5 ms·

I like the 'out-of-the-box' thinking. The 'opt out' if you don't want to, in combination with a high change of poor black males being the guinea pig... Not so m

I like the 'out-of-the-box' thinking. The 'opt out' if you don't want to, in combination with a high change of poor black males being the guinea pig... Not so much.

67726e 12y ago
"The 'opt out' if you don't want to, in combination with a high change of poor black males being the guinea pig... Not so much." My understanding is that they only use this procedure if your chances of otherwise surviving without this are very slim, per the article the injuries are the kind where "Less than 1 in 10 survive". As for the opt-out/opt-in, you cannot really opt-in to any procedure if you're undergoing cardiac arrest, so perhaps we should let anyone in this scenario die since they cannot truly consent?
- vog 12y ago
  -1 for the strawman: The alternative to "opt-out before" is "opt-in before", not "opt-in afterwards".
  - mikeash 12y ago
    Most people won't opt in before, so I think his question is entirely legitimate: in an emergency situation, the patient often can't give consent, and most of them won't have the foresight to give it in advance, so are we to simply let them die?
    - deleted 12y ago
      [deleted]
      - 67726e 12y ago
        I left that piece out because I just assumed it would be sufficiently obvious. That was my bad.
        deleted 12y ago
        [deleted]
    - vog 12y ago
      That depends a lot on the quality of the treatment. If it is a good treatment with some risks, that makes sense. However, if you don't enforce any minimum quality for the treatment, this is nothing more than misusing the patient's situation for scientific experiments. Rephrased with some exaggeration: "Our patient will die anyway, so let's run the experiments. Maybe one of our experiments is successful. If not, who cares?" I believe the main dissent here is whether to think of this as a medical treatment with minor risks, or as an experiment done on defenseless victims.
      - mikeash 12y ago
        It's not exactly "who cares?" but more like, "it's unfortunate, but they were dying and we tried something that gave them a better chance of survival." It's experimental, but they also have good reason to believe that it works. Now it's being tested in a scenario where it's likely to save lives. I can understand the objections overall. But in this particular case, where it's being used as a last-ditch effort to save people who otherwise are almost certain to die, seems pretty reasonable. How else are medical researchers to advance the state of the art in emergency care? I assume that we don't want to just take what we have now and set it in stone forever, but I don't see any other way to validate new procedures.
      - reversal 12y ago
        I believe this is a case for Dr. Jay Freireich who was considered a barbarian and labeled as a pariah in the medical community because he gave out experimental treatments on childhood leukemia patients who had no chance of survival outside of a few months. Mind you this treatment is literally poisoning the patient and hoping the cancer dies while the patient still has a thread of life remaining. There was also a very good chance that the chemicals would end up doing the job the cancer was already doing. He was able to save very few of his patients from the same end, as well as developing what would become modern chemotherapy that's saving countless more cancer patients today. So a better question is: is the situation we're presented with so grim that we're willing to use a method that's just as deadly as the disease/injury but has a glimmer of hope for survival?
  - avz 12y ago
    Both are alternatives since this is not a dichotomy: a potential patient can opt-in before, opt-out before or they can leave the status unspecified until they arrive in the ER. Someone must make a decision for them and it will be either opt-in afterwards or opt-out afterwards. Since the group leaving the status unspecified is by far the largest, your practical ability to evaluate the procedure depends on what default is selected for the patients who haven't decided beforehand. Given the need, potential to save lives and widespread agreement among the public, I'd say there is no real ethical controversy here.
- digitalengineer 12y ago
  It's not so simple, I'm afraid. People have opt-out of a lot of things to prefent them 'turing in to a plant' as the popular saying is. Things like DNR or even human blood (religion based opting out). There was no ad-campagin in the region informing people what could happen. There is a specific demographic (poor black people) so they could target them with information about what's going on and specifically what the risks are. Other than that, they could ask a relative/parent/child's permission if possible.
_mulder_ 12y ago
Are you really suggesting a Hitleresque racial motive behind these experiments? Or just sad that black males (in that locale) have a higher incidence of homicide, and therefore more likely to be suitable for this procedure?
- digitalengineer 12y ago
  I did not. As the article stated: poor (black) people do have a significant higher change to end up in that experimental room. Your comment did made me think about not-so-old CIA experiments on poor powerless people: http://en.wikipedia.org/wiki/Unethical_human_experimentation_in_the_United_States http://en.wikipedia.org/wiki/Unethical_human_experimentation... But lets be clear: this is not CIA stuff.
- sp332 12y ago
  Black males have a lot going against them, which makes them vulnerable to all kinds of things. Sure they're more likely to be victims of violence, but this makes them more open to any abuse going on at hospitals. It's just a compounding of an already bad situation - now you got stabbed and experimented on. (Hitlerian? as if Americans aren't racist.)
  - tinco 12y ago
    It sure is racist. They would never do this in a region where there are not a lot of stabbings, so I as a rich white person living in an area with mostly rich white people have no chance at receiving experimental treatment if I get stabbed, so I would most likely die. You make it sound like being experimented on is a bad thing, when you have only a 10% chance of surviving. There's thousands of people out there who would do anything for an experimental treatment funded by the government.
    - sp332 12y ago
      It's not about dying vs not dying. It's about maybe surviving with horrible pervasive problems caused by having no pulse for an hour. If this were in an area with more white people, they would ask for permission first because they respect you more than they respect these black people who are getting stabbed. <- Speculation, but plausible.
6d0debc071 12y ago
What's the alternative to test the thing practically? Getting people to opt in before they got stabbed or shot or whatever would be phenomenally difficult - making contact with that demographic - and could delay the study by years or decades. And in the mean time more people would possibly be dying, something they haven't consented to either.
vacri 12y ago
It's not like they're selecting for poor black males. Remember, if this treatment works, it's not going to be primarily applied to rich whites; it's going to be applied to the exact same demographic as the guinea pigs.
- ceejayoz 12y ago
  > Remember, if this treatment works, it's not going to be primarily applied to rich whites; it's going to be applied to the exact same demographic as the guinea pigs. What are you basing this on? Chances are this is absurdly expensive (ICU stays can cost millions) and may be unlikely to see wide use in poor areas - the hospitals'd be eating the cost most of the time.
  - afarrell 12y ago
    Do US hospitals ever turn away people from the ICU because of cost? If so, how do they verify the ability of an unconscious person to pay before treatment? I was under the impression that they already ate those costs.
    - prutschman 12y ago
      My brief googling turns up the Emergency Medical Treatment and Active Labor Act, and an accompanying FAQ: http://www.emtala.com/faq.htm http://www.emtala.com/faq.htm > 13. Can the hospital inquire about the patient's ability to pay? > Yes, but timing is everything. The statute does not prohibit an inquiry into availability of medical insurance; it does provide that neither examination nor treatment may be delayed to make the inquiry. > Prior to 2003, some knowledgeable commentators had suggested that no discussion of any payment issues should take place before the medical screening examination and any needed stabilizing treatment are provided. CMS has even recommended that hospital personnel not answer any questions initiated by the patient, apparently on the theory that some patients may be dissuaded from staying if they learn that they will be financially responsible for the treatment, even if they are assured that they will be seen without consideration of payment issues. Such recommendations, however, do not arise to the level of a definitive statement of what is required. I don't know if the Affordable Care Act changed any of this.

I like the 'out-of-the-box' thinking. The 'opt out' if you don't want to, in combination with a high change of poor black males being the guinea pig... Not so much.

67726e 12y ago

"The 'opt out' if you don't want to, in combination with a high change of poor black males being the guinea pig... Not so much." My understanding is that they only use this procedure if your chances of otherwise surviving without this are very slim, per the article the injuries are the kind where "Less than 1 in 10 survive". As for the opt-out/opt-in, you cannot really opt-in to any procedure if you're undergoing cardiac arrest, so perhaps we should let anyone in this scenario die since they cannot truly consent?

vog 12y ago
-1 for the strawman: The alternative to "opt-out before" is "opt-in before", not "opt-in afterwards".
- mikeash 12y ago
  Most people won't opt in before, so I think his question is entirely legitimate: in an emergency situation, the patient often can't give consent, and most of them won't have the foresight to give it in advance, so are we to simply let them die?
  - deleted 12y ago
    [deleted]
    - 67726e 12y ago
      I left that piece out because I just assumed it would be sufficiently obvious. That was my bad.
      - deleted 12y ago
        [deleted]
  - vog 12y ago
    That depends a lot on the quality of the treatment. If it is a good treatment with some risks, that makes sense. However, if you don't enforce any minimum quality for the treatment, this is nothing more than misusing the patient's situation for scientific experiments. Rephrased with some exaggeration: "Our patient will die anyway, so let's run the experiments. Maybe one of our experiments is successful. If not, who cares?" I believe the main dissent here is whether to think of this as a medical treatment with minor risks, or as an experiment done on defenseless victims.
    - mikeash 12y ago
      It's not exactly "who cares?" but more like, "it's unfortunate, but they were dying and we tried something that gave them a better chance of survival." It's experimental, but they also have good reason to believe that it works. Now it's being tested in a scenario where it's likely to save lives. I can understand the objections overall. But in this particular case, where it's being used as a last-ditch effort to save people who otherwise are almost certain to die, seems pretty reasonable. How else are medical researchers to advance the state of the art in emergency care? I assume that we don't want to just take what we have now and set it in stone forever, but I don't see any other way to validate new procedures.
    - reversal 12y ago
      I believe this is a case for Dr. Jay Freireich who was considered a barbarian and labeled as a pariah in the medical community because he gave out experimental treatments on childhood leukemia patients who had no chance of survival outside of a few months. Mind you this treatment is literally poisoning the patient and hoping the cancer dies while the patient still has a thread of life remaining. There was also a very good chance that the chemicals would end up doing the job the cancer was already doing. He was able to save very few of his patients from the same end, as well as developing what would become modern chemotherapy that's saving countless more cancer patients today. So a better question is: is the situation we're presented with so grim that we're willing to use a method that's just as deadly as the disease/injury but has a glimmer of hope for survival?
- avz 12y ago
  Both are alternatives since this is not a dichotomy: a potential patient can opt-in before, opt-out before or they can leave the status unspecified until they arrive in the ER. Someone must make a decision for them and it will be either opt-in afterwards or opt-out afterwards. Since the group leaving the status unspecified is by far the largest, your practical ability to evaluate the procedure depends on what default is selected for the patients who haven't decided beforehand. Given the need, potential to save lives and widespread agreement among the public, I'd say there is no real ethical controversy here.
digitalengineer 12y ago
It's not so simple, I'm afraid. People have opt-out of a lot of things to prefent them 'turing in to a plant' as the popular saying is. Things like DNR or even human blood (religion based opting out). There was no ad-campagin in the region informing people what could happen. There is a specific demographic (poor black people) so they could target them with information about what's going on and specifically what the risks are. Other than that, they could ask a relative/parent/child's permission if possible.

_mulder_ 12y ago

Are you really suggesting a Hitleresque racial motive behind these experiments? Or just sad that black males (in that locale) have a higher incidence of homicide, and therefore more likely to be suitable for this procedure?

digitalengineer 12y ago
I did not. As the article stated: poor (black) people do have a significant higher change to end up in that experimental room. Your comment did made me think about not-so-old CIA experiments on poor powerless people: http://en.wikipedia.org/wiki/Unethical_human_experimentation_in_the_United_States http://en.wikipedia.org/wiki/Unethical_human_experimentation... But lets be clear: this is not CIA stuff.
sp332 12y ago
Black males have a lot going against them, which makes them vulnerable to all kinds of things. Sure they're more likely to be victims of violence, but this makes them more open to any abuse going on at hospitals. It's just a compounding of an already bad situation - now you got stabbed and experimented on. (Hitlerian? as if Americans aren't racist.)
- tinco 12y ago
  It sure is racist. They would never do this in a region where there are not a lot of stabbings, so I as a rich white person living in an area with mostly rich white people have no chance at receiving experimental treatment if I get stabbed, so I would most likely die. You make it sound like being experimented on is a bad thing, when you have only a 10% chance of surviving. There's thousands of people out there who would do anything for an experimental treatment funded by the government.
  - sp332 12y ago
    It's not about dying vs not dying. It's about maybe surviving with horrible pervasive problems caused by having no pulse for an hour. If this were in an area with more white people, they would ask for permission first because they respect you more than they respect these black people who are getting stabbed. <- Speculation, but plausible.

6d0debc071 12y ago

What's the alternative to test the thing practically? Getting people to opt in before they got stabbed or shot or whatever would be phenomenally difficult - making contact with that demographic - and could delay the study by years or decades. And in the mean time more people would possibly be dying, something they haven't consented to either.

vacri 12y ago

It's not like they're selecting for poor black males. Remember, if this treatment works, it's not going to be primarily applied to rich whites; it's going to be applied to the exact same demographic as the guinea pigs.

ceejayoz 12y ago
> Remember, if this treatment works, it's not going to be primarily applied to rich whites; it's going to be applied to the exact same demographic as the guinea pigs. What are you basing this on? Chances are this is absurdly expensive (ICU stays can cost millions) and may be unlikely to see wide use in poor areas - the hospitals'd be eating the cost most of the time.
- afarrell 12y ago
  Do US hospitals ever turn away people from the ICU because of cost? If so, how do they verify the ability of an unconscious person to pay before treatment? I was under the impression that they already ate those costs.
  - prutschman 12y ago
    My brief googling turns up the Emergency Medical Treatment and Active Labor Act, and an accompanying FAQ: http://www.emtala.com/faq.htm http://www.emtala.com/faq.htm > 13. Can the hospital inquire about the patient's ability to pay? > Yes, but timing is everything. The statute does not prohibit an inquiry into availability of medical insurance; it does provide that neither examination nor treatment may be delayed to make the inquiry. > Prior to 2003, some knowledgeable commentators had suggested that no discussion of any payment issues should take place before the medical screening examination and any needed stabilizing treatment are provided. CMS has even recommended that hospital personnel not answer any questions initiated by the patient, apparently on the theory that some patients may be dissuaded from staying if they learn that they will be financially responsible for the treatment, even if they are assured that they will be seen without consideration of payment issues. Such recommendations, however, do not arise to the level of a definitive statement of what is required. I don't know if the Affordable Care Act changed any of this.