medical ethics
i had absolutely no idea i would find ethics so interesting. i well remember learning the exact same concepts in 1st year (in fact, hy is learning the same thing now...which is a strange concept), but back then, i was totally disinterested, thinking what's the point in debating something that no one has the answer to and you can't change it anyway by debating?
but now that i am 1.5 years away from being a doctor (hopefully), it all seems so real. the decisions i will have to make - to treat or not, how much to treat, etc. and learning about what the law tells us to do, what our guidelines are, it's so interesting! and funnily enough, i particularly enjoyed the forensic part of psychiatry, just cuz it involved the mental health act and legislation and stuff. maybe should've been a lawyer.
and of course, there's the sense that it's not all futile argument...that if i really wanted to, i would have the power and responsibility to lobby for and against principles and hot potato topics like euthanasia and human cloning and things. and that when it comes down to it, i need to have an opinion. whether or not i will delve in TOP or even assisted suicide if it becomes legal.
of course, it's a long time more till my decisions actually matter...obviously junior doctors aren't really expected to make such decisions. obviously, it becomes easier with experience.
but i just can't say how amazed i am at how much power a doctor has. i remember having that revelation when i watched cardiac surgery months and months ago...and now, the feeling of awe and almost fear is resurfacing.
that in the case of 'do not attempt resus', ultimately it's a clinical judgement. that the patient has no choice in the matter. even if he/she rejects the filling of a DNAR form and refuses to accept that CPR will not be successful, if the medical team has made a decision that CPR is not suitable, then it won't be attempted.
that in the case of advanced directives in Scotland, there isn't any statutory law provision for them. so they are legally binding under common law but only if they meet criteria of informed consent. which is hard to ascertain because there are no guidelines for when it was written. so it's a matter of judgement. and ultimately, advanced directive requests are refused if not clinically appropriate. again, clinical judgement.
watched a video about euthanasia today. it was purposefully emoted strongly...like even showed the doctor interacting with babies in the midst of the whole euthanasia (or)deal. and showed like the couple talking about the illness and their decision. and even after the patient had gone, showed the wife reading a letter written by her husband the day before. it was a dutch video with eng subtitles, and seriously by that point, i just closed my eyes so i didn't have to read what he wrote. surely it's something personal he wrote for her, it feels so much of an intrusion to read it. and i was already tearing up so badly, didn't need any more stimulation.
and there's the part about how he's going on this journey alone eventho they'd always been together. and he told her he was going to be at the milky way and big dipper. so she would know where to find him. how hard must it be to the spouse left behind! as if it's not hard enough knowing that you're going to have to face everything alone from then on, and how different and lonely it's going to be...you also have to live with the knowledge that it was your choice. that you're the reason he's not there. and you can either be happy he's no longer in suffering. or you can be guilty because you were part of his dying. or you can be selfish and wish he were still around. but i think the emptiness must be overwhelming. because your entire life was based around him, and caring for him...and suddenly, it's like your purpose for existence is gone. suddenly, you wake up in the morning, and there's no one to bathe and dress and feed and shift from bed to wheelchair.
and the way the video portrayed the doctor...so difficult to describe what he was like. a shell of a man. 'not exactly the life and soul of the party' he described himself. affected by every single death he caused yet numb from the countless number of episodes he's been through. i can't imagine how he could've interacted and built rapport with the couple, joked with them, comforted them, and after all that, culminate in him killing one of them. i suppose compassion in the justification, but deep down, i wonder if he really can justify with rational thought, when it's overwhelming bereavement for a lost friend almost.
there's the classic ethical question about turning the ventilator off when a competent person refuses to have life-prolonging treatment. and suddenly, it occurred to me today...if i weren't the doctor, but if i were the patient...would i be able to tell the doctor to turn the ventilator off? is it courage to accept the inevitable fate? or is it courage to hold on and hope for a miracle? and then, i thought, surely if i believe in miracles, then there will always be a hope to cling on to, no matter how slim. and then it goes back to DNARs and CPR. how can you confidently say that CPR will never work for someone...when really, you're meant to believe in miracles?
but now that i am 1.5 years away from being a doctor (hopefully), it all seems so real. the decisions i will have to make - to treat or not, how much to treat, etc. and learning about what the law tells us to do, what our guidelines are, it's so interesting! and funnily enough, i particularly enjoyed the forensic part of psychiatry, just cuz it involved the mental health act and legislation and stuff. maybe should've been a lawyer.
and of course, there's the sense that it's not all futile argument...that if i really wanted to, i would have the power and responsibility to lobby for and against principles and hot potato topics like euthanasia and human cloning and things. and that when it comes down to it, i need to have an opinion. whether or not i will delve in TOP or even assisted suicide if it becomes legal.
of course, it's a long time more till my decisions actually matter...obviously junior doctors aren't really expected to make such decisions. obviously, it becomes easier with experience.
but i just can't say how amazed i am at how much power a doctor has. i remember having that revelation when i watched cardiac surgery months and months ago...and now, the feeling of awe and almost fear is resurfacing.
that in the case of 'do not attempt resus', ultimately it's a clinical judgement. that the patient has no choice in the matter. even if he/she rejects the filling of a DNAR form and refuses to accept that CPR will not be successful, if the medical team has made a decision that CPR is not suitable, then it won't be attempted.
that in the case of advanced directives in Scotland, there isn't any statutory law provision for them. so they are legally binding under common law but only if they meet criteria of informed consent. which is hard to ascertain because there are no guidelines for when it was written. so it's a matter of judgement. and ultimately, advanced directive requests are refused if not clinically appropriate. again, clinical judgement.
watched a video about euthanasia today. it was purposefully emoted strongly...like even showed the doctor interacting with babies in the midst of the whole euthanasia (or)deal. and showed like the couple talking about the illness and their decision. and even after the patient had gone, showed the wife reading a letter written by her husband the day before. it was a dutch video with eng subtitles, and seriously by that point, i just closed my eyes so i didn't have to read what he wrote. surely it's something personal he wrote for her, it feels so much of an intrusion to read it. and i was already tearing up so badly, didn't need any more stimulation.
and there's the part about how he's going on this journey alone eventho they'd always been together. and he told her he was going to be at the milky way and big dipper. so she would know where to find him. how hard must it be to the spouse left behind! as if it's not hard enough knowing that you're going to have to face everything alone from then on, and how different and lonely it's going to be...you also have to live with the knowledge that it was your choice. that you're the reason he's not there. and you can either be happy he's no longer in suffering. or you can be guilty because you were part of his dying. or you can be selfish and wish he were still around. but i think the emptiness must be overwhelming. because your entire life was based around him, and caring for him...and suddenly, it's like your purpose for existence is gone. suddenly, you wake up in the morning, and there's no one to bathe and dress and feed and shift from bed to wheelchair.
and the way the video portrayed the doctor...so difficult to describe what he was like. a shell of a man. 'not exactly the life and soul of the party' he described himself. affected by every single death he caused yet numb from the countless number of episodes he's been through. i can't imagine how he could've interacted and built rapport with the couple, joked with them, comforted them, and after all that, culminate in him killing one of them. i suppose compassion in the justification, but deep down, i wonder if he really can justify with rational thought, when it's overwhelming bereavement for a lost friend almost.
there's the classic ethical question about turning the ventilator off when a competent person refuses to have life-prolonging treatment. and suddenly, it occurred to me today...if i weren't the doctor, but if i were the patient...would i be able to tell the doctor to turn the ventilator off? is it courage to accept the inevitable fate? or is it courage to hold on and hope for a miracle? and then, i thought, surely if i believe in miracles, then there will always be a hope to cling on to, no matter how slim. and then it goes back to DNARs and CPR. how can you confidently say that CPR will never work for someone...when really, you're meant to believe in miracles?