Medical Ethics for Interviews and for Life

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CodeBlu said:
How about this one...Placebo (Ethical Decision Making)
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This is interesting from a purely ethical standpoint, but I'm afraid it will unleash a violent flame war, so we better leave it alone.
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aSagacious said:
This is interesting from a purely ethical standpoint, but I'm afraid it will unleash a violent flame war, so we better leave it alone.
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I'm surprised we've made it a whole page without any flaming. This may actually prove useful.

Here's something...

A 15 year old girl is pregnant and wants to have an abortion, but her parents want you to tell her to give the child up for adoption.
 
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CodeBlu said:
I like this one. For those who don't want to click the link for the background info...

In Europe, a woman was near death from a special kind of cancer. There was one drug that the doctors thought might save her. It was a form of radium that a druggist in the same town had recently discovered. The drug was expensive to make, but the druggist was charging ten times what the drug cost him to make. He paid $200 for the radium and charged $2,000 for a small dose of the drug.

The sick woman's husband, Heinz, went to everyone he knew to borrow the money, but he could only get together about $ 1,000 which is half of what it cost. He told the druggist that his wife was dying and asked him to sell it cheaper or let him pay later. But the druggist said: "No, I discovered the drug and I'm going to make money from it." So Heinz got desperate and broke into the man's store to steal the drug-for his wife. Should the husband have done that? (Kohlberg, 1963)."
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No, the ends don't justify the means. It's a slippery slope. For a more extreme example, what if his wife needed a kidney and there was a way for him to steal one from another person to save his wife? Obviously that would be wrong.

The druggist is greedy, but that doesn't justify criminal action against him. Can I blame the man for doing it? No. But it isn't a morally justifiable choice, it's selfish. He doesn't want his wife to die.
 
luli said:
No, the ends don't justify the means. It's a slippery slope. For a more extreme example, what if his wife needed a kidney and there was a way for him to steal one from another person to save his wife? Obviously that would be wrong.

The druggist is greedy, but that doesn't justify criminal action against him. Can I blame the man for doing it? No. But it isn't a morally justifiable choice, it's selfish. He doesn't want his wife to die.
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Is the druggist not also being selfish by marking up the drug so much?

The US drug market boasts one of the most expensive price list in the world. Yet, drugs in Europe are cheaper. Same drug, different price. Something's off about that.
 
aSagacious said:
Easy. She's a minor so her parents' wishes dictate my actions. I refuse to perform the abortion.
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Age of consent for abortion in US is 16 or older, so yep. No choice here.
 
aSagacious said:
Easy. She's a minor so her parents' wishes dictate my actions. I refuse to perform the abortion.
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False. Patient retains the rights to make medical decisions regarding her fetus. You may not be able to perform the abortion. BUT she doesn't have to keep the child either. She can put it up for adoption.
 
CodeBlu said:
Is the druggist not also being selfish by marking up the drug so much?

The US drug market boasts one of the most expensive price list in the world. Yet, drugs in Europe are cheaper. Same drug, different price. Something's off about that.
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I agree that the druggist is selfish, but that doesn't make it okay to steal from him. It just makes him a jerk.
 
luli said:
No, the ends don't justify the means. It's a slippery slope. For a more extreme example, what if his wife needed a kidney and there was a way for him to steal one from another person to save his wife? Obviously that would be wrong.

The druggist is greedy, but that doesn't justify criminal action against him. Can I blame the man for doing it? No. But it isn't a morally justifiable choice, it's selfish. He doesn't want his wife to die.
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From a legal standpoint and a community standpoint what he did was wrong, however in my book what he did was right. There is a difference between hurting someone physically to preserve another person (the one you love) and hurting someone financially to preserve another person. Ya he should probably get hit with a lawsuit afterwards or legal penalties, and that's because from a community standpoint we can't have people taking things forcibly (slippery slope)
 
CodeBlu said:
False. Patient retains the rights to make medical decisions regarding her fetus. You may not be able to perform the abortion. BUT she doesn't have to keep the child either. She can put it up for adoption.
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To be honest, once she gives birth to the thing I don't care what she does with it because then it's out of my jurisdiction (or whatever a doctor has).
 
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I have a medical ethics question, and one that can be solved by logic alone.

Say you were to be the lead researcher in a study and had the option to go ahead with it or cancel.

Let's say to a very high certainty the results of this study would lead to a cure for HIV. However, let's also say that the results of this study to a very high certainty would also lead to the unavoidable death in thousands of participants.

Would you choose to go ahead with the study?
 
aSagacious said:
To be honest, once she gives birth to the thing I don't care what she does with it because then it's out of my jurisdiction (or whatever a doctor has).
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Core ethical principles

Autonomy - obligation to respect patients as individuals and to honor their preferences in medical treatment

Beneficence - physicians have a fiduciary duty to act in the patient's best interest. May conflict with autonomy, but if the patient can make an informed decision, ultimately the patient has the right to decide.

Non-maleficence - Do no harm. However, if the benefits of an intervention outweighs the risks, a patient may make an informed decision to proceed

Justice - To treat persons fairly.

Beneficence, states I must act in my patients best interests. So to let her go through with pregnancy might not be in her best interests, not necessarily medically, but socially. Her education may suffer etc. She's 15... she's not 3 years old. She understands what pregnancy entails by now. You should inform her of all possible avenues to deal with this pregnancy.

side note: I remember a friend who sought an abortion in my senior year of high school. The nurse who initially consulted her was pro life... tried to push her towards adoption. Neutrality is key.
 
CodeBlu said:
So there's a sliding scale for when it's ok to steal right? Even if it saves her life? (playing devils advocate)
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No, I don't think there is a sliding scale at all. Like I said, I can understand why he felt the need to do it, but that doesn't make it morally justifiable.

Perhaps the druggist could have been coerced into changing his mind via community pressure, ostracism, protests, whatever. Maybe people could boycott that druggist. He's not a good citizen...

...still not okay to steal from him.
 
Eric01 said:
I have a medical ethics question, and one that can be solved by logic alone.

Say you were to be the lead researcher in a study and had the option to go ahead with it or cancel.

Let's say to a very high certainty the results of this study would lead to a cure for HIV. However, let's also say that the results of this study to a very high certainty would also lead to the unavoidable death in thousands of participants.

Would you choose to go ahead with the study?
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No. I would not. Then I would be no better than the Nazi Regime. Many medical advances were made at the sacrifice of thousands of lives in WWII. I am grateful, and yes I do feel for those lives that were lost. But, I also understand that it was fundamentally wrong. Now, to choose to ignore what we learned about the human body in Nazi Germany would be ignorant and wrong as well. But, we can damn well make sure that such atrocities aren't committed.

You never WILLINGLY condemn 1000s of lives, to save millions. You have no right to choose one life over another.
 
CodeBlu said:
No. I would not. Then I would be no better than the Nazi Regime. Many medical advances were made at the sacrifice of thousands of lives in WWII. I am grateful, and yes I do feel for those lives that were lost. But, I also understand that it was fundamentally wrong. Now, to choose to ignore what we learned about the human body in Nazi Germany would be ignorant and wrong as well. But, we can damn well make sure that such atrocities aren't committed.

You never WILLINGLY condemn 1000s of lives, to save millions. You have no right to choose one life over another.
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This. As soon as I read this I thought of the Nuremberg trials.
 
CodeBlu said:
No. I would not. Then I would be no better than the Nazi Regime. Many medical advances were made at the sacrifice of thousands of lives in WWII. I am grateful, and yes I do feel for those lives that were lost. But, I also understand that it was fundamentally wrong. Now, to choose to ignore what we learned about the human body in Nazi Germany would be ignorant and wrong as well. But, we can damn well make sure that such atrocities aren't committed.

You never WILLINGLY condemn 1000s of lives, to save millions. You have no right to choose one life over another.
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But in a way, aren't you condemning milliions of lives by not going ahead with it? Remember, to a very high certainty you will find a cure. Would you change your mind if you were guaranteed to find a cure?
 
Eric01 said:
But in a way, aren't you condemning milliions of lives by not going ahead with it? Remember, to a very high certainty you will find a cure. Would you change your mind if you were guaranteed to find a cure?
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Never. The rule is... I CANNOT choose between one human life or another. While I am not Jewish, this is something that the Talmud explicitly states.

You're playing G-D. Not cool. At all.
 
CodeBlu said:
Never. The rule is... I CANNOT choose between one human life or another. While I am not Jewish, this is something that the Talmud explicitly states.

You're playing G-D. Not cool. At all.
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No, you're not playing god. Either choice you are choosing a life over another. If you choose not to do it, many people will die as a result, if you choose to do it, people will die as a result.
 
Eric01 said:
No, you're not playing god. Either choice you are choosing a life over another. If you choose not to do it, many people will die as a result, if you choose to do it, people will die as a result.
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One choice means letting people die, the other means actively killing people.

Killing is worse.
 
Eric01 said:
No, you're not playing god. Either choice you are choosing a life over another. If you choose not to do it, many people will die as a result, if you choose to do it, people will die as a result.
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No. I do not agree here.

If I do not intervene... knowingly that if I do intervene, I kill thousands to save millions? Who has to answer to those people's families, children, loved ones?

Sure the millions of people with HIV will be happy... but then you've got a bullseye on your forehead, and a bounty on your life.

Brings me to my next point... INFORMED consent. If you know that to get your cure... what do you do? Lie to the 1000s of people?

This reminds me of an episode of Star Trek: Voyager. Where's Myuu when you need her?
 
CodeBlu said:
No. I do not agree here.

If I do not intervene... knowingly that if I do intervene, I kill thousands to save millions? Who has to answer to those people's families, children, loved ones?

Sure the millions of people with HIV will be happy... but then you've got a bullseye on your forehead, and a bounty on your life.

Brings me to my next point... INFORMED consent. If you know that to get your cure... what do you do? Lie to the 1000s of people?

This reminds me of an episode of Star Trek: Voyager. Where's Myuu when you need her?
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To be honest, I think you would be able to find people who would willingly risk their lives to find a cure for HIV, especially if they themselves are already dying from it.

I accept the distinction between letting people die and actively killing them, however, in this context when you have the ability to save someone and you let them die, is that not killing them?
 
Eric01 said:
To be honest, I think you would be able to find people who would willingly risk their lives to find a cure for HIV, especially if they themselves are already dying from it.

I accept the distinction between letting people die and actively killing them, however, in this context when you have the ability to save someone and you let them die, is that not killing them?
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First thing I learned when working with physicians...

"you can't save everyone. even if you physically have the knowledge to do so."

What do you do in the following situation, you're on of the only surgeons around... two patients come in simultaneously, both with critical injuries, you can't work on both at the same time... one of them will die... how do you choose?
 
CodeBlu said:
What do you do in the following situation, you're on of the only surgeons around... two patients come in simultaneously, both with critical injuries, you can't work on both at the same time... one of them will die... how do you choose?
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Show me the money :D. JK, probably the one that I think has the better prognosis.
 
CodeBlu said:
First thing I learned when working with physicians...

"you can't save everyone. even if you physically have the knowledge to do so."

What do you do in the following situation, you're on of the only surgeons around... two patients come in simultaneously, both with critical injuries, you can't work on both at the same time... one of them will die... how do you choose?
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If this was a real life scenario I would call in more doctors first hand and then do whatever I can to preserve both until help arrives.

But I mean if it's like 5 minutes until both die and that's just not possible, I would choose the one who had the highest likelihood of surviving. Order to put the other into a chemical coma so they don't feel pain.

That situation is a little different though because you're not directly responsible for the patient dying. The lack of work resources was. In my situation you would be directly responsible.
 
Eric01 said:
If this was a real life scenario I would call in more doctors first hand and then do whatever I can to preserve both until help arrives.

But I mean if it's like 5 minutes until both die and that's just not possible, I would choose the one who had the highest likelihood of surviving. Order to put the other into a chemical coma so they don't feel pain.

That situation is a little different though because you're not directly responsible for the patient dying. The lack of work resources was. In my situation you would be directly responsible.
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But you made a choice... even if you didn't have resources available. You still made a CHOICE.


Who gets the heart transplant? 45 year old smoker? Or 18 year old olympic gymnast?
 
But for real... who gets the heart transplant... you only have one heart... the 18 year old olympic gymnast/figure skater... or the 45 year old smoker/alcoholic?
 
CodeBlu said:
Who gets the heart transplant? 45 year old smoker? Or 18 year old olympic gymnast?
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This one came up in a slightly different version in my bioethics class.

In that question, the patient was an alcoholic, not a smoker, and then the choice is clear for me because alcohol abuse increases his chances of rejecting the organ. I'm not sure if smoking = higher risk of rejection, but it does mean that he has poorer self care than the gymnast. I say give the organ to the person who will take better care of it.
 
CodeBlu said:
But for real... who gets the heart transplant... you only have one heart... the 18 year old olympic gymnast/figure skater... or the 45 year old smoker/alcoholic?
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Doesn't the morality get taken out in the ratio. (choose life) x/[(choose life) y] = x/y

and in this case x being the figure skater has more life to live (presumably) and so x>y?

I mean I'm not saying I feel right in answering questions like these. These questions aren't for people to answer, but I'm just wondering if the logic mathematically holds?
 
luli said:
This one came up in a slightly different version in my bioethics class.

In that question, the patient was an alcoholic, not a smoker, and then the choice is clear for me because alcohol abuse increases his chances of rejecting the organ. I'm not sure if smoking = higher risk of rejection, but it does mean that he has poorer self care than the gymnast. I say give the organ to the person who will take better care of it.
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Excellent. Now enter the power of genetics.

Sergei Grinkov was a world class athlete in figure skating.
Sudden death
"On November 20, 1995 Grinkov collapsed and died from a massive heart attack in Lake Placid, New York, while he and Gordeeva were practicing for the upcoming 1995–1996 Stars on Ice tour. Doctors found that Grinkov had severely clogged coronary arteries (to the point where his arterial opening was reportedly the size of a pinhole), which caused the heart attack; later testing revealed that he also had a genetic risk factor linked with premature heart attacks. The risk factor is called the PLA-2 variant and is also known as the "Grinkov Risk Factor".[8] Grinkov was 28 years old. His wife was 24 and their daughter was 3 years old."

Winston Churchill was the prime minister of the UK... drank and smoked like a chimney. Bastard lived to be 91 years old.

Now what?
 
Is it ethical to consider genetic information in organ transplant scenarios? A person with a higher risk of developing certain diseases vs someone with a clean bill of genetic health...

Anyone ever see minority report? See where I'm going with this?
 
CodeBlu said:
Excellent. Now enter the power of genetics.

Sergei Grinkov was a world class athlete in figure skating.
Sudden death
"On November 20, 1995 Grinkov collapsed and died from a massive heart attack in Lake Placid, New York, while he and Gordeeva were practicing for the upcoming 1995–1996 Stars on Ice tour. Doctors found that Grinkov had severely clogged coronary arteries (to the point where his arterial opening was reportedly the size of a pinhole), which caused the heart attack; later testing revealed that he also had a genetic risk factor linked with premature heart attacks. The risk factor is called the PLA-2 variant and is also known as the "Grinkov Risk Factor".[8] Grinkov was 28 years old. His wife was 24 and their daughter was 3 years old."

Winston Churchill was the prime minister of the UK... drank and smoked like a chimney. Bastard lived to be 91 years old.

Now what?
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We can admit that there are no perfect answers. However when making decisions like these we have to look at statistics, because that's the only data and predictive value we have. Yes maybe the figure skater has a congenital defect that will make them an unworthy candidate of a heart transplant, and maybe the 45 year old will lead a nation out of annihilation. However, statistics would say the 18 year old would lead a healthy life and enjoy 27 more years of life whereas the 45 year old is more likely to die.

If we play this scenario out 1000s of times, it will look embarrassing to choose the 45 year old over the 18 year old.
 
aSagacious said:
You of all people should acknowledge the expression, "the plural of anecdote is not data." If data suggests that a certain demographic is more risky then you must play your odds.
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I do acknowledge this expression. However, you just said... play your odds.

Is this not playing god?

The advent of modern science/medicine has saved a lot of lives... but are we really doing more good than we are harm. We've stopped evolving more or less... (let's not turn this into that annoying evolution thread that finally has seemed to die).

But seriously... it's the ripple effect. Our actions as doctors have consequences, we must acknowledge that before anything else.
 
Eric01 said:
We can admit that there are no perfect answers. However when making decisions like these we have to look at statistics, because that's the only data and predictive value we have. Yes maybe the figure skater has a congenital defect that will make them an unworthy candidate of a heart transplant, and maybe the 45 year old will lead a nation out of annihilation. However, statistics would say the 18 year old would lead a healthy life and enjoy 27 more years of life whereas the 45 year old is more likely to die.

If we play this scenario out 1000s of times, it will look embarrassing to choose the 45 year old over the 18 year old.
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I agree. But genetic data... genetics is a powerful force. It's your body's bible. It tells your body to make this protein and do x, y, z. So...
 
CodeBlu said:
I agree. But genetic data... genetics is a powerful force. It's your body's bible. It tells your body to make this protein and do x, y, z. So...
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Oh I didn't know we were assuming the 18 year old definitely had a genetic defect, you didn't include that in your original description.

In that case, I would have to research the disorder and look at the statistics on who has a better prognosis.
 
Eric01 said:
Oh I didn't know we were assuming the 18 year old definitely had a genetic defect, you didn't include that in your original description.

In that case, I would have to research the disorder and look at the statistics on who has a better prognosis.
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I didn't include that, on purpose! I'm just saying... we are human, we are prone to err. We as doctors can be wrong. And we will most likely eff up to the point that we kill someone one day.
 
CodeBlu said:
Is this not playing god?
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That's a weak argument to an atheist. ;)

CodeBlu said:
The advent of modern science/medicine has saved a lot of lives... but are we really doing more good than we are harm. We've stopped evolving more or less...Our actions as doctors have consequences, we must acknowledge that before anything else.
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The only possible harm I see as a result of modern medicine is the unsustainable global population growth. Does this mean we should mandate euthanasia at 65? Stop treating individuals at birth who seem 'unfit'? You will quickly come to the realization that even if we were to achieve Hitler's 'perfect race' of humans (whatever arbitrary attributes we decide to go with) our society would be no better than before. So why not administer treatment in the most 'just' form possible?
 
But how would you deal with these situations? I mean if you're going to make a choice in these situations wouldn't you be choosing one life over another?
 
Eric01 said:
But how would you deal with these situations? I mean if you're going to make a choice in these situations wouldn't you be choosing one life over another?
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The point is that we have to make a choice. We just need to feel comfortable with them.

Ideally, the best physician is one with a skewed moral compass. AKA Dr. House. But then again, I would only want him treating me, after I'd exhausted other more... humane options. I don't need him finding my porn stash.


*side note* I am very pleased that we are being productive here. This is seriously what SDN should be like. Thanks for contributing guys. Means a lot*
 
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