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Medical decisions: who has the last word?

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Old 05-01-2018, 01:06 AM
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Default Medical decisions: who has the last word?


(Prompted by Mo's thread, but rather than get bogged down in that specific case I wanted to discuss the subject generally.)

We trust doctors a lot so it's usually not an issue. And we can always get a second opinion if we think a doctor is wrong. But at the end of the day who should get to make the final decision on whether we get treatment and what that treatment should be?

The fact is, doctors can be just as opportunistic as anyone else. Isn't a plastic surgeon exploiting the foibles of his "patients" when he keeps giving them larger breasts or smaller noses?

And shouldn't people be trusted to decide for themselves, and by extension their families? Doctors don't know everything. But then again, neither do parents.

Who do we belong to, in the final analysis? Who should decide to switch off life support when we aren't able to decide for ourselves? Is it helping anyone to drag cases through the courts to settle it?

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Old 05-01-2018, 02:17 AM
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[QUOTE=flyingtart

Is it helping anyone to drag cases through the courts to settle it?

[/QUOTE]


Wouldn't know about "helping" but I do note the medical profession and the lawyers are enduring the inconvenience of the legal proceedings admirably.
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Old 05-01-2018, 02:26 AM
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Originally Posted by Nick Pierce View Post
Wouldn't know about "helping" but I do note the medical profession and the lawyers are enduring the inconvenience of the legal proceedings admirably.
Oh, I'm sure the lawyers don't mind one bit.
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Old 05-01-2018, 05:16 AM
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The final say will also be based on considerations of effectiveness. Of course each party (individual/family members vs medical pro's) will have a part to play.

Treatment is unlikely to be administered without the patient's permission, so in that scenario it is the individual who has the last say on whether they receive treatment.

But in cases where the patient wishes to have some treatment, and the medical professionals are resistant, leverage will be on the former's side in a private setting and on the latter's side in a publicly funded setting for fairly obvious reasons.

In the publicly funded scenario where treatment is estimated to have a reasonably good chance of success (what's reasonable? I'd say 50/50, anything with lower odds would require special consideration), and we're not talking cosmetics, I think most people would agree it should be granted.

In the private setting pretty much anything should be granted within reason, ie: if I want liposuction and medically it shouldn't do any significant harm then I get it.

There are a bunch of grey areas but I think that the gist of it.

Grey area... OK so what about a 10% chance -- and it's your child. Personally I wouldn't expect it to be sustainable to operate on every critically ill person with a 10% chance of success. The reality is that there really is a limited amount of resources in the world -- so saying stuff like there should be no cost put on life is great but a system predicated on that assumption will simply collapse under crippling debt before long.

So private funding streams are probably most appropriate for those long shot cases.

On a personal note, I don't know if I'm a psychopath or something but I've never really cared too much about death. Murder and killing is different. But people die, it is what it is. I don't expect anyone to spend ridiculous amounts to keep me alive. When it's my time, I'll check out -- I've had a pretty good innings already.
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Old 05-01-2018, 10:51 AM
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Originally Posted by JohnConstantine View Post

Treatment is unlikely to be administered without the patient's permission, so in that scenario it is the individual who has the last say on whether they receive treatment.
Not in every case. What if a person isn't capable of giving permission, by being unconscious, too young or mentally incapable, for example?

I recall a high profile case of a mentally handicapped woman who had fallen pregnant and her doctors/family wanted to abort the child and sterilise her. Can't recall the exact details now, it was a while ago. But it raised all these issues of consent and medical intervention.

I'm not really looking for definitive answers. I know there are grey areas but they are usually the most interesting because they make us confront our assumptions about who we are and what rights we should have.
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Old 05-01-2018, 03:11 PM
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Default Medical decisions: who has the last word?

Funny you say we trust doctors a lot. Maybe more so across the pond, but increasingly there seems to be an inept group of ďdoctorsĒ in the US.

We used to have a family doctor we trusted. He was old and then retired. Since then we have had a long string of retards posing as physicians.most of them are DOís or PAís instead of MDís, but itís all thatís covered by our insurance plans now.
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Old 05-05-2018, 06:52 AM
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Originally Posted by flyingtart View Post
Not in every case. What if a person isn't capable of giving permission, by being unconscious, too young or mentally incapable, for example?

.
As an EMT that concept is taught as Implied Consent.
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Old 05-05-2018, 07:01 AM
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In a way this is a bit ironic - because I have seen many arguments that the State (we'll let this be the amorphous State) should step in when parents, for religious reasons decide to not treat/save a child.

When the argument flips, and it's the State wanting to pull the plug....

The answer to this is - if the State, and not the parent, guardian, patient/citizen makes the decision, then you (the collective you) are subjects and not citizens.
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Old 05-22-2018, 11:56 PM
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Originally Posted by flyingtart View Post
(Prompted by Mo's thread, but rather than get bogged down in that specific case I wanted to discuss the subject generally.)

We trust doctors a lot so it's usually not an issue. And we can always get a second opinion if we think a doctor is wrong. But at the end of the day who should get to make the final decision on whether we get treatment and what that treatment should be?

The fact is, doctors can be just as opportunistic as anyone else. Isn't a plastic surgeon exploiting the foibles of his "patients" when he keeps giving them larger breasts or smaller noses?

And shouldn't people be trusted to decide for themselves, and by extension their families? Doctors don't know everything. But then again, neither do parents.

Who do we belong to, in the final analysis? Who should decide to switch off life support when we aren't able to decide for ourselves? Is it helping anyone to drag cases through the courts to settle it?
We belong to ourselves, court is a way to present evidence, discuss complex issues and represent the best interest of the party who cannot represent themselves should a breakdown in trust occur or a complex judgement call be required. Advances in medicine have taken things to the point where the patient’s representatives can become burdened or empowered by options and the controlling effects their right to choose has on the outcome of another.

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Old 05-24-2018, 09:58 PM
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I've been with the same woman now for eight years ( a record for me), but two years into our relationship she contracted meningitis and went into a coma for three and a half weeks.

When it came time to insert a feeding tube, or allow her to die, the hospital's palliative care doctor advocated not inserting the tube, and stopping the I.V. fluids she was receiving, as he said it was more humane to end her life quickly through dehydration (about three days, he said) as opposed to the three weeks or so she might hang on while starving to death.

I had spent every hour I was not working, sitting by her side, sleeping in that tortuous contraption they called a chair, watching her, so I was there when she woke for a few seconds or a minute every once in a while. I saw her eyes open, I saw life within them, then the light would fade and she would go out again.

I saw life, though, where no one else did.

This doctor, though, dismissed my input, attributing it to false hope, and the general consensus was leaning toward his way of thinking, that she was brain dead and there was no hope.

I called a meeting of everyone who mattered in her life: her family, her medical caregivers, her social workers, and I told them what I'd seen, then let the doctor give his recommendations.

During the meeting, Lisa woke up, and the doctor asked her if she knew why we were there.

"You want to let me die," she said.

"Is that what you want?" he asked, and she said, "Nooo..." and sank back into a coma.

The doctor proceeded to maintain that she was beyond hope, and we needed to let her go, so I called a vote. Each person was asked, one by one, what they thought Lisa would want, and outside of the medical community, they all said she would want to fight.

The decision was made, and she was immediately flown to San Francisco where a world renowned brain surgeon drilled a hole in her skull, inserted a tube which drained the excess fluid to her stomach, and saved her life.

There was some damage, but she survived, and we will be married soon.

The thing about it is, this same palliative care doctor was the one who we turned to when my father suffered a seizure and ended up in a coma (he had Alzheimer's). His recommendations were the same, then, and we went with them (my input, again, was based on what I'd seen when no one else was there -- my father awake for a moment, looking down on his wasted body with a look of anguish, clearly not wanting to be here anymore), but afterwards, I wondered, is this what he recommends every time? What if the patient has no advocate?

Since then, I've come to trust doctors a lot less. They're fallible, like anyone else, more so in some cases, because they get so full of themselves they refuse to entertain any evidence that they may be wrong.

My advice is, when it comes to critical decisions, educate yourself. Doctors are nothing more than mechanics; they know how to work on something you don't. It's best to find out what you need, then have them do it, rather than give them free rein to do as they please. They'll put a 'Vette motor in a Honda Accord, if you've got the money, but if you don't, it's off to the junkyard for you.

Fuck them.
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Old 05-25-2018, 12:55 PM
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Originally Posted by Prodigalson View Post
I've been with the same woman now for eight years ( a record for me), but two years into our relationship she contracted meningitis and went into a coma for three and a half weeks.

When it came time to insert a feeding tube, or allow her to die, the hospital's palliative care doctor advocated not inserting the tube, and stopping the I.V. fluids she was receiving, as he said it was more humane to end her life quickly through dehydration (about three days, he said) as opposed to the three weeks or so she might hang on while starving to death.

I had spent every hour I was not working, sitting by her side, sleeping in that tortuous contraption they called a chair, watching her, so I was there when she woke for a few seconds or a minute every once in a while. I saw her eyes open, I saw life within them, then the light would fade and she would go out again.

I saw life, though, where no one else did.

This doctor, though, dismissed my input, attributing it to false hope, and the general consensus was leaning toward his way of thinking, that she was brain dead and there was no hope.

I called a meeting of everyone who mattered in her life: her family, her medical caregivers, her social workers, and I told them what I'd seen, then let the doctor give his recommendations.

During the meeting, Lisa woke up, and the doctor asked her if she knew why we were there.

"You want to let me die," she said.

"Is that what you want?" he asked, and she said, "Nooo..." and sank back into a coma.

The doctor proceeded to maintain that she was beyond hope, and we needed to let her go, so I called a vote. Each person was asked, one by one, what they thought Lisa would want, and outside of the medical community, they all said she would want to fight.

The decision was made, and she was immediately flown to San Francisco where a world renowned brain surgeon drilled a hole in her skull, inserted a tube which drained the excess fluid to her stomach, and saved her life.

There was some damage, but she survived, and we will be married soon.

The thing about it is, this same palliative care doctor was the one who we turned to when my father suffered a seizure and ended up in a coma (he had Alzheimer's). His recommendations were the same, then, and we went with them (my input, again, was based on what I'd seen when no one else was there -- my father awake for a moment, looking down on his wasted body with a look of anguish, clearly not wanting to be here anymore), but afterwards, I wondered, is this what he recommends every time? What if the patient has no advocate?

Since then, I've come to trust doctors a lot less. They're fallible, like anyone else, more so in some cases, because they get so full of themselves they refuse to entertain any evidence that they may be wrong.

My advice is, when it comes to critical decisions, educate yourself. Doctors are nothing more than mechanics; they know how to work on something you don't. It's best to find out what you need, then have them do it, rather than give them free rein to do as they please. They'll put a 'Vette motor in a Honda Accord, if you've got the money, but if you don't, it's off to the junkyard for you.

Fuck them.


I have watched Hospice kill or allow to die, two people now. Thereís is a business around facilitating the death of an individual. They make wonderful money at this business.

They are like natures garbage men. They pick up the trash and discreetly get rid of it for us. Itís what most people want. They want someone to take away the bad and make us feel good about what weíve allowed them to do.

I donít know the right answer here; both of the people I watched die were old and in pain. I just know Iím not going to let hospice ďtake careĒ of me. Once they get that heroin in you, you canít resist.
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Old 05-26-2018, 03:17 AM
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It is clear it is the medical that has the upper hand for now.
It is not about what one wants it is what they want to do.
Humans are the experiment for science to embodyment.
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Old 05-26-2018, 11:14 AM
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Originally Posted by brianpatrick View Post
I have watched Hospice kill or allow to die, two people now. Thereís is a business around facilitating the death of an individual. They make wonderful money at this business.

They are like natures garbage men. They pick up the trash and discreetly get rid of it for us. Itís what most people want. They want someone to take away the bad and make us feel good about what weíve allowed them to do.

I donít know the right answer here; both of the people I watched die were old and in pain. I just know Iím not going to let hospice ďtake careĒ of me. Once they get that heroin in you, you canít resist.
Like you say, Hospice helps to clean up the mess. Grandma getting cranky because she's dying? No need to run in there every time she cries out, or wants someone to just sit with her - just call Hospice and gow that bitch out on liquid morphine.

That's what they did with my mother-in-law (five daughters, and only one would sit with her), until Hospice was called in with their heroin - then the one daughter was right there, administering that shit every couple of hours, keeping her damn near comatose, but somehow getting her to sign over power-of-attorney to her. She drained twenty grand from the bank account, and stole the safe with all the financial documentation (there was evidence of a variety of accounts and investments which disappeared) before we caught on and reversed it.

In another instance, their help was welcome, as a woman I knew was dying (liver failure from too many years of alcohol and drugs), and her kids were all on drugs, too busy to pay any attention to her. I hooked her up with a woman who did in-home health care (a saint), who took care of her until right before the end, when she called in Hospice. They were a god-send, that time.

Originally Posted by Nacia View Post
It is clear it is the medical that has the upper hand for now.
It is not about what one wants it is what they want to do.
Humans are the experiment for science to embodyment.
It's all an experiment. That's why doctors 'practice'. That said, they've saved my life and a couple of limbs before, that I would have lost otherwise, so I can't criticize too much...
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