Ethics Debate: DNR Order for a ******ed Kid

[DropkickMurphy]

He was saying what most of us were thinking (according to the comments made after the guy came down off the ledge).

---

Members don't see this ad.

 

[Davjc2009]

That is assuming the said-person actually jumped. Get back to me if that actually happens. Then, I will agree with your statement.

I was saying he should have...

 

[Tired]

He was saying what most of us were thinking (according to the comments made after the guy came down off the ledge).

We walk a dangerous line. The comments and "humor" are a ready-made defence mechanism, but I still remember the first time a family member heard a comment I made, and I still feel sick at what I probably made them feel. That being said, I still make comments, because the alternative is to fall apart completely, which wouldn't do anyone any good.

I went to an autopsy today on a 23-year old car accident victim. That hurt. Then the pathologist asks the students, "Why do we make the incision in the scalp in the occipital region and flip it up over the face before we remove the skull cap? Why not make the cut at the hair line and pull it back?" The correct answer: "So they can't tell who's taking out their brain." It was twisted, yes, but it also distracted us from the tragedy of the situation.

 

[KeyzerSoze]

Nice.

You know, despite your righteous indignation, the issue in this thread comes up pretty frequently. People (MR or not) with recurrent pneumonia will request no further intubation or have it requested for them by their guardians. And children born with severe chromosomal abnormalities will have invasive/life-saving interventions refused by the their parents. A parent faced with a profoundly MR infant will sometimes refuse surgery for TE fistulas, cardiac repair, or other interventions that will undoubtedly result in the child's death. Sometimes this is met with a fight by the physician, other times the doctor will go along with it.

You do realize that DKM's hypothetical case involves the parents are refusing antibiotics for their DS child who has presented with a suspected case of pneumonia? Thus, most of your examples are pretty much irrelevant. To your credit, you make this distinction yourself later on.

So why are you getting so worked up? Is it DKM's "lack of sensitivity to the subject"? Because I've got news for you, people who have actually functioned in this world frequently do not show the level of reverence you are demanding. If you want to cry with every patient facing a hard situation, feel free. The rest of us utilize callousness to protect our own hearts. Wanna guess who lasts longer in this field, seeing pain and horror every day?

What utter nonsense. This has nothing to do with the obvious fact that doctors can't become overly emotionally involved in their patient's lives. The point at hand is that DKM doesn't seem to have any automatic respect for human life, unless he deems that life to be worthy of respect, according to arbitrary criteria such as "extreme (likelihood) to grow up to be a meaningful and productive member of society." This very disturbing, for obvious reasons. (No, you can't invoke Godwin's rule, because DKM made the comparison first, and also because the comparison is actually relevant here.)

BTW DKM, why does the kid have to have pneumonia? What if the parents just don't want to feed him, because he's not going to have a normal lifespan or be an especially productive member of society?

 

[DropkickMurphy]

I went to an autopsy today on a 23-year old car accident victim. That hurt. Then the pathologist asks the students, "Why do we make the incision in the scalp in the occipital region and flip it up over the face before we remove the skull cap? Why not make the cut at the hair line and pull it back?" The correct answer: "So they can't tell who's taking out their brain." It was twisted, yes, but it also distracted us from the tragedy of the situation.

 

[DropkickMurphy]

The point at hand is that DKM doesn't seem to have any automatic respect for human life

If I didn't have respect for human life, I could certainly find more profitable ways to make a living than being a doctor. I just simply believe we have a right to self-determination (or to have someone who is legally responsible for us make that decision). That is different than lacking respect for human life.
It is simply admitting that there is a great deal of futility in our chosen profession and we need to be willing to recognize and accept the fact that not everyone should be saved every time ("just because you can, doesn't mean you should").

This very disturbing, for obvious reasons.

[YOUTUBE]http://www.youtube.com/watch?v=nNm6ZbX3k9I[/YOUTUBE]

What if the parents just don't want to feed him, because he's not going to have a normal lifespan or be an especially productive member of society?

Because I don't think they'd be so stupid as to admit that plan to a doctor.

 

[Tired]

You do realize that DKM's hypothetical case involves the parents are refusing antibiotics for their DS child who has presented with a suspected case of pneumonia? Thus, most of your examples are pretty much irrelevant. To your credit, you make this distinction yourself later on.

The examples are not irrelevant because the issue of withholding treatment exists across a continuum. At one end lies the relatively benign interventions of antibiotics, at the other extremely-invasive measures. If you want to distinguish between the ends of this continuum (as I do), then you need to discuss risk/benefit ratios. A component of this argument usually involves quality of life considerations, which if we're going to be really honest, is a more socially acceptable way of saying, "Ability to feed yourself and wipe your own drool".

On the other hand, if you want to invoke the "all life is sacred" argument, then yes, the examples are completely out of the scope of this. More on this later.

What utter nonsense. This has nothing to do with the obvious fact that doctors can't become overly emotionally involved in their patient's lives. The point at hand is that DKM doesn't seem to have any automatic respect for human life, unless he deems that life to be worthy of respect, according to arbitrary criteria such as "extreme (likelihood) to grow up to be a meaningful and productive member of society." This very disturbing, for obvious reasons. (No, you can't invoke Godwin's rule, because DKM made the comparison first, and also because the comparison is actually relevant here.)

Setting aside your Nazi comparison (bleah), you actually make a more valid point than you realize. Yes, you could take DKM's comments to imply a lack of automatic respect for human life. You could take a lot of our comments here that way, and I'm not sure that this is as terrible as you make it sound.

The very reason that many people have DNRs on themselves is precisely that they do not want to live if they are unable to be "meaningful and productive member of society"; ie - they see their lives are less valuable (or more specifically not valuable) in such a state. We are comfortable making this distinction in reference to ourselves, so why is it so terrible that parents might make a similar distinction for their children? Then factor in the emotional and financial devastation such situations create for families. You may not agree with the conclusions some people reach in these situations, but you cannot dismiss the argument out of hand as neo-nazi propaganda.

The relativity of human life is actively debated every day. It occurs in the abortion argument, in the "persistent vegatative state" argument, in the DNR debate, in the Iraq debate, and in this debate. You may not like DKM's position, but he is open and honest about his opinion. Comparing him to the 3rd Reich is disingenous, and feels a lot like an attempt to dodge his substantive arguments.

 

[DocBR]

The very reason that many people have DNRs on themselves is precisely that they do not want to live if they are unable to be "meaningful and productive member of society"; ie - they see their lives are less valuable (or more specifically not valuable) in such a state. We are comfortable making this distinction in reference to ourselves, so why is it so terrible that parents might make a similar distinction for their children? Then factor in the emotional and financial devastation such situations create for families. You may not agree with the conclusions some people reach in these situations, but you cannot dismiss the argument out of hand as neo-nazi propaganda.

 

[NickRiviera]

The very reason that many people have DNRs on themselves is precisely that they do not want to live if they are unable to be "meaningful and productive member of society"; ie - they see their lives are less valuable (or more specifically not valuable) in such a state. We are comfortable making this distinction in reference to ourselves, so why is it so terrible that parents might make a similar distinction for their children?

Smooth, Hitler. (kidding)

There are also selfish reasons for DNRs, like not being able to communicate with other people post-resuscitation. Trapped in your own body, no thanks.

 

[Tired]

Smooth, Hitler. (kidding)

There are also selfish reasons for DNRs, like not being able to communicate with other people post-resuscitation. Trapped in your own body, no thanks.

Hey now, just remember this.

DropkickMurphy: He let the Holocaust happen.

 

[NickRiviera]

Hey now, just remember this.

DropkickMurphy: He let the Holocaust happen.

Yea, I can see that. Good work on the Autobahns DKM.

 

[KeyzerSoze]

Setting aside your Nazi comparison (bleah), you actually make a more valid point than you realize. Yes, you could take DKM's comments to imply a lack of automatic respect for human life. You could take a lot of our comments here that way, and I'm not sure that this is as terrible as you make it sound.

The very reason that many people have DNRs on themselves is precisely that they do not want to live if they are unable to be "meaningful and productive member of society"; ie - they see their lives are less valuable (or more specifically not valuable) in such a state. We are comfortable making this distinction in reference to ourselves, so why is it so terrible that parents might make a similar distinction for their children? Then factor in the emotional and financial devastation such situations create for families. You may not agree with the conclusions some people reach in these situations, but you cannot dismiss the argument out of hand as neo-nazi propaganda.

The relativity of human life is actively debated every day. It occurs in the abortion argument, in the "persistent vegatative state" argument, in the DNR debate, in the Iraq debate, and in this debate. You may not like DKM's position, but he is open and honest about his opinion. Comparing him to the 3rd Reich is disingenous, and feels a lot like an attempt to dodge his substantive arguments.

First of all, about the Nazi comparison: As I said, DKM brought up the subject first, when he felt the need to pre-emptively defend himself against the comparison:

Nah, if it was twisted, I would have used the term lebensunwerten Lebens and suggested rounding them all up and actively euthanizing them. (BTW, not to add fuel to this, but the initial method the Nazis used to get rid of people they felt were unfit (mainly ******ed kids) was starvation).

2nd of all, the subject is relevant. The slippery slope is quite evident in the arguments you are using. For example, you said "Then factor in the emotional and financial devastation such situations create for families." It is not such a tremendous leap to start debating the financial strain placed upon society as a whole by the moderately to severely mentally handicapped. If the family has a say in the matter, why not the State, as a representative of society as a whole?

To clarify: I am not accusing anyone of spreading "neo-nazi propaganda', nor am I comparing DKM to the 3rd Reich, as you stated. However, I believe that the suggestion that antibiotic treatment may be withheld from the mentally handicapped is indicative of a callousness towards human life, and is a step towards the Nazi mentality behind the T4 Program.

 

[Tired]

2nd of all, the subject is relevant. The slippery slope is quite evident in the arguments you are using. For example, you said "Then factor in the emotional and financial devastation such situations create for families." It is not such a tremendous leap to start debating the financial strain placed upon society as a whole by the moderately to severely mentally handicapped. If the family has a say in the matter, why not the State, as a representative of society as a whole?

There is a big difference between the family having a say and the State having a say. The difference is that the family has an emotional investment in the patient, whereas the State does not. As a society, we generally presume that the parents of a patient have a desire to protect them and look out for their best interest.

Based on your argument, the "next of kin" of an incapacitated adult with no advanced directive should have no right to ask for a DNR order or for care to be withdrawn?

 

[KeyzerSoze]

There is a big difference between the family having a say and the State having a say. The difference is that the family has an emotional investment in the patient, whereas the State does not. As a society, we generally presume that the parents of a patient have a desire to protect them and look out for their best interest.

Based on your argument, the "next of kin" of an incapacitated adult with no advanced directive should have no right to ask for a DNR order or for care to be withdrawn?

What do you mean by incapacitated? If you are referring to a terminally ill adult or a case of irreversible PVS, I don't see how the two cases are comparable.

In the case you present, the family are clearly making a choice based on the fact that they would not want to be rescuscitated/treated if they were in such a condition. This presumption is confirmed by the fact that most people, in fact, would prefer not to "live" in such a state.

In DKM's scenario, or I should say in its final version, one would be hard pressed to believe the family were they to say that they would rather die of pneumonia than take amoxicillin and return to their former state of health, which I believe we established to be moderately to severely diminished mental capacity and a life expectancy of several decades. One would then be forced to consider the possibility that the family did not have the best interests of the child in mind when choosing to not initiate antibiotic therapy.

Again, DKM made it clear that his definition of "******" was along the lines of "non-functional member of society." He specifically used the example of DS. The fact is that many or even most DS children seem to be quite happy in general, despite their future non-productiveness (or low productiveness) and their diminished lifespans. Therefore, it's unreasonable to suggest that they would rather die than take antibiotics and return to their previous state of health. Preventing the family from making that choice is therefore not analogous to preventing a family from asking for a DNR on a terminally ill relative.

 

[DocBR]

2nd of all, the subject is relevant. The slippery slope is quite evident in the arguments you are using. For example, you said "Then factor in the emotional and financial devastation such situations create for families." It is not such a tremendous leap to start debating the financial strain placed upon society as a whole by the moderately to severely mentally handicapped. If the family has a say in the matter, why not the State, as a representative of society as a whole?

You are comparing the personal and emotional decision of a family to sign a DNR to the wide spread elimination of an entire social group - it just doesn't work.

While family motives may be wrong (i.e. death as an escape from responsibility for a sick child) they are to some extent self regulating. If a family were to be the kind of people who are seal clubbing, blood drinking, child killing jerks, their destruction is limited only to their own family, where as social programs like T4 can quickly become out of hand and lead to the destruction of 60,000 people w/o any regard for the interests of the disabled.

The families emotional investment serves to protect the disabled person, where as any social program would be in the interest of the state alone. You cannot compare the two.

 

[winthug]

*wags finger* Personal attacks are a good way to get banned around here.

I'm not a heartless prick, I'm just playing devil's advocate. Just because I don't support the Special Olympics (it's more for the parents than the athletes.....it's like a dog agility trial for humans) or go on about how many homeless people I spent my days picking lice off of as an EC, it doesn't make me a bad person. Neither does the fact that I choose to be open about the judgments I make about people and their rights (such as the right to refuse care for themselves or those for whom they are legally responsible) and their place in society. Oh wait, you do the same thing. Nice way to demonstrate the definition of hypocrisy.

I probably support DKM 90% of the way. For anybody else who makes a post, please state your hospital experience or experience with these types of patients (aside from family members). Unless you've worked long enough in the medical field to see its dirty side, you really have no say as to what ought to be done. I totally see where DKM is coming from. I've worked (not volunteered) in the ED for a bit now and seriously, if you guys don't callous up, you won't make it as a doctor. You know you'll survive in the medical field if you see a patient come in with a sawed off thumb or multiple stab wounds and think it's pretty cool. Most other people will probably say, HOW SAD!!!, he's going to die! I have a really hard time telling people my hospital stories for that reason. Dunno, maybe I've become too desensitized after having watched too many rated R movies before I was 10 yo and made Jack Bauer my idol.

Anyways, try not to be so idealistic about what a doctor might think or if all of them are 100% patient advocates. I know many doctors that would rather not see that homeless guy that's come in 18 times in 12 months (for a gurney to sleep on), and I'd probably shoot myself if I have to clean his smelly a$$ again. The medical field isn't pretty. What seems to be not PC tends to be the most practical. It's just that DKM is one of the few that has the b@lls to say what is true about DS patients and etc. Will he say this in his interview or as a doctor? Hell no, no one is that stupid. It's really hard to get a doctor's true opinion about an ethical dilemma as it could ruin their reputation or what not. I'm betting that most will agree with DKM to some extent. Those doctors that don't agree probably haven't gotten their hands dirty, as stupid as that may sound. In my hospital (and many others I would assume), the doctor is always the hero in that he gets to see the patient after they've been cleaned and placed nicely in their gurney. He sees the patient for 10 minutes, writes up some orders, gives it to the nurses, and leaves. THEN, that patient has a bowel movement, starts reaching in his diaper w/ his hands, and starts trying to eat it poop, gets it all over his IV site, pisses on the gurney, makes these incomprehensible noises, and this happens for the next 12 hours during night time. When the doctor comes back in the morning, all that I just said magically disappears and the patient looks perfectly sane and humane. Remember guys, when you become doctors, give your nurses LOTS of credit instead of nonstop nagging.

 

[estairella]

Just for you, KeyzerSoze

Arguers also often link the slippery slope fallacy to the straw man fallacy in order to attack the initial position:

1. A has occurred (or will or might occur); therefore
2. B will inevitably happen. (slippery slope)
3. B is wrong; therefore
4. A is wrong. (straw man)

This form of argument often provides evaluative judgments on social change: once an exception is made to some rule, nothing will hold back further, more egregious exceptions to that rule.

So... cranium out of rectal region, if you please.

Anyways, I would personally say no, you can't do a DNR for a "child" (I mean under 18, 19 or 21, depending on where you live). I think having a child is a responsibility, and if you are the parental guardian you are legally responsible for the child's well-being until he is of age.

(Ideally) nobody is ignorant about what DS entails. If you are informed you could have a baby with DS, you should be given a choice - either keep it and raise properly until adulthood and take care of it until its an adult, or kill it ASAP (oops, I mean, "abortion").

Finally, KeyzerSoze, your happiness argument, while nice, means one of two things

a) you're a member of PETA
b) you haven't thought it through

What mammal of reasonable intelligence would not rather live than die? Certain monkeys (Bonobos?) have linguistic IQs approaching that of a 3 year old. What makes one different from the other? Well, a 3 year old usually has the potential to develop a level of consciousness much higher. So if someone's level of consciousness (by which I mean - self-concept, abstract thinking, etc.) is so low that it approaches or is below that of the smartest non-human mammals -> what makes them human?

You can't tell me that because they're genetically human and they're alive, they're human. I will be working with human embryonic stem cells this summer - I do not consider them human. Young women who have abortions do not consider the aborted fetii to be human. You can keep a human alive for quite a while with all of the cerebrum removed - they can eat, walk a bit, etc. but I would not consider them human.

Now, what I'm saying may sound inhuman to you. The only problem with what you're saying is, that there is no GOOD argument to call someone with severely low IQ "human" and to not call certain primates human. Why should they get any LESS rights if they are just as intelligent?

Hey, who knows though, maybe PETA is for you!

 

[riceman04]

Yes, that is quite an interesting problem. Is the child suffering from intractable pain, or otherwise suffering condition, that to artificially prolong his life would be tatamount to prolonging his suffering? You'd have to make a case that mental ******ation would result in this, I think. Personally, I don't think a cognitively delayed child could be said to be suffering in that way, not in the manner that, say, an advanced COPDer, or a 70 y/o septic male, undergoing systemic organ failure, who is being kept alive by a vent and some drugs, or a woman with wide-spread metastasis in just about every region of her body as a result of advanced breast cancer, or the AIDS patient that has to take 50 pills just to stave off, albeit temporarily, deadly and painful diseases/infections as a result of irreverseable immunocompromise.

I want to think about this more though.

 

[Haemulon]

I am very surprised by some of the comments in this thread and I really question the motives for why it has been created. The ethical guidelines and recommendations for scenarios similar to this are fairly well established, although admittedly still debated and somewhat amorphous in some circumstances. To have a discussion about the criteria for establishing a DNR order in various situations is legitimate. However, it is apparent to me that the overall tone of this thread has been to offer a negative judgment of the overall value of individuals with MR, DS in particular. Perhaps this was not the intent, but many of the comments sure read this way. Also, many of the posts about the quality of life for most DS individuals are either misinformed, or intentionally misleading. I prefer to assume the former.

The rawness of some of the comments here, while perhaps truly representing the posters' personal opinions, should certainly be expected to produce a viceral response in some of the other members. I do not believe that this approach is either effective in convincing others of an opinion or appropriate as being representative of how physicians should view their patients. A physician has the duty to be an advocate for what is in the best medical interest of the patient, while still respecting guidlines and laws for incoporating 3rd party decision makers (such as parents). I believe that compassion and sensitivity are just as important to have (and to exhibit) as the ability to emotionally detach in dealing with the harsh realities of medical practice. Lets hold on to our humanity the best we can and try not to become calloused quite so early in our path to medicine.

 

[Jejton]

This is drawn from a discussion with another SDN member, but could provide a very interesting ethical conundrum. What would you do if the parents of a ******ed kid wanted to put a do not resuscitate order on their otherwise healthy (beyond the mental ******ation) child? What if they refused treatment for their child as being futile, given the fact that the quality of life it experiences is not likely to improve with treatment and it could be construed as having what amounts to a terminal condition- just as a patient with a brain tumor can have treatment withheld even if the acute problem (pneumonia for example)- might be readily treated?

Good question but a clarification is in order. Your comparison to a patient with a brain tumour is not valid because a brain tumour very often is terminal. Mental ******ation is not.

 

[Jejton]

What is so wrong with rational, logical people refusing care for their child based on the fact that there is something seriously wrong with it? I see no difference between such a case and if it involved a patient with any other devestating condition (as opposed to JWs who are simply operating with a questionable grasp on reality). The choice should be left to the ******ed child's guardian(s) so long as they are truly working from the standpoint of it's best interest.

If the child is intractable pain for which nothing can be done, then you might be able to argue for it. Arguing that the child is not a productive citizen or is a burden on the parents is not arguing in the child's best interest but rather in the parents. I am not trying to make light of the parent's situation as I know personally what this situation involves and it is not easy for anyone, especially the parents.

 

[Jejton]

It is completely a quality of life issue. If the patient is going to be functioning at a level that basically reduces them to a oxygen consuming, carbon dioxide expelling mechanism for turning enteral feeding into loose watery stool, then yes, I would definitely say quality of life plays a major role in it.

I know many non-******ed people who fit this description - on and off SDN.

 

[epigastric]

(Ideally) nobody is ignorant about what DS entails. If you are informed you could have a baby with DS, you should be given a choice - either keep it and raise properly until adulthood and take care of it until its an adult, or kill it ASAP (oops, I mean, "abortion").

Keeping well away from the inflammatory mention of abortion, "taking care of [a DS child] until adulthood" is misleading: the adults I know with DS are almost always dependent on their parents/family to a far greater degree than the average 20- or 30-something. Taking care of a DS child is generally a life-long commitment. This is changing, a bit, as a recent NY Times article pointed out, but not to a drastic degree.

 

[DrMom]

moving to topics in healthcare

 

[Jejton]

My cousin is ******ed thank you very much (and I mean that....I'm not just being funny or sarcastic). I just don't think changing the name of the disorder changes anything in a real sense. I mean AIDS would still be AIDS if we called it the "a really bad cold" or even if it was "Happy Fun Sunshine and Kittens Disease".

Speaking of AIDS, how about we start putting all HIV+ on an isolated island and deny them treatment until the disease runs its course? I mean after all, these are people who are a drain on the economy, medical resources, government time, will often go on to infect other people, and then fill up our ER's and hospices, often while giving little to nothing back to society especially when they reach advanced stages. So why not save the headache and nip the problem in the bud?

 

[xylem29]

Wouldn't you be breaking the law if you disobeyed a DNR order? Or if not the law, then at least hospital policy and would then get sued - you may even have your license suspended or revoked right?

 

[Jejton]

I think the argument can be made for a lot of these parents that they would rather not have to deal with their children's disabilities. You may not like it, but it is the truth.

You are right. It is difficult and noone should ever have to be in the situation. Wishing to not have had to deal with it, and actively putting an end to the situation are different, though a DNR is not actively ending the life, there are arguments that in certain situations it is just as bad. As far as the negative influence on the family's life, that is unfortunately the case usually, but again that is arguing for the parent's welfare and not the child's.

 

[Jejton]

Just for you, KeyzerSoze


You can't tell me that because they're genetically human and they're alive, they're human. I will be working with human embryonic stem cells this summer - I do not consider them human. Young women who have abortions do not consider the aborted fetii to be human. You can keep a human alive for quite a while with all of the cerebrum removed - they can eat, walk a bit, etc. but I would not consider them human.

Now, what I'm saying may sound inhuman to you. The only problem with what you're saying is, that there is no GOOD argument to call someone with severely low IQ "human" and to not call certain primates human. Why should they get any LESS rights if they are just as intelligent?

Hey, who knows though, maybe PETA is for you!

Since when is intelligence the defining factor of who is human? Why draw the line at 3 year olds? How about anyone who cannot graduate from highschool or get a GED? After all, how productive will that person be? What about quadrapalegics? Their minds are working but their bodies are not. They need someone to feed them, clean them, wipe their drool and their bums? Oh wait, then we would have to kill of Steven Hawkings.

 

[Jejton]

Wouldn't you be breaking the law if you disobeyed a DNR order? Or if not the law, then at least hospital policy and would then get sued - you may even have your license suspended or revoked right?

Noone is arguing to disregard a DNR for an adult. What we are discussing is whether one should be able to make a DNR for a ( ******ed ) child.

 

[DoctorPLASTIC]

Just throw the potatoe away, It is rotten anyways!

 

[DropkickMurphy]

Yea, I can see that. Good work on the Autobahns DKM.

Danke. Überraschen was Sie mit genügender Sklavenarbeit vollenden können, nein? (amazing what you can accomplish with sufficient slave labor, no?)***



***-Pardon me if the translation is not exactly correct, I don't have access to an English-German dictionary at the moment.

 

[DropkickMurphy]

The fact is that many or even most DS children seem to be quite happy in general, despite their future non-productiveness (or low productiveness) and their diminished lifespans.

So were schizophrenics and others who were lobotomized from what I've heard. Apparently the lack of the ability to comprehend one's own situation in a way comparable to the average person leads one to have an at least a less morose outlook on things. As people like to say, "ignorance is bliss".

Besides, if you smile and speak in dulcent tones- just as many people who work with these kids are prone to do- to them, most people will appear happy (often even those who are clinically ill, or even depressed)....hell, even a dog will wag its tail if you do that.

 

[DropkickMurphy]

Speaking of AIDS, how about we start putting all HIV+ on an isolated island and deny them treatment until the disease runs its course? I mean after all, these are people who are a drain on the economy, medical resources, government time, will often go on to infect other people, and then fill up our ER's and hospices, often while giving little to nothing back to society especially when they reach advanced stages. So why not save the headache and nip the problem in the bud?

I've actually brought up quarantine on here as a suggestion for rapidly gaining control of AIDS in Africa. Only those who refuse to comply with control efforts should be forcibly quarantined, but sadly in many areas of that continent that would be a majority of the infected population due to cultural beliefs.

 

[Haemulon]

So were schizophrenics and others who were lobotomized from what I've heard. Apparently the lack of the ability to comprehend one's own situation in a way comparable to the average person leads one to have an at least a less morose outlook on things. As people like to say, "ignorance is bliss".

Besides, if you smile and speak in dulcent tones- just as many people who work with these kids are prone to do- to them, most people will appear happy (often even those who are clinically ill, or even depressed)....hell, even a dog will wag its tail if you do that.

I can't believe that you are comparing a person with DS to someone that has been lobotomized. Your posts make you seem completely out of touch with the realities of DS in this day and age. Children with this condition are often mainstreamed into regular schools, are able to learn and perform well academically, can read, write, and even philosophise about their own existance. They can even grow up to hold down jobs and live on their own, depending upon their particular circumstances. The fact that these children often have a very positive and pleasant disposition in no way equates them to a dog that wags its tail in response to kind tones. I actually do interact with children that have DS and am a member of a regional DS association. I am around this condition every single day and have seen their accomplishments and lifestyles first hand. I am in fundamental disagreement with your entire point of view and I believe that you are doing a great disservice by propagating your version of the DS stereotype. I am gratefull that the typical SDNer is smart enough to take your comments for what they are, and not be influenced by what appears to be your contempt for people with mental disabilities.

 

[DocBR]

Haemulon -

With regard to the original issue, do you think that parents of a sick child with DS have the right to DNR their child who would otherwise recover from their illness?

 

[docB]

I think that assigning a DNR is a moot point if no life support is necessary.

I see your point but those of us in the ER have to deal with the awful situations that arise when a DNR has not been handled properly. You can imagine how tough a situation it is when you're holding the tube and the family is yelling to do this or not do that and there's no clear direction. DNRs a always best created with the patient, family and PMD before they become actionable.

 

[DropkickMurphy]

Children with this condition are often mainstreamed into regular schools

Where they are often disruptive and act out causing headaches for the teachers (although this is more of a problem with autistic children than DS victims). Mainstreaming was the dumbest idea to come out of the educational community in a LOOOOONG time- and it was more correctly described as being shoved upon them by the PC police that are the "advocates" for the ******ed students.

They can even grow up to hold down jobs and live on their own, depending upon their particular circumstances

I've also seen someone survive 60+ minutes of down time after a cold water drowning, but a few anecdotal cases does not supersede the fact that MOST do not. And I don't think someone working as a greeter at Walmart or sorting donations at Goodwill is exactly a job that helps you argue your point that you can't draw parallels between ******s and animals, since you could argue that a parrot or a chimp could easily those jobs respectively.

I actually do interact with children that have DS and am a member of a regional DS association. I am around this condition every single day and have seen their accomplishments and lifestyles first hand.

And I'm sure it was a spectacular EC for you.

I am gratefull that the typical SDNer is smart enough to take your comments for what they are, and not be influenced by what appears to be your contempt for people with mental disabilities.

This isn't contempt. I just like to be honest about my assessments of those with whom I have had contact. Most of them have little if any chance of leading an independent life. If it were my child, I would certainly not hold out much hope for such an occurrence. In fact, I would hope that the condition was caught before it was too late to abort. If it was I would certainly demand a paternity test before I ever allowed my name to go on the birth certificate. Even if I was the biological father of the child, I would only fulfill my legal obligations- i.e., pay child support. Other than that I would never count it among my legitimate progeny, because I simply do not need that kind of a burden upon me.

The fact that these children often have a very positive and pleasant disposition in no way equates them to a dog that wags its tail in response to kind tones.

Yeah, I see your point. Dogs have much more complex behavior than that. (j/k)

 

[Dr.Inviz]

I don't know if I could handle that much excitement every day!

 

[SURAmbyLou]

I'm not for or against anyone with mental disabilities in the public system, but as the daughter of a teacher, let me give you a few points to ponder.

Standards for any school is going to be high and continually going up, just because the government is telling teachers to do so (I personally don't think this is right, considering most politicians have never stepped foot inside of a classroom to teach on a daily basis). Most standards are for the entirety of the school, disabilities not taken into consideration. The students that are "slower" due to disabilities or whatever issue are the ones bringing the other students down, making America's schools "look bad" according to the idiot politicians.
Now, my mother has a student in her class that is considered "slow". She doesn't have any kind of disability, her only issue is that her parents are borderline ******ed and passed the gene on to their kids. Class is disrupted twice a day because another teacher comes to get her to help her with work that mom doesn't have time to work with her on.
Let me say, too, that this disruption is also caused by mom teaching in a lower income area, with most of the students having a lower attention span or interest in what they're there for.
Basically what this long winded spiel is getting at is the fact that it's not only the "disabled" in the classroom that could cause a few issues, but the people that help educate them. Take it as you will.

 

[DocBR]

This isn't contempt. I just like to be honest about my assessments of those with whom I have had contact. Most of them have little if any chance of leading an independent life. If it were my child, I would certainly not hold out much hope for such an occurrence. In fact, I would hope that the condition was caught before it was too late to abort. If it was I would certainly demand a paternity test before I ever allowed my name to go on the birth certificate. Even if I was the biological father of the child, I would only fulfill my legal obligations- i.e., pay child support. Other than that I would never count it among my legitimate progeny, because I simply do not need that kind of a burden upon me.

I would hope if you ever did have a child with DS, ASD, MR, etc that you would change your mind for the sake of the child. The fact is, with early intervention and habilitative support these kids can make huge advancements and reach their potential (however high or low that may be), but with that kind of attitude your child would be doomed from the start.

 

[DropkickMurphy]

I would hope if you ever did have a child with DS, ASD, MR, etc that you would change your mind for the sake of the child. The fact is, with early intervention and habilitative support these kids can make huge advancements and reach their potential (however high or low that may be), but with that kind of attitude your child would be doomed from the start.

Eh.....whatever.

 

[Dr.Inviz]

I would hope if you ever did have a child with DS, ASD, MR, etc that you would change your mind for the sake of the child. The fact is, with early intervention and habilitative support these kids can make huge advancements and reach their potential (however high or low that may be), but with that kind of attitude your child would be doomed from the start.

I don't think I would ever wish for anyone to keep me going with that sort of quality of life if it were me.

 

[DocBR]

I don't think I would ever wish for anyone to keep me going with that sort of quality of life if it were me.

I wouldn't want to either if it were such severe ******ation that made me a burden for my family (not able to bathe myself, work, etc), my thinking was more focused on autism and high functioning down syndrome which can both be diseases of recession.

For instance, I work with one kid in particular who was non vocal until the age of 6 1/2, he just completed his first semester at a Community College with a gpa of 3.4. His parents had the foresight to get him into speech therapy, occupational therapy and interventional habilitation very early.

My point is this: If you were to give up on your kid at an early age, there is no way to know how functional they could be, much less help them get there.

 

[Haemulon]

Haemulon -

With regard to the original issue, do you think that parents of a sick child with DS have the right to DNR their child who would otherwise recover from their illness?

I do not think that the condition of DS should have any relevance to this decision. The parents should not have any more or fewer rights to establish a DNR order in such a situation than they would have for any other child. If it was just a typical DS child with some acute illness, and I was the physician, I would say no and ask for the ethics committee of the hospital, the judiciary, and other relevant entities to evaluate the situation and intervene.

 

[Haemulon]

I would hope if you ever did have a child with DS, ASD, MR, etc that you would change your mind for the sake of the child. The fact is, with early intervention and habilitative support these kids can make huge advancements and reach their potential (however high or low that may be), but with that kind of attitude your child would be doomed from the start.

Agreed.

Some people are just really missing out on what it means to take responsibility for and love a child, no matter what preconceived expectations the child may or may not live up to. When my first child was born, I realized that it was the first time I felt such a strong love for an individual simply because she existed, and not for anything she did or what she was like or what I expected for her the future. Just because she existed and she was mine.

I honostly feel sorry for people that objectify children and assign relative values to them based upon whatever subjective criteria on which they believe that their individual worth should be based. It is sad for the children that they have, and it is sad for them to be missing out on a deeper relationship. But everyone approaches life in their own way. Some people just arn't strong enough to take on what life gives them, and handle it head on. The world is an imperfect place to be sure.