Re: OT
- From: Fred J. McCall <fjmccall@xxxxxxxxx>
- Date: Sun, 22 Mar 2009 17:55:29 -0700
"nebulous" <pig@xxxxxxxx> wrote:
:
:"Fred J. McCall" <fjmccall@xxxxxxxxx> wrote in message
:news:f40ds4t9eftj2iufv59lrdlre75679oq0b@xxxxxxxxxx
:> "Glenallan" <robt.black@xxxxxxxxx> wrote:
:> :
:> :>
:> http://scotlandonsunday.scotsman.com/latestnews/Baby-OT-dies-after-treatment.5096558.jp
:> :>
:> :>
:> :> As you know I have a professional involvement in this field - so don't
:> :> really bring the laymans view to it, but it looks as though the judges and
:> :> health staff have made an effort to be more sympathetic and compassionate
:> :> than they sometimes appear.
:> :>
:> :> I don't really think its off-topic. We can and maybe should do the big
:> :> questions as well.
:> :>
:> :
:> :We used to do 'the big questions' here, though
:> :the tenor of the group was quite different and a bit more
:> :conducive to serious discussion. Alas, this particular asylum is
:> :now run by invading lunatics.
:> :
:>
:> There are, of course, several different issues involved in this case.
:>
:> The first, of course, is that since the State is paying for all this,
:> it is the State's call as to whether treatment occurs or not. This is
:> true for any medical treatment of anyone. If the State determines
:> that paying for this or that treatment or procedure is not in the best
:> interests of the State, then that treatment or procedure is not
:> covered. It's really that simple and that's the bottom line.
:> Presumably if the parents had had the wherewithal to move this baby to
:> a private hospital and pay for the treatment themselves it would have
:> been much more difficult for a court to have much, if any, say at all.
:
:This is, surprisingly perhaps, not something that our system has become very
:proficient at. There is some work on QuALYs (Quality Adjusted Life Years)
:but they will spend a lot on treatment when there is reason to hope for a
:good outcome.
:
And that's a good thing, but at some point they have to look at costs.
No matter who is paying, there is only so much money and only so many
resources. Rationing WILL occur, one way or another.
:
:>
:> The second is whether continued treatment makes medical sense. With
:> the medical decision that there is no chance of recovery, does it make
:> sense to inflict the distress of having to continue torturing this
:> poor baby on the medical staff? The family couldn't even bear to
:> attend court, yet they want to inflict much worse emotional distress
:> on the medical team keeping their child alive. Perhaps if the parents
:> should have been required to observe all treatment of this baby their
:> view would have been different.
:>
:
:I'm sure their motives were to protect their son, rather than to inflict
:distress!
:
Oh, I'm sure the family had only the best of motives. What I question
is whether or not they understood what they were putting everyone else
involved through, when they couldn't even scrape up the gumption to
attend court to hear the outcome.
:
:>
:> The third question, of course, is the ethical issue of whether just
:> because it is possible to keep a human being 'alive' in some sense
:> does that impose an ethical requirement to do so, no matter what the
:> quality of life or the remaining brain function may be? I would say
:> 'no', but that leaves the issue of just who is competent to make the
:> decision and just where that line should be drawn.
:>
:
:Exactly. Who decides, and how do they decide?
:
Even when the patient seems competent the patient isn't necessarily
competent. Neither are some medical professionals. My mother came
down with pneumonia and was on a ventilator. They'd tried to take her
off it and it didn't work. My sister (the nurse) gave up. The ER
nurse was the same. They wanted to move into the "just make her as
comfortable as possible, even if it kills her" mode. My mother said
she was ready to go (although she said later she doesn't remember
that). Sounds like a good case to just terminate, doesn't it?
The next day the doctor came in, got upset about some narcotics she
was given the night before ("Who the hell is trying to kill my
patient?"), took her off the vent, and she got better and was fine for
years.
Even the patient's wishes aren't necessarily a good guide, as you can
see above.
:
:Then again, is there a difference between withdrawing treatment, which is
:legal (in some cases including withdrawal of nutrition) and expediting the
:end, with medication which is not?
:
Personally, I don't see a lot of difference. Decisions that will
knowingly cause the demise of the patient, whether through action or
inaction, seem ethically the same to me. However, the law doesn't
agree (and neither do the medical canons in a lot of places).
--
You are
What you do
When it counts.
.
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