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When should life support be cut off?

Medical Ethics End of life 2008

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#21 Lord of the Sword

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Posted 22 June 2008 - 11:48 PM

View PostG1223, on Jun 23 2008, 12:45 AM, said:

So the doctors here should have kept the brain damaged  slowly rotting to death body alive? Because the oath seems to be keep people alive and let them suffer. So we drop the do no harm part of the oath to keep a person alive in this condition?

That is not what I'm saying at all...and if you recall, in the Shiavo case, I was for letting her go. I considered it torture to be in that state, and thought the family was wrong to insist she be kept in that condition. You completely missed my points.
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#22 Raina

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Posted 23 June 2008 - 01:03 AM

View PostLin731, on Jun 22 2008, 09:53 AM, said:

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Hey if pharmacists can refuse to do their jobs because of their deeply held convictions, why not doctors too.

Exactly...So we should get our bobsleds ready for that slipperly slope on the horizon because that's where we're headed.

If I were a nurse (under those standards) would I have the right to not take care of drug addicts because the bible says it's a sin? If I were an anethesiologist and an emergency abortion or some other procedure that might violate my religious beleifs came in, should I be able to refuse to put the patient under? How about a police officer? Should I have the right to not take an abusive spouse into custody, counsel the wife to "pray for him"?
That's why I think, under no circumstances, should people be allowed to let their religion dictate what they do in their professional life.

This situation, imho, with the doctors refusing treatment is different, because they are doing it based on their professional oaths. Their professional oaths are the guidelines for how they should perform their jobs, so they (and people in general) are well within their rights to make judgement calls based on their professional ethics. I would feel uneasy with a single person making life-and-death calls like this, but if several people all make the same call based on the guidelines of their profession, then I think they should be able to refuse to treat someone.

By the same token, if a pharmacist knew that a woman were using the morning-after pill as a form of contraception (i.e. she comes in every week), then I think they would be within their rights to refuse to give her a drug that she's abusing and that could threaten her health.

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#23 Shalamar

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Posted 23 June 2008 - 02:15 AM

First off, I want to say that there is NOT one over all, standard  Hippocratic Oath, there are many...

this is one I believe in...

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The Oath of the Healer by Louis Weinstein


In the eyes of God and in the presence of my fellow students and teachers, I at this most solemn time in my life do freely take this Oath, whereby I shall pledge to myself and all others the manner in which I shall live the rest of my days.

I shall be ever grateful to my teachers who have planted the seeds of knowledge, which I shall nurture forever. I thank them for allowing me to see the importance of learning and realize that lifelong study is critically important to becoming a Healer.

I realize that on this day, I become a physician for all eternity. I shall strive to be a person of good will, high moral character, and impeccable conduct. I shall learn to love my fellow man as much as I have learned to love the art of healing.

I shall always act in the best interest of my patient and shall never allow personal reward to impact on my judgment. I shall always have the highest respect for human life and remember that it is wrong to terminate life in certain circumstances, permissible in some, and an act of supreme love in others. I shall never promise a cure, as only death is certain, and I shall understand that preserving health is as important as treating disease. When a patient for whom I have been caring dies, I shall have the strength to allow him or her to die with dignity and in peace.

I shall have as a major focus in my life the promoting of a better world in which to live. I shall strive to take a comprehensive approach to understanding all aspects of life. To become the Healer I wish to be, I must expand my thinking and practice from a system of episodic care to one of a preventive approach to the problems of mankind, including the social ills of malnutrition and poverty that plague the world in which we live.

I am not a God and I cannot perform miracles. I am simply a person who has been given the rights and responsibilities to be a Healer. I pledge to myself and all who can hear me that this is what I shall become.

and this one is very similar...

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A Modern Hippocratic Oath by Dr. Louis Lasagna

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow;

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say I know not, nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body, as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection hereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

This is the one most call The Hippocratic Oath, I believe...

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The Oath of Hippocrates of Kos, 5th century BC:

I swear by Apollo the physician, by Aesculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and judgment the following oath:

To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; to look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and to the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone, the precepts and the instruction. I will prescribe regimen for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug, nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my art. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction, and especially from the pleasures of love with women or with men, be they free or slaves. All that may come to my knowledge in the exercise of my profession or outside of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

There are many others...Seven at this site alone

And all of them speak of good conscience and honor. I can see what is driving these doctors and nurse to quite - not jut to refuse to treat one mortibund man, but to go so far as to quit... What a terrible delima to be caught in.

either they stay and - I'm going to be horribly blunt and it is not meant as disrespect for the hope and dream of this mans family - and participate in what they honestly consider torture of their fellow man, or they quit.

and this is very honestly a far different delima than the one where life begins - this is where does life end - and while we can debate from here to dooms day about when life begins - we must equally look at "when does it end and what is compassion, what is best for the patients health - because death is a part of overall health - the health not just of the body, but the soul.
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#24 Godeskian

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Posted 23 June 2008 - 02:39 AM

View PostLord of the Sword, on Jun 23 2008, 05:40 AM, said:

because there have been too many times the doctors have been proven wrong. How many times have doctors swore that a patient wouldn't walk again...only to have that patient eventually walk?

As compared to the number of times they've said someone won't walk again, and they haven't? Very, very few times I imagine.

The thing is that when a doctor says that someone will never walk again, and they do, it becomes news. It becomes a celebration of human spirit, of drive and determination and an unwillingness to cease to strugglein the face of tremendous obstacles. It becomes an inspiring story for others, and allows someone to regain their former life.

But I can't imagine that it's a statistically signifigant percentage.

Yes, doctors do get it wrong from time to time because medicine isn't a perfect science. However that doesn't mean they get it wrong often, or even regularly when it comes to massive trauma. If they did, then it wouldn't be news. If every person told they'll never walk again did, or even if a signifigant minority of those that were told that did, we'd know about it because it would simply be impossible to hide.

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#25 Raina

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Posted 23 June 2008 - 02:57 AM

View PostShalamar, on Jun 23 2008, 12:15 AM, said:

and this is very honestly a far different delima than the one where life begins - this is where does life end - and while we can debate from here to dooms day about when life begins - we must equally look at "when does it end and what is compassion, what is best for the patients health - because death is a part of overall health - the health not just of the body, but the soul.
Yeah that's why I decided to start this thread now (this may have actually been discussed here a few months ago, before those doctors quit). I figured it'd be an interesting counterpoint to the other thread, and that it'd be especially interesting to see what different points of view the same people have on each issue. :cool:

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#26 Broph

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Posted 23 June 2008 - 06:37 AM

View PostLord of the Sword, on Jun 23 2008, 04:40 AM, said:

because there have been too many times the doctors have been proven wrong. How many times have doctors swore that a patient wouldn't walk again...only to have that patient eventually walk?

Well, what about the case of Christopher Reeve? He decided that he would walk again one day, pushed himself too far and eventually died from his attempts. He probably would have lived a lot longer if he had lived with his condition, but that was his decision.

But for the most part, we're talking about people who can't make their own decisions. Someone who can't walk is obviously alive and can make their own decisions. Take Terry Shiavo (mentioned earlier). I admit that I was wrong. I thought that her actions were a sign that she was alive and awake, but it was obvious later that she was reacting to stimulus. Starving her to death was awful and cruel. But then again, she was hardly on "life support", so I don't know that "letting her die" was the right thing, either.

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I'm all for letting the doctor give his honest opinion...but to then just up and say "No, not treating you any more." just seems like a very slippery slope. You could easily have patients denied care for racial, gender, or religious reasons...only covered up with the doctor's comment of "It would cause undo pain, "ect.

Again, if you're talking about a patient who is awake and making decisions, they can always go to another doctor. But if a person has a terminal illness, the doctor's education and experience probably tells more than the patient can.

#27 G1223

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Posted 23 June 2008 - 07:30 AM

View PostRaina, on Jun 23 2008, 02:03 AM, said:

That's why I think, under no circumstances, should people be allowed to let their religion dictate what they do in their professional life.

Then why limit it to professional life. Why not dictate what professions people of a particualr faith can be into. Oh wait that means Jews can be silversmiths and money lenders.

Sorry trying to say people must leave their faith at the door can leave us with the part that keeps them from acting like monsters at that same door.
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#28 Lord of the Sword

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Posted 23 June 2008 - 01:05 PM

View PostGodeskian, on Jun 23 2008, 03:39 AM, said:

Yes, doctors do get it wrong from time to time because medicine isn't a perfect science. However that doesn't mean they get it wrong often, or even regularly when it comes to massive trauma. If they did, then it wouldn't be news. If every person told they'll never walk again did, or even if a signifigant minority of those that were told that did, we'd know about it because it would simply be impossible to hide.

Very good point.
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#29 Lord of the Sword

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Posted 23 June 2008 - 01:13 PM

View PostBroph, on Jun 23 2008, 07:37 AM, said:

Well, what about the case of Christopher Reeve? He decided that he would walk again one day, pushed himself too far and eventually died from his attempts. He probably would have lived a lot longer if he had lived with his condition, but that was his decision.

True, he might've lived longer. But there is no way of knowing for certain whether he would've or not..He might've simply died around the same time.

Quote

Again, if you're talking about a patient who is awake and making decisions, they can always go to another doctor. But if a person has a terminal illness, the doctor's education and experience probably tells more than the patient can.

I'll admit I'm very biased when it comes to doctors...I lost someone very close to me due to a doctor's screw up, so I can't just agree whole heartedly that the doctor's word is law. And I've seen other doctors who were shall we say, less then intelligent.

Another one wanted to send my Grandfather home when he was on a morphine drip...cause the cancer had spread and he was in that much pain. The doctor said they were having a hard time controlling his pain at the hospital, and were thinking of releasing him to go home with prescriptions for morphine. Or something like that. I started seeing red as soon as I heard they couldn't controll the pain and were going to send him home.

Needless to say I tore that doctor a new one. I "explained" that if they couldn't control the pain here there was no way he would be able to do so at home..and would probably OD from taking too much morphine. And the look on this Doctor's face after I said that was down right scary...almost like he didn't even think of that possibility.

So you'll excuse me if I don't always believe the doctors.
"Sometimes you get the point of the sword, sometimes the edge, sometimes the flat of the blade (even if you're the Lord of the Sword) and sometimes you're the guy wielding it. But any day without the Sword or its Lord is one that could've been better  " ~Orpheus.

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#30 Kosh

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Posted 23 June 2008 - 03:50 PM

View PostGodeskian, on Jun 22 2008, 12:55 PM, said:

View PostLin731, on Jun 22 2008, 05:53 PM, said:

Exactly...So we should get our bobsleds ready for that slipperly slope on the horizon because that's where we're headed.

If I were a nurse (under those standards) would I have the right to not take care of drug addicts because the bible says it's a sin? If I were an anethesiologist and an emergency abortion or some other procedure that might violate my religious beleifs came in, should I be able to refuse to put the patient under? How about a police officer? Should I have the right to not take an abusive spouse into custody, counsel the wife to "pray for him"?

Apparently you can refuse to do your job, as these doctors and the pharmacists from the other thread are proving.


They aren't refusing to do their jobs, they are quitting their jobs, which the nurse can do if she doesn't want to work in a hospitol that treats Drug addicts.
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#31 Lin731

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Posted 23 June 2008 - 05:22 PM

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Then why limit it to professional life. Why not dictate what professions people of a particualr faith can be into. Oh wait that means Jews can be silversmiths and money lenders.

Sorry trying to say people must leave their faith at the door can leave us with the part that keeps them from acting like monsters at that same door.

No one is asking anyone to leave their faith G, they are asking them to leave their faith at the door when they go to work because many, many people don't share the same views. If they can't do that, then honestly they need to find a different profession or specialty within their profession that doesn't infringe on those who don't share their faith. If someone that was Jewish wanted to open a Honey Baked Ham store, fine by me but given that it does conflict so directly with their faith, WOULD THEY? I think the answer in most cases would be "no".

I don't go to people's church and tell them what they must beleive in, I don't go to their homes and tell them how to live. I expect the same respect. If they can't do that without violating their faith, then they picked the wrong career in the first place.

Quote

They aren't refusing to do their jobs, they are quitting their jobs, which the nurse can do if she doesn't want to work in a hospitol that treats Drug addicts.

Don't be surprised though if such an incident occured and the nurse DIDN'T quit but  got fired and then claimed religious persecution
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#32 G1223

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Posted 23 June 2008 - 06:02 PM

View PostLin731, on Jun 23 2008, 06:22 PM, said:

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Then why limit it to professional life. Why not dictate what professions people of a particualr faith can be into. Oh wait that means Jews can be silversmiths and money lenders.

Sorry trying to say people must leave their faith at the door can leave us with the part that keeps them from acting like monsters at that same door.

No one is asking anyone to leave their faith G, they are asking them to leave their faith at the door when they go to work because many, many people don't share the same views. If they can't do that, then honestly they need to find a different profession or specialty within their profession that doesn't infringe on those who don't share their faith. If someone that was Jewish wanted to open a Honey Baked Ham store, fine by me but given that it does conflict so directly with their faith, WOULD THEY? I think the answer in most cases would be "no".

I don't go to people's church and tell them what they must beleive in, I don't go to their homes and tell them how to live. I expect the same respect. If they can't do that without violating their faith, then they picked the wrong career in the first place.

Quote

They aren't refusing to do their jobs, they are quitting their jobs, which the nurse can do if she doesn't want to work in a hospitol that treats Drug addicts.

Don't be surprised though if such an incident occured and the nurse DIDN'T quit but  got fired and then claimed religious persecution

The comment was that those in the medical profession should leave their faith at the door. You do not get to be picky about what gets cut out.

That faith might well have shaped them to be otherwise fine doctors who felt it a sin to keep a rotting corpse alive. I can say that anyone kept this man in such a inhuman condition deserves to suffer it.  Sorry keeping someone alive because they might recover is acceptable but when the writing is this clearly on the wall is something that is very wrong.
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#33 Raina

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Posted 24 June 2008 - 12:14 AM

View PostG1223, on Jun 23 2008, 04:02 PM, said:

The comment was that those in the medical profession should leave their faith at the door. You do not get to be picky about what gets cut out.

That faith might well have shaped them to be otherwise fine doctors who felt it a sin to keep a rotting corpse alive.
There are enough different specialties and jobs available in the medical field that there are other options for people who want to be doctors but object to specific forms of doctoring. If you don't want to have to keep brain-dead patients alive, then work somewhere other than the ICU. If you don't want to perform abortions, go into cardiology or something where you won't have to touch the reproductive system.

Last I checked, it was normal practice in job searching to only apply for jobs that you are actually able and willing to do, based on your skills and any limitations you may have, be they physical or religious.


Though, imho, this is a slightly different matter than faith interfering with your work for the reasons I mentioned above.

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#34 G1223

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Posted 24 June 2008 - 12:57 AM

Nice to live in the hive mind world you descibe.

Here are a few. If you want to deliver healthy babies bea OB/GYN who does not perfprm abortions if you feel they are wrong to perform. Be a critical care line up doctor but be willing to to tell the family that the lights are on but no one is home in the husk that was your father. Have the stomach to look them in the eyes and sy you will not continue to keep the dead body on life support hoping that the blue fairy will be back to tap the dead body into being alive again.

That is the system we have right now.

Edited by G1223, 24 June 2008 - 12:57 AM.

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#35 Raina

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Posted 24 June 2008 - 01:07 AM

I'm still truely confused as to why some people think it's wrong to expect people to perform the jobs that they willingly applied for. :unsure:

"First thing they tell you is to assume you're already dead... dead men don't get scared or freeze up under fire. Me, I'm just worried that hell's gonna be a lonely place. And I'm gonna fill it up with every toaster son of a bitch I find." -Racetrack

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#36 G1223

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Posted 24 June 2008 - 01:21 AM

The soliders should be foreced to obey orders they think are wrong. They signed up for it after all. or is it only those folks who YOU feel should have to do what YOU want and their objections be dammed.
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#37 Captain Jack

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Posted 24 June 2008 - 03:32 AM

Edited since no one gives a sh*t... Obiviously no one wants to read about one's personal experience and would rather go on arguing.  So fine.  It's the last time I share a personal experience here.

Edited by Captain Jack, 26 June 2008 - 12:12 AM.

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#38 Broph

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Posted 24 June 2008 - 06:18 AM

View PostRaina, on Jun 24 2008, 06:07 AM, said:

I'm still truely confused as to why some people think it's wrong to expect people to perform the jobs that they willingly applied for. :unsure:

I'm still confused why laypeople think that they know better than doctors as to whether a life is being saved by a treatment. Sure, doctors disagree at times, so there are 2nd and 3rd opinions. And maybe it would have been that 10th opinion that might have made a difference, but just because a machine can be used doesn't mean that it should be used.

Celtics star Reggie Lewis had a heart problem and was told by cardiac experts that he'd never play basketball again. He went to another hospital where doctors cleared him to play and he died of a heart attack during a pickup game several days later. He would have kept looking for a doctor until he heard what he wanted to hear.

#39 G1223

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Posted 24 June 2008 - 12:49 PM

View PostCaptain Jack, on Jun 24 2008, 04:32 AM, said:

And soldiers are not supposed to simply take orders, G1223.  If an order is unethical, wrong, or goes against protocol in any way, that is unjustifiable under the laws of military code, it can and should be refused.  If the person giving the order is unfit for duty mentally, for example.  Or an order to execute civilians just because, is another.


But Captain they knew this and signed up anyway. According to the Raina method of thinking it appears they should not be allowed to question the orders given.

Just as doctors should treat all illnesses without any concern for the ethical issues they might feel. We cannot allow people in the medical profession to have any opinions on what they do. But we then demand show us compassion towards our loved ones as well as ourselves. I guess folks want Greg House but demand he be understanding of their feelings.

Edited by G1223, 24 June 2008 - 03:27 PM.

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paraphrased from H. "Breaker" Morant

TANSTAAFL
If you voted for Obama then all the mistakes he makes are your fault and I will point this out to you every time he does mess up.

When the fall is all that remains. It matters a great deal.

All hail the clich's all emcompassing shadow.

My playing well with other's skill has been vastly overrated

Member of the Order of the Knigths of the Woeful Countance.

#40 Captain Jack

Captain Jack

    Where's the rum?

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Posted 24 June 2008 - 03:24 PM

View PostG1223, on Jun 24 2008, 10:49 AM, said:

View PostCaptain Jack, on Jun 24 2008, 04:32 AM, said:

And soldiers are not supposed to simply take orders, G1223.  If an order is unethical, wrong, or goes against protocol in any way, that is unjustifiable under the laws of military code, it can and should be refused.  If the person giving the order is unfit for duty mentally, for example.  Or an order to execute civilians just because, is another.


But Captain they knew this and signed up anyway. According ther Raina method of thinking it appears they should not be allowed to question the orders given.

Just as doctors should treat all illnesses without any concern for the ethical issues they might feel. We cannot allow people in the medical profession to have any opinions on what they do. But we then demand show us compassion towards our loved ones as well as ourselves. I guess folks want greg House but demadn he be understanding of their feelings.

Ah, okay.  I see what you mean.
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Also tagged with one or more of these keywords: Medical Ethics, End of life, 2008

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