The Captain
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Post by The Captain on Jan 27, 2015 9:46:16 GMT -5
Serious question here. I know in my business curriculum we had to take a business ethics class... Sooooooo - I was wondering if there is something similar for the medical profession? This question was raised by a situation someone I know is going through. They have a relative who has multiple complex medical issues going on. The relative in question wants to have surgery done to fix one of the more severe issues. Their doctor is refusing to do so until their health status "improves". Thing is, there is no way in hell their health will ever improve, and unless they have the surgery, it's likely they will die soon. If they do have the surgery odds are 90%+ the individual will die on the table. My friend understands on one level that the doctor doesn't want someone dying under his hands on the operating table, but thinks it's unethical for the doctor to refuse to do the surgery. I have no base to draw on here so wonder what those in the medical profession would say. I know mmhmm has that background, anyone else?
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NancysSummerSip
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Post by NancysSummerSip on Jan 27, 2015 10:08:03 GMT -5
I've heard of this issue coming up in regards to weight-loss surgery, where a doctor will not perform the surgery until the patient displays a commitment to lifelong change by making improvements to their health (and losing some of the weight in the process). I forget which channel it's on, but on the show My 600-LB Life often refers to the subjects dieting first, then surgery second.
My plastic surgeon has a policy like this. He had people coming in all the time for what were really weight reduction surgeries disguised as plastic surgery. He won't do the work. He'll ask the person to lose weight first and get to a healthier place, then reconsider. And he will not perform surgery on a smoker under any circumstances, ever. No amount of money changes his mind.
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mmhmm
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Post by mmhmm on Jan 27, 2015 10:14:51 GMT -5
Probably, the best thing for your friend to do is to get a second, and even a third opinion. It's not considered unethical for the surgeon to refuse to operate if he/she feels the surgery will result in the death of the patient.
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The Captain
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Post by The Captain on Jan 27, 2015 10:40:28 GMT -5
My friend's relative has been in the hospital for over a month, and in and out of ICU several times. They've gotten multiple opinions.
Basically (as I understand it) without the surgery the relative will die in a few months (or less). The surgery (if successful) may buy a few years, but there's very little chance of living through it.
So, by not performing the surgery - the surgeon knows the person will die.
Horrible position for everyone, and yet another reason I went into numbers.
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Bonny
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Post by Bonny on Jan 27, 2015 11:25:59 GMT -5
Well there's the Hippocratic Oath. Here's a wiki sample:
en.wikipedia.org/wiki/Hippocratic_Oath
When my mom was diagnosed with Stage 4 pancreatic cancer she was given an array of options all of which had her dying within a few months. She did pursue some quack remedies for a short period of time but then realized she wouldn't be able to keep them up. Realistically the most promising option was to do chemo to extend her life by about 4 months. Wisely she realized that wasn't going to be "living" and opted not to go through that treatment.
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zibazinski
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Post by zibazinski on Jan 27, 2015 11:52:30 GMT -5
DH had to take his mother to another hospital in another town. They did the surgery and she lived several more years. My suggestion is find another hospital and doctor. If you can.
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whoisjohngalt
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Post by whoisjohngalt on Jan 27, 2015 11:55:56 GMT -5
I wonder if it's really an ethics dilemma or more of "I don't want to get sued by relatives" dilemma.
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zibazinski
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Post by zibazinski on Jan 27, 2015 11:57:58 GMT -5
Both. As well as a death is counted against the hospital and doctor.
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GRG a/k/a goldenrulegirl
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Post by GRG a/k/a goldenrulegirl on Jan 27, 2015 13:33:08 GMT -5
But, if I understand the situation correctly, it isn't a "life-saving" procedure. The surgery won't cure the patient, it only has a 10% possibility of extending life that is already compromised in other ways, correct?
So, while *I* want to eek out every possible second out of this one go-round we are given and would personally want such surgery, I can understand why others might see this as a no-win situation. The doctor must "first, do no harm" and may be interpreting such a high-risk, incurable surgery as harmful.
Get a copy of the patient's records and reach out to other doctors and hospitals. I am sure you will find SOME doctor to do it, but it is important to accept the risk that the patient will not survive the surgery.
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NomoreDramaQ1015
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Post by NomoreDramaQ1015 on Jan 27, 2015 13:41:07 GMT -5
With a 90% chance of failure I can understand why the doctor doesn't want to perform the surgery.
I don't think it's an unethical to not want to perform a surgery that has little chance of actually improving the patient's life and is far more likely to kill them.
Either way the patient is likely to die. And by performing surgery there is always the chance the patient could live but with such severe complications what little life they have is even more miserable than it is now.
They might get lucky and be part of the 10% it works for and they live a long happy life. I don't think it's unethical of the doctor to side with the proven statistics though.
They may have to doctor shop extensively. There is always somebody willing to do the work, the question will be is that person the most qualified to do it? It doesn't sound like a surgery I'd want just any old doctor to do, finding someone specialized enough to be willing to take it on is going to be very difficult.
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The Captain
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Post by The Captain on Jan 27, 2015 13:47:04 GMT -5
But, if I understand the situation correctly, it isn't a "life-saving" procedure. The surgery won't cure the patient, it only has a 10% possibility of extending life that is already compromised in other ways, correct? So, while *I* want to eek out every possible second out of this one go-round we are given and would personally want such surgery, I can understand why others might see this as a no-win situation. The doctor must "first, do no harm" and may be interpreting such a high-risk, incurable surgery as harmful. Get a copy of the patient's records and reach out to other doctors and hospitals. I am sure you will find SOME doctor to do it, but it is important to accept the risk that the patient will not survive the surgery. Actually good point - but a lot of times medicine doesn't provide a cure, only prolonging life. This person has been in and out of the hospital many times during the period I've known my friend. They are currently at one of the top teaching hospitals in Chicago. If the doc's there don't think surgery is a good idea, then no one will. One of the medical issues is related to a genetic condition the person was born with, so they are used as a "case study" for teaching purposes (with their permission). They have access to the top specialists in the area.
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Bluerobin
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Post by Bluerobin on Jan 27, 2015 13:58:42 GMT -5
My mother died from lung cancer. Although surgery would have cured her, the operation would have killed her. She was just too weak. Being a retired nurse, she bull shitted everyone that it was just a stubborn cold (she knew!) until it was too late. She was too weak to survive the surgery when diagnosed. We had her for a few more days, and kept her as pain free as possible.
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mmhmm
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Post by mmhmm on Jan 27, 2015 14:12:09 GMT -5
But, if I understand the situation correctly, it isn't a "life-saving" procedure. The surgery won't cure the patient, it only has a 10% possibility of extending life that is already compromised in other ways, correct? So, while *I* want to eek out every possible second out of this one go-round we are given and would personally want such surgery, I can understand why others might see this as a no-win situation. The doctor must "first, do no harm" and may be interpreting such a high-risk, incurable surgery as harmful. Get a copy of the patient's records and reach out to other doctors and hospitals. I am sure you will find SOME doctor to do it, but it is important to accept the risk that the patient will not survive the surgery. Actually good point - but a lot of times medicine doesn't provide a cure, only prolonging life. This person has been in and out of the hospital many times during the period I've known my friend. They are currently at one of the top teaching hospitals in Chicago. If the doc's there don't think surgery is a good idea, then no one will. One of the medical issues is related to a genetic condition the person was born with, so they are used as a "case study" for teaching purposes (with their permission). They have access to the top specialists in the area. This is just an all-around sad situation, from the sounds of it. It's difficult for loved ones (and, sometimes, for the patient) to accept the bitter truth in such situations. It sounds like this patient has the very best medical care available. Still, it's hard to just let go and feel you're giving up. I do understand. I'm sure the medical staff at the hospital understands, too.
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The Captain
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Post by The Captain on Jan 27, 2015 14:18:41 GMT -5
Yea, mmhmm. It doesn't help that the person is the youngest of several siblings and not even in their 40's. My friend is the oldest of the kids and not dealing well with it at all.
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mmhmm
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Post by mmhmm on Jan 27, 2015 14:21:07 GMT -5
Yea, mmhmm. It doesn't help that the person is the youngest of several siblings and not even in their 40's. My friend is the oldest of the kids and not dealing well with it at all. No, that sure doesn't help! It's even more difficult when the patient is young, like this one. It's harder to accept for everyone concerned. Sounds like, too, this poor patient has been through more than his/her share of misery, with multiple hospitalizations, etc. There just really is no bright spot to which to cling. My heart really goes out to all involved.
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siralynn
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Post by siralynn on Jan 27, 2015 15:10:43 GMT -5
Terrible situation. But I also somewhat commend the doctor. There is unlikely to be substantial reform in the American medical system until doctors start working with patients about realistic end-of-life care. Maybe slowly the American cultural refusal to accept death can be shifted.
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Cookies Galore
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Post by Cookies Galore on Jan 27, 2015 16:41:37 GMT -5
Medical ethics/safety/etc is part of the medical curriculum and more is being incorporated. What a physician does with that info after (s)he is licensed, well...
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Post by The Walk of the Penguin Mich on Jan 27, 2015 17:55:53 GMT -5
My dad is in this position right now. He needs his gall bladder removed, as it's been infected once and it may very well get infected again in the future. However, pancreatic cancer aside, no anesthesiologist will touch him because of his pulmonary fibrosis.
The surgery could keep him comfortable and avoid future infections. However, it could also leave him permanently dependent upon a ventilator and he does not want that. It's not going to cure his pulmonary fibrosis or his pancreatic cancer, but it will make his QOL better for the time he does have remaining.
I don't disagree with the doctors.
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Post by The Walk of the Penguin Mich on Jan 27, 2015 18:01:42 GMT -5
This being said, TD has a coworker who is just about our age - or maybe younger. She needs both new knees and new hips, but she has a horrible weight problem. I would imagine that she is well on her way to 400 lbs. No orthopedic surgeon will touch her, and her joints pain her to the point that doing just about anything is difficult. Her life has narrowed down to nothing.
Losing weight is difficult when you CAN move, when you cannot it is impossible. So she is waiting insurance approval for gastric bypass.
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Tennesseer
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Post by Tennesseer on Jan 27, 2015 18:14:36 GMT -5
This subject of this thread reminds me of a short passage of dialogue from the movie, Meet Joe Black. The Angel of Death, Joe Black, has come to Earth to escort business mogul William Parrish to the afterlife. But before that happens, Joe Black has an opportunity to experience what it is like to live as a human on Earth and experience all life has to offer.
Watching the fireworks above the birthday party held in Parrish's honor, and before they depart to the afterlife, Parrish says to Joe Black:
William Parrish: It's hard to let go, isn't it? Joe Black: Yes it is, Bill. William Parrish: And that's life... what can I tell you.
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