Medical Ethics (Guided Forum)

[Talon87]

We haven't had a good discussion in a while, and everybody's talking about how UPN is their "go-to" place for mature and enlightening discussions. So ... this is an oldie but a goodie, and it's been on my mind a lot of late as I anticipate going to med school and taking a course in Medical Ethics.

Life 1: you live a short but happy life. Your decisions hurt no one outside of yourself: you have no living family or friends, you support your own existence by farming your own plot of land and raising your own chickens and sheep, etc. You are a self-sustaining island unto yourself. And it is in this "island" that you do drugs. The drugs themselves don't matter -- just so long as you're not hurting anybody, it could even be a drug that kills you within the week. The point is, you chose to use this drug of your own free will, and you feel infinitely happy while on the drug. Within two months, you die.

Life 2: you live a long, protracted life in a hospital ward. You are alive. You are cognizant. But you cannot move a single muscle -- not even one eyelid. You are kept alive solely through the magic of modern medicine, and even if you wanted to die, you cannot communicate this desire due to your paralysis. Nurses come to change your feeding tube and to change your diaper, and you simply sit, staring up at the ceiling. Your mind is able to process everything like it used to, but you are all alone with your thoughts and whatever else the doctors and nurses might be chitchatting about down the hall. And you spend days, weeks, months, years in this ward ... until you finally cannot be kept alive any longer, at the ripe age of 102. You entered this hospital eighty-five years earlier.

Which situation is worse, and why?

Some sub-questions to think about in approaching the major challenge:
- Is hedonism a valid approach to life? (If so, what prevents you from becoming a coke addict?)
- Is life worth living simply because it is life? (i.e. does life have intrinsic merit? or is any merit to life assigned by our minds and our society?)
- Is it better to live long and be sad or to live briefly but to die happy?

This is not an easy question to answer, I believe. We obviously all hope for "Option C," the answer which says you can live both a happy and a long, healthy life. But given the choice between longevity and self-destructive happiness, which would you choose?

[Kasumi Violet]

1.) No man is an island. I can't even begin to fathom the ethics involved in that situation. I suppose if someone lives by themselves, they have a right to kill themselves. I just don't think it should be touted as a happy choice. Honestly, some people are going to be hedonistic no matter what. What society’s job should be is to limit its impact on others. The whole "Your rights end where I begin" type of the thing works pretty well and has been one of the more prevalent ideas explored in the court rooms in recent times. I have to admit that being pro-choice makes me more aware of who tries to control others and if it's necessary or an invasion of rights.
Things like drugs add in a grey area in the realm of choice, drugs certainly begin as a voluntary activity, but at some point they become involuntary (as many former addicts have stated). At what point can something that messes with a person's brain chemistry be considered a free choice, and at what point can a person be pronounced as not being in their right mind due to the damage to the chemical balance due to drugs?

2.) I'd hate for that to happen to anyone. I believe people should have a right to terminate medical treatment (including feeding tubes and respirators) whenever they want to, barring those who are not in their right mind and those suffering from mental illness.
I think that there is a danger in giving a value to a person's life that conflicts with their assigned value of their own life. Very few people argue that the soldiers of WWII or the Civil War were wrong in their actions to fight and in many cases to die for a cause they believed in. In fact, most people see soldiers of most wars as heroes.

[Doppleganger]

This sounds like comparing a long, sustained nightmare with a short, eventful wet dream. The former (Life 2) is far more horrible than the latter (Life 1), since human beings were bestowed by biology with the equipment for locomotion and sensing one's surroundings - the latter denies the poor bed-wridden fellow both of these gifts, with the added nail of an extremely long period of undue stress. If that was enough, the final choise puts a burden on the living people, whereas choice one's hermit life affects no one but the individual who chose that life.

>>Is hedonism a valid approach to life? (If so, what prevents you from becoming a coke addict?)

Depends on the criteria of a person's afterlife perception. People are naturally inclined to maximize pleasure in the short-run with less weight given to matters in the far future. Because, if one does not survive enough to get to Point A, why should one worry about Point B distance X beyond Point A? But if people have the belief that they will get automatically transported to, say, Point C when they die, and there are branches from Point D that a living human being would favour or disfavour (id est, a life of pain or pleasure) taking into account Point B and how to get there becomes all the more salient.

That said, it also depends on the degree of hedomism. Does the hedonism harm other people, or is it relatively benign? Certainly most moral dieties would not frown on a person for having an obsession with collecting buttons (outside of giving up worldly pleasures to reach the next life), but I'm certain nine out of ten dieties would have condemned Ken Lay. In fact, I think one of them went out and punished him. >_>

>>Is life worth living simply because it is life? (i.e. does life have intrinsic merit? or is any merit to life assigned by our minds and our society?)

Nature doesn't think so. She gave us pain and a mortal fear of death to keep us alive but at the same time programmed us with a "threshold" point where we weaken, become sick and eventually die to enrich the Earth again. The idea that one should "try to live because one is already alive" needs to have a "except when you've lived enough" clause at the end.

>>Is it better to live long and be sad or to live briefly but to die happy?

As phrased, this question leans heavily toward the latter, since the "value" is different for both - "live long and be sad" implies that long life is the value, and "live briefly but to die happy" implies happiness is the preferred goal. Given this choice, I'm sure most people would pick the latter unless they have good reason to be positively terrified of death.

Thinking about old folks though, it really depends on a case - what do they care about? Some old folks live alone with the hope that someone will take notice of them - others enjoy privacy and various hobbies. Others live for the sake of seeing grand children or great grandchildren or, in one strange case with a woman at my church, great great grand children and interacting with them. Some have an axe to grind!

Values are shaped by culture and life experience, so I do not think we would he able to make a general hypothesis of what people should do across nations and ideologies - "firecracker" and "voltive candle" type folks exist in all societies.

[Another Fan]

First situation is better. Suffering is worse than being high. Doesn't mean the first is good. Mainly cause I do not believe that that would be as described with infinite happiness. Certainly not with me, as the parts where I am not completely doped up, and that is like completely, I will feel horrible due to caused by loneliness (man needs people, and is goal-oriented, in such a situation, most if not all people will eventually be hit by morbid depression and psychosis during the even short sober stages)

- Is hedonism a valid approach to life? (If so, what prevents you from becoming a coke addict?)
Duh. Reason above. Pleasure is causes us to seek out and do things. However, it is possible to get pleasure from doing things that aren't exactly the best for us (evolutionwise). We are wired so that we eventually feel horrible misery if we get only pleasure from things like that.

- Is life worth living simply because it is life? (i.e. does life have intrinsic merit? or is any merit to life assigned by our minds and our society?)
No. But we think it is, it is not possible to think otherwise for us. Most of all our actions are steered for it, at least originally. The only reason we can even consider the idea of life being bad, is because this sort of reasoning is a byproduct of the things we developed to survive better. Oh, and I disagree Doppel. Sickness and weakness is either for extending the life of other things (sickness) or flaws (weakness).

- Is it better to live long and be sad or to live briefly but to die happy?
Nothing is better. Life is a neutral ground. All happiness is a trick of the mind. So, if accepting that, we can say that whatever makes you happy is the best. Some would say, a long and sad life would make them feel meaningful and full, which would give them ultimate happiness above brief bliss. Others would disagree.

[PiccoloNamek]

N/M

[Another Fan]

Hey can we choose terminal but with people and not high?

I guess that isn't an option cause we are contemplating extremes but the discussion is really pushed off the basic theme cause of the drugs and loneliness. We could just say short and happy (for the right reasons) or slow but sad (for the right reasons). That would make the discussion slightly different, but closer to the original idea I think.

[Talon87]

Imagine you are in a medical ethics course. You and your fifteen classmates are all sat in the same room at a long rectangular table. Your proctor raises the question I posed in the first post. Imagine how the conversation would naturally evolve.

We are the classmates. Respond to me. Respond to each other. Pose questions. Challenges. Ethical dilemmas. All on topic, of course. "What is on topic, Talon?" you may ask me. Well, at the very least, I would hope to see replies dealing with the following questions:

- Is a sad life worth living? Should people kill themselves? Or is there hope for a better tomorrow? Is death justifiable if all the signs point to No Hope?

- Assuming it is a victimless crime outside of the user, is drug use something we should allow individuals to decide for themselves? Or do we as health care providers have a civic responsibility to tell other people what they can and cannot do to their bodies?

- If somebody tells you, "I want to do This. Doing This will make me happy but kill me. Not being allowed to do This will keep me alive a little longer but I will not be happy during that time," should you allow them to satisfy their desire for happiness and kill themselves? Or is it your responsibility to make sure they live, even if it is suffering? In other words, is a doctor's duty to save lives or to save psyches?



One example I can think of (from a medical context) is ...

There is a patient with a brain tumor in the area responsible for musical creativity. He is a musician and defines himself by his music. He tells you, "I would rather die than lose my ability to play and compose music." Are you Savior or Villain if you restrain him and surgically remove his tumor? (Never mind the after-effects; in the here and now of deciding to restrain him and operate, have you committed a sin or are you doing what's best?) On the one hand, this example seems open-book, case closed. "Don't take away his music. :cry:" But on the other hand, people make new lives for themselves all the time. By definition, any new life is better than no life at all ... isn't it?




This is the platform from which I would like to see you spring. These are the questions I (selfishly) would like to see answered by each of you. However, you are free to dive from this diving-board and to swim for however long you want in any direction you so choose. Explore what interests you.

[Another Fan]

Super. Life is worth swat. Let the guy do what he wants. Screwing himself over yeah, but whatever.

Of course, I can't work like that. I'm way too sensitive a person. So, making people horribly miserable through inaction isn't great for my conscience. Nor is killing people in general. Super.

Basically, it is a catch 22. This guy will never be happy. That's great. However, that is if we accept the idea of happiness to be unreachable. Most people do not accept that, and therefore would file against it. Super. Majority wins. He stays alive against his will in hopes that things will get better.

The neutrality of death is a horribly fascinating thing.

So, I see you don't want to be a part of the discussion yourself, Talsies?

Anyway, I'm for life. Even discussing the idea of suicide as a option will cause most people to cause a fit. My mom would hurt me now probably for contemplating this.

[Doppleganger]

Found this on /m/. Distantly (http://www.metro.co.uk/weird/article.html?in_article_id=56500&in_page_id=2) related?

[Talon87]

I not only want to be (why else would I have asked if I didn't plan to partake in the pleasantries?) but I will have to be a part of the discussion in the real world. For us today, I am inviting you to roleplay as a medical student. For me in a month, this is the sort of question my ethics prof might pose to me and my fifteen other classmates. These questions are very, very real.

I don't want to say too much yet (although as Doppel has pointed out, my bias is oozing out of the posts due to my subconscious choice of words). I would like to try to give everybody as unbiased a chance as possible to respond and get the ball rolling. And then, via replying to your replies, I will be able to express my own beliefs.

The buck doesn't stop there, though; you guys are my colleagues, not my tools. :P You are free (and encouraged!) to then use my replies for your own growth, your own curiosities, etc. Pose challenges to me. Ask me stuff. etc. Nobody's really asked me what I think yet, nor has anybody made up examples of their own that fascinate them. (And you don't have to! But I'm saying you can if you want. This thread is your platform. Go where you will.)

I will say one thing: you cannot become a doctor without taking the Hippocratic Oath. Yet I wonder how many doctors ...
a) truly believe in the Oath when they take it?
b) believe in the Oath when they take it but quit believing in it later in life?
c) violate the Oath in practice, even if they [think they] believe in it in theory?


I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

[Talon87]

I have changed the thread title to "Medical Ethics (Guided Forum)", implying that we do not have to keep this thread restricted to the original polar question ... although I must insist that I would like to explore it! ^_^; But by all means, let's have a discussion.

Imagine we are all sat in the same room at the same table!!! Show proper debate etiquette. When in doubt, assume your peers are intelligent but perhaps not aware of what you're sharing. Do not patronize, but also do not assume they can read your mind. Citations are welcome. So are "opinions which cannot be disproved" -- we are not here to discuss science, we are here to discuss philosophy. Philosophy is rife with opinions and beliefs which (like religion) cannot always be disproved but can only be argued for or against.

As usual ... I will have a much harder time of following my own instructions than most of you. ^_^; *horrible hypocrite, gotta work on that* So don't take this as an attack at anybody, so much as guidelines for all of us ([strike:15052]including[/strike:15052] ESPECIALLY me! :oops: :x ).

[Kasumi Violet]

Re: Hippocratic Oath
I think that an abortion back in the day was far different than an abortion is today. It used to basically be a poison and more dangerous than childbirth. And correct me if I'm wrong, but didn't most people of that time period deal with unwanted babies by leaving them exposed to the elements? Yup 4th Century BC

It also has other elements which aren't followed. http://en.wikipedia.org/wiki/Hippocrati ... _relevance (http://en.wikipedia.org/wiki/Hippocratic_Oath#Modern_relevance)

[Talon87]

Yeah yeah, I read that myself last night. But the important thing to note is "depending on the institution", i.e. I have no idea what form IU's Hippocratic Oath might take.

[PiccoloNamek]

Hey Talon, tell me what you think of this:

http://forums.intpcentral.com/showpost. ... stcount=35 (http://forums.intpcentral.com/showpost.php?p=660005&postcount=35)

In particular, the part where he says his buddies threatened the doctor with mafia tactics to get the medicine.

[Holy Emperor]

The second one is worse. How is it any difference then being a ghost? Unable to interact with the world, just sitting on the sidelines watching it go by.

[Talon87]

Hey Talon, tell me what you think of this:

http://forums.intpcentral.com/showpost. ... stcount=35 (http://forums.intpcentral.com/showpost.php?p=660005&postcount=35)

In particular, the part where he says his buddies threatened the doctor with mafia tactics to get the medicine.

Wow, just read this. (Sorry for the delay! :oops: ) That guy described the story somewhat graphically, but it got the point across: his mother suffered not only painful but humiliating consequences from radiation surgery. The thing is, none of that is the doctors' fault. That's the cancer's fault, or you could say "that's nobody's fault." The doctors did the best they could, and this guy is getting all pissy with them. The only part where I think he has a legitimate point that the doctors were not giving it their full (human) all, even though they were giving it their legal all, was the morphine bit. Otherwise, he's getting angry at the doctors for his mother's "scarring," "oozing", "vaginal probings," etc. etc. when NONE of that is their fault and is all the consequence of the radiation therapy needed to keep her alive. In other words ... I think this guy is a rather disgusting son, since he's putting too much Heroism on his plate and too much Villainy on the doctors'. "For goodness' sake, if the doctors had not "welded her asshole shut such that she needed you to pry it open with your fingers and get her pubes in your mouth," then your mother would likely be dead" is what I would like to tell this guy. Unfortunately, you can't get away with such words without losing your license unless you are defending yourself in a court of law. :|

Now, on to the morphine bit + "mafia tactics." I think "a man's gotta do what a man's gotta do." I think what he did is both unethical and ethical. I think what the doctor was originally planning on doing was both unethical and ethical. And I think what the doctor ultimately did was both unethical and ethical. Welcome to the real world where there is no Black and White and everything is gray. If they had done this to me, I guess I'd have to make a tough decision between ...

a) doing whatever they asked, and then calling the police and mentioning how I was threatened and cutting my relationship with them. (However, I consider this abandonment of the patient and, in this particular case, the threats are not baseless.)

b) doing whatever they asked, and praying that if I ever do get caught, I can then prove to a jury that I don't deserve to lose my license and I was doing the right thing by the patient (However, I don't think this would hold up in a court of law and I would lose my license.)

So while I wouldn't be having to choose between license + wheelchair and no license + legs, I would have to have be making a similar choice of disgusting results: between license + patient abandomment and no license + standing by the patient.