Guest everyoneloveschem Posted May 15, 2003 Report Share Posted May 15, 2003 Okay, out of pure boredom and the need to be not thinking of May 30th, I'm starting a new thread, hopefully a thought provoking one;) . Say you did (of course!!) get into med school. What is the proceedure that you most dread doing? Is it giving a needle, or a spinal tap, or some sort of internal exam? What body part do you fear most? What bodily fluid grosses you out the most? I know this is quite immature, but I think we all need some distraction. Please do not write back saying 'but all of the human body is beautiful, nothing is gross, nothing freaks me out....', that's boring. Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted May 15, 2003 Report Share Posted May 15, 2003 Killing people. It was my greatest dread when I first applied, and it is still my greatest dread now that I'm halfway through. Hope that's not too boring for you. Link to comment Share on other sites More sharing options...
Guest MayFlower1 Posted May 15, 2003 Report Share Posted May 15, 2003 Although I must agree with UWOMED2005 that killing people is a big fear...I worry more about the possibility of doing something that would negatively change someone's life forever...an example from the past...prescribing a woman (or many women) thalidomide during pregnancy...I'm not sure how I would cope with that...those types of situations scare me. With respect to parts of bodies or procedures...I'm afraid that, perhaps in ignorance, I'm going to be a bit boring here...nothing I've seen or heard about would freak me out...ok...actually, my wife has stories about subaceous cysts she removes...and how they smell...how they ooze sebum when they're excised...yuccky...but definitely tolerable. Peter Link to comment Share on other sites More sharing options...
Guest Lynlloyd Posted May 15, 2003 Report Share Posted May 15, 2003 Eyes...most definitely eyes:eek :eek Giving an opthalmic local anaesthetic just HAS to be the worst!!! In fact, I'm pretty sure I won't be able to do that one. Anything else is probably a go!!! Lynlloyd. Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted May 15, 2003 Report Share Posted May 15, 2003 Great point, Mayflower. I could see circumstances, particularly working in Obs/gyn or peds, where killing the patient just might not be as bad as incapacitating them for life. . . depending on the form of incapacitation. This year I was exposed to both an neonatal ICU with kids who will never make it, either due to the degree of prematurity or birth defect. I was also also exposed to a developmental pediatrics ward filled with kids who had severe delvelopmental problems, severe enough that some/many will not survive to adolescence (ie mother was infected with CMV or rubella while pregnant.) The pediatrician literally made a comment that suggested that some of the cases she saw made her wonder if euthanasia should be an option. Pretty mind blowing to hear someone who has dedicated their life to helping people say something like that. If something I had done had been the cause of something like that, wow, I don't know how I'd cope. Mayflower, what are your feelings on Maternal Serum Screening, by the way? For those of you who don't know, the Maternal Serum Screening program is a relatively new program that screens maternal blood for certain markers that could indicate the fetus will have Down's Syndrome, anencephaly, spina bifida, or another type of neural tube defect. I believe the results of the test are most valid between 16 and 20 weeks (4 to 5 months) gestation, and as none of these conditions are curable, a positive result leaves parents with quite the dilemma. I ask only because I think maternal serum screening is quite relevant to the question of whether it is worse to kill or maim. Link to comment Share on other sites More sharing options...
Guest MayFlower1 Posted May 15, 2003 Report Share Posted May 15, 2003 UWOMED2005, I first learned about Maternal Serum Screening last year while I was conducting the Maternity Experiences Survey for Health Canada. I think it is a wonderful discovery...however...I should mention that I also believe in abortion. If abortion isn't an option (or some sort of intervention to set things straight), for whatever reason, then I believe it, like all pre-natal tests, are obviously not useful. Personally, I think it's hard enough to grow up in this world being relatively normal...I have grown up with friends who were unlucky enough to have genetic abnormalities...and also those with children who have Down's Syndrome and other genetic problems who just seem to get the short of both ends of the figurative stick. Some may argue that the kids are quite happy, intelligent, etc...and many of them are...no doubt...but a life of dependence, etc., etc., in my opinion is not worth it. Also, the job of a parent is tough enough without having a severely challenged child. Although my friends say they wouldn't give up their children for anything...and that they love them (and I know they do)...and that it's not that much harder than raising a "normal" child...I know it's very tough on them...and I suspect they might choose differently should they ever be faced with the horrific choice again. I do believe that life begins at conception...but through my study of the brain and psychology, I don't believe that consciousness or awareness does...that is what makes abortion a viable option for me. Anyway, I'm sure this is going to strike up an interesting variety of perspectives...I look forward to them. Peter Link to comment Share on other sites More sharing options...
Guest peachy Posted May 15, 2003 Report Share Posted May 15, 2003 It's just so sad. A no-win situation. I don't see it happening any time soon, but I so wish that the communities we live in could set up really good living and caring arrangements for these people. When the burdens are shared, then we can take advantage of all the things they bring into the world. Community is so important. Every time I go volunteer with kids who have severe disabilities, I learn things from them. It changes my outlook on life. They affect me just as I affect them. Like when kids with disabilities are integrated into regular classrooms - the other kids in the class gain just as much benefit as the integrated kids themselves. Wow, that's so sappy. UWOMED2005, I bet you're thinking that this is that idealism that changes when one gets into the real world of medicine. Oh yeah, and it's definitely EYES for me too!! I can't put drops in my own eyes, let alone touch someone else's. Yuck. Link to comment Share on other sites More sharing options...
Guest Mimicat65 Posted May 15, 2003 Report Share Posted May 15, 2003 Hope you guys don't mind me crashing the Mac board, but I am trying to distract myself from this ENDLESS waiting... :rolleyes I agree with the previous poster who expressed a high "freak-metre" with eyes!! Eyes freak me out, and dealing with some terrible trauma to the eye would be about the worst thing I can imagine facing. I volunteer in palliative care, so I think I am fairly comfortable with dealing with death. But dismembered body parts would score high on my list of things that make me nervous about medicine. Just as an aside, regarding the maternal serum screening programme, I declined it for all three of my pregnancies. I am not a banner-waving anti-abortion activist, but I knew that on a very personal level, neither my husband nor I could decide to terminate a pregnancy on the basis of a screening test. So then the question was, what good is that info for us? Some might argue that if the test indicates an increased probability of a particular problem (eg. Down's) that early knowledge of that would allow the couple to "prepare" themselves for that possible outcome.... But for me, I just felt that pre-knowledge would just give me one more thing to worry about, resulting in increased stress (not good for fetus or me) and detract from my enjoyment of the miracle of pregnancy. I am glad that this screening programme is available for couples who feel strongly about avoiding such problems with their children, and who are willing to act on the results. Good discussion topics!! Link to comment Share on other sites More sharing options...
Guest everyoneloveschem Posted May 15, 2003 Report Share Posted May 15, 2003 Okay, so this thread has turned quite serious and interesting, which is good, it's the point of having a forum. Another issue with the MSS is that by the time you are 16-20 weeks, it can be quite difficult to arrange an abortion if you get 'bad' results - I know from having tried to arrange one for a pt in her 18th week. I too agree with abortion (that's why I had to book the appt for that pt, no one else I work with would do it), but not as a sad sad form of birth control. I think MSS is especially important the older the mother gets and the higher the risk. Also, if you aren't cut out for that kind of child/parenting lifestyle, you aren't, no one is going to give you a medal if you stick it out. I don't know what I would do if I were pregnant; if I would have MSS, or what I would do if I received 'bad' results. There are a LOT of variables; career, support, city/rural, etc. Its hard too, when you have known such individuals with different physical problems, they're just special as the rest of us, so who knows if by having an abortion you kill the next Stephen Hawkins, or someone's future best friend/spouse. You might have a 'normal' child who grows up to be a horrible deviant youth that drives you mad. How do you feel about euthanasia? I have to admit I agree with it. If I were in the situation where I was dying, slowly, losing all control of my body/mind, in pain, etc, I wouldn't want my family to let me go that way. I'd rather they remember me as I were. Link to comment Share on other sites More sharing options...
Guest shelleyrn Posted May 15, 2003 Report Share Posted May 15, 2003 I hate to say it, but in my profession I have had the opportunity to pretty much smell, touch, taste(that's another story!:eek ) see much, for lack of a more refined word, some pretty gross stuff in my day. "Hey, nice knife, how did you manage to get in stuck in your belly" To, "Whoa, that chainsaw is pretty sharp...." I have had opportunity to stitch up some nasty wounds, but not some of the complicated ones such as the chainsaw accident....so, my fear would be..."Hmmm...which goes where" and ensuring that it looks "right". If I get in, I would like to do Family Medicine in the North as well, so, sewing skills are definitely important...maybe I should get into quilting? One of my fellow nurses actually reattached someone's ear as the weather was out in the remote community that she was working in, and couldn't get the patient out via plane....so, she figured, what the heck....better to sew it on (5 hr stitching job) and have it turn black later, than package it up nicely and send the patient home with it (his ear) in his pocket and not even try....needless to say, it was a success (whew) Also, smells are a tough one...Melena...look it up...it's a bad one...and you will never forget the smell once it has entered your nose...(damn, I'm having a flashback!):x (Vicks vaporub is a must have for all students).........Cheers! Link to comment Share on other sites More sharing options...
Guest everyoneloveschem Posted May 15, 2003 Report Share Posted May 15, 2003 Okay, so (surprise) I've worked quite a bit in chem labs, so I know about some pretty nasty smells (amines, anything containing sulfur, or selenium). There were these chemicals my one prof used to love talking about like putriscene (not sure of the smelling). Smells definitely put me off. I can handle urine (and I do at my current job), and I think most other stuff. I can't imagine being a burn doctor though, ugh. Its truly impressive what the human mind/body can handle when it needs to (i.e we just go into machine mode). In terms of eyes, I was watching that show 'little miracles' or something (the one that is shot at Sick Kids in TO), and they were showing a cornea transplant, ya'll would've loved it, lots of eye surgery and needles!!! Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted May 16, 2003 Report Share Posted May 16, 2003 Hey Mayflower, I don't think MSS is strictly a matter of abortion (which I'm not against myself.) There are so many other ethical implications involved - half the reason I brought it up was that this was the subject of my UWO second year bioethics project. By the way, my position is undecided but the last point I will bring up here definitely leans me against the concept. Part of the problem is that the tests themselves aren't 100% sensitive or 100% specific, meaning even if the test is positive the child may be perfectly normal, or the child might have a neural tube defect or Down's syndrome even if the test is negative. The only way to know for sure is to do further tests, and to be the most accurate (which I hope someone is trying to be if they are considering aborting a 20wk/5mo fetus) you need to do an amniocentesis, an invasive procedure which has a 1/200 change of causing a miscarriage. I know (through a friend of a non-medical friend) of a woman who got pregnant in her late 30s, and as a result of her age was told to take the MSS test. She did, and she got an abnormal result. So, they decided to do the amniocentesis and it ended up being one of those unfortunate occasions where it caused a miscarriage. Well, the trauma of that led to the breakup of this woman with her boyfriend, and she's had ongoing episodes of depression after that. There's a very real possibility at this point she won't have another chance to conceive. And that's a fairly good chance her first child was normal and that the MSS test was a fluke. On the flip side to what I've written above, there are some very valid arguments for Maternal Serum Screening and the theoretical framework behind it, which could be used the future against other conditions if tests can be found. As Mayflower points out, people with such disabilities often are limited in what they can achieve -llike Ethan Hawke's character in GATTACA? Oops, bad example! But seriously, I have worked with a number of disabled groups and to say some of the kids I worked with could choose any career they wanted would be impossible.* For example, I almost regret saying this but I don't think a visually impaired child could grow up to be a pilot. Further to that, many people with conditions such as spina bifida and Down's syndrome are dependent their whole lives. But the perspective of this that causes me to lean my own opinion against the MSS program is the one Peachy alludes to, and the one disabled groups argued in the context of the Latimer case. If we promote these programs, what are we saying about the people who currently live with these conditions. That they are not worthy? That they are a burden on society so we are trying to get rid of others like them? As I said, I've worked with a number of disabled groups and from that experience I totally agree with Peachy. It does totally change your perspective on life, you learn a lot from them, and to that I'd add some of the most amazing human beings I've met, in terms of accomplishment, have had a disability of one sort or another (see Peachy, med school has corrupted me completely. I'm still a bit sappy too! ) How do we measure the worth of an individual in our society? Is it by the size of the figures on their T4 slip? Is it what we all want a 6 ft blonde haired kid who plays quarterback in highschool, was prom king/queen, graduates cum laude, completes and MD or LLB or MBA and is always good at everything, so should we screen out everyone else? (Sorry if this sounds outlandish, but I hope you see the link.) To put a different spin on it, would I personally want my child to have Down's Syndrome, or Cystic Fibrosis, or be visually impaired? No. But would I learn to live with it and see the child for who (s)he was, just as if I had to sons/daughters and they weren't exactly equal? Definitely (Peachy btw, there's nothing wrong with a bit of sappiness. And I think you should definitely keep that perspective throughout medical school. But be prepared to have others who have a completely different perspective on these things than you do. . . some of my classmate's perspectives on this issue surprised me.) I'd just like to conclude by pointing out that eugenics has been a concept that has come in and out of favour several times over the last century, and contrary to many people's beliefs the debate did not end with the fall of Nazi Germany or with the cancellation of the Alberta sexual sterilization program started by John MacEachern. There are tempting arguments in favour of eugenics, MSS, or whatever you want to call it. Oh yeah, and apologies if I've made things to serious for some! It's just needles, eyeballs and bodily fluids don't really faze me! *Of course, the counterargument is that as a 5' 10" white guy who can't jump and has a 8' range on his shot, if I'd decided I wanted to play in the NBA, that would be sadly unrealistic as well. (I hope they don't start a screening program for 5' 10" white guys. . . I'd be screwed) Link to comment Share on other sites More sharing options...
Guest MayFlower1 Posted May 16, 2003 Report Share Posted May 16, 2003 UWOMED2005, As usual...you are annoyingly convincing with your arguments :lol I don't think MSS is strictly a matter of abortion (which I'm not against myself.) There are so many other ethical implications involved You're absolutely correct about this. I guess, for me, the purpose for MSS would primarily be to diagnose a potential problem. By the way, I was speaking with my wife about this last night and she indicated that MSS is really not used that much any more...she indicated that there is another test(s)...and I've forgotten the acronym...I believe it is called something like pre-natal screening battery or something like that...is used way more often...it is done earlier...and MSS is left only for those cases where the timeframe to perform this other test has been missed. She did, and she got an abnormal result. So, they decided to do the amniocentesis and it ended up being one of those unfortunate occasions where it caused a miscarriage. This is, indeed an unfortunate situation. However, personally, I would prefer to err this way rather than bring a child into this harsh world with a serious disability. If we promote these programs, what are we saying about the people who currently live with these conditions. That they are not worthy? That they are a burden on society so we are trying to get rid of others like them? OK...this is the "juicy" part. People with disabilities are no better or worse than any other person. They are valued...often very bright and great contributors to society as I've previously mentioned. I would absolutely never suggest we would try to get rid of people with disabilities...after all, we all have disabilities in one form or another...perhaps just not visible to the naked eye. On the other hand, if you asked a disabled person if they could have had the choice of whether to be disabled or not disabled what would be their answer? If you asked a parent whether they would have preferred a disabled or a non-disabled child what might they have answered? Sure, some would say they would have wanted exactly the child they conceived...I think that's wonderful. I believe, however, that many people with serious disabilities and parents of those with severe disabilities would choose differently if given the choice. On the subject of euthanasia, brought up by peachy, I am both for and against it. I watched my dad go through a decade of decay with alzhymers/parkinsons/dementia...I can tell you it wasn't pretty. He was an amazing man...bright as bright can be...a Mechanical Engineer...combined with a Master's in Psychology...pretty incredible. Anyway, he was pretty much like a zombie for the last 5 years of his life...would he have wanted that? I don't think so. I think he would have chosen to end his life had he had the chance. Of course, this is merely speculation. Projecting myself into that situation has been a very fruitful exercise...thanks for bringing it up...as a healthy person, and one who would fear being totally dependent and a burden on others...I would want to have the choice to end my life if I so chose. HOWEVER, I could easily see myself in a situation where I had a problem (let's say, expressive aphasia resulting from a severe stroke which rendered me unable to move...only to listen and understand, for example)...which my family members felt warranted euthanasia (assuming it was legal) and me, not being able to express my feelings, thoughts, etc., would be trapped and at their mercy...would they really know what I wanted? I don't think so...they would be more likely to know what they wanted and project it onto me. Being healthy, it is horrible to think of myself in a state like this...at this point I think I might choose euthanasia...but what if one's perspective changes based on one's situation? Perhaps if I were in the state described above "Quality of Life" would be modified to mean "Just having life, regardless of the condition". Would I want to die? I'm not so sure...I could easily see myself wanting to be able to see my loved ones by my side for as long as possible, regardless of my condition. After having been through a couple of interesting life events...I know my perspective on things changes has the capacity to change dramatically once, on "the other side" so to speak. My net out? I think euthanasia should be legalized...nobody should have to live that doesn't want to... however, the challenge would be to ensure that the person is really choosing "end of life" versus...getting rid of some other unpleasant experience they are having. Anyway, those are my thoughts...what a great discussion. Peter Link to comment Share on other sites More sharing options...
Guest Mimicat65 Posted May 16, 2003 Report Share Posted May 16, 2003 Mayflower, I think I understand your underlying meaning, but unfortunately, the reason that these types of issues are so difficult is it gets very hard to draw the line as to what is a serious disability. Originally posted by Mayflower I would absolutely never suggest we would try to get rid of people with disabilities...after all, we all have disabilities in one form or another...perhaps just not visible to the naked eye. On the other hand, if you asked a disabled person if they could have had the choice of whether to be disabled or not disabled what would be their answer? If you asked a parent whether they would have preferred a disabled or a non-disabled child what might they have answered? Sure, some would say they would have wanted exactly the child they conceived...I think that's wonderful. I believe, however, that many people with serious disabilities and parents of those with severe disabilities would choose differently if given the choice. So does that mean that parents whose families tend towards obesity, high blood pressure, etc should choose to screen their fetuses for these genes, given the opportunity? What about those with weak eyes? What about those who are really short? I agree that avoiding a serious disability like Down's would be desirable for most parents (myself included). What is difficult about these tests is that: 1) they do not give a definitive result (as mentioned) 2) there doesn't seem to be much in the way of improving the outcome, other than abortion (correct me if I'm wrong) If it was possible to take some kind of treatment to improve the outcome of a pregnancy that was identified as high risk for down's or Spina bifida or something, then I would have undergone the testing. But since it seemed that the only possible action was abortion or "live with it", what was the point? (although I think that in some cases of spina bifida, surgery may be possible while the fetus is still in the uterus... is that correct?) As I said, this is my personal opinion. As a (hopefully) future physician, I am glad that this type of screening is available for people who feel differently about the abortion issue. Link to comment Share on other sites More sharing options...
Guest Dannyboy Posted May 16, 2003 Report Share Posted May 16, 2003 I can't believe I am writing this--only because I am doing so on my neighbour's computer on my one morning I was able to sleep in this week. You obviously upset my neigbour Peter. First off Peter---please do your research when discussing issues around disabilities. You are SERIOUSLY and DANGEROUSLY off with your OPINIONS. Actually, people with disabilities and yes, even serious ones, tend to live happy, content lives. This holds true even in countries not as fortunate as Canada. It's not what others think of thier lives Peter, it is what they think of thier lives. People are amazingly resilent--people with disabilities even more so. What you may look at and see as pain may actually be a body language commonly interpreted as pain (e.g. a grimace) but pain may not be present. Sometimes they are in pain. I have chronic migraines; I am allergic to most medicines so I must just deal with the pain without the assistance of pain meds. It is difficult but it is done--should I be allowed to live? People constantly feel pity for me and I am: are you serious? Get real. I am fine with it and I consider it an insignificant aspect of my life; therefore, so should others. Dependence? Some could argue that needing a partner in life is a form of dependence--should we perhaps not these people live? (please say no) You are right: parenting can be a challenge. And your point? How do we define "challenging"; what parameters do we draw? Parenting could be twice as challenging to me but it would still be worth it. Once again people always want to hit me with pity because my son has a mulitude of medical problems and I am a completely single parent (i.e. no partner). What? Do people not notice how much fun we have, how much time we spend together, how much a value being a parent, and what a special person my son is? Many people don't Peter. That is the way it is; I just filter those people out of our lives. I am more than willing to give up everything in my life but my son. And I want him just the way he is, thank you very much. Peter, with half of my friends and family working with people with serious disabilities, I would without any hesitation say the overwhelming majority of these parents would say the same about their children. Given a chance they would not change things. Any reasonable person would say this considering life doesn't come with a crystal ball and an instruction manual. Also, you should also note that for those who would change things, well HELLO there are equal numbers of parents with non-disabled children who would say the same. We often don't value what we have and we tend to want what we don't have--that's just the way we are. Have you ever spent alot of time with someone with Down's Syndrome, for example? They are amazing. Just don't look for the bad things; see them for the positives and you will be greatly rewarded. It isn't your life or anyone else's life they are living, it is their own. The good, the bad, and the sometimes ugly. Back to the dependence issue--I have a 83 year old friend who is now taking care of his son. His son fell down some stairs and is now an invalid with an IQ of a six year old. Should he be allowed to live? Life's a gamble; parenting lasts a lifetime. There are also no guarantees in life. That genetically "perfect" child is not going to grow up in a "perfect" world; things will happen that will cause him/her great pain. They will grow up dependent in some way--it is part of being human. BTW remember what disability is: essentially a deviation from the norm. Among people with disabilities Peter--you are the disabled, not them. Think hard about that one; it can be a difficult concept to work your head around (one of those easy but not so easy things). Their lives are different than yours; not necessarily any worse. In the end we are looking at differences among people and not necessarily disabilities. I for one think differences should be respected and at times, protected and not necessarily selected against. Choice is another matter but I am tired and my neighbour is given me the go to get my tired butt back to bed. Link to comment Share on other sites More sharing options...
Guest everyoneloveschem Posted May 16, 2003 Report Share Posted May 16, 2003 I think that its true, that most of 'normal' folk assume that disabled people (even the label says it all) can't live full lives, which is untrue. At the same time, when most people decide to have children, it's with the underlying assumption that they will raise and support their children, but that their children will eventually move on, have their own families, etc. So finding out you are going to have a child who may always be dependent on you for all their life, can be a shock. When you think about the fact that most people in our society cannot even remained married to one person, bringing the responsibility of a child, any child into the picture, is a questionable decision. There are always going to be parents who rise to the challenge, but I think its only fair to let them decide. If they don't think they can bring up a child with the love and attention it deserves, than they shouldn't have the child. With respect to 'disabled' children, the one problem I see is the longevity aspect. What if you are 43 when you have such a child, you are 63 when they are 20, and so on. If you have no support, from a spouse, or family, or other children, what happens to your child when/if you die? On a lighter note, in terms of asking people if they would rather not be disabled, that is kind of silly. Most people are always going to want what they don't have, especially if they've never had it, because they likely don't understand the pitfalls. For example, being rich (everyone wants your money), being beautiful (everyone thinks your dumb/wants to sleep with you), being smart (you're brutal at parties), I'm over-exagerating, but the point is there. Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted May 16, 2003 Report Share Posted May 16, 2003 Dannyboy - while my perspective on this issue is actually quite close to your own, I find what you have written is a little offensive towards Mayflower. (And why would his post upset your neighbour? Sorry, you have me confused) I think as as physician you have to be able to see things from ALL perspectives, even if they are not your own. This is a controversial topic quite simply because of the dilemmas it presents. While I personally favour one side of the debate, I also recognize there is an argument for the other side. In medicine, you'll find there's a lot of people on that other side as well. If you're too militant with your arguments ("you're dangerously off with your opinions") you'll find it hard to get along with your classmates, and have a hard time forming the teams you need to practice medicine in this day and age. But, I will point out that the eugenics/MSS argument is a slippery slope. One day you're preventing 10 years of suffering of a child with spina bifida severe enough that they won't make it to adolscence. Or someone who was infected with CMV in utero. But then you're going after visual impairments, the Deaf, and people with down's syndrome. Then it's the short people, people with high blood pressure, need glasses to read, or are susceptible to old football injuries ( sorry Peter, I could resist). Finally, you get to the stage where you decide to eliminate anyone who won't end up as prom king or prom queen, eliminate anyone who won't be the star quarterback for their football team (can you imagine a football team of 12 quarterbacks? Yikes!), or eliminate anyone who might get a B sometime somwhere, eliminate anyone who didn't get into every medical school in the country on the first try. (yikes, can you imagine a society entirely composed of doctors! As one of my clinical methods instructors pointed out, party conversations would be so boring!) These is a really good topic to discuss as the implications are huge and decisions are being made now (not just by doctors) that have huge implications for the future. Anyone still afraid of giving needles, the smell of melena, or touching eyeballs? But seriously, please keep things civil. These are sensitive issues and people have very personal opinions on these matters, so let's not go after the person but try to show why you think that opinion might be in err. Link to comment Share on other sites More sharing options...
Guest IRNBRUD Posted May 16, 2003 Report Share Posted May 16, 2003 What a great discussion! I really believe that all of these decisions are extremely personal and therefore, generalizations are simply impossible. I would never advocate that the lives of persons with disabilities are not valuable. I too have had been humbled and amazed by the achievements of people with severe disabilities. However, I do not feel that I am the type of person that could devote my entire life to caring for a child who would never be able to live independently from me. Knowing this, I currently wonder if I should have children at all. I know that it sounds completely selfish but the decision to have a child whether or not the child has a disability inevitably involves sacrifice and reward. For me, the decision comes down to how much I am willing to sacrifice and how much I expect in return. With any medical condition I feel that the patient has a right to be informed and the right to make decisions about his or her own care. Since the technology for this testing is available, I think it should always be considered as an option. Doctors must always recognize the individual nature of such decisions and to respect the patients wishes. I don't really think that it is our place to judge whether or not the decision is morally acceptable. In the end, is the decision to end a high risk pregnancy any worse than forcing a mother to give birth to a child that she is simply not prepared to care for? For me....the answer is no. I really respect the opinions of everyone here and have learned a lot from this discussion. I hope it stays civil... IB Link to comment Share on other sites More sharing options...
Guest MayFlower1 Posted May 16, 2003 Report Share Posted May 16, 2003 Mimicat, I think I understand your underlying meaning, but unfortunately, the reason that these types of issues are so difficult is it gets very hard to draw the line as to what is a serious disability. You're absolutely right about this. I think "serious disability" is in the eye of the beholder. The operational definition I was using as I wrote my post pointed at issues like sever affliction from thalidomide (e.g., no arms or legs), severe Down's syndrome where the individual is NOT capable of functioning independently...really, very very serious cases. I don't believe anybody would choose that for themselves or their children...but, I could definitely be wrong on this one. So does that mean that parents whose families tend towards obesity, high blood pressure, etc should choose to screen their fetuses for these genes, given the opportunity? What about those with weak eyes? What about those who are really short? Again, I obviously wouldn't subscribe to this...I think what I was referring to were disabilities that most people would think are very serious and those that cause an individual extreme difficulty functioning and having a good quality of life (whatever that is...again, in the eye of the beholder, I believe). I agree that avoiding a serious disability like Down's would be desirable for most parents (myself included). What is difficult about these tests is that: 1) they do not give a definitive result (as mentioned) 2) there doesn't seem to be much in the way of improving the outcome, other than abortion (correct me if I'm wrong) Yup...Yup...and that's where I believe personal beliefs and values come into play. Again, if a test indicated my unborn child was very likely to have a serious genetic defect, I would not hesitate to abort...but this is my personal opinion. Others would obviously hold other perspectives...and I respect them for that. If it was possible to take some kind of treatment to improve the outcome of a pregnancy that was identified as high risk for down's or Spina bifida or something, then I would have undergone the testing. But since it seemed that the only possible action was abortion or "live with it", what was the point? (although I think that in some cases of spina bifida, surgery may be possible while the fetus is still in the uterus... is that correct?) I think this is a very reasonable perspective (not that my perspective really matters)...you have to be able to take action on a test (again, in my opinion) for it to be useful or outweigh possible risks of taking the test itself (e.g., amniocentesis). As I said, this is my personal opinion. As a (hopefully) future physician, I am glad that this type of screening is available for people who feel differently about the abortion issue. It's wonderful that you bring your perspective to the table...and even more wonderful that you are able to articulate your position without attacking anybody else...you will make a great physician. Thanks for bringing your perspectives to this discussion. Peter Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted May 16, 2003 Report Share Posted May 16, 2003 Doctors must always recognize the individual nature of such decisions and to respect the patients wishes. I don't really think that it is our place to judge whether or not the decision is morally acceptable. IRNBRUD - that is a great point. I believe it is now mandatory for doctors to offer these tests to patients, but it is the patient's choice as to whether to have them. The problem is, when doctors are presenting this test to patients, what effect to their biases have on that patient's decision? My roommate wrote the following play on the subject, as part of the aforementioned bioethics project we did, showing the inherent bias in presenting this info. Two Doctors (stage L and R), 1 patient in the centre . Dr1+2 (to audience): I have no real opinion when it comes to MSS. To patient who is sitting neutral in the centre. Dr1: Thank you for coming in today. Dr2: Congratulations on your pregnancy. 1: I know you and your husband have been trying fow awhile and I’m glad it’s worked itself out. 2: Now that you are pregnant, there are some tests we should discuss. Patient now faces Dr who is talking (starting with 1). 1: Most of my patients get a test called the MSS. 2: The government requires us to discuss the MSS. Patient (returns to neutral): Well, what is that? 1: The MSS is a blood test, 2: that measures various hormones. 1: These hormone levels will help us to predict whether your baby, 2: is at increased risk for Downs Syndrome, Trisomy 18, or neural tube defects. Patient (neutral): Can you tell me a little about these conditions? 1: Trisomy 18 is very rare fatal genetic disease where, 2: 90% of babies that survive to term die within the first year of life. Patient turns to Dr1 1: All babies have profound cognitive delays, feeding difficulties and failure to thrive. 2: So even if we find it there is nothing we can do to save or heal the child 1: If we do detect this abnormality we can avoid any procedures that may put you at risk on behalf of a child with no chance of survival. 2: Now neural tube defects are a little more common at about 1-2 births/1000. 1: they can range in severity from a fatal brain abnormality to a small, treatable lesion on the lower back. 2: In the unlikely event that your baby has a severe form of NTD it would be detected by U/S later in your pregnancy, and in the case of a minor lesion both the MSS and U/S are ineffective. 1: The MSS is 90% effective at predicting severe NTDs. Any minor defect that is detectable can alter our decision of delivery method or the defect could potentially be treated in utero. 2: Any in utero treatments for NTDs are still in the experimental phase. Patient: OK, well what about DS? 2: DS is the most common chromosome abnormality in live births, and the prevalence increases with the maternal age. 1: So I recommend that all my patients over 35 have the MSS. 2: People with DS tend to have some mental handicap, as well as some changes in their physical appearance. 1: DS is a condition that causes mental retardation, and is often associated with major structural malformation, including congenital heart defects. 2: Although the life expectancies are somewhat shortened you probably have seen many individuals with DS living productive lives well into their 50’s, especially now that society is making an effort to incorporate these people into the main stream. 1: DS is a condition that dramatically reduces life expectancy and places severe limitations on everyday functioning. 2: As in trisomy 18 there is no treatment for DS, and also the MSS fives a false positive result in ¼ of mothers your age. 1: The MSS is capable of detecting ~90% of babies with DS in mothers your age. Patient: OK, so if the MSS is positive than how do I confirm the diagnosis? 2: Good point with all the uncertainty of a positive MSS, confirmation with other tests would be necessary. 1: Good point, now that the MSS has identified a potential problem we can go on to take more steps to be more certain of a diagnosis. 2: U/S is a safe option, but again can give an unreliable result. Many physical markers that can make us suspect DS can be found in normal babies as well. 1: U/S is very good at picking up major abnormalities and there are many markers that are increased in fetuses with DS. Patient: OK, so does that mean we’d be sure? 2: No, the only way to be almost sure is to perform a more invasive test, such as amniocentesis. 1: This test is more invasive, but there is still only a 1/200 chance of miscarriage, whereas with the positive screening result the risk of having a baby with DS is now 1/30. 2: The problem with this test is that it carries the same risk for miscarriage, 1/200, as your baseline risk of having a baby with DS before any screening. Patient: Wow, this is a little confusing. 1: Of course, it is up to you, but… 2: With the high false positive rate, there is the chance of exposing a perfectly healthy baby to potentially dangerous invasive testing. 1: The MSS is a great way to determine increased risk of having a fetus with DS or NTDs. 2: Even if DS is detected, there is no cure. 1: Prior knowledge of a baby with DS gives you the ability to prepare for a disabled child, plan to give up the child for adoption, or to plan termination if that is your choice. 2: Often, parents of disabled children are much happier than they could have predicted they would be in this situation anyway. 1: Basically, the MSS is the first step to peace of mind, or at least the knowledge, which will allow for you to make difficult decisions with confidence. 2: In the end the MSS is simply an inaccurate tool that can cause people to make hasty decisions, and more often than not simply causes unwarranted stress. Dr1+2: But don't let us bias your decision. Link to comment Share on other sites More sharing options...
Guest Dannyboy Posted May 16, 2003 Report Share Posted May 16, 2003 First off: no internet=no forum. Which is a good thing because although I think it is overall a wonderful source of information, it is no longer something I like for reasons that derive from responses such as yours. I miss the internet though. My neighbour reads the forum and she was annoyed with the thread, in particular what Peter wrote. Because of the research I do I am very informed about the subject so she wanted me to respond. Secondly, please don't be so condescending to me. Duh, you have to see things via all perspectives. That is exactly what was occurring. I was responding to other's perspectives. I may not agree with them but that certainly does not bother me nor should it bother YOU. I have been completey shocked by many things you write but I've always given you the benefit of the doubt--you meant well, your **opinions** are just that. Peter was citing opinions--opinions are meant to be criticized and defended. If a dr can't do either than he/she may be in trouble. Peter can do both and he can do them well so I certainly don't worry about him. That is a significant problem with drs and med students, in my opinion--they don't see all perspectives, just their own which they falsely interpret as being respresentative of others. They know what's best, right? So funny. I am not at all "militant" with my opinions. May I suggest you watch your words--what you interpret as "militant" I think others might write is "passionate". One involves a very rigid stance, the other the opposite. BTW: I am niether. Do you know what? North American medicine is evidence based--Peter was citing opinion not currently accepted evidence. Regardless of my opinions, I will side with evidence. IF Peter sugggested that drinking Coke would cure cancer would you have reacted the same way---that would have been his opinion vs. evidence-based fact. I have NEVER found it hard to get along with anyone, actually. Like I wrote, differences should be valued, respected and even at times protected. Team work? I have about 20 years worth of successful, positive, effective and effecient team work experience in a very wide variety of contexts--how about you? My academic career has been almost exclusively group and team based. It has been a great six years. There have been high conflict times, for sure. And every single such incident has resulted in my carving out a solid friendship with people who I initially did not get along with. There is nothing inherently wrong with conflict--it can so easily be turned into something positve and enriching. Each time the foundation of the friendship in these high confict situiations has been built from mutual respect for our differences. I have worked and gotten along very well with people society deems extremely difficult to deal with--child rapists, murderers, street people, people with serious mental disorders, neo-nazis, terrorists, anti-abortions--you name it. Why do I get along with them? I may not agree with their opinions, actions, values or beliefs but they are THEIRS. I can appreciate their perspective and I respect that they are different. You have know idea what I am about. My gift is my ability to see the perspectives of others and to get along with people. Thanks for your completely below the belt, uninformed opinion though. You write that and then write "keep things civil". That is truly funny. Perhaps you should listen to your own advice. Remember, I was commenting on Peter's opinion and strongly suggesting he note the differences between opinion and empirically informed, evidence-based fact. You don't actually know my opinion on the matter. I didn't provide it; I only provided examples, some personal some not. The questions posed were purely rhetorical in nature. This is truly my last visit on this forum. My neighbour has gotten me out of bed twice this morning to write responses--I certainly do NOT appreciate having to defend myself (note: at no point did I knock Peter--he seems great--I just criticized his opinions). Enough is quite enough!! Best of luck to my fellow Mac posters. Y'all are the BEST!!!!!!!!!!!!!!!!!!!!!!!!!! Link to comment Share on other sites More sharing options...
Guest Mimicat65 Posted May 16, 2003 Report Share Posted May 16, 2003 Interesting read and perspective UWOMED2005. And thanks for your comments Peter. I don't think anyone on this board would argue that they want anything less than the "best life" for their child. It's just that people's life influences vary, and therefore definitions of "best" can be very different. Obviously it is a very emotional issue for some members, and I think we should try to remember that defensiveness is often a natural reaction when someone feels that someone close to them has been unfairly judged (especially if that someone is a child). I think this discussion is very valuable, and I hope we can continue to be civil to one another. It is one of the things I appreciate the most about this board vs others such as SDN. Mimi Link to comment Share on other sites More sharing options...
Guest MayFlower1 Posted May 16, 2003 Report Share Posted May 16, 2003 Mimicat, Well put. You're right about the defensiveness...and it is understandable... Peter Link to comment Share on other sites More sharing options...
Guest grandmellon Posted May 16, 2003 Report Share Posted May 16, 2003 Hi everyone I don't have time to read all those long posts but I thought I'd add me two cents about gross things i would not look forward to as a MD. They actually have to do with smells.... anything that smells aweful really gets to me because I think in my mind... if I can smell it that means that there are little particles of it in the air and its getting into me. YUCK! The grossest thing I have seen so far is faeces esp. those with Clostridium Difficile. Another would have to be an infect stage 4 pressure ulcer on a paraplegic which had tunneled through his hips and was draining purulent stinky drainage... yuck! I have proposed to my engineering friends a new invention called the nose filter / plug. It would filter out any particulates and aweful smells... hopefully we can get it all patented and on the manufacturing line before I graduate! (Wishful thinking I know) GM HAVE A GREAT HOLIDAY WEEKEND EVERYONE!! :rollin Link to comment Share on other sites More sharing options...
Guest MayFlower1 Posted May 16, 2003 Report Share Posted May 16, 2003 ha ha grandmellon...cheers...what a great idea...I must admit I get somewhat grossed out also by the thought that there are particles of the "smell" in me...oh well...once you've done baby diapers, dog puke (two-foot-round puddles) and liquid poo...it doesn't get much worse...or does it? :eek Peter Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.