Author Topic: Doctors Versus Disabled Patients  (Read 11632 times)

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QueenofHearts

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Re: Doctors Versus Disabled Patients
« Reply #60 on: January 03, 2014, 06:04:36 am »
Pardon, are you saying that people with Asperger's and Bipolar Disorder have a lower chance of survival?

'Cause I don't think they do.

You can harp on about "political correctness" all you want, but it's about anti-discrimination.  Would you support it if a black person was put behind white people because "black people are more likely to be murdered"?

Zachski, I'm going to put it in the most basic terms. There has been one fact critical to this debate that has been ignored, organs are limited, people will die.

I repeat. No matter what decisions you make, I make, doctors make, or society makes, people will die. This is the unpleasant fact here. This is not My Little Ponies. Princess Celestia will not come out of the clouds at the last minute and create a secondary organ. If A lives, B dies; if B lives, A dies.

So, how do answer this question? How do we determine which lives are worthy of living relative to those who unfortunately are not worthy? As Nick said, "doctors are not going to flip coins or throw dice over such an important decision." The answer, we literally put a value on life. We look at this in the most Un-PC manner. It's not fair, but neither is life nor the situation. We factor in certain conditions, come up with a value of that person's life, and we come to the conclusion on who lives and who dies. Unfortunately, we've gotten on a bit of a tangent. The OP discussed Coffin-Siris syndrome and Down's Syndrome; two conditions which (again, un-PC) objectively create a lower value and quality of life. They are less likely to be the heads of households, less likely to be important or contributing people in society (in purely economical terms), and less likely to enjoy the same quality of life as most society. Call this ableist all you want, but such is the unpleasant reality of triage.

Then, you got off on the tangent of transsexuality (largely I feel as a political point, a "gotcha Queen"). But you know, I will say it, in this instance, we have to look at the issue on paper. Again, it's not fair, but neither is life, nor the situation. If life were fair, I'd have a vagina. If factors stemming from my transsexuality (lack of dependents, weaker organs via HRT, etc) determines I should die, so be it. Like I said, people will die and this isn't pretty. Now, of course I would understand someone being a hypocrite and fighting tooth and nail when it's them, I would. But on paper, some people have to die and I could very well be that person.

And the whole reason is, as Sylvana said, triage. The purpose is to determine who has the best chance of living a productive live (productive in both personal and societal senses). Like, pretend we have two patients. Both need livers, we have one liver. Patient A is 25, has a host of health problems, in and out of the hospital, and with the liver, likely wouldn't live past 40. Patient A has no job, no children, and no body who depends on her. She lives largely off of medicaid and low income assistance. Patient B is 40, a widower with three children who depend on him. He makes enough of an income to give them a good life. If we ignore these health factors (or if we include them, ergo a de facto discrimination) and go with patient A, we have condemned 3 kids to a life of poverty and in a few years will have 2 dead people instead of 1.* To choose B solely because of A's condition would be ableism, but it would also be the best decision to make for society. Ultimately, the goal of all institutions should be utilitarian.

And this is the whole cause of the debate, the intentional misrepresentation of triage. It's not a list of qualifiers and disqualifiers, but a hierarchy of who is most deserving all the way down to the least deserving. Unfortunately, we perpetually have a lower amount of organs than patients who need them. Thus, the criteria which put one at the bottom of the list is a de facto disqualifier (down's syndrome for example, they go to the bottom of the list, we have limited organs, they don't get one, they die). If science were to develop advanced 3-D organ printing tomorrow or find a cache of well-preserved organs, those with coffin siris or down's syndrome would not be disqualified from transplants, they would get them. Therefore, the issue is not "you have down's syndrome no organs" but "we have limited organs, you have this condition, we're sorry." So, what we are arguing is not "qualifiers and disqualifiers," but the hierarchy of needs the medical profession uses. It just appears as a list of qualifiers and disqualifiers because perennially we have fewer organs than patients.

*while we can't know for certain, hey, patient B may be hit by a bus tomorrow, again, we look at this on paper.
« Last Edit: January 03, 2014, 06:07:04 am by QueenofHearts »

Offline Shane for Wax

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Re: Doctors Versus Disabled Patients
« Reply #61 on: January 03, 2014, 07:15:12 am »
Re- "ignoring"



Except not. Also that jab about MLP was unnecessary but whatever.

You keep using the word triage. I don't think it means what you think it means. Triage isn't performed on paper unless you're in the classroom. I went to the ER throwing up with a high blood pressure and they didn't decide to take me back quickly based on what they saw ~on paper~. They didn't see me as being depressed with ADHD while they were doing their triage. Because it wasn't pertinent.

But whichever. Believe as you will, I guess.

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QueenofHearts

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Re: Doctors Versus Disabled Patients
« Reply #62 on: January 03, 2014, 10:18:09 am »
1. Snarky GIFs do not make a point. I'm kind of sick of seeing the same posters use them ad nauseam.
2. The MLP reference was necessary to say, "the world isn't sunshine and unicorn farts." What part of "PEOPLE WILL DIE," is so hard to understand? There isn't going to be a "happy ending" only a "less worse" one.
3. From Wikipedia,

Quote
Triage is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately... Because treatment is intentionally delayed or withheld from patients, advanced triage has ethical implications.

4. Do you know what it means? There is a bit of difference between "going to the hospital throwing up" and "I need one of a limited few kidneys." They could realistically treat everyone throwing up (unless it were life threatening and they had limited vaccines) your conjecture proves nothing.

Art Vandelay

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Re: Doctors Versus Disabled Patients
« Reply #63 on: January 03, 2014, 11:31:13 am »
1. Snarky GIFs do not make a point. I'm kind of sick of seeing the same posters use them ad nauseam.
Slightly off topic, but fucking thank you. I thought I was the only one who was fed up with it.

Offline Ghoti

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Re: Doctors Versus Disabled Patients
« Reply #64 on: January 03, 2014, 11:45:34 am »
{rant}
{more rant}
*with the intention of lightening the mood somewhat* Jerry, Jerry, Jerry...?
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wrightway

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Re: Doctors Versus Disabled Patients
« Reply #65 on: January 03, 2014, 12:27:56 pm »
Okay, I'm curious. Do doctors seriously have a quanitfiable list of traits worth X number of points to determine who does and does not get an organ? Or are you guys talking strictly in the hypothetical?

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Re: Doctors Versus Disabled Patients
« Reply #66 on: January 03, 2014, 04:38:08 pm »
I thought you were going to sit out of this conversation, Queen?
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QueenofHearts

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Re: Doctors Versus Disabled Patients
« Reply #67 on: January 03, 2014, 06:24:06 pm »
I thought you were going to sit out of this conversation, Queen?

I tried to sit it out, I really did, but this conversation just looked like too much fun for me to avoid.

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Re: Doctors Versus Disabled Patients
« Reply #68 on: January 03, 2014, 06:33:26 pm »
I thought you were going to sit out of this conversation, Queen?

I tried to sit it out, I really did, but this conversation just looked like too much fun for me to avoid.

Alright, then I have a simple question for you.

Do you think a doctor should be allowed to exclude black people from the list?
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Offline Ghoti

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Re: Doctors Versus Disabled Patients
« Reply #69 on: January 03, 2014, 07:06:18 pm »
Oh boy, here we go. *prepares popcorn, hotdogs, marshmallows, etc*
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Re: Doctors Versus Disabled Patients
« Reply #70 on: January 03, 2014, 07:09:00 pm »
Oooh, can I have some?
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Re: Doctors Versus Disabled Patients
« Reply #71 on: January 03, 2014, 07:17:06 pm »
Oooh, can I have some?
Sure, what would you like? Hot dog? S'more? Campfire baked potato? The popcorn will be ready in a minute.
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QueenofHearts

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Re: Doctors Versus Disabled Patients
« Reply #72 on: January 03, 2014, 07:17:27 pm »
No treats for anyone, I'm here to shit on this parade.

I thought you were going to sit out of this conversation, Queen?

I tried to sit it out, I really did, but this conversation just looked like too much fun for me to avoid.

Alright, then I have a simple question for you.

Do you think a doctor should be allowed to exclude black people from the list?

Of course not, there is nothing about being black that affects quality of one's life. Now, other factors stemming from racism (lower education, less resources, less education, more likely to be harassed by cops) should. Again, this isn't humane or ideal, but neither is the situation. Unfortunately, this would bias the system against blacks for the aforementioned reasons. Thing is, we can't qualify how much these things matter (example: If this black man were given the resources and respect of this white man, the former would life and not the latter). Just like how I said that transsexual traits (unlikely to have biological kids and possible organ damage from HRT) should factor in, even though trans-asterisk-ness should not (because, again, we can't qualify such things.) But instead of having affirmative action for minorities in organ trans*plants, why not focus our energies on society to change these problems so things like skin color and homosexuality won't correlate with being denied the organ. Shit, lord knows I'd rather society just be cool about me being trans-asterisk than be shitty to me and give me a needed organ.

But that's the joy, the OP and the article mentioned two very serious problems which would prima facie affect one's quality of life; coffin siris syndrome and down's syndrome. You've continued to strawman the issue from those serious problems into miniscule things like race and trans-asterisk-sexuality because you refuse to see this as a triage hierarchy issue and instead view it as "that mean doctor won't do this solely because of X characteristic." The difference being the former is an example of who lives and who dies. The latter would be discrimination, but that isn't happening. You're so sure it is, and you're confusing correlation with causation. If we had the organs, they would receive them. However, the status quo is a de facto denial because such problems put those people near the bottom of the list. Do you really think if we had 100 patients (50 with down syndrome, 50 without) and 51 organs, a doctor would be so callous as to say "well, throw that liver in the compost pile, we have no use for it"?

But quid pro quo, you ask me a question, now I get to ask you one. Remember Sylvana's question on page four about the two identical patients, but one was bi-polar, albeit in remission? I would really like to see your answer to that question. Or better, two patients, one liver. Patient A has down's syndrome, is 30, lives off welfare, has no family, no job. Patient B is the same age, has two kids who depend on her. She is the breadwinner for her family making a sizable income with a top accounting firm in the country. Neither have criminal records nor histories of drug abuse. Who lives, who dies Dr. Silveresti? Why?

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Re: Doctors Versus Disabled Patients
« Reply #73 on: January 03, 2014, 07:25:43 pm »
And I will tell you the same thing I told Sylvana.

I'm not qualified to make that decision.  However, both should have a chance at it.  That is all I have argued and all I will ever argue.

As it stands now, neuro-atypicals have zero chance because they are not on the list at all.

Let me emphasize something before you try shoving arguments down my throat again:

If it was a simple case of them being lower priority on the list, that would be understandable.  It's not fair, but then you are right about one thing, life isn't fair and doctors have to make difficult decisions.

But they aren't lower priority on the list.  They aren't even on the list.  THAT is the part I and Shepard have an issue with.  This IS discrimination, whether you like it or not.


There are no strawmen involved here.  Just plain and simple fact.

So, I suppose to answer your question, BOTH should be on the list, but all factors considered, Patient B should get the liver.  But then if another liver comes into play, then Patient A should get a liver, too, because Patient A should be on the list.
« Last Edit: January 03, 2014, 07:28:53 pm by Magus Silveresti »
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QueenofHearts

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Re: Doctors Versus Disabled Patients
« Reply #74 on: January 03, 2014, 08:08:10 pm »
Would anything change if I told you the person in the OP, the one who needed the heart and lung transplants in 1995, got both?

Would anything change if I told you she died 16 months later?

End result, we have two dead bodies instead of one.