There are many things in life, we might call truisms, that we take for granted, seem so self-evident that we don’t pay attention or try to find out more about them or find another explanation. And when you hear about them, you may ask yourself “why didn’t I think about that before?” Wikipedia defines truism as “In philosophy, a sentence which asserts incomplete truth conditions for a proposition may be regarded as a truism. An example of such a sentence would be: ‘Under appropriate conditions, the sun rises.’ Without contextual support — a statement of what those appropriate conditions are — the sentence is true but uncontestable.” In other words, “there is more to that statement than that!” I think that ethicists are often faced with truisms and the job is to find another explanation. For example, some may say that “the act of a physician turning off life-support is simply killing the patient”. On the other hand (see about “on the other hand” below), maybe removing the life support, at the request of the patient, is simply allowing the patient to die from his or her underlying fatal illness. However, in the context of a relative intent on financial gain, the relative pulling the plug on the ventilator might represent killing. What do you think?
Hans Engel, M.D. has sent me an amusing list of statements which I think may contain within them truisms. Can you find them? ..Maurice..
1. Save the whales. Collect the whole set.
2. A day without sunshine is like....night.
3. On the other hand, you have different fingers.
4. Remember, half the people you know are below average.
5. He who laughs last thinks slowest.
6. Depression is merely anger without enthusiasm.
7. Support bacteria. They're the only culture some people have.
8. A clear conscience is usually the sign of a bad memory.
9. How many of you believe in psycho kinesis?...Raise my hand.
10. OK...so what's the speed of dark?
11. When everything is coming your way, you're in the wrong lane.
12. Everyone has a photographic memory. Some just don't have film.
13. How much deeper would the ocean be without sponges.
14. What happens if you get scared half to death twice?
15. I couldn't repair your brakes, so I made your horn louder.
16. Why do psychics have to ask you for your name?
17. Inside every older person is a younger person wondering what
happened.
18. Just remember---if the world didn't suck, we would all fall
off.
19. Light travels faster than sound. That is why some people
appear bright until you hear them speak.
20. Life isn't like a box of chocolates....it's more like a jar of
jalapenos. What you do today, might burn your ass tomorrow.
=
Thursday, April 13, 2006
Saturday, April 8, 2006
Ethics and Law: "Two Porcupines Making Love"
Ethics and law: how are the two related. Does one come from another? Does one (for example law) always trump the other (ethics)? Well, back in 2000 Erich H. Loewy, who is a physician-ethicist wrote the following to my now inactive "Bioethics Discussion Pages". I think that in his few words, he has helped me understand that relationship between the two disciplines. What do you think? ..Maurice.
Ethics and the Law
Dr. Erich H. Loewy
Professor and Endowed Alumni Association Chair of Bioethics
Associate, Department of Philosophy
University of California, Davis
In my view (and that is my view and, therefore, may well be wrong) one of the measures of civilization in a society is to see if its laws derive from ethics or if its ethics (or at least its ethos) derive from laws. In my view, the more civilized a society the more is the former the case. Another measure is the protection of the vulnerable within such a society, something which is closely related.
The Nazi example fits -- mark you, I am not saying the holocaust, I am saying the Nazi state. The ethos shifted with the Nürnberg laws so that what was formerly simply not done became doable. The reciprocal influence of law on ethos (not the same as ethics but still the way we feel comfortable behaving) and of ethos on law is evident.
The question, of course, is "how do you translate ethics into law?". As I tell my students: like two porcupines making love: very carefully!!! To translate ethical precepts into laws must, I think, meet at least two conditions. First it should be something about which a wide consensus exists in society (murder might be an example); secondly it should be the doing of which is not only held to be ethically wrong but "threatens the king's peace" (the origin of law, really: in other words something which seriously impacts the peace of the realm).
Example: Most of us would pay lip service to the statement that it is ethically inappropriate to lie to one's spouse. But it doesn't threaten the king's peace and few of us would want it made into a criminal offense (is the death penalty too harsh??)- Murder, in that it threatens the peace of the realm because of vendettas, falls in the same categories. So, in my view, is a social structure which provides all with basic needs: here you curiously enough have something which threatens the public peace but something that there is no wide consensus about (and hence no or no adequate appropriate laws).
Obedience to law is, in my view, not absolute. When important ethical principles are jeopardized by law citizens are confronted with an ethical problem. An attempt to alter the law and, if need be, civil disobedience remains one of the corner stones of democratic process.
________________________________________
(c) 2000,Erich H. Loewy. All rights reserved. ehloewy@ucdavis.edu
Ethics and the Law
Dr. Erich H. Loewy
Professor and Endowed Alumni Association Chair of Bioethics
Associate, Department of Philosophy
University of California, Davis
In my view (and that is my view and, therefore, may well be wrong) one of the measures of civilization in a society is to see if its laws derive from ethics or if its ethics (or at least its ethos) derive from laws. In my view, the more civilized a society the more is the former the case. Another measure is the protection of the vulnerable within such a society, something which is closely related.
The Nazi example fits -- mark you, I am not saying the holocaust, I am saying the Nazi state. The ethos shifted with the Nürnberg laws so that what was formerly simply not done became doable. The reciprocal influence of law on ethos (not the same as ethics but still the way we feel comfortable behaving) and of ethos on law is evident.
The question, of course, is "how do you translate ethics into law?". As I tell my students: like two porcupines making love: very carefully!!! To translate ethical precepts into laws must, I think, meet at least two conditions. First it should be something about which a wide consensus exists in society (murder might be an example); secondly it should be the doing of which is not only held to be ethically wrong but "threatens the king's peace" (the origin of law, really: in other words something which seriously impacts the peace of the realm).
Example: Most of us would pay lip service to the statement that it is ethically inappropriate to lie to one's spouse. But it doesn't threaten the king's peace and few of us would want it made into a criminal offense (is the death penalty too harsh??)- Murder, in that it threatens the peace of the realm because of vendettas, falls in the same categories. So, in my view, is a social structure which provides all with basic needs: here you curiously enough have something which threatens the public peace but something that there is no wide consensus about (and hence no or no adequate appropriate laws).
Obedience to law is, in my view, not absolute. When important ethical principles are jeopardized by law citizens are confronted with an ethical problem. An attempt to alter the law and, if need be, civil disobedience remains one of the corner stones of democratic process.
________________________________________
(c) 2000,Erich H. Loewy. All rights reserved. ehloewy@ucdavis.edu
Thursday, April 6, 2006
What Can You Say to Mr. B?
The following is a recent response to the subject of euthanasia on my now inactive "Bioethics Discussion Pages". It is not unusual for a patient to come to the physician's office with a history similar to Mr. B., below. If you were Mr. B.'s new physician what can YOU say to Mr. B.? ..Maurice.
I've been fighting to live for the past 17 years and it hasn't been until the last 3yrs that I've started thinking about how to get it done with.I have periods where I get violently ill the doctors have no clue as to the cause of the spells,nor anything that they can do to help,stop,or treat whatever it is.The only explaination they have is it is a buildup of toxins,or the release of toxins,that are making me so ill.I have just gone through 12-14 weeks of it and more than one nite was spent praying/wishing for the end to come.To get any relief form the nausea,vomiting,aching,and the pain from the tumors/masses from as near as we've been able to determine is some type of bone disease.I've been to Mayo clinic,Johns Hopkins,and the state medical school and every medical facility that thought they might do some good.Not one has been able or willing to do anything to help and several have done more harm than good.I'm no fan of doctors and the games that they play.they should have to live a day in their patients body that are as ill or worse than I have it and then see if they have any doubts about wether they should assist the relief of someone that all they want is relief from the illness they have.I've read the letters from those who think they have any idea of what someone wants that nolonger has any control of themselves,or that is in unbearable pain like I have from the areas of soft bone that the surgeons have described as being like rubber,to areas that have collapsed like the 4 vertabra that partially collapsed 5-6 years ago.I lost 6 inches in height in 30 seconds.I don't dare even discuss the idea of euthansia with any of the doctors for fear that they will take away what little morphine I do get for the bone and tumor pain that I have to deal with 24/7/365.Another problem that I've developed is a resistance to the morphine and every other pain med that I've taken.I may not know what is best for everyone,but from my own positi! on and what I go through every day there needs to be an avenue of some type making availble for those who can't take the pain and sickness they bare some way to get the relief and somekind of end.I would never have let any animal that I've ever had go through the first year of the past 6-8 that I've been through,let alone go this far.We always treat our pets and livestock better than we do our ill family and friends,there is noway that any selfrespecting farmer/stockman would let an animal suffer like we do and those we claim to care about.I'm sick tired and out of any more to say,only that I hope that those who think they know what is best for anyone hasn't likely a clue as to what is best for anyone and sure as hell they've not a clue as what's best for me. B
I've been fighting to live for the past 17 years and it hasn't been until the last 3yrs that I've started thinking about how to get it done with.I have periods where I get violently ill the doctors have no clue as to the cause of the spells,nor anything that they can do to help,stop,or treat whatever it is.The only explaination they have is it is a buildup of toxins,or the release of toxins,that are making me so ill.I have just gone through 12-14 weeks of it and more than one nite was spent praying/wishing for the end to come.To get any relief form the nausea,vomiting,aching,and the pain from the tumors/masses from as near as we've been able to determine is some type of bone disease.I've been to Mayo clinic,Johns Hopkins,and the state medical school and every medical facility that thought they might do some good.Not one has been able or willing to do anything to help and several have done more harm than good.I'm no fan of doctors and the games that they play.they should have to live a day in their patients body that are as ill or worse than I have it and then see if they have any doubts about wether they should assist the relief of someone that all they want is relief from the illness they have.I've read the letters from those who think they have any idea of what someone wants that nolonger has any control of themselves,or that is in unbearable pain like I have from the areas of soft bone that the surgeons have described as being like rubber,to areas that have collapsed like the 4 vertabra that partially collapsed 5-6 years ago.I lost 6 inches in height in 30 seconds.I don't dare even discuss the idea of euthansia with any of the doctors for fear that they will take away what little morphine I do get for the bone and tumor pain that I have to deal with 24/7/365.Another problem that I've developed is a resistance to the morphine and every other pain med that I've taken.I may not know what is best for everyone,but from my own positi! on and what I go through every day there needs to be an avenue of some type making availble for those who can't take the pain and sickness they bare some way to get the relief and somekind of end.I would never have let any animal that I've ever had go through the first year of the past 6-8 that I've been through,let alone go this far.We always treat our pets and livestock better than we do our ill family and friends,there is noway that any selfrespecting farmer/stockman would let an animal suffer like we do and those we claim to care about.I'm sick tired and out of any more to say,only that I hope that those who think they know what is best for anyone hasn't likely a clue as to what is best for anyone and sure as hell they've not a clue as what's best for me. B
Friday, March 31, 2006
A Truism in the Practice of Medicine: THINK SIMPLE
Jerry went to a psychiatrist. "Doc," he said, "I've got trouble. Every time I
get into bed, I think there's somebody under it ... I'm going crazy!"
"Just put yourself in my hands for one year," said the shrink. "Come to me
three times a week, and I'll cure your fears."
"How much do you charge?"
"A hundred dollars per visit."
"I'll have to think about that," said Jerry.
Six months later the doctor met Jerry on the street . "Why didn't you ever
come to see me again?" asked the psychiatrist.
"For a hundred bucks a visit? A bartender cured me for $10."
"Is that so? How?"
"He told me to cut the legs off the bed! Ain't nobody under there now!!!"
There is a truism about the practice of medical diagnosis and treatment in that amusing story. There is often a simple explanation for a complex combination of symptoms with which the patient is presenting. It is the sign of a thinking physician to find that explanation. The medical workup for a disease also can be simplified. Just because techniques such as expensive CAT scans or MRIs, as examples, are available, ordering these may not substitute for appropriate testing with less expensive and less invasive approaches. Often, many various testing methods are used which are unnecessary because it is easier for the physician to write the orders for these tests than to take time to THINK. And the issue of thinking simple can be applied to medication and prescription writing. Is that more expensive drug (usually the newer drug) or drug which requires more patient attention to be compliant with the directions really necessary to prescribe or could a less expensive drug or one to be taken once a day be equally as effective or in the case of compliance issues (cost or dosing schedules) even more effective? Why is thinking simple important? The simple diagnosis is often the more common. The simple workup is often the less expensive and the least harmful for the patient, especially if invasive testing is being ordered. The prescription of treatment which is not being influenced by pharmaceutical company pressures to use their newer and more expensive drugs or procedures more to enhance the physician’s pocketbook, all will make medical care less a financial hardship and lead to better care for all patient groups. I don’t want anyone to think that the effective practice of medicine is always simple. It isn’t. But doctors must learn when they are diagnosing and treating their patients to STOP A MOMENT, TAKE A DEEP BREATH and just consider to THINK SIMPLE. ..Maurice.
get into bed, I think there's somebody under it ... I'm going crazy!"
"Just put yourself in my hands for one year," said the shrink. "Come to me
three times a week, and I'll cure your fears."
"How much do you charge?"
"A hundred dollars per visit."
"I'll have to think about that," said Jerry.
Six months later the doctor met Jerry on the street . "Why didn't you ever
come to see me again?" asked the psychiatrist.
"For a hundred bucks a visit? A bartender cured me for $10."
"Is that so? How?"
"He told me to cut the legs off the bed! Ain't nobody under there now!!!"
There is a truism about the practice of medical diagnosis and treatment in that amusing story. There is often a simple explanation for a complex combination of symptoms with which the patient is presenting. It is the sign of a thinking physician to find that explanation. The medical workup for a disease also can be simplified. Just because techniques such as expensive CAT scans or MRIs, as examples, are available, ordering these may not substitute for appropriate testing with less expensive and less invasive approaches. Often, many various testing methods are used which are unnecessary because it is easier for the physician to write the orders for these tests than to take time to THINK. And the issue of thinking simple can be applied to medication and prescription writing. Is that more expensive drug (usually the newer drug) or drug which requires more patient attention to be compliant with the directions really necessary to prescribe or could a less expensive drug or one to be taken once a day be equally as effective or in the case of compliance issues (cost or dosing schedules) even more effective? Why is thinking simple important? The simple diagnosis is often the more common. The simple workup is often the less expensive and the least harmful for the patient, especially if invasive testing is being ordered. The prescription of treatment which is not being influenced by pharmaceutical company pressures to use their newer and more expensive drugs or procedures more to enhance the physician’s pocketbook, all will make medical care less a financial hardship and lead to better care for all patient groups. I don’t want anyone to think that the effective practice of medicine is always simple. It isn’t. But doctors must learn when they are diagnosing and treating their patients to STOP A MOMENT, TAKE A DEEP BREATH and just consider to THINK SIMPLE. ..Maurice.
Wednesday, March 29, 2006
Human Enhancement in the Healthy:A Role for Physicians?
Continuing with the topic of human enhancement, I had a topic on my now inactive "Bioethics Discussion Pages" on whether there was a role for physicians to prescribe or perform procedures for strictly cosmetic reasons: in order to improve the patient's appearance and performance in the absence of disease or deformities from birth or injury or illness? Here are my visitors responses 2000 to 2004, with the oldest at the bottom of the post. As I noted in the comments section to the last post, I am not in favor of such human enhancement by physicians and therefore I would not be in favor of human enhancement of brain or body with nanotechnology in which physicians would be involved. ..Maurice.
Is a Role of Physicians to Prescribe or Perform Procedures for Cosmetic Reasons in the Healthy?
There are questions raised whether everything physicians do or are requested to do are part of their role which society has given them through the ages. There have been questions, for example, whether physicians should participate in legal executions. Tylor Kase, in his posting below, raises the issue of prescription of anabolic drugs to improve performance.
The concern expressed by Tyler raises a more general issue and that is whether physicians are responsible to not only prevent and treat disease but also to make patients look and feel more attractive and powerful. Prescriptions for anabolic steroids as Tyler noted have potential hazards but also there are hazards related to, for example, cosmetic surgery.
On Friday February 11, 2000 Tyler Kase ( lil_g_ride@hotmail.com) wrote:
"My position on Anabolic steroids is that I don't think it should be used only by doctor's through the means of rehabilitating patients who have weak ligament, joints, and tendons. It shouldn't be used by any kind of athlete to help them to become better at sports and to make them more muscular. After doing a little research on this topic I learned some of the side effects that comes with these steroids such as hair loss, massive amounts of acne on the body, and men developing breast. I think everyone should be informed on these side effects. I'm sure people know what they are. I just don't understand why people still use the steroids. This is not a kinda of drug you want to abuse. People should think before they ruin their lives.
Thanks alot,
Tyler Kase"
Here is the question:
Do you think it is right for the role of a physician to include writing prescriptions or carrying out procedures in order to improve the patient's appearance and performance in the absence of disease or deformities from birth or injury or illness?
---- THE DISCUSSIONS ----
Date: Thu, May 6, 2004 12:11 PM From: khmaio@earthlink.net To: DoktorMo@aol.com
Do you think it is right for the role of a physician to include writing prescriptions or carrying out procedures in order to improve the patient's appearance and performance------------------------------( in the absence of disease or deformities from birth or injury or illness)?
The issue that comes to mind ( I would end the sentence above earlier) is administering drugs so that a person can appear competent to take part in a trial. The "cosmetic" reason, an appearance to present a false reality, is in direct conflict with ethics, a blurring of line betwen medical ethics and trial ethics.
The drugs are forced by law. Should they also be forced by medicine is the dilemma.
Harold A. Maio
Date: Wed, Apr 2, 2003 4:48 PM From: joquina@hotmail.com To: DoktorMo@aol.com
It all depends on what type of surgery it is.I do not see anything wrong for a woman who want larger breast if they are a size A or B cup.I do see something wrong for a small frame woman to want a size D cup. I do not see anything wrong with having a tummy tuck done for someone who lost a substantial amount of weight; but still have excess skin.I do believe that some of the cosmetic surgeries being performed today are not necessary. Society is so big on looks and the shape of their body; plastic surgeons see it as away to make money by doing these outrageous procedures.
Date: Mon, Nov 11, 2002 8:39 AM From: elizabethalecrone@hotmail.com To: DoktorMo@aol.com
DoktorMo@aol.com My name is Elizabeth LeCrone, I am a Philosophy major at the University of Oklahoma, a healthcare worker for over twenty years and the wife of a physician. My interest in the field of medical ethics has increased over the past ten years because of the changes in the healthcare delivery systems and the new technology introduced in the past decade. The responsibility of a physician is to treat each patient to the best of his ability, to inform patients of possible side effects of any procedure or medication and to also safe guard the mental health and welfare of his patient. When you deal with the physical enhancement of a person you deal not only with the physical appearance of that person but also their feelings about their own identity and self-perception. Our culture dictates that everyone should be young and thin and beautiful and those who do not meet that criteria often suffer. A physician who is a skilled reconstructive surgeon can take years off of a persons appearance. Unfortunately, there are many less than ethical doctors and dentists who have jumped on the bandwagon to do skin-peels, botox injections, colagen injections, etc. just because these are seemingly simple yet lucrative procedures. Sometimes they are not skilled or trained to give the results that should be expected. The sad commentary for our society is the fact that as humans we have become conditioned and compelled to be more than what nature made us to be. For a child who is ridiculed by a nose that is a little to big or ears that stick out too far, most often, time is the best cure. Any mother who would consent to allowing her sixteen year old daughter to have breast augmentation is sending a very wrong message to her daughter. Our society is so caught up with sex appeal, that every twelve year old girl wants to be Brittney Spears. The idea of reducing young girls to sexual objects before puberty is just wrong. All enhancing surgeries are not successful. Many times the expectations of the patient go far beyond the ability of the surgeon, no matter how skillful. Many times, the psychological need of the patient is what needs to be addressed, not their bodies. It is my opinion, that to constantly be searching for artificial means to satisfy our egos and failing to accept ourselves as human beings, we lose sight of the importance of our individuality. Women more than men have struggled with unrealistic role-models. The media and advertising depends on the fact that we will never be satisfied with who we are and how we look. I am more than my appearance. I have tried to instill in my daughters their own sense of identity and self-worth. Medical advances have made it possible for anyone to do procedures that are cosmetic in nature. There are dentists who have gotten into the botox business because it is lucrative. There are plenty of OB-Gyn physicians who have turned their practices away from the delivery of babies to tummy-tucks and breast augmentation. This is a sad commentary of modern medicine. There will always be those in the profession who look more to the money than to the welfare of their patients. A physician who truly has the well-being of his patient in mind will not be doing procedures on his patients that he is not board certified to perform and most good reconstructive surgeons will look at the psychological motivation and seek counseling for that patient prior to any radical changes. Plastic surgery becomes an obsession to many who can afford it. It is the health care provider who must look beyond the revenue generated from the procedure and help his patient make a wise and prudent choice before electing surgery. Until we change the perception of a society who values Jennifer Lopez and any professional sports personality over the great minds of our world we will deal with unscrupulous physicians who seek to make a buck off those who are so shallow that beauty can only be "skin deep".
Date: Sun, Apr 27, 2002 8:21 AM From: paralogik@optushome.com.au To: DoktorMo@aol.com
It seems that it would be inappropriate to legally preclude treatment for non-pathological and non-medical conditions (I am very thankful for having had braces as a kid). western societies are built upon ideals of personal choice and freedom, and preventing people from pursuing their own aesthetic projects does violate this. however, being unwilling to completely proscribe against cosmetic surgery/prescriptions does not mean that we should fail to critique them when the social structure that such practices arise within and sustain can be extremely damaging, both psychologically and physically. the first problem i would like to suggest with the 'individual choice and freedom' defense is this: that it seems distinctly naive to claim that the motivations of people to get breast enlargements or liposuction or face-lifts arise from purely autonomous motivations. such desires arise within a social context which valorises certain physically ideals and stigmatises others. this is problematic. furthermore, our focus on appearance as something to be assessed, corrected, worked upon and subjected to judgement can lead to a real shallow materialism in our dealings with others and interpersonal relations. in such a context, can the desire to have surgery to correct the deformity of small breasts really be considered autonomous? secondly, I am interested in the extent to which aesthetic modification, in that it can involve surgery, can lead to the medicalisation of certain traits previously considered normal, i.e. the pathologisation of more and more features which we generally just live with. for example, the American Society of Reconstructive and Plastic Surgeons stated in an official comment to the FDA that small breasts are not only a deformity but a disease, which leads to increased levels of depression associated with poor self-image. surely this begs the question of whether it is the disease of small breasts which leads to poor self esteem, or the social construction of small-breastedness as disease and pathology requiring corrective surgery?! maybe what is required is not medical intervention to correct those features we consider aesthetically unacceptable, but a less shallow way of dealing with issues of beauty and self-esteem. all this may seem tangential to the issue of whether cosmetic surgery should be permissible. i do not believe that it should be prohibited, but I think that we should be very critical of it, and particularly when it is linked in with a capitalist system in which people's sense of self is exploited and manipulated in order to make money for cosmetic surgeons.
Date: Mon, Feb 4, 2002 10:36 AM From: joe_palmer@att.net To: DoktorMo@aol.com
Yes, I think a valid and legitimate role is for the physician to assist in improvement of a patients appearance and/or wellbeing even in the absence of disease. So much of our psychic health comes from our actual image as well as the mental self image we have. If appearance were not important, the cosmetic industry would not exist. The ability to enhance one's appearance should be encouraged and promoted. Joel Palmer
Date: Tue, Aug 7, 2001 4:43 PM From: dmacdoug@usc.edu To: DoktorMo@aol.com
This question opens up a very large area of physicians roles. Traditionally the physician has held a certain role in society. But in modern society that role is and has been changing for many reasons one of which is the law. Under US law and those also of many other countries, over the last century or so, physicians have gained a legal status that they didn't formerly have. They have been given the almost exclusive legal right to prescribe drugs and to perform surgery. This changes the physicians ethical responsibilities somewhat, for under this legal franchise, it means that if the physician, for moral, ethical, financial or other reasons, refuses to perform these tasks, he is, in practice denying those who would like to have these things performed, the right to do so. It would seem as though, the physician would have to choose either to reliquish the exclusive right to perform these tasks, or alternatively, accept the responsibility to do so. It wouldn't seem as though he could ethically take the position that I only can do this and then refuse to do so. It would not be the physicians role to make this choice, unilaterally on behalf of society.
Donald MacDougall dmacdoug@usc.edu
Date: Thu, Jan 4, 2001 11:28 AM From: aj_16_16@hotmail.com To: DoktorMo@aol.com
I think if the people want to pay for the doctor to make them look better or something, that is their business. I also think if the procedure is not going to harm anyone else, then the doctor should follow through with the patients orders.
Date: Wed, Dec 6, 2000 4:05 PM From: slicks@home.com To: DoktorMo@aol.com
Hi, I firmly believe in reconstructive and cosmetic surgery! I work for one of the most well respected plastic surgeons. I have seen him work wonders for patients. There are to many people out there who obviously have to much time on their hands, to be so opinionated about such a thing. Everyone is an individual and it should be their personal choice. It's about what makes them feel good, not what everyone else thinks. Anyone doctor can call himself a plastic surgeon but believe me it is not learned it is a true talent.
Date: Sun, Nov 5, 2000 5:47 PM From: keileym@hotmail.com To: DoktorMo@aol.com
what about liposuction? what if a only slightly overweight person wants liposuction? should it be provided even if the risks outweigh the benefits?
Date: Tue, May 16, 2000 10:32 AM From: af485@lafn.org To: DoktorMo@aol.com
Phisicians should definitely provide cosmetic care to patients, but always under the auspices of "primum non nocere". We are responsible not only to the patient's physical but also his psychic health. When a person's body image is defective, it is the physician's responsibility to help alleviate the psychic pain. Help might be in the form of counseling, psychotherapy, medications or plastic surgery or a combination of these. Of course whatever course is chosen, the same mandates apply as in any other treatment. Is the patient's request rational in view of what is requested? Does the physician agree that the treatment the patient wishes is the best in his opinion also? (If not, explanation of his reasoning against the treatment and, if the patient still wishes referral, this should be done by recommending the best physician for th the requested course of treatment). Does the benefit of the treatment significantly exceed the risk? This point is far more essential in cosmetic therapy than in the treatment of illness or disability. The physician might include a mental risk profile with a necessity scale from 1 to 10: 10) being a disabling or disfiguring congenital defect, 1) a recommendation by a family member or friend(?) that the patient's appearance might be improved by plastic surgery.Hans
Date: Wed, Mar 29, 2000 7:37 AM From: SBERKOWI@AspenMed.org To: DoktorMo@aol.com
Braces, acne, contacts - these are all types of treatements that are recommended to improve appearance and are generally accepted. Braces may often be recommended to simply straighten one's teeth without any space problem. Acne could be considered a normal developmental state, yet we treat it to improve appearance and prevent disfigurement. Contacts are often requested by patients so that they can get rid of their glasses and/or to improve their appearance. I site these examples to show that a universal ban on helping patients for cosmetic reasons is not appropriate, while a thoughtful approach to the use of any treatment that is primarily designed to improve appearance, such as growth hormone treatment for "normal" short stature (non-GH deficiency) or steroids to increase mass, is indicated. As with all treatments, balancing the potential benefits of the treatment against the risks of both the treatment itself as well as non-treatment of the "condition" is a worthwhile way to proceed. - Sheldon Berkowitz, MD
Is a Role of Physicians to Prescribe or Perform Procedures for Cosmetic Reasons in the Healthy?
There are questions raised whether everything physicians do or are requested to do are part of their role which society has given them through the ages. There have been questions, for example, whether physicians should participate in legal executions. Tylor Kase, in his posting below, raises the issue of prescription of anabolic drugs to improve performance.
The concern expressed by Tyler raises a more general issue and that is whether physicians are responsible to not only prevent and treat disease but also to make patients look and feel more attractive and powerful. Prescriptions for anabolic steroids as Tyler noted have potential hazards but also there are hazards related to, for example, cosmetic surgery.
On Friday February 11, 2000 Tyler Kase ( lil_g_ride@hotmail.com) wrote:
"My position on Anabolic steroids is that I don't think it should be used only by doctor's through the means of rehabilitating patients who have weak ligament, joints, and tendons. It shouldn't be used by any kind of athlete to help them to become better at sports and to make them more muscular. After doing a little research on this topic I learned some of the side effects that comes with these steroids such as hair loss, massive amounts of acne on the body, and men developing breast. I think everyone should be informed on these side effects. I'm sure people know what they are. I just don't understand why people still use the steroids. This is not a kinda of drug you want to abuse. People should think before they ruin their lives.
Thanks alot,
Tyler Kase"
Here is the question:
Do you think it is right for the role of a physician to include writing prescriptions or carrying out procedures in order to improve the patient's appearance and performance in the absence of disease or deformities from birth or injury or illness?
---- THE DISCUSSIONS ----
Date: Thu, May 6, 2004 12:11 PM From: khmaio@earthlink.net To: DoktorMo@aol.com
Do you think it is right for the role of a physician to include writing prescriptions or carrying out procedures in order to improve the patient's appearance and performance------------------------------( in the absence of disease or deformities from birth or injury or illness)?
The issue that comes to mind ( I would end the sentence above earlier) is administering drugs so that a person can appear competent to take part in a trial. The "cosmetic" reason, an appearance to present a false reality, is in direct conflict with ethics, a blurring of line betwen medical ethics and trial ethics.
The drugs are forced by law. Should they also be forced by medicine is the dilemma.
Harold A. Maio
Date: Wed, Apr 2, 2003 4:48 PM From: joquina@hotmail.com To: DoktorMo@aol.com
It all depends on what type of surgery it is.I do not see anything wrong for a woman who want larger breast if they are a size A or B cup.I do see something wrong for a small frame woman to want a size D cup. I do not see anything wrong with having a tummy tuck done for someone who lost a substantial amount of weight; but still have excess skin.I do believe that some of the cosmetic surgeries being performed today are not necessary. Society is so big on looks and the shape of their body; plastic surgeons see it as away to make money by doing these outrageous procedures.
Date: Mon, Nov 11, 2002 8:39 AM From: elizabethalecrone@hotmail.com To: DoktorMo@aol.com
DoktorMo@aol.com My name is Elizabeth LeCrone, I am a Philosophy major at the University of Oklahoma, a healthcare worker for over twenty years and the wife of a physician. My interest in the field of medical ethics has increased over the past ten years because of the changes in the healthcare delivery systems and the new technology introduced in the past decade. The responsibility of a physician is to treat each patient to the best of his ability, to inform patients of possible side effects of any procedure or medication and to also safe guard the mental health and welfare of his patient. When you deal with the physical enhancement of a person you deal not only with the physical appearance of that person but also their feelings about their own identity and self-perception. Our culture dictates that everyone should be young and thin and beautiful and those who do not meet that criteria often suffer. A physician who is a skilled reconstructive surgeon can take years off of a persons appearance. Unfortunately, there are many less than ethical doctors and dentists who have jumped on the bandwagon to do skin-peels, botox injections, colagen injections, etc. just because these are seemingly simple yet lucrative procedures. Sometimes they are not skilled or trained to give the results that should be expected. The sad commentary for our society is the fact that as humans we have become conditioned and compelled to be more than what nature made us to be. For a child who is ridiculed by a nose that is a little to big or ears that stick out too far, most often, time is the best cure. Any mother who would consent to allowing her sixteen year old daughter to have breast augmentation is sending a very wrong message to her daughter. Our society is so caught up with sex appeal, that every twelve year old girl wants to be Brittney Spears. The idea of reducing young girls to sexual objects before puberty is just wrong. All enhancing surgeries are not successful. Many times the expectations of the patient go far beyond the ability of the surgeon, no matter how skillful. Many times, the psychological need of the patient is what needs to be addressed, not their bodies. It is my opinion, that to constantly be searching for artificial means to satisfy our egos and failing to accept ourselves as human beings, we lose sight of the importance of our individuality. Women more than men have struggled with unrealistic role-models. The media and advertising depends on the fact that we will never be satisfied with who we are and how we look. I am more than my appearance. I have tried to instill in my daughters their own sense of identity and self-worth. Medical advances have made it possible for anyone to do procedures that are cosmetic in nature. There are dentists who have gotten into the botox business because it is lucrative. There are plenty of OB-Gyn physicians who have turned their practices away from the delivery of babies to tummy-tucks and breast augmentation. This is a sad commentary of modern medicine. There will always be those in the profession who look more to the money than to the welfare of their patients. A physician who truly has the well-being of his patient in mind will not be doing procedures on his patients that he is not board certified to perform and most good reconstructive surgeons will look at the psychological motivation and seek counseling for that patient prior to any radical changes. Plastic surgery becomes an obsession to many who can afford it. It is the health care provider who must look beyond the revenue generated from the procedure and help his patient make a wise and prudent choice before electing surgery. Until we change the perception of a society who values Jennifer Lopez and any professional sports personality over the great minds of our world we will deal with unscrupulous physicians who seek to make a buck off those who are so shallow that beauty can only be "skin deep".
Date: Sun, Apr 27, 2002 8:21 AM From: paralogik@optushome.com.au To: DoktorMo@aol.com
It seems that it would be inappropriate to legally preclude treatment for non-pathological and non-medical conditions (I am very thankful for having had braces as a kid). western societies are built upon ideals of personal choice and freedom, and preventing people from pursuing their own aesthetic projects does violate this. however, being unwilling to completely proscribe against cosmetic surgery/prescriptions does not mean that we should fail to critique them when the social structure that such practices arise within and sustain can be extremely damaging, both psychologically and physically. the first problem i would like to suggest with the 'individual choice and freedom' defense is this: that it seems distinctly naive to claim that the motivations of people to get breast enlargements or liposuction or face-lifts arise from purely autonomous motivations. such desires arise within a social context which valorises certain physically ideals and stigmatises others. this is problematic. furthermore, our focus on appearance as something to be assessed, corrected, worked upon and subjected to judgement can lead to a real shallow materialism in our dealings with others and interpersonal relations. in such a context, can the desire to have surgery to correct the deformity of small breasts really be considered autonomous? secondly, I am interested in the extent to which aesthetic modification, in that it can involve surgery, can lead to the medicalisation of certain traits previously considered normal, i.e. the pathologisation of more and more features which we generally just live with. for example, the American Society of Reconstructive and Plastic Surgeons stated in an official comment to the FDA that small breasts are not only a deformity but a disease, which leads to increased levels of depression associated with poor self-image. surely this begs the question of whether it is the disease of small breasts which leads to poor self esteem, or the social construction of small-breastedness as disease and pathology requiring corrective surgery?! maybe what is required is not medical intervention to correct those features we consider aesthetically unacceptable, but a less shallow way of dealing with issues of beauty and self-esteem. all this may seem tangential to the issue of whether cosmetic surgery should be permissible. i do not believe that it should be prohibited, but I think that we should be very critical of it, and particularly when it is linked in with a capitalist system in which people's sense of self is exploited and manipulated in order to make money for cosmetic surgeons.
Date: Mon, Feb 4, 2002 10:36 AM From: joe_palmer@att.net To: DoktorMo@aol.com
Yes, I think a valid and legitimate role is for the physician to assist in improvement of a patients appearance and/or wellbeing even in the absence of disease. So much of our psychic health comes from our actual image as well as the mental self image we have. If appearance were not important, the cosmetic industry would not exist. The ability to enhance one's appearance should be encouraged and promoted. Joel Palmer
Date: Tue, Aug 7, 2001 4:43 PM From: dmacdoug@usc.edu To: DoktorMo@aol.com
This question opens up a very large area of physicians roles. Traditionally the physician has held a certain role in society. But in modern society that role is and has been changing for many reasons one of which is the law. Under US law and those also of many other countries, over the last century or so, physicians have gained a legal status that they didn't formerly have. They have been given the almost exclusive legal right to prescribe drugs and to perform surgery. This changes the physicians ethical responsibilities somewhat, for under this legal franchise, it means that if the physician, for moral, ethical, financial or other reasons, refuses to perform these tasks, he is, in practice denying those who would like to have these things performed, the right to do so. It would seem as though, the physician would have to choose either to reliquish the exclusive right to perform these tasks, or alternatively, accept the responsibility to do so. It wouldn't seem as though he could ethically take the position that I only can do this and then refuse to do so. It would not be the physicians role to make this choice, unilaterally on behalf of society.
Donald MacDougall dmacdoug@usc.edu
Date: Thu, Jan 4, 2001 11:28 AM From: aj_16_16@hotmail.com To: DoktorMo@aol.com
I think if the people want to pay for the doctor to make them look better or something, that is their business. I also think if the procedure is not going to harm anyone else, then the doctor should follow through with the patients orders.
Date: Wed, Dec 6, 2000 4:05 PM From: slicks@home.com To: DoktorMo@aol.com
Hi, I firmly believe in reconstructive and cosmetic surgery! I work for one of the most well respected plastic surgeons. I have seen him work wonders for patients. There are to many people out there who obviously have to much time on their hands, to be so opinionated about such a thing. Everyone is an individual and it should be their personal choice. It's about what makes them feel good, not what everyone else thinks. Anyone doctor can call himself a plastic surgeon but believe me it is not learned it is a true talent.
Date: Sun, Nov 5, 2000 5:47 PM From: keileym@hotmail.com To: DoktorMo@aol.com
what about liposuction? what if a only slightly overweight person wants liposuction? should it be provided even if the risks outweigh the benefits?
Date: Tue, May 16, 2000 10:32 AM From: af485@lafn.org To: DoktorMo@aol.com
Phisicians should definitely provide cosmetic care to patients, but always under the auspices of "primum non nocere". We are responsible not only to the patient's physical but also his psychic health. When a person's body image is defective, it is the physician's responsibility to help alleviate the psychic pain. Help might be in the form of counseling, psychotherapy, medications or plastic surgery or a combination of these. Of course whatever course is chosen, the same mandates apply as in any other treatment. Is the patient's request rational in view of what is requested? Does the physician agree that the treatment the patient wishes is the best in his opinion also? (If not, explanation of his reasoning against the treatment and, if the patient still wishes referral, this should be done by recommending the best physician for th the requested course of treatment). Does the benefit of the treatment significantly exceed the risk? This point is far more essential in cosmetic therapy than in the treatment of illness or disability. The physician might include a mental risk profile with a necessity scale from 1 to 10: 10) being a disabling or disfiguring congenital defect, 1) a recommendation by a family member or friend(?) that the patient's appearance might be improved by plastic surgery.Hans
Date: Wed, Mar 29, 2000 7:37 AM From: SBERKOWI@AspenMed.org To: DoktorMo@aol.com
Braces, acne, contacts - these are all types of treatements that are recommended to improve appearance and are generally accepted. Braces may often be recommended to simply straighten one's teeth without any space problem. Acne could be considered a normal developmental state, yet we treat it to improve appearance and prevent disfigurement. Contacts are often requested by patients so that they can get rid of their glasses and/or to improve their appearance. I site these examples to show that a universal ban on helping patients for cosmetic reasons is not appropriate, while a thoughtful approach to the use of any treatment that is primarily designed to improve appearance, such as growth hormone treatment for "normal" short stature (non-GH deficiency) or steroids to increase mass, is indicated. As with all treatments, balancing the potential benefits of the treatment against the risks of both the treatment itself as well as non-treatment of the "condition" is a worthwhile way to proceed. - Sheldon Berkowitz, MD
Monday, March 27, 2006
Human Enhancement Through Nanotechnology: Is it Right?
From Nano-Ethics comes this very interesting paper that looks at the arguments for nanotechnological human enhancement and presents the authors’ caution on the subject.
Many of you will wonder: what is “human enhancement through nanotechnology"? Well, I have copied below the section of the paper which tells us what it is and what it isn’t.. This should whet your appetite to click on the link above and read the entire paper. I think I’ll be posting on the ethics of human enhancement and nanotechnology in the future. But maybe, especially after reading the entire paper (it's not too lengthy), you might want to comment here. ..Maurice.
March 27, 2006 - RESEARCH PAPER
[This paper may be reprinted under a GNU Free Documentation License. Also see Center for Responsible Nanotechnology for other papers in this collection.]
Published in Nanotechnology Perceptions (2006), Vol. 2, Issue 1: 47-52:
Nanoethics and Human Enhancement:
A Critical Evaluation of Recent Arguments
By Patrick Lin and Fritz Allhoff
2.0 Context
Before we proceed, we should lay out a few actual and possible scenarios in order to be clear on what we mean by “human enhancement.” In addition to steroid use to become stronger and plastic surgery to become more attractive, people today also use drugs to boost creativity, attentiveness, perception, and more. In the future, nanotechnology might give us implants that enable us to see in the dark, or in currently non-visible spectrums such as infrared. As artificial intelligence advances, nano-computers might be imbedded into our bodies in order to help process more information faster, even to the point where man and machine become indistinguishable.
These scenarios admittedly sound like science fiction, but with nanotechnology, we move much closer to turning them into reality. Atomically-precise manufacturing techniques continue to become more refined and will be able to build cellular-level sensors and other tools that can be integrated into our bodies. Indeed, designs have already been worked out for such innovations as a “respirocyte” – an artificial red blood cell that holds a reservoir of oxygen.[2] A respirocyte would come in handy for, say, a heart attack victim to continue breathing for an extra hour until medical treatment is available, despite a lack of blood circulation to the lungs or anywhere else. But in an otherwise-healthy athlete, a respirocyte could boost performance by delivering extra oxygen to the muscles, as if the person were breathing from a pure oxygen tank.
What we do not mean by “human enhancement” is the mere use of tools, such as a hammer or Microsoft Word, to aid human activities, or “natural” improvements of diet and exercise – though, as we shall discuss later, agreeing on a definition may not be a simple matter. Further, we must distinguish the concept from therapeutic applications, such as using steroids to treat any number of medical conditions, which we take to be unobjectionable for the purposes of this paper.
Also, our discussion here can benefit from quickly noting some of the intuitions on both sides of the debate. The anti-enhancement camp may point to steroids in sports as an argument for regulating technology: that it corrupts the notion of fair competition. Also, some say, by condoning enhancement we are setting the wrong example for our children, encouraging risky behavior in bodies that are still developing. “Human dignity” is also a recurring theme for this side, believing that such enhancements pervert the notion of what it means to be human (with all our flaws).
On the pro-enhancement side, it seems obvious that the desire for self-improvement is morally laudable. Attempts to improve ourselves through, for example, education, hard work, and so on are uncontroversially good; why should technology-based enhancements be viewed any differently? In addition to virtue-based defenses of technological enhancement, we might also appeal to individual autonomy to defend the practice: so long as rational, autonomous individuals freely choose to participate in these projects, intervention against them is morally problematic.
In More Than Human, it is interesting to see that the debate is framed as a conservative (anti-enhancement) versus liberal (pro-enhancement) issue.[3] This proposed dichotomy is undoubtedly influenced by the creation and work of the U.S. President’s Council on Bioethics. Led by Leon Kass, M.D., PhD, the council released a report, Beyond Therapy, in 2004 that endorsed an anti-enhancement position; this report has become the prime target for both liberals and pro-enhancement groups. However, it would be a mistake to think that the issue necessarily follows political lines, since there may be good reason for a liberal to be anti-enhancement, as well as for a conservative to support it.
Many of you will wonder: what is “human enhancement through nanotechnology"? Well, I have copied below the section of the paper which tells us what it is and what it isn’t.. This should whet your appetite to click on the link above and read the entire paper. I think I’ll be posting on the ethics of human enhancement and nanotechnology in the future. But maybe, especially after reading the entire paper (it's not too lengthy), you might want to comment here. ..Maurice.
March 27, 2006 - RESEARCH PAPER
[This paper may be reprinted under a GNU Free Documentation License. Also see Center for Responsible Nanotechnology for other papers in this collection.]
Published in Nanotechnology Perceptions (2006), Vol. 2, Issue 1: 47-52:
Nanoethics and Human Enhancement:
A Critical Evaluation of Recent Arguments
By Patrick Lin and Fritz Allhoff
2.0 Context
Before we proceed, we should lay out a few actual and possible scenarios in order to be clear on what we mean by “human enhancement.” In addition to steroid use to become stronger and plastic surgery to become more attractive, people today also use drugs to boost creativity, attentiveness, perception, and more. In the future, nanotechnology might give us implants that enable us to see in the dark, or in currently non-visible spectrums such as infrared. As artificial intelligence advances, nano-computers might be imbedded into our bodies in order to help process more information faster, even to the point where man and machine become indistinguishable.
These scenarios admittedly sound like science fiction, but with nanotechnology, we move much closer to turning them into reality. Atomically-precise manufacturing techniques continue to become more refined and will be able to build cellular-level sensors and other tools that can be integrated into our bodies. Indeed, designs have already been worked out for such innovations as a “respirocyte” – an artificial red blood cell that holds a reservoir of oxygen.[2] A respirocyte would come in handy for, say, a heart attack victim to continue breathing for an extra hour until medical treatment is available, despite a lack of blood circulation to the lungs or anywhere else. But in an otherwise-healthy athlete, a respirocyte could boost performance by delivering extra oxygen to the muscles, as if the person were breathing from a pure oxygen tank.
What we do not mean by “human enhancement” is the mere use of tools, such as a hammer or Microsoft Word, to aid human activities, or “natural” improvements of diet and exercise – though, as we shall discuss later, agreeing on a definition may not be a simple matter. Further, we must distinguish the concept from therapeutic applications, such as using steroids to treat any number of medical conditions, which we take to be unobjectionable for the purposes of this paper.
Also, our discussion here can benefit from quickly noting some of the intuitions on both sides of the debate. The anti-enhancement camp may point to steroids in sports as an argument for regulating technology: that it corrupts the notion of fair competition. Also, some say, by condoning enhancement we are setting the wrong example for our children, encouraging risky behavior in bodies that are still developing. “Human dignity” is also a recurring theme for this side, believing that such enhancements pervert the notion of what it means to be human (with all our flaws).
On the pro-enhancement side, it seems obvious that the desire for self-improvement is morally laudable. Attempts to improve ourselves through, for example, education, hard work, and so on are uncontroversially good; why should technology-based enhancements be viewed any differently? In addition to virtue-based defenses of technological enhancement, we might also appeal to individual autonomy to defend the practice: so long as rational, autonomous individuals freely choose to participate in these projects, intervention against them is morally problematic.
In More Than Human, it is interesting to see that the debate is framed as a conservative (anti-enhancement) versus liberal (pro-enhancement) issue.[3] This proposed dichotomy is undoubtedly influenced by the creation and work of the U.S. President’s Council on Bioethics. Led by Leon Kass, M.D., PhD, the council released a report, Beyond Therapy, in 2004 that endorsed an anti-enhancement position; this report has become the prime target for both liberals and pro-enhancement groups. However, it would be a mistake to think that the issue necessarily follows political lines, since there may be good reason for a liberal to be anti-enhancement, as well as for a conservative to support it.
Friday, March 24, 2006
Aiding and Abetting a Suicide?
OK..as a segue from my last posting and as a followup on a topic I have mentioned on this blog previously, here is a real case with which I had experience.
A lady in her 30s, in jail for a prostitution charge, hung herself in the jail cell. She was brought to the hospital still alive but with severe brain damage due to the prolonged lack of oxygen to the brain before she was found (anoxic encephalopathy). The patient, of course, was comatose and couldn’t communicate and was kept alive by breathing by means of the ventilator and blood pressure sustained by IV medications. When the family arrived at the hospital the neurologist told them that the prognosis was grim and if the patient survived at all she would be severely handicapped. The family decided to have the physicians stop the life support and allow her to die. The hospital, however, was concerned that by turning off the life support, the act might be interpreted as aiding and abetting a suicide, an action which was against the hospital’s religious directives. So.. if you were the ethicist called in for consultation, what would you have advised the hospital? ..Maurice.
A lady in her 30s, in jail for a prostitution charge, hung herself in the jail cell. She was brought to the hospital still alive but with severe brain damage due to the prolonged lack of oxygen to the brain before she was found (anoxic encephalopathy). The patient, of course, was comatose and couldn’t communicate and was kept alive by breathing by means of the ventilator and blood pressure sustained by IV medications. When the family arrived at the hospital the neurologist told them that the prognosis was grim and if the patient survived at all she would be severely handicapped. The family decided to have the physicians stop the life support and allow her to die. The hospital, however, was concerned that by turning off the life support, the act might be interpreted as aiding and abetting a suicide, an action which was against the hospital’s religious directives. So.. if you were the ethicist called in for consultation, what would you have advised the hospital? ..Maurice.
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