as simple as you would imagine. Bureaucratic inefficiency is infamous for wasteful expenditures.

 

 

Regarding the young and old patient, I did not realize, nor do I now, that I had changed the hypothetical, rather I had clarified it. If, for example, the prognosis for the elderly person’s likely outcome was significantly better than the child, my decision would also be a no-brainer as I would be in the life saving business and not in the hope for a miracle business; realistic probabilities mean more than mere possibilities and hope against the odds.

[Avalanche]

The reality is that under the scenario of the OP, the physician would have absolutely no power or authority to choose to re-allocate the $300,000 toward the training of other health care providers. This is b/c the physician has not been empowered to be the bean counter, only to ensure that the patient receives the best care and/or treatment the health care system provides.

Given that you consider the expenditure “reckless” – your words Avalanche, not mine – you would have to recuse yourself from being the patient’s physician as your view is biased and therefore, you are unable to represent the patient as physician and to advocate the patient’s best interests which would put you in an untenable ethical position. Your own prejudgments and subjective views disqualify you and you would need to recognize this so as to avoid doing harm to your patient by deliberate acts of omission and commission. While you do not have an obligation of result, you certainly have an obligation to use the best means available to promote the welfare of your patient.

 

[/Quote]

 

 

If you read carefully, future_doc, you would see that the words "reckless" and "senseless" address my own patients and not the specific case stated by the OP. This is straw man argumentation at its best. You make a huge argument based on something I did not say.

 

Let me clarify for you then: I believe that recklessly allocating resources to just one of my patients without considering the toll it can take on the rest of society is senseless. (Wait a minute, isn't this the exact same thing?)

 

As physician, you can seek to become bureaucratic head bean counter but would have to remain away from patient care b/c you cannot serve both the needs of your patient and those needs you perceive of society, if you as physician would not protect the patient when whom? Your efficiency would be judged by the auditor general and his efficient would be judged by the legislator and there might even be many committee meetings and jaunts to other jurisdictions to investigate how bean counters there do their jobs, perhaps better – and easily more than $300,000 per year could be spent on these useless activities.

 

The reality is that the $300,000 per year saved would be squandered elsewhere, not spent as you would hope or like to save the lives of others. It is not as simple as you would imagine. Bureaucratic inefficiency is infamous for wasteful expenditures.

 

Granted. Our bureaucratic system is inefficient. However, should we look to curb this problem or should we further these inefficiencies by spending our limited health care funds recklessly without considering better alternative uses for these resources?

 

Regarding the young and old patient, I did not realize, nor do I now, that I had changed the hypothetical, rather I had clarified it. If, for example, the prognosis for the elderly person’s likely outcome was significantly better than the child, my decision would also be a no-brainer as I would be in the life saving business and not in the hope for a miracle business.

 

Alright. If its so difficult for you to realize that you have changed the previous question, I will ask a follow-up question: If the prognosis for the elderly and the child were the same (or the discrepancy is too slight to detect), who would you choose?

[future_doc]

Let me clarify for you then: I believe that recklessly allocating resources to just one of my patients without considering the toll it can take on the rest of society is senseless. (Wait a minute, isn't this the exact same thing?)

 

Your personal view is that certain situations would constitute "recklessly allocating resources". Fine. In such a case, remove yourself from being the patient's physician and find for your patient before removing yourself the best physician and best advocate possible to represent the best interests of the patient without reference to financial considerations - and only then, go ahead and argue vehemently against recklessly allocating resources for this ex-patient. There will be no conflict of interest situation. And what will be, will be. This is fair and acceptable.

 

 

Granted. Our bureaucratic system is inefficient. However, should we look to curb this problem or should we further these inefficiencies by spending our limited health care funds recklessly without considering better alternative uses for these resources?

 

This is the job of others, the so-called bean counters. Let there be a healthy tension between the advocates of the patient and the advocates of the system. Let us as physicians not err on the side of society and leave our patients to fend for themselves. Society will protect its own interests, you can be sure. We as physicians cannot and should not be in a conflict situation and our loyalty to our patients must be complete and unambiguous.

 

 

Alright. If its so difficult for you to realize that you have changed the previous question, I will ask a follow-up question: If the prognosis for the elderly and the child were the same (or the discrepancy is too slight to detect), who would you choose?

 

The answer is a no-brainer, I wouild choose the same person as you and every other person on this forum would choose.

 

 

 

In Afghanistan, Canadian physicians routinely save the lives of the enemy, although the enemy is blindfolded and has ear plugs so as not to be able to identify the doctor who saved his life, lest he decide to kill the doctor later. Canada spends a fortune on humanitarian medical causes, including devoting medical personnel, equipment and financial resources to saving the lives of others, without making jusgments as to whether this life is worth saving. Yet, future physicians on this forum who are destined to save lives are willing to place themselves in the position of judge and jury to dispense the death penalty to the severely mentally and physically impaired as if they were merely handing out candy.

 

Each of us need to understand the scope of our roles on an ethical and practical basis before we become an M.D. We cannot misunderstand our role in the grand scheme. I understand with absolute certainty that my role is not to be a bean counter when it comes to withholding or withdrawing care or tratement vs. allowing the patient to die so as to save some more beans. There will be plenty of bean counters doing trheir best to curtail my intervention for patients for the sake of saving beans. I will have enough tough calls without needing to go out of my way to tread in questionable territory b/c of my personal beliefs and judgments. I will willingly save the life of someone who when well would try to kill me and my family. As physicians we are not to bring our personal prejudgments to the table. We need the benefit of the advice and experience of practitioners who have decades of experience in the trenches of the real world. Our lack of experience or limited experience works against us all.

[Rayven]

The reality is that under the scenario of the OP, the physician would have absolutely no power or authority to choose to re-allocate the $300,000 toward the training of other health care providers. This is b/c the physician has not been empowered to be the bean counter, only to ensure that the patient receives the best care and/or treatment the health care system provides.

 

Given that you consider the expenditure “reckless” – your words Avalanche, not mine – you would have to recuse yourself from being the patient’s physician as your view is biased and therefore, you are unable to represent the patient as physician and to advocate the patient’s best interests which would put you in an untenable ethical position. Your own prejudgments and subjective views disqualify you and you would need to recognize this so as to avoid doing harm to your patient by deliberate acts of omission and commission. While you do not have an obligation of result, you certainly have an obligation to use the best means available to promote the welfare of your patient.

 

You could not in all good conscience while being there to protect the patient’s best interests, and without the patient’s prior knowledge and consent giving informed consent of which he is incapable, sell the patient down the river for the sake of more beans going toward perhaps what you consider to be the greater good.

 

Your ethical duty would not allow you to do this and should you so proceed and an advocate for the patient be aware of your intentions or actions, you would be too busy attending conferences with your lawyer with respect to defending as multimillion dollar lawsuit and in preparing for and giving pre-trial testimony than attending to your normal practice. It is a no-brainer that a lawsuit against you for $300,000 plus cost of living increases x no. of years left in calculating life expectancy plus damages for loss of life early, etc. If you were able to live with yourself selling your patient down the river so and believe that you had performed your ethical duty to your patient doing no harm, you shall have indeed started an avalanche, internally and externally. Moreover, it is more likely than not that in addition to a malpractice suit, you would be brought before the disciplany board of the medical association for either removal or censure and one would look into whether there is criminal responsibility should the patient die because of your intervention. The mere fact that you find the expenditure both “reckless” and “senseless” ensures at a minimum your liability in damages beyond doubt.

 

As physician, you can seek to become bureaucratic head bean counter but would have to remain away from patient care b/c you cannot serve both the needs of your patient and those needs you perceive of society, if you as physician would not protect the patient when whom? Your efficiency would be judged by the auditor general and his efficient would be judged by the legislator and there might even be many committee meetings and jaunts to other jurisdictions to investigate how bean counters there do their jobs, perhaps better – and easily more than $300,000 per year could be spent on these useless activities.

 

The reality is that the $300,000 per year saved would be squandered elsewhere, not spent as you would hope or like to save the lives of others. It is not as simple as you would imagine. Bureaucratic inefficiency is infamous for wasteful expenditures.

^

All of the above argument of yours is based on the assumption that Avalanche thought that, as a doctor, he or she has the power or authority to re-allocate the federal and provincial funding (which of course he or she does not) nor do I think he or she believed or stated as such. You note this in your very first sentence. But then you go on for 500 words or more to attack this strawman argument that you've deliberately setup yourself.

 

Regarding the young and old patient, I did not realize, nor do I now, that I had changed the hypothetical, rather I had clarified it. If, for example, the prognosis for the elderly person’s likely outcome was significantly better than the child, my decision would also be a no-brainer as I would be in the life saving business and not in the hope for a miracle business.

I lol'd.

 

I lol'd even harder when she said it was a "no-brainer".

[future_doc]

I lol'd.

 

I lol'd even harder when she said it was a "no-brainer".

 

(Rayven)

 

PS Good luck to us all as we face the countdown. A sense of humour is what we all need.

[avenir001]

future_doc's right and everybody against her is wrong. the future needs more docs like future_doc

 

*the judge has spoken. case closed*

 

no actually i really like this thread..the links are interesting too. good job ppl

[Rayven]

Your personal view is that certain situations would constitute "recklessly allocating resources". Fine. In such a case, remove yourself from being the patient's physician and find for your patient before removing yourself the best physician and best advocate possible to represent the best interests of the patient without reference to financial considerations - and only then, go ahead and argue vehemently against recklessly allocating resources for this ex-patient. There will be no conflict of interest situation. And what will be, will be. This is fair and acceptable.

 

This is the job of others, the so-called bean counters. Let there be a healthy tension between the advocates of the patient and the advocates of the system. Let us as physicians not err on the side of society and leave our patients to fend for themselves. Society will protect its own interests, you can be sure. We as physicians cannot and should not be in a conflict situation and our loyalty to our patients must be complete and unambiguous.

I don't know why you don't understand that as doctors we'll be doctors when we're on the job but we're allowed to have our own personal views and opinions. This argument of yours leads no where. And it's getting really annoying because you keep repeating it...

 

The answer is a no-brainer, I wouild choose the same person as you and every other person on this forum would choose.

And what would YOUR answer be?

 

I'm sorry, but this getting to be ridiculously hilarious!

 

You went from "clarifying" AndrewB's question to make it easier to answer by first injecting that the child had a better prognosis, then you "clarified" it again by saying if the senior had the better prognosis, but now that you can't "clarify" it anymore you're saying your answer is whatever everyone else wrote down... LOL

 

In Afghanistan, Canadian physicians routinely save the lives of the enemy, although the enemy is blindfolded and has ear plugs so as not to be able to identify the doctor who saved his life, lest he decide to kill the doctor later. Canada spends a fortune on humanitarian medical causes, including devoting medical personnel, equipment and financial resources to saving the lives of others, without making jusgments as to whether this life is worth saving. Yet, future physicians on this forum who are destined to save lives are willing to place themselves in the position of judge and jury to dispense the death penalty to the severely mentally and physically impaired as if they were merely handing out candy.

 

Each of us need to understand the scope of our roles on an ethical and practical basis before we become an M.D. We cannot misunderstand our role in the grand scheme. I understand with absolute certainty that my role is not to be a bean counter when it comes to withholding or withdrawing care or tratement vs. allowing the patient to die so as to save some more beans. There will be plenty of bean counters doing trheir best to curtail my intervention for patients for the sake of saving beans. I will have enough tough calls without needing to go out of my way to tread in questionable territory b/c of my personal beliefs and judgments. I will willingly save the life of someone who when well would try to kill me and my family. As physicians we are not to bring our personal prejudgments to the table. We need the benefit of the advice and experience of practitioners who have decades of experience in the trenches of the real world. Our lack of experience or limited experience works against us all.

Seriously... what the fff--truck. -.-

 

Hippocratic oath. Doctors treat patients. We get that. Like OMG. We get that! But that's not what we're debatingggg!!

 

Ughhhh!! You might as well avoid every debate by saying that farmers farm, pharmacist fill out prescriptions, engineers engineer, and teachers teach.

 

Yeah.. good luck this Friday on your MCAT. I hope the argument in your writing samples are a lot more convincing.

[future_doc]

Yes? No?

 

Well then, I guess we will keep going.

[future_doc]

You might as well avoid every debate by saying that farmers farm, pharmacist fill out prescriptions, engineers engineer, and teachers teach.

 

Let it be known: farmers farm, pharmacists fill out prescriptions, engineer engineer engineer, and teachers teach. [source: Rayven]

 

 

Yeah.. good luck this Friday on your MCAT.

 

I am ready as I expect you are too.

 

 

I hope the argument in your writing samples are a lot more convincing.

 

I am not worried and my approach will be what MCAT expect. I do know that anything is possible, and if I am having particular difficulty, I will think back to this thread for inspiration.

 

 

I am sure we both will be good physicians one day and when we meet, we will recognize each other by instant disagreement and argument.PEACE!

 

 

P.S.

future_doc's right and everybody against her is wrong. the future needs more docs like future_doc

 

*the judge has spoken. case closed*

[Rayven]

Yes? No?

 

Well then, I guess we will keep going.

We should close this thread because everyone's taken notice that you skirt questions and can't make good arguments..? Mmm okay then...

 

Let it be known: farmers farm, pharmacists fill out prescriptions, engineer engineer engineer, and teachers teach. [source: Rayven]

You do realize I was responding to your constant "argument" that doctors treat patients, right? And how that isn't a relevant argument to this debate? You do realize this, right? How utterly irrelevant your obvious statements are?

 

People have asked you what to do about finite resource allocation, what's considered ethical when lives are at stake on both sides, and what's considered too much. And all you can answer with is a doctor's job description and the Hippocratic oath............

 

Seriously, just leave if you have nothing meaningful to say. It's insulting to me and probably many others when you lecture us with 500 word essays on something so obvious as "doctors treat patients".

 

P.S.

Way to skirt around the rest of my posts. You pull little phrases out of my replies out of context to try to make me look stupid while you completely ignore all my rebuttals and questions posed to you.

 

Like I said already, if you can't reply with something meaningful then don't. But don't try to mask your inability to give real answers by insulting us with obvious diatribe that doctors treat patients and then asking to close the thread. Like 4-5 other guys including the OP have already said you're avoiding answering the real questions so please just stop it.

[AndrewB]

This thread is making me a compulsive facepalmer. It's obvious that it isn't going anywhere, which is unfortunate because this is a relevant topic to all of us future physicians. I hope that you soon develop the ability to look at both sides of an argument, future_doc.

 

Ta ta for now.

[future_doc]

I understand clearly the need to allocate resources properly so as to ensure the greatest number of patients gets the greatest bang from the public trough with has only finite resources. I get it, my head is not in the sand. I get it that physicians in ordering tests and treatments want to do so in a cost effective manner while protecting the patient's interests. I understand about futility and there comes a point in time when the patient will receive no benefit or virtually no benefit for the expenditure of large sums that just disappear into the sky.

 

I also understand that as physicians our responsibility is to the patient first and foremost and that there can be absolutely no conflict with respect to any other responsibilities placed upon our shoulders by the administration, society, the government, etc. This is based upon our ethical duty to the patient.

 

I understand that if a child and elderly citizen have equally serious medical problems and I can only serve one of them, even if the elderly is Prime Minister, I will deal with the child first. But if the child is likely to die anyhow and I expect a better outcome for the elderly, I will treat the elderly.

 

I do understand both sides. I am not sure that others do.

 

I am prepared to go ta ta or engage in discussion. I will not be available on the 14th as I will be otherwise engaged.

[AndrewB]

That was a reasonable response. I understand and agree with it.

 

I think the problem with some of your other responses is that you get bogged down with including extraneous information that is irrelevant to the question. Your answers therefore included a bunch of stuff that confused me and didn't answer existing questions, posed new ones, or reiterated old arguments. I don't think you would be unreasonable face to face but your written rhetoric could be easier to understand.

[Rayven]

I understand clearly the need to allocate resources properly so as to ensure the greatest number of patients gets the greatest bang from the public trough with has only finite resources. I get it, my head is not in the sand.

If you "get it" then say so. Because it's completely contradictory to what you've been saying this entire time.

 

I also understand that as physicians our responsibility is to the patient first and foremost and that there can be absolutely no conflict with respect to any other responsibilities placed upon our shoulders by the administration, society, the government, etc. This is based upon our ethical duty to the patient.

A doctor's job is to be a doctor and treat their patients. This is one of those "Duhhh" statements that you keep reiterating and the more you keep reiterating it the more it becomes annoying and irrelevant.

 

I understand that if a child and elderly citizen have equally serious medical problems and I can only serve one of them, even if the elderly is Prime Minister, I will deal with the child first. But if the child is likely to die anyhow and I expect a better outcome for the elderly, I will treat the elderly.

Well obviously if one patient is likely to die anyways then you'd treat the one that is more likely to survive. That's why when you changed AndrewB's original hypothetical scenario it was hilarious that you'd call it a no-brainer after changing the prompt making it so easy.

 

So a question, why would you save the child over the elderly given that both have the same chance of surviving? What happened to your sanctity of life argument?

 

I do understand both sides. I am not sure that others do.

That's really funny. You only had about 5 people + the OP say that you were narrow-sighted and avoided addressing questions...

 

I think the great divide occurs when some want to re-allocate financial resources away from their patients and toward the great good.

It's all perspective. Conversely, I could argue that you're taking resources away from other people to give to the few. Depending on how you state this, it sounds like one is stealing from the other when in fact we're all entitled to the samething (yes, even if we haven't contributed hundreds of thousands of dollars in income tax).

 

I understand the goal, but I question the means and do not know how a doctor can juggle his/her responsibility toward a patient and the greater good.

7:00 AM: Wake up, shower, have breakfast

7:45 AM: Arrive to work, go out of your way to say hello to the new cute nurse

8:00 AM to 12:00 PM: Treat your patients to the best of your ability

12:00 PM to 1:00 PM: Have lunch, talk about stuff with your colleagues (possibly ethical questions like this). Mention how it's a shame that one of your patients died while waiting for a MRI. Talk about how if there was only more funding or better distribution.

1:00 PM to 2:00 PM: Drive 15 minutes away to check up on the $300,000/year patient. Treat him or her to the best of your ability.

2:00 PM to 5:00 PM: Return to your workplace (ie hospital) and continue to see your patients and treat them to the best of your ability. Finish up any paperwork. Go home if you're lucky enough to get into such a nice specialty.

6:00 PM: Have dinner

7:00 PM: Go log onto premed101.com or write your opinions and arguments to someone who cares and who might be able to actually do something about it (maybe a journal, a newspaper editorial, etc). Possibly contemplate going into politics.

8:00 PM: Call up the cute nurse and sexually harass her.

 

Basically what I'm saying (for the 10th time to you) is that as a doctor you should be a doctor when you're working. No one's asking you to worry about what you'd do to amend the federal and provincial budget and resources when you're treating your patients. No one's asking you to pull the tube to help the government save some money. But as a human being you're entitled to think.

 

On a theoretical level, I understand where people are coming from. On a practical level, on the basis that we are practicing physicians, I have problems with the ethical implications. That is why this discussion could be so much more meaningful if there were partcipants who are already MDs and have real experience. We need, I need, the benefit of the experience of others to test our views.

Doctors are just as human as we are too. They're flawed just like we are. The MD designation really holds no water. You have some doctors who are vehemently opposed to abortion at any stage and then you'll have some who are for it or maybe only at certain terms.

 

For sure, we all want to have a compass to help steer our course as physicians. To the extent that any of us can begin to learn or begin to develop strategies of how to deal with real life situations involving ethics, futility, withdrawal or withholding of treatment, this thread could be of great benefit to us all. Are there any med students or new MDs reading this thread who can help us?

Logically I would assume that if the given patient is capable that it is their decision to continue or stop treatment. If they're not capable then you'd find a substitute decision maker (ie family). I think it's rare that a physician would make the decision. And if it really came down to the doctor making the decision then I imagine there's quite a bit of paperwork to be done to avoid being legally sued and stripped of your license. But hey I'm probably wrong, that's just how I would imagine the system to work anyways.

[future_doc]

7:45 AM: Arrive to work, go out of your way to say hello to the new cute nurse

8:00 PM: Call up the cute nurse and sexually harass her.

 

keep your mind on the topic, lol;)

 

ok, i have a girl crush..it's future_doc. i love the way she's arguing in the other thread, it's very cute

 

avenir does part time nursing, stay away from avenir or I will report you to the matron of nursing. who may sexually harass you, lol