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Thread: Wrongful life suit???

  1. #11
    Senior Member dnf777's Avatar
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    Quote Originally Posted by ducknwork View Post
    ...I don't know enough about what a doctor is required to do or not do.

    When it comes to those issues, nobody does. That's what the courts are trying to define as we speak. (like they're the best to make those decisions!)

    When I was a medical student at Jefferson Hospital in Philly, our NICU would try to save premies down to 24 weeks. At that time ('92) 24 wks was considered the age of viability, with a 50% survival rate. Even with those "odds" many decided for comfort measures, and let the baby return to peace, given the high rate of complications and so forth. NOW, we're down to 20 weeks, and the REAL ethical issue is becoming the "artificial womb". As technology advances, we may move beyond the test-tube baby having to be implanted into a woman AT ALL! I mention that to demonstrate the HUGE ethical issues we'll be facing soon. Surrogate mothers will be obsolete. Gay male couples will be able to have a baby "made" for them if they choose! If a mom is caught three times with drugs on board, could a court order her fetus removed and placed in the "protective custody" of an artificial womb for it's own good?

    These may seem obscure or extreme, but they are questions that we as humans, and supposedly "free" society, will be facing. The questions I originally posted here are going on right now. There was one doc at the conference who gives ALL his patients a letter encouraging them to share all their medical conditions with their children and relatives, so in case one of them turns out to be hereditary, he can say he "warned" them! Crazy, huh?

    Thanks for your reply, I'm fascinated by what others think about this stuff. I don't think there's any right or wrong answers, and if anyone else does, I find that interesting too!

    cheers,
    dave
    God Bless PFC Jamie Harkness. The US Army's newest PFC, but still our neighbor's little girl!

  2. #12
    Senior Member Gerry Clinchy's Avatar
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    If the doctors personal morals and values would make him anti abortion and he feels certain that a test or information would almost certainly result in the parents decided to abort the child, his best course of action would probably be to refer the parents to another doctor. That's probably the best solution that I would be able to come up with if I was in that situation.
    If a member of the military can choose not to go to war due to religious reasons (Muhammed Ali comes to mind) then what would make a doctor any different? A doctor should not be forced by law to do something that directly violates his morals, but given the state of the legal system, his best course of action would probably be to refer the patient to another doctor.
    ducknwork, these two quotes seem very consistent. Since an obstetrician has two patients, both the mother and the child, it seems obligatory to let the mother know what genetic tests are available; the costs, etc. It would be easy to put together an educational booklet on that which doctors could give to all pregnant women at their first visit. They would then have the information to decide whether any genetic testing, based on their family background information, seems in order for them. The parents could make their decision to have genetic testing as early in the pregnancy as possible.

    Then, if the doctor has any religious or moral issues with performing abortions, he can make that clear early on. The patient can then make their judgment early to seek another doctor for their care.

    Like WRL, I would believe that anyone not personally faced with such a decision can second-guess what a mother's/parents' decision might be.

    dnf777
    There was one doc at the conference who gives ALL his patients a letter encouraging them to share all their medical conditions with their children and relatives, so in case one of them turns out to be hereditary, he can say he "warned" them! Crazy, huh?
    No, I don't think this is crazy. It's probably a good thing ... not just as protection against being sued. Some adopted children are encouraged to seek out this information from their birth-parents for this very reason as they reach child-bearing age. I just think it would be better for the AMA (or an obstetrical specialty organization) to come up with such educational material that includes this, as well as a summary of the inherited traits already known to us.

    The reality of that artificial womb would not be all bad. There are couples who dearly want a child, but where the mother cannot carry a fetus to viable term. Those couples would welcome such an advance, I would imagine. The question of a pregnant woman's habits seriously endangering an otherwise healthy fetus (v. choosing to abort one that is genetically faulted) would be a different question, I think.

    What might be more distressing is the govt actually making the decisions to abort or not abort a fetus. For example, a child with Downs Syndrome could be expected, in many instances, to put a "drain" on a govt-run health care system during their lifetime. Would a govt system of health care, strained for funds and staffing, make it compulsory to abort a Downs Syndrome fetus? In that way, would the govt then be interfering, in some cases, with an individual's freedom of religion? Even now that is a large issue, I think, with parents whose religion interferes with seeking traditional doctor care for their children. Perhaps an even more difficult issue for an unborn?

    You are so very correct, DNF, that technological advances present us with issues not faced by previous generations. Only a very few of us (thankfully) would like the chance to "play God" ... many of those who have that bent, turn out to be tyrants and monsters to the rest of us.
    G.Clinchy@gmail.com
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  3. #13
    Senior Member dnf777's Avatar
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    Gerry,
    Thanks for your thoughtful reply. Your hypothetical regarding the gov't wanting to terminate a Down's pregnancy raises excellent questions. I doubt if the gov't or any other entity would outright require that, not that they could, but a much more plausible scenario would be them saying, "fine, carry on, but we're not paying for it on behalf of the other subscribers/citizens". I could see this argument being run parallel to the anti-abortion supporters who want gov't to NOT PAY for abortions. (current event in the health bill) The 'we can't stop you, but we don't have to pay for it' solution.

    All very interesting. All the moreso when we realize these are REAL people, REAL lives that are being affected. Odd that the decisions are made in mahogany panelled, rustic courtrooms, far removed from the harsh reality with which they deal!
    God Bless PFC Jamie Harkness. The US Army's newest PFC, but still our neighbor's little girl!

  4. #14
    Senior Member YardleyLabs's Avatar
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    There was a time when physicians routinely made decisions on how much information it was appropriate for a patient to be told. Happily, that time is past. Medicine is one of a limited number of professions where the consumer/patient is assumed to be incapable of making an independent judgment concerning the appropriateness of the services being provided. That is the basis for the various licensure procedures governing the profession and is also the basis for ongoing discussions concerning what is required to obtain informed consent for treatment.

    My assumption is that my physician will provide me with a balanced view of the risks associated with my medical condition and any related treatment. I also expect honest answers to the questions I ask. I do not expect the physician to necessarily share my priorities and therefore do not expect that we will necessarily agree on treatment. However, I am also not an average patient as a result of both family background and prior employment.

    In most cases, informed consent is difficult to achieve and may be impossible with many patients. Increasingly, doctors have (wisely) resorted to preprinted descriptions of medical conditions and treatments that contain carefully written information. However, while this may be the only way to provide a document trail proving what a patient was told, it is not necessarily an effective communication strategy. For 20 years, I had a physician who believed that his primary role was to make sure I understood my condition and the options available to me. However, as a direct consequence, his average office visits were 30-40 minutes long. That clearly didn't meet the norms required for a "modern" clinical practice and he ultimately moved to a "concierge" practice charging each patient a flat fee of $2000/year for routine care.

    With respect to the question you asked, I believe that a physician has an obligation to ask questions concerning the existence of heriditary, environmental, and behavioral risks that could affect the mother and the fetus. The availability of genetic tests should also be discussed along with information allowing the patient to participate in deciding what tests if any to do. That was certainly the case with all three of my wife's pregnancies 27-35 years ago and also the case with my daughters pregnancies over the last seven years. In all of those cases, my daughter and her husband and my wife an I decided not to test for conditions such as Down's Syndrome since no result would have affected our willingness to proceed with the pregnancies. However, that decision belongs exclusively to the patient, not the doctor. In my mind, the doctor has a responsibility for providing the patient with the information. If the patient elects for a legal and medically valid form of treatment that the physician cannot or will not provide, I believe the physician has a professional responsibility for assisting the patient to find a provider that can help.

  5. #15
    Senior Member Gerry Clinchy's Avatar
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    dnf777
    All very interesting. All the moreso when we realize these are REAL people, REAL lives that are being affected. Odd that the decisions are made in mahogany panelled, rustic courtrooms, far removed from the harsh reality with which they deal!
    You said a mouthful there!

    I believe that this is the big issue with health care today, and maybe even more so with heavy govt involvement. Will the policy-makers, sitting in their ivory towers, never having to face the patients, be the ones to make life-and-death decisions? It's no wonder that even now a compassionate doctor has to fight a bureaucracy to get the right care for some patients in a timely fashion, or at all. There may be good doctors and bad doctors, but, overall, I'd rather trust medical decisions to a doctor rather than a bureaucrat (private or public!)
    G.Clinchy@gmail.com
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  6. #16
    Senior Member Gerry Clinchy's Avatar
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    Yardley
    In my mind, the doctor has a responsibility for providing the patient with the information. If the patient elects for a legal and medically valid form of treatment that the physician cannot or will not provide, I believe the physician has a professional responsibility for assisting the patient to find a provider that can help.
    By golly, I think we may have actually found something upon which we can all agree!

    Freedom for the individual ... the doctor gives all information, but can still make his/her individual choice to participate in terminating a pregnancy, or not. The parents also can make their individual choice when they have the information as well. Even if the doctor does not want to participate in terminating a pregnancy, it would be entirely ethical for the doctor to provide the information, even if it were only to prepare the parents for what might happen. If the parents decide not to terminate, then they have had the time to make the preparations for their decision, taking their own personal responsibility for the results of that decision.
    G.Clinchy@gmail.com
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    What might be more distressing is the govt actually making the decisions to abort or not abort a fetus. For example, a child with Downs Syndrome could be expected, in many instances, to put a "drain" on a govt-run health care system during their lifetime. Would a govt system of health care, strained for funds and staffing, make it compulsory to abort a Downs Syndrome fetus? In that way, would the govt then be interfering, in some cases, with an individual's freedom of religion? Even now that is a large issue, I think, with parents whose religion interferes with seeking traditional doctor care for their children. Perhaps an even more difficult issue for an unborn

    Once you start analizing all the what ifs you will end up with more bureaucratic bull chit paper work.


    If aborting is murder than logically you have to investigate every miscarrage,,, that sort of thing.
    The more complicated we make this stuff the deeper we sink into a bureaucrtic quagmire, and the more agencies we need to invent to push even more paper around.

    Nothing is diffenet than 5o years ago,,,but no wthat we have computers we think we are so smart.
    Pete

  8. #18
    Senior Member Gerry Clinchy's Avatar
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    Once you start analizing all the what ifs you will end up with more bureaucratic bull chit paper work.
    Absolutely. The idea, then, is to keep the govt doing those things that govt appropriately should do, and not inject govt edicts into areas where they are not appropriate.

    The problem with our legislators is that they often do not analyze the what if's before they hand down their edicts. Then we are left with bureaucrats trying to figure out how to implement the stuff that the lawmakers didn't anticipate.
    G.Clinchy@gmail.com
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  9. #19
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    Absolutely. The idea, then, is to keep the govt doing those things that govt appropriately should do, and not inject govt edicts into areas where they are not appropriate
    Exactly Gerry.,
    the government has its place,,, but anymore they are in everything,,, like an undiciplined little puppy,,, they tear everything up and ruin everything they touch.

    Pete

  10. #20
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    dnf777-

    Court cases revolve around legal theories. A lawyer puts forward a legal theory supported by case law and the facts of the case and draws a conclusion from it. He hopes to convince the jury or judge that his theory has merit and is a correct one.

    I would be interested in know how this case ended. We don't know how old the plaintiff was but suppose s/he was over 21. The theory is that 21 years ago the standards of care and informed consent would have required notification (probably yes) and that the action by the parents to abort would have been rather pro forma. The second part is sort of hard to prove or disprove.

    Eric

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