6 ms·

"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

by 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.

by 67726e 12y ago

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.