Brazen new world?

[heart]

Mar 4, 2008 21:32 | Updated Mar 5, 2008 9:26
Brazen new world
By AVI SHAFRAN


"....This past January 30, the College of Physicians and Surgeons of Manitoba, Canada issued a policy statement that may come to permit the professor to add "prophet" to his curriculum vitae.

In that document, the governing body of the Canadian province's medical profession directs that doctors have the final say with regard to ending life-sustaining treatment of patients - regardless of the wishes or religious beliefs of the patients or their families. It also establishes a baseline for justifying life-sustaining treatment - including a patient's ability to "experience his/her own existence" - below which a doctor is directed to end life-sustaining treatment, regardless of the wishes of the patient's family. The new policy paper has garnered much attention, and may well have ramifications throughout Canada and, conceivably, elsewhere.

Underlying the document - saturating it, actually - is the premise that ending a human life is a medical decision, not a moral one. Or, alternately, that medical training somehow confers the ultimate moral authority to pass judgments on the worthiness of human lives.

Either contention is offensive. A foundation of what has come to be called civilization is that people are not mere things or even animals, that human life has a special, sacred, nature....(more at link)


Thoughts on this issue?

 

[Kiddo]

Wow, some tough issues.

Morality does not allow for common sense. If a person is in severe nontreatable pain or is brain dead then it just doesn't make sense to force them to live. Nonetheless, many families who value life because of their moral beliefs would do just that.

On the other hand, giving that power to doctors could be giving them a license to practice euthanasia.

 

[mippus]

If medical means objective, then it takes away all liberty of a patient, if it doesn't, then it is the doctor's morality.

 

[Magic Poriferan]

I've always supported pulling the plug on permanently incapacitated people, as well as assisted suicide.
The big issue has always been a matter of proving that death was desired by the patient, or given to a patient that had no sentience or hope to recover.
What ensues is an enormous argument of splitting hairs that is legal, scientific, and ethical... and it's really a headache that I don't feel like dealing with.

I'd like to add that I believe humans are animals and things. I spit at the word "special".

Wow, some tough issues.

Morality does not allow for common sense. If a person is in severe nontreatable pain or is brain dead then it just doesn't make sense to force them to live. Nonetheless, many families who value life because of their moral beliefs would do just that.

On the other hand, giving that power to doctors could be giving them a license to practice euthanasia.

I agree with your general commentary, but I greatly dislike the bolded line.
In my philosophy, there usually isn't even difference between morality and common sense.

I can combat the people that consider it immoral with my own moral stance.
I think it's wrong to keep people alive in pain. I think it's wrong to waste useful medical resources on hopeless vegetables.
I think the families that want to preserve their own people either in agony or in mindlessness are actually selfish. What they are doing only serves to satisfy their own emotional problems, it does not help the patient or any other patient.

As you can see, my morality trumps theirs because it's also mixed with rationale. Someone who's mindless doesn't know what's going on, keeping them alive is no gain. It cost to keep them alive, though.
No gain + some cost = net loss.

 

[heart]

What if it is person with terminal cancer? Should that person be allowed to have pallative treatment and live their life out or should a medical board decide who has a "worthwhile" life and who does not?

 

[mippus]

What if it is person with terminal cancer? Should that person be allowed to have pallative treatment and live their life out or should a medical board decide who has a "worthwhile" life and who does not?

I believe it is arrogant to be allowed to judge the deathwish of a patient like this. Such choices should always be the patient's.
It becomes more difficult when talking about children...

 

[heart]

I believe it is arrogant to be allowed to judge the deathwish of a patient like this. Such choices should always be the patient's.
It becomes more difficult when talking about children...

What about the lifewish of someone who is not productive, will never recover and is a drain on resources? Should a medical board be allowed to decide if they should be allowed access to pallative treatments? Even once they begin to slide into the twilight of dementia, should a previous desire for treatment be honored or is it then up to objective terms to decide who is allowed treatment and who is to be put out of their misery?

 

[Magic Poriferan]

I say, if a person is conscious and capable of communicating, or surely will be in the near future, they should get the final say in the medical decision(and this includes being killed, if they want to be killed).

As for people that are brain dead: "Kill" them.

 

[CzeCze]

Wow, that is really scary. But what does it mean? That the medical establishment has declared it thinks it should have the final say? I doubt anyone would let that pass and even hospitals are not going to green light that into policy. No way they would take on the risk of massive widespread lawsuits.

I already think the (Western) medical establihment (and it is an establishment) carries hegemonic elements that equals a giant god-complex and already have a habit of disregarding patients. In the past doctors/surgeons have conducted sexual reassignment surgery on ("intersexed") babies without fully informing parents and sometimes without even asking permission. The children of course, once they grow up often have major issues with this (if they ever discover it happened).

Also, I've known people who have been hospitalized for chronic and serious health issues and seeing the attitudes and practices of the hospital and employees -- hell no attending physcians absolutely should not have the right to arbitrarily make this decision.

 

[heart]

I say, if a person is conscious and capable of communicating, or surely will be in the near future, they should get the final say in the medical decision(and this includes being killed, if they want to be killed).

As for people that are brain dead: "Kill" them.

There are people in a gray zone though. They aren't brain dead, but they may have dementia or problems with communication.

 

[Magic Poriferan]

There are people in a gray zone though. They aren't brain dead, but they may have dementia or problems with communication.

This is true. Fortunately, you can pretty clearly tell when someone is brain-dead. Those are not brain-dead, but can't communicate, are still in the clear.
Regardless of their ability to communicate, it can still be identified that they are conscious. In such cases, I would not allow for any execution of the patient. The severity of the patient's condition must be assessed.

I have not yet formulated my stance on the demented, as it requires a very complex policy.

 

[heart]

Are they in the clear? What will keep them there? What protects them?

 

[WobblyStilettos]

I think that if a patient is unable to say whether they want to live or die (i.e. if they are in a coma) then it should be up to their family to decide what happens to them. However, I also think keeping them alive when they have no hope of recovery and are unconsious may prevent the family properly coming to terms with what happened. Despite this, I think turning off the machines without the family's consent would do more harm than good.

 

[cafe]

That recent case where the boy came out of his coma right after his family gave permission for his organs to be harvested makes me doubt that the medical establishment is clear and infallible on just who is and is not brain dead and beyond hope.

The patient should have the final say if they have a living will or are communicative. If they cannot speak for themselves, then it is the job of their next of kin to speak for them.

 

[Siúil a Rúin]

What if it is person with terminal cancer? Should that person be allowed to have pallative treatment and live their life out or should a medical board decide who has a "worthwhile" life and who does not?

Objectivity and morals aside, a decision process like that will be based on money.

 

[Geoff]

Mar 4, 2008 21:32 | Updated Mar 5, 2008 9:26
Brazen new world
By AVI SHAFRAN


"....This past January 30, the College of Physicians and Surgeons of Manitoba, Canada issued a policy statement that may come to permit the professor to add "prophet" to his curriculum vitae.

In that document, the governing body of the Canadian province's medical profession directs that doctors have the final say with regard to ending life-sustaining treatment of patients - regardless of the wishes or religious beliefs of the patients or their families. It also establishes a baseline for justifying life-sustaining treatment - including a patient's ability to "experience his/her own existence" - below which a doctor is directed to end life-sustaining treatment, regardless of the wishes of the patient's family. The new policy paper has garnered much attention, and may well have ramifications throughout Canada and, conceivably, elsewhere.

Underlying the document - saturating it, actually - is the premise that ending a human life is a medical decision, not a moral one. Or, alternately, that medical training somehow confers the ultimate moral authority to pass judgments on the worthiness of human lives.

Either contention is offensive. A foundation of what has come to be called civilization is that people are not mere things or even animals, that human life has a special, sacred, nature....(more at link)


Thoughts on this issue?

Ah, another oblique reference to Huxley. Interesting how often one sees this phrase bastardised. Anyway.. on topic...

There are some interesting and challenging questions here. To me, the fundamental difficulty is the inherent tension between the need that society has for hard and fast rules vs the genuine grey areas that exist in moral issues.

The classic one is something like abortion. When does humanity start and when does it gain "human" rights? We need a rule that can apply en masse to a large population so we pick a certain number of weeks and determine that up to that point it isnt a human, and after that point it is. We do this, because the "moving boundary" is of no practical use in a legal and medical guidance sense. It makes perfect sense if one can examine a situation in depth and to cover all of the affected parties, but the resources are not available, and too much subjectivity increases the risk of corruption and unfairness, even if for most it might be better.

So, we do this a lot... a child becomes an adult gradually, yet we apply an "everything ok but only after this date" rule which is clearly a real world nonsense, but we've become desensitised to using it because we are so familiar with it.

What's the solution? Guidelines that are clear as can be for many situations, but there must be an independent review board available in a number of situations. A group of, say, 3 trained experts. They don't have to spend months deliberating and be endlessly dragged through the courts - but being made free to decide they can help correct the practical difficulties of real world greyness crashing straight into the brick wall of society's rule book.

 

[heart]

It also establishes a baseline for justifying life-sustaining treatment - including a patient's ability to "experience his/her own existence" - below which a doctor is directed to end life-sustaining treatment, regardless of the wishes of the patient's family.

This is the part that disturbs me. It does not just say "brain death", it is about a patient's experience and quality of life. It seems to be it is grey language directed at being able to now focus on people in gray zones, not just the people who have achieved brain death.

 

[Falcarius]

Just put it this way: If I was in a life threatening situation or a vegetable state, I would rather have the decision made by someone who knows a thing or two about medicine, rather than someone who knows nothing.

So I guess that means I think "decisions about life should be medical not moral".

 

[nightning]

All physicians goes by to the creed "Do no harm"...

Terminating a life... it doesn't just affect the patient... but also the family members watching the patient "suffer"... really it's not the unconscious patient suffering... it's the family. And the family themselves can sometimes be too caught up in pain... hoping for the person to wake up... Having it drag on and on for them with no end in sight.

We're told to move on from relationships that hurt us... That foolish hope isn't going to change anything... this is no different. Perhaps it is necessary to have somebody on the outside to remind us that life goes on... have to go on.

I think it's a decision that should be made by the physician along with the family... but ultimately the doctor should have the final say. Because somebody has to make the decision.

 

[heart]

If they mean coma or brain dead, why don't they spell that out? Why put in the bit about patient quality and experience of life? Sounds like opening the door to more than just vegatative states to me.