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While I view the modern approach--give the infant some anesthetic--as best, here is another thought about not being able to remember the pain afterwards (report

While I view the modern approach--give the infant some anesthetic--as best, here is another thought about not being able to remember the pain afterwards (reportedly babies that were operated on without anesthesia have no memory of it, even years later). I have had several colonoscopies, dating back 20 years or more. (Yes, I am that old, and get off my lawn.) For the first couple, I remember it as at best uncomfortable, and at times painful. But ten or so years ago, they started giving some kind of anesthesia. I've heard that you're not really unconscious from this, and from what I've been able to squeeze out of the doctors and anesthesiologists, it sounds like you still feel some pain. But I (and apparently other patients) have absolutely no memory of that; I can recall getting the IV and being told to lay on my side, and that's all until I woke up in recovery. And the odd thing about that is, I'm perfectly ok with it. I don't go into colonoscopies now dreading the discomfort, and I don't worry afterwards that I might have been in pain. I don't understand it, but There It Is.

kqr 4y ago
Yeah, this is an interesting aspect of the problem for me. Is it unethical to hurt someone if you're doing it in a way that they definitely won't be able to remember later? Would you like to go through extreme torture (without lasting physical damage) if you could get a guarantee that you wouldn't remember any of it once it's done? Are we who we are now, or are we our memories of our past? This is not just academical, it has practical polic consequences: our perception of how painful a procedure was is based primarily on two things: how painful it was at its worst, and how painful it was at the very end. So a procedure can seem a lot less painful if you subject the patient to pain over a longer time (instead of an intense peak) and end on a softer note. But of course, that's when you're asked to judge the painfulness of the procedure after the fact -- not while you're undergoing it. When you're undergoing it, you might want it to end quickly, even if that means higher intensity pain. Who should you satisfy? Patient on the table now, or patient tomorrow after a good night's sleep?
- DavidSJ 4y ago
  Is it unethical to hurt someone if you're doing it in a way that they definitely won't be able to remember later? Assuming humans remain mortal, all pain definitely won't be remembered sufficiently later.
antognini 4y ago
My dad is an anesthesiologist and I've heard similar things from him. Anesthetics have three goals: 1. Elimination of pain; 2. Loss of consciousness; 3. Loss of memory. Of these, he was saying that the most important is the last. If you have no memory of the pain, in some sense it didn't really happen. It does sort of make sense that they are okay with the patient experiencing some pain because anesthetics (at least those used for general anesthesia) are very dangerous drugs. There is a metric called the "therapeutic index" given to drugs, which is the ratio between the amount needed to get the medical benefit to the amount needed to kill you. Most drugs in medicine have a very high therapeutic index, like 1:100 or 1:1000. (Morphine is around 1:70 for instance.) But the drugs used for general anesthesia are closer to 1:2. So there's very little margin for error which means they try to provide lower doses if at all possible.
- bscphil 4y ago
  > Of these, he was saying that the most important is the last. If you have no memory of the pain, in some sense it didn't really happen. That strikes me as a very strange thing to think. When I am dead, I will have no memory of anything. I should not conclude on this basis that any pain I have during my lifetime "didn't really happen", or doesn't matter. On the contrary, it seems like the only thing that could matter is the pain I actually do feel, for as long as I feel it. Of course, given the choice, it would probably be preferable to not have to remember the pain later, but I wouldn't call the gap between the two an enormous one.
  - antognini 4y ago
    I think that it is partly because the drugs generally have an amnesiac effect at lower doses, so if you don't give enough of the drug to cause amnesia, there will almost certainly be pain, too. But maybe there's a more cynical interpretation that it it "didn't happen" in a liability sense. If the patient has no memory of the pain then they have no reason to sue you for messing up the dosage. Incidentally I recently watched through Severance and I can't help but see the parallels to the show.
GauntletWizard 4y ago
I have no doubt that people have no conscious memories of surgery that happened when they were babies; Few people have conscious memories of any time before 2 years old [1]. That doesn't mean you're not learning before then. It doesn't mean you're not making associations. What I want to know is this: Of babies who had surgery with and without anesthesia, how many of them are afraid of doctors 10 years later? 20? Hospitals? Knives and needles? There's a ton of psychological effects that it could or could not be having! You will not get answers from anything less than a huge study, probably too huge to be remotely practical to consider. [1] https://www.sciencedaily.com/releases/2021/06/210614110824.htm https://www.sciencedaily.com/releases/2021/06/210614110824.h...

kqr 4y ago

Yeah, this is an interesting aspect of the problem for me. Is it unethical to hurt someone if you're doing it in a way that they definitely won't be able to remember later? Would you like to go through extreme torture (without lasting physical damage) if you could get a guarantee that you wouldn't remember any of it once it's done? Are we who we are now, or are we our memories of our past? This is not just academical, it has practical polic consequences: our perception of how painful a procedure was is based primarily on two things: how painful it was at its worst, and how painful it was at the very end. So a procedure can seem a lot less painful if you subject the patient to pain over a longer time (instead of an intense peak) and end on a softer note. But of course, that's when you're asked to judge the painfulness of the procedure after the fact -- not while you're undergoing it. When you're undergoing it, you might want it to end quickly, even if that means higher intensity pain. Who should you satisfy? Patient on the table now, or patient tomorrow after a good night's sleep?

DavidSJ 4y ago
Is it unethical to hurt someone if you're doing it in a way that they definitely won't be able to remember later? Assuming humans remain mortal, all pain definitely won't be remembered sufficiently later.

antognini 4y ago

My dad is an anesthesiologist and I've heard similar things from him. Anesthetics have three goals: 1. Elimination of pain; 2. Loss of consciousness; 3. Loss of memory. Of these, he was saying that the most important is the last. If you have no memory of the pain, in some sense it didn't really happen. It does sort of make sense that they are okay with the patient experiencing some pain because anesthetics (at least those used for general anesthesia) are very dangerous drugs. There is a metric called the "therapeutic index" given to drugs, which is the ratio between the amount needed to get the medical benefit to the amount needed to kill you. Most drugs in medicine have a very high therapeutic index, like 1:100 or 1:1000. (Morphine is around 1:70 for instance.) But the drugs used for general anesthesia are closer to 1:2. So there's very little margin for error which means they try to provide lower doses if at all possible.

bscphil 4y ago
> Of these, he was saying that the most important is the last. If you have no memory of the pain, in some sense it didn't really happen. That strikes me as a very strange thing to think. When I am dead, I will have no memory of anything. I should not conclude on this basis that any pain I have during my lifetime "didn't really happen", or doesn't matter. On the contrary, it seems like the only thing that could matter is the pain I actually do feel, for as long as I feel it. Of course, given the choice, it would probably be preferable to not have to remember the pain later, but I wouldn't call the gap between the two an enormous one.
- antognini 4y ago
  I think that it is partly because the drugs generally have an amnesiac effect at lower doses, so if you don't give enough of the drug to cause amnesia, there will almost certainly be pain, too. But maybe there's a more cynical interpretation that it it "didn't happen" in a liability sense. If the patient has no memory of the pain then they have no reason to sue you for messing up the dosage. Incidentally I recently watched through Severance and I can't help but see the parallels to the show.

GauntletWizard 4y ago

I have no doubt that people have no conscious memories of surgery that happened when they were babies; Few people have conscious memories of any time before 2 years old [1]. That doesn't mean you're not learning before then. It doesn't mean you're not making associations. What I want to know is this: Of babies who had surgery with and without anesthesia, how many of them are afraid of doctors 10 years later? 20? Hospitals? Knives and needles? There's a ton of psychological effects that it could or could not be having! You will not get answers from anything less than a huge study, probably too huge to be remotely practical to consider. [1] https://www.sciencedaily.com/releases/2021/06/210614110824.htm https://www.sciencedaily.com/releases/2021/06/210614110824.h...