Dateline 11/18/06

The holidays are looking extra special this year. I will hopefully be going home next wed. for thanksgiving, although I do still need to figure out when... I will get a bonus weekend trip with the family in early December because my cousin is getting married near NYC. Even better, I am going to Florida for Christmas this year to visit my Grandparents. I finally got around to getting the tickets last week, and I can't wait. I am also flying back to Rochester a few days later so I don't miss the friends and family there. Should be a good time...

Opinion : Abortion

Submitted as a position paper for my Med. and Society ethics class:

I believe that abortion is an issue for women, and personally, I do not care either way. However, I do like arguing, so for the sake of writing this essay, abortion is wrong. For the sake of argument, I will also try to avoid any Christian morals. Instead, I will site what is my highest personal ethical belief: that individuals need to take responsibility and accept the consequences of their actions. I am not judging people who are careless and casual with sex, I am merely saying that this behavior has biological and social consequences and that abortion is cheating and therefore is wrong.

There are several cases when abortion is clearly justified. These include cases of rape, where the female clearly was not and should not be responsible. In addition, anytime that maternal health is endangered, abortion should be considered a medical procedure and is clearly justified. Slightly more questionable are cases where the pregnancy was planned but early tests show abnormalities (Down's Syndrome for example). I worked with these individuals in the past and question whether these abortions are necessary, yet I would accept the argument that the parents are not responsible (consciously) for bad luck with nature and therefore should be entitled to an abortion. The majority of abortions in this country however do not fall under these circumstances. Most are simply unplanned pregnancies that are unwanted or inconvenient for some reason (1).

First, let's divide the women seeking abortions for unplanned pregnancies into 2 groups. In the first group are girls who fooled around without being in a serious relationship and got pregnant. This group likely covers the majority of abortions, as the average person seeking an abortion is young and unmarried. (1) The second group includes couples who got pregnant but do not want the child for lifestyle or economic reasons. We will assume for the sake of argument that all of the women in these groups had sex consensually and have no medical indications against childbirth. While there are likely unique mitigating circumstances in every case, in general, the abortions for all these women represent a way to evade the consequences for their actions.

Any woman seeking an abortion will be bypassing the pain of labor and childbirth, as well as the life disruption that pregnancy brings. These are the natural biological consequences of their decision to engage in unprotected intercourse. Furthermore, the specific consequences that these women are evading depend on which group they are in. Women in the first group were likely not expected to get pregnant, especially if they are in their teens. If allowed to carry the pregnancy, there will likely be social consequences varying from rejection by family and friends to disruption in their education or job. Yet if their education or family is that important to them, then they should have risked it for one night of fun. There may also be physiological consequences of having to give the baby up for adoption, and financial consequences from the healthcare involved or if the decision is made to keep the child. These are simply the price that must be paid however for the selfish and dangerous choice to have unprotected intercourse, and hopefully these consequences will inspire a better decision in the future.

As for the women in the second group, the specific consequences are less serious but more selfish. Women in stable relationships are likely seeking to avoid having the child because having a baby would affect their lifestyle. The child would disrupt their education or job, and leave them with less disposable income. Again, abortion is a cheap way to evade parental responsibilities. Condoms or the pill cost a lot less than raising a child, so they knowingly took a risk by not using them. That risk has potential consequences; personal greed and convenience are no excuse to evade those consequences.

Many of the problems facing the US today are caused by a general attitude that no one has to be responsible for their actions. It is in this justification that millions of people are have unprotected sex and subsequently abortions. Abortion is a cheap and convenient way to evade responsibility for ones actions, therefore I believe that it is ethically wrong if rape and medical indications are not involved.

1. Trupin, RS. E-medicine: Abortion. Available at : http://www.emedicine.com/med/topic5.htm. 2006.

Dateline 11/2/06

Some days you win, and some days you lose. and some days you win but find yourself on the floor of a temporary Red Cross clinic contemplating that victory. And as you may have guessed by the fact that I am writing this, today is one of those days. I completed my first full round of block exams on Wednesday and did some partying yesterday with my fellow IMS students to celebrate. That was topped today by finding out that I had beaten the average on all the exams (acing endocrine physiology as it happens). Tooday's lecture was the introduction to Cardio physiology so it seemed appropriate to celebrate by donating some blood (they were having a drive today by chance). More good news came that my blood pressure was rather low (100/60, my running hobby must be good for my health...). The bad part of this was that I got light-headed and fell on the floor trying to get some cookies after giving blood. And I felt nauseaus for a good 3hrs after as well. Guess thats why I don't give blood very often... Also I managed to buy a pre-smashed lightbulb for the birthday present from my parents that I probably shouldn't have opened early. Also I joined a dodgeball team.

so much crap to do, so little time...

Opinion : Winning the War on Terror

All I see on TV this last week is political ads arguing about the effectiveness of the War in Iraq and the War on terror. While I am for the effort in general and believe that it is a worthy cause, I will admit that we are losing, and here is why:

The civilized West in general has lost its sense of direction and principles, and we are fighting against the most principled enemy that history has ever seen.

It makes no difference who is right or wrong (democracy and freedom are right, fascist, sexist, murderers are wrong), the difference in a fight is who wants victory more. And quite frankly, the Islamic suicide bomber wants it more than we do. Much like Michael Coreleone's assessment of the Cuban freedom fighters in the Godfather (part 2?), we need to recognize that beliefs willing to die for are going to win out eventually over beliefs willing to spend money on. The martyrs of Christendom eventually won the ideological battle against the Roman Empire, and we face the same type of threat to our society today from Islamic fundamentalists.

Now I understand that thousands of Americans are willing to put their lives on the line and I deeply respect them for fighting for what they believe in. Yet their actions are ultimately misguided. The only thing the military is spreading in the world at the moment is violence and fear, and these are not guiding principals. Western civilization is built up on respect for human rights, (life, liberty, pursuit of happiness etc.) and on empirical rational reasoning in learning and law. And of course capitalism. These ideals are what we need to spread to the Middle East to be successful in the War on Terror.

Imagine what would happen if a group of nuns went into the suburbs of Baghdad and started teaching children and caring for sick and wounded. These nuns would certainly be persecuted and would likely become martyrs. Yet they would be martyrs for a good cause, a cause that would rally support and sympathy of both war hawks and pacifists and maybe even the people that they are trying to help. If western missionaries persisted despite these threats, they would eventually bring progress. By showing a shining example of what the west is like, they would likely win converts among people who are sick of violence and anxious to improve their lives. This would be true progress in the war on terror.

The problem is that this scenario is unlikely to play out in Iraq or elsewhere. Americans and Europeans simply lack the courage to die for something like teaching literacy or bringing modern medical care to repressed minority groups. And yet, Islamic radicals are clearly willing to die for the causes of repression and blind faith. They simply want it more, and we have no strong answers. In the past, dedicated missionaries who both sought truth and were willing to die for it spread Christian and Western values. When combined with appropriate military action, this strategy was very successful in defeating and civilizing many different areas (see America, etc). Yet we have inexplicably given up on this strategy, often believing that we are so obviously in the right that we don't have to prove our moral beliefs through our actions. Yet all the poor repressed people of the world see is our immoral actions. If we do not take action to gain the moral high ground, those on the moral low ground may well defeat us.

Opinion : Right to refuse treatment

Submitted as part of my medical ethics class:

When a physician is providing treatment to a patient, the goal is generally to make the patient better. A physician will typically use any means at their disposal and a good doctor will never give up on a patient. Yet sometimes the patient may want to give up on treatment themselves. Just as it has been argued that a patient has autonomy to choose the treatment option that they feel is best (even if against the physician's wishes), we must also consider that the patients can choose no treatment as an option. It may seem counterintuitive that a person would deny even a slight possibility of recovery, but there are many reasons that a patient may choose to for go treatment.

Reasons for denying treatment vary from person to person, and may involve good or bad decisions from an ethics point of view. Reasons may include fear of unpleasant side effects, religious or moral objections, and simply personal preference if the positive outcome is remote. These are all good objections and should be honored by the physician. Physicians should recognize that sometimes palliative care is the best option and should cease more conventional treatments in terminal cases. Another reason for treatment refusal is financial or economic concerns. These reasons are an unfortunate reality in our profit-driven capitalist health care system and warrant a separate discussion from this one. Another set of reasons includes the patients refusing care because of fear, duress or the influence of others, their ignorance of the options or out of an irrational state of mind. These options are not acceptable for a physician and care needs to be taken that they do not cause bad outcomes.

Avoiding the reason of irrational refusal or any irrational decision can be a serious problem for physicians. Most physicians are in a bad place to make judgments about a patient’s capacity for decision, and their can be a lot of mitigating factors. A perfectly competent person who was just told they have a serious disease may be devastated and may instantly become irrational. Letting patients take time to think about a decision (at least 1 day) is a good idea in general but not possible in all cases. It is also hard to tell if the irrational decision may be caused by an underlying problem such as ignorance of the subject (which can be fixed if the physician embraces their role as an educator) or a mental illness. The mental illness problem is especially serious if it is separate from but interferes with the treatment of an illness such as cancer.

The options for a physician in the case of irrational decisions come down to whether the patient can be brought to a rational state of mind or simply taking the authority of autonomy away from them. Removing a patient’s autonomy and treating them against their will is an extreme case and should only be done if the patient is clearly not able to comprehend their situation and the treatment has an estimated positive outcome of at least 50%. All attempts must be made to educate the patient but the patient’s comprehension must be tested by having them explain their situation and the outcomes in their own words. If they are unable to demonstrate comprehension and continue to refuse treatment against good odds of recovery, they should be referred to a mental health professional for an evaluation. If the evaluation comes back that they are mentally incompetent, then a physician should make the treatment decisions for this individual. If a psychology evaluation comes back negative, than the patient’s wish must be honored, as long as the sign some sort of waiver absolving the physician of outcome responsibility. A patient always has the right to refuse treatment unless it can be shown that they are not mentally competent.

Opinion : Population medicine

Submitted as a position paper for my Med. and Society ethics class:

In traditional health care delivery, the role of the physician has been to look after the health of the small group of patients who regularly come into his office. This model works great as long as everyone in a given area has a physician and goes to see them regularly. Physicians in this model can work together to solve local problems and can quickly implement public health policies by coordinating informative office visits. This model applies poorly to current healthcare in the US however, and therefore works poorly to implement change. The traditional model is poorly representative because not everyone in society has a physician and many people do not go regularly. Traditional models are also affected by current economic realities and modern health communication techniques that do not involve physicians. The reason that these realities are important is that patients do not live in a vacuum. Each person's health and actions affect the health and welfare of others in the general community. To serve the health interests of their patients, therefore, modern physicians must take on a public health role and tend to the needs of the community at large.

To serve the needs of the community, physicians should strive to achieve 4 things: rational, proactive, public policies that promote health and safety, expanded access to health care for all individuals, public education, and minimizing the cost of healthcare to society. While these imperatives do not trump the care that needs to be provided to an individual, these ideals must influence decisions and guide the actions of physicians in their private lives.

As far as influencing public policy, physicians have a duty to promote government policies and organizations that improve public health. They must use expertise and influence to gain benefits for everyone and to counteract economic and social forces that may seek to hurt patients for profit. This may include lobbying for clinics for the underserved, lobbying for healthcare reform, and supporting research in the public interest. Expanding healthcare access follows along the same lines, and may mean moving to underserved areas and supporting charity clinics.

Working to lower the cost of healthcare is another interrelated topic that should be strived for. Physicians should make treatment decisions that keep the cost low, no matter who is paying the bill. Sometimes, financial decisions that benefit patients must be made contrary to physicians own interests, but this is something that physicians owe society as professionals as long as the cost is reasonable.

A final duty of a physician to their community is that of public education. Doctors need to go beyond simply teaching their individual patients and seek ways to spread effective health messages to the community at large. This should be easier with modern media such as the internet, but also old-fashioned lectures should help as well.

To fully serve their patients, physicians have a duty to reach out to others in the community. When people are more educated about their health, have greater access to health care, and live under a government with pro-health policies, everyone benefits.