is this evil?

[fang]

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I'm trying to decide finally between pediatrics and medicine. I like both, but what it comes down to is that while peds is less frustrating, I have a moral issue with doing extremely complicated interventions on children.

Here's an example:
2 y/o with congenital cranio-facial abnormalities here for 14th surgery to correct facial features and revise intraventricular shunt. Has feeding tube, tracheostomy; unsure if she will ever eat on her own, but may have ok mental functioning (can't talk now due to tracheostomy). Has older sister who has by default spent much of HER life in hospitals. Parents totally stressed out; mother quit job to take care of kid, father changed jobs to have more time at home.

My question is, is this the right thing to do?? She would have died about 1 mo after birth if there were no interventions. This kid has known nothing but surgery, hospitals, and pain, and her right to live is interfering with another child's well-being. There are lots of kids who can't get appointments for antibiotics, but we're spending millions of dollars on one child. On the other hand, children have the most to gain in terms of years of life, why shouldn't we do everything possible to "save" them? I KNOW if it were my kid I'd probably want everything possible done, just like these parents, but in the bigger picture I can't convince myself it's right. And, can you be a good pediatritian if you don't agree with all of this?

What do you think?

 

[gregMD]

I'm trying to decide finally between pediatrics and medicine. I like both, but what it comes down to is that while peds is less frustrating, I have a moral issue with doing extremely complicated interventions on children.

Here's an example:
2 y/o with congenital cranio-facial abnormalities here for 14th surgery to correct facial features and revise intraventricular shunt. Has feeding tube, tracheostomy; unsure if she will ever eat on her own, but may have ok mental functioning (can't talk now due to tracheostomy). Has older sister who has by default spent much of HER life in hospitals. Parents totally stressed out; mother quit job to take care of kid, father changed jobs to have more time at home.

My question is, is this the right thing to do?? She would have died about 1 mo after birth if there were no interventions. This kid has known nothing but surgery, hospitals, and pain, and her right to live is interfering with another child's well-being. There are lots of kids who can't get appointments for antibiotics, but we're spending millions of dollars on one child. On the other hand, children have the most to gain in terms of years of life, why shouldn't we do everything possible to "save" them? I KNOW if it were my kid I'd probably want everything possible done, just like these parents, but in the bigger picture I can't convince myself it's right. And, can you be a good pediatritian if you don't agree with all of this?

What do you think?

Euthanize the kid.

 

[THP]

I'm trying to decide finally between pediatrics and medicine. I like both, but what it comes down to is that while peds is less frustrating, I have a moral issue with doing extremely complicated interventions on children.

Here's an example:
2 y/o with congenital cranio-facial abnormalities here for 14th surgery to correct facial features and revise intraventricular shunt. Has feeding tube, tracheostomy; unsure if she will ever eat on her own, but may have ok mental functioning (can't talk now due to tracheostomy). Has older sister who has by default spent much of HER life in hospitals. Parents totally stressed out; mother quit job to take care of kid, father changed jobs to have more time at home.

My question is, is this the right thing to do?? She would have died about 1 mo after birth if there were no interventions. This kid has known nothing but surgery, hospitals, and pain, and her right to live is interfering with another child's well-being. There are lots of kids who can't get appointments for antibiotics, but we're spending millions of dollars on one child. On the other hand, children have the most to gain in terms of years of life, why shouldn't we do everything possible to "save" them? I KNOW if it were my kid I'd probably want everything possible done, just like these parents, but in the bigger picture I can't convince myself it's right. And, can you be a good pediatritian if you don't agree with all of this?

What do you think?

its not your decision to make its the parent's

 

[fang]

its not your decision to make its the parent's

I don't want to make the decision for them, I just think as a society we're making the wrong decision. It's definitely an argument of autonomy vs. utilitarianism.

 

[ShyRem]

As a physician, it is your job to present options, possible complications, possible outcomes. It is the patient's (or parent's or guardian's) job to make the decision. Yes, it is difficult. Yes, you will come into contact with patients that will not do what you say or patients that will make decisions you don't agree with. This pervades almost all medical specialties (with the most likely exception being path and rads). Being a good physician doesn't mean your patients have to agree with all of your ideals. Being a good physician is helping them make a decision that agrees with THEIR ideals, morals, lifestyle, etc. and putting their lives ahead of your own opinions.

Sidenote: would this kid be seen by a "regular" pediatrician? Seems most of this kid's problems would be taken care of by a peds surgeon (or the very least some sort of specialist) and not a "regular" pediatrician.

 

[Zweihander]

I don't want to make the decision for them, I just think as a society we're making the wrong decision. It's definitely an argument of autonomy vs. utilitarianism.

This is true, and if you believe in utilitarianism you can make it your goal to lobby for (what you see as) more appropriate use of medical funding. However, within the current scheme, these parents have a right to the interventions they are receiving, and while you are free to disagree with that I also think you should not begrudge them the access.

I take great issue with drug-users who blew out their livers with hepatitis C being able to receive transplants; were it up to me, heroin abuse and resultant hep C would automatically disqualify one from receiving a donation. But, though it is not the way I would do things, I think that if a heroin junkie s/p OLT was my patient, it would still be my job to take care of them.

What I'm trying to say is, wanting to change the rules and wanting to care for patients are not mutually exclusive.

 

[Samoa]

I think if the intervention is futile, you don't have to intervene, regardless of what the parents wish. But this sounds like a case that could define the lines between what's ethical and what's not. And I think with kids, because they are so resilient, the prevailing assumption has always been that continued life=good. However, you raise an excellent point about the effect of all this hospitalization on the child's older sibling. In Western medical ethics, we don't consider the well-being of anyone but the patient, and maybe in the case of other children in the family, we should.

 

[dnw826]

This is true, and if you believe in utilitarianism you can make it your goal to lobby for (what you see as) more appropriate use of medical funding. However, within the current scheme, these parents have a right to the interventions they are receiving, and while you are free to disagree with that I also think you should not begrudge them the access.

I take great issue with drug-users who blew out their livers with hepatitis C being able to receive transplants; were it up to me, heroin abuse and resultant hep C would automatically disqualify one from receiving a donation. But, though it is not the way I would do things, I think that if a heroin junkie s/p OLT was my patient, it would still be my job to take care of them.

What I'm trying to say is, wanting to change the rules and wanting to care for patients are not mutually exclusive.

😀

I totally agree with you here.

 

[71263]

Ahhh, deontology vs utilitarianism: ETHICS REALLY DOES HAVE AN APPLICATION IN REAL MEDICINE!!! 😱

 

[Zweihander]

😀

I totally agree with you here.

That either means that MY haldol is working, or *yours* is wearing off.
Which is it?

 

[8744]

I'm trying to decide finally between pediatrics and medicine. I like both, but what it comes down to is that while peds is less frustrating, I have a moral issue with doing extremely complicated interventions on children.

Here's an example:
2 y/o with congenital cranio-facial abnormalities here for 14th surgery to correct facial features and revise intraventricular shunt. Has feeding tube, tracheostomy; unsure if she will ever eat on her own, but may have ok mental functioning (can't talk now due to tracheostomy). Has older sister who has by default spent much of HER life in hospitals. Parents totally stressed out; mother quit job to take care of kid, father changed jobs to have more time at home.

My question is, is this the right thing to do?? She would have died about 1 mo after birth if there were no interventions. This kid has known nothing but surgery, hospitals, and pain, and her right to live is interfering with another child's well-being. There are lots of kids who can't get appointments for antibiotics, but we're spending millions of dollars on one child. On the other hand, children have the most to gain in terms of years of life, why shouldn't we do everything possible to "save" them? I KNOW if it were my kid I'd probably want everything possible done, just like these parents, but in the bigger picture I can't convince myself it's right. And, can you be a good pediatritian if you don't agree with all of this?

What do you think?

No no no....this post shoud end, "My question is, how do I tell my mother I'm dating a disc jockey?"

 

[fang]

No no no....this post shoud end, "My question is, how do I tell my mother I'm dating a disc jockey?"

huh? (Is this a reference to something I totally missed in the 80's?)

 

[fang]

What I'm trying to say is, wanting to change the rules and wanting to care for patients are not mutually exclusive.

True, and this is a good way to focus on the positive (taking care of a patient) and not the negative (extending the life of one person at the expense of many, watching a family suffer).

 

[sga814]

a doctor's job is to heal- not to to judge- that crap is for lawyers

 

[8744]

huh? (Is this a reference to something I totally missed in the 80's?)

It's the punchline to a famous kind of joke where the comedian asks the audience to help him figure something out, spins a long convoluted tale about a cascading series of mishaps and then finishes with, "So my question is, how do I tell my mother I'm dating a disc jockey (or a sailor, a methodist, or any other vaguely disreputable characater.)"

 

[Zweihander]

It's the punchline to a famous kind of joke where the comedian asks the audience to help him figure something out, spins a long convoluted tale about a cascading series of mishaps and then finishes with, "So my question is, how do I tell my mother I'm dating a disc jockey (or a sailor, a methodist, or any other vaguely disreputable characater.)"

Is that what you old-timers refer to as a "shaggy dog story"?