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When should life support be cut off?

Medical Ethics End of life 2008

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#41 gsmonks

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Posted 24 June 2008 - 03:32 PM

View PostRaina, on Jun 22 2008, 01:22 AM, said:

I've been following this story, which is related to another current discussion about religion and medicine, and whether someone's religious beliefs should be allowed to trump medical practice.

From CTV

Quote

Two more doctors have stopped working shifts at a Winnipeg hospital's critical care unit to avoid treating an 84-year-old man on life support. A third doctor said surgery needed to keep the patient alive was like "torture."
...
Golubchuck's doctors have recommended that he be removed from life support, but his family has fought that in court. They are Orthodox Jews, and their beliefs strictly forbid the hastening of a death.
...
On Monday, doctors Bojan Paunovic and David Easton became the second and third doctors to stop accepting shifts at Grace Hospital's critical care unit.

Dr. Anand Kumar had told Golubchuck's family it would be best to take him off life support because he has minimal brain function and his chances of recovery are slim.
...
In his resignation letter, Kumar detailed how doctors had to "surgically hack away at Golubchuck's infected flesh" because of ulcers on his skin. He likened the treatment to torture.
...
"It would be against their religious convictions not to fight for life and there is life and they are fighting," Kravetsky told CTV Winnipeg.

I also read in the newspaper (I can't find the same article online) that that hospital had to close down two ICU beds in order to come up with the resources to keep the man alive, and that the average ICU patient costs $2000/day to keep alive.



Do you think the doctors had a right to refuse treatment? Do you think their medical oaths and/or personal ethics should trump the family's religious beliefs?

Do you think that the healthcare system has the right to cut off treatment and indirectly kill him? Do you think that the family has the right to put more strain on an already strained healthcare system and use up resources that could be used to help someone else who does have a chance at recovery, when he's likely dead in all but body?

What should happen when a person's religious beliefs (the family's belief that cutting off life support would be murder) cross the line into impeding on the rights and beliefs of others (the doctors' belief that keeping him alive is torture, and the rights of other people to use the resources that he's taking up)?

The claim of "hastening of death" is ridiculous because just the opposite is what is occurring. This is a case of stupidity, not of being Jewish. None of my Jewish relatives or friends would buy into this.
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#42 Raina

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Posted 24 June 2008 - 05:57 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 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.

View PostBroph, on Jun 24 2008, 04:18 AM, said:

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.

There is a difference between personal/religious ethics and professional ethics. If soldiers refuse orders because it goes against their personal or religious ethics, then I would object. But if they refuse orders because it goes against their professional ethics as codified under the laws of the military code, then that's fine because that's what the code is there for to begin with.

I don't know if I haven't made myself clear or some people just aren't bothering to actually read my posts, but as I said earlier: 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.

That's why I don't think pharmacists should be refusing to fill birth control prescriptions because it conflicts with their personal ethics, but I think that doctors should be allowed to refuse treatment of a brain dead person because it is in line with their professional ethics.

*sigh* I don't know why I keep hoping that people can make fine distinctions like this between personal and professional.

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#43 Broph

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Posted 24 June 2008 - 08:19 PM

View PostRaina, on Jun 24 2008, 10:57 PM, said:

I don't know if I haven't made myself clear or some people just aren't bothering to actually read my posts, but as I said earlier: 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 don't think what you said was clear; it sounded to me like you were saying that a patient's family should order the doctor the keep the patient alive with machines even if the doctor doesn't think that there is a chance for survival.

Quote

That's why I don't think pharmacists should be refusing to fill birth control prescriptions because it conflicts with their personal ethics, but I think that doctors should be allowed to refuse treatment of a brain dead person because it is in line with their professional ethics.

Why not, though, when the patient is choosing BC because of their personal ethics?

#44 Nikcara

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Posted 24 June 2008 - 09:56 PM

I agree with Raina here, and it feels like a lot of people are misreading her

For example: a solider knows, when s/he signs up, that they may have to kill another human being in battle.  If this violates your personal ethics, because you are Quaker or even a non-religious pacifist, you shouldn't sign up.  If you believe that killing another person under any circumstance is wrong, you would probably not even bother signing up for a job in the military.
BUT
There are also guidelines within the military that you can expect to be adhered to.  Soldiers KNOW that they should not kill children who are doing nothing worse then playing in their front yard, or raping women, or torturing people.  That is in the professional guidelines.  It's in the handbooks.  It's known that this is not allowed, and if you are ordered to do something that is not allowed, the military rule supersedes your commanding officer and you can be punished for following that order.  I mean, generally speaking people will do what a cop tells them to, but if a cop came up to them and told them to beat up a homeless guy in front of them, most people would know that DESPITE having the cop tell them to do it, that action would still be illegal.


Here's another example of separating professional and personal life: I work with the mentally retarded.  Basically speaking, I control what my clients do all day.  So what if I decided that since some of my clients aren't Christan, that means I need to spend the entire day teaching them about their lord and savior jesus christ?  Even if they don't want to hear about it?  What if I tried to convert all my clients to Wicca or paganism?  Some of my clients have very deep religious convictions - would I be right in telling them that I think they're going to burn in hell because they don't believe what I believe?  A few weeks ago one of my clients had her 72nd birthday party and asked me to go to church with her.  Generally speaking I hate church, Christianity isn't my religion and I want to tell most pastors to leave me alone.  But I went, because A) she really wanted me to and B) I can separate between what my personal beliefs are and harmless ways of making another person happy.  The fact that I personally find it morally appalling to teach people to shun and condemn people who are different because they are gay or follow a different religious path does NOT give me the right to tell my clients that their beliefs are wrong (yes, I know not all churches do this, and this tactic is certainly not limited to Christian churches)
And since I really do have alot of control over their lives...I'm a vegetarian.  Does that mean I should be allowed to tell my clients that they can't eat meat?  Should I really be allowed to throw away any of their food for them because it violates my personal convictions?  Some of these people have pretty delicate metabolic systems to begin with.  If I'm allowed to, without any repercussion, not separate my personal ethics, which I follow, with my professional ethics, I could deny meat to all of my clients, mess up their diets in ways that can do serious physical harm, and make them go hungry after lunch everyday because I threw out half their food.
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#45 Nikcara

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Posted 24 June 2008 - 10:00 PM

View PostBroph, on Jun 25 2008, 01:19 AM, said:

View PostRaina, on Jun 24 2008, 10:57 PM, said:

I don't know if I haven't made myself clear or some people just aren't bothering to actually read my posts, but as I said earlier: 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 don't think what you said was clear; it sounded to me like you were saying that a patient's family should order the doctor the keep the patient alive with machines even if the doctor doesn't think that there is a chance for survival.

Quote

That's why I don't think pharmacists should be refusing to fill birth control prescriptions because it conflicts with their personal ethics, but I think that doctors should be allowed to refuse treatment of a brain dead person because it is in line with their professional ethics.

Why not, though, when the patient is choosing BC because of their personal ethics?

Very often the patient isn't choosing BC because of their personal ethics.  It's often a matter of health.  And it's FAAAAR more often then most people believe.  Just look at the number of women on this board alone who have come out and said "I need BC for medical reasons".  It's not at all uncommon for women to be on BC until they want kids, and then they suffer through the effects of not having BC in order to conceive, and then get right back on BC as soon as they can to mitigate pain, mood swings, endometriosis, or other medical problems that BC manages.
We have fourty million reasons for failure, but not a single excuse  -- Rudyard Kipling

Develop compassion for your enemies, that is genuine compassion.  Limited compassion cannot produce this altruism.  -- H. H. the Dalai Lama

#46 Shalamar

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Posted 24 June 2008 - 10:05 PM

Standing Ovation for Nikcara - exactly what needed to be said.

Do not join a profession if you can not follow the professional ethics of that profession.

If your personal ethics will override your professional ones there is a problem and you should not have joined that profession in the first place.

No one is make to join any profession- our jobs we choose for ourselves and IF we take a job we should do it. IF you can't then quit the job.

Jobs are not mandatory  - and while working to bring in a paycheck generally is - but which job you do is YOUR choice and yours alone. and when you go to do your job - you do adhereing to the ethics of the profession - or you are failing your job, and need to find another one.

Plainly if brutually put.
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#47 Raina

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Posted 24 June 2008 - 10:27 PM

What Nikcara and Shal said.

Broph said:

I don't think what you said was clear; it sounded to me like you were saying that a patient's family should order the doctor the keep the patient alive with machines even if the doctor doesn't think that there is a chance for survival.
I was saying that in this case, when the doctors made a call based on their professional ethics, then it should stand (especially since there was a consensus among several doctors). But then G objected to people with strong religious convictions being kept out of specific fields, and I responded that people should only be applying for jobs that they are willing to do, based on their religious limitations.

It's a fine distinction, but an important one nonetheless.

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#48 G1223

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Posted 24 June 2008 - 11:10 PM

And I point out that these people wanted to pull the plug on the man. They did not do it out of issues of faith.The people with the faith issues were the man's family. These doctors quit their position rather than keep cutting dead tissue off the husk that was on life support.

Edited by G1223, 24 June 2008 - 11:10 PM.

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#49 Broph

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Posted 25 June 2008 - 06:13 AM

View PostNikcara, on Jun 25 2008, 03:00 AM, said:

Very often the patient isn't choosing BC because of their personal ethics.

We're debating that on the other thread.

#50 Nikcara

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Posted 25 June 2008 - 11:46 PM

ACK!  thread confusion.  Sorry bout that.
We have fourty million reasons for failure, but not a single excuse  -- Rudyard Kipling

Develop compassion for your enemies, that is genuine compassion.  Limited compassion cannot produce this altruism.  -- H. H. the Dalai Lama

#51 Raina

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Posted 26 June 2008 - 03:08 AM

The poor man is finally at peace.

"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

"I believe what goes around comes around and if I am the instrument of 'coming round' then I'll do it happily. " -Shal


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#52 G1223

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Posted 26 June 2008 - 08:38 AM

He had been for a great while the husk was finally allowed to stop existing.
If you encounter any Trolls. You really must not forget them.
And if you want to save these shores. For Pity sake Don't Trust them.
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.



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