A Simple Surgery

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WanderingGaze22
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A Simple Surgery

Post by WanderingGaze22 »

Suppose a patient comes into a doctor's office with a number of symptoms, and the ailment is identified-- a failing heart. They will surely die without treatment. In fact, they pass out in the office. Luckily, a heart transplant is all that is required to save a life. Yet, a small medical card falls out of the patient's pocket indicating that for religious reasons, they do not want any organ transplants and it is legally sanctioned. If the heart is not installed, the patient will die. But even with a successful operation, the patient's wishes and rights are violated. Should the doctor uphold the Hippocratic Oath? Or respect the government-approved waive of rights and let the patient die?

Child Variation: Let us say the patient is a child with the same condition. The parents tell you that they do not want to give them a synthetic heart for religious reasons. You tell the parents the child will die without the surgery. They are not swayed. Let us say that in this example, you have the legal authority to do whatever you want. Do you perform the surgery anyway? Or do you respect the parent's wishes and let their child die?

Additional Variation: What if there was only a chance the person would die? Would it matter if it was a small chance or a large chance?
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JackDaydream
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Re: A Simple Surgery

Post by JackDaydream »

@WanderingGaze22

Cases like this are complex, and I am familiar with some cases where people are refusing some medical interventions, especially medication. In England, and I don't know how it works in other countries, a lot hinges on medical consent, and capacity to consent. This will involve assessments of mental state and ability to make choices.

In the case you describe, heart transplant surgery is a major form of surgery, so it does usually involve a person making a choice. If would probably not be the first line of intervention. You say that the person has passed out, meaning that they are unconscious. So, basic life support and the input of ambulance and paramedics would be needed, defibrillators and steps to ensure immediate dangers were covered.

The right to override a person's wishes, such as declared religious ones, probably only extends to immediate threats to life. The doctor may advise the patient to undergo heart transplant, but enforcing it would be questionable, especially as it carries medical risks. The doctor would need to explore all the intricacies, and risks. In the end, you say what if there was only a chance that the patient would die without surgery, all of this would need to be assessed and weighed up by medical examinations and discussed with the patient.

With children, it may be more complex, and to what extent does the parent have the right to make a choice, and what about the voice of the child? There are issues worth exploring about children and the ability to consent to make choices to various forms of surgery and medical interventions.
AverageBozo
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Re: A Simple Surgery

Post by AverageBozo »

Most likely, cases like these would be assessed by the court and/or a medical ethics committee.
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Pattern-chaser
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Re: A Simple Surgery

Post by Pattern-chaser »

WanderingGaze22 wrote: October 27th, 2021, 3:56 am Suppose a patient comes into a doctor's office with a number of symptoms, and the ailment is identified-- a failing heart. They will surely die without treatment. In fact, they pass out in the office. Luckily, a heart transplant is all that is required to save a life. Yet, a small medical card falls out of the patient's pocket indicating that for religious reasons, they do not want any organ transplants and it is legally sanctioned. If the heart is not installed, the patient will die. But even with a successful operation, the patient's wishes and rights are violated. Should the doctor uphold the Hippocratic Oath? Or respect the government-approved waive of rights and let the patient die?

Child Variation: Let us say the patient is a child with the same condition. The parents tell you that they do not want to give them a synthetic heart for religious reasons. You tell the parents the child will die without the surgery. They are not swayed. Let us say that in this example, you have the legal authority to do whatever you want. Do you perform the surgery anyway? Or do you respect the parent's wishes and let their child die?

Additional Variation: What if there was only a chance the person would die? Would it matter if it was a small chance or a large chance?
Moral issues like this have only one thing in common: they must be considered on a case-by-case basis. Each example is different. No matter how precisely you describe your example, there are always details of circumstances and context that differ, and those details often make a significant difference. No matter what general moral guidelines one follows, they need to be individually applied to each individual case.

There are no general or universal guidelines, codes or rules that apply to all cases. If there were, judgement would be a lot easier.

In your example, for example (😉), it would make a big difference (to me) if the patient is a close family member, or not. There are many other influences. There are no shortcuts. And every example is challenging; there are no easy wins in situations such as you describe here.
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Ecurb
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Re: A Simple Surgery

Post by Ecurb »

Here in the Pacific Northwest, this has become a legal issue. A religious cult (I forget the name) does not believe in any medical treatment. Here's a link to a documentary about them, which my son worked on (he's a journalist, and had written stories about the cult):

https://www.watchonline.guide/movies/no ... XaEALw_wcB

The cult members live in Oregon and Idaho. Oregon tried and convicted two parents of a young child who died (manslaughter) from some disease that is easily treatable. In Libertarian Idaho (which may be GE Morton's home state), prosecuters have declined to prosecute, and minor children continue to die (diabetes, for example, is a death sentence). It's a tricky problem.
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Pattern-chaser
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Re: A Simple Surgery

Post by Pattern-chaser »

Ecurb wrote: October 27th, 2021, 10:12 am Here in the Pacific Northwest, this has become a legal issue. A religious cult (I forget the name) does not believe in any medical treatment. Here's a link to a documentary about them, which my son worked on (he's a journalist, and had written stories about the cult):

https://www.watchonline.guide/movies/no ... XaEALw_wcB

The cult members live in Oregon and Idaho. Oregon tried and convicted two parents of a young child who died (manslaughter) from some disease that is easily treatable. In Libertarian Idaho (which may be GE Morton's home state), prosecuters have declined to prosecute, and minor children continue to die (diabetes, for example, is a death sentence). It's a tricky problem.
Is it really so tricky? My knowledge of American law comes more from Judge Dredd than other sources. But isn't it the case that, in your country,
  • Any citizen has the right to refuse any form of medical treatment?
  • Any parent has the right and the duty to decide such things on behalf of their children?
Given that this is so, there is no legal dilemma at all. Perhaps you are asking whether the law, as it applies in such cases as you describe, is morally wrong? 🤔🤔🤔
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Steve3007
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Re: A Simple Surgery

Post by Steve3007 »

Ecurb wrote:... It's a tricky problem.
I agree it's a tricky problem because it seems to be in the same category as a lot of other tricky ethical problems, like, for example, the abortion debate. The thing these sorts of problems seem to have in common is that they require us to place an arbitrary dividing line on a continuum. In the case of abortion its the continuum from non-sentient single cell to sentient human being. In this case it's the continuum from moral subject to moral agent; from child to adult; from a sentient being whose welfare is wholly decided by others to one who has self determination can make their own decisions about their own welfare.
Ecurb
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Re: A Simple Surgery

Post by Ecurb »

Pattern-chaser wrote: October 27th, 2021, 10:49 am

Is it really so tricky? My knowledge of American law comes more from Judge Dredd than other sources. But isn't it the case that, in your country,
  • Any citizen has the right to refuse any form of medical treatment?
  • Any parent has the right and the duty to decide such things on behalf of their children?
Given that this is so, there is no legal dilemma at all. Perhaps you are asking whether the law, as it applies in such cases as you describe, is morally wrong? 🤔🤔🤔
In Oregon, members of the Followers of Christ Church have been convicted of manslaughter for refusing treatment for their minor children. In Idaho there has been no prosecution. Adults can decide for themselves. Here's a link to a story:

https://www.oregonlive.com/oregon-city/ ... tigat.html

I don't know if you need to subscribe to a service to watch the documentary, but it's pretty good (if creepy). The filmmakers were Scottish, and were smart and fun (I got to hang out with them at my son's house in Portland).
Ecurb
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Re: A Simple Surgery

Post by Ecurb »

By the way, if you don't want to watch the whole documentary, here's a news story about it: https://www.youtube.com/watch?v=0Q6TcVJWjzs
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LuckyR
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Re: A Simple Surgery

Post by LuckyR »

The OP is clearly revolves around the issue of patient autonomy. In the first case the correct (and legal) thing to do is follow the wishes of the patient and withhold the surgery. Having said that, no one would prosecute an overzealous surgeon, though since hearts are in very limited supply the next person on the transplant list would have a legitimate complaint as such a surgery would be wrong as above.

Children can't consent to surgery so the second scenario is identical.

Ecurb's article went to court (correctly) because the treatment involved wasn't extremely risky surgery followed by a lifetime of immunosuppressant drugs, like a heart transplant. If my memory serves me it was the withholding of antibiotics for a minor infection that killed the kid. Completely different situation. More along the lines of child abuse.
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Sculptor1
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Re: A Simple Surgery

Post by Sculptor1 »

WanderingGaze22 wrote: October 27th, 2021, 3:56 am Suppose a patient comes into a doctor's office with a number of symptoms, and the ailment is identified-- a failing heart. They will surely die without treatment. In fact, they pass out in the office. Luckily, a heart transplant is all that is required to save a life. Yet, a small medical card falls out of the patient's pocket indicating that for religious reasons, they do not want any organ transplants and it is legally sanctioned. If the heart is not installed, the patient will die. But even with a successful operation, the patient's wishes and rights are violated. Should the doctor uphold the Hippocratic Oath? Or respect the government-approved waive of rights and let the patient die?
Operating on the patient is a violation of the Hippocratic Oath to "Do No Harm", flouting the wishes of the patient is doing them harm.


Child Variation: Let us say the patient is a child with the same condition. The parents tell you that they do not want to give them a synthetic heart for religious reasons. You tell the parents the child will die without the surgery. They are not swayed. Let us say that in this example, you have the legal authority to do whatever you want. Do you perform the surgery anyway? Or do you respect the parent's wishes and let their child die?
If the doctor is going to perform the surgery free of cost then let them do so against the wishes of the parents.

Additional Variation: What if there was only a chance the person would die? Would it matter if it was a small chance or a large chance?
That's a clinical not an ethical issue.
Last edited by Sculptor1 on October 28th, 2021, 12:47 pm, edited 1 time in total.
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Sculptor1
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Re: A Simple Surgery

Post by Sculptor1 »

Pattern-chaser wrote: October 27th, 2021, 10:49 am
Ecurb wrote: October 27th, 2021, 10:12 am Here in the Pacific Northwest, this has become a legal issue. A religious cult (I forget the name) does not believe in any medical treatment. Here's a link to a documentary about them, which my son worked on (he's a journalist, and had written stories about the cult):

https://www.watchonline.guide/movies/no ... XaEALw_wcB

The cult members live in Oregon and Idaho. Oregon tried and convicted two parents of a young child who died (manslaughter) from some disease that is easily treatable. In Libertarian Idaho (which may be GE Morton's home state), prosecuters have declined to prosecute, and minor children continue to die (diabetes, for example, is a death sentence). It's a tricky problem.
Is it really so tricky? My knowledge of American law comes more from Judge Dredd than other sources. But isn't it the case that, in your country,
  • Any citizen has the right to refuse any form of medical treatment?
  • Any parent has the right and the duty to decide such things on behalf of their children?
Given that this is so, there is no legal dilemma at all. Perhaps you are asking whether the law, as it applies in such cases as you describe, is morally wrong? 🤔🤔🤔
There are also laws about child neglect and chuld abuse too.
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chewybrian
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Re: A Simple Surgery

Post by chewybrian »

Pattern-chaser wrote: October 27th, 2021, 10:49 am isn't it the case that, in your country,
  • Any citizen has the right to refuse any form of medical treatment?
  • Any parent has the right and the duty to decide such things on behalf of their children?
In pretty much all cases, an adult can refuse any and all medical treatment. This even extends to when they lack the capacity to say yes or no, if they properly document their wishes and have them recorded while they are still competent to give consent. Unfortunately, they have many of the same freedoms when it comes to the care of their children. The state faces a high bar to show that they can intervene on behalf of the child:
The medical community is in agreement about the appropriate course of treatment for the child
The expected outcome of that treatment is a relatively normal life with a reasonably good quality of life
The child would die without the treatment
The parent is refusing to grant consent for the treatment
https://www.lawinfo.com/resources/insur ... -to-a.html
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Pattern-chaser
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Re: A Simple Surgery

Post by Pattern-chaser »

chewybrian wrote: October 29th, 2021, 9:49 am
Pattern-chaser wrote: October 27th, 2021, 10:49 am isn't it the case that, in your country,
  • Any citizen has the right to refuse any form of medical treatment?
  • Any parent has the right and the duty to decide such things on behalf of their children?
In pretty much all cases, an adult can refuse any and all medical treatment. This even extends to when they lack the capacity to say yes or no, if they properly document their wishes and have them recorded while they are still competent to give consent. Unfortunately, they have many of the same freedoms when it comes to the care of their children. The state faces a high bar to show that they can intervene on behalf of the child:
The medical community is in agreement about the appropriate course of treatment for the child
The expected outcome of that treatment is a relatively normal life with a reasonably good quality of life
The child would die without the treatment
The parent is refusing to grant consent for the treatment
https://www.lawinfo.com/resources/insur ... -to-a.html
If the state can intervene between a child and its parents, then the state is the parent, and must assume full parental responsibility - and credit for whatever comes out right. But they also assume the responsibility for what goes wrong. That's what being a parent is all about. The buck stops with you.
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Ecurb
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Re: A Simple Surgery

Post by Ecurb »

Pattern-chaser wrote: October 29th, 2021, 10:14 am

If the state can intervene between a child and its parents, then the state is the parent, and must assume full parental responsibility - and credit for whatever comes out right. But they also assume the responsibility for what goes wrong. That's what being a parent is all about. The buck stops with you.
Oh, come on! Are you suggesting that the state should never intervene in cases of child abuse? How about sexual abuse? The buck for such offenses does not stop with the parent -- it stops with the rest of us who are legally and morally obliged to do what we can to protect helpless children. I'll agree that the State (i.e. all of us) has a responsibility to protect, feed and care for the children whom we have removed from their parents.
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