4 ms·

A very interesting ethical discussion I had with a doctor friend recently is that in some cases where a doctor identifies that amputation is the right/only cour

by yomly 8y ago

A very interesting ethical discussion I had with a doctor friend recently is that in some cases where a doctor identifies that amputation is the right/only course of action, they will only present that as a soft option to the patient, if at all. This is because studies have since found that amputations can cause a great deal of psychological harm and it can be better for the patient if they arrive at the conclusion to amputate of their own volition - even if that takes months of excrutiating agony spent realizing not having the limb is better than the pain. It was an interesting additional dimension to consider - even if the doctor knows much better than the patient, sometimes the patient feeling a sense of autonomy could be important for their wellbeing, and that short term pain could be beneficial.

joshgel 8y ago
In some ways this applies to everything we do that we think might be helpful. Sure we could get patients to loose weight by locking them up and only feeding them 1300 calories of veggies, but for some obvious reasons that isn't really an option. We can encourage them to take medications, but they still have to take them. Atul Gawande talks about how much we have discovered in medicine in the last century, but that the next century is going to be about how to effectively implement that knowledge to help people. This applies to both the first world and to the developing world, though the challenges in both are different. (also we probably wont stop discovering new treatments that we will them have to deploy...)
- derefr 8y ago
  > Sure we could get patients to loose weight by locking them up and only feeding them 1300 calories of veggies, but for some obvious reasons that isn't really an option. Yeah, but a lot of patients would consent to an offered treatment plan where they're locked up (and unable to sign themselves out!) and fed only 1300 calories of veggies. The weird thing is, there are private businesses willing to provide exactly that kind of service (see: de-tox centers.) But doctors and hospitals generally don't see this as a valid form of in-patient medical treatment. Why is that? Do doctors think that patients have an inalienable right to bodily autonomy? (If so, how would surgery ever work?) (The annoying point about this difference, to me, is that if a doctor were to diagnose you with X thing that keeps you at the hospital for a month, unable to leave—then your insurance would likely pay for that, and your employer would likely consider you on sick leave. But if a private business like a detox center keeps you for a month, then you have to pay for that out-of-pocket and you're likely to be fired from your job if you don't have the requisite vacation days saved up. From what I can see, it is in the patient's long-term interest if doctors get into this business!)

by yomly 8y ago

joshgel 8y ago

In some ways this applies to everything we do that we think might be helpful. Sure we could get patients to loose weight by locking them up and only feeding them 1300 calories of veggies, but for some obvious reasons that isn't really an option. We can encourage them to take medications, but they still have to take them. Atul Gawande talks about how much we have discovered in medicine in the last century, but that the next century is going to be about how to effectively implement that knowledge to help people. This applies to both the first world and to the developing world, though the challenges in both are different. (also we probably wont stop discovering new treatments that we will them have to deploy...)

derefr 8y ago
> Sure we could get patients to loose weight by locking them up and only feeding them 1300 calories of veggies, but for some obvious reasons that isn't really an option. Yeah, but a lot of patients would consent to an offered treatment plan where they're locked up (and unable to sign themselves out!) and fed only 1300 calories of veggies. The weird thing is, there are private businesses willing to provide exactly that kind of service (see: de-tox centers.) But doctors and hospitals generally don't see this as a valid form of in-patient medical treatment. Why is that? Do doctors think that patients have an inalienable right to bodily autonomy? (If so, how would surgery ever work?) (The annoying point about this difference, to me, is that if a doctor were to diagnose you with X thing that keeps you at the hospital for a month, unable to leave—then your insurance would likely pay for that, and your employer would likely consider you on sick leave. But if a private business like a detox center keeps you for a month, then you have to pay for that out-of-pocket and you're likely to be fired from your job if you don't have the requisite vacation days saved up. From what I can see, it is in the patient's long-term interest if doctors get into this business!)