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    (Original post by randdom)
    If the person doesn't want to die and the doctor gives them an overdose of something then that is deffinately murder don't you think?
    as a 2nd year BSMS i'm disappointed that you haven't come across this scenario.
    There is a specific name for it, but the jist is that if your intention is pain relief, even if you know that death may/will result then you are justified. [this obviously has stringent cases where it is applied]
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    the catholic stance for instance.
    "It is important to emphasise that the alleviation of pain is a worthy aim even when the treatment itself carries the risk of shortening life. In such cases there need be no intention of seeking death. It should also be noted that high doses of painkillers do not shorten life in all cases. If the dose is increased gradually over some time the patient will develop a level of tolerance. Nevertheless, in cases where it is foreseen that high doses of painkillers will shorten someone's life, it may still be reasonable to use them to counter the pain. The Church's Declaration on Euthanasia is clear: 'In this case, of course, death is in no way intended or sought, even if the risk of it is reasonably taken; the intention is simply to relieve pain effectively.' On the other hand, what is not acceptable is the deliberate use of painkillers as a means to euthanasia. "
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    (Original post by Navindu)
    and with that you prove that you have never opened an ethics book in your life.
    its the most widely qouted possible scenario for a doctor.

    its easy to be dogmatic about the black and white things in life - assigning with very little thought what is black, and what is white, but very hard to follow.


    thinkabout it. THe man in front of you in his bed is terminally ill with colon cancer. he is screaming in agony.
    "PLEASE THE PAIN IS TOO MUCH!!!"
    He is sweating like mad, his pulse is racing, there isno doubt he is in searing agony. He's had his maximum safe dose of morphine. Any more might slow his breathing down and kill him.
    Sorry, but you can't have any more.
    It really does depend to be honest. The ethics around this situation aren't as clear cut as you make it. You seem to suggest that an over does of morphine only has a small chance of killing someone. Overdosing on morphine can cause sever respiritory depression which will lead to death in some cases so it isnt really a decision that you can just make off hand. Yes in this situation I would guess that the majority of doctors would give the patient more morphine to try and help with the pain. However unfortunately there is no evidence that this would help with the pain. Studies that we have been shown in our ssc have shown that people with metestatic pain are more likely to feel more sever pain which is less responsive to pain killing medication.

    Sorry but I just don't think the decision is as easy as you make out.

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    (Original post by Navindu)
    as a 2nd year BSMS i'm disappointed that you haven't come across this scenario.
    There is a specific name for it, but the jist is that if your intention is pain relief, even if you know that death may/will result then you are justified. [this obviously has stringent cases where it is applied]
    I thought that you were asking if the doctor gave a patient a fatal does with the intention of euthanasia with out the patient knowing about it. I re-read it just then and saw what your actual point was and I have replied to it in me previous post.
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    (Original post by randdom)
    It really does depend to be honest. The ethics around this situation aren't as clear cut as you make it. You seem to suggest that an over does of morphine only has a small chance of killing someone. Overdosing on morphine can cause sever respiritory depression which will lead to death in some cases so it isnt really a decision that you can just make off hand. Yes in this situation I would guess that the majority of doctors would give the patient more morphine to try and help with the pain. However unfortunately there is no evidence that this would help with the pain. Studies that we have been shown in our ssc have shown that people with metestatic pain are more likely to feel more sever pain which is less responsive to pain killing medication.

    Sorry but I just don't think the decision is as easy as you make out.

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    I thought that you were asking if the doctor gave a patient a fatal does with the intention of euthanasia with out the patient knowing about it. I re-read it just then and saw what your actual point was and I have replied to it in me previous post.
    See that is my precise point! [though not aimed at you, but the lass]
    Its not an esay decision to make. there are lots of shades of grey. ethics is one of those areas which doctors have to find their own way around (with guidance of course) but it is a hugely complex and burdonsome area.
    you can't just say 'thwy should do this' and 'they should never do that'. it doesn't work because medicine is not engineering - its not a simple case of fixing human being machines, but helpingreal people each with heir own unique stories and situations. expediting the death of a man in searing agony because of a broken arm through use of painkillers would be terrible, but how about an elderly lady with terminal ovarian cancer and weeks to live who is similary in agony?
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    (Original post by Navindu)
    See that is my precise point! [though not aimed at you, but the lass]
    Its not an esay decision to make. there are lots of shades of grey. ethics is one of those areas which doctors have to find their own way around (with guidance of course) but it is a hugely complex and burdonsome area.
    you can't just say 'thwy should do this' and 'they should never do that'. it doesn't work because medicine is not engineering - its not a simple case of fixing human being machines, but helpingreal people each with heir own unique stories and situations. expediting the death of a man in searing agony because of a broken arm through use of painkillers would be terrible, but how about an elderly lady with terminal ovarian cancer and weeks to live who is similary in agony?
    We were doing something like this today in the clinical side of our course. We looked into the endstage of peoples lives. We also looked into the ethical dilema around removing a nasogastric tube (as was done recently in the usa with terry shapova (sp?)) Like you said it is a grey area which no one can really say what is right and what is wronge.
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    (Original post by yawn)
    In essence, doctors are fallible.
    I'll bet you didn't know this: They are also human :eek:
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    (Original post by yawn)
    Thank you - so they do include in that oath (as I highlighted)
    "I will maintain the utmost respect for human life from the time of conception"

    Umm...interesting - seeing as there was much debate on whether the newly conceived child was classed as human.
    Doctors in the UK do not take any kind of oath upon graduation.
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    (Original post by Sally)
    Is it impossible to disprove you don't have a brain?
    Grade 3 flashback!! :laugh:

    Sally... really.... do not drag the conversation down to THAT level
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    (Original post by yawn)
    Yes, it has got a bit side-tracked, hasn't it? (and I'm as guilty of that as any other person)

    But - the central point that whenever it is a question of what is best for the patient, the doctor has the arrogance to presume they know best, remains.

    As I said, quality of life cannot be judged subjectively, whether we are talking of illnesses that impact greatly on the sufferer's life or whether it is best to take a certain route with treatment or withholding of.

    In essence, doctors are fallible.
    Of course they are - they're only human. One of the most important principles doctors must uphold is to be aware of their own limits.

    Sure, doctors tend to be ambitious high achievers with a specialist body of knowledge but to classify the whole profession as arrogant or increasingly arrogant is nonsense. The reverse, in fact, is the case. Some older doctors are guilty of the very unfashionable trait of paternalism (quite acceptable in their day) but now all doctors are taught about the benefits of mutualism and patient-centred decision making, i.e. autonomy. Doctors never override the will of a competent patient. If a competent, fully-informed patient refuses treatment or advice, that's their lookout.

    And to get another thing straight - no doctor worth the name would ever coerce a woman into having an abortion if she was against it. If a foetus is seriously disabled or has a grave genetic abnormality, it is the patient's decision whether to terminate or continue with the pregnancy - not the doctor's. There are plenty of incidences where a woman, for whatever reason, decides to carry the baby to term, just as there are many cases where mothers' lives are at risk, yet they give birth, even if that means the death of the mother.

    Doctors always act in their patients' best interests and do their utmost to respect patient autonomy - if they don't they can be struck off and even prosecuted.
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    (Original post by spk)
    Doctors always act in their patients' best interests and do their utmost to respect patient autonomy - if they don't they can be struck off and even prosecuted.
    like the new article in the beginning of this thread shows.
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    (Original post by spk)
    Doctors in the UK do not take any kind of oath upon graduation.
    about half of med schools here do actually. whereas in the US its nearly all of them
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    All medical doctors in Britain must register with the GMC, accepting the code of conduct, before they can practice, much like the code of conduct for any job. I think these guidelines have many parallels with the hippocratic oath. The last I heard, UK doctors are under no obligation to take the oath, however.
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    (Original post by Navindu)
    and with that you prove that you have never opened an ethics book in your life.
    its the most widely qouted possible scenario for a doctor.

    its easy to be dogmatic about the black and white things in life - assigning with very little thought what is black, and what is white, but very hard to follow.


    thinkabout it. THe man in front of you in his bed is terminally ill with colon cancer. he is screaming in agony.
    "PLEASE THE PAIN IS TOO MUCH!!!"
    He is sweating like mad, his pulse is racing, there isno doubt he is in searing agony. He's had his maximum safe dose of morphine. Any more might slow his breathing down and kill him.
    Sorry, but you can't have any more.

    i dont understand you- if a man is saying the pain is too much- he's not saying KILL ME- so you dont give him an overdose of morphine... eventhough he's in pain, because you know you'll kill him, and the person in pain just wants the pain to stop, he doesnt want to be killed in the process. so as a doctor, obviously u are obliged to let him carry on with the pain. i mean.. i know its not the same, but people are always complaining of pains...and sometimes use the expression- oh i wish i was dead the pain is too much! now any respectable doctor wont take that seriously will they?

    i dont see how its a great ethics issue, and no, i havent read a single ethics book in my life, but that doesnt mean my comments on this issue are invalid.
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    (Original post by lady_daisychain)
    i dont understand you- if a man is saying the pain is too much- he's not saying KILL ME- so you dont give him an overdose of morphine... eventhough he's in pain, because you know you'll kill him, and the person in pain just wants the pain to stop, he doesnt want to be killed in the process. so as a doctor, obviously u are obliged to let him carry on with the pain. i mean.. i know its not the same, but people are always complaining of pains...and sometimes use the expression- oh i wish i was dead the pain is too much! now any respectable doctor wont take that seriously will they?

    i dont see how its a great ethics issue, and no, i havent read a single ethics book in my life, but that doesnt mean my comments on this issue are invalid.
    if someone is in extreme pain, morphine is given to stop the pain NOT to kill them, this is NOT euthanasia as you are suggesting... this is against the law.

    if the doctor wanted to kill them he'd give KCl, not a pain killer, so you argument is a bit odd... perhaps you are saying that you shouldn't give an overdose of a drug to kill someone but this isn't what is happening... instead a very high dose of painkiller to remove sufferring of someone that is at deaths door... this is totally different from someone who is in pain with a head ache and that is why the dose is totally type of pain killer and dosage is different
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    (Original post by psycho(logist))
    I'll bet you didn't know this: They are also human :eek:
    Indeed I do and I know their limitations as well!

    I have to see doctors on a very frequent basis so am well qualified to suss out the difference between those who are very good and those who are less good - for my particular, chronic, life-threatening condition - and those who are arrogant and those are aren't!

    I am all for patient empowerment - it's my body and subsequently I have a responsibility to know what is happening to it.

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    (Original post by Navindu)
    the catholic stance for instance.
    "It is important to emphasise that the alleviation of pain is a worthy aim even when the treatment itself carries the risk of shortening life. In such cases there need be no intention of seeking death. It should also be noted that high doses of painkillers do not shorten life in all cases. If the dose is increased gradually over some time the patient will develop a level of tolerance. Nevertheless, in cases where it is foreseen that high doses of painkillers will shorten someone's life, it may still be reasonable to use them to counter the pain. The Church's Declaration on Euthanasia is clear: 'In this case, of course, death is in no way intended or sought, even if the risk of it is reasonably taken; the intention is simply to relieve pain effectively.' On the other hand, what is not acceptable is the deliberate use of painkillers as a means to euthanasia. "
    Absolutely correct - and this viewpoint is mirrored by many in the medical profession.
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    (Original post by Navindu)


    thinkabout it. THe man in front of you in his bed is terminally ill with colon cancer. he is screaming in agony.
    "PLEASE THE PAIN IS TOO MUCH!!!"
    He is sweating like mad, his pulse is racing, there isno doubt he is in searing agony. He's had his maximum safe dose of morphine. Any more might slow his breathing down and kill him.
    Sorry, but you can't have any more.
    Most big hospitals now have 'palliative care Nurse Specialists' and it is their role to prescribe effective pain relief, particularly for those whose condition is terminal.

    My problem with that experience however is this. My brother had been told he had about one week left to live - he was in total organ shutdown and in great pain and discomfort. The palliative care nurse specialist prescribed his medication, which would mean that, whilst hastening the time of his death, he could die free from pain.
    A house officer reduced the dosage because of his own perception of the event and the ward staff did not recall the specialist nurse to review and rebuke the junior doctor! My brother suffered needlessly before his death.

    One other thing I would like to say on the matter of pain - we don't experience pain in a vacuum - pain is not solely the result of signals coming from an 'injured' body region, but instead emerges from the interation between these signals and cognitive information unique to every individual. Counselling is often more successful in removing pain than any potent pain reliever.

    --------------

    (Original post by spk)
    Doctors in the UK do not take any kind of oath upon graduation.
    In a discussion of this type, the UK is not the centre of the universe!
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    (Original post by yawn)
    In a discussion of this type, the UK is not the centre of the universe!
    This forum has a co.uk domain, and this particular thread was initiated by the OP referring specifically to a case of British medical malpractice.

    Your question was "Do all doctors still take the Hippocratic Oath?" and specifically, do they swear to "maintain the utmost respect for human life from the time of conception?" - with respect to the issue under discussion (a deranged British doctor, who killed a patient and was struck off for doing so), it was not unreasonable to refer to the situation in the UK, unless specified otherwise, which it was not.

    In the light of the above, it was right and proper to direct the discussion expressly to UK law and the state of affairs here.

    If you were after a country by country, state by state breakdown of the situation across the globe, you should have been a little more specific.
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    (Original post by yawn)
    Indeed I do and I know their limitations as well!

    I have to see doctors on a very frequent basis so am well qualified to suss out the difference between those who are very good and those who are less good - for my particular, chronic, life-threatening condition - and those who are arrogant and those are aren't!

    I am all for patient empowerment - it's my body and subsequently I have a responsibility to know what is happening to it.
    I'm sorry to hear that.
    There are many considerations doctors have to make on how much to inform the patient. I think most would agree that in a chronic situation, everything the patients wants explained should be, and they should be fully involved in the choice of treatment. However in acute situations, where explaining the problem to the patient wastes time, doctors should take the initiative and explain later. There are also many patients who are not interested in the why of their problem, taking the attitude that you don't ask a plummer why he's doing everything.
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    i dont think that doctors are arrogant, and in the case of taking them to court, whats better... someone living a month or so in agony and knowing that death is coming, or their family agreeing to end theyre life in the most humane way?
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    (Original post by Alas12)
    i dont think that doctors are arrogant, and in the case of taking them to court, whats better... someone living a month or so in agony and knowing that death is coming, or their family agreeing to end theyre life in the most humane way?
    The point is in the UK it is not the opinion of the doctor or the family that counts but that of the patient.

    If, however, a patient is not competent to make decisions about their care (i.e. if they cannot understand, retain and weigh the information), it is the duty of the doctor to act in the patient's best interests, not those of the family, although of course, friends and relations do have an input, especially in ascertaining what the wishes and views of the patient were thought to be, if the patient was previously competent.

    This is not arrogance but merely respecting patient autonomy.
 
 
 
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