Sticky ethical question

[NewfieMike]

I was born in 1988

[future_doc]

From ACOG Committee Opinion Number 362, March 2007

Medical Futility

 

A proliferation in medical technology has dramatically increased the number of diagnostic and therapeutic options available in patient care. Health care costs also have increased as a byproduct of this technologic expansion. Simultaneously, medical ethics has undergone a rapid metamorphosis from a beneficence-focused ethic to one in which autonomy dominates: that is, from an ethic in which the physician attempted to determine what was in the patient’s best interest and then acted on behalf of the patient to an ethic in which alternatives are presented to the patient and the patient makes the ultimate decision. Thus, both the physician and the patient may face the daunting task of selecting from among myriad highly technologic and expensive health care choices.

 

These choices, among other factors, have created situations in which patients or families have sometimes demanded care that physicians deem futile, or incapable of producing a desired result. The construct of medical futility has been used to justify a physician’s unilateral refusal to provide treatment requested or demanded by a patient or the family of a patient. Such decisions may be based on the physician’s perception of the inability of treatment to achieve a physiologic goal, to attain other goals of the patient or family, or to achieve a reasonable quality of life.

 

Although there is general agreement with the notion that physicians are not obligated to provide futile care, there is vigorous debate and little agreement on the definition of futile care…and on whose values should determine e the definition of futility. Proposed definitions of medical futility include one or more of the following elements:

 

- The patient has a lethal diagnosis or prognosis of imminent death.

- Evidence exists that the suggested therapy cannot achieve its physiologic goal.

- Evidence exists that the suggested therapy will not or cannot achieve the patient’s or family’s stated goals.

- Evidence exists that the suggested therapy will not or cannot extend the patient’s life span.

- Evidence exists that the suggested therapy will not or cannot enhance the patient’s quality of life.

 

The following questions need to be addressed concerning each of the previously identified elements:

 

- What is imminent death? Is it death that is expected within hours or days, or would it include death expected any time up to six months or longer?

- At what point can a therapy be defined as unable to achieve a physiologic goal? Is futility reached when the goal could never be achieved or when the goal could be achieved in less than 1% of the cases, in 5% of the cases, or within some other established limit?

- What defines when a therapy can no longer achieve the patient’s or family’s goals, and who should decide this?

- What constitutes an enhanced life span – 1 day, 1 week, 1 month?

- How is quality of life measured, and who should determine what constitutes a satisfactory quality of life for a given patient?

 

…….Disagreements will sometimes occur will sometimes occur between stakeholders……Physicians or society may be less willing to provide the requested care as they balance the use of resources and their individual or collective view of the potential for and degree of benefit. Patients may not include the use of resources in their equation at all……..Society may be more likely to accede to patient wishes when the use of resources is minimal than when it is significant…….Reasonableness and equity in the distribution of resources may play a role in determining whether societal and institutional values should prevail in contested decisions. When resource distribution is an issue, however, the values of the patient and the preservation of life ordinarily take priority and are ethical default positions.

[future_doc]

I was born in 1988

 

(10 characters)

[future_doc]

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.

 

The OP or his friend is suggesting euthanasia!!! This is the starting point of the debate.

 

So, I am taking their argument to its logical conclusion in a more efficient form, i.e., if society goes for euthanasia b/c these people have no value, and since financial resources are being used as the yardstick, let's do organ harvesting, save other lives and make it a win-win situation, Canada that already causes thousands of deaths by exporting asbestos illegal to use here to India can mitigate the damages by becoming an organ donor country, perhaps selling organs to citizens of other countries (many organs come from poor Indians who sell them and so, we can literally 'cut' into this market).

 

If we are going to kill the mentally and physically infirm - sorry, I mean euthanise these people of no value (according to the OP) - why not save other lives by harvesting organs. Of course, both extremes are absurd, which is my point. The debate is whether to waste excessive financial resources on these allegedly worthless people or better to simply use euthanasia, save a buck and put it to better use on more productive patients. I would like to see this issue on a MMI when I am involved in making the decision of who gets a seat and I would consider euthanasia on those applicants with inappropriate answers to save future patients from such a fate should such applicants become doctors.

[avenir001]

I was born in 1988

 

awwww come to momma

[Rayven]

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.

lol..?

 

Well that's mighty generous of you although I'm sure most of us would fork out $3,000 to save a life too.

 

But even in Microbiodude's example, he states that 10 people need a dialysis machine each. So that's already $30,000. You could probably still cover that. But the the issue is that this scenario's patient uses 100 times that ($300,000/$3,000 = 100).

 

So what if we needed 100 dialysis machines?

 

You're just painting yourself into another corner again by avoiding the real question. Last time you tried to hide behind the "do no harm" to your own patient clause but again that was just another way of saying that dealing with resources wasn't your problem. You can only "fork out" so much money. Basically we're saying our resources are finite.. so what do we do? Your answer is to inject more resources out of your own pocket but obviously that's not a real answer.

 

From ACOG Committee Opinion Number 362,

When resource distribution is an issue, however, the values of the patient and the preservation of life ordinarily take priority and are ethical default positions.

Yes. One patient. In the case of ONE patient we should do whatever it takes to preserve life. That's obvious. No one's questioning that.

 

But what happens when you have more than one patient?? When saving patient A's life will result in patient B to W to die?

[future_doc]

lol..?

 

Well that's mighty generous of you although I'm sure most of us would fork out $3,000 to save a life too.

 

But even in Microbiodude's example, he states that 10 people need a dialysis machine each. So that's already $30,000. You could probably still cover that. But the the issue is that this scenario's patient uses 100 times that ($300,000/$3,000 = 100).

 

So what if we needed 100 dialysis machines?

 

You're just painting yourself into another corner again by avoiding the real question. Last time you tried to hide behind the "do no harm" to your own patient clause but again that was just another way of saying that dealing with resources wasn't your problem. You can only "fork out" so much money. Basically we're saying our resources are finite.. so what do we do? Your answer is to inject more resources out of your own pocket but obviously that's not a real answer.

 

 

Yes. One patient. In the case of ONE patient we should do whatever it takes to preserve life. That's obvious. No one's questioning that.

 

But what happens when you have more than one patient?? When saving patient A's life will result in patient B to W to die?

 

The world is about one patient, one patient at a time. However, you would like this. The last sentence of the Article I previously quoted says:

 

However, situations may occur in which claims of reasonableness and equity in the distribution of resources are so powerful that the views of caregivers, the institution and scoiety will prevail.

 

My comment is that there should not be a situation where the choice is euthanasia or the financial resources. This is one of the default positions in the original post. As a practioner and once my student loans are behind me, I could and probably would go for the $300,000 as affordable, but I understand, you will then raise it to $3M or $3B, I get it. And remember at the MMI, be challenged in your position b ut if you believe in it, stick to it or perhaps you may be on the waitlist if you are lucky. Also, welcome to my Cabinet, we are all the future leaders of society, sooner than any of us think, soon we really will be in charge as we each take positions that gives us some degree of influence or power and cumulatively, we will impact society greatly - far more than caring for our patients. Adcoms want active citizens, not merely good doctors, so be ready to do battle with me and others in the pursuit of a better world. Why don't you set up a poll and see where members stands, and where our father Ian stands.

[w8kg6]

Why don't you set up a poll and see where members stands, and where our father Ian stands.

 

I'm on it. It'll be in the main forum.

 

UPDATE: I wasn't able to get the important intricacies into the voting options, so never mind.

[Microbiodude]

The world is about one patient, one patient at a time.

 

That's a very broad sweeping statement and I don't fully understand it. Did you mean a physician's world is about one patient at a time?

 

Either way, from a Physician's standpoint the one patient at a time sounds like a good mantra but from a health minister's standpoint....I'd really hope they're looking at the big picture with multiples of patients. Otherwise, they'd be addressing one issue while neglecting another every time something comes up.

 

P.S - I like that you posted the ACOG opinions, it kind of gives us forum users the issues brought up at the organization level and if we're on the right track with our debate....woah did this just become a PBL style class, cool.

[future_doc]

From ACOG Committee Opinion Number 362, March 2007

Medical Futility

 

…….Disagreements will sometimes occur will sometimes occur between stakeholders……Physicians or society may be less willing to provide the requested care as they balance the use of resources and their individual or collective view of the potential for and degree of benefit. Patients may not include the use of resources in their equation at all……..Society may be more likely to accede to patient wishes when the use of resources is minimal than when it is significant…….Reasonableness and equity in the distribution of resources may play a role in determining whether societal and institutional values should prevail in contested decisions. When resource distribution is an issue, however, the values of the patient and the preservation of life ordinarily take priority and are ethical default positions.

 

 

Yes. One patient. In the case of ONE patient we should do whatever it takes to preserve life. That's obvious. No one's questioning that.

 

But what happens when you have more than one patient?? When saving patient A's life will result in patient B to W to die?

 

Rayven, the above quote deals with the entire health care system and in the end, it comes down to a decision for each individual patient even when considering the limited financial and other resources. I would be fearful for you as a future trained physician to be looking after a severely disabled family member of mine in view of your preconceptions to save the State money at the risk of an individual severely disabled patient. I would know how to deal with that situation, but a homeless, severely mentally or physically disabled patient wouldn’t have a chance. Would you be one of those hospital medical administrators or doctors who would arrange for a hospital ambulance to deliver such a patient burdening the hospital financially to be dumped on skid row, with the ambulance taking off? This regularly happens in US cities today to the shame of doctors and administrators who don’t know the value of ethics or human life. When it comes to light of day on TV exposes, the administrator usually says, “This is contrary to policy and I will definitely look into it”, while he then arranges for these deliveries of what he considers to be human garbage be dropped off at 1 AM.

 

 

That's a very broad sweeping statement and I don't fully understand it. Did you mean a physician's world is about one patient at a time?

 

Yes. And on an ethical level, the medical associations also look at it one patient at a time, even if they are looking at the broad picture. No medical association will recommend euthanasia of the severely mentally and physically impaired for the sake of saving society money. I was trying to make it more attractive by going for an organ grab if euthanasia is the route to follow as suggested in the original post.

 

BTW, I am the physician under this scenario. If I was the Prime Minister, Minister of Health or Minister of Finance, I would have a broader perspective while never forgetting the purpose of the health care system I s to go no harm, to care, treat and help and never to do harm or kill.

 

 

Either way, from a Physician's standpoint the one patient at a time sounds like a good mantra but from a health minister's standpoint....I'd really hope they're looking at the big picture with multiples of patients. Otherwise, they'd be addressing one issue while neglecting another every time something comes up.

 

P.S - I like that you posted the ACOG opinions, it kind of gives us forum users the issues brought up at the organization level and if we're on the right track with our debate....woah did this just become a PBL style class, cool.

 

This should be required discussion in med school.

[The Law]

awwww come to momma

 

stay away from my son woman!

[avenir001]

stay away from my son woman!

 

lol what a relief it must be to finally find someone even younger than you law..but don't forget you already have a son

[future_doc]

Those of us interested in becoming physicians and not administrators, economists, number crunchers or politicians, should read the article I just came across at http://findarticles.com/p/articles//mi_m0FSL/is_n3_v67/ai_20613080/ [if it does not work change 0FSL to OFSL] entitled "knowledge helps health care professionals deal with ethical dilemmasa" from AORN Journal, March 1998 by Marieanne C Dunn. I quote an extract as follows:

 

FOUR KEY PRINCIPLES

 

Four key principles that health care professionals must consider when faced with ethical dilemmas are: autonomy, beneficence, nonmalfeasance, and justice. Autonomy is the independence to determine one's own direction conditioned only by the need to respect others' individual liberties. Beneficence is the righteous philosophy of doing good. Beneficence differs from nonmalfeasance whereby the duty requires no harm to be incurred. Thusif an act does not assist an individual there is no beneficence: yet all individuals should be protected from harm. According to the principle of nonmalfeasance, every human has the responsibility to protect all individuals from harm.

 

Justice -- arguably the principle that creates the most controversy -- may be defined as fair, just, equitable, and unbiased decision making that is supposedly in favour of the person in need. Ill health may not be regarded as equitable, let alone fair. Medical treatment, however, should be deemded to be just, which may not be fair in all cases (eg, resource allocation).

 

 

My commentary is that there can never be abuse of process or conflict of interest, including a conflict where the health professional gives weight to considerations that do not relate to the patient per se and that relate to issues of financiial considerations of the medical facility and items of a similar nature. It is such considerations that lead to the dumping of patients who cannot pay for the medical services needed, with the consequent dumping of all ethical considerations, nonmalfeasance and justice.

[infinic]

Those of us interested in becoming physicians and not administrators, economists, number crunchers or politicians, should read the article I just came across at http://findarticles.com/p/articles//mi_m0FSL/is_n3_v67/ai_20613080/ [if it does not work change 0FSL to OFSL] entitled "knowledge helps health care professionals deal with ethical dilemmasa" from AORN Journal, March 1998 by Marieanne C Dunn. I quote an extract as follows:

 

FOUR KEY PRINCIPLES

 

Four key principles that health care professionals must consider when faced with ethical dilemmas are: autonomy, beneficence, nonmalfeasance, and justice. Autonomy is the independence to determine one's own direction conditioned only by the need to respect others' individual liberties. Beneficence is the righteous philosophy of doing good. Beneficence differs from nonmalfeasance whereby the duty requires no harm to be incurred. Thusif an act does not assist an individual there is no beneficence: yet all individuals should be protected from harm. According to the principle of nonmalfeasance, every human has the responsibility to protect all individuals from harm.

 

Justice -- arguably the principle that creates the most controversy -- may be defined as fair, just, equitable, and unbiased decision making that is supposedly in favour of the person in need. Ill health may not be regarded as equitable, let alone fair. Medical treatment, however, should be deemded to be just, which may not be fair in all cases (eg, resource allocation).

 

 

My commentary is that there can never be abuse of process or conflict of interest, including a conflict where the health professional gives weight to considerations that do not relate to the patient per se and that relate to issues of financiial considerations of the medical facility and items of a similar nature. It is such considerations that lead to the dumping of patients who cannot pay for the medical services needed, with the consequent dumping of all ethical considerations, nonmalfeasance and justice.

 

hmm, i have a feeling of deja vu , here's a question... which came first: that or wikipedia http://en.wikipedia.org/wiki/Medical_ethics

 

but tks for the article

[future_doc]

hmm, i have a feeling of deja vu , here's a question... which came first: that or wikipedia http://en.wikipedia.org/wiki/Medical_ethics

 

but tks for the article

 

yes, thanks too:p

see http://learn.gwumc.edu/hscidist/LearningObjects/EthicalDecisionMaking/framework_stand.htm#

[future_doc]

The rx to my new thread on Euthanasia is interesting, not even a nibble. This thread was candy coated to bring posters in, essentially the same topic without any candy.

[Rayven]

The world is about one patient, one patient at a time. However, you would like this.

No, the "world" is not about one patient at a time. That is by far too simplistic of a view to be held seriously.

 

You might be in the ER tending to one patient but then you're needed somewhere else for a more critical case. You're going to have to make judgment calls on that and other urgent situations.

 

As a practioner and once my student loans are behind me, I could and probably would go for the $300,000 as affordable, but I understand, you will then raise it to $3M or $3B, I get it.

If you get it then please tell me already how much is too much for one person. Do we count this in monetary numbers or number of lives?

 

And remember at the MMI, be challenged in your position b ut if you believe in it, stick to it or perhaps you may be on the waitlist if you are lucky. Also, welcome to my Cabinet, we are all the future leaders of society, sooner than any of us think, soon we really will be in charge as we each take positions that gives us some degree of influence or power and cumulatively, we will impact society greatly - far more than caring for our patients. Adcoms want active citizens, not merely good doctors, so be ready to do battle with me and others in the pursuit of a better world. Why don't you set up a poll and see where members stands, and where our father Ian stands.

Stop saying "your" cabinet... neither of us are even in med school yet so it's kind of bold for you to lay claim to this 'cabinet'... =.=

 

Rayven, the above quote deals with the entire health care system and in the end, it comes down to a decision for each individual patient even when considering the limited financial and other resources. I would be fearful for you as a future trained physician to be looking after a severely disabled family member of mine in view of your preconceptions to save the State money at the risk of an individual severely disabled patient.

Don't insult me.

 

If I'm a physician then I'll be a physician and do my job. It's about keeping personal opinions and politics separate from business. I thought you'd know that since you keep deflecting from answering the questions for like ever by saying that as a DOCTOR we deal with patients and not politics or economics. Like how you said as a DOCTOR we would do no harm to our patients to which I have agreed many times over.

 

I would know how to deal with that situation, but a homeless, severely mentally or physically disabled patient wouldn’t have a chance. Would you be one of those hospital medical administrators or doctors who would arrange for a hospital ambulance to deliver such a patient burdening the hospital financially to be dumped on skid row, with the ambulance taking off? This regularly happens in US cities today to the shame of doctors and administrators who don’t know the value of ethics or human life. When it comes to light of day on TV exposes, the administrator usually says, “This is contrary to policy and I will definitely look into it”, while he then arranges for these deliveries of what he considers to be human garbage be dropped off at 1 AM.

Source please.

 

Yes. And on an ethical level, the medical associations also look at it one patient at a time, even if they are looking at the broad picture. No medical association will recommend euthanasia of the severely mentally and physically impaired for the sake of saving society money. I was trying to make it more attractive by going for an organ grab if euthanasia is the route to follow as suggested in the original post.

 

 

BTW, I am the physician under this scenario. If I was the Prime Minister, Minister of Health or Minister of Finance, I would have a broader perspective while never forgetting the purpose of the health care system I s to go no harm, to care, treat and help and never to do harm or kill.

I think when I first started posting in this thread you replied with how if the Supreme Courts didn't rule your way that you'd then run and be Prime Minister. Your platform was then to raise and raise taxes which I countered that most Canadians would probably not pay out more money every year for something that they do not benefit from.

 

In all of this debate, I'm finding that you don't seem to have a grasp around the idea of what is finite. Like just recently with microbiodude's dialysis scenario... the main idea behind that was that we only have enough money to save either the one $300,000 patient or the 10 renal-failing patients. Your answer was to fork out your own money, and as commendable as that would be, it clearly was yet another side-step from answering the question. Hmm.. Maybe you should run for political office afterall.

 

Justice -- arguably the principle that creates the most controversy -- may be defined as fair, just, equitable, and unbiased decision making that is supposedly in favour of the person in need. Ill health may not be regarded as equitable, let alone fair. Medical treatment, however, should be deemded to be just, which may not be fair in all cases (eg, resource allocation).

Yes, as a PHYSICIAN, you should not deny anyone medical treatment if they so want and need it. I don't know why you're beating this dead horse. Poor dead horse.

 

But the question arises when you get something like 11 patients that come through the door at the same time. 11 patients that are YOUR patients now. However, in order to treat patient #5 would mean that the 10 other patients die due to lack of resources (ie not enough manpower). But if you choose instead to do the other 10 patients, then patient #5 will die. What do you do?

 

My commentary is that there can never be abuse of process or conflict of interest, including a conflict where the health professional gives weight to considerations that do not relate to the patient per se and that relate to issues of financiial considerations of the medical facility and items of a similar nature. It is such considerations that lead to the dumping of patients who cannot pay for the medical services needed, with the consequent dumping of all ethical considerations, nonmalfeasance and justice.

Patients who cannot pay for their medical treatment is a whole different debate. Unless... you wanted to make the argument that if the government were to somehow have more money or resources to subsidize for the these financially-inept patients.

[future_doc]

No, the "world" is not about one patient at a time. That is by far too simplistic of a view to be held seriously.

 

I am a simple person. I willl save one person at a time.

 

You might be in the ER tending to one patient but then you're needed somewhere else for a more critical case. You're going to have to make judgment calls on that and other urgent situations.

 

I will handle the one closer to death first or the one with the more serious injury if neither have life threatening injuries.

 

 

If you get it then please tell me already how much is too much for one person. Do we count this in monetary numbers or number of lives?

 

I will tell you when I get in (not "if" I get in) if it comes up.

 

 

Stop saying "your" cabinet... neither of us are even in med school yet so it's kind of bold for you to lay claim to this 'cabinet'... =.=

 

We all make plans for the future. Sure, anything can happen, but without goals and plans to reach them, who are we? In any case, I want us both to be in government together.

 

 

Don't insult me.

 

I did not mean to insult you and apologize.

 

 

If I'm a physician then I'll be a physician and do my job. It's about keeping personal opinions and politics separate from business. I thought you'd know that since you keep deflecting from answering the questions for like ever by saying that as a DOCTOR we deal with patients and not politics or economics. Like how you said as a DOCTOR we would do no harm to our patients to which I have agreed many times over.

 

I fully accept that. And therefore, we would do the same thing professionally under identical circumstances.

 

 

Source please.

 

It is the document we both quote above somewhere.

 

 

I think when I first started posting in this thread you replied with how if the Supreme Courts didn't rule your way that you'd then run and be Prime Minister. Your platform was then to raise and raise taxes which I countered that most Canadians would probably not pay out more money every year for something that they do not benefit from.

 

And I replied that my government wouldn't last too long.

 

 

In all of this debate, I'm finding that you don't seem to have a grasp around the idea of what is finite. Like just recently with microbiodude's dialysis scenario... the main idea behind that was that we only have enough money to save either the one $300,000 patient or the 10 renal-failing patients. Your answer was to fork out your own money, and as commendable as that would be, it clearly was yet another side-step from answering the question. Hmm.. Maybe you should run for political office afterall.

 

I answered the question as posed.

 

 

Yes, as a PHYSICIAN, you should not deny anyone medical treatment if they so want and need it. I don't know why you're beating this dead horse. Poor dead horse.

 

I believe in the ethical care of animals and that includes horses. I practice what I preach, i.e., one of my favourite ECs is regularly horse riding and jumping for pleasure and competitively for pleasure. I repeat, I don't beat horses:) ever, they respond to kindness and a firm leader.

 

 

But the question arises when you get something like 11 patients that come through the door at the same time. 11 patients that are YOUR patients now. However, in order to treat patient #5 would mean that the 10 other patients die due to lack of resources (ie not enough manpower). But if you choose instead to do the other 10 patients, then patient #5 will die. What do you do?

 

Triage:p

 

 

Patients who cannot pay for their medical treatment is a whole different debate. Unless... you wanted to make the argument that if the government were to somehow have more money or resources to subsidize for the these financially-inept patients.

 

I guess I am financially-inept as I have no money, cannot pay for medical treatment and am relying upon the government for medical care and education:p and I will be happy to repay society as soon as possible. I hope nobody suggests to euthanize pre-meds, especially those of us who don't get into med school. It has been suggested that those severely mentally and physically impaired by euthanized b/c they would not be productive and I would hope this debate has changed their minds.

 

Good luck to us both with MCAT, I write in a week. I wish it were now. I am sorry for my tardy reply but I thibk we have covered all the ground we are going to. Why don't you answer my new thread on euthanasia which was inspired by the first post on this thread.

[Rayven]

I am a simple person. I willl save one person at a time.

It's not a matter of saving one person at a time.. it's a question of saving one and letting 10 die or vice versa.

 

I will handle the one closer to death first or the one with the more serious injury if neither have life threatening injuries.

So you're saying you'd look at TWO patients at the same time and evaluate both before preceding? Shocker.

lol

 

I will tell you when I get in.

Sigh. Stop.. avoiding.. the.. question...............

 

We all make plans for the future. Sure, anything can happen, but without goals and plans to reach them, who are we? In anhy case, I want use both to be in government together.

Geez.. at least buy me dinner first. ^^

 

I did not mean to insult you and apologize.

Mhmmmmm.

 

I fully accept that. And therefore, we would do the same thing professionally under identical circumstances.

Mhmmmmmmmm.

 

It is the document we both quote above somewhere.

I don't recall reading any document about some hospital admin, after being exposed on tv, who then changed the dumping schedule to 1 am...

 

And I replied that my government wouldn't last too long.

On a platform of higher taxes and more higher taxes... sorry to say but your government wouldn't even be elected.

 

I answered the question as posed.

Stop avoiding...

 

The question was that of finite resources in order to save 1 or save 10.

 

You side-stepped.

 

I believe in the ethical care of animals and that includes horses. I practice what I preach, i.e., one of my favourite ECs is regularly horse riding and jumping for pleasure and competitively for pleasure. I repeat, I don't beat horses ever, they respond to kindness and a firm leader.

Okayyy.. you're missing the point.

 

Besides, do you think horses really like to be rode and forced to jump over obstacles? Pretty sure forcing a horse to jump for nothing more than an EC is kind of cruel as every jump can cause a horse to unnecessarily break a leg. Poor horse.

 

Triage

Stop avoiding....

 

Triage wouldn't work. You only have time to either save patient #5 or the 10 other patients. No other way around it. You're the only doctor within a 100 miles.

 

I guess I am financially-inept as I have no money but I am still sponging off the government for medical care and education:p and I will be happy to repay society as soon as possible. I hope nobody suggests to euthanize pre-meds.

It was you that went off-topic and brought up patients that couldn't pay for medical costs. I merely interjected that perhaps if the healthcare system had more money somehow then they could've possibly subsidize such costs.

 

I'm not sure where you're trying to go with this.

 

Good luck to us both with MCAT, I write in a week. I wish it were now. I am sorry for my tardy reply but I thibk we have covered all the ground we are going to. Why don't you answer my new thread on euthanasia which was inspired by the first post on this thread.

 

You haven't answered my main questions againnnn... Always side-stepping. This time with what I thinkkk you consider.. "humor". You're funny.. sorta... I'll give you that. lol

 

Good luck on Friday. Yonge Street in Toronto right? What will you be wearing? =p

[beebee]

Hi there!

 

That question about the 10 renal failure patients and 1 dialysis patient reminded me of my RN exam that I just wrote in June, so I thought I would put in my 2 cents as ethics is ethics (whether nursing or medical or otherwise).

 

As heartless as the ease with which I make this decision may seam, my opinion along with what I have learned in nursing is....save the ten guys! of course! Especially with something like renal dialysis, as far as I can remember it is only used on average for 4 years, meaning it only 'buys' four years of life on average. Attending to early renal dialysis has a better prognosis in terms of how long a patient will live for if appropriate and timely care is given. Plus in terms of lack of resources shouldn't we be looking at the benefit of greater amount of people? Please don't attack, I am just thinking out loud...

 

I haven't even LOOKED at any ethics books so I may be very far from what medschools would like to hear but I thought I would write smtn even though this thread appears to have deviated a bit from ethics questions....

[future_doc]

Good luck on Friday. What will you be wearing? =p

 

mini-skirt, heels and I look like a dumb blonde or dumb brunette (depending), you will do a double take if you see me. In life, you can never judge a book by its cover. What you will not see is the brains. And as I am experienced in EMS, should there be several guys who suddenly faint before (and not after it starts), I will take care of the one who appeals to me most (simply b/c I will understand everybody will recover:)).

 

Good luck!

P.S. Horses are very bored in the stable all day. They enjoy the outdoors. They needs lots of exercise and quite enjoy riding and jumping so long as their rider is comfortable, in control and a bond of mutual trust is established. If the rider is scared, the horse senses if and this is a different story, the horse would rather be in the stable and the rider would rather be somewhere else. So, no 'poor horse'. Horses have another advantage over us - no MCAT.

[future_doc]

Hi there!

 

That question about the 10 renal failure patients and 1 dialysis patient reminded me of my RN exam that I just wrote in June, so I thought I would put in my 2 cents as ethics is ethics (whether nursing or medical or otherwise).

 

As heartless as the ease with which I make this decision may seam, my opinion along with what I have learned in nursing is....save the ten guys! of course! Especially with something like renal dialysis, as far as I can remember it is only used on average for 4 years, meaning it only 'buys' four years of life on average. Attending to early renal dialysis has a better prognosis in terms of how long a patient will live for if appropriate and timely care is given. Plus in terms of lack of resources shouldn't we be looking at the benefit of greater amount of people? Please don't attack, I am just thinking out loud...

 

beebee, the hypothetical I was given was the following:

 

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?

 

I haven't even LOOKED at any ethics books so I may be very far from what medschools would like to hear but I thought I would write smtn even though this thread appears to have deviated a bit from ethics questions....

 

I answered that I would gladly spend the $3,000 to buy another dialysis machine. I was not faced with your hypothetical.

 

And then there was the other hypothetical posed in the orginal post where it costs $300,000/year to look after someone severely mentally impaired and the post suggested the best way to look after finite financial resources was to euthanize the person. I wnet to the other equally absurd end and suggested why not harvest organs at the same time, Canada could even go into the organ selling business if it had a surplus and these funds would/could certainly help out with finance in health care. This entire thread has been quite a ride, I am tired, please take over:), thank you.

[Rayven]

I answered that I would gladly spend the $3,000 to buy another dialysis machine. I was not faced with your hypothetical.

Againnn, microbiodude's example was to illustrate a limited resources scenario. You avoided answering the question by side-stepping again by saying you'd just pay for it.

 

It reminds me one of the Batman the animated series episodes were Bruce Wayne dreams that he's giving money away to the homeless but more and more homeless people keep showing up until he's consumed by the crowd.

 

And then there was the other hypothetical posed in the orginal post where it costs $300,000/year to look after someone severely mentally impaired and the post suggested the best way to look after finite financial resources was to euthanize the person. I wnet to the other equally absurd end and suggested why not harvest organs at the same time, Canada could even go into the organ selling business if it had a surplus and these funds would/could certainly help out with finance in health care. This entire thread has been quite a ride, I am tired, please take over:), thank you.

I think the euthanization debate here was over before it even started. It seems more like we were debating whether it would be more ethical to treat one patient at the cost of many other patients or vice versa.

 

If you want to take it to the extreme with the organ harvesting (ie the ultimate sacrifice) then we could just look at the other end of the spectrum. What if we have one patient that requires a person die for every day that they're alive?

[NewfieMike]

you've really outdone yourself on this thread, f_d

[future_doc]

(10 characters)

 

Rayven, are you sure you not writing the LSAT? hehe You may wish to consider both law and medicine, I recently saw that one 25 year old guy is about to graduate from both (in US) and he plans to practice in each profession and then perhpas stick to law in malpractice.