Ethics and Health Care

[uppityperson]

I am a RN of many yrs. One of the things we discussed in school, and since, is ethics in health care. There are many situations in which what should be done is not all that clear cut.

-At what point does keeping someone alive become unethical? (Example: Terri Schiavo)
-In an emergency situation with many people involved, how do you triage? (Triaging is dividing patients into 3 categories. 1-someone who can survive without any immediate care. 2-someone who can survive with immediate care. 3-someone who will not survive even with immediate care.) (# 1 you ignore , # 2 you give them what is needed to sustain life and that is all, # 3 you ignore also which is difficult)
-Allocation of resources. what is more ethical to put limited resources (money, people) into? (example: vaccinations for 1,000 children or more costly (people and/or financial) care for 1) (Another example: do you save the rich or "powerful" person or the impoverished one?) (Another: where do you put research resources?) And yes, resources are limited.

It can, and does, seem cold, inhumane perhaps, to discuss this and have to make these choices. And it is not always done the right way. It can, and is, difficult for those of us who went into health care BECAUSE we care about people to have to do this also.

I am posting this because of the hoopla about the octuplets. If someone chooses to have multiple children, I cannot and will not pass judgment (well, I do to myself, but then again that is their choice and my pro-choice beliefs rule here). I can understand why some do (basing their opinion on allocation of resources).

I will and do pass judgment on the ethics of any doctor who would transfer more embryos than necessary though as I think this was unethical. But then again, I am looking at this not only from a mother's viewpoint, but a RN viewpoint also.

[PeaceNikki]

1. I agree with you.

The problem was the judgment of the doctor here.

I am disgusted that a doctor and this woman would make such a dangerous decision.

I am equally disgusted and appalled at some of the comments here that suggest that the government should regulate reproductive rights on any level.

[uppityperson]

2. Thanks. Problem with ethical stuff is it is also emotional stuff.

And there is a difference between government regulations and ethical regulations by providers.

[KittyWampus]

6. So you don't think medical professionals should be limited by the government to 2 embryos at a time?

You don't think society has an interest in the health and well being of the mother and resulting children when it comes to a medical procedure like IVF?

[uppityperson]

7. I think that should be ethical office policy to limit to 3. Not gvt regulation.

Seems like 3 is a large enough number to have at least 1 have a chance, and if all 3 develop it won't cause harm to any of the 3.

But I see it being ethical office policy vs gvt regulation.

[rebecca_herman]

14. No, because one size fits all doesn't work

There should be ethical/medical guidelines, but a doctor should be able to transfer more in a situation where he feels it is appropriate for the patient - such as a woman over 40 who produced only 4 embryos, that aren't particuarly good quality, who wants to put them all back (rather then freeze some and lower their quality further) because the chances of more then 1 or 2 being viable are so small at that age. I don't think the government knows what's best for all infertility patients.

[NashVegas]

3. It Was Horribly Unethical

I understand the fears of GLBT here, who argue that doctors should have no say in whether or not to participate in such a procedure, but disagree wildly specifically because of cases like this.

The six children already in this family were at risk; now there are another 8 at risk.

[uppityperson]

10. I see a difference between discriminating based on sexual orientation vs

limiting the # of embryos transferred. First case is discrimination, second case is following the Hippocratic Oath of first, do no harm.

I also find it humorous that this topic sinks while the other ones on this case are hot and heavy, guess I'm just not uppity enough today.

[NashVegas]

11. Well, It's Just So Much More Fun

To scream pro/con about "breeders" than it is to demand ethical behavior from professionals.

[nadinbrzezinski]

4. It was unethical, the problem is that regulating ethics

by the government is always hard... if not impossible

Personally this should not have gotten beyond the Medical Ethics Committee at the hospital.

And yes, I worked as a medic for ten years and had to make those very hard triage decisions in the field... or as I liked to call it, play god

[uppityperson]

9. Playing god is very difficult on those of us who have had to.

No wonder we end up an odd bunch. Pragmatic, open hearted and minded, cynical, dark humored even.

Gvt regulation of ethics is very difficult. Health care ethical decisions are also.

[nadinbrzezinski]

13. Well in the health care decisions arena, one "downside" of single

health care is that seventy five year olds in the transplant list will have to go...

See triage...

And reality is that we have many procedures we do on the aged that we simply will not be able to afford....

See that kidney transplant on the 75 year old... and yes, I can hear the screams already... but the pragmatic decision is to use those resources on individuals who will definitely have a life ahead of them...

And yes, that is the reality in places with single payer... and that is the pragmatic decision... the triage based decision

[uppityperson]

15. In a perfect world, resources would not be limited. In this world, they are.

"perfect worlds" only exist in fantasy. There are a lot of people suffering in this world, and figuring out how to get the most for the buck and the time and energy is not always a comfortable thing.

[KittyWampus]

5. Thank You. The spotlight should be on the doctor, the profession and its standards, IMO

[TZ]

8. Yeah I think the doctor showed poor judgement

If there was a valid IVF treatment that would have worked without having to implant so many embryos he should have done it.

[NashVegas]

12. Kicking for Ethics

yay ethics!

[uppityperson]

16. kicking since the debate goes on.