Sticky ethical question

[LostLamb]

raevyn, maybe I just missed it, but I was wondering where you would draw the line? How much to you is too much?

[Wolvenstar]

I understand your perspective better now. I was under the impression that you were accusing physicians of active euthanasia, or assisted suicide, and using strong words like murder in your posts reinforced this for me. I work with many physicians however, and I have yet to meet one who makes end of life decisions for terminally ill individuals. I don't think these ethical situations arise very often, except in intensive care units, and even then I believe most people pass on their own accord and physicians aren't rushing to "pull the plug" for exactly the reasons we are listing.

 

The fact remains that nobody is better qualified to decide if somebody is going to live or die than a physician, and this puts them exactly in the position to make these calls, both legally and morally.

 

 

 

Well I have been busy this summer working and house hunting so i have not posted much lately, but this topic stole my attention.

 

The first thing that I wish to speak of is the idea of euthanasia, which to my knowledge no form of which is legal in Canada. However even though it is illegal, I do have extended-family who have had to deal with family members who were extremely sick (and old), who were slowly dying in a very painful manner. assisted suicides while not allowed are occuring, and they were able to put a grandmother to rest rather than living out a few more weeks in extreme pain. From what I was told the doctors tend to stay far away from such things, probably for both ethical and legal reasons, and that it is mostly nurses that are giving "under the table" assistance.

 

 

 

in terms of "pulling the plug" I agree with future_doc that should not be decided by someone who has a conflict of interest in the matter. However the only real solution to this is to have a mandatory writing of medical instructions (DNRs, etc) to doctors once people reach a certain age. It is hard for any relative to have an unbiased opinion about these things. I know that if I am in a vegetative state and the doctors don't know when/if I will come out of it that I would want them to pull the plug, but my family would be strongly opposed to this.

 

 

 

This is EXACTLY the broad question I had in mind when I made the original post. There have been some extremely interesting turning points in this thread, but before we skip off on another tangent, I'd like you guys to discuss this one for a bit. I've been watching from the wings for the past few days, and I want to thank you for your interest! The question quoted above would be really cool to focus on and explore further.

 

Back to the main idea, I really do believe that there is a limit to the amount of money the health care industry should invest in one patient before it becomes unethical. Yes I am saying that at some point, giving a patient too much care is unethical. Some people have stated what would some say about a normally able person who had complications in surgery needed to be in the ICU for 6months or so and a large amount of money being spent on her to live. This is very distinct in my mind in that she is; her quality of life, her ability to contribute to society, how much she can potentiall recover from the complications.

 

Now I am sure someone will throw some example at me but lemme give you a strong example. If I were to become a quadripelgic, couldnt use my arms or legs, and have no chance of becoming mobile again, rather than having the government spend almost half a million dollars on keeping me alive so that I can live for another decade or two trapped in a wrecked body. My life isn't important only in the number of years but also in the quality of those years.

 

I do believe it would be better if the government spent less money people with these mental disabilities caused from some trauma during development. I ask myself if it is ethical to spend money making one person comfortable that could help 100 people or potentially save 10 lives, and I have to say no. Mind you I am also of the belief that somewhere in the next 20-75 years we will develop new methods in which we will be able to reverse/mitigate the damage that has been dealt to people with these who have mental handicaps, bringing them to a level that is close if not caught up to the average human being.

 

I know some people question whether that is ethical, and say that it is horrible to describe these people as being less than average. However it is the truth the average human has two legs, two arms, ten fingers and toes, a standard range of height, health, and intelligence. Most mental handicaps are natural, or how someone is supposed to be, it is the result of some sort of trauma at some stage of development. People with mental handicaps, have had some sort of trauma and one day this will be able to be fixed the same as a broken bone. The only limiting agent is our knowledge and technology in dealing with trauma.

 

One question that interests me, is say that we know that eventually, within a hundred years we can realistically predict that a technic will be developed to heal those who have mental handicaps so that they can function on a similar level to an average human being. However this is reliant on those with extreme handicaps being institutionalized for 30,000 a year and the 250,000 that is saved being invested in researching this technic to heal these people. Is it better to institutionalize severe mental handicaps for a several decades or allow them to live more comfortably but delay the development of technics to heal mental handicaps for over 100 years?

 

(i did not read every page of this thread only the first two pages and the last 3 or 4 pages, so I am hoping we are still argueing about those who have severe mental handicaps)

[future_doc]

The first thing that I wish to speak of is the idea of euthanasia, which to my knowledge no form of which is legal in Canada. However even though it is illegal, I do have extended-family who have had to deal with family members who were extremely sick (and old), who were slowly dying in a very painful manner. assisted suicides while not allowed are occuring

 

Correct. But it is not "illegal", it is called "murder".

 

 

......... From what I was told the doctors tend to stay far away from such things, probably for both ethical and legal reasons, and that it is mostly nurses that are giving "under the table" assistance.

 

hmm, well it may be a mixed bag

 

 

in terms of "pulling the plug" I agree with future_doc that should not be decided by someone who has a conflict of interest in the matter. However the only real solution to this is to have a mandatory writing of medical instructions (DNRs, etc) to doctors once people reach a certain age. It is hard for any relative to have an unbiased opinion about these things. I know that if I am in a vegetative state and the doctors don't know when/if I will come out of it that I would want them to pull the plug, but my family would be strongly opposed to this.

 

the DNRs are straightforward and the easy ones. We are talking about the others

 

 

Back to the main idea, I really do believe that there is a limit to the amount of money the health care industry should invest in one patient before it becomes unethical. Yes I am saying that at some point, giving a patient too much care is unethical.

 

Here, you are putting a financial value on life, it gets more slippery below.

 

 

Some people have stated what would some say about a normally able person who had complications in surgery needed to be in the ICU for 6 months or so and a large amount of money being spent on her to live. This is very distinct in my mind in that she is; her quality of life, her ability to contribute to society, how much she can potentiall recover from the complications.

 

I gave that example. The lady was 74 years of age. She told me that what she went through in those 6 months was horrible and if she was able to communicate, she wanted death. Of course, nobody knew that, she has since recovered, she is too old and ill to contribute productively to society and although happy to ber alive, she would never want that experience again, death would be welcome compared to her experience.

 

 

Now I am sure someone will throw some example at me but lemme give you a strong example. If I were to become a quadripelgic, couldnt use my arms or legs, and have no chance of becoming mobile again, rather than having the government spend almost half a million dollars on keeping me alive so that I can live for another decade or two trapped in a wrecked body. My life isn't important only in the number of years but also in the quality of those years.

 

Slippery slope and ethically challenging. There are developments in this area with limited mobility. These people have active minds and it is for them to decide about their lives, not us. We spend this same kiond of money on locking up prisoners who would debase society if given the chance, yet to throw away quadripelgics, I don't think so. Were do we draw the line? One limb works? Or two? And do we relate this to an I.Q. test?

 

 

I do believe it would be better if the government spent less money people with these mental disabilities caused from some trauma during development.

 

Another slippery slope of evaluating people's value of life vs money.

 

 

I ask myself if it is ethical to spend money making one person comfortable that could help 100 people or potentially save 10 lives, and I have to say no. Mind you I am also of the belief that somewhere in the next 20-75 years we will develop new methods in which we will be able to reverse/mitigate the damage that has been dealt to people with these who have mental handicaps, bringing them to a level that is close if not caught up to the average human being.

 

perhaps, we freeeze these people in the meantime and bring them back to life later, hmm, good reserach perhaps......

 

 

I know some people question whether that is ethical, and say that it is horrible to describe these people as being less than average. However it is the truth the average human has two legs, two arms, ten fingers and toes, a standard range of height, health, and intelligence. Most mental handicaps are natural, or how someone is supposed to be, it is the result of some sort of trauma at some stage of development. People with mental handicaps, have had some sort of trauma and one day this will be able to be fixed the same as a broken bone. The only limiting agent is our knowledge and technology in dealing with trauma.

 

less than average or less than human?

 

 

One question that interests me, is say that we know that eventually, within a hundred years we can realistically predict that a technic will be developed to heal those who have mental handicaps so that they can function on a similar level to an average human being. However this is reliant on those with extreme handicaps being institutionalized for 30,000 a year and the 250,000 that is saved being invested in researching this technic to heal these people.

 

 

 

Is it better to institutionalize severe mental handicaps for a several decades or allow them to live more comfortably but delay the development of technics to heal mental handicaps for over 100 years?

 

perhaps we should murder them

[Rayven]

Future_doc, you keep pushing that it's murder to withhold treatment to a patient but you're forgetting that the cost it takes (both financially from taxpayers and human resources) to keep this one patient alive is indirectly hurting hundreds to thousands of other lives.

 

I gave it some thought and I really have to reiterate my disdain for your cop out last night when you said:

I will not knowingly do harm to my patients. If you say I might be doing harm to other patients b/c of my views, my reply is that these patients will be treated my others and be the responsibility of other health professionals, if they are mhy patients they will not receive harm.

A big problem is that the other patients (basically everyone else in society) won't be treated as well or as fast as they could've potentially because of less funding. Throwing money at things certainly doesn't fix things but it does help a lot sometimes. Having more money "to throw" around makes us able to hire more doctors (and nurses) to cut down on wait times, to increase salaries to increase incentives for doctors to becomes GPs, to buy new medical equipment (ie MRIs), to open more MD seats, etc... And that's just looking at it from the health care perspective. $300,000/year PER patient is a pretty big sum of money that could really be used anywhere. Just 10 of these patients and we're looking at $3,000,000 a year.

 

So yeah... long story short.. it was a cop out on your part to avoid answering the ethical question of this entire debate by saying you, as a future physician, will do no harm to your patients. That goes without saying.

[AndrewB]

"The phrase does not, however, include the withholding or wthdrawal of inappropriate, futile or unwanted medical treatment or the provision of compassionate palliative care, ecen when these practices shorten life. The policy is that CMA members should specifically exclude participation in euthanasia and assisted suicide."

 

It appears that the CMA is ducking the bullet too.

 

Ducking what bullet?

 

Physicians are currently prohibited from participating in euthanasia. A few have been charged with murder over the past 20 years for aiding suicide. I'm not sure what you are trying to prove.

 

As well, you continue to reiterate your stance to "do no harm", but what about administering narcotics to a terminally ill patient, on life support or a respirator, suffering from intense pain? The narcotics relieve pain and make life more bearable, while also causing respiratory depression, making them more dependent on life support and likely leading to a quicker death. Is this wrong? You are harming the patient, there is no doubt about it. They WILL die faster because of your actions. What would you do?

[future_doc]

Ducking what bullet?

 

See the additions to my last post (no. 106). What bullet, well everything is delivberately ambiguous and individual doctors are left to make difficult decisions on their own without real guidelines from the profession, while they are definitely exposed to criminal prosecution. Very few cases are dramatic and reach the press, most go on one at atime behind closed doors.

[future_doc]

Future_doc, you keep pushing that it's murder to withhold treatment to a patient but you're forgetting that the cost it takes (both financially from taxpayers and human resources) to keep this one patient alive is indirectly hurting hundreds to thousands of other lives.

 

I gave it some thought and I really have to reiterate my disdain for your cop out last night...

 

A big problem is that the other patients (basically everyone else in society) won't be treated as well or as fast as they could've potentially because of less funding. Throwing money at things certainly doesn't fix things but it does help a lot sometimes. Having more money "to throw" around makes us able to hire more doctors (and nurses) to cut down on wait times, to increase salaries to increase incentives for doctors to becomes GPs, to buy new medical equipment (ie MRIs), to open more MD seats, etc... And that's just looking at it from the health care perspective. $300,000/year PER patient is a pretty big sum of money that could really be used anywhere. Just 10 of these patients and we're looking at $3,000,000 a year.

 

So yeah... long story short.. it was a cop out on your part to avoid answering the ethical question of this entire debate by saying you, as a future physician, will do no harm to your patients. That goes without saying.

 

Rayven, I absolutely understand your disdain and your reasons. I return to this thread b/c of the upsetting issues raised and the ethics. I would love to take a full course on this topic alone and grapple with it for months, write a thesis or a long paper, and come to a conclusion that I could live with that would be satisfactory to individuals and society. I am unable to wrap my mind around the suggestions made for financial considerations, for doing good for the greater numbers of people and thereby allowing a few to become expendable. I am unable to budge or won't.

[joey]

Quote ''...Future_doc, you keep pushing that it's murder to withhold treatment to a patient but you're forgetting ...''

 

 

Hi everyone,

 

I haven't been following this discussion as much as some of you here, but this phrase caught my attention. It is NOT murder to withhold treatment if it is the patient's wish. Any patient has the right to not be treated.

 

Now I just picked up on that sentence... and although I do agree with it, there are always exceptions to everything. I hope this doesn't cause a big lash out or anything! haha

[future_doc]

Quote ''...Future_doc, you keep pushing that it's murder to withhold treatment to a patient but you're forgetting ...''

 

I haven't been following this discussion as much as some of you here, but this phrase caught my attention. It is NOT murder to withhold treatment if it is the patient's wish. Any patient has the right to not be treated.

 

A g r e e d

[Rayven]

Nah. Joey, you're just taking it out of context. I was addressing how future_doc keeps saying that they could never harm their patient, which, in this case would mean removing (withholding) the $300,000/year specialist care from the patient that's keeping them alive.

Rayven, I absolutely understand your disdain and your reasons. I return to this thread b/c of the upsetting issues raised and the ethics. I would love to take a full course on this topic alone and grapple with it for months, write a thesis or a long paper, and come to a conclusion that I could live with that would be satisfactory to individuals and society. I am unable to wrap my mind around the suggestions made for financial considerations, for doing good for the greater numbers of people and thereby allowing a few to become expendable. I am unable to budge or won't.

future_doc, I think the biggest problem is that you tend to think too small. Your answer of putting YOUR patient first is a great answer as a physician who only deals with patients. And from what I hear, putting your patient first is one of the tips to keep in mind when doing your med school interviews.

 

However, with that said, I think it's a cop out when you fail to address the ethical question (aka the prompt) by dividing people into "YOUR" patients and "OTHER" patients. And then you go on further to say that you'd do no harm to YOUR patient and therefore your answer is obvious. We keep pouring resources (financial and human) into YOUR patient while being allowed to essentially ignore all "OTHER" patients. You're basically saying it's not your problem.

[avenir001]

It is NOT murder to withhold treatment if it is the patient's wish. Any patient has the right to not be treated.

 

A g r e e d

 

but what ifff 'no' means 'yes'...so the patient says she doesn't want treatment, but she really does???

[future_doc]

Hey all. I was having a discussion with a friend earlier today, and he raised a few interesting points about a topic that will definitely be considered controversial (and hence appropriate for these forums). I work with a severely mentally handicapped youth, who is under 24/7 one on one care. The endgame in our program with the youth is a hope that he'll one day be able to spend an hour or so at home alone without beating the hell out of himself. He will never be able to have even a menial job, and is exceptionally low functioning. Our program costs the government about 280 000 dollars every year, even though it is being carried out in the youth's home. This is obviously very expensive, as the funds going to this one youth where very little can be expected in the way of results represent the salaries of 6 police officers or 2 family doctors. Given that there is very little that can be hoped for, and that it is unreasonable to expect the youth to ever be an even slightly productive member of society, my friend made the contention that euthanasia is warranted. He felt that even the 30 000 it would cost to institutionalize this youth would represent too heavy of an unnecessary cost on the Canadian economy, and that this differed from housing an inmate in that the inmate could be rehabilitated, while this is not a possibility for the youth I work with.

 

I'd like to hear your thoughts. I know that many will be against this idea, but please, support your feelings with sound ethical statements. Thanks for you time.

 

Did you or your friend give thought to the possibility of taking organs in these circumstances, thereby cutting down on the many deaths that occur by people who die while waiting for organs?

 

Just imagine, should society speed up the process of bringing the lives of those with mental and physical affirmities to an end (presumably for the best interests of those so afflicted(?)) - after all they are not productive citizens - we may even have enough organs available to go into the sale of organ business? Organized murder assembly line style with financial benefits, quite an accomplishment, eh?

 

And if society was considering any questionable deaths to occur, instead or going to the Court as final decision maker, or the politicians, and not using the system used in Rome with gladiators in the stadium of 'thumbs up' or 'thumbs down', in o ur enlightened era, we could use the electronic polling system and have instant votes of millions who would decide life or death literally, thereby absolving individuals of any blame or guilt.

 

Some on this thread would say it would be a win-win situation, increasing our GNP while disposing of those unnecessary human beings clogging up the healthcare system and utilizing finacial resources unnecessarily. Can you imagine how proud your parents would be of you (except for those parents mentally or physicially afflicted who would soon suffer that fate) not just for becoming a doctor, but for such creative and enterprising ideas that you then have implemented? The 'final solution' in democratic society!

[AndrewB]

what............

[future_doc]

what............

 

Well, it has been suggested that the "cost" of caring for these peole becomes too expensive for society. A logical extension of the argument of not caring for these people and letting them die is to turn a handsome profit -after all the discussion is centered around the issue of cost vs benefit (to society, not the individual patient).

[future_doc]

see http://www.cbc.ca/canada/story/2009/02/09/f-assisted-suicide.html for good discussion re the issues centered round 1992 Sue Rodriguez seeking right to die which Supreme Court turned down but then in 1994, she committed suicide with the help of an anonymous doctor. It discuesses both assisted suicide and euthanasia, law in Canada and US.

 

also http://dsp-psd.pwgsc.gc.ca/Collection-R/LoPBdP/CIR/919-e.htm from Government of Canada, discussion of Euthanasia and Assisted Suicide, the Law, other countries, Reports, Recent Events, etc. Reference is made to the 1995 policy summary issued by the Canadian Medical Association on physician-assisted death, "a phrase that includes both euthanasia and assistance in suicide." "The phrase does not, however, include the withholding or wthdrawal of inappropriate, futile or unwanted medical treatment or the provision of compassionate palliative care, ecen when these practices shorten life. The policy is that CMA members should specifically exclude participation in euthanasia and assisted suicide."

 

It appears that the CMA is ducking the bullet too.

 

In No.9 entitled "Recent Events", there is discussion of the Latimer case where the father killed (by placing her in the family truck and then piping exhaust fumes into it) his 12 year old disabled daughter Tracy who had a severe form of cerebral palsy, could not walk, talk or feed herself and was suffering considerassble pain. He was convicted of second-degree murder, appealed ultimately to the Supreme Court, was granted a new trial. In 1997, he was again found guilty of second-degree murder and at the sentencing hearing, his lawyer argued he should be given a "constitutional exemption" or that the judge should find that the mandatory minimum sentence of 10 years to be "cruel and unusal punishment" in the circumstances and a violation of his rights under the Canadian Charter of Rights and Freedoms. The sentencing judge found that a ten year sentence would indeed be "grossly disproportionate" to the offence and Mr. Latimer was sentenced to tweo years less a day, half of which would be served on his farm.

 

Moreover, in 1997, a Toronto AIDS doctor pleaded guilty to two charges of assisted suicide and a Montreal woman in a depressed state had drowned her 6 year old autistic son, before attempting suicide, and was given a suspended sentence.

 

In additon to other cases set forth in the article, Dr. Nancy Morrison was arrested in 1997 in Halifax and charged with first-degree murder in the death of a terminally ill cancer patient. The patient had no hope of recovery and in addition to pain killing and sedative drugs given routinely to patients like the one being dealt with, it was alleged that the patient was also given a mediciation considered to be outside ethical and acceptable medical practice. The hospital had not consulted the Medical Advisory Committee, the Board of Directors, the Coolege of Physicians and Surgeons and an external review of the administrative and medical leadership of the hospital found that their response had been "indecisive and inapprpriate". In 1998, the Judge refused to commit Dr. Morrison to stand trial. The Crown had then appealed the dismissal of the charge - and the outcome was not know I presume at time of publication.

 

see http://www.internationaltaskforce.org/canada.htm dealing with 2005 Bill C-407 introduced by Member Francine Lalonde so as permit a medical practitioner or someone assisted by a medical practioner to aid another person to die if that person has a terminal illness or is experiencing severe physical or mental pain and "appears to be lucid" when he/she requests death. The measure failed to gain support and the Justice Minister was against it. A Position Paper is to be found on that website.

 

see http://www.cmaj.ca/cgi/reprint/156/10/1405.pdf Bioethics for clinicians:Euthanasia and assisted suicide

 

Suffice to say, the medical profession is in one big muddle over these sticky ethical issues, seems to be duckin the issue leaving decisions to individual phyisicans - whose actions might then lead then into criminal prosecution should they become public.

 

What a mess.

[AndrewB]

I don't even know what point you are trying to make. All physicians know that assisted suicide is illegal. There is no "ducking the issue" going on. The very few that break the law are charged.

 

In cases of withdrawing or withholding care, the circumstances are likely very different each time. The health care team attempts to consider the best interests of patients and their families. I don't get how this is "a mess".

[Rayven]

I don't even know what point you are trying to make. All physicians know that assisted suicide is illegal. There is no "ducking the issue" going on. The very few that break the law are charged.

 

In cases of withdrawing or withholding care, the circumstances are likely very different each time. The health care team attempts to consider the best interests of patients and their families. I don't get how this is "a mess".

A G R E E D.

 

The only one "ducking the issue" is you, future_doc. Btw, are you avoiding my posts now..? =/

 

I respect your high value for life and for your future patients, however, I think it's a shame that you fail to see that saving the one life may be inadvertently hurting or (worst case scenario) killing many many others. To me, it's not a matter of if that patient can contribute to society or not, but simply a numbers game. If I had an equal chance of saving a hundred elderly residents from a fire or a newborn baby... I would probably choose the one hundred lives over the one. It's not an easy choice.

 

I know that most of us are use to hearing about how the government spends millions and even billions all the time so it's kind of hard to grasp that our budget is limited... but really... $300,000 a year for one person (who will never pay taxes themselves) is a bit excessive and a heavy burden on the system.

 

The question still remains: How much is too much? Would you or we really be okay with it if each patient cost $500 million a year? What if they took up half of the entire Canadian healthcare budget?

 

"Canada's healthcare spending is expected to reach $171.9 billion, or $5,170 per person, in 2008." (http://en.wikipedia.org/wiki/Health_care_in_Canada)

 

Not exactly the best source, i know, but I'm kind of busy studying for the MCAT right now.

 

So the average healthcare cost of each Canadian is around $5,000.

 

$300,000/$5,000 = 60

[NewfieMike]

Did you or your friend give thought to the possibility of taking organs in these circumstances, thereby cutting down on the many deaths that occur by people who die while waiting for organs?

 

Just imagine, should society speed up the process of bringing the lives of those with mental and physical affirmities to an end (presumably for the best interests of those so afflicted(?)) - after all they are not productive citizens - we may even have enough organs available to go into the sale of organ business? Organized murder assembly line style with financial benefits, quite an accomplishment, eh?

 

And if society was considering any questionable deaths to occur, instead or going to the Court as final decision maker, or the politicians, and not using the system used in Rome with gladiators in the stadium of 'thumbs up' or 'thumbs down', in o ur enlightened era, we could use the electronic polling system and have instant votes of millions who would decide life or death literally, thereby absolving individuals of any blame or guilt.

 

Some on this thread would say it would be a win-win situation, increasing our GNP while disposing of those unnecessary human beings clogging up the healthcare system and utilizing finacial resources unnecessarily. Can you imagine how proud your parents would be of you (except for those parents mentally or physicially afflicted who would soon suffer that fate) not just for becoming a doctor, but for such creative and enterprising ideas that you then have implemented? The 'final solution' in democratic society!

 

"Mr. Madison, what you've just said is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul. "

[future_doc]

Rayven,

 

I ain’t avoiding you and Posts 101 & 109 say what they say. BTW, I too am doing MCAT on 14th. We both have covered all the ground we are going to. I went back to the OP which is quoted in Post 114 and explored its logical conclusion when taken to the extreme. And Post 117 with readings covers lots of territory.

 

I would like you to join my Cabinet in 15-20 years if for no other reason to have a counter-point. Wouldn’t it be interesting if this issue comes up on our MCAT? This should be in med school curriculum in some form/forum. I will look at the web reference you have given on the basis you look at mine. You have found a strong friend in NewfieMike who agreed with me the last time in 1988, and although he has not examined all posts and does not understand my post no. 114, w8kg6, the OP can, if he has the patience.

 

Cheers and good luck on MCAT. May we be in the same class in med school.

[w8kg6]

Hey future_doc, it seems you've been on the defense the past little bit .

 

I've been watching this thread intently (and have read all the posts as they appear). Concerning your argument, I think it's admirable that you recognize that as a physician it is your responsibility to set your primary allegiance with your patient, and not with the health care system at large. It seems as though you're reluctant to recognize (or at least to admit to recognize) that keeping such a severe burden on the health care system alive when it represents such harm to the general populace is an injustice. Having read through all posts, I agree with many that you are dodging this aforementioned issue, but that it seems you may have (if only in the background) reached the same conclusions that we all have, and that this conclusion is (at least concerning the severely mentally handicapped who have been discussed. Please don't extrapolate to the elderly, prisoners, homeless, etc.):

 

Although it is the duty of a physician to fight for the best treatment for each patient he or she is given, one must recognize that some people are far too severe of a burden on the limited resources of the system. For this reason, from a broad perspective, it is an injustice to keep the burden alive, in spite of the fact the physician must fight for the treatment (even though it may not, and perhaps should not be granted).

[Microbiodude]

okay future_doc, let's play some more with the do no harm principle. So as a physician you are more than likely to have several patients with several different underlying conditions. Now one of you patients is a severely challenged individual who costs $300k/ year to nurture and you will do no harm to this patient and will see to it that his/her care is continued. Now you have about 5 other patients who are suffering from late stage renal failure and will have to start dialysis very soon. BUT alas the health care budget only allows for so many dialysis machines and your patients will die without dialysis. A dialysis machine costs roughly a $3000 or so (google search). Now you're faced with the dilemma of having to do harm to someone since they're all your patients. Who do you harm?

 

It's a tough question and I'm not really looking for an answer (unless you're willing to provide one) but I just brought it forth to illustrate the simple point that despite the principles that are set forth its sometimes hard to uphold them all for every individual. You can't hide behind the "do no harm" principle, inevitably you're going to do harm and intentionally because someone will have to take a hit (limited resources argument). It was admirable that you stood strong for the resources of your one patient, but in turn you have to realize you may have compromised the resources of your other patients. I think this was the point many others were making, but they simply didn't state the "other health care costs" as those belonging to your patients.

[future_doc]

okay future_doc, let's play some more with the do no harm principle. So as a physician you are more than likely to have several patients with several different underlying conditions. Now one of you patients is a severely challenged individual who costs $300k/ year to nurture and you will do no harm to this patient and will see to it that his/her care is continued. Now you have about 5 other patients who are suffering from late stage renal failure and will have to start dialysis very soon. BUT alas the health care budget only allows for so many dialysis machines and your patients will die without dialysis. A dialysis machine costs roughly a $3000 or so (google search). Now you're faced with the dilemma of having to do harm to someone since they're all your patients. Who do you harm?

 

It's a tough question and I'm not really looking for an answer (unless you're willing to provide one) but I just brought it forth to illustrate the simple point that despite the principles that are set forth its sometimes hard to uphold them all for every individual. You can't hide behind the "do no harm" principle, inevitably you're going to do harm and intentionally because someone will have to take a hit (limited resources argument). It was admirable that you stood strong for the resources of your one patient, but in turn you have to realize you may have compromised the resources of your other patients. I think this was the point many others were making, but they simply didn't state the "other health care costs" as those belonging to your patients.

 

Hey Microbiodude, the question you raise is straightforward and fairly simple. Without a shadow of a doubt, I would immediately fork out the $3,000 and buy a dialysis machine immediately. Fair is fair, I honestly answered your question and it took me less time to know what I would do than it did to write it.

 

Now Microbiodude, please have the same courtesy to answer my question. Look at the original post, or just look at my Post.114, treat my commments seriously and comment. I am taking the OP's comments to the extreme, but hey on this thread, many people give the extreme example. Well, when we are talking about ethical issues involving termination of life, this is probably the greatest issue we and society will deal with.

[Microbiodude]

Did you or your friend give thought to the possibility of taking organs in these circumstances, thereby cutting down on the many deaths that occur by people who die while waiting for organs?

 

Just imagine, should society speed up the process of bringing the lives of those with mental and physical affirmities to an end (presumably for the best interests of those so afflicted(?)) - after all they are not productive citizens - we may even have enough organs available to go into the sale of organ business? Organized murder assembly line style with financial benefits, quite an accomplishment, eh?

 

And if society was considering any questionable deaths to occur, instead or going to the Court as final decision maker, or the politicians, and not using the system used in Rome with gladiators in the stadium of 'thumbs up' or 'thumbs down', in o ur enlightened era, we could use the electronic polling system and have instant votes of millions who would decide life or death literally, thereby absolving individuals of any blame or guilt.

 

Some on this thread would say it would be a win-win situation, increasing our GNP while disposing of those unnecessary human beings clogging up the healthcare system and utilizing finacial resources unnecessarily. Can you imagine how proud your parents would be of you (except for those parents mentally or physicially afflicted who would soon suffer that fate) not just for becoming a doctor, but for such creative and enterprising ideas that you then have implemented? The 'final solution' in democratic society!

 

Here you are talking about killing people to TAKE organs. The debate is whether it is ethical to GIVE funding when withholding it could cost lives. Of course I wouldn't support a bill suggesting we round up mentally challenged individuals and harvesting their organs (which I believe is what you were pointing to?) One way I can think of explaining the difference is the conclusion of Batman Begins...Batman's code is to never kill a villain, but that doesn't mean he has to save them from inevitable death (i.e. Raz dying in the train crash).

 

So to answer your question, no i would not give $300k to one family to spend time with their loved one when I could distribute it to 10 other families to spend time with their loved ones. Bottom line is somebody has to die and I would opt for preserving the most lives as possible (i.e. 100 patients v.s. 1 patient).

 

In terms of active euthanasia, I would not administer a killing dose personally since it is against the law. Even if the family insisted and I knew I could get away with it. It would also, as you had mentioned, create a very slippery slope as to when to draw the line. However, I would cut down support/ paid supervision to reduce costs fully aware that I was increasing this individual's chance of injury or death. In that regards, I would support "semi-passive" Euthanasia.

[Rayven]

Hey future_doc, it seems you've been on the defense the past little bit .

 

I've been watching this thread intently (and have read all the posts as they appear). Concerning your argument, I think it's admirable that you recognize that as a physician it is your responsibility to set your primary allegiance with your patient, and not with the health care system at large. It seems as though you're reluctant to recognize (or at least to admit to recognize) that keeping such a severe burden on the health care system alive when it represents such harm to the general populace is an injustice. Having read through all posts, I agree with many that you are dodging this aforementioned issue, but that it seems you may have (if only in the background) reached the same conclusions that we all have, and that this conclusion is (at least concerning the severely mentally handicapped who have been discussed. Please don't extrapolate to the elderly, prisoners, homeless, etc.):

 

Although it is the duty of a physician to fight for the best treatment for each patient he or she is given, one must recognize that some people are far too severe of a burden on the limited resources of the system. For this reason, from a broad perspective, it is an injustice to keep the burden alive, in spite of the fact the physician must fight for the treatment (even though it may not, and perhaps should not be granted).

 

A g r e e d.

 

I think this was the point many others were making, but they simply didn't state the "other health care costs" as those belonging to your patients.

 

A g r e e d.

 

I tried to make the point about 2 posts again when I said,

 

However, with that said, I think it's a cop out when you fail to address the ethical question (aka the prompt) by dividing people into "YOUR" patients and "OTHER" patients. And then you go on further to say that you'd do no harm to YOUR patient and therefore your answer is obvious. We keep pouring resources (financial and human) into YOUR patient while being allowed to essentially ignore all "OTHER" patients. You're basically saying it's not your problem.

 

...but I guess making up an example works better. =p

 

Rayven,

 

I ain’t avoiding you and Posts 101 & 109 say what they say. BTW, I too am doing MCAT on 14th. We both have covered all the ground we are going to. I went back to the OP which is quoted in Post 114 and explored its logical conclusion when taken to the extreme. And Post 117 with readings covers lots of territory.

Oh? It just really seemed like you were avoiding me since you reply to everyone else that posted after me... usually with multiple posts too. =.=

 

The reason I ask is because I don't think you really answered my questions. My questions regarding how much is too much and how the "shall do no harm" to your own patient clause is really just a cop out. Rather it feels like you've just dismissing me as a whole by falsely stating we're arguing in circles which really isn't the case.

 

I would like you to join my Cabinet in 15-20 years if for no other reason to have a counter-point. Wouldn’t it be interesting if this issue comes up on our MCAT? This should be in med school curriculum in some form/forum. I will look at the web reference you have given on the basis you look at mine. You have found a strong friend in NewfieMike who agreed with me the last time in 1988, and although he has not examined all posts and does not understand my post no. 114, w8kg6, the OP can, if he has the patience.

 

Cheers and good luck on MCAT. May we be in the same class in med school.

Who the heck is NewfieMike? o.O?

 

You make it sound like he was your friend 11 years ago and now he's stabbing you in the back...??

 

I've read all the posts in this thread and I the OP has said the same.

[Halcyon]

Wow, this thread is still going?!?